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Vachatimanont S, Sirisalipoch S, Chantadisai M. Comparison of the Diagnostic Performance of Myocardial Perfusion Scintigraphy with and Without Attenuation Correction. Mol Imaging Radionucl Ther 2022; 31:130-138. [PMID: 35771002 PMCID: PMC9246313 DOI: 10.4274/mirt.galenos.2021.27880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: Myocardial perfusion scintigraphy (MPS) is an important diagnostic test for detecting of coronary artery stenosis (CAS); however, tissue attenuation can lead to a difference in accuracy. We evaluated the diagnostic accuracy of attenuation-corrected (AC) and non-attenuation-corrected (NC) MPS for the detection of CAS. Methods: We retrospectively recruited patients who underwent invasive coronary angiography within 10 months after Tc-99m sestamibi MPS. The AC and NC perfusion images were analyzed separately, and each myocardial segment was scored based on relative uptake from 0 to 4. The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were calculated. The diagnostic performances were analyzed using the area under the curve (AUC) of the receiver operating characteristic curve. Results: From 117 patients, significant coronary stenosis was present in 66 patients (56%). The SSS and SRS obtained from NC-images were higher than those from AC, supporting the presence of attenuation artifacts in NC images. The AUC of SSS and SDS were significantly higher than those of SRS in both AC- and NC-images, but no significant difference was found between the AUC of SSS, and those of SDS. The optimal cut-offs were >12 for AC-SSS, >15 for NC-SSS, >4 for AC-SDS and >3 for NC-SDS. There was no statistically significant difference in the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy among AC-SSS, NC-SSS, AC-SDS, and NC-SDS. Conclusion: NC-based Tc-99m-sestamibi MPS promised comparable accuracy to AC images by using different cut-off values for diagnosis.
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Affiliation(s)
- Sira Vachatimanont
- Chulalongkorn University and King Chulalongkorn Memorial Hospital, Department of Radiology, Division of Nuclear Medicine, Bangkok, Thailand
| | - Sasitorn Sirisalipoch
- Chulalongkorn University and King Chulalongkorn Memorial Hospital, Department of Radiology, Division of Nuclear Medicine, Bangkok, Thailand
| | - Maythinee Chantadisai
- Chulalongkorn University and King Chulalongkorn Memorial Hospital, Department of Radiology, Division of Nuclear Medicine, Bangkok, Thailand
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Farrell CM, Pinson JA, Dennett AM. CT Attenuation correction and its impact on image quality of myocardial perfusion imaging in coronary artery disease: A systematic review. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2021; 9:31-38. [PMID: 33392347 DOI: 10.22038/aojnmb.2020.50692.1346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Myocardial perfusion imaging is a non-invasive procedure that plays an integral role in the diagnosis and management of coronary artery disease. With the routine use of computerised tomography attenuation correction (CTAC) in myocardial perfusion imaging still under debate, the aim of this review was to determine the impact of CTAC on image quality in myocardial perfusion imaging. Medline, Embase and CINAHL were searched from the earliest available time until August 2019. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2. Details pertaining to image quality and diagnostic accuracy were analysed, and results summarised descriptively. Three studies with 'unclear' risk of bias and low applicability concerns (1002 participants) from a yield of 2725 articles were identified. Two studies demonstrated an increase in image quality, and one study found no difference in image quality when using CTAC compared to no attenuation correction. Benefits of CTAC for improving image quality remain unclear. Given the potential exposure risk with the addition of CTAC, patient and clinician factors should inform decision making for use of CTAC in myocardial perfusion imaging for coronary artery disease.
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Affiliation(s)
- Claire M Farrell
- Department of Medical Imaging, Medical Radiations and Nuclear Medicine, Eastern Health, Victoria, Australia
| | - Jo-Anne Pinson
- Department of Medical Imaging, Monash Health, Peninsula Health, Victoria, Australia.,Department of Medical Imaging and Radiation Sciences, Monash University, Australia
| | - Amy M Dennett
- School of Allied Health, Human Services and Sport, La Trobe University, Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
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Huang JY, Yen RF, Lee WC, Huang CK, Hsu PY, Cheng MF, Lu CC, Lin YH, Chien KL, Wu YW. Improved diagnostic accuracy of thallium-201 myocardial perfusion single-photon emission computed tomography with CT attenuation correction. J Nucl Cardiol 2019; 26:1584-1595. [PMID: 29484543 DOI: 10.1007/s12350-018-1230-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/18/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The benefits of attenuation correction (AC) in technetium-99m myocardial perfusion imaging (MPI) have been well established. However, the value of thallium (Tl-201) AC and routine computed tomography AC (CTAC) were less well established. The aims of this study were to evaluate the diagnostic performance of thallium (Tl-201) MPI with additional CTAC and to determine which participants would benefit most. METHODS AND RESULTS A total of 108 consecutive patients who underwent Tl-201 MPI and received coronary angiography within 3 months were enrolled. Diagnostic performance was determined by sensitivity, specificity, and receiver operating characteristic curve analysis. Subgroup analyses were performed using gender and obesity. CTAC improved the area under the curve (0.84 vs. 0.77, P = 0.037 at patient level), primarily due to a significant improvement in specificity (0.78 vs. 0.57, P = 0.013) and no significant difference in sensitivity (0.79 vs. 0.82, P = 0.75). In subgroup analysis, CTAC was most helpful in obese subjects, men, and especially right coronary artery lesions. CONCLUSIONS CTAC significantly improved diagnostic performance primarily by increasing the specificity, and the improvements were significantly greater in obese patients and male patients. These findings suggest that CTAC should be applied to Tl-201 MPI as routine clinical practice.
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Affiliation(s)
- Jei-Yie Huang
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 501, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 501, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan
| | - Chun-Kai Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 501, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan
| | - Pei-Ying Hsu
- Department of Nuclear Medicine, National Taiwan University Hospital, Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, 640, Yun-Lin County, Taiwan
| | - Mei-Fang Cheng
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 501, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 501, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan.
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd, Banciao Dist., New Taipei City, 220, Taiwan.
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
- National Yang-Ming University School of Medicine, No.155, Sec.2, Linong Street, Taipei City, 112, Taiwan.
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Xin W, Yang X, Wang J, Shao X, Zhang F, Shi Y, Liu B, Yu W, Tang H, Wu Z, Wang Y, Zhou W. Gated single-photon emission computed tomography myocardial perfusion imaging is superior to computed tomography attenuation correction in discriminating myocardial infarction from attenuation artifacts in men and right coronary artery disease. Nucl Med Commun 2019; 40:491-498. [PMID: 30855541 PMCID: PMC10955149 DOI: 10.1097/mnm.0000000000001009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) studies, attenuation artifacts frequently cause false positives, which can be partially overcome by computed tomography attenuation correction (CT-AC) or gated acquisition [gated myocardial perfusion imaging (GMPI)]. The purpose of this study is to evaluate their relative diagnostic performances for coronary artery disease (CAD). PATIENTS AND METHODS We enrolled 181 patients who underwent gated SPECT with CT-AC in this study. Two observers who were blinded to the clinical data interpreted the GMPI and CT-AC images. Coronary angiography was considered as the reference standard. The diagnostic efficacy was evaluated based on sex, BMI, and individual coronary arteries. RESULTS The diagnostic accuracy of GMPI was higher than that of nonattenuation correction overall, as well as for men, overweight individuals, and right CAD (P<0.05). Compared with CT-AC, GMPI overall had a higher specificity (96.3 vs. 86.9%, P=0.014) but the same sensitivity, achieving an increased accuracy and area under the curve (AUC, P>0.05). For diagnosing right CAD, GMPI had a higher diagnostic efficacy (AUC: 0.733 vs. 0.596, P<0.001) because of its higher sensitivity (52.0 vs. 26.0%, P=0.008); for men, the diagnostic efficacy of GMPI was significantly higher than that of CT-AC (AUC: 0.754 vs. 0.681, P=0.038). CONCLUSION Both CT-AC and GMPI led to an increased diagnostic efficacy compared with nonattenuation correction in differentiating attenuation artifacts from fixed perfusion defects. These improvements were, however, more obvious for GMPI than for CT-AC, especially in men and right CAD.
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Affiliation(s)
- Wenchong Xin
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Xiaoyu Yang
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Jianfeng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Bao Liu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Wenji Yu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Haipeng Tang
- School of Computing, University of Southern Mississippi, Long Beach, Mississippi, USA
| | - Zhifang Wu
- Department of Nuclear Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu Province, China
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, Mississippi, USA
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Tanaka H, Takahashi T, Ohashi N, Tanaka K, Okada T, Kihara Y. Diagnostic value of thallium-201 myocardial perfusion IQ-SPECT without and with computed tomography-based attenuation correction to predict clinically significant and insignificant fractional flow reserve: A single-center prospective study. Medicine (Baltimore) 2017; 96:e9275. [PMID: 29390486 PMCID: PMC5758188 DOI: 10.1097/md.0000000000009275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to clarify the predictive value of fractional flow reserve (FFR) determined by myocardial perfusion imaging (MPI) using thallium (Tl)-201 IQ-SPECT without and with computed tomography-based attenuation correction (CT-AC) for patients with stable coronary artery disease (CAD).We assessed 212 angiographically identified diseased vessels using adenosine-stress Tl-201 MPI-IQ-SPECT/CT in 84 consecutive, prospectively identified patients with stable CAD. We compared the FFR in 136 of the 212 diseased vessels using visual semiquantitative interpretations of corresponding territories on MPI-IQ-SPECT images without and with CT-AC.FFR inversely correlated most accurately with regional summed difference scores (rSDS) in images without and with CT-AC (r = -0.584 and r = -0.568, respectively, both P < .001). Receiver-operating characteristics analyses using rSDS revealed an optimal FFR cut-off of <0.80 without and with CT-AC. Although the diagnostic accuracy of FFR <0.80 did not significantly differ, FFR ≥0.82 was significantly more accurate with, than without CT-AC. Regions with rSDS ≥2 without or with CT-AC predicted FFR <0.80, and those with rSDS ≤1 without and with CT-AC predicted FFR ≥0.81, with 73% and 83% sensitivity, 84% and 67% specificity, and 79% and 75% accuracy, respectively.Although limited by the sample size and the single-center design, these findings showed that the IQ-SPECT system can predict FFR at an optimal cut-off of <0.80, and we propose a novel application of CT-AC to MPI-IQ-SPECT for predicting clinically significant and insignificant FFR even in nonobese patients.
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Affiliation(s)
- Haruki Tanaka
- Department of Cardiology, Miyoshi Central Hospital, Miyoshi City, Hiroshima, Japan
| | | | - Norihiko Ohashi
- Department of Cardiology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital
| | - Koichi Tanaka
- Department of Cardiology, Miyoshi Central Hospital, Miyoshi City, Hiroshima, Japan
| | - Takenori Okada
- Department of Cardiology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Japan
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