Quantitative analysis of regional motion and thickening by gated myocardial perfusion SPECT: normal heterogeneity and criteria for abnormality.

UNLABELLED Quantitation of regional myocardial function is valuable in patients with coronary artery disease. This study assessed normal heterogeneity and developed and validated normal limits for quantitative regional motion and thickening by gated myocardial perfusion SPECT. METHODS Patients underwent rest (201)Tl/exercise (99m)Tc-sestamibi gated SPECT. Reference values of motion and thickening for 20 myocardial segments were obtained in 105 patients with <5% likelihood of coronary disease (low-likelihood group). Criteria for abnormality of motion and thickening were defined for each segment, using receiver operator characteristic analysis, in 101 patients with coronary disease (training group). Semiquantitative visual interpretation was used as the gold standard. These criteria were prospectively validated in 100 patients (validation group). Criteria for grading motion and thickening abnormalities by severity levels were also defined and validated. RESULTS Normal thickening decreased substantially along the longitudinal axis of the left ventricle, from 69% +/- 13% at the apex to 25% +/- 11% at the basal segments, whereas normal motion varied within the same ventricular plane. Validation of the criteria for abnormality yielded high accuracy in the detection of motion abnormalities (sensitivity, 88%; specificity, 92%) and thickening abnormalities (sensitivity, 87%; specificity, 89%). Quantitative motion and thickening segmental scores showed good agreement with visual scores. CONCLUSION Normal regional myocardial contraction by gated myocardial perfusion SPECT is characterized by a substantial apex-to-base decline in thickening and by circumferential heterogeneity in endocardial motion. The assignment of segment-specific threshold values for defining motion and thickening abnormalities provided reasonably accurate identification and grading of regional myocardial dysfunction.