Multicenter clinical trial to evaluate the efficacy of correction for photon attenuation and scatter in SPECT myocardial perfusion imaging

Robert C. Hendel*, Daniel S. Berman, S. James Cullom, William Follansbee, Gary V. Heller, Hosen Kiat, Mark W. Groch, John J. Mahmarian

*Corresponding author for this work

Research output: Contribution to journalArticle

201 Citations (Scopus)


Background - Soft tissue attenuation is a prominent cause of single- photon emission computed tomography (SPECT) imaging artifacts, which may result in reduced diagnostic accuracy of myocardial perfusion imaging. A method incorporating simultaneously acquired transmission data permits nonuniform attenuation correction and when incorporating scatter correction and resolution compensation may substantially reduce interpretive errors. Methods and Results - A prospective multicenter trial was performed recruiting patients with angiographically documented coronary disease (n=96) and group of subjects with a low likelihood of disease (n=88). The uncorrected and attenuation/scatter corrected images were read independently, without knowledge of the patient's clinical data. The detection of ≥50% stenosis was similar using uncorrected perfusion data or with attenuation/scatter correction and resolution compensation (visual or visual plus quantitative analysis), 76% versus 75% versus 78%, respectively (P=NS). The normalcy rate, however, was significantly improved with this new methodology, using either the corrected images (86% vs 96%; P=0.011) or with the corrected data and quantitative analysis (86% vs 97%; P=0.007). The receiver operator characteristic curves were also found to be marginally but not significantly higher with attenuation/scatter correction than with tradition SPECT imaging. However, the ability to detect multivessel disease was reduced with attenuation/scatter correction. Regional differences were also noted, with reduced sensitivity but improved specificity for right coronary lesions using attenuation/scatter correction methodology. Conclusions - This multicenter trial demonstrates the initial clinical results of a new SPECT perfusion imaging modality incorporating attenuation and scatter correction in conjunction with 99mTc sestamibi perfusion imaging. Significant improvements in the normalcy rate were noted without a decline in overall sensitivity but with a reduction in detection of extensive coronary disease.

Original languageEnglish
Pages (from-to)2742-2749
Number of pages8
Issue number21
Publication statusPublished - 1 Jun 1999
Externally publishedYes


  • Diagnosis
  • Imaging
  • Nuclear medicine
  • Perfusion
  • Radioisotopes

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