Site qualification and clinical interpretation standards for 99mTc-SPECT perfusion imaging in a multi-center study of MITNEC (Medical Imaging Trials Network of Canada)

Jennifer M. Renaud, Manuja Premaratne, Marie Claude Villeneuve, Vincent Finnerty, Francois Harel, Therèse Heinonen, Jean Claude Tardif, Terrence D. Ruddy, Robert A. deKemp

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Background: Qualification and interpretation standards are essential for establishing 99mTc-SPECT MPI accuracy vs. alternative modalities. Methods: Rest–stress 99mTc-SPECT phantom scans were acquired on 35 cameras. LV defects were quantified with summed stress (SSS) and difference scores (SDS) at 2 core labs. SDS ≥ 2 in the right coronary artery (RCA) was the qualifying standard. Twenty rest (R)–stress (S) patient images were acquired on qualified cameras and interpreted by core labs. Global scoring differences > 3 between labs or discordant clinical interpretations underwent review. Scoring, interpretation, image quality, and diagnostic parameter agreement were assessed. Results: Phantom scans: visual scoring confirmed RCA-ischemia on all cameras. Regional SSS, SDS agreement was moderate to very good: ICC-r = 0.57, 0.84. Patient scans: 90% of global SSS, 85% of SDS differences were ≤ 3. Regional SSS, SDS agreement: ICC-r = 0.87, 0.86, and global abnormal (SSS ≥ 4) and ischemic (SDS ≥ 2) interpretation: ICC-r = 0.90 were excellent. Clinical interpretation agreement was 100% following review. Image quality agreement was 70%. Automated metrics also agreed: ischemic total perfusion deficit ICC-r = 0.75, reversible perfusion defect, transient ischemic dilation, and S-R LV ejection fraction ICC-r ≥ 0.90. Conclusion: Quantitative scoring and interpretation of scans were highly repeatable with site qualification and clinical interpretation standardization, indicating that dual-core lab interpretation is appropriate to determine 99mTc-SPECT MPI accuracy.

Original languageEnglish
Pages (from-to)6712-6725
Number of pages14
JournalJournal of Nuclear Cardiology
Issue number6
Publication statusPublished - Dec 2021


  • Ischemia quantification
  • Non-invasive myocardial perfusion imaging
  • Single-photon emission computed tomography
  • Standardization
  • Technetium-99m

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