Abstract: Although myocardial perfusion imaging with single photon emission computed tomography (SPECT) is an accurate and reliable diagnostic study, artifacts must be avoided, or detected and corrected, to minimize the rate of false-positive results. We aimed to compare supine uncorrected (NC) and attenuation correction (AC) via Gadolinium-153 (Gd-153)-based attenuation maps with prone SPECT imaging. METHODS: A total of 40 consecutive patients referred for stress/rest Myocardial Perfusion Imaging (MPI) were included in this study. Transmission source used was Gd-153 line source and emission sources were Technitium-99m Methoxy Isobutyl Isonitrile (MIBI) and Thalllium-201. In supine position simultaneous or sequential transmission emission protocol (STEP) was carried out for Tc-99m MIBI and Tl-201 respectively. NC, AC MPI data was acquired. In addition patients were imaged in prone position too. Data was analyzed visually and by Cedars Quantitative Perfusion SPECT (QPS). 20 segment cardiac model was used to analyze the data and percentage uptake (%U) in all 20 cardiac segments was noted and compared (NC/AC, NC/Prone &AC/Prone. Student t test was applied on the data. RESULTS: In males anterior wall showed more improvement in mean of %U with prone positioning than AC but insignificant difference (p>.05) was noticed in their means for both in Tl-201 MPI and Tc-99m MIBI MPI. In males inferior wall, AC images showed more mean %U than in prone data (p<.001) in all pairs for both in Tl-201 MPI and Tc-99m MIBI MPI except in Tl-201 stress MPI study where prone images showed improved %U (p<.001). In females anterior wall %U was improved more with prone positioning than AC both in MIBI (p<.05) and Tl-201(p<.05). In females mean of %U in inferior wall was significantly improved with AC in MIBI stress data (p<.001) but in rest study with Tc-99m MIBI correction improvement in mean of %U was just significant in prone (p=.05) CONCLUSIONS: In conclusion, interpretation with all the 16 sets of supine AC /prone revealed that in 9 out of 16 sets attenuation was better corrected by prone as compared to AC. 7 showed more improvement with AC. It is recommended that the method of attenuation correction should be according to nature of artifact encountered, its anatomic location and radiopharmaceutical used Summary: A head to head comparison between two validated methods for correction of attenuation artifacts encountered in Myocardial Perfusion Imaging.References: East of England, NHS, UK
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