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Sensitivity, specificity and accuracy of stress SPECT myocardial perfusion imaging for detection of coronary artery disease in the distribution of first-order branch vessels, using an anatomical matching of angiographic and perfusion data

SCHWARTZ, J G1; JOHNSON, R B1; AEPFELBACHER, F C1; PARKER, J A2; CHEN, L3; AZAR, R R4; PARKER, R A3; DANIAS, P G1

Nuclear Medicine Communications: May 2003 - Volume 24 - Issue 5 - pp 543-549
Original Paper

We sought to investigate the utility of stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the identification of coronary artery disease (CAD) in the distribution of first-order branch vessels. We evaluated 135 consecutive patients with coronary angiography and stress SPECT MPI. We anatomically matched angiography and SPECT to assess the sensitivity, specificity and accuracy of SPECT MPI for the detection of CAD in the distribution of first-order branches. Subgroup analysis for stress test performance and previous coronary artery bypass grafting (CABG) was also performed. The sensitivity, specificity and accuracy of stress SPECT MPI for the detection of CAD in the distribution of first-order branch vessels were all 67%. For isolated branch vessel CAD, stress SPECT MPI had a sensitivity of 44%. In patients without CABG, the sensitivity, specificity and accuracy for the detection of CAD in the distribution of first-order branch vessels were 71%, 67% and 68%, compared with 60%, 67% and 64% for patients with CABG. The sensitivity for isolated branch vessel CAD was 50% for patients without CABG, but only 29% for patients with CABG. The sensitivity and specificity for CAD in the distribution of branch vessels were similar for all patients for all stress test modalities and heart rate response (sensitivity, 64-69%; specificity, 61-69%). Stress SPECT MPI offers intermediate sensitivity, specificity and accuracy for the detection of CAD in the distribution of first-order coronary artery branch vessels. However, for isolated branch vessel CAD, stress SPECT has a lower sensitivity, particularly in patients with previous CABG.

1Cardiovascular Division, Department of Medicine, 2Division of Nuclear Medicine, Department of Radiology and 3Biometrics Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and 4Division of Cardiology, French School of Medicine of the St-Joseph University, Beirut, Lebanon

Address all correspondence to Peter G. Danias, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. Tel.: (617) 667-4842. Fax: (617) 667-4833. e-mail: pdanias@bidmc.harvard.edu

Received 22 October 2002, in revised form 22 November 2002 and accepted 25 November 2002

© 2003 Lippincott Williams & Wilkins, Inc.