Clinical Utility of CT-based Attenuation-correction in Myocardial Perfusion SPECT Imaging

Abstract

Objectives: We aimed to investigate and compare the role of computed tomography (CT)-based attenuation-corrected images (AC) with non-attenuation-corrected images (NAC) obtained by single-photon emission computed tomography/computed tomography (SPECT/CT) myocardial perfusion imaging (MPI). Methods: The data of 124 patients who were applied one-day stress-rest Tc-99m sestamibi SPECT/CT MPI and who had coronary angiography (CAG) results within ±3 months were retrospectively reviewed. AC and NAC images were visually evaluated by two nuclear medicine specialists in a consensus. CAG results were used as the reference standard. Results: Specificity, sensitivity, and accuracy were calculated as 66%, 61%, 71%, 79% and 69%, 70% for AC and NAC imaging in the whole group, respectively. There was no statistically significant difference between AC and NAC images for specificity, sensitivity, and accuracy in the male and female subgroups. In the diagnosis of right coronary artery (RCA) disease, CT AC significantly increased the specificity from 87% to 96%. However, in the left anterior descending artery (LAD) region, the specificity was significantly reduced from 95% to 77%. Conclusion: CT-based AC did not significantly contribute to diagnostic performance for increased specificity for the RCA and reduced specificity in the LAD region. Therefore, AC images should always be evaluated side by side with NAC images to benefit from the different advantages of both techniques.

Repeatability analysis of cardiac function parameters in gated SPECT myocardial perfusion imaging

“…In clinical practice, it has been observed that obesity or breast tissue in female patients can cause sparse or defective perfusion in the inferior or anterior wall of MPI, leading to false positives. This is primarily attributed to the attenuation of γ photons as they pass through human tissues, with male patients experiencing attenuation primarily at the diaphragm, and female patients, especially those with enlarged and dense mammary glands, experiencing attenuation in the mammary gland 11,12 . However, with the signi cant advantages of CTAC, which provides precise anatomical positioning information and accurate attenuation correction data for MPI, we can obtain higher-quality MPI tomographic images.…”