ArticleThe international journal of cardiovascular imaging2026
Platform-specific impact of CT attenuation correction on CZT myocardial perfusion SPECT: per-vessel detection of obstructive coronary artery disease.
Article in The international journal of cardiovascular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Attenuation artifacts on myocardial perfusion SPECT differ across camera geometries. This study evaluated whether CT attenuation correction (CTAC) improves per-vessel detection of obstructive coronary artery disease (CAD) on a stationary 19-pinhole CZT system. Rest-stress ⁹⁹ᵐTc-tetrofosmin CZT SPECT studies from 48 patients with angiographically confirmed CAD (185 vessels) were retrospectively reconstructed with and without CTAC. The reference standard was ≥ 70% diameter stenosis on coronary CT angiography or invasive angiography, with no perfusion input. Disease-negative participants were excluded by design. Perfusion was quantified as the percent defect averaged within each coronary territory, assigned per patient on hybrid SPECT/CT fusion images. Per-vessel discrimination of the reversible (stress - rest) defect rate was compared between reconstructions. Compared with non-attenuation-corrected (NAC) reconstructions, CTAC lowered the global rest defect rate (P < 0.0001) and raised the reversible defect rate (median 5.9% vs. 1.5%; P < 0.0001). The reversible defect rate discriminated territories subtended by obstructive stenosis better with CTAC than with NAC (AUC 0.717 vs. 0.614; ΔAUC 0.103; DeLong P = 0.0164; bootstrap P = 0.010; within-patient permutation P = 0.0474). At the Youden point, sensitivity rose to 75.5% from 52.8%, with specificity 64.4% versus 68.9%. The gain was greatest in the LCX (0.803 vs. 0.658; P = 0.043) and RCA territories. On this 19-pinhole CZT platform, CTAC improves per-vessel discrimination of obstructive CAD, most prominently in the LCX and RCA territories. The benefit is sensitivity-led, opposite to the specificity-led gain reported on Anger cameras, at a modest cost in specificity.
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