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Lee C, Dennett AM, Pinson JA, Lewis AK. Caffeine consumed prior to cardiac stress testing may affect diagnostic accuracy of nuclear medicine myocardial imaging of myocardial ischemia: A systematic review and meta-analysis. J Med Imaging Radiat Sci 2024; 55:134-145. [PMID: 38233285 DOI: 10.1016/j.jmir.2023.12.011] [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: 10/17/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) is a well-established, non-invasive imaging procedure for the diagnosis and evaluation of patients with known or suspected coronary artery disease. With the increasing use of pharmacologic stress agents in myocardial perfusion imaging, strict preparation, including caffeine abstinence, is required. The aim of this review was to determine the effect of caffeine consumed prior to nuclear cardiac stress testing on the diagnostic accuracy. METHODS Medline, Embase and CINAHL were searched from the earliest available time until August 2022. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2. Data pertaining to diagnostic accuracy were analysed using meta-analysis where appropriate and overall certainty of evidence evaluated using the Grades of Research, Assessment, Development and Evaluation approach. RESULTS Six studies (307 participants) from a yield of 735 articles were identified. Meta-analysis of two studies found no difference in the left ventricular ejection fraction of patients pre and post caffeine consumption (MD -0.31 %, 95% CI -4.32% to 3.7%). Meta-analysis of three studies found there was uncertainty as to whether caffeine consumption affected reversibility (MD -2.16 segments 95% CI -4.61 to 0.28) and descriptive summary of three studies found mixed results for size of stress defects. CONCLUSION The low quality evidence synthesized in this systematic review suggests caffeine may affect the diagnostic accuracy in myocardial perfusion imaging for ischemia detection in patients with chest pain and intermediate-to-high risk of coronary artery disease.
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Affiliation(s)
- Christine Lee
- Department of Nuclear Medicine, Eastern Health, Box Hill Hospital, Box Hill, Melbourne, Australia.
| | - Amy M Dennett
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Australia; School of Allied Health Human Services and Sport, La Trobe University, Bundoora Australia
| | - Jo-Anne Pinson
- Sir Peter MacCallum Department of Oncology, The Radiopharmaceutical Research Laboratory, The Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia; Medicinal Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Monash Institute of Pharmaceutical Sciences, Monash University (Parkville Campus), Parkville, Australia
| | - Annie K Lewis
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Australia; School of Allied Health Human Services and Sport, La Trobe University, Bundoora Australia
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Amini M, Pursamimi M, Hajianfar G, Salimi Y, Saberi A, Mehri-Kakavand G, Nazari M, Ghorbani M, Shalbaf A, Shiri I, Zaidi H. Machine learning-based diagnosis and risk classification of coronary artery disease using myocardial perfusion imaging SPECT: A radiomics study. Sci Rep 2023; 13:14920. [PMID: 37691039 PMCID: PMC10493219 DOI: 10.1038/s41598-023-42142-w] [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: 04/04/2023] [Accepted: 09/06/2023] [Indexed: 09/12/2023] Open
Abstract
This study aimed to investigate the diagnostic performance of machine learning-based radiomics analysis to diagnose coronary artery disease status and risk from rest/stress Myocardial Perfusion Imaging (MPI) single-photon emission computed tomography (SPECT). A total of 395 patients suspicious of coronary artery disease who underwent 2-day stress-rest protocol MPI SPECT were enrolled in this study. The left ventricle myocardium, excluding the cardiac cavity, was manually delineated on rest and stress images to define a volume of interest. Added to clinical features (age, sex, family history, diabetes status, smoking, and ejection fraction), a total of 118 radiomics features, were extracted from rest and stress MPI SPECT images to establish different feature sets, including Rest-, Stress-, Delta-, and Combined-radiomics (all together) feature sets. The data were randomly divided into 80% and 20% subsets for training and testing, respectively. The performance of classifiers built from combinations of three feature selections, and nine machine learning algorithms was evaluated for two different diagnostic tasks, including 1) normal/abnormal (no CAD vs. CAD) classification, and 2) low-risk/high-risk CAD classification. Different metrics, including the area under the ROC curve (AUC), accuracy (ACC), sensitivity (SEN), and specificity (SPE), were reported for models' evaluation. Overall, models built on the Stress feature set (compared to other feature sets), and models to diagnose the second task (compared to task 1 models) revealed better performance. The Stress-mRMR-KNN (feature set-feature selection-classifier) reached the highest performance for task 1 with AUC, ACC, SEN, and SPE equal to 0.61, 0.63, 0.64, and 0.6, respectively. The Stress-Boruta-GB model achieved the highest performance for task 2 with AUC, ACC, SEN, and SPE of 0.79, 0.76, 0.75, and 0.76, respectively. Diabetes status from the clinical feature family, and dependence count non-uniformity normalized, from the NGLDM family, which is representative of non-uniformity in the region of interest were the most frequently selected features from stress feature set for CAD risk classification. This study revealed promising results for CAD risk classification using machine learning models built on MPI SPECT radiomics. The proposed models are helpful to alleviate the labor-intensive MPI SPECT interpretation process regarding CAD status and can potentially expedite the diagnostic process.
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Affiliation(s)
- Mehdi Amini
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
| | - Mohamad Pursamimi
- Department of Biomedical Engineering and Medical Physics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghasem Hajianfar
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
| | - Yazdan Salimi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
| | - Abdollah Saberi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
| | - Ghazal Mehri-Kakavand
- Department of Medical Physics, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Mostafa Nazari
- Department of Biomedical Engineering and Medical Physics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Ghorbani
- Department of Biomedical Engineering and Medical Physics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ahmad Shalbaf
- Department of Biomedical Engineering and Medical Physics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva 4, Switzerland.
- University Research and Innovation Center, Obuda University, Budapest, Hungary.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University of Medical Center Groningen, Groningen, The Netherlands.
- Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark.
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Wang SY, Lin KH, Wu YW, Yu CW, Yang SY, Shueng PW, Hsu CX, Wu TH. Evaluation of the cardiac subvolume dose and myocardial perfusion in left breast cancer patients with postoperative radiotherapy: a prospective study. Sci Rep 2023; 13:10578. [PMID: 37386034 PMCID: PMC10310776 DOI: 10.1038/s41598-023-37546-7] [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: 12/08/2022] [Accepted: 06/23/2023] [Indexed: 07/01/2023] Open
Abstract
Adjuvant breast radiotherapy could reduce the risk of local recurrence. However, the radiation dose received by the heart also increases the risk of cardiotoxicity and causes consequential heart diseases. This prospective study aimed to evaluate more precisely cardiac subvolume doses and corresponding myocardial perfusion defects according to the American Heart Association (AHA)'s 20-segment model for single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) interpretation for breast cancer after radiotherapy. The 61 female patients who underwent adjuvant radiotherapy following breast cancer surgery for left breast cancer were enrolled. SPECT MPI were performed before radiotherapy for baseline study, and 12 months after for follow-up. Enrolled patients were divided into two groups, new perfusion defect (NPD) and non new perfusion defect found (non-NPD) according to myocardial perfusion scale score. CT simulation data, radiation treatment planning, and SPECT MPI images were fused and registered. The left ventricle was divided into four rings, three territories, and 20 segments according to the AHA's 20-segment model of the LV. The doses between NPD and non-NPD groups were compared by the Mann-Whitney test. The patients were divided into two groups: NPD group (n = 28) and non-NPD group (n = 33). The mean heart dose was 3.14 Gy in the NPD group and 3.08 Gy in the non-NPD group. Mean LV doses were 4.84 Gy and 4.71 Gy, respectively. The radiation dose of the NPD group was higher than the non-NPD group in the 20 segments of LV. There was significant difference in segment 3 (p = 0.03). The study indicated that the radiation doses to 20 segments of LV in NPD were higher than those in non-NPD significantly at segment 3, and higher in other segments in general. In the bull's eye plot combining radiation dose and NPD area, we found that the new cardiac perfusion decline may exist even in the low radiation dose region.Trial registration: FEMH-IRB-101085-F. Registered 01/01/2013, https://clinicaltrials.gov/ct2/show/NCT01758419?cond=NCT01758419&draw=2&rank=1 .
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Affiliation(s)
- Shan-Ying Wang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Heng Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Wei Yu
- Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu County, Taiwan
| | - Shu-Ya Yang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pei-Wei Shueng
- Department of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Xiong Hsu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Department of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Vesnina ZV, Grakova EV. Diagnostic radiology methods for assessing coronary artery bypass graft viability. BULLETIN OF SIBERIAN MEDICINE 2022. [DOI: 10.20538/1682-0363-2022-3-140-153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The review describes available modern radiological methods which are currently applied for a detailed and comprehensive anatomical and functional assessment of the viability of various coronary artery bypass grafts. In addition, it presents some aspects of the implementation of these methods and clinical interpretation of the results.
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Affiliation(s)
- Zh. V. Vesnina
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
| | - E. V. Grakova
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
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Kim IH, Lee SJ, An YS, Choi SY, Yoon JK. Simulating dose reduction for myocardial perfusion SPECT using a Poisson resampling method. Nucl Med Mol Imaging 2021; 55:245-252. [PMID: 34721717 DOI: 10.1007/s13139-021-00710-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to determine the lowest Tl-201 dose that does not reduce the image quality of myocardial perfusion SPECT (MPS) by Poisson resampling simulation. Methods One hundred and twelve consecutive MPS data from patients with suspected or known coronary artery disease were collected retrospectively. Stress and rest MPS data were resampled using the Poisson method with 33%, 50%, 67%, and 100% count settings. Two nuclear medicine physicians assessed the image quality of reconstructed data visually by giving grades from - 2 to + 2. The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were obtained on the workstation. Image quality grades and semi-quantitative scores were then compared among these resampled images. Results The proportions of "adequate" image quality were 0.48, 0.75, 0.92, and 0.96 for the groups of images with 33%, 50%, 67%, and 100% data, respectively. The quality of the resampled images was significantly degraded at 50% and 33% count settings, while the image quality was not different between 67 and 100% count settings. We also found that high body mass index further decreased image quality at 33% count setting. Among the semi-quantitative parameters, SSS and SRS showed a tendency to increase with a decline in count. Conclusion Based on the simulation results, Tl-201 dose for MPS can be reduced to 74 MBq without significant loss of image quality. However, the SSS and SRS can be changed significantly, and it needs to be further verified under the different conditions.
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Affiliation(s)
- Il-Hyun Kim
- Departments of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 16499
| | - Su Jin Lee
- Departments of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 16499
| | - Young-Sil An
- Departments of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 16499
| | - So-Yeon Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Joon-Kee Yoon
- Departments of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, Kyunggi-do Republic of Korea 16499
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Koracevic G, Micic S, Stojanovic M. By discontinuing beta-blockers before an exercise test we may precipitate a rebound phenomenon. Curr Vasc Pharmacol 2021; 19:624-633. [PMID: 33653252 DOI: 10.2174/1570161119666210302152322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a need to analyse the current approach to beta-blocker (BB) use in relation to exercise-based stress tests. OBJECTIVE We compared various guidelines regarding recommending abrupt vs gradual discontinuation of BB prior to exercise tests. We also analyse the shortcomings of the currently recommended approach and suggest a new approach to avoid BB rebound. METHODS A narrative review is used to analyse this topic due to lack of valid randomized clinical trials. RESULTS Omitting the BB therapy prior to exercise-based test has been recommended in guidelines for many years. Although reasonable, this approach has potential disadvantages since sudden BB withdrawal may induce a rebound phenomenon, which is, also, acknowledged in several guidelines. CONCLUSIONS We observed inconsistency among relevant guidelines; there is no homogenous approach regarding BB use before exercise tests. Most guidelines recommend BB withdrawal for a couple of days before the test; they do not advise BB dose tapering. This approach is not standardised and raises the risk of BB rebound phenomenon both before and during the test. Therefore, we suggest using the half the prescribed BB dose at the usual time of administration (in the morning, prior to the exercise test).
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Affiliation(s)
- Goran Koracevic
- Department for Cardiovascular Diseases, Clinical Center Nis. Serbia
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Semaan H, Elsamaloty H, Bazerbashi M, Obri J, Elsamaloty M, Arroyo AJ, Obri T. Diagnosing cystic duct patency during myocardial perfusion imaging (MPI), using Tc99m Sestamibi (MIBI), as an adjunct benefit in the acute setting. BJR Open 2020; 2:20200008. [PMID: 33364545 PMCID: PMC7756244 DOI: 10.1259/bjro.20200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/09/2020] [Accepted: 10/28/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: Tc99m methoxy isobutyl isonitrile (MIBI) has been used for myocardial perfusion imaging (MPI) for the detection of ischemia. This study aimed to investigate the feasibility of effectively evaluating cystic duct patency, during routine visual analysis of the raw MPI and/or with the three-dimensional reconstructed data. Methods: A retrospective investigation of 91 patients undergoing cardiac MIBI scan for acute chest pain and hepatobiliary scintigraphy (HBS) was performed, within no more than 3 months for suspected gallbladder obstructive disease. Gallbladder visualization during either the stress or rest portion of the MIBI was indicative of cystic duct patency. These results were compared to those by the HBS studies. Results: Ten patients had the MIBI and HBS 4 days apart, both analyses concurred 100% with the diagnosis of cystic duct patency. 16 patients had both examinations between 4 days and 3 weeks and had an agreement of 87.5% with cystic duct patency. 65 patients had both tests 3 weeks to 3 months apart and had an agreement of 84.6% with cystic duct patency. Conclusion: The initial results of this study indicate that MPI with Tc99m MIBI is useful in detecting a patent cystic duct, above all in the setting of acute gallbladder pathology. Advances in knowledge: In this article, we introduce a novel method to diagnose cystic duct patency in the acute setting thus effectively ruling out acute cholecystitis, during MPI. Our method can potentially improve patient outcomes by reducing the volume of imaging needed to exclude a diagnosis of acute gallbladder pathology. This in turn, keeps in line with decreasing the cost for the patient, leading to a more sound value-based care.
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Affiliation(s)
- Hassan Semaan
- Department of Radiology, University of Toledo Medical Center, Toledo, OH, USA
| | - Haitham Elsamaloty
- Department of Radiology, University of Toledo Medical Center, Toledo, OH, USA
| | - Mohamad Bazerbashi
- Department of Radiology, University of Toledo Medical Center, Toledo, OH, USA
| | - Joud Obri
- Department of Radiology, University of Toledo Medical Center, Toledo, OH, USA
| | - Mazzin Elsamaloty
- Department of Radiology, University of Toledo Medical Center, Toledo, OH, USA
| | - Alberto J Arroyo
- Department of Radiology, Nuclear Medicine, St. Vincent Mercy Medical Center, Toledo, OH, USA
| | - Tawfik Obri
- Department of Radiology, University of Toledo Medical Center, Toledo, OH, USA
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Matsutomo N, Seki H, Hishikawa M, Motegi K, Yamamoto T. Technical Note: Development of an ischemic defect model insert attachable to a commercially available myocardial phantom. Med Phys 2020; 47:4340-4347. [PMID: 32463928 DOI: 10.1002/mp.14296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to develop a novel myocardial phantom insert model that attaches to commercially available myocardial phantoms and simulates an ischemic area, using three-dimensional printing technology. METHODS Ischemic inserts were designed to give four levels of absolute percent contrast (Low; 10%, Medium; 20%, High; 35%, and Defect; 100%) using CT images and computer-aided design software. The ischemic insert was composed of multiple slit structures to replicate myocardial ischemia. Myocardial phantom images with developed ischemic inserts were acquired using a SPECT/CT system and were then reconstructed using filtered back projection (FBP) and iterative reconstruction (IR) with various cutoff frequencies of a Butterworth filter. The performance and utility of ischemic inserts were evaluated according to percent contrast and 5-point scoring. RESULTS The percent contrast and scoring results changed according to the ischemic insert type, cutoff frequency, and reconstruction method. The percent contrast of each insert obtained by FBP with 0.4 cycles/cm was 4.1% (Low), 15.7% (Medium), 17.4% (High), and 36.1% (Defect). Similarly, the percent contrast of each insert obtained by IR with 0.4 cycles/cm was 5.0% (Low), 17.0% (Medium), 21.9% (High), and 47.7% (Defect). CONCLUSIONS We successfully developed an ischemic insert that attaches to a commercially available myocardial phantom by using CT imaging and 3D printing technology. Our proposed ischemic insert provided several abnormal perfusion patterns on myocardial SPECT images and may be useful for evaluating SPECT image quality.
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Affiliation(s)
- Norikazu Matsutomo
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan.,Graduate School of Health Sciences, Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan
| | - Harumi Seki
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan
| | - Mizuho Hishikawa
- Graduate School of Health Sciences, Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan
| | - Kazuki Motegi
- Graduate School of Health Sciences, Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan.,Department of Nuclear Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Tomoaki Yamamoto
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan.,Graduate School of Health Sciences, Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-307, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan
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Shibutani T, Okuda K, Ichikawa H, Kato T, Miwa K, Tsushima H, Onoguchi M, Nagaki A. Imaging technology for myocardial perfusion single-photon emission computed tomography 2018 in Japan. Jpn J Radiol 2020; 38:274-282. [PMID: 31919636 DOI: 10.1007/s11604-019-00915-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022]
Abstract
AIM Recently, nuclear cardiology has dramatically advanced by a new technology development such as the device, short-term acquisition system, image reconstruction algorithm and image analysis. Although these innovations have been gradually employed in routine examinations, we did not investigate the current use of image acquisition, image reconstruction, and image analysis with myocardial perfusion single-photon emission computed tomography (MPS). We investigated the current status of MPS imaging technology in Japan. METHODS We carried out a survey using a Web-based questionnaire system, the opening of which was announced via e-mail, and it was available on a website for 3 months. We collected data on the current use of MPS with 201Tl and/or 99mTc agents with respect to routine protocols, image acquisition, image reconstruction, and image analysis. RESULTS We received responses to the Web-based questionnaire from 178 and 174 people for 99mTc and 201Tl MPS, respectively. The routine protocols of MPS of stress-rest and rest-stress MPS on 1-day protocols with 99mTc were 41.2% and 14.5%, respectively, and the rest-only scan response rate was 23.7%, whereas that of 201Tl MPS was 65.9% with stress-rest MPS, 19.0% with rest-only MPS, and 10.9% with stress-rest MPS adding a rest scan 24 h after injection. The filtered back projection (FBP) method is most commonly used image reconstruction method, yielding 70.5% for 99mTc MPS and 76.8% for 201Tl MPS, including combined FBP and ordered subset expectation maximization method. The results for no-correction (NC) images were 49.2% with 99mTc MPS and 55.2% with 201Tl MPS including the response of NC and combined attenuation correction (AC) and scatter correction (SC) (i.e., ACSC) images. The AC or ACSC images of 99mTc and 201Tl were provided by 30-40% of the institutions surveyed. CONCLUSIONS We investigated the current status of MPS imaging technology in Japan, and found that although the use of various technical developments has been reported, some of these technologies have not been utilized effectively. Hence, we expect that nuclear medicine technology will be used more effectively to improve diagnosis.
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Affiliation(s)
- Takayuki Shibutani
- Department of Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa, Japan.
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Kahoku, Japan
| | - Hajime Ichikawa
- Department of Radiology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Toyohiro Kato
- Department of Radiology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Kenta Miwa
- Department of Radiological Sciences, School of Health Sciences, International University of Health and Welfare, Ohtawara, Japan
| | - Hiroyuki Tsushima
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa, Japan
| | - Akio Nagaki
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki, Japan
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Quantitative low-dose rest and stress CT myocardial perfusion imaging with a whole-heart coverage scanner improves functional assessment of coronary artery disease. IJC HEART & VASCULATURE 2019; 24:100381. [PMID: 31763433 PMCID: PMC6859740 DOI: 10.1016/j.ijcha.2019.100381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 12/02/2022]
Abstract
Objective We evaluated the diagnostic accuracy of myocardial blood flow (MBF) and perfusion reserve (MPR) measured from low-dose dynamic contrast-enhanced (DCE) imaging with a whole-heart coverage CT scanner for detecting functionally significant coronary artery disease (CAD). Methods Twenty one patients with suspected or known CAD had rest and dipyridamole stress MBF measurements with CT and SPECT myocardial perfusion imaging (MPI), and lumen narrowing assessment with coronary angiography (catheter and/or CT based) within 6 weeks. SPECT MBF measurements and coronary angiography were used together as reference to determine the functional significance of coronary artery stenosis. In each CT MPI study, DCE images of the whole heart were acquired with breath-hold using a low-dose acquisition protocol to generate MBF maps. Binomial logistic regression analysis was used to determine the diagnostic accuracy of CT-measured MBF and MPR (ratio of stress to rest MBF) for assessing functionally significant coronary stenosis. Results Mean stress MBF and MPR in ischemic segments were lower than those in non-ischemic segments (1.37 ± 0.34 vs. 2.14 ± 0.64 ml/min/g; 1.56 ± 0.41 vs. 2.53 ± 0.70; p < 0.05 for all). The receiver operating characteristic curve analysis revealed that MPR (AUC 0.916, 95%CI: 0.885–0.947) had a superior power than stress MBF (AUC 0.869, 95%CI: 0.830–0.909) for differentiating non-ischemic and ischemic myocardial segments (p = 0.045). On a per-vessel and per-segment analysis, concomitant use of MPR and stress MBF thresholds further improved the diagnostic accuracy compared to MPR or stress MBF alone for detecting obstructive coronary lesions (per-vessel: 93.4% vs. 83.6% and 88.5%, respectively; per-segment: 90.0% vs. 83.7% and 83.1%, respectively). The estimated effective dose of a rest and stress CT MPI study was 3.04 and 3.19 mSv respectively. Conclusion Quantitative rest and stress myocardial perfusion measurement with a large-coverage CT scanner improves the diagnostic accuracy for detecting functionally significant coronary stenosis.
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Khan MI, Farwa U, Iqbal T, Ali S, Nazir A, Ijaz M. Comparison of 99mTc Injected Activity with Prescribed Activity in Four Types of Nuclear Medicine Exams. Curr Radiopharm 2019; 13:80-85. [PMID: 31258094 PMCID: PMC7509723 DOI: 10.2174/1874471012666190620144803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/02/2019] [Accepted: 04/22/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND 99mTc is a radioactive isotope that is obtained by eluting a 99Mo/99mTc generator. (PINSTECH, Islamabad) and used for radionuclide scanning. OBJECTIVES The objective of this work is to study the uncertainties in 99mTc activity that exist due to time delay between injection preparation and administration to patients, during the process of gamma camera scanning. METHODS Lead canisters were used for storing elution vials and dose calibrator for measuring 99mTc activity in mCi. The activity of preparing 99mTc injection and its administration to patients were compared with the prescribed values of activity recommended in the Society of Nuclear Medicine procedure guidelines. RESULTS This study showed that uncertainty in the activity existed in one thyroid patient, 38 bone patients, 5 renal patients and 45 cardiac patients. CONCLUSION This uncertainty in activity exists due to time delay between injection preparation and administration to patients, as well as due to residual radionuclide that is not injected into patients and remains in the syringe.
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Affiliation(s)
- Muhammad Isa Khan
- Department of Physics, Faculty of Science, University of Gujrat, Hafiz Hayat Campus, Gujrat, 50700, Pakistan
| | - Umme Farwa
- Department of Physics, Faculty of Science, University of Gujrat, Hafiz Hayat Campus, Gujrat, 50700, Pakistan
| | - Tahir Iqbal
- Department of Physics, Faculty of Science, University of Gujrat, Hafiz Hayat Campus, Gujrat, 50700, Pakistan
| | - Saadat Ali
- Gujranwala Institute of Nuclear Medicine & Radiotherapy, Gujranwala, Pakistan
| | - Aalia Nazir
- Department of Physics, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Mohsin Ijaz
- Department of Physics, Faculty of Science, University of Gujrat, Hafiz Hayat Campus, Gujrat, 50700, Pakistan
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12
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Salvarese N, Carta D, Marzano C, Gerardi G, Melendez-Alafort L, Bolzati C. [99mTc][Tc(N)(DASD)(PNPn)]+ (DASD = 1,4-Dioxa-8-azaspiro[4,5]decandithiocarbamate, PNPn = Bisphosphinoamine) for Myocardial Imaging: Synthesis, Pharmacological and Pharmacokinetic Studies. J Med Chem 2018; 61:11114-11126. [DOI: 10.1021/acs.jmedchem.8b01191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Nicola Salvarese
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE)-CNR, Corso Stati Uniti, 4, 35127 Padova, Italy
| | - Davide Carta
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Via Marzolo, 5, 35131 Padova, Italy
| | - Cristina Marzano
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Via Marzolo, 5, 35131 Padova, Italy
| | - Gabriele Gerardi
- Department of Veterinary Clinical Science, University of Padua, Viale dell’Università 16, 35020 Legnaro, Padua, Italy
| | | | - Cristina Bolzati
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE)-CNR, Corso Stati Uniti, 4, 35127 Padova, Italy
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13
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Kilic-Toprak E, Yaylali O, Yaylali YT, Ozdemir Y, Yuksel D, Senol H, Sengoz T, Bor-Kucukatay M. Hemorheological dysfunction in cardiac syndrome X. Acta Cardiol 2018; 73:257-265. [PMID: 28889793 DOI: 10.1080/00015385.2017.1373967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiac syndrome X (CSX) is often described as angina or angina-like chest pain with a normal coronary arteriogram, yet the underlying pathophysiological mechanisms have not been fully elucidated. The aim of the current study was to determine alterations in blood rheology (erythrocyte aggregation and deformability, plasma viscosity - PV) in patients with CSX. METHODS The study comprised 26 CSX patients (55.77 ± 12.33 years) and 37 age- and sex-matched (56.32 ± 11.98 years) healthy controls. Erythrocyte aggregation and deformability were measured by an ektacytometer and PV with a rotational viscometer. RESULTS Erythrocyte deformability measured at 1.69 and 3.00 Pa was lower in the CSX patients compared to the controls (p = .0001 and .017, respectively). Erythrocyte aggregation index (AI) (72.758 ± 7.65 vs. 66.483 ± 6.63, p = .002) and PV measured at a shear rate of 375 s-1 (1.932 ± 0.225 vs. 1.725 ± 0.331, p = .019) were significantly higher in patients with CSX. When AI, RDW and erythrocyte deformability measured at 1.69 Pa were evaluated together, it was observed that the increase in AI and RDW augments the risk of having CSX (OR: 1.2 and 2.65, respectively), while the rise in deformability decreases this risk (OR = 0.02). CONCLUSIONS Hemorheological impairments are associated with CSX.
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Affiliation(s)
- Emine Kilic-Toprak
- Faculty of Medicine, Department of Physiology, Pamukkale University, Kinikli, Denizli, Turkey
| | - Olga Yaylali
- Faculty of Medicine, Department of Nuclear Medicine, Pamukkale University, Kinikli, Denizli, Turkey
| | - Yalin Tolga Yaylali
- Faculty of Medicine, Department of Cardiology, Pamukkale University, Kinikli, Denizli, Turkey
| | - Yasin Ozdemir
- Faculty of Medicine, Department of Physiology, Pamukkale University, Kinikli, Denizli, Turkey
| | - Dogangun Yuksel
- Faculty of Medicine, Department of Nuclear Medicine, Pamukkale University, Kinikli, Denizli, Turkey
| | - Hande Senol
- Faculty of Medicine, Department of Biostatistics, Pamukkale University, Kinikli, Denizli, Turkey
| | - Tarık Sengoz
- Faculty of Medicine, Department of Nuclear Medicine, Pamukkale University, Kinikli, Denizli, Turkey
| | - Melek Bor-Kucukatay
- Faculty of Medicine, Department of Physiology, Pamukkale University, Kinikli, Denizli, Turkey
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14
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Gultekin SS, Sadic M, Bilgin M, Koca G, Acikel S, Yeter E, Korkmaz M. The value of transient ischemic dilation for detecting restenosis after coronary artery revascularization. J Nucl Cardiol 2018; 25:586-592. [PMID: 27663249 DOI: 10.1007/s12350-016-0607-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Abstract
AIM Transient ischemic dilation (TID) is a marker of severe coronary artery disease (CAD). We aimed to assess the incremental value of TID in a cohort of patients with known significant CAD who had recurrence of symptoms after revascularization. METHODS We identified in our databases 104 patients who had recent coronary revascularization and recurrence of symptoms. 62 patients had PCI (75 arteries) and 42 patients had CABG (104 arteries). All had follow-up stress SPECT MPI and repeat coronary angiography. Myocardial perfusion findings of ischemia and TID were correlated with presence of significant obstructive CAD (>70% stenosis). RESULTS Follow-up stress Tc-99m Sestamibi SPECT MPI revealed inducible ischemia in 38 patients (36.5%) and TID > 1.20 in 49 patients (47%). Subsequent coronary angiography showed significant obstructive CAD in 44 patients (42%). The sensitivity for detecting obstructive CAD was 61% for SPECT MPI alone, but increased significantly to 93% by the addition of TID as a diagnostic criterion (P < 0.0001). CONCLUSIONS In this selected patient cohort with prior coronary revascularization, TID is an important marker of obstructive CAD and has incremental value over SPECT MPI alone.
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Affiliation(s)
- Salih Sinan Gultekin
- Department of Nuclear Medicine, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Etlik, Ankara, Turkey.
| | - Murat Sadic
- Department of Nuclear Medicine, Ministry of Health, Ankara Training and Research Hospital, Ulucanlar Street, 06560, Ankara, Turkey
| | - Murat Bilgin
- Department of Cardiology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Altindag, Ankara, Turkey
| | - Gökhan Koca
- Department of Nuclear Medicine, Ministry of Health, Ankara Training and Research Hospital, Ulucanlar Street, 06560, Ankara, Turkey
| | - Sadik Acikel
- Department of Cardiology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Altindag, Ankara, Turkey
| | - Ekrem Yeter
- Department of Cardiology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Altindag, Ankara, Turkey
| | - Meliha Korkmaz
- Department of Nuclear Medicine, Ministry of Health, Ankara Training and Research Hospital, Ulucanlar Street, 06560, Ankara, Turkey
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15
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Oddstig J, Hindorf C, Hedeer F, Jögi J, Arheden H, Hansson MJ, Engblom H. The radiation dose to overweighted patients undergoing myocardial perfusion SPECT can be significantly reduced: validation of a linear weight-adjusted activity administration protocol. J Nucl Cardiol 2017; 24:1912-1921. [PMID: 27506700 DOI: 10.1007/s12350-016-0628-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 06/25/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Large body size can cause a higher proportion of emitted photons being attenuated within the patient. Therefore, clinical myocardial perfusion SPECT (MPS) protocols often include unproportionally higher radioisotope activity to obese patients. The aim was to evaluate if a linear weight-adjusted low-dose protocol can be applied to obese patients and thereby decrease radiation exposure. METHODS AND RESULT Two hundred patients (>110 kg, BMI 18-41, [n = 69], ≤ 110 kg, BMI 31-58, [n = 131]) underwent 99mTc-tetrofosmin stress examination on a Cadmium Zinc Telluride or a conventional gamma camera using new generations of reconstruction algorithm (Resolution Recovery). Patients <110 kg were administered 2.5 MBq/kg, patients between 110 and 120 kg received 430 MBq and patients >120 kg received 570 MBq according to clinical routine. Patients >110 kg had 130% total number of counts in the images compared to patients <110 kg. Recalculating the counts to correspond to an administered activity of 2.5 MBq/kg resulted in similar number of counts across the groups. Image analyses in a subgroup with images corresponding to high activity and 2.5 MBq/kg showed no difference in image quality or ischemia quantification. CONCLUSION Linear low-dose weight-adjusted protocol of 2.5 MBq/kg in MPS can be applied over a large weight span without loss of counts or image quality, resulting in a significant reduction in radiation exposure to obese patients.
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Affiliation(s)
- Jenny Oddstig
- Department of Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Cecilia Hindorf
- Department of Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Fredrik Hedeer
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, 221 85, Lund, Sweden
| | - Jonas Jögi
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, 221 85, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, 221 85, Lund, Sweden
| | - Magnus J Hansson
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, 221 85, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, 221 85, Lund, Sweden.
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16
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A randomized-controlled study of a modified technique to reduce extracardiac activity in myocardial perfusion imaging. Nucl Med Commun 2017; 38:21-28. [DOI: 10.1097/mnm.0000000000000600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Mental Stress–Induced Myocardial Ischemia Related to Generalized Anxiety Disorder in a Patient With Acute Coronary Syndrome and Normal Coronary Arteries. Clin Nucl Med 2016; 41:e487-e490. [DOI: 10.1097/rlu.0000000000001348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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18
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Dilsizian V, Bacharach SL, Beanlands RS, Bergmann SR, Delbeke D, Dorbala S, Gropler RJ, Knuuti J, Schelbert HR, Travin MI. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol 2016; 23:1187-1226. [PMID: 27392702 DOI: 10.1007/s12350-016-0522-3] [Citation(s) in RCA: 384] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, South Greene Street, Rm N2W78, Baltimore, MD, 21201-1595, USA.
| | - Stephen L Bacharach
- Department of Radiology, University of California-San Francisco, San Francisco, CA, USA
| | - Rob S Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Steven R Bergmann
- Pat and Jim Calhoun Cardiology Center, UConn Health, Farmington, CT, USA
| | - Dominique Delbeke
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert J Gropler
- Division of Nuclear Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mark I Travin
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
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19
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Development of a myocardial phantom and analysis system toward the standardization of myocardial SPECT image across institutions. Ann Nucl Med 2016; 30:699-707. [PMID: 27544378 DOI: 10.1007/s12149-016-1113-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We developed a novel myocardial phantom and analysis program to standardize using a quantitative index to objectively evaluate the image quality. We aimed to reveal whether our proposed phantom and analysis program are suitable for image standardization. METHODS An evaluation system of myocardial image based on technical grounds (EMIT) phantom was developed to standardize the image quality of myocardial SPECT and was constructed with the lung and myocardium in the thorax phantom; the myocardial phantom included five normal areas and eight defective areas with four defects in size (5, 10, 15, and 20 mm) and four defects in thickness (10, 7.5, 5, and 2.5 mm). Therefore, this phantom was appropriate to simultaneously simulate eight different defects and normal myocardium. The %rate value, calculated using the region of interest method, and the %count value, calculated from the profile method, were automatically analyzed to evaluate myocardial defects. The phantom was validated using difference in count levels and filter parameters compared with those in previously reported models. RESULTS The average %count of eight defects by 0.3, 0.4, 0.5, and 0.6 cycles/cm were 56.8, 47.4, 44.3, and 43.4 %, respectively, whereas the %count for 0.3 cycles/cm was significantly higher than that for 0.5 and 0.6 cycles/cm. The uniformity between full- and half-time images was 16.5 ± 4.2 and 18.7 ± 5.5 % for integral uniformity and 3.4 ± 1.2 and 3.4 ± 1.3 % for differential uniformity, respectively, revealing a significant difference in integral uniformity between the two acquisition times. Visual differences in defects were evident in full-time images between 0.30 and 0.50 cycles/cm, and defect detectability of the myocardial image at 0.30 cycles/cm was poor. Normal myocardial thickness widened in comparison with images at 0.50 cycles/cm. Compared with full-time myocardial image at the same cut-off frequency, the half-time myocardial image demonstrated inhomogeneous distribution and thickness of the normal myocardium. CONCLUSION We developed a new phantom and program to standard image quality among multicenter for myocardial SPECT. The EMIT phantom and quantitative indices were useful for evaluating image quality. The physical characteristics of the image quality, including defects and uniformity, were properly measured by this method.
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20
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Watanabe H, Ishii K, Hosono M, Imabayashi E, Abe K, Inubushi M, Ohno K, Magata Y, Ono K, Kikuchi K, Wagatsuma K, Takase T, Saito K, Takahashi Y. Report of a nationwide survey on actual administered radioactivities of radiopharmaceuticals for diagnostic reference levels in Japan. Ann Nucl Med 2016; 30:435-44. [PMID: 27154308 PMCID: PMC4925688 DOI: 10.1007/s12149-016-1079-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/20/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The optimization of medical exposure is one of the major issues regarding radiation protection in the world, and The International Committee of Radiological Protection and the International Atomic Energy Agency recommend establishing diagnostic reference levels (DRLs) as tools for dose optimization. Therefore, the development of DRLs based on the latest survey has been required for nuclear medicine-related societies and organizations. This prompted us to conduct a nationwide survey on the actual administered radioactivity to adults for the purpose of developing DRLs in nuclear medicine. METHODS A nationwide survey was conducted from November 25, 2014 to January 16, 2015. The questionnaire was sent to all of the 1249 nuclear medicine facilities in Japan, and the responses were collected on a website using an answered form. RESULTS Responses were obtained from 516 facilities, for a response rate of 41 %. 75th percentile of (99m)Tc-MDP and (99m)Tc-HMDP: bone scintigraphy, (99m)Tc-HM-PAO, (99m)Tc-ECD and (123)I-IMP: cerebral blood flow scintigraphy, (99m)Tc-Tetrofosmin, (99m)Tc-MIBI and (201)Tl-Cl; myocardial perfusion scintigraphy and (18)F-FDG: oncology PET (in-house-produced or delivery) in representative diagnostic nuclear medicine scans were 932, 937, 763, 775, 200, 831, 818, 180, 235 and 252, respectively. More than 90 % of the facilities were within the range of 50 % from the median of these survey results in representative diagnostic nuclear medicine facilities in Japan. Responses of the administered radioactivities recommended by the package insert, texts and guidelines such as 740 MBq ((99m)Tc-MDP and (99m)Tc-HMDP: bone scintigraphy), 740 MBq ((99m)Tc-ECD and (99m)Tc-HM-PAO: cerebral blood flow scintigraphy) and 740 MBq ((99m)Tc-Tetrofosmin and (99m)Tc-MIBI: myocardial perfusion scintigraphy), etc. were numerous. The administered activity of many radiopharmaceuticals of bone scintigraphy ((99m)Tc-MDP and (99m)Tc-HMDP), cerebral blood flow scintigraphy ((99m)Tc-HM-PAO) and myocardial perfusion scintigraphy ((99m)Tc-Tetrofosmin and (99m)Tc-MIBI), etc. were within the range of the EU DRLs and almost none of the administered radioactivity in Japan exceeded the upper limit of SNMMI standard administered radioactivity. CONCLUSIONS This survey indicated that the administered radioactivity in diagnostic nuclear medicine in Japan had been in the convergence zone and nuclear medicine facilities in Japan show a strong tendency to adhere to the texts and guidelines. Furthermore, the administered radioactivities in Japan were within the range of variation of the EU and the SNMMI administered radioactivities.
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Affiliation(s)
- Hiroshi Watanabe
- Department of Radiological Technology, Japan Labour Health and Welfare Organization Yokohama Rosai Hospital, 3211, Kozukue, Kohoku, Yokohama, Kanagawa, 222-0036, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, Ohnohigashi 377-2, Osakasayama, Osaka, 589-8511, Japan.
| | - Makoto Hosono
- Institute of Advanced Clinical Medicine, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Etsuko Imabayashi
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Koichiro Abe
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Women's Medical University, Kawada-cho 8-1, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masayuki Inubushi
- Division of Nuclear Medicine, Department of Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Kazuko Ohno
- Department of Radiological Technology, Kyoto College of Medical Science, 1-3 Oyamahigashimachi Sonobe-cho Nantan, Kyoto, 622-0041, Japan
| | - Yasuhiro Magata
- Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Kinya Ono
- Department of Radiology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa, 210-0013, Japan
| | - Kei Kikuchi
- Department of Radiology, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Kei Wagatsuma
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Tadashi Takase
- Department of Radiology, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Kyoko Saito
- Department of Radiological Technology, Faculty of Health Sciences, Nihon Institute of Medical Science, 1276, Shimogawara, Moroyama-machi, Iruma-gun, Saitama, 350-0435, Japan
| | - Yasuyuki Takahashi
- Department of Nuclear Medicine Technology, Gunma Prefectural College of Health Sciences, 323-1 Kamioki-cho, Maebashi, Gunma, 371-0052, Japan
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Aboul-Enein F, Aljuaid MO, Alharthi HT, Almudhhi AM, Alzahrani MA. The Concordance between Myocardial Perfusion Imaging and Coronary Angiography in Detecting Coronary Artery Disease: A Retrospective Study in a Tertiary Cardiac Center at King Abdullah Medical City. Cardiol Res Pract 2016; 2016:9847575. [PMID: 27429833 PMCID: PMC4939340 DOI: 10.1155/2016/9847575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/06/2016] [Accepted: 05/29/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Coronary artery disease (CAD) is considered as the leading cause of the cardiovascular fatalities worldwide. CAD is diagnosed by many modalities of imaging such as myocardial perfusion imaging (MPI) and coronary angiography (CAG). Methods. A retrospective cross-sectional study was conducted that included all patients referred to the KAMC (King Abdullah Medical City) nuclear cardiology lab from its opening until the end of May 2014 (a period of 17 months). A total of 228 patient reports with a history of conducting either CAG or MPI or both were used in this study and statistically analyzed. Results. An analysis of the MPI results revealed that 78.5% of the samples were abnormal. On the other hand, 26.75% of the samples revealed that they were subjected to CAG and MPI. There was a significant and fair agreement between MPI and CAG by using all the agreement coefficients (kappa = 0.237, phi = 0.310, and P value = 0.043). The sensitivity, specificity, and accuracy of MPI with reference to CAG were 97.8%, 20%, and 78.69%, respectively. In addition, positive predictive and negative predictive values were 78.95% and 75%, respectively. Conclusion. In a tertiary referral center, there was a significant agreement between MPI and CAG and a high accuracy of MPI. MPI was a noninvasive diagnostic test that could be used as a gatekeeper for CAG.
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22
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Redgate S, Barber DC, Fenner JW, Al-Mohammad A, Taylor JC, Hanney MB, Tindale WB. A study to quantify the effect of patient motion and develop methods to detect and correct for motion during myocardial perfusion imaging on a CZT solid-state dedicated cardiac camera. J Nucl Cardiol 2016; 23:514-26. [PMID: 26684196 DOI: 10.1007/s12350-015-0314-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/29/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Due to differences in the design and acquisition parameters on the solid-state CZT cardiac camera the effect of patient motion may vary compared to Anger cameras. This study evaluates the effect of motion, two new methods of three-dimensional (3D) motion detection and a method of motion correction. METHOD Phantom acquisitions were offset in the X, Y, and Z directions and combined to simulate different types of motion. Motion artifacts were identified using the total perfusion defect and blinded visual interpretation. Motion was detected by registering planar and reconstructed 30 second images, and corrected by summing the aligned reconstructed images. Validation was performed on phantom data. These techniques were then applied to 40 patient studies. RESULTS Motion ≥10 mm and ≥60 seconds in duration introduced significant artifacts. There was no significant difference (P = .258) between the two methods of motion detection. Motion correction removed artifacts from 9/10 phantom simulations. Superior-inferior motion ≥8 mm was measured on 10% of patient studies, and 5% were affected by motion. Motion in the lateral and anterior-posterior directions was <8 mm. CONCLUSION Superior-inferior patient motion artifacts have been identified on myocardial perfusion images acquired on a CZT camera. Routine QC to identify studies with significant motion is recommended.
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Affiliation(s)
- Shelley Redgate
- Nuclear Medicine Department, Sheffield Teaching Hospitals NHS Foundation Trust, I-Floor, Royal Hallamshire Hospital, Glossop Rd, Sheffield, S10 2JF, United Kingdom.
- Medical Physics Group (Cardiovascular Science), University of Sheffield, Sheffield, United Kingdom.
| | - David C Barber
- Medical Physics Group (Cardiovascular Science), University of Sheffield, Sheffield, United Kingdom
| | - John W Fenner
- Medical Physics Group (Cardiovascular Science), University of Sheffield, Sheffield, United Kingdom
| | - Abdallah Al-Mohammad
- Cardiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Jonathon C Taylor
- Nuclear Medicine Department, Sheffield Teaching Hospitals NHS Foundation Trust, I-Floor, Royal Hallamshire Hospital, Glossop Rd, Sheffield, S10 2JF, United Kingdom
| | - Michael B Hanney
- Nuclear Medicine Department, Sheffield Teaching Hospitals NHS Foundation Trust, I-Floor, Royal Hallamshire Hospital, Glossop Rd, Sheffield, S10 2JF, United Kingdom
| | - Wendy B Tindale
- Nuclear Medicine Department, Sheffield Teaching Hospitals NHS Foundation Trust, I-Floor, Royal Hallamshire Hospital, Glossop Rd, Sheffield, S10 2JF, United Kingdom
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23
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Shibutani T, Onoguchi M, Yamada T, Kamida H, Kunishita K, Hayashi Y, Nakajima T, Kinuya S. Optimization of the filter parameters in (99m)Tc myocardial perfusion SPECT studies: the formulation of flowchart. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:571-81. [PMID: 27052439 DOI: 10.1007/s13246-016-0433-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Abstract
Myocardial perfusion single photon emission computed tomography (SPECT) is typically subject to a variation in image quality due to the use of different acquisition protocols, image reconstruction parameters and image display settings by each institution. One of the principal image reconstruction parameters is the Butterworth filter cut-off frequency, a parameter strongly affecting the quality of myocardial images. The objective of this study was to formulate a flowchart for the determination of the optimal parameters of the Butterworth filter for filtered back projection (FBP), ordered subset expectation maximization (OSEM) and collimator-detector response compensation OSEM (CDR-OSEM) methods using the evaluation system of the myocardial image based on technical grounds phantom. SPECT studies were acquired for seven simulated defects where the average counts of the normal myocardial components of 45° left anterior oblique projections were approximately 10-120 counts/pixel. These SPECT images were then reconstructed by FBP, OSEM and CDR-OSEM methods. Visual and quantitative assessment of short axis images were performed for the defect and normal parts. Finally, we formulated a flowchart indicating the optimal image processing procedure for SPECT images. Correlation between normal myocardial counts and the optimal cut-off frequency could be represented as a regression expression, which had high or medium coefficient of determination. We formulated the flowchart in order to optimize the image reconstruction parameters based on a comprehensive assessment, which enabled us to perform objectively processing. Furthermore, the usefulness of image reconstruction using the flowchart was demonstrated by a clinical case.
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Affiliation(s)
- Takayuki Shibutani
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan.,Department of Biotracer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan.
| | - Tomoki Yamada
- Department of Radiological Technology, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, Japan
| | - Hiroki Kamida
- Department of Radiological Technology, Higashiosaka City General Hospital, 3-4-5 Nishiiwata, Higashiosaka, Osaka, Japan
| | - Kohei Kunishita
- Department of Radiological Technology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinariku, Osaka, Japan
| | - Yuuki Hayashi
- Department of Radiological Technology, Sakai City Medical Center, 1-1-1 Ebaraji, Nishiku, Sakai, Osaka, Japan
| | - Tadashi Nakajima
- Department of Radiological Technology, Kishiwada City Hospital, 1001 Gakuhara-cho, Kishiwada, Osaka, Japan
| | - Seigo Kinuya
- Department of Biotracer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Karahan Şen NP, Bekiş R, Ceylan A, Derebek E. The use of pre-test and post-test probability values as criteria before selecting patients to undergo coronary angiography in patients who have ischemic findings on myocardial perfusion scintigraphy. Anatol J Cardiol 2016; 16:512-519. [PMID: 27004704 PMCID: PMC5331399 DOI: 10.5152/anatoljcardiol.2015.6347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: Myocardial perfusion scintigraphy (MPS) is a diagnostic test which is frequently used in the diagnosis of coronary heart disease (CHD). MPS is generally interpreted as ischemia present or absent; however, it has a power in predicting the disease, similar to other diagnostic tests. In this study, we aimed to assist in directing the high-risk patients to undergo coronary angiography (CA) primarily by evaluating patients without prior CHD history with pre-test and post-test probabilities. Methods: The study was designed as a retrospective study. Between January 2008 and July 2011, 139 patients with positive MPS results and followed by CA recently (<6 months) were evaluated from patient files. Patients’ pre-test probabilities based on the Diamond and Forrester method and the likelihood ratios that were obtained from the literature were used to calculate the patients’ post-exercise and post-MPS probabilities. Patients were evaluated in risk groups as low, intermediate, and high, and an ROC curve analysis was performed for the post-MPS probabilities. Results: Coronary artery stenosis (CAS) was determined in 59 patients (42.4%). A significant difference was determined between the risk groups according to CAS, both for the pre-test and post-test probabilities (p<0.001, p=0.024). The ROC analysis provided a cut-off value of 80.4% for post-MPS probability in predicting CAS with 67.9% sensitivity and 77.8% specificity. Conclusion: When the post-MPS probability is ≥80% in patients who have reversible perfusion defects on MPS, we suggest interpreting the MPS as “high probability positive” to improve the selection of true-positive patients to undergo CA, and these patients should be primarily recommended CA.
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Affiliation(s)
| | - Recep Bekiş
- Department of Nuclear Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir-Turkey
| | - Ali Ceylan
- Department of Public Health, Faculty of Medicine, Dokuz Eylül University, İzmir-Turkey
| | - Erkan Derebek
- Department of Nuclear Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir-Turkey
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Wu MC, Tsai CT, Lin HC, Sun FJ, Lin KH. Thallium-201 is comparable to technetium-99m-sestamibi for estimating cardiac function in patients with abnormal myocardial perfusion imaging. Kaohsiung J Med Sci 2015; 31:562-7. [PMID: 26678935 DOI: 10.1016/j.kjms.2015.09.002] [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: 03/30/2015] [Revised: 09/07/2015] [Accepted: 09/08/2015] [Indexed: 11/19/2022] Open
Abstract
We analyzed the left-ventricular functional data obtained by cardiac-gated single-photon emission computed tomography myocardial perfusion imaging (MPI) with thallium-201 (Tl-201) and technetium-99m-sestamibi (MIBI) protocols in different groups of patients, and compared the data between Tl-201 and MIBI. Two hundred and seventy-two patients undergoing dipyridamole stress/redistribution Tl-201 MPI and 563 patients undergoing 1-day rest/dipyridamole stress MIBI MPI were included. Higher mean stress ejection fraction (EF), rest EF, and change in EF (ΔEF) were noticed in the normal MPI groups by both Tl-201 and MIBI protocols. Higher mean EF was observed in the females with normal MPI results despite their higher mean age. Comparisons between the Tl-201 and MIBI groups suggested a significant difference in all functional parameters, except for the rest end diastolic volume/end systolic volume and ΔEF between groups with negative MPI results. For the positive MPI groups, there was no significant difference in all parameters, except for the change in end diastolic volume and change in end systolic volume after stress between both protocols. The Tl-201 provides comparable left-ventricular functional data to MIBI cardiac-gated single-photon emission computed tomography in patients with positive MPI results, and may therefore be undertaken routinely for incremental functional information that is especially valuable to this patient group.
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Affiliation(s)
- Ming-Che Wu
- Department of Nuclear Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Cheng-Ting Tsai
- Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hui-Chun Lin
- Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ku-Hung Lin
- Department of Nuclear Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
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Evaluation of the diagnostic and prognostic use of gated myocardial perfusion single-photon emission computed tomography in patients with acute chest pain. Nucl Med Commun 2015; 36:945-51. [DOI: 10.1097/mnm.0000000000000336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kortelainen MJ, Koivumäki TM, Vauhkonen MJ, Hakulinen MA. Dependence of left ventricular functional parameters on image acquisition time in cardiac-gated myocardial perfusion SPECT. J Nucl Cardiol 2015; 22:643-51. [PMID: 26048265 DOI: 10.1007/s12350-015-0178-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Reduction of image acquisition time in single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) examinations has been considered. However, association between left ventricular (LV) functional parameters and acquisition time is unclear. METHODS Twenty-four patients referred to one-day stress/rest SPECT MPI examinations were imaged at rest with dual-headed gamma camera. List-mode emission data were processed into sets of cardiac-gated images corresponding to different acquisition times: 20%, 30%, 40%, 50%, 60%, 80%, and 100% of total acquisition time (30 seconds per projection). Image quality was quantitatively evaluated by computing contrast-to-noise ratio. LV volumes, wall motion, wall thickening, and mechanical dyssynchrony were quantified with automatic clinical software (QGS; Cedars-Sinai Medical Center). RESULTS A significant negative dependence was found between phase analysis parameter values and image acquisition time. Differences in LV volume parameters were small but statistically significant at relative acquisition times of less than 50%. LV wall motion and wall thickening were found to be robust to the increase of noise. CONCLUSIONS Image acquisition time of gated SPECT MPI examination can be reduced to 15 seconds per projection without significantly affecting LV volumes, wall motion, or wall thickening. However, reduction of acquisition time has a significant effect on phase analysis results.
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Affiliation(s)
- Matti J Kortelainen
- Diagnostic Imaging Centre, Kuopio University Hospital, POB 100, 70029 KYS, Kuopio, Finland,
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Drozdovitch V, Brill AB, Callahan RJ, Clanton JA, DePietro A, Goldsmith SJ, Greenspan BS, Gross MD, Hays MT, Moore SC, Ponto JA, Shreeve WW, Melo DR, Linet MS, Simon SL. Use of radiopharmaceuticals in diagnostic nuclear medicine in the United States: 1960-2010. HEALTH PHYSICS 2015; 108:520-37. [PMID: 25811150 PMCID: PMC4376015 DOI: 10.1097/hp.0000000000000261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
To reconstruct reliable nuclear medicine-related occupational radiation doses or doses received as patients from radiopharmaceuticals over the last five decades, the authors assessed which radiopharmaceuticals were used in different time periods, their relative frequency of use, and typical values of the administered activity. This paper presents data on the changing patterns of clinical use of radiopharmaceuticals and documents the range of activity administered to adult patients undergoing diagnostic nuclear medicine procedures in the U.S. between 1960 and 2010. Data are presented for 15 diagnostic imaging procedures that include thyroid scan and thyroid uptake; brain scan; brain blood flow; lung perfusion and ventilation; bone, liver, hepatobiliary, bone marrow, pancreas, and kidney scans; cardiac imaging procedures; tumor localization studies; localization of gastrointestinal bleeding; and non-imaging studies of blood volume and iron metabolism. Data on the relative use of radiopharmaceuticals were collected using key informant interviews and comprehensive literature reviews of typical administered activities of these diagnostic nuclear medicine studies. Responses of key informants on relative use of radiopharmaceuticals are in agreement with published literature. Results of this study will be used for retrospective reconstruction of occupational and personal medical radiation doses from diagnostic radiopharmaceuticals to members of the U.S. radiologic technologists' cohort and in reconstructing radiation doses from occupational or patient radiation exposures to other U.S. workers or patient populations.
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Affiliation(s)
- Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD 20892
| | - Aaron B. Brill
- Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN
| | | | | | | | | | | | - Milton D. Gross
- Nuclear Medicine and Radiation Service, Department of Veterans Affairs Health System, Ann Arbor, MI
| | | | | | | | | | - Dunstana R. Melo
- Center for Countermeasures against Radiation, Lovelace Respiratory Research Institute, Albuquerque, NM
| | - Martha S. Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD 20892
| | - Steven L. Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD 20892
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Incidental Mammary Fibromyoblastoma on 82Rb Myocardial Perfusion Imaging. Clin Nucl Med 2015; 40:343-4. [DOI: 10.1097/rlu.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Iqbal B, Currie G, Greene L, Kiat H. Novel Radiopharmaceuticals in Cardiovascular Medicine: Present and Future. J Med Imaging Radiat Sci 2014; 45:423-434. [DOI: 10.1016/j.jmir.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/03/2014] [Accepted: 09/05/2014] [Indexed: 01/25/2023]
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Mut F, Giubbini R, Vitola J, Lusa L, Sobic-Saranovic D, Peix A, Bertagna F, Hang Bui D, Cunha C, Obaldo J, Rodella C, Camoni L, Paez D, Dondi M. Detection of post-exercise stunning by early gated SPECT myocardial perfusion imaging: results from the IAEA multi-center study. J Nucl Cardiol 2014; 21:1168-76. [PMID: 25213203 DOI: 10.1007/s12350-014-9983-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Transient post-ischemic LV dysfunction due to myocardial stunning in patients with coronary artery disease can be missed by conventional gated SPECT (GSPECT) acquisitions. The aim of this IAEA-sponsored multi-center study was to determine whether early post-exercise imaging is more likely to detect stunning than conventional without adversely affecting image quality or perfusion information. METHODS AND RESULTS Patients undergoing exercise/rest GSPECT were enrolled in this international multicenter study. Post-exercise studies were acquired at 15 ± 5 minutes after radiotracer injection (Stress-1) and repeated at 60 ± 15 minutes (Stress-2). Rest studies (R) were acquired at 60 minutes post injection. A core laboratory quantitatively assessed perfusion pattern and LV blinded to the acquisition time. Ischemia was defined as summed stress score (SDS) ≥4, and stunning was defined as the difference between rest and post-stress LVEF (Δ-LVEF). In the 229 patients enrolled into the study, both image quality and perfusion information were similar between Stress-1 and Stress-2. Post-stress LVEF was associated with both ischemia and time of acquisition, with a significant correlation between SDS and Δ-LVEF, which was stronger at Stress-1 than Stress-2 in the ischemic compared to the non-ischemic population (r = 0.23 vs 0.08, P = 0.10). CONCLUSIONS Early post-exercise imaging is feasible, and can potentially improve the detection of post-ischemic stunning without compromising image quality and perfusion data.
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Affiliation(s)
- Fernando Mut
- Department of Nuclear Medicine, Spanish Association Hospital, Montevideo, Uruguay
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Lin LF, Cheng CY, Hou CH, Ku CH, Tseng NC, Shen DHY. Experience of low-dose aminophylline use to relieve minor adverse effects of dipyridamole in patients undergoing stress myocardial perfusion imaging. J Nucl Cardiol 2014; 21:563-9. [PMID: 24627347 DOI: 10.1007/s12350-014-9883-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 02/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intravenous administration of aminophylline is widely adopted to reverse dipyridamole-related adverse effects (AEs) during stress myocardial perfusion imaging (MPI). The study aimed to investigate the efficacy of lower-dose aminophylline to relieve minor AEs. METHODS 2,250 consecutive patients undergoing dipyridamole-stressed MPI were enrolled. Information concerning AE occurrence and dosages of aminophylline was collected to evaluate the efficacy of lower-dose aminophylline. A logistic regression was used to determine independent predictors of dipyridamole-related AE occurrence. RESULTS No severe AE was noted. Overall mild AE incidence was 37.0% (833/2,250 patients). Initial low-dose (25 mg) aminophylline relieved symptoms in 98.8% of patients with mild AEs (823/833 patients). An extra 25 mg aminophylline sufficed to reverse all such AEs. Mean body mass index (BMI) differed significantly between patients with and without any AE [25.6 vs 25.1 (P = .009)]. There was no significant difference between two subgroups in mean age, male gender prevalence, body height and weight, dipyridamole dose/BMI, or prevalence of significant perfusion defect(s) on MPI. Multivariable logistic regression demonstrated BMI remained the independent predictor of dipyridamole-related AE occurrence (odds ratio 1.028, 95% confidence interval 1.007-1.049, P = .01). CONCLUSION Low-dose (≦50 mg, and usually 25 mg) aminophylline seems sufficient to relieve mild dipyridamole-related AEs during stress MPI.
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Affiliation(s)
- Li-Fan Lin
- PET center and Department of Nuclear Medicine, Tri-Service General Hospital & National Defense Medical Center, 325, Cheng-Kung Road, Section 2, Taipei, 114, Taiwan, ROC
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Jain R, Sharma A, Uliel L, Mellnick V, McConathy J. An overview of nuclear medicine studies for urgent and emergent indications. Semin Roentgenol 2014; 49:210-24. [PMID: 24836495 DOI: 10.1053/j.ro.2014.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rashmi Jain
- Mallinckrodt Institute of Radiology, St. Louis, MO
| | - Akash Sharma
- Mallinckrodt Institute of Radiology, St. Louis, MO
| | - Livnat Uliel
- Mallinckrodt Institute of Radiology, St. Louis, MO
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Valente AM, Cook S, Festa P, Ko HH, Krishnamurthy R, Taylor AM, Warnes CA, Kreutzer J, Geva T. Multimodality Imaging Guidelines for Patients with Repaired Tetralogy of Fallot: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr 2014; 27:111-41. [DOI: 10.1016/j.echo.2013.11.009] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Bowen JD, Huang Q, Ellin JR, Lee TC, Shrestha U, Gullberg GT, Seo Y. Design and performance evaluation of a 20-aperture multipinhole collimator for myocardial perfusion imaging applications. Phys Med Biol 2013; 58:7209-26. [PMID: 24061162 PMCID: PMC3855225 DOI: 10.1088/0031-9155/58/20/7209] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Single photon emission computed tomography (SPECT) myocardial perfusion imaging remains a critical tool in the diagnosis of coronary artery disease. However, after more than three decades of use, photon detection efficiency remains poor and unchanged. This is due to the continued reliance on parallel-hole collimators first introduced in 1964. These collimators possess poor geometric efficiency. Here we present the performance evaluation results of a newly designed multipinhole collimator with 20 pinhole apertures (PH20) for commercial SPECT systems. Computer simulations and numerical observer studies were used to assess the noise, bias and diagnostic imaging performance of a PH20 collimator in comparison with those of a low energy high resolution (LEHR) parallel-hole collimator. Ray-driven projector/backprojector pairs were used to model SPECT imaging acquisitions, including simulation of noiseless projection data and performing MLEM/OSEM image reconstructions. Poisson noise was added to noiseless projections for realistic projection data. Noise and bias performance were investigated for five mathematical cardiac and torso (MCAT) phantom anatomies imaged at two gantry orbit positions (19.5 and 25.0 cm). PH20 and LEHR images were reconstructed with 300 MLEM iterations and 30 OSEM iterations (ten subsets), respectively. Diagnostic imaging performance was assessed by a receiver operating characteristic (ROC) analysis performed on a single MCAT phantom; however, in this case PH20 images were reconstructed with 75 pixel-based OSEM iterations (four subsets). Four PH20 projection views from two positions of a dual-head camera acquisition and 60 LEHR projections were simulated for all studies. At uniformly-imposed resolution of 12.5 mm, significant improvements in SNR and diagnostic sensitivity (represented by the area under the ROC curve, or AUC) were realized when PH20 collimators are substituted for LEHR parallel-hole collimators. SNR improves by factors of 1.94-2.34 for the five patient anatomies and two orbital positions studied. For the ROC analysis the PH20 AUC is larger than the LEHR AUC with a p-value of 0.0067. Bias performance, however, decreases with the use of PH20 collimators. Systematic analyses showed PH20 collimators present improved diagnostic imaging performance over LEHR collimators, requiring only collimator exchange on existing SPECT cameras for their use.
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Affiliation(s)
- Jason D. Bowen
- Physics Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Qiu Huang
- Shanghai Jiaotong University, Shanghai, China
| | - Justin R. Ellin
- Physics Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Tzu-Cheng Lee
- Physics Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Uttam Shrestha
- Physics Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Grant T. Gullberg
- Physics Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Department of Radiotracer Development and Imaging Technology, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - Youngho Seo
- Physics Research Laboratory, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Department of Radiation Oncology, University of California, San Francisco, California, USA
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Hung GU. Diagnosing CAD: additional markers from myocardial perfusion SPECT. J Biomed Res 2013; 27:467-77. [PMID: 24285945 PMCID: PMC3841472 DOI: 10.7555/jbr.27.20130135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 09/15/2013] [Indexed: 11/04/2022] Open
Abstract
Over the past decades, stress/rest myocardial perfusion SPECT (MPS) has been utilized as a standard modality for the diagnosis, risk stratification and prognostic assessment of coronary artery disease (CAD). In addition to the perfusion information, MPS can also provide functional information of the left ventricle, including volume, ejection fraction, wall motion and dyssynchrony. This article introduces the incremental value of these non-perfusion parameters as markers and prognosticators of CAD.
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Affiliation(s)
- Guang-Uei Hung
- Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan 505, China
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Comparative study of the safety of regadenoson between patients with mild/moderate chronic obstructive pulmonary disease and asthma. Eur J Nucl Med Mol Imaging 2013; 41:119-25. [PMID: 23857459 DOI: 10.1007/s00259-013-2493-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the safety of regadenoson, a selective agonist of A2A adenosine receptors, combined with low-level exercise, between subjects with mild/moderate chronic obstructive pulmonary disease (COPD) and asthma referred for myocardial perfusion imaging (MPI). METHODS We studied 116 patients, of whom 67 had COPD and 49 asthma (62 % men, mean age 68.3 ± 11.3 years, range 31 - 87 years). Patient demographics, past medical history, medications, clinical symptoms during stress and changes in blood pressure (BP) and heart rate (HR) were evaluated. RESULTS Both groups were comparable with regard to hypertension, dyslipidaemia, diabetes and medications with the exception of a higher rate of use of anticholinergics in patients with COPD and of antileukotrienes in asthmatics (58.2 % vs. 28.6 % and 1.5 % vs. 14.3 %, respectively; all p < 0.01). There was a higher incidence of dyspnoea in COPD patients and of headache and feeling hot in asthmatic patients (40.3 % vs. 22.4 %, 6 % vs. 18.4 % and 10.4 % vs. 26.5 %, respectively; all p < 0.05). Although there was no difference in the incidence of other adverse events, we observed a higher frequency in asthmatics of flushing, dry mouth, sweating and fatigue (1.5 % vs. 6.1 %, 14.9 % vs. 24.5 %, 0 % vs. 4.1 % and 37.3 % vs. 49 %, respectively). Adverse events were self-limiting, except in three patients who suffered persistent dyspnoea (2 of 67 COPD patients; 1 of 49 asthma patients) requiring theophylline administration. We observed no significant changes in BP among either group, but there was a tendency towards a higher increase in systolic BP in COPD patients following regadenoson administration (148.3 ± 27.6 vs. 154.6 ± 31.0 mmHg, p = 0.056). CONCLUSION This study showed a good safety profile in our series of COPD and asthma patients undergoing MPI. Regadenoson was well tolerated by all patients, with dyspnoea, headache and feeling hot showing differences between groups.
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Dorbala S, Di Carli MF, Delbeke D, Abbara S, DePuey EG, Dilsizian V, Forrester J, Janowitz W, Kaufmann PA, Mahmarian J, Moore SC, Stabin MG, Shreve P. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med 2013; 54:1485-507. [PMID: 23781013 DOI: 10.2967/jnumed.112.105155] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Procedure guidelines for radionuclide myocardial perfusion imaging with single-photon emission computed tomography. Nucl Med Commun 2013; 34:813-26. [PMID: 23719150 DOI: 10.1097/mnm.0b013e32836171eb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Akalın EN, Yaylalı O, Kıraç FS, Yüksel D, Kılıç M. The Role of Myocardial Perfusion Gated SPECT Study in Women with Coronary Artery Disease: A Correlative Study. Mol Imaging Radionucl Ther 2013; 21:69-74. [PMID: 23486759 PMCID: PMC3590968 DOI: 10.4274/mirt.359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 07/10/2012] [Indexed: 12/28/2022] Open
Abstract
Objective: We aimed to evaluate the role of gated myocardial perfusion SPECT (MPS) and to investigate whether only the invasive coronary angiography (CAG) is sufficient in the diagnosis of the coronary artery disease (CAD) in women. Material and Methods: Sixty-four women (62±10 years) with known CAD were included in this study. They had echocardiography (ECHO), stress/rest gated MPS and invasive CAG. Coronary stenosis as of > 50 % in invasive CAG was accepted as significant. Gated MPS data were compared with invasive CAG and ECHO. Results: Invasive CAG results were abnormal in 34 patients, and normal in 30 cases. Myocardial ischemia was detected by gated MPS in 22/ 30 cases with normal invasive CAG, 6 had mild coronary stenosis in major coronary arteries ranging from 30% to 50% in invasive CAG. 16/ 22 women were diagnosed as metabolic syndrome according to MetSend Diagnostic Criteria and only 8 of 30 patients with normal invasive CAG had false positive MPS data on the reevaluation by a nuclear cardiologist. Conclusion: We think that invasive coronary angiography method is not sufficient alone in the diagnosis of CAD in women. Gated MPS study is recommended to achieve the final decision for myocardial ischemia in the cases with CAD and raw data must always be evaluated to avoid attenuation artifacts. Conflict of interest:None declared.
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Rossi AM, Davies E, Lavoie KL, Arsenault A, Gordon JL, Meloche B, Bacon SL. The impact of metabolic syndrome and endothelial dysfunction on exercise-induced cardiovascular changes. Obesity (Silver Spring) 2013; 21:E143-8. [PMID: 23505196 DOI: 10.1002/oby.20258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 04/27/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is limited information regarding the synergistic or additive effects of metabolic syndrome (MS) and endothelial dysfunction (ED) on cardiovascular disease (CVD). Altered cardiovascular responses to exercise have been shown to predict future cardiovascular events as well as assess autonomic function. The present study evaluated the impact of MS and brachial artery reactivity (a proxy of ED) on peak exercise-induced cardiovascular changes. DESIGN AND METHODS Individuals (n = 303) undergoing a standard nuclear medicine exercise stress test were assessed for MS. Participants underwent a Forearm Hyperaemic Reactivity test and were considered to have dysfunctional reactivity if their rate of uptake ratio (RUR) was <3.55. Resting and peak blood pressure (BP) and heart rate (HR) were measured. Reactivity was calculated as the difference between peak and resting measures. RESULTS Analyses, adjusting for age, sex, resting HR, total metabolic equivalents (METs), and a history of major CVD, revealed a main effect of MS (F = 5.51, η(2) = 0.02, P = 0.02) and RUR (F = 6.69, η(2) = 0.02, P = 0.01) on HR reactivity, such that patients with MS and/or poor RUR had reduced HR reactivity. There were no interactive effects of RUR and MS. There were no effects of RUR or MS on systolic BP (SBP) or diastolic BP (DBP) reactivity or rate pressure product (RPP) reactivity. CONCLUSIONS The presence of decreased HR reactivity among participants with MS or poor brachial artery reactivity, combined with the lack of difference in other exercise-induced cardiovascular changes, indicates that these patients may have some degree of parasympathetic dysregulation. Further longitudinal studies are needed to understand the long-term implications of MS and endothelial abnormalities in this context.
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Affiliation(s)
- Amanda M Rossi
- Montreal Behavioral Medicine Centre, Montréal, Québec, Canada
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Notghi A, Low CS. Myocardial perfusion scintigraphy: past, present and future. Br J Radiol 2012; 84 Spec No 3:S229-36. [PMID: 22723530 DOI: 10.1259/bjr/14625142] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
During the last two decades, radionuclide myocardial perfusion scintigraphy (MPS) has become established as the main functional cardiac imaging technique for the assessment of ischaemic heart disease (IHD). Despite a growing number of alternative functional imaging techniques, MPS still remains the most widely used technique, with a wealth of literature supporting its usefulness in assessing IHD and predicting prognosis. The technique itself has evolved, making it more reliable and robust, with additional ventricular functional information that further defines the prognosis in these patients. With the advent of hybrid single photon emission with CT and positron emission tomography with CT cameras together with the development of new camera technology that enables faster images with less radiation and better resolution, MPS will remain an essential part of IHD investigation. There are new promising radiopharmacological developments and applications such as radiolabelled fatty acids and meta-iodobenzylguanidine. These will widen the scope of nuclear medicine imaging to include patients with cardiac failure and acute chest pain presenting to accident and emergency departments. Nuclear medicine cardiac investigations will continue to have an essential role in the diagnosis, stratification and prognosis of patients with cardiac disease, complementing the new developing cardiac modalities such as CT coronary angiography and MRI.
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Affiliation(s)
- A Notghi
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
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Prognostic Implications of the Difference Between Left Ventricular Ejection Fractions After Stress and at Rest in Addition to the Quantification of Myocardial Perfusion Abnormalities Obtained With Gated SPECT. Clin Nucl Med 2012; 37:748-54. [DOI: 10.1097/rlu.0b013e31825ae755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khan ZR, Syed A, Noor L, Shah SS, Hafizullah M. Quantification of diagnostic accuracy using nitrate enhanced Tc-99m sestamibi gated myocardial SPECT in assessing myocardial viability: prospective analysis. Asian Cardiovasc Thorac Ann 2012; 20:130-6. [PMID: 22499958 DOI: 10.1177/0218492311434333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this prospective study was to assess myocardial viability with nitrate-enhanced Tc-99m sestamibi gated single-photon emission computed tomography in patients with known coronary artery disease. We enrolled 48 consecutive patients (39 men, 9 women) aged 24–82 years, with coronary artery disease and history of myocardial infarction. A Tc-99m sestamibi study was conducted at rest as baseline, followed by a nitrate-enhanced study the next day. Of 960 segments analyzed, 244 of 480 in the left anterior descending coronary artery territory showed viability on the baseline study, and 276 were viable according to the nitrate-enhanced study. Similarly, of 192 right coronary segments analyzed, 148 showed viability on the baseline study compared to 153 on the nitrate study. Of 288 left circumflex territory segments analyzed, 206 showed viability on the baseline study compared to 241 on the nitrate study. The overall improvement of viability with the nitrate study was 12.04%. On the gated studies, the overall improvement with nitrate was 2.02%. The gated study also allowed grading of wall motion and thickness. It was concluded that nitrate-augmented Tc-99m sestamibi myocardial imaging significantly improved the detection of hibernating myocardium, with gated images further improving the accuracy of detection in borderline cases.
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Affiliation(s)
- Zahid Rahman Khan
- Department of Radiodiagnostics and Medical Imaging, North West Armed Forces Hospital, PO Box: 100, Tabuk, Kingdom of Saudi Arabia
- Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Aitizazuddin Syed
- Department of Cardiac Services, North West Armed Forces Hospital, PO Box: 100, Tabuk, Kingdom of Saudi Arabia
| | - Lubna Noor
- Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan
| | - Syed Sadiq Shah
- Department of Cardiology, Bacha Khan Medical College, Mardan, Pakistan
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Bacon SL, Lavoie KL, Arsenault A, Dupuis J, Pilote L, Laurin C, Gordon J, Gautrin D, Vadeboncoeur A. The research on endothelial function in women and men at risk for cardiovascular disease (REWARD) study: methodology. BMC Cardiovasc Disord 2011; 11:50. [PMID: 21831309 PMCID: PMC3170269 DOI: 10.1186/1471-2261-11-50] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
Background Endothelial function has been shown to be a highly sensitive marker for the overall cardiovascular risk of an individual. Furthermore, there is evidence of important sex differences in endothelial function that may underlie the differential presentation of cardiovascular disease (CVD) in women relative to men. As such, measuring endothelial function may have sex-specific prognostic value for the prediction of CVD events, thus improving risk stratification for the overall prediction of CVD in both men and women. The primary objective of this study is to assess the clinical utility of the forearm hyperaemic reactivity (FHR) test (a proxy measure of endothelial function) for the prediction of CVD events in men vs. women using a novel, noninvasive nuclear medicine -based approach. It is hypothesised that: 1) endothelial dysfunction will be a significant predictor of 5-year CVD events independent of baseline stress test results, clinical, demographic, and psychological variables in both men and women; and 2) endothelial dysfunction will be a better predictor of 5-year CVD events in women compared to men. Methods/Design A total of 1972 patients (812 men and 1160 women) undergoing a dipyridamole stress testing were recruited. Medical history, CVD risk factors, health behaviours, psychological status, and gender identity were assessed via structured interview or self-report questionnaires at baseline. In addition, FHR was assessed, as well as levels of sex hormones via blood draw. Patients will be followed for 5 years to assess major CVD events (cardiac mortality, non-fatal MI, revascularization procedures, and cerebrovascular events). Discussion This is the first study to determine the extent and nature of any sex differences in the ability of endothelial function to predict CVD events. We believe the results of this study will provide data that will better inform the choice of diagnostic tests in men and women and bring the quality of risk stratification in women on par with that of men.
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Affiliation(s)
- Simon L Bacon
- Montreal Behavioural Medicine Centre, Montreal, Canada.
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Abstract
Pharmacologic stress myocardial perfusion imaging is a noninvasive method for evaluating coronary artery disease in patients unable to exercise sufficiently to achieve a heart rate high enough to facilitate satisfactory imaging. The nuclear cardiology nurse is an invaluable member of the laboratory team that performs these tests. In this specialist role, the nurse must have a thorough knowledge of the different pharmacologic stress agents (dipyridamole, adenosine, regadenoson, and dobutamine) that can be used. This should comprise an understanding of their mechanisms of action, contraindications, drug-drug interactions, adverse effects, and administration protocols. By drawing on this knowledge, the nurse is able to verify that the right agent has been selected for each patient based on his/her medical history. The nurse also can help patients follow pretest instructions (such as withholding caffeine and certain medications) by explaining that the measures are necessary for a safe and successful procedure and that violation may result in test cancellation or postponement. On the day of the stress test, the nurse has an important role in safeguarding the patient as well as providing support and reassurance throughout the different stages of the examination. Responsibilities include explaining the entire procedure to the patients, notably, what they will be asked to do, the effect of the stress agent, the timing of each step, the adverse effects that they may experience, how any adverse events will be managed, and the importance of remaining still during imaging. This central role of the nuclear cardiology nurse in overseeing the practical aspects of the pharmacologic stress test has important implications in terms of optimizing the productivity and efficiency of their noninvasive cardiology laboratory and nuclear medicine department.
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Tejani FH, Thompson RC, Iskandrian AE, McNutt BE, Franks B. Effect of caffeine on SPECT myocardial perfusion imaging during regadenoson pharmacologic stress: rationale and design of a prospective, randomized, multicenter study. J Nucl Cardiol 2011; 18:73-81. [PMID: 21082298 DOI: 10.1007/s12350-010-9311-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 10/17/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Caffeine attenuates the coronary hyperemic response to adenosine by competitive A₂(A) receptor blockade. This study aims to determine whether oral caffeine administration compromises diagnostic accuracy in patients undergoing vasodilator stress myocardial perfusion imaging (MPI) with regadenoson, a selective adenosine A(2A) agonist. METHODS This multicenter, randomized, double-blind, placebo-controlled, parallel-group study includes patients with suspected coronary artery disease who regularly consume caffeine. Each participant undergoes three SPECT MPI studies: a rest study on day 1 (MPI-1); a regadenoson stress study on day 3 (MPI-2), and a regadenoson stress study on day 5 with double-blind administration of oral caffeine 200 or 400 mg or placebo capsules (MPI-3; n = 90 per arm). Only participants with ≥ 1 reversible defect on the second MPI study undergo the subsequent stress MPI test. The primary endpoint is the difference in the number of reversible defects on the two stress tests using a 17-segment model. Pharmacokinetic/pharmacodynamic analyses will evaluate the effect of caffeine on the regadenoson exposure-response relationship. Safety will also be assessed. CONCLUSION The results of this study will show whether the consumption of caffeine equivalent to 2-4 cups of coffee prior to an MPI study with regadenoson affects the diagnostic validity of stress testing (ClinicalTrials.gov number, NCT00826280).
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Garcia EV, Faber TL, Esteves FP. Cardiac Dedicated Ultrafast SPECT Cameras: New Designs and Clinical Implications. J Nucl Med 2011; 52:210-7. [DOI: 10.2967/jnumed.110.081323] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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