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Liu H, Aslan M, Sandoval V, Liu YH. Potential Impact of SPECT Resolution on Quantification of Left Ventricular Volumes and Ejection Fraction: A Phantom Study. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ito T, Maeno T, Tsuchikame H, Shishido M, Nishi K, Kojima S, Hayashi T, Suzuki K. Adapting a low-count acquisition of the bone scintigraphy using deep denoising super-resolution convolutional neural network. Phys Med 2022; 100:18-25. [PMID: 35716484 DOI: 10.1016/j.ejmp.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/21/2022] [Accepted: 06/11/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Deep-layer learning processing may improve contrast imaging with greater precision in low-count acquisition. However, no data on noise reduction using super-resolution processing for deep-layer learning have been reported in nuclear medicine imaging. OBJECTIVES This study was designed to evaluate the adaptability of deep denoising super-resolution convolutional neural networks (DDSRCNN) in nuclear medicine by comparing them with denoising convolutional natural networks (DnCNN), Gaussian processing, and nonlinear diffusion (NLD) processing. METHODS In this study, 156 patients were included. Data were collected using a matrix size of 256 × 256 with a pixel size of 2.46 mm at 0.898 folds, 15% energy window at the center of the photopeak energy (140 keV), and total count of 1000 kilocounts (kct). Following the training and validation of two learning models, we created 100 images for each 20-test datum. The peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) between each image and the reference image were calculated. RESULTS DDSRCNN showed the highest PSNR values for all total counts. Regarding SSIM, DDSRCNN had significantly higher values than the original and Gaussian. In DnCNN, false accumulation was observed as the total counts increased. Regarding PSNR and SSIM transition, the model using 100-500-kct training data was significantly higher than that using 100-kct training data. CONCLUSIONS Edge-preserving noise reduction processing was possible, and adaptability to low-count acquisition was demonstrated using DDSRCNN. Using training data with different noise levels, DDSRCNN could learn the noise components with high accuracy and contrast improvement.
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Affiliation(s)
- Toshimune Ito
- Department of Radiological, Technology, Faculty of Medical Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
| | - Takafumi Maeno
- Department of Radiology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-0012, Japan.
| | - Hirotatsu Tsuchikame
- Department of Radiology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-0012, Japan.
| | - Masaaki Shishido
- Department of Radiology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-0012, Japan.
| | - Kana Nishi
- Department of Radiology, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-0012, Japan
| | - Shinya Kojima
- Department of Radiological, Technology, Faculty of Medical Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
| | - Tatsuya Hayashi
- Department of Radiological, Technology, Faculty of Medical Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
| | - Kentaro Suzuki
- Department of Radiological Technology, Toranomon Hospital, 2-2-2 Tranomon, Minato-ku, Tokyo 105-8470, Japan; Department of Radiation Oncology, Graduated School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
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Błaszczyk M, Adamczewski Z, Płachcińska A. Capabilities of Modern Semiconductor Gamma Cameras in Radionuclide Diagnosis of Coronary Artery Disease. Diagnostics (Basel) 2021; 11:diagnostics11112130. [PMID: 34829477 PMCID: PMC8620025 DOI: 10.3390/diagnostics11112130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
This paper presents a review of the literature concerning the clinical application of modern semiconductor (CZT) gamma cameras in the radioinuclide diagnosis of coronary artery disease. It contains information on the diagnostic efficacy of myocardial perfusion studies performed with those cameras compared with the widely used scintillation (Anger) cameras, an overview of their effectiveness in comparison with coronary angiography (also fractional flow reserve) and currently available clinical results of a myocardial flow reserve measured with a dynamic SPECT study. Introduction of this imaging modality to the measurement of a myocardial flow reserve aims to facilitate access to this type of study compared to the less available and more expensive PET method used so far.
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Affiliation(s)
- Michał Błaszczyk
- Department of Quality Control and Radiological Protection, Medical University of Łódź, Czechosłowacka 8/10 Street, 92-216 Łódź, Poland; (M.B.); (A.P.)
| | - Zbigniew Adamczewski
- Department of Nuclear Medicine, Medical University of Łódź, Czechosłowacka 8/10 Street, 92-216 Łódź, Poland
- Correspondence:
| | - Anna Płachcińska
- Department of Quality Control and Radiological Protection, Medical University of Łódź, Czechosłowacka 8/10 Street, 92-216 Łódź, Poland; (M.B.); (A.P.)
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Xu B, Liu L, Abdu FA, Yin G, Mohammed AQ, Xu S, Lv X, Fan R, Feng C, Shi T, Zhang W, Xu Y, Cai H, Yu F, Che W. Prognostic Value of Diastolic Dysfunction Derived From D-SPECT in Coronary Artery Disease Patients With Normal Ejection Fraction. Front Cardiovasc Med 2021; 8:700027. [PMID: 34336957 PMCID: PMC8319539 DOI: 10.3389/fcvm.2021.700027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 12/31/2022] Open
Abstract
Diastolic dysfunction (DD) with normal systolic function has been elucidated to be associated with heart failure and worse prognosis. The recently introduced single photon emission computed tomography (SPECT) with dedicated cardiac cadmium-zinc-telluride (CZT) cameras (D-SPECT) is a novel method to quantitate left ventricular functional parameters. We aimed to evaluate the prognostic value of DD derived from D-SPECT in coronary artery disease (CAD) patients with normal ejection fraction. All CAD patients who underwent D-SPECT and invasive coronary angiography within 3 months were considered. DD was defined as peak filling rate (PFR) <2.1 end diastolic volume (EDV, ml)/s according to the D-SPECT results. Patients were divided into three groups: group 1 (n = 226)-normal PFR; group 2 (n = 67)-ischemia-related DD (abnormal stress PFR and normal rest PFR); and group 3 (n = 106)-rest DD (abnormal rest PFR). The primary clinical endpoint of the present study was a composite of heart failure events (HFE). A total of 399 consecutive CAD patients with normal systolic function undergoing stress D-SPECT were analyzed. The incidence rates of HFE among the three groups were 4.0, 7.5, and 11.3%, respectively. Cox regression analysis showed that the multivariate predictors of HFE were rest PFR, diabetes mellitus, obesity, and old age. DD derived from D-SPECT in CAD patients with normal ejection fraction is predictive of HFE.
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Affiliation(s)
- Bin Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Medical College of Soochow University, Soochow University, Suzhou, China
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Siling Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xian Lv
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rui Fan
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cailin Feng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tingting Shi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wen Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Haidong Cai
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fei Yu
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Cardiology, Shanghai Tenth People' s Hospital Chongming Branch, Shanghai, China
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Mannarino T, Assante R, Ricciardi C, Zampella E, Nappi C, Gaudieri V, Mainolfi CG, Di Vaia E, Petretta M, Cesarelli M, Cuocolo A, Acampa W. Head-to-head comparison of diagnostic accuracy of stress-only myocardial perfusion imaging with conventional and cadmium-zinc telluride single-photon emission computed tomography in women with suspected coronary artery disease. J Nucl Cardiol 2021; 28:888-897. [PMID: 31222530 DOI: 10.1007/s12350-019-01789-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Breast attenuation may impact the diagnostic accuracy of stress myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT). We compared the performance of conventional (C)-SPECT and cadmium-zinc-telluride (CZT)-SPECT systems in women with low-intermediate likelihood of coronary artery disease (CAD). METHODS AND RESULTS A total of 109 consecutive women underwent stress-optional rest MPI by both C-SPECT and CZT-SPECT. In the overall study population, a weak albeit significant correlation between total perfusion defect (TPD) measured by C-SPECT and CZT-SPECT was observed (r = 0.38, P < .001) and at Bland-Altman analysis the mean difference in TPD (C-SPECT minus CZT-SPECT) was 2.40% (P < .001). Overall concordance of semi-quantitative diagnostic performance between C-SPECT and CZT-SPECT was observed in 52 (48%) women with a κ value of 0.09. Normalcy rate was significantly higher using CZT-SPECT compared to C-SPECT (P < .001). Machine learning analysis performed through the implementation of J48 algorithm proved that CZT-SPECT has higher sensitivity, specificity, and accuracy than C-SPECT. CONCLUSIONS In women with low-intermediate likelihood of CAD, there is a poor concordance of diagnostic performance between C-SPECT and CZT-SPECT, and CZT-SPECT allows better normalcy rate detection compared to C-SPECT.
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Affiliation(s)
- Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carlo Ricciardi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Ciro Gabriele Mainolfi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Eugenio Di Vaia
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Mario Cesarelli
- Department of Electrical Engineering and Information Technology, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
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Plateau A, Bouvet C, Merlin C, Pereira B, Barres B, Clerfond G, Cachin F, Cassagnes L. Assessment of four different cardiac softwares for evaluation of LVEF with CZT-SPECT vs CMR in 48 patients with recent STEMI. J Nucl Cardiol 2020; 27:2017-2026. [PMID: 30426398 DOI: 10.1007/s12350-018-01493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare, vs CMR, four softwares: quantitative gated SPECT (QGS), myometrix (MX), corridor 4DM (4DM), and Emory toolbox (ECTb) to evaluate left ventricular ejection fraction (LVEF), end-systolic (ESV), and end-diastolic volumes (EDVs) by gated MPI CZT-SPECT. METHODS 48 patients underwent MPI CZT-SPECT and CMR 6 weeks after STEMI, LV parameters were measured with four softwares at MPI CZT-SPECT vs CMR. We evaluated (i) concordance and correlation between MPI CZT-SPECT and CMR, (ii) concordance MPI CZT-SPECT/CMR for the categorical evaluation of the left ventricular dysfunction, and (iii) impacts of perfusion defects > 3 segments on concordance. RESULTS LVEF: LCC QGS/CMR = 0.81 [+ 2.2% (± 18%)], LCC MX/CMR = 0.83 [+ 1% (± 17.5%)], LCC 4DM/CMR = 0.73 [+ 3.9% (± 21%)], LCC ECTb/CMR = 0.69 [+ 6.6% (± 21.1%)]. ESV: LCC QGS/CMR = 0.90 [- 8 mL (± 40 mL)], LCC MX/CMR = 0.90 [- 9 mL (± 36 mL)], LCC 4DM/CMR = 0.89 [+ 4 mL (± 45 mL)], LCC ECTb/CMR = 0.87 [- 3 mL (± 45 mL)]. EDV: LCC QGS/CMR = 0.70 [- 16 mL (± 67 mL)], LCC MX/CMR = 0.68 [- 21 mL (± 63 mL], LCC 4DM/CMR = 0.72 [+ 9 mL (± 73 mL)], LCC ECTb/CMR = 0.69 [+ 10 mL (± 70 mL)]. CONCLUSION QGS and MX were the two best-performing softwares to evaluate LVEF after recent STEMI.
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Affiliation(s)
- Antoine Plateau
- Department of Radiology, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Clément Bouvet
- Nuclear Medicine Department, Jean Perrin Comprehensive Cancer, Clermont-Ferrand, France
| | - Charles Merlin
- Nuclear Medicine Department, Jean Perrin Comprehensive Cancer, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- DRCI, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Bertrand Barres
- Nuclear Medicine Department, Jean Perrin Comprehensive Cancer, Clermont-Ferrand, France
- UMR INSERM 1240 "Molecular Imaging and Theranostic Strategy", Clermont Auvergne University, Clermont-Ferrand, France
| | - Guillaume Clerfond
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, 63000, Clermont-Ferrand, France
- Department of Cardiology, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Florent Cachin
- Nuclear Medicine Department, Jean Perrin Comprehensive Cancer, Clermont-Ferrand, France
- UMR INSERM 1240 "Molecular Imaging and Theranostic Strategy", Clermont Auvergne University, Clermont-Ferrand, France
| | - Lucie Cassagnes
- Department of Radiology, CHU Gabriel Montpied, Clermont-Ferrand, France.
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, 63000, Clermont-Ferrand, France.
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Giorgetti A, Marzullo P. Children of a lesser god: From radiocardiogram to CZT GSPECT. J Nucl Cardiol 2020; 27:2027-2030. [PMID: 30506154 DOI: 10.1007/s12350-018-01512-y] [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: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Assuero Giorgetti
- Fondazione Toscana Gabriele Monasterio, Via G. Moruzzi 1, 56124, Pisa, Italy.
| | - Paolo Marzullo
- Fondazione Toscana Gabriele Monasterio, Via G. Moruzzi 1, 56124, Pisa, Italy
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Direct correlation between ischemic burden induced by dipyridamole and stress peak filling rate: a gated perfusion single-photon emission computed tomography study. Nucl Med Commun 2020; 42:173-181. [PMID: 33165259 DOI: 10.1097/mnm.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM AND PATIENTS The aim of the present study was to assess the effects of dipyridamole on stress and rest peak filling rate in consecutive patients who showed perfusion and, or function abnormalities at Gated-SPECT. Were enrolled 96 patients (73 males (76%); mean age 71.7 ± 9.57). Forty patients (41.7%) had an history of myocardial infarction and fifty-seven (59.4%) of previous cardiac revascularization. All patients underwent a 2-day 99mTc-SestaMIBI gated perfusion SPECT protocol. RESULTS Twenty-nine (30.2%) patients showed fixed perfusion defects, 54 (56.2%) showed partially or completely reversible ones, while 13 (13.5%) showed normal perfusion but reduced LVEF. SSS was significantly higher than SRS (9.55 ± 9.29 vs. 7.10 ± 8.48; P = 0.0001). Stress peak filling rate was not significantly higher than rest peak filling rate (1.73 EDV/s ± 0.69 EDV/s vs. 1.67 EDV/s ± 0.56 EDV/s; P = 0.62). At a multivariate regression analysis, only stress peak filling rate, as independent variable, was directly correlated with myocardial ischemia (SDS) (P = 0.018). We divided patients according to SDS in those with mild (SDS < 5) and severe (SDS ≥ 5) ischemia. Stress peak filling rate was the only parameter significantly different between groups. CONCLUSION Stress PFR showed a better correlation with the degree of ischemia compared to the remaining perfusion and functional parameters. The direct correlation between SDS and stress PFR leads us to speculate that dipyridamole could improve diastolic function in ischemic patients.
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Barison A, Aimo A, Todiere G, Grigoratos C, Aquaro GD, Emdin M. Cardiovascular magnetic resonance for the diagnosis and management of heart failure with preserved ejection fraction. Heart Fail Rev 2020; 27:191-205. [DOI: 10.1007/s10741-020-09998-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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10
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Gimelli A, Liga R, Clemente A, Marras G, Kusch A, Marzullo P. Left ventricular eccentricity index measured with SPECT myocardial perfusion imaging: An additional parameter of adverse cardiac remodeling. J Nucl Cardiol 2020; 27:71-79. [PMID: 28083831 DOI: 10.1007/s12350-017-0777-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/27/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Single-photon emission computed-tomography (SPECT) allows the quantification of LV eccentricity index (EI), a measure of cardiac remodeling. We sought to evaluate the feasibility of EI measurement with SPECT myocardial perfusion imaging and its interactions with relevant LV functional and structural parameters. METHODS AND RESULTS Four-hundred and fifty-six patients underwent myocardial perfusion imaging on a Cadmium-Zinc-Telluride (CZT) camera. The summed rest, stress, and difference scores were calculated. From rest images, the LV end-diastolic (EDV) and end-systolic volumes, ejection fraction (EF), and peak filling rate (PFR) were calculated. In every patient, the EI, ranging from 0 (sphere) to 1 (line), was computed using a dedicated software (QGS/QPS; Cedars-Sinai Medical Center). Three-hundred and thirty-eight/456 (74%) patients showed a normal EF (>50%), while 26% had LV systolic dysfunction. The EI was computed from CZT images with excellent reproducibility (interclass correlation coefficient: 0.99, 95% CI 0.98-0.99). More impaired EI values correlated with the presence of a more abnormal LV perfusion (P < .001), function (EF and PFR, P < .001), and structure (EDV, P < .001). On multivariate analysis, higher EDV (P < .001) and depressed EF (P = .014) values were independent predictors of abnormal EI. CONCLUSIONS The evaluation of LV eccentricity is feasible on gated CZT images. Abnormal EI associates with significant cardiac structural and functional abnormalities.
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Affiliation(s)
| | - Riccardo Liga
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56100, Pisa, Italy.
| | | | | | | | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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Assante R, Cuocolo A. Real-time gated-SPECT myocardial perfusion imaging with CZT detectors: A promising tool for monitoring left ventricular function. J Nucl Cardiol 2019; 26:1743-1745. [PMID: 29546490 DOI: 10.1007/s12350-017-0924-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: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
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Prospective diagnostic performance of semiconductor SPECT myocardial perfusion imaging: wall thickening analysis reduces the need for an additional prone acquisition. Eur J Nucl Med Mol Imaging 2019; 46:2042-2050. [PMID: 31321484 DOI: 10.1007/s00259-019-04415-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/25/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE To determine whether the assessment of regional wall thickening (WT) in addition to myocardial perfusion from stress supine acquisitions could compensate for the lack of prone acquisition and the corresponding decrease in the diagnostic performance of SPECT myocardial perfusion imaging (MPI) in patients with known or suspected coronary artery disease (CAD). METHODS The study group comprised 41 patients (123 vessels) with known or suspected CAD prospectively recruited for systematic prone and supine 201Tl stress SPECT MPI. The diagnostic performance of SPECT MPI was determined for various image sets including nongated supine images (supine NG), nongated combined prone and supine images (prone and supine NG) and gated supine images, allowing WT evaluation from NG images in addition to perfusion (supine NG + WT) using invasive coronary angiography and fractional flow reserve as the gold standards. RESULTS The rate of false positives was significantly higher among the supine NG images (20.8%) than among either the prone and supine NG or the supine NG + WT images (3.3% and 2.7%, respectively, P < 0.05 vs. supine NG). Consequently, specificity was higher for the prone and supine NG images than for the supine NG images (96.1% vs. 76.1%, P < 0.01) and was highest for the supine NG + WT images (96.8%, P not significant vs. prone and supine NG), without significant differences in sensitivity (80.0%, 86.6% and 73.3%, respectively, P not significant for all comparisons). CONCLUSION The diagnostic performance of supine stress SPECT MPI is improved when WT assessment of ischaemic segments is used as an additional diagnostic criterion to values not significantly different from those with combined prone and supine acquisitions.
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Hyafil F, Gimelli A, Slart RHJA, Georgoulias P, Rischpler C, Lubberink M, Sciagra R, Bucerius J, Agostini D, Verberne HJ. EANM procedural guidelines for myocardial perfusion scintigraphy using cardiac-centered gamma cameras. Eur J Hybrid Imaging 2019; 3:11. [PMID: 34191169 PMCID: PMC8218102 DOI: 10.1186/s41824-019-0058-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/10/2019] [Indexed: 01/28/2023] Open
Abstract
An increasing number of Nuclear Medicine sites in Europe are using cardiac-centered gamma cameras for myocardial perfusion scintigraphy (MPS). Three cardiac-centered gamma cameras are currently the most frequently used in Europe: the D-SPECT (Spectrum Dynamics), the Alcyone (Discovery NM 530c and Discovery NM/CT 570c; General Electric Medical Systems), and the IQ-SPECT (Siemens Healthcare). The increased myocardial count sensitivity of these three cardiac-centered systems has allowed for a decrease in the activities of radiopharmaceuticals injected to patients for myocardial perfusion imaging and, consequently, radiation exposure of patients. When setting up protocols for MPS, the overall objective should be to maintain high diagnostic accuracy of MPS, while injecting the lowest activities reasonably achievable to reduce the level of radiation exposure of patient and staff. These guidelines aim at providing recommendations for acquisition protocols and image interpretation using cardiac-centered cameras. As each imaging system has specific design and features for image acquisition and analysis, these guidelines have been separated into three sections for each gamma camera system. These recommendations have been written by the members of the Cardiovascular Committee of EANM and were based on their own experience with each of these systems and on the existing literature.
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Affiliation(s)
- Fabien Hyafil
- Department of Nuclear Medicine; Bichat University Hospital, Assistance Publique - Hôpitaux de Paris; Inserm UMR 1148, Paris Diderot-Paris 7 University, 46 rue Henri Huchard, 75018, Paris, France.
| | | | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.,TechMed Centre, Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Panagiotis Georgoulias
- Department of Nuclear Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Mark Lubberink
- Department of Medical Physics and PET Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Roberto Sciagra
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Jan Bucerius
- Department of Nuclear Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Denis Agostini
- Department of Nuclear Medicine, CHU Caen Normandy University, Caen, France
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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14
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Gimelli A, Liga R, Magro S, Novo S, Pedrinelli R, Petronio AS, Marzullo P, Pepe A. Evaluation of left ventricular mass on cadmium-zinc-telluride imaging: Validation against cardiac magnetic resonance. J Nucl Cardiol 2019; 26:899-905. [PMID: 29043554 DOI: 10.1007/s12350-017-1086-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/26/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Single-photon emission computed tomography has shown relevant limitations in the quantification of left ventricular (LV) mass. We sought to compare the estimates of LV mass on Cadmium-Zinc-Telluride (CZT) myocardial perfusion imaging (MPI) as compared to cardiac magnetic resonance (CMR). METHODS AND RESULTS Twenty-five patients underwent MPI on a CZT camera and CMR on a 1.5 T scanner within 12 ± 3 weeks. LV mass was quantified on CZT images using two softwares: 4D-MSPECT (4DM) and Emory Cardiac Toolbox (ECTb). LV mass by CMR was quantified using MASS software (Medis, Leiden, The Netherlands). LV mass values obtained with 4DM and ECTb were highly reproducible [intraclass correlation coefficients .98 (95% CI .97-.99), and .98 (95% CI 0.97-.99), respectively]. The mean LVM mass values were 151 ± 44 g on CMR, 151 ± 43 g with 4DM (P = NS vs CMR), and 157 ± 42 g with ECTb (P < .001 vs CMR; P = .007 vs 4DM) CZT images. There was an excellent correlation between LV mass values between CMR and both 4DM (R2 = .95; P < .001) and ECTb (R2 = .98; P < .001) with narrow limits of agreement (- 13.6% to + 13.4% for 4DM, and - 5.6% to + 14.1% for ECTb). CONCLUSIONS The evaluation of LV mass is feasible on CZT images, showing excellent agreement with CMR.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana/CNR G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Riccardo Liga
- Dipartimento di Patologia Chirurgica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy.
| | - Serena Magro
- Fondazione Toscana/CNR G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
- Department of Cardiology, University of Palermo, Palermo, Italy
| | - Salvatore Novo
- Department of Cardiology, University of Palermo, Palermo, Italy
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy
| | - Anna Sonia Petronio
- Dipartimento di Patologia Chirurgica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy
| | - Paolo Marzullo
- Fondazione Toscana/CNR G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
- Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Alessia Pepe
- Fondazione Toscana/CNR G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
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15
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Wu D, Zhang Z, Ma R, Guo F, Wang L, Fang W. Comparison of CZT SPECT and conventional SPECT for assessment of contractile function, mechanical synchrony and myocardial scar in patients with heart failure. J Nucl Cardiol 2019; 26:443-452. [PMID: 28623525 DOI: 10.1007/s12350-017-0952-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
AIM The aim of this study was to compare CZT-SPECT (CZT SPECT) to conventional SPECT (C-SPECT) in the assessment of left ventricular myocardial scar, contractile function, and mechanical synchrony in patients with heart failure (HF). METHODS Fifty-nine patients with HF who were referred for myocardial perfusion/metabolism imaging were enrolled. All patients underwent resting 99mTc-MIBI gated myocardial perfusion imaging using a CZT SPECT camera and a C-SPECT camera, respectively, and 18F-FDG PET myocardial metabolism imaging within three days. Summed rest score (SRS) and total perfusion defect (TPD) (as indices of perfusion abnormality), left ventricular (LV), end diastolic volume (EDV), end systolic volume (ESV), and ejection fraction (EF) (as indices of LV systolic function), and histogram band width (BW) and standard deviation (SD) (as indices of mechanical synchrony) were analyzed by automated software while the perfusion/metabolism patterns were analyzed visually. RESULTS There was a good correlation between CZT SPECT and C-SPECT for SRS and TPD. CZT SPECT tended to underestimate SRS and TPD compared to C-SPECT. CZT-SPECT and C-SPECT showed excellent agreement in assessing the perfusion/metabolism pattern though a small proportion of normal segments (6.6%) identified by CZT/PET exhibited mismatch pattern on C-SPECT/PET. CZT SPECT also showed excellent correlation with C-SPECT in measuring EDV, ESV, and EF. Finally, BW and SD measured by CZT SPECT correlated well with C-SPECT but CZT SPECT tended to overestimate BW and SD compared to C-SPECT. CONCLUSION CZT SPECT provided comparable data to C-SPECT for measuring LV scar, function and synchrony at a considerable reduction in imaging time. CZT SPECT holds a promise for comprehensive evaluation of myocardial performance in patients with HF.
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Affiliation(s)
- Dayong Wu
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Nuclear Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Zongyao Zhang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rongzheng Ma
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Guo
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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16
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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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17
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Claudin M, Imbert L, Djaballah W, Veran N, Poussier S, Roch V, Perrin M, Verger A, Boutley H, Karcher G, Marie PY. Routine evaluation of left ventricular function using CZT-SPECT, with low injected activities and limited recording times. J Nucl Cardiol 2018; 25:249-256. [PMID: 27677613 DOI: 10.1007/s12350-016-0615-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/12/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Gamma-cameras, with Cadmium-Zinc-Telluride (CZT) detectors, allow to perform myocardial perfusion imaging (MPI) with limited injected activities and recorded times. This study aimed at determining whether the routine assessment of left ventricular (LV) function with such limited counts protocols compares well with reference values from cardiac MRI. METHODS The study included patients who have undergone cardiac MRI and an MPI routinely planned on a CZT camera with a low-dose protocol (120 MBq of Sestamibi for stress and 360 MBq at rest for 75 kg body weight), while targeting the recording of only 500 myocardial kcounts in order to limit the recording times (<10 minutes for stress, <4 minutes for rest). SPECT images were reconstructed with a method maintaining rather high spatial (8 mm) and temporal (16 frames/cycle) resolutions. RESULTS Seventy-six patients were included, and mean effective dose was 3.5 ± 1.7 mSv for the total MPI protocol. Correlations between CZT-SPECT and MRI were good to excellent for ejection fraction (r 2 = 0.77), end-diastolic (r 2 = 0.88) and end-systolic (r 2 = 0.93) volumes, and the analysis of segmental contractility correlated well between the two techniques (kappa score = 0.72 ± 0.02). CONCLUSION LV function, assessed on a CZT camera with low injected activities and limited recording times, correlates well with the reference assessment from cardiac MRI.
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Affiliation(s)
- Marine Claudin
- Department of Nuclear Medicine, CHU-Nancy, Nancy, France
| | - Laetitia Imbert
- Department of Nuclear Medicine, CHU-Nancy, Nancy, France.
- Nancyclotep Molecular Imaging Platform, Nancy, France.
- UMR 7039 CRAN and Université de Lorraine, Nancy, France.
| | - Wassila Djaballah
- Department of Nuclear Medicine, CHU-Nancy, Nancy, France
- INSERM U947 and Université de Lorraine, Nancy, France
| | - Nicolas Veran
- Department of Nuclear Medicine, CHU-Nancy, Nancy, France
- Nancyclotep Molecular Imaging Platform, Nancy, France
| | - Sylvain Poussier
- Nancyclotep Molecular Imaging Platform, Nancy, France
- INSERM U947 and Université de Lorraine, Nancy, France
| | - Véronique Roch
- Department of Nuclear Medicine, CHU-Nancy, Nancy, France
- Nancyclotep Molecular Imaging Platform, Nancy, France
| | - Mathieu Perrin
- Department of Nuclear Medicine, CHU-Nancy, Nancy, France
| | - Antoine Verger
- Department of Nuclear Medicine, CHU-Nancy, Nancy, France
- Nancyclotep Molecular Imaging Platform, Nancy, France
- INSERM U947 and Université de Lorraine, Nancy, France
| | - Henri Boutley
- Nancyclotep Molecular Imaging Platform, Nancy, France
| | - Gilles Karcher
- Department of Nuclear Medicine, CHU-Nancy, Nancy, France
- Nancyclotep Molecular Imaging Platform, Nancy, France
- INSERM U947 and Université de Lorraine, Nancy, France
| | - Pierre-Yves Marie
- Department of Nuclear Medicine, CHU-Nancy, Nancy, France
- Nancyclotep Molecular Imaging Platform, Nancy, France
- INSERM U1116 and Université de Lorraine, Nancy, France
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18
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Malhotra S, Canty JM. American perspective: Comparing the AHA/ACC and ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. J Nucl Cardiol 2017; 24:1904-1908. [PMID: 28831741 PMCID: PMC5705322 DOI: 10.1007/s12350-017-1046-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Saurabh Malhotra
- Departments of Medicine, Biomedical Engineering and Physiology & Biophysics, the VA WNY Health Care System and the Clinical and Translational Science Institute at the University at Buffalo, Buffalo, NY, USA.
| | - John M Canty
- Departments of Medicine, Biomedical Engineering and Physiology & Biophysics, the VA WNY Health Care System and the Clinical and Translational Science Institute at the University at Buffalo, Buffalo, NY, USA
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Clinical and Translational Research Center, Suite 7030, 875 Ellicott Street, Buffalo, NY, 14203, USA
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19
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Gimelli A, Liga R, Pasanisi EM, Casagranda M, Marzullo P. Myocardial ischemia in the absence of obstructive coronary lesion: The role of post-stress diastolic dysfunction in detecting early coronary atherosclerosis. J Nucl Cardiol 2017; 24:1542-1550. [PMID: 27025845 DOI: 10.1007/s12350-016-0456-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/19/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The interactions between non-obstructive coronary atherosclerosis (<50% stenosis) and myocardial perfusion and functional parameters on myocardial perfusion imaging (MPI) have never been evaluated. METHODS AND RESULTS One-hundred and ninety-five patients were submitted to stress-rest MPI and invasive coronary angiography. The presence of obstructive coronary lesions (>50% stenosis) was excluded. The summed stress score (SSS) was calculated in every patient. Moreover, the left ventricular (LV) ejection fraction (EF) and peak filling rate (PFR) were computed from gated MPI images as measures of systolic and diastolic functions. Sixty/195 patients (31%) showed the presence of non-obstructive atherosclerosis (>20% and <50% diameter reduction). Interestingly, they presented a higher SSS than those with normal coronary arteries (P < 0.001) despite a similar myocardial scar burden. If compared to patients with normal coronary arteries, those with non-obstructive atherosclerosis showed more abnormal post-stress PFR values (2.5 ± 0.9 vs 2.9 ± 0.8, P = 0.004), despite a similar EF. On multivariate analysis, the presence non-obstructive atherosclerosis was the only significant predictor (P = 0.026) of post-stress LV diastolic impairment, independently from perfusion parameters. CONCLUSIONS In patients without anatomically significant coronary lesions, the development of post-stress LV diastolic dysfunction on MPI associates with the presence of non-obstructive atherosclerosis on coronary angiography.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Riccardo Liga
- Cardio-thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
| | | | - Mirta Casagranda
- Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
- Institute of Clinical Physiology, CNR, Pisa, Italy
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20
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Liga R, Gimelli A. Detection of ischemia with early myocardial perfusion imaging: You see more if you watch before. J Nucl Cardiol 2017; 24:1157-1160. [PMID: 27074757 DOI: 10.1007/s12350-016-0470-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Riccardo Liga
- Cardio-thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Alessia Gimelli
- Fondazione Toscana, Gabriele Monasterio, Via Moruzzi 1, Pisa, 56124, Italy.
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21
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Gimelli A, Liga R, Duce V, Kusch A, Clemente A, Marzullo P. Accuracy of myocardial perfusion imaging in detecting multivessel coronary artery disease: A cardiac CZT study. J Nucl Cardiol 2017; 24:687-695. [PMID: 26846367 DOI: 10.1007/s12350-015-0360-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/23/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) performed on traditional single-photon emission computed-tomography cameras has been shown to have a sub-optimal accuracy in detecting multivessel coronary artery disease (CAD). METHODS Six-hundred and ninety-five patients were submitted to MPI on a novel cadmium-zinc-telluride (CZT) camera and coronary angiography. A coronary stenosis >70% was considered obstructive. In every patient, the summed stress score (SSS) was computed. Moreover, the regional stress scores were also calculated for every coronary territory. RESULTS Four-hundred and forty-one patients had obstructive CAD in one (28%), two (19%), or three (17%) vessels. At per-patient analysis, the SSS showed a significant accuracy in detecting obstructive CAD (AUC 0.87, P < .001). Specifically, its accuracy was maintained also in patients with double (AUC 0.83; P < .001) or triple-vessels disease (AUC 0.79, P < .001), where CZT was able to correctly identify CAD extent in 64% of patients. On a per-vessel basis, CZT confirmed its high accuracy in detecting obstructive CAD (AUC 0.88, P < .001), independently from the involved coronary vessel. CONCLUSIONS MPI performed on a CZT camera is highly accurate in detecting obstructive CAD, independently from the coronary artery involved and the overall disease burden.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Riccardo Liga
- Cardio-thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
| | - Valerio Duce
- Cardio-thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Annette Kusch
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Alberto Clemente
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Paolo Marzullo
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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22
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Gimelli A, Liga R, Pasanisi EM, Casagranda M, Coceani M, Marzullo P. Influence of cardiac stress protocol on myocardial perfusion imaging accuracy: The role of exercise level on the evaluation of ischemic burden. J Nucl Cardiol 2016; 23:1114-1122. [PMID: 25814218 DOI: 10.1007/s12350-015-0101-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Some specifics of cardiac stress protocols, i.e., stressor used or exercise level achieved, may impact myocardial perfusion imaging (MPI) accuracy. METHODS Four-hundred and seventy-five patients were submitted to MPI and coronary angiography. MPI was performed after exercise (303 patients) or dipyridamole stress (172 patients). A coronary stenosis ≥70% was considered significant. In case of exercise test, a peak heart rate (HR) <85% of the maximal age predicted was considered submaximal and categorized as follows: >75% and <85% ("Group 1"); <75% ("Group 2"). RESULTS At coronary angiography, 312/475 (66%) patients showed significant stenosis. In the overall population, MPI showed a high accuracy in unmasking significant coronary stenosis, independently of the stress protocol adopted (AUC .76 for exercise vs .78 for vasodilator; P = NS). However, in case of an exercise stress test, a significant interaction between peak %HR and MPI diagnostic power was evident. While an elevated accuracy was still maintained in "Group 1" patients (AUC .79; P vs maximal exercise = NS), a significant drop was demonstrated in "Group 2" patients (AUC .66; P vs maximal exercise = .012, and P vs "Group 1" = .042). CONCLUSIONS The accuracy of MPI is not influenced by the stress protocol adopted. Exercise MPI maintains an elevated accuracy as long as the %HR remains >75%.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
| | - Riccardo Liga
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
| | | | - Mirta Casagranda
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
| | - Michele Coceani
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
| | - Paolo Marzullo
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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Giubbini R, Milan E. The time for radionuclide ventriculography resurrection is coming. J Nucl Cardiol 2016; 23:1139-1141. [PMID: 26253328 DOI: 10.1007/s12350-015-0245-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 07/10/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Elisa Milan
- San Giacomo Apostolo Hospital, Castelfranco Veneto, TV, Italy
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24
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Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease: a review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging 2016; 43:2423-2432. [PMID: 27542010 DOI: 10.1007/s00259-016-3467-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
The trade-off between resolution and count sensitivity dominates the performance of standard gamma cameras and dictates the need for relatively high doses of radioactivity of the used radiopharmaceuticals in order to limit image acquisition duration. The introduction of cadmium-zinc-telluride (CZT)-based cameras may overcome some of the limitations against conventional gamma cameras. CZT cameras used for the evaluation of myocardial perfusion have been shown to have a higher count sensitivity compared to conventional single photon emission computed tomography (SPECT) techniques. CZT image quality is further improved by the development of a dedicated three-dimensional iterative reconstruction algorithm, based on maximum likelihood expectation maximization (MLEM), which corrects for the loss in spatial resolution due to line response function of the collimator. All these innovations significantly reduce imaging time and result in a lower patient's radiation exposure compared with standard SPECT. To guide current and possible future users of the CZT technique for myocardial perfusion imaging, the Cardiovascular Committee of the European Association of Nuclear Medicine, starting from the experience of its members, has decided to examine the current literature regarding procedures and clinical data on CZT cameras. The committee hereby aims 1) to identify the main acquisitions protocols; 2) to evaluate the diagnostic and prognostic value of CZT derived myocardial perfusion, and finally 3) to determine the impact of CZT on radiation exposure.
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25
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Patel CD, Mukherjee A. Assessment of left ventricular mechanical dyssynchrony in coronary artery disease. J Nucl Cardiol 2016; 23:737-40. [PMID: 26358084 DOI: 10.1007/s12350-015-0276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Chetan D Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, B-54, South Extension Part-1, New Delhi, 110049, India.
| | - Anirban Mukherjee
- Department of Nuclear Medicine, All India Institute of Medical Sciences, B-54, South Extension Part-1, New Delhi, 110049, India
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26
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Gimelli A, Liga R, Giorgetti A, Favilli B, Pasanisi EM, Marzullo P. Determinants of left ventricular mechanical dyssynchrony in patients submitted to myocardial perfusion imaging: A cardiac CZT study. J Nucl Cardiol 2016; 23:728-36. [PMID: 26338425 DOI: 10.1007/s12350-015-0247-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/19/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND An interaction between coronary anatomy, myocardial perfusion, and left ventricular (LV) functional parameters in the development of mechanical LV dyssynchrony (LVD) has been suggested. This study examined the correlates of LVD in a large sample size of patients with known or suspected coronary artery disease (CAD) using cadmium-zinc-telluride camera. METHODS Six-hundred and fifty-seven consecutive patients who underwent myocardial perfusion imaging (MPI) and coronary angiography were included. Coronary stenosis >70% was considered significant. LV perfusion and functional parameters were computed from MPI images. The presence of significant LVD was evaluated by phase standard deviation and histogram bandwidth. RESULTS 415/657 (63%) patients had significant CAD. LVD was present in 247 (38%) patients and was associated with the presence of a higher CAD burden (P < .001), more impaired measures of LV perfusion (P < .001), contractile function (P < .001), and larger LV volumes (P < .001). By multivariate analysis, the LV end-systolic volume index (P < .001) and ischemic burden (P < .001) were the strongest predictors of LVD independent of CAD extent and LV systolic dysfunction. CONCLUSIONS LVD is frequent in patients undergoing MPI for suspected or known CAD. Its presence is independent of CAD burden and LV systolic dysfunction, but is dependent on the presence of myocardial perfusion abnormalities and LV end-systolic volume.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana G. Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
| | | | | | - Brunella Favilli
- Fondazione Toscana G. Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
| | | | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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27
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Bailliez A, Lairez O, Merlin C, Piriou N, Legallois D, Blaire T, Agostini D, Valette F, Manrique A. Left Ventricular Function Assessment Using 2 Different Cadmium-Zinc-Telluride Cameras Compared with a γ-Camera with Cardiofocal Collimators: Dynamic Cardiac Phantom Study and Clinical Validation. J Nucl Med 2016; 57:1370-5. [DOI: 10.2967/jnumed.115.168575] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/26/2016] [Indexed: 11/16/2022] Open
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28
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Haarmark C, Haase C, Jensen MM, Zerahn B. Pre-chemotherapy values for left and right ventricular volumes and ejection fraction by gated tomographic radionuclide angiography using a cadmium-zinc-telluride detector gamma camera. J Nucl Cardiol 2016; 23:87-97. [PMID: 26338424 DOI: 10.1007/s12350-015-0177-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Estimation of left ventricular ejection fraction (LVEF) using equilibrium radionuclide angiography is an established method for assessment of left ventricular function. The purpose of this study was to establish normative data on left and right ventricular volumes and ejection fraction, using cadmium-zinc-telluride SPECT camera. METHODS AND RESULTS From routine assessments of left ventricular function in 1172 patients, we included 463 subjects (194 men and 269 women) without diabetes, previous potentially cardiotoxic chemotherapy, known cardiovascular or pulmonary disease. The lower limits defined as mean value minus two standard deviations for ventricular ejection fraction and end diastolic volume were LVEF (men: 50%, women: 50%), LEDV (men: 45 mL, women: 40 mL), RVEF (men: 29%, women: 28%), and REDV (men: 73 mL, women: 57 mL).There was a significant negative correlation between age and both left and right ventricular volumes in women (r = -0.4, P < .001) but only for right end systolic ventricular volume in men (r = -0.3, P = .001). CONCLUSION A set of reference values for cardiac evaluation prior to chemotherapy in cancer patients without other known cardiopulmonary disease is presented. There are age-related changes in cardiac dimensions with age depending on gender, although with only limited influence on LVEF or RVEF.
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Affiliation(s)
- Christian Haarmark
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev, Denmark.
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, Building 60, Floor A, 2400, Copenhagen, Denmark.
| | - Christine Haase
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev, Denmark
| | - Maria Maj Jensen
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev, Denmark
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Chronotropic response to vasodilator-stress in patients submitted to myocardial perfusion imaging: impact on the accuracy in detecting coronary stenosis. Eur J Nucl Med Mol Imaging 2015; 42:1903-11. [PMID: 26194718 DOI: 10.1007/s00259-015-3129-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
AIMS A lower heart rate response (HRR) during vasodilator MPI has been shown to have a relevant adverse prognostic impact. We sought to evaluate the interaction among individual HRR to vasodilator stress and myocardial perfusion imaging (MPI) accuracy in patients with suspected ischemic heart disease (IHD). METHODS AND RESULTS One hundred and sixty-five consecutive patients were submitted to vasodilator-stress MPI on a cardiac camera equipped with cadmium-zinc-thelluride detectors and coronary angiography. A coronary stenosis >70 % was considered significant. In every patient, the summed difference score (SDS) was computed from MPI images. Patients were categorized according to the tertiles of the distribution of individual HRR during dipyridamole: "Group 1" (HRR < 8 bpm; lowest tertile); "Group 2" (8 ≤ HRR ≤ 12 bpm; middle tertile); "Group 3" (HRR >12 bpm; highest tertile). Significant coronary artery disease (CAD) was present in 102 (62 %) patients. In the overall population, MPI showed a significant accuracy (AUC: 0.81, 95 % CI 0.74-0.86; p < 0.001) in unmasking the presence of significant coronary stenosis. Interestingly, in patients with a blunted HRR during dipyridamole ("Group 1") MPI showed a significantly lower sensitivity (68 %) in detecting CAD than in those with a higher HRR ("Group 3") (91 %, p = 0.007), despite a preserved specificity (76 % vs 77 %, P=NS). Similarly, the correlation among CAD extent and post-stress LV functional stunning was limited to "Group 3" patients, while it disappeared in those with blunted HRR. CONCLUSIONS In patients with suspected IHD, MPI sensitivity is strongly influenced by the magnitude of patient heart rate increase to the pharmacologic stressor, suggesting an interaction among blunted HRR and lower accuracy in unmasking CAD.
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Gimelli A, Liga R, Giorgetti A, Kusch A, Pasanisi EM, Marzullo P. Relationships between myocardial perfusion abnormalities and poststress left ventricular functional impairment on cadmium-zinc-telluride imaging. Eur J Nucl Med Mol Imaging 2015; 42:994-1003. [DOI: 10.1007/s00259-015-3008-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/22/2015] [Indexed: 11/29/2022]
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Gimelli A, Liga R, Giorgetti A, Casagranda M, Marzullo P. Relationship between myocardial perfusion abnormalities and contractile impairment in anginal patients. J Nucl Cardiol 2014; 21:1181-90. [PMID: 25080198 DOI: 10.1007/s12350-014-9950-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND A relationship between left ventricular (LV) contractile impairment and myocardial perfusion abnormalities has been suggested. METHODS AND RESULTS Three-hundred and thirty-seven patients underwent myocardial perfusion imaging at CZT and coronary angiography. On scintigraphic images, the summed difference score (SDS) and LV-ejection fraction (EF) were computed. Patients were categorized as follows: Group-1 (LV-EF < 40%; 71 patients), Group-2 (LV-EF ≥ 40% and < 55%; 77 patients), and Group-3 (LV-EF ≥ 55%; 189 patients). Significant coronary artery disease (CAD; ≥50% stenosis) was recognized in 159/337 (47%) patients. Interestingly, while in Group-3 subjects an inverse relationship between SDS values and post-stress LV-EF was evident (P < .001), Group-1 patients presented a significant association between an increased SDS and more elevated post-stress LV-EF values (P = .009). Similarly, despite in the overall population an increasing severity of CAD was associated with higher SDS values (P < .001), this relationship disappeared in Group-1 patients (P = .298). At multiple regression analysis, after correction for CAD, LV dysfunction was negatively associated with an elevated SDS (P = .018). Conversely in patients with normal LV function and no history of myocardial infarction, CAD extent, and functional measures of stress-induced myocardial ischemia were strictly correlated. CONCLUSIONS Independently from CAD, a significantly impaired LV function associates with a lower prevalence of reversible ischemia.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy,
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Gimelli A, Liga R, Bottai M, Pasanisi EM, Giorgetti A, Fucci S, Marzullo P. Diastolic dysfunction assessed by ultra-fast cadmium-zinc-telluride cardiac imaging: impact on the evaluation of ischaemia. Eur Heart J Cardiovasc Imaging 2014; 16:68-73. [DOI: 10.1093/ehjci/jeu166] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gimelli A, Liga R, Pasanisi EM, Giorgetti A, Marras G, Favilli B, Marzullo P. Evaluation of left ventricular diastolic function with a dedicated cadmium-zinc-telluride cardiac camera: comparison with Doppler echocardiography. Eur Heart J Cardiovasc Imaging 2014; 15:972-9. [PMID: 24618658 DOI: 10.1093/ehjci/jeu037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To evaluate the relationships between measures of left ventricular (LV) filling dynamics at cadmium-zinc-telluride (CZT) imaging and indexes of LV diastolic function at transthoracic echocardiography. METHODS AND RESULTS Two hundred and forty-seven patients underwent myocardial perfusion imaging at rest and after stress with a low-dose CZT protocol and a baseline transthoracic echocardiography study. All patients were submitted to invasive or computed coronary angiography. The peak filling rate (PFR) and the time to PFR (TPFR) were derived from gated CZT images as measures of LV filling dynamics. LV diastolic function was also evaluated at echocardiography and the presence of significantly increased LV filling pressures determined. Increased LV filling pressures at transthoracic echocardiography were evident in 103 (42%) patients. Interestingly, independently from the presence of coronary artery disease, there was a strict correlation between the presence and severity of LV diastolic dysfunction at echocardiography and CZT-derived measures of filling dynamics, i.e., PFR (P = 0.001) and TPFR (P = 0.001). At receiving operating characteristic analysis, a composite index of reduced PFR (≤2.11 end-diastolic volume s(-1)) and increased TPFR (>234 ms) showed a sensitivity of 84% and a specificity of 67% in unmasking the presence of elevated LV filling pressures at echocardiography. CONCLUSIONS CZT-derived measures of LV filling dynamics correlate with echocardiographic parameters of diastolic function and may identify the presence of increased LV filling pressures.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124 Pisa, Italy
| | | | | | | | - Gavino Marras
- Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Brunella Favilli
- Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124 Pisa, Italy
| | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Via Moruzzi, 1, 56124 Pisa, Italy University Hospital of Pisa, Pisa, Italy CNR, Institute of Clinical Physiology, Pisa, Italy
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Gimelli A, Liga R, Genovesi D, Giorgetti A, Kusch A, Marzullo P. Association between left ventricular regional sympathetic denervation and mechanical dyssynchrony in phase analysis: a cardiac CZT study. Eur J Nucl Med Mol Imaging 2013; 41:946-55. [DOI: 10.1007/s00259-013-2640-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 11/12/2013] [Indexed: 11/30/2022]
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