title: Analysis of stress-only imaging, comparing upright and supine CZT camera acquisition to conventional gamma camera images with and without attenuation correction, with coronary angiography as a reference.
abstract: Diagnostic performance of stress-only imaging using a Cadmium-Zinc-Telluride (CZT) camera has not been directly compared in the same patients to stress-only attenuation-corrected conventional Anger camera images.
  
  
  
  112 subjects with correlative coronary angiographic data and 40 subjects with <5% pre-test likelihood of coronary disease completed attenuation-corrected stress-only images on a conventional Anger camera and uncorrected upright and supine stress images on a CZT camera. Two readers provided independent, blinded interpretations of stress-only images.
  
  
  
  Upright and supine stress-only CZT images and attenuation-corrected Anger camera images provided similar positive (reader 1/reader 2, 50.0%/44.1% vs 46.4%/51.9%) and negative (66.7%/64.0% vs 67.9%/67.7%) predictive values (all P = NS) for obstructive coronary artery disease; however, the sensitivity was higher (81.3% vs 58.3%, P = .05), specificity lower (29.7% vs 50.0%, P = .005), and normalcy rate lower (87.5% vs 100%, P = .025) with attenuation-corrected Anger camera images for the first reader with no significant differences between cameras for the second reader.
  
  
  
  Stress-only upright and supine CZT imaging was non-inferior statistically to attenuation-corrected stress-only Anger camera imaging. Nevertheless, stress-only CZT imaging may be associated with reduced diagnostic sensitivity for some readers compared to attenuation-corrected Anger camera images, which may be less acceptable clinically compared to stress plus rest images.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Zenith A
authors.initials: ZA
authors.lastname: Jameria
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Mouhamad
authors.initials: M
authors.lastname: Abdallah
authors.affiliation: Division of Nuclear Medicine, Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Mariano
authors.initials: M
authors.lastname: Fernandez-Ulloa
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: O'Donnell
authors.affiliation: Division of Biostatistics and Epidemiology, Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA.
authors.forename: Alok K
authors.initials: AK
authors.lastname: Dwivedi
authors.affiliation: Division of Nuclear Medicine, Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Washburn
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Naseer
authors.initials: N
authors.lastname: Khan
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: Mahyar
authors.initials: M
authors.lastname: Khaleghi
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, USA.
authors.forename: Nischelle
authors.initials: N
authors.lastname: Kalakota
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA. myron.gerson@uc.edu.
authors.forename: Myron C
authors.initials: MC
authors.lastname: Gerson
mesh_terms: D000368:Aged; D002104:Cadmium; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D005080:Exercise Test; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000295:instrumentation*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013691:Tellurium; D015899:Tomography, Emission-Computed, Single-Photon; D015032:Zinc
chemical_list: C474490:CdZnTe; D002104:Cadmium; D015032:Zinc; D013691:Tellurium
keywords: Cadmium-zinc-telluride; Myocardial perfusion imaging; Stress-only