title: Simultaneous transmission/emission myocardial perfusion tomography. Diagnostic accuracy of attenuation-corrected 99mTc-sestamibi single-photon emission computed tomography.
abstract: BACKGROUND
  The purpose of the present study was to assess the diagnostic performance of attenuation-corrected (AC) stress 99mTc-sestamibi cardiac single-photon emission computed tomography (SPECT) for the identification of coronary heart disease (CHD).
  
  
  RESULTS
  With a triple-detector SPECT system with a 241Am transmission line source, simultaneous transmission/emission tomography (TCT/ECT) was performed on 60 patients with angiographic coronary disease and 59 patients with < or = 5% likelihood of CHD. Iteratively reconstructed AC stress 99mTc-sestamibi perfusion images were compared with uncorrected (NC) filtered-backprojection images. Normal database polar maps were constructed from AC and NC images for quantitative analyses. From the low-likelihood patients, the visual and quantitative normalcy rates increased from 0.88 and 0.76 for NC to 0.98 and 0.95 for AC (P < .05). For the detection of CHD, the receiver operating characteristic curves for the AC images demonstrated improved discrimination capacity (P < .05), and sensitivity/specificity values increased from 0.78/0.46 (NC) to 0.84/0.82 (AC) with visual analysis and from 0.84/0.46 (NC) to 0.88/0.82 (AC) with quantitative analysis. For localization of stenosed vessels, visual and quantitative sensitivity values were 0.51 and 0.63 for NC and 0.64 and 0.78 for AC images (P < .05), respectively.
  
  
  CONCLUSIONS
  TCT/ECT myocardial perfusion imaging significantly improves the diagnostic accuracy of cardiac SPECT for the detection and localization of CHD. Clinical use of TCT/ECT imaging deserves serious consideration.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA. eficaro@umich.edu
authors.forename: E P
authors.initials: EP
authors.lastname: Ficaro
authors.forename: J A
authors.initials: JA
authors.lastname: Fessler
authors.forename: P D
authors.initials: PD
authors.lastname: Shreve
authors.forename: J N
authors.initials: JN
authors.lastname: Kritzman
authors.forename: P A
authors.initials: PA
authors.lastname: Rose
authors.forename: J R
authors.initials: JR
authors.lastname: Corbett
mesh_terms: D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods / Q000592:standards*
chemical_list: D017256:Technetium Tc 99m Sestamibi