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CLINICAL STUDIES

Attenuation-corrected ^99mTc-tetrofosmin single-photon emission computed tomography in the detection of viable myocardium: comparison with positron emission tomography using ¹⁸F-fluorodeoxyglucose

Ichiro Matsunari, MD^*, Guido Böning^*, Sibylle I. Ziegler, PhD^*, Stephan G. Nekolla, PhD^*, Jens C. Stollfuss, MD^*, Istvan Kosa, MD^*, Edward P. Ficaro, PhD and Markus Schwaiger, MD, FACC^*

^* Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Klinikum rechts der Isar, Munich, Germany
Department of Internal Medicine, Division of Nuclear Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA

Manuscript received January 2, 1998; revised manuscript received May 27, 1998, accepted June 4, 1998.

Address for correspondence: Dr. Markus Schwaiger, Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675 München, Germany

Objectives. The purpose of this study was to assess the efficacy of attenuation-corrected (AC) technetium-99m (^99mTc)-tetrofosmin single-photon emission computed tomography (SPECT) in detecting viable myocardium compared to ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET).

Background. The role of ^99mTc-labeled perfusion tracers in the assessment of myocardial viability remains controversial. Attenuation artifacts affect the diagnostic accuracy of SPECT images.

Methods. Twenty-four patients with coronary artery disease (mean left ventricular ejection fraction 30%) underwent resting ^99mTc-tetrofosmin SPECT and FDG PET imaging. Both AC and non–attenuation-corrected (NC) SPECT images were generated.

Results. Using a 50% threshold for viability by FDG PET, the percentage of concordant segments of viability between ^99mTc-tetrofosmin and FDG on the patient basis increased from 79.8% ± 14.0% (mean ± SD) on the NC images to 90.8% ± 10.6% on the AC images (p = 0.002). The percentage of ^99mTc-tetrofosmin defect segments within PET-viable segments, an estimate for the degree of underestimation of viability, decreased from 19.8% ± 15.2% on the NC images to 9.7% ± 12.6% on the AC images (p = 0.01). Similar results were obtained when a 60% threshold was used to define viability by FDG PET. When the anterior-lateral and inferior-septal regions were separately analyzed, the effect of attenuation correction was significant only in the inferior-septal region.

Conclusions. The results indicate that AC ^99mTc-tetrofosmin SPECT improves the detection of viable myocardium mainly by decreasing the underestimation of viability particularly in the inferior-septal region, although some underestimation/overestimation of viability may still occur even with attenuation correction.

Abbreviations and Acronyms   AC = attenuation-corrected   CAD = coronary artery disease   FDG = 18F-fluorodeoxyglucose   LV = left ventricular   NC = non–attenuation-corrected   PET = positron emission tomography   SPECT = single-photon emission computed tomography

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