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Abedi SM, Ghadirzadeh E, Karimi H, Nezhadnaderi P, Daryabari SS, Moradi A, Khorrami Moghaddam A, Hosseinimehr SJ, Taghavi M, Golshani S, Farsavian AA, Mardanshahi A, Mostafavinia A. A comparison between 64-projection and 32-projection myocardial perfusion scintigraphy. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2025; 3:qyae142. [PMID: 39811013 PMCID: PMC11726827 DOI: 10.1093/ehjimp/qyae142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 12/07/2024] [Indexed: 01/16/2025]
Abstract
Aims While most clinical guidelines recommend using a 64-projection view technique, some protocols do not specify a preference between 32-projection and 64-projection methods for conducting myocardial perfusion scintigraphy (MPS), which shows the lack of consensus in this matter. Nevertheless, these guidelines and protocols have not provided us with compelling evidence to support why the 64-projection technique is usually chosen. Thus, we aimed to determine if there is a significant difference between them in the assessment of cardiac perfusion and functional indices. Methods and results Sixty-nine patients were included in this pilot prospective, cross-sectional, cross-over, same patient control protocol study and underwent 32- and 64-projection MPS at both stress and rest phases after injecting 740-925 MBq of 99mTc-MIBI for every patient. Then, cardiac indices, including summed stress, rest, and difference scores, extent-stress and rest, left ventricular volumes and ejection-fraction, peak filling rate (PFR), and time to peak filling rate (TTPF) were recorded. Lin's concordance correlation coefficient was used to assess the agreement between protocols, and a paired sample t-test was used to compare the means of variables where appropriate. Findings revealed no significant difference as well as excellent/good agreement between the two methods in either the stress or rest state, except for the TTPF and PFR. Conclusion The findings suggest that lower-projection techniques could be adequate for routine clinical assessments without sacrificing diagnostic accuracy. However, the poor agreement for PFR and TTPF indicates that the 32-projection method may not reliably assess diastolic function, implying that the 64-projection protocol is preferable when precise evaluations are necessary.
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Affiliation(s)
- Seyed Mohammad Abedi
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, 4818813371 Sari, Iran
| | - Erfan Ghadirzadeh
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hanie Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Nezhadnaderi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Amir Moradi
- Atherosclerosis Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Khorrami Moghaddam
- Department of Radiology, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Jalal Hosseinimehr
- Department of Radiopharmacy, Faculty of Pharmacy, Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Morteza Taghavi
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samad Golshani
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Asghar Farsavian
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Mardanshahi
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, 4818813371 Sari, Iran
| | - Ali Mostafavinia
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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van der Meulen NP, Strobel K, Lima TVM. New Radionuclides and Technological Advances in SPECT and PET Scanners. Cancers (Basel) 2021; 13:cancers13246183. [PMID: 34944803 PMCID: PMC8699425 DOI: 10.3390/cancers13246183] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Advances in nuclear medicine are made by technological and radionuclide improvements. Throughout nuclear medicine’s history, these advances were often intertwined and complementary based on different clinical questions, availability and need. This paper covers some of these developments in radionuclides and instrumentation. Abstract Developments throughout the history of nuclear medicine have involved improvements in both instrumentation and radionuclides, which have been intertwined. Instrumentation developments always occurred during the search to improving devices’ sensitivity and included advances in detector technology (with the introduction of cadmium zinc telluride and digital Positron Emission Tomography—PET-devices with silicon photomultipliers), design (total body PET) and configuration (ring-shaped, Single-Photon Emission Computed Tomography (SPECT), Compton camera). In the field of radionuclide development, we observed the continual changing of clinically used radionuclides, which is sometimes influenced by instrumentation technology but also driven by availability, patient safety and clinical questions. Some areas, such as tumour imaging, have faced challenges when changing radionuclides based on availability, when this produced undesirable clinical findings with the introduction of unclear focal uptakes and unspecific uptakes. On the other end of spectrum, further developments of PET technology have seen a resurgence in its use in nuclear cardiology, with rubidium-82 from strontium-82/rubidium-82 generators being the radionuclide of choice, moving away from SPECT nuclides thallium-201 and technetium-99m. These continuing improvements in both instrumentation and radionuclide development have helped the growth of nuclear medicine and its importance in the ever-evolving range of patient care options.
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Affiliation(s)
- Nicholas P. van der Meulen
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Laboratory of Radiochemistry, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Correspondence: (N.P.v.d.M.); (T.V.M.L.)
| | - Klaus Strobel
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, 6000 Luzern, Switzerland;
| | - Thiago Viana Miranda Lima
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, 6000 Luzern, Switzerland;
- Institute of Radiation Physics, Lausanne University Hospital, University of Lausanne, 1007 Lausanne, Switzerland
- Correspondence: (N.P.v.d.M.); (T.V.M.L.)
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Arida-Moody L, Moody JB, Renaud JM, Poitrasson-Rivière A, Hagio T, Smith AM, Ficaro EP, Murthy VL. Effects of two patient-specific dosing protocols on measurement of myocardial blood flow with 3D 82Rb cardiac PET. Eur J Nucl Med Mol Imaging 2021; 48:3835-3846. [PMID: 33982174 DOI: 10.1007/s00259-021-05385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Clinical measurement of myocardial blood flow (MBF) has emerged as an important component of routine PET-CT assessment of myocardial perfusion in patients with known or suspected coronary artery disease. Although multiple society guidelines recommend patient-specific dosing, there is a lack of studies evaluating the efficacy of patient-specific dosing for quantitative MBF accuracy. METHODS Two patient-specific dosing protocols (weight- and BMI-adjusted) were retrospectively evaluated in 435 consecutive clinical patients referred for PET myocardial perfusion assessment. MBF was estimated at rest and after regadenoson-induced hyperemia. The effect of dosing protocol on dose reduction, PET scanner saturation, relative perfusion, and image quality was compared. The effect of PET saturation on the accuracy of MBF and myocardial flow reserve (MFR) in remote myocardium was assessed with multivariable linear regression. RESULTS BMI-adjusted dosing was associated with lower administered 82Rb activities (1036.0 ± 274 vs. 1147 ± 274 MBq, p = 0.003) and lower PET scanner saturation incidence (28 vs. 38%, p = 0.006) and severity (median saturation severity index 0.219 ± 0.33 vs. 0.397 ± 0.59%, p = 0.018) compared to weight-adjusted dosing. PET saturation that occurred with either dosing protocol was moderate and resulted in modest remote MBF and MFR biases ranging from 2 to 9% after adjusting for patient age, sex, BMI, rate-pressure product, and LV ejection fraction. No adverse effects of BMI dose adjustment were observed in relative perfusion assessment or image quality. CONCLUSIONS Patient-specific dosing according to BMI is an effective method for guideline-directed dose reduction while maintaining image quality and accuracy for routine MBF and MFR quantification.
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Affiliation(s)
- Liliana Arida-Moody
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | | | - Edward P Ficaro
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- INVIA, LLC, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2020; 48:1040-1069. [PMID: 33135093 PMCID: PMC7603916 DOI: 10.1007/s00259-020-05046-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed.
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AlJaroudi WA, Hage FG. Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2018. Part 1 of 2: Positron emission tomography, computed tomography, and magnetic resonance. J Nucl Cardiol 2019; 26:524-535. [PMID: 30603892 DOI: 10.1007/s12350-018-01558-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 12/26/2022]
Abstract
In this review, we summarize key articles that have been published in the Journal of Nuclear Cardiology in 2018 pertaining to nuclear cardiology with advanced multi-modality and hybrid imaging including positron emission tomography, cardiac-computed tomography, and magnetic resonance. In an upcoming review, we will summarize key articles that relate to the progress made in the field of single-photon emission computed tomography. We hope that these sister reviews will be useful to the reader to navigate the literature in our field.
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Affiliation(s)
- Wael A AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 306 Lyons-Harrison Research Building, 701 19th Street South, Birmingham, AL, 35294-0007, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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Moncayo VM, Garcia EV. Prompt-gamma compensation in Rb-82 myocardial perfusion 3D PET/CT: Effect on clinical practice. J Nucl Cardiol 2018; 25:606-608. [PMID: 27659456 DOI: 10.1007/s12350-016-0672-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Valeria M Moncayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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O' Doherty J, Chalampalakis Z, Schleyer P, Nazir MS, Chiribiri A, Marsden PK. The effect of high count rates on cardiac perfusion quantification in a simultaneous PET-MR system using a cardiac perfusion phantom. EJNMMI Phys 2017; 4:31. [PMID: 29230607 PMCID: PMC5725400 DOI: 10.1186/s40658-017-0199-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND PET-MRI is under investigation as a new strategy for quantitative myocardial perfusion imaging. Consideration is required as to the maximum scanner count rate in order to limit dead-time losses resulting from administered activity in the scanner field of view during the first pass of the radiotracer. RESULTS We performed a decaying-source experiment to investigate the high count-rate performance of a PET-MR system (Siemens mMR) over the expected range of activities during a clinical study. We also performed imaging of a cardiac perfusion phantom, which provides an experimental simulation of clinical transit of a simultaneous radiotracer (phantom injected activities range 252 to 997 MBq) and gadolinium-based contrast agent (GBCA). Time-activity and time-intensity curves of the aorta and myocardium compartments from PET and MR images were determined, and quantification of perfusion was then performed using a standard cardiac kinetic model. The decaying-source experiment showed a maximum noise equivalent count rate (NECRmax) of 286 kcps at a singles rate of 47.1 Mcps. NECR was maintained within 5% (NECR95%) of the NECRmax with a singles rate of 34.1 Mcps, corresponding to 310 MBq in the phantom. Count-rate performance was degraded above the singles rate of 64.9 Mcps due to the number of detection events impacting the quantitative accuracy of reconstructed images. A 10% bias in image activity concentration was observed between singles rates of 78.2 and 82.9 Mcps. Perfusion phantom experiments showed that image-based activity concentration and quantified values of perfusion were affected by count losses when the total singles rate was greater than 64.9 Mcps. This occurred during the peak arterial input function (AIF) phase of imaging for injected activities to the phantom of 600 MBq and greater. CONCLUSIONS Care should be taken to avoid high count-rate losses in simultaneous PET-MRI studies. Based on our results in phantoms, bias in reconstructed images should be avoided by adhering to a singles rate lower than 64.9 Mcps on the mMR system. Quantification of perfusion values using singles rates higher than 64.9 Mcps on this system may be compromised and should be avoided.
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Affiliation(s)
- Jim O' Doherty
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, UK.
- Department of Molecular Imaging, Sidra Medical and Research Center, Al Luqta St, Doha, Qatar.
| | - Zacharias Chalampalakis
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, UK
| | | | - Muhummad Sohaib Nazir
- BHF Centre of Excellence, NIHR Biomedical Research Centre and Wellcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amedeo Chiribiri
- BHF Centre of Excellence, NIHR Biomedical Research Centre and Wellcome Trust and EPSRC Medical Engineering Centre at Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul K Marsden
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, UK
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