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Receiver Operating Characteristic Evaluation of Iterative Reconstruction with Attenuation Correction in ^99mTc-Sestamibi Myocardial SPECT Images

Departments of Biomedical Engineering and Radiology, The University of North Carolina at Chapel Hill, Chapel Hill
Department of Radiology, Duke University Medical Center, Durham
Department of Biomedical Engineering, Duke University, Durham, North Carolina

Correspondence: For correspondence or reprints contact: Karen J. LaCroix, PhD, Department of Biomedical Engineering, CB 7575, 152 MacNider, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599.

ABSTRACT

The purpose of this study was to evaluate differences in myocardial defect detection between ^99mTc-sestamibi myocardial SPECT images reconstructed using conventional filtered backprojection (FBP) without attenuation correction (AC) and those reconstructed using maximum-likelihood expectation maximization with nonuniform attenuation correction (MLAC). Methods: An observer study and receiver operating characteristic (ROC) curve analysis were performed using simulated ^99mTc-sestamibi SPECT data from a population of 24 mathematic anthropomorphic torso phantoms, which realistically modeled a wide range of anatomic variations. The phantoms modeled male patients with a flat diaphragm, male patients with a diaphragm raised to the level of the heart, and female patients with large breasts. Transmural, cold defects with a contrast of 0.25 were simulated in the left ventricular wall for 6 locations. Noisy projection data were generated from the phantoms and included the effects of nonuniform attenuation, collimator-detector response, and scatter. The data were then reconstructed using FBP and MLAC. Images were displayed in the short- and long-axis formats, as in clinical practice. Eight observers viewed blocks of FBP and MLAC images and, for each image, indicated on a continuous rating scale the probability that a defect was present. From the rating data, FBP and MLAC ROC curves were generated, and their areas (A_z) were estimated and compared. Results: In general, the FBP and MLAC ROC curves did not cross and the MLAC curve showed a higher A_z than did the corresponding FBP curve. For male phantoms with a flat diaphragm, the average difference in A_z was 0.04 and was not statistically significant (at the P = 0.05 level) for 6 of 8 observers. For male phantoms with a raised diaphragm, the average difference in A_z was 0.22 and was statistically significant for 6 of 8 observers. For female phantoms with large breasts, the average difference in A_z was 0.19 and was statistically significant for all 8 observers. Conclusion: This study showed an improvement in defect detection in myocardial SPECT images using MLAC in comparison with images using FBP without AC, particularly for patients with large breasts or with a diaphragm raised to the level of the heart.

Key Words: cardiac SPECT • attenuation correction • ^99mTc-sestamibi radionuclide • ROC study • phantom study

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