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Fitch JS, Schwartz RG. Detection and quantification of myocardial scar and LVEF with high efficiency digital SPECT: The expanding value proposition for clinical cardiology. J Nucl Cardiol 2023; 30:2803-2806. [PMID: 36682016 DOI: 10.1007/s12350-023-03197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/23/2023]
Affiliation(s)
- Jeffrey S Fitch
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 679-N, Rochester, NY, 14642-8679, USA
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 679-N, Rochester, NY, 14642-8679, USA.
- Division of Nuclear Medicine, Department of Imaging Sciences, The University of Rochester Medical Center, Rochester, USA.
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2
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Chopra S, Singh SS, Sood A, Parmar M, Parihar AS, Vadi SK, Mittal BR. Comparison of positional artifacts in myocardial perfusion imaging in supine and semi-reclining position using dedicated D-SPECT cardiac camera: validation using CT based attenuation correction. J Nucl Cardiol 2023; 30:1782-1793. [PMID: 36849635 DOI: 10.1007/s12350-023-03210-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 01/14/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Soft-tissue attenuation remains a major limitation of SPECT-MPI which interferes with the diagnosis of CAD. The current study aims to evaluate the pattern of attenuation artifacts in supine and semi-reclining positions on CZT cardiac camera and their interaction with gender, BMI and stress protocols. METHODS We prospectively analysed 150 patients acquired in supine and semi-reclining positions on CZT camera. The images were evaluated for severity and extent of defect using 17-segment model. An additional CT scan was acquired to generate AC image in the first 50 patients studied to assist investigator learning for comparison of artifact vs true defects in the two SPECT systems. The defects present in one position or showing change in severity within two positions were considered as positional artifacts and further validated using CTAC supine image. RESULTS In overall analysis, higher extent and severity of positional artifacts were observed more in semi-reclining position affecting the apex, apico-inferior, inferolateral and inferoseptal segments. Females showed more positional artifacts than males with inferior wall attenuation in the semireclining position and anterior wall attenuation in the supine position. A positive correlation of the extent and severity of positional artifacts was noted with an increasing BMI. In patients with BMI > 30, mid inferior and inferolateral segments were most affected followed by anterior wall segments. Highest correction of artifactual perfusion defects by CTAC was noted in inferior wall followed by inferolateral segments. CONCLUSION The incidence of positional artifacts was greater in semi-reclining position in females, higher BMI groups and adenosine stress subsets. Knowledge of the pattern of positional artifacts appears to be a reliable alternative of CTAC for correct interpretation of myocardial perfusion images.
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Affiliation(s)
- Sejal Chopra
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shashank Shekhar Singh
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Madan Parmar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwin Singh Parihar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shelvin Kumar Vadi
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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3
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Ochoa-Figueroa M, Frias-Rose J, Good E, Sanchez-Rodriguez V, Davidsson A, Pagonis C. Diagnostic performance of different cardiac stress protocols for myocardial perfusion imaging for the diagnosis of coronary artery disease using a cadmium-zinc-telluride camera with invasive coronary angiography correlation. Rev Esp Med Nucl Imagen Mol 2023; 42:281-288. [PMID: 36103979 DOI: 10.1016/j.remnie.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/08/2021] [Accepted: 01/23/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of three different cardiac stress protocols for myocardial perfusion imaging (MPI) using a cadmium-zinc-telluride (CZT) camera with invasive coronary angiography (ICA) correlation for the diagnosis of coronary artery disease in a high risk population. METHODS Retrospective study of 263 patients (96 women and 167 males, mean age 68 years) from which 119 patients performed a bicycle stress test (BST), 113 pharmacological stress test (PST) and 31 a combination of the two (CST) between September 2014 and December 2018. The patients then underwent myocardial perfusion imaging (MPI), followed by ICA and evaluated by means of quantitative angiography software, within six months after the MPI. The mean pre-test probability score for coronary disease according to the European Society of Cardiology criteria was 36% for the whole population. The MPI was performed in a dedicated CZT cardio camera (D-SPECT Spectrum Dynamics) with a two-day protocol, according to the European Association of Nuclear Medicine guidelines. RESULTS No significant difference was observed between the three stress protocols in terms of diagnostic accuracy (BST 85%, PST 88%, CST 84%). The overall diagnostic accuracy of MPI to identify patients with any obstructive CAD at ICA was 86%, Sensitivity 93%, Specificity 54%, PPV 90% and NPV 63%. CONCLUSION The CZT D-SPECT camera achieves overall satisfactory results in the diagnosis of CAD, observing no significant differences in the diagnostic performance when the stress test was performed as a BST, PST or CST.
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Affiliation(s)
- Miguel Ochoa-Figueroa
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden; Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Jeronimo Frias-Rose
- Department of Pathology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Elin Good
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Veronica Sanchez-Rodriguez
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden; Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anette Davidsson
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Christos Pagonis
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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4
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Hage FG, Einstein AJ, Ananthasubramaniam K, Bourque JM, Case J, DePuey EG, Hendel RC, Henzlova MJ, Shah NR, Abbott BG, Al Jaroudi W, Better N, Doukky R, Duvall WL, Malhotra S, Pagnanelli R, Peix A, Reyes E, Saeed IM, Sanghani RM, Slomka PJ, Thompson RC, Veeranna V, Williams KA, Winchester DE. Quality metrics for single-photon emission computed tomography myocardial perfusion imaging: an ASNC information statement. J Nucl Cardiol 2023; 30:864-907. [PMID: 36607538 DOI: 10.1007/s12350-022-03162-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Fadi G Hage
- Section of Cardiology, Birmingham VA Medical Center, Birmingham, AL, USA.
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 446 GSB, 520 19Th Street South, Birmingham, AL, 35294, USA.
| | - Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine and Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Jamieson M Bourque
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - James Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
| | - E Gordon DePuey
- Mount Sinai Morningside Hospital, New York, NY, USA
- Bay Ridge Medical Imaging, Brooklyn, NY, USA
| | - Robert C Hendel
- Department of Medicine, Division of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Nishant R Shah
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Brian G Abbott
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Wael Al Jaroudi
- Division of Cardiovascular Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nathan Better
- Department of Nuclear Medicine and Cardiology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - W Lane Duvall
- Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | - Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
| | - Eliana Reyes
- Nuclear Medicine Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ibrahim M Saeed
- Virginia Heart, Falls Church, VA, USA
- INOVA Heart and Vascular Institute, Falls Church, VA, USA
- University of Missouri, Kansas City, MO, USA
| | - Rupa M Sanghani
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - Randall C Thompson
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Vikas Veeranna
- Division of Cardiology, Department of Medicine, New England Heart and Vascular Institute, Manchester, NH, USA
| | - Kim A Williams
- Department of Medicine, University of Louisville Department of Medicine, Louisville, KY, USA
| | - David E Winchester
- Malcom Randall VA Medical Center, Gainesville, FL, USA
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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5
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Krizsan AK, Kukuts K, Al-Muhanna W, Szoboszlai Z, Balazs L, Szabo B, Kiss J, Nekolla S, Barna S, Garai I, Bukki T, Forgacs A. Performance evaluation of a novel multi-pinhole collimator on triple-NaI-detector SPECT/CT for dedicated myocardial imaging. EJNMMI Phys 2023; 10:24. [PMID: 36964406 PMCID: PMC10039219 DOI: 10.1186/s40658-023-00541-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/01/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In this study we evaluated the imaging capabilities of a novel Multi-pinhole collimator (MPH-Cardiac) specially designed for nuclear cardiology imaging on a Triple-NaI-detector based SPECT/CT system. METHODS 99mTc point source measurements covering the field of view (FOV) were used to determine tomographic sensitivity (TSpointsource) and spatial resolution. Organ-size tomographic sensitivity (TSorgan) was measured with a left ventricle (LV) phantom filled with typical myocardial activity of a patient scan. Reconstructed image uniformity was measured with a 140 mm diameter uniform cylinder phantom. Using the LV phantom once filled with 99mTc and after with 123I, Contrast-to-noise ratio (CNR) was measured on the reconstructed images by ROI analysis on the myocardium activity and on the LV cavity. Furthermore, a polar map analysis was performed determining Spill-Over-Ratio in water (SORwater) and image noise. The results were compared with that of a dual-head parallel-hole low energy high resolution (LEHR) collimator system. A patient with suspected coronary artery disease (CAD) was scanned on the LEHR system using local protocol of 16 min total acquisition time, followed by a 4-min MPH-Cardiac scan. RESULTS Peak TSpointsource was found to be 1013 cps/MBq in the axial center of the FOV while it was decreasing toward the radial edges. TSorgan in the CFOV was found to be 134 cps/MBq and 700 cps/MBq for the LEHR and MPH-Cardiac, respectively. Average spatial resolution throughout the FOV was 4.38 mm FWHM for the MPH-Cardiac collimator. Reconstructed image uniformity values were found to be 0.292% versus 0.214% for the LEHR and MPH-Cardiac measurements, respectively. CNR was found to be higher in case of MPH-Cardiac than for LEHR in case of 99mTc (15.5 vs. 11.7) as well as for 123I (13.5 vs. 8.3). SORwater values were found to be 28.83% and 21.1% for the 99mTc measurements, and 31.44% and 24.33% for the 123I measurements for LEHR and MPH-Cardiac, respectively. Pixel noise of the 99mTc polar maps resulted in values of 0.38% and 0.24% and of the 123I polar maps 0.62% and 0.21% for LEHR and MPH-Cardiac, respectively. Visually interpreting the patient scan images, MPH-Cardiac resulted in better image contrast compared to the LEHR technique with four times shorter scan duration. CONCLUSIONS The significant image quality improvement achieved with dedicated MPH-Cardiac collimator on triple head SPECT/CT system paves the way for short acquisition and low-dose cardiovascular SPECT applications.
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Affiliation(s)
- Aron K Krizsan
- ScanoMed Nuclear Medicine Centers, Nagyerdei Krt. 98, Debrecen, 4032, Hungary.
| | - Kornel Kukuts
- ScanoMed Nuclear Medicine Centers, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
| | - Walid Al-Muhanna
- ScanoMed Nuclear Medicine Centers, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
| | - Zoltan Szoboszlai
- ScanoMed Nuclear Medicine Centers, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
| | | | | | - Janos Kiss
- Medical Imaging Clinic - Radiology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Stephan Nekolla
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technische Universitӓt München, München, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sandor Barna
- ScanoMed Nuclear Medicine Centers, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
- Mediso Ltd., Budapest, Hungary
- Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildiko Garai
- ScanoMed Nuclear Medicine Centers, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
- Mediso Ltd., Budapest, Hungary
- Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Attila Forgacs
- ScanoMed Nuclear Medicine Centers, Nagyerdei Krt. 98, Debrecen, 4032, Hungary
- Mediso Ltd., Budapest, Hungary
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6
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Arvidsson I, Davidsson A, Overgaard NC, Pagonis C, Åström K, Good E, Frias-Rose J, Heyden A, Ochoa-Figueroa M. Deep learning prediction of quantitative coronary angiography values using myocardial perfusion images with a CZT camera. J Nucl Cardiol 2023; 30:116-126. [PMID: 35610536 DOI: 10.1007/s12350-022-02995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Evaluate the prediction of quantitative coronary angiography (QCA) values from MPI, by means of deep learning. METHODS 546 patients (67% men) undergoing stress 99mTc-tetrofosmin MPI in a CZT camera in the upright and supine position were included (1092 MPIs). Patients were divided into two groups: ICA group included 271 patients who performed an ICA within 6 months of MPI and a control group with 275 patients with low pre-test probability for CAD and a normal MPI. QCA analyses were performed using radiologic software and verified by an expert reader. Left ventricular myocardium was segmented using clinical nuclear cardiology software and verified by an expert reader. A deep learning model was trained using a double cross-validation scheme such that all data could be used as test data as well. RESULTS Area under the receiver-operating characteristic curve for the prediction of QCA, with > 50% narrowing of the artery, by deep learning for the external test cohort: per patient 85% [95% confidence interval (CI) 84%-87%] and per vessel; LAD 74% (CI 72%-76%), RCA 85% (CI 83%-86%), LCx 81% (CI 78%-84%), and average 80% (CI 77%-83%). CONCLUSION Deep learning can predict the presence of different QCA percentages of coronary artery stenosis from MPIs.
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Affiliation(s)
- Ida Arvidsson
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Anette Davidsson
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, 581 85, Linköping, Sweden
| | | | - Christos Pagonis
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kalle Åström
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Elin Good
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Jeronimo Frias-Rose
- Department of Pathology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Heyden
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Miguel Ochoa-Figueroa
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, 581 85, Linköping, Sweden.
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
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7
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Advances in Single-Photon Emission Computed Tomography. Cardiol Clin 2023; 41:117-127. [PMID: 37003670 DOI: 10.1016/j.ccl.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The clinical presentation of coronary artery disease (CAD) has changed during the last 20 years with less ischemia on stress testing and more nonobstructive CAD on coronary angiography. Single-photon emission computed tomography (SPECT) myocardial perfusion imaging should include the measurement of myocardial flow reserve and assessment of coronary calcium for the diagnosis of nonobstructive CAD and coronary microvascular disease. SPECT/CT systems provide reliable attenuation correction for better specificity and low-dose CT for coronary calcium evaluation. SPECT MFR measurement is accurate, well validated, and repeatable.
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8
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Werner RA, Martinez RB, Marcus C, Kruse MJ, Sheikhbahaei S, Solnes LB, Higuchi T, Javadi MS, Rowe SP. Diagnostic performance of IQ·SPECT with high-speed scanning: A preliminary quality control study in obese patients. J Nucl Cardiol 2022; 29:3443-3449. [PMID: 35386095 DOI: 10.1007/s12350-022-02928-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/02/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND IQ·SPECT is a recently introduced collimator design for myocardial perfusion imaging (MPI). Little data exist on use of this collimator type in obese patients, particularly Class 2 or 3 [body mass index (BMI) > 35 kg/m2]. METHODS Two consecutive rest-stress MPI scans were prospectively acquired using a conventional collimator and IQ·SPECT (acquisition times of 20 and 7 minutes, respectively) in 20 patients with a BMI of >30 kg/m2. Assigned by two blinded, independent readers, image quality (on a 5-point scale) and metrics of myocardial perfusion [summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS)] were compared. Software-based left ventricular ejection fraction (EF) was also correlated. RESULTS Mean BMI was 39.6 ± 7.6 kg/m2. Class 2 or 3 obesity was present in 12 patients (BMI, 44.1 ± 6.8 kg/m2). Gated/non-gated images from IQ·SPECT revealed fair to good quality scores (median ≥ 3.25), which were inferior to the conventional collimator (median ≥ 4.0; P ≤ 0.01). Significant correlative indices were achieved when comparing IQ·SPECT and conventional collimators for EF values (r = 0.86, P < 0.01), SSS (r = 0.75, P < 0.0001) and SRS (r = 0.60, P < 0.005), but not for SDS (r = 0.15). CONCLUSION IQ·SPECT was comparable to conventional SPECT in obese patients. The reduced acquisition time of IQ·SPECT may allow for improved throughput with no loss in diagnostic accuracy.
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Affiliation(s)
- Rudolf A Werner
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Ricardo Bello Martinez
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Marcus
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew J Kruse
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sara Sheikhbahaei
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lilja B Solnes
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Mehrbod S Javadi
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven P Rowe
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Klein E, Miller RJH, Sharir T, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Otaki Y, Gransar H, Liang JX, Dey D, Berman DS, Slomka PJ. Automated quantitative analysis of CZT SPECT stratifies cardiovascular risk in the obese population: Analysis of the REFINE SPECT registry. J Nucl Cardiol 2022; 29:727-736. [PMID: 32929639 PMCID: PMC8497048 DOI: 10.1007/s12350-020-02334-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obese patients constitute a substantial proportion of patients referred for SPECT myocardial perfusion imaging (MPI), presenting a challenge of increased soft tissue attenuation. We investigated whether automated quantitative perfusion analysis can stratify risk among different obesity categories and whether two-view acquisition adds to prognostic assessment. METHODS Participants were categorized according to body mass index (BMI). SPECT MPI was assessed visually and quantified automatically; combined total perfusion deficit (TPD) was evaluated. Kaplan-Meier and Cox proportional hazard analyses were used to assess major adverse cardiac event (MACE) risk. Prognostic accuracy for MACE was also compared. RESULTS Patients were classified according to BMI: BMI < 30, 30 ≤ BMI < 35, BMI ≥ 35. In adjusted analysis, each category of increasing stress TPD was associated with increased MACE risk, except for 1% ≤ TPD < 5% and 5% ≤ TPD < 10% in patients with BMI ≥ 35. Compared to visual analysis, single-position stress TPD had higher prognostic accuracy in patients with BMI < 30 (AUC .652 vs .631, P < .001) and 30 ≤ BMI < 35 (AUC .660 vs .636, P = .027). Combined TPD had better discrimination than visual analysis in patients with BMI ≥ 35 (AUC .662 vs .615, P = .003). CONCLUSIONS Automated quantitative methods for SPECT MPI interpretation provide robust risk stratification in the obese population. Combined stress TPD provides additional prognostic accuracy in patients with more significant obesity.
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Affiliation(s)
- Eyal Klein
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Robert J H Miller
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Center, Tel Aviv, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Mathews B Fish
- Department of Nuclear Medicine, Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Albert J Sinusas
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | - Edward J Miller
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | | | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Yuka Otaki
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Heidi Gransar
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Joanna X Liang
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Damini Dey
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Daniel S Berman
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA
| | - Piotr J Slomka
- Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA.
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10
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Imbert L, Marie PY. Dedicated CZT gamma cameras for nuclear cardiology. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00080-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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11
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Baumgarten R, Cerci RJ, de Nadai Costa A, Pereira-Neto CC, Prado P, Zapparoli M, Masukawa M, Cerci JJ, Vitola JV, Fernandes-Silva MM. Radiation exposure after myocardial perfusion imaging with Cadmium-Zinc-Telluride camera versus conventional camera. J Nucl Cardiol 2021; 28:992-999. [PMID: 32410061 DOI: 10.1007/s12350-020-02146-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patient exposure to radiation during the management of coronary heart disease (CHD) can be reduced with more efficient technologies in nuclear medicine, such as the Cadmium-Zinc-Telluride (CZT) gamma-camera for myocardial perfusion imaging (MPI) studies. However, it has been suggested that CZT has lower specificity, which might lead to more downstream radiological procedures, particularly among obese individuals. METHODS AND RESULTS We evaluated 244 patients with suspected CHD who underwent CZT-SPECT and matched 1:1 according to sex, age, and body mass index (BMI) with those undergoing MPI study with the Anger gamma-camera (Anger-SPECT). The outcome was the total radiation exposure from the MPI study added to the radiation exposure from all subsequent cardiac examinations during a 90-day follow-up. The total radiation dose after 90 days was significantly lower in the CZT-SPECT group (6.4 ± 4.8 vs 9.5±4.9 mSv, P < .001). After adjusting for potential confounders, CZT-SPECT remained associated with lower total radiation dose, but it significantly attenuated among obese individuals (Beta coefficient - 3.73 ± 0.86 for BMI < 30 vs - 2.30 ± 0.92 for BMI ≥ 30 Kg/m2, P for interaction < 0.032). CONCLUSIONS CZT-SPECT was associated with lower total radiation doses compared to Anger-SPECT, albeit this benefit may be attenuated in obese individuals.
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Affiliation(s)
- Ricardo Baumgarten
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - Rodrigo Julio Cerci
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - Amanda de Nadai Costa
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | | | - Pedro Prado
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - Marcello Zapparoli
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - Margaret Masukawa
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - Juliano Julio Cerci
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - João Vicente Vitola
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
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12
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Veeranna V, Freeman AM. The magic of improved crystal technology coupled with better resolution: Novel imaging findings may promise improved disease detection. J Nucl Cardiol 2021; 28:328-330. [PMID: 33025471 DOI: 10.1007/s12350-020-02380-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Vikas Veeranna
- New England Heart and Vascular Institute, Manchester, USA
| | - Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, USA.
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13
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Piekarski E, Manrique A, Rouzet F, Le Guludec D. Current Status of Myocardial Perfusion Imaging With New SPECT/CT Cameras. Semin Nucl Med 2020; 50:219-226. [PMID: 32284108 DOI: 10.1053/j.semnuclmed.2020.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Myocardial perfusion imaging (MPI) with Single-Photon Emission Computed Tomography (SPECT) has a major role in the management of coronary artery disease. Recent technological advances regarding SPECT detectors with the use of solid-state detectors has allowed for improved imaging quality since a decade with dramatic dose and/or time reduction of imaging protocols due to improved sensitivity and spatial resolution, and is now performed as a routine exam. Interestingly, this new technology has modified our everyday practice, from acquisition protocols (low dose and ultra-fast protocols) to image semiology. Numerous studies have shown how these technical advances have allowed for improved patient management, with similar or improved diagnostic and prognostic information derived from MPI. These improvements have also led to the straightforward implementation of myocardial blood flow measurement. This article reviews the current status of MPI using new SPECT and SPECT/CT cameras.
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Affiliation(s)
- Eve Piekarski
- Nuclear Medicine Department, Bichat Hospital, AP-HP, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, INSERM, Paris, France
| | - Alain Manrique
- Normandie Univ, UNICAEN, Caen, France; Médecine Nucléaire, CHU de Caen, Caen, France; GIP Cyceron, Campus Jules Horowitz, Caen, France
| | - François Rouzet
- Nuclear Medicine Department, Bichat Hospital, AP-HP, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, INSERM, Paris, France
| | - Dominique Le Guludec
- Nuclear Medicine Department, Bichat Hospital, AP-HP, Paris, France; Université de Paris, Paris, France; Laboratory for Vascular Translational Science, INSERM, Paris, France.
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14
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Left ventricular mechanical dyssynchrony assessment in obese patients using the cadmium-zinc telluride SPECT camera. Int J Cardiovasc Imaging 2020; 36:757-765. [PMID: 31919704 DOI: 10.1007/s10554-019-01762-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
The use of phase analysis techniques to assess left ventricular mechanical dyssynchrony (LVMD) has been well documented. However, artifacts have reduced the accuracy of the assessment due to soft tissue attenuation, so little information is available about the effects of obesity on LVMD. The aim of this study was to evaluate LVMD in patients with simple obesity by SPECT with a new cadmium-zinc telluride (CZT) detector and to explore the effects of obesity on left ventricular wall motion. We retrospectively analyzed 95 patients with myocardial perfusion imaging (MPI) images without perfusion defects, of which 55 were diagnosed with simple obesity (BMI > 30), and 40 non-obese patients (BMI < 25) matched for age and sex were used as controls. The five-point method was used to analyze the MPI images of the two groups, and the complete cardiac function parameters including phase bandwidth (PBW) and phase standard deviation (PSD) were obtained. Although the PBW values of the two groups were within the normal range (cut-off value > 90°), the PBW (35.4 ± 28 vs 24.9 ± 7.5, P < .001; 36.6 ± 18.4 vs 28.7 ± 9.1, P = 0.01) and PSD (8.7 ± 7.6 vs 5.9 ± 2, P = 0.02; 9.2 ± 4.9 vs 7.1 ± 2.7, P = 0.01) of the obese group were larger than the control group under both stressing and resting, and the difference was statistically significant. CZT-SPECT can effectively assess LVMD in obese patients, and they are more likely to develop LVMD, which may be related to their left ventricular volume.
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15
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Slomka PJ, Miller RJ, Hu LH, Germano G, Berman DS. Solid-State Detector SPECT Myocardial Perfusion Imaging. J Nucl Med 2019; 60:1194-1204. [DOI: 10.2967/jnumed.118.220657] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/18/2019] [Indexed: 02/07/2023] Open
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16
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Naqvi SY, Wittlin SD, Schwartz RG. Refining risk in diabetes and CAD with SPECT MPI: New insights and future challenges. J Nucl Cardiol 2019; 26:1103-1106. [PMID: 29404896 DOI: 10.1007/s12350-017-1177-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Syed Y Naqvi
- Department of Medicine, Cardiology Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Steven D Wittlin
- Department of Medicine, Endocrine-Metabolism Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Ronald G Schwartz
- Department of Medicine, Cardiology Division, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Imaging Sciences, Nuclear Medicine Division, University of Rochester Medical Center, Rochester, NY, USA.
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17
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Spier N, Nekolla S, Rupprecht C, Mustafa M, Navab N, Baust M. Classification of Polar Maps from Cardiac Perfusion Imaging with Graph-Convolutional Neural Networks. Sci Rep 2019; 9:7569. [PMID: 31110326 PMCID: PMC6527613 DOI: 10.1038/s41598-019-43951-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 02/25/2019] [Indexed: 11/09/2022] Open
Abstract
Myocardial perfusion imaging is a non-invasive imaging technique commonly used for the diagnosis of Coronary Artery Disease and is based on the injection of radiopharmaceutical tracers into the blood stream. The patient's heart is imaged while at rest and under stress in order to determine its capacity to react to the imposed challenge. Assessment of imaging data is commonly performed by visual inspection of polar maps showing the tracer uptake in a compact, two-dimensional representation of the left ventricle. This article presents a method for automatic classification of polar maps based on graph convolutional neural networks. Furthermore, it evaluates how well localization techniques developed for standard convolutional neural networks can be used for the localization of pathological segments with respect to clinically relevant areas. The method is evaluated using 946 labeled datasets and compared quantitatively to three other neural-network-based methods. The proposed model achieves an agreement with the human observer on 89.3% of rest test polar maps and on 91.1% of stress test polar maps. Localization performed on a fine 17-segment division of the polar maps achieves an agreement of 83.1% with the human observer, while localization on a coarse 3-segment division based on the vessel beds of the left ventricle has an agreement of 78.8% with the human observer. Our method could thus assist the decision-making process of physicians when analyzing polar map data obtained from myocardial perfusion images.
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Affiliation(s)
- Nathalia Spier
- Computer Aided Medical Procedures & Augmented Reality, Faculty of Informatics, Technical University of Munich, Munich, Germany
| | - Stephan Nekolla
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Rupprecht
- Computer Aided Medical Procedures & Augmented Reality, Faculty of Informatics, Technical University of Munich, Munich, Germany
| | - Mona Mustafa
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nassir Navab
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian Baust
- Computer Aided Medical Procedures & Augmented Reality, Faculty of Informatics, Technical University of Munich, Munich, Germany.
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18
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Zhang YQ, Jiang YF, Hong L, Chen M, Zhang NN, Yang HJ, Zhou YF. Diagnostic value of cadmium-zinc-telluride myocardial perfusion imaging versus coronary angiography in coronary artery disease: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019; 98:e14716. [PMID: 30817614 PMCID: PMC6831125 DOI: 10.1097/md.0000000000014716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Rapid progress has been made in research of cadmium-zinc-telluride (CZT) technology in the last few years, which might serve as a new method to diagnose coronary artery disease. However, compared with coronary angiography, the diagnostic value of CZT is still controversial. We aimed to evaluate diagnosis value of coronary angiography versus CZT in coronary artery disease. METHODS We searched the database for eligible researches associated with CZT- myocardial perfusion imaging (MPI) and invasive coronary angiography, extracted the relevant data, and rigorously screened it according to the inclusion and exclusion criteria. The accuracy indicators included sensitivity, specificity, accuracy, positive and negative likelihood ratios. RESULTS According to the inclusion and exclusion criteria, we finally found 20 studies containing 2350 patients in this search. Pooled results showed that sensitivity of CZT-MPI was 0.84% and 95% confidence interval (95% CI): 0.78 to 0.89, specificity was 0.72, 95% CI (0.62-0.76), the specificity was lower apparently. The positive likelihood ratio was 3.0, 95% CI (2.4-3.8), the negative likelihood ratio was 0.22, 95% CI (0.16-0.31), diagnostic odds ratio was 14, 95% CI (7.84-17.42). CONCLUSION This meta-analysis showed that CZT-MPI had satisfactory sensitivity and specificity for diagnosing coronary artery disease. Larger studies are required for further evaluation.
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19
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Peters A, Kumar J, Patil PV. Diagnostic implications of CZT SPECT and impact of CT attenuation correction. J Nucl Cardiol 2019; 26:246-249. [PMID: 28646293 DOI: 10.1007/s12350-017-0961-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew Peters
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, 9th Floor Parkinson Pavilion, 3401 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Jeevan Kumar
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, 9th Floor Parkinson Pavilion, 3401 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Pravin V Patil
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, 9th Floor Parkinson Pavilion, 3401 N. Broad Street, Philadelphia, PA, 19140, USA.
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20
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Dorbala S, Ananthasubramaniam K, Armstrong IS, Chareonthaitawee P, DePuey EG, Einstein AJ, Gropler RJ, Holly TA, Mahmarian JJ, Park MA, Polk DM, Russell R, Slomka PJ, Thompson RC, Wells RG. Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation. J Nucl Cardiol 2018; 25:1784-1846. [PMID: 29802599 DOI: 10.1007/s12350-018-1283-y] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Sharmila Dorbala
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | - Andrew J Einstein
- Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | | | - Thomas A Holly
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John J Mahmarian
- Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA
| | | | - Donna M Polk
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - R Glenn Wells
- University of Ottawa Heart Institute, Ottawa, Canada
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21
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Slomka P, Germano G. Factors affecting appearance of a normal myocardial perfusion scan. J Nucl Cardiol 2018; 25:1655-1657. [PMID: 28361475 DOI: 10.1007/s12350-017-0857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, USA.
| | - Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, USA
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22
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Ishihara M, Onoguchi M, Shibutani T. An Exploratory Study of Washout Rate Analysis for Thallium-201 Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging Using Cadmium Zinc Telluride Detectors. Mol Imaging 2018; 17:1536012118782322. [PMID: 29952215 PMCID: PMC6077886 DOI: 10.1177/1536012118782322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to assess the washout rate (WOR) for thallium-201-chloride single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) using cadmium zinc telluride detectors for SPECT (CZT SPECT) versus conventional Anger-type SPECT (conventional SPECT). A total of 52 Japanese patients were examined using CZT SPECT and conventional SPECT, and the global WORs were compared. Additionally, the MPI WORs were compared for patients with a normal MPI versus those in whom MPI reflected the patients’ multivessel disease (MVD) MPI. Washout rates were similar when approximated by CZT SPECT versus conventional SPECT 12.59 ± 2.26%/h vs 12.57 ± 2.27%/h (P = .997), respectively. The WOR values for CZT SPECT versus conventional SPECT were 13.42%/h (1.53%/h) vs 13.93%/h (1.24%/h) (P = .337), respectively, for 7 normal MPI patients, and 10.64 ± 2.20%/h vs 10.84 ± 2.26%/h (P = .848), respectively, for 7 MVD-MPI patients. The WOR values for normal MPI versus MVD-MPI patients for CZT SPECT were 13.42 ± 1.53%/h vs 10.64 ± 2.20%/h (P = .025), respectively. Thallium-201-chloride WOR values obtained with high-efficiency CZT SPECT, which enabled significantly reduced imaging times and use of a low-dose protocol, were similar to those obtained with conventional SPECT.
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Affiliation(s)
- Masaru Ishihara
- Department of Radiology, Hyogo Cancer Center, Akashi, Japan
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
- Masahisa Onoguchi, Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa 920-0942, Japan.
| | - Takayuki Shibutani
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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23
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Ishihara M, Taniguchi Y, Onoguchi M, Shibutani T. Optimal thallium-201 dose in cadmium-zinc-telluride SPECT myocardial perfusion imaging. J Nucl Cardiol 2018; 25:947-954. [PMID: 28008559 DOI: 10.1007/s12350-016-0749-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We aimed to determine the optimal thallium 201 chloride (thallium-201) dose using a novel ultrafast cardiac gamma camera with cadmium-zinc-telluride (CZT) solid-state semiconductor detectors (D-SPECT). METHODS AND RESULTS The optimal thallium-201 dose for obtaining left ventricular (LV) myocardial counts was determined from a phantom study. Consecutive 292 patients underwent stress myocardial perfusion imaging with a thallium-201 injection. Stress test comprised exercise or pharmacological (adenosine) provocation. We calculated an optimal thallium-201 dose that resulted in better LV myocardial counts during 6 minutes of acquisition time. We corrected the respective values according to the patient's age, sex, body mass index (BMI), and type of stress test. The lowest thallium-201 dose for obtaining acceptable imaging was 1.2 million counts. Radiopharmaceutical doses showed a positive correlation with the patient's age (P < .001), sex (P = .012), BMI (P < .001), and type of stress test (P < .001). Multivariate analysis revealed that the patient's BMI and the type of stress test were statistically significant factors for determining the correct radiopharmaceutical dose (P < .001 for both). CONCLUSIONS For clinical use of the CZT SPECT system, the optimal individual thallium-201 doses can be determined based on the patient's BMI and type of stress test.
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Affiliation(s)
- Masaru Ishihara
- Department of Radiology, Hyogo Brain and Heart Center at Himeji, Himeji, Japan
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
| | - Yasuyo Taniguchi
- Department of Cardiology, Hyogo Brain and Heart Center at Himeji, Himeji, Japan
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan.
| | - Takayuki Shibutani
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan
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24
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Slomka PJ, Rubeaux M, Germano G. Quantification with normal limits: New cameras and low-dose imaging. J Nucl Cardiol 2017; 24:1637-1640. [PMID: 27301961 DOI: 10.1007/s12350-016-0563-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Piotr J Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA.
- David Geffen School of Medicine, UCLA, Los Angeles, USA.
| | - Mathieu Rubeaux
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA
- David Geffen School of Medicine, UCLA, Los Angeles, USA
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25
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Nudi F, Iskandrian AE, Schillaci O, Peruzzi M, Frati G, Biondi-Zoccai G. Diagnostic Accuracy of Myocardial Perfusion Imaging With CZT Technology: Systemic Review and Meta-Analysis of Comparison With Invasive Coronary Angiography. JACC Cardiovasc Imaging 2017; 10:787-794. [PMID: 28330657 DOI: 10.1016/j.jcmg.2016.10.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/29/2016] [Accepted: 10/05/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study sought to summarize the evidence on stress myocardial perfusion imaging (MPI) using cadmium-zinc-telluride (CZT) technology for the diagnosis of obstructive coronary artery disease (CAD). The CZT cameras are newly introduced, and comparative data with the conventional Anger technology (Anger-MPI) are lacking. BACKGROUND The diagnostic accuracy of Anger-MPI for detection of angiographically significant CAD is well established; however, less evidence is available on the diagnostic accuracy of CZT-MPI. METHODS Clinical studies comparing CZT-MPI and invasive coronary angiography were systematically searched and abstracted. Calculations of diagnostic accuracy, including sensitivity, specificity, likelihood ratios, and diagnostic odds ratio, were obtained with fixed and random effects, reporting point estimates and 95% confidence intervals. RESULTS Based on our search, a total of 16 studies (N = 2,092) were included. The sensitivity of CZT-MPI was 0.84 (95% confidence interval [CI]: 0.78 to 0.89), whereas the specificity of 0.69 (95% CI: 0.62 to 0.76) was significantly reduced. The positive likelihood ratio was 2.73 (95% CI: 2.21 to 3.39), the negative likelihood ratio was 0.24 (95% CI: 0.17 to 0.31), and the diagnostic odds ratio was 11.93 (95% CI: 7.84 to 17.42). At subgroup and meta-regression analyses, the diagnostic accuracy between D-SPECT and Discovery cameras was similar (p = 0.711) and not impacted upon by smaller sample size studies (p = 0.573). CONCLUSIONS CZT-MPI has satisfactory sensitivity for angiographically significant CAD, but its suboptimal specificity warrants further development and research.
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Affiliation(s)
- Francesco Nudi
- Service of Hybrid Cardio Imaging, Madonna della Fiducia Clinic, Rome, Italy; Ostia Radiologica, Ostia, Italy; Etisan, Rome, Italy
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Alabama
| | - Orazio Schillaci
- Department of Nuclear Medicine, Tor Vergata University, Rome, Italy
| | - Mariangela Peruzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
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26
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Ishihara M, Onoguchi M, Taniguchi Y, Shibutani T. Comparison of conventional and cadmium-zinc-telluride single-photon emission computed tomography for analysis of thallium-201 myocardial perfusion imaging: an exploratory study in normal databases for different ethnicities. Int J Cardiovasc Imaging 2017; 33:2057-2066. [PMID: 28664481 DOI: 10.1007/s10554-017-1205-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/22/2017] [Indexed: 02/02/2023]
Abstract
The aim of this study was to clarify the differences in thallium-201-chloride (thallium-201) myocardial perfusion imaging (MPI) scans evaluated by conventional anger-type single-photon emission computed tomography (conventional SPECT) versus cadmium-zinc-telluride SPECT (CZT SPECT) imaging in normal databases for different ethnic groups. MPI scans from 81 consecutive Japanese patients were examined using conventional SPECT and CZT SPECT and analyzed with the pre-installed quantitative perfusion SPECT (QPS) software. We compared the summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) for the two SPECT devices. For a normal MPI reference, we usually use Japanese databases for MPI created by the Japanese Society of Nuclear Medicine, which can be used with conventional SPECT but not with CZT SPECT. In this study, we used new Japanese normal databases constructed in our institution to compare conventional and CZT SPECT. Compared with conventional SPECT, CZT SPECT showed lower SSS (p < 0.001), SRS (p = 0.001), and SDS (p = 0.189) using the pre-installed SPECT database. In contrast, CZT SPECT showed no significant difference from conventional SPECT in QPS analysis using the normal databases from our institution. Myocardial perfusion analyses by CZT SPECT should be evaluated using normal databases based on the ethnic group being evaluated.
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Affiliation(s)
- Masaru Ishihara
- Department of Radiology, Hyogo Cancer Center, 13-70 Kitaoji, Akashi, Hyogo, 673-8558, Japan.,Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan.
| | - Yasuyo Taniguchi
- Department of Cardiology, Hyogo Brain and Heart Center at Himeji, 520 Saisho-ko, Himeji, Hyogo, 670-0981, Japan
| | - Takayuki Shibutani
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
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Lecchi M, Martinelli I, Zoccarato O, Maioli C, Lucignani G, Del Sole A. Comparative analysis of full-time, half-time, and quarter-time myocardial ECG-gated SPECT quantification in normal-weight and overweight patients. J Nucl Cardiol 2017; 24:876-887. [PMID: 26911365 DOI: 10.1007/s12350-015-0382-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The introduction of a camera-based dose-reduction strategy in myocardial perfusion imaging (MPI) clinical setting entails the definition of objective and reproducible criteria for establishing the amount of activity to be injected. AIM The aim is to evaluate the impact of count statistics on the estimation of summed-scores (SS), end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF). METHODS Data rest/stress ECG-gated SPECT (2-day protocol and 8 MBq·kg-1) were acquired with Bright View gamma camera and Astonish algorithm for 40 normal-weight and 40 overweight patients. Assuming that count statistics of shorter acquisition time may simulate that of lower injected activity, three simultaneous scans (full-time, half-time, and quarter-time scans) were started at the same time but with different acquisition time/projection (30, 15 and 8 seconds). RESULTS A significant difference between SS values of half-time and quarter-time stress scans was found for overweight group (P = .006). Post hoc test showed significant differences for ESV (P < .05), EDV (P < .01) and EF (P < .05) between half-time and quarter-time scans for both patient groups. CONCLUSIONS The reduction of the count-statistics to a quarter of the MPI reference influenced negatively the quantification in overweight patients. The decrease of radiopharmaceutical activity to 25% of the reference seems practicable for normal-weight patients, while it is more appropriate an activity reduction limited to 50% for overweight and obese patients.
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Affiliation(s)
- M Lecchi
- Nuclear Medicine Unit, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudini, 8, 20142, Milan, Italy
| | - I Martinelli
- Nuclear Medicine Unit, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudini, 8, 20142, Milan, Italy
| | - O Zoccarato
- Unit of Nuclear Medicine, S. Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, NO, Italy
| | - C Maioli
- Nuclear Medicine Unit, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudini, 8, 20142, Milan, Italy
| | - Giovanni Lucignani
- Nuclear Medicine Unit, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudini, 8, 20142, Milan, Italy.
| | - A Del Sole
- Nuclear Medicine Unit, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudini, 8, 20142, Milan, Italy
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Henzlova MJ, Duvall WL. What do we know? What do we need to know? J Nucl Cardiol 2017; 24:252-254. [PMID: 27535415 DOI: 10.1007/s12350-016-0640-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Milena J Henzlova
- Division of Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - W Lane Duvall
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA.
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Slomka P, Hung GU, Germano G, Berman DS. Novel SPECT Technologies and Approaches in Cardiac Imaging. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016; 2:31-46. [PMID: 29034066 PMCID: PMC5640436 DOI: 10.15212/cvia.2016.0052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Recent novel approaches in myocardial perfusion single photon emission CT (SPECT) have been facilitated by new dedicated high-efficiency hardware with solid-state detectors and optimized collimators. New protocols include very low-dose (1 mSv) stress-only, two-position imaging to mitigate attenuation artifacts, and simultaneous dual-isotope imaging. Attenuation correction can be performed by specialized low-dose systems or by previously obtained CT coronary calcium scans. Hybrid protocols using CT angiography have been proposed. Image quality improvements have been demonstrated by novel reconstructions and motion correction. Fast SPECT acquisition facilitates dynamic flow and early function measurements. Image processing algorithms have become automated with virtually unsupervised extraction of quantitative imaging variables. This automation facilitates integration with clinical variables derived by machine learning to predict patient outcome or diagnosis. In this review, we describe new imaging protocols made possible by the new hardware developments. We also discuss several novel software approaches for the quantification and interpretation of myocardial perfusion SPECT scans.
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Affiliation(s)
- Piotr Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Guido Germano
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S. Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Brodov Y, Fish M, Rubeaux M, Otaki Y, Gransar H, Lemley M, Gerlach J, Berman D, Germano G, Slomka P. Quantitation of left ventricular ejection fraction reserve from early gated regadenoson stress Tc-99m high-efficiency SPECT. J Nucl Cardiol 2016; 23:1251-1261. [PMID: 27387521 PMCID: PMC5116262 DOI: 10.1007/s12350-016-0519-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ejection fraction (EF) reserve has been found to be a useful adjunct for identifying high risk coronary artery disease in cardiac positron emission tomography (PET). We aimed to evaluate EF reserve obtained from technetium-99m sestamibi (Tc-99m) high-efficiency (HE) SPECT. METHODS Fifty patients (mean age 69 years) undergoing regadenoson same-day rest (8-11 mCi)/stress (32-42 mCi) Tc-99m gated HE SPECT were enrolled. Stress imaging was started 1 minute after sequential intravenous regadenoson .4 mg and Tc-99m injections, and was composed of five 2 minutes supine gated acquisitions followed by two 4 minutes supine and upright images. Ischemic total perfusion deficit (ITPD) ≥5 % was considered as significant ischemia. RESULTS Significantly lower mean EF reserve was obtained in the 5th and 9th minute after regadenoson bolus in patients with significant ischemia vs patients without (5th minute: -4.2 ± 4.6% vs 1.3 ± 6.6%, P = .006; 9th minute: -2.7 ± 4.8% vs 2.0 ± 6.6%, P = .03). CONCLUSIONS Negative EF reserve obtained between 5th and 9th minutes of regadenoson stress demonstrated best concordance with significant ischemia and may be a promising tool for detection of transient ischemic functional changes with Tc-99m HE-SPECT.
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Affiliation(s)
- Yafim Brodov
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mathews Fish
- Nuclear Medicine Department, Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Mathieu Rubeaux
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yuka Otaki
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Heidi Gransar
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark Lemley
- Nuclear Medicine Department, Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA
| | - Jim Gerlach
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Guido Germano
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Piotr Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
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Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease: a review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging 2016; 43:2423-2432. [PMID: 27542010 DOI: 10.1007/s00259-016-3467-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
The trade-off between resolution and count sensitivity dominates the performance of standard gamma cameras and dictates the need for relatively high doses of radioactivity of the used radiopharmaceuticals in order to limit image acquisition duration. The introduction of cadmium-zinc-telluride (CZT)-based cameras may overcome some of the limitations against conventional gamma cameras. CZT cameras used for the evaluation of myocardial perfusion have been shown to have a higher count sensitivity compared to conventional single photon emission computed tomography (SPECT) techniques. CZT image quality is further improved by the development of a dedicated three-dimensional iterative reconstruction algorithm, based on maximum likelihood expectation maximization (MLEM), which corrects for the loss in spatial resolution due to line response function of the collimator. All these innovations significantly reduce imaging time and result in a lower patient's radiation exposure compared with standard SPECT. To guide current and possible future users of the CZT technique for myocardial perfusion imaging, the Cardiovascular Committee of the European Association of Nuclear Medicine, starting from the experience of its members, has decided to examine the current literature regarding procedures and clinical data on CZT cameras. The committee hereby aims 1) to identify the main acquisitions protocols; 2) to evaluate the diagnostic and prognostic value of CZT derived myocardial perfusion, and finally 3) to determine the impact of CZT on radiation exposure.
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Ben-Haim S, Kennedy J, Keidar Z. Novel Cadmium Zinc Telluride Devices for Myocardial Perfusion Imaging—Technological Aspects and Clinical Applications. Semin Nucl Med 2016; 46:273-85. [DOI: 10.1053/j.semnuclmed.2016.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
PURPOSE OF REVIEW Myocardial perfusion imaging (MPI) with SPECT is performed clinically worldwide to detect and monitor coronary artery disease (CAD). MPI allows an objective quantification of myocardial perfusion at stress and rest. This established technique relies on normal databases to compare patient scans against reference normal limits. In this review, we aim to introduce the process of MPI quantification with normal databases and describe the associated perfusion quantitative measures that are used. RECENT FINDINGS New equipment and new software reconstruction algorithms have been introduced which require the development of new normal limits. The appearance and regional count variations of normal MPI scan may differ between these new scanners and standard Anger cameras. Therefore, these new systems may require the determination of new normal limits to achieve optimal accuracy in relative myocardial perfusion quantification. Accurate diagnostic and prognostic results rivaling those obtained by expert readers can be obtained by this widely used technique. SUMMARY Throughout this review, we emphasize the importance of the different normal databases and the need for specific databases relative to distinct imaging procedures. use of appropriate normal limits allows optimal quantification of MPI by taking into account subtle image differences due to the hardware and software used, and the population studied.
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Feasibility of ultra low-dose thallium stress-redistribution protocol including prone imaging in obese patients using CZT camera. Int J Cardiovasc Imaging 2016; 32:1463-1469. [PMID: 27250348 DOI: 10.1007/s10554-016-0919-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
High efficiency cadmium-zinc-telluride (CZT) cameras provide an opportunity to lower the injected activities of radiopharmaceuticals for single photon emission tomography (SPECT) myocardial perfusion imaging (MPI). The limits for reducing activities of thallium have not been determined, particularly in obese patients. After an injection of 0.7 megabecquerel (MBq) of thallium/kg, we collected an average 1.5 million counts for the 10-min acquisition in a pilot cohort of ten patients. After extrapolation, we reduced the administered activity to 0.5 MBq/kg to obtain the expected 1 million counts. We studied the image quality in 124 patients (86 men, 43 obese with body mass index over 30 kg/m2) referred for MPI. The quality of images was assessed by a number of recorded counts and visually by a four-grade scale (one-poor quality, four-excellent quality). In non-obese and obese patients, the average number of recorded counts was 1.1 vs. 1.07 million counts for the 10-min stress acquisition, 1.04 vs. 1.06 million counts for the 13-min rest acquisition, and the average quality score was 3.97 vs. 3.90, respectively (p = NS).The mean administered activity was 39.2 ± 7 MBq for non-obese and 48.7 ± 6 for obese patients (p < 0.0001), and the calculated effective dose was 4.0 ± 0.7 and 4.9 ± 0.6 mSv respectively (p < 0.0001). The ultra-low-dose thallium stress-redistribution protocol, including post-stress prone imaging, provides good quality of images with a low radiation burden, even in obese patients.
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Hage FG, AlJaroudi WA. Review of Cardiovascular Imaging in the Journal of Nuclear Cardiology in 2015-Part 2 of 2: Myocardial perfusion imaging. J Nucl Cardiol 2016; 23:493-8. [PMID: 26892251 DOI: 10.1007/s12350-016-0444-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 12/24/2022]
Abstract
In 2015, the Journal of Nuclear Cardiology (®) published many high-quality articles. In this series, we will summarize key articles that have appeared in the Journal last year to provide for the interested reader a quick review of the advancements that have recently occurred in the field. In the first article of this 2-part series, we concentrated on publications dealing with plaque imaging, cardiac positron emission tomography, computed tomography, and magnetic resonance. This review will focus on myocardial perfusion imaging summarizing advances in the field including in diagnosis, prognosis, and appropriate use.
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Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, UK
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, UK
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Cardiovascular Imaging, Clemenceau Medical Center, P.O.Box 11-2555, Beirut, Lebanon.
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Hung GU, Wang YF, Su HY, Hsieh TC, Ko CL, Yen RF. New Trends in Radionuclide Myocardial Perfusion Imaging. ACTA CARDIOLOGICA SINICA 2016; 32:156-66. [PMID: 27122946 DOI: 10.6515/acs20150803a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Radionuclide myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) has been widely used clinically as one of the major functional imaging modalities for patients with coronary artery disease (CAD) for decades. Ample evidence has supported the use of MPI as a useful and important tool in the diagnosis, risk stratification and treatment planning for CAD. Although popular in the United States, MPI has become the most frequently used imaging modality among all nuclear medicine tests in Taiwan. However, it should be acknowledged that MPI SPECT does have its limitations. These include false-positive results due to certain artifacts, false-negative due to balanced ischemia, complexity and adverse reaction arising from current pharmacological stressors, time consuming nature of the imaging procedure, no blood flow quantitation and relatively high radiation exposure. The purpose of this article was to review the recent trends in nuclear cardiology, including the utilization of positron emission tomography (PET) for MPI, new stressor, new SPECT camera with higher resolution and higher sensitivity, dynamic SPECT protocol for blood flow quantitation, new software of phase analysis for evaluation of LV dyssynchrony, and measures utilized for reducing radiation exposure of MPI. KEY WORDS Coronary artery disease • Myocardial flow reserve • Myocardial perfusion imaging • Phase analysis • PET • SPECT.
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Affiliation(s)
- Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua
| | - Yuh-Feng Wang
- Department of Nuclear Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi; ; School of Medicine, Tzu Chi University, Hualian
| | - Hung-Yi Su
- Department of Nuclear Medicine, Cathay General Hospital, Taipei
| | - Te-Chun Hsieh
- Department of Nuclear Medicine and PET Center, China Medical University Hospital; ; Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung
| | - Chi-Lun Ko
- Department of Nuclear Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital; ; Department of Radiology, National Taiwan University College of Medicine, Taipei, Taiwan
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Abstract
Quantitative analysis of SPECT and PET has become a major part of nuclear cardiology practice. Current software tools can automatically segment the left ventricle, quantify function, establish myocardial perfusion maps, and estimate global and local measures of stress/rest perfusion, all with minimal user input. State-of-the-art automated techniques have been shown to offer high diagnostic accuracy for detecting coronary artery disease, as well as predict prognostic outcomes. This article briefly reviews these techniques, highlights several challenges, and discusses the latest developments.
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Affiliation(s)
- Manish Motwani
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Guido Germano
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Piotr Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Prognostic evaluation in obese patients using a dedicated multipinhole cadmium-zinc telluride SPECT camera. Int J Cardiovasc Imaging 2015; 32:355-361. [DOI: 10.1007/s10554-015-0770-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/14/2015] [Indexed: 01/22/2023]
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39
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Blankstein R. Can advances in nuclear cardiology hardware overcome the challenges of imaging obese patients? J Nucl Cardiol 2015; 22:276-8. [PMID: 25294434 DOI: 10.1007/s12350-014-0005-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Ron Blankstein
- Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA,
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