Semi-quantitative segmental perfusion scoring in myocardial perfusion SPECT: visual vs. automated analysis

Document Type: Original Article


1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Ferdowsi University of Mashhad, Mashhad, Iran

3 Radiology Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: It is recommended that the physician apply at least a semi-quantitative segmental scoring system in myocardial perfusion SPECT.  We aimed to assess the agreement between automated semi-quantitative analysis using QPS (quantitative Perfusion SPECT) software and visual approach for calculation of summed stress  score (SSS), summed rest score (SRS) and summed difference score (SDS).
Methods: We retrospectively studied 1782 consecutive patients who had undergone two-day stress-rest Tc99m-MIBI myocardial perfusion SPECT. Based on 17-segment 5-scale scoring system, SSS, SRS and SDS were calculated visually and using QPS software.
Results: There was good correlation between visual analysis and QPS software in calculation of SSS and SRS and a fair correlation for SDS. However, there was statistically significant difference between two methods. By Bland-Altman analyses mean value of the differences (estimated bias) differs significantly from 0 on the basis of 1-sample t-test. Based on bias, Precision and 95% limits of agreement, discrepancies between measurements indicate no agreement equally through the range of measurements, so there is a proportional bias. Based on SSS, SRS and SDS ≤3 and SSS, SRS and SDS >3, there was fair concordance between the visual assessment and automated QPS calculation. Kappa statistics was 0.41 (P<0.001), 0.69 (P<0.001) and 0.25 (P<0.001) for SSS, SRS and SDS respectively.

Conclusion: Although semi-quantification sores by visual and automated analysis is correlated, the agreement assessed by Bland-Altman analysis is not high especially in more extensive perfusion defects. Semi-quantitative automated analysis should be used as a supplement to the visual assessment.


Main Subjects

Xu Y, Hayes S, Ali I, Ruddy TD, Wells RG, Berman DS, Germano G, Slomka PJ. Automatic and visual reproducibility of perfusion and function measures for myocardial perfusion SPECT. J Nucl Cardiol. 2010 Dec;17(6):1050-7.

Berman DS, Kang X, Gransar H, Gerlach J, Friedman JD, Hayes SW, Thomson LE, Hachamovitch R, Shaw LJ, Slomka PJ, Yang LD, Germano G. Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis. J Nucl Cardiol. 2009 Jan-Feb;16(1):45-53.

Hsu CC, Chen YW, Hao CL, Chong JT, Lee CI, Tan HT, Wu MS, Wu JC. Comparison of automated 4D-MSPECT and visual analysis for evaluating myocardial perfusion in coronary artery disease. Kaohsiung J Med Sci. 2008 Sep;24(9):445-52.

Holly TA, Abbott BG, Al-Mallah M, Calnon DA, Cohen MC, DiFilippo FP, Ficaro EP, Freeman MR, Hendel RC, Jain D, Leonard SM, Nichols KJ, Polk DM, Soman P; American Society of Nuclear Cardiology. Single photon-emission computed tomography. J Nucl Cardiol. 2010 Oct;17(5):941-73.

Dabbagh Kakhki VR. Gated myocardial perfusion SPECT in patients with kidney transplantation: Semi-quantification. Iran J Nucl Med. 2013;21(2):44-45.

Dabbagh Kakhki VR,  Zakavi SR, Sadeghi R, Emadzadeh MR, Vejdani A. Normal values of left ventricular functional indices in gated 99mTc-MIBI myocardial perfusion SPECT. Iran J Nucl Med. 2008;16(1):14-19.

Dabbagh Kakhki VR, Jabari H. Dipyridamole stress and rest gated 99mTc-sestamibi myocardial perfusion SPECT: left ventricular function indices and myocardial perfusion findings. Iran J Nucl Med. 2007;15(1):1-7.

Kakhki VR, Zakavi SR, Sadeghi R. Comparison of two software in gated myocardial perfusion single photon emission tomography, for the measurement of left ventricular volumes and ejection fraction, in patients with and without perfusion defects. Hell J Nucl Med. 2007 Jan-Apr;10(1):19-23.

Sharir T, Germano G, Waechter PB, Kavanagh PB, Areeda JS, Gerlach J, Kang X, Lewin HC, Berman DS. A new algorithm for the quantitation of myocardial perfusion SPECT. II: validation and diagnostic yield. J Nucl Med. 2000 Apr;41(4):720-7.

Hesse B, Tägil K, Cuocolo A, Anagnostopoulos C, Bardiés M, Bax J, Bengel F, Busemann Sokole E, Davies G, Dondi M, Edenbrandt L, Franken P, Kjaer A, Knuuti J, Lassmann M, Ljungberg M, Marcassa C, Marie PY, McKiddie F, O'Connor M, Prvulovich E, Underwood R, van Eck-Smit B; EANM/ESC Group. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging. 2005 Jul;32(7):855-97.

A guide to the interpretation and reporting of myocardial perfusion and gated SPECT.

Leslie WD, Tully SA, Yogendran MS, Ward LM, Nour KA, Metge CJ. Automated quantification of 99mTc sestamibi myocardial perfusion compared with visual analysis. Nucl Med Commun. 2004 Aug;25(8):833-8.