title: Difference in appearance between prone and supine myocardial perfusion images obtained on a high-efficiency cadmium zinc telluride SPECT camera.
abstract: OBJECTIVE
  The recent introduction of high-efficiency solid-state gamma cameras for myocardial perfusion single photon emission computed tomography has enabled lower patient radiation dose, faster imaging, and improved image quality. However, artifacts still complicate interpretation. Prone imaging is a common maneuver to reduce artifacts and increase accuracy for detection of coronary artery disease, but its effect on imaging relative to supine imaging has not been fully characterized in these new systems.
  
  
  METHODS
  In this IRB-approved, HIPAA-compliant retrospective study, 30 patients were reviewed, who underwent prone and supine imaging on the GE 530c multipinhole cadmium zinc telluride camera under both rest and stress conditions. Informed consent was waived. Perfusion was scored visually by two readers on a five-point scale according to the 17-segment model. Differences were assessed for significance using a multivariate linear effects model and restricted maximum likelihood method.
  
  
  RESULTS
  Prone positioning resulted in increased activity in the basal inferior (P<0.001), basal inferolateral (P=0.009), basal inferoseptal (P<0.001), and mid-inferior (P<0.001) segments when taking into account factors such as stress versus rest, perfusion scores of other segments, and reader.
  
  
  CONCLUSIONS
  Prone imaging on the GE 530c camera increases measured tracer activity in the basal inferior, basal inferolateral, basal inferoseptal, and mid-inferior segments. Caution is advised when diagnosing myocardial ischemia in these territories, particularly if clinical data are unavailable.
authors.affiliation: aDepartment of Radiology, Division of Nuclear Medicine, Duke University Medical Center bDepartment of Biostatistics and Bioinformatics, Duke University, Durham cDepartment of Radiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Howard
authors.forename: Kingshuk
authors.initials: K
authors.lastname: Roy Choudhury
authors.forename: Jorge D
authors.initials: JD
authors.lastname: Oldan
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pagnanelli
authors.forename: Salvador
authors.initials: S
authors.lastname: Borges-Neto
mesh_terms: D000328:Adult; D000368:Aged; D002104:Cadmium; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000295:instrumentation / Q000379:methods*; D016684:Prone Position; D012146:Rest; D012189:Retrospective Studies; D013312:Stress, Physiological; D016683:Supine Position; D013691:Tellurium; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation / Q000379:methods*; D015032:Zinc
chemical_list: C474490:CdZnTe; D002104:Cadmium; D015032:Zinc; D013691:Tellurium