title: Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging.
abstract: BACKGROUND
  Attenuation artifact remains a substantial limitation to confident interpretation of images and reduces laboratory efficiency by requiring comparison of stress and rest image sets. Attenuation-corrected stress-only imaging has the potential to ameliorate these limitations.
  
  
  RESULTS
  Ten experienced nuclear cardiologists independently interpreted 90 stress-only electrocardiography (ECG)-gated technetium 99m sestamibi images in a sequential fashion: myocardial perfusion imaging (MPI) alone, MPI plus ECG-gated data, and attenuation-corrected MPI with ECG-gated data. Images were interpreted for diagnostic certainty (normal, probably normal, equivocal, probably abnormal, abnormal, and perceived need for rest imaging). With stress MPI data alone, only 37% of studies were interpreted as definitely normal or abnormal, with a very high perceived need for rest imaging (77%). The addition of gated data did not alter the interpretations. However, attenuation-corrected data significantly increased the number of studies characterized as definitely normal or abnormal (84%, P <.005) and significantly reduced the perceived need for rest imaging (43%, P <.005). These results were confirmed by use of a nonsequential consensus interpretation of three readers.
  
  
  CONCLUSIONS
  Attenuation correction applied to studies with stress-only Tc-99m ECG-gated single photon emission computed tomography images significantly increases the ability to interpret studies as definitely normal or abnormal and reduces the need for rest imaging. These findings may improve laboratory efficiency and diagnostic accuracy.
authors.affiliation: Nuclear Cardiology Laboratory, Hartford Hospital, CT 06102-5037, USA. gheller@harthosp.org
authors.forename: Gary V
authors.initials: GV
authors.lastname: Heller
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Bateman
authors.forename: Lynne L
authors.initials: LL
authors.lastname: Johnson
authors.forename: S James
authors.initials: SJ
authors.lastname: Cullom
authors.forename: James A
authors.initials: JA
authors.lastname: Case
authors.forename: James R
authors.initials: JR
authors.lastname: Galt
authors.forename: Ernest V
authors.initials: EV
authors.lastname: Garcia
authors.forename: Keith
authors.initials: K
authors.lastname: Haddock
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Moutray
authors.forename: Carlos
authors.initials: C
authors.lastname: Poston
authors.forename: Eli H
authors.initials: EH
authors.lastname: Botvinick
authors.forename: Matthews B
authors.initials: MB
authors.lastname: Fish
authors.forename: William P
authors.initials: WP
authors.lastname: Follansbee
authors.forename: Sean
authors.initials: S
authors.lastname: Hayes
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
authors.forename: John J
authors.initials: JJ
authors.lastname: Mahmarian
authors.forename: William
authors.initials: W
authors.lastname: Vandecker
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D005080:Exercise Test; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006801:Humans; D007089:Image Enhancement; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D009765:Obesity / Q000150:complications / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi