Download PDF
Der Nuklearmediziner 2004; 27(3): 147-154
DOI: 10.1055/s-2004-822717
Kardiologie aktuell

© Georg Thieme Verlag Stuttgart · New York

Schwächungskorrektur bei der Myokardszintigraphie: Aktueller Stand

Attenuation Correction for Myocardial Scintigraphy: State-of-the-ArtO. Lindner1 , A. Kammeier1 , E. Fricke1
  • 1Institut für molekulare Biophysik, Radiopharmazie und Nuklearmedizin, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
Further Information

Publication History

Publication Date:
16 September 2004 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Myokardperfusionsszintigraphie (MPS), durchgeführt als Single-Photonen-Emissions-Computer-Tomographie (SPECT), ist ein etabliertes nichtinvasives Verfahren in der Diagnostik der koronaren Herzkrankheit mit hoher prognostischer Aussagekraft. Limitationen entstehen durch Bildartefakte, welche die Sensitivität und insbesondere die Spezifität der MPS herabsetzen. Die inhomogene Schwächung der Photonen im Thorax wird hierbei als wesentlicher Faktor angesehen. Unterschiedliche Ansätze zur Durchführung einer individuellen Schwächungskorrektur werden derzeit von den Kameraherstellern angeboten. Ziel ist, die Emissionsdaten mittels einer Transmissionsaufnahme, die die Verteilung der verschiedenen schwächenden Gewebe im Körper wiedergibt, zu überlagern bzw. zu korrigieren, um so den Einfluss der inhomogenen Photonenabsorption zu eliminieren. Größere Studien haben gezeigt, dass auf diese Weise die Spezifität der MPS verbessert wird, bei nahezu unveränderter Sensitivität. Dreh- und Angelpunkt einer erfolgreichen Schwächungskorrektur bei der MPS sind entsprechende Qualitätskontrollen und Erfahrung von ärztlicher und physikalisch-technischer Seite.

Abstract

Myocardial perfusion imaging has been proved as an accurate, noninvasive method for diagnosis of coronary artery disease with a high prognostic value. However image artifacts, which decrease sensitivity and in particular specificity, degrade the clincal impact of this method. Soft tissue attenuation is regarded as one of the most important factors of impaired image quality. Different approaches to correct for tissue attenuation have been implemented by the camera manufacturers. The principle is to derive an attenuation map from the transmission data and to correct the emission data for nonuniform photon attenuation with this map. There have been several reports published demonstrating an improved specificity with no substantial change in sensitivity by this method. To accurately perform attenuation correction quality control measurements and adequate training of technologists and physicians are mandatory.

Schlüsselwörter

Myokardperfusionsszintigraphie - SPECT - Schwächungskorrektur - Transmissionsmessung

Key words

Myocardial perfusion scintigraphy - SPECT - attenuation correction - transmission scan

Literatur

  • 1 Araujo L I, Jimenez-Hoyuela J M, McClellan J R, Lin E, Viggiano J, Alavi A. Improved uniformity in tomographic myocardial perfusion imaging with attenuation correction and enhanced acquisition and processing.  J Nucl Med. 2000;  41 1139-1144
    PubMedGoogle Scholar
  • 2 Bailey D L, Meikle S R. Does attenuation correction work?.  J Nucl Med. 2000;  41 960-961
    PubMedGoogle Scholar
  • 3 Corbett J R, Ficaro E P. “Attenuation compensation of cardiac SPECT: a critical look at a confusing world” by Wackers FJTh.  J Nucl Cardiol. 2003;  10 214-216
    CrossrefPubMedGoogle Scholar
  • 4 DePuey E G, Garcia E V. Optimal specificity of thallium-201 SPECT through recognition of imaging artifacts.  J Nucl Med. 1989;  30 441-449
    PubMedGoogle Scholar
  • 5 DePuey E G, Rozanski A. Using gated technetium-99m-sestamibi SPECT to characterize fixed myocardial defects as infarct or artifact.  J Nucl Med. 1995;  36 952-955
    PubMedGoogle Scholar
  • 6 DePuey E G. Imaging guidelines for transmission-emission tomographic systems to be used for attenuation correction.  J Nucl Cardiol. 2001;  8 G51-G58
    PubMedGoogle Scholar
  • 7 Eisner R L, Tamas M J, Cloninger K, Shonkoff D, Oates J A, Gober A M, Dunn D W, Malko J A, Churchwell A L, Patterson R E. Normal SPECT thallium-201 bull's-eye display: gender differences.  J Nucl Med. 1988;  29 1901-1909
    PubMedGoogle Scholar
  • 8 Ficaro E P. Should SPET attenuation correction be more widely employed in routine clinical practice? For.  Eur J Nucl Med Mol Imaging. 2002;  29 409-412
    CrossrefPubMedGoogle Scholar
  • 9 Ficaro E P, Fessler J A, Shreve P D, Kritzman J N, Rose P A, Corbett J R. Simultaneous transmission/emission myocardial perfusion tomography. Diagnostic accuracy of attenuation-corrected 99mTc-sestamibi single-photon emission computed tomography.  Circulation. 1996;  93 463-473
    PubMedGoogle Scholar
  • 10 Fricke E, Fricke H, Esdorn E, Lindner O, Weise R, Burchert W. Evaluierung einer CT-basierten Schwächungskorrektur in der Myokardszintigraphie.  Nuklearmedizin. 2003;  42 A88-A89
    PubMedGoogle Scholar
  • 11 Gallowitsch H J, Sykora J, Mikosch P, Kresnik E, Unterweger O, Molnar M, Grimm G, Lind P. Attenuation-corrected thallium-201 single-photon emission tomography using a gadolinium-153 moving line source: clinical value and the impact of attenuation correction on the extent and severity of perfusion abnormalities.  Eur J Nucl Med. 1998;  25 220-228
    CrossrefPubMedGoogle Scholar
  • 12 Gerson M, Singh B, Lukes J, Baumann B. Comparison of attenuation and compton scatter corrected to uncorrected thallium-201 tomograms for diagnosis of coronary artery disease (CAD) [abstract].  J Nucl Med. 1999;  40 89
    PubMedGoogle Scholar
  • 13 Gibson P B, Demus D, Noto R, Hudson W, Johnson L L. Low event rate for stress-only perfusion imaging in patients evaluated for chest pain.  J Am Coll Cardiol. 2002;  39 999-1004
    CrossrefPubMedGoogle Scholar
  • 14 Gregoriou G K, Tsui B M, Gullberg G T. Effect of truncated projections on defect detection in attenuation-compensated fanbeam cardiac SPECT.  J Nucl Med. 1998;  39 166-175
    PubMedGoogle Scholar
  • 15 Heller G, Links J, Bateman T, Ziffer J, Ficaro E, Cohen M, Hendel R.. The Amercian Society of Nuclear Cardiology and The Society of Nuclear Medicine .Joint position statement: attenuation correction of myocardial perfusion SPECT scintigraphy. www.asnc.org/resources/jointposstatement_attcor.pdf. 2003
    Google Scholar
  • 16 Hendel R C, Berman D S, Cullom S J, Follansbee W, Heller G V, Kiat H, Groch M W, Mahmarian J J. Multicenter clinical trial to evaluate the efficacy of correction for photon attenuation and scatter in SPECT myocardial perfusion imaging.  Circulation. 1999;  99 2742-2749
    PubMedGoogle Scholar
  • 17 Hendel R C, Corbett J R, Cullom S J, DePuey E G, Garcia E V, Bateman T M. The value and practice of attenuation correction for myocardial perfusion SPECT imaging: a joint position statement from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine.  J Nucl Cardiol. 2002;  9 135-143
    CrossrefPubMedGoogle Scholar
  • 18 Kammeier A, Lindner O, Weise R, Burchert W. Nuklearmedizin als Paradigma molekularer Bildgebung. Abstractband der 40. Jahrestagung der DGN in Freiburg, 10.-13.04.2002. Blackwell, Berlin 2002; 75
    Google Scholar
  • 19 Kluge R, Sattler B, Seese A, Knapp W H. Attenuation correction by simultaneous emission-transmission myocardial single-photon emission tomography using a technetium-99m-labelled radiotracer: impact on diagnostic accuracy.  Eur J Nucl Med. 1997;  24 1107-1114
    PubMedGoogle Scholar
  • 20 Lenzo N, Ficaro N, Kritzman J, Corbett J. Clinical comparison of Profile attenuation correction and the Michigan modified STEPP methods [abstract].  J Nucl Cardiol. 2001;  8 19
    CrossrefPubMedGoogle Scholar
  • 21 Links J M, Becker L C, Rigo P, Taillefer R, Hanelin L, Anstett F, Burckhardt D, Mixon L. Combined corrections for attenuation, depth-dependent blur, and motion in cardiac SPECT: a multicenter trial.  J Nucl Cardiol. 2000;  7 414-425
    CrossrefPubMedGoogle Scholar
  • 22 Links J M, DePuey E G, Taillefer R, Becker L C. Attenuation correction and gating synergistically improve the diagnostic accuracy of myocardial perfusion SPECT.  J Nucl Cardiol. 2002;  9 183-187
    CrossrefPubMedGoogle Scholar
  • 23 Matsunari I, Boning G, Ziegler S I, Nekolla S G, Stollfuss J C, Kosa I, Ficaro E P, Schwaiger M. Attenuation-corrected 99mTc-tetrofosmin single-photon emission computed tomography in the detection of viable myocardium: comparison with positron emission tomography using 18F-fluorodeoxyglucose.  J Am Coll Cardiol. 1998;  32 927-935
    CrossrefPubMedGoogle Scholar
  • 24 Narayanan M V, King M A, Pretorius P H, Dahlberg S T, Spencer F, Simon E, Ewald E, Healy E, MacNaught K, Leppo J A. Human-observer receiver-operating-characteristic evaluation of attenuation, scatter, and resolution compensation strategies for 99mTc myocardial perfusion imaging.  J Nucl Med. 2003;  44 1725-1734
    PubMedGoogle Scholar
  • 25 O'Connor M K, Kemp B, Anstett F, Christian P, Ficaro E P, Frey E, Jacobs M, Kritzman J N, Pooley R A, Wilk M. A multicenter evaluation of commercial attenuation compensation techniques in cardiac SPECT using phantom models.  J Nucl Cardiol. 2002;  9 361-376
    CrossrefPubMedGoogle Scholar
  • 26 Prvulovich E M, Jarritt P H, Lonn A H, Vorontsova E, Bomanji J B, Ell P J. Influence of arm positioning on tomographic thallium-201 myocardial perfusion imaging and the effect of attenuation correction.  Eur J Nucl Med. 2000;  27 1349-1355
    CrossrefPubMedGoogle Scholar
  • 27 Sorenson J, Phelps M. Physics in Nuclear Medicine. 2nd ed. W.B. Saunders Company, Philadelphia 1987
    Google Scholar
  • 28 Stowers S A, Umfrid R. Supine-prone SPECT myocardial perfusion imaging: the poor man's attenuation compensation.  J Nucl Cardiol. 2003;  10 338
    CrossrefPubMedGoogle Scholar
  • 29 Vidal R, Buvat I, Darcourt J, Migneco O, Desvignes P, Baudouy M, Bussiere F. Impact of attenuation correction by simultaneous emission/transmission tomography on visual assessment of 201Tl myocardial perfusion images.  J Nucl Med. 1999;  40 1301-1309
    PubMedGoogle Scholar
  • 30 Wackers F J. Attenuation correction, or the emperor's new clothes?.  J Nucl Med. 1999;  40 1310-1312
    PubMedGoogle Scholar
  • 31 Wackers F J. Should SPET attenuation correction be more widely employed in routine clinical practice? Against.  Eur J Nucl Med Mol Imaging. 2002;  29 412-415
    CrossrefPubMedGoogle Scholar
  • 32 Watson D. Acquisition, processing, and quantification of nuclear cardiac images. In: Iskandrian AS, Verani MS (eds). Nuclear cardiac imaging. Oxford University Press, New York 2003; 74-90
    Google Scholar

Dr. Oliver Lindner

Institut für molekulare Biophysik, Radiopharmazie und Nuklearmedizin · Herz- und Diabeteszentrum NRW · Universitätsklinik der Ruhr-Universität Bochum

Georgstr. 11

32545 Bad Oeynhausen

Phone: +49/57 31/97 13 09

Fax: +49/57 31/97 21 90

Email: olindner@hdz-nrw.de

      >