Soft tissue attenuation patterns in stress myocardial perfusion SPECT images: A comparison between supine and upright acquisition systems

Chawla, David; Rahaby, Mouyyad; Amin, Amit P.; Vashistha, Raj; Alyousef, Tareq; Martinez, Hector X.; Doukky, Rami

doi:10.1007/s12350-010-9336-x

Cited by 25 publications

(12 citation statements)

References 16 publications

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“…A recent study demonstrated substantially increased contribution to inferior and lateral wall attenuation within women who were imaged upright (12). This study does not focus on the apical artifacts that are seen on our system.…”

Section: Discussionmentioning

confidence: 98%

Sources of Apical Defects on a High-Sensitivity Cardiac Camera: Experiences from a Practice Performance Assessment

Tsai

Donohoe

Stokes

et al. 2013

Journal of Nuclear Medicine Technology

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Apical perfusion artifacts seen on a high-sensitivity camera warranted a practice performance assessment to evaluate contributions from soft-tissue attenuation, patient positioning, and image processing techniques. Methods: Cardiac perfusion studies (n 5 534) spanning 5 mo were retrospectively reviewed. Images were acquired with the patient in the upright position, and attenuation correction was used. Regression analysis and contingency tables correlated clinical data to the presence of apical artifacts. Results: There was a positive correlation of with female sex (x 2 5 32, P , 0.001), degree of overlying soft tissues (x 2 5 20, P , 0.002), and breast cleavage (x 2 5 7, P , 0.008) and a negative correlation with angiography-confirmed disease (x 2 5 6, P , 0.02). There was moderate interobserver agreement between 2 observers in determining the presence of apical defects (k5 0.44, 95% confidence interval 5 0.19-0.69), and there was a perceived improvement of apical defects using fewer iterative updates (x 2 5 8, P , 0.003). Conclusion: An understanding of sources contributing to imaging artifacts is a crucial portion of quality assessment in radiology and nuclear medicine. A practice performance assessment study at our institution showed that apical artifacts on a new-generation cardiac camera can be partially attributed to overlying soft-tissue attenuation and ameliorated by altering the reconstruction.Key Words: cardiology (basic/technical); instrumentation; quality assurance; iterative reconstruction; myocardial perfusion; practice performance assessment J Nucl Med Technol 2013; 41:197-202 DOI: 10.2967/jnmt.113.124198 Myocardi al perfusion imaging is susceptible to a wide variety of artifacts that mimic perfusion defects (1-3). These can arise from several sources, including the patient, imaging system, and processing techniques. Characterization of these defects is important, because artifacts can lower the specificity for detection of true cardiac perfusion abnormalities.Examinations performed on a single high-sensitivity, dedicated cardiac camera in our institution using resolution recovery appeared to result in a substantially higher rate of apparent apical perfusion defects (#17 of the American Heart Association segment model) (4). These artifacts were only partially, and usually marginally, ameliorated by attenuation correction. The objective of this practice performance assessment project (http://en.wikipedia.org/wiki/ American_Board_of_Medical_Specialties) was to measure the rate and severity of these defects and to characterize the clinical correlates on this single system. By considering the effects of reconstruction algorithms, we developed a plan to ameliorate these defects. We then remeasured defect severity after modifying the reconstruction parameters. MATERIALS AND METHODSA quality initiative waiver was approved by the institutional review board for this retrospective study. Practice Performance AssessmentA goal of maintenance of certification part 4 projects is the identification and measu...

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Section: Discussionmentioning

confidence: 98%

Sources of Apical Defects on a High-Sensitivity Cardiac Camera: Experiences from a Practice Performance Assessment

Tsai

Donohoe

Stokes

et al. 2013

Journal of Nuclear Medicine Technology

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“…The defect was assigned a classification (anterior, inferior or lateral) based on the location of the segment of minimum activity. The detailed methodology used in this study was published elsewhere [6]. The “density” of an attenuation defect was considered to be the inverse of normalized cont statistics of photon activity; as the lower the normalized cont statistics in a defect was, the denser the attenuation.…”

Section: Methodsmentioning

confidence: 99%

“…However, attenuation patterns with upright imaging systems have not been described. We compared the attenuation patterns observed in upright vs. supine acquisition [6]. In this paper we further examined the association of the attenuation patterns seen in upright imaging with gender and body habitus.…”

Section: Introductionmentioning

confidence: 99%

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

Doukky¹,

Rahaby²,

Chawla³

et al. 2012

TOCMJ

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Background: Little is known about soft tissue attenuation artifacts when an upright patient-position SPECTmyocardial perfusion imaging (MPI) system is used. In this investigation we sought to describe the patterns and frequency of attenuation artifacts associated with this type of instruments and we explored the impact of gender and body habitus on these artifacts.Methods: In a cross-sectional study, we described the prevalence of various soft-tissue attenuation patterns in 212 normal SPECT-MPI studies acquired with an upright patient-position imaging system.Results: In these 212 normal, clinically-indicated, upright-acquisition SPECT-MPIs the attenuation patterns observed were: anterior (6.1%), inferior (63.7%) and lateral (24.1%). Though uncommon, anterior attenuation trended to being more prevalent among women [9.5% vs. 3.4%, P=0.07] and was independently associated with chest circumference. Lateral attenuation was more common among women [34.7% vs. 15.4%, p=0.001] and was strongly associated with obesity (p<0.001). Inferior attenuation was more prevalent among men than women (75.2% vs. 49.5% respectively, P<0.001).Conclusions: Soft-tissue attenuation artifacts are common in upright-acquisition SPECT-MPI. Recognizing the frequency of these attenuation patterns and their interaction with gender and body habitus is critical for the accurate interpretation of SPECT-MPI.

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“…Worden et al supported this Bsecond look strategy^by observing a significant higher rate cardiac death or myocardial infarction in patients with matched prone and supine test results compared to patients with normal scan results (6.3 vs. 2.3 %) [60]. However, there is the potential of marked different attenuation profiles in prone and supine imaging, since inferior attenuation defects are more prevalent in women undergoing upright imaging [61]. Finally, the incremental value of prone imaging is debated by Malkerneker et al who found no incremental value of prone imaging in combination with AC versus AC or prone imaging alone in the number of equivocal test results in 324 patients with a mixed pre-rest likelihood of CAD (8,11, and 18 %, respectively) [62].…”

Section: Prone Imagingmentioning

confidence: 99%

Is Attenuation Correction for Myocardial Perfusion Imaging Underutilized?

Kauling

Post

Rensing

et al. 2015

Curr Cardiovasc Imaging Rep

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Myocardial SPECT remains an important diagnostic technique in patients suspected of significant coronary artery disease. However, the diagnostic accuracy is hampered by several clinical and technical difficulties. Among these, soft tissue attenuation is one of the most frequent causes. Attenuation correction has the power to correct for these artifacts, increasing the diagnostic accuracy of myocardial SPECT. The current review summarizes the available clinical evidence for attenuation correction and raises the question if this technique is not underutilized in current clinical practice.

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Soft tissue attenuation patterns in stress myocardial perfusion SPECT images: A comparison between supine and upright acquisition systems

Cited by 25 publications

References 16 publications

Sources of Apical Defects on a High-Sensitivity Cardiac Camera: Experiences from a Practice Performance Assessment

Sources of Apical Defects on a High-Sensitivity Cardiac Camera: Experiences from a Practice Performance Assessment

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

Is Attenuation Correction for Myocardial Perfusion Imaging Underutilized?

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