title: Combined supine and prone myocardial perfusion single-photon emission computed tomography with a cadmium zinc telluride camera for detection of coronary artery disease.
abstract: BACKGROUND
  Myocardial perfusion SPECT (MPS) traditionally requires the patient to be in the supine position, but diaphragmatic attenuation of the inferior wall reduces test specificity. The aim of this study was to assess the feasibility of combined MPS in the supine and prone positions using a novel cadmium zinc telluride (CZT) camera.
  
  
  RESULTS
  A total of 276 consecutive patients with suspected/known coronary artery disease (CAD) who underwent single-day (99m)Tc-tetrofosmin or (99m)Tc-sestamibi stress/rest CZT SPECT, were enrolled in the study. Seventy-six underwent coronary angiography. Five-minute scan in the supine (S) position and thereafter in the prone (P) position produced images that were visually interpreted to obtain summed stress (SSS) and rest (SRS) scores. A combined stress score (C-SSS) was calculated by grouping anterior perfusion defects observed during supine imaging with inferior half segments observed during prone imaging. The SSS for the supine, prone, and combined protocols were 9±8, 7±8, and 7±8, respectively (P<0.0001). The SRS were 5±8, 4±7, and 6±7, respectively (P=0.005). The area under the ROC curve for the S-SSS, P-SSS, and C-SSS scores was 0.815 (95% CI: 0.713-0.917), 0.813 (0.711-0.914), and 0.872 (0.783-0.961), respectively. Corresponding sensitivities and specificities for detecting CAD were 87% and 50%, 80% and 77%, and 85% and 82%, respectively. C-SSS had significantly better specificity and accuracy than S-SSS (P<0.05).
  
  
  CONCLUSIONS
  Combined imaging with a CZT camera is suitable for routine clinical MPS and provides greater diagnostic accuracy than supine imaging alone.
authors.affiliation: Department of Radiology, Ehime University Graduate School of Medicine.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Nishiyama
authors.forename: Masao
authors.initials: M
authors.lastname: Miyagawa
authors.forename: Naoto
authors.initials: N
authors.lastname: Kawaguchi
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kido
authors.forename: Akira
authors.initials: A
authors.lastname: Kurata
authors.forename: Teruhito
authors.initials: T
authors.lastname: Kido
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Ogimoto
authors.forename: Jitsuo
authors.initials: J
authors.lastname: Higaki
authors.forename: Teruhito
authors.initials: T
authors.lastname: Mochizuki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000295:instrumentation* / Q000379:methods; D009206:Myocardium; D009943:Organophosphorus Compounds / Q000008:administration & dosage*; D015609:Organotechnetium Compounds / Q000008:administration & dosage*; D011859:Radiography; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi / Q000008:administration & dosage*; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation* / Q000379:methods
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin; D017256:Technetium Tc 99m Sestamibi