Impact of attenuation correction and gated acquisition in SPECT myocardial perfusion imaging: results of the multicentre SPAG (SPECT Attenuation Correction vs Gated) study
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In clinical myocardial single photon emission computed tomography (SPECT), attenuation artefacts may cause a loss of specificity in the identification of diseased vessels that can be corrected by means of gated SPECT (GSPECT) acquisition or CT attenuation correction (AC). The purpose of this multicentre study was to assess the impact of GSPECT and AC on the diagnostic performance of myocardial scintigraphy, according to patient’s sex, body mass index (BMI) and site of coronary artery disease (CAD).
We studied a group of 104 patients who underwent coronary angiography within 1 month before or after the SPECT study. Patients with a BMI > 27 were considered “overweight”. Attenuation-corrected and standard GSPECT early images were randomly interpreted by three readers blinded to the clinical data.
In the whole group, GSPECT and AC showed a diagnostic accuracy of 86.5% (sensitivity 82%, specificity 93%) and 77% (sensitivity 75.4%, specificity 81.4%), respectively (p < 0.05). In women, when anterior ischaemia was matched with CAD, AC failed to show any increase in specificity (AC 63.6% vs GSPECT 63.6%) with evident loss of sensitivity (AC 72.7% vs GSPECT 90.9%). AC significantly improved SPECT specificity in the identification of right CAD in overweight men (AC 100% vs GSPECT 66.7%, p <0.05).
AC improved specificity in the evaluation of right CAD in overweight men. In the other evaluable subgroups specificity was not significantly affected while sensitivity was frequently reduced.
KeywordsCardiac perfusion imaging Gated SPECT Attenuation correction
We gratefully acknowledge all the SPAG study investigators from the five Italian centres (Nuclear Medicine of: A.O.V. Cervello – Palermo, Spedali Civili – Brescia, Ospedale Maggiore – Bologna, Ospedale SS Giacomo e Cristoforo – Massa and Fondazione CNR –Regione Toscana “G. Monasterio” – Pisa) who contributed to the recruitment of a valid study population. We also acknowledge the support we have received from Ilaria Citti.
This study was an investigator-initiated study. No sponsor had any role in the analysis and interpretation of data or in the preparation of the manuscript. None of the authors had a conflict of interest.
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