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(Circulation. 1996;93:463-473.)
© 1996 American Heart Association, Inc.
Articles |
Simultaneous Transmission/Emission Myocardial Perfusion Tomography
Diagnostic Accuracy of Attenuation-Corrected 99mTc-SestamibiSingle-Photon Emission Computed Tomography
From the Department of Internal Medicine, Division of Nuclear Medicine, University of Michigan Medical Center (Ann Arbor).
Background The purpose of the present study was to assess the diagnostic performance of attenuation-corrected (AC) stress 99mTc-sestamibi cardiac single-photon emission computed tomography (SPECT) for the identification of coronary heart disease (CHD).
Methods and Results With a triple-detector SPECT system with
a 241Am transmission line source, simultaneous
transmission/emission tomography (TCT/ECT) was performed on 60 patients
with angiographic coronary disease and 59 patients with 
5%
likelihood of CHD. Iteratively reconstructed AC stress
99mTc-sestamibi perfusion images were compared with
uncorrected (NC) filtered-backprojection images. Normal
database polar maps were constructed from AC and NC images for
quantitative analyses. From the low-likelihood patients,
the visual and quantitative normalcy rates increased from 0.88 and 0.76
for NC to 0.98 and 0.95 for AC (P<.05). For the detection
of CHD, the receiver operating characteristic curves for the AC
images demonstrated improved discrimination capacity
(P<.05), and sensitivity/specificity values increased from
0.78/0.46 (NC) to 0.84/0.82 (AC) with visual analysis and from
0.84/0.46 (NC) to 0.88/0.82 (AC) with quantitative analysis.
For localization of stenosed vessels, visual and quantitative
sensitivity values were 0.51 and 0.63 for NC and 0.64 and 0.78 for AC
images (P<.05), respectively.
Conclusions TCT/ECT myocardial perfusion imaging significantly improves the diagnostic accuracy of cardiac SPECT for the detection and localization of CHD. Clinical use of TCT/ECT imaging deserves serious consideration.
Key Words: cardiovascular disease • coronary disease • imaging • radioisotopes • tomography
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