Skip to main content

Advertisement

SpringerLink
Log in

Simplified normal limits and automated quantitative assessment for attenuation-corrected myocardial perfusion SPECT

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We aimed to compare normal limits and the detection of coronary artery disease (CAD) with attenuation-corrected (AC) and non-attenuation-corrected (NC) myocardial perfusion single photon emission computed tomography (MPS) by use of a recently improved automated quantification technique.

Methods and Results

We acquired 415 rest/stress technetium 99m MPS studies on a Vertex dual-detector camera with a gadolinium 153 line source (Vantage Pro). Gender-specific NC, AC, and gender-combined AC normal limits were created from rest/stress images of 50 women and 50 men with a low likelihood of CAD (<5%) and a median body mass index (BMI) of 30 kg/m2 in each gender group. BMI-specific normal limits (<30 kg/m2 and >30 kg/m2) were also compared. Total perfusion deficit and 17-segment summed scores in 174 patients were compared with angiography, and normalcy rates were established from 141 studies of low-likelihood patients. There were no differences between low-BMI and high-BMI normal limits for AC or NC studies. Male and female normal limits differed in 12 of 17 segments for NC stress studies and in 3 of 17 segments for AC stress studies (P < .01). The sensitivity, specificity, and normalcy rates for stenoses with 70% narrowing or greater were 89%, 73%, and 91%, respectively, for NC studies and 87%, 80%, and 95%, respectively, for AC studies (P = not significant).

Conclusion

Automated detection of CAD by AC and NC MPS demonstrated similar sensitivity, specificity, and normalcy rates. Some gender differences were noted for AC normal limits.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Slomka PJ, Nishina H, Berman DS, et al. Automated quantification of myocardial perfusion SPECT using simplified normal limits. J Nucl Cardiol 2005;12:66–77.

    Article  PubMed  Google Scholar 

  2. Slomka PJ, Fieno D, Thomson L, et al. Automatic detection and size quantification of infarcts by myocardial perfusion SPECT: clinical validation by delayed-enhancement MRI. J Nucl Med 2005;46:728–35.

    PubMed  Google Scholar 

  3. Nishina H, Slomka PJ, Abidov A, et al. Combined supine and prone quantitative myocardial perfusion SPECT: method development and clinical validation in patients with no known coronary artery disease. J Nucl Med 2006;47:51–8.

    PubMed  Google Scholar 

  4. Hendel RC, Corbett JR, Cullom SJ, DePuey EG, Garcia EV, Bateman TM. 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.

    Article  PubMed  Google Scholar 

  5. Hendel RC, Corbett JR, Cullom SJ, DePuey EG, Garcia EV, Bateman TM. 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 Med 2002;43:273–80.

    Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. Ficaro EP, Fessler JA, Shreve PD, Kritzman JN, Rose PA, Corbett JR. Simultaneous transmission/emission myocardial perfusion tomography: diagnostic accuracy of attenuation-corrected 99mTcsestamibi single-photon emission computed tomography. Circulation 1996;93:463–73.

    PubMed  CAS  Google Scholar 

  8. Grossman GB, Garcia EV, Bateman TM, et al. Quantitative Tc-99m sestamibi attenuation-corrected SPECT: development and multicenter trial validation of myocardial perfusion stress genderindependent normal database in an obese population. J Nucl Cardiol 2004;11:263–72.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  CAS  Google Scholar 

  10. 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.

    PubMed  CAS  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  CAS  Google Scholar 

  14. Thompson RC, Heller GV, Johnson LL, et al. Value of attenuation correction on ECG-gated SPECT myocardial perfusion imaging related to body mass index. J Nucl Cardiol 2005;12:195–202.

    Article  PubMed  Google Scholar 

  15. Masood Y, Liu Y-H, DePuey G, et al. Clinical validation of SPECT attenuation correction using x-ray computed tomographyderived attenuation maps: multicenter clinical trial with angiographic correlation. J Nucl Cardiol 2005;12:676–86.

    Article  PubMed  Google Scholar 

  16. Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 1979;300:1350–8.

    PubMed  CAS  Google Scholar 

  17. Germano G, Kiat H, Kavanagh PB, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:2138–47.

    PubMed  CAS  Google Scholar 

  18. Slomka PJ, Nishina H, Berman DS, et al. Automatic quantification of myocardial perfusion stress-rest change: a new measure of ischemia. J Nucl Med 2004;45:183–91.

    PubMed  Google Scholar 

  19. Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Int J Cardiovasc Imaging 2002;18:539–42.

    PubMed  Google Scholar 

  20. Ladenheim ML, Pollock BH, Rozanski A, et al. Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease. J Am Coll Cardiol 1986; 7:464–71.

    Article  PubMed  CAS  Google Scholar 

  21. Germano G, Kavanagh PB, Waechter P, et al. A new algorithm for the quantitation of myocardial perfusion SPECT. I: Technical principles and reproducibility. J Nucl Med 2000;41:712–9.

    PubMed  CAS  Google Scholar 

  22. Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 1983;148:839–43.

    PubMed  CAS  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. Kluge R, Sattler B, Seese A, Knapp WH. 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;24:1107–14.

    PubMed  CAS  Google Scholar 

  25. Van Train KF, Garcia EV, Maddahi J, et al. Multicenter trial validation for quantitative analysis of same-day rest-stress technetium- 99m-sestamibi myocardial tomograms. J Nucl Med 1994;35:609–18.

    Google Scholar 

  26. Prvulovich EM, Lonn AH, Bomanji JB, Jarritt PH, Ell PJ. 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.

    PubMed  CAS  Google Scholar 

  27. Chouraqui P, Livschitz S, Sharir T, et al. Evaluation of an attenuation correction method for thallium-201 myocardial perfusion tomographic imaging of patients with low likelihood of coronary artery disease. J Nucl Cardiol 1998;5:369–77.

    Article  PubMed  CAS  Google Scholar 

  28. Ficaro EP, Fessler JA, Ackermann RJ, Rogers WL, Corbett JR, Schwaiger M. Simultaneous transmission-emission thallium-201 cardiac SPECT: effect of attenuation correction on myocardial tracer distribution. J Nucl Med 1995;36:921–31.

    PubMed  CAS  Google Scholar 

  29. Links JM, Becker LC, Anstett F. Clinical significance of apical thinning after attenuation correction. J Nucl Cardiol 2004;11:26–31.

    Article  PubMed  Google Scholar 

  30. O’Connor MK, Kemp B, Anstett F, et al. A multicenter evaluation of commercial attenuation compensation techniques in cardiac SPECT using phantom models. J Nucl Cardiol 2002;9:361–76.

    Article  PubMed  Google Scholar 

  31. Fricke E, Fricke H, Weise R, et al. Attenuation correction of myocardial SPECT perfusion images with low-dose CT: evaluation of the method by comparison with perfusion PET. J Nucl Med 2005;46:736–44.

    PubMed  Google Scholar 

  32. Matsunari I, Boning G, Ziegler SI, et al. Effects of misalignment between transmission and emission scans on attenuation-corrected cardiac SPECT. J Nucl Med 1998;39:411–6.

    PubMed  CAS  Google Scholar 

  33. Fricke H, Fricke E, Weise R, Kammeier A, Lindner O, Burchert W. A method to remove artifacts in attenuation-corrected myocardial perfusion SPECT introduced by misalignment between emission scan and CT-derived attenuation maps. J Nucl Med 2004;45:1619–25.

    PubMed  Google Scholar 

  34. Pan T, Mawlawi O, Nehmeh SA, et al. Attenuation correction of PET images with respiration-averaged CT images in PET/CT. J Nucl Med 2005;46:1481–7.

    PubMed  Google Scholar 

  35. Schwaiger M, Ziegler S, Nekolla SG. PET/CT: challenge for nuclear cardiology. J Nucl Med 2005;46:1664–78.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Imaging, Cedars-Sinai Medical Center, Room A1258, 8700 Beverly Blvd, 90048, Los Angeles, CA

    Piotr J. Slomka, Hidetaka Nishina, James Gerlach, Daniel S. Berman & Guido Germano

  2. Department of Medicine, Cedars-Sinai Medical Center, Room A1258, 8700 Beverly Blvd, 90048, Los Angeles, CA

    Piotr J. Slomka, Daniel S. Berman & Guido Germano

  3. Cedars-Sinai Medical Center, Room A1258, 8700 Beverly Blvd, 90048, Los Angeles, CA

    Piotr J. Slomka, Daniel S. Berman & Guido Germano

  4. Los Angeles, Calif, and Oregon Heart & Vascular Institute, Sacred Heart Medical Center, CA

    Mathews B. Fish

  5. Department of Human Physiology, University of Oregon, Eugene, Ore

    Santiago Lorenzo

Authors
  1. Piotr J. Slomka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hidetaka Nishina
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James Gerlach
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel S. Berman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guido Germano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mathews B. Fish
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Santiago Lorenzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Piotr J. Slomka.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Slomka, P.J., Nishina, H., Gerlach, J. et al. Simplified normal limits and automated quantitative assessment for attenuation-corrected myocardial perfusion SPECT. J Nucl Cardiol 13, 642–651 (2006). https://doi.org/10.1016/j.nuclcard.2006.06.131

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.nuclcard.2006.06.131

Key Words

Search

Navigation