Mathews Fish

Metropolitan Heart and Vascular Institute, Minneapolis, Minnesota, United States

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Publications (15)54.57 Total impact

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    ABSTRACT: SPECT myocardial perfusion imaging plays a central role in coronary artery disease diagnosis, but concerns exist regarding its radiation burden. Compared with standard Anger SPECT (A-SPECT) cameras, new high-efficiency (HE) cameras with specialized collimators and solid-state cadmium-zinc-telluride detectors offer potential to maintain image quality (IQ), while reducing administered activity and thus radiation dose to patients. No previous study has compared IQ, interpretation, total perfusion deficit (TPD), or ejection fraction (EF) in patients receiving both ultra-low-dose (ULD) imaging on an HE SPECT camera and standard low-dose (SLD) A-SPECT imaging.
    Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 06/2014;
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    ABSTRACT: We aimed to compare the inter-observer agreement between two experienced readers using supine vs combined supine/prone myocardial perfusion SPECT (MPS) in a large population. 1,181 consecutive patients without known coronary artery disease (CAD) undergoing rest (201)Tl/stress (99m)Tc-sestamibi MPS studies were evaluated. Visual reads were performed in two consecutive steps, with readers scoring the stress supine perfusion images during step 1 and rescoring the images using both supine/prone data during step 2. Visual summed stress scores (SSS) of two readers including regional scores in different vascular territories were compared. The specificity for both readers improved using combined supine/prone imaging (reader 1: 92% vs 86% [P = .0002], reader 2: 88% vs 72% [P < .0001]). The inter-observer correlation for SSS (0.90 vs 0.84, P < .0001) and inter-observer agreement for combined supine/prone reading (bias = 1.0, 95% confidence interval (CI) 0.9-1.2 vs bias = 3.1, 95% CI 2.8-3.4, P < .0001) were significantly better as compared to supine-only reading. The overall correlation between SSS scores for two readers improved with supine/prone imaging for both genders, as well as in the left anterior descending and right coronary territories. The inter-observer correlation and agreement significantly improve using two-position supine/prone vs supine-only imaging.
    Journal of Nuclear Cardiology 05/2014; · 2.85 Impact Factor
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    ABSTRACT: OBJECTIVE: We aimed to improve the diagnostic accuracy of myocardial perfusion SPECT (MPS) by integrating clinical data and quantitative image features with machine learning (ML) algorithms. METHODS: 1,181 rest (201)Tl/stress (99m)Tc-sestamibi dual-isotope MPS studies [713 consecutive cases with correlating invasive coronary angiography (ICA) and suspected coronary artery disease (CAD) and 468 with low likelihood (LLk) of CAD <5%] were considered. Cases with stenosis <70% by ICA and LLk of CAD were considered normal. Total stress perfusion deficit (TPD) for supine/prone data, stress/rest perfusion change, and transient ischemic dilatation were derived by automated perfusion quantification software and were combined with age, sex, and post-electrocardiogram CAD probability by a boosted ensemble ML algorithm (LogitBoost). The diagnostic accuracy of the model for prediction of obstructive CAD ≥70% was compared to standard prone/supine quantification and to visual analysis by two experienced readers utilizing all imaging, quantitative, and clinical data. Tenfold stratified cross-validation was performed. RESULTS: The diagnostic accuracy of ML (87.3% ± 2.1%) was similar to Expert 1 (86.0% ± 2.1%), but superior to combined supine/prone TPD (82.8% ± 2.2%) and Expert 2 (82.1% ± 2.2%) (P < .01). The receiver operator characteristic areas under curve for ML algorithm (0.94 ± 0.01) were higher than those for TPD and both visual readers (P < .001). The sensitivity of ML algorithm (78.9% ± 4.2%) was similar to TPD (75.6% ± 4.4%) and Expert 1 (76.3% ± 4.3%), but higher than that of Expert 2 (71.1% ± 4.6%), (P < .01). The specificity of ML algorithm (92.1% ± 2.2%) was similar to Expert 1 (91.4% ± 2.2%) and Expert 2 (88.3% ± 2.5%), but higher than TPD (86.8% ± 2.6%), (P < .01). CONCLUSION: ML significantly improves diagnostic performance of MPS by computational integration of quantitative perfusion and clinical data to the level rivaling expert analysis.
    Journal of Nuclear Cardiology 05/2013; · 2.85 Impact Factor
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    ABSTRACT: High-sensitivity dedicated cardiac camera systems provide an opportunity to lower the injected doses for SPECT myocardial perfusion imaging (MPI), but the exact limits for lowering doses have not been determined. List-mode data acquisition allows for reconstruction of various fractions of acquired counts, enabling a simulation of gradually lower administered dose. We aimed to determine the feasibility of very low dose MPI by exploring the minimal count level in the myocardium required for accurate MPI. METHODS: Seventy-nine patients were studied (mean body mass index, 30.0 ± 6.6; range, 20.2-54.0 kg/m(2)) who underwent 1-d standard-dose (99m)Tc-sestamibi exercise or adenosine rest-stress MPI for clinical indications using a cadmium-zinc-telluride dedicated cardiac camera. The imaging time was 14 min, with averaged 803 ± 200 MBq (21.7 ± 5.4 mCi) of (99m)Tc injected at stress. To simulate clinical scans with a lower dose at that imaging time we reframed the list-mode raw data. Accordingly, 6 stress-equivalent datasets were reconstructed containing various count fractions of the original scan. Automated quantitative perfusion and gated SPECT software was used to quantify total perfusion deficit (TPD) and ejection fraction for all 553 datasets (7 × 79). The minimal acceptable left ventricular region counts were determined on the basis of a previous report with repeatability of same-day, same-injection Anger camera studies. Pearson correlation coefficients and the SD of differences in TPD for all scans were calculated. RESULTS: The correlations of quantitative perfusion and function analysis were excellent for both global and regional analysis between original scans and all simulated low-count scans (all r ≥ 0.95, P < 0.0001). The minimal acceptable counts were determined to be 1.0 million for the left ventricular region. At this count level, the SD of differences was 1.7% for TPD and 4.2% for ejection fraction. This count level would correspond to a 92.5-MBq (2.5-mCi) injected dose for the 14-min acquisition or 125.8-MBq (3.4-mCi) injected dose for the 10-min acquisition. CONCLUSION: 1.0 million counts appear to be sufficient to produce myocardial images that agree well with 8.0-million-count images on quantitative perfusion and function parameters. With a dedicated cardiac camera, these images can be obtained over 10 min with an effective radiation dose of less than 1 mSv without significant sacrifice of accuracy.
    Journal of Nuclear Medicine 01/2013; · 5.77 Impact Factor
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    ABSTRACT: We compared the performance of fully automated quantification of attenuation-corrected (AC) and noncorrected (NC) myocardial perfusion SPECT (MPS) with the corresponding performance of experienced readers for detection of coronary artery disease (CAD). METHODS: Rest-stress (99m)Tc-sestamibi MPS studies (n = 995; 650 consecutive cases with coronary angiography and 345 with likelihood of CAD < 5%) were obtained by MPS with AC. The total perfusion deficit (TPD) for AC and NC data was compared with the visual summed stress and rest scores of 2 experienced readers. Visual reads were performed in 4 consecutive steps with the following information progressively revealed: NC data, AC + NC data, computer results, and all clinical information. RESULTS: The diagnostic accuracy of TPD for detection of CAD was similar to both readers (NC: 82% vs. 84%; AC: 86% vs. 85%-87%; P = not significant) with the exception of the second reader when clinical information was used (89%, P < 0.05). The receiver-operating-characteristic area under the curve (ROC AUC) for TPD was significantly better than visual reads for NC (0.91 vs. 0.87 and 0.89, P < 0.01) and AC (0.92 vs. 0.90, P < 0.01), and it was comparable to visual reads incorporating all clinical information. The per-vessel accuracy of TPD was superior to one reader for NC (81% vs. 77%, P < 0.05) and AC (83% vs. 78%, P < 0.05) and equivalent to the second reader (NC, 79%; and AC, 81%). The per-vessel ROC AUC for NC (0.83) and AC (0.84) for TPD was better than that for the first reader (0.78-0.80, P < 0.01) and comparable to that of the second reader (0.82-0.84, P = not significant) for all steps. CONCLUSION: For detection of ≥70% stenoses based on angiographic criteria, a fully automated computer analysis of NC and AC MPS data is equivalent for per-patient and can be superior for per-vessel analysis, when compared with expert analysis.
    Journal of Nuclear Medicine 01/2013; · 5.77 Impact Factor
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    ABSTRACT: Changes in myocardial wall motion and thickening during myocardial perfusion SPECT are typically assessed separately from gated studies for the presence of stress-induced functional abnormalities. We sought to develop and validate a novel approach for automatic quantification of rest-stress myocardial motion and thickening changes (MTCs). Endocardial surfaces at the end-diastolic and end-systolic frames for rest-stress studies were registered automatically to each other by matching ventricular surfaces. Myocardial MTCs were computed, and normal limits of change were determined as the mean and SD for each polar sample. Normal limits were used to quantify the MTCs for each map, and the accumulated sample values were used for abnormality assessments in segmental regions. A hybrid method was devised by combining the total perfusion deficit (TPD) and MTC for each vessel territory. Normal limits were obtained from 100 subjects with low likelihood of coronary artery disease. For validation, 623 subjects with correlating invasive angiography were studied. All subjects underwent a rest-stress (99m)Tc-sestamibi exercise or adenosine test and coronary angiography within 3 months of myocardial perfusion SPECT. All MTC and TPD measurements were derived automatically. The diagnostic accuracy for detection of coronary artery disease for MTC plus TPD was compared with TPD alone. Segmental normal values were between -1.3 and -4.1 mm for motion change and between -30.1% and -9.8% for thickening change. MTC combined with TPD achieved 61% sensitivity for 3-vessel-disease (3VD), 63% for 2-vessel-disease (2VD), and 90% for 1-vessel-disease (1VD) detection, compared with 32% for 3VD (P < 0.0001), 53% for 2VD (P < 0.001), and 90% for 1VD (P = 1.0) detection using the TPD-alone method. The specificity for the combined method was 71% for 3VD, 72% for 2VD, and 47% for 1VD detection versus 90% for 3VD (P < 0.0001), 80% for 2VD (P < 0.001), and 50% for 1VD detection (P = 0.0625) for the TPD-alone method. The accuracy of 3VD detection by MTC plus TPD was higher (69%) than the accuracy of TPD plus change in ejection fraction (63%) (P < 0.004). We established normal limits and a novel method for computation of regional functional changes between the rest and poststress studies. Compared with TPD alone, the combination of TPD with MTC improved the sensitivity for the detection of 3VD and 2VD.
    Journal of Nuclear Medicine 08/2012; 53(9):1392-400. · 5.77 Impact Factor
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    ABSTRACT: Transient ischemic dilation (TID) of the left ventricle in myocardial perfusion SPECT (MPS) has been shown to be a clinically useful marker of severe coronary artery disease (CAD). However, TID has not been evaluated for 99mTc-sestamibi rest/stress protocols (Mibi-Mibi). We aimed to develop normal limits and evaluate diagnostic power of TID ratio for Mibi-Mibi scans. TID ratios were automatically derived from static rest/stress MPS (TID) and gated rest/stress MPS from the end-diastolic phase (TID(ed)) in 547 patients who underwent Mibi-Mibi scans [215 patients with correlating coronary angiography and 332 patients with low likelihood (LLk) of CAD]. Scans were classified as severe (≥ 70% stenosis in proximal left anterior descending (pLAD) artery or left main (LM), or ≥ 90% in ≥ 2 vessels), mild to moderate (≥ 90% stenosis in 1 vessel or ≥ 70%-90% in ≥ 1 vessel except pLAD or LM), and normal (<70% stenosis or LLk group). Another classification based on the angiographic Duke prognostic CAD index (DI) was also applied: DI ≥ 50, 30 ≤ DI < 50 and DI < 30 or LLk group. The upper normal limits were 1.19 for TID and 1.23 for TID(ed) as established in 259 LLk patients. Both ratios increased with disease severity (P < .0001). Incidence of abnormal TID increased from 2% in normal patients to >36% in patients with severe CAD. Similarly, when DI was used to classify disease severity, the average ratios showed significant increasing trend with DI increase (P < .003); incidence of abnormal TID also increased with increasing DI. The incidence of abnormal TID in the group with high perfusion scores significantly increased compared to the group with low perfusion scores (stress total perfusion deficit, TPD < 3%) (P < .0001). The sensitivity for detecting severe CAD improved for TID when added to mild to moderate perfusion abnormality (3% ≤ TPD < 10%): 71% vs 64%, P < .05; and trended to improve for TID(ed)/TID(es): 69% vs 64%, P = .08, while the accuracy remained consistent if abnormal TID was considered as a marker in addition to stress TPD. Similar results were obtained when DI was used for the definition of severe CAD (sensitivity: 76% vs 66%, P < .05 when TID was combined with stress TPD). TID ratios obtained from gated or ungated Mibi-Mibi MPS and are useful markers of severe CAD.
    Journal of Nuclear Cardiology 03/2012; 19(3):465-73. · 2.85 Impact Factor
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    ABSTRACT: Changes in myocardial function signatures such as wall motion and thickening are typically computed separately from myocardial perfusion SPECT (MPS) stress and rest studies to assess for stress-induced function abnormalities. The standard approach may suffer from the variability in contour placements and image orientation when subtle changes between stress and rest scans in motion and thickening are being evaluated. We have developed a new measure of regional change of function signature (motion and thickening) computed directly from registered stress and rest gated MPS data. In our novel approach, endocardial surfaces at the end-diastolic and end-systolic frames for stress and rest studies were registered by matching ventricular surfaces. Furthermore, we propose a new global registration method based on finding the optimal rotation for myocardial best ellipsoid fit to minimize the indexing disparities between two surfaces between stress and rest studies. Myocardial stress-rest function changes were computed and normal limits of change were determined as the mean and standard deviation of the training set for each polar sample. Normal limits were utilized to quantify the stress-rest function change for each polar map sample and the accumulated quantified function signature values were used for abnormality assessments in territorial regions. To evaluate the effectiveness of our novel method, we examined the agreements of our results against visual scores for motion change on vessel territorial regions obtained by human experts on a test group with 623 cases and were able to show that our detection method has a improved sensitivity on per vessel territory basis, compared to those obtained by human experts utilizing gated MPS data.
    Proc SPIE 02/2012; 2012(8315).
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    ABSTRACT: Objective assessment of wall motion (M) and thickening (T) will aid in diagnosis of coronary artery disease (CAD) from myocardial perfusion SPECT (MPS). We aimed to develop and validate an improved fully automated M/T segmental scoring system for MPS. 100 normal gated stress/rest Tc-99m sestamibi MPS scans from patients with low-likelihood (LLk) of CAD were used to derive the regional normal M/T ranges. A new automatic algorithm incorporated regional dependence on the global contractility in polar map coordinates by linear regression analysis and automatically derived 17-segment M (scale 0-5) and T (scale 0-3) scores. We validated this new method in 630 consecutive Tc-99m stress MPS studies in patients with suspected CAD and available correlating angiography, and an additional 241 LLk studies. Two independent observers with 12 and 30 years of experience in nuclear cardiology, blinded to clinical and angiographic data, scored M /T in 17-segments for all 971 studies. Computation time was <1 s per case. In the angiography group, there was a high correlation between the summed scores (averaged for two observers) and automatic scores with r = 0.91 (slope = 1.02, offset = 0.2; P < .0001) for M and r = 0.88 (slope = 1.06, offset = 0.28 for T; P < .0001). Weighted kappa was 0.63 for M and 0.57 for T, with expected agreement of 89% (M) and 91% (T) in individual segments (n = 10710). Weighted kappa between two experts was 0.45 for M and 0.52 for T. The normalcy rate in LLk cases was 96% for automated M and 99% for T (summed score <3). Detection of the angiographically significant disease by automated M or T scoring was better than or equivalent to individual expert observer scoring, and better than the previous automated system. Fully automated scoring of MPS regional ventricular function can be performed rapidly, is highly correlated with expert visual scoring, can outperform individual experienced observers in the detection of CAD by wall thickening from MPS, and avoids inter-observer variability.
    Journal of Nuclear Cardiology 01/2012; 19(2):291-302. · 2.85 Impact Factor
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    ABSTRACT: Attenuation corrected myocardial perfusion SPECT (AC-MPS) has been demonstrated to improve the specificity of detecting coronary artery disease (CAD) by visual analysis which utilizes both non-corrected (NC) and AC data. However, the combined automated quantification of NC and AC-MPS has not been previously described. We aimed to develop a combined quantitative analysis from AC and NC data to improve the accuracy of automated detection of CAD from AC-MPS. Stress total perfusion deficit (TPD) values were generated by standard analysis for NC (NC-TPD), AC (AC-TPD) and by combined NC-AC analysis (NA-TPD), in which the hypoperfusion severity in each polar map location was defined as the average of AC and NC severity computed by comparison with separate AC and NC normal limits. Ischemic TPD was also calculated as the difference between stress TPD and rest TPD for each measure. Stress/rest Tc-99m sestamibi MPS studies in 650 patients with correlating coronary angiography and in 345 patients with a low-likelihood (LLk) of CAD were used to assess diagnostic performance of combined NC-AC analysis. NA-TPD had a higher receiver-operator-characteristic area under the curve (ROC-AUC) (0.87) than NC-TPD (0.85; P < .01) or AC-TPD (0.85; P < .01) for detection of stenosis >or=70% in angiographic group. It also had higher specificity (75%) vs NC-TPD (65%; P < .0001), or AC-TPD (70%; P = .016). In LLk group, the normalcy rate of NA-TPD (95%) was higher than for NC-TPD (90%; P < .01) and similar to AC-TPD (94%; P = NS). NA-TPD had higher ROC-AUC than that for 17-segment expert visual scoring of stress scans in angiographic group (0.84; P = .01), comparable accuracy (81%) and similar normalcy rates (95% vs 97%; P = NS). Ischemic TPD by combined NC-AC analysis had higher ROC-AUC than that for any ischemic measure. Similar to stress NA-TPD, it also obtained the similar performance results as compared with ischemic TPD based on NC or AC and higher sensitivity (89% vs 85%; P = .0295) as compared with ischemic visual score in angiographic group. Combined NC-AC MPS quantification using either stress or ischemic TPD shows significant improvements for ROC-AUC and specificity of MPS in the detection of CAD compared with standard NC-MPS or AC-MPS and comparable performance to expert visual scoring. This technique may lead to an enhancement in a fully automated quantification for the perfusion analysis by AC-MPS.
    Journal of Nuclear Cardiology 04/2010; 17(4):591-9. · 2.85 Impact Factor
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    ABSTRACT: We aimed to improve the quantification of myocardial perfusion stress-rest changes in myocardial perfusion SPECT (MPS) studies for the optimal automatic detection of ischemia and coronary artery disease (CAD). Rest-stress (99m)Tc MPS studies (997 cases; 651 consecutive cases with correlating angiography and 346 cases with less than 5% likelihood (low likelihood [LLK]) of CAD) were analyzed. Normal limits for stress-rest changes were derived from additional LLK patients (40 women, 40 men). We computed the global stress-rest change (C-SR) by integrating direct stress-rest changes for each polar map pixel. Additionally, stress-rest change and total perfusion deficit (TPD) at stress were combined in 1 variable (C-TPD) for the optimal detection of CAD. The area under the receiver-operating-characteristic curve (AUC) for C-SR (0.92) was larger than that for stress TPD-rest TPD (0.88) for the identification of stenosis of 70% or more (P < 0.0001). AUC (0.94) and sensitivity (90%) for C-TPD were higher than those for stress TPD (0.91 and 83%, respectively) (P < 0.0001), whereas specificity remained the same (81%). C-SR and C-TPD provide higher diagnostic performance than difference between stress and rest TPD or stress hypoperfusion analysis.
    Journal of Nuclear Medicine 02/2010; 51(2):204-9. · 5.77 Impact Factor
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    ABSTRACT: Left ventricular (LV) segmentation, including accurate assignment of LV contours, is essential for the quantitative assessment of myocardial perfusion SPECT (MPS). Two major types of segmentation failures are observed in clinical practices: incorrect LV shape determination and incorrect valve-plane (VP) positioning. We have developed a technique to automatically detect these failures for both nongated and gated studies. A standard Cedars-Sinai perfusion SPECT (quantitative perfusion SPECT [QPS]) algorithm was applied to derive LV contours in 318 consecutive (99m)Tc-sestamibi rest/stress MPS studies consisting of stress/rest scans with or without attenuation correction and gated stress/rest images (1,903 scans total). Two numeric parameters, shape quality control (SQC) and valve-plane quality control, were derived to categorize the respective contour segmentation failures. The results were compared with the visual classification of automatic contour adequacy by 3 experienced observers. The overall success of automatic LV segmentation in the 1,903 scans ranged from 66% on nongated images (incorrect shape, 8%; incorrect VP, 26%) to 87% on gated images (incorrect shape, 3%; incorrect VP, 10%). The overall interobserver agreement for visual classification of automatic LV segmentation was 61% for nongated scans and 80% for gated images; the agreement between gray-scale and color-scale display for these scans was 86% and 91%, respectively. To improve the reliability of visual evaluation as a reference, the cases with intra- and interobserver discrepancies were excluded, and the remaining 1,277 datasets were considered (101 with incorrect LV shape and 102 with incorrect VP position). For the SQC, the receiver-operating-characteristic area under the curve (ROC-AUC) was 1.0 +/- 0.00 for the overall dataset, with an optimal sensitivity of 100% and a specificity of 98%. The ROC-AUC was 1.0 in all specific datasets. The algorithm was also able to detect the VP position errors: VP overshooting with ROC-AUC, 0.91 +/- 0.01; sensitivity, 100%; and specificity, 70%; and VP undershooting with ROC-AUC, 0.96 +/- 0.01; sensitivity, 100%; and specificity, 70%. A new automated method for quality control of LV MPS contours has been developed and shows high accuracy for the detection of failures in LV segmentation with a variety of acquisition protocols. This technique may lead to an improvement in the objective, automated quantitative analysis of MPS.
    Journal of Nuclear Medicine 09/2009; 50(9):1418-26. · 5.77 Impact Factor
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    ABSTRACT: Attenuation correction (AC) for myocardial perfusion SPECT (MPS) had not been evaluated separately in women despite specific considerations in this group because of breast photon attenuation. We aimed to evaluate the performance of AC in women by using automated quantitative analysis of MPS to avoid any bias. Consecutive female patients--134 with a low likelihood (LLk) of coronary artery disease (CAD) and 114 with coronary angiography performed within less than 3 mo of MPS--who were referred for rest-stress electrocardiography-gated 99mTc-sestamibi MPS with AC were considered. Imaging data were evaluated for contour quality control. An additional 50 LLk studies in women were used to create equivalent normal limits for studies with AC and with no correction (NC). An experienced technologist unaware of the angiography and other results performed the contour quality control. All other processing was performed in a fully automated manner. Quantitative analysis was performed with the Cedars-Sinai myocardial perfusion analysis package. All automated segmental analyses were performed with the 17-segment, 5-point American Heart Association model. Summed stress scores (SSS) of > or =3 were considered abnormal. CAD (> or =70% stenosis) was present in 69 of 114 patients (60%). The normalcy rates were 93% for both NC and AC studies. The SSS for patients with CAD and without CAD for NC versus AC were 10.0 +/- 9.0 (mean +/- SD) versus 10.2 +/- 8.5 and 1.6 +/- 2.3 versus 1.8 +/- 2.5, respectively; P was not significant (NS) for all comparisons of NC versus AC. The SSS for LLk patients for NC versus AC were 0.51 +/- 1.0 versus 0.6 +/- 1.1, respectively; P was NS. The specificity for both NC and AC was 73%. The sensitivities for NC and AC were 80% and 81%, respectively, and the accuracies for NC and AC were 77% and 78%, respectively; P was NS for both comparisons. There are no significant diagnostic differences between automated quantitative MPS analyses performed in studies processed with and without AC in women.
    Journal of Nuclear Medicine 06/2008; 49(6):915-22. · 5.77 Impact Factor
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    ABSTRACT: We aimed to compare the automation and diagnostic performance in the detection of coronary artery disease (CAD) of the 4DMSPECT (4DM), Emory Cardiac Toolbox (EMO), and QPS systems for automated quantification of myocardial perfusion. We studied 328 patients referred for rest/stress Tc-99m sestamibi imaging, 140 low-likelihood patients and 188 with angiography. Contours were corrected when necessary. All other processing was fully automated. A 17-segment analysis was performed, and a summed stress score (SSS) > or =4 was considered abnormal. The average SSSs (+/-SD) for 4DM, EMO, and QPS were 10.5 +/- 9.4, 11.1 +/- 8.3, and 10.1 +/- 8.9, respectively (P = .02 for QPS versus EMO). The receiver operator characteristics areas-under-the-curve for the detection of CAD (+/-SEM) were 0.84 +/- 0.03, 0.76 +/- 0.04, and 0.88 +/- 0.03 for 4DM, EMO, and QPS, respectively (P = .001 for QPS versus EMO, and P = .03 for 4DM versus EMO). Normalcy rate was higher for QPS and 4DM versus EMO, at 91% and 94% versus 77%, respectively (P = .02). Sensitivity was higher for QPS (87%) versus 4DM (80%) (P = .045). Specificity was higher for QPS (71%) versus EMO (49%) (P = .01). The accuracy rate was higher for QPS versus 4DM and EMO, at 83% versus 77% and 76%, respectively (P = .05). There are differences in myocardial-perfusion quantification, diagnostic performance, and degree of automation of software packages.
    Journal of Nuclear Cardiology 01/2008; 15(1):27-34. · 2.85 Impact Factor
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    ABSTRACT: We aimed to compare normal limits and the detection of coronary artery disease (CAD) with attenuation-corrected (AC) and non-attenuation-corrected (NC) myocardial perfusion single photon emission computed tomography (MPS) by use of a recently improved automated quantification technique. We acquired 415 rest/stress technetium 99m MPS studies on a Vertex dual-detector camera with a gadolinium 153 line source (Vantage Pro). Gender-specific NC, AC, and gender-combined AC normal limits were created from rest/stress images of 50 women and 50 men with a low likelihood of CAD (< 5%) and a median body mass index (BMI) of 30 kg/m2 in each gender group. BMI-specific normal limits (< 30 kg/m2 and > or = 30 kg/m2) were also compared. Total perfusion deficit and 17-segment summed scores in 174 patients were compared with angiography, and normalcy rates were established from 141 studies of low-likelihood patients. There were no differences between low-BMI and high-BMI normal limits for AC or NC studies. Male and female normal limits differed in 12 of 17 segments for NC stress studies and in 3 of 17 segments for AC stress studies (P < .01). The sensitivity, specificity, and normalcy rates for stenoses with 70% narrowing or greater were 89%, 73%, and 91%, respectively, for NC studies and 87%, 80%, and 95%, respectively, for AC studies (P = not significant). Automated detection of CAD by AC and NC MPS demonstrated similar sensitivity, specificity, and normalcy rates. Some gender differences were noted for AC normal limits.
    Journal of Nuclear Cardiology 09/2006; 13(5):642-51. · 2.85 Impact Factor

Publication Stats

116 Citations
54.57 Total Impact Points

Institutions

  • 2012–2014
    • Metropolitan Heart and Vascular Institute
      Minneapolis, Minnesota, United States
  • 2006–2013
    • Sacred Heart Medical Center
      Spokane, Washington, United States
  • 2006–2012
    • Cedars-Sinai Medical Center
      • Cedars Sinai Medical Center
      Los Angeles, CA, United States