Background-Soft tissue attenuation is a prominent cause of single-photon emission computed tomography (SPECT) imaging artifacts, which may result in reduced diagnostic accuracy of myocardial perfusion imaging. A method incorporating simultaneously acquired transmission data permits nonuniform attenuation correction and when incorporating scatter correction and resolution compensation may substantially reduce interpretive errors. Methods and Results-A prospective multicenter trial was performed recruiting patients with angiographically documented coronary disease (nϭ96) and group of subjects with a low likelihood of disease (nϭ88). The uncorrected and attenuation/scatter corrected images were read independently, without knowledge of the patient's clinical data. The detection of Ն50% stenosis was similar using uncorrected perfusion data or with attenuation/ scatter correction and resolution compensation (visual or visual plus quantitative analysis), 76% versus 75% versus 78%, respectively (PϭNS). The normalcy rate, however, was significantly improved with this new methodology, using either the corrected images (86% vs 96%; Pϭ0.011) or with the corrected data and quantitative analysis (86% vs 97%; Pϭ0.007). The receiver operator characteristic curves were also found to be marginally but not significantly higher with attenuation/scatter correction than with tradition SPECT imaging. However, the ability to detect multivessel disease was reduced with attenuation/scatter correction. Regional differences were also noted, with reduced sensitivity but improved specificity for right coronary lesions using attenuation/scatter correction methodology.
Conclusions-This multicenter trial demonstrates the initial clinical results of a new SPECT perfusion imaging modalityincorporating attenuation and scatter correction in conjunction with 99m Tc sestamibi perfusion imaging. Significant improvements in the normalcy rate were noted without a decline in overall sensitivity but with a reduction in detection of extensive coronary disease. (Circulation. 1999;99:2742-2749.)