Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease

R. S. Driessen; P. G. Raijmakers; I. Danad; W. J. Stuijfzand; S. P. Schumacher; J. A. Leipsic; J. K. Min; J. Knuuti; A. A. Lammertsma; A. C. van Rossum; N. van Royen; S. R. Underwood; P. Knaapen

doi:https://doi.org/10.1007/s00259-018-3951-1

Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease

R. S. Driessen, P. G. Raijmakers, I. Danad, W. J. Stuijfzand, S. P. Schumacher, J. A. Leipsic, J. K. Min, J. Knuuti, A. A. Lammertsma, A. C. van Rossum, N. van Royen, S. R. Underwood, P. Knaapen

Research output: Contribution to journal › Article › Academic › peer-review

18 Citations (Scopus)

Abstract

Purpose: Traditionally, interpretation of myocardial perfusion imaging (MPI) is based on visual assessment. Computer-based automated analysis might be a simple alternative obviating the need for extensive reading experience. Therefore, the aim of the present study was to compare the diagnostic performance of automated analysis with that of expert visual reading for the detection of obstructive coronary artery disease (CAD). Methods: 206 Patients (64% men, age 58.2 ± 8.7 years) with suspected CAD were included prospectively. All patients underwent ^99mTc-tetrofosmin single-photon emission computed tomography (SPECT) and invasive coronary angiography with fractional flow reserve (FFR) measurements. Non-corrected (NC) and attenuation-corrected (AC) SPECT images were analyzed both visually as well as automatically by commercially available SPECT software. Automated analysis comprised a segmental summed stress score (SSS), summed difference score (SDS), stress total perfusion deficit (S-TPD), and ischemic total perfusion deficit (I-TPD), representing the extent and severity of hypoperfused myocardium. Subsequently, software was optimized with an institutional normal database and thresholds. Diagnostic performances of automated and visual analysis were compared taking FFR as a reference. Results: Sensitivity did not differ significantly between visual reading and most automated scoring parameters, except for SDS, which was significantly higher than visual assessment (p < 0.001). Specificity, however, was significantly higher for visual reading than for any of the automated scores (p < 0.001 for all). Diagnostic accuracy was significantly higher for visual scoring (77.2%) than for all NC images scores (p < 0.05), but not compared with SSS AC and S-TPD AC (69.8% and 71.2%, p = 0.063 and p = 0.134). After optimization of the automated software, diagnostic accuracies were similar for visual (73.8%) and automated analysis. Among the automated parameters, S-TPD AC showed the highest accuracy (73.5%). Conclusion: Automated analysis of myocardial perfusion SPECT can be as accurate as visual interpretation by an expert reader in detecting significant CAD defined by FFR.

Original language	English
Pages (from-to)	1091-1100
Number of pages	10
Journal	European journal of nuclear medicine and molecular imaging
Volume	45
Issue number	7
DOIs	https://doi.org/10.1007/s00259-018-3951-1
Publication status	Published - Jul 2018

Keywords

Automated analysis
Coronary artery disease
Ischemia
Myocardial perfusion imaging
SPECT

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Driessen, R. S., Raijmakers, P. G., Danad, I., Stuijfzand, W. J., Schumacher, S. P., Leipsic, J. A., Min, J. K., Knuuti, J., Lammertsma, A. A., van Rossum, A. C., van Royen, N., Underwood, S. R., & Knaapen, P. (2018). Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease. European journal of nuclear medicine and molecular imaging, 45(7), 1091-1100. https://doi.org/10.1007/s00259-018-3951-1

@article{259d0b5e40fa41be821ee0424e344d61,

title = "Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease",

abstract = "Purpose: Traditionally, interpretation of myocardial perfusion imaging (MPI) is based on visual assessment. Computer-based automated analysis might be a simple alternative obviating the need for extensive reading experience. Therefore, the aim of the present study was to compare the diagnostic performance of automated analysis with that of expert visual reading for the detection of obstructive coronary artery disease (CAD). Methods: 206 Patients (64% men, age 58.2 ± 8.7 years) with suspected CAD were included prospectively. All patients underwent 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) and invasive coronary angiography with fractional flow reserve (FFR) measurements. Non-corrected (NC) and attenuation-corrected (AC) SPECT images were analyzed both visually as well as automatically by commercially available SPECT software. Automated analysis comprised a segmental summed stress score (SSS), summed difference score (SDS), stress total perfusion deficit (S-TPD), and ischemic total perfusion deficit (I-TPD), representing the extent and severity of hypoperfused myocardium. Subsequently, software was optimized with an institutional normal database and thresholds. Diagnostic performances of automated and visual analysis were compared taking FFR as a reference. Results: Sensitivity did not differ significantly between visual reading and most automated scoring parameters, except for SDS, which was significantly higher than visual assessment (p < 0.001). Specificity, however, was significantly higher for visual reading than for any of the automated scores (p < 0.001 for all). Diagnostic accuracy was significantly higher for visual scoring (77.2%) than for all NC images scores (p < 0.05), but not compared with SSS AC and S-TPD AC (69.8% and 71.2%, p = 0.063 and p = 0.134). After optimization of the automated software, diagnostic accuracies were similar for visual (73.8%) and automated analysis. Among the automated parameters, S-TPD AC showed the highest accuracy (73.5%). Conclusion: Automated analysis of myocardial perfusion SPECT can be as accurate as visual interpretation by an expert reader in detecting significant CAD defined by FFR.",

keywords = "Automated analysis, Coronary artery disease, Ischemia, Myocardial perfusion imaging, SPECT",

author = "Driessen, {R. S.} and Raijmakers, {P. G.} and I. Danad and Stuijfzand, {W. J.} and Schumacher, {S. P.} and Leipsic, {J. A.} and Min, {J. K.} and J. Knuuti and Lammertsma, {A. A.} and {van Rossum}, {A. C.} and {van Royen}, N. and Underwood, {S. R.} and P. Knaapen",

year = "2018",

month = jul,

doi = "https://doi.org/10.1007/s00259-018-3951-1",

language = "English",

volume = "45",

pages = "1091--1100",

journal = "European journal of nuclear medicine and molecular imaging",

issn = "1619-7070",

publisher = "Springer Verlag",

number = "7",

}

Driessen, RS , Raijmakers, PG , Danad, I , Stuijfzand, WJ, Schumacher, SP, Leipsic, JA, Min, JK, Knuuti, J, Lammertsma, AA , van Rossum, AC, van Royen, N, Underwood, SR & Knaapen, P 2018, 'Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease', European journal of nuclear medicine and molecular imaging, vol. 45, no. 7, pp. 1091-1100. https://doi.org/10.1007/s00259-018-3951-1

TY - JOUR

T1 - Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease

AU - Driessen, R. S.

AU - Raijmakers, P. G.

AU - Danad, I.

AU - Stuijfzand, W. J.

AU - Schumacher, S. P.

AU - Leipsic, J. A.

AU - Min, J. K.

AU - Knuuti, J.

AU - Lammertsma, A. A.

AU - van Rossum, A. C.

AU - van Royen, N.

AU - Underwood, S. R.

AU - Knaapen, P.

PY - 2018/7

Y1 - 2018/7

N2 - Purpose: Traditionally, interpretation of myocardial perfusion imaging (MPI) is based on visual assessment. Computer-based automated analysis might be a simple alternative obviating the need for extensive reading experience. Therefore, the aim of the present study was to compare the diagnostic performance of automated analysis with that of expert visual reading for the detection of obstructive coronary artery disease (CAD). Methods: 206 Patients (64% men, age 58.2 ± 8.7 years) with suspected CAD were included prospectively. All patients underwent 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) and invasive coronary angiography with fractional flow reserve (FFR) measurements. Non-corrected (NC) and attenuation-corrected (AC) SPECT images were analyzed both visually as well as automatically by commercially available SPECT software. Automated analysis comprised a segmental summed stress score (SSS), summed difference score (SDS), stress total perfusion deficit (S-TPD), and ischemic total perfusion deficit (I-TPD), representing the extent and severity of hypoperfused myocardium. Subsequently, software was optimized with an institutional normal database and thresholds. Diagnostic performances of automated and visual analysis were compared taking FFR as a reference. Results: Sensitivity did not differ significantly between visual reading and most automated scoring parameters, except for SDS, which was significantly higher than visual assessment (p < 0.001). Specificity, however, was significantly higher for visual reading than for any of the automated scores (p < 0.001 for all). Diagnostic accuracy was significantly higher for visual scoring (77.2%) than for all NC images scores (p < 0.05), but not compared with SSS AC and S-TPD AC (69.8% and 71.2%, p = 0.063 and p = 0.134). After optimization of the automated software, diagnostic accuracies were similar for visual (73.8%) and automated analysis. Among the automated parameters, S-TPD AC showed the highest accuracy (73.5%). Conclusion: Automated analysis of myocardial perfusion SPECT can be as accurate as visual interpretation by an expert reader in detecting significant CAD defined by FFR.

AB - Purpose: Traditionally, interpretation of myocardial perfusion imaging (MPI) is based on visual assessment. Computer-based automated analysis might be a simple alternative obviating the need for extensive reading experience. Therefore, the aim of the present study was to compare the diagnostic performance of automated analysis with that of expert visual reading for the detection of obstructive coronary artery disease (CAD). Methods: 206 Patients (64% men, age 58.2 ± 8.7 years) with suspected CAD were included prospectively. All patients underwent 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) and invasive coronary angiography with fractional flow reserve (FFR) measurements. Non-corrected (NC) and attenuation-corrected (AC) SPECT images were analyzed both visually as well as automatically by commercially available SPECT software. Automated analysis comprised a segmental summed stress score (SSS), summed difference score (SDS), stress total perfusion deficit (S-TPD), and ischemic total perfusion deficit (I-TPD), representing the extent and severity of hypoperfused myocardium. Subsequently, software was optimized with an institutional normal database and thresholds. Diagnostic performances of automated and visual analysis were compared taking FFR as a reference. Results: Sensitivity did not differ significantly between visual reading and most automated scoring parameters, except for SDS, which was significantly higher than visual assessment (p < 0.001). Specificity, however, was significantly higher for visual reading than for any of the automated scores (p < 0.001 for all). Diagnostic accuracy was significantly higher for visual scoring (77.2%) than for all NC images scores (p < 0.05), but not compared with SSS AC and S-TPD AC (69.8% and 71.2%, p = 0.063 and p = 0.134). After optimization of the automated software, diagnostic accuracies were similar for visual (73.8%) and automated analysis. Among the automated parameters, S-TPD AC showed the highest accuracy (73.5%). Conclusion: Automated analysis of myocardial perfusion SPECT can be as accurate as visual interpretation by an expert reader in detecting significant CAD defined by FFR.

KW - Automated analysis

KW - Coronary artery disease

KW - Ischemia

KW - Myocardial perfusion imaging

KW - SPECT

UR - http://www.scopus.com/inward/record.url?scp=85042388827&partnerID=8YFLogxK

U2 - https://doi.org/10.1007/s00259-018-3951-1

DO - https://doi.org/10.1007/s00259-018-3951-1

M3 - Article

C2 - 29470616

SN - 1619-7070

VL - 45

SP - 1091

EP - 1100

JO - European journal of nuclear medicine and molecular imaging

JF - European journal of nuclear medicine and molecular imaging

IS - 7

ER -

Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease

Abstract

Keywords

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