International Journal of Radiology & Medical Imaging Volume 2 (2016), Article ID 2:IJRMI-113, 12 pages
Review Article
Cardiac SPECT/CT Imaging: CT Attenuation Correction and SPECT/CT Hybrid Imaging

Yoshimitsu Fukushima* and Shin-ichiro Kumita

Department of Radiology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ward, Tokyo 113-8603, Japan
Dr. Yoshimitsu Fukushima, M.D., Ph.D., Department of Radiology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ward, Tokyo 113-8603, Japan, Tel: +81-3-3822-2131; E-mail:
30 January 2016; 20 July 2016; 22 July 2016
Fukushima Y, Kumita S (2016) Cardiac SPECT/CT Imaging: CT Attenuation Correction and SPECT/CT Hybrid Imaging. Int J Radiol Med Imag 2: 113. doi:


  1. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS (2003) Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 07: 2900-2907. View
  2. Hendel RC, Berman DS, Di Carli MF, Heidenreich PA, Henkin RE, et al. (2009) ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. J Am Coll Cardiol 53: 2201-2229. View
  3. Tamaki N, Morita K, Kuge Y, Tsukamoto E (2000) The role of fatty acids in cardiac imaging. J Nucl Med 41: 1525-1534. View
  4. Fazel R, Krumholz HM, Wang Y, Ross JS, Chen J, et al. (2009) Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 361: 849-857. View
  5. DePuey EG (1994) How to detect and avoid myocardial perfusion SPECT artifacts. J Nucl Med 35: 699-702. View
  6. Desmarais RL, Kaul S, Watson DD, Beller GA (1993) Do false positive thallium-201 scans lead to unnecessary catheterization? Outcome of patients with perfusion defects on quantitative planar thallium- 201 scintigraphy. J Am Coll Cardiol 21:1058-1063. View
  7. Heller GV, Links J, Bateman TM, Ziffer JA, Ficaro E, et al. (2004) American Society of Nuclear Cardiology and Society of Nuclear Medicine joint position statement: attenuation correction of myocardial perfusion SPECT scintigraphy. J Nucl Cardio 11: 229-230. View
  8. Tonge CM, Manoharan M, Lawson RS, Shields RA, Prescott MC (2005) Attenuation correction of myocardial SPECT studies using low resolution computed tomography images. Nucl Med Commun 26: 231-237. View
  9. Masood Y, Liu YH, Depuey G, Taillefer R, Araujo LI, et al. (2005) Clinical validation of SPECT attenuation correction using x-ray computed tomography-derived attenuation maps: multicenter clinical trial with angiographic correlation. J Nucl Cardiol 12: 676-686. View
  10. Malkerneker D, Brenner R, Martin WH, Sampson UK, Feurer ID, et al. (2007) CT-based attenuation correction versus prone imaging to decrease equivocal interpretations of rest/stress Tc-99m tetrofosmin SPECT MPI. J Nucl Cardiol 14: 314-323. View
  11. Gaemperli O, Schepis T, Kalff V, Namdar M, Valenta I, et al. (2007) Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography. Eur J Nucl Med Mol Imaging 34: 1097-1106. View
  12. Gaemperli O, Schepis T, Valenta I, Koepfli P, Husmann L, et al. (2008) Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology 248: 414-423. View
  13. Matsuo S, Nakajima K, Akhter N, Wakabayashi H, Taki J, et al. (2009) Clinical usefulness of novel cardiac MDCT/SPECT fusion image. Ann Nucl Med 23: 579-586. View
  14. Kiriyama T, Toba M, Fukushima Y, Hayashi H, Takano H, et al. (2011) Discordance between the morphological and physiological information of 64-slice MSCT coronary angiography and myocardial perfusion imaging in patients with intermediate to high probability of coronary artery disease. Circ J 75: 1670-1677. View
  15. Koukouraki S, Pagonidis K, Perisinakis K, Klinaki I, Stathaki M, et al. (2013) Hybrid cardiac imaging: insights in the dilemma of the appropriate clinical management of patients with suspected coronary artery disease. Eur J Radiol 82: 281-287. View
  16. DePuey EG, Garcia EV (1989) Optimal specificity of thallium-201 SPECT through recognition of imaging artifacts. J Nucl Med 30: 441-449. View
  17. Beller GA (1991) Diagnostic accuracy of thallium-201 myocardial perfusion imaging. Circulation 84: I1-6. View
  18. Nishina H, Slomka PJ, Abidov A, Yoda S, Akincioglu C, et al. (2006) Combined supine and prone quantitative myocardial perfusion SPECT: method development and clinical validation in patients with no known coronary artery disease. J Nucl Med 47: 51-58. View
  19. Tan P, Bailey DL, Meikle SR, Eberl S, Fulton RR, et al. (1993) A scanning line source for simultaneous emission and transmission measurements in SPECT. J Nucl Med 34: 1752-1760. View
  20. Fricke E, Fricke H, Weise R, Kammeier A, Hagedorn R, et al. (2005) Attenuation correction of myocardial SPECT perfusion images with lowdose CT: evaluation of the method by comparison with perfusion PET. J Nucl Med 46: 736-744. View
  21. Bocher M, Balan A, Krausz Y, Shrem Y, Lonn A, Wilk M, et al. (2000) Gamma camera-mounted anatomical X-ray tomography: technology, system characteristics and first images. Eur J Nucl Med 27: 619-627. View
  22. Lang TF, Hasegawa BH, Liew SC, Brown JK, Blankespoor SC, et al. (1992) Description of a prototype emission-transmission computed tomography imaging system. J Nucl Med 33: 1881-1887. View
  23. Koepfli P, Hany TF, Wyss CA, Namdar M, Burger C, et al. (2004) CT attenuation correction for myocardial perfusion quantification using a PET/ CT hybrid scanner. J Nucl Med 45: 537-542. View
  24. O'Connor MK, Kemp BJ (2006) Single-photon emission computed tomography/computed tomography: basic instrumentation and innovations. Semin Nucl Med 36: 258-266. View
  25. Preuss R, Weise R, Lindner O, Fricke E, Fricke H, et al. (2008) Optimisation of protocol for low dose CT-derived attenuation correction in myocardial perfusion SPECT imaging. Eur J Nucl Med Mol Imaging 35: 1133-1141. View
  26. Madsen MT (2007) Recent advances in SPECT imaging. J Nucl Med 48: 661-673. View
  27. Fricke H, Fricke E, Weise R, Kammeier A, Lindner O, et al. (2004) A method to remove artifacts in attenuation-corrected myocardial perfusion SPECT Introduced by misalignment between emission scan and CT-derived attenuation maps. J Nucl Med 45: 1619-1625. View
  28. Martinez-Möller A, Souvatzoglou M, Navab N, Schwaiger M, Nekolla SG (2007) Artifacts from misaligned CT in cardiac perfusion PET/CT studies: frequency, effects, and potential solutions. J Nucl Med 48: 188-193. View
  29. Gould KL, Pan T, Loghin C, Johnson NP, Guha A, et al. (2007) Frequent diagnostic errors in cardiac PET/CT due to misregistration of CT attenuation and emission PET images: a definitive analysis of causes, consequences, and corrections. J Nucl Med 48: 1112-1121. View
  30. Goetze S, Brown TL, Lavely WC, Zhang Z, Bengel FM (2007) Attenuation correction in myocardial perfusion SPECT/CT: effects of misregistration and value of reregistration. J Nucl Med 48: 1090-1095. View
  31. Kennedy JA, Israel O, Frenkel A (2009) Directions and magnitudes of misregistration of CT attenuation-corrected myocardial perfusion studies: incidence, impact on image quality, and guidance for reregistration. J Nucl Med 50: 1471-1478. View
  32. McQuaid SJ, Hutton BF (2008) Sources of attenuation-correction artefacts in cardiac PET/CT and SPECT/CT. Eur J Nucl Med Mol Imaging 35: 1117- 1123. View
  33. Chen J, Caputlu-Wilson SF, Shi H, Galt JR, Faber TL, et al. (2006) Automated quality control of emission-transmission misalignment for attenuation correction in myocardial perfusion imaging with SPECT-CT systems. J Nucl Cardiol 13: 43-49. View
  34. Kovalski G, Israel O, Keidar Z, Frenkel A, Sachs J, et al. (2007) Correction of heart motion due to respiration in clinical myocardial perfusion SPECT scans using respiratory gating. J Nucl Med 48: 630-636. View
  35. Sharir T, Ben-Haim S, Merzon K, Prochorov V, Dickman D, et al. (2008) High-speed myocardial perfusion imaging initial clinical comparison with conventional dual detector anger camera imaging. JACC Cardiovasc Imaging 1: 156-163. View
  36. Esteves FP, Raggi P, Folks RD, Keidar Z, Askew JW, et al. (2009) Novel solid-state-detector dedicated cardiac camera for fast myocardial perfusion imaging: multicenter comparison with standard dual detector cameras. J Nucl Cardiol 16: 927-934. View
  37. Herzog BA, Buechel RR, Katz R, Brueckner M, Husmann L, et al. (2010) Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: optimized protocol for scan time reduction. J Nucl Med 51: 46-51. View
  38. Sharir T, Slomka PJ, Hayes SW, DiCarli MF, Ziffer JA, et al. (2010) Multicenter trial of high-speed versus conventional single-photon emission computed tomography imaging: quantitative results of myocardial perfusion and left ventricular function. J Am Coll Cardiol 55: 1965-1974. View
  39. Tsuchiya K, Takahashi I, Kawaguchi T, Yokoi K, Morimoto Y, et al. (2010) Basic performance and stability of a CdTe solid-state detector panel. Ann Nucl Med 24: 301-311. View
  40. Fukushima Y, Kumita S, Kawaguchi T, Maruyama T, Kawasaki Y, et al. (2014) Nuclear myocardial perfusion imaging with a cadmium-telluride semiconductor detector gamma camera in patients with acute myocardial infarction. Ann Nucl Med 28: 646-655. View
  41. Takahashi Y, Miyagawa M, Nishiyama Y, Ishimura H, Mochizuki T (2013) Performance of a semiconductor SPECT system: comparison with a conventional Anger-type SPECT instrument. Ann Nucl Med 27: 11-16. View
  42. Liu CJ, Cheng JS, Chen YC, Huang YH, Yen RF (2015) A performance comparison of novel cadmium-zinc-telluride camera and conventional SPECT/CT using anthropomorphic torso phantom and water bags to simulate soft tissue and breast attenuation. Ann Nucl Med 29: 342-350. View
  43. Herzog BA, Buechel RR, Husmann L, Pazhenkottil AP, Burger IA, et al. (2010) Validation of CT attenuation correction for high-speed myocardial perfusion imaging using a novel cadmium-zinc-telluride detector technique. J Nucl Med 51: 1539-1544. View
  44. Caobelli F, Akin M, Thackeray JT, Brunkhorst T, Widder J, et al. (2015) Diagnostic accuracy of cadmium-zinc-telluride-based myocardial perfusion SPECT: impact of attenuation correction using a co-registered external computed tomography. Eur Heart J Cardiovasc Imaging. [In press]. View
  45. Schroeder S, Achenbach S, Bengel F, Burgstahler C, Cademartiri F, et al. (2008) Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J 29: 531-556. View
  46. Bartúnek J, Sys SU, Heyndrickx GR, Pijls NH, De Bruyne B (1995) Quantitative coronary angiography in predicting functional significance of stenoses in an unselected patient cohort. J Am Coll Cardiol 26: 328-334. View
  47. Schuijf JD, Wijns W, Jukema JW, Atsma DE, de Roos A, et al. (2006) Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 48: 2508-2514. View
  48. Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, et al. (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356: 1503-1516. View
  49. Group BDS, Frye RL, August P, Brooks MM, Hardison RM, Kelsey SF, et al. (2009) A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med 360: 2503-2515. View
  50. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, et al. (2003) ACC/ AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging- -executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (ACC/AHA/ ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 42: 1318-1333. View
  51. Iskander S, Iskandrian AE (1998) Risk assessment using single-photon emission computed tomographic technetium-99m sestamibi imaging. J Am Coll Cardiol 32: 57-62. View
  52. Ragosta M, Bishop AH, Lipson LC, Watson DD, Gimple LW, et al. (2007) Comparison between angiography and fractional flow reserve versus single-photon emission computed tomographic myocardial perfusion imaging for determining lesion significance in patients with multivessel coronary disease. Am J Cardiol 99: 896-902. View
  53. Yoshinaga K, Katoh C, Noriyasu K, Iwado Y, Furuyama H, et al. (2003) Reduction of coronary flow reserve in areas with and without ischemia on stress perfusion imaging in patients with coronary artery disease: a study using oxygen 15-labeled water PET. J Nucl Cardiol 10:275-283. View
  54. Lima RS, Watson DD, Goode AR, Siadaty MS, Ragosta M, et al. (2003) Incremental value of combined perfusion and function over perfusion alone by gated SPECT myocardial perfusion imaging for detection of severe three-vessel coronary artery disease. J Am Coll Cardiol 42: 64-70. View
  55. Gaemperli O, Schepis T, Koepfli P, Valenta I, Soyka J, et al. (2007) Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 34: 1162-1171. View
  56. Falk E, Shah PK, Fuster V (1995) Coronary plaque disruption. Circulation 92: 657-671. View
  57. Dilsizian V, Bateman TM, Bergmann SR, Des Prez R, Magram MY, et al. (2005) Metabolic imaging with beta-methyl-p-[(123)I]-iodophenylpentadecanoic acid identifies ischemic memory after demand ischemia. Circulation 112: 2169-2174. View
  58. Kontos MC, Dilsizian V, Weiland F, DePuey G, Mahmarian JJ, et al. (2010) Iodofiltic acid I 123 (BMIPP) fatty acid imaging improves initial diagnosis in emergency department patients with suspected acute coronary syndromes: a multicenter trial. J Am Coll Cardiol 56: 290-299. View
  59. Fukushima Y, Toba M, Ishihara K, Mizumura S, Seino T, et al. (2008) Usefulness of 201TlCl/123I-BMIPP dual-myocardial SPECT for patients with non-ST segment elevation myocardial infarction. Ann Nucl Med 22: 363-369. View
  60. Ishida Y, Yasumura Y, Nagaya N, Fukuchi K, Komamura K, et al. (1999) Myocardial imaging with 123I-BMIPP in patients with congestive heart failure. Int J Card Imaging 15: 71-77. View
  61. Budoff MJ, Dowe D, Jollis JG, Gitter M, Halamert E, et al. (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52: 1724-1732. View
  62. Hamon M, Morello R, Riddell JW, Hamon M (2007) Coronary arteries: diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography--meta-analysis. Radiology 245: 720-731. View
  63. Sharma A, Arbab-Zadeh A (2012) Assessment of coronary heart disease by CT angiography: current and evolving applications. J Nucl Cardiol 19: 796-806. View
  64. Morsbach F, Desbiolles L, Plass A, Leschka S, Schmidt B, et al. (2013) Stenosis quantification in coronary CT angiography: impact of an integrated circuit detector with iterative reconstruction. Invest Radiol 48: 32-40. View
  65. Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, et al. (2007) Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 50: 319-326. View
  66. Motoyama S, Sarai M, Harigaya H, Anno H, Inoue K, et al. (2009) Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome. J Am Coll Cardiol 54: 49-57. View
  67. Maurovich-Horvat P, Hoffmann U, Vorpahl M, Nakano M, Virmani R, et al. (2010) The napkin-ring sign: CT signature of high-risk coronary plaques? JACC Cardiovasc Imaging 3: 440-444. View
  68. Seifarth H, Schlett CL, Nakano M, Otsuka F, Károlyi M, et al. (2012) Histopathological correlates of the napkin-ring sign plaque in coronary CT angiography. Atherosclerosis 224: 90-96. View
  69. Maurovich-Horvat P, Schlett CL, Alkadhi H, Nakano M, Otsuka F, et al. (2012) The napkin-ring sign indicates advanced atherosclerotic lesions in coronary CT angiography. JACC Cardiovasc Imaging 5: 1243-1252. View
  70. Slomka PJ, Dey D, Duvall WL, Henzlova MJ, Berman DS, et al. (2012) Advances in nuclear cardiac instrumentation with a view towards reduced radiation exposure. Curr Cardiol Rep 14: 208-216. View
  71. Javadi MS, Lautamäki R, Merrill J, Voicu C, Epley W, et al. (2010) Definition of vascular territories on myocardial perfusion images by integration with true coronary anatomy: a hybrid PET/CT analysis. J Nucl Med 51: 198-203. View
  72. Nakajo H, Kumita S, Cho K, Kumazaki T (2005) Three-dimensional registration of myocardial perfusion SPECT and CT coronary angiography. Ann Nucl Med 19: 207-215. View
  73. Rispler S, Keidar Z, Ghersin E, Roguin A, Soil A, et al. (2007) Integrated single-photon emission computed tomography and computed tomography coronary angiography for the assessment of hemodynamically significant coronary artery lesions. J Am Coll Cardiol 49: 1059-1067. View
  74. Sato A, Nozato T, Hikita H, Miyazaki S, Takahashi Y, et al. (2010) Incremental value of combining 64-slice computed tomography angiography with stress nuclear myocardial perfusion imaging to improve noninvasive detection of coronary artery disease. J Nucl Cardiol 17: 19-26. View
  75. Gaemperli O, Schepis T, Valenta I, Husmann L, Scheffel H, et al. (2007) Cardiac image fusion from stand-alone SPECT and CT: clinical experience. J Nucl Med 48: 696-703. View
  76. Santana CA, Garcia EV, Faber TL, Sirineni GK, Esteves FP, et al. (2009) Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography. J Nucl Cardiol 16: 201- 211. View
  77. Slomka PJ, Cheng VY, Dey D, Woo J, Ramesh A, et al. (2009) Quantitative analysis of myocardial perfusion SPECT anatomically guided by coregistered 64-slice coronary CT angiography. J Nucl Med 50: 1621-1630. View
  78. van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, et al. (2009) Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol 53: 623-632. View
  79. Pazhenkottil AP, Nkoulou RN, Ghadri JR, Herzog BA, Buechel RR, et al. (2011) Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary computed tomography angiography. Eur Heart J 32: 1465-1471. View
  80. Pazhenkottil AP, Nkoulou RN, Ghadri JR, Herzog BA, Kuest SM, et al. (2011) Impact of cardiac hybrid single-photon emission computed tomography/ computed tomography imaging on choice of treatment strategy in coronary artery disease. Eur Heart J 32: 2824-2829. View
  81. Schaap J, de Groot JA, Nieman K, Meijboom WB, Boekholdt SM, et al. (2013) Hybrid myocardial perfusion SPECT/CT coronary angiography and invasive coronary angiography in patients with stable angina pectoris lead to similar treatment decisions. Heart 99: 188-194. View
  82. Hachamovitch R, Nutter B, Hlatky MA, Shaw LJ, Ridner ML, et al. (2012) Patient management after noninvasive cardiac imaging results from SPARC (Study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease). J Am Coll Cardiol 59: 462-474. View
  83. Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Mosler TP, et al. (2007) Longterm prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol 49: 1860-1870. View
  84. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, et al. (2008) Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 358: 1336-1345. View
  85. Madhavan MV, Tarigopula M, Mintz GS, Maehara A, Stone GW, et al. (2014) Coronary artery calcification: pathogenesis and prognostic implications. J Am Coll Cardiol 63: 1703-1714. View
  86. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. 92: 2157-2162. View
  87. Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, et al. (2007) ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 49: 378-402. View
  88. Rozanski A, Gransar H, Wong ND, Shaw LJ, Miranda-Peats R, et al. (2007) Clinical outcomes after both coronary calcium scanning and exercise myocardial perfusion scintigraphy. J Am Coll Cardiol 49: 1352-1361. View
  89. Schepis T, Gaemperli O, Koepfli P, Namdar M, Valenta I, et al. (2007) Added value of coronary artery calcium score as an adjunct to gated SPECT for the evaluation of coronary artery disease in an intermediate-risk population. J Nucl Med 48: 1424-1430. View
  90. Ghadri JR, Pazhenkottil AP, Nkoulou RN, Goetti R, Buechel RR, et al. (2011) Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI. Heart 97: 998-1003. View
  91. Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ (2007) Radiation dose to patients from cardiac diagnostic imaging. Circulation 116: 1290-1305. View
  92. Husmann L, Valenta I, Gaemperli O, Adda O, Treyer V, et al. (2008) Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating. Eur Heart J 29: 191-197. View
  93. Hausleiter J, Martinoff S, Hadamitzky M, Martuscelli E, Pschierer I, et al. (2010) Image quality and radiation exposure with a low tube voltage protocol for coronary CT angiography results of the PROTECTION II Trial. JACC Cardiovasc Imaging 3: 1113-1123. View
  94. Achenbach S, Marwan M, Ropers D, Schepis T, Pflederer T, et al. (2010) Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J 31: 340-346. View
  95. Buechel RR, Herzog BA, Husmann L, Burger IA, Pazhenkottil AP, et al. (2010) Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: first clinical validation. Eur J Nucl Med Mol Imaging 37: 773-778. View
  96. Husmann L, Herzog BA, Gaemperli O, Tatsugami F, Burkhard N, et al. (2009) Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating. Eur Heart J 30: 600-607. View
  97. Palyo R, Sinusas A, Liu YH (2016) High-Sensitivity and High-Resolution SPECT/CT Systems Provide Substantial Dose Reduction without Compromising Quantitative Precision for Assessment of Myocardial Perfusion or Function. J Nucl Med [In press]. View
  98. Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 300: 1350-1358. View
  99. Tonino PA, Fearon WF, De Bruyne B, Oldroyd KG, Leesar MA, et al. (2010) Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 55: 2816-2821. View
  100. Stahli BE, Bonassin F, Goetti R, Kuest SM, Frank M, et al. (2012) Coronary computed tomography angiography indicates complexity of percutaneous coronary interventions. J Invasive Cardiol 24: 196-201. View
  101. FitzGibbon GM, Leach AJ, Kafka HP, Keon WJ (1991) Coronary bypass graft fate: long-term angiographic study. J Am Coll Cardiol 17: 1075-1080. View
  102. van Brussel BL, Plokker HW, Voors AA, Ernst SM, Kelder HC (1997) Progression of atherosclerosis after venous coronary artery bypass graft surgery: a 15-year follow-up study. Cathet Cardiovasc Diagn 41: 141-150. View
  103. Mathew V, Clavell AL, Lennon RJ, Grill DE, Holmes DR, Jr. (2000) Percutaneous coronary interventions in patients with prior coronary artery bypass surgery: changes in patient characteristics and outcome during two decades. Am J Med 108: 127-135. View
  104. Abe H, Iguchi N, Utanohara Y, Inoue K, Takamisawa I, et al. (2014) Noninvasive diagnosis of coronary artery disease by 123I-BMIPP/201TlCl dual myocardial SPECT in patients with heart failure. Int J Cardiol 176: 969-974. View
  105. Miyachi H, Kumita S, Tanaka K (2013) PET/CT and SPECT/CT cardiac fusion imaging in a patient with takotsubo cardiomyopathy. Eur Heart J 34: 397. View