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Impact of Attenuation Correction by Simultaneous Emission/Transmission Tomography on Visual Assessment of ²⁰¹Tl Myocardial Perfusion Images

Service de Médecine Nucléaire, Centre Antoine Lacassagne-Laboratoire de Biophysique et de Traitement de l'Image, Université de Nice-Sophia Antipolis, Nice
Service de Cardiologie, Centre Hospitalier Universitaire de Nice, Nice
U494 INSERM, Centre Hospitalier Universitaire Pitié-Salpétrière, Paris, France

Correspondence: For correspondence or reprints contact: Jacques Darcourt, MD, PhD, Laboratoire de Biophysique et Traitement de l'Image, Faculté de Médecine, 28 Avenue de Valombrose, 06107 Nice Cedex 2, France.

ABSTRACT

It has been shown in clinical studies that for subjects with a low likelihood of coronary artery disease (CAD), attenuation correction (AC) improves the specificity of defect detection in the inferior wall (right coronary artery [RCA] region). The aim of this study was to investigate the effect of AC on the visual interpretation of the RCA and anteroseptal (corresponding to the left anterior descending artery (LAD]) regions in CAD patients. Methods: Fifty-six patients with suspected CAD underwent ²⁰¹Tl stress/4 h-delayed imaging SPECT using a simultaneous ²⁰¹Tl emission/^99mTc transmission imaging protocol. Images were reconstructed using the maximum likelihood-expectation maximum algorithm without and with AC. The stress/4 h-delayed images were interpreted blindly for reversible or fixed defects in the RCA and LAD regions by three experienced physicians. Coronary angiography, electrocardiography and enzyme findings were used to establish diagnoses of ischemia or infarction, and receiver operating characteristic (ROC) analyses were performed. Results: Statistical testing of ROC curve areas showed that defect detection performance improved with AC when compared with performance without AC in the RCA region. This was mainly the result of a systematic increase in specificity of 12% or more (for any observer and any type of defect) for a similar sensitivity (no definite change in sensitivity values). However, defect detection performance significantly decreased in the LAD territory with AC images (P < 0.05) because of a systematic decrease in sensitivity of 20% or more, with no consistent change in specificity. Similar trends were observed when reversible and fixed defects were considered separately. Conclusion: AC significantly affects the visual interpretation of ²⁰¹Tl stress/4h-delayed SPECT images.This study confirmed the increase in specificity obtained with AC in the RCA territory. However, in the population considered, the studied AC was deleterious for the LAD territory assessment.

Key Words: attenuation correction • ²⁰¹Tl cardiac SPECT • receiver operating characteristic analysis • coronary artery disease

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