Are Shades of Gray Prognostically Useful in Reporting Myocardial Perfusion Single-Photon Emission Computed Tomography?

Autor: Guido Germano, Ling De Yang, Louise Thomson, Daniel S. Berman, Aiden Abidov, John D. Friedman, Rory Hachamovitch, Piotr J. Slomka, Ishac Cohen, Xingping Kang, Sean W. Hayes
Rok vydání: 2009
Předmět:
Male
Technetium Tc 99m Sestamibi
medicine.medical_specialty
Time Factors
Vasodilator stress
Heart Diseases
medicine.medical_treatment
Single-photon emission computed tomography
Revascularization
Risk Assessment
Severity of Illness Index
Myocardial perfusion imaging
Predictive Value of Tests
Risk Factors
Internal medicine
Image Interpretation
Computer-Assisted
medicine
Humans
Radiology
Nuclear Medicine and imaging
Aged
Proportional Hazards Models
Retrospective Studies
Aged
80 and over
Observer Variation
Tomography
Emission-Computed
Single-Photon
medicine.diagnostic_test
business.industry
Myocardial Perfusion Imaging
Reproducibility of Results
Middle Aged
Prognosis
Thallium Radioisotopes
Increased risk
Cardiology
Population study
Female
Radiopharmaceuticals
Cardiology and Cardiovascular Medicine
business
Nuclear medicine
Perfusion
Emission computed tomography
Zdroj: Circulation: Cardiovascular Imaging. 2:290-298
ISSN: 1942-0080
1941-9651
DOI: 10.1161/circimaging.108.815811
Popis: Background— We have advocated the use of a 5-category “normal,” “probably normal,” “equivocal,” “probably abnormal,” and “definitely abnormal” approach to final interpretation of myocardial perfusion single-photon emission computed tomography (SPECT). The prognostic value of expressing levels of certainty compared with a dichotomous normal/abnormal classification or categories for summed stress scores is unclear. Methods and Results— Myocardial perfusion SPECT (MPS) was visually assessed using a standard semiquantitative approach, yielding summed scores that were used for preliminary interpretation using 5 levels of certainty. The interpreter was permitted to then shift the level of certainty in the final interpretation by 1 degree, based on nonperfusion MPS variables and available clinical information. To examine the prognostic value of expressing levels of clinical certainty, we evaluated 20 740 unique consecutive patients who underwent rest Tl-201/stress Tc-99m sestamibi MPS (34.3% vasodilator stress), of whom 845 (4.4%) were lost to follow-up and 1695 were excluded from prognostic analysis due to an early revascularization ( Conclusions— The use of multicategory reporting of MPS results incorporating nonperfusion MPS results and clinical information enhances risk stratification compared with both a dichotomous normal/abnormal approach or approaches based solely on segmental categories of perfusion scores. Whether this enhanced risk stratification based on the clinical certainty of the MPS interpretation leads to a more effective therapeutic regimen, tailored to the individual patient’s need, requires further prospective evaluation.
Databáze: OpenAIRE
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