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Multicenter evaluation of stress-first myocardial perfusion image triage by nuclear technologists and automated quantification

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

A stress-first myocardial perfusion imaging (MPI) protocol saves time, is cost effective, and decreases radiation exposure. A limitation of this protocol is the requirement for physician review of the stress images to determine the need for rest images. This hurdle could be eliminated if an experienced technologist and/or automated computer quantification could make this determination.

Methods

Images from consecutive patients who were undergoing a stress-first MPI with attenuation correction at two tertiary care medical centers were prospectively reviewed independently by a technologist and cardiologist blinded to clinical and stress test data. Their decision on the need for rest imaging along with automated computer quantification of perfusion results was compared with the clinical reference standard of an assessment of perfusion images by a board-certified nuclear cardiologist that included clinical and stress test data.

Results

A total of 250 patients (mean age 61 years and 55% female) who underwent a stress-first MPI were studied. According to the clinical reference standard, 42 (16.8%) and 208 (83.2%) stress-first images were interpreted as “needing” and “not needing” rest images, respectively. The technologists correctly classified 229 (91.6%) stress-first images as either “needing” (n = 28) or “not needing” (n = 201) rest images. Their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 66.7%, 96.6%, 80.0%, and 93.5%, respectively. An automated stress TPD score ≥1.2 was associated with optimal sensitivity and specificity and correctly classified 179 (71.6%) stress-first images as either “needing” (n = 31) or “not needing” (n = 148) rest images. Its sensitivity, specificity, PPV, and NPV were 73.8%, 71.2%, 34.1%, and 93.1%, respectively. In a model whereby the computer or technologist could correct for the other’s incorrect classification, 242 (96.8%) stress-first images were correctly classified. The composite sensitivity, specificity, PPV, and NPV were 83.3%, 99.5%, 97.2%, and 96.7%, respectively.

Conclusion

Technologists and automated quantification software had a high degree of agreement with the clinical reference standard for determining the need for rest images in a stress-first imaging protocol. Utilizing an experienced technologist and automated systems to screen stress-first images could expand the use of stress-first MPI to sites where the cardiologist is not immediately available for interpretation.

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Abbreviations

MPI:

Myocardial perfusion imaging

CAD:

Coronary artery disease

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

CABG:

Coronary artery bypass grafting

CZT:

Cadmium-zinc-telluride

TPD:

Total perfusion deficit

AUC:

Area under the curve

PPV:

Positive predictive value

NPV:

Negative predictive value

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Acknowledgments

We would like to thank all of the nuclear technologists at Hartford Hospital (April Mann, Glen Tadeo, Gary Heald, Diana Pelletier, Jane Klepinger, and Federico Quevedo), Mount Sinai (Titus George, Krista Demers, Iosef Kraydman, Iosef Mershon, Alex Reznikov), and Cedars-Sinai (Jim Gerlach).

Disclosure

All financial and material support for this research project for Mount Sinai and Hartford Hospital staff came from within the Department of Cardiology at the Mount Sinai Medical Center and Hartford Hospital. Dr. Slomka’s research was supported in part by Grant R01HL089765 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NHLBI/NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI.

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Authors and Affiliations

  1. Henry Low Heart Center, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA

    Waseem Chaudhry MD, Nasir Hussain MD, Alan W. Ahlberg MA, Antonio B. Fernandez MD, Mathew W. Parker MD, Heather H. Swales MD & W. Lane Duvall MD

  2. Mount Sinai Division of Cardiology (Mount Sinai Heart), New York, NY, USA

    Lori B. Croft MD & Milena J. Henzlova MD

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Piotr J. Slomka PhD

Authors
  1. Waseem Chaudhry MD
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  2. Nasir Hussain MD
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  3. Alan W. Ahlberg MA
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  4. Lori B. Croft MD
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  5. Antonio B. Fernandez MD
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  6. Mathew W. Parker MD
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  7. Heather H. Swales MD
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  8. Piotr J. Slomka PhD
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  9. Milena J. Henzlova MD
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  10. W. Lane Duvall MD
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Corresponding author

Correspondence to W. Lane Duvall MD.

Additional information

See related editorial, doi:10.1007/s12350-015-0334-x.

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Chaudhry, W., Hussain, N., Ahlberg, A.W. et al. Multicenter evaluation of stress-first myocardial perfusion image triage by nuclear technologists and automated quantification. J. Nucl. Cardiol. 24, 809–820 (2017). https://doi.org/10.1007/s12350-015-0291-4

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  • DOI: https://doi.org/10.1007/s12350-015-0291-4

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