Soft Tissue Attenuation Patterns Associated with Upright Acquisition SPECT Myocardial Perfusion Imaging: A Descriptive Study

Doukky, Rami; Rahaby, Mouyyad; Chawla, Dave; Vashistha, Raj; Alyousef, Tareq; Amin, Amit P.

doi:10.2174/1874192401206010022

Cited by 9 publications

(2 citation statements)

References 8 publications

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“…It is known that inferior wall artifacts are more common in males due to diaphragmatic attenuation [ 5 ]. Prone imaging has been shown to improve inferior wall attenuation artifacts [ 6 , 7 ]; however, the supine-prone acquisition protocol is underutilized at our institution. Despite the high baseline incidence of false positives in the group with right coronary artery dominance, there was a statistically significant difference in the incidence of false positive studies in the left or codominant circulation (59%) -- an absolute difference of 20% with a p-value of 0.01.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Coronary Dominance and Positive Results in Myocardial Perfusion Imaging

Aldaoud¹,

Patel²,

Alex³

et al. 2022

Cureus

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Our study aims to evaluate the possible relationship between coronary artery dominance and its effect on accurately identifying reversible ischemia of inferior/inferior-lateral wall on cardiac perfusion imaging. BackgroundCoronary artery dominance is conventionally defined by the vessel which gives the rise to the AV nodal artery/posterior descending artery (PDA). Previous studies have explored the potential effect of coronary dominance on the accuracy of single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) tests in detecting inferior/inferior-lateral wall ischemia; further evidence is necessary to study that potential effect. MethodsWe conducted a single-center retrospective analysis to explore the potential relationship between coronary artery dominance and inferior/inferior-lateral wall ischemia on SPECT imaging. We identified a cohort of patients with a reversible defect(s) in the inferior and/or inferolateral walls on SPECT MPI who had subsequently undergone invasive coronary angiography. Coronary angiography was used to determine coronary dominance and to confirm the presence/absence of obstructive coronary artery disease in the distribution of the inferior and/or inferolateral wall(s). We correlated the findings on SPECT MPI to coronary angiography to identify true positives and false positive MPIs. ResultsA cohort of 200 patients was identified, patients in the cohort had undergone stress MPI with reversible defects with subsequent invasive coronary angiography. Baseline characteristics including age, BMI and sex were fairly well-balanced between the groups. The mean age was 68 +/-11 in the right dominant group and 70 +/-9 in the non right dominant group. One hundred and sixty-one patients (81%) were found to have right dominant circulation and 39 patients (19%) were found to have left or codominant circulation. Of the 161 patients in the right dominant group, 58 patients (36%) were found to have false positive stress MPI. Of the 39 patients in the left or codominant group, 23 patients (59%) were found to have false positive stress MPI. The incidence of false positive stress MPI in the inferior and inferolateral distribution is significantly higher in patients with non-right dominant coronary anatomy (p-value: 0.01). ConclusionNon-right coronary dominant anatomy could have high false positive MPI results in the inferior and inferolateral distribution. Therefore, the interpreting clinicians should exercise caution during the clinical evaluation of these patients.

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Section: Discussionmentioning

confidence: 99%

The Relationship Between Coronary Dominance and Positive Results in Myocardial Perfusion Imaging

Aldaoud¹,

Patel²,

Alex³

et al. 2022

Cureus

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“…An important factor affecting CZT SPECT volumetric measurements is patient positioning. Unlike other imaging modalities obtained in a single supine position, CZT SPECT studies are commonly performed in two positions to reduce the risk of incorrectly interpreting attenuation artifacts as perfusion abnormalities (24)(25)(26)(27)(28). This potentially provides the imager with both upright and supine LVEF and volume data.…”

Section: Introductionmentioning

confidence: 99%

Prediction of angiographic coronary disease and mortality with a cadmium-zinc-telluride camera: a comparison of upright and supine ejection fractions and left ventricular volumes

Walker¹,

Christianson²,

Athar³

et al. 2023

Front. Nucl. Med.

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IntroductionPerfusion imaging strongly predicts coronary artery disease (CAD), whereas cardiac volumes and left ventricular ejection fraction (LVEF) strongly predict mortality. Compared to conventional Anger single photon emission computed tomography (SPECT) cameras, cadmium-zinc-telluride (CZT) cameras provide higher resolution, resulting in different left ventricular volumes. The cadmium-zinc-telluride D-SPECT camera is commonly used to image in the upright position, which introduces changes in left ventricular loading conditions and potentially alters left ventricular volumes. However, little or no data exist on the predictive value of left ventricular volumes and ejection fraction when acquired in the upright position. We investigated models for the prediction of CAD and mortality, comparing upright and supine imaging.MethodsA retrospective study of patients with upright/supine stress and rest imaging and coronary angiography within 3 months was performed. Univariate and multivariable analyses were performed to predict abnormal angiograms and all-cause mortality.ResultsOf the 392 patients, 210 (53.6%) had significant angiographic CAD; 78 (19.9%) patients died over 75 months. The best multivariable model for CAD included the supine summed stress score and supine stress LVEF, with an area under the receiver operating characteristic of 0.862, a sensitivity of 76.7%, and a specificity of 82.4%, but this model was not statistically superior to the best upright model. The best multivariable models for mortality included age, diabetes, history of cardiovascular disease, and end-systolic volume, with the upright and supine models being equivalent.DiscussionAngiographic CAD was best predicted by the supine summed stress score and LVEF but was not statistically superior to the next-best upright model. Mortality was best predicted by end-systolic volume in combination with age, diabetes status, and cardiovascular disease status, with equivalent results from the upright and supine images.

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Novel attenuation correction of SPECT images using scatter photopeak window data for the detection of coronary artery disease

Yamauchi

Kanzaki

Otsuka

et al. 2014

Journal of Nuclear Cardiology

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Soft Tissue Attenuation Patterns Associated with Upright Acquisition SPECT Myocardial Perfusion Imaging: A Descriptive Study

Cited by 9 publications

References 8 publications

The Relationship Between Coronary Dominance and Positive Results in Myocardial Perfusion Imaging

The Relationship Between Coronary Dominance and Positive Results in Myocardial Perfusion Imaging

Prediction of angiographic coronary disease and mortality with a cadmium-zinc-telluride camera: a comparison of upright and supine ejection fractions and left ventricular volumes

Novel attenuation correction of SPECT images using scatter photopeak window data for the detection of coronary artery disease

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