Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging
- Gary V. Heller,
- Timothy M. Bateman,
- Lynne L. Johnson,
- S. James Cullom,
- James A. Case,
- James R. Galt,
- Ernest V. Garcia,
- Keith Haddock,
- Kelly L. Moutray,
- Carlos Poston,
- Eli H. Botvinick,
- Matthews B. Fish,
- William P. Follansbee,
- Sean Hayes,
- Ami E. Iskandrian,
- John J. Mahmarian,
- William Vandecker
- … show all 17 hide
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Attenuation artifact remains a substantial limitation to confident interpretation of images and reduces laboratory efficiency by requiring comparison of stress and rest image sets. Attenuation-corrected stress-only imaging has the potential to ameliorate these limitations.
Methods and Results
Ten experienced nuclear cardiologists independently interpreted 90 stress-only electrocardiography (ECG)-gated technetium 99m sestamibi images in a sequential fashion: myocardial perfusion imaging (MPI) alone, MPI plus ECG-gated data, and attenuation-corrected MPI with ECG-gated data. Images were interpreted for diagnostic certainty (normal, probably normal, equivocal, probably abnormal, abnormal, and perceived need for rest imaging). With stress MPI data alone, only 37% of studies were interpreted as definitely normal or abnormal, with a very high perceived need for rest imaging (77%). The addition of gated data did not alter the interpretations. However, attenuation-corrected data significantly increased the number of studies characterized as definitely normal or abnormal (84%, P < 005) and significantly reduced the perceived need for rest imaging (43%, P < .005). These results were confirmed by use of a nonsequential consensus interpretation of three readers.
Attenuation correction applied to studies with stress-only Tc-99m ECG-gated single photon emission computed tomography images significantly increases the ability to interpret studies as definitely normal or abnormal and reduces the need for rest imaging. These findings may improve laboratory efficiency and diagnostic accuracy.
- Hachamovitch R, Berman DS, Shaw LJ, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death. Circulation 1998;97:535–43.
- Hachamovitch R, Berman DS, Kiat H, et al. Exercise myocardial perfusion SPECT in patients without known coronary artery disease. Circulation 1996;93:905–14.
- Travin MI, Duca MD, Kline GM, et al. Relation of gender to physician use of test results and to the prognostic value of stress technetium 99m sestamibi myocardial single-photon emission computed tomography scintigraphy. Am Heart J 1997;134:73- 82. CrossRef
- Iskander S, Iskandrian AE. Risk assessment using single-photon emission computed tomographic technetium-99m sestamibi imaging. J Am Coll Cardiol 1998;32:57–62. CrossRef
- Taillefer R, DePuey EG, Udelson JE, et al. Comparative diagnostic accuracy of Tl-201 and Tc-99m sestamibi SPECT imaging (perfusion and ECG-gated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol 1997;29:69–71. CrossRef
- DePuey EG, Rozanski A. Using gated technetium-99m-sestamibi SPECT to characterize fixed myocardial defects as infarct or artifact. J Nucl Med 1995;36:952–5.
- Smanio PEP, Watson DD, Segalla DL, et al. Value of gating of technetium-99m sestamibi single-photon emission computed tomographic imaging. J Am Coll Cardiol 1997;30:1687–92. CrossRef
- Hendel RC, Corbett JR, Cullom SJ, et al. The value and practice of attenuation correction for myocardial perfusion SPECT imaging: a joint position statement from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine. J Nucl Cardiol 2002;9:135–43. CrossRef
- Hendel RC, Berman DS, Cullom SJ, et al. Multicenter clinical trail to evaluate the efficacy of correction for photon attenuation and scatter in SPECT myocardial perfusion imaging. Circulation 1999; 99:2742–9.
- Lee DS, So Y, Cheon GJ, et al. Limited incremental diagnostic values of attenuation-noncorrected gating and ungated attenuation correction to rest/stress myocardial perfusion SPECT in patients with an intermediate likelihood of coronary artery disease. J Nucl Med 2000;41:852–9.
- Vidal R, Buvat I, Darcourt J, et al. Impact of attenuation correction by simultaneous emission/transmission tomography on visual assessment of 201Tl myocardial perfusion images. J Nucl Med 1999;40:1301–9.
- Ficaro EP, Fessler JA, Shreve PD, et al. Simultaneous transmission/ emission myocardial perfusion tomography. Diagnostic accuracy of attenuation-corrected 99mTc-sestamibi single-photon emission tomography. Circulation 1996;93:463–73.
- Links JM, Becker LC, Rigo P, et al. Combined corrections for attenuation, depth-dependent blur, and motion in cardiac SPECT: a multicenter trial. J Nucl Cardiol 2000;7:414–25. CrossRef
- Kluge R, Sattler B, Leese A, et al. Attenuation correction by simultaneous emission-transmission myocardial single-photon emission tomography using a technetium-99m labeled radiotracer: impact on diagnostic accuracy. Eur J Nucl Med 1997;24:1107–14.
- Shotwell M, Singh BM, Fortman C, et al. Improved coronary disease detection with quantitative attenuation-corrected Tl-201 images. J Nucl Cardiol 2002;9:52–61. CrossRef
- Cullom SJ, Case JA, Bateman TM. Attenuation correction for cardiac SPECT: clinical and developmental challenges. J Nucl Med 2000;41:860–1.
- Cullom SJ, Case JA, Bateman TM, et al. Reconstruction of attenuation maps from low-count Gd-153 transmission studies using an iterative Bayesian algorithm: clinical evaluation with simultaneous Tc-99m-sestamibi SPECT [abstract]. J Nucl Med 2000;41:134P.
- Gibson PB, Demus D, Noto R, et al. Low event rate for stress-only perfusion imaging in patients evaluated for chest pain. J Am Coll Cardiol 2002;39:999–1004. CrossRef
- Shao L, Ye J, Durbin MK. Use of a prestudy information density scan to improve transmission map acquisition for attenuation correction [abstract]. J Nucl Med 2000;5:177P.
- Case JA, Cullom SJ, Galt JR, et al. Impact of transmission scan reconstruction using an iterative algorithm (BITGA) versus FBP: clinical appearance of attenuation-corrected myocardial perfusion SPECT images [abstract]. J Nucl Med 2001;42:51P.
- Galt JR, Blais M, Cullom SJ, et al. Quality control of transmission scans for attenuation correction in cardiac SPECT [abstract]. J Nucl Med 1999;40:286P.
- Tress MV. Distribution function and probability calculator 1977. Version 2.4. Available at: http://ourworld.compuserve.com/ homepages/MSVonTress/wdist.htm. Accessed January, 2004.
- Johnson LL, Verdesca SA, Aude WY, et al. Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress gated sestamibi tomograms. J Am Coll Cardiol 1997;30:1641–8. CrossRef
- Hendel RC, Selker HR, Heller GV, et al. The impact of attenuation correction and gating on SPECT perfusion imaging in patients presenting to the emergency department with chest pain [abstract]. Circulation 2000;102:II-543.
- Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging
Journal of Nuclear Cardiology
Volume 11, Issue 3 , pp 273-281
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Myocardial perfusion imaging
- attenuation correction
- single photon emission computed tomography
- electrocardiography gating
- Industry Sectors
- Gary V. Heller (1)
- Timothy M. Bateman (2)
- Lynne L. Johnson (3)
- S. James Cullom (2)
- James A. Case (2)
- James R. Galt (4)
- Ernest V. Garcia (4)
- Keith Haddock (5)
- Kelly L. Moutray (2)
- Carlos Poston (5)
- Eli H. Botvinick (6)
- Matthews B. Fish (7)
- William P. Follansbee (8)
- Sean Hayes (9)
- Ami E. Iskandrian (10)
- John J. Mahmarian (11)
- William Vandecker (12)
- Author Affiliations
- 1. Nuclear Cardiology Laboratory, Hartford Hospital, 80 Seymour St, PO Box 5037, 06102-5037, Hartford, CT
- 2. Cardiovascular Consultants, Kansas City, Mo
- 3. Rhode Island Hospital, Providence, RI
- 4. Emory University, Atlanta, Ga
- 5. Mid America Heart Institute, Kansas City, Mo
- 6. University of California at San Francisco Medical Center, San Francisco, Calif
- 7. Sacred Heart Medical Center, Spokane, Wash
- 8. University of Pittsburgh, Pittsburgh, Pa
- 9. Cedars-Sinai Medical Center, Los Angeles, Calif
- 10. University of Alabama at Birmingham, Birmingham, Ala
- 11. Baylor College Medical Center, Houston, Tex
- 12. Medical College of Pennsylvania, Philadelphia, Pa