Impact of Gd-153 scanning line source attenuation correction on downstream invasive testing

Area of Science:

• Nuclear Medicine
• Cardiology
• Medical Imaging

Background:

• Attenuation correction (AC) in SPECT MPI aims to improve specificity and prognostic ability, theoretically reducing downstream testing and costs.
• Gd-153 scanning line source AC is a hardware/software solution for SPECT MPI.
• The impact of AC on downstream invasive testing requires assessment.

Purpose of the Study:

• To evaluate the effect of Gd-153 scanning line source attenuation correction during SPECT MPI on subsequent invasive testing.
• To determine if AC influences abnormal MPI results, coronary angiography rates, and revascularization decisions.

Main Methods:

• Retrospective review of 9968 patients undergoing Tc-99m stress SPECT MPI from 2013-2015 across five hospitals (2 with AC, 3 without).
• Data collected included patient demographics, MPI results, coronary angiography within 90 days, and revascularization.
• Propensity matched subgroup analysis was performed to compare outcomes between groups with and without AC.

Main Results:

• No significant difference in abnormal MPI results between AC and non-AC groups (31.5% vs 30.4%).
• Higher rates of coronary angiography within 90 days in the AC group (10.6% vs 8.7%).
• Fewer patients with obstructive coronary disease in the AC group underwent revascularization (36.1% vs 46.8%).

Conclusions:

• Gd-153 scanning line source AC did not substantially change abnormal MPI rates or downstream invasive testing in this cohort.
• The clinical utility of this AC method may be limited, potentially aiding stress-first imaging protocols.
• Further research may be needed to clarify the role of AC in optimizing patient management pathways.