Is computed tomography attenuation correction more efficient than gated single photon emission computed tomography analysis in improving the diagnostic performance of myocardial perfusion imaging in patients with low prevalence of ischemic heart disease?

Abstract

Its widespread availability, cost effectiveness, safety in terms of radiation exposure, and ability to significantly improve myocardial perfusion imaging specificity and accuracy make gated SPECT a self-sufficient modality for coronary artery disease screening and follow-up, whereas CT-AC should be discussed on a case-by-case basis.

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

“…Taken together with the intention to avoid additional radiation exposure, some clinicians do not generally consider CT-AC, except for significantly obese patients with a body mass index >40. [ 11 ] Using FFR as the reference standard in this study, we determined that FFR ≥0.82 was diagnosed significantly more accurately with, than without CT-AC. The findings were similar in both LAD and non-LAD regions and the diagnostic accuracy of FFR <0.80 did not significantly differ between images without and with CT-AC acquired by MPI-IQ-SPECT.…”

“…AC techniques in MPI-SPECT are recommended and several studies using CT-AC have improved the accuracy of diagnosing CAD. [ 10 , 11 ] However, other findings that have been contradictory, [ 42 – 44 ] those of which were derived using angiographic findings as the reference standard. Otherwise, several methods have been proposed for AC, including prone, [ 6 ] and ECG-gated SPECT [ 45 ] imaging that could serve as an alternative to CT-AC.…”

“…[ 9 ] Several studies have shown that CT-based AC (CT-AC) can improve specificity without reducing sensitivity, which consequently improve detection, and thus the accuracy of diagnosing CAD. [ 10 , 11 ] However, all of these findings were derived using conventional collimators and γ-cameras with angiographic findings as the reference standard.…”

One year of nuclear cardiology in Europe

“…Until now, analysis of wall thickening using ECG gating has been routinely used to identify attenuation artifacts. Considering these two different approaches, Benkiran et al offer to evaluate the consequences of computed X-ray tomography-based attenuation correction and wall thickening analysis on the diagnostic performance of MPI in routine clinical settings [ 3 ].…”

“…Benkiran and co-authors [ 3 ] explored prospectively, in 70 patients, the relative impact of computed tomography-based attenuation correction and the segmental thickening scores using ECG-gating on the sensitivity, specificity, and overall accuracy on the basis of coronary angiography (for 19 % of patients) and ECG, echocardiography, and clinical follow-up (for 81 % of patients). In their population, the prevalence of ischemic heart disease was low with 81 % of patients considered free of CAD; and 3, 11, and 4 % of patients with myocardial ischemia, myocardial necrosis, and both ischemia and necrosis, respectively.…”