Gated single-photon emission computed tomography myocardial perfusion imaging is superior to computed tomography attenuation correction in discriminating myocardial infarction from attenuation artifacts in men and right coronary artery disease

BACKGROUND: In single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) studies, attenuation artifacts frequently cause false positives, which can be partially overcome by computed tomography attenuation correction (CT-AC) or gated acquisition [gated myocardial perfusion imaging (GMPI)]. The purpose of this study is to evaluate their relative diagnostic performances for coronary artery disease (CAD). PATIENTS AND METHODS: We enrolled 181 patients who underwent gated SPECT with CT-AC in this study. Two observers who were blinded to the clinical data interpreted the GMPI and CT-AC images. Coronary angiography was considered as the reference standard. The diagnostic efficacy was evaluated based on sex, BMI, and individual coronary arteries. RESULTS: The diagnostic accuracy of GMPI was higher than that of nonattenuation correction overall, as well as for men, overweight individuals, and right CAD (P<0.05). Compared with CT-AC, GMPI overall had a higher specificity (96.3 vs. 86.9%, P=0.014) but the same sensitivity, achieving an increased accuracy and area under the curve (AUC, P>0.05). For diagnosing right CAD, GMPI had a higher diagnostic efficacy (AUC: 0.733 vs. 0.596, P<0.001) because of its higher sensitivity (52.0 vs. 26.0%, P=0.008); for men, the diagnostic efficacy of GMPI was significantly higher than that of CT-AC (AUC: 0.754 vs. 0.681, P=0.038). CONCLUSION: Both CT-AC and GMPI led to an increased diagnostic efficacy compared with nonattenuation correction in differentiating attenuation artifacts from fixed perfusion defects. These improvements were, however, more obvious for GMPI than for CT-AC, especially in men and right CAD.