Lena Johansson, Milan Lomsky, Jens Marving, Mattias Ohlssom, Sven-Eric Svensson and Lars Edenbrandt
Diagnostic evaluation of three cardiac software packages using a consecutive group of patients
LU TP 11-50

Purpose To compare the diagnostic performance of the three software packages 4DMSPECT (4DM), Emory Cardiac Toolbox (EMO), and Cedars Quantitative Perfusion SPECT (QPS) for quantification of myocardial perfusion scintigram (MPS) using a large group of consecutive patients.

Methods We studied 1,052 consecutive patients who underwent 2-day stress/rest 99mTc-sestamibi MPS studies. The reference/gold standard classifications for the MPS studies were obtained from three physicians, with more than 25 years each of experience in nuclear cardiology, who re-evaluated all MPS images. Automatic processing was carried out using 4DM, EMO, and QPS software packages. Total stress defect extent (TDE) and summed stress score (SSS) based on a 17-segment model were obtained from the software packages. Receiver-operating characteristic (ROC) analysis was performed.

Results A total of 734 patients were classified as normal and the remaining 318 were classified as having infarction and/or ischemia. The performance of the software packages calculated as the area under the SSS ROC curve were 0.87 for 4DM, 0.80 for QPS and 0.76 for EMO (QPS vs. EMO p=0.03; other differences p<0.0001). The area under the TED ROC curve were 0.87 for 4DM, 0.82 for QPS and 0.76 for EMO (QPS vs. EMO p=0.0005; other differences p<0.0001).

Conclusion There are considerable differences in performance between the three software packages with 4DM showing the best performance and EMO the worst. These differences in performance should be taken in consideration when software packages are used in clinical routine or in clinical studies.

LU TP 11-50