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

36 Scopus citations


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
Issue number1
StatePublished - Feb 1 2013


  • Attenuation correction
  • myocardial perfusion imaging
  • stress-only

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Mathur, S., Heller, G. V., Bateman, T. M., Ruffin, R., Yekta, A., Katten, D., Alluri, N., & 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.