Two-position supine/prone myocardial perfusion SPECT (MPS) imaging improves visual inter-observer correlation and...

Area of Science:

• Nuclear Cardiology
• Cardiovascular Imaging
• Diagnostic Accuracy

Background:

• Myocardial perfusion SPECT (MPS) is crucial for diagnosing coronary artery disease (CAD).
• Reader variability can impact the interpretation of MPS imaging.
• Supine imaging is standard, but prone positioning may improve accuracy.

Purpose of the Study:

• To compare inter-observer agreement between two experienced readers using supine versus combined supine/prone myocardial perfusion SPECT (MPS).
• To evaluate the impact of imaging position on diagnostic performance in a large patient cohort.

Main Methods:

• 1,181 patients without known CAD underwent rest (201)Tl/stress (99m)Tc-sestamibi MPS.
• Visual reads were performed in two steps: supine-only, then combined supine/prone.
• Inter-observer correlation and agreement for summed stress scores (SSS) were compared.

Main Results:

• Combined supine/prone imaging significantly improved specificity for both readers (P < .0002).
• Inter-observer correlation for SSS was higher with supine/prone imaging (0.90 vs 0.84, P < .0001).
• Inter-observer agreement showed significantly less bias with supine/prone views (1.0 vs 3.1, P < .0001).

Conclusions:

• Two-position supine/prone MPS significantly enhances inter-observer correlation and agreement compared to supine-only imaging.
• This approach improves the reliability of MPS interpretation.
• Combined imaging offers better diagnostic performance in evaluating myocardial perfusion.