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Zavadovsky KV, Mochula AV, Maltseva AN, Shipulin VV, Sazonova SI, Gulya MO, Liga R, Gimelli A. The current status of CZT SPECT myocardial blood flow and reserve assessment: Tips and tricks. J Nucl Cardiol 2022; 29:3137-3151. [PMID: 33939162 DOI: 10.1007/s12350-021-02620-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 01/18/2023]
Abstract
Cardiac PET-derived measurements of myocardial blood flow (MBF) and myocardial flow reserve (MFR) are proven robust indexes of the severity of coronary artery disease (CAD). They facilitate the diagnosis of diffuse epicardial and microvascular disease and are also of prognostic significance. However, low availability and high cost have limited their wide clinical implementation. Over the last 15 years, cadmium zinc telluride (CZT)-based detectors have been implemented into SPECT imaging devices. Myocardial perfusion scintigraphy can be performed faster and with less radiation exposure as compared with standard gamma cameras. Rapid dynamic SPECT studies with higher count rates can be performed. This technological breakthrough has renewed the interest in SPECT MBF assessment in patients with CAD. Currently, two cardiac-centered CZT gamma cameras are available commercially-Discovery NM530c and D-SPECT. They differ in parameters such as collimator design, number of detectors, sensitivity, spatial resolution and image reconstruction. A number of publications have focused on the feasibility of dynamic CZT SPECT and on the correlation with cardiac PET and invasive coronary angiography measurements of fractional flow reserve. Current study reviews the present status of MBF and MFR assessment with CZT SPECT. It also aims to provide an overview of specific issues related to acquisition, processing and interpretation of quantitative studies in patients with CAD.
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Affiliation(s)
- Konstantin V Zavadovsky
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia.
- Siberian State Medical University, Tomsk, Russia.
| | - Andrew V Mochula
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia
| | - Alina N Maltseva
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia
| | - Vladimir V Shipulin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia
| | - Svetlana I Sazonova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia
| | - Marina O Gulya
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia
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Fu B, Wei X, Lin Y, Chen J, Yu D. Pathophysiologic Basis and Diagnostic Approaches for Ischemia With Non-obstructive Coronary Arteries: A Literature Review. Front Cardiovasc Med 2022; 9:731059. [PMID: 35369287 PMCID: PMC8968033 DOI: 10.3389/fcvm.2022.731059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/31/2022] [Indexed: 02/05/2023] Open
Abstract
Ischemia with non-obstructive coronary arteries (INOCA) has gained increasing attention due to its high prevalence, atypical clinical presentations, difficult diagnostic procedures, and poor prognosis. There are two endotypes of INOCA-one is coronary microvascular dysfunction and the other is vasospastic angina. Diagnosis of INOCA lies in evaluating coronary flow reserve, microcirculatory resistance, and vasoreactivity, which is usually obtained via invasive coronary interventional techniques. Non-invasive diagnostic approaches such as echocardiography, single-photon emission computed tomography, cardiac positron emission tomography, and cardiac magnetic resonance imaging are also valuable for assessing coronary blood flow. Some new techniques (e.g., continuous thermodilution and angiography-derived quantitative flow reserve) have been investigated to assist the diagnosis of INOCA. In this review, we aimed to discuss the pathophysiologic basis and contemporary and novel diagnostic approaches for INOCA, to construct a better understanding of INOCA evaluation.
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Affiliation(s)
- Bingqi Fu
- Shantou University Medical College, Shantou, China
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuebiao Wei
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Division of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingwen Lin
- Shantou University Medical College, Shantou, China
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Danqing Yu
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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3
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Kovalski G, Sharir T. Myocardial blood flow assessment with SPECT systems: The renovation continues. J Nucl Cardiol 2020; 27:2303-2305. [PMID: 30820816 DOI: 10.1007/s12350-019-01666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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Okizaki A, Nakayama M, Nakajima K, Fujimoto O, Oshikiri S, Koike-Satake M, Nakahara Y. Noninvasive estimation of quantitative myocardial blood flow with Tc-99m MIBI by a compartment model analysis in rat. J Nucl Cardiol 2020; 27:1368-1374. [PMID: 29654445 DOI: 10.1007/s12350-018-1274-z] [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: 01/25/2018] [Accepted: 03/29/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to investigate the use of dynamic cardiac planar images to estimate myocardial blood flow (MBF) by a compartment model analysis using time-to-peak (TP) map and compared it by the microsphere technique in rat. Positron emission tomography is considered the gold standard method, but is not available everywhere. By contrast, although myocardial perfusion imaging (MPI) with single-photon tracers is more widely available, it may be difficult to obtain adequate region of interest (ROI) settings. We proposed using the TP map to set the ROI, and hypothesized that this method could facilitate the measurement of absolute MBF by MPI in rat. METHODS Twenty-one normal rats were studied. Dynamic planar images with Tc-99m MIBI were obtained, and input function and cardiac ROIs were set using the obtained TP map. MBF was estimated by a one-compartment model analysis with the Renkin-Crone model and by the microsphere technique. RESULTS The MBFs from these two methods were significantly correlated. A negative proportional bias was observed, but no significant difference was observed between the mean MBFs calculated with each method. CONCLUSIONS MBF estimation by a compartment model analysis using TP map could facilitate absolute MBF measurement in rats.
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Affiliation(s)
- Atsutaka Okizaki
- Department of Radiology, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, 078-8510, Japan.
| | - Michihiro Nakayama
- Department of Radiology, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, 078-8510, Japan
| | - Kaori Nakajima
- Department of Radiology, Asahikawa Medical University, 2-1-1-1 Midorigaoka-higashi, Asahikawa, 078-8510, Japan
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5
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Bindschadler M, Branch KR, Alessio AM. Quantitative myocardial perfusion from static cardiac and dynamic arterial CT. Phys Med Biol 2018; 63:105020. [PMID: 29701608 PMCID: PMC6154784 DOI: 10.1088/1361-6560/aac0bd] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Quantitative myocardial blood flow (MBF) estimation by dynamic contrast enhanced cardiac computed tomography (CT) requires multi-frame acquisition of contrast transit through the blood pool and myocardium to inform the arterial input and tissue response functions. Both the input and the tissue response functions for the entire myocardium are sampled with each acquisition. However, the long breath holds and frequent sampling can result in significant motion artifacts and relatively high radiation dose. To address these limitations, we propose and evaluate a new static cardiac and dynamic arterial (SCDA) quantitative MBF approach where (1) the input function is well sampled using either prediction from pre-scan timing bolus data or measured from dynamic thin slice 'bolus tracking' acquisitions, and (2) the whole-heart tissue response data is limited to one contrast enhanced CT acquisition. A perfusion model uses the dynamic arterial input function to generate a family of possible myocardial contrast enhancement curves corresponding to a range of MBF values. Combined with the timing of the single whole-heart acquisition, these curves generate a lookup table relating myocardial contrast enhancement to quantitative MBF. We tested the SCDA approach in 28 patients that underwent a full dynamic CT protocol both at rest and vasodilator stress conditions. Using measured input function plus single (enhanced CT only) or plus double (enhanced and contrast free baseline CT's) myocardial acquisitions yielded MBF estimates with root mean square (RMS) error of 1.2 ml/min/g and 0.35 ml/min/g, and radiation dose reductions of 90% and 83%, respectively. The prediction of the input function based on timing bolus data and the static acquisition had an RMS error compared to the measured input function of 26.0% which led to MBF estimation errors greater than threefold higher than using the measured input function. SCDA presents a new, simplified approach for quantitative perfusion imaging with an acquisition strategy offering substantial radiation dose and computational complexity savings over dynamic CT.
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Affiliation(s)
- Michael Bindschadler
- Department of Radiology, University of Washington, Seattle, WA 98195, United States of America
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6
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Yoshinaga K, Manabe O, Tamaki N. Absolute quantification of myocardial blood flow. J Nucl Cardiol 2018; 25:635-651. [PMID: 27444500 DOI: 10.1007/s12350-016-0591-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/01/2016] [Indexed: 12/22/2022]
Abstract
With the increasing availability of positron emission tomography (PET) myocardial perfusion imaging, the absolute quantification of myocardial blood flow (MBF) has become popular in clinical settings. Quantitative MBF provides an important additional diagnostic or prognostic information over conventional visual assessment. The success of MBF quantification using PET/computed tomography (CT) has increased the demand for this quantitative diagnostic approach to be more accessible. In this regard, MBF quantification approaches have been developed using several other diagnostic imaging modalities including single-photon emission computed tomography, CT, and cardiac magnetic resonance. This review will address the clinical aspects of PET MBF quantification and the new approaches to MBF quantification.
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Affiliation(s)
- Keiichiro Yoshinaga
- Diagnostic and Therapeutic Nuclear Medicine, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-Ku, Chiba, 263-8555, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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7
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Marini C, Seitun S, Zawaideh C, Bauckneht M, Morelli MC, Ameri P, Ferrarazzo G, Budaj I, Balbi M, Fiz F, Boccalini S, Pregliasco AG, Buschiazzo A, Saracco A, Bagnara MC, Bruzzi P, Brunelli C, Ferro C, Bezante GP, Sambuceti G. Comparison of coronary flow reserve estimated by dynamic radionuclide SPECT and multi-detector x-ray CT. J Nucl Cardiol 2017; 24:1712-1721. [PMID: 27151303 DOI: 10.1007/s12350-016-0492-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 03/28/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent technical advances in multi-detector computed tomography (MDCT) allow for assessment of coronary flow reserve (CFR). We compared regional CFR by dynamic SPECT and by dynamic MDCT in patients with suspected or known coronary artery disease (CAD). METHODS Thirty-five patients, (29 males, mean age 69 years) with greater than average Framingham risk of CAD, underwent dipyridamole vasodilator stress imaging. CFR was estimated using dynamic SPECT and dynamic MDCT imaging in the same patients. Myocardial perfusion findings were correlated with obstructive CAD (≥50% luminal narrowing) on CT coronary angiography (CA). RESULTS Mean CFR estimated by SPECT and MDCT in 595 myocardial segments was not different (1.51 ± 0.46 vs. 1.50 ± 0.37, p = NS). Correlation of segmental CFR by SPECT and MDCT was fair (r 2 = 0.39, p < 0.001). Bland-Altman analysis revealed that MDCT in comparison to SPECT systematically underestimated CFR in higher CFR ranges. By CTCA, 12 patients had normal CA, 11 had non-obstructive, and 12 had obstructive CAD. CFR by both techniques was significantly higher in territories of normal CA than in territories subtended by non-obstructive or obstructive CAD. SPECT CFR was also significantly different in territories subtended by non-obstructive and obstructive CAD, whereas MDCT CFR was not. CONCLUSION Despite relative underestimation of high CFR values, MDCT CFR shows promise for assessing the pathophysiological significance of anatomic CAD.
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Affiliation(s)
- Cecilia Marini
- CNR Institute of Bioimaging and Molecular Physiology, Milan, Section of Genoa, Italy
| | - Sara Seitun
- Interventional Radiology, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Camilla Zawaideh
- Clinic of Cardiovascular Diseases, IRCCS-AOU San Martino-IST, Genoa, Italy
| | | | | | - Pietro Ameri
- Clinic of Cardiovascular Diseases, IRCCS-AOU San Martino-IST, Genoa, Italy
| | | | - Irilda Budaj
- Interventional Radiology, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Manrico Balbi
- Clinic of Cardiovascular Diseases, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Francesco Fiz
- Nuclear Medicine, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Sara Boccalini
- Interventional Radiology, IRCCS-AOU San Martino-IST, Genoa, Italy
| | | | | | | | | | - Paolo Bruzzi
- Epidemiology Unit, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Claudio Brunelli
- Clinic of Cardiovascular Diseases, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Carlo Ferro
- Interventional Radiology, IRCCS-AOU San Martino-IST, Genoa, Italy
| | - Gian Paolo Bezante
- Clinic of Cardiovascular Diseases, IRCCS-AOU San Martino-IST, Genoa, Italy
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8
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Are SPECT measurements of myocardial blood flow and flow reserve ready for clinical use? Eur J Nucl Med Mol Imaging 2015; 41:2291-3. [PMID: 25311927 DOI: 10.1007/s00259-014-2924-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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Apostolopoulos DJ, Kaspiri A, Spyridonidis T, Patsouras N, Savvopoulos CA, Davlouros P, Vassilakos PJ, Alexopoulos D. Assessment of absolute Tc-99m tetrofosmin retention in the myocardium as an index of myocardial blood flow and coronary flow reserve by gated-SPECT/CT: a feasibility study. Ann Nucl Med 2015; 29:588-602. [DOI: 10.1007/s12149-015-0982-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/06/2015] [Indexed: 12/24/2022]
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10
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Petretta M, Storto G, Pellegrino T, Bonaduce D, Cuocolo A. Quantitative Assessment of Myocardial Blood Flow with SPECT. Prog Cardiovasc Dis 2015; 57:607-14. [PMID: 25560327 DOI: 10.1016/j.pcad.2014.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The quantitative assessment of myocardial blood flow (MBF) and coronary flow reserve (CFR) may be useful for the functional evaluation of coronary artery disease, allowing judgment of its severity, tracking of disease progression, and evaluation of the anti-ischemic efficacy of therapeutic strategies. Quantitative estimates of myocardial perfusion and CFR can be derived from single-photon emission computed tomography (SPECT) myocardial perfusion images by use of equipment, tracers, and techniques that are available in most nuclear cardiology laboratories. However, this method underestimates CFR, particularly at high flow rates. The recent introduction of cardiac-dedicated gamma cameras with solid-state detectors provides very fast perfusion imaging with improved resolution, allowing fast acquisition of serial dynamic images during the first pass of a flow agent. This new technology holds great promise for MBF and CFR quantification with dynamic SPECT. Future studies will clarify the effectiveness of dynamic SPECT flow imaging.
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Affiliation(s)
- Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Giovanni Storto
- Nuclear Medicine Unit, IRCCS Regional Cancer Hospital CROB, Rionero in Vulture, Italy
| | - Teresa Pellegrino
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Domenico Bonaduce
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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11
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Liu C, Sinusas AJ. Is assessment of absolute myocardial perfusion with SPECT ready for prime time? J Nucl Med 2014; 55:1573-5. [PMID: 25236351 DOI: 10.2967/jnumed.114.144550] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chi Liu
- Yale University School of Medicine New Haven, Connecticut
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12
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Ohira H, Dowsley T, Dwivedi G, deKemp RA, Chow BJ, Ruddy TD, Davies RA, DaSilva J, Beanlands RSB, Hessian R. Quantification of myocardial blood flow using PET to improve the management of patients with stable ischemic coronary artery disease. Future Cardiol 2014; 10:611-31. [DOI: 10.2217/fca.14.44] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ABSTRACT Cardiac PET has been evolving over the past 30 years. Today, it is accepted as a valuable imaging modality for the noninvasive assessment of coronary artery disease. PET has demonstrated superior diagnostic accuracy for the detection of coronary artery disease compared with single-photon emission computed tomography, and also has a well-established prognostic value. The routine addition of absolute quantification of myocardial blood flow increases the diagnostic accuracy for three-vessel disease and provides incremental functional and prognostic information. Moreover, the characterization of the vasodilator capacity of the coronary circulation may guide proper decision-making and monitor the effects of lifestyle changes, exercise training, risk factor modification or medical therapy for improving regional and global myocardial blood flow. This type of image-guided approach to individualized patient therapy is now attainable with the routine use of cardiac PET flow reserve imaging.
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Affiliation(s)
- Hiroshi Ohira
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Taylor Dowsley
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Girish Dwivedi
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Robert A deKemp
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Benjamin J Chow
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Terrence D Ruddy
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ross A Davies
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Jean DaSilva
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rob SB Beanlands
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Renee Hessian
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
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13
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Hsu B, Chen FC, Wu TC, Huang WS, Hou PN, Chen CC, Hung GU. Quantitation of myocardial blood flow and myocardial flow reserve with 99mTc-sestamibi dynamic SPECT/CT to enhance detection of coronary artery disease. Eur J Nucl Med Mol Imaging 2014; 41:2294-306. [PMID: 25143072 DOI: 10.1007/s00259-014-2881-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/28/2014] [Indexed: 01/06/2023]
Abstract
PURPOSE Conventional dual-head single photon emission computed tomography (SPECT)/CT systems capable of fast dynamic SPECT (DySPECT) imaging have a potential for flow quantitation. This study introduced a new method to quantify myocardial blood flow (MBF) and myocardial flow reserve (MFR) with DySPECT scan and evaluated the diagnostic performance of detecting coronary artery disease (CAD) compared with perfusion using invasive coronary angiography (CAG) as the reference standard. METHODS This study included 21 patients with suspected or known CAD who had received DySPECT, ECG-gated SPECT (GSPECT), and CAG (13 with ≥ 50% stenosis in any vessel; non-CAD group: 8 with patent arteries or < 50% stenosis). DySPECT and GSPECT scans were performed on a widely used dual-head SPECT/CT scanner. The DySPECT imaging protocol utilized 12-min multiple back-and-forth gantry rotations during injections of (99m)Tc-sestamibi (MIBI) tracer at rest or dipyridamole-stress stages. DySPECT images were reconstructed with full physical corrections and converted to the physical unit of becquerels per milliliter. Stress MBF (SMBF), rest MBF (RMBF), and MFR were quantified by a one-tissue compartment flow model using time-activity curves derived from DySPECT images. Perfusion images were processed for GSPECT scan and interpreted to obtain summed stress score (SSS) and summed difference score (SDS). Receiver-operating characteristic (ROC) analyses were conducted to evaluate the diagnostic performance of flow and perfusion. RESULTS Using the criteria of ≥ 50% stenosis as positive CAD, areas under the ROC curve (AUCs) of flow assessment were overall significantly greater than those of perfusion. For patient-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.91 ± 0.07, 0.86 ± 0.09, 0.64 ± 0.12, and 0.59 ± 0.13. For vessel-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.81 ± 0.05, 0.76 ± 0.06, 0.62 ± 0.07, and 0.56 ± 0.08, respectively. CONCLUSION The preliminary data suggest that MBF quantitation with a conventional SPECT/CT system and the flow quantitation method is a clinically effective approach to enhance CAD detection.
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Affiliation(s)
- Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA
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14
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Ben-Haim S, Murthy VL, Breault C, Allie R, Sitek A, Roth N, Fantony J, Moore SC, Park MA, Kijewski M, Haroon A, Slomka P, Erlandsson K, Baavour R, Zilberstien Y, Bomanji J, Di Carli MF. Quantification of Myocardial Perfusion Reserve Using Dynamic SPECT Imaging in Humans: A Feasibility Study. J Nucl Med 2013; 54:873-9. [PMID: 23578996 PMCID: PMC3951831 DOI: 10.2967/jnumed.112.109652] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED Myocardial perfusion imaging (MPI) is well established in the diagnosis and workup of patients with known or suspected coronary artery disease (CAD); however, it can underestimate the extent of obstructive CAD. Quantification of myocardial perfusion reserve with PET can assist in the diagnosis of multivessel CAD. We evaluated the feasibility of dynamic tomographic SPECT imaging and quantification of a retention index to describe global and regional myocardial perfusion reserve using a dedicated solid-state cardiac camera. METHODS Ninety-five consecutive patients (64 men and 31 women; median age, 67 y) underwent dynamic SPECT imaging with (99m)Tc-sestamibi at rest and at peak vasodilator stress, followed by standard gated MPI. The dynamic images were reconstructed into 60-70 frames, 3-6 s/frame, using ordered-subsets expectation maximization with 4 iterations and 32 subsets. Factor analysis was used to estimate blood-pool time-activity curves, used as input functions in a 2-compartment kinetic model. K1 values ((99m)Tc-sestamibi uptake) were calculated for the stress and rest images, and K2 values ((99m)Tc-sestamibi washout) were set to zero. Myocardial perfusion reserve (MPR) index was calculated as the ratio of the stress and rest K1 values. Standard MPI was evaluated semiquantitatively, and total perfusion deficit (TPD) of at least 5% was defined as abnormal. RESULTS Global MPR index was higher in patients with normal MPI (n = 51) than in patients with abnormal MPI (1.61 [interquartile range (IQR), 1.33-2.03] vs. 1.27 [IQR, 1.12-1.61], P = 0.0002). By multivariable regression analysis, global MPR index was associated with global stress TPD, age, and smoking. Regional MPR index was associated with the same variables and with regional stress TPD. Sixteen patients undergoing invasive coronary angiography had 20 vessels with stenosis of at least 50%. The MPR index was 1.11 (IQR, 1.01-1.21) versus 1.30 (IQR, 1.12-1.67) in territories supplied by obstructed and nonobstructed arteries, respectively (P = 0.02). MPR index showed a stepwise reduction with increasing extent of obstructive CAD (P = 0.02). CONCLUSION Dynamic tomographic imaging and quantification of a retention index describing global and regional perfusion reserve are feasible using a solid-state camera. Preliminary results show that the MPR index is lower in patients with perfusion defects and in regions supplied by obstructed coronary arteries. Further studies are needed to establish the clinical role of this technique as an aid to semiquantitative analysis of MPI.
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Affiliation(s)
- Simona Ben-Haim
- Institute of Nuclear Medicine, University College London Hospitals, NHS Trust, London, United Kingdom.
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15
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Winant CD, Aparici CM, Zelnik YR, Reutter BW, Sitek A, Bacharach SL, Gullberg GT. Investigation of dynamic SPECT measurements of the arterial input function in human subjects using simulation, phantom and human studies. Phys Med Biol 2012; 57:375-93. [PMID: 22170801 PMCID: PMC3325151 DOI: 10.1088/0031-9155/57/2/375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Computer simulations, a phantom study and a human study were performed to determine whether a slowly rotating single-photon computed emission tomography (SPECT) system could provide accurate arterial input functions for quantification of myocardial perfusion imaging using kinetic models. The errors induced by data inconsistency associated with imaging with slow camera rotation during tracer injection were evaluated with an approach called SPECT/P (dynamic SPECT from positron emission tomography (PET)) and SPECT/D (dynamic SPECT from database of SPECT phantom projections). SPECT/P simulated SPECT-like dynamic projections using reprojections of reconstructed dynamic (94)Tc-methoxyisobutylisonitrile ((94)Tc-MIBI) PET images acquired in three human subjects (1 min infusion). This approach was used to evaluate the accuracy of estimating myocardial wash-in rate parameters K(1) for rotation speeds providing 180° of projection data every 27 or 54 s. Blood input and myocardium tissue time-activity curves (TACs) were estimated using spatiotemporal splines. These were fit to a one-compartment perfusion model to obtain wash-in rate parameters K(1). For the second method (SPECT/D), an anthropomorphic cardiac torso phantom was used to create real SPECT dynamic projection data of a tracer distribution derived from (94)Tc-MIBI PET scans in the blood pool, myocardium, liver and background. This method introduced attenuation, collimation and scatter into the modeling of dynamic SPECT projections. Both approaches were used to evaluate the accuracy of estimating myocardial wash-in parameters for rotation speeds providing 180° of projection data every 27 and 54 s. Dynamic cardiac SPECT was also performed in a human subject at rest using a hybrid SPECT/CT scanner. Dynamic measurements of (99m)Tc-tetrofosmin in the myocardium were obtained using an infusion time of 2 min. Blood input, myocardium tissue and liver TACs were estimated using the same spatiotemporal splines. The spatiotemporal maximum-likelihood expectation-maximization (4D ML-EM) reconstructions gave more accurate reconstructions than did standard frame-by-frame static 3D ML-EM reconstructions. The SPECT/P results showed that 4D ML-EM reconstruction gave higher and more accurate estimates of K(1) than did 3D ML-EM, yielding anywhere from a 44% underestimation to 24% overestimation for the three patients. The SPECT/D results showed that 4D ML-EM reconstruction gave an overestimation of 28% and 3D ML-EM gave an underestimation of 1% for K(1). For the patient study the 4D ML-EM reconstruction provided continuous images as a function of time of the concentration in both ventricular cavities and myocardium during the 2 min infusion. It is demonstrated that a 2 min infusion with a two-headed SPECT system rotating 180° every 54 s can produce measurements of blood pool and myocardial TACs, though the SPECT simulation studies showed that one must sample at least every 30 s to capture a 1 min infusion input function.
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Affiliation(s)
- Celeste D Winant
- UCSF Physics Research Laboratory, Department of Radiology, University of California San Francisco, 185 Berry St, Suite 350, PO Box 0946, San Francisco, CA 94107, USA
| | - Carina Mari Aparici
- UCSF Physics Research Laboratory, Department of Radiology, University of California San Francisco, 185 Berry St, Suite 350, PO Box 0946, San Francisco, CA 94107, USA
| | - Yuval R Zelnik
- Edmond J Safra Campus, Hebrew University, Jerusalem 91904, Israel
| | - Bryan W Reutter
- Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, CA 94720, USA
| | - Arkadiusz Sitek
- Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Stephen L Bacharach
- UCSF Physics Research Laboratory, Department of Radiology, University of California San Francisco, 185 Berry St, Suite 350, PO Box 0946, San Francisco, CA 94107, USA
| | - Grant T Gullberg
- UCSF Physics Research Laboratory, Department of Radiology, University of California San Francisco, 185 Berry St, Suite 350, PO Box 0946, San Francisco, CA 94107, USA
- Lawrence Berkeley National Laboratory, One Cyclotron Road, Berkeley, CA 94720, USA
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Daniele S, Nappi C, Acampa W, Storto G, Pellegrino T, Ricci F, Xhoxhi E, Porcaro F, Petretta M, Cuocolo A. Incremental prognostic value of coronary flow reserve assessed with single-photon emission computed tomography. J Nucl Cardiol 2011; 18:612-9. [PMID: 21626091 DOI: 10.1007/s12350-011-9345-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 01/24/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND We assessed the prognostic value of coronary flow reserve (CFR) estimated by single-photon emission computed tomography (SPECT) in patients with suspected myocardial ischemia. METHODS AND RESULTS Myocardial perfusion and CFR were assessed in 106 patients using dipyridamole/rest Tc-99m sestamibi SPECT and follow-up was obtained in 103 (97%) patients. Four early revascularized patients were excluded and 99 were assigned to normal (summed stress score <3) vs abnormal myocardial perfusion and to normal (≥2.0) vs abnormal CFR. During the follow-up (5.8 ± 2.1 years), 28 patients experienced a cardiac event (cardiac death, nonfatal myocardial infarction, and late revascularization). Abnormal perfusion (P < .01) and abnormal CFR (P < .05) were independent predictors of cardiac events at Cox proportional hazard regression analysis. Also in patients with normal perfusion, abnormal CFR was associated with a higher annual event rate compared with normal CFR (5.2% vs 0.7%; P < .05). CFR data improved the prognostic power of the model including clinical and myocardial perfusion data increasing the global chi-square from 18.6 to 22.8 (P < .05). Finally, at parametric survival analysis, in patients with normal perfusion the time to achieve ≥2% risk of events was >60 months in those with normal and <12 months in those with abnormal CFR. CONCLUSIONS Myocardial perfusion findings and CFR at SPECT imaging are both independent predictors of cardiac events. Estimated CFR provides incremental prognostic information over those obtained from clinical and myocardial perfusion data, particularly in patients with normal perfusion findings.
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Affiliation(s)
- Stefania Daniele
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
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17
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Storto G, Soricelli A, Pellegrino T, Petretta M, Cuocolo A. Assessment of the arterial input function for estimation of coronary flow reserve by single photon emission computed tomography: comparison of two different approaches. Eur J Nucl Med Mol Imaging 2011; 36:2034-41. [PMID: 19526233 DOI: 10.1007/s00259-009-1186-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 05/21/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Attempts to estimate coronary flow reserve (CFR) with single photon emission computed tomography (SPECT) tracers have been recently made. We compared two different methods for the estimation of CFR by SPECT imaging. METHODS Fourteen patients with coronary artery disease underwent dipyridamole 99mTc-sestamibi SPECT and intracoronary Doppler within 5 days. Myocardial blood flow (MBF) was estimated by measurement of first transit counts in the right pulmonary artery (PA) and left ventricular (LV) chamber, and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of stress MBF to rest MBF. RESULTS Rest and stress MBF obtained using first transit counts from PA were higher compared to that from LV chamber (rest: 1.05 ± 0.38 vs 0.87 ± 0.34 counts/pixel per s, respectively, p < 0.01 and stress: 1.34 ± 0.45 vs 0.91 ± 0.20 counts/pixel per s, respectively, p < 0.05). In the study vessels, CFR by Doppler was 1.39 ± 0.42, and SPECT CFR obtained using first transit counts from PA and LV chamber were 1.36 ± 0.43 and 1.16 ± 0.39, respectively (p across categories NS). A significant relationship between SPECT CFR obtained using first transit counts from PA and CFR by Doppler was found (r = 0.85, p < 0.001). No relationship between SPECT CFR obtained using first transit counts from LV chamber and CFR by intracoronary Doppler was OBSERVED (R = 0.43, P = NS). CONCLUSION SPECT-estimated CFR obtained using first transit counts from right PA is more accurate and correlates better with the results of intracoronary Doppler than estimated CFR obtained using arterial input function from LV chamber.
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18
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Gullberg GT, Reutter BW, Sitek A, Maltz JS, Budinger TF. Dynamic single photon emission computed tomography--basic principles and cardiac applications. Phys Med Biol 2010; 55:R111-91. [PMID: 20858925 PMCID: PMC3306016 DOI: 10.1088/0031-9155/55/20/r01] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The very nature of nuclear medicine, the visual representation of injected radiopharmaceuticals, implies imaging of dynamic processes such as the uptake and wash-out of radiotracers from body organs. For years, nuclear medicine has been touted as the modality of choice for evaluating function in health and disease. This evaluation is greatly enhanced using single photon emission computed tomography (SPECT), which permits three-dimensional (3D) visualization of tracer distributions in the body. However, to fully realize the potential of the technique requires the imaging of in vivo dynamic processes of flow and metabolism. Tissue motion and deformation must also be addressed. Absolute quantification of these dynamic processes in the body has the potential to improve diagnosis. This paper presents a review of advancements toward the realization of the potential of dynamic SPECT imaging and a brief history of the development of the instrumentation. A major portion of the paper is devoted to the review of special data processing methods that have been developed for extracting kinetics from dynamic cardiac SPECT data acquired using rotating detector heads that move as radiopharmaceuticals exchange between biological compartments. Recent developments in multi-resolution spatiotemporal methods enable one to estimate kinetic parameters of compartment models of dynamic processes using data acquired from a single camera head with slow gantry rotation. The estimation of kinetic parameters directly from projection measurements improves bias and variance over the conventional method of first reconstructing 3D dynamic images, generating time-activity curves from selected regions of interest and then estimating the kinetic parameters from the generated time-activity curves. Although the potential applications of SPECT for imaging dynamic processes have not been fully realized in the clinic, it is hoped that this review illuminates the potential of SPECT for dynamic imaging, especially in light of new developments that enable measurement of dynamic processes directly from projection measurements.
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Affiliation(s)
- Grant T Gullberg
- E O Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA.
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19
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Cicala S, Pellegrino T, Storto G, Caprio MG, Paladini R, Mainolfi C, de Leva F, Cuocolo A. Noninvasive quantification of coronary endothelial function by SPECT imaging in children with a history of Kawasaki disease. Eur J Nucl Med Mol Imaging 2010; 37:2249-55. [PMID: 20680267 DOI: 10.1007/s00259-010-1575-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 07/15/2010] [Indexed: 01/07/2023]
Abstract
PURPOSE The feasibility of coronary function estimation by single photon emission computed tomography (SPECT) has been recently demonstrated. The aim of this study was to apply SPECT imaging in patients with previous Kawasaki disease (KD) to assess the coronary functional status at long-term follow-up of the acute phase of the disease. METHODS Sixteen children with a history of KD underwent 99mTc-sestamibi imaging at rest and during the cold pressor test (CPT). Myocardial blood flow (MBF) was estimated by measuring first transit counts in the pulmonary artery and myocardial counts from SPECT images. Coronary endothelial function was expressed as the ratio of the CPT to rest MBF. RESULTS Six KD patients without coronary artery lesions served as controls and ten with coronary artery aneurysms during the acute phase of the disease were separated into two groups: group 1 (n=4) with regressed and group 2 (n=6) with persistent aneurysm at follow-up. The estimated coronary endothelial function was higher in controls compared to patients with coronary artery aneurysms (2.5±0.3 vs 1.7±0.7, p<0.05). A significant difference in coronary endothelial function among groups was found (F=5.21, p<0.02). Coronary endothelial function was higher in patients of group 1 than in those of group 2 (1.9±0.6 vs 1.4±0.7, p<0.02). CONCLUSION SPECT may be applied as a noninvasive method for assessing coronary vascular function in children with a history of KD, demonstrating an impaired response to the CPT, an endothelial-dependent vasodilator stimulus. These findings reinforce the concept that coronary endothelial dysfunction may represent a long-term sequela of KD.
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Affiliation(s)
- Silvana Cicala
- Division of Cardiology, Department of Paediatrics, Santobono-Pausilipon Children Medical Hospital, and Department of Biomorphological and Functional Sciences, Federico II University, Naples, Italy
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20
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Cuocolo A, Petretta M, Soricelli A. Measurement of coronary flow reserve by noninvasive cardiac imaging. Eur J Nucl Med Mol Imaging 2010; 37:1198-202. [DOI: 10.1007/s00259-010-1401-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Regensteiner JG, Bauer TA, Reusch JEB, Quaife RA, Chen MY, Smith SC, Miller TM, Groves BM, Wolfel EE. Cardiac dysfunction during exercise in uncomplicated type 2 diabetes. Med Sci Sports Exerc 2009; 41:977-84. [PMID: 19346991 DOI: 10.1249/mss.0b013e3181942051] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Type 2 diabetes mellitus (T2DM) has been associated with reduced peak exercise capacity (VO(2peak)). The causes of this impairment are not clearly established, but evidence suggests that abnormalities in cardiac function play a significant role. We hypothesized that exercise would be associated with impaired cardiac function and hemodynamics in recently diagnosed T2DM, even in the absence of clinically evident cardiovascular complications. METHODS After baseline normal echocardiography screening, 10 premenopausal women with uncomplicated T2DM (average duration of diagnosed T2DM, 3.6 yr) and 10 healthy nondiabetic women of similar age, weight, and activity levels performed a peak cardiopulmonary exercise test while instrumented with an indwelling pulmonary artery catheter for assessing cardiac function. On separate days, technetium-99m sestamibi (cardolite) imaging was performed to assess myocardial perfusion at rest and peak exercise in seven T2DM and seven control patients. RESULTS Resting measures of cardiac hemodynamics were similar in T2DM and control subjects. Absolute VO(2peak) (mL x min(-1)) and peak cardiac output (L x min(-1)) tended to be lower in T2DM than in control subjects but did not reach statistical significance. However, pulmonary capillary wedge pressure (PCWP) rose significantly more during exercise in T2DM than in controls (148% vs 109% increase at peak exercise, P < 0.01). Normalized myocardial perfusion index was lower in persons with diabetes than in controls (11.0 +/- 3.5 x e(-9) vs 17.5 +/- 8.1 x e(-9), respectively, P < 0.05) and inversely related to peak exercise PCWP (R = -0.56, P < 0.05). CONCLUSIONS Cardiac hemodynamics during graded exercise are altered in women with recently diagnosed T2DM as demonstrated by the disproportionate increase in PCWP at peak exercise compared with controls subjects. Cardiac abnormalities observed are potentially early signs of subclinical cardiac dysfunction associated with T2DM, which may precede the more greatly impaired cardiac function at rest and with exercise observed in longer established T2DM.
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Affiliation(s)
- Judith G Regensteiner
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA.
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22
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Petretta M, Soricelli A, Storto G, Cuocolo A. Assessment of coronary flow reserve using single photon emission computed tomography with technetium 99m-labeled tracers. J Nucl Cardiol 2008; 15:456-65. [PMID: 18513652 DOI: 10.1016/j.nuclcard.2008.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The quantitative assessment of coronary flow reserve (CFR) may be useful for the functional evaluation of coronary artery disease (CAD), allowing judgment of its severity, tracking of disease progression, and evaluation of the anti-ischemic efficacy of therapeutic strategies. Invasive techniques, such as intracoronary Doppler ultrasound and the pressure-derived method, which directly assess CFR velocity and fractional flow reserve, have been used for the evaluation of the physiologic significance of coronary lesions. Considerable progress has been made in the improvement of technologies directed toward the noninvasive quantification of myocardial blood flow and CFR. Positron emission tomography has emerged as an accurate technique to quantify CFR. The absolute measurements obtained with this noninvasive approach have been widely validated. Nevertheless, it has not been applied to routine studies because of its high cost and complexity. On the other hand, technetium 99m-labeled tracers have been largely used for the evaluation of myocardial perfusion with single photon emission computed tomography (SPECT) imaging in patients with suspected or known CAD. Recently, attempts to estimate CFR with SPECT tracers have been made to obtain, with noninvasive methods, data for quantitative functional assessment of CAD. This review analyzes the relative merit and limitations of CFR measurements by cardiac SPECT imaging with Tc-99m-labeled tracers and describes the potential clinical applications of this technique.
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Affiliation(s)
- Mario Petretta
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy
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23
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Castell-Conesa J, Candell-Riera J. Estimation of coronary flow reserve by SPECT: myth or reality? Eur J Nucl Med Mol Imaging 2007; 34:1152-5. [PMID: 17497107 DOI: 10.1007/s00259-007-0415-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ohba M, Hosokawa R, Kambara N, Tadamura E, Mamede M, Kubo S, Yamamuro M, Fujita M, Kimura T, Nohara R, Kita T. Difference in myocardial flow reserve between patients with dilated cardiomyopathy and those with dilated phase of hypertrophic cardiomyopathy: evaluation by 15O-water PET. Circ J 2007; 71:884-90. [PMID: 17526985 DOI: 10.1253/circj.71.884] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical features of patients with the dilated phase of hypertrophic cardiomyopathy (DHCM) may resemble those of patients with dilated cardiomyopathy (DCM); that is, systolic dysfunction and left ventricular dilatation. Myocardial flow reserve (MFR) is impaired in patients with nonischemic cardiomyopathy, and the reduced MFR may be related to poor prognosis. Several studies report that the mortality rate for patients with DHCM is higher than for DCM, but the difference between these 2 cardiomyopathies is still unclear. The purpose of this study was to assess the MFR of these 2 cardiomyopathies, using (15)O-water positron emission tomography (PET) to elucidate their differences. METHODS AND RESULTS In total 30 patients were investigated: 23 with DCM (Group A) and 7 with DHCM (Group B). All those who were in a stable condition underwent cardiac catheterization. Myocardial blood flow (MBF) at rest and under ATP infusion was measured by (15)O-water PET, and the MFR was calculated. There were no significant differences in the hemodynamics of the 2 groups. The mean MFR in DHCM was significantly lower than that in DCM (1.49+/-0.31 vs 2.62+/-1.08; p=0.042), whereas MBF at rest did not differ (DCM vs DHCM: 0.66+/-0.20 vs 0.49+/-0.05 ml . min(-1) . g(-1); NS). The MFR in both Group A and B was significantly decreased compared with the normal controls (MFR in normal controls: 5.15+/-1.64, p=0.00015, 0.00013, respectively). CONCLUSIONS These results suggest that impaired vasodilatation (ie, dysfunction of the microcirculation) is more severe in patients with DHCM than in patients with DCM, even though patients' characteristics and hemodynamics do not differ.
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Affiliation(s)
- Muneo Ohba
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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25
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Brunken RC. Challenges for measurement of myocardial perfusion and perfusion reserve by SPECT imaging. J Nucl Cardiol 2007; 14:145-9. [PMID: 17386375 DOI: 10.1016/j.nuclcard.2007.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Noninvasive quantitative measurement of myocardial perfusion has played an important role in cardiac research and also has potential applications in clinical imaging. Positron emission tomography (PET) methods for measuring absolute perfusion are well established, although the need for an on-site cyclotron has restricted its use to a limited number of centers. Single-photon emission CT (SPECT) also has potential for quantifying myocardial perfusion and has more widespread availability. In this article we review the basic principles of absolute myocardial perfusion quantification and the radiopharmaceuticals that are available for both PET and SPECT. We also examine the extent to which recent developments in instrumentation have increased the practicality of absolute perfusion quantification in PET and the potential for absolute quantification in SPECT.
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Affiliation(s)
- Martin A Lodge
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Storto G, Sorrentino AR, Pellegrino T, Liuzzi R, Petretta M, Cuocolo A. Assessment of coronary flow reserve by sestamibi imaging in patients with typical chest pain and normal coronary arteries. Eur J Nucl Med Mol Imaging 2007; 34:1156-61. [PMID: 17206413 DOI: 10.1007/s00259-006-0333-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 08/08/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE We assessed coronary flow reserve (CFR) by sestamibi imaging in patients with typical chest pain, positive exercise stress test and normal coronary vessels. METHODS Thirty-five patients with typical chest pain and normal angiogram and 12 control subjects with atypical chest pain underwent dipyridamole/rest (99m)Tc-sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in the pulmonary artery and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of stress to rest MBF. Rest MBF and CFR were corrected for rate-pressure product (RPP) and expressed as normalised MBF (MBF(n)) and normalised CFR (CFR(n)). Coronary vascular resistances (CVR) were calculated as the ratio between mean arterial pressure and estimated MBF. RESULTS At rest, estimated MBF and MBF(n) were lower in controls than in patients (0.98 +/- 0.4 vs 1.30 +/- 0.3 counts/pixel/s and 1.14 +/- 0.5 vs 1.64 +/- 0.6 counts/pixel/s, respectively, both p < 0.02). Stress MBF was not different between controls and patients (2.34 +/- 0.8 vs 2.01 +/- 0.7 counts/pixel/s, p=NS). Estimated CFR was 2.40 +/- 0.3 in controls and 1.54 +/- 0.3 in patients (p < 0.0001). After correction for the RPP, CFR(n) was still higher in controls than in patients (2.1 +/- 0.5 vs 1.29 +/- 0.5, p < 0.0001). At baseline, CVR values were lower (p < 0.01) in patients than in controls. Dipyridamole-induced changes in CVR were greater (p < 0.0001) in controls (-63%) than in patients (-35%). In the overall study population, a significant correlation between dipyridamole-induced changes in CVR and CFR was observed (r = -0.88, p < 0.0001). CONCLUSION SPECT might represent a useful non-invasive method for assessing coronary vascular function in patients with angina and a normal coronary angiogram.
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Affiliation(s)
- Giovanni Storto
- Department of Biomorphological and Functional Sciences, Institute of Biostructures and Bioimages of the National Council of Research, University Federico II, Naples, Italy
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Mori T, Nomura M, Hori A, Kondo N, Bando S, Ito S. Mechanism of ST segment depression during exercise tests in patients with liver cirrhosis. THE JOURNAL OF MEDICAL INVESTIGATION 2007; 54:109-15. [PMID: 17380021 DOI: 10.2152/jmi.54.109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE To our experience, ST segment depression is sometimes detected in an exercise electrocardiogram (ECG) test in patients with liver cirrhosis who have no significant coronary stenosis. In this study, the mechanism of ST segment depression in liver cirrhosis was examined using (99m)Tc-methoxy-isobutyl-isonitrile (MIBI) myocardial scintigraphy. METHODS Six patients with liver cirrhosis (LC group), and 15 normal subjects (N group) were examined. To evaluate the level of myocardial blood flow, a Bull's eye display of myocardial blood flow was performed after dividing the left ventricle into 9 segments. Exercise myocardial scintigraphy with MIBI was performed to obtain the increase in % uptake. Angiographies were performed with a CAG system by inserting a 5 French Judkins catheter via the right femoral artery. RESULTS No significant coronary stenosis was found in any of the LC patients. Neither a decrease in MIBI uptake nor defect was observed on Bull's eye images from the LC group. The mean % uptake increase was 61.0 +/- 5.6% in the N group. In the LC group, although neither a decrease in MIBI uptake nor a defect was visually observed on Bull's eye images obtained during exercise, the % uptake increases (mean: 52.5 +/- 5.8%) were lower than those of the N group (p<0.05). CONCLUSION These findings suggest that a disorder in coronary flow reserve occurs in liver cirrhosis patients, because the decreased MIBI uptake during exercise is due to the depression of flow-mediated vasodilatation controlled by the endothelium of the coronary artery and the estrogenic digitalis action of blood flow independency.
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Affiliation(s)
- Toshifumi Mori
- Department of Digestive and Cardiovascular Medicine, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
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Palmieri V, Storto G, Arezzi E, Pellegrino T, Mancini M, Di Minno G, Ferrara AL, Cuocolo A, Celentano A. Relations of left ventricular mass and systolic function to endothelial function and coronary flow reserve in healthy, new discovered hypertensive subjects. J Hum Hypertens 2006; 19:941-50. [PMID: 16079883 DOI: 10.1038/sj.jhh.1001921] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Left ventricular hypertrophy (LVH) is prognostically relevant, associated with major cardiovascular risk factors and with atherosclerosis. However, whether LVH is independently associated with impaired coronary flow reserve (CFR) and with endothelial dysfunction is disputed. We assessed the relationship of LV mass and systolic function to CFR and endothelial function in new discovered never treated subjects with essential arterial hypertension, but without coronary artery disease or microalbuminuria. LVH, ejection fraction (EF) and stress-corrected midwall shortening (MWS, a measure of myocardial contractility) were assessed by echocardiography. CFR was assessed by single-photon emission computed tomography and dipyridamole infusion. Endothelial function was evaluated by assessing 1-min postischaemic flow-mediated dilatation of the brachial artery (FMD); nitroglycerine-mediated dilatation (NMD) of the same brachial artery was used as measure of nonendothelium-dependent vasodilatation. In approximately 1 year, we enrolled 21 subjects who met stringent inclusion criteria (47+/-10 years old, 26.6+/-2.8 kg/m2, 78% men). Five patients showed LVH. Multivariate analyses showed a significant negative correlation of LV mass index with FMD (beta=-0.61, P<0.05) but not with NMD, neither with CFR. Stress-corrected MWS showed independent correlation with CFR (beta=0.51, P<0.05). Thus, in clinically healthy, new discovered hypertensive subjects, never treated and mostly in the early stage of arterial hypertension, LVH can be associated with endothelial dysfunction while maximal dipyridamole- dependent CFR may be preserved; nevertheless, a cardiac phenotype presenting with tendency to impaired myocardial contractility, assessed by stress-corrected MWS, showed association with lower CFR in the early stage of arterial hypertension.
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Affiliation(s)
- V Palmieri
- Department of Clinical and Experimental Medicine, Federico II University School of Medicine, Naples, Italy.
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Tsukamoto T, Ito Y, Noriyasu K, Morita K, Katoh C, Okamoto H, Tamaki N. Quantitative Assessment of Regional Myocardial Flow Reserve Using Tc-99m-Sestamibi Imaging-Comparison With Results of O-15 Water PET-. Circ J 2005; 69:188-93. [PMID: 15671611 DOI: 10.1253/circj.69.188] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aims of this study were to develop a method for quantitative estimation of the myocardial blood flow index (MBFI) and myocardial flow reserve (MFR) of the whole left ventricle using (99m)technetium (Tc-99m)-sestamibi imaging. METHODS AND RESULTS Twenty-two patients with suspected coronary artery disease and 7 controls underwent both Tc-99m-sestamibi imaging and O-15 water positron emission tomography (PET). The global MBFI was calculated on the basis of the microsphere model from the ratio of the myocardial count to the area under the time - activity curve on the aortic arch. The regional MBFI was calculated from the relative distributions of Tc-99m-sestamibi uptake values. The regional MBFI and MFR (Tc-MFR) obtained using single-photon emission computed tomography were compared with the myocardial blood flow (MBF) and MFR (PET-MFR) obtained using PET as the gold standard. Regional MBFI significantly correlated with the MBF obtained using PET. Regional Tc-MFR also correlated with the regional PET-MFR, with some underestimation. CONCLUSION These results indicate that regional MBF and MFR may be estimated by dynamic Tc-99m-sestamibi imaging and can be used for the early detection and estimation of the functional severity of coronary lesions without the need for a PET camera.
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Affiliation(s)
- Takahiro Tsukamoto
- Department of Cardiovascular Medicine, Hokkaido University, Sapporo, Japan
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Storto G, Cirillo P, Vicario MLE, Pellegrino T, Sorrentino AR, Petretta M, Galasso G, De Sanctis V, Piscione F, Cuocolo A. Estimation of coronary flow reserve by Tc-99m sestamibi imaging in patients with coronary artery disease: comparison with the results of intracoronary Doppler technique. J Nucl Cardiol 2004; 11:682-8. [PMID: 15592191 DOI: 10.1016/j.nuclcard.2004.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study compared coronary flow reserve (CFR) estimated by technetium 99m sestamibi imaging with the results obtained with intracoronary Doppler in patients with coronary artery disease. Intraobserver and interobserver reproducibility of the radionuclide-estimated CFR was also assessed. METHODS AND RESULTS Fourteen consecutive patients (mean age, 54 +/- 7 years) with documented coronary artery disease in whom percutaneous coronary intervention was planned underwent dipyridamole (0.74 mg/kg) sestamibi imaging and intracoronary Doppler within 5 days. Myocardial blood flow (MBF) was estimated by measurement of first transit counts in the pulmonary artery and myocardial counts from single photon emission computed tomography images. Estimated CFR was expressed as the ratio of stress MBF to rest MBF. In the study vessels, CFR was 1.36 +/- 0.43 as estimated by sestamibi and 1.39 +/- 0.42 by intracoronary Doppler ( P = .69). A significant relationship between CFR estimated by sestamibi and CFR obtained by intracoronary Doppler was observed ( r = 0.85, P < .001). On Bland-Altman analysis, the mean difference between CFR by sestamibi and by Doppler was 0.03 and the intraclass correlation coefficients for intraobserver and interobserver reproducibility were high (all P < .001) for both global and regional CFR. CONCLUSIONS This study demonstrates a good agreement between CFR estimated by sestamibi imaging and by intracoronary Doppler results and a lack of intraobserver and interobserver variability of this noninvasive approach.
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Affiliation(s)
- Giovanni Storto
- Department of Biomorphological Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy
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Ragosta M. The clinical assessment of coronary flow reserve in patients with coronary artery disease. J Nucl Cardiol 2004; 11:651-5. [PMID: 15592186 DOI: 10.1016/j.nuclcard.2004.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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