PT  - JOURNAL ARTICLE
AU  - Levent A. Guner
AU  - Billur Caliskan
AU  - Ilknur Isik
AU  - Tamer Aksoy
AU  - Erkan Vardareli
AU  - Afsin Parspur
TI  - Evaluating the Role of Routine Prone Acquisition on Visual Evaluation of SPECT Images
AID  - 10.2967/jnmt.115.165936
DP  - 2015 Dec 01
TA  - Journal of Nuclear Medicine Technology
PG  - 282--288
VI  - 43
IP  - 4
4099  - http://tech.snmjournals.org/content/43/4/282.short
4100  - http://tech.snmjournals.org/content/43/4/282.full
SO  - J. Nucl. Med. Technol.2015 Dec 01; 43
AB  - Attenuation artifacts reduce our ability to evaluate perfusion of affected myocardial segments. The aim of this study was to evaluate the impact of routine prone-position image evaluation within a stepwise visual interpretation of myocardial perfusion studies. Methods: We have included 279 consecutive patients who were referred for evaluation of myocardial ischemia. All patients underwent routine electrocardiogram-gated supine SPECT imaging and non–electrocardiogram-gated prone-position SPECT imaging. Three nuclear medicine physicians interpreted the images in the following order: polar maps, supine images, raw images, motion-frozen gated images, and prone images, using a scale of 0–4. Segments with perfusion abnormalities were noted. Results: All physicians reported lower proportions of equivocal evaluations after evaluating prone images (18.3% vs. 4.7%, 19% vs. 11.1%, and 12.2% vs. 6.1%, P < 0.0001, P = 0.0077, and P = 0.0125, respectively). At the prone stage, normalcy rates were 89%, 87%, and 91%. Two physicians had significantly increased normalcy rates at the prone stage (72%–89%, P = 0.039, and 66%–87%, P = 0.006). At the prone stage, a decision reversal to normal or probably normal was observed in 40% (29/72), 33% (17/51), and 43% (21/48). In men, apical, mid, and basal inferior walls and in women apical and mid parts of anterior walls were more likely to be attributed to attenuation. The 2 steps that increased normalcy rates for interpreters were the review of raw images and of prone images. Conclusion: Routine prone imaging increases interpretive certainty and interobserver agreement and changes the final evaluation in a substantial number of patients and significantly decreases the number of equivocal evaluations.