Journal of Nuclear Cardiology

, Volume 12, Issue 2, pp 195–202 | Cite as

Value of attenuation correction on ECG-gated SPECT myocardial perfusion imaging related to body mass index

  • Randall C. Thompson
  • Gary V. Heller
  • Lynne L. Johnson
  • James A. Case
  • S. James Cullom
  • Ernest V. Garcia
  • Philip G. Jones
  • Kelly L. Moutray
  • Timothy M. Bateman
Original Article

Abstract

Background

Obesity is a growing problem in the United States, and attenuation artifacts are more prevalent in this patient group. This study evaluated the impact of attenuation correction in patients with a high body mass index (BMI).

Methods and Results

Three readers interpreted gated attenuation-corrected and non-attenuation-corrected rest/stress technetium 99m sestamibi myocardial perfusion imaging results in 116 patients (BMI <30, n = 60; BMI ≥30, n = 56) who had coronary angiography no more than 60 days after imaging. Readers were blinded to all clinical information and as to whether myocardial perfusion imaging was attenuation-corrected or non-attenuation-corrected. Sensitivity, specificity, and accuracy for detection of coronary artery disease of 70% or greater for attenuation-corrected versus non-attenuation-corrected single photon emission computed tomography (SPECT) were 86% versus 89%, 79% versus 50%, and 84% versus 79%, respectively. Sensitivity, specificity, and accuracy for attenuation-corrected versus non-attenu-ation-corrected SPECT for patients with BMI less than 30 were 90% versus 90%, 82% versus 64%, and 88% versus 85%, respectively. For BMI of 30 or greater, the results were 82% versus 87%, 76% versus 41%, and 80% versus 73%, respectively. There was a significant difference in specificity overall (P =.02) and for the category of BMI of 30 or greater (P =.03).

Conclusions

This study demonstrates that electrocardiography-gated attenuation-corrected Tc-99m sestamibi SPECT myocardial perfusion imaging improves specificity compared with electrocardiography-gated non-attenuation-corrected SPECT myocardial perfusion imaging, especially in patients with BMI of 30 or greater.

Key Words

Attenuation correction single photon emission computed tomography body mass index 

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References

  1. 1.
    Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA 1994;272:205–11.PubMedCrossRefGoogle Scholar
  2. 2.
    National Task Force on the Prevention and Treatment of Obesity. Overweight, obesity, and health risk. Arch Intern Med 2000; 160:898–904.CrossRefGoogle Scholar
  3. 3.
    Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA 1999;282:1523–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Allison DB, Fontaine KR, Manson JE, Stevens J, Vanltallie TB. Annual deaths attributable to obesity in the United States. JAMA 1999;282:1530–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Hansen CL, Woodhouse S, Kramer M. Effect of patient obesity on the accuracy of thallium-201 myocardial perfusion imaging. Am J Cardiol 2000;85:749–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Freedman N, Schechter D, Klein M, Marciano R, Rozenman Y, Chisin R. SPECT attenuation artifacts in normal and overweight persons, insights from a retrospective comparison of Rb-82 positron emission tomography and Tl-201 SPECT myocardial perfusion imaging. Clin Nucl Med 2000;25:1019–23.PubMedCrossRefGoogle Scholar
  7. 7.
    Hendel RC, Berman DS, Cullom SJ, Follansbee W, Heller GV, Kiat H, et al. Multicenter clinical trial to evaluate the efficacy of collection for photon attenuation and scatter in SPECT myocardial perfusion imaging. Circulation 1999;99:2742–9.PubMedGoogle Scholar
  8. 8.
    Links JM, Becker LC, Rigo P, Taillefer R, Hanelen L, Anstett F, et al. Combined collections for attenuation, depth-dependent blur, and motion in cardiac SPECT: a multicenter trial. J Nucl Cardiol 2000;7:414–25.PubMedCrossRefGoogle Scholar
  9. 9.
    Shotwell M, Singh BM, Fortman C, Bauman BD, Lukes J, Gerson MC. Improved coronary disease detection with quantitative attenuation-corrected Tl-201 images. J Nucl Cardiol 2002;9:52–61.PubMedCrossRefGoogle Scholar
  10. 10.
    O’Connor MK, Kemp B, Anstett F, Christian P, Ficaro EP, Frey E, et al. A multicenter evaluation of commercial attenuation compensation techniques in cardiac SPECT using phantom models. J Nucl Cardiol 2002;9:361–76.PubMedCrossRefGoogle Scholar
  11. 11.
    Links JM, DePuey EG, Taillefer R, Becker LC. Attenuation collection and gating synergistically improved the diagnostic accuracy of myocardial perfusion SPECT. J Nucl Cardiol 2002;9:183–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Harel F, Genin R, Daou D, Lebtahi R, Delahaye N, Helal BO, Le Guidee D, Faraggi M. Clinical impact of combination of scatter, attenuation correction, and depth-dependent resolution recovery for (201) Tl studies. J Nucl Med 2001;42:1451–6.PubMedGoogle Scholar
  13. 13.
    Duvemoy CS, Ficaro EP, Karabajakian MZ, Rose PA, Corbett JR. Improved detection of left main coronary artery disease with attenuation-corrected SPECT. J Nucl Cardiol 2000;7:639–48.CrossRefGoogle Scholar
  14. 14.
    DePuey EG, Rozanski A. Using gated technetium 99-m sestamibi SPECT to characterize fixed myocardial defects as infarct or artifact. J Nucl Med 1995;36:952–5.PubMedGoogle Scholar
  15. 15.
    Bateman TM, Berman DS, Heller GV, Brown KA, Cerqueira MD, Verani MS, et al. American Society of Nuclear Cardiology position statement on electrocardiographic gating of myocardial perfusion SPECT scintigrams. J Nucl Cardiol 1999;6:470–1.PubMedCrossRefGoogle Scholar
  16. 16.
    Smanio PE, Watson DD, Segalla DL, Vinson EL, Smith WH, Beller GA. Value of gating technetium-99m sestamibi single- photon emission computer tomographic imaging. J Am Coll Cardiol 1997;30:1687–92.PubMedCrossRefGoogle Scholar
  17. 17.
    Imaging guidelines for nuclear cardiology procedures. American Society of Nuclear Cardiology. Myocardial perfusion stress protocols. J Nucl Cardiol 1996;3:Gll-5.Google Scholar
  18. 18.
    Hendel RC, Wackers FJT, Berman DS, Ficaro E, DePuey EG, Klein L, et al. American Society of Nuclear Cardiology consensus statement: reporting of radionuclide myocardial perfusion imaging studies. J Nucl Cardiol 2003;10:705–22.PubMedCrossRefGoogle Scholar
  19. 19.
    Brown DB. The global epidemic of obesity. International Association for the Study of Obesity web site. Available from: URL: www.iotf.org. Accessed March 3, 2005.Google Scholar
  20. 20.
    Case JA, Cullom SJ, Bateman TM O’Keefe JHO, McGhie IA. Evaluation of a Bayesian transmission reconstruction algorithm: implications for attenuation collection [abstract]. J Nucl Cardiol 2000;7:Sll.Google Scholar
  21. 21.
    Cullom SJ, Case JA, Bateman TM, O’Keefe JHO, McGhie AI. 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.Google Scholar
  22. 22.
    Cerqueira MD, Weisnman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic images of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539–42.PubMedCrossRefGoogle Scholar
  23. 23.
    Agresti A. Categorical data analysis. New York: John Wiley & Sons; 1990.Google Scholar
  24. 24.
    DePuey EG, Garcia EV. Optimal specificity of thallium-201 SPECT through recognition of imaging artifacts. J Nucl Med 1989;30:441–9.PubMedGoogle Scholar
  25. 25.
    DePuey EG. How to detect and avoid myocardial perfusion SPECT artifacts. J Nucl Med 1994;35:699–702.PubMedGoogle Scholar
  26. 26.
    Fleischmann KE, Hunink MGM, Kuntz KM, Douglas PS. Exercise echocardiography or exercise SPECT imaging. JAMA 1998;280:913–20.PubMedCrossRefGoogle Scholar
  27. 27.
    Kuntz KM, Fleischmann KE, Hunink MG, Douglas PS. Cost- effectiveness of diagnostic strategies for patients with chest pain. Ann Intern Med 1999;130:709–18.PubMedGoogle Scholar
  28. 28.
    Segall GM, Davis MJ. Prone versus supine thallium myocardial SPECT: a method to decrease artifactual inferior wall defects. J Nucl Med 1989;30:548–55.PubMedGoogle Scholar
  29. 29.
    Perault C, Loboguerrero A, Liehn JC, Wambpach H, Gibold C, Ouzan J, et al. Quantitative comparison of prone and supine myocardial SPECT MIBI images. Clin Nucl Med 1995;20:678–84.PubMedCrossRefGoogle Scholar
  30. 30.
    Hayes SW, De Lorenzo A, Hachamovich R, Dhar SC, Hsu P, Cohen I, et al. Prognostic implications of combined prone and supine acquisitions in patients with equivocal or abnormal supine myocardial perfusion SPECT. J Nucl Med 2003;10:1633–40.Google Scholar
  31. 31.
    Grossman GB, Garcia EV, Bateman TM, Heller GV, Johnson LL, Folks RD, et al. Quantitative Tc-99m sestamibi attenuation- correction SPECT: development and multicenter trial validation of myocardial perfusion stress gender-independent normal database in an obese population. J Nucl Med 2004;11:263–72.Google Scholar
  32. 32.
    Ficaro EP, Fessier JA, Shreve PD, Kritzman JN, Rose PA, Corbett JR. Simultaneous transmission/emission myocardial perfusion tomog- raphy: diagnostic accuracy of attenuation corrected 99mTc-sestamibi single-photon emission computed tomography. Circulation 1996;93:463–73.PubMedGoogle Scholar
  33. 33.
    Gallowitsch HJ, Sykora J, Mikosch P, Kresnik E, Unterweger O, Molnar M, et al. Attenuation-corrected thallium-201 single-photon emission tomography using gadolinium-153 moving line source: clinical value and the impact of attenuation correction on the extent and severity of perfusion abnormalities. Eur J Nucl Med 1998;25:220–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Heller GV, Links J, Bateman TM, Ziffer JA, Ficaro E, Cohen MC, Hendel RC. American Society of Nuclear Cardiology and Society of Nuclear Medicine joint position statement: attenuation correction of myocardial perfusion SPECT scintigraphy. J Nucl Cardiol 2004;11:229–39.PubMedCrossRefGoogle Scholar
  35. 35.
    Gregoriou GK, Tsui BM, Gullberg GT. Effect of truncated projections on defect detection in attenuation-compensation fan- beam cardiac SPECT. J Nucl Med 1998;39:166–75.PubMedGoogle Scholar
  36. 36.
    Cullom SJ, Case JA, Bateman TM. Attenuation correction for cardiac SPECT: clinical and developmental challenges. J Nucl Med 2000;41:860–2.Google Scholar

Copyright information

© American Society of Nuclear Cardiology 2005

Authors and Affiliations

  • Randall C. Thompson
    • 1
    • 2
  • Gary V. Heller
    • 3
  • Lynne L. Johnson
    • 4
  • James A. Case
    • 2
  • S. James Cullom
    • 2
  • Ernest V. Garcia
    • 5
  • Philip G. Jones
    • 1
  • Kelly L. Moutray
    • 1
    • 2
  • Timothy M. Bateman
    • 1
    • 2
  1. 1.Mid America Heart InstituteKansas City
  2. 2.Cardiovascular ConsultantsKansas City
  3. 3.Henry Low Heart CenterThe Hartford HospitalHartford
  4. 4.Columbia Presbyterian Medical CenterNew York
  5. 5.Emory UniversityAtlanta

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