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(Circulation. 1999;99:2742-2749.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Multicenter Clinical Trial to Evaluate the Efficacy of Correction for Photon Attenuation and Scatter in SPECT Myocardial Perfusion Imaging
Presented in part at the 69th Scientific Sessions of the American Heart Association, New Orleans, La, November 10-13, 1996, and published in abstract form (Circulation. 1996;94:I-303).
From Northwestern University Medical School, Chicago, Ill (R.C.H., M.W.G.); Cedars-Sinai Medical Center, Los Angeles, Calif (D.S.B.); Emory University, Atlanta, Ga (S.J.C.); University of Pittsburgh (Pa) (W.F.); Hartford (Conn) Hospital (G.V.H.); Sydney Cardiology Group, Westmead, Australia (H.K.); and Baylor College of Medicine, Houston, Tex (J.J.M.).
Correspondence to Robert C. Hendel, MD, 250 E Superior St, Suite 456, Chicago, IL 60611. E-mail r-hendel{at}nwu.edu
Background—Soft tissue attenuation is a prominent cause of single-photon emission computed tomography (SPECT) imaging artifacts, which may result in reduced diagnostic accuracy of myocardial perfusion imaging. A method incorporating simultaneously acquired transmission data permits nonuniform attenuation correction and when incorporating scatter correction and resolution compensation may substantially reduce interpretive errors.
Methods and Results—A prospective multicenter trial was
performed recruiting patients with angiographically documented
coronary disease (n=96) and group of subjects with a low
likelihood of disease (n=88). The uncorrected and attenuation/scatter
corrected images were read independently, without knowledge of the
patient's clinical data. The detection of 
50% stenosis was
similar using uncorrected perfusion data or with attenuation/scatter
correction and resolution compensation (visual or visual plus
quantitative analysis), 76% versus 75% versus 78%,
respectively (P=NS). The normalcy rate, however, was
significantly improved with this new methodology, using either the
corrected images (86% vs 96%; P=0.011) or with the
corrected data and quantitative analysis (86% vs 97%;
P=0.007). The receiver operator characteristic curves
were also found to be marginally but not significantly higher with
attenuation/scatter correction than with tradition SPECT imaging.
However, the ability to detect multivessel disease was reduced with
attenuation/scatter correction. Regional differences were also noted,
with reduced sensitivity but improved specificity for right
coronary lesions using attenuation/scatter correction
methodology.
Conclusions—This multicenter trial demonstrates the initial clinical results of a new SPECT perfusion imaging modality incorporating attenuation and scatter correction in conjunction with 99mTc sestamibi perfusion imaging. Significant improvements in the normalcy rate were noted without a decline in overall sensitivity but with a reduction in detection of extensive coronary disease.
Key Words: imaging • perfusion • nuclear medicine • diagnosis • radioisotopes
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