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

doi:10.1016/j.nuclcard.2004.12.298

Journal of Nuclear Cardiology

Volume 12, Issue 2, March–April 2005, Pages 195-202

https://doi.org/10.1016/j.nuclcard.2004.12.298 Get rights and content

Background

Obesity is a growing problem in the United States, and attenuation artifacts are more prevalent in this patient group. This study evaluated the impact of attenuation correction in patients with a high body mass index (BMI).

Methods and results

Three readers interpreted gated attenuation-corrected and non-attenuation-corrected rest/stress technetium 99m sestamibi myocardial perfusion imaging results in 116 patients (BMI <30, n = 60; BMI ≥30, n = 56) who had coronary angiography no more than 60 days after imaging. Readers were blinded to all clinical information and as to whether myocardial perfusion imaging was attenuation-corrected or non-attenuation-corrected. Sensitivity, specificity, and accuracy for detection of coronary artery disease of 70% or greater for attenuation-corrected versus non-attenuation-corrected single photon emission computed tomography (SPECT) were 86% versus 89%, 79% versus 50%, and 84% versus 79%, respectively. Sensitivity, specificity, and accuracy for attenuation-corrected versus non-attenuation-corrected SPECT for patients with BMI less than 30 were 90% versus 90%, 82% versus 64%, and 88% versus 85%, respectively. For BMI of 30 or greater, the results were 82% versus 87%, 76% versus 41%, and 80% versus 73%, respectively. There was a significant difference in specificity overall (P = .02) and for the category of BMI of 30 or greater (P = .03).

Conclusions

This study demonstrates that electrocardiography-gated attenuation-corrected Tc-99m sestamibi SPECT myocardial perfusion imaging improves specificity compared with electrocardiography-gated non-attenuation-corrected SPECT myocardial perfusion imaging, especially in patients with BMI of 30 or greater.

Section snippets

Study population

The study population consisted of 116 patients who had coronary angiography 60 days or less after same-day rest/stress technetium 99m sestamibi SPECT imaging. Excluded were those who had prior coronary artery bypass surgery, percutaneous coronary intervention, or prior myocardial infarction within 6 months before stress imaging. Stress testing was performed via treadmill exercise in 76 patients (65.6%); adenosine or dobutamine stress was used in 40 patients (34.4%) according to published

Patients

The patients’ mean age was 60.1 ± 11 years, with a range of 36 to 89 years. The study population was heavy, having a mean BMI of 31.3 ± 7.2. The range of BMIs was 16.2 to 51.8. Of the patients, 28 (24%) did not have significant CAD (Table 1). For the group of patients with BMI less than 30, 82% had at least 1 coronary artery stenosis greater than 70% compared with 70% of those with BMI of 30 or greater (P = not significant [NS]).

Interpretive certainty

Reader confidence was quite high on both sets of interpretations.

Discussion

This is the first study to demonstrate that attenuation correction improves the diagnostic specificity of visually interpreted Tc-99m sestamibi SPECT myocardial perfusion images in obese patients. Indeed, in patients with BMI of 30 or greater, the specificity of non-attenuation-corrected studies was only 47%, despite gated SPECT data, compared with 76% with attenuation correction. This improvement in specificity was not associated with a statistically significant reduction in sensitivity.

Acknowledgment

We thank Connie Smith for her assistance in manuscript preparation.

The following authors have a commercial association in that they received royalties from ExSPECT II sales: T.M.B., J.A.C., S.J.C., and E.V.G. The other authors have indicated they have no financial conflicts of interest.

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

Background

Methods and results

Conclusions

Section snippets

Study population

Patients

Interpretive certainty

Discussion

Acknowledgment

Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991

JAMA

Overweight, obesity, and health risk

Arch Intern Med

The disease burden associated with overweight and obesity

JAMA

Annual deaths attributable to obesity in the United States

JAMA

Effect of patient obesity on the accuracy of thallium-201 myocardial perfusion imaging

Am J Cardiol

SPECT attenuation artifacts in normal and overweight persons, insights from a retrospective comparison of Rb-82 positron emission tomography and Tl-201 SPECT myocardial perfusion imaging

Clin Nucl Med

Multicenter clinical trial to evaluate the efficacy of correction for photon attenuation and scatter in SPECT myocardial perfusion imaging

Circulation

Combined corrections for attenuation, depth-dependent blur, and motion in cardiac SPECTa multicenter trial

J Nucl Cardiol

Improved coronary disease detection with quantitative attenuation-corrected Tl-201 images

J Nucl Cardiol

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

J Nucl Cardiol

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

J Nucl Cardiol

Clinical impact of combination of scatter, attenuation correction, and depth-dependent resolution recovery for (201) Tl studies

J Nucl Med

Improved detection of left main coronary artery disease with attenuation-corrected SPECT

J Nucl Cardiol

Using gated technetium 99-m sestamibi SPECT to characterize fixed myocardial defects as infarct or artifact

J Nucl Med

American Society of Nuclear Cardiology position statement on electrocardiographic gating of myocardial perfusion SPECT scintigrams

J Nucl Cardiol

Value of gating technetium-99m sestamibi single-photon emission computer tomographic imaging

J Am Coll Cardiol

Imaging guidelines for nuclear cardiology procedures. American Society of Nuclear Cardiology. Myocardial perfusion stress protocols

J Nucl Cardiol

American Society of Nuclear Cardiology consensus statementreporting of radionuclide myocardial perfusion imaging studies

J Nucl Cardiol

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