Vol 11, No 2 (2008)
Submitted: 2012-01-23
Published online: 2008-11-05
Effect of attenuation correction on normal 99mTc-MIBI myocardial perfusion scintigrams acquired with a hybrid SPECT/CT camera
Anna Płachcińska, Jakub Siennicki, Katarzyna Kovacevic-Kuśmierek, Małgorzata Bieńkiewicz, Jacek Kuśmierek
Nucl. Med. Rev 2008;11(2):59-66.
Vol 11, No 2 (2008)
Submitted: 2012-01-23
Published online: 2008-11-05
Abstract
The aim of this study was to evaluate the effect of the CT-derived
attenuation correction on 99mTc-MIBI normal myocardial
perfusion scintigrams. Rest perfusion scintigrams of patients
in whom coronary artery disease was suspected, without a
history or any signs in ECG of a myocardial infarction, were
analysed. Patients were included in the material if their rest
perfusion scintigrams were normal. This criterion was fulfilled
by 61 patients (29 men and 32 women) aged between 40 and
74 (mean value 57) years, with body mass between 50 and
120 (mean value 70) kg. Tomographic reconstruction of a radionuclide
study was performed with an iterative OSEM method
(10 subsets, 2 iterations) sequentially without and with attenuation
and scatter corrections on a dedicated Xeleris workstation,
applying an ACQC tool to enable manual realignment
of SPECT and CT images. SPECT studies were evaluated visually
and semiquantitatively. Visual analysis of tomograms was
performed with the aim of finding sites of significantly lower counts in comparison with the maximal level (in the lateral wall).
Semiquantitative analysis was based on counts in 20 segments
of a polar map. Attenuation correction caused a complete (in
32 of 40 - 80% of patients) or partial (in 8 of 40 - 20% of
patients) filling out of all areas of lower counts in the inferior
wall. However, although in the anterior wall attenuation correction
caused a complete (in 11 of 35 - 31% of cases) or
partial (10 of 35 - 29% of cases) filling of areas of lower counts,
in 14 cases (40%) those areas remained unchanged or increased,
and in 8 cases (13% of all patients) new areas of decreased
counts appeared. The same was true for the apical
region, in which areas of decreased counts were detected in
14 of 61 (23%) cases without attenuation correction, but after
application of the correction number of apical defects, this figure
grew to 22 (36%) patients. Altogether, attenuation correction
reduced the total number of lower count areas from 104 to
66. Semi-quantitative analysis revealed that attenuation correction
reduced nonuniformity in counts in the whole myocardium
- the mean difference between segment with maximum
counts and values in all segments was reduced from 17.5 ±
± 12% to 11.0 ± 10.3% (p < 0.0001) in male patients, and in
female patients, from 11.5 ± 9% to 10.5 ± 8.6%, thus equalling
non-uniformities in myocardial scintigrams of both sexes.
Misalignment of CT and SPECT studies was observed in 17
(28%) patients but only in 2 (3% of all patients) patients did CT
realignment evidently change the attenuation corrected scintigrams.
Although attenuation correction can cause artefacts, its use is
justified by the reduction of the total number of areas of lower
counts and the improvement of uniformity of images of normally
perfused myocardium.
Abstract
The aim of this study was to evaluate the effect of the CT-derived
attenuation correction on 99mTc-MIBI normal myocardial
perfusion scintigrams. Rest perfusion scintigrams of patients
in whom coronary artery disease was suspected, without a
history or any signs in ECG of a myocardial infarction, were
analysed. Patients were included in the material if their rest
perfusion scintigrams were normal. This criterion was fulfilled
by 61 patients (29 men and 32 women) aged between 40 and
74 (mean value 57) years, with body mass between 50 and
120 (mean value 70) kg. Tomographic reconstruction of a radionuclide
study was performed with an iterative OSEM method
(10 subsets, 2 iterations) sequentially without and with attenuation
and scatter corrections on a dedicated Xeleris workstation,
applying an ACQC tool to enable manual realignment
of SPECT and CT images. SPECT studies were evaluated visually
and semiquantitatively. Visual analysis of tomograms was
performed with the aim of finding sites of significantly lower counts in comparison with the maximal level (in the lateral wall).
Semiquantitative analysis was based on counts in 20 segments
of a polar map. Attenuation correction caused a complete (in
32 of 40 - 80% of patients) or partial (in 8 of 40 - 20% of
patients) filling out of all areas of lower counts in the inferior
wall. However, although in the anterior wall attenuation correction
caused a complete (in 11 of 35 - 31% of cases) or
partial (10 of 35 - 29% of cases) filling of areas of lower counts,
in 14 cases (40%) those areas remained unchanged or increased,
and in 8 cases (13% of all patients) new areas of decreased
counts appeared. The same was true for the apical
region, in which areas of decreased counts were detected in
14 of 61 (23%) cases without attenuation correction, but after
application of the correction number of apical defects, this figure
grew to 22 (36%) patients. Altogether, attenuation correction
reduced the total number of lower count areas from 104 to
66. Semi-quantitative analysis revealed that attenuation correction
reduced nonuniformity in counts in the whole myocardium
- the mean difference between segment with maximum
counts and values in all segments was reduced from 17.5 ±
± 12% to 11.0 ± 10.3% (p < 0.0001) in male patients, and in
female patients, from 11.5 ± 9% to 10.5 ± 8.6%, thus equalling
non-uniformities in myocardial scintigrams of both sexes.
Misalignment of CT and SPECT studies was observed in 17
(28%) patients but only in 2 (3% of all patients) patients did CT
realignment evidently change the attenuation corrected scintigrams.
Although attenuation correction can cause artefacts, its use is
justified by the reduction of the total number of areas of lower
counts and the improvement of uniformity of images of normally
perfused myocardium.
Keywords
attenuation correction; perfusion study; CT misalignment
Title
Effect of attenuation correction on normal 99mTc-MIBI myocardial perfusion scintigrams acquired with a hybrid SPECT/CT camera
Journal
Nuclear Medicine Review
Issue
Vol 11, No 2 (2008)
Pages
59-66
Published online
2008-11-05
Page views
621
Article views/downloads
1502
Bibliographic record
Nucl. Med. Rev 2008;11(2):59-66.
Keywords
attenuation correction
perfusion study
CT misalignment
Authors
Anna Płachcińska
Jakub Siennicki
Katarzyna Kovacevic-Kuśmierek
Małgorzata Bieńkiewicz
Jacek Kuśmierek