Head-to-Head Comparison of CZT-SPECT and SPECT/CT Myocardial Perfusion Imaging: Interobserver and Intraobserver Agreement and Diagnostic Performance
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Stress and Acquisition Protocols
2.3. Automated Quantification
2.4. Visual Interpretation
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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n = 77 | |
---|---|
Gender, male (n, %) | 45 (58.4%) |
Age, years (mean ± SD) | 71.9 ± 8.9 |
Weight, kg (mean ± SD) | 82.0 ± 15.6 |
Height, cm (mean ± SD) | 170.8 ± 8.5 |
BMI (mean ± SD) Patients with known CAD (n) Patients with HTN (n) Patients with DM (n) Patients with dyslipidemia (n) | 27.7 ± 5.6 27 53 16 41 |
Injected activity at stress test, MBq (mean ± SD) | 334.8 ± 50.1 |
Injected activity at rest test §, MBq (mean ± SD) | 577.8 ± 176.7 |
Time interval between the two acquisitions for stress test £, mins (median (range)) | 17 (7–72) |
Parameter | Reader 1 | Reader 2 | ||
---|---|---|---|---|
Kappa (95% CI) | Weighted Kappa | Kappa (95% CI) | Weighted Kappa | |
Final conclusion | 0.798 (0.643 to 0.952) | - | 0.811 (0.668 to 0.953) | - |
Perfusion defect/ischemia | 0.560 (0.383 to 0.737) | - | 0.564 (0.396 to 0.733) | - |
Territory | 0.344 (0.219 to 0.470) | 0.453 | 0.350 (0.229 to 0.470) | 0.507 |
Severity | 0.402 (0.256 to 0.547) | 0.568 | 0.354 (0.216 to 0.492) | 0.532 |
Attenuation | 0.270 (0.049 to 0.492) | - | 0.247 (0.024 to 0.471) | - |
Attenuation location | 0.225 (0.055 to 0.395) | 0.229 | 0.249 (0.067 to 0.430) | 0.223 |
Presence of artifact | 0.279 (0.064 to 0.494) | - | 0.113 (−0.144 to 0.369) | - |
Artifact severity | 0.172 (0.035 to 0.309) | 0.273 | 0.120 (−0.016 to 0.257) | 0.223 |
Gastrointestinal artifact | 0.323 (0.114 to 0.532) | - | 0.095 (−0.154 to 0.344) | - |
Scar | 0.762 (0.584 to 0.960) | - | 0.725 (0.499 to 0.952) | - |
TID | 0.147 (−0.197 to 0.491) | - | 0.529 (0.197 to 0.860) | - |
ICC (95% CI) | ICC (95% CI) | |||
Visual SSS | 0.822 (0.734 to 0.883) | 0.719 (0.591 to 0.812) | ||
Visual SDS | 0.788 (0.813 to 0.924) | 0.672 (0.529 to 0.779) |
Attenuation | Reader 1 | Reader 2 | ||||
---|---|---|---|---|---|---|
SPECT/CT | CZT-SPECT | p Value † | SPECT/CT | CZT-SPECT | p Value † | |
None | 49 (63.6%) | 50 (64.9%) | 0.97 | 53 (68.8%) | 49 (63.6%) | 0.67 |
Breast attenuation | 12 (15.6%) | 11 (14.3%) | 12 (15.6%) | 10 (13.0%) | ||
Diaphragmatic attenuation | 12 (15.6%) | 13 (16.9%) | 9 (11.7%) | 14 (18.2%) | ||
Breast + diaphragmatic attenuation | 4 (5.2%) | 3 (3.9%) | 3 (3.9%) | 4 (5.2%) |
Parameter | SPECT/CT | CZT-SPECT | ||
---|---|---|---|---|
Kappa (95% CI) | Weighted Kappa | Kappa (95% CI) | Weighted Kappa | |
Final conclusion | 0.930 (0.835 to 1.000) | - | 0.876 (0.759 to 0.993) | - |
Perfusion defect/ischemia | 0.974 (0.923 to 1.000) | - | 0.799 (0.658 to 0.940) | - |
Territory | 0.755 (0.646 to 0.865) | 0.777 | 0.750 (0.639 to 0.862) | 0.781 |
Severity | 0.779 (0.666 to 0.891) | 0.850 | 0.609 (0.473 to 0.745) | 0.708 |
Attenuation | 0.711 (0.545 to 0.876) | - | 0.663 (0.489 to 0.837) | - |
Attenuation location | 0.699 (0.546 to 0.852) | 0.704 | 0.685 (0.530 to 0.840) | 0.679 |
Presence of artifact | 0.467 (0.256 to 0.687) | - | 0.444 (0.264 to 0.625) | - |
Artifact severity | 0.522 (0.387 to 0.657) | 0.685 | 0.508 (0.370 to 0.647) | 0.567 |
Gastrointestinal artifact | 0.446 (0.237 to 0.654) | - | 0.383 (0.203 to 0.562) | - |
Scar | 0.656 (0.401 to 0.910) | - | 0.723 (0.514 to 0.931) | - |
TID | 0.708 (0.398 to 1.000) | - | 0.916 (0.753 to 1.000) | - |
ICC (95% CI) | ICC (95% CI) | |||
Visual SSS | 0.904 (0.853 to 0.938) | 0.782 (0.677 to 0.856) | ||
Visual SDS | 0.758 (0.644 to 0.839) | 0.639 (0.486 to 0.755) |
Parameter | Stress Test | Rest Test | ||||
---|---|---|---|---|---|---|
SPECT/CT (n = 16) | CZT-SPECT (n = 16) | Adj. p Value Ψ | SPECT/CT (n = 13) | CZT-SPECT (n = 13) | Adj. p Value Ψ | |
EDV gated | 147.81 ± 60.46 | 136.37 ± 33.84 | 0.300 | 149.54 ± 45.90 | 145.38 ± 48.02 | 0.467 |
ESV gated | 81.94 ± 62.80 | 60.00 ± 28.60 | 0.097 | 86.61 ± 48.69 | 70.69 ± 52.03 | 0.011 |
EF gated | 49.19 ± 15.74 | 57.56 ± 12.07 | 0.031 | 45.08 ± 15.10 | 55.38 ± 18.06 | 0.011 |
STS gated | 7 (1–31) | 11.5 (3–34) | 0.097 | 7 (1–32) | 18 (0–43) | 0.121 |
SMS gated | 15.5 (0–58) | 5.5 (0–46) | 0.031 | 13 (1–49) | 5 (0–51) | 0.374 |
SSS NC/SA | 9 (0–22) | 11.5 (2–24) | 0.257 | - | - | |
SRS NC/SA | - | - | 4 (0–19) | 9 (0–20) | 0.647 | |
SDS £ NC/SA | - | - | 7 (0–13) | 7 (0–10) | 0.936 | |
Total blackout score NC | 19.5 (0–43) | 21 (0–38) | 0.756 | 5 (0–32) | 15 (0–43) | 0.448 |
SSS SC/gated | 12.5 (0–30) | 8 (0–17) | 0.081 | - | - | |
SRS SC/gated | - | - | 5 (0–19) | 5 (0–19) | 0.433 | |
SDS £ SC/gated | - | - | 5 (0–18) | 6 (1–11) | 0.791 | |
Total blackout score SC/gated | 23 (0–70) | 17 (0–34) | 0.081 | 11 (0–55) | 12 (0–39) | 0.448 |
Parameter | Stress Test | Rest Test | ||||
---|---|---|---|---|---|---|
SPECT/CT (n = 77) | CZT-SPECT (n = 77) | Adj. p Value Ψ | SPECT/CT (n = 23) | CZT-SPECT (n = 23) | Adj. p Value Ψ | |
EDV gated | 114.44 ± 47.17 | 108.65 ± 38.68 | 0.026 | 139.68 ± 42.03 | 138.73 ± 41.44 | 0.803 |
ESV gated | 54.65 ± 39.93 | 42.75 ± 28.85 | 0.0001 | 77.59 ± 40.69 | 65.14 ± 41.41 | 0.001 |
EF gated | 56.04 ± 13.48 | 63.53 ± 11.95 | 0.0001 | 46.77 ± 13.55 | 55.55 ± 15.11 | <0.001 |
STS gated | 4 (0–41) | 15 (0–48) | <0.0001 | 5.5 (0–38) | 17 (0–51) | 0.008 |
SMS gated | 8 (0–58) | 2 (0–46) | <0.0001 | 13.5 (1–49) | 6.5 (0–51) | 0.009 |
SSS NC/SA | 2 (0–28) | 3 (0–24) | 0.270 | - | - | |
SRS NC/SA | - | - | 4.5 (0–25) | 7 (0–20) | 0.463 | |
SDS £ NC/SA | - | - | 4.5 (0–13) | 4.5 (0–11) | 0.539 | |
Total blackout score NC | 3 (0–69) | 5 (0–43) | 0.200 | 8.5 (0–53) | 15 (0–43) | 0.289 |
SSS SC/gated | 3 (0–39) | 1 (0–17) | 0.015 | - | - | |
SRS SC/gated | - | - | 5 (0–19) | 4 (0–19) | 0.463 | |
SDS £ SC/gated | - | - | 3 (0–18) | 4.5 (0–13) | 0.968 | |
Total blackout score SC/gated | 3 (0–85) | 2 (0–34) | 0.040 | 9 (0–55) | 8 (0–39) | 0.463 |
TP | FP | TN | FN | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | NPV (95% CI) | Accuracy (95% CI) | |
---|---|---|---|---|---|---|---|---|---|
Reader 1, SPECT/CT | 18 | 8 | 14 | 8 | 0.69 (0.48–0.86) | 0.64 (0.41–0.83) | 0.69 (0.48–0.86) | 0.64 (0.41–0.83) | 0.67 (0.52–0.80) |
Reader 1, CZT-SPECT | 21 | 8 | 14 | 5 | 0.81 (0.61–0.93) | 0.64 (0.41–0.83) | 0.72 (0.53–0.87) | 0.74 (0.49–0.91) | 0.73 (0.58–0.85) |
Reader 2, SPECT/CT | 19 | 12 | 10 | 7 | 0.73 (0.52–0.88) | 0.45 (0.24–0.68) | 0.61 (0.42–0.78) | 0.59 (0.33–0.82) | 0.60 (0.45–0.74) |
Reader 2, CZT-SPECT | 22 | 11 | 10 | 5 | 0.81 (0.62–0.94) | 0.48 (0.26–0.70) | 0.67 (0.48–0.82) | 0.67 (0.38–0.88) | 0.67 (0.52–0.80) |
TP | FP | TN | FN | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | NPV (95% CI) | Accuracy (95% CI) | |
---|---|---|---|---|---|---|---|---|---|
Reader | |||||||||
Reader 1, SPECT/CT | 12 | 4 | 0 | 0 | 1.00 (0.73–1.00) | 0.00 (0.00–0.60) | 0.75 (0.48–0.93) | N/A | 0.75 (0.48–0.93) |
Reader 1, CZT-SPECT | 11 | 3 | 1 | 1 | 0.92 (0.61–0.99) | 0.25 (0.01–0.81) | 0.79 (0.49–0.95) | 0.50 (0.01–0.99) | 0.75 (0.48–0.93) |
Reader 2, SPECT/CT | 12 | 4 | 0 | 0 | 1.00 (0.73–1.00) | 0.00 (0.00–0.60) | 0.75 (0.48–0.93) | N/A | 0.75 (0.48–0.93) |
Reader 2, CZT-SPECT | 12 | 4 | 0 | 0 | 1.00 (0.73–1.00) | 0.00 (0.00–0.60) | 0.75 (0.48–0.93) | N/A | 0.75 (0.48–0.93) |
Imaging modality | |||||||||
SPECT/CT £ | 6 | 2 | 0 | 5 | 0.54 (0.23–0.83) | 0.00 (0.00–0.84) | 0.75 (0.35–0.97) | 0.00 (0.00–0.52) | 0.46 (0.19–0.75) |
CZT-SPECT £ | 9 | 1 | 1 | 2 | 0.82 (0.48–0.98) | 0.50 (0.12–0.99) | 0.90 (0.55–0.99) | 0.33 (0.01–0.91) | 0.77 (0.46–0.95) |
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Kalantari, F.; Mohseninia, N.; Wetsch, A.; Harsini, S.; Hehenwarter, L.; Schweighofer-Zwink, G.; Zamani-Siahkali, N.; Rendl, G.; Beheshti, M.; Pirich, C. Head-to-Head Comparison of CZT-SPECT and SPECT/CT Myocardial Perfusion Imaging: Interobserver and Intraobserver Agreement and Diagnostic Performance. Life 2023, 13, 1879. https://doi.org/10.3390/life13091879
Kalantari F, Mohseninia N, Wetsch A, Harsini S, Hehenwarter L, Schweighofer-Zwink G, Zamani-Siahkali N, Rendl G, Beheshti M, Pirich C. Head-to-Head Comparison of CZT-SPECT and SPECT/CT Myocardial Perfusion Imaging: Interobserver and Intraobserver Agreement and Diagnostic Performance. Life. 2023; 13(9):1879. https://doi.org/10.3390/life13091879
Chicago/Turabian StyleKalantari, Forough, Nasibeh Mohseninia, Andreas Wetsch, Sara Harsini, Lukas Hehenwarter, Gregor Schweighofer-Zwink, Nazanin Zamani-Siahkali, Gundula Rendl, Mohsen Beheshti, and Christian Pirich. 2023. "Head-to-Head Comparison of CZT-SPECT and SPECT/CT Myocardial Perfusion Imaging: Interobserver and Intraobserver Agreement and Diagnostic Performance" Life 13, no. 9: 1879. https://doi.org/10.3390/life13091879