Multi-center study of inter-rater reproducibility, image quality, and diagnostic accuracy of CZT versus conventional SPECT myocardial perfusion imaging

• Published in: Journal of nuclear cardiology 2023-04, Vol.30 (2), p.528-539
• Main Authors: Mansour, Nabeel, Nekolla, Stephan G., Reyes, Eliana, Angelidis, George, Georgoulias, Panagiotis, Anagnostopoulos, Constantinos, Bravo, Paco, Bruno, Isabella, Flotats, Albert, Fuentes-Ocampo, Francisco, Sciagrà, Roberto, Keng, Felix, Kessler, Lukas, Papathanasiou, Maria, Soman, Prem, Rischpler, Christoph
• Format: Article
• Language: English
• Subjects: Cadmium; cadmium-zinc-telluride; Cameras; Cardiology; Cardiovascular disease; Coronary Artery Disease; Humans; Imaging; Medical diagnosis; Medicine; Medicine & Public Health; myocardial perfusion imaging; Myocardial Perfusion Imaging - methods; Nuclear Medicine; Original; Original Article; Radiology; Reproducibility; Reproducibility of Results; single-photon emission tomography; Tellurium; Tomography, Emission-Computed, Single-Photon - methods
• ISSN: 1071-3581; 1532-6551
• DOI: 10.1007/s12350-022-03054-w

Cadmium-zinc-telluride (CZT)-based detectors exhibit higher diagnostic sensitivity in myocardial perfusion imaging (MPI) than conventional Anger-MPI for detection of coronary artery disease (CAD); however, reduced specificity and diagnostic accuracy of CZT-MPI were observed. This study aims to compare these different camera systems and to examine the degree of inter-rater reproducibility among readers with varying experience in MPI. 83 patients who underwent double stress/rest examinations using both a CZT and conventional SPECT cameras within one visit were included. Anonymized and randomized MPI-images were distributed to 15 international readers using a standardized questionnaire. Subsequent coronary angiography findings of ten patients served as a reference for analysis of sensitivity and specificity. Image quality was significantly better in CZT-MPI with significantly lower breast attenuation (P < 0.05). CZT-MPI exhibited higher sensitivity than Anger-MPI (87.5% vs. 62.5%) and significantly reduced specificity (40% vs. 100%). Readers experienced with both camera systems had the highest inter-rater agreement indicating higher reproducibility (CZT 0.54 vs. conv. 0.49, P < 0.05). Higher diagnostic sensitivity of CZT-MPI offers advantages in detection of CAD yet potentially of at the cost of reduced specificity, therefore it requires special training and a differentiated evaluation approach, especially for non-experienced readers with such camera systems.