Guner, Levent A.Caliskan, BillurIsik, IlknurAksoy, TamerVardareli, ErkanParspur, Afsin2023-02-212023-02-212015-01-0110.2967/jnmt.115.165936https://hdl.handle.net/11443/2209http://dx.doi.org/10.2967/jnmt.115.165936Attenuation artifacts reduce our ability to evaluate perfusion of affected myocardial segments. The aim of this study was to evaluate the impact of routine prone-position image evaluation within a stepwise visual interpretation of myocardial perfusion studies. Methods: We have included 279 consecutive patients who were referred for evaluation of myocardial ischemia. All patients underwent routine electrocardiogram-gated supine SPECT imaging and non-electrocardiogram-gated prone-position SPECT imaging. Three nuclear medicine physicians interpreted the images in the following order: polar maps, supine images, raw images, motion-frozen gated images, and prone images, using a scale of 0-4. Segments with perfusion abnormalities were noted. Results: All physicians reported lower proportions of equivocal evaluations after evaluating prone images (18.3\% vs. 4.7\%, 19\% vs. 11.1\%, and 12.2\% vs. 6.1\%, P < 0.0001, P = 0.0077, and P = 0.0125, respectively). At the prone stage, normalcy rates were 89\%, 87\%, and 91\%. Two physicians had significantly increased normalcy rates at the prone stage (72\%-89\%, P = 0.039, and 66\%87\%, P = 0.006). At the prone stage, a decision reversal to normal or probably normal was observed in 40\% (29/72), 33\% (17/51), and 43\% (21/48). In men, apical, mid, and basal inferior walls and in women apical and mid parts of anterior walls were more likely to be attributed to attenuation. The 2 steps that increased normalcy rates for interpreters were the review of raw images and of prone images. Conclusion: Routine prone imaging increases interpretive certainty and interobserver agreement and changes the final evaluation in a substantial number of patients and significantly decreases the number of equivocal evaluations.prone imagingSPECTmyocardial perfusionArticleWOS:000439235700013