Intra-Interobserver Variability in Myocardial Perfusion and Function Interpretation and Reproducibility of QGS/QPS Software

Abstract

Aim: To assess three different level experienced nuclear medicine specialists’ intra- and interobserver variability of semiquantitative visual interpretations of left ventricular (LV) myocardial perfusion, wall motion (WM), and wall thickening (WT) in gated myocardial perfusion single- photon emission tomography (gMPS), and to compare the compatibility between the observers’ and coronary angiography (CAG) reports. Methods: A 5-point perfusion scale, a 6-point scale for WM, and a 4-point scale for WT were used to score each segment. The images were interpreted 3 times at least one-month intervals separately by 3 observers. Subsequently, the visual semiquantitative summed scores for stress (SSS) and rest (SRS) were calculated by summing the respective segmental perfusion scores. Summed difference score (SDS) was also calculated as the difference between SSS and SRS. Both visual semiquantitative WM and WT scores were calculated from the stress images by summing all corresponding segmental scores. Results: Intraobserver agreement in the evaluation of global perfusion was statistically significant (71.9-100 %). There was a significant agreement in all LAD-SSS, Cx-SSS, ve RCA-SSS interpretations. There was good agreement between 3 readings of 3 observers' (p=0.0). Due to the high interobserver agreement levels in the global evaluation, the mean values of the 1. and the 2. interpretations (mean 1.-2. int.) were calculated and regional comparisons were made with this new value and the 3. interpretation. There was a a significant agreement in 3 of the regional SSS interpretations. Although lowest agreement rates were calculated in LAD artery territory, the agreement levels were statistically, and highly significant in all territories. In both Cx and RCA territories, the agreement levels were statistically significant (p<0.05). Conclusion: The interobserver and intraobserver agreement levels of perfusion interpretations were significant both in the global and regional base. There was a significant agreement between the visual interpretations and CAG results, especially in the Cx and RCA artery territories. The interobserver and intraobserver agreements were higher in WM scores than wall thickness scores. QPS/QGS software quantitative perfusion and left ventricular ejection fraction (LVEF) values showed high repeatability.

Keywords

• Gated myocardial perfusion single-photon emission tomography; left ventricular myocardial perfusion
• wall motion
• QGS/QPS Software

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