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Kovalski G, Sharir T. Myocardial blood flow assessment with SPECT systems: The renovation continues. J Nucl Cardiol 2020; 27:2303-2305. [PMID: 30820816 DOI: 10.1007/s12350-019-01666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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Shiraishi S, Tsuda N, Sakamoto F, Ogasawara K, Tomiguchi S, Tsujita K, Yamashita Y. Clinical usefulness of quantification of myocardial blood flow and flow reserve using CZT-SPECT for detecting coronary artery disease in patients with normal stress perfusion imaging. J Cardiol 2020; 75:400-409. [DOI: 10.1016/j.jjcc.2019.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/18/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022]
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Cho SG, Kim J, Song HC. Debates over NICE Guideline Update: What Are the Roles of Nuclear Cardiology in the Initial Evaluation of Stable Chest Pain? Nucl Med Mol Imaging 2019; 53:301-312. [PMID: 31723359 PMCID: PMC6821897 DOI: 10.1007/s13139-019-00607-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 12/12/2022] Open
Abstract
Recent clinical trials have demonstrated the values of cardiac computed tomography (CT) in the initial evaluation of stable chest pain which led to drastic changes in the National Institute for Health and Care Excellence (NICE) guidelines in 2016. According to the updated NICE guidelines, cardiac CT should be performed as the initial cardiac testing in stable chest pain regardless of pre-test probability (PTP) of coronary artery disease (CAD). As a result, cardiac CT is now considered as a validated gatekeeper for assessing stable chest pain, which precedes all the functional studies including nuclear myocardial perfusion imaging (MPI). Nuclear MPI, in contrast, has been assigned as one of the second-line studies, which is inevitably dependent on the results of cardiac CT. However, nuclear MPI has genuine values in the diagnosis, treatment decision, and prognostic stratification of stable chest pain, which cannot be replaced by cardiac CT. In this review, the updated NICE guidelines and related cardiac CT trials will be critically reviewed from the view of nuclear physicians and the exceptional values of nuclear MPI will be described along with the future perspectives.
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Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469 South Korea
| | - Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469 South Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469 South Korea
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Sciammarella M, Shrestha UM, Seo Y, Gullberg GT, Botvinick EH. A combined static-dynamic single-dose imaging protocol to compare quantitative dynamic SPECT with static conventional SPECT. J Nucl Cardiol 2019; 26:763-771. [PMID: 28776314 PMCID: PMC5920770 DOI: 10.1007/s12350-017-1016-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND SPECT myocardial perfusion imaging (MPI) is a clinical mainstay that is typically performed with static imaging protocols and visually or semi-quantitatively assessed for perfusion defects based upon the relative intensity of myocardial regions. Dynamic cardiac SPECT presents a new imaging technique based on time-varying information of radiotracer distribution, which permits the evaluation of regional myocardial blood flow (MBF) and coronary flow reserve (CFR). In this work, a preliminary feasibility study was conducted in a small patient sample designed to implement a unique combined static-dynamic single-dose one-day visit imaging protocol to compare quantitative dynamic SPECT with static conventional SPECT for improving the diagnosis of coronary artery disease (CAD). METHODS Fifteen patients (11 males, four females, mean age 71 ± 9 years) were enrolled for a combined dynamic and static SPECT (Infinia Hawkeye 4, GE Healthcare) imaging protocol with a single dose of 99mTc-tetrofosmin administered at rest and a single dose administered at stress in a one-day visit. Out of 15 patients, eleven had selective coronary angiography (SCA), 8 within 6 months and the rest within 24 months of SPECT imaging, without intervening symptoms or interventions. The extent and severity of perfusion defects in each myocardial region was graded visually. Dynamically acquired data were also used to estimate the MBF and CFR. Both visually graded images and estimated CFR were tested against SCA as a reference to evaluate the validity of the methods. RESULTS Overall, conventional static SPECT was normal in ten patients and abnormal in five patients, dynamic SPECT was normal in 12 patients and abnormal in three patients, and CFR from dynamic SPECT was normal in nine patients and abnormal in six patients. Among those 11 patients with SCA, conventional SPECT was normal in 5, 3 with documented CAD on SCA with an overall accuracy of 64%, sensitivity of 40% and specificity of 83%. Dynamic SPECT image analysis also produced a similar accuracy, sensitivity, and specificity. CFR was normal in 6, each with CAD on SCA with an overall accuracy of 91%, sensitivity of 80%, and specificity of 100%. The mean CFR was significantly lower for SCA detected abnormal than for normal patients (3.86±1.06 vs 1.94±0. 0.67, P < 0.001). CONCLUSIONS The visually assessed image findings in static and dynamic SPECT are subjective, and may not reflect direct physiologic measures of coronary lesion based on SCA. The CFR measured with dynamic SPECT is fully objective, with better sensitivity and specificity, available only with the data generated from the dynamic SPECT method.
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Affiliation(s)
- Maria Sciammarella
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Uttam M Shrestha
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., Suite 350, San Francisco, CA, 94143-0946, USA.
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., Suite 350, San Francisco, CA, 94143-0946, USA
| | - Grant T Gullberg
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., Suite 350, San Francisco, CA, 94143-0946, USA
| | - Elias H Botvinick
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., Suite 350, San Francisco, CA, 94143-0946, USA
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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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Chetrit M, Verma BR, Xu B. Choosing the Appropriate Stress Test for Myocardial Perfusion Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9488-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim DY, Cho SG, Bom HS. Emerging Tracers for Nuclear Cardiac PET Imaging. Nucl Med Mol Imaging 2018; 52:266-278. [PMID: 30100939 PMCID: PMC6066491 DOI: 10.1007/s13139-018-0521-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/05/2018] [Accepted: 04/12/2018] [Indexed: 12/16/2022] Open
Abstract
Myocardial perfusion imaging using positron emission tomography (PET) has several advantages over single photon emission computed tomography (SPECT). The recent advances in SPECT technology have shown promise, but there is still a large need for PET in the clinical management of coronary artery disease (CAD). Especially, absolute quantification of myocardial blood flow (MBF) using PET is extremely important. In spite of considerable advances in the diagnosis of CAD, novel PET radiopharmaceuticals remain necessary for the diagnosis of CAD because clinical use of current cardiac radiotracers is limited by their physical characteristics, such as decay mode, emission energy, and half-life. Thus, the use of a radioisotope that has proper characteristics and a proper half-life to develop myocardial perfusion agents could overcome these limitations. In this review, the current state of cardiac PET and a general overview of novel 18F or 68Ga-labeled radiotracers, including their radiosynthesis, in vivo characterization, and evaluation, are provided. The future perspectives are discussed in terms of their potential usefulness based on new image analysis methods and hybrid imaging.
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Affiliation(s)
- Dong-Yeon Kim
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
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8
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Raggi P, Mancini GBJ. Myocardial perfusion with single-photon emission computed tomography, multidetector computed tomography, or neither? J Nucl Cardiol 2017; 24:1722-1724. [PMID: 27189172 DOI: 10.1007/s12350-016-0528-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: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Suite 4A7.050, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - G B John Mancini
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Quantification of Myocardial Blood Flow with CZT SPECT Imaging: Is It Ready for Clinical Use? CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9432-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Fang YHD, Liu YC, Ho KC, Kuo FC, Yang CF, Yen TC, Hsieh IC. Single-scan rest/stress imaging with 99mTc-Sestamibi and cadmium zinc telluride-based SPECT for hyperemic flow quantification: A feasibility study evaluated with cardiac magnetic resonance imaging. PLoS One 2017; 12:e0183402. [PMID: 28817662 PMCID: PMC5560722 DOI: 10.1371/journal.pone.0183402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/14/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction We aimed to evaluate whether the hyperemic myocardial blood flow (MBF) can be estimated using cadmium zinc telluride (CZT)-based single-photon emission computed tomography (SPECT) cameras with a single, rapid rest/stress dynamic scan. Dynamic contrast-enhanced (DCE) cardiac magnetic resonance imaging (MRI) was used as a reference modality for flow measurement. Materials and methods The proposed protocol included both the rest and stress acquisitions within a 24-min scan. Patients were first injected with 99mTc-Sestamibi at the resting state. Sixty minutes after the first injection, the subject was positioned via scintigraphy, after which the list-mode data acquisition was initiated and continued for 24 minutes. Five minutes after data acquisition was initiated, a stressed state was induced via dipyridamole infusion, after which a second dose of 99mTc-Sestamibi was injected. Dynamic SPECT images were reconstructed for all subjects, who also underwent T1-weighted cardiac DCE-MRI performed on days other than those of the SPECT studies. MBF values were estimated for the rest and stress MRI studies, and for the stress portion of the SPECT study. The SPECT-measured hyperemic MBF was compared with the MR-measured hyperemic MBF and coronary flow reserve (CFR), based on the regions of interest. Results A total of 30 subjects were included in this study. The hyperemic MBF estimated from SPECT showed a strong correlation with the MR-measured hyperemic MBF (r2 = 0.76) and a modest correlation with the MR-measured CFR (r2 = 0.56). Using MR-measured CFR <1.3 as a cutoff for coronary stenosis, we found that the SPECT-measured hyperemic MBF served as a useful clinical index with 94% sensitivity, 90% specificity, and 93% accuracy. Conclusions Hyperemic MBF can be measured with a rapid, single-scan rest/stress study with CZT-based SPECT cameras.
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Affiliation(s)
- Yu-Hua Dean Fang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Chang Liu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kung-Chu Ho
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Feng-Cheng Kuo
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Fang Yang
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Center for Advanced Molecular Imaging and Translation & Cyclotron Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- * E-mail: (TY); (IH)
| | - I-Chang Hsieh
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan
- * E-mail: (TY); (IH)
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11
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Taqueti VR, Dorbala S, Wolinsky D, Abbott B, Heller GV, Bateman TM, Mieres JH, Phillips LM, Wenger NK, Shaw LJ. Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease-state-of-the-evidence and clinical recommendations. J Nucl Cardiol 2017; 24:1402-1426. [PMID: 28585034 PMCID: PMC5942593 DOI: 10.1007/s12350-017-0926-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 12/21/2022]
Abstract
This document from the American Society of Nuclear Cardiology represents an updated consensus statement on the evidence base of stress myocardial perfusion imaging (MPI), emphasizing new developments in single-photon emission tomography (SPECT) and positron emission tomography (PET) in the clinical evaluation of women presenting with symptoms of stable ischemic heart disease (SIHD). The clinical evaluation of symptomatic women is challenging due to their varying clinical presentation, clinical risk factor burden, high degree of comorbidity, and increased risk of major ischemic heart disease events. Evidence is substantial that both SPECT and PET MPI effectively risk stratify women with SIHD. The addition of coronary flow reserve (CFR) with PET improves risk detection, including for women with nonobstructive coronary artery disease and coronary microvascular dysfunction. With the advent of PET with computed tomography (CT), multiparametric imaging approaches may enable integration of MPI and CFR with CT visualization of anatomical atherosclerotic plaque to uniquely identify at-risk women. Radiation dose-reduction strategies, including the use of ultra-low-dose protocols involving stress-only imaging, solid-state detector SPECT, and PET, should be uniformly applied whenever possible to all women undergoing MPI. Appropriate candidate selection for stress MPI and for post-MPI indications for guideline-directed medical therapy and/or invasive coronary angiography are discussed in this statement. The critical need for randomized and comparative trial data in female patients is also emphasized.
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Affiliation(s)
- Viviany R Taqueti
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, ASBI-L1 037-G, 75 Francis Street, Boston, MA, 02115, USA.
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sharmila Dorbala
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, ASBI-L1 037-G, 75 Francis Street, Boston, MA, 02115, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Wolinsky
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston, FL, USA
| | - Brian Abbott
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Cardiovascular Institute, The Miriam and Newport Hospitals, Providence, RI, USA
| | - Gary V Heller
- Gagnon Cardiovascular Center, Morristown Medical Center, Morristown, NJ, USA
| | - Timothy M Bateman
- Saint Luke's Health System, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Lawrence M Phillips
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Leslee J Shaw
- Division of Cardiology, Department of Medicine, Emory University Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
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Keith GA, Rodgers CT, Chappell MA, Robson MD. A look-locker acquisition scheme for quantitative myocardial perfusion imaging with FAIR arterial spin labeling in humans at 3 tesla. Magn Reson Med 2016; 78:541-549. [PMID: 27604183 PMCID: PMC5516148 DOI: 10.1002/mrm.26388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE A novel method for quantitative measurement of myocardial blood flow (MBF) using arterial spin labeling (ASL) in a single breath-hold is presented, evaluated by simulations, phantom studies and in vivo studies and tested for reproducibility and variability. METHODS A flow-sensitive alternating inversion recovery (FAIR) ASL method with Look-Locker readout (LL-FAIR-ASL) was implemented at 3 tesla. Scans were performed on 10 healthy volunteers and MBF measured in three slices. The method was investigated for reproducibility by Bland-Altman analysis and statistical measures, the coefficients of reproducibility (CR) and variation (CV) are reported. RESULTS The MBF values for the basal, mid, and apical slices were 1.04 ± 0.40, 1.06 ± 0.46, and 1.06 ± 0.38 ml/g/min, respectively (mean ± SD), which compare well with literature values. The CV across all scans, 43%, was greater than the between-session and within-session values, at 16 and 13%, respectively, for the mid-ventricular slice. The change in MBF required for detection, from the CR, was 61% between-session and 53% within-session for the mid-ventricle. CONCLUSION This study shows the feasibility of the LL-FAIR-ASL method for the quantification of MBF. The statistical measures reported will allow the planning of future clinical research studies involving rest and stress measurements. Magn Reson Med 78:541-549, 2017. © 2016 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- Graeme A. Keith
- Oxford Centre for Clinical Magnetic Resonance ResearchUniversity of Oxford, John Radcliffe HospitalOxfordUnited Kingdom
| | - Christopher T. Rodgers
- Oxford Centre for Clinical Magnetic Resonance ResearchUniversity of Oxford, John Radcliffe HospitalOxfordUnited Kingdom
| | - Michael A. Chappell
- Institute of Biomedical EngineeringUniversity of Oxford, Old Road CampusOxfordUnited Kingdom
| | - Matthew D. Robson
- Oxford Centre for Clinical Magnetic Resonance ResearchUniversity of Oxford, John Radcliffe HospitalOxfordUnited Kingdom
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Hsu B, Hu LH, Yang BH, Chen LC, Chen YK, Ting CH, Hung GU, Huang WS, Wu TC. SPECT myocardial blood flow quantitation toward clinical use: a comparative study with 13N-Ammonia PET myocardial blood flow quantitation. Eur J Nucl Med Mol Imaging 2016; 44:117-128. [PMID: 27585576 DOI: 10.1007/s00259-016-3491-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/07/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the accuracy of myocardial blood flow (MBF) quantitation of 99mTc-Sestamibi (MIBI) single photon emission computed tomography (SPECT) compared with 13N-Ammonia (NH3) position emission tomography (PET) on the same cohorts. BACKGROUND Recent advances of SPECT technologies have been applied to develop MBF quantitation as a promising tool to diagnose coronary artery disease (CAD) for areas where PET MBF quantitation is not available. However, whether the SPECT approach can achieve the same level of accuracy as the PET approach for clinical use still needs further investigations. METHODS Twelve healthy volunteers (HVT) and 16 clinical patients with CAD received both MIBI SPECT and NH3 PET flow scans. Dynamic SPECT images acquired with high temporary resolution were fully corrected for physical factors and processed to quantify K1 using the standard compartmental modeling. Human MIBI tracer extraction fraction (EF) was determined by comparing MIBI K1 and NH3 flow on the HVT group and then used to convert flow values from K1 for all subjects. MIBI and NH3 flow values were systematically compared to validate the SPECT approach. RESULTS The human MIBI EF was determined as [1.0-0.816*exp(-0.267/MBF)]. Global and regional MBF and myocardial flow reserve (MFR) of MIBI SPECT and NH3 PET were highly correlated for all subjects (global R2: MBF = 0.92, MFR = 0.78; regional R2: MBF ≥ 0.88, MFR ≥ 0.71). No significant differences for rest flow, stress flow, and MFR between these two approaches were observed (All p ≥ 0.088). Bland-Altman plots overall revealed small bias between MIBI SPECT and NH3 PET (global: ΔMBF = -0.03Lml/min/g, ΔMFR = 0.07; regional: ΔMBF = -0.07 - 0.06 , ΔMFR = -0.02 - 0.22). CONCLUSIONS Quantitation with SPECT technologies can be accurate to measure myocardial blood flow as PET quantitation while comprehensive imaging factors of SPECT to derive the variability between these two approaches were fully addressed and corrected.
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Affiliation(s)
- Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Lien-Hsin Hu
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bang-Hung Yang
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lung-Ching Chen
- Division of Cardiology, Shin Kong Wu-Ho Su Memorial Hospital, Taipei, Taiwan
| | - Yen-Kung Chen
- Department of Nuclear Medicine, Shin Kong Wu-Ho Su Memorial Hospital, Taipei, Taiwan
| | - Chien-Hsin Ting
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Wen-Sheng Huang
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Tao-Cheng Wu
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.
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Chatal JF, Rouzet F, Haddad F, Bourdeau C, Mathieu C, Le Guludec D. Story of Rubidium-82 and Advantages for Myocardial Perfusion PET Imaging. Front Med (Lausanne) 2015; 2:65. [PMID: 26442267 PMCID: PMC4566054 DOI: 10.3389/fmed.2015.00065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/26/2015] [Indexed: 01/07/2023] Open
Abstract
Rubidium-82 has a long story, starting in 1954. After preclinical studies in dogs showing that myocardial uptake of this radionuclide was directly proportional to myocardial blood flow (MBF), clinical studies were performed in the 80s leading to an approval in the USA in 1989. From that time, thousands of patients have been tested and their results have been reported in three meta-analyses. Pooled patient-based sensitivity and specificity were, respectively, 0.91 and 0.90. By comparison with 99mTc-SPECT, 82Rb PET had a much better diagnostic accuracy, especially in obese patients with body mass index ≥30 kg/m2 (85 versus 67% with SPECT) and in women with large breasts. A great advantage of 82Rb PET is its capacity to accurately quantify MBF. Quite importantly, it has been recently shown that coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity. Moreover, coronary flow reserve is a functional parameter particularly useful in the estimate of microvascular dysfunction, such as in diabetes mellitus. Due to the very short half-life of rubidium-82, the effective dose calculated for a rest/stress test is roughly equivalent to the annual natural exposure and even less when stress-only is performed with a low activity compatible with a good image quality with the last generation 3D PET scanners. There is still some debate on the relative advantages of 82Rb PET with regard to 99mTc-SPECT. For the last 10 years, great technological advances substantially improved performances of SPECT with its accuracy getting closer to this of 82Rb/PET. Currently, the main advantages of PET are its capacity to accurately quantify MBF and to deliver a low radiation exposure.
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Affiliation(s)
- Jean-François Chatal
- Groupement d'Intérêt Public Arronax, University of Nantes , Saint-Herblain , France
| | - François Rouzet
- UMR 1148, Department of Nuclear Medicine, Bichat Hospital, Assistance Publique Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation, Remodeling in Cardiovascular, Respiratory and Renal Diseases), Paris-Diderot University , Paris , France
| | - Ferid Haddad
- Groupement d'Intérêt Public Arronax, University of Nantes , Saint-Herblain , France
| | - Cécile Bourdeau
- Groupement d'Intérêt Public Arronax, University of Nantes , Saint-Herblain , France
| | - Cédric Mathieu
- Department of Nuclear Medicine, Nantes University Hospital , Nantes , France
| | - Dominique Le Guludec
- UMR 1148, Department of Nuclear Medicine, Bichat Hospital, Assistance Publique Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation, Remodeling in Cardiovascular, Respiratory and Renal Diseases), Paris-Diderot University , Paris , France
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15
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Ben Bouallègue F, Roubille F, Lattuca B, Cung TT, Macia JC, Gervasoni R, Leclercq F, Mariano-Goulart D. SPECT Myocardial Perfusion Reserve in Patients with Multivessel Coronary Disease: Correlation with Angiographic Findings and Invasive Fractional Flow Reserve Measurements. J Nucl Med 2015; 56:1712-7. [DOI: 10.2967/jnumed.114.143164] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/10/2015] [Indexed: 11/16/2022] Open
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16
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Timmins R, Klein R, Petryk J, Marvin B, Wei L, deKemp RA, Ruddy TD, Wells RG. Reduced dose measurement of absolute myocardial blood flow using dynamic SPECT imaging in a porcine model. Med Phys 2015; 42:5075-83. [DOI: 10.1118/1.4927723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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17
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Garcia EV. Proceedings of the cardiac PET summit meeting 12 may 2014: Cardiac PET and SPECT instrumentation. J Nucl Cardiol 2015; 22:563-70. [PMID: 25824018 DOI: 10.1007/s12350-015-0114-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
Abstract
Advances in PET and SPECT and imaging hardware and software are vastly improving the noninvasive evaluation of myocardial perfusion and function. PET perfusion imaging has benefitted from the introduction of novel detectors that now allow true 3D imaging, and precise attenuation correction (AC). These developments have also resulted in perfusion images with higher spatial and contrast resolution that may be acquired in shorter protocols and/or with less patient radiation exposure than traditional PET or SPECT studies. Hybrid PET/CT cameras utilize transmission computed tomographic (CT) scans for AC, and offer the additional clinical advantages of evaluating coronary calcium and myocardial anatomy but at a higher cost than PET scanners that use (68)Ge radioactive line sources. As cardiac PET systems continue to improve, dedicated cardiac SPECT systems are also undergoing a profound change in their design. The scintillation camera general purpose design is being replaced with systems with multiple detectors focused on the heart yielding 5 to 10 times the sensitivity of conventional SPECT. As a result, shorter acquisition times and/or lower tracer doses produce higher quality SPECT images than were possible before. This article reviews these concepts and compares the attributes of PET and SPECT instrumentation.
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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,
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18
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Abstract
The American Society of Nuclear Cardiology has recently published documents that encourage laboratories to take all the appropriate steps to greatly decrease patient radiation dose and has set the goal of 50% of all myocardial perfusion studies performed with an associated radiation exposure of 9mSv by 2014. In the present work, a description of the major software techniques readily available to shorten procedure time and decrease injected activity is presented. Particularly new reconstruction methods and their ability to include means for resolution recovery and noise regularization are described. The use of these improved reconstruction algorithms results in a consistent reduction in acquisition time, injected activity and consequently in the radiation dose absorbed by the patient. The clinical implications to the use of these techniques are also described in terms of maintained and even improved study quality, accuracy and sensitivity for the detection of heart disease.
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