Original articleClinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging☆
Section snippets
Study design
Ten experienced nuclear cardiologists interpreted 90 stress ECG-gated Tc-99m sestamibi images in a blinded sequential fashion as follows: MPI alone, MPI plus gated SPECT data, and finally, attenuation-corrected MPI plus gated SPECT data. Resting data were not made available. Each reader individually interpreted the study and gave an indication of the confidence of the interpretation and the perceived necessity for rest imaging to make an appropriate diagnosis.
Patient selection data
Ninety consecutive patients who
Results
The impact of attenuation correction on the interpretation of stress-only images is shown in Figure 1. When MPI alone was used, the interpretation categories were relatively equally divided between the 5 categories. The addition of gated SPECT imaging had little influence on interpretations in comparison to MPI alone (P = not significant). In contrast, interpretation with attenuation-corrected images resulted in a statistically significant increase in the definitely normal/abnormal category
Discussion
In our study, stress images from 90 patients with either known CAD or a 5% or lower likelihood of CAD were interpreted sequentially by 10 independent readers using MPI data alone, in combination with ECG-gated data, and with attenuation correction added. Categorization of MPI or gated studies without attenuation correction as definitely normal or abnormal was very low (37%; 41%). The addition of attenuation correction resulted in a significantly greater number of patients being interpreted as
Acknowledgements
We express gratitude to April Mann, CNMT, and Scott Harrison, CNMT, who participated in the preparation and processing of the SPECT studies. We also thank Elizabeth Doucette for manuscript preparation.
The following authors received royalties from VantagePro/ExSPECT II sales: Timothy M. Bateman, MD, S. James Cullom, PhD, James A. Case, PhD, James R. Galt, PhD, and Ernest V. Garcia, PhD. The other authors have indicated they have no financial conflicts of interest.
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This study was supported by an unrestricted research grant from ADAC/Philips Laboratories, Milpitas, Calif.