Quantitative high-efficiency cadmium-zinc-telluride SPECT with dedicated parallel-hole collimation system in obese patients: results of a multi-center study.
BACKGROUND
Obesity is a common source of artifact on conventional SPECT myocardial perfusion imaging (MPI). We evaluated image quality and diagnostic performance of high-efficiency (HE) cadmium-zinc-telluride parallel-hole SPECT MPI for coronary artery disease (CAD) in obese patients.


RESULTS
118 consecutive obese patients at three centers (BMI 43.6 ± 8.9 kg·m(-2), range 35-79.7 kg·m(-2)) had upright/supine HE-SPECT and invasive coronary angiography > 6 months (n = 67) or low likelihood of CAD (n = 51). Stress quantitative total perfusion deficit (TPD) for upright (U-TPD), supine (S-TPD), and combined acquisitions (C-TPD) was assessed. Image quality (IQ; 5 = excellent; < 3 nondiagnostic) was compared among BMI 35-39.9 (n = 58), 40-44.9 (n = 24) and ≥45 (n = 36) groups. ROC curve area for CAD detection (≥50% stenosis) for U-TPD, S-TPD, and C-TPD were 0.80, 0.80, and 0.87, respectively. Sensitivity/specificity was 82%/57% for U-TPD, 74%/71% for S-TPD, and 80%/82% for C-TPD. C-TPD had highest specificity (P = .02). C-TPD normalcy rate was higher than U-TPD (88% vs 75%, P = .02). Mean IQ was similar among BMI 35-39.9, 40-44.9 and ≥45 groups [4.6 vs 4.4 vs 4.5, respectively (P = .6)]. No patient had a nondiagnostic stress scan.


CONCLUSIONS
In obese patients, HE-SPECT MPI with dedicated parallel-hole collimation demonstrated high image quality, normalcy rate, and diagnostic accuracy for CAD by quantitative analysis of combined upright/supine acquisitions.
Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building Suite 1258, Los Angeles, CA, 90048, USA.
Ryo
R
Nakazato
Piotr J
PJ
Slomka
Mathews
M
Fish
Ronald G
RG
Schwartz
Sean W
SW
Hayes
Louise E J
LE
Thomson
John D
JD
Friedman
Mark
M
Lemley
Maria L
ML
Mackin
Benjamin
B
Peterson
Arielle M
AM
Schwartz
Jesse A
JA
Doran
Guido
G
Germano
Daniel S
DS
Berman
D016477:Artifacts; D019187:Cadmium Compounds; D002140:California; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods; D009765:Obesity / Q000150:complications; D015203:Reproducibility of Results; D018036:Selenium Compounds; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation*; D014159:Transducers; D017967:Zinc Compounds
D019187:Cadmium Compounds; D018036:Selenium Compounds; D017967:Zinc Compounds; C058667:cadmium selenide; C044696:zinc selenide