Jei-Yie Huang1,2, Ruoh-Fang Yen1, Wen-Chung Lee2, Chun-Kai Huang2,3, Pei-Ying Hsu4, Mei-Fang Cheng1, Ching-Chu Lu1,2, Yen-Hung Lin3, Kuo-Liong Chien2,3, Yen-Wen Wu5,6,7,8,9. 1. Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan. 2. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 501, No. 17, Xu-Zhou Road, Taipei City, 100, Taiwan. 3. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan. 4. Department of Nuclear Medicine, National Taiwan University Hospital, Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliu City, 640, Yun-Lin County, Taiwan. 5. Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan. wuyw0502@gmail.com. 6. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan S. Rd, Taipei City, 10002, Taiwan. wuyw0502@gmail.com. 7. Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd, Banciao Dist., New Taipei City, 220, Taiwan. wuyw0502@gmail.com. 8. Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan. wuyw0502@gmail.com. 9. National Yang-Ming University School of Medicine, No.155, Sec.2, Linong Street, Taipei City, 112, Taiwan. wuyw0502@gmail.com.
Abstract
BACKGROUND: The benefits of attenuation correction (AC) in technetium-99m myocardial perfusion imaging (MPI) have been well established. However, the value of thallium (Tl-201) AC and routine computed tomography AC (CTAC) were less well established. The aims of this study were to evaluate the diagnostic performance of thallium (Tl-201) MPI with additional CTAC and to determine which participants would benefit most. METHODS AND RESULTS: A total of 108 consecutive patients who underwent Tl-201 MPI and received coronary angiography within 3 months were enrolled. Diagnostic performance was determined by sensitivity, specificity, and receiver operating characteristic curve analysis. Subgroup analyses were performed using gender and obesity. CTAC improved the area under the curve (0.84 vs. 0.77, P = 0.037 at patient level), primarily due to a significant improvement in specificity (0.78 vs. 0.57, P = 0.013) and no significant difference in sensitivity (0.79 vs. 0.82, P = 0.75). In subgroup analysis, CTAC was most helpful in obese subjects, men, and especially right coronary artery lesions. CONCLUSIONS: CTAC significantly improved diagnostic performance primarily by increasing the specificity, and the improvements were significantly greater in obese patients and male patients. These findings suggest that CTAC should be applied to Tl-201 MPI as routine clinical practice.
BACKGROUND: The benefits of attenuation correction (AC) in technetium-99m myocardial perfusion imaging (MPI) have been well established. However, the value of thallium (Tl-201) AC and routine computed tomography AC (CTAC) were less well established. The aims of this study were to evaluate the diagnostic performance of thallium (Tl-201) MPI with additional CTAC and to determine which participants would benefit most. METHODS AND RESULTS: A total of 108 consecutive patients who underwent Tl-201 MPI and received coronary angiography within 3 months were enrolled. Diagnostic performance was determined by sensitivity, specificity, and receiver operating characteristic curve analysis. Subgroup analyses were performed using gender and obesity. CTAC improved the area under the curve (0.84 vs. 0.77, P = 0.037 at patient level), primarily due to a significant improvement in specificity (0.78 vs. 0.57, P = 0.013) and no significant difference in sensitivity (0.79 vs. 0.82, P = 0.75). In subgroup analysis, CTAC was most helpful in obese subjects, men, and especially right coronary artery lesions. CONCLUSIONS:CTAC significantly improved diagnostic performance primarily by increasing the specificity, and the improvements were significantly greater in obesepatients and male patients. These findings suggest that CTAC should be applied to Tl-201 MPI as routine clinical practice.
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