Combined quantitative supine-prone myocardial perfusion SPECT improves detection of coronary artery disease and normalcy rates in women

Background. We sought to determine the diagnostic performance of a recently developed combined supine-prone quantification algorithm for myocardial perfusion single photon emission computed tomography (NIPS) for the detection of coronary artery disease (CAD) in women. Methods and Results. Consecutive MPS scans of women without known CAD and coronary angiography within 3 months of MPS, (n = 168) and with a low likelihood of CAD (n = 291) were considered. Total perfusion deficit (TPD) was automatically derived for supine (S-TPD), prone (P-TPD), and combined prone-supine (C-TPD) data sets. The low-likelihood patients were grouped by bra cup size (A/B, n = 102; C, n = 101; and D, n = 88). The areas under the receiver operator characteristic curves for S-TPD, P-TPD, and C-TPD were 0.84 +/- 0.03, 0.88 +/- 0.03, and 0.90 +/- 0.03, respectively. C-TPD had a higher specificity than S-TPD and P-TPD for identification of CAD (stenosis :70%) without compromising sensitivity (61%, 76%, and 94% for S-, P-, and C-TPD, respectively; P <.0005 vs S-TPD and P <.05 vs P-TPD). Normalcy rates were higher for C-TPD than for S-TPD or P-TPD. Conclusions. Combined supine-prone quantitative MPS in women yields significantly increased specificity and normalcy rates without compromising sensitivity for the detection of CAD compared with standard analysis.