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Updated: Aug 24, 2026
High-Resolution Cardiac Positron Emission Tomography/Computed Tomography for Small Animals
Published on: December 16, 2022
Scatter and attenuation correction changes interpretation of gated myocardial perfusion imaging
Allan Johansen1, Peter Grupe, Annegrete Veje
1Department of Nuclear Medicine, Odense University Hospital, 5000, Odense C, Denmark, allan.johansen@dadlnet.dk
Abstract:
Attenuation correction may improve the diagnostic accuracy of myocardial perfusion imaging (MPI). However, few studies have dealt with the clinical consequences for reporting. We compared routine reports based on scatter-corrected MPI (MPI-routine) with consensus readings of scatter-corrected (MPI-scatter) and scatter plus attenuation-corrected studies (MPI-attenuation) to investigate the impact of attenuation correction on reporting. One hundred consecutive stable angina patients (including 55 men) were investigated in a 99mTc-sestamibi 2-day gated protocol with scatter and attenuation correction. With MPI-routine, 53 patients had normal perfusion and 47 abnormal perfusion, compared to 62 and 38 with MPI-attenuation, and 54 and 46, respectively, with MPI-scatter. Agreement between MPI-routine and MPI-attenuation with respect to overall diagnosis (normal/abnormal perfusion) was 89% (kappa=0.78) compared to 95% (kappa=0.90) between MPI-routine and MPI-scatter. With MPI-attenuation, the overall routine diagnosis changed in 11 patients, of which ten cases were judged normal after scatter plus attenuation correction. The majority of the "normalised" studies were among patients with apparently single-vessel RCA disease as judged from MPI. Agreement rates with regard to normal, reversible or irreversible defects between MPI-attenuation and MPI-routine for the LAD, LCX and RCA territories were 88%, 97% and 85%, respectively, without significant sex differences. In conclusion, attenuation correction caused a change in diagnosis in approximately 10% of the patients, corresponding to one-fifth of the abnormal studies. In all but one case, the shift was from abnormal to normal, mostly because of a different interpretation in the RCA territory.
Insights
Attenuation correction in myocardial perfusion imaging (MPI) significantly impacts diagnostic accuracy, often changing abnormal findings to normal. This improves reporting for conditions like coronary artery disease.
Area of Science:
- Nuclear Medicine
- Cardiology
- Medical Imaging
Background:
- Myocardial perfusion imaging (MPI) is crucial for diagnosing heart conditions.
- Attenuation correction can enhance MPI's diagnostic accuracy.
- Clinical reporting consequences of attenuation correction in MPI require further investigation.
Purpose of the Study:
- To investigate the impact of attenuation correction on the clinical reporting of myocardial perfusion imaging (MPI).
- To compare routine MPI reports with consensus readings incorporating scatter and attenuation correction.
Main Methods:
- A 99mTc-sestamibi 2-day gated MPI protocol was used with scatter and attenuation correction.
- One hundred stable angina patients were analyzed.
- Routine reports were compared against consensus readings of scatter-corrected and scatter plus attenuation-corrected studies.
Main Results:
- Attenuation correction changed the diagnosis in approximately 10% of patients, primarily from abnormal to normal.
- Agreement between routine and attenuation-corrected MPI was 89% for overall diagnosis.
- The majority of normalized studies were in patients with apparent single-vessel RCA disease.
Conclusions:
- Attenuation correction significantly alters MPI diagnoses, leading to more normal findings.
- The interpretation of the RCA territory was most affected by attenuation correction.
- Scatter plus attenuation correction improves diagnostic reporting accuracy in MPI.
