Medical Radiology and Radiation Safety. 2017. Vol. 62. No. 6. P. 51-57

NUCLEAR MEDICINE

DOI: 10.12737/article_5a2541849d5335.59531206

Effect of Correction of Gamma-Radiation Absorption in the Study of Myocardial Perfusion by SPECT/CT

E.A. Khachirova¹, L.E. Samoylenko², O.P. Shevchenko¹

1. N.I. Pirogov Russian National Research Medical University, Moscow, Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ; 2. Russian Medical Academy of Postgraduate Education, Moscow, Russia

E.A. Khachirova – assistant; L.E. Samoylenko – Dr. Sc. Med., Prof.; O.P. Shevchenko – Dr. Sc. Med., Prof., Head the Department, Member of the European Society of Cardiology

Abstract

Purpose: Assessment of the impact of absorption correction (AC) on quantitative parameters of myocardial perfusion and determination of the extent of stress-induced myocardial microcirculation disorders on SPECT/CT in patients with chest pain and unchanged coronary arteries.

Material and methods: the study included 35 patients, each of whom was carried a selective coronary angiography and rest/stress SPECT/CT of the myocardium with ^99mTc -MIBI with- and without AC.

Results: In all patients with stress-induced myocardial ischemia was detected both without and with AC images. However, quantitative parameters of myocardial perfusion were lower after the AC: SSS 6.9 ± 1.2 vs. 7.7 ± 1.1; SDS 4.0 ± 0.8 vs. 4.9 ± 0.6; Stress ext. Total 11.2 ± 1.8 vs. 13.0 ± 1.9; Stress TPD total 9.3 ± 1.2 vs.10.9 ± 1.2; TPDi 4.1 ± 1.0 vs.5.9 ± 0.9 (for all p < 0.05). For SRS, Rest ext. Total, and Rest TPD total difference was not significant. The number of hypoperfused segments, according to the segmental analysis, was less after AC and was 126 vs. 153 at rest, 242 vs. 177 under stress. In women, significant difference was obtained for all parameters, for men – only for the SSS, SDS, Stress ext. Total, Stress TPD total. In patients with BMI ≥25 significant difference for all parameters was obtained. However, patients with the normal BMI (18,5–24,9; WHO, 2004) significant difference was obtained only for Stress ext. Total, Stress TPD total.

Conclusion: The use of SPECT/CT with AC allow to detect microcirculatory violations of perfusion and myocardial reserve perfusion in patients with pain in the chest with the unchanged AC, as evidenced by indicators of the average values of quantitative parameters of perfusion scintigram. The most significant impact on the quantitative perfusion parameters was observed in women with well-developed breasts and obese patients. The findings give reason to assume the use of AC to avoid revaluation incidence and severity of stress-induced myocardial perfusion disturbances.

Key words: SPECT/CT, gamma-ray emission, absorption correction, microvascular angina, myocardial perfusion

REFERENCES

1. Sciagra R., Leoncini M. Gated single-photon emission computed tomography. The present-day ‹›one-stop-shop›› for cardiac imaging. J. Nucl. Med. Mol. Imaging. 2005. Vol. 49. No. 1. P. 19–29.
2. Beyer T., Townsend D.W., Blodgett T.M. Dualmodality PET/CT tomography for clinical oncology. J. Nucl. Med. 2002. Vol. 46. No. 1. P. 24–34.
3. Friedman T.D., Greene A.C., Iskandrian A.S. et al. Exercise thallium-201 myocardial scintigraphy in women: correlation with coronary arteriography. Amer. J. Cardiol. 1982. Vol. 49. P. 1632–1637.
4. Gaemperli O., Schepis T., Kalff V., Namdar M. et al. Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography. Eur. J. Nucl. Med. Mol. Imaging. 2007. Vol. 34. No. 7. P. 1097–1106.
5. Schillaci O. Hybrid SPECT/CT: a new era for SPECT imaging?. Eur. J. Nucl. Med. Mol. Imaging. 2005. Vol. 32. No. 5. P. 521– 524.
6. Gaemperli O., Saraste A., Knuuti J. Cardiac hybrid imagine. Eur. Heart J. Cardiovasc. Imaging. 2012. Vol. 13. No. 1. P. 51–60.
7. Hendel R., Corbett J., Cullom S. et al. The value and practice of attenuation correction for myocardial perfusion SPECT imaging: a joint position statement from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine. J. Nucl. Cardiol. 2002. Vol. 9. No. 1. P. 135–143.
8. Dvorak R.A., Brown R.K., Corbett J.R. Interpretation of SPECT/CT myocardial perfusion images: common artifacts and quality control techniques. Radiographics. 2011. Vol. 31. No. 7. P. 2041–2057.
9. Solomyanyy V., Sergienko V. Quantitative evaluation with attenuation correction improves specificity of myocardial perfusion SPECT in the assessment of functionally significant intermediate coronary artery stenosis: a comparative study with fractional flow reserve 23 measurements. Eur. J. Nucl. Med. Mol. Imaging. 2013. Vol. 40. No. 2. Supplement. P. 546–550.
10. Apostolopoulos D. J., Savvopoulos C. What is the benefit of CT-based attenuation correction in myocardial perfusion SPET?. Hell. J. Nucl. Med. 2016. Vol. 19. No. 2. P. 89–92.
11. Prasad M., Slomka P.J., Fish M. et al. Improved quantification and normal limits for myocardial perfusion stress-rest change. J. Nucl. Med. 2010. Vol. 51. P. 204–209.
12. Genovesi D., Giorgetti A. Impact of attenuation correction and gated acquisition in SPECT myocardial perfusion imaging: Results of the multicentre SPAG (SPECT Attenuation Correction vs Gated) study. Eur. J. Nucl. Med. 2011. Vol. 38. No. 10. P. 1890–1898.
13. Shawgi M., Tonge C. et al. Attenuation correction of myocardial perfusion SPET in patients of normal body mass index. Hell. J. Nucl. Med. 2012. 15. No. 3. P. 2015–2019.
14. Karpova I.E., Samoylenko L.E., Soboleva G.N. et al. Primeneniye odnofotonnoy emissionnoy kompyuternoy tomografii s ^99mTc-MIBI v sochetanii s farmakologicheskoy proboy s adenozintrifosfatom natriya v diagnostike ishemii miokarda u bolnykh s mikrovaskulyarnoy stenokardiyey. Kardiologiya. 2014. No. 7. P. 4–8. (In Russ.).
15. Khachirova E.A., Samoylenko L.E., Shevchenko O.P., Karpova I.E. Otsenka perfuzii miokarda u patsiyentov s bolevym sindromom v grudnoy kletke i angiograficheski neizmenennymi koronarnymi arteriyami. po dannym odnofotonnoy emissionnoy kompyuternoy tomografii. sovmeshchennoy s rentgenovskoy kompyuternoy tomografiyey. Kardiovaskulyarnaya terapiya i profilaktika . 2016. Vol. 15. No. 1. P. 58–63. (In Russ.).
16. Massoud T., Gambhir S. Molecular imaging in living subjects: seeing fundamental biological processes in a new light. Genes. Dev. 2003. Vol. 17. No. 5. P. 545–580.
17. Goodgold H.M., Render J.G., Samuels L.D. et al. Improved interpretation of exercise Tl-201 myocardial perfusion scintigraphy in women: characterization of breast attenuation artifacts. Radiology. Vol. 165. P. 361–366.
18. Desmarias R., Kaul, S., Watson D. et al. Do false positive thallium-201 scans lead to unnecessary catheterization? Outcome of patients with perfusion defects on quantitative planar thallium scintigraphy. J. Amer. Coll. Cardiol. 1993. Vol. 21. P. 1058–1063.
19. Holly T.A., Parker M.A., Hendel R.C. The prevalence of non-uniform soft tissue attenuation in myocardial SPECT perfusion imaging and the impact of gated SPECT. J. Nucl. Cardiol. 1997. Vol. 4. P. S103 (abstract).
20. Namdar M., Hany T.F., Koepfli P. et al. Integrated PET/CT for the assessment of coronary artery disease: a feasibility study. J. Nucl. Med. 2005. Vol. 46. P. 930–935.
21. Corbett J. R., Ficaro E.P. Clinical review of attenuation-corrected cardiac SPECT. J. Nucl. Cardiol. 1999. Vol. 6. P. 54–68.
22. Nelson M.D., Szczepaniak L.S., Wei J. et al. Diastolic dysfunction in women with signs and symptoms of ischemia in the absence of obstructive coronary artery disease a hypothesis-generating study. Circ. Imaging. 2014. Vol. 7. P. 510–516.

For citation: Khachirova EA, Samoylenko LE, Shevchenko OP. Effect of Correction of Gamma-Radiation Absorption in the Study of Myocardial Perfusion by SPECT/CT. Medical Radiology and Radiation Safety. 2017;62(6):51–7. Russifn. DOI: 10.12737/article_5a2541849d5335.59531206

PDF (RUS) Full-text article (in Russian)