Multicenter investigation comparing a highly efficient half-time stress-only attenuation correction approach against standard rest-stress Tc-99m SPECT imaging

Abstract

Background: New iterative algorithms for scatter compensation (SC), noise suppression, and depth-dependent collimator resolution (RR) can shorten rest and stress SPECT acquisitions by 50% while maintaining quality and accuracy equivalent to conventional scans. Full-time stress-only myocardial perfusion SPECT is accurate and efficient when combined with line-source attenuation correction (LSAC). We investigated the potential for half-time stress-only LSAC-SPECT by comparing this to conventional rest/stress SPECT in patients imaged for suspected CAD at three different centers.

Methods: One hundred and ten patients (58% men, 53% exercise) had 64 projection rest/stress Tc-99m ECG-gated SPECT with simultaneous Gd-153 LSAC: 18 had <or=5% CAD likelihood and 92 had coronary angiography. The stress scans were retrospectively 'stripped' to create equally spaced 32 projection "half-time" (HT) scans for the emission and transmission (TX) projections. Astonish (Philips, Milpitas, CA) processing with AC, SC, and RR was applied to the HT data with the HT TX maps reconstructed using a Bayesian iterative method. The conventional rest/stress image sets processed using filtered back projection and without AC and the HT-AC stress-only images were interpreted in random sequence by consensus of two readers blinded to clinical information in separate reading sessions.

Results: Comparing rest/stress FBP and HT-LSAC, stress perfusion quality was excellent/good in 82 and 89% (P = .13); interpretive certainty (definitely normal or abnormal) was 88 and 95% (P = .14); sensitivity was 77 and 83% (P = .38); specificity was 67 and 71% (P = .65); normalcy was 94 and 100% (P = 1.0); SSS for CAD pts was 7.4 vs 7.8 and for non-CAD pts was 0.7 vs 0 (P = .44 and .16, respectively). Mean stress LVEF was 60% in both groups.

Conclusion: Stress-only imaging with HT-LSAC using the Astonish acquisition/processing method provides results equivalent to conventional rest/stress scanning. This new approach has the potential to significantly improve operational efficiency without sacrificing accuracy.