Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction

Shishir Mathur, Gary V. Heller, Timothy M. Bateman, Richard Ruffin, Arshad Yekta, Deborah Katten, Nitya Alluri, Alan W. Ahlberg

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: In selected patients, stress-only SPECT imaging has been proposed as an alternative to rest-stress SPECT imaging to improve laboratory efficiency and reduce radiation exposure. The impact of attenuation correction (AC) upon interpretation, post-test patient management and cardiac risk stratification in relation to stress-only imaging is not well understood. Objectives: The purpose of this study was to determine the clinical value for laboratory throughput and predicting outcomes of normal and abnormal stress-only SPECT imaging with AC in a consecutive series of clinically referred patients. Methods: A retrospective analysis of 1,383 consecutive patients who were scheduled for stress-only SPECT imaging for symptom assessment of suspected myocardial ischemia was performed. All images had been interpreted and categorized using the standard 17-segment model without AC followed by AC. Follow-up data for 2.1 ± 1.3 years after SPECT imaging for the occurrence of cardiac events (non-fatal MI, cardiac death, and cardiac revascularization) previously collected by routine methods were reviewed. Results: Non-AC SPECT image interpretation revealed that 58% (802/1383) of patients had abnormal stress images. AC image interpretation of the abnormal non-AC images re-classified 83% (666/802) of these as normal. Among patients with abnormal stress images after AC (136/1383), 63% (86/136) returned for additional rest scans, while the remaining 37% (50/136) were clinically managed without further rest images. The incidence of cardiac death or non-fatal MI was very low in patients with normal stress-only scans (0.7%). Conclusion: A strategy of stress-only imaging with AC in symptomatic patients is an efficient method which appropriately identifies at risk and low-risk patients yielding a low percentage requiring rest imaging. Clinical decisions can be made based on abnormal stress-only imaging without further rest imaging if clinically appropriate.

Original languageEnglish (US)
Pages (from-to)27-37
Number of pages11
JournalJournal of Nuclear Cardiology
Volume20
Issue number1
DOIs
StatePublished - Feb 2013
Externally publishedYes

Fingerprint

Single-Photon Emission-Computed Tomography
Symptom Assessment
Risk Management
Myocardial Ischemia
Incidence

Keywords

  • Attenuation correction
  • myocardial perfusion imaging
  • SPECT
  • stress-only

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Mathur, S., Heller, G. V., Bateman, T. M., Ruffin, R., Yekta, A., Katten, D., ... Ahlberg, A. W. (2013). Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction. Journal of Nuclear Cardiology, 20(1), 27-37. https://doi.org/10.1007/s12350-012-9633-7

Clinical value of stress-only Tc-99m SPECT imaging : Importance of attenuation correction. / Mathur, Shishir; Heller, Gary V.; Bateman, Timothy M.; Ruffin, Richard; Yekta, Arshad; Katten, Deborah; Alluri, Nitya; Ahlberg, Alan W.

In: Journal of Nuclear Cardiology, Vol. 20, No. 1, 02.2013, p. 27-37.

Research output: Contribution to journalArticle

Mathur, S, Heller, GV, Bateman, TM, Ruffin, R, Yekta, A, Katten, D, Alluri, N & Ahlberg, AW 2013, 'Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction', Journal of Nuclear Cardiology, vol. 20, no. 1, pp. 27-37. https://doi.org/10.1007/s12350-012-9633-7
Mathur, Shishir ; Heller, Gary V. ; Bateman, Timothy M. ; Ruffin, Richard ; Yekta, Arshad ; Katten, Deborah ; Alluri, Nitya ; Ahlberg, Alan W. / Clinical value of stress-only Tc-99m SPECT imaging : Importance of attenuation correction. In: Journal of Nuclear Cardiology. 2013 ; Vol. 20, No. 1. pp. 27-37.
@article{2d053e18f0dd494e9f627f3038975e36,
title = "Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction",
abstract = "Background: In selected patients, stress-only SPECT imaging has been proposed as an alternative to rest-stress SPECT imaging to improve laboratory efficiency and reduce radiation exposure. The impact of attenuation correction (AC) upon interpretation, post-test patient management and cardiac risk stratification in relation to stress-only imaging is not well understood. Objectives: The purpose of this study was to determine the clinical value for laboratory throughput and predicting outcomes of normal and abnormal stress-only SPECT imaging with AC in a consecutive series of clinically referred patients. Methods: A retrospective analysis of 1,383 consecutive patients who were scheduled for stress-only SPECT imaging for symptom assessment of suspected myocardial ischemia was performed. All images had been interpreted and categorized using the standard 17-segment model without AC followed by AC. Follow-up data for 2.1 ± 1.3 years after SPECT imaging for the occurrence of cardiac events (non-fatal MI, cardiac death, and cardiac revascularization) previously collected by routine methods were reviewed. Results: Non-AC SPECT image interpretation revealed that 58{\%} (802/1383) of patients had abnormal stress images. AC image interpretation of the abnormal non-AC images re-classified 83{\%} (666/802) of these as normal. Among patients with abnormal stress images after AC (136/1383), 63{\%} (86/136) returned for additional rest scans, while the remaining 37{\%} (50/136) were clinically managed without further rest images. The incidence of cardiac death or non-fatal MI was very low in patients with normal stress-only scans (0.7{\%}). Conclusion: A strategy of stress-only imaging with AC in symptomatic patients is an efficient method which appropriately identifies at risk and low-risk patients yielding a low percentage requiring rest imaging. Clinical decisions can be made based on abnormal stress-only imaging without further rest imaging if clinically appropriate.",
keywords = "Attenuation correction, myocardial perfusion imaging, SPECT, stress-only",
author = "Shishir Mathur and Heller, {Gary V.} and Bateman, {Timothy M.} and Richard Ruffin and Arshad Yekta and Deborah Katten and Nitya Alluri and Ahlberg, {Alan W.}",
year = "2013",
month = "2",
doi = "10.1007/s12350-012-9633-7",
language = "English (US)",
volume = "20",
pages = "27--37",
journal = "Journal of Nuclear Cardiology",
issn = "1071-3581",
publisher = "Springer New York",
number = "1",

}

TY - JOUR

T1 - Clinical value of stress-only Tc-99m SPECT imaging

T2 - Importance of attenuation correction

AU - Mathur, Shishir

AU - Heller, Gary V.

AU - Bateman, Timothy M.

AU - Ruffin, Richard

AU - Yekta, Arshad

AU - Katten, Deborah

AU - Alluri, Nitya

AU - Ahlberg, Alan W.

PY - 2013/2

Y1 - 2013/2

N2 - Background: In selected patients, stress-only SPECT imaging has been proposed as an alternative to rest-stress SPECT imaging to improve laboratory efficiency and reduce radiation exposure. The impact of attenuation correction (AC) upon interpretation, post-test patient management and cardiac risk stratification in relation to stress-only imaging is not well understood. Objectives: The purpose of this study was to determine the clinical value for laboratory throughput and predicting outcomes of normal and abnormal stress-only SPECT imaging with AC in a consecutive series of clinically referred patients. Methods: A retrospective analysis of 1,383 consecutive patients who were scheduled for stress-only SPECT imaging for symptom assessment of suspected myocardial ischemia was performed. All images had been interpreted and categorized using the standard 17-segment model without AC followed by AC. Follow-up data for 2.1 ± 1.3 years after SPECT imaging for the occurrence of cardiac events (non-fatal MI, cardiac death, and cardiac revascularization) previously collected by routine methods were reviewed. Results: Non-AC SPECT image interpretation revealed that 58% (802/1383) of patients had abnormal stress images. AC image interpretation of the abnormal non-AC images re-classified 83% (666/802) of these as normal. Among patients with abnormal stress images after AC (136/1383), 63% (86/136) returned for additional rest scans, while the remaining 37% (50/136) were clinically managed without further rest images. The incidence of cardiac death or non-fatal MI was very low in patients with normal stress-only scans (0.7%). Conclusion: A strategy of stress-only imaging with AC in symptomatic patients is an efficient method which appropriately identifies at risk and low-risk patients yielding a low percentage requiring rest imaging. Clinical decisions can be made based on abnormal stress-only imaging without further rest imaging if clinically appropriate.

AB - Background: In selected patients, stress-only SPECT imaging has been proposed as an alternative to rest-stress SPECT imaging to improve laboratory efficiency and reduce radiation exposure. The impact of attenuation correction (AC) upon interpretation, post-test patient management and cardiac risk stratification in relation to stress-only imaging is not well understood. Objectives: The purpose of this study was to determine the clinical value for laboratory throughput and predicting outcomes of normal and abnormal stress-only SPECT imaging with AC in a consecutive series of clinically referred patients. Methods: A retrospective analysis of 1,383 consecutive patients who were scheduled for stress-only SPECT imaging for symptom assessment of suspected myocardial ischemia was performed. All images had been interpreted and categorized using the standard 17-segment model without AC followed by AC. Follow-up data for 2.1 ± 1.3 years after SPECT imaging for the occurrence of cardiac events (non-fatal MI, cardiac death, and cardiac revascularization) previously collected by routine methods were reviewed. Results: Non-AC SPECT image interpretation revealed that 58% (802/1383) of patients had abnormal stress images. AC image interpretation of the abnormal non-AC images re-classified 83% (666/802) of these as normal. Among patients with abnormal stress images after AC (136/1383), 63% (86/136) returned for additional rest scans, while the remaining 37% (50/136) were clinically managed without further rest images. The incidence of cardiac death or non-fatal MI was very low in patients with normal stress-only scans (0.7%). Conclusion: A strategy of stress-only imaging with AC in symptomatic patients is an efficient method which appropriately identifies at risk and low-risk patients yielding a low percentage requiring rest imaging. Clinical decisions can be made based on abnormal stress-only imaging without further rest imaging if clinically appropriate.

KW - Attenuation correction

KW - myocardial perfusion imaging

KW - SPECT

KW - stress-only

UR - http://www.scopus.com/inward/record.url?scp=84872676512&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872676512&partnerID=8YFLogxK

U2 - 10.1007/s12350-012-9633-7

DO - 10.1007/s12350-012-9633-7

M3 - Article

C2 - 23188624

AN - SCOPUS:84872676512

VL - 20

SP - 27

EP - 37

JO - Journal of Nuclear Cardiology

JF - Journal of Nuclear Cardiology

SN - 1071-3581

IS - 1

ER -