Nuclear Medicine & Radiation Therapy

Role of Prone SPECT Myocardial Perfusion Imaging in Patients with Equivocal or Abnormal Supine Myocardial Perfusion SPECT

Abstract

Hasnain Dilawar*, Salman Habib, Javaid Iqbal, Imran Hadi, Talal Abdul Rehman, Akhtar Ahmed and Atif Hussain

Combined supine prone Myocardial Perfusion SPECT (MPS) has been shown to reduce attenuation artifact in comparison to supine only MPS in mixed gender populations with varying risk for coronary artery disease. The aim of this study is to determine whether the additional prone MPS has an advantage over the supine only MPS in determining the diagnostic value of myocardial perfusion SPECT inpatient with known and unknown coronary artery disease.
Material and methods: This prospective study was performed on 93 patients, divided into two major group’s patients with known coronary artery disease and without known coronary artery disease. The duration of this study was 06 months including 03 months for clinical follow up? All patients who were assessed using standard stress supine protocol in addition to stress prone included who were observed either inferior, anterior or antero-septal wall perfusion defect in the stress supine study and they were underwent stress prone using LHC as gold standard evaluating coronary artery disease.
Results: Total n=93 patients were enrolled in this prospective study and divided into two main categories. Group I (n=29) included 31% of study population with known coronary artery disease and group II (n=64) comprises of 69% of study population with no prior history of coronary artery disease. Chi-Square (Pearson) test was applied collectively on both group I and II for statistical analysis which revealed p value of “0.005”. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of prone stress MPS in group I was calculated as 92%, 80%, 96%, 67% and 90% while in group I these values were 86%, 81%, 80%, 87% and 83.3% respectively. The combined sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of prone stress was 89.5%, 81%, 89.5%, 81% and 86.4%.
Conclusion: It is concluded that the addition of prone MPS with supine MPS overcomes soft tissue attenuation artifact hence decreases the false positive rates and preventing unnecessary further investigations and improves diagnostic accuracy.