Quantitative Diagnostic Performance of Myocardial Perfusion SPECT with Attenuation Correction in Women
Arik Wolak 1,
Piotr J. Slomka 2*,
Mathews B. Fish 3,
Santiago Lorenzo 4,
Daniel S. Berman 2,
and
Guido Germano 2
1 Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
2 Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
3 Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Eugene, Oregon
4 Department of Human Physiology, University of Oregon, Eugene, Oregon
* To whom correspondence should be addressed. E-mail: slomkap{at}cshs.org.
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Abstract |
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Attenuation correction (AC) for myocardial perfusion SPECT (MPS) had not been evaluated separately in women despite specific considerations in this group because of breast photon attenuation. We aimed to evaluate the performance of AC in women by using automated quantitative analysis of MPS to avoid any bias. Methods: Consecutive female patients—134 with a low likelihood (LLk) of coronary artery disease (CAD) and 114 with coronary angiography performed within less than 3 mo of MPS—who were referred for rest–stress electrocardiography-gated 99mTc-sestamibi MPS with AC were considered. Imaging data were evaluated for contour quality control. An additional 50 LLk studies in women were used to create equivalent normal limits for studies with AC and with no correction (NC). An experienced technologist unaware of the angiography and other results performed the contour quality control. All other processing was performed in a fully automated manner. Quantitative analysis was performed with the Cedars-Sinai myocardial perfusion analysis package. All automated segmental analyses were performed with the 17-segment, 5-point American Heart Association model. Summed stress scores (SSS) of 
3 were considered abnormal. Results: CAD (70% stenosis) was present in 69 of 114 patients (60%). The normalcy rates were 93% for both NC and AC studies. The SSS for patients with CAD and without CAD for NC versus AC were 10.0 ± 9.0 (mean ± SD) versus 10.2 ± 8.5 and 1.6 ± 2.3 versus 1.8 ± 2.5, respectively; P was not significant (NS) for all comparisons of NC versus AC. The SSS for LLk patients for NC versus AC were 0.51 ± 1.0 versus 0.6 ± 1.1, respectively; P was NS. The specificity for both NC and AC was 73%. The sensitivities for NC and AC were 80% and 81%, respectively, and the accuracies for NC and AC were 77% and 78%, respectively; P was NS for both comparisons. Conclusion: There are no significant diagnostic differences between automated quantitative MPS analyses performed in studies processed with and without AC in women.
Key Words:
attenuation correction, myocardial perfusion, quantification, women, gender
