背景：近十年來以非一致性衰變校正(non-uniformed attenuation correction, AC)技術應用於心肌灌注單光子電腦斷層掃描(Single Photon emission computed tomograPhy; SPECT)加上部分散射校正技術已廣用於核醫心臟學研究，惟國內迄今僅三家醫院擁有此類設備。本研究首次探討非一致性衰變校正鉈-201心肌灌注掃描及無衰變校正(non-attenuation correctionp; NC)之診斷準確度，並與心導管結果比較。
材料與方法：本研究收集142例冠心病例(94男，48女：年齡：66±11歲)。每一病人皆以tceamill運動或潘西丁;(persantin)藥理刺激於次最大心跳速率(submaximal heart rate)時靜脈注射2mCi(74 MBq)鉈-201氯化亞鉈，給藥後五分鐘造影，並於三小時後再進行一次以資比較。兩次造影皆以ADAC VANTAGE之兩條釓-153(153Gd)線射源進行穿過性(transmissionl)與射出性(emission)掃描，同時以鉈-201進行射出性掃描。掃描數據經衰變圖處理者為AC資料，反之未經衰變圖處理者為NC資料。每位病人之四組資料並同時再與心導管結果比較。
結果：與心導管比較，病灶位於前壁、下室壁與側壁之冠心病診斷，AC的靈敏度分別為81%、74%與60%，特異性分別為64％、55％與91%，準確率分別為70%、61%與82%;而NC之診斷靈敏度分別為87%、88%與51％，特異性分別為72%、68%與90％，準確率分別為了79%、74%與80%。對於心室之前壁與下壁之偵側，AC並未比NC為佳，而對於外側壁之偵測略優於NC，但AC與NC結果並無統計學上的顯著差異(P>O.05)。核醫報告是合併閱讀AC與NC結果下的結論，其靈敏度、特異性與準確性，前壁為82%、59%、67%;下壁為84%、54%、62%;側壁為59%、90%、82%。
結論：雖然本研究發現AC在幫助心肌灌注掃描診斷方面並未比NC好;核醫報告用AC合併NC的病灶偵測結果可以補充單獨偵測AC或NC的不足，好處介於兩者之間。本研究主要的問題在於鉈-201 SPECT造影的總計測數不夠高，因此建議提高鉈-201劑量，增加每張影像的收錄時間。本研究對於AC的好處並無定論。

Background: Non-uniformed attenuation correction has been applied in myocardial perfusion single photon emission computed tomography (SPECT) in recent to years. However, there are only three hospitals in Taiwan having such equipments. To the best of our knowledge, this is the first paper discussing the d(agnostic accuracy of 201TI myocardial SPECT with (AC) and without (NC) non-uniformed attenuation correction in Taiwanese in compared with PTCA study.
Materials and Methods: Totally 142 patients with clinically suspicious coronary artery disease (94 male, 48 female; mean age 66 ± 11 years old) were included. All had coronary catheterization and 201TI myocardial SPECT (persantin or treadmill exercise) with consent of patients. The 201TI SPECT data were acquired using ADAC Vertex plus and ADAC VANTAGE for transmission and emission scans.
Results: The gold standard of this study was stenosis ≧ 70% of the coronary artery by coronary catheterization. As compared with coronary catheterization, the sensitivity and of AC in anterior (A), inferior (I) and lateral (L) walls was 81%, 74%, 60% and the specificity was 64%, 55%, 91%, respectively. The accuracy was 70%, 61%, and 82%. The sensitivity of NC in A, I, L walls was 87%, 88%, 51% and the specificity is 72%, 68% and 90%, respectively. The accuracy was 79%, 74%, and 80%. NC seemed to be better correlated with coronary catheterization in A and I walls but worse in L as compared with AC, However, there was no statistically significant difference between AC and NC in lesion detection (P>0.05). The reports of nuclear scans were combined reading of AC and NC results, the sensitivity, specificity and accuracy in 82%, 59%, 67% on anterior wall, 84%, 54%, 62% on inferior wall and 59%, 90%, 82% on lateral waif, respectively.
Conclusion: In comparison with NC, AC provides no significant advantages for lesion detection. AC plus NC yielded sensitivity, specificity and accuracy between AC and NC did. The main problem may be due to low total counts for 201TI SPECT examination. To solve this problem, we suggest that using higher dose and longer acquisition time. Besides, we recommend reading AC and NC simu (taneously at the time being, if possible. Conclusion to the advantage of AC was not made in this study.