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Computed tomography attenuation correction improves the risk stratification accuracy of myocardial perfusion imaging

Ou, Xiaohong*; Jiang, Lisha*; Huang, Rui; Li, Fanglan; Zhao, Zhen; Li, Lin

Nuclear Medicine Communications: May 2013 - Volume 34 - Issue 5 - p 495–500
doi: 10.1097/MNM.0b013e328360053a
Original Articles

Purpose: Computed tomography attenuation correction (CT-AC) may improve the image quality and diagnostic accuracy of myocardial perfusion imaging. We evaluated the prognostic value of single-photon emission computed tomography (SPECT) myocardial perfusion imaging with CT-AC.

Methods: Technetium-99m sestamibi stress/rest myocardial perfusion imaging was performed with SPECT and CT-AC in 935 patients. Images without and with AC were rated using the summed stress score (SSS) and classified as normal (SSS, 0–3), mildly abnormal (SSS, 4–8), or moderately or severely abnormal (SSS>8). All patients were followed up for a major adverse cardiac event (MACE).

Results: At the end of a mean follow-up period of 2.2±0.8 years, there had occurred 42 MACEs [17 all-cause deaths (2%) and 25 nonfatal myocardial infarctions (3%)]. The annual frequency of MACEs in patients with normal SSS was 0.5%, that in patients with mildly abnormal SSS was 2%, and in patients with moderately or severely abnormal SSS was 8%. With AC, more studies were categorized as definitely normal, and the number of patients with moderately to severely abnormal perfusion on CT-AC was reduced (κ=0.32, P≤0.001). The annual frequency of MACEs was similar between studies without AC and those with CT-AC for patients with normal or mildly abnormal SSS, whereas for the moderately to severely abnormal group the annual frequency increased significantly after CT-AC (4.5 vs. 8.1%, P=0.03). Cumulative survival without MACE was highest among patients who had normal CT-AC studies (SSS<4) and was the least among patients who had moderately to severely abnormal studies (SSS>8; P≤0.01).

Conclusion: CT-AC allows improved risk stratification for MACEs because there is a more clear separation between low risk and moderately to severely abnormal findings.

Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China

*Xiaohong Ou and Lisha Jiang contributed equally to the writing of this article.

Correspondence to Lin Li, MD, Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China Tel: +86 18 98 0 601 584; fax: +8602 885 422 187; e-mail:

Received January 19, 2013

Accepted February 10, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins