Role of Attenuation Correction to Discriminate Defects Caused by Left Bundle Branch Block Versus Coronary Stenosis in Single Photon Emission Computed Tomography Myocardial Perfusion Imaging

Hoefflinghaus, Tobias; Husmann, Lars; Valenta, Ines; Moonen, Clemens; Gaemperli, Oliver; Schepis, Tiziano; Namdar, Mehdi; Koepfli, Pascal; Siegrist, Patrick T.; Kaufmann, Philipp A.

doi:10.1097/rlu.0b013e318187ee9c

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…CT-AC may improve the image quality and diagnostic accuracy of MPI [4][5][6][7][8] and increase the ability to interpret studies as normal or abnormal [9]. CT-AC, by reducing the number of equivocal studies and improving specificity, may be better than prone MPI acquisition [10] and gated SPECT imaging [11].…”

Section: Introductionmentioning

confidence: 96%

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

Jiang²,

Huang³

et al. 2013

Nuclear Medicine Communications

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Section: Introductionmentioning

confidence: 96%

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

Jiang²,

Huang³

et al. 2013

Nuclear Medicine Communications

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“…This improvement in accuracy is to a great proportion due to successful correction of attenuation artifacts, often located in the RCA territory. Similarly, CTAC has been shown to be helpful in discriminating artifacts due to left bundle branch block from true ischemia [23]. After applying CTAC in our study, the proportion of segments with perfusion defects having less than 70% and less than 50% uptake decreased by 28 and 49%, respectively.…”

Section: Discussionmentioning

confidence: 73%

Impact of CT attenuation correction on the viability pattern assessed by 99mTc-tetrofosmin SPECT/18F-FDG PET

Nkoulou

Pazhenkottil

Buechel

et al. 2010

Int J Cardiovasc Imaging

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SPECT myocardial perfusion imaging (MPI) is commonly used for comprehensive interpretation of metabolic PET FDG imaging in ischemic dysfunctional myocardium. We evaluated the difference in scan interpretation introduced by CT attenuation correction (CTAC) of SPECT MPI in patients undergoing viability characterization by (99m)Tc SPECT MPI/PET FDG. In 46 consecutive patients (mean age 64, range 36-83 years) with dysfunctional myocardium, we analyzed viability from combined SPECT MPI and PET FDG scanning without attenuation correction (NC) and with CTAC for SPECT MPI. FDG uptake was classified in groups of percent uptake using the segment with maximum tracer in SPECT perfusion uptake as reference. Viability patterns were categorized as normal, mismatch, mild match and scar by relative comparison of SPECT and PET. Applying CTAC introduced a different reference segment for the normalization of PET FDG study in 57% of cases. As a result, the flow-metabolism pattern changed in 28% of segments, yielding a normal, mismatch, mild match and scar pattern in 462, 150, 123, and 47 segments with NC and 553, 86, 108, and 35 with CTAC, respectively (P = 0.001). Thus, by introducing CTAC for SPECT MPI 25% of segments originally classified as scar were reclassified and the number of normal segments increased by 20%. Introducing CTAC decreased by 54% the number of patients with possible indication for revascularization, from 26/46 to 12/46 (P < 0.001). Different interpretation of myocardial viability can be observed when using CTAC instead of NC SPECT MPI as reference for PET FDG scans.

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“…CTAC has evolved as the most common standard used, since it not only improves diagnostic accuracy and outcome prediction by reducing attenuation artifacts 1,5,6 but also enables the evaluation of coronary calcium scoring, 7 offering substantial added diagnostic and prognostic value. 8,9 Furthermore, the application of a CTAC can discriminate defects caused by left bundle branch block from real perfusion defects in SPECT MPI 10 and allows diagnosis of pulmonary hypertension by determining the diameter of the main pulmonary artery in CTAC. 11 Moreover, incidental findings can be found in CTAC with a high prevalence.…”

Section: See Related Article Pp 1574-1583mentioning

confidence: 99%

Extracardiac findings on computed tomography attenuation correction: Is it worth paying extra attention?

Benz

Fuchs

2018

Journal of Nuclear Cardiology

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Due to the profound impact of attenuation artifacts on diagnostic accuracy, especially specificity, 1 several methods like computed tomography attenuation correction (CTAC), 2 prone myocardial perfusion image (MPI) acquisition, 3 or external radionuclide sources like 153 Gd 4 have been developed. CTAC has evolved as the most common standard used, since it not only improves diagnostic accuracy and outcome prediction by reducing attenuation artifacts 1,5,6 but also enables the evaluation of coronary calcium scoring, 7 offering substantial added diagnostic and prognostic value. 8,9 Furthermore, the application of a CTAC can discriminate defects caused by left bundle branch block from real perfusion defects in SPECT MPI 10 and allows diagnosis of pulmonary hypertension by determining the diameter of the main pulmonary artery in CTAC. 11 Moreover, incidental findings can be found in CTAC with a high prevalence. 12,13 These early results on incidental findings in CTAC have recently been confirmed by a systematic review and meta-analysis demonstrating a prevalence of 44% incidental extracardiac findings, 16% major incidental extracardiac findings, and 0.7% previously unknown malignancies. 14 Although most of these findings might be negligible, some are of clinical relevance. In fact, it is recommended by the EANM procedural guidelines for radionuclide MPI with SPECT and SPECT/CT that noncontrast-enhanced CT scans for AC and also scouts should be additionally screened by a physician fully trained in CT readings. 15 Accordingly, the review of all visible non-cardiovascular structures is recommended by the Society of Cardiovascular Computed Tomography in patients undergoing non-contrast calcium scoring and coronary CT angiography. 16 Despite these recommendations, the field still remains controversial. Considering the high prevalence of these findings, concerns are reported about increased cost and radiation exposure due to follow-up scans, morbidity of biopsy or resection, and anxiety of both the patient and the physician about a non-significant pathology. In addition, only a minority of incidental findings that seem clinically significant in CTAC might actually be detrimental to patient outcome. 17 Hence, considering doubtful clinical relevance, the debate is ongoing whether it is worth paying extra attention to extracardiac findings.In the current issue of the Journal of Nuclear Cardiology, Zadro et al. investigated the prevalence of extracardiac findings on CTAC for MPI by SPECT and evaluated the prognostic outcome. The authors retrospectively screened 1506 patients who underwent MPI SPECT and low-dose CTAC. Extracardiac findings of CTAC were captured and classified as major or minor abnormalities. The prevalence of minor and major extracardiac findings was high, which were found in 830 (55.1%) and 212 (14.1%) patients, respectively, whereas 464 (30.8%) patients had no abnormality. Aneurysm of the aorta (33.8%), liver cirrhosis (27.2%), non cystic hypodense lesions of the liver (18.5%), and suspicious nodules in the ...

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Role of Attenuation Correction to Discriminate Defects Caused by Left Bundle Branch Block Versus Coronary Stenosis in Single Photon Emission Computed Tomography Myocardial Perfusion Imaging

Abstract: Spontaneous and PM-induced LBBB often induces typical perfusion defects in MPI at stress, partly reversible at rest. With IR-AC this typical pattern is more pronounced and less reversible, strengthening the confidence to discriminate such findings from ischemia.

Cited by 10 publications

References 16 publications

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

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

Impact of CT attenuation correction on the viability pattern assessed by 99mTc-tetrofosmin SPECT/18F-FDG PET

Extracardiac findings on computed tomography attenuation correction: Is it worth paying extra attention?

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