title: Two-position supine/prone myocardial perfusion SPECT (MPS) imaging improves visual inter-observer correlation and agreement.
abstract: OBJECTIVE
  We aimed to compare the inter-observer agreement between two experienced readers using supine vs combined supine/prone myocardial perfusion SPECT (MPS) in a large population.
  
  
  METHODS
  1,181 consecutive patients without known coronary artery disease (CAD) undergoing rest (201)Tl/stress (99m)Tc-sestamibi MPS studies were evaluated. Visual reads were performed in two consecutive steps, with readers scoring the stress supine perfusion images during step 1 and rescoring the images using both supine/prone data during step 2. Visual summed stress scores (SSS) of two readers including regional scores in different vascular territories were compared.
  
  
  RESULTS
  The specificity for both readers improved using combined supine/prone imaging (reader 1: 92% vs 86% [P = .0002], reader 2: 88% vs 72% [P < .0001]). The inter-observer correlation for SSS (0.90 vs 0.84, P < .0001) and inter-observer agreement for combined supine/prone reading (bias = 1.0, 95% confidence interval (CI) 0.9-1.2 vs bias = 3.1, 95% CI 2.8-3.4, P < .0001) were significantly better as compared to supine-only reading. The overall correlation between SSS scores for two readers improved with supine/prone imaging for both genders, as well as in the left anterior descending and right coronary territories.
  
  
  CONCLUSIONS
  The inter-observer correlation and agreement significantly improve using two-position supine/prone vs supine-only imaging.
authors.affiliation: Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA, Reza.Arsanjani@cshs.org.
authors.forename: Reza
authors.initials: R
authors.lastname: Arsanjani
authors.forename: Sean W
authors.initials: SW
authors.lastname: Hayes
authors.forename: Mathews
authors.initials: M
authors.lastname: Fish
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shalev
authors.forename: Rine
authors.initials: R
authors.lastname: Nakanishi
authors.forename: Louise E J
authors.initials: LE
authors.lastname: Thomson
authors.forename: John D
authors.initials: JD
authors.lastname: Friedman
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Piotr
authors.initials: P
authors.lastname: Slomka
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D015588:Observer Variation; D056888:Patient Positioning; D016684:Prone Position; D015203:Reproducibility of Results; D016683:Supine Position; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*