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Clinical Trial
. 2025 Jul:49:102226.
doi: 10.1016/j.nuclcard.2025.102226. Epub 2025 Apr 19.

Assessment of sestamibi CZT-SPECT reconstructed using deep-learning-based virtual attenuation correction maps according to coronary artery territory and with comparison to rubidium-PET

Telma Sprauel  1 , Laetitia Imbert  2 , Kaya Doyeux  3 , Mathieu Perrin  1 , Marine Claudin  1 , Véronique Roch  1 , Matthieu Doyen  4 , Nathaniel Roth  5 , Yechiel Lamash  5 , Renata Chequer  6 , François Rouzet  6 , Fabien Hyafil  7 , Pierre-Yves Marie  8
Affiliations
Clinical Trial

Assessment of sestamibi CZT-SPECT reconstructed using deep-learning-based virtual attenuation correction maps according to coronary artery territory and with comparison to rubidium-PET

Telma Sprauel et al. J Nucl Cardiol. 2025 Jul.

Abstract

Background: Attenuation artifacts affect the analysis of single-photon emission computed tomography (SPECT) myocardial perfusion imaging, especially in the right coronary artery (RCA) territory, although computed tomography (CT)-based attenuation corrections minimize this issue. This study aims to assess stress-rest [99mTc]sestamibi cadmium zinc telluride (CZT)-SPECT reconstructed using deep-learning-based attenuation correction (DLAC) maps according to coronary artery territory and with comparison to [82Rb]rubidium-positron emission tomography (Rb-PET) conventionally reconstructed with CT-based attenuation correction.

Methods: We compared stress-rest [99mTc]sestamibi CZT-SPECT reconstructed without (i.e., standard (SD-SPECT)) and with DLAC (DLAC-SPECT) in 84 patients at risk of attenuation artifacts (overweight individuals and women) with no previous history of coronary artery disease (CAD), and who also had Rb-PET and, when indicated, coronary angiography.

Results: In 74 very low CAD-risk patients: (i) the stress segmental activity values were homogeneous between the three coronary artery territories with DLAC-SPECT and Rb-PET but exhibited a marked reduction in the RCA territory with SD-SPECT (69.1% ± 8.2% vs 81.2% ± 7.1% and 77.7% ± 8.5% for DLAC-SPECT and Rb-PET, respectively, both P < .001), and (ii) the absolute value of the difference between the rest and stress segmental activities was higher in the RCA territory with SD-SPECT (5.13% ± 4.04%) than with DLAC-SPECT (4.21% ± 3.24%) and Rb-PET (3.92% ± 3.08%, both P < .001).

Conclusions: When utilizing DLAC maps for reconstruction of [99mTc]sestamibi CZT-SPECT, there is no more drop in the RCA territory uptake with lower fluctuations in stress-to-rest activity, aligning closely with the results observed using Rb-PET in the same patients.

Trial registration number: NCT01679886 on clinicaltrials.gov.

Keywords: Attenuation correction; CZT-camera; Deep learning; Myocardial perfusion imaging; Rubidium-PET; Sestamibi-SPECT.

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