Methods of Differentiation of Inferior, or Other Myocardial Wall Defects From Artifacts in Myocardial Scintigraphy: The Role of Prone Positioning and/or Other Techniques

Stress radionuclide myocardial perfusion scintigraphy (MPS) with the use of single photon emission computed tomography (SPECT) is a widely established method for the detection of coronary artery disease, patient management and patient risk stratification, as well as evaluation of revascularization results. MPS SPECT is traditionally being performed with patients in the supine position. This practice is, however, associated with various soft tissue attenuation artifacts, resulting in reduced test specificity.Various methods have been investigated to deal with this problem including the inspection of planar projection images, the integration of wall motion and wall thickening information from gated MPS, the application of transmission attenuation maps from radionuclide sources and the MPS SPECT with the patient in prone position.Most of the above methods suffer from several limitations.However, the addition of prone acquisition to traditional supine MPS SPECT has been proven to be an easy and efficient way to reduce attenuation artifacts (concerning mainly the inferior wall) leading to a significant improvement in the specificity of this imaging technique