Attenuation smear: A ‘paradoxical’ increase in counts due to attenuation artifact

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Abstract
Background: Attenuation is a well recognized cause of reconstruction artifacts in SPECT imaging. Occasionally, we have noted an increase in activity extending from the apical septal portion of the ventricle in women with significant breast attenuation. Although the idea that attenuation can produce an increase in activity on the reconstructed images seems paradoxical at first, it is consistent with the process of filtered back projection. Methods: We filled a cardiac phantom with 1 mCi of Technetium-99m, placed it in a water filled anthropomorphic torso phantom and imaged it over a 180° orbit. Next, a breast phantom designed to simulate a significant degree of breast attenuation was placed on the torso phantom and imaging was repeated. The images were reconstructed first using conventional filtered back projection then with maximum likelihood. Results: When the phantoms with and without breast attenuation were reconstructed using filtered back projection and compared, the phantom with breast attenuation had a large ‘smear’ of activity extending anteriorly from the apical septal wall which was very similar to the abnormalities previously noted in clinical images; the phantom without breast attenuation had no such defect. This artifact was significantly less prominent when the images were reconstructed using the maximum likelihood technique. Conclusions: Attenuation artifact can also produce a seemingly paradoxical increase in counts on the reconstructed image but this phenomenon is consistent with the workings of filtered back projection.