title: Influence of SPECT attenuation correction on the quantification of hibernating myocardium as derived from combined myocardial perfusion SPECT and ¹⁸F-FDG PET.
abstract: BACKGROUND
  To evaluate the influence of SPECT attenuation correction on the quantification of hibernating myocardium derived from perfusion SPECT and (18)F-FDG PET.
  
  
  RESULTS
  20 patients underwent rest (99m)Tc-tetrofosmin perfusion SPECT/CT and (18)F-FDG PET/CT. Perfusion images were reconstructed without attenuation correction (NC), with attenuation correction based on the CT from the SPECT/CT (AC_SPECT), and with attenuation correction based on the CT from the PET/CT (AC_PET). Another 56 patients had rest (99m)Tc-tetrofosmin perfusion SPECT and (18)F-FDG PET/CT. Perfusion images were reconstructed as NC and AC_PET. The amounts of hibernating myocardium and scar were quantified with QPS and corresponding AC and NC normative databases. In both cohorts, perfusion in the inferior wall was higher in the AC scans than without AC. Global and regional values for total perfusion deficit (TPD), hibernation and scar areas did not differ between NC, AC_SPECT, and AC_PET scans. In a retrospective evaluation with 7% cut-off of hibernating myocardium as a condition for revascularization, the therapeutic approach would have been altered in 5 of 56 patients, if the AC_PET approach had been used.
  
  
  CONCLUSIONS
  AC of SPECT perfusion scans with an attenuation map derived from PET/CT scans is feasible. If AC is unavailable, perfusion scans should be compared to NC normative databases for assessing TPD, hibernation, and mismatch. It should be taken into account that in approximately 10% of the patients, a therapeutic recommendation based on published thresholds for hibernating myocardium would be altered if NC scans were used as compared to AC scans.
authors.affiliation: Department of Nuclear Medicine, University of Munich, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lehner
authors.forename: Christian
authors.initials: C
authors.lastname: Sussebach
authors.forename: Andrei
authors.initials: A
authors.lastname: Todica
authors.forename: Christopher
authors.initials: C
authors.lastname: Uebleis
authors.forename: Stefan
authors.initials: S
authors.lastname: Brunner
authors.forename: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.forename: Serge D
authors.initials: SD
authors.lastname: Van Kriekinge
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
authors.forename: Marcus
authors.initials: M
authors.lastname: Hacker
mesh_terms: D000368:Aged; D000465:Algorithms; D016477:Artifacts; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D017682:Myocardial Stunning / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18