Ultra-low-dose computed tomography for attenuation correction of cadmium-zinc-telluride single photon emission computed tomography myocardial perfusion imaging

• DOI: 10.1007/s12350-018-1303-y
• Publication Date: 2018-06-19T20:06:37Z
• Authors: Marvin Grossmann; Andreas A. Gianno...; Fabiola A. Bechtiger; Michael Messerli; Moritz Schwyzer; Dominik C. Benz; Ken Kudura; Catherine Gebhard; Christoph Gräni; Aju P. Pazhenkottil; Philipp A. Kaufmann; Ronny R. Buechel
• Keywords: Male; Heart Diseases; 610 Medicine & health; Radiation Dosage; Sensitivity and Specificity; 2705 Cardiology and Cardiovascular Medicine; 03 medical and health sciences; Organophosphorus Compounds; 0302 clinical medicine; 2741 Radiology, Nuclear Medicine and Imaging; Humans; Prospective Studies; Aged; Tomography, Emission-Computed, Single-Photon; Myocardial Perfusion Imaging; Reproducibility of Results; 10181 Clinic for Nuclear Medicine; Organotechnetium Compounds; Middle Aged; 3. Good health; Zinc; Radiology Nuclear Medicine and imaging; 10209 Clinic for Cardiology; Female; Tellurium; Cardiology and Cardiovascular Medicine; Tomography, X-Ray Computed; Cadmium

The applicability of ultra-low-dose computed tomography (CT) for attenuation correction (AC) of single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI) remains elusive.One-hundred patients underwent one-day 99mTc-tetrofosmin stress-rest MPI and non-contrast enhanced cardiac CT with 120, 80, and 70 kilovolt peak (kVp) tube voltage and tube current of 200 milliamperes for creation of AC maps. Normalized percent myocardial uptake from SPECT-MPI using 80 kVp scans for AC showed excellent correlation vs AC from 120 kVp scans for stress [intraclass correlation (ICC) = 0.988, 95% CI = 0.986-0.989, P < .001] and rest (ICC = 0.985, 95% CI = 0.983-0.987, P < .001) with narrow Bland-Altman limits of agreement (BA-LA) (- 5.3% to 4.5% and - 5.4% to 4.4%, respectively) and minimal bias (- 0.4% and - 0.5%, respectively). Correlation of AC SPECT-MPI based on 70 vs 120 kVp scans was excellent for stress (ICC = 0.988, 95% CI = 0.986-0.989, P < .001) and rest (ICC = 0.986, 95% CI = 0.984-0.987, P < .001) with narrow BA-LA (- 5.3% to 4.4% and - 5.2% to 4.5%, respectively) and small bias (- 0.4% and - 0.3%, respectively). Mean effective radiation dose for the 120, 80 and 70 kVp scans were 0.58 ± 0.07, 0.19 ± 0.02, and 0.12 ± 0.01 mSv, respectively.Attenuation maps for MPI obtained from ultra-low radiation dose CT scans are interchangeable with attenuation maps from standard-dose CT while offering a substantial reduction in radiation dose exposure.