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Clinical validation of SPECT attenuation correction using x-ray computed tomography—derived attenuation maps: Multicenter clinical trial with angiographic correlation

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Nonuniform attenuation artifacts cause suboptimal specificity of stress single photon emission computed tomography (SPECT) myocardial perfusion images. In phantoms, normal subjects, and patients suspected of having coronary artery disease (CAD), we evaluated a new hybrid attenuation correction (AC) system that combines x-ray computed tomography (CT) with conventional stress SPECT imaging.

Methods and Results

The effect of CT-based AC was evaluated in phantoms by assessing homogeneity of normal cardiac inserts. AC improved homogeneity of normal cardiac phantoms from 11% ± 2% to 5% ± 1% (P < .001). Attenuation-corrected normal patient files were created from 37 normal subjects with a low likelihood (<3%) of CAD. The diagnostic performance of AC for detection of CAD was evaluated in 118 patients who had stress technetium 99m sestamibi or tetrofosmin stress SPECT imaging and coronary angiography. SPECT images with and without AC were interpreted by 4 blinded readers with different interpretative attitudes. Overall, AC improved the diagnostic performance of all readers, particularly the normalcy rate. The degree of improvement depended on interpretative attitude. Readers prone to high sensitivity or with less experience had the greatest gain in the normalcy rate, whereas a reader prone to higher specificity had improvements in sensitivity and specificity but not the normalcy rate. Importantly, improvement of one diagnostic variable was not associated with worsening of other variables.

Conclusion

CT-based AC of SPECT images consistently improved overall diagnostic performance of readers with different interpretive attitudes and experience. CT-based AC is well suited for routine use in clinical practice. (J Nucl Cardiol 2005;12:676-86.)

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Authors and Affiliations

  1. Cardiovascular Nuclear Imaging Laboratory, Yale University School of Medicine, 333 Cedar St, Fitkin-3, 06520, New Haven, Conn

    Yasmin Masood, Yi -Hwa Liu, Mary -Jo Zito, Vera Tsatkin & Frans J. Th. Wackers

  2. Department of Nuclear Medicine, St. Lukes-Roosevelt Hospital, New York, NY

    Gordon DePuey

  3. Department of Nuclear Medicine, Hôtel Dieu de Montréal, Montréal, Québec, Canada

    Raymond Taillefer

  4. Department of Nuclear Medicine, University of Pennsylvania, Philadelphia, Pa

    Luis I. Araujo

  5. Department of Nuclear Medicine, Mercy Medical Center, Springfield, Mass

    Steven Allen

  6. Department of Nuclear Medicine, Vanderbilt University, Nashville, Tenn

    Dominique Delbeke

  7. GE Healthcare, Waukesha, Wis

    Frank Anstett & Aharon Peretz

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  1. Yasmin Masood
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  2. Yi -Hwa Liu
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Correspondence to Frans J. Th. Wackers.

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Masood, Y., Liu, Y.H., DePuey, G. et al. Clinical validation of SPECT attenuation correction using x-ray computed tomography—derived attenuation maps: Multicenter clinical trial with angiographic correlation. J Nucl Cardiol 12, 676–686 (2005). https://doi.org/10.1016/j.nuclcard.2005.08.006

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  • DOI: https://doi.org/10.1016/j.nuclcard.2005.08.006

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