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Spect attenuation correction: an essential tool to realize nuclear cardiology’s manifest destiny

  • Ernest V. GarciaEmail author
Controversies in Nuclear Cardiology

Abstract

Single photon emission computed tomography (SPECT) myocardial perfusion imaging has attained widespread clinical acceptance as a standard of care for cardiac patients. Yet, physical phenomena degrade the accuracy of how our cardiac images are visually interpreted or quantitatively analyzed. This degradation results in cardiac images in which brightness or counts are not necessarily linear with tracer uptake or myocardial perfusion. Attenuation correction (AC) is a methodology that has evolved over the last 30 years to compensate for this degradation. Numerous AC clinical trials over the last 10 years have shown increased diagnostic accuracy over non-AC SPECT for detecting and localizing coronary artery disease, particularly for significantly increasing specificity and normalcy rate. This overwhelming evidence has prompted our professional societies to issue a joint position statement in 2004 recommending the use of AC to maximize SPECT diagnostic accuracy and clinical usefulness. Phantom and animal studies have convincingly shown how SPECT AC recovers the true regional myocardial activity concentration, while non-AC SPECT does not. Thus, AC is also an essential tool for extracting quantitative parameters from all types of cardiac radionuclide distributions, and plays an important role in establishing cardiac SPECT for flow, metabolic, innervation, and molecular imaging, our manifest destiny. (J Nucl Cardiol 2007;14:16–24.)

Key Words

SPECT attenuation correction absolute quantification myocardial perfusion imaging 

References

  1. 1.
    Snyderman R, Williams RS. Prospective medicine: the next health care transformation. Acad Med 2003;78:1079–84.PubMedCrossRefGoogle Scholar
  2. 2.
    Hood L, Heath JR, Phelps ME, Lin B. Systems biology and new technologies enable predictive and preventative medicine. Science 2004;306:640–3.PubMedCrossRefGoogle Scholar
  3. 3.
    Stodika RZ, Blackwood KJ, Kong H, Prato FS. A method for quantitative cell tracking using SPECT for the evaluation of myocardial stem cell therapy. Nucl Med Commun 2006;27:807–133.CrossRefGoogle Scholar
  4. 4.
    Patterson RE, Eisner RL, Horowitz SF. Comparison of costeffectiveness and utility of exercise ECG, single photon emission computed tomography, positron emission tomography, and coronary angiography for diagnosis of coronary artery disease. Circulation 1995;91:54–65.PubMedGoogle Scholar
  5. 5.
    DePuey EG, Garcia EV. Optimal specificity of thallium-201 SPECT through recognition of imaging artifacts. J Nucl Med 1989;30:441–9.PubMedGoogle Scholar
  6. 6.
    Garcia EV. Quantitative myocardial perfusion single-photon emission computed tomographic imaging: quo vadis? (Where do we go from here). J Nucl Cardiol 1994;1:83–93.PubMedCrossRefGoogle Scholar
  7. 7.
    Links JM, Becker LC, Anstett F. Clinical significance of apical thinning after attenuation correction. J Nucl Cardiol 2004;11:26–311.PubMedCrossRefGoogle Scholar
  8. 8.
    Borges-Neto S, Pagnanelli R, Shaw L, Coleman R. Clinical validation of the wide beam reconstruction method for shortening scan time of gated cardiac SPECT perfusion studies [abstract]. J Nucl Med 2006;47:272P.Google Scholar
  9. 9.
    Galt JR, Garcia EV, Robbins W. Effects of myocardial wall thickness on SPECT quantification. IEEE Trans Med Imaging 1990;9:144–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Chen J, Garcia EV, Galt JR, Folks RD, Carrio I. Improved quantification in 123-I cardiac SPECT imaging with deconvolution of septal penetration. Nucl Med Comm 2006;27:551–8.CrossRefGoogle Scholar
  11. 11.
    Pitman AG, Kalff V, Van Every B, et al. Contributions of subdiaphragmatic activity, attenuation, and diaphragmatic motion to inferior wall artifact in attenuation-corrected Tc-99m myocardial perfusion SPECT. J Nucl Cardiol 2005;12:401–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Pitman AG, Kalff V, Van Every B, et al. Effect of mechanically simulated diaphragmatic respiratory motion on myocardial SPECT processed with and without attenuation correction. J Nucl Med 2002;43:1259–67.PubMedGoogle Scholar
  13. 13.
    Da Silva AJ, Tang HR, Wong KH, et al. Absolute quantification of regional myocardial uptake of 99mTc-sestamibi with SPECT: experimental validation in a porcine model. J Nucl Med 2001;42:772–99.Google Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    Heller GV, Links J, Bateman TM, et al. American Society of Nuclear Cardiology and Society of Nuclear Medicine joint position statement: attenuation correction of myocardial perfusion SPECT scintigraphy. J Nucl Cardiol 2004;11:229–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Heller GV, Bateman TM, Johnson LL, et al. Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging. J Nucl Cardiol 2004;11:273–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Ficaro EP, Fessler JA, Achermann RJ, et al. Simultaneous transmission-emission thallium-201 cardiac SPECT: effect of attenuation correction on myocardial tracer distribution. J Nucl Med 1995;36:921–31.PubMedGoogle Scholar
  18. 18.
    Grossman GB, Garcia EV, Bateman TM, Heller GV, Johnson LL, Folks RD, et al. Quantitative Tc-99m sestamibi attenuationcorrected SPECT: development and multicenter trial validation of myocardial perfusion stress gender-independent normal database in an obese population. J Nucl Cardiol 2004;11:263–72.PubMedCrossRefGoogle Scholar
  19. 19.
    Prvulovich EM, Lonn AH, Bomanji JB, et al. Effect of attenuation correction on myocardial thallium-201 distribution in patients with a low likelihood of coronary artery disease. Eur J Nucl Med 1997;24:266–75.PubMedGoogle Scholar
  20. 20.
    Kluge R, Sattler B, Seese A, et al. Attenuation correction by simultaneous emission-transmission myocardial single-photon emission tomography using a technetium-99m-labelled radiotracer: impact on diagnostic accuracy. Eur J Nucl Med 1997;24:1107–144.PubMedGoogle Scholar
  21. 21.
    Ficaro EP. Should SPET attenuation correction be more widely employed in routine clinical practice? Eur J Nucl Med Mol Imaging 2002;29:409–12.PubMedCrossRefGoogle Scholar
  22. 22.
    Links JM, DePuey EG, Taillefer R, Becker LC. Attenuation correction and gating synergistically improve the diagnostic accuracy of myocardial perfusion SPECT. J Nucl Cardiol 2002;9:183–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Thompson RC, Heller GV, Johnson LJ, Case JA, Cullom J, Garcia EV, et al. Value of attenuation correction on ECG-gated myocardial perfusion imaging related to body mass index. J Nucl Cardiol 2005;12:195–202.PubMedCrossRefGoogle Scholar
  24. 24.
    Duvernoy 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.PubMedCrossRefGoogle Scholar
  25. 25.
    Ficaro E, Duvernoy C, Karabajakian M, Corbett J. Evaluation of attenuation corrected SPECT perfusion imaging in patients with multi-vessel disease [abstract]. Circulation 1997;96:I-308.Google Scholar
  26. 26.
    Ficaro EP, Fessler JA, Shreve PD, et al. Simultaneous transmission/ emission myocardial perfusion tomography. Diagnostic accuracy of attenuation-corrected 99mTc-sestamibi single-photon emission computed tomography. Circulation 1996;93:463–73.PubMedGoogle Scholar
  27. 27.
    Gallowitsch HJ, Sykora J, Mikosch P, et al. Attenuation-corrected thallium-201 single-photon emission tomography using a 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
  28. 28.
    Hendel RC, Berman DS, Cullom SJ, et al. Multicenter clinical trial to evaluate the efficacy of correction for photon attenuation and scatter in SPECT myocardial perfusion imaging. Circulation 1999; 99:2742–9.PubMedGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    Lenzo N, Ficaro EP, Kritzman JN, Corbett JR. Clinical comparison of profile attenuation correction and the Michigan STEP methods [abstract]. J Nucl Cardiol 2001;8:S19.CrossRefGoogle Scholar
  31. 31.
    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;9:52–62.PubMedCrossRefGoogle Scholar
  32. 32.
    Slart RH, Tjin HQ, Dirk J, et al. Effect of attenuation correction on the interpretation of 99mTc-sestamibi myocardial perfusion scintigraphy: the impact of 1 year’s experience. Eur J Nucl Med Mol Imaging 2003;30:1505–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Banzo I, Hernandez AR, Pena FJ, et al. Prospective clinical comparison of non-corrected and attenuation- and scatter-corrected myocardial perfusion SPECT in patients with suspicion of coronary artery disease. Nucl Med Commun 2003;24:995–1002.PubMedCrossRefGoogle Scholar
  34. 34.
    Masood Y, Liu YH, 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 2005;12:676–86.PubMedCrossRefGoogle Scholar
  35. 35.
    Utsunomiya D, Tomiguchi S, Shiraishi S, et al. Initial experience with X-ray CT based attenuation correction in myocardial perfusion SPECT imaging using a combined SPECT/CT system. Ann Nucl Med 2005;19:485–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Esteves FP, Santana CA, Folks RD, Lerakis S, Garcia EV. Attenuation-corrected adenosine stress Tc-99m sestamibi myocardial perfusion SPECT: does it make a difference in image interpretation? [abstract]. J Nucl Cardiol 2006;13:S9.CrossRefGoogle Scholar
  37. 37.
    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.PubMedCrossRefGoogle Scholar
  38. 38.
    Holly TA, Toth BM, Leonard SM, et al. Incremental value of attenuation correction in SPECT myocardial perfusion imaging for patients with acute chest pain [abstract]. Circulation 1997;96:I-7355.Google Scholar
  39. 39.
    Malkemeker D, Brenner R, Martin WH, Delbeke D. X-ray attenuation correction versus prone imaging to decrease equivocal interpretations of rest/stress 99mTc-tetrofosmin SPECT MPI [abstract]. J Nucl Cardiol 2006;13:S6.CrossRefGoogle Scholar
  40. 40.
    O’Connor MK, Kemp BJ. Single-photon emission computed tomography/computed tomography: basic instrumentation and innovations. Semin Nucl Med 2006;36:258–66.PubMedCrossRefGoogle Scholar
  41. 41.
    Chen J, Caputlu-Wilson SF, Shi H, Galt JR, Faber TL, Garcia EV. Automated quality control of emission-transmission misalignment for attenuation correction in myocardial perfusion imaging with SPECT-CT systems. J Nucl Cardiol 2006;13:43–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Patton J, Sandler M, Berman D, et al. D-SPECT: a new solid state camera for high speed molecular imaging [abstract]. J Nucl Med 2006;47:189P.Google Scholar
  43. 43.
    Li S, Dobrucki LW, Sinusas AJ, Liu YH. A new method for SPECT quantification of targeted radiotracers uptake in the myocardium. Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv 2005;8(Pt 2):684–911.PubMedGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2007

Authors and Affiliations

  1. 1.Emory University School of MedicineAtlanta

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