Performance of simultaneous emission-transmission systems for attenuation-corrected SPEct: a method for validation applied to two camera systems

[Diagnostic accuracy of the SPECT of post-stress myocardial perfusion with attenuation and scatter correction]

OBJECTIVE

To evaluate the effect of attenuation and scatter correction (AC-SC) on the diagnostic accuracy of post-stress myocardial perfusion (MP) SPECT.

MATERIAL AND METHODS

The retrospective analysis included 121 patients who had a non-corrected (NC) and AC-SC 99mTc-Tetrofosmin MP SPECT after stress. The left ventricle was divided into 13 segments. Two observers performed a visual assessment of the MP on a scale from 0 (perfusion defect) to 3 (normal uptake). A consensus on concordances and discordances between the NC and AC-SC images was established. Final diagnosis of coronary artery disease (CAD) was established by coronary angiography (CANG) (stenosis > or = 70 %).

RESULTS

The combined analysis of NC and AC-SC images produced 93 concordances and 28 discordances. Of the 93 concordances, both studies were abnormal in 67 patients (abnormal CANG in 57) and normal in 26 patients (normal CANG in 20). Among the 28 discordances, 23 were abnormal NC/normal AC-SC (normal CANG in 18) and 5 normal NC/abnormal AC-SC. In these 5 patients AC-SC generated anterior perfusion defects but the CANG was normal. Overall, the appearance of NC and AC-SC images were in agreement with the CANG findings in the 72 % (87/121) and 78 % (95/121) of the patients, respectively. Sixty-seven of the 90 patients with abnormal NC had also abnormal AC-SC (abnormal CANG in 57) and the other 23 had normal AC-SC (normal CANG in 18). The appearance of AC-SC was in agreement with CANG finding in the 83 % (75/90) of patients with abnormal NC. MP abnormalities in NC normalized by AC-SC were more frequently located in inferior wall

CONCLUSION

AC-SC improves the diagnostic accuracy of post stress NC MP SPECT for the diagnosis of CAD. From these results we consider that AC-SC is of clinical value for the correction of attenuation artifacts, more frequently observed in the inferior wall. The presence of antero-apical perfusion defects in AC-SC with normal NC does not mean CAD. So it is necessary to adjust the normalcy pattern of MP SPECT when AC-SC is performed.

Dependency of energy and spatial distributions of photons on edge of object in brain SPECT

OBJECTIVES

Accurate mu maps are important for quantitative image reconstruction in SPECT. The Compton scatter energy window (CSW) technique has been proposed to define the outline of objects. In this technique, a lower energy window image is acquired in addition to the main photo-peak energy window. The image of the lower energy window is used to estimate the edge of the scanned object to produce a constant attenuation map. The aim of this study was to investigate the dependency of CSW on the spatial and energy distribution of radioisotope to predict the edges of objects.

METHODS

Two particular cases of brain study were considered, namely uniform distribution and non-uniform distribution using Monte Carlo simulation and experiments with uniform cylindrical phantom and hotspot phantom. The phantoms were filled with water and a radioactive solution of 99mTc. For each phantom, 20%, 30%, 40% and 50% thresholds of the mean profile were applied to estimate Ewt, the energy window for minimum difference between the estimated and true edge of objects.

RESULTS

The Ewt's were 100-120 keV with a 40% threshold and 92-114 keV with a 30% threshold for uniform and hotspot phantoms, respectively.

CONCLUSIONS

Edge of the objects with CSW technique varies with energy window and thresholds. Careful setting of the energy window is required to use the CSW technique.

[Effect of attenuation correction and scatter compensation on the 99mTc-MIBI myocardial perfusion spect in patients without coronary artery disease]

OBJECTIVE

Attenuation correction (AC) and scatter compensation (SC) techniques are recent developments of myocardial perfusion SPECT. Our aim was to evaluate the effect of AC + SC on the myocardial distribution of 99mTc-MIBI in a population without coronary artery disease.

MATERIAL AND METHODS

A multiarray of Gd-153 linear sources was used for simultaneous transmission/emission 99mTc-MIBI myocardial perfusion SPECT in 27 patients without coronary artery disease. A visual analysis and polar map quantification was performed. Changes between non-corrected (NC) and corrected (AC + SC) studies were compared.

RESULTS

AC + SC produced an increase in liver activity and better visualization of the right ventricle. Intestinal activity increased in six patients. Myocardial homogeneity was increased by AC + SC. No differences by gender were observed after AC + SC. In females AC + SC led to a decrease of uptake in the anterior wall, apex and apical segments of the lateral wall and septum, and an increase in the inferior wall. In males AC + SC caused an increase of uptake in the inferior wall and in the basal segments of septum and a decrease of uptake in apex and apical segments of anterior and lateral walls. AC + SC generated false defects in the anterior wall of five patients.

CONCLUSIONS

Our results show the usefulness of AC + SC for compensating the interferences produced by attenuation on the myocardial distribution of 99mTc-MIBI. Because AC + SC may introduce false defects, it must not be applied to normal perfused myocardium.