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Bentsen S, Bang LE, Hasbak P, Kjaer A, Ripa RS. Amiodarone attenuates cardiac Rubidium-82 in consecutive PET/CT scans in a rodent model. J Nucl Cardiol 2022; 29:2853-2862. [PMID: 34611850 DOI: 10.1007/s12350-021-02785-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/23/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Risk stratification and diagnosis using Rubidium-82 (82Rb) positron emission tomography (PET) is a routine clinical approach in coronary artery disease (CAD). Various drugs are used to treat CAD; however, whether any of them change the uptake of 82Rb in the heart has not been investigated. The aim of this study is to determine whether drugs used in treatment of CAD affect the uptake of 82Rb in the heart in healthy rats. METHODS Seventy-seven Sprague-Dawley rats were included in the cross-sectional study. All rats underwent baseline 82Rb PET/CT and divided into eleven groups treated with different drugs. One group was control group (no treatment), eight groups were treated with monotherapy (amiodarone, acetylsalicylic acid (ASA), clopidogrel, ticagrelor, atorvastatin, enalapril, amlodipine, metoprolol succinate), and two groups were treated with polypharmacy (ASA, ticagrelor, atorvastatin, amlodipine or ASA, clopidogrel, atorvastatin, amlodipine). Once a day, they were administered pharmacological therapy through oral gavage, and on day seven, follow-up scanned with 82Rb PET/CT. RESULTS In the control group without pharmacological treatment, no difference in the standard uptake value (SUV) ratio between heart and muscle from baseline to follow-up (5.8 vs 7.0, P = .3) was found. The group treated with amiodarone had a significantly reduced SUV ratio from baseline to follow-up (5.8 vs 5.1, P = .008). All other drugs investigated had no difference in SUV ratio from baseline to follow-up. CONCLUSION In this study, we showed that drugs normally used to treat CAD do not affect the uptake of 82Rb. However, amiodarone result in a significantly lowered 82Rb uptake, compared to control. This information about amiodarone would probably not change the size assessment of a myocardial perfusion defect in a clinical setting. However, it could change the kinetic parameters when assessing absolute myocardial blood flow in patients treated with amiodarone.
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Affiliation(s)
- Simon Bentsen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark
- Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lia E Bang
- Department of Cardiology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark.
- Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Rasmus S Ripa
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark
- Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Sciagrà R, Lubberink M, Hyafil F, Saraste A, Slart RHJA, Agostini D, Nappi C, Georgoulias P, Bucerius J, Rischpler C, Verberne HJ; Cardiovascular Committee of the European Association of Nuclear Medicine (EANM). EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2021; 48:1040-69. [PMID: 33135093 DOI: 10.1007/s00259-020-05046-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed.
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Gebhard C, Messerli M, Lohmann C, Treyer V, Bengs S, Benz DC, Giannopoulos AA, Kudura K, von Felten E, Schwyzer M, Gaemperli O, Gräni C, Pazhenkottil AP, Buechel RR, Kaufmann PA. Sex and age differences in the association of heart rate responses to adenosine and myocardial ischemia in patients undergoing myocardial perfusion imaging. J Nucl Cardiol 2020; 27:159-170. [PMID: 29687292 DOI: 10.1007/s12350-018-1276-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND In light of growing cardiovascular mortality rates observed in young women, sexual dimorphism in cardiac autonomic nervous control is gaining increasing attention. Heart rate responses to adenosine mirror autonomic activity and may carry important prognostic information. METHODS AND RESULTS Hemodynamic changes during adenosine stress were retrospectively analysed in a propensity-matched cohort of 1932 consecutive patients undergoing myocardial perfusion single-photon-emission computed tomography (MPI-SPECT). Heart rate (HR) and systolic blood pressure (SBP) increased during adenosine infusion (P < 0.001). The increase in SBP and HR (heart rate reserve, HRR), was significantly more pronounced in women compared with men (P < 0.05). Patients ≤ 55 years had a higher HRR compared with patients > 55 years (46.8% vs 37.5%, P = 0.015). Women ≤ 55 years with a reversible perfusion defect on MPI-SPECT exhibited the highest HRR (89.2%), while age-matched men showed a blunted HR response to adenosine (26.4%, P = 0.01). Accordingly, age and an interaction term of female sex and increased HRR were identified as significant predictors of myocardial ischemia in a multiple regression analysis (OR 1.4, 95% CI 1.02-1.9, P = 0.038). CONCLUSION HRR during adenosine infusion is influenced by age and sex. Our data suggest a stronger, sympathetic-driven, hemodynamic response to adenosine in younger women with myocardial ischemia.
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Affiliation(s)
- Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland.
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Christine Lohmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Moritz Schwyzer
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
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Nkoulou R, Fuchs T, Pazhenkottil AP, Wolfrum M, Buechel RR, Gaemperli O, Kaufmann PA. High efficiency gamma camera enables ultra-low fixed dose stress/rest myocardial perfusion imaging. Eur Heart J Cardiovasc Imaging 2019; 20:218-224. [PMID: 29868718 DOI: 10.1093/ehjci/jey077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 05/11/2018] [Indexed: 11/13/2022] Open
Abstract
Aims We validated a 1-day myocardial perfusion imaging (MPI) protocol using an ultra low-dose(ULD) equal for stress and rest on a cadmium zinc telluride (CZT). Methods and results Fifty-six patients underwent a 1-day MPI protocol using a standard (SD) 99mTc-tetrofosmin dose at stress (320 MBq) and rest (960 MBq) with 5 min acquisition time each (SD). Within 2 weeks MPI was repeated using ULD 99mTc-tetrofosmin equal for stress and rest (160 MBq) with 15 min acquisition time each (ULD). All scans were performed on a CZT camera (DNM 570c, GE Healthcare). Background subtraction was applied on the rest MPI of the ULD using P-mod software. Presence and extent of perfusion defect were analysed. Pearson's correlation was used to compare ejection fraction (EF), end diastolic volume (EDV), and end systolic volume (ESV) between both protocols. SD revealed ischaemia in 23, scar in 3, and an equivocal finding in 1 patient, while normal findings were documented in 29 patients. ULD resulted in the following findings: ischaemia 23, scar 3, and 30 normal scans. Congruence of SD and ULD was 22/23 for ischaemia, 3/3 for scar, and 29/29 in normal patients; one patient with ischaemia in SD was classified as scar in ULD. Overall agreement of ULD with SD was 98%. The mean extent of defect was comparable between SD and ULD for the stress (10% vs. 11%, respectively, P = NS) and rest studies (5% vs. 7%, respectively, P = NS). An excellent correlation between SD and ULD was found for EF (r = 0.93), EDV (r = 0.95), and ESV (r = 0.97). Conclusion CZT cameras may enable reliable MPI scanning in patients with known or suspected coronary artery disease using protocols with about a factor 4-decrease in radiation dose exposure compared with traditional protocols.
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Affiliation(s)
- Rene Nkoulou
- Department of Cardiology, University Hospitals Geneva, Rue Gabrielle Perret Gentil 4, Geneva, Switzerland
| | - Tobias Fuchs
- Deparment of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Deparment of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Mathias Wolfrum
- Deparment of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Deparment of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gaemperli
- Deparment of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Deparment of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
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Haider A, Bengs S, Maredziak M, Messerli M, Fiechter M, Giannopoulos AA, Treyer V, Schwyzer M, Kamani CH, Patriki D, von Felten E, Benz DC, Fuchs TA, Gräni C, Pazhenkottil AP, Kaufmann PA, Buechel RR, Gebhard C. Heart rate reserve during pharmacological stress is a significant negative predictor of impaired coronary flow reserve in women. Eur J Nucl Med Mol Imaging 2019; 46:1257-67. [PMID: 30648200 DOI: 10.1007/s00259-019-4265-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/04/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Evidence to date has failed to adequately explore determinants of cardiovascular risk in women with coronary microvascular dysfunction (CMVD). Heart rate responses to adenosine mirror autonomic activity and may carry important prognostic information for the diagnosis of CMVD. METHODS Hemodynamic changes during adenosine stress were analyzed in a propensity-matched cohort of 404 patients (202 women, mean age 65.9 ± 11.0) who underwent clinically indicated myocardial perfusion 13N-ammonia Positron-Emission-Tomography (PET) at our institution between September 2013 and May 2017. RESULTS Baseline heart rate (HR) was significantly higher in patients with abnormal coronary flow reserve (CFR, p < 0.001 vs normal CFR). Accordingly, a blunted HR response to adenosine (=reduced heart rate reserve, %HRR) was seen in patients with abnormal CFR, with a most pronounced effect being observed in female patients free of myocardial ischemia (45.9 ± 34.9 vs 26.5 ± 18.0, p < 0.001 in women and 29.1 ± 16.9 vs 24.3 ± 21.7, p = 0.15 in men). Hence, a fully-adjusted multivariate logistic regression model identified HRR as the strongest negative predictor of reduced CFR in women free of myocardial ischemia, but not in men. Accordingly, receiver operating characteristics (ROC) curves for the presence of reduced CFR revealed that a %HRR <35 was a powerful predictor for abnormal CFR with a sensitivity of 81% and a specificity of 60% in women. CONCLUSION A blunted HRR <35% is associated with abnormal CFR in women. Taking into account HR responses during stress test in women may help to risk stratify the heterogeneous female population of patients with non-obstructive coronary artery disease (CAD).
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Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent advancements, current trends, and the expanding role for cardiac CT (CCT) in the evaluation of ischemic heart disease, nonischemic cardiomyopathies, and some specific congenital myocardial disease states. RECENT FINDINGS CCT is a highly versatile imaging modality for the assessment of numerous cardiovascular disease states. Coronary CT angiography (CCTA) is now a well-established first-line imaging modality for the exclusion of significant coronary artery disease (CAD); however, CCTA has modest positive predictive value and specificity for diagnosing obstructive CAD in addition to limited capability to evaluate myocardial tissue characteristics. SUMMARY CTP, when combined with CCTA, presents the potential for full functional and anatomic assessment with a single modality. CCT is a useful adjunct in select patients to both TTE and CMR in the evaluation of ventricular volumes and systolic function. Newer applications, such as dynamic CTP and DECT, are promising diagnostic tools offering the possibility of more quantitative assessment of ischemia. The superior spatial resolution and volumetric acquisition of CCT has an important role in the diagnosis of other nonischemic causes of cardiomyopathies.
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Affiliation(s)
- Bryan C. Ramsey
- Cardiology Division, Department of Medicine, San Antonio Military Medical Center, San Antonio, TX USA
| | - Emilio Fentanes
- Cardiology Division, Department of Medicine, Tripler Army Medical Center, Honolulu, HI USA
| | - Andrew D. Choi
- Division of Cardiology, Department of Radiology, The George Washington University School of Medicine, Washington, DC USA
| | | | - Dustin M. Thomas
- Cardiology Division, Department of Medicine, San Antonio Military Medical Center, San Antonio, TX USA
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Bengel F, Burchert W, Dörr R, Hacker M, Schäfer W, Schäfers MA, Schmidt M, Schwaiger M, Dahl JV, Zimmermann R, Lindner O. Myokard-Perfusions-SPECT. Nuklearmedizin 2018; 56:115-123. [DOI: 10.3413/nukmed-2017040001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 12/13/2022]
Abstract
ZusammenfassungDie S1-Leitlinie Myokard-Perfusions-SPECT wurde überarbeitet und bei der Arbeitsgemeinschaft der wissenschaftlichen Fachgesellschaften (AWMF) online publiziert. Sie ist in ihrer aktuellen Fassung bis 2/2022 gültig. Dieser Beitrag gibt in gekürzter Form und mit Kommentaren versehen die Kapitel und Unterkapitel wieder, in denen Änderungen und Ergänzungen vorgenommen wurden.
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Hoffmeister K, Preuss R, Weise R, Burchert W, Lindner O. The effect of beta blocker withdrawal on myocardial SPECT modeled from adenosine 13N-ammonia PET. Nuklearmedizin 2015; 55:29-33. [PMID: 26642439 DOI: 10.3413/nukmed-0769-15-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/27/2015] [Indexed: 11/20/2022]
Abstract
AIM The effect of beta blockers (BB) on myocardial imaging has been studied in several SPECT and PET studies with divergent results concerning perfusion and impact on diagnostic accuracy. The present study evaluated the effect of BB withdrawal on virtual SPECT studies modeled from quantitative PET perfusion scans. PATIENTS, METHODS Data from 20 CAD patients scheduled for adenosine 13N-ammonia imaging with and without BB were considered. Modeling the uptake characteristics of 99mTc-MIBI, all parametric stress PET polarmaps were transferred to virtual 20-segment SPECT polarmaps. The SPECT studies were categorized with a 5-point score and read to assess the effect of the BB withdrawal on scan result and interpretation. RESULTS The SPECT analysis revealed a mean score of 6.0 ± 4.7 with, and of 5.9 ± 4.5 without BB (p = 0.84). In 260 (74.9%) segments the scores were equal in both conditions. Without BB a downstaging was recorded in 44 segments (12.7%), an upstaging in 43 segments (12.4%). An essentially different interpretation (shift from medical therapy recommendation to angiography) was recorded in one patient. In six cases the interpretation differed mildly. CONCLUSION In the majority of patients studied, scan results and interpretation remain unchanged after discontinuation of the BB. Nevertheless, the segmental scan results are not uniformly affected. The recommendation to stop BBs prior to stress testing in order to ensure the highest MBF remains advisable. If temporary BB withdrawal is unfeasible due to contraindications, a tight clinical schedule, or because a patient forgot to withhold the BB, it is appropriate to perform adenosine stress testing according to the results of this study.
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Affiliation(s)
| | | | | | | | - O Lindner
- Oliver Lindner, Heart and Diabetes Center North Rhine-Westphalia - Institute of Radiology, Nuclearmedicine and Molecular Imaging, Georgstr. 11, 32545 Bad Oeynhausen, Germany, Tel. +49/(0)5731/97-13 09, Fax -21 90,
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Manisty C, Ripley DP, Herrey AS, Captur G, Wong TC, Petersen SE, Plein S, Peebles C, Schelbert EB, Greenwood JP, Moon JC. Splenic Switch-off: A Tool to Assess Stress Adequacy in Adenosine Perfusion Cardiac MR Imaging. Radiology 2015; 276:732-40. [PMID: 25923223 DOI: 10.1148/radiol.2015142059] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the pharmacology and potential clinical utility of splenic switch-off to identify understress in adenosine perfusion cardiac magnetic resonance (MR) imaging. MATERIALS AND METHODS Splenic switch-off was assessed in perfusion cardiac MR examinations from 100 patients (mean age, 62 years [age range, 18-87 years]) by using three stress agents (adenosine, dobutamine, and regadenoson) in three different institutions, with appropriate ethical permissions. In addition, 100 negative adenosine images from the Clinical Evaluation of MR Imaging in Coronary Heart Disease (CE-MARC) trial (35 false and 65 true negative; mean age, 59 years [age range, 40-73 years]) were assessed to ascertain the clinical utility of the sign to detect likely pharmacologic understress. Differences in splenic perfusion were compared by using Wilcoxon signed rank or Wilcoxon rank sum tests, and true-negative and false-negative findings in CE-MARC groups were compared by using the Fisher exact test. RESULTS The spleen was visible in 99% (198 of 200) of examinations and interobserver agreement in the visual grading of splenic switch-off was excellent (κ = 0.92). Visually, splenic switch-off occurred in 90% of adenosine studies, but never in dobutamine or regadenoson studies. Semiquantitative assessments supported these observations: peak signal intensity was 78% less with adenosine than at rest (P < .001), but unchanged with regadenoson (4% reduction; P = .08). Calculated peak splenic divided by myocardial signal intensity (peak splenic/myocardial signal intensity) differed between stress agents (adenosine median, 0.34; dobutamine median, 1.34; regadenoson median, 1.13; P < .001). Failed splenic switch-off was significantly more common in CE-MARC patients with false-negative findings than with true-negative findings (34% vs 9%, P < .005). CONCLUSION Failed splenic switch-off with adenosine is a new, simple observation that identifies understressed patients who are at risk for false-negative findings on perfusion MR images. These data suggest that almost 10% of all patients may be understressed, and that repeat examination of individuals with failed splenic switch-off may significantly improve test sensitivity.
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Affiliation(s)
- Charlotte Manisty
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - David P Ripley
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Anna S Herrey
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Gabriella Captur
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Timothy C Wong
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Steffen E Petersen
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Sven Plein
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Charles Peebles
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Erik B Schelbert
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - John P Greenwood
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - James C Moon
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
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Takahashi T, Tanaka H, Kozono N, Tanakamaru Y, Idei N, Ohashi N, Ohtsubo H, Okada T, Yasunobu Y, Kaseda S. Characteristics of images of angiographically proven normal coronary arteries acquired by adenosine-stress thallium-201 myocardial perfusion SPECT/CT-IQ[Symbol: see text]SPECT with CT attenuation correction changed stepwise. Ann Nucl Med 2014; 29:256-67. [PMID: 25472779 DOI: 10.1007/s12149-014-0935-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/20/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although several studies have shown the diagnostic and prognostic value of CT-based attenuation correction (AC) of single photon emission computed tomography (SPECT) images for diagnosing coronary artery disease (CAD), this issue remains a matter of debate. To clarify the characteristics of CT-AC SPECT images that might potentially improve diagnostic performance, we analyzed images acquired using adenosine-stress thallium-201 myocardial perfusion SPECT/CT equipped with IQ[Symbol: see text]SPECT (SPECT/CT-IQ[Symbol: see text]SPECT) from patients with angiographically proven normal coronary arteries after changing the CT attenuation correction (CT-AC) in a stepwise manner. METHODS We enrolled 72 patients (Male 36, Female 36) with normal coronary arteries according to findings of invasive coronary angiography or CT-angiography within three months after a SPECT/CT study. Projection images were reconstructed at CT-AC values of (-), 40, 60, 80 and 100 % using a CT number conversion program according to our definition and analyzed using polar maps according to sex. RESULTS CT attenuation corrected segments were located from the mid- and apical-inferior spread through the mid- and apical-septal regions and finally to the basal-anterior and basal- and mid-lateral regions in males, and from the mid-inferior region through the mid-septal and mid-anterior, and mid-lateral regions in females as the CT-AC values increased. Segments with maximal mean counts shifted from the apical-anterior to mid-anterolateral region under both stress and rest conditions in males, whereas such segments shifted from the apical-septal to the mid-anteroseptal region under both stress and rest conditions in females. CONCLUSIONS We clarified which part of the myocardium and to which degree CT-AC affects it in adenosine-stress thallium-201 myocardial perfusion SPECT/CT-IQ[Symbol: see text]SPECT images by changing the CT-AC value stepwise. We also identified sex-specific shifts of segments with maximal mean counts that changed as CT-AC values increased.
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Affiliation(s)
- Teruyuki Takahashi
- Department of Radiology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
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12
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Hoffmeister C, Preuss R, Weise R, Burchert W, Lindner O. The effect of beta blocker withdrawal on adenosine myocardial perfusion imaging. J Nucl Cardiol 2014; 21:1223-9. [PMID: 25124825 PMCID: PMC4228113 DOI: 10.1007/s12350-014-9952-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/30/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effect of beta blockers on myocardial blood flow (MBF) under vasodilators has been studied in several SPECT and PET myocardial perfusion imaging (MPI) studies with divergent results. The present study evaluated the effect of a beta blocker withdrawal on quantitative adenosine MBF and on MPI results. METHODS Twenty patients with beta blockers and CAD history were studied with quantitative adenosine N-13 ammonia PET. The first study was performed under complete medication and the second after beta blocker withdrawal. The PET studies were independently read with respect to MPI result and clinical decision making. RESULTS Global MBF showed an increase from 180.2 ± 59.9 to 193.6 ± 60.8 mL·minute(-1)/100 g (P = .02) after beta blocker withdrawal. The segmental perfusion values were closely correlated (R(2) = 0.82) over the entire range of perfusion values. An essentially different interpretation after beta blocker discontinuation was found in two cases (10%). CONCLUSION A beta blocker withdrawal induces an increase in adenosine MBF. In the majority of cases, MPI interpretation and decision making are independent of beta blocker intake. If a temporary beta blocker withdrawal before MPI is not possible or was not realized by the patient, it is appropriate to perform adenosine stress testing without loss of the essential MPI result.
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Affiliation(s)
- C. Hoffmeister
- Diabetes Center, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - R. Preuss
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - R. Weise
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - W. Burchert
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - O. Lindner
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
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13
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Fukushima Y, Kumita S, Kawaguchi T, Maruyama T, Kawasaki Y, Shinkai Y. Nuclear myocardial perfusion imaging with a cadmium-telluride semiconductor detector gamma camera in patients with acute myocardial infarction. Ann Nucl Med 2014; 28:646-55. [PMID: 24878888 DOI: 10.1007/s12149-014-0859-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 05/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Since myocardial perfusion imaging (MPI) with conventional sodium iodine (NaI) device has low spatial resolution, there have been some cases in which small structures such as non-transmural myocardial infarction could not be properly detected. The purpose of this study was to evaluate potential usefulness of cadmium-telluride (CdTe) semiconductor detector-based high spatial resolution gamma cameras in detecting myocardial infarction sites, especially non-transmural infarction. METHODS A total of 38 patients (mean age ± SD: 64 ± 21 year) who were clinically diagnosed with acute myocardial infarction were included. Twenty-eight cases of them were with ST segment elevation myocardial infarction (STEMI) and 10 cases with non-ST segment elevation myocardial infarction (NSTEMI). In all patients, myocardial perfusion single photon emission computed tomography images were acquired with Infinia (NaI device) and R1-M (CdTe device), and the images were compared concerning the detectability of acute myocardial infarction sites. RESULTS The detection rates of the myocardial infarction site in cases with STEMI were 100% both by NaI and CdTe images. In cases with NSTEMI, detection rate by NaI images was 50%, while that of CdTe images was 100% (p = 0.033). The summed rest score (SRS) value derived from CdTe images was significantly higher than that from NaI images in cases with STEMI [NaI images: 12 (7-18) versus CdTe images: 14 (9-20)] (p < 0.001). SRS derived from CdTe images was significantly higher than that derived from NaI images in cases with NSTEMI [NaI images: 2 (0-5) versus CdTe images: 6 (6-8)] (p = 0.006). CONCLUSIONS These results indicate that MPI using CdTe-semiconductor device will provide a much more accurate assessment of acute myocardial infarction in comparison to current methods.
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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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Arumugam P, Harbinson M, Reyes E, Sabharwal N, Tonge C, Underwood R, Kelion A. 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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lindner O, Burchert W, Hacker M, Schaefer W, Schmidt M, Schober O, Schwaiger M, vom Dahl J, Zimmermann R, Schäfers M. [Myocardial perfusion scintigraphy - short form of the German guideline]. Nuklearmedizin 2013; 52:51-63; quiz N22. [PMID: 23370730 DOI: 10.3413/nukmed-0550-12-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/08/2013] [Indexed: 11/20/2022]
Abstract
This guideline is a short summary of the guideline for myocardial perfusion scintigraphy published by the Association of the Scientific Medical Societies in Ger-many (AWMF). The purpose of this guideline is to provide practical assistance for indication and examination procedures as well as image analysis and to present the state-of-the-art of myocardial-perfusion-scintigraphy. After a short introduction on the fundamentals of imaging, precise and detailed information is given on the indications, patient preparation, stress testing, radiopharmaceuticals, examination protocols and techniques, radiation exposure, data reconstruction as well as information on visual and quantitative image analysis and interpretation. In addition possible pitfalls, artefacts and key elements of reporting are described.
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Affiliation(s)
- O Lindner
- Universitätsklinikum der Ruhr-Universität Bochum, Institut für Radiologie, Nuklearmedizin und Molekulare Bildgebung, Georgstr. 11, 32545 Bad Oeynhausen.
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Fallahi B, Beiki D, Akbarpour S, Gholamrezanezhad A, Fard-Esfahani A, Akhzari F, Izadyar S, Esmaeli J, Saghari M, Eftekhari M. Withholding or continuing beta-blocker treatment before dipyridamole myocardial perfusion imaging for the diagnosis of coronary artery disease? A randomized clinical trial. Daru 2013; 21:8. [PMID: 23351617 PMCID: PMC3565929 DOI: 10.1186/2008-2231-21-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/05/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Although it has been shown that acute beta-blocker administration may reduce the presence or severity of myocardial perfusion defects with dipyridamole stress, little information is available about the potential effect of chronic beta-blocker treatment on the sensitivity of dipyridamole myocardial perfusion imaging (DMPI). METHODS As a randomized clinical trial, one hundred twenty patients (103 male and 17 female) with angiographically confirmed CAD who were on long-term beta blocker therapy (≥3 months) enrolled in a randomized clinical trial study. The patients were allocated into two groups: Group A (n=60) in whom the beta-blocker agent was discontinued for 72h before DMPI and Group B (n=60) without discontinuation of beta-blockers prior to DMPI. RESULTS No significant difference was noted between the groups concerning age, sex, type of the injected radiotracer and number of involved coronary vessels. The mean rank of total perfusion scores for whole myocardium (irrespective of reversibility or irreversibility) in group B was not significantly different from that of group A, (65.75 vs. 55.25, P=0.096). Regarding the only irreversible perfusion defects, the mean rank of perfusion score in group B was higher than that of group A for whole myocardium (72 vs. 49, P=0.0001); however, no difference was noted between two groups for only reversible perfusion defects (61.0 vs. 60.0, P=0.898). The overall sensitivity of DMPI for the diagnosis of CAD in group A (91.7%) was not statistically different from group B (90%). CONCLUSION Beta-blocker withholding before DMPI did not generally affect the sensitivity of the test for the diagnostic purposes in our study. Thus, beta-blocker withdrawal for just the purpose of diagnostic imaging is not mandatory particularly when medication discontinuation may cause the patients to face increased risk of heart events.
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Affiliation(s)
- Babak Fallahi
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Nkoulou R, Pazhenkottil AP, Kuest SM, Ghadri JR, Wolfrum M, Husmann L, Fiechter M, Buechel RR, Herzog BA, Koepfli P, Burger C, Gaemperli O, Kaufmann PA. Semiconductor Detectors Allow Low-Dose–Low-Dose 1-Day SPECT Myocardial Perfusion Imaging. J Nucl Med 2011; 52:1204-9. [DOI: 10.2967/jnumed.110.085415] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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