title: Multicenter clinical trial to evaluate the efficacy of correction for photon attenuation and scatter in SPECT myocardial perfusion imaging.
abstract: BACKGROUND
  Soft tissue attenuation is a prominent cause of single-photon emission computed tomography (SPECT) imaging artifacts, which may result in reduced diagnostic accuracy of myocardial perfusion imaging. A method incorporating simultaneously acquired transmission data permits nonuniform attenuation correction and when incorporating scatter correction and resolution compensation may substantially reduce interpretive errors.
  
  
  RESULTS
  A prospective multicenter trial was performed recruiting patients with angiographically documented coronary disease (n=96) and group of subjects with a low likelihood of disease (n=88). The uncorrected and attenuation/scatter corrected images were read independently, without knowledge of the patient's clinical data. The detection of >/=50% stenosis was similar using uncorrected perfusion data or with attenuation/scatter correction and resolution compensation (visual or visual plus quantitative analysis), 76% versus 75% versus 78%, respectively (P=NS). The normalcy rate, however, was significantly improved with this new methodology, using either the corrected images (86% vs 96%; P=0.011) or with the corrected data and quantitative analysis (86% vs 97%; P=0.007). The receiver operator characteristic curves were also found to be marginally but not significantly higher with attenuation/scatter correction than with tradition SPECT imaging. However, the ability to detect multivessel disease was reduced with attenuation/scatter correction. Regional differences were also noted, with reduced sensitivity but improved specificity for right coronary lesions using attenuation/scatter correction methodology.
  
  
  CONCLUSIONS
  This multicenter trial demonstrates the initial clinical results of a new SPECT perfusion imaging modality incorporating attenuation and scatter correction in conjunction with 99mTc sestamibi perfusion imaging. Significant improvements in the normalcy rate were noted without a decline in overall sensitivity but with a reduction in detection of extensive coronary disease.
authors.affiliation: Northwestern University Medical School, Chicago, IL, USA. r-hendel@nwu.edu
authors.forename: R C
authors.initials: RC
authors.lastname: Hendel
authors.forename: D S
authors.initials: DS
authors.lastname: Berman
authors.forename: S J
authors.initials: SJ
authors.lastname: Cullom
authors.forename: W
authors.initials: W
authors.lastname: Follansbee
authors.forename: G V
authors.initials: GV
authors.lastname: Heller
authors.forename: H
authors.initials: H
authors.lastname: Kiat
authors.forename: M W
authors.initials: MW
authors.lastname: Groch
authors.forename: J J
authors.initials: JJ
authors.lastname: Mahmarian
mesh_terms: D003627:Data Interpretation, Statistical; D005069:Evaluation Studies as Topic; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D017785:Photons; D011237:Predictive Value of Tests; D015899:Tomography, Emission-Computed, Single-Photon