title: Value of attenuation correction in stress-only myocardial perfusion imaging using CZT-SPECT.
abstract: Attenuation correction (AC) improves the diagnostic outcome of stress-only myocardial perfusion imaging (MPI) using conventional SPECT. Our aim was to determine the value of AC using a cadmium zinc telluride-based (CZT)-SPECT camera.
  
  
  
  We retrospectively included 107 consecutive patients who underwent stress-optional rest MPI CZT-SPECT/CT. Next, we created three types of images for each patient; (1) only displaying reconstructed data without the CT-based AC (NC), (2) only displaying AC, and (3) with both NC and AC (NC + AC). Next, two experienced physicians visually interpreted these 321 randomized images as normal, equivocal, or abnormal. Image outcome was compared with all hard events over a mean follow-up time of 47.7 ± 9.8 months. The percentage of images interpreted as normal increased from 45% using the NC images to 72% using AC and to 67% using NC + AC images (P < .001). Hard event hazard ratios for images interpreted as normal were not different between using NC and AC (1.01, P = .99), or NC and NC + AC images (0.97, P = .97).
  
  
  
  AC lowers the need for additional rest imaging in stress-first MPI using CZT-SPECT, while long-term patient outcome remained identical. Use of AC reduces the need for additional rest imaging, decreasing the mean effective dose by up to 1.2 mSv.
authors.affiliation: Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands. jorisvdijk@gmail.com.|MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. jorisvdijk@gmail.com.
authors.forename: J D
authors.initials: JD
authors.lastname: van Dijk
authors.affiliation: Department of Cardiology, Isala Hospital, Zwolle, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Mouden
authors.affiliation: Department of Cardiology, Isala Hospital, Zwolle, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: Department of Medical Physics, Isala Hospital, Zwolle, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: van Dalen
authors.affiliation: Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Knollema
authors.affiliation: MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
authors.forename: C H
authors.initials: CH
authors.lastname: Slump
authors.affiliation: Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
authors.forename: P L
authors.initials: PL
authors.lastname: Jager
mesh_terms: D000465:Algorithms; D016477:Artifacts; D002104:Cadmium / Q000528:radiation effects; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005080:Exercise Test / Q000295:instrumentation*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality*; D055414:Myocardial Perfusion Imaging / Q000295:instrumentation*; D009426:Netherlands / Q000453:epidemiology; D015588:Observer Variation; D015995:Prevalence; D011379:Prognosis; D011877:Radionuclide Imaging / Q000295:instrumentation / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013691:Tellurium / Q000528:radiation effects; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation*; D015032:Zinc / Q000528:radiation effects
chemical_list: C474490:CdZnTe; D002104:Cadmium; D015032:Zinc; D013691:Tellurium
keywords: Attenuation correction; CdZnTe; myocardial perfusion imaging: SPECT; stress-only