Value of Computer Analysis of Exercise Thallium Images in the Noninvasive Detection of Coronary Artery Disease

WHEN a patient presents with either chest pain or an abnormal electrocardiogram, coronary artery disease (CAD) is suspected. Thallium imaging with exercise is performed frequently at this point to confirm whether CAD is present.^1-13 This test provides numerous scintigraphic and nonscintigraphic data, which are usually provided to the physician separately in an unsystematic way. The physician must subjectively integrate the individual results and then decide about the presence of CAD. This decision may be difficult when the data in an individual are discordant regarding the presence or absence of CAD. If the presence of any abnormality is used to diagnose CAD, sensitivity is maximized at the expense of specificity. If the presence of multiple abnormalities is required, specificity is maximized at the expense of sensitivity. To study this problem, we analyzed 196 patients with no previous myocardial infarction who had undergone thallium imaging with exercise and cardiac catheterization. Patients