title: Head-to-head comparison of a 2-day myocardial perfusion gated SPECT protocol and cardiac magnetic resonance late gadolinium enhancement for the detection of myocardial infarction.
abstract: BACKGROUND
  The aim was to determine the sensitivity and specificity of gated myocardial perfusion SPECT (MPS) with a technetium-labelled (Tc) perfusion tracer to detect myocardial infarction (MI) in a clinical population referred for assessment of stress-induced ischemia using late gadolinium enhancement cardiac magnetic resonance (CMR) as reference method.
  
  
  METHODS
  119 patients referred for evaluation of stress-induced ischemia with MPS were included. 108 patients (age 62 ± 10 years, 39% females) completed MPS and CMR. A 2-day protocol for MPS was used for most patients (n = 105).
  
  
  RESULTS
  MI was found in 31 patients (29%) using MPS and in 30 patients using CMR (28%). The sensitivity and specificity on a patient basis were 93% and 96%, respectively. Positive predictive value (PPV) was 90% and negative predictive value (NPV) was 97%. Per territory, the sensitivity and specificity for LAD infarcts were 83% and 97%, respectively. PPV was 77% and NPV was 98% for LAD infarcts. The sensitivity and specificity for RCA/LCx infarcts were 95% and 95%, respectively. PPV was 84% and NPV was 99% for RCA/LCx infarcts. The MI size on CMR was 12.0 ± 7.3% of the LV and mean transmurality was 66.3 ± 12.0%. All MI > 3% were detected on gated SPECT.
  
  
  CONCLUSIONS
  This study has demonstrated high sensitivity and specificity for gated Tc-MPS detecting subendocardial and transmural MI.
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Skane University Hospital, Lund University, 221 85, Lund, Sweden, marcus.carlsson@med.lu.se.
authors.forename: Marcus
authors.initials: M
authors.lastname: Carlsson
authors.forename: Fredrik
authors.initials: F
authors.lastname: Hedeer
authors.forename: Henrik
authors.initials: H
authors.lastname: Engblom
authors.forename: Hakan
authors.initials: H
authors.lastname: Arheden
mesh_terms: D000368:Aged; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D055414:Myocardial Perfusion Imaging; D009206:Myocardium / Q000473:pathology*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012306:Risk; D012680:Sensitivity and Specificity; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D003287:Contrast Media; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin; D005682:Gadolinium