Effect of patient positioning on the evaluation of myocardial perfusion SPECT

  • Bertalan Kracskó
  • Sándor Barna
  • Orsolya Sántha
  • Anett Kiss
  • József Varga
  • Attila Forgács
  • Ildikó Garai
Original Article



ECG-gated SPECT myocardial perfusion imaging is usually acquired in supine position. However, some patients are not comfortable in this position for a variety of personal or medical reasons. Our aim was to investigate the effect of patient positioning on quantitative SPECT imaging results using normal supine database.


55 patients (mean age 58.5 ± 8.3 years) were enrolled in this prospective study. Each patient had a pair of ECG-gated stress SPECT myocardial perfusion images acquired on two gamma cameras: one in supine position and the other in upright sitting position. Left ventricular (LV) ejection fraction (EF), end-diastolic (ED), and end-systolic (ES) left ventricular volumes (V), LV mass, summed stress perfusion defect score (SSS), and total severity score (TSS) were calculated automatically relative to a supine normal reference database.


There were no significant differences in LVEF using the two cameras (0.65 ± 0.08 vs. 0.66 ± 0.10; P > 0.1). However, EDV, ESV, and LV mass were significantly smaller in sitting position than in supine position (89 vs. 80 ml; 33 vs. 29 ml and 115 vs. 109 ml, respectively, all P < 0.0001). On the other hand, SSS and TSS were significantly higher in sitting position than in supine position (5.16 vs. 8.73 and 166.82 vs. 288.27, both P < 0.0001). Overall, more studies in sitting position were interpreted as abnormal than in supine position (P < 0.05).


Patient positioning has a significant impact on quantitative gated SPECT imaging results. Using a supine normal reference database, SSS and TSS were larger in sitting position than in supine position. Thus, for imaging in sitting position, separate normal limits are required.


Myocardial perfusion imaging patient positioning ECG-gated SPECT sitting vs. supine position 



Myocardial perfusion imaging


Single photon emission computed tomography


Summed stress score


Total severity score


Left ventricular ejection fraction


End-diastolic volume


End-systolic volume


Emory cardiac tool box


Body mass index



This article was finalized under the auspices of the “Mentorship at Distance” committee of the Journal of Nuclear Cardiology. The authors gratefully acknowledge the editorial suggestions by Frans J. Th. Wackers, MD, PhD.


The authors have no conflict of interest.


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Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Bertalan Kracskó
    • 1
  • Sándor Barna
    • 2
  • Orsolya Sántha
    • 2
  • Anett Kiss
    • 2
  • József Varga
    • 3
  • Attila Forgács
    • 2
  • Ildikó Garai
    • 2
  1. 1.Institute of CardiologyUniversity of DebrecenDebrecenHungary
  2. 2.ScanoMed Ltd.DebrecenHungary
  3. 3.Department of Nuclear MedicineUniversity of DebrecenDebrecenHungary

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