title: Apical thinning: real or artefact?
abstract: OBJECTIVE
  Apical thinning is a well-known phenomenon in myocardial perfusion SPECT, often attributed to reduced myocardial thickness at the apex of the left ventricle. Attenuation correction processing appears to exaggerate this effect. Although currently there is agreement that reduced apical counts are not a diagnostic indicator, opinions differ over the cause of this effect; we sought to clarify this using results from a phantom study.
  
  
  METHODS
  A commercially available anthropomorphic torso phantom was expanded using attachments mimicking tissue and bone to create three phantoms of increasing size. These were imaged using a dual-headed gamma camera and low-dose CT-based attenuation correction. The data were processed using iterative reconstruction, with and without attenuation correction.
  
  
  RESULTS
  The cardiac insert had a uniform wall thickness and yet defects characteristic of apical thinning appeared after attenuation correction, increasing in severity with phantom size. Before attenuation correction, a flare of activity was seen at the apex corresponding in position and size to the defect after attenuation correction. Further investigations showed the following: depth-dependent resolution was not responsible; the severity of the defect was more noticeably dependent on the addition of breast activity than the addition of attenuating material; the artefact was not unique to one particular algorithm; increasing the number of iterations reduced the severity of the artefact.
  
  
  CONCLUSIONS
  Data acquisition and processing methods are thought to be responsible for the apparent apical defect. This phantom study therefore demonstrates that apical thinning is not simply an anatomical feature but can also be an artefact introduced by the use of attenuation correction.
authors.affiliation: Nuclear Medicine Department, Manchester Royal Infirmary, Manchester, UK.
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Purser
authors.forename: Ian S
authors.initials: IS
authors.lastname: Armstrong
authors.forename: Heather A
authors.initials: HA
authors.lastname: Williams
authors.forename: Christine M
authors.initials: CM
authors.lastname: Tonge
authors.forename: Richard S
authors.initials: RS
authors.lastname: Lawson
mesh_terms: D016477:Artifacts; D005189:False Positive Reactions; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D019047:Phantoms, Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*