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Ayalew BD, Rodoshi ZN, Patel VK, Alresheq A, Babu HM, Aurangzeb RF, Aurangzeb RI, Mdivnishvili M, Rehman A, Shehryar A, Hassan A. Nuclear Cardiology in the Era of Precision Medicine: Tailoring Treatment to the Individual Patient. Cureus 2024; 16:e58960. [PMID: 38800181 PMCID: PMC11127713 DOI: 10.7759/cureus.58960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Nuclear cardiology, employing advanced imaging technologies like positron emission tomography (PET) and single photon emission computed tomography (SPECT), is instrumental in diagnosing, risk stratifying, and managing heart diseases. Concurrently, precision medicine advocates for treatments tailored to each patient's genetic, environmental, and lifestyle specificities, promising a revolution in personalized cardiovascular care. This review explores the synergy between nuclear cardiology and precision medicine, highlighting advancements, potential enhancements in patient outcomes, and the challenges and opportunities of this integration. We examined the evolution of nuclear cardiology technologies, including PET and SPECT, and their role in cardiovascular diagnostics. We also delved into the principles of precision medicine, focusing on genetic and molecular profiling, data analytics, and individualized treatment strategies. The integration of these domains aims to optimize diagnostic accuracy, therapeutic interventions, and prognostic evaluations in cardiovascular care. Advancements in molecular imaging and the application of artificial intelligence in nuclear cardiology have significantly improved the precision of diagnostics and treatment plans. The adoption of precision medicine principles in nuclear cardiology enables the customization of patient care, leveraging genetic information and biomarkers for enhanced therapeutic outcomes. However, challenges such as data integration, accessibility, cost, and the need for specialized expertise persist. The confluence of nuclear cardiology and precision medicine offers a promising pathway toward revolutionizing cardiovascular healthcare, providing more accurate, effective, and personalized patient care. Addressing existing challenges and fostering interdisciplinary collaboration is crucial for realizing the full potential of this integration in improving patient outcomes.
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Affiliation(s)
- Biruk D Ayalew
- Internal Medicine, Saint Paul's Hospital Millennium Medical College, Addis Ababa, ETH
| | | | | | - Alaa Alresheq
- Primary Care, United Nations for Relief and Works Agency, Ramallah, PSE
| | - Hisham M Babu
- Internal Medicine, Jagadguru Sri Shivarathreeshwara (JSS) Medical College and Hospital, JSS Academy of Higher Education and Research (JSSAHER), Mysore, IND
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Chow BJ, Galiwango P, Poulin A, Raggi P, Small G, Juneau D, Kazmi M, Ayach B, Beanlands RS, Sanfilippo AJ, Chow CM, Paterson DI, Chetrit M, Jassal DS, Connelly K, Larose E, Bishop H, Kass M, Anderson TJ, Haddad H, Mancini J, Doucet K, Daigle JS, Ahmadi A, Leipsic J, Lim SP, McRae A, Chou AY. Chest Pain Evaluation: Diagnostic Testing. CJC Open 2023; 5:891-903. [PMID: 38204849 PMCID: PMC10774086 DOI: 10.1016/j.cjco.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/01/2023] [Indexed: 01/12/2024] Open
Abstract
Chest pain/discomfort (CP) is a common symptom and can be a diagnostic dilemma for many clinicians. The misdiagnosis of an acute or progressive chronic cardiac etiology may carry a significant risk of morbidity and mortality. This review summarizes the different options and modalities for establishing the diagnosis and severity of coronary artery disease. An effective test selection algorithm should be individually tailored to each patient to maximize diagnostic accuracy in a timely fashion, determine short- and long-term prognosis, and permit implementation of evidence-based treatments in a cost-effective manner. Through collaboration, a decision algorithm was developed (www.chowmd.ca/cadtesting) that could be adopted widely into clinical practice.
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Affiliation(s)
- Benjamin J.W. Chow
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Galiwango
- Department of Medicine, Scarborough Health Network and Lakeridge Health, University of Toronto, Toronto, Ontario, Canada
| | - Anthony Poulin
- Department of Medicine, Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Paolo Raggi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gary Small
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel Juneau
- Department of Radiology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Mustapha Kazmi
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bilal Ayach
- Department of Medicine, Lakeridge Health, Queen’s University, Kingston, Ontario, Canada
| | - Rob S. Beanlands
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Anthony J. Sanfilippo
- Department of Medicine, Lakeridge Health, Queen’s University, Kingston, Ontario, Canada
| | - Chi-Ming Chow
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - D. Ian Paterson
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael Chetrit
- Department of Cardiovascular Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Davinder S. Jassal
- Department of Physiology and Pathophysiology, Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kim Connelly
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eric Larose
- Department of Medicine, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Quebec, Canada
| | - Helen Bishop
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Malek Kass
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd J. Anderson
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Haissam Haddad
- Division of Cardiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John Mancini
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katie Doucet
- Peterborough Regional Health Centre, Kawartha Cardiology Clinic, Peterborough, Ontario, Canada
| | - Jean-Sebastien Daigle
- Department of Internal Medicine, Dr Everett Chalmers Hospital, Fredericton, New Brunswick, Canada
| | - Amir Ahmadi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan Leipsic
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Siok Ping Lim
- Mayfair Diagnostics, Saskatoon, Saskatchewan, Canada
| | - Andrew McRae
- Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Annie Y. Chou
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, St. Paul’s Hospital, Vancouver, British Columbia, Canada
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Slomka P. Do we need dedicated cardiac SPECT systems? J Nucl Cardiol 2021; 28:1331-1333. [PMID: 31650495 DOI: 10.1007/s12350-019-01921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, USA.
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Hirschfeld CB, Mercuri M, Pascual TNB, Karthikeyan G, Vitola JV, Mahmarian JJ, Better N, Bouyoucef SE, Hee-Seung Bom H, Lele V, Magboo VPC, Alexánderson E, Allam AH, Al-Mallah MH, Dorbala S, Flotats A, Jerome S, Kaufmann PA, Luxenburg O, Shaw LJ, Underwood SR, Rehani MM, Paez D, Dondi M, Einstein AJ. Worldwide Variation in the Use of Nuclear Cardiology Camera Technology, Reconstruction Software, and Imaging Protocols. JACC Cardiovasc Imaging 2021; 14:1819-1828. [PMID: 33454257 DOI: 10.1016/j.jcmg.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study sought to describe worldwide variations in the use of myocardial perfusion imaging hardware, software, and imaging protocols and their impact on radiation effective dose (ED). BACKGROUND Concerns about long-term effects of ionizing radiation have prompted efforts to identify strategies for dose optimization in myocardial perfusion scintigraphy. Studies have increasingly shown opportunities for dose reduction using newer technologies and optimized protocols. METHODS Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study) registry, a multinational, cross-sectional study comprising 7,911 imaging studies from 308 labs in 65 countries. The study compared regional use of camera technologies, advanced post-processing software, and protocol characteristics and analyzed the influence of each factor on ED. RESULTS Cadmium-zinc-telluride and positron emission tomography (PET) cameras were used in 10% (regional range 0% to 26%) and 6% (regional range 0% to 17%) of studies worldwide. Attenuation correction was used in 26% of cases (range 10% to 57%), and advanced post-processing software was used in 38% of cases (range 26% to 64%). Stress-first single-photon emission computed tomography (SPECT) imaging comprised nearly 20% of cases from all world regions, except North America, where it was used in just 7% of cases. Factors associated with lower ED and odds ratio for achieving radiation dose ≤9 mSv included use of cadmium-zinc-telluride, PET, advanced post-processing software, and stress- or rest-only imaging. Overall, 39% of all studies (97% PET and 35% SPECT) were ≤9 mSv, while just 6% of all studies (32% PET and 4% SPECT) achieved a dose ≤3 mSv. CONCLUSIONS Newer-technology cameras, advanced software, and stress-only protocols were associated with reduced ED, but worldwide adoption of these practices was generally low and varied significantly between regions. The implementation of dose-optimizing technologies and protocols offers an opportunity to reduce patient radiation exposure across all world regions.
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Affiliation(s)
- Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Mathew Mercuri
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Thomas N B Pascual
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Nathan Better
- Department of Nuclear Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | | | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Vikram Lele
- Department of Nuclear Medicine and PET-CT, Jaslok Hospital and Research Centre, Mumbai, India
| | - V Peter C Magboo
- Department of Physical Sciences and Mathematics, University of the Philippines, Manila, the Philippines; Department of Nuclear Medicine, University of Santo Tomas Hospital, Manila, the Philippines
| | - Erick Alexánderson
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, Mexico
| | - Adel H Allam
- Cardiology Department, Al Azhar University, Cairo, Egypt
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Scott Jerome
- Intersocietal Accreditation Commission, Ellicott City, Maryland; Division of Cardiology, University of Maryland, Baltimore, Maryland, USA
| | - Philipp A Kaufmann
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Israel; Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Leslee J Shaw
- New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - S Richard Underwood
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diana Paez
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Maurizio Dondi
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA.
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Liga R, Gimelli A. Automatic evaluation of myocardial perfusion on SPECT: Need for "Normality". J Nucl Cardiol 2019; 26:786-789. [PMID: 29071669 DOI: 10.1007/s12350-017-1097-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 11/30/2022]
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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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Bourque JM, Iskandrian AE, Hage FG. Screening pre-renal transplant: Risk factors appear key but important questions remain. J Nucl Cardiol 2018; 25:2069-2071. [PMID: 28585033 PMCID: PMC6191360 DOI: 10.1007/s12350-017-0944-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, 1215 Lee Street, Box 800158, Charlottesville, VA, 22908, USA.
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Betancur J, Hu LH, Commandeur F, Sharir T, Einstein AJ, Fish MB, Ruddy TD, Kaufmann PA, Sinusas AJ, Miller EJ, Bateman TM, Dorbala S, Di Carli M, Germano G, Otaki Y, Liang JX, Tamarappoo BK, Dey D, Berman DS, Slomka PJ. Deep Learning Analysis of Upright-Supine High-Efficiency SPECT Myocardial Perfusion Imaging for Prediction of Obstructive Coronary Artery Disease: A Multicenter Study. J Nucl Med 2018; 60:664-670. [PMID: 30262516 DOI: 10.2967/jnumed.118.213538] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/14/2018] [Indexed: 12/19/2022] Open
Abstract
Combined analysis of SPECT myocardial perfusion imaging (MPI) performed with a solid-state camera on patients in 2 positions (semiupright, supine) is routinely used to mitigate attenuation artifacts. We evaluated the prediction of obstructive disease from combined analysis of semiupright and supine stress MPI by deep learning (DL) as compared with standard combined total perfusion deficit (TPD). Methods: 1,160 patients without known coronary artery disease (64% male) were studied. Patients underwent stress 99mTc-sestamibi MPI with new-generation solid-state SPECT scanners in 4 different centers. All patients had on-site clinical reads and invasive coronary angiography correlations within 6 mo of MPI. Obstructive disease was defined as at least 70% narrowing of the 3 major coronary arteries and at least 50% for the left main coronary artery. Images were quantified at Cedars-Sinai. The left ventricular myocardium was segmented using standard clinical nuclear cardiology software. The contour placement was verified by an experienced technologist. Combined stress TPD was computed using sex- and camera-specific normal limits. DL was trained using polar distributions of normalized radiotracer counts, hypoperfusion defects, and hypoperfusion severities and was evaluated for prediction of obstructive disease in a novel leave-one-center-out cross-validation procedure equivalent to external validation. During the validation procedure, 4 DL models were trained using data from 3 centers and then evaluated on the 1 center left aside. Predictions for each center were merged to have an overall estimation of the multicenter performance. Results: 718 (62%) patients and 1,272 of 3,480 (37%) arteries had obstructive disease. The area under the receiver operating characteristics curve for prediction of disease on a per-patient and per-vessel basis by DL was higher than for combined TPD (per-patient, 0.81 vs. 0.78; per-vessel, 0.77 vs. 0.73; P < 0.001). With the DL cutoff set to exhibit the same specificity as the standard cutoff for combined TPD, per-patient sensitivity improved from 61.8% (TPD) to 65.6% (DL) (P < 0.05), and per-vessel sensitivity improved from 54.6% (TPD) to 59.1% (DL) (P < 0.01). With the threshold matched to the specificity of a normal clinical read (56.3%), DL had a sensitivity of 84.8%, versus 82.6% for an on-site clinical read (P = 0.3). Conclusion: DL improves automatic interpretation of MPI as compared with current quantitative methods.
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Affiliation(s)
- Julian Betancur
- Division of Nuclear Medicine, Department of Imaging, and Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lien-Hsin Hu
- Division of Nuclear Medicine, Department of Imaging, and Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Frederic Commandeur
- Division of Nuclear Medicine, Department of Imaging, and Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tali Sharir
- Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel.,Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York.,Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York
| | - Mathews B Fish
- Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, Oregon
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marcelo Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Guido Germano
- Division of Nuclear Medicine, Department of Imaging, and Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yuka Otaki
- Division of Nuclear Medicine, Department of Imaging, and Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joanna X Liang
- Division of Nuclear Medicine, Department of Imaging, and Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Balaji K Tamarappoo
- Division of Nuclear Medicine, Department of Imaging, and Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Damini Dey
- Division of Nuclear Medicine, Department of Imaging, and Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel S Berman
- Division of Nuclear Medicine, Department of Imaging, and Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Piotr J Slomka
- Division of Nuclear Medicine, Department of Imaging, and Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
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Duvall WL, Tandon TS, Henzlova MJ. The time is now: Dose reduction for myocardial perfusion imaging. J Nucl Cardiol 2018; 25:131-133. [PMID: 27535414 DOI: 10.1007/s12350-016-0639-4] [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: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- W Lane Duvall
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA.
| | - Tarun S Tandon
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA
| | - Milena J Henzlova
- Division of Cardiology, Mount Sinai Medical Center, New York, NY, USA
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Stress-only myocardial perfusion scintigraphy: a prospective study on the accuracy and observer agreement with quantitative coronary angiography as the gold standard. Nucl Med Commun 2017; 38:904-911. [PMID: 28885540 DOI: 10.1097/mnm.0000000000000739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patients with normal stress perfusion have an excellent prognosis. Prospective studies on the diagnostic accuracy of stress-only scans with contemporary, independent examinations as gold standards are lacking. PATIENTS AND METHODS A total of 109 patients with typical angina and no previous coronary artery disease underwent a 2-day stress (exercise)/rest, gated, and attenuation-corrected (AC), 99m-technetium-sestamibi perfusion study, followed by invasive coronary angiography. The stress datasets were evaluated twice by four physicians with two different training levels (expert and novice): familiar and unfamiliar with AC. The two experts also made a consensus reading of the integrated stress-rest datasets. The consensus reading and quantitative data from the invasive coronary angiography were applied as reference methods. RESULTS The sensitivity/specificity were 0.92-1.00/0.73-0.90 (reference: expert consensus reading), 0.93-0.96/0.63-0.82 (reference: ≥1 stenosis>70%), and 0.75-0.88/0.70-0.88 (reference: ≥1 stenosis>50%). The four readers showed a high and fairly equal sensitivity independent of their familiarity with AC. The expert familiar with AC had the highest specificity independent of the reference method. The intraobserver and interobserver agreements on the stress-only readings were good (readers without AC experience) to excellent (readers with AC experience). CONCLUSION AC stress-only images yielded a high sensitivity independent of the training level and experience with AC of the nuclear physician, whereas the specificity correlated positively with both. Interobserver and intraobserver agreements tended to be the best for physicians with AC experience.
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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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Lecchi M, Martinelli I, Zoccarato O, Maioli C, Lucignani G, Del Sole A. Comparative analysis of full-time, half-time, and quarter-time myocardial ECG-gated SPECT quantification in normal-weight and overweight patients. J Nucl Cardiol 2017; 24:876-887. [PMID: 26911365 DOI: 10.1007/s12350-015-0382-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The introduction of a camera-based dose-reduction strategy in myocardial perfusion imaging (MPI) clinical setting entails the definition of objective and reproducible criteria for establishing the amount of activity to be injected. AIM The aim is to evaluate the impact of count statistics on the estimation of summed-scores (SS), end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF). METHODS Data rest/stress ECG-gated SPECT (2-day protocol and 8 MBq·kg-1) were acquired with Bright View gamma camera and Astonish algorithm for 40 normal-weight and 40 overweight patients. Assuming that count statistics of shorter acquisition time may simulate that of lower injected activity, three simultaneous scans (full-time, half-time, and quarter-time scans) were started at the same time but with different acquisition time/projection (30, 15 and 8 seconds). RESULTS A significant difference between SS values of half-time and quarter-time stress scans was found for overweight group (P = .006). Post hoc test showed significant differences for ESV (P < .05), EDV (P < .01) and EF (P < .05) between half-time and quarter-time scans for both patient groups. CONCLUSIONS The reduction of the count-statistics to a quarter of the MPI reference influenced negatively the quantification in overweight patients. The decrease of radiopharmaceutical activity to 25% of the reference seems practicable for normal-weight patients, while it is more appropriate an activity reduction limited to 50% for overweight and obese patients.
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Affiliation(s)
- M Lecchi
- Nuclear Medicine Unit, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudini, 8, 20142, Milan, Italy
| | - I Martinelli
- Nuclear Medicine Unit, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudini, 8, 20142, Milan, Italy
| | - O Zoccarato
- Unit of Nuclear Medicine, S. Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, NO, Italy
| | - C Maioli
- Nuclear Medicine Unit, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudini, 8, 20142, Milan, Italy
| | - Giovanni Lucignani
- Nuclear Medicine Unit, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudini, 8, 20142, Milan, Italy.
| | - A Del Sole
- Nuclear Medicine Unit, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudini, 8, 20142, Milan, Italy
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Zan Y, Long Y, Chen K, Li B, Huang Q, Gullberg GT. Design of a short nonuniform acquisition protocol for quantitative analysis in dynamic cardiac SPECT imaging - a retrospective123I-MIBG animal study. Med Phys 2017; 44:3639-3649. [DOI: 10.1002/mp.12288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Yunlong Zan
- School of Biomedical Engineering; Shanghai Jiao Tong University; Shanghai China
- School of Medicine; Department of Nuclear Medicine; Rui Jin Hospital; Shanghai Jiao Tong University; Shanghai China
- University of Michigan - Shanghai Jiao Tong University Joint Institute; Shanghai Jiao Tong University; Shanghai China
| | - Yong Long
- University of Michigan - Shanghai Jiao Tong University Joint Institute; Shanghai Jiao Tong University; Shanghai China
| | - Kewei Chen
- Image Analysis and Research Lab.; Banner Good Samaritan Medical Center; Phoenix AZ USA
| | - Biao Li
- School of Medicine; Department of Nuclear Medicine; Rui Jin Hospital; Shanghai Jiao Tong University; Shanghai China
| | - Qiu Huang
- School of Biomedical Engineering; Shanghai Jiao Tong University; Shanghai China
- School of Medicine; Department of Nuclear Medicine; Rui Jin Hospital; Shanghai Jiao Tong University; Shanghai China
| | - Grant T. Gullberg
- Life Science Division; Lawrence Berkeley National Laboratory; Berkeley CA USA
- Radiology and Biomedical Imaging; University of California; San Francisco CA USA
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Chinnaiyan KM, Weiner RB. Trials of Quality Improvement in Imaging. JACC Cardiovasc Imaging 2017; 10:368-378. [PMID: 28279386 DOI: 10.1016/j.jcmg.2016.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
Cardiovascular imaging plays a central role in the diagnosis and treatment of cardiovascular disease. Recently, increased emphasis has been placed on quality in cardiovascular imaging, and it is becoming a central priority for various stakeholders, including patients, physicians, and payers. The changing health care landscape and associated challenges imposed on cardiac imagers, including reductions in reimbursement and growing need for pre-authorization, have also helped bring quality metrics to the forefront. Continuous quality improvement initiatives provide the framework for the team of physicians, technical staff members, administrators, and other health care professionals to deliver high-quality care. Efforts to improve quality in cardiac imaging have started to form the foundation for numerous research studies in this arena, and although few in number, randomized control trials have begun to emerge. This review highlights quality improvement studies focusing on appropriate use education, reporting, and radiation dose reduction in cardiovascular imaging.
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Affiliation(s)
| | - Rory B Weiner
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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15
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Henzlova MJ, Duvall WL. What do we know? What do we need to know? J Nucl Cardiol 2017; 24:252-254. [PMID: 27535415 DOI: 10.1007/s12350-016-0640-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Milena J Henzlova
- Division of Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - W Lane Duvall
- Division of Cardiology, Hartford Hospital, Hartford, CT, USA.
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16
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Left ventricular function in response to dipyridamole stress: head-to-head comparison between 82Rubidium PET and 99mTc-sestamibi SPECT ECG-gated myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2016; 44:876-885. [DOI: 10.1007/s00259-016-3588-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
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17
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Myocardial perfusion scintigraphy dosimetry: optimal use of SPECT and SPECT/CT technologies in stress-first imaging protocol. Clin Transl Imaging 2016; 4:491-498. [PMID: 27933282 PMCID: PMC5118398 DOI: 10.1007/s40336-016-0212-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/20/2016] [Indexed: 01/11/2023]
Abstract
Purpose Over the past decade, nuclear medicine experts have been seeking to minimize patient exposure to radiation in myocardial perfusion scintigraphy (MPS). This review describes the latest technological innovations in MPS, particularly with regard to dose reduction. Methods We searched in PubMed for original clinical papers in English, published after 2008, using the following research criteria: (dose) and ((reduction) or (reducing)) and ((myocardial) or (cardiac) or (heart)) and ((nuclear medicine) or (nuclear imaging) or (radionuclide) or (scintigraphy) or (SPET) or (SPECT)). Thereafter, recent reviews on the topic were considered and other relevant clinical papers were added to the results. Results Of 202 non-duplicate articles, 17 were included. To these, another eight papers cited in recent reviews were added. By optimizing the features of software, i.e., through algorithms for iterative reconstruction with resolution recovery (IRRs), and hardware, i.e., scanners and collimators, and by preferring, unless otherwise indicated, the use of stress-first imaging protocols, it has become possible to reduce the effective dose by at least 50% in stress/rest protocols, and by up to 89% in patients undergoing a diagnostic stress-only study with new technology. With today’s SPECT/CT systems, the use of a stress-first protocol can conveniently be performed, resulting in an overall dose reduction of about 35% if two-thirds of stress-first examinations were considered definitively normal. Conclusion Using innovative gamma cameras, collimators and software, as well as, unless otherwise indicated, stress-first imaging protocols, it has become possible to reduce significantly the effective dose in a high percentage of patients, even when X-ray CT scanning is performed for attenuation correction.
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Duvall WL, Guma-Demers KA, George T, Henzlova MJ. Radiation reduction and faster acquisition times with SPECT gated blood pool scans using a high-efficiency cardiac SPECT camera. J Nucl Cardiol 2016; 23:1128-1138. [PMID: 26231888 DOI: 10.1007/s12350-015-0214-4] [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: 04/27/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Planar gated blood pool scans are an established method for the evaluation of left ventricular ejection fraction (LVEF) but the camera technology used for these studies has not significantly changed in decades. The purpose of this study was to determine the diagnostic accuracy of new high-efficiency SPECT gated blood pool scans compared to traditional scans and determine if they can be performed with lower radiation doses or faster acquisition times. METHODS Patients undergoing a planar gated blood pool scan on a Na-I SPECT camera who consented to participate were subsequently imaged for 5 minutes in "List Mode" using a high-efficiency SPECT camera. LVEF was calculated for both the planar study and at 1, 2, 3, 4, and 5 minutes of acquisition on the high-efficiency camera. Counts acquired in the field of view, counts in the cardiac blood pool and LVEF were compared. RESULTS A total of 46 patients were analyzed (48% male, mean age 55 years, and BMI 27.6 kg/m(2)) who received an average Tc-99m dose of 20.3 mCi (5.3 mSv), 17 (37%) with abnormal LVEF's. The Na-I camera averaged 24,514 counts/min/mCi in the field of view and 8662 counts/min/mCi in the cardiac blood pool while the high-efficiency camera averaged 65,219 counts/min/mCi and 41,427 counts/min/mCi, respectively. Compared to the planar calculation of LVEF, 1-minute SPECT LVEF was on average 8.6 ± 10.7 higher, 2 minutes 3.5 ± 7.6 higher, 3 minutes 2.9 ± 8.5 higher, 4 minutes 2.5 ± 7.0 higher, and 5 minutes 1.1 ± 6.2 higher. Good correlation was seen between the SPECT LVEF's and the planar LVEF's across all acquisition times with correlation coefficients of 0.74-0.93. CONCLUSIONS High-efficiency SPECT technology can reduce radiation exposure to patients during gated blood pool imaging or decrease acquisition time while maintaining diagnostic accuracy. Based on the improved count sensitivity with high-efficiency SPECT, a 50% reduction in injected activity may be achievable while maintaining short imaging times of 5 minutes, with further reduction possible at longer imaging times.
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Affiliation(s)
- W Lane Duvall
- Hartford Hospital Division of Cardiology (Henry Low Heart Center), Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
| | - Krista A Guma-Demers
- Mount Sinai Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, New York, NY, USA
| | - Titus George
- Mount Sinai Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, New York, NY, USA
| | - Milena J Henzlova
- Mount Sinai Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, New York, NY, USA
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19
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Lyon MC, Foster C, Ding X, Dorbala S, Spence D, Bhattacharya M, Vija AH, DiCarli MF, Moore SC. Dose reduction in half-time myocardial perfusion SPECT-CT with multifocal collimation. J Nucl Cardiol 2016; 23:657-67. [PMID: 27033352 DOI: 10.1007/s12350-016-0471-x] [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: 11/30/2015] [Revised: 01/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent technological advances in myocardial perfusion imaging may warrant the use of lower injected activity. We evaluated whether quantitative measures of stress myocardial perfusion defects using Tc-99m sestamibi and low-energy high-resolution (LEHR) collimators are equivalent to lower dose SPECT-CT with cardiac multifocal collimators and software (IQ·SPECT). METHODS 93 patients underwent one-day rest-stress gated SPECT-CT. Following conventional rest imaging, 925-1100 MBq (25-30 mCi) of Tc-99m sestamibi was injected during stress testing. Stress SPECT-CT images were acquired two ways: with LEHR (13 minutes) and IQ·SPECT (7 minutes). Low-dose IQ·SPECT stress was simulated by subsampling the full-dose data to half-, quarter-, and eighth-count levels. Abnormalities were quantified using the total perfusion deficit (TPD) score and dose-specific databases. RESULTS The mean ± SD of the differences between LEHR and IQ·SPECT TPD scores were -1.01 ± 5.36%, -0.10 ± 5.81%, 1.78 ± 4.81%, and 1.75 ± 6.05% at full, half, quarter, and eighth doses, respectively. Differences were statistically significant for quarter and eighth doses. Correlation between LEHR and IQ·SPECT was excellent at all doses (R ≥ 0.93). Bland-Altman plots demonstrated minimal bias. CONCLUSIONS With IQ·SPECT, quantitative stress SPECT-CT imaging is possible with half of the standard injected activity in half the time.
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Affiliation(s)
- Morgan C Lyon
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Radiology, Harvard Medical School, Boston, MA, USA.
- inviCRO, 27 Drydock Ave, Boston, MA, 02210, USA.
| | - Courtney Foster
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Xinhong Ding
- Molecular Imaging, Siemens Medical Solutions USA, Inc., Hoffman Estates, IL, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Don Spence
- Molecular Imaging, Siemens Medical Solutions USA, Inc., Hoffman Estates, IL, USA
| | | | - A Hans Vija
- Molecular Imaging, Siemens Medical Solutions USA, Inc., Hoffman Estates, IL, USA
| | - Marcelo F DiCarli
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Stephen C Moore
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
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20
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Buechel RR, Gaemperli O. Newer generation cameras are preferred. J Nucl Cardiol 2016; 23:790-4. [PMID: 27072003 DOI: 10.1007/s12350-016-0462-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Ronny R Buechel
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Oliver Gaemperli
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland.
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21
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Acampa W, Buechel RR, Gimelli A. Low dose in nuclear cardiology: state of the art in the era of new cadmium–zinc–telluride cameras. Eur Heart J Cardiovasc Imaging 2016; 17:591-5. [DOI: 10.1093/ehjci/jew036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/13/2016] [Indexed: 01/22/2023] Open
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Adamson PD, Williams MC, Newby DE. Cardiovascular PET-CT imaging: a new frontier? Clin Radiol 2016; 71:647-59. [PMID: 26951964 DOI: 10.1016/j.crad.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/12/2016] [Accepted: 02/02/2016] [Indexed: 11/28/2022]
Abstract
Cardiovascular positron-emission tomography combined with computed tomography (PET-CT) has recently emerged as an imaging technology with the potential to simultaneously describe both anatomical structures and physiological processes in vivo. The scope for clinical application of this technique is vast, but to date this promise has not been realised. Nonetheless, significant research activity is underway to explore these possibilities and it is likely that the knowledge gained will have important diagnostic and therapeutic implications in due course. This review provides a brief overview of the current state of cardiovascular PET-CT and the likely direction of future developments.
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Affiliation(s)
- P D Adamson
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - M C Williams
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - D E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Polte CL, Burck I, Gjertsson P, Lomsky M, Nekolla SG, Nagel E. Cardiac Positron Emission Tomography: a Clinical Perspective. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Duvall WL, Henzlova MJ. Nuclear cardiology as it should look in the twenty-first century. J Nucl Cardiol 2016; 23:21-3. [PMID: 25971989 DOI: 10.1007/s12350-015-0169-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 11/28/2022]
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25
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Saric A, Andreau K, Armand AS, Møller IM, Petit PX. Barth Syndrome: From Mitochondrial Dysfunctions Associated with Aberrant Production of Reactive Oxygen Species to Pluripotent Stem Cell Studies. Front Genet 2016; 6:359. [PMID: 26834781 PMCID: PMC4719219 DOI: 10.3389/fgene.2015.00359] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 12/15/2015] [Indexed: 12/22/2022] Open
Abstract
Mutations in the gene encoding the enzyme tafazzin, TAZ, cause Barth syndrome (BTHS). Individuals with this X-linked multisystem disorder present cardiomyopathy (CM) (often dilated), skeletal muscle weakness, neutropenia, growth retardation, and 3-methylglutaconic aciduria. Biopsies of the heart, liver and skeletal muscle of patients have revealed mitochondrial malformations and dysfunctions. It is the purpose of this review to summarize recent results of studies on various animal or cell models of Barth syndrome, which have characterized biochemically the strong cellular defects associated with TAZ mutations. Tafazzin is a mitochondrial phospholipidlysophospholipid transacylase that shuttles acyl groups between phospholipids and regulates the remodeling of cardiolipin (CL), a unique inner mitochondrial membrane phospholipid dimer consisting of two phosphatidyl residues linked by a glycerol bridge. After their biosynthesis, the acyl chains of CLs may be modified in remodeling processes involving up to three different enzymes. Their characteristic acyl chain composition depends on the function of tafazzin, although the enzyme itself surprisingly lacks acyl specificity. CLs are crucial for correct mitochondrial structure and function. In addition to their function in the basic mitochondrial function of ATP production, CLs play essential roles in cardiac function, apoptosis, autophagy, cell cycle regulation and Fe-S cluster biosynthesis. Recent developments in tafazzin research have provided strong insights into the link between mitochondrial dysfunction and the production of reactive oxygen species (ROS). An important tool has been the generation of BTHS-specific induced pluripotent stem cells (iPSCs) from BTHS patients. In a complementary approach, disease-specific mutations have been introduced into wild-type iPSC lines enabling direct comparison with isogenic controls. iPSC-derived cardiomyocytes were then characterized using biochemical and classical bioenergetic approaches. The cells are tested in a "heart-on-chip" assay to model the pathophysiology in vitro, to characterize the underlying mechanism of BTHS deriving from TAZ mutations, mitochondrial deficiencies and ROS production and leading to tissue defects, and to evaluate potential therapies with the use of mitochondrially targeted antioxidants.
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Affiliation(s)
- Ana Saric
- INSERM U 1124 "Toxicologie, Pharmacologie et Signalisation Cellulaire" and "FR 3567" CNRS Chimie, Toxicologie, Signalisation Cellulaire et Cibles Thérapeutiques, Université Paris Descartes - Centre Universitaire des Saints-PèresParis, France; Division of Molecular Medicine, Ruđer Bošković InstituteZagreb, Croatia
| | - Karine Andreau
- INSERM U 1124 "Toxicologie, Pharmacologie et Signalisation Cellulaire" and "FR 3567" CNRS Chimie, Toxicologie, Signalisation Cellulaire et Cibles Thérapeutiques, Université Paris Descartes - Centre Universitaire des Saints-Pères Paris, France
| | - Anne-Sophie Armand
- INSERM U 1124 "Toxicologie, Pharmacologie et Signalisation Cellulaire" and "FR 3567" CNRS Chimie, Toxicologie, Signalisation Cellulaire et Cibles Thérapeutiques, Université Paris Descartes - Centre Universitaire des Saints-Pères Paris, France
| | - Ian M Møller
- Department of Molecular Biology and Genetics, Aarhus University Slagelse, Denmark
| | - Patrice X Petit
- INSERM U 1124 "Toxicologie, Pharmacologie et Signalisation Cellulaire" and "FR 3567" CNRS Chimie, Toxicologie, Signalisation Cellulaire et Cibles Thérapeutiques, Université Paris Descartes - Centre Universitaire des Saints-Pères Paris, France
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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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Ko SM, Hwang HK, Kim SM, Cho IH. Multi-modality imaging for the assessment of myocardial perfusion with emphasis on stress perfusion CT and MR imaging. Int J Cardiovasc Imaging 2015; 31 Suppl 1:1-21. [PMID: 25809387 DOI: 10.1007/s10554-015-0645-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/16/2015] [Indexed: 01/29/2023]
Abstract
High-quality and non-invasive diagnostic tools for assessing myocardial ischemia are necessary for therapeutic decisions regarding coronary artery disease. Myocardial perfusion has been studied using myocardial contrast echo perfusion, single-photon emission computed tomography, positron emission tomography, cardiovascular magnetic resonance, and, more recently, computed tomography. The addition of coronary computed tomography angiography to myocardial perfusion imaging improves the specificity and overall diagnostic accuracy of detecting the hemodynamic significance of coronary artery stenosis. This study reviews the benefits, limitations, and imaging findings of various imaging modalities for assessing myocardial perfusion, with particular emphasis on stress perfusion computed tomography and cardiovascular magnetic resonance imaging.
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Affiliation(s)
- Sung Min Ko
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea,
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Abstract
OBJECTIVE. The purpose of this study was to comprehensively study estimated radiation doses for subjects included in the main analysis of the Combined Non-invasive Coronary Angiography and Myocardial Perfusion Imaging Using 320 Detector Computed Tomography (CORE320) study ( ClinicalTrials.gov identifier NCT00934037), a clinical trial comparing combined CT angiography (CTA) and perfusion CT with the reference standard catheter angiography plus myocardial perfusion SPECT. SUBJECTS AND METHODS. Prospectively acquired data on 381 CORE320 subjects were analyzed in four groups of testing related to radiation exposure. Radiation dose estimates were compared between modalities for combined CTA and perfusion CT with respect to covariates known to influence radiation exposure and for the main clinical outcomes defined by the trial. The final analysis assessed variations in radiation dose with respect to several factors inherent to the trial. RESULTS. The mean radiation dose estimate for the combined CTA and perfusion CT protocol (8.63 mSv) was significantly (p < 0.0001 for both) less than the average dose delivered from SPECT (10.48 mSv) and the average dose from diagnostic catheter angiography (11.63 mSv). There was no significant difference in estimated CTA-perfusion CT radiation dose for subjects who had false-positive or false-negative results in the CORE320 main analyses in a comparison with subjects for whom the CTA-perfusion CT findings were in accordance with the reference standard SPECT plus catheter angiographic findings. CONCLUSION. Radiation dose estimates from CORE320 support clinical implementation of a combined CT protocol for assessing coronary anatomy and myocardial perfusion.
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Nakazato R, Heo R, Leipsic J, Min JK. CFR and FFR assessment with PET and CTA: strengths and limitations. Curr Cardiol Rep 2014; 16:484. [PMID: 24652346 DOI: 10.1007/s11886-014-0484-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Positron emission tomography (PET) myocardial perfusion imaging (MPI) has high diagnostic accuracy and prognostic value. PET-MPI can also be used to quantitatively evaluate regional myocardial blood flow (MBF). This technique also allows the calculation of the coronary flow reserve (CFR)/myocardial flow reserve (MFR), which is the ratio of MBF at peak hyperemia to resting MBF. Coronary computed tomography angiography (CTA) is a non-invasive method for accurate detection and exclusion of high-grade coronary stenoses, when compared to an invasive coronary angiography reference standard. However, CTA assessment of coronary stenoses tends toward overestimation, and CTA cannot determine physiologic significance of lesions. Recent advances in computational fluid dynamics and image-based modeling permit calculation of non-invasive fractional flow reserve derived from CT (FFRCT), without the need for additional imaging, modification of acquisition protocols, or administration of medications. In this review, we cover the CFR/MFR assessment by PET and FFR assessment by CT.
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Abstract
The practice of diagnostic nuclear medicine involves the use of ionizing radiation, and thus the potential risk associated with such exposure must be weighed against the benefits to the patient. This requires that the right test with the right dose be administered to the right patient at the right time. Therefore the procedure should be performed only if it is deemed most appropriate for the clinical question being asked. If appropriate, the procedure should be performed in the most optimum manner that keeps the radiation dose to the patient as low as possible while providing the patient's clinician with information that is needed to devise a plan of medical management. If this approach is followed, the benefits to the patient will far outweigh the small potential risks associate with the procedure. This article discusses these issues, particularly in the context of cardiovascular nuclear medicine and hybrid imaging including PET/CT and SPECT/CT.
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Affiliation(s)
- Frederic Fahey
- Department of Radiology, Boston Children׳s Hospital, Harvard Medical School, Boston, MA.
| | - Michael Stabin
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN
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31
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Slomka PJ, Berman DS, Germano G. Absolute myocardial blood flow quantification with SPECT/CT: is it possible? J Nucl Cardiol 2014; 21:1092-5. [PMID: 25294433 DOI: 10.1007/s12350-014-0002-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Piotr J Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA,
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Gowd BMP, Heller GV, Parker MW. Stress-only SPECT myocardial perfusion imaging: a review. J Nucl Cardiol 2014; 21:1200-12. [PMID: 25005348 DOI: 10.1007/s12350-014-9944-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/10/2014] [Indexed: 11/26/2022]
Abstract
Myocardial perfusion imaging (MPI) has enjoyed considerable success for decades due to its diagnostic accuracy and wealth of prognostic data. Despite this success several limitations such as lengthy protocols and radiation exposure remain. Advancements to address these shortcomings include abbreviated stress-only MPI (SO MPI) protocols, PET and both hardware and software methods to reduce radiation exposure and time. SO MPI has advantages in protocol time and radiation reduction with a wealth of supporting data in terms of diagnostic validity and prognostic value. Newer technologies such as attenuation correction, and advanced camera technologies have enabled SO MPI to be more efficient in reducing the time of acquisition and radiation dose and improving accuracy. This review examines the literature available, regarding accuracy, patient outcomes, implementation strategies, and newer developments associated with SO MPI.
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Affiliation(s)
- B M Pampana Gowd
- Henry Low Heart Center, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA,
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Abstract
Noninvasive cardiac imaging is widely used to evaluate the presence of coronary artery disease. Recently, with improvements in imaging technology, noninvasive imaging has also been used for evaluation of the presence, severity, and prognosis of coronary artery disease. Coronary CT angiography and MRI of coronary arteries provide an anatomical assessment of coronary stenosis, whereas the hemodynamic significance of a coronary artery stenosis can be assessed by stress myocardial perfusion imaging, such as SPECT/PET and stress MRI. For appropriate use of multiple imaging modalities, the strengths and limitations of each modality are discussed in this review.
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Affiliation(s)
- Ran Heo
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | | | - Dan Kalra
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021.
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Slomka PJ, Berman DS, Germano G. New Cardiac Cameras: Single-Photon Emission CT and PET. Semin Nucl Med 2014; 44:232-51. [DOI: 10.1053/j.semnuclmed.2014.04.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Einstein AJ, Blankstein R, Andrews H, Fish M, Padgett R, Hayes SW, Friedman JD, Qureshi M, Rakotoarivelo H, Slomka P, Nakazato R, Bokhari S, Di Carli M, Berman DS. Comparison of image quality, myocardial perfusion, and left ventricular function between standard imaging and single-injection ultra-low-dose imaging using a high-efficiency SPECT camera: the MILLISIEVERT study. J Nucl Med 2014; 55:1430-7. [PMID: 24982439 DOI: 10.2967/jnumed.114.138222] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED SPECT myocardial perfusion imaging plays a central role in coronary artery disease diagnosis, but concerns exist regarding its radiation burden. Compared with standard Anger SPECT (A-SPECT) cameras, new high-efficiency (HE) cameras with specialized collimators and solid-state cadmium-zinc-telluride detectors offer potential to maintain image quality (IQ), while reducing administered activity and thus radiation dose to patients. No previous study has compared IQ, interpretation, total perfusion deficit (TPD), or ejection fraction (EF) in patients receiving both ultra-low-dose (ULD) imaging on an HE SPECT camera and standard low-dose (SLD) A-SPECT imaging. METHODS We compared ULD HE SPECT with SLD A-SPECT imaging by dividing the rest dose in 101 patients at 3 sites scheduled to undergo clinical A-SPECT myocardial perfusion imaging using a same day rest-stress (99m)Tc protocol. Patients underwent HE SPECT imaging after an initial approximately 130-MBq (3.5 mCi) dose and SLD-A-SPECT imaging after the remainder of the planned dose. Images were scored visually by 2 masked readers for IQ and summed rest score. TPD and EF were assessed quantitatively. RESULTS Mean activity was 134 MBq (3.62 mCi) for ULD HE SPECT (effective dose, 1.15 mSv) and 278 MBq (7.50 mCi, 2.39 mSv) for SLD A-SPECT. Overall IQ was superior for ULD HE SPECT (P < 0.0001), with twice as many studies graded excellent quality. Extracardiac activity and overall perfusion assessment were similar. Between-method correlations were high for summed rest score (r = 0.87), TPD (r = 0.91), and EF (r = 0.88). CONCLUSION ULD HE SPECT rest imaging correlates highly with SLD A-SPECT. It has improved image quality, comparable extracardiac activity, and achieves radiation dose reduction to 1 mSv for a single injection.
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Affiliation(s)
- Andrew J Einstein
- Department of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York
| | - Ron Blankstein
- Department of Medicine, Cardiology Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Howard Andrews
- Department of Biostatistics, Columbia University, New York, New York
| | - Mathews Fish
- Oregon Heart and Vascular Institute, Springfield, Oregon
| | | | - Sean W Hayes
- Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and
| | - John D Friedman
- Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and
| | - Mehreen Qureshi
- Department of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York
| | - Harivony Rakotoarivelo
- Department of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York
| | - Piotr Slomka
- Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ryo Nakazato
- Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan
| | - Sabahat Bokhari
- Department of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York
| | - Marcello Di Carli
- Department of Medicine, Cardiology Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel S Berman
- Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and
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36
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Duvall WL, Parker MW, Henzlova MJ. Improving Nuclear Cardiology Practice. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9271-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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New SPECT and PET radiopharmaceuticals for imaging cardiovascular disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:942960. [PMID: 24901002 PMCID: PMC4034657 DOI: 10.1155/2014/942960] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/16/2014] [Indexed: 01/08/2023]
Abstract
Nuclear cardiology has experienced exponential growth within the past four decades with converging capacity to diagnose and influence management of a variety of cardiovascular diseases. Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) with technetium-99m radiotracers or thallium-201 has dominated the field; however new hardware and software designs that optimize image quality with reduced radiation exposure are fuelling a resurgence of interest at the preclinical and clinical levels to expand beyond MPI. Other imaging modalities including positron emission tomography (PET) and magnetic resonance imaging (MRI) continue to emerge as powerful players with an expanded capacity to diagnose a variety of cardiac conditions. At the forefront of this resurgence is the development of novel target vectors based on an enhanced understanding of the underlying pathophysiological process in the subcellular domain. Molecular imaging with novel radiopharmaceuticals engineered to target a specific subcellular process has the capacity to improve diagnostic accuracy and deliver enhanced prognostic information to alter management. This paper, while not comprehensive, will review the recent advancements in radiotracer development for SPECT and PET MPI, autonomic dysfunction, apoptosis, atherosclerotic plaques, metabolism, and viability. The relevant radiochemistry and preclinical and clinical development in addition to molecular imaging with emerging modalities such as cardiac MRI and PET-MR will be discussed.
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Duvall WL, Savino JA, Levine EJ, Baber U, Lin JT, Einstein AJ, Hermann LK, Henzlova MJ. A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department. J Nucl Cardiol 2014; 21:305-18. [PMID: 24310280 DOI: 10.1007/s12350-013-9823-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent studies have compared CTA to stress testing and MPI using older Na-I SPECT cameras and traditional rest-stress protocols, but are limited by often using optimized CTA protocols but suboptimal MPI methodology. We compared CTA to stress testing with modern SPECT MPI using high-efficiency CZT cameras and stress-first protocols in an ED population. METHODS In a retrospective, non-randomized study, all patients who underwent CTA or stress testing (ETT or Tc-99m sestamibi SPECT MPI) as part of their ED assessment in 2010-2011 driven by ED attending preference and equipment availability were evaluated for their disposition from the ED (admission vs discharge, length of time to disposition), subsequent visits to the ED and diagnostic testing (within 3 months), and radiation exposure. CTA was performed using a 64-slice scanner (GE Lightspeed VCT) and MPI was performed using a CZT SPECT camera (GE Discovery 530c). Data were obtained from prospectively acquired electronic medical records and effective doses were calculated from published conversion factors. A propensity-matched analysis was also used to compare outcomes in the two groups. RESULTS A total of 1,458 patients underwent testing in the ED with 192 CTAs and 1,266 stress tests (327 ETTs and 939 MPIs). The CTA patients were a lower-risk cohort based on age, risk factors, and known heart disease. A statistically similar proportion of patients was discharged directly from the ED in the stress testing group (82% vs 73%, P = .27), but their time to disposition was longer (11.0 ± 5 vs 20.5 ± 7 hours, P < .0001). There was no significant difference in cardiac return visits to the ED (5.7% CTA vs 4.3% stress testing, P = .50), but more patients had follow-up studies in the CTA cohort compared to stress testing (14% vs 7%, P = .001). The mean effective dose of 12.6 ± 8.6 mSv for the CTA group was higher (P < .0001) than 5.0 ± 4.1 mSv for the stress testing group (ETT and MPI). A propensity score-matched cohort showed similar results to the entire cohort. CONCLUSIONS Stress testing with ETT, high-efficiency SPECT MPI, and stress-only protocols had a significantly lower patient radiation dose and less follow-up diagnostic testing than CTA with similar cardiac return visits. CTA had a shorter time to disposition, but there was a trend toward more revascularization than with stress testing.
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Affiliation(s)
- W Lane Duvall
- Mount Sinai Division of Cardiology (Mount Sinai Heart), Mount Sinai Medical Center, One Gustave L Levy Place, Box 1030, New York, NY, 10029, USA,
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Cardiac hybrid imaging. Eur J Nucl Med Mol Imaging 2014; 41 Suppl 1:S91-103. [DOI: 10.1007/s00259-013-2566-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 08/27/2013] [Indexed: 01/07/2023]
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40
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Zoccarato O, Scabbio C, De Ponti E, Matheoud R, Leva L, Morzenti S, Menzaghi M, Campini R, Marcassa C, Del Sole A, Garancini S, Crivellaro C, Brambilla M, Lecchi M. Comparative analysis of iterative reconstruction algorithms with resolution recovery for cardiac SPECT studies. A multi-center phantom study. J Nucl Cardiol 2014; 21:135-48. [PMID: 24272971 DOI: 10.1007/s12350-013-9821-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/30/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND This investigation used image data generated by a physical phantom over a wide range of count statistics to evaluate the effectiveness of several of the newer commercially available SPECT reconstruction iterative algorithms (IRR) in improving perfusion defect contrast and spatial resolution, while controlling image noise. METHODS A cardiac phantom was imaged using four different gamma cameras over a wide range of counts statistics (from 6 to 0.8 Mcounts). Images were reconstructed with FBP, OSEM, and the IRR available on site. IRR were applied without corrections (IRR NC), with attenuation correction (IRR AC), scatter correction (IRR SC), and attenuation + scatter corrections (IRR SCAC). Four image performance indices related to spatial resolution, contrast, and image noise were analyzed. RESULTS IRR NC always determined significant improvements in all indices in comparison to FBP or OSEM. Improvements were emphasized with IRR SC and IRR SCAC. Count reduction from 6 to 1.5 Mcounts did not impair the performances of any of the considered indices. CONCLUSIONS This is the first study comparing the relative performance of different, commercially available, IRR software, over a wide range of count statistics; the additional effect of scatter and attenuation corrections, alone or in combination, was also evaluated. Our results confirm that IRR algorithms produce substantial benefits with respect to conventional FBP or OSEM reconstruction methods, as assessed through different figures of merit, in particular when SC and/or SCAC are also included.
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Affiliation(s)
- Orazio Zoccarato
- Department of Nuclear Medicine, S. Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, NO, Italy
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Hruska CB, O'Connor MK. Nuclear imaging of the breast: translating achievements in instrumentation into clinical use. Med Phys 2013; 40:050901. [PMID: 23635248 DOI: 10.1118/1.4802733] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Approaches to imaging the breast with nuclear medicine and∕or molecular imaging methods have been under investigation since the late 1980s when a technique called scintimammography was first introduced. This review charts the progress of nuclear imaging of the breast over the last 20 years, covering the development of newer techniques such as breast specific gamma imaging, molecular breast imaging, and positron emission mammography. Key issues critical to the adoption of these technologies in the clinical environment are discussed, including the current status of clinical studies, the efforts at reducing the radiation dose from procedures associated with these technologies, and the relevant radiopharmaceuticals that are available or under development. The necessary steps required to move these technologies from bench to bedside are also discussed.
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Affiliation(s)
- Carrie B Hruska
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Radiation risk and protection of patients in clinical SPECT/CT. Eur J Nucl Med Mol Imaging 2013; 41 Suppl 1:S125-36. [PMID: 24052089 DOI: 10.1007/s00259-013-2543-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
Abstract
Clinical studies have demonstrated that hybrid single photon emission computed tomography (SPECT)/CT for various diagnostic issues has an added value as compared to SPECT alone. However, the combined acquisition of functional and anatomical images can substantially increase radiation exposure to patients, in particular when using a hybrid system with diagnostic CT capabilities. It is, therefore, essential to carefully balance the diagnostic needs and radiation protection requirements. To this end, the evidence on health effects induced by ionizing radiation is outlined. In addition, the essential concepts for estimating radiation doses and lifetime attributable cancer risks associated with SPECT/CT examinations are presented taking into account both the new recommendations of the International Commission on Radiological Protection (ICRP) as well as the most recent radiation risk models. Representative values of effective dose and lifetime attributable risk are reported for ten frequently used SPECT radiopharmaceuticals and five fully diagnostic partial-body CT examinations. A diagnostic CT scan acquired as part of a combined SPECT/CT examination contributes considerably to, and for some applications even dominates, the total patient exposure. For the common SPECT and CT examinations considered in this study, the lifetime attributable risk of developing a radiation-related cancer is less than 0.27 %/0.37 % for men/women older than 16 years, respectively, and decreases markedly with increasing age at exposure. Since there is no clinical indication for a SPECT/CT examination unless an emission scan has been indicated, the issue on justification comes down to the question of whether it is necessary to additionally acquire a low-dose CT for attenuation correction and anatomical localization of tracer uptake or even a fully diagnostic CT. In any case, SPECT/CT studies have to be optimized, e.g. by adapting dose reduction measures from state-of-the-art CT practice, and exposure levels should not exceed the national diagnostic reference levels for standard situations.
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Slomka PJ, Berman DS, Germano G. State of the Art Hybrid Technology: PET/CT. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9208-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gutstein A, Navzorov R, Solodky A, Mats I, Kornowski R, Zafrir N. Angiographic correlation of myocardial perfusion imaging with half the radiation dose using ordered-subset expectation maximization with resolution recovery software. J Nucl Cardiol 2013; 20:539-44. [PMID: 23703379 DOI: 10.1007/s12350-013-9730-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND We previously described the feasibility of performing myocardial perfusion imaging (MPI) with half the technetium (Tc-99m) activity using ordered-subset expectation maximization with resolution recovery (OSEM-RR) processing. This study sought to assess the accuracy of this technique by correlating the findings with coronary angiography. METHODS Of 290 patients who underwent MPI-gated SPECT using a half dose of Tc-99m sestamibi and OSEM-RR software in 2010-2012 at a tertiary medical center, 62 were referred for invasive coronary angiography within 90 days and formed the study group. Ischemia was defined as a summed difference score (SDS) of >3 on the MPI scan. Luminal stenosis of ≥70% on invasive coronary angiography served as the reference. RESULTS Mean Tc-99m activity per study was 23.9 ± 11.5 mCi and mean effective radiation dose was 7.2 ± 3.4 mSv. MPI revealed no abnormalities in 10 patients (16.2%), myocardial infarction only in 8 patients (12.9%), and ischemia in 44 patients (71.1%). Overall sensitivity, specificity, and positive and negative predictive values for MPI compared to invasive angiography were 89.1%, 75.0%, 91.1%, and 70.5%, respectively. CONCLUSIONS MPI SPECT performed with a half dose of Tc-99m and OSEM-RR image processing correlates well with invasive angiography. (J Nucl Cardiol 2013).
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Affiliation(s)
- Ariel Gutstein
- Cardiology Department, Beilinson, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
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Abstract
We report the case of a 20-year-old woman with surgically corrected transposition of the great arteries, pulmonary valve defects, and absence of left coronary ostium at a previous cardiac catheterization. Because of worsening dyspnea, she underwent myocardial perfusion PET/CT study with 13N-ammonia at rest and during pharmacological stress, which showed extensive ischemia in the left coronary territory and signs of severe left ventricle dysfunction. Quantitative PET data showed impaired regional coronary flow reserve (<2.0) in the left coronary territory, thus allowing a precise and reliable evaluation of the myocardial perfusion defect because of the absence of left coronary ostium.
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Duvall WL, Guma KA, Kamen J, Croft LB, Parides M, George T, Henzlova MJ. Reduction in Occupational and Patient Radiation Exposure from Myocardial Perfusion Imaging: Impact of Stress-Only Imaging and High-Efficiency SPECT Camera Technology. J Nucl Med 2013; 54:1251-7. [DOI: 10.2967/jnumed.112.112680] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Germano G, Slomka PJ, Berman DS. New Hardware Solutions for Cardiac SPECT Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9206-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Advances in Cardiac SPECT and PET Imaging: Overcoming the Challenges to Reduce Radiation Exposure and Improve Accuracy. Can J Cardiol 2013; 29:275-84. [DOI: 10.1016/j.cjca.2012.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/27/2012] [Accepted: 10/04/2012] [Indexed: 11/22/2022] Open
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Nakazato R, Berman DS, Alexanderson E, Slomka P. Myocardial perfusion imaging with PET. ACTA ACUST UNITED AC 2013; 5:35-46. [PMID: 23671459 DOI: 10.2217/iim.13.1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PET-myocardial perfusion imaging (MPI) allows accurate measurement of myocardial perfusion, absolute myocardial blood flow and function at stress and rest in a single study session performed in approximately 30 min. Various PET tracers are available for MPI, and rubidium-82 or nitrogen-13-ammonia is most commonly used. In addition, a new fluorine-18-based PET-MPI tracer is currently being evaluated. Relative quantification of PET perfusion images shows very high diagnostic accuracy for detection of obstructive coronary artery disease. Dynamic myocardial blood flow analysis has demonstrated additional prognostic value beyond relative perfusion imaging. Patient radiation dose can be reduced and image quality can be improved with latest advances in PET/CT equipment. Simultaneous assessment of both anatomy and perfusion by hybrid PET/CT can result in improved diagnostic accuracy. Compared with SPECT-MPI, PET-MPI provides higher diagnostic accuracy, using lower radiation doses during a shorter examination time period for the detection of coronary artery disease.
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Affiliation(s)
- Ryo Nakazato
- Departments of Imaging & Medicine, & Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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