Zhiyun Yang, Presenter: Nothing to Disclose

Joshua Holliday, Abstract Co-Author: Nothing to Disclose

Qingsong Zhao, Abstract Co-Author: Nothing to Disclose

Runhua Shi MD, PhD, Abstract Co-Author: Nothing to Disclose

Denish Kumar MD, Abstract Co-Author: Nothing to Disclose

Horacio B. D'Agostino MD, Abstract Co-Author: Nothing to Disclose

To evaluate 11 methods used to determine transient ischemic dilation (TID) in myocardial perfusion imaging (MPI) and compare these results to cardiac catheterization (CC) findings to assess which methods were most specific for detecting TID.

This study included 120 consecutive patients suspected of having coronary artery disease (CAD) using MPI and CC. Eleven methods of determining TID(an apparent increase in the left ventricular size observed under stress relative to the rest image with a ratio ≥1.22) in MPI were utilized. Visual methods of evaluating TID from images included 1) projection view, 2) e-soft processing in cool color, 3) e-soft processing in gray scale, 4) e-soft and Cedars automated processing in cool color, 5) e-soft and Cedars automated processing in gray scale and 6) e-soft and Cedars manual processing in cool color. Quantitative methods of evaluating TID from images included 7) Photoshop measurement after e-soft processing in cool color, 8) Photoshop measurement after e-soft and Cedars automated processing in cool color, 9) Photoshop measurement after e-soft and Cedars manual processing in cool color, 10) computer evaluation after e-soft and Cedars automated processing and 11)computer evaluation after e-soft and Cedars manual processing. The interpretation of TID was performed by a nuclear medicine physician blinded to clinical and CC information. TID and CC findings were compared to determine which TID method was most specific in diagnosing true CAD.

Sixty-six of 120 patients were found to have true CAD(stenosis ≥ 70% in at least one vessel)based on CC. Our findings concluded that method 11 was most specific in detecting true CAD (p = 0.03 and a positive predictive value of 76%). The remaining 10 methods did not demonstrate statistical significance between TID and CC (p values > 0.05 and positive predictive values < 65%).

Computer calculated TID using e-soft and Cedars manual processing was found to be the most specific method for diagnosing true CAD.

TID is a strong positive predictor of CAD. Accurate evaluation of TID can extend a patient’s life or avoid unnecessary invasive procedures.

Yang, Z, Holliday, J, Zhao, Q, Shi, R, Kumar, D, D'Agostino, H, Determining Transient Ischemic Dilation in Myocardial Perfusion Imaging: An Evaluation of Eleven Methods.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5013633.html