Analysis of stress-only imaging, comparing upright and supine CZT camera acquisition to conventional gamma camera images with and without attenuation correction, with coronary angiography as a reference

Diagnostic performance of stress-only imaging using a cadmium-zinc-telluride (czt) camera has not been directly compared in the same patients to stress-only attenuation-corrected conventional anger camera images. 112 subjects with correlative coronary angiographic data and 40 subjects with <5% pre-test likelihood of coronary disease completed attenuation-corrected stress-only images on a conventional anger camera and uncorrected upright and supine stress images on a czt camera. two readers provided independent, blinded interpretations of stress-only images. upright and supine stress-only czt images and attenuation-corrected anger camera images provided similar positive (reader 1/reader 2, 50.0%/44.1% vs 46.4%/51.9%) and negative (66.7%/64.0% vs 67.9%/67.7%) predictive values (all p = ns) for obstructive coronary artery disease; however, the sensitivity was higher (81.3% vs 58.3%, p = .05), specificity lower (29.7% vs 50.0%, p = .005), and normalcy rate lower (87.5% vs 100%, p = .025) with attenuation-corrected anger camera images for the first reader with no significant differences between cameras for the second reader. stress-only upright and supine czt imaging was non-inferior statistically to attenuation-corrected stress-only anger camera imaging. nevertheless, stress-only czt imaging be associated with reduced diagnostic sensitivity for some readers compared to attenuation-corrected anger camera images, which be less acceptable clinically compared to stress plus rest images.