Combined Supine and Prone Quantitative Myocardial Perfusion SPECT: Method Development and Clinical Validation in Patients with No Known Coronary Artery Disease

Acquisition in the prone position has been demonstrated to im-prove the specificity of visually analyzed myocardial perfusion SPECT (MPS) for detecting coronary artery disease (CAD). How-ever, the diagnostic value of prone imaging alone or combined acquisition has not been previously described using quantitative analysis.Methods: A total of 649 patients referred for MPS com-prised the study population. Separate supine and prone normal limitswere derived from40males and 40 femaleswith a low likeli-hood (LLk) of CAD using a 3 average-deviation cutoff for all pixels on the polarmap. These limits were applied to the test population of 369 consecutive patients (65%males; age, 656 13 y; 49%ex-ercise stress) without known CAD who had diagnostic coronary angiography within 3 mo of MPS. Total perfusion deficit (TPD), defined as a product of defect extent and severity scores, was obtained for supine (S-TPD), prone (P-TPD), and combine