title: Adding attenuation corrected images in myocardial perfusion imaging reduces the need for a rest study.
abstract: BACKGROUND
  The American Society of Nuclear Cardiology and the Society of Nuclear Medicine conclude that incorporation of attenuation corrected (AC) images in myocardial perfusion scintigraphy (MPS) will improve diagnostic accuracy. The aim was to investigate the value of adding AC stress-only images for the decision whether a rest study is necessary or not.
  
  
  METHODS
  1,261 patients admitted to (99m)Tc MPS were studied. The stress studies were interpreted by two physicians who judged each study as "no rest study necessary" or "rest study necessary", by evaluating NC stress-only and NC + AC stress-only images. When there was disagreement between the two physicians, a third physician evaluated the studies. Thus, agreement between 2 out of 3 physicians was evaluated.
  
  
  RESULTS
  The physicians assessed 214 more NC + AC images than NC images as "no rest study necessary" (17% of the study population). The number of no-rest-study-required was significantly higher for NC + AC studies compared to NC studies (859 vs 645 cases (p < 0.0001). In the final report according to clinical routine, ischemia or infarction was reported in 23 patients, assessed as "no rest study necessary" (22 NC + AC cases; 8 NC cases), (no statistically significant difference). In 11 of these, the final report stated "suspected/possible ischemia or infarction in a small area".
  
  
  CONCLUSIONS
  Adding AC stress-only images to NC stress-only images reduce the number of unnecessary rest studies substantially.
authors.affiliation: Clinical Physiology and Nuclear Medicine Unit, Skåne University Hospital, Lund University, Entrance 44, 205 05 Malmö, Sweden. elin.tragardh@med.lu.se
authors.forename: Elin
authors.initials: E
authors.lastname: Trägårdh
authors.forename: Sven
authors.initials: S
authors.lastname: Valind
authors.forename: Lars
authors.initials: L
authors.lastname: Edenbrandt
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012146:Rest; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013548:Sweden / Q000453:epidemiology
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