Should SPET attenuation correction be more widely employed in routine clinical practice? Against.
The development of reliable and accurate devices for the correction of nonuniform soft tissue attenuation is essential for the future clinical use of SPET myocardial perfusion imaging. In addition to abolishing false-positive defects, which is the chief goal, such corrected SPET images may allow for improved detection of coronary artery disease and perhaps ultimately for true quantification of regional myocardial blood flow. Although progress has been made, most existing attenuation correction devices are not yet ready for prime time. To date the literature shows as many positive results as negative results. There is considerable uncertainty, confusion, and skepticism about the true reliability and value of currently available attenuation correction packages. Although commonly referred to as "attenuation correction devices," these packages are in fact much more complex systems and contain novel mechanical designs, novel image acquisition and image reconstruction algorithms, scatter correction, and depth-dependent resolution compensation, in addition to attenuation correction. Each of these variables needs to be better understood and tested prior to clinical implementation. Although the general concepts are shared, there are as may different approaches to attenuation correction as there are vendors. In order to minimize the confusion of potential buyers about such complex systems, it is desirable that, before attenuation correction is implemented in routine clinical practice, each attenuation correction device is rigorously tested using a standardized testing protocol. Potential buyers of equipment should be able to compare the results of testing with various devices against predefined criteria in order to make an educated decision. Such standards have as yet not been developed. At the present time it is unclear whether attenuation correction of cardiac SPET will remain the emperor's new clothes or will develop into a fashionable Armani suit. Until further progress has been made, one cannot recommend attenuation correction devices for routine clinical practice.
Wackers
Frans J T
FJ
Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520-8042, USA. frans.wackers@diagrad.med.yale.edu
D016477:Artifacts; D009202:Cardiomyopathies / Q000000981:diagnostic imaging*; D004867:Equipment Design; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation* / Q000379:methods / Q000592:standards* / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000379:methods*