Quantitative analysis of Tc-99(m)-sestamibi myocardial perfusion SPECT using a three-dimensional reference heart: a comparison with experienced observers

Background Quantification of myocardial perfusion single photon emission co mputed tomography (SPECT) may improve scintigraphic analysis. Recently, a f ully operator independent technique for the quantification of myocardial pe rfusion SPECT was described, based on a normal three-dimensional averaged r eference heart. The purpose of this study was to compare the automated SPEC T quantification technique with experienced observers. Methods A total of 43 patients, 36 with one-vessel coronary artery disease (CAD) and seven with a low likelihood of CAD, underwent (99)Tcm-sestamibi S PECT (Tc-99(m)-MIBI SPECT). Three experienced observers and a panel (compos ed of the three observers), blinded to the clinical and angiographic data, analysed the size and severity of perfusion defects and the relation to the distribution areas of the coronary arteries. Inter-observer agreement was calculated by using kappa (kappa) statistics. Results The inter-observer agreement between the human observers and the au tomated quantitative analysis, for severity and size of perfusion abnormali ty, was moderate (kappa range 0.38-0.68), while this was fair between three individual observers (kappa range 0.36-0.87) and good between the individu al observers and the panel (kappa range 0.63-0.89). There were no differenc es between the quantitative analysis and the panel in the allocation of per fusion abnormalities to the affected coronary artery. Conclusions The operator independent quantification method showed a moderat e agreement with individual observers and a panel analysis for size and sev erity of perfusion abnormalities. The automatic quantification has a simila r ability to assign perfusion abnormalities to the diseased coronary artery as compared to an expert panel. ((C) 2001 Lippincott Williams & Wilkins).