Cardiovascular medicine
Effect of power Doppler and digital subtraction techniques on the
comparison of myocardial contrast echocardiography with SPECT
B Haluska, C Case, L Short, J Anderson, T H Marwick
University of
Queensland, Department of Medicine, Princess Alexandra Hospital,
Ipswich Road, Brisbane, Qld 4102, Brisbane, Australia
Correspondence to: Professor Marwick tmarwick{at}medicine.pa.uq.edu.au
Accepted 18 January
2000
OBJECTIVE
To compare the accuracy and
feasibility of harmonic power Doppler and digitally subtracted colour
coded grey scale imaging for the assessment of perfusion defect
severity by single photon emission computed tomography (SPECT) in
an unselected group of patients.
DESIGNCohort study.
SETTINGRegional cardiothoracic unit.
PATIENTS49 patients (mean (SD) age
61 (11) years; 27 women, 22 men) with known or suspected coronary
artery disease were studied with simultaneous myocardial contrast echo
(MCE) and SPECT after standard dipyridamole stress.
MAIN OUTCOME MEASURESRegional
myocardial perfusion by SPECT, performed with 99mTc
tetrafosmin, scored qualitatively and also quantitated as per cent maximum activity.
RESULTSNormal perfusion was
identified by SPECT in 225 of 270 segments (83%). Contrast echo images
were interpretable in 92% of patients. The proportion of normal MCE by
grey scale, subtracted, and power Doppler techniques were respectively
76%, 74%, and 88% (p < 0.05) at > 80% of maximum counts,
compared with 65%, 69%, and 61% at < 60% of maximum counts. For
each technique, specificity was lowest in the lateral wall, although
power Doppler was the least affected. Grey scale and subtraction
techniques were least accurate in the septal wall, but power Doppler
showed particular problems in the apex. On a per patient analysis, the
sensitivity was 67%, 75%, and 83% for detection of coronary artery
disease using grey scale, colour coded, and power Doppler,
respectively, with a significant difference between power Doppler and
grey scale only (p < 0.05). Specificity was also the highest for
power Doppler, at 55%, but not significantly different from subtracted
colour coded images.
CONCLUSIONSMyocardial contrast echo
using harmonic power Doppler has greater accuracy than with grey scale
imaging and digital subtraction. However, power Doppler appears to be
less sensitive for mild perfusion defects.
Keywords: myocardial contrast echo; SPECT; coronary artery disease; dipyridamole stress
© 2001 by Heart
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