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Quantitative evaluation of myocardial stress/rest 201TL SPECT: results of a ROI-based method in 108 patients with CHD
U Buell1, H Stirner, J vom Dahl
1Department of Nuclear Medicine, University of Aachen, FRG.
Insights
This study shows that quantitative analysis of thallium-201 (201Tl) SPECT using region-of-interest polar maps reliably detects coronary heart disease (CHD). The method accurately quantifies 201Tl kinetics for improved CHD diagnosis.
Area of Science:
- Nuclear Medicine
- Cardiology
- Medical Imaging
Background:
- Coronary heart disease (CHD) diagnosis relies on accurate myocardial perfusion assessment.
- Thallium-201 (201Tl) single-photon emission computed tomography (SPECT) is a key imaging modality.
- Quantitative analysis of 201Tl SPECT can enhance diagnostic capabilities.
Purpose of the Study:
- To quantitatively evaluate stress/rest myocardial 201Tl SPECT using ROI-based polar maps for CHD detection.
- To assess the sensitivity and specificity of this method in patients with proven CHD.
- To compare the diagnostic performance based on stenosis severity and myocardial infarction status.
Main Methods:
- Utilized 33 ROIs and polar maps for quantitative analysis of 201Tl SPECT in 108 CHD patients and 30 controls.
- Determined sensitivity for detecting stenoses >50% using myocardial viability (VI) and wash-out corrected redistribution (RD).
- Evaluated method validity based on disease severity, number of ROIs with changes, and combination of VI and RD.
Main Results:
- Sensitivity for detecting CHD was high, particularly in supply areas with old myocardial infarctions (95% with 1 ROI, 86% with >2 ROIs).
- In patients without infarction, sensitivity was 96% (1 ROI) and 79% (>2 ROIs).
- Combined VI and RD evaluation yielded high sensitivities (91-100% and 77-94%) with specificities of 91% and 97%.
Conclusions:
- The presented ROI-based polar map method reliably quantifies 201Tl kinetics in myocardial SPECT.
- This quantitative approach is effective for detecting and describing coronary heart disease.
- The method offers a valuable tool for numerical assessment of 201Tl SPECT data in CHD evaluation.
Abstract:
ROI-based polar maps (33 ROIs) were employed to evaluate quantitatively stress/rest myocardial 201Tl SPECT in 108 patients with angiographically proven coronary heart disease (CHD) in comparison with 30 controls. Sensitivity in detecting a CHD with stenoses of greater than 50% of luminal diameter was determined versus normal regional values (+/- 2.5 SD) employing vitality (VI) and wash-out corrected redistribution (RD). The method was evaluated referring to the severity of the disease, to the number of ROIs displaying changes [(a) 1 ROI, (b) greater than 2 ROIs], to validity of VI, RD or a combination thereof, and for specificity. Wash-out values were found to depend on degree of stress individually achieved and thus were not used as a threshold criterion. Sensitivity in supply areas with old myocardial infarctions was 95% (a) and 86% (b), resp. With no infarction, it was 96% (a) and 79% (b), resp. VI in stenosis greater than 75% was more sensitive than RD. However, combined evaluation of VI and RD yielded sensitivities from 91-100% (a) and 77-94% (b), resp. for different main supply areas. In stenosis less than 50% with normal VI, RD was positive in 18-31%. Specificity turned out to be 91% (a) and 97% (b), resp. We conclude that the method presented is reliable to quantify numerically 201Tl kinetics in myocardial SPECT, aimed at detecting and describing CHD.