Comparison of the Diagnostic Performance of Myocardial Perfusion Scintigraphy with and Without Attenuation Correction

Vachatimanont, Sira; Sirisalipoch, Sasitorn; Chantadisai, Maythinee

doi:10.4274/mirt.galenos.2021.27880

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…Several limitations of this study were noticeable. First, it should be reminded that perfusion defect on perfusion images is still the most crucial findings for diagnosis of CAD from the MPI [16]. Although up to 7.2% of patients with normal perfusion images had CAD [12], correctable causes of false negative perfusion images must be excluded before the perfusion be considered normal.…”

Section: Discussionmentioning

confidence: 99%

Utility of gated SPECT parameters in detection of coronary artery disease in patients with normal perfusion images

Chantadisai

Sirisalipoch

Vachatimanont

2022

Egypt J Radiol Nucl Med

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Background False negative myocardial perfusion images on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a substantial problem in the interpretation of MPI. To explore possible parameters from gated SPECT that could detected coronary artery disease (CAD) in patients with normal perfusion images, we retrospectively selected patients who underwent a 2-day Tc-99 m MIBI adenosine stress/rest MPI and a subsequent invasive coronary angiography. Gated SPECT parameters, including end systolic volume (ESV), end diastolic volume (EDV), left ventricular ejection fraction (LVEF), and transient ischemic dilation (TID) ratio of patients with and without CAD were compared and assessed for their respective diagnostic performance using receiver operating characteristics (ROC) area under the curve (AUC). Results Among 22 patients with normal perfusion images, 7 patients had CAD. Despite the small number of patients, we found significant differences between the ESV, the EDV, and the LVEF between patients with and without CAD. The analysis of ROC curve showed the stress ESV could excellently detect CAD (AUC = 0.900). The rest ESV, the stress EDV, the rest EDV, the stress LVEF and the rest LVEF could likewise perform well in the detection of CAD (AUC = 0.833, 0.819, 0.790, 0.862, and 0.838, respectively). In contrast, the change in LVEF and the TID ratio (AUC = 0.667 and 0.524, respectively) did not seem as reliable as other parameters. Optimal cutoffs for detection of CAD in patients with normal perfusion images from our study were ≥ 20.0 mL for the stress ESV, ≥ 71.0 mL for the stress EDV, ≤ 66.3 EF units for the stress LVEF, ≥ 18.0 mL for the rest ESV, ≥ 67.0 mL for the rest EDV and ≤ 70.0 EF unit for the rest LVEF. Conclusions Gated SPECT parameters could facilitate detection of CAD in patient with normal perfusion images on Tc-99m MIBI MPI. These parameters should be carefully interpreted to improve diagnostic accuracy and reduce false negative MPI.

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Section: Discussionmentioning

confidence: 99%

Utility of gated SPECT parameters in detection of coronary artery disease in patients with normal perfusion images

Chantadisai

Sirisalipoch

Vachatimanont

2022

Egypt J Radiol Nucl Med

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“…The coronary angiography scoring system used a scale of zero to three, with zero indicating normal studies, one indicating one-vessel disease, two indicating two-vessel disease, and three indicating three-vessel disease. The imaging times for both scanners ranged from 4 to 6 min [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Head-to-Head Comparison of CZT-SPECT and SPECT/CT Myocardial Perfusion Imaging: Interobserver and Intraobserver Agreement and Diagnostic Performance

Kalantari,

Mohseninia,

Wetsch

et al. 2023

Life

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Background: Myocardial perfusion imaging (MPI) plays a crucial role in diagnosing coronary artery disease (CAD), with single-photon emission computed tomography (SPECT) being a widely accepted method. The accuracy of MPI relies on image quality and the expertise of physicians. While CZT-SPECT cameras offer advantages, they can be susceptible to attenuation artifacts. Therefore, our objective was to evaluate the diagnostic accuracy of CZT-SPECT and SPECT/CT in a clinical setting. Method: We conducted a prospective single-center study involving patients with known or suspected stable ischemic heart disease who underwent SPECT-MPI using CZT-SPECT and SPECT/CT scanners, and the latter was equipped with cardiofocal collimation. Experienced physicians performed analysis and reporting based on automated quantification and visual image interpretation. Results: A total of 77 patients (32 women (41.6%) and 45 men (58.4%) with an average age of 71.9 ± 8.9 years) were included. The agreement between readers regarding the final conclusion based on imaging reporting using both devices was very high (Kappa 0.87–0.93). Per-vessel analysis revealed a trend suggesting that CZT-SPECT was superior to conventional SPECT/CT in terms of sensitivity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, although the difference did not reach statistical significance. Conclusion: Our study demonstrated that CZT-SPECT imaging offers comparable diagnostic accuracy, improved patient comfort, and eliminates CT-induced radiation compared to SPECT/CT. These findings suggest that cardiac CZT-SPECT imaging has the potential to become a valuable imaging modality in clinical practice.

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Impact of CT attenuation correction on viable myocardium detection in combined SPECT and PET/CT: A retrospective cohort study

Zhao,

Chen,

Zhao

et al. 2024

Medicine

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The influence of computed tomography attenuation correction (CTAC) on the accuracy of diagnosing viable myocardium using Tc-99m-MIBI dedicated cardiac cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) combined with F-18-FDG Positron Emission Tomography/Computed Tomography (PET/CT) metabolic imaging, compared with conventional SPECT MPI, remains to be fully elucidated. To evaluate the impact of CTAC on the accuracy of diagnosing viable myocardium using Tc-99m-MIBI dedicated cardiac CZT SPECT MPI combined with F-18-FDG PET/CT, compared to conventional SPECT MPI. 193 patients underwent CZT SPECT and F-18-FDG PET/CT imaging, while 39 patients underwent conventional SPECT and F-18-FDG PET/CT imaging, with both groups utilizing CT for attenuation correction. The injured myocardium (hibernating and scarring) was quantified using the Q.PET software. After CTAC, both groups showed significant improvements in perfusion of the injured myocardial areas, particularly in the inferior wall (INF). The reduction in perfusion was more notable in the CZT SPECT group than that in the conventional group, particularly in the inferior and lateral walls. Among patients with large cardiac chambers, those undergoing MPI with CZT, with normal weights, or males, hibernating myocardium (HM) and scar post-CTAC reductions were particularly significant in the INF. If HM ≥ 10% is considered an indicator for recommended revascularization, among the 87 patients without prior cardiac bypass, 25 (28.7%) might not require revascularization treatment. Dedicated cardiac CZT SPECT and conventional SPECT MPI combined with F-18-FDG PET/CT significantly influenced the assessment of viable myocardium. The impact of CTAC was more profound in dedicated cardiac CZT SPECT, particularly in the INF region. CTAC significantly enhances the accuracy of viable myocardial assessment and may influence clinical decisions regarding revascularization therapy. Therefore, CTAC should be routinely used in dedicated cardiac CZT SPECT MPI combined with F-18-FDG PET/CT for myocardial viability diagnosis.

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Comparison of the Diagnostic Performance of Myocardial Perfusion Scintigraphy with and Without Attenuation Correction

Cited by 4 publications

References 24 publications

Utility of gated SPECT parameters in detection of coronary artery disease in patients with normal perfusion images

Utility of gated SPECT parameters in detection of coronary artery disease in patients with normal perfusion images

Head-to-Head Comparison of CZT-SPECT and SPECT/CT Myocardial Perfusion Imaging: Interobserver and Intraobserver Agreement and Diagnostic Performance

Impact of CT attenuation correction on viable myocardium detection in combined SPECT and PET/CT: A retrospective cohort study

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