Computed tomography attenuation correction improves the risk stratification accuracy of myocardial perfusion imaging

Ou, Xiaohong; Jiang, Lisha; Huang, Rui; Li, Fanglan; Zhao, Zhuang; Li, Lin

doi:10.1097/mnm.0b013e328360053a

Cited by 12 publications

(5 citation statements)

References 23 publications

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“…Our findings are in agreement with previous studies proposing patient-specific protocols for prospective ECG-triggered CCTA [ 7 – 14 , 17 ]. Most of these studies propose correction protocols based on the attenuation or image noise in preceding scans, for example in a bolus scan.…”

Section: Discussionsupporting

confidence: 93%

A practical approach for a patient-tailored dose protocol in coronary CT angiography using prospective ECG triggering

Dijk

Huizing

Jager

et al. 2015

Int J Cardiovasc Imaging

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To derive and validate a practical patient-specific dose protocol to obtain an image quality, expressed by the image noise, independent of patients’ size and a better radiation dose justification in coronary CT angiography (CCTA) using prospective ECG triggering. 43 patients underwent clinically indicated CCTA. The image noise, defined as the standard deviation of pixel attenuation values in a homogeneous region in the liver, was determined in all scans. Subsequently, this noise was normalized to the radiation exposure. Next, three patient-specific parameters, body weight, body mass index and mass per length (MPL), were tested for the best correlation with normalized image noise. From these data, a new dose protocol to provide a less variable image noise was derived and subsequently validated in 84 new patients. The normalized image noise increased for heavier patients for all patients’ specific parameters (p < 0.001). MPL correlated best with the normalized image noise and was selected for dose protocol optimization. This new protocol resulted in image noise levels independent of patients’ MPL (p = 0.28). A practical method to obtain CCTA images with noise levels independent of patients’ MPL was derived and validated. It results in a less variable image quality and better radiation exposure justification and can also be used for CT scanners from other vendors.

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Section: Discussionsupporting

confidence: 93%

A practical approach for a patient-tailored dose protocol in coronary CT angiography using prospective ECG triggering

Dijk

Huizing

Jager

et al. 2015

Int J Cardiovasc Imaging

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“…Some studies have reported that AC can result in more efficient risk stratification compared with non-AC (NAC) by demonstrating greater event rates in AC images compared with the same scoring group of NAC images, and significant hazard ratios (HR) of AC images [ 11 , 12 , 14 ]. Other studies have shown similar event rates between the same AC and NAC scoring groups and significant HR of NAC images [ 13 , 15 ].…”

Section: Introductionmentioning

confidence: 61%

“…CT-based AC MPI provided a high-resolution transmission map in a short time [ 19 ]. With regards to the prognostic effect of CT-based AC, two of three studies have demonstrated similar value between CT-based AC and NAC images [ 13 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Long-term prognostic value of computed tomography-based attenuation correction on thallium-201 myocardial perfusion imaging: A cohort study

et al. 2021

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Background Myocardial perfusion imaging (MPI) is a well-established diagnostic tool to evaluate coronary artery disease (CAD) and also an effective prognostic tool for patients with CAD. However, few studies investigated the prognostic value of attenuation correction (AC) in MPI, and the results were controversial. Objectives To investigate the prognostic value of computed tomography (CT)-based AC thallium-201 (Tl-201) MPI. Methods A total of 108 consecutive patients who underwent Tl-201 MPI and received coronary angiography within 90 days were included. Medical records were reviewed and missing information was completed after telephone contact. The prognostic value was evaluated by Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards model. Results After a mean follow-up of 7.72 ± 3.72 years, 27 patients had died, 41 had been readmitted for cardiovascular (CV)-related events and 44 had reached the composite of death plus CV-related re-admission. Kaplan-Meier curves for all-cause mortality for SSS with a cutoff value of 13 for AC and 16 for non-AC (NAC) images showed a significant difference between the two curves for both AC and NAC images (p = 0.011 for AC and p = 0.021 for NAC). In the multivariable model, SSS and SRS showed similar independent predictive values in predicting all-cause mortality and composite of all-cause mortality plus CV-related re-admission, in both AC and NAC images. Subgroup analysis implicated that AC MPI possibly provided better risk stratification in obese patients. Conclusion CT-based AC and NAC MPI showed similar value and were the only significant predictors for the composite of mortality and CV events.

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“…When considered with the reported benefits of CTAC in improving the sensitivity and Full paper: Comparison of dose and risk of CTAC and radiopharmaceutical for MPI BJR specificity, it can be said that the reported benefits of attenuation and scatter correction using CT benefits do outweigh the risks. [33][34][35] A comparison of doses from the CTAC acquisitions showed some interesting findings. The protocol from the Siemens Symbia T6 gave the lowest E; this was significantly different to the protocols from the Philips Precedence and GE Hawkeye 4 slice systems (paired t-test, p , 0.05).…”

Section: Discussionmentioning

confidence: 99%

Comparison of effective dose and lifetime risk of cancer incidence of CT attenuation correction acquisitions and radiopharmaceutical administration for myocardial perfusion imaging

Tootell

Szczepura²,

Hogg³

2014

BJR

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Cite this article as: Tootell AK, Szczepura K, Hogg P. Comparison of effective dose and lifetime risk of cancer incidence of CT attenuation correction acquisitions and radiopharmaceutical administration for myocardial perfusion imaging. Br J Radiol 2014;87:20140110. FULL PAPERComparison of effective dose and lifetime risk of cancer incidence of CT attenuation correction acquisitions and radiopharmaceutical administration for myocardial perfusion imaging Objective: To measure the organ dose and calculate effective dose from CT attenuation correction (CTAC) acquisitions from four commonly used gamma camera single photon emission CT/CT systems. Methods: CTAC dosimetry data was collected using thermoluminescent dosemeters on GE Healthcare's Infinia™ Hawkeye™ (GE Healthcare, Buckinghamshire, UK) four-and single-slice systems, Siemens Symbia™ T6 (Siemens Healthcare, Erlangen, Germany) and the Philips Precedence (Philips Healthcare, Amsterdam, Netherlands). Organ and effective dose from the administration of 99m Tc-tetrofosmin and 99m Tc-sestamibi were calculated using International Commission of Radiological Protection reports 80 and 106. Using these data, the lifetime biological risk was calculated. Results: The Siemens Symbia gave the lowest CTAC dose (1.8 mSv) followed by the GE Infinia Hawkeye single-slice (1.9 mSv), GE Infinia Hawkeye four-slice (2.5 mSv) and Philips Precedence v. 3.0. Doses were significantly lower than the calculated doses from radiopharmaceutical administration (11 and 14 mSv for 99m Tc-tetrofosmin and 99m Tc-sestamibi, respectively). Overall lifetime biological risks were lower, which suggests that using CTAC data posed minimal risk to the patient. Comparison of data for breast tissue demonstrated a higher risk than that from the radiopharmaceutical administration. Conclusion: CTAC doses were confirmed to be much lower than those from radiopharmaceutical administration. The localized nature of the CTAC exposure compared to the radiopharmaceutical biological distribution indicated dose and risk to the breast to be higher. Advances in knowledge: This research proved that CTAC is a comparatively low-dose acquisition. However, it has been shown that there is increased risk for breast tissue especially in the younger patients. As per legislation, justification is required and CTAC should only be used in situations that demonstrate sufficient net benefit.Single-photon emission CT (SPECT)/CT has become common place in clinical imaging, and a major role for CT is for the attenuation correction (AC) of SPECT data in myocardial perfusion imaging (MPI). 1,2 The benefits of CT attenuation correction (CTAC) in MPI are well known and many national and international professional organizations recommend its use to improve SPECT MPI diagnostic accuracy. 3,4 Associated with the CT acquisition is an additional radiation dose that is often considered to be low, yet very few articles quantify the dose and the associated risk.Effective dose is a useful figure that allows for a comparison between different tech...

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Computed tomography attenuation correction improves the risk stratification accuracy of myocardial perfusion imaging

Abstract: CT-AC allows improved risk stratification for MACEs because there is a more clear separation between low risk and moderately to severely abnormal findings.

Cited by 12 publications

References 23 publications

A practical approach for a patient-tailored dose protocol in coronary CT angiography using prospective ECG triggering

A practical approach for a patient-tailored dose protocol in coronary CT angiography using prospective ECG triggering

Long-term prognostic value of computed tomography-based attenuation correction on thallium-201 myocardial perfusion imaging: A cohort study

Comparison of effective dose and lifetime risk of cancer incidence of CT attenuation correction acquisitions and radiopharmaceutical administration for myocardial perfusion imaging

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