Interpretive reproducibility of stress Tc-99m sestamibi tomographic myocardial perfusion imaging

Robert J. Golub, Alan W. Ahlberg, Joseph R. McClellan, Steven D. Herman, Mark I. Travin, Jeffrey F. Mather, Percy W. Aitken, John I. Baron, Gary V. Heller

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34 Scopus citations

Abstract

Background: Observer variability has been shown with interpretation of planar thallium-201 images. The interpretive reproducibilIity of technetium-99m sestamibi tomographic imaging is unknown. This study evaluated the interpretive reproducibility of interpretable Tc-99m sestamibi tomographic images among nuclear cardiologists with a wide range of training and experience. Methods: Three experienced readers (EX) and 3 less-experienced readers (LEX) interpreted 138 exercise and rest Tc-99m sestamibi tomographic images (101 were abnormal in patients with coronary artery disease [CAD], 37 were normal in patients with < 5% likelihood of CAD) twice in random sequence without clinical data. Images of good to excellent quality were randomly selected from a database at 2 nuclear cardiology laboratories. Intraobserver and interobserver agreement for global, left anterior descending (LAD) territory, non-LAD first (normal/abnormal) and second (normal/fixed/reversible) order, and defect extent (normal/singIe-vessel CAD/multi-vesseI CAD) were assessed with percent agreement and Cohen's kappa (κ) statistic. Results: With regard to intraobserver agreement, first and second order ranged from 87% to 94% and 80% to 90% for global, 82% to 96% and 78% to 95% for LAD, and 88% to 91% and 80% to 90% for non-LAD, respectively. Defect extent ranged from 75% to 90%. There were no differences between EX and LEX for global and non-LAD first and second order, LAD first order, and defect extent. LAD second order was 93% for EX compared with 88% (P = .015) for LEX. With regard to interobserver agreement, first and second order ranged from 73% to 89% and 64% to 85% for global, 73% to 93% and 69% to 91% for LAD, and 76% to 88% and 68% to 84% for non-LAD, respectively. Defect extent ranged from 61% to 82%. Global first and second order ranged from 85% to 87% and 78% to 82% for EX compared with 73% to 84% and 64% to 79% for LEX. LAD first and second order ranged from 89% to 91% and 88% to 89% for EX compared with 73% to 91% and 69% to 70% for LEX. Non-LAD first and second order ranged from 82% to 86% and 76% to 77% for EX compared with 76% to 86% and 68% to 81% for LEX. Defect extent ranged from 69% to 75% for EX compared with 59% to 77% for LEX. Conclusions: There is moderate to excellent interpretive reproducibility with stress Tc-99m sestamibi SPECT imaging among nuclear cardiologists with a wide range of training and experience.

Original languageEnglish (US)
Pages (from-to)257-269
Number of pages13
JournalJournal of Nuclear Cardiology
Volume6
Issue number3
DOIs
StatePublished - Jan 1 1999
Externally publishedYes

Keywords

  • Interobserver agreement
  • Interpretive reproducibility
  • Intraobserver agreement
  • Tomographic imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Golub, R. J., Ahlberg, A. W., McClellan, J. R., Herman, S. D., Travin, M. I., Mather, J. F., Aitken, P. W., Baron, J. I., & Heller, G. V. (1999). Interpretive reproducibility of stress Tc-99m sestamibi tomographic myocardial perfusion imaging. Journal of Nuclear Cardiology, 6(3), 257-269. https://doi.org/10.1016/S1071-3581(99)90037-5