Editorial point of view
Attenuation artifact, attenuation correction, and the future of myocardial perfusion SPECT

https://doi.org/10.1016/j.nuclcard.2007.01.037Get rights and content

Section snippets

Prone imaging

Diaphragmatic attenuation of the inferior wall on MPI in the supine position results in false-positive reversible and fixed defects.5 The use of prone imaging has been proposed to improve inferior wall uniformity with both Tl-201 and technetium 99m SPECT imaging. In theory, the heart shifts slightly upward in the prone position, whereas the diaphragm is pushed down, thus increasing the distance between the diaphragm and the inferior wall of the left ventricle and decreasing the potential for

ECG-gated SPECT imaging

ECG-gated functional data may be obtained simultaneously with SPECT MPI. Gating may help in differentiating between CAD and attenuation artifact in patients with fixed perfusion abnormalities. Normal function associated with a fixed defect on perfusion imaging can be classified as a soft-tissue attenuation artifact, whereas abnormal function in conjunction with a similar fixed defect would be compatible with myocardial infarction or myocardial stunning. Gated SPECT imaging cannot be used to

Attenuation correction

Although prone imaging and ECG-gated SPECT imaging have been partially successful in improving identification of attenuation artifact, each has serious limitations. A more scientific approach should use various techniques of attenuation correction, such as routinely performed with positron emission tomography (PET) imaging.20 To apply the methods of attenuation correction, it is necessary to create patient-specific nonuniform attenuation maps that accurately reflect the attenuation potential of

Attenuation correction and the future of myocardial perfusion SPECT

The recently published perspectives on attenuation correction of myocardial perfusion SPECT scans nicely lay out both the intellectualism of our pioneers and the immense dilemma currently confronting our field.4, 55 The past 20 years have seen a virtual explosion in the utilization of myocardial perfusion SPECT imaging, to a point where this technique now accounts for the largest outlay of Medicare dollars going to cardiology services. According to a recent MedPAC analysis, the average annual

Acknowledgment

Authors James A. Case and Timothy M. Bateman receive royalties for ExSPECT II software for myocardial perfusion attenuation correction. Gary V. Heller receives honoraria and unrestricted research grants from Philips Medical Systems.

References (55)

  • M.K. O’Connor et al.

    A multicenter evaluation of commercial attenuation compensation techniques in cardiac SPECT using phantom models

    J Nucl Cardiol

    (2002)
  • M.A. King et al.

    Attenuation compensation for cardiac single-photon emission computed tomographic imaging: part 1Impact of attenuation and methods of estimating attenuation maps

    J Nucl Cardiol

    (1995)
  • M.A. King et al.

    Attenuation compensation for cardiac single-photon emission computed tomographic imaging: part 2Attenuation compensation algorithms

    J Nucl Cardiol

    (1996)
  • J. Chen et al.

    Automated quality control of emission-transmission misalignment for attenuation correction in myocardial perfusion imaging with SPECT-CT systems

    J Nucl Cardiol

    (2006)
  • S. Goetze et al.

    SPECT/CT misregistration in attenuation corrected myocardial perfusion studies

    J Nucl Cardiol

    (2006)
  • J.M. Links et al.

    Attenuation correction and gating synergistically improve the diagnostic accuracy of myocardial perfusion SPECT

    J Nucl Cardiol

    (2002)
  • R.C. Hendel et al.

    The value and practice of attenuation correction for myocardial perfusion SPECT imaging: a joint position statement from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine

    J Nucl Cardiol

    (2002)
  • R.C. Thompson et al.

    Value of attenuation correction on ECG-gated SPECT myocardial perfusion imaging related to body mass index

    J Nucl Cardiol

    (2005)
  • G.B. Grossman et al.

    Quantitative Tc-99m sestamibi attenuation-corrected SPECT: development and multicenter trial validation of myocardial perfusion stress gender-independent normal database in an obese population

    J Nucl Cardiol

    (2004)
  • Y. Masood et al.

    Clinical validation of SPECT attenuation correction using x-ray computed tomography-derived attenuation maps: multicenter clinical trial with angiographic correlation

    J Nucl Cardiol

    (2005)
  • P.B. Gibson et al.

    Low event rate for stress-only perfusion imaging in patients evaluated for chest pain

    J Am Coll Cardiol

    (2002)
  • G.V. Heller et al.

    Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging

    J Nucl Cardiol

    (2004)
  • S.B. Baghdasarian et al.

    Risk stratification with attenuation corrected stress spect myocardial perfusion imaging in the absence of ECG-gating

    J Nucl Cardiol

    (2006)
  • G.V. Heller et al.

    American Society of Nuclear Cardiology and Society of Nuclear Medicine joint position statement: attenuation correction of myocardial perfusion SPECT scintigraphy

    J Nucl Cardiol

    (2004)
  • D.D. Watson

    Is it time for SPECT attenuation correction?

    J Nucl Cardiol

    (2004)
  • J. Machac et al.

    Positron emission tomography myocardial perfusion and glucose metabolism imaging

    J Nucl Cardiol

    (2006)
  • J.M. Links et al.

    Combined corrections for attenuation, depth-dependent blur, and motion in cardiac SPECT: a multicenter trial

    J Nucl Cardiol

    (2000)
  • Cited by (0)

    View full text