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SPECT and SPECT/CT. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00008-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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52
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Ma R, Wang L, Wu D, Wang M, Sun X, Hsu B, Fang W. Myocardial blood flow quantitation in patients with congestive heart failure: head-to-head comparison between rapid-rotating gantry SPECT and CZT SPECT. J Nucl Cardiol 2020; 27:2287-2302. [PMID: 30783997 DOI: 10.1007/s12350-019-01621-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/01/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE Recently, the feasibility of myocardial blood flow (MBF) quantitation using rapid-rotating gantry (RRG) and cadmium-zinc-telluride (CZT) SPECT cameras has been demonstrated. We compared MBF quantitation using these two camera systems. METHODS Twenty patients with congestive heart failure (CHF) and 20 patients without CHF (non-CHF) were included. On two consecutive days, dynamic SPECT imaging was performed after a bolus injection of 20 mCi of 99mTc-Sestamibi (MIBI) with RRG-SPECT and list-mode acquisition with CZT-SPECT. All dynamic SPECT images were reconstructed with full physical corrections, corrections for ventricular spillover and partial volume effect, using one-tissue kinetic modeling. Resting MBF converted from K1 was then corrected for MIBI extraction fraction and adjusted for rate-pressure product. RESULTS In both patient groups, there was no significant difference between resting MBF values measured with RRG-SPECT and CZT-SPECT systems (P = 0.06, P = 0.2 respectively). For CHF patients, linear regression (LR) was y(RRG) = 1.0412x (CZT) (r = 0.97) with a small systemic difference (Δ = 0.03 mL·min-1·g-1, 95% CI - 0.11 to 0.20) by Bland-Altman analysis. For non-CHF patients, LR was y(RRG) = 1.025x (CZT) (r = 0.89) with also small systemic difference (ΔT= 0.02 mL·min-1·g-1, 95% CI - 0.14 to 0.19) in BA analysis. CONCLUSION Physical corrections along with other image corrections can provide comparable MBF quantitations in both CHF and non-CHF patients, regardless of the type of SPECT systems used.
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Affiliation(s)
- Rongzheng Ma
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Lei Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Dayong Wu
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Meng Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Xiaoxin Sun
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, E2433 Lafferre Hall, Columbia, MO, 65211, USA.
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
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Zannoni EM, Wilson MD, Bolz K, Goede M, Lauba F, Schöne D, Zhang J, Veale MC, Verhoeven M, Meng LJ. Development of a multi-detector readout circuitry for ultrahigh energy resolution single-photon imaging applications. NUCLEAR INSTRUMENTS & METHODS IN PHYSICS RESEARCH. SECTION A, ACCELERATORS, SPECTROMETERS, DETECTORS AND ASSOCIATED EQUIPMENT 2020; 981:164531. [PMID: 32968332 PMCID: PMC7505227 DOI: 10.1016/j.nima.2020.164531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this paper, we present the design and preliminary performance evaluation of a novel external multi-channel readout circuitry for small-pixel room-temperature semiconductor detectors, namely CdZnTe (CZT) and CdTe, that provide an excellent intrinsic spatial (250 and 500 μm pixel size) and an ultrahigh energy resolution (~1% at 122 keV) for X-ray and gamma-ray imaging applications. An analog front-end printed circuit board (PCB) was designed and developed for data digitization, data transfer and ASIC control of pixelated CZT or CdTe detectors. Each detector unit is 2 cm × 2 cm in size and 1 or 2 mm in thickness, being bump-bonded onto a HEXITEC ASIC, and wire-bonded to a readout detector module PCB. The detectors' front-end is then connected, through flexible cables of up to 10 m in length, to a remote data acquisition system that interfaces with a PC through USB3.0 connection. We present the design and performance of a prototype multi-channel readout system that can read out up to 24 detector modules synchronously. Our experimental results demonstrated that the readout circuitry offers an ultrahigh spectral resolution (0.8 keV at 60 keV and 1.05 keV at 122 keV) with the Cd(Zn)Te/HEXITEC ASIC modules tested. This architecture was designed to allow easy expansion to accommodate a larger number of detector modules, and the flexibility of arranging the detector modules in a large and deformable detector array without degrading the excellent energy resolution.
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Affiliation(s)
- Elena Maria Zannoni
- Bioengineering, University of Illinois at Urbana-Champaign, United States of America
| | - Matthew D. Wilson
- Science and Technology Facilities Council, Rutherford Appleton Laboratory, United Kingdom
| | - Krystian Bolz
- aSpect Systems GmbH, Eisenbahnstrasse 2, 01097 Dresden, Germany
| | - Mario Goede
- aSpect Systems GmbH, Eisenbahnstrasse 2, 01097 Dresden, Germany
| | - Frank Lauba
- aSpect Systems GmbH, Eisenbahnstrasse 2, 01097 Dresden, Germany
| | - Daniel Schöne
- aSpect Systems GmbH, Eisenbahnstrasse 2, 01097 Dresden, Germany
| | - Jiajin Zhang
- Nuclear, Plasma and Radiological Engineering, University of Illinois at Urbana-Champaign, United States of America
| | - Matthew C. Veale
- Science and Technology Facilities Council, Rutherford Appleton Laboratory, United Kingdom
| | | | - Ling-Jian Meng
- Bioengineering, University of Illinois at Urbana-Champaign, United States of America
- Nuclear, Plasma and Radiological Engineering, University of Illinois at Urbana-Champaign, United States of America
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Ozsahin I, Chen L, Könik A, King MA, Beekman FJ, Mok GSP. The clinical utilities of multi-pinhole single photon emission computed tomography. Quant Imaging Med Surg 2020; 10:2006-2029. [PMID: 33014732 PMCID: PMC7495312 DOI: 10.21037/qims-19-1036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/30/2020] [Indexed: 11/06/2022]
Abstract
Single photon emission computed tomography (SPECT) is an important imaging modality for various applications in nuclear medicine. The use of multi-pinhole (MPH) collimators can provide superior resolution-sensitivity trade-off when imaging small field-of-view compared to conventional parallel-hole and fan-beam collimators. Besides the very successful application in small animal imaging, there has been a resurgence of the use of MPH collimators for clinical cardiac and brain studies, as well as other small field-of-view applications. This article reviews the basic principles of MPH collimators and introduces currently available and proposed clinical MPH SPECT systems.
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Affiliation(s)
- Ilker Ozsahin
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, China
- Department of Biomedical Engineering, Faculty of Engineering, Near East University, Nicosia/TRNC, Mersin-10, Turkey
- DESAM Institute, Near East University, Nicosia/TRNC, Mersin-10, Turkey
| | - Ling Chen
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, China
| | - Arda Könik
- Department of Imaging, Dana Farber Cancer Institute, Boston, MA, USA
| | - Michael A. King
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Freek J. Beekman
- Section of Biomedical Imaging, Department of Radiation Science and Technology, Delft University of Technology, Mekelweg 15, 2629 JB Delft, The Netherlands
- MILabs B.V, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Greta S. P. Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, China
- Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macau, China
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55
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Wetzl M, Sanders JC, Kuwert T, Ritt P. Effect of reduced photon count levels and choice of normal data on semi-automated image assessment in cardiac SPECT. J Nucl Cardiol 2020; 27:1469-1482. [PMID: 29654444 DOI: 10.1007/s12350-018-1272-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The SMARTZOOM multifocal collimator from Siemens Healthcare was developed to improve the γ-photon sensitivity in myocardial perfusion imaging without truncating the field of view. As part of the IQ-SPECT package, it may be used to reduce radiopharmaceutical dose to patients, as well as acquisition time. The aim of this study was twofold: (1) to evaluate the influence of dose reduction in semi-automated MPI scoring, with focus on different strategies for the choice of normal data (count-matched, full-count), and (2) to evaluate the effect of dose reduction afforded by Siemens' IQ-SPECT package. METHODS 50 patients underwent Tc-99m-sestamibi one-day stress/rest SPECT/CT. Multiple levels of count reduction were generated using binomial thinning. Using Corridor 4DM, summed stress score (SSS) was calculated using either count-matched or full-count normal data. Studies were classified as low-risk (SSS < 4) or intermediate/high-risk (SSS ≥ 4). RESULTS Count reduction using count-matched normal data increases false-normal rate and decreases sensitivity. With full-count normal data, count reduction increases false-hypoperfusion rate, leading to decreased specificity. Altogether, rate of reclassification was significant at roughly 67% dose and below. CONCLUSION Significant bias results from count level of normal data relative to actual patient data. Compared to standard LEHR, IQ-SPECT should allow for significant dose reduction.
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Affiliation(s)
- Matthias Wetzl
- Clinic of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - James C Sanders
- Clinic of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
- Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Torsten Kuwert
- Clinic of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - Philipp Ritt
- Clinic of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.
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56
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Hansen NL, Haarmark C, Zerahn B. Ventricular peak emptying and filling rates measured by gated tomographic radionuclide angiography using a cadmium-zinc-telluride SPECT camera in chemotherapy-naïve cancer patients. J Nucl Cardiol 2020; 27:1193-1201. [PMID: 31127488 DOI: 10.1007/s12350-019-01756-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Radionuclide angiography is widely used for left ventricular function assessment. This study establishes normative data and inter-study repeatability on peak ventricular filling and emptying rates obtained by a cadmium-zinc-telluride SPECT camera. METHOD Cancer patients (N = 764) without diabetes or cardiovascular diseases referred for baseline assessment of cardiac function were included. Repeatability was assessed in 46 patients where two separate acquisitions were performed. Left and right ventricular emptying rates (LPER, RPER) and filling rates (LPFR, RPFR) were obtained and whenever possible also atrial filling rates (PFRa). RESULTS Filling rates were higher in women than men. Emptying rates tended to increase with age, whereas filling rates and the E/A ratio decreased. One patient was excluded from the repeatability analysis due to an unexplained high intra-observer variation. Intraclass correlation coefficients for LPER, RPER, LPFR, and RPFR were 0.99, 0.94, 0.99, and 0.84, no proportional biases were detected. CONCLUSION Reference values and relations to age and gender in chemotherapy-naïve cancer patients without cardiopulmonary disease are presented. The CZT camera provides reproducible estimates of peak emptying and filling rates.
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Affiliation(s)
- Naja Liv Hansen
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Copenhagen, Denmark.
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, Copenhagen, Denmark.
| | - Christian Haarmark
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Copenhagen, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Copenhagen, Denmark
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57
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Morelle M, Bellevre D, Hossein-Foucher C, Manrique A, Bailliez A. First comparison of performances between the new whole-body cadmium-zinc-telluride SPECT-CT camera and a dedicated cardiac CZT camera for myocardial perfusion imaging: Analysis of phantom and patients. J Nucl Cardiol 2020; 27:1261-1269. [PMID: 30963419 DOI: 10.1007/s12350-019-01702-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dedicated cardiac Cadmium-zinc-telluride (CZT) cameras show superior performances compared with Anger systems, particularly in terms of spatial resolution and count sensitivity. This study evaluated the performances of a new polyvalent whole body CZT camera (DNM 670CZT) compared with a cardiac dedicated CZT camera (DNM 530c) for myocardial perfusion SPECT. METHODS The spatial resolution was evaluated with three linear sources filled with 99mTc. We used a cardiac phantom to evaluate count sensitivity, sharpness index, contrast-to-noise ratio, wall thickness, non-uniformity index, perfusion scores and ventricle volumes for both cameras. The impact of matrix size, and acquisition time was investigated. Concordance between the two cameras was evaluated in patients using QPS/QGS software for quantitative segmental perfusion, motion and thickness scores. RESULTS The spatial resolution was identical with the two cameras. Count sensitivity of the DNM 670CZT was twofold lower compared with the DNM 530c, leading to lower sharpness index and contrast-to-noise ratio. The wall thickness and the myocardial volumes were similar. Visual and quantitative assessments of the perfusion patterns have shown a good concordance of the two cameras on phantoms and in patients. CONCLUSION This study demonstrated the feasibility of myocardial perfusion SPECT imaging using the new whole-body DNM 670CZT camera.
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Affiliation(s)
- Maxime Morelle
- Nuclear Medicine Department, Hôpital Roger Salengro, CHRU-Lille, Universit de Lille 2, Lille, France.
| | - Dimitri Bellevre
- Nuclear Medicine Department, IRIS, Hôpital Privé Le Bois, Lille, France
| | - Claude Hossein-Foucher
- Nuclear Medicine Department, Hôpital Roger Salengro, CHRU-Lille, Universit de Lille 2, Lille, France
| | - Alain Manrique
- Normandie Univ, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France
- Nuclear Medicine, CHU de Caen, Caen, France
| | - Alban Bailliez
- Nuclear Medicine Department, IRIS, Hôpital Privé Le Bois, Lille, France
- Normandie Univ, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, Caen, France
- Department of Nuclear Medicine, UF 5881, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lomme, France
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Wells RG, Ruddy TD. Cardiac myocardial perfusion imaging with new SPECT cameras: Comparing apples and oranges. J Nucl Cardiol 2020; 27:1270-1273. [PMID: 31044404 DOI: 10.1007/s12350-019-01729-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- R Glenn Wells
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada.
| | - Terrence D Ruddy
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
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Marcassa C, Zoccarato O. Multi-peak multi-isotopes myocardial SPECT: It's easier said than done. J Nucl Cardiol 2020; 27:751-754. [PMID: 30478658 DOI: 10.1007/s12350-018-01481-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/26/2022]
Affiliation(s)
- C Marcassa
- Maugeri Clinical and Scientific Institutes, IRCCS, Cardiology Department, Scientific Institute of Veruno (NO), Via Per Revislate 13, 28010, Veruno, Italy.
| | - O Zoccarato
- Maugeri Clinical and Scientific Institutes, IRCCS, Nuclear Medicine Department, Scientific Institute of Veruno (NO), Via Per Revislate 13, 28010, Veruno, Italy
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Abstract
Cardiac imaging has a pivotal role in the prevention, diagnosis and treatment of ischaemic heart disease. SPECT is most commonly used for clinical myocardial perfusion imaging, whereas PET is the clinical reference standard for the quantification of myocardial perfusion. MRI does not involve exposure to ionizing radiation, similar to echocardiography, which can be performed at the bedside. CT perfusion imaging is not frequently used but CT offers coronary angiography data, and invasive catheter-based methods can measure coronary flow and pressure. Technical improvements to the quantification of pathophysiological parameters of myocardial ischaemia can be achieved. Clinical consensus recommendations on the appropriateness of each technique were derived following a European quantitative cardiac imaging meeting and using a real-time Delphi process. SPECT using new detectors allows the quantification of myocardial blood flow and is now also suited to patients with a high BMI. PET is well suited to patients with multivessel disease to confirm or exclude balanced ischaemia. MRI allows the evaluation of patients with complex disease who would benefit from imaging of function and fibrosis in addition to perfusion. Echocardiography remains the preferred technique for assessing ischaemia in bedside situations, whereas CT has the greatest value for combined quantification of stenosis and characterization of atherosclerosis in relation to myocardial ischaemia. In patients with a high probability of needing invasive treatment, invasive coronary flow and pressure measurement is well suited to guide treatment decisions. In this Consensus Statement, we summarize the strengths and weaknesses as well as the future technological potential of each imaging modality.
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Shortened acquisition time in simultaneous 99mTc-tetrofosmin and 123I-β-methyl-p-iodophenyl pentadecanoic acid dual-tracer imaging with cadmium-zinc-telluride detectors in patients undergoing primary coronary intervention for acute myocardial infarction. Nucl Med Commun 2020; 40:1130-1137. [PMID: 31524763 DOI: 10.1097/mnm.0000000000001084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The use of cadmium-zinc-telluride-based scanners may increase the clinical feasibility of simultaneous dual-isotope imaging. In the current study, we sought to investigate a potential acquisition time in simultaneous Tc-tetrofosmin/I-β-methyl-p-iodophenyl pentadecanoic acid dual-isotope imaging using a Discovery NM/CT 670 cadmium-zinc-telluride. METHODS Simultaneous Tc-tetrofosmin/I-β-methyl-p-iodophenyl pentadecanoic acid dual-isotope imaging was performed in 29 patients who had undergone primary percutaneous coronary intervention for acute myocardial infarction. Referenced images with an acquisition time of 65 s/view (16.25 min) were reframed to produce images with acquisition times of 33, 16, and 8 s/view. The values for the quantitative-gated single-photon emission computed tomography (SPECT) and the quantitative perfusion SPECT were compared. RESULTS The quantitative-gated SPECT values for images with 33, 16, and 8 s/views showed good consistency with those for 65 s/view (the lower 95% confidence intervals for the intraclass correlation were ≥0.80). The quantitative perfusion SPECT values for Tc-tetrofosmin images with 33, 16, and 8 s/views also showed good consistency with those for 65 s/view; however, the quantitative perfusion SPECT values for I-β-methyl-p-iodophenyl pentadecanoic acid images with an acquisition time of 8 s/view were not consistent with the reference acquisition time of 65 s/view. CONCLUSIONS The quantitative-gated SPECT and quantitative perfusion SPECT values obtained from images with shorter acquisition times correlated with the values obtained from images with a reference acquisition time of 65 s/view; however, tracer-specific predisposition should be considered. These findings suggest that it is possible to reduce acquisition time when performing simultaneous Tc-tetrofosmin/I-β-methyl-p-iodophenyl pentadecanoic acid dual-tracer imaging with the novel cadmium-zinc-telluride scanner.
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Test-Retest Precision of Myocardial Blood Flow Measurements With
99m
Tc-Tetrofosmin and Solid-State Detector Single Photon Emission Computed Tomography. Circ Cardiovasc Imaging 2020; 13:e009769. [DOI: 10.1161/circimaging.119.009769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background:
Measurement of myocardial blood flow (MBF) with single photon emission computed tomography (SPECT) is feasible using cardiac cameras with solid-state detectors. SPECT MBF has been shown to be accurate when compared with positron emission tomography MBF measured in the same patients. However, the value of a test result applied to an individual patient depends strongly on the precision or repeatability of the test. The purpose of our study is to measure the precision of SPECT MBF measurements using
99m
Tc-tetrofosmin and a solid-state cardiac camera.
Methods:
SPECT MBF was measured in 30 patients and repeated at a mean interval of 18 days. MBF was evaluated from images with and without attenuation correction based on a separately acquired CT scan. The dynamic images were processed independently by 2 operators using in-house kinetic analysis software that applied a 1-tissue-compartment model. The K1 rate constant was converted to MBF using previously determined extraction fraction corrections. Correction for patient body motion was applied manually.
Results:
The average coefficient of variation (COV) in the differences between the 2 MBF measurements was between 28% and 31%. The interobserver COV was between 11% and 15%. Myocardial flow reserve is the ratio of MBF measured at stress and rest, and the COV is correspondingly higher. The COV for the difference in repeated myocardial flow reserve was 33% to 38%, whereas the interobserver COV was 13% to 22%.
Conclusions:
The COV for the difference in SPECT MBF measurements obtained on separate days is 28% to 31%. The corresponding COV for myocardial flow reserve is 33% to 38%.
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Garcia EV, Slomka P, Moody JB, Germano G, Ficaro EP. Quantitative Clinical Nuclear Cardiology, Part 1: Established Applications. J Nucl Cardiol 2020; 27:189-201. [PMID: 31654215 DOI: 10.1007/s12350-019-01906-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has attained widespread clinical acceptance as a standard of care for patients with known or suspected coronary artery disease (CAD). A significant contribution to this success has been the use of computer techniques to provide objective quantitative assessment in the standardization of the interpretation of these studies. Software platforms have been developed as a pipeline to provide the quantitative algorithms researched, developed and validated to be clinically useful so diagnosticians everywhere can benefit from these tools. The goal of this CME article (PART 1) is to describe the many quantitative tools that are clinically established and more importantly how clinicians should use them routinely in the interpretation, clinical management and therapy guidance of patients with CAD.
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Affiliation(s)
- Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, 101 Woodruff Circle, Room 1203, Atlanta, GA, 30322, USA.
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Mastrocola LE, Amorim BJ, Vitola JV, Brandão SCS, Grossman GB, Lima RDSL, Lopes RW, Chalela WA, Carreira LCTF, Araújo JRND, Mesquita CT, Meneghetti JC. Update of the Brazilian Guideline on Nuclear Cardiology - 2020. Arq Bras Cardiol 2020; 114:325-429. [PMID: 32215507 PMCID: PMC7077582 DOI: 10.36660/abc.20200087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Barbara Juarez Amorim
- Universidade Estadual de Campinas (Unicamp), Campinas, SP - Brazil
- Sociedade Brasileira de Medicina Nuclear (SBMN), São Paulo, SP - Brazil
| | | | | | - Gabriel Blacher Grossman
- Hospital Moinhos de Vento, Porto Alegre, RS - Brazil
- Clínica Cardionuclear, Porto Alegre, RS - Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
- Fonte Imagem Medicina Diagnóstica, Rio de Janeiro, RJ - Brazil
- Clínica de Diagnóstico por Imagem (CDPI), Grupo DASA, Rio de Janeiro, RJ - Brazil
| | | | - William Azem Chalela
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | | | | | | | - José Claudio Meneghetti
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
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Ko KY, Wang SY, Yen RF, Shiau YC, Hsu JC, Tsai HY, Lee CL, Chiu KM, Wu YW. Clinical significance of quantitative assessment of glucose utilization in patients with ischemic cardiomyopathy. J Nucl Cardiol 2020; 27:269-279. [PMID: 30109593 DOI: 10.1007/s12350-018-1395-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/27/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to prospectively quantify the rate of myocardial glucose uptake (MRGlu) in myocardium with different perfusion-metabolism patterns and determine its prognostic value in patients with ischemic cardiomyopathy. METHODS AND RESULTS 79 patients with ischemic cardiomyopathy were prospectively enrolled for dynamic cardiac FDG PET, and then followed for at least 6 months. Perfusion-metabolism patterns were determined based on visual score analysis of 201Tl SPECT and FDG PET. MRGlu was analyzed using the Patlak kinetic model. The primary end-point was cardiovascular mortality. Significantly higher MRGlu was observed in viable compared with non-viable areas. Negative correlations were found between MRGlu in transmural match and a history of hyperlipidemia, statin usage, and triglyceride levels. Diabetic patients receiving dipeptidyl peptidase-4 inhibitors (DPP4i) had a significantly lower MRGlu in transmural match, mismatch, and reverse mismatch. Patients with MRGlu in transmural match ≥ 23.40 or reverse mismatch ≥ 36.90 had a worse outcome. CONCLUSIONS Myocardial glucose utilization was influenced by substrates and medications, including statins and DPP4i. MRGlu could discriminate between viable and non-viable myocardium, and MRGlu in transmural match and reverse mismatch may be prognostic predictors of cardiovascular death in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Kuan-Yin Ko
- Department of Nuclear Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin County, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chien Shiau
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jung-Cheng Hsu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hao-Yuan Tsai
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chien-Lin Lee
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Ming Chiu
- Division of Cardiovascular Surgery, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yen-Wen Wu
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
- National Yang-Ming University School of Medicine, Taipei, Taiwan.
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Abstract
The continuous development of SPECT over the past 50 years has led to improved image quality and increased diagnostic confidence. The most influential developments include the realization of hybrid SPECT/CT devices, as well as the implementation of attenuation correction and iterative image reconstruction techniques. These developments have led to a preference for SPECT/CT devices over SPECT-only systems and to the widespread adoption of the former, strengthening the role of SPECT/CT as the workhorse of Nuclear Medicine imaging. New trends in the ongoing development of SPECT/CT are diverse. For example, whole-body SPECT/CT images, consisting of acquisitions from multiple consecutive bed positions in the manner of PET/CT, are increasingly performed. Additionally, in recent years, some interesting approaches in detector technology have found their way into commercial products. For example, some SPECT cameras dedicated to specific organs employ semiconductor detectors made of cadmium telluride or cadmium zinc telluride, which have been shown to increase the obtainable image quality by offering a higher sensitivity and energy resolution. However, the advent of quantitative SPECT/CT which, like PET, can quantify the amount of tracer in terms of Bq/mL or as a standardized uptake value could be regarded as most important development. It is a major innovation that will lead to increased diagnostic accuracy and confidence, especially in longitudinal studies and in the monitoring of treatment response. The current work comprises two main aspects. At first, physical and technical fundamentals of SPECT image formation are described and necessary prerequisites of quantitative SPECT/CT are reviewed. Additionally, the typically achievable quantitative accuracy based on reports from the literature is given. Second, an extensive list of studies reporting on clinical applications of quantitative SPECT/CT is provided and reviewed.
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Affiliation(s)
- Philipp Ritt
- Clinic of Nuclear Medicine, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
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67
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Wang B, Kreuger R, Huizenga J, Beekman FJ, Goorden MC. Experimental Validation of a Gamma Detector With a Novel Light-Guide-PMT Geometry to Reduce Dead Edge Effects. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2020. [DOI: 10.1109/trpms.2019.2916386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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68
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Manrique A, Dudoignon D, Brun S, N'Ganoa C, Cassol E, Legallois D, Lavie-Badie Y, Agostini D, Lairez O. Quantification of myocardial 99mTc-labeled bisphosphonate uptake with cadmium zinc telluride camera in patients with transthyretin-related cardiac amyloidosis. EJNMMI Res 2019; 9:117. [PMID: 31873816 PMCID: PMC6928186 DOI: 10.1186/s13550-019-0584-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/06/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE We aimed to compare different methods for semi-quantitative analysis of cardiac retention of bone tracers in patients with cardiac transthyretin amyloidosis (ATTR). METHODS Data from 67 patients with ATTR who underwent both conventional whole-body scan and a CZT myocardial SPECT (DSPECT, Spectrum Dynamics) 3 h after injection of 99mTc-labeled bone tracer were analyzed. Visual scoring of cardiac retention was performed on whole-body scan according to Perugini 4-point grading system from 0 (no uptake) to 3 (strong cardiac uptake with mild/absent bone uptake). A planar heart-to-background (H:B) ratio was calculated using whole-body scan (wb-H:B). CZT SPECT was quantified using three methods: planar H:B ratio calculated from anterior reprojection (ant-H:B), left anterior oblique reprojection (LAO-H:B), and 3D-H:B ratio calculated from transaxial slices as mean counts in a VOI encompassing the heart divided by background VOI in the contralateral lung. Interventricular septal thickness was obtained using echocardiography. RESULTS H:Bs obtained from planar and reprojected data were not statistically different (wb-H:B, 2.05 ± 0.64, ant-H:B, 1.97 ± 0.61, LAO-H:B, 2.06 ± 0.64, all p = ns). However, 3D-H:B was increased compared to planar H:Bs (3D-H:B, 4.06 ± 1.77, all p < 0.0001 vs. wb-H:B, ant-H:B, and LAO-H:B). Bland-Altman plots demonstrated that the difference between 3D and planar H:Bs increased with the mean value of myocardial uptake. 3D-H:B was best correlated to septal thickness (r = 0.45, p < 0.001). Finally, abnormal right ventricular uptake was associated with higher values of cardiac retention. CONCLUSION 3D semi-quantitative analysis of CZT SPECT optimized the assessment of 99mTc-labeled bone tracer myocardial uptake in patients with cardiac amyloidosis.
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Affiliation(s)
- Alain Manrique
- Department of Nuclear Medicine, Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen, 14000, Caen, France. .,GIP Cyceron, Campus Jules Horowitz, Boulevard Henri Becquerel, BP 5229, 14074, Caen, France.
| | - David Dudoignon
- Department of Nuclear Medicine, Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen, 14000, Caen, France
| | - Stéphanie Brun
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.,Medical School, Toulouse III Paul Sabatier University, Toulouse, France
| | - Catherine N'Ganoa
- Department of Nuclear Medicine, Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen, 14000, Caen, France
| | - Emmanuelle Cassol
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.,Medical School, Toulouse III Paul Sabatier University, Toulouse, France
| | - Damien Legallois
- Department of Cardiology, Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen, 14000, Caen, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Denis Agostini
- Department of Nuclear Medicine, Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen, 14000, Caen, France
| | - Olivier Lairez
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.,Medical School, Toulouse III Paul Sabatier University, Toulouse, France
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Eckelman WC, Kuwert T, Ciarmiello A, Riondato M, Mansi L. Changes over the years in radiopharmaceutical design. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2019; 66:261-271. [PMID: 31833739 DOI: 10.23736/s1824-4785.19.03216-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Of the many uses of radiopharmaceuticals, developing radiotracers that contribute significantly to diagnosis and therapy of patients has been a major focus. This requires a broad spectrum of expertise including that of the attending physician who lends insight to an unmet clinical need neither addressed by other imaging techniques nor by analysis of tissue, blood, and urine for diagnostics and addressed by pharmaceuticals for therapeutic applications. The design criteria have depended on radiochemistry, on matching the radiopharmaceutical with the imaging devices, and basing the design on current pharmaceuticals. The chelates of technetium-99m were based on radiochemistry rather than clinical need yet are still used today in >70% of the clinical studies. Targeted radiotracers in neurologic and psychiatric disorders, inflammation, cardiovascular disease, and oncology have all been studied with the goal of determining the change in the density of a target protein as a function of disease or treatment or, especially in oncology, detection of the total extent of disease. In latter approach PET in university settings leads the way; however, the use of SPECT/CT has increased the specificity of SPECT imaging to complement the cost- effective generator and instant kits already available. Remarkable advances has been achieved in radionuclide therapy using theragnostic agents, with the exclusive domain of oncology For this application the design of radionuclide therapy follows that used for diagnostics. The increased impact of the discipline depends on the opportunity to continue the search for the most appropriate radiopharmaceutical for each individual patient.
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Affiliation(s)
| | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | | | - Mattia Riondato
- Nuclear Medicine Unit, S. Andrea Hospital, La Spezia, Italy -
| | - Luigi Mansi
- Section Health and Development, Interuniversity Research Center for Sustainability (CIRPS), Napoli, Italy
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Könik A, Auer B, De Beenhouwer J, Kalluri K, Zeraatkar N, Furenlid LR, King MA. Primary, scatter, and penetration characterizations of parallel-hole and pinhole collimators for I-123 SPECT. Phys Med Biol 2019; 64:245001. [PMID: 31746783 DOI: 10.1088/1361-6560/ab58fe] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Multi-pinhole (MPH) collimators are known to provide better trade-off between sensitivity and resolution for preclinical, as well as for smaller regions in clinical SPECT imaging compared to conventional collimators. In addition to this geometric advantage, MPH plates typically offer better stopping power for penetration than the conventional collimators, which is especially relevant for I-123 imaging. The I-123 emits a series of high-energy (>300 keV, ~2.5% abundance) gamma photons in addition to the primary emission (159 keV, 83% abundance). Despite their low abundance, high-energy photons penetrate through a low-energy parallel-hole (LEHR) collimator much more readily than the 159 keV photons, resulting in large downscatter in the photopeak window. In this work, we investigate the primary, scatter, and penetration characteristics of a single pinhole collimator that is commonly used for I-123 thyroid imaging and our two MPH collimators designed for I-123 DaTscan imaging for Parkinson's Disease, in comparison to three different parallel-hole collimators through a series of experiments and Monte Carlo simulations. The simulations of a point source and a digital human phantom with DaTscan activity distribution showed that our MPH collimators provide superior count performance in terms of high primary counts, low penetration, and low scatter counts compared to the parallel-hole and single pinhole collimators. For example, total scatter, multiple scatter, and collimator penetration events for the LEHR were 2.5, 7.6 and 14 times more than that of MPH within the 15% photopeak window. The total scatter fraction for LEHR was 56% where the largest contribution came from the high-energy scatter from the back compartments (31%). For the same energy window, the total scatter for MPH was 21% with only 1% scatter from the back compartments. We therefore anticipate that using MPH collimators, higher quality reconstructions can be obtained in a substantially shorter acquisition time for I-123 DaTscan and thyroid imaging.
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Affiliation(s)
- Arda Könik
- Department of Imaging, Dana Farber Cancer Institute, Boston, MA 02215, United States of America
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71
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Oddstig J, Martinsson E, Jögi J, Engblom H, Hindorf C. Differences in attenuation pattern in myocardial SPECT between CZT and conventional gamma cameras. J Nucl Cardiol 2019; 26:1984-1991. [PMID: 29796975 PMCID: PMC6908561 DOI: 10.1007/s12350-018-1296-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/26/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND In myocardial perfusion imaging (MPI), single-photon emission tomography (SPECT) soft-tissue attenuation by the abdomen, breasts, and lateral chest wall may create artifacts that mimic true perfusion defects. This may cause misdiagnosis of myocardial perfusion. The aim of the present study was to compare the localization, extent, and depth of attenuation artifacts in MPI SPECT for a multi-pinhole cadmium zinc telluride (CZT) camera vs a conventional gamma camera. METHODS Phantom and patient measurements were performed using a CZT camera (GE NM 530c) and a conventional gamma camera (GE Ventri). All images were attenuation corrected with externally acquired low-dose computed tomography. The localization, extent, and depth of the attenuation artifact were quantified by comparing attenuation-corrected and non-attenuation-corrected images. RESULTS Attenuation artifacts were shifted from the inferolateral wall to the lateral wall using the CZT camera compared to a conventional camera in both the patient and the phantom. The extent of the attenuation artifact was significantly larger for the CZT camera compared to the conventional camera (23 ± 5% vs 15 ± 5%, P < .001) for patients and the result was similar for the phantom (28% vs 19%). Furthermore, the depth of the attenuation artifact (percent of maximum counts) was less pronounced for the CZT camera than for the conventional camera, both for phantom measurements (73% vs 67%) and patients (72 ± 3% vs 68 ± 4%, P < .001). CONCLUSIONS Attenuation artifacts are found in different locations to different extents and depths when using a CZT camera vs a conventional gamma camera for MPI SPECT. This should be taken into consideration when evaluating MPI SPECT studies to avoid misinterpretation of myocardial perfusion distribution.
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Affiliation(s)
- Jenny Oddstig
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden.
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, 221 85, Lund, Sweden.
| | - Elin Martinsson
- Department of Medical Radiation Physics, Clinical Sciences, Lund University, Lund, Sweden
| | - Jonas Jögi
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, 221 85, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, 221 85, Lund, Sweden
| | - Cecilia Hindorf
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
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72
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Nkoulou R, Wolfrum M, Pazhenkottil AP, Fiechter M, Buechel RR, Gaemperli O, Kaufmann PA. Gated SPECT myocardial perfusion imaging with cadmium-zinc-telluride detectors allows real-time assessment of dobutamine-stress-induced wall motion abnormalities. J Nucl Cardiol 2019; 26:1734-1742. [PMID: 29340989 DOI: 10.1007/s12350-018-1187-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 12/18/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left ventricular (LV) ejection fraction (EF) during high dobutamine stress (HD) by real-time gated-SPECT myocardial perfusion imaging (MPI) on a cadmium-zinc-telluride (CZT) gamma camera was validated versus cardiac magnetic resonance imaging (CMR). METHODS AND RESULTS After injecting 99mTc-tetrofosmin (320 MBq) in 50 patients (mean age 64 +/- 11 years), EF at rest and post-stress as well as relevant changes in EF at HD (ΔEF ≥ 5%) were assessed. CZT and CMR rest EF values yielded an excellent correlation and agreement (r = 0.96; P < 0.001; Bland-Altman limits of agreement (BA): + 0 to 14.8%). HD EF acquisition was feasible using CZT and correlated better to HD CMR EF than did post-stress CZT EF (r = 0.85 vs 0.76, respectively, all P < 0.001). Agreement in ΔEF detection between HD CMR and immediate post-stress CZT (reflecting standard acquisition using conventional SPECT camera unable to scan during stress) was 45%, while this increased to 85% with real-time HD CZT scan. CONCLUSION Real-time ultrafast dobutamine gated-SPECT MPI with a CZT device is feasible and provides accurate measurements of HD LV performance.
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Affiliation(s)
- Rene Nkoulou
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
- Department of Cardiology, University Hospital Geneva, Geneva, Switzerland.
| | - Mathias Wolfrum
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Michael Fiechter
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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73
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Liu FS, Wang SY, Shiau YC, Wu YW. The clinical value and safety of ECG-gated dipyridamole myocardial perfusion imaging in patients with aortic stenosis. Sci Rep 2019; 9:12443. [PMID: 31455862 PMCID: PMC6712027 DOI: 10.1038/s41598-019-48901-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/15/2019] [Indexed: 12/31/2022] Open
Abstract
The role of vasodilator myocardial perfusion imaging (MPI) for aortic stenosis (AS) is controversial due to safety and accuracy concerns. In addition, its utility after aortic valve (AV) interventions remains unclear. Patients with AS who underwent thallium-201-gated dipyridamole MPI using a cadmium-zinc-telluride camera were retrospectively reviewed and divided into three groups: mild AS, moderate-to-severe AS, and prior AV interventions. Patients with coronary artery disease with ≥50% stenosis, severe arrhythmia, left ventricular ejection fraction (LVEF) <40%, left bundle branch block or no follow-up were excluded. Relationships between the severity of AS, clinical characteristics, hemodynamic response, serious adverse events (SAE) and MPI parameters were analyzed. None of the 47 patients had SAE, including significant hypotension or LVEF reduction. The moderate-to-severe AS group had higher summed stress scores (SSSs) and depressed LVEF than the mild AS group, however there were no differences after AV interventions. SSS was positively correlated with AV mean pressure gradient, post-stress lung-heart ratio (LHRs), and post-stress end-diastolic volume (EDVs) (P < 0.05). In multivariate analysis, LHRs and EDVs were independent contributors to SSS. Dipyridamole-induced ischemia and LV dysfunction is common, and dipyridamole stress could be a safe diagnostic tool in evaluation and follow-up in patients with AS.
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Affiliation(s)
- Fang-Shin Liu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Yu-Chien Shiau
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan. .,Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan. .,National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
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Garcia EV, Slomka P, Moody JB, Germano G, Ficaro EP. Quantitative Clinical Nuclear Cardiology, Part 1: Established Applications. J Nucl Med 2019; 60:1507-1516. [PMID: 31375569 DOI: 10.2967/jnumed.119.229799] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/11/2019] [Indexed: 01/10/2023] Open
Abstract
SPECT myocardial perfusion imaging has attained widespread clinical acceptance as a standard of care for patients with known or suspected coronary artery disease. A significant contribution to this success has been the use of computer techniques to provide objective quantitative assessment in the standardization of the interpretation of these studies. Software platforms have been developed as a pipeline to provide the quantitative algorithms researched, developed and validated to be clinically useful so diagnosticians everywhere can benefit from these tools. The goal of this continuing medical education article (part 1) is to describe the many quantitative tools that are clinically established and, more importantly, how clinicians should use them routinely in interpretation, clinical management, and therapy guidance for patients with coronary artery disease.
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Affiliation(s)
- Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, Michigan; and.,Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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75
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Massalha S, Almufleh A, Small G, Marvin B, Keidar Z, Israel O, Kennedy JA. Strategies for Minimizing Occupational Radiation Exposure in Cardiac Imaging. Curr Cardiol Rep 2019; 21:71. [PMID: 31227929 DOI: 10.1007/s11886-019-1157-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Radiation safety has been at the center of interest of both researchers and healthcare institutions. This review will summarize and shed light on the various techniques adapted to reduce staff exposure to ionizing radiation (IR) in the field of cardiac imaging. RECENT FINDINGS In the last years, with the advance of awareness and the development of new technologies, there have been several tools and techniques adapted. The breakthrough of several technologies to lower radiation dose and shorten the duration of diagnostic tests associated with IR, the use of protection devices by staff members, and mostly the awareness of exposure to IR are the hallmark of these advances. Using all these measures has led to a significant decrease in staff exposure to IR. Reducing staff exposure to meet the "As Low As Reasonably Achievable" principle is feasible. This review introduces the most important strategies applied in cardiac imaging.
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Affiliation(s)
- Samia Massalha
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada. .,Department of Cardiology, Rambam Health Care Campus, Haifa, Israel. .,Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.
| | - Aws Almufleh
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Garry Small
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Brian Marvin
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Ora Israel
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - John A Kennedy
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.,Faculty of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel
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Clackdoyle R, Noo F. Quantification of Tomographic Incompleteness in Cone-Beam Reconstruction. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2019; 4:63-80. [PMID: 33506155 DOI: 10.1109/trpms.2019.2918222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
For situations of cone-beam scanning where the measurements are incomplete, we propose a method to quantify the severity of the missing information at each voxel. This incompleteness metric is geometric; it uses only the relative locations of all cone-beam vertices with respect to the voxel in question, and does not apply global information such as the object extent or the pattern of incompleteness of other voxels. The values are non-negative, with zero indicating "least incompleteness," i.e. minimal danger of incompleteness artifacts. The incompleteness value can be related to the severity of the potential reconstruction artifact at the voxel location, independent of reconstruction algorithm. We performed a computer simulation of x-ray sources along a circular trajectory, and used small multi-disk test-objects to examine the local effects of data incompleteness. The observed behavior of the reconstructed test-objects quantitatively matched the precalculated incompleteness values. A second simulation of a hypothetical SPECT breast imaging system used only 12 pinholes. Reconstructions were performed using analytic and iterative methods, and five reconstructed test-objects matched the behavior predicted by the incompleteness model. The model is based on known sufficiency conditions for data incompleteness, and provides strong predictive guidance for what can go wrong with incomplete cone-beam data.
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Affiliation(s)
| | - Frédéric Noo
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, USA
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Nguyen MP, Goorden MC, Kamphuis C, Beekman FJ. Evaluation of pinhole collimator materials for micron-resolution ex vivo SPECT. ACTA ACUST UNITED AC 2019; 64:105017. [DOI: 10.1088/1361-6560/ab1618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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78
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Kennedy JA, Reizberg I, Lugassi R, Himmelman S, Keidar Z. Absolute radiotracer concentration measurement using whole-body solid-state SPECT/CT technology: in vivo/in vitro validation. Med Biol Eng Comput 2019; 57:1581-1590. [PMID: 31025249 DOI: 10.1007/s11517-019-01979-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 04/04/2019] [Indexed: 11/25/2022]
Abstract
The accuracy of recently approved quantitative clinical software was determined by comparing in vivo/in vitro measurements for a solid-state cadmium-zinc-telluride SPECT/CT (single photon emission computed tomography/x-ray computed tomography) camera. Bone SPECT/CT, including the pelvic region in the field of view, was performed on 16 patients using technetium-99m methylene diphosphonic acid as a radiotracer. After imaging, urine samples from each patient provided for the measurement of in vitro radiopharmaceutical concentrations. From the SPECT/CT images, three users measured in vivo radiotracer concentration and standardized uptake value (SUV) for the bladder using quantitative software (Q.Metrix, GE Healthcare). Linear regression was used to validate any in vivo/in vitro identity relations (ideally slope = 1, intercept = 0), within a 95% confidence interval (CI). Thirteen in vivo/in vitro pairs were available for further analysis, after rejecting two as clinically irrelevant (SUVs > 100 g/mL) and one as an outlier (via Cook's distance calculations). All linear regressions (R2 ≥ 0.85, P < 0.0001) provided identity in vivo/in vitro relations (95% CI), with SUV averages from all users giving a slope of 0.99 ± 0.25 and intercept of 0.14 ± 5.15 g/mL. The average in vivo/in vitro residual difference was < 20%. Solid-state SPECT/CT imaging can reliably provide in vivo urinary bladder radiotracer concentrations within approximately 20% accuracy. This practical, non-invasive, in vivo quantitation method can potentially improve diagnosis and assessment of response to treatment. Graphical abstract.
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Affiliation(s)
- John A Kennedy
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 3109601, Haifa, Israel. .,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ilya Reizberg
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 3109601, Haifa, Israel
| | - Rachel Lugassi
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 3109601, Haifa, Israel
| | - Shoham Himmelman
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 3109601, Haifa, Israel
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 3109601, Haifa, Israel.,The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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79
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Lee Y. Performance evaluation of noise reduction algorithm with median filter using improved thresholding method in pixelated semiconductor gamma camera system: A numerical simulation study. NUCLEAR ENGINEERING AND TECHNOLOGY 2019. [DOI: 10.1016/j.net.2018.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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80
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Daou D. Dedicated cardiac CZT SPECT is steadily moving to achieve its destiny. J Nucl Cardiol 2019; 26:453-455. [PMID: 28744820 DOI: 10.1007/s12350-017-1006-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 01/26/2023]
Affiliation(s)
- Doumit Daou
- EA 7334 REMES, Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.
- Nuclear Medicine Department, Cochin University Hospital, 27 rue du Faubourg Saint-Jacques, 75679, Paris Cedex 14, France.
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81
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Lee JS, Kovalski G, Sharir T, Lee DS. Advances in imaging instrumentation for nuclear cardiology. J Nucl Cardiol 2019; 26:543-556. [PMID: 28718074 DOI: 10.1007/s12350-017-0979-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/08/2017] [Indexed: 12/22/2022]
Abstract
Advances in imaging instrumentation and technology have greatly contributed to nuclear cardiology. Dedicated cardiac SPECT cameras incorporating novel, highly efficient detector, collimator, and system designs have emerged with the expansion of nuclear cardiology. Solid-state radiation detectors incorporating cadmium zinc telluride, which directly convert radiation to electrical signals and yield improved energy resolution and spatial resolution and enhanced count sensitivity geometries, are increasingly gaining favor as the detector of choice for application in dedicated cardiac SPECT systems. Additionally, hybrid imaging systems in which SPECT and PET are combined with X-ray CT are currently widely used, with PET/MRI hybrid systems having also been recently introduced. The improved quantitative SPECT/CT has the potential to measure the absolute quantification of myocardial blood flow and flow reserve. Rapid development of silicon photomultipliers leads to enhancement in PET image quality and count rates. In addition, the reduction of emission-transmission mismatch artifacts via application of accurate time-of-flight information, and cardiac motion de-blurring aided by anatomical images, are emerging techniques for further improvement of cardiac PET. This article reviews recent advances such as these in nuclear cardiology imaging instrumentation and technology, and the corresponding diagnostic benefits.
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Affiliation(s)
- Jae Sung Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | | | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Korea.
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Suwon, Korea.
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Abstract
Cardiac SPECT continues to play a critical role in detecting and managing cardiovascular disease, in particularly coronary artery disease (CAD) (Jaarsma et al 2012 J. Am. Coll. Cardiol. 59 1719-28), (Agostini et al 2016 Eur. J. Nucl. Med. Mol. Imaging 43 2423-32). While conventional dual-head SPECT scanners using parallel-hole collimators and scintillation crystals with photomultiplier tubes are still the workhorse of cardiac SPECT, they have the limitations of low photon sensitivity (~130 count s-1 MBq-1), poor image resolution (~15 mm) (Imbert et al 2012 J. Nucl. Med. 53 1897-903), relatively long acquisition time, inefficient use of the detector, high radiation dose, etc. Recently our field observed an exciting growth of new developments of dedicated cardiac scanners and collimators, as well as novel imaging algorithms for quantitative cardiac SPECT. These developments have opened doors to new applications with potential clinical impact, including ultra-low-dose imaging, absolute quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR), multi-radionuclide imaging, and improved image quality as a result of attenuation, scatter, motion, and partial volume corrections (PVCs). In this article, we review the recent advances in cardiac SPECT instrumentation and imaging methods. This review mainly focuses on the most recent developments published since 2012 and points to the future of cardiac SPECT from an imaging physics perspective.
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Affiliation(s)
- Jing Wu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, United States of America
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83
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Okano N, Osawa I, Tsuchihashi S, Takahashi M, Niitsu M, Matsunari I. High-speed scanning of planar images showing 123I-MIBG uptake using a whole-body CZT camera: a phantom and clinical study. EJNMMI Res 2019; 9:22. [PMID: 30806836 PMCID: PMC6391509 DOI: 10.1186/s13550-019-0491-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background The heart-to-mediastinum ratio (HMR) obtained in myocardial sympathetic innervation imaging using 123I-metaiodobenzylguanidine (MIBG) is used for heart failure or Lewy body diseases (LBD). Discovery NM/CT 670 CZT, a novel whole-body scanner, enables direct HMR measurements in planar images, in contrast to cardiac-dedicated CZT-based cameras which require specific post-processing reconstruction. We sought to investigate the clinical utility of the Discovery NM/CT 670 CZT for myocardial innervation imaging and the potential time reduction. Results Following preliminary phantom examinations, 123I-MIBG planar imaging was performed in 36 patients with suspected or known LBD to measure HMRs with a collection time of 300 s. Images for different collection times were subsequently reframed using already acquired data, and changes in HMRs were evaluated. The HMRs for patients with versus without clinically diagnosed LBD were 1.63 ± 0.08 versus 2.21 ± 0.08 at early phase (p < 0.001) and 1.54 ± 0.09 versus 2.08 ± 0.09 at delayed phase (p < 0.001). The difference of HMRs (300 s − other collection time) became greater as the collection time became shorter. There was good consistency in HMRs between the 300-s images (reference) and the 200-s (intra-class correlation (ICC) coefficients > 0.99), 100-s (ICC coefficients > 0.97), and 50-s (ICC coefficients > 0.89) images. Conclusions In planar images with a whole-body CZT-based camera, the HMRs of patients with LBD were significantly lower than those without. HMRs with the collection time of 50 s and longer showed good consistency with those of 300 s in the ICC analysis. These findings indicate a clinical utility of this novel scanner for HMR measurements and potential time reductions. Electronic supplementary material The online version of this article (10.1186/s13550-019-0491-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nanami Okano
- Department of Radiology, Saitama Medical University Hospital, 38 Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan.
| | - Iichiro Osawa
- Department of Radiology, Saitama Medical University Hospital, 38 Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan
| | - Saki Tsuchihashi
- Department of Radiology, Saitama Medical University Hospital, 38 Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan
| | - Masafumi Takahashi
- Department of Central Radiological Technology, Saitama Medical University Hospital, Saitama, Japan
| | - Mamoru Niitsu
- Department of Radiology, Saitama Medical University Hospital, 38 Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan
| | - Ichiro Matsunari
- Division of Nuclear Medicine, Department of Radiology, Saitama Medical University Hospital, Saitama, Japan
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84
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Kennedy JA, Brodov Y, Weinstein AL, Israel O, Frenkel A. The effect of CT-based attenuation correction on the automatic perfusion score of myocardial perfusion imaging using a dedicated cardiac solid-state CZT SPECT/CT. J Nucl Cardiol 2019; 26:236-245. [PMID: 28462467 DOI: 10.1007/s12350-017-0905-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/18/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Data regarding cardiac cadmium-zinc-telluride (CZT)-specific augmented databases and their impact on CT-based attenuation correction (AC) perfusion scores in myocardial perfusion imaging (MPI) were obtained on a multiple-pinhole CZT SPECT/CT. METHODS AND RESULTS Summed stress (SSS) and rest scores (SRS) were measured using automated software in three independent patient groups: group 1 (n = 80) underwent MPI on both CZT and conventional sodium iodide (NaI) devices, group 2 (n = 80) with low coronary artery disease likelihood and normal MPI provided reference CZT databases; and group 3 (n = 152) served to compare AC and non-AC (NAC) scores on CZT. Group 1 CZT and NaI scores gave a significant 1:1 linear correlation for CZT scores referenced to the custom database vs NaI scores referenced to the default database, but these were not concordant when CZT scores were referenced to the default database. AC significantly decreased average SSS and SRS in men vs NAC, 4.29 ± 6.30 vs 5.37 ± 7.26 (P < 0.001) and 2.37 ± 4.72 vs 3.13 ± 5.85 (P < 0.001), but not in women, 2.28 ± 3.42 vs 2.28 ± 3.08 (p NS) and 0.46 ± 1.51 vs 0.61 ± 1.86, (p NS), respectively. CONCLUSIONS Specifically designed databases for solid-state CZT cardiac SPECT provide accurate quantitation of perfusion scores concordant with those previously validated for conventional SPECT. AC and NAC CZT scores differed significantly, especially in men.
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Affiliation(s)
- John A Kennedy
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 31096, Haifa, Israel.
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel.
| | - Yafim Brodov
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 31096, Haifa, Israel
| | - Adam L Weinstein
- B. and R. Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ora Israel
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 31096, Haifa, Israel
- B. and R. Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Alex Frenkel
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 31096, Haifa, Israel
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85
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Mohy-Ud-Din H, Boutagy NE, Stendahl JC, Zhuang ZW, Sinusas AJ, Liu C. Quantification of intramyocardial blood volume with 99mTc-RBC SPECT-CT imaging: A preclinical study. J Nucl Cardiol 2018; 25:2096-2111. [PMID: 28695406 PMCID: PMC5985225 DOI: 10.1007/s12350-017-0970-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Currently, there is no established non-invasive imaging approach to directly evaluate myocardial microcirculatory function in order to diagnose microvascular disease independent of co-existing epicardial disease. In this work, we developed a methodological framework for quantification of intramyocardial blood volume (IMBV) as a novel index of microcirculatory function with SPECT/CT imaging of 99mTc-labeled red blood cells (RBCs). METHODS Dual-gated myocardial SPECT/CT equilibrium imaging of 99mTc-RBCs was performed on twelve canines under resting conditions. Five correction schemes were studied: cardiac gating with no other corrections (CG), CG with attenuation correction (CG + AC), CG + AC with scatter correction (CG + AC + SC), dual cardiorespiratory gating with AC + SC (DG + AC + SC), and DG + AC + SC with partial volume correction (DG + AC + SC + PVC). Quantification of IMBV using each approach was evaluated in comparison to those obtained from all corrections. The in vivo SPECT estimates of IMBV values were validated against those obtained from ex vivo microCT imaging of the casted hearts. RESULTS The estimated IMBV with all corrections was 0.15 ± 0.03 for the end-diastolic phase and 0.11 ± 0.03 for the end-systolic phase. The cycle-dependent change in IMBV (ΔIMBV) with all corrections was 23.9 ± 8.6%. Schemes that applied no correction or partial correction resulted in significant over-estimation of IMBV and significant under-underestimation of ΔIMBV. Estimates of IMBV and ΔIMBV using all corrections were consistent with values reported in the literature using invasive techniques. In vivo SPECT estimates of IMBV strongly correlated (R2 ≥ 0.70) with ex vivo measures for the various correction schemes, while the fully corrected scheme yielded the smallest bias. CONCLUSIONS Non-invasive quantification of IMBV is feasible using 99mTc-RBCs SPECT/CT imaging, however, requires full compensation of physical degradation factors.
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Affiliation(s)
- Hassan Mohy-Ud-Din
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
- Shaukat Khanum Memorial Cancer Hospital and Research Center, 7-A, Block R-3, Johar Town, Lahore, 54000, Pakistan.
| | - Nabil E Boutagy
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - John C Stendahl
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Zhen W Zhuang
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
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86
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de Souza ACDAH, Gonçalves BKD, Tedeschi A, Lima RDSL. Quantification of Coronary Flow Reserve with CZT Gamma Camera in the Evaluation of Multivessel Coronary Disease. Arq Bras Cardiol 2018; 111:635-637. [PMID: 30365687 PMCID: PMC6199508 DOI: 10.5935/abc.20180196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/10/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ana Carolina do Amaral Henrique de Souza
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ -
Brazil ,Mailing Addressa: Ana Carolina do Amaral Henrique de
Souza, Av. Jornalista Alberto Francisco Torres, 67 apto 601, Postal
Code 24230-000, Icaraí, Niterói, RJ - Brazil. E-mail:
| | | | - Angelo Tedeschi
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ -
Brazil
| | - Ronaldo de Souza Leão Lima
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ -
Brazil , Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ
- Brazil
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87
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Blaire T, Bailliez A, Ben Bouallegue F, Bellevre D, Agostini D, Manrique A. First assessment of simultaneous dual isotope ( 123I/ 99mTc) cardiac SPECT on two different CZT cameras: A phantom study. J Nucl Cardiol 2018; 25:1692-1704. [PMID: 28275896 DOI: 10.1007/s12350-017-0841-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND We studied the impact of simultaneous dual-isotope acquisition on 123I/99mTc mismatch assessment using two CZT cameras (DNM 530c, GE Healthcare and DSPECT, Biosensors International). METHODS We used an anthropomorphic torso phantom (respectively filled with a solution of 123I alone, 99mTc alone, and a mixture of 123I and 99mTc) and its cardiac insert with two defects mimicking two matched and mismatched defects. Mismatch extent and reconstructed image contrast were evaluated. RESULTS The acquisition mode (single vs dual) significantly impacted (i) 99mTc (but not 123I) reconstructed segmental activities using both camera (P < .001), and (ii) image contrast (using 123I and DNM 530c, P < .0001; and using both 123I and 99mTc with DSPECT, P < .0001). However, the defect and mismatch size were not impacted by the type of acquisition. With both DNM 530c and DSPECT, Lin's concordance correlation coefficient and Bland-Altman analysis demonstrated an almost perfect concordance and agreement between single- and simultaneous dual-isotope segmental activity (123I and 99mTc). CONCLUSIONS This study found no impact of the acquisition mode (single vs dual) or the type of camera (DSPECT vs DNM 530c) on 123I and 99mTc defect size and mismatch, providing a new step toward simultaneous dual-isotope acquisition for combined innervation and perfusion assessment.
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Affiliation(s)
- Tanguy Blaire
- Department of Nuclear Medicine, UF 5881, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lomme, France.
- Normandie Univ, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, 14000, Caen, France.
- Department of Nuclear Medicine, IRIS, Hôpital Privé Le Bois, Lille, France.
| | - Alban Bailliez
- Department of Nuclear Medicine, UF 5881, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lomme, France
- Normandie Univ, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, 14000, Caen, France
- Department of Nuclear Medicine, IRIS, Hôpital Privé Le Bois, Lille, France
| | | | | | - Denis Agostini
- Normandie Univ, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, 14000, Caen, France
- Department of Nuclear Medicine, CHU Cote de Nacre, Caen, France
| | - Alain Manrique
- Normandie Univ, UNICAEN, Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, FHU REMOD-VHF, 14000, Caen, France
- Department of Nuclear Medicine, CHU Cote de Nacre, Caen, France
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88
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Dorbala S, Ananthasubramaniam K, Armstrong IS, Chareonthaitawee P, DePuey EG, Einstein AJ, Gropler RJ, Holly TA, Mahmarian JJ, Park MA, Polk DM, Russell R, Slomka PJ, Thompson RC, Wells RG. Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation. J Nucl Cardiol 2018; 25:1784-1846. [PMID: 29802599 DOI: 10.1007/s12350-018-1283-y] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Sharmila Dorbala
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | - Andrew J Einstein
- Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | | | - Thomas A Holly
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John J Mahmarian
- Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA
| | | | - Donna M Polk
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - R Glenn Wells
- University of Ottawa Heart Institute, Ottawa, Canada
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89
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Giannopoulos AA, Buechel RR. A further step towards getting cardiac respiratory motion under control. J Nucl Cardiol 2018; 25:1310-1312. [PMID: 28247262 DOI: 10.1007/s12350-017-0835-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Andreas A Giannopoulos
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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90
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Daou D, Sabbah R, Coaguila C, Boulahdour H. Impact of data-driven cardiac respiratory motion correction on the extent and severity of myocardial perfusion defects with free-breathing CZT SPECT. J Nucl Cardiol 2018; 25:1299-1309. [PMID: 28160264 DOI: 10.1007/s12350-017-0806-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/24/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND We previously reported the clinical feasibility and positive impact on image characteristics of a data-driven cardiac respiratory motion (RM) correction method (REGAT) applicable to CZT SPECT myocardial perfusion imaging (MPI). Here, we evaluate its impact on the extent and severity of myocardial perfusion defects (MPD). METHODS We included 25 patients having a 1-day 99mTc-Tetrofosmin stress/rest MPI acquired with multi-pinhole CZT SPECT. Acquisitions were processed with REGAT to generate mean RM gated SPECT. These were summed either after (R-SPECT) or without realignment (NR-SPECT). We noted the maximal cardiac RM shift in the 3 axes of the left ventricle (LV). Both visual and semi-quantitative analyses of myocardial tracer uptake were realized. Studies were classified as having an impact on the extent/severity of MPD with REGAT if ≥1 segment presented a severity score changing by ≥1 level between NR-SPECT and R-SPECT. An impact on the extent of MPD was considered present if at least 1 segment shifted from normal (score = 0) to abnormal (score different from 0) or inversely. RESULTS Cardiac RM was >10 mm in 55% of studies. With visual and semi-quantitative analyses, an impact on the extent/severity MPD was observed in 14% of all studies (7/49) and 60% of studies with cardiac RM >15 mm. An impact on the extent of MPD was observed in 5 of the 7 upper listed studies. All studies presenting an impact on MPD had RM in the anterior to inferior LV axis >10 mm. CONCLUSIONS A substantial number of MPI studies presented significant cardiac RM. Cardiac RM compensation showed a frequent impact on the extent/severity of MPD.
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Affiliation(s)
- Doumit Daou
- EA 7334 REMES, Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.
- Nuclear Medicine Department, Cochin University Hospital, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679, Paris Cedex 14, France.
| | - Rémy Sabbah
- Nuclear Medicine Department, CHU Jean Minjoz, Besançon, France
| | - Carlos Coaguila
- Nuclear Medicine Department, Centre Hospitalier de Bigorre, Tarbes, France
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91
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Feasibility of dynamic stress 201Tl/rest 99mTc-tetrofosmin single photon emission computed tomography for quantification of myocardial perfusion reserve in patients with stable coronary artery disease. Eur J Nucl Med Mol Imaging 2018; 45:2173-2180. [DOI: 10.1007/s00259-018-4057-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/23/2018] [Indexed: 10/14/2022]
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92
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Cuddy-Walsh SG, Wells RG. Patient-specific estimation of spatially variant image noise for a pinhole cardiac SPECT camera. Med Phys 2018; 45:2033-2047. [DOI: 10.1002/mp.12883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/14/2017] [Accepted: 03/15/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sarah G. Cuddy-Walsh
- Department of Physics; Carleton University; Ottawa ON K1S 5B6 Canada
- Division of Cardiology; University of Ottawa Heart Institute; Ottawa ON K1Y 4W7 Canada
| | - R. Glenn Wells
- Department of Physics; Carleton University; Ottawa ON K1S 5B6 Canada
- Division of Cardiology; University of Ottawa Heart Institute; Ottawa ON K1Y 4W7 Canada
- Department of Medicine; University of Ottawa; Ottawa ON K1N 6N5 Canada
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93
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Goshen E, Beilin L, Stern E, Kenig T, Goldkorn R, Ben-Haim S. Feasibility study of a novel general purpose CZT-based digital SPECT camera: initial clinical results. EJNMMI Phys 2018. [PMID: 29536291 PMCID: PMC5849748 DOI: 10.1186/s40658-018-0205-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The performance of a prototype novel digital single-photon emission computed tomography (SPECT) camera with multiple pixelated CZT detectors and high sensitivity collimators (Digital SPECT; Valiance X12 prototype, Molecular Dynamics) was evaluated in various clinical settings. Images obtained in the prototype system were compared to images from an analog camera fitted with high-resolution collimators. Clinical feasibility, image quality, and diagnostic performance of the prototype were evaluated in 36 SPECT studies in 35 patients including bone (n = 21), brain (n = 5), lung perfusion (n = 3), and parathyroid (n = 3) and one study each of sentinel node and labeled white blood cells. Images were graded on a scale of 1–4 for sharpness, contrast, overall quality, and diagnostic confidence. Results Digital CZT SPECT provided a statistically significant improvement in sharpness and contrast in clinical cases (mean score of 3.79 ± 0.61 vs. 3.26 ± 0.50 and 3.92 ± 0.29 vs. 3.34 ± 0.47 respectively, p < 0.001 for both). Overall image quality was slightly higher for the digital SPECT but not statistically significant (3.74 vs. 3.66). Conclusion CZT SPECT provided significantly improved image sharpness and contrast compared to the analog system in the clinical settings evaluated. Further studies will evaluate the diagnostic performance of the system in large patient cohorts in additional clinical settings.
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Affiliation(s)
- Elinor Goshen
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | - Eli Stern
- Molecular Dynamics, Hamilton, Bermuda
| | - Tal Kenig
- Molecular Dynamics, Hamilton, Bermuda
| | - Ronen Goldkorn
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Cardiology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Simona Ben-Haim
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Institute of Nuclear Medicine, University College London and UCL Hospitals, London, UK
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94
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Mechanical dyssynchrony and diastolic dysfunction are common in LVH: a pilot correlation study using Doppler echocardiography and CZT gated-SPECT MPI. Sci Rep 2018. [PMID: 29520004 PMCID: PMC5843584 DOI: 10.1038/s41598-018-22213-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an often under-diagnosed cause of left ventricular hypertrophy (LVH). It affects 1/500 of the population, is the most commonly inherited cardiovascular disorder, and can present in apical, concentric, or septal forms. Although most patients are asymptomatic, sudden cardiac death can be the initial presentation of HCM. By retrospectively enrolling patients suspected of having three different types of HCM in the absence of epicardial coronary stenosis, we aimed to examine systolic and diastolic dysfunction and perfusion abnormalities using both Doppler echocardiography and state-of-the-art gated single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) with a cadmium-zinc-telluride camera and thallium-201. Both regional perfusion and gated SPECT parameters were collected in addition to diastolic parameters from Doppler echocardiography. The results showed that mild ischemia was common in patients suspected of having HCM, with a mean summed stress score of 4.7 ± 4.9 (score 0–4 in 17-segment model). The patients with HCM were associated with discernible left ventricular mechanical dyssynchrony, especially those with the apical form. In addition, diastolic dysfunction was prevalent and early to late ventricular filling velocity ratios were significantly different between groups. By combining gated-MPI and Doppler data, the trivial functional changes in HCM may be identified.
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95
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Daou D, Sabbah R, Coaguila C, Alattar Y, Boulahdour H. A new era in gated myocardial perfusion imaging: Feasibility of data-driven cardiac contraction gating with multiple pinhole CZT SPECT. J Nucl Cardiol 2018; 25:257-268. [PMID: 28776313 DOI: 10.1007/s12350-017-1010-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We previously validated the use of a data-driven cardiac respiratory-motion (RM) correction method (REGAT) applicable to CZT SPECT myocardial perfusion imaging (MPI). In this study, we adapted the same process used with REGAT for RM to generate data-driven cardiac contraction triggers and corresponding cardiac contraction-gated SPECT studies (GSPECT-DD). We aimed to study its feasibility and compare its performances to GSPECT studies generated with ECG monitor-based triggers (GSPECT-ECG). METHODS We included seven non-consecutive randomly chosen patients addressed for 1-day 99mTc-Tetrofosmin stress/rest MPI acquired with multi-pinhole CZT SPECT. We studied the degree of agreement between GSPECT-DD and GSPECT-ECG for the classification of acquired images into the 16 categories of mean cardiac cycle, and compared between the two methods the cine image quality and global LV systolic function of reconstructed studies. RESULTS We found almost perfect agreement between cardiac contraction triggers generated with data-driven and ECG monitor-based methods. As compared to GSPECT-ECG, GSPECT-DD provided comparable and well-correlated LV global systolic function parameters and similar cine image quality at both stress and rest. CONCLUSIONS Data-driven cardiac contraction gating using REGAT is feasible with low-dose and high-dose MPI CZT SPECT. It provides GSPECT-DD studies comparable to GSPECT-ECG.
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Affiliation(s)
- Doumit Daou
- EA 7334 REMES, Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.
- Nuclear Medicine Department, Cochin University Hospital, AP-HP, 27 rue du Faubourg Saint-Jacques, 75679, Paris Cedex 14, France.
| | - Rémy Sabbah
- Nuclear Medicine Department, CHU Jean Minjoz, Besançon, France
| | - Carlos Coaguila
- Nuclear Medicine Department, Centre Hospitalier de Bigorre, Tarbes, France
| | - Yousef Alattar
- Cardiology Department, Cochin University Hospital, AP-HP, Paris, France
| | - Hatem Boulahdour
- Nuclear Medicine Department, CHU Jean Minjoz, Besançon, France
- EA 4662, Université de Franche-Comté, Besançon, France
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96
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Hutton BF, Erlandsson K, Thielemans K. Advances in clinical molecular imaging instrumentation. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0264-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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97
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Caobelli F, Wollenweber T, Bavendiek U, Kühn C, Schütze C, Geworski L, Thackeray JT, Bauersachs J, Haverich A, Bengel FM. Simultaneous dual-isotope solid-state detector SPECT for improved tracking of white blood cells in suspected endocarditis. Eur Heart J 2018; 38:436-443. [PMID: 27469371 DOI: 10.1093/eurheartj/ehw231] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/29/2016] [Indexed: 11/13/2022] Open
Abstract
Aims High-energy resolution and sensitivity of novel cadmium-zinc-telluride (CZT) detector equipped SPECT systems facilitate simultaneous imaging of multiple isotopes and may enhance the detection of molecular/cellular signals. This may refine the detection of endocarditis. This study was designed to determine the feasibility and diagnostic accuracy of simultaneous imaging of inflammation with 111In-labeled white blood cells (WBCs) and myocardial perfusion with 99mTc-sestamibi, for localization of WBCs relative to the valve plane in suspected endocarditis. Methods and results A dedicated cardiac CZT camera (Discovery 530c, GE Healthcare) was employed. Anthropomorphic thorax phantom studies were followed by clinical studies in 34 patients with suspected infection of native valves (n = 12) or implants (n = 22). Simultaneous 111In-WBC/99mTc perfusion imaging was performed, and compared with standard 111In-WBC planar scintigraphy and SPECT-CT. Phantom studies ruled out significant radioisotope crosstalk. Downscatter on 99mTc images was not observed for 111In activity as high as 2.5*99mTc activity. In patients, image quality was superior for CZT imaging vs. conventional SPECT-CT and planar scintigraphy (P < 0.01). Cadmium-zinc-telluride dual isotope imaging improved reader confidence for detection of inflammatory foci. Diagnostic accuracy based on surgery or Duke Criteria during follow-up was highest for CZT imaging (P < 0.001). Conclusion Novel CZT SPECT technology improves the accuracy of molecular/cellular cardiac imaging. Simultaneous multi-isotope imaging with 111In and 99mTc is feasible and aids in the workup of suspected endocarditis.
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Affiliation(s)
- Federico Caobelli
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Tim Wollenweber
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Udo Bavendiek
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Schütze
- Department of Radiation Protection and Medical Physics, Hannover Medical School, Hannover, Germany
| | - Lilli Geworski
- Department of Radiation Protection and Medical Physics, Hannover Medical School, Hannover, Germany
| | - James T Thackeray
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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98
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Sohns JM, Bavendiek U, Ross TL, Bengel FM. Targeting Cardiovascular Implant Infection: Multimodality and Molecular Imaging. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.005376. [PMID: 29222120 DOI: 10.1161/circimaging.117.005376] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Owing to their success in clinical practice, the prevalence of cardiovascular implants is continuously increasing. Implant infection is a relevant complication but remains a diagnostic challenge because echocardiography as a first-line test may be limited. Accordingly, a multimodality approach is increasingly used for diagnostic workup and supported by recent guidelines. As reviewed here, computed tomography and nuclear imaging provide incremental diagnostic value and may be combined in a single hybrid imaging session using positron emission tomography/computed tomography or single photon emission computed tomography/computed tomography. Molecular or cellular imaging helps to overcome the limitations of morphological imaging in implants. Larger-scale clinical studies, earlier application in the time course of diagnosis, monitoring of therapy success, technical advances, and novel radiopharmaceuticals will all contribute to sustained growth of advanced infection-targeted imaging in cardiovascular medicine.
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Affiliation(s)
- Jan M Sohns
- From the Department of Nuclear Medicine (J.M.S., T.L.R., F.M.B.) and Department of Cardiology and Angiology (U.B.), Hanover Medical School, Germany
| | - Udo Bavendiek
- From the Department of Nuclear Medicine (J.M.S., T.L.R., F.M.B.) and Department of Cardiology and Angiology (U.B.), Hanover Medical School, Germany
| | - Tobias L Ross
- From the Department of Nuclear Medicine (J.M.S., T.L.R., F.M.B.) and Department of Cardiology and Angiology (U.B.), Hanover Medical School, Germany
| | - Frank M Bengel
- From the Department of Nuclear Medicine (J.M.S., T.L.R., F.M.B.) and Department of Cardiology and Angiology (U.B.), Hanover Medical School, Germany.
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99
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Peterson M, Gustafsson J, Ljungberg M. Monte Carlo-based quantitative pinhole SPECT reconstruction using a ray-tracing back-projector. EJNMMI Phys 2017; 4:32. [PMID: 29247300 PMCID: PMC5732128 DOI: 10.1186/s40658-017-0198-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 11/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background Monte Carlo simulations provide accurate models of nuclear medicine imaging systems as they can properly account for the full physics of photon transport. The accuracy of the model included in the maximum-likelihood–expectation-maximization (ML-EM) reconstruction limits the overall accuracy of the reconstruction results. In this paper, we present a Monte Carlo-based ML-EM reconstruction method for pinhole single-photon emission computed tomography (SPECT) that has been incorporated into the SIMIND Monte Carlo program. The Monte Carlo-based model, which accounts for all of the physical and geometrical characteristics of the camera system, is used in the forward-projection step of the reconstruction, while a simpler model based on ray-tracing is used for back-projection. The aim of this work was to investigate the quantitative accuracy of this combination of forward- and back-projectors in the clinical pinhole camera GE Discovery NM 530c. Results The total activity was estimated in 99mTc-filled spheres with volumes between 0.5 and 16 mL. The total sphere activity was generally overestimated but remained within 10% of the reference activity defined by the phantom preparation. The recovered activity converged towards the reference activity as the number of iterations increased. Furthermore, the recovery of the activity concentrations within the physical boundaries of the spheres increased with increasing sphere volume. Additionally, the Monte Carlo-based reconstruction enabled recovery of the true activity concentration in the myocardium of a cardiac phantom mounted in a torso phantom regardless of whether the torso was empty or water-filled. A qualitative comparison to data reconstructed using the clinical reconstruction algorithm showed that the two methods performed similarly, although the images reconstructed using the clinical software were more uniform due to the incorporation of noise regularization and post-filtration in that reconstruction technique. Conclusions We developed a Monte Carlo-based reconstruction method for pinhole SPECT and evaluated it using phantom measurements. The combination of a Monte Carlo-based forward-projector and a simplified analytical ray-tracing back-projector produced quantitative images of acceptable image quality. No explicit calibration is necessary in this method since the forward-projector model maintains a relationship between the number of counts and activity.
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Affiliation(s)
- Mikael Peterson
- Department of Medical Radiation Physics, Lund University, SE-221 85, Lund, Sweden.
| | - Johan Gustafsson
- Department of Medical Radiation Physics, Lund University, SE-221 85, Lund, Sweden
| | - Michael Ljungberg
- Department of Medical Radiation Physics, Lund University, SE-221 85, Lund, Sweden
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100
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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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