PT - JOURNAL ARTICLE AU - Ahmed Mohamed Esameldin Tawakol AU - Hazem Mohieldin Tantawy AU - Yasser Gaber Abdelhafez AU - Yasser Mohamed Elsayed TI - Added Value of Computed Tomography Attenuation Correction and Prone Position in Improvement of Breast and Subdiaphragmatic Attenuations in Myocardial Perfusion Imaging AID - 10.2967/jnmt.120.255943 DP - 2020 Dec 01 TA - Journal of Nuclear Medicine Technology PG - jnmt.120.255943 4099 - http://tech.snmjournals.org/content/early/2020/12/23/jnmt.120.255943.short 4100 - http://tech.snmjournals.org/content/early/2020/12/23/jnmt.120.255943.full AB - Soft tissue attenuation of gamma photons is the most common source of artifacts and remains an intricate problem for myocardial perfusion imaging (MPI) by single-photon emission computed tomography (SPECT) imaging. Breast and Sub-diaphragmatic artifacts are the most frequent causes of false-positive images in female patients. Many ways are introduced to overcome the attenuation artifacts, including the prone position to avoid breast attenuation or by using hybrid SPECT/ computed tomography (CT) systems. The purpose of the study is to evaluate the role of prone images in attenuation correction comparing to CT attenuation correction in MPI. Material and Methods: Forty-four patients were initially included in the study. Statistical analysis was done for thirty patients with suspected or confirmed ischemic heart disease (IHD). All the patients underwent the ordinary supine stress/rest SPECT myocardial perfusion imaging (MPI) then; additional stress/rest prone SPECT as well as stress/rest SPECT/CT images were acquired, each study was interpreted separately and their results were compared. Results: It was found that 58% (31/53) of the depicted defects were attributed to attenuation artifacts; the computed tomography attenuation correction (CT-AC) imaging technique was able to correct 52% versus 49% for prone imaging. The sensitivity, specificity, and diagnostic accuracy were 100%, 90.3%, and 94% for CT_AC respectively versus 100%, 83.8%, and 91% for prone imaging. Inferior wall defects were more common in males (95%) and CT_AC provided better performance than prone imaging for them (i.e. 92.9% in CT_AC versus 90.9% in prone imaging). On the other hand, anterior wall defects were more common in females (83.3%) in which prone imaging was better than CT-AC for them. Conclusion: both CT and prone imaging increased the specificity and diagnostic accuracy of myocardial perfusion imaging without affecting the sensitivity.