RT Journal Article
SR Electronic
T1 Improved Outcome Prediction by SPECT Myocardial Perfusion Imaging After CT Attenuation Correction
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 196
OP 200
DO 10.2967/jnumed.110.080580
VO 52
IS 2
A1 Pazhenkottil, Aju P.
A1 Ghadri, Jelena-Rima
A1 Nkoulou, Rene N.
A1 Wolfrum, Mathias
A1 Buechel, Ronny R.
A1 Küest, Silke M.
A1 Husmann, Lars
A1 Herzog, Bernhard A.
A1 Gaemperli, Oliver
A1 Kaufmann, Philipp A.
YR 2011
UL http://jnm.snmjournals.org/content/52/2/196.abstract
AB The aim of this study was to determine the impact of attenuation correction with CT (CT-AC) on the prognostic value of SPECT myocardial perfusion imaging (SPECT MPI). Methods: The summed stress score (SSS; 20-segment model) was obtained from filtered backprojection (FBP) and iterative reconstruction with CT-AC in 876 consecutive patients undergoing a 1-d stress–rest 99mTc-tetrofosmin SPECT MPI study for the evaluation of known or suspected coronary artery disease. Survival free of major adverse cardiac events (MACEs; cardiac death or nonfatal myocardial infarction) and survival free of any adverse cardiac events (including cardiac hospitalization, unstable angina, and late coronary revascularization) were analyzed by Kaplan–Meier analysis. Results: At a mean follow-up of 2.3 ± 0.6 y, a total of 184 adverse events occurred in 145 patients, including 35 MACEs (16 cardiac deaths [rate, 1.8%] and 19 nonfatal myocardial infarctions [rate, 2.2%]). With FBP, an SSS of 0–3 best distinguished patients with a low MACE rate (0.6%), followed by an SSS of 4–8 (4.3%), with increased MACE rate, and an SSS of 9–13 (3.8%), which was comparable. By contrast, with CT-AC the discrimination of low from intermediate MACE rate was best observed between an SSS of 0 (0%) and an SSS of 1–3 (3.7%), with a plateau at an SSS of 4–8 (3.2%). Conclusion: CT-AC for SPECT MPI allows improved risk stratification. The prognostically relevant SSS cutoff is shifted toward lower values.