title: The influence of coronary calcium score on the interpretation of myocardial perfusion imaging.
abstract: OBJECTIVE
  Coronary artery calcium (CAC) scores influence the pre-test likelihood of ischemia in patients undergoing myocardial perfusion imaging (MPI). We investigated the influence of CAC score knowledge on the visual interpretation of MPI in patients referred for the diagnostic work-up of suspected coronary artery disease.
  
  
  METHODS
  We retrospectively analyzed symptomatic patients who were referred for MPI. For the current analysis, we selected 151 patients who underwent SPECT MPI with simultaneous CAC scoring. MPI was visually interpreted in two separate sessions, first without and then with knowledge of the CAC score. MPI results were classified into four groups: normal, fixed defects, ischemia, and equivocal.
  
  
  RESULTS
  Mean age of the patients was 64 ± 11 years, 56% were male. Without knowledge of the CAC score MPI was evaluated as normal in 36%, compared to 40% with knowledge of the CAC score (P = 0.636). Overall, the addition of the CAC score changed the interpretation of MPI in 56 patients (37%). Importantly, the frequency of equivocal MPI interpretations decreased from 21% without knowledge of CAC score to 9% with knowledge of CAC score (P = 0.002).
  
  
  CONCLUSIONS
  Knowledge of the CAC score has a major impact on the interpretation of MPI, increasing the interpretative certainty.
authors: Department of Cardiology, Isala klinieken, Zwolle, The Netherlands, m.mouden@isala.nl.
authors: Mohamed
authors: M
authors: Mouden
authors: Jan Paul
authors: JP
authors: Ottervanger
authors: Jorik R
authors: JR
authors: Timmer
authors: Stoffer
authors: S
authors: Reiffers
authors: Ad H J
authors: AH
authors: Oostdijk
authors: Siert
authors: S
authors: Knollema
authors: Pieter L
authors: PL
authors: Jager
mesh_terms: D000465:Algorithms; D002114:Calcinosis / Q000000981:diagnostic imaging*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*