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Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single-photon emission computed tomography

Daniel S. Berman, MD, FACC^*, Xingping Kang, MD^b, Kenneth F. Van Train, MS^b, Howard C. Lewin, MD^b, Ishac Cohen, PhD^b, Joseph Areeda^b, John D. Friedman, MD, FACC^b, Guido Germano, PhD, FACC^b, Leslee J. Shaw, PhD and Rory Hachamovitch, MD

^* Department of Imaging (Division of Nuclear Medicine), Department of Medicine (Division of Cardiology), and CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
^b Department of Medicine, University of California Los Angeles, School of Medicine, Los Angeles, California, USA
Department of Medicine (Division of Cardiology), New York Hospital-Cornell Medical Center, New York, New York, USA
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA

View larger version (22K): [in a new window]   Figure 1 Defect extent represents the number of pixels that fall below the normal (Nl) limit (% abnormal), defect severity represents the degree of abnormality within the defined defect zone, measured by the area between the patient’s profile and the normal limit profile, and defect reversibility represents the number of pixels that fall above the normal limit (% reversibility).

View larger version (14K): [in a new window]   Figure 2 Hard event rates over the 20-month follow-up period in patients with exercise sestamibi single-photon emission computed tomography by quantitative analysis (solid bars) and semiquantitative visual analysis (open bars) as a function of stress defect extent. *p < 0.001. Abnl = abnormal; Ext = extent; Quant = quantitative; Seg = segment.

View larger version (16K): [in a new window]   Figure 3 Hard event rates over the 20-month follow-up period in patients with exercise sestamibi single-photon emission computed tomography by quantitative analysis (solid bars) and semiquantitative visual analysis (open bars) as a function of stress defect severity. *p < 0.001. Q = quantitative; Sev = severity; SSS = summed stress score.

View larger version (13K): [in a new window]   Figure 4 Hard event rates over the 20-month follow-up period in patients with exercise sestamibi single-photon emission computed tomography by quantitative analysis (solid bars) and semiquantitative visual analysis (open bars) as a function of defect reversibility. *p < 0.001. Quant = quantitative; Rev = reversibility; SDS = summed difference score.

View larger version (15K): [in a new window]   Figure 5 Receiver operating characteristic curves performed for quantitative (Quant) defect extent (area = 0.72 ± 0.04) and the number of abnormal segments (area = 0.74 ± 0.05). There is no significant difference in prognostic accuracy (p = 0.74).

View larger version (14K): [in a new window]   Figure 6 Receiver operating characteristic curves performed for quantitative (Quant) defect severity (area = 0.73 ± 0.04) and the summed stress score (area = 0.75 ± 0.04). There is no significant difference in prognostic accuracy (p = 0.86). SSS = summed stress score.

View larger version (14K): [in a new window]   Figure 7 Receiver operating characteristic curves performed for quantitative defect reversibility (area = 0.70 ± 0.05) and the summed difference score (SDS) (area = 0.70 ± 0.05). There is no significant difference in prognostic accuracy (p = 0.98).