1
|
Fiechter M, Ghadri JR, Gebhard C, Fuchs TA, Pazhenkottil AP, Nkoulou RN, Herzog BA, Wyss CA, Gaemperli O, Kaufmann PA. Diagnostic Value of 13N-Ammonia Myocardial Perfusion PET: Added Value of Myocardial Flow Reserve. J Nucl Med 2012; 53:1230-4. [DOI: 10.2967/jnumed.111.101840] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
2
|
Burger IA, Husmann L, Herzog BA, Buechel RR, Pazhenkottil AP, Ghadri JR, Nkoulou RN, Jenni R, Russi EW, Kaufmann PA. Main pulmonary artery diameter from attenuation correction CT scans in cardiac SPECT accurately predicts pulmonary hypertension. J Nucl Cardiol 2011; 18:634-41. [PMID: 21688066 DOI: 10.1007/s12350-011-9413-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To establish the value of the main pulmonary artery (MPA) diameter assessed from unenhanced computer tomography (CT) scans used for attenuation correction (AC) of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) to predict pulmonary hypertension (PHT). BACKGROUND In contrast-enhanced chest CT scans an MPA diameter of 29 mm or greater is an established predictor of PHT. However, it is unknown, whether measurements from an unenhanced CT scan for AC may be used as predictor of PHT. METHODS 100 patients underwent SPECT MPI for assessment of coronary artery disease. PHT was defined as a right ventriculo-atrial gradient of 30 mm Hg or greater by Doppler echocardiography. We compared MPA diameter from CT to SPECT findings (right ventricular hypertrophy/enlargement, septal wall motion abnormality/perfusion defect, and D-shape) to determine the best predictor of PHT. RESULTS PHT was found in 37 patients. An MPA diameter of 30 mm or greater yielded a sensitivity, specificity, accuracy, positive, and negative predictive value of 78%, 91%, 86%, 83%, and 88%, respectively. This yielded an area under the ROC curve of 0.85. CONCLUSIONS MPA diameter from low-dose unenhanced multi-slice CT reliably predicts PHT, providing an important added clinical value from AC for SPECT MPI.
Collapse
Affiliation(s)
- Irene A Burger
- Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Pazhenkottil AP, Nkoulou RN, Ghadri JR, Herzog BA, Küest SM, Husmann L, Wolfrum M, Goetti R, Buechel RR, Gaemperli O, Lüscher TF, Kaufmann PA. Impact of cardiac hybrid single-photon emission computed tomography/computed tomography imaging on choice of treatment strategy in coronary artery disease. Eur Heart J 2011; 32:2824-9. [PMID: 21804107 PMCID: PMC3214723 DOI: 10.1093/eurheartj/ehr232] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS Cardiac hybrid imaging by fusing single-photon emission computed tomography (SPECT) myocardial perfusion imaging with coronary computed tomography angiography (CCTA) provides important complementary diagnostic information for coronary artery disease (CAD) assessment. We aimed at assessing the impact of cardiac hybrid imaging on the choice of treatment strategy selection for CAD. METHODS AND RESULTS Three hundred and eighteen consecutive patients underwent a 1 day stress/rest (99m)Tc-tetrofosmin SPECT and a CCTA on a separate scanner for evaluation of CAD. Patients were divided into one of the following three groups according to findings in the hybrid images obtained by fusing SPECT and CCTA: (i) matched finding of stenosis by CCTA and corresponding reversible SPECT defect; (ii) unmatched CCTA and SPECT finding; (iii) normal finding by both CCTA and SPECT. Follow-up was confined to the first 60 days after hybrid imaging as this allows best to assess treatment strategy decisions including the revascularization procedure triggered by its findings. Hybrid images revealed matched, unmatched, and normal findings in 51, 74, and 193 patients. The revascularization rate within 60 days was 41, 11, and 0% for matched, unmatched, and normal findings, respectively (P< 0.001 for all inter-group comparisons). CONCLUSION Cardiac hybrid imaging with SPECT and CCTA provides an added clinical value for decision making with regard to treatment strategy for CAD.
Collapse
Affiliation(s)
- Aju P Pazhenkottil
- Department of Radiology, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Ghadri JR, Küest SM, Goetti R, Fiechter M, Pazhenkottil AP, Nkoulou RN, Kuhn FP, Pietsch C, von Schulthess P, Gaemperli O, Templin C, Kaufmann PA. Image quality and radiation dose comparison of prospectively triggered low-dose CCTA: 128-slice dual-source high-pitch spiral versus 64-slice single-source sequential acquisition. Int J Cardiovasc Imaging 2011; 28:1217-25. [PMID: 21744246 DOI: 10.1007/s10554-011-9921-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [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: 06/07/2011] [Accepted: 07/04/2011] [Indexed: 11/30/2022]
Abstract
Currently 64-multislice computed tomography (MSCT) scanners are the most widely used devices allowing low radiation dose coronary CT angiography (CCTA) with prospective ECG triggering. Latest 128-slice dual-source CT (DSCT) scanners offer prospective high-pitch spiral acquisition covering the heart during one single beat. We compared radiation dose and image quality from prospective 64-MSCT versus high-pitch spiral 128-slice DSCT scanning, as such data is lacking. CCTA of 50 consecutive patients undergoing 128-DSCT (2 × 64 × 0.6 mm collimation, 0.28 s rotation time, 3.4 pitch, 100-120 kV tube voltage and 320 mAs tube current-time product) were compared to CCTA of 50 heart rate (HR) and BMI matched patients undergoing 64-MSCT (64 × 0.625 mm collimation, 0.35 s rotation time, 100-120 kV tube voltage and 400-650 mA tube current). Image quality was rated on a 4-point scale by two independent cardiac imaging physicians (1 = excellent to 4 = non-diagnostic). Of 710 coronary segments assessed on 128-DSCT, 216 (30.4%) achieved an image quality score 1 excellent, 400 (56.3%) score 2, 76 (10.7%) score 3 and 18 (2.6%) score 4 (non-diagnostic). Of 737 coronary segments evaluated on 64-MSCT 271 (36.8%) had an image quality score of 1, 327 (44.4%) 2, 110 (14.9%) score 3, and 29 (3.9%) segments score 4. Average image quality score for both scanners was similar (P = 0.641). The mean heart rate during scanning was 58.7 ± 5.6 bpm on 128-DSCT and 59.0 ± 5.6 bpm on 64-MSCT, respectively. Mean effective radiation dose was 1.0 ± 0.2 mSv for 128-DSCT and 1.7 ± 0.6 mSv for 64-MSCT (P < 0.001). 128-DSCT with high-pitch spiral mode allows CCTA acquisition with reduced radiation dose at maintained image quality compared to 64-MSCT.
Collapse
Affiliation(s)
- Jelena R Ghadri
- Department of Radiology, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, 8091 Zurich, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Ghadri JR, Goetti R, Fiechter M, Pazhenkottil AP, Küest SM, Nkoulou RN, Windler C, Buechel RR, Herzog BA, Gaemperli O, Templin C, Kaufmann PA. Inter-scan variability of coronary artery calcium scoring assessed on 64-multidetector computed tomography vs. dual-source computed tomography: a head-to-head comparison. Eur Heart J 2011; 32:1865-74. [PMID: 21546450 DOI: 10.1093/eurheartj/ehr157] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIMS Coronary artery calcium (CAC) scoring has emerged as a tool for risk stratification and potentially for monitoring response to risk factor modification. Therefore, repeat measurements should provide robust results and low inter-scanner variability for allowing meaningful comparison. The purpose of this study was to investigate inter-scanner variability of CAC for Agatston, volume, and mass scores by head-to-head comparison using two different cardiac computed tomography scanners: 64-detector multislice CT (MSCT) and 64-slice dual-source CT (DSCT). METHODS AND RESULTS Thirty patients underwent CAC measurements on both 64-MSCT (GE LightSpeed XT scanner: 120 kV, 70 mAs, 2.5 mm slices) and 64-DSCT (Siemens Somatom Definition: 120 kV, 80 mAs, 3 mm slices) within <100 days (0-97). Retrospective intra-scan comparison revealed an excellent correlation. The excellent intra-scan (inter-observer) agreement was documented by narrow limits of agreement and a correlation coefficient of variation (COV) of r ≥ 0.99 (P < 0.001) for all CAC scores with a low COV for both scanners (64-MSCT/64-DSCT), i.e. Agatston (2.0/2.1%), mass (3.0/2.0%), and volume (4.7/3.9%). Inter-scanner comparison revealed larger Bland-Altman (BA) limits of agreement, despite high correlation (r ≥ 0.97) for all scores, with COV at 15.1, 21.6, and 44.9% for Agatston, mass, and volume scores. The largest BA limits were observed for volume scores (-1552.8 to 574.2), which was massively improved (-241.0 to 300.4, COV 11.5%) after reanalysing the 64-DSCT scans (Siemens) with GE software/workstation (while Siemens software/workstation does not allow cross-vendor analysis). Phantom measurements confirmed overestimation of volume scores by 'syngo Ca-Scoring' (Siemens) software which should therefore be reviewed (vendor has been notified). CONCLUSION Intra- and inter-scan agreement of CAC measurement in a given data set is excellent. Inter-scanner variability is reasonable, particularly for Agatston units in the clinically most relevant range <1000. The use of different software solutions has a greater influence particularly on volume scores than the use of different scanner types.
Collapse
Affiliation(s)
- Jelena R Ghadri
- Department of Radiology, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 32, CH-8091 Zurich, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Ghadri JR, Pazhenkottil AP, Nkoulou RN, Goetti R, Buechel RR, Husmann L, Herzog BA, Wolfrum M, Wyss CA, Templin C, Kaufmann PA. Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI. Heart 2011; 97:998-1003. [PMID: 21487127 DOI: 10.1136/hrt.2010.217281] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To study the clinical impact of a very high coronary artery calcium score (CAC >1000) in patients with no known coronary artery disease (CAD) and normal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). The secondary aim was to evaluate whether triple vessel disease would support the notion of balanced ischaemia as an underlying mechanism of false negative SPECT MPI in patients with very high CAC. BACKGROUND No data exist on the clinical value of high CAC in patients with normal SPECT MPI. METHODS 50 patients with suspected CAD and normal stress/rest SPECT MPI and CAC >1000 prospectively underwent invasive coronary angiography as the standard of reference. Coronary lesions with ≥50% luminal diameter narrowing on invasive coronary angiography were considered to represent significant stenosis. RESULTS The median total CAC was 1975 (range 1018-8046). In 37/50 (74%) patients, coronary angiography revealed one-vessel disease (1-VD) (n=15), 2-VD (n=10) or 3-VD (n=12). Twenty-six revascularisations (percutaneous coronary intervention/coronary artery bypass grafting) were performed in seven (6/1), seven (6/1) and 12 (7/5) patients with 1-VD, 2-VD and 3-VD, respectively. CONCLUSIONS In patients with normal SPECT MPI, a CAC >1000 confers a high diagnostic added value for detecting CAD. This is not solely based on unmasking balanced ischaemia due to epicardial 3-VD, as it occurred predominantly in patients with 1-VD and 2-VD.
Collapse
Affiliation(s)
- Jelena R Ghadri
- Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Pazhenkottil AP, Ghadri JR, Nkoulou RN, Wolfrum M, Buechel RR, Küest SM, Husmann L, Herzog BA, Gaemperli O, Kaufmann PA. Improved outcome prediction by SPECT myocardial perfusion imaging after CT attenuation correction. J Nucl Med 2011; 52:196-200. [PMID: 21270455 DOI: 10.2967/jnumed.110.080580] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The aim of this study was to determine the impact of attenuation correction with CT (CT-AC) on the prognostic value of SPECT myocardial perfusion imaging (SPECT MPI). METHODS The summed stress score (SSS; 20-segment model) was obtained from filtered backprojection (FBP) and iterative reconstruction with CT-AC in 876 consecutive patients undergoing a 1-d stress-rest (99m)Tc-tetrofosmin SPECT MPI study for the evaluation of known or suspected coronary artery disease. Survival free of major adverse cardiac events (MACEs; cardiac death or nonfatal myocardial infarction) and survival free of any adverse cardiac events (including cardiac hospitalization, unstable angina, and late coronary revascularization) were analyzed by Kaplan-Meier analysis. RESULTS At a mean follow-up of 2.3 ± 0.6 y, a total of 184 adverse events occurred in 145 patients, including 35 MACEs (16 cardiac deaths [rate, 1.8%] and 19 nonfatal myocardial infarctions [rate, 2.2%]). With FBP, an SSS of 0-3 best distinguished patients with a low MACE rate (0.6%), followed by an SSS of 4-8 (4.3%), with increased MACE rate, and an SSS of 9-13 (3.8%), which was comparable. By contrast, with CT-AC the discrimination of low from intermediate MACE rate was best observed between an SSS of 0 (0%) and an SSS of 1-3 (3.7%), with a plateau at an SSS of 4-8 (3.2%). CONCLUSION CT-AC for SPECT MPI allows improved risk stratification. The prognostically relevant SSS cutoff is shifted toward lower values.
Collapse
|
8
|
Herzog BA, Buechel RR, Husmann L, Pazhenkottil AP, Burger IA, Wolfrum M, Nkoulou RN, Valenta I, Ghadri JR, Treyer V, Kaufmann PA. Validation of CT Attenuation Correction for High-Speed Myocardial Perfusion Imaging Using a Novel Cadmium-Zinc-Telluride Detector Technique. J Nucl Med 2010; 51:1539-44. [PMID: 20847159 DOI: 10.2967/jnumed.110.078170] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
9
|
Herzog BA, Husmann L, Buechel RR, Pazhenkottil AP, Burger IA, Valenta I, Altorfer U, Wolfrum M, Nkoulou RN, Ghadri JR, Wyss CA, Kaufmann PA. Rapid cardiac hybrid imaging with minimized radiation dose for accurate non-invasive assessment of ischemic coronary artery disease. Int J Cardiol 2010; 153:10-3. [PMID: 20826020 DOI: 10.1016/j.ijcard.2010.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [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: 02/24/2010] [Revised: 07/09/2010] [Accepted: 08/07/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ischemic coronary artery disease (CAD) is a major cause for morbidity and mortality resulting in a continuously increasing number of diagnostic interventions. We have validated a new hybrid imaging method using minimized radiation dose for rapid non-invasive prediction of invasive coronary angiography (CA) findings with regard to coronary lesion detection and revascularization. METHODS Forty patients referred for elective invasive coronary angiography (CA) due to suspected CAD were prospectively enrolled to undergo a low-dose CTCA with prospective ECG-triggering and a stress-only SPECT-MPI scan administering half of the standard low-dose stress (99m)Tc-tetrofosmin activity. The latter was acquired immediately after adenosine stress (omitting the standard 30-60 min waiting time). After fusing CTCA and SPECT-MPI decisions towards conservative management versus revascularization strategy based on hybrid images were compared to the decisions taken by the interventional operator in the catheterization laboratory based on CA. The latter served as standard of reference. RESULTS Hybrid images yielded sensitivity, specificity, positive and negative predictive values and accuracy of 100%, 96.0%, 100%, 93.8% and 97.5% for predicting coronary revascularization. The estimated mean effective radiation doses were significantly lower for hybrid imaging (4.7 ± 1.0 mSv) than for invasive CA (8.7 ± 4.2 mSv; P<0.001 vs. hybrid). Total non-invasive protocol time was below 60 min, comparing favourably to standard SPECT protocols. CONCLUSIONS Rapid cardiac hybrid imaging allows accurate prediction of invasive CA findings and of treatment decision despite minimized radiation dose and protocol time.
Collapse
|