title: Comparison of fully automated computer analysis and visual scoring for detection of coronary artery disease from myocardial perfusion SPECT in a large population.
abstract: We compared the performance of fully automated quantification of attenuation-corrected (AC) and noncorrected (NC) myocardial perfusion SPECT (MPS) with the corresponding performance of experienced readers for detection of coronary artery disease (CAD).
  
  
  METHODS
  Rest-stress (99m)Tc-sestamibi MPS studies (n = 995; 650 consecutive cases with coronary angiography and 345 with likelihood of CAD < 5%) were obtained by MPS with AC. The total perfusion deficit (TPD) for AC and NC data was compared with the visual summed stress and rest scores of 2 experienced readers. Visual reads were performed in 4 consecutive steps with the following information progressively revealed: NC data, AC + NC data, computer results, and all clinical information.
  
  
  RESULTS
  The diagnostic accuracy of TPD for detection of CAD was similar to both readers (NC: 82% vs. 84%; AC: 86% vs. 85%-87%; P = not significant) with the exception of the second reader when clinical information was used (89%, P < 0.05). The receiver-operating-characteristic area under the curve (ROC AUC) for TPD was significantly better than visual reads for NC (0.91 vs. 0.87 and 0.89, P < 0.01) and AC (0.92 vs. 0.90, P < 0.01), and it was comparable to visual reads incorporating all clinical information. The per-vessel accuracy of TPD was superior to one reader for NC (81% vs. 77%, P < 0.05) and AC (83% vs. 78%, P < 0.05) and equivalent to the second reader (NC, 79%; and AC, 81%). The per-vessel ROC AUC for NC (0.83) and AC (0.84) for TPD was better than that for the first reader (0.78-0.80, P < 0.01) and comparable to that of the second reader (0.82-0.84, P = not significant) for all steps.
  
  
  CONCLUSIONS
  For detection of ≥70% stenoses based on angiographic criteria, a fully automated computer analysis of NC and AC MPS data is equivalent for per-patient and can be superior for per-vessel analysis, when compared with expert analysis.
authors: Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors: Reza
authors: R
authors: Arsanjani
authors: Yuan
authors: Y
authors: Xu
authors: Sean W
authors: SW
authors: Hayes
authors: Mathews
authors: M
authors: Fish
authors: Mark
authors: M
authors: Lemley
authors: James
authors: J
authors: Gerlach
authors: Sharmila
authors: S
authors: Dorbala
authors: Daniel S
authors: DS
authors: Berman
authors: Guido
authors: G
authors: Germano
authors: Piotr
authors: P
authors: Slomka
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D023921:Coronary Stenosis / Q000473:pathology; D001330:Electronic Data Processing; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D010477:Perfusion; D011786:Quality Control; D012372:ROC Curve; D015203:Reproducibility of Results; D012984:Software; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D017256:Technetium Tc 99m Sestamibi