Author + information
- Received June 18, 1986
- Revision received December 17, 1986
- Accepted January 7, 1987
- Published online July 1, 1987.
- Terrence D. Ruddy, MD, FACC1,2,
- Humberto R. Dighero, MD1,
- John B. Newell, BA1,
- Gerald M. Pohost, MD, FACC1,
- H. William Strauss, MD, FACC1,
- Robert D. Okada, MD, FACC1 and
- Charles A. Boucher, MD, FACC*,1
- ↵*Address for reprints: Charles A. Boucher, MD, Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts 02114.
To determine if the detection of coronary artery disease by dipyridamole-thallium imaging is improved by 1) quantitative versus qualitative analysis, and 2) combining quantitative variables, 80 patients with chest pain (53 with and 27 without coronary artery disease) who underwent cardiac catheterization were studied. Segmental thallium initial uptake, linear clearance, mono-exponential clearance and redistribution were measured from early, intermediate and delayed images acquired in three projections. Normal values were determined from 13 other clinically normal subjects.
When five segments per view were used for quantitative analysis, sensitivity and specificity were 87 and 63%, respectively, for uptake, 77 and 67% for linear clearance, 60 and 60% for monoexponential clearance and 62 and 56% for redistribution. Of the four variables, uptake and linear clearance were the most sensitive (p < 0.01) and specificity did not differ significantly. Using three segments per view, the specificity of uptake increased (p < 0.05) to 78% without a significant change in sensitivity (85%). With this approach, sensitivity and specificity did not differ from those of qualitative analysis (85 and 78%, respectively).
Stepwise logistic regression analysis demonstrated that the best quantitative thallium correlate of the presence of coronary artery disease was a combination variable of “either abnormal uptake or abnormal linear clearance, or both.” Using five segments per view, the model's specificity (85%) was greater than that of uptake alone (p < 0.02), with similar sensitivity (92%). Using three segments per view, the model's specificity (93%) was greater than that of uptake alone (p < 0.05) and of qualitative analysis (p < 0.05), with similar sensitivity (85%). Compared with qualitative analysis, the diagnostic accuracy of the model was greater using either five segments (90 versus 82%, p < 0.01) or three segments (88 versus 82%, p < 0.05) per view.
Quantitative analysis of dipyridamole-thallium images using single individual variables provides results comparable with those of qualitative analysis and this can be further optimized when a combination of quantitative variables is used.
- Received June 18, 1986.
- Revision received December 17, 1986.
- Accepted January 7, 1987.
- American College of Cardiology Foundation