Apical thinning: real or artefact?

Purser, Nicola J.; Armstrong, Ian; Williams, Helen; Tonge, Christine M.; Lawson, Richard

doi:10.1097/mnm.0b013e3282f4a22e

Cited by 20 publications

(13 citation statements)

References 13 publications

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“…Indeed, a phantom study on conventional SPECT with a parallel-hole collimator has shown that CTAC can introduce artificial apical defects [15]. Furthermore, in a study in human using technetium-99m tetrofosmin MPS with a parallel-hole collimator, myocardial tracer accumulation in the apex was lower in supine images acquired with CTAC than in those acquired without CTAC [16].…”

Section: Discussionmentioning

confidence: 96%

Validation of prone myocardial perfusion SPECT with a variable-focus collimator versus supine myocardial perfusion SPECT with or without computed tomography-derived attenuation correction

et al. 2015

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Section: Discussionmentioning

confidence: 96%

Validation of prone myocardial perfusion SPECT with a variable-focus collimator versus supine myocardial perfusion SPECT with or without computed tomography-derived attenuation correction

et al. 2015

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“…This apical thinning is a well known phenomenon when using the X-ray based AC method [14,15]. This phenomenon may induce false-positive perfusion defects and may reduce the specificity in a normal perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Some reports evaluated the apical thinning in phantom and clinical studies by AC [8,14]. In the phantom study, phantom sizes, breast tissues and reconstruction parameters were thought to be responsible for apical thinning, whereas apical thinning was a consistent finding independent on gender or between AC and NC differed between stress and rest conditions for both gender.…”

Section: Discussionmentioning

confidence: 99%

Attenuation correction of myocardial SPECT by scatter-photopeak window method in normal subjects

et al. 2009

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Objective: Segmentation with scatter and photopeak window data using attenuation correction (SSPAC) method can provide a patient-specific non-uniform attenuation coefficient map only by using photopeak and scatter images without X-ray computed tomography (CT). The purpose of this study is to evaluate the performance of attenuation correction (AC) by the SSPAC method on normal myocardial perfusion database. Methods:A total of 32 sets of exercise-rest myocardial images with Tc-99m-sestamibi were acquired in both photopeak (140keV±10%) and scatter (7% of lower side of the photopeak window) energy windows. Myocardial perfusion databases by the SSPAC method and non-AC (NC) were created from 15 female and 17 male subjects with low likelihood of cardiac disease using quantitative perfusion SPECT software (QPS). Segmental myocardial counts of a 17-segment model from these databases were compared on the basis of paired T test . Results: AC average myocardial perfusion count was significantly higher than that in NC in the septal and inferior regions (P<0.02). On the contrary, AC average count was significantly lower in the anterolateral and apical regions (P<0.01). Coefficient variation (CV) of the AC count in the mid, apical and apex regions was lower than that of NC. Conclusions: The SSPAC method can improve average myocardial perfusion uptake in the septal and inferior regions and provide uniform distribution of myocardial perfusion. The SSPAC method could be a practical method of attenuation correction without X-ray CT.

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“… 1‐5 This anatomy carries a potential life‐threatening risk during any interventional approaches within the left ventricle, and such treatment may lead to a catastrophic consequence 6‐8 . However, available data regarding this structural anatomy are limited to variable samples, methodologies, and results 2–5,9‐11 . Considering the recent growing advancement in transcatheter procedures related to the left ventricle, including endocardial and/or epicardial radiofrequency catheter ablation 12‐14 and transcatheter therapies for structural heart diseases, 15,16 it is an appropriate time to revisit this particular structural anatomy using living heart datasets with the latest computed tomography scanner.…”

Section: Introductionmentioning

confidence: 99%

Revisiting the prevalence and diversity of localized thinning of the left ventricular apex

Yamamoto

Mori

Fukuzawa

et al. 2020

Cardiovasc electrophysiol

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Background The left ventricular apex commonly has a paper‐thin structure. However, available data about its structure are limited to variable samples, methodologies, and results. Objective To investigate the structural anatomy of the left ventricular apex using living heart datasets with the latest computed tomography scanner. Methods One hundred thirty‐one consecutive patients (median age, 73 years; 58% men) who underwent cardiac computed tomography were retrospectively analyzed. Patients with severe aortic stenosis were analyzed separately. Thickness and diameters of the thinnest part of the left ventricular apex during mid‐diastole were measured using orthogonal multiplanar reconstruction images. The area of thinning was estimated using the formula for the ellipse. Results In 88 patients without severe aortic stenosis, the median thickness of the thinnest area of the left ventricular apex was only 0.9 mm. Among them, 74%, 99%, and 100% of cases displayed a left ventricular apex thinner than 1.0, 3.0, and 5.0 mm, respectively. The median area of the thinnest region was 5.6 mm2. In 43 patients with severe aortic stenosis, the median thickness of the thinnest area of the left ventricular apex was 1.2 mm. Among them, 51%, 93%, and 100% of cases displayed a left ventricular apex thinner than 1.0, 3.0, and 5.0 mm, respectively. The median area of the thinnest region was 3.9 mm2. Conclusions Localized thinning of the left ventricular apex is unexceptional, regardless of aortic stenosis with concentric left ventricular hypertrophy, thus highlighting the need for a reappreciation of this feature to avoid inadvertent catastrophic complications.

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Apical thinning: real or artefact?

Abstract: Data acquisition and processing methods are thought to be responsible for the apparent apical defect. This phantom study therefore demonstrates that apical thinning is not simply an anatomical feature but can also be an artefact introduced by the use of attenuation correction.

Cited by 20 publications

References 13 publications

Validation of prone myocardial perfusion SPECT with a variable-focus collimator versus supine myocardial perfusion SPECT with or without computed tomography-derived attenuation correction

Validation of prone myocardial perfusion SPECT with a variable-focus collimator versus supine myocardial perfusion SPECT with or without computed tomography-derived attenuation correction

Attenuation correction of myocardial SPECT by scatter-photopeak window method in normal subjects

Revisiting the prevalence and diversity of localized thinning of the left ventricular apex

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