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Impact of CT attenuation correction on the viability pattern assessed by (99m)Tc-tetrofosmin SPECT/ (18)F-FDG PET.
MedLine Citation:
PMID:  20931288     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
SPECT myocardial perfusion imaging (MPI) is commonly used for comprehensive interpretation of metabolic PET FDG imaging in ischemic dysfunctional myocardium. We evaluated the difference in scan interpretation introduced by CT attenuation correction (CTAC) of SPECT MPI in patients undergoing viability characterization by (99m)Tc SPECT MPI/PET FDG. In 46 consecutive patients (mean age 64, range 36-83 years) with dysfunctional myocardium, we analyzed viability from combined SPECT MPI and PET FDG scanning without attenuation correction (NC) and with CTAC for SPECT MPI. FDG uptake was classified in groups of percent uptake using the segment with maximum tracer in SPECT perfusion uptake as reference. Viability patterns were categorized as normal, mismatch, mild match and scar by relative comparison of SPECT and PET. Applying CTAC introduced a different reference segment for the normalization of PET FDG study in 57% of cases. As a result, the flow-metabolism pattern changed in 28% of segments, yielding a normal, mismatch, mild match and scar pattern in 462, 150, 123, and 47 segments with NC and 553, 86, 108, and 35 with CTAC, respectively (P = 0.001). Thus, by introducing CTAC for SPECT MPI 25% of segments originally classified as scar were reclassified and the number of normal segments increased by 20%. Introducing CTAC decreased by 54% the number of patients with possible indication for revascularization, from 26/46 to 12/46 (P < 0.001). Different interpretation of myocardial viability can be observed when using CTAC instead of NC SPECT MPI as reference for PET FDG scans.
Authors:
Rene Nkoulou; Aju P Pazhenkottil; Ronny R Buechel; Lars Husmann; Ines Valenta; Bernhard A Herzog; Mathias Wolfrum; Jelena R Ghadri; Philipp A Kaufmann
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Publication Detail:
Type:  Journal Article     Date:  2010-10-08
Journal Detail:
Title:  The international journal of cardiovascular imaging     Volume:  27     ISSN:  1875-8312     ISO Abbreviation:  Int J Cardiovasc Imaging     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100969716     Medline TA:  Int J Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  913-21     Citation Subset:  IM    
Affiliation:
Cardiac Imaging, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
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