Clinical value of supine and upright myocardial perfusion imaging in obese patients using the D-SPECT camera

• Published in: Journal of nuclear cardiology 2014-06, Vol.21 (3), p.478-485
• Main Authors: Ben-Haim, Simona, Almukhailed, Omar, Neill, Johanne, Slomka, Piotr, Allie, Rayjanah, Shiti, Dalia, Berman, Daniel S., Bomanji, Jamshed
• Format: Article
• Language: English
• Subjects: Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - instrumentation; Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography - methods; Cardiology; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Dobutamine; Equipment Design; Equipment Failure Analysis; Exercise Test; Female; Humans; image artifacts; Image Enhancement - instrumentation; Image Enhancement - methods; Imaging; instrumentation; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial perfusion imaging; Myocardial Perfusion Imaging - instrumentation; Nuclear Medicine; Obesity - complications; Obesity - diagnostic imaging; Observer Variation; Original Article; Patient Positioning - methods; Radiology; Reproducibility of Results; Sensitivity and Specificity; Supine Position; Vasodilator Agents
• ISSN: 1071-3581; 1532-6551
• DOI: 10.1007/s12350-014-9853-0

We have assessed whether additional upright imaging increases the confidence of interpretation of stress only supine myocardial perfusion imaging (MPI) in obese patients. Tc-MIBI stress MPI of 101 consecutive patients (M = 49, 62 ± 12 years) with BMI ≥30 scanned on the D-SPECT cardiac camera were assessed. Images were interpreted as diagnostic or equivocal and the need for a rest study was recorded. Stress supine MPI was interpreted first, then gated and finally upright data were added. Defects on supine but not on upright were defined as artefacts and defects seen on both as abnormal. The total perfusion deficit (TPD) was also quantified. There were 27 normal, 22 abnormal, and 52 equivocal supine scans. The median EF was 52%, unaffecting the need for rest imaging. Upright imaging reclassified 32/52 (62%) equivocal studies as normal and 6/52 (11%) as abnormal (P < 0.001). Rest scan was deemed needed in 74/101 patients on supine vs 42/101 on supine/upright (P < 0.001). Supine TPD was normal in 53 and supine/upright TPD was normal in 70 patients (P < 0.001). Supine stress MPI is inadequate in obese patients. The addition of upright imaging significantly increases the ability to interpret scans as diagnostic and may reduce considerably the need for rest imaging.