Initial experience with X-ray CT based attenuation correction in myocardial perfusion SPECT imaging using a combined SPECT/CT system
Initial experience with X-ray CT based attenuation correction in myocardial perfusion SPECT imaging using a combined SPECT/CT system
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DOI：
10.1007/bf02985576
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发表时间：
2005-09-01
影响因子：
2.6
通讯作者：
Yamashita, Y
中科院分区：
文献类型：
--
作者：
Utsunomiya, D;Tomiguchi, S;Yamashita, Y
目的：衰减伪影影响心肌灌注成像的诊断准确性。我们通过比较心肌AC和非校正（NC） SPECT图像与冠状动脉造影（CAG），评估了x线CT衰减校正（AC）在心肌灌注成像患者中的临床应用价值。方法：回顾性分析30例患者的心肌SPECT图像（男18例，女12例，平均年龄68岁）。30例冠心病（CAD）患者中13例经CAG确诊，17例无冠心病。在运动或药理学应激方案下，使用我们的联合SPECT/ CT系统，他们接受了铊-201 （111 MBq）序列CT和心肌SPECT成像。两位读者回顾了心肌SPECT图像是否存在CAD的4分制，其中1 =正常，2 =可能正常，3 =可能异常，4 =异常。举办了两次读书会。首先，使用x射线CT图像解释非校正(NC)-SPECT和第二，AC-SPECT图像。用kappa统计评估观察者间的变异。比较AC和nc影像对冠状动脉狭窄的诊断效能（准确性）。结果：观察者之间对视觉评价的一致是实质性的或几乎完全的。对于ac图像，分析的观察者共识为LAD- 0.84, LCX- 0.87, rca - 0.71。nc图像分别为0.91、0.71和0.78。AC导致总体诊断准确性的统计学显著提高（AC和nc图像的敏感性/特异性/准确性分别为76%/93%/89%，67%/86%/81%）。结论：由于特异性的增加，ac图像的诊断准确性显著提高。这些初步数据表明，基于x线CT的AC在心肌SPECT成像中有可能发展成为一种可靠的临床技术。
Objective: Attenuation artifacts adversely affect the diagnostic accuracy of myocardial perfusion imaging. We assessed the clinical usefulness of X-ray CT based attenuation correction (AC) in patients undergoing myocardial perfusion imaging by comparing their myocardial AC- and non-corrected (NC) SPECT images with the coronary angiography (CAG). Methods: We retrospectively reviewed the myocardial SPECT images of 30 patients (18 men, 12 women; mean age 68 years). Thirteen of 30 patients with coronary artery disease (CAD) and 17 without CAD were confirmed by CAG. They underwent sequential CT and myocardial SPECT imaging with thallium-201 (111 MBq) under an exercise or pharmacological stress protocol using our combined SPECT/ CT system. Two readers reviewed the myocardial SPECT images for the presence of CAD on a 4-point scale where 1 = normal, 2 = probably normal, 3 = probably abnormal, and 4 = abnormal. Two reading sessions were held. First, non-corrected (NC)-SPECT and second, AC-SPECT images using X-ray CT images were interpreted. Interobserver variability was assessed with kappa statistics. Diagnostic performance (accuracy) of coronary arterial stenosis was compared between AC- and NC-images. Results: Interobserver agreement for visual assessment was substantial or almost perfect. For AC-images, the observer consensus for analysis was 0.84 for the LAD-, 0.87 for the LCX-, and 0.71 for the RCA-territory. For NC-images, it was 0.91, 0.71, and 0.78. AC resulted in statistically significant improvements in overall diagnostic accuracy (sensitivity/ specificity/accuracy = 76%/93%/89%, 67%/86%/81%, respectively, for AC- and NC-images). Conclusions: Because of an increase in the specificity, diagnostic accuracy was significantly increased on AC-images. These preliminary data suggest that X-ray CT based AC in myocardial SPECT imaging has the potential to develop into a reliable clinical technique.