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Updated: Aug 14, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Reproducibility of quantitative hexakis-2-methoxyisobutylisonitrile single photon emission tomography in stable
M Milcinski1, E Henze, R Lietzenmayer
1Department of Nuclear Medicine, University Medical Centre, Ljubljana, Yugoslavia.
Insights
This study shows good inter-observer reproducibility for quantifying myocardial perfusion defects using semi-automatic processing of Technetium 99m hexakis-2-methoxyisobutylisonitrile (99mTc-Sestamibi) SPECT imaging.
Area of Science:
- Nuclear cardiology
- Cardiovascular imaging
- Medical physics
Background:
- Accurate quantification of myocardial perfusion is crucial for evaluating treatment efficacy in coronary artery disease.
- Reproducibility in repeated studies is essential for reliable comparisons.
- Semi-automatic quantitative programs aid in objective assessment of perfusion defects.
Purpose of the Study:
- To assess the inter-observer reproducibility of tomographic myocardial perfusion study processing.
- To evaluate a semi-automatic quantitative program for analyzing Technetium 99m hexakis-2-methoxyisobutylisonitrile (99mTc-Sestamibi) SPECT data.
- To determine the reliability of quantifying perfusion defects in different coronary artery territories.
Main Methods:
- Utilized 99mTc-Sestamibi for rest-stress tomographic imaging in patients with stable coronary artery disease.
- Employed a modified Cedars polar coding method for quantification against a normal database.
- Quantified perfusion defects in left anterior descending (LAD), right coronary (RCA), and left circumflex (LCX) artery territories and total hypoperfused myocardium.
- Assessed inter-observer variability across 40 tomographic studies.
Main Results:
- Good inter-observer reproducibility was observed for total hypoperfused myocardium (correlation coefficient r=0.87).
- The largest average defects were in the LAD territory (19.7%), with high reproducibility (r=0.84).
- The LCX region showed the greatest variability (r=0.55) due to smaller average defects (7.1%).
Conclusions:
- Semi-automatic quantitation of myocardial perfusion defects demonstrates good inter-observer reproducibility.
- The method is reliable for assessing treatment outcomes in coronary artery disease.
- Careful interpretation of smaller defects is advised, especially in the LCX region, when multiple observers process 99mTc-Sestamibi SPECT studies.
Abstract:
The quantification of myocardial perfusion abnormalities is necessary to allow comparison of repeated studies, especially in the evaluation of the success of medical, interventional or combined treatment in stable coronary artery disease or in evolving myocardial infarction. The purpose of this study was to assess inter-observer reproducibility of tomographic study processing using a semi-automatic quantitative programme. Technetium 99m hexakis-2-methoxyisobutylisonitrile (99mTc-Sestamibi) was chosen for tomographic imaging of repeated rest-stress studies in patients with stable coronary artery disease. The quantification was performed using a modification of the Cedars polar coding and comparison with the normal data base. The perfusion defects were quantified separately for each standard perfusion area [left anterior descending (LAD), right coronary (RCA) and left circumflex (LCX) arteries] and total area of hypoperfused myocardium. The inter-observer variability for 40 tomographic studies was accomplished. The defects were the largest in the LAD perfusion area (average 19.7% of the normalized LAD supply area) with an inter-observer correlation of 0.84 for this region. The greatest variability was found for the LCX region (r = 0.55) and is attributed to a small average perfusion defect (7.1%), only 18 studies having abnormal perfusion in this area. In total, an average 14.3% of the left ventricular myocardium was significantly hypoperfused, and the inter-observer correlation was 0.87. These results show good inter-observer reproducibility using semi-automatic quantitation of perfusion defects. Careful interpretation of smaller defects in the evaluation of treatment results is advised when repeated 99mTc-Sestamibi single photon emission tomography studies are processed by more than one observer.
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