Comparative accuracy of supine-only and combined supine-prone myocardial perfusion imaging in men

Abstract

CSP MPI increases diagnostic certainty and improves test accuracy for CAD detection in men with CAD risk factors, especially obese patients, compared to SU MPI.

Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation

“…44,45 The combination of supine and prone images (2-position imaging) may be helpful identifying attenuation artifacts due to the shift in position of the attenuating structures that occur in the prone position and can improve interpretive confidence and accuracy. [46][47][48] By comparing supine and prone images, artifactual defects will resolve or change their location whereas true perfusion defects will remain in the same position. 19,49 When being used in this fashion, the acquisition time for the secondary (prone) image set can be reduced by 20% to 40%.…”

Combined supine and prone imaging acquisition in cardiac SPECT: A turn for the better

“…13 As Taason and colleagues correctly point out the benefits of prone imaging include downward displacement of the diaphragm and abdominal organs, compression of anterior chest soft tissue including breast tissue, a shift of the heart more anteriorly, and reduction of patient motion. 1 There is no doubt that attenuation correction decreases equivocal studies compared to prone imaging. 10 However, in the same study utilizing Tc-99m-based rest and stress imaging with attenuation correction, prone imaging, and prone and supine imaging without attenuation correction, prone imaging significantly reduced equivocal studies.…”

“…False-positive rates were 40% higher in supine-only imaging in obese patients compared to 20% higher in non-obese patients though the difference did not quite reach statistical significance (P = .06), likely related to small sample size in the subsets. 1 The authors are to be congratulated on this study. Though not the first to demonstrate the benefit of prone imaging in combination with supine imaging, 2-11 the investigation is unique in that patients were protocoled for either supine-only or combined supine and prone imaging independent of criteria such as obesity or the presence of artifact on supine imaging.…”

Prone-only SPECT myocardial perfusion imaging: An alternative standard in clinical practice?

“…If interpretation of a study obtained in the supine position is hampered by infradiaphragmatic attenuation or scatter, an additional acquisition in the prone position may be tried. As Taasan and colleagues 15 correctly point out the benefits of prone imaging include downward displacement of the diaphragm and abdominal organs, compression of anterior chest soft tissue including breast tissue, a shift of the heart more anteriorly, and reduction of patient motion. There is no doubt that attenuation correction decreases equivocal studies compared to prone imaging.…”