title: Attenuation correction of myocardial SPECT perfusion images with low-dose CT: evaluation of the method by comparison with perfusion PET.
abstract: In cardiac SPECT, specificity is significantly affected by artifacts due to photon absorption. As the success of attenuation correction depends mainly on high-quality attenuation maps, SPECT low-dose CT devices are promising. We wanted to evaluate the usefulness of a SPECT low-dose CT device in myocardial perfusion scintigraphy. For the evaluation of attenuation correction systems, primarily comparisons with coronary angiography are used. Because the comparison of a method showing myocardial perfusion with an investigation displaying the morphology of vessels yields some difficulties, we chose perfusion PET with (13)N-ammonia as the reference method.
  
  
  METHODS
  We prospectively analyzed 23 patients (6 women, 17 men) with known or suspected coronary artery disease. Rest studies and studies under pharmacologic stress with adenosine were performed. After simultaneous injection of (13)N-ammonia and (99m)Tc-sestamibi, a dynamic PET acquisition was started. The SPECT study was performed about 2 h later. Based on 20-segment polar maps, SPECT with and without attenuation correction was compared with PET-derived perfusion values and ammonia uptake values. The PET uptake images were also smoothed to adjust their resolution to the resolution of the SPECT images.
  
  
  RESULTS
  The concordance of SPECT and PET studies was improved after attenuation correction. The main effect was seen in the inferior wall. Especially in the apex and anterolateral wall, there were differences between SPECT and PET studies not attributable to attenuation artifacts. Because these differences diminished after smoothing of the PET studies, they might be due to partial-volume effects caused by the inferior resolution of the SPECT images.
  
  
  CONCLUSIONS
  The x-ray-derived attenuation correction leads to SPECT images that represent myocardial perfusion more accurately than nonattenuation-corrected SPECT images. The benefit of the method is seen primarily in the inferior wall. The low resolution of the SPECT system may lead to artifacts due to partial-volume effects. This phenomenon must be considered when perfusion PET is used as a reference method to investigate the effect of attenuation correction.
authors.affiliation: Institute of Molecular Biophysics, Radiopharmacy and Nuclear Medicine, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany. efricke@hdz-nrw.de
authors.forename: Eva
authors.initials: E
authors.lastname: Fricke
authors.forename: Harald
authors.initials: H
authors.lastname: Fricke
authors.forename: Reiner
authors.initials: R
authors.lastname: Weise
authors.forename: Annett
authors.initials: A
authors.lastname: Kammeier
authors.forename: Ralph
authors.initials: R
authors.lastname: Hagedorn
authors.forename: Norbert
authors.initials: N
authors.lastname: Lotz
authors.forename: Oliver
authors.initials: O
authors.lastname: Lindner
authors.forename: Diethelm
authors.initials: D
authors.lastname: Tschoepe
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Burchert
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016477:Artifacts; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*