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21.09.2017 | Original Article | Ausgabe 10/2017

Annals of Nuclear Medicine 10/2017

CT-based SPECT attenuation correction and assessment of infarct size: results from a cardiac phantom study

Annals of Nuclear Medicine > Ausgabe 10/2017
Alexander Stephan Kroiss, Stephan Gerhard Nekolla, Georg Dobrozemsky, Thomas Grubinger, Barry Lynn Shulkin, Markus Schwaiger
Wichtige Hinweise
Alexander Stephan Kroiss and Stephan Gerhard Nekolla contributed equally to this work.



Myocardial perfusion SPECT is a commonly performed, well established, clinically useful procedure for the management of patients with coronary artery disease. However, the attenuation of photons from myocardium impacts the quantification of infarct sizes. CT-Attenuation Correction (AC) potentially resolves this problem. This contention was investigated by analyzing various parameters for infarct size delineation in a cardiac phantom model.


A thorax phantom with a left ventricle (LV), fillable defects, lungs, spine and liver was used. The defects were combined to simulate 6 infarct sizes (5–20% LV). The LV walls were filled with 100120 kBq/ml 99mTc and the liver with 10–12 kBq/ml 99mTc. The defects were filled with water of 50% LV activity to simulate transmural and non-transmural infarction, respectively. Imaging of the phantom was repeated for each configuration in a SPECT/CT system. The defects were positioned in the anterior as well as in the inferior wall. Data were acquired in two modes: 32 views, 30 s/view, 180° and 64 views, 15 s/view, 360° orbit. Images were reconstructed iteratively with scatter correction and resolution recovery. Polar maps were generated and defect sizes were calculated with variable thresholds (40–60%, in 5% steps). The threshold yielding the best correlation and the lowest mean deviation from the true extents was considered optimal.


AC data showed accurate estimation of transmural defect extents with an optimal threshold of 50% [non attenuation correction (NAC): 40%]. For the simulation of non-transmural defects, a threshold of 55% for AC was found to yield the best results (NAC: 45%). The variability in defect size due to the location (anterior versus inferior) of the defect was reduced by 50% when using AC data indicating the benefit from using AC. No difference in the optimal threshold was observed between the different orbits.


Cardiac SPECT/CT shows an improved capability for quantitative defect size assessment in phantom studies due to the positive effects of attenuation correction.

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