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Impact of Gd-153 scanning line source attenuation correction on downstream invasive testing

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Attenuation correction (AC) using hardware and software solutions has been shown to increase the specificity of SPECT MPI by decreasing false positive results and improving prognostic ability. Theoretically this should reduce downstream testing and unnecessary costs. We sought to assess the consequences of the use of Gd-153 scanning line source attenuation correction during SPECT myocardial perfusion imaging (MPI) on downstream invasive testing.

Methods

All patients who underwent a clinically indicated Tc-99m stress SPECT MPI study from 2013 to 2015 at five hospitals (2 with AC and 3 without) were retrospectively reviewed. Patient demographics, results of testing, subsequent coronary angiography within 3 months, and revascularization were recorded. The results of the MPI studies, downstream angiogram utilization, and results of angiography were compared and a propensity matched subgroup analysis was performed.

Results

A total of 9968 patients underwent SPECT MPI during the study time period (6106 performed with AC and 3862 without). Out of 3928 patients included in the propensity matched cohort, there was no difference in the proportion of abnormal MPI results between the two groups (31.5% vs 30.4%, P = 0.47), however, more patients underwent coronary angiography within 90 days in the AC group (10.6% vs 8.7%, P = 0.05). There was no significant difference in the proportion of patients with angiographically significant obstructive disease (53.4% vs 56.1%, P = 0.19), however, fewer patients in the AC group with obstructive coronary disease were revascularized (36.1% vs 46.8%, P = 0.04). The findings remained consistent after sub-group analysis in patients without known coronary disease.

Conclusion

The use of scanning line source AC did not meaningfully influence the rate of abnormal MPI results or downstream invasive testing in this cohort. The clinical utility of scanning line source AC may be limited to facilitating stress-first imaging protocols.

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Abbreviations

SPECT:

Single photon emission computed tomography

MPI:

Myocardial perfusion imaging

AC:

Attenuation correction

Gd:

Gadolinium

CAD:

Coronary artery disease

SMD:

Standard mean difference

BMI:

Body mass index

OR:

Odds ratio

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Author notes

  1. Aditi Singhvi and Stephanie Suacier are co-first authors.

Authors and Affiliations

  1. Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA

    Aditi Singhvi MD, Stephanie Suacier MD, Isha Verma MD, Tarun Tandon MD, Sean McMahon & W. Lane Duvall

  2. Department of Medicine, University of Connecticut Medical Center, Farmington, CT, USA

    Kevin Felpel MD, Andre Gabriel MD & Zackary Tushak DO

  3. Department of Research Administration, Hartford Hospital, Hartford, CT, USA

    Jeffrey Mather

Authors
  1. Aditi Singhvi MD
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  2. Stephanie Suacier MD
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  3. Isha Verma MD
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  10. W. Lane Duvall
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Correspondence to W. Lane Duvall.

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Singhvi, A., Suacier, S., Verma, I. et al. Impact of Gd-153 scanning line source attenuation correction on downstream invasive testing. J. Nucl. Cardiol. 29, 1832–1842 (2022). https://doi.org/10.1007/s12350-021-02565-2

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  • DOI: https://doi.org/10.1007/s12350-021-02565-2

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