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Nguyen AT, Kim HK. Recent Progress in Synthesis of 99mTc-labeled Complexes with Nitroimidazoles as SPECT Probes for Targeting Tumor Hypoxia. Nucl Med Mol Imaging 2024; 58:258-278. [PMID: 39036459 PMCID: PMC11255181 DOI: 10.1007/s13139-024-00860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 07/23/2024] Open
Abstract
The majority of solid tumors have hypoxia, or low oxygen levels, which is one of the hallmarks of cancer. Hypoxia was found to relate to cancer metastases and resistance to therapies, therefore, detection of hypoxia plays an important role in the process of cancer prognosis and treatment. Single-photon emission computed tomography (SPECT) is a non-invasive imaging technique using gamma-emitting radiopharmaceuticals to visualize biological activities within the body. SPECT is also applied for the detection of tumor hypoxia with the development of hypoxia-targeting radiopharmaceuticals. Radiopharmaceuticals containing nitroimidazole moieties have received increasing attention due to their bio-reducible characteristics which make the radiopharmaceuticals accumulate in the hypoxia regions. This review summarizes the recent development of 99mTc-labeled radiopharmaceuticals bearing nitroimidazoles for SPECT imaging of tumor hypoxia including the synthetic methods and results of animal studies.
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Affiliation(s)
- Anh Thu Nguyen
- Department of Nuclear Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, 54907 Republic of Korea
| | - Hee-Kwon Kim
- Department of Nuclear Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, 54907 Republic of Korea
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2
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Wang J, Chen Y, Chu H, Pang Z, Hsu B, Li J. Feasibility of myocardial blood flow quantification to detect flow-limited coronary artery disease with a one-day rest/stress continuous rapid imaging protocol on cardiac-dedicated cadmium zinc telluride single photon emission computed tomography. J Nucl Cardiol 2024; 34:101825. [PMID: 38387736 DOI: 10.1016/j.nuclcard.2024.101825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/25/2024] [Accepted: 02/11/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND It is clinically needed to explore a more efficient imaging protocol for single photon emission computed tomography (SPECT) myocardial blood flow (MBF) quantitation derived from cadmium zinc telluride (CZT) SPECT camera for the routine clinical utilization. METHODS One hundred and twenty patients with matched clinical characteristics and angiographic findings who completed one-day rest/stress SPECT imaging with either the intermittently sequential imaging (ISI) protocol (two dynamic and two electrocardiography (ECG)-gated scans) or the continuous rapid imaging (CRI) protocol (two dynamic/ECG-gated scans) were included. MBF quantitation adopted residual activity correction (RAC) to correct for rest residual activity (RRA) in the stress dynamic SPECT scan for the detection of flow-limited coronary artery disease. RESULTS The CRI protocol reduced about 6.2 times shorter than the ISI protocol (25.5 min vs 157.6 min), but slightly higher than the RRA (26.7% ± 3.6% vs 22.3% ± 4.9%). With RAC, both protocols demonstrated close stress MBF (2.18 ± 1.13 vs 2.05 ± 1.10, P > 0.05) and myocardial flow reserve (MFR) (2.42 ± 1.05 vs 2.48 ± 1.11, P > 0.05) to deliver comparable diagnostic performance (sensitivity = 82.1%-92.3%, specificity = 81.2%-91.2%). Myocardial perfusion and left ventricular function overall showed no significant difference (all P > 0.26). CONCLUSION One-day rest/stress SPECT with the CRI protocol and rest RAC is feasible to warrant the diagnostic performance of MBF quantitation with a shortened examination time and enhanced patient comfort. Further evaluation on the impact of extracardiac activity to regional MBF and perfusion pattern is required. Additional evaluation is needed in a patient population that is typical of those referred for SPECT MPI, including those with known or suspected coronary microvascular disease.
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Affiliation(s)
- Jiao Wang
- Nuclear Medicine Department, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Yue Chen
- Nuclear Medicine Department, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Hongxin Chu
- Nuclear Medicine Department, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Zekun Pang
- Nuclear Medicine Department, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA.
| | - Jianming Li
- Nuclear Medicine Department, TEDA International Cardiovascular Hospital, Tianjin, China.
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3
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Pijeira MSO, Nunes PSG, Chaviano SL, Diaz AMA, DaSilva JN, Ricci-Junior E, Alencar LMR, Chen X, Santos-Oliveira R. Medicinal (Radio) Chemistry: Building Radiopharmaceuticals for the Future. Curr Med Chem 2024; 31:5481-5534. [PMID: 37594105 DOI: 10.2174/0929867331666230818092634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/30/2023] [Accepted: 07/13/2023] [Indexed: 08/19/2023]
Abstract
Radiopharmaceuticals are increasingly playing a leading role in diagnosing, monitoring, and treating disease. In comparison with conventional pharmaceuticals, the development of radiopharmaceuticals does follow the principles of medicinal chemistry in the context of imaging-altered physiological processes. The design of a novel radiopharmaceutical has several steps similar to conventional drug discovery and some particularity. In the present work, we revisited the insights of medicinal chemistry in the current radiopharmaceutical development giving examples in oncology, neurology, and cardiology. In this regard, we overviewed the literature on radiopharmaceutical development to study overexpressed targets such as prostate-specific membrane antigen and fibroblast activation protein in cancer; β-amyloid plaques and tau protein in brain disorders; and angiotensin II type 1 receptor in cardiac disease. The work addresses concepts in the field of radiopharmacy with a special focus on the potential use of radiopharmaceuticals for nuclear imaging and theranostics.
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Affiliation(s)
- Martha Sahylí Ortega Pijeira
- Laboratory of Nanoradiopharmaceuticals and Synthesis of Novel Radiopharmaceuticals, Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Rio de Janeiro 21941906, Brazil
| | - Paulo Sérgio Gonçalves Nunes
- Brazilian Biosciences National Laboratory, Brazilian Center for Research in Energy and Materials, Campinas SP13083-970, Brazil
| | - Samila Leon Chaviano
- Laboratoire de Biomatériaux pour l'Imagerie Médicale, Axe Médicine Régénératrice, Centre de Recherche du Centre Hospitalier Universitaire de Québec - Université Laval, Québec, QC, Canada
| | - Aida M Abreu Diaz
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- Institute de Génie Biomédical, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Jean N DaSilva
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
- Institute de Génie Biomédical, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Eduardo Ricci-Junior
- Laboratório de Desenvolvimento Galênico, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
| | - Luciana Magalhães Rebelo Alencar
- Laboratory of Biophysics and Nanosystems, Federal University of Maranhão, Av. dos Portugueses, 1966, Vila Bacanga, São Luís MA65080-805, Brazil
| | - Xiaoyuan Chen
- Departments of Diagnostic Radiology, Chemical and Biomolecular Engineering, and Biomedical Engineering, Yong Loo Lin School of Medicine and Faculty of Engineering, National University of Singapore 117597, Singapore
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 117599, Singapore
- Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore 117597, Singapore
| | - Ralph Santos-Oliveira
- Laboratory of Nanoradiopharmaceuticals and Synthesis of Novel Radiopharmaceuticals, Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Rio de Janeiro 21941906, Brazil
- Laboratory of Radiopharmacy and Nanoradiopharmaceuticals, Rio de Janeiro State University, Rio de Janeiro 23070200, Brazil
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Assante R, Zampella E, Cantoni V, Green R, D'Antonio A, Mannarino T, Gaudieri V, Nappi C, Buongiorno P, Panico M, Petretta M, Cuocolo A, Acampa W. Prognostic value of myocardial perfusion imaging by cadmium zinc telluride single-photon emission computed tomography in patients with suspected or known coronary artery disease: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2023; 50:3647-3658. [PMID: 37480369 PMCID: PMC10547640 DOI: 10.1007/s00259-023-06344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Aim of this study was to define the prognostic value of stress myocardial perfusion imaging by cadmium zinc telluride (CZT) single-photon emission computed tomography (SPECT) for prediction of adverse cardiovascular events in patients with known or suspected coronary artery disease (CAD). METHODS AND RESULTS Studies published until November 2022 were identified by database search. We included studies using stress myocardial perfusion imaging by CZT-SPECT to evaluate subjects with known or suspected CAD and providing primary data of adverse cardiovascular events. Total of 12 studies were finally included recruiting 36,415 patients. Pooled hazard ratio (HR) for the occurrence of adverse events was 2.17 (95% confidence interval, CI, 1.78-2.65) and heterogeneity was 66.1% (P = 0.001). Five studies reported data on adjusted HR for the occurrence of adverse events. Pooled HR was 1.69 (95% CI, 1.44-1.98) and heterogeneity was 44.9% (P = 0.123). Seven studies reported data on unadjusted HR for the occurrence of adverse events. Pooled HR was 2.72 (95% CI, 2.00-3.70). Nine studies reported data useful to calculate separately the incidence rate of adverse events in patients with abnormal and normal myocardial perfusion. Pooled incidence rate ratio was 2.38 (95% CI, 1.39-4.06) and heterogeneity was 84.6% (P < 0.001). The funnel plot showed no evidence of asymmetry (P = 0.517). At meta-regression analysis, we found an association between HR for adverse events and presence of angina symptoms and family history of CAD. CONCLUSIONS Stress myocardial perfusion imaging by CZT-SPECT is a valuable noninvasive prognostic indicator for adverse cardiovascular events in patients with known or suspected CAD.
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Affiliation(s)
- Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Mariarosaria Panico
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
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Trumbull DA, Braschi EL, Jain A, Southwick FS, Parsons AS, Radhakrishnan NS. Lessons in clinical reasoning - pitfalls, myths, and pearls: a case of crushing, substernal chest pain. Diagnosis (Berl) 2023; 10:316-321. [PMID: 37441731 DOI: 10.1515/dx-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/25/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Diagnostic error is not uncommon and diagnostic accuracy can be improved with the use of problem representation, pre-test probability, and Bayesian analysis for improved clinical reasoning. CASE PRESENTATION A 48-year-old female presented as a transfer from another Emergency Department (ED) to our ED with crushing, substernal pain associated with dyspnea, diaphoresis, nausea, and a tingling sensation down both arms with radiation to the back and neck. Troponins were elevated along with an abnormal electrocardiogram. A negative myocardial perfusion scan led to the patient's discharge. The patient presented to the ED 10 days later with an anterior ST-elevation myocardial infarction. CONCLUSIONS An overemphasis on a single testing modality led to diagnostic error and a severe event. The use of pre-test probabilities guided by history-taking can lead to improved interpretation of test results, ultimately improving diagnostic accuracy and preventing serious medical errors.
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Affiliation(s)
| | - Erica L Braschi
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Ankur Jain
- Baptist Heart Specialists, Jacksonville, FL, USA
| | | | - Andrew S Parsons
- Section of Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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Fang Z, Cai W, Chen B, Li C, Zhao J, Tian Z, Chen L, Bu J, Zhao Z, Li D. Association between CZT‑SPECT myocardial blood flow and coronary stenosis: A cross‑sectional study. Exp Ther Med 2023; 26:350. [PMID: 37324508 PMCID: PMC10265712 DOI: 10.3892/etm.2023.12049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/11/2023] [Indexed: 06/17/2023] Open
Abstract
The association between the quantitative and semi-quantitative parameters of myocardial blood flow obtained using cadmium-zinc-telluride single photon emission computed tomography (CZT-SPECT) and coronary stenosis remains unclear. Therefore, the objective of the present study was to evaluate the diagnostic value of two parameters obtained using CZT-SPECT in patients with suspected or known coronary artery disease. A total of 24 consecutive patients who underwent CZT-SPECT and coronary angiography within 3 months of each other were included in the study. To evaluate the predictive ability of the regional difference score (DS), coronary flow reserve (CFR), and the combination thereof for positive coronary stenosis at the vascular level, receiver operating characteristic (ROC) curves were plotted and the area under the curves (AUCs) were calculated. Comparisons of the reclassification ability for coronary stenosis between different parameters were assessed by calculating the net reclassification index (NRI) and the integrated discrimination improvement (IDI). The 24 participants (median age: 65 years; range: 46-79 years; 79.2% male) included in this study had a total of 72 major coronary arteries. When stenosis ≥50% was defined as the criteria for positive coronary stenosis, the AUCs and the 95% confidence interval (CI) for regional DS, CFR, and the combination of the two indices were 0.653 (CI, 0.541-0.766), 0.731 (CI, 0.610-0.852) and 0.757 (CI, 0.645-0.869), respectively. Compared with single DS, the combination of DS and CFR increased the predictive ability for positive stenosis, with an NRI of 0.197-1.060 (P<0.01) and an IDI of 0.0150-0.1391 (P<0.05). When stenosis ≥75% was considered as the criteria, the AUCs were 0.760 (CI, 0.614-0.906), 0.703 (CI, 0.550-0.855), and 0.811 (CI, 0.676-0.947), respectively. Compared with DS, CFR had an IDI of -0.3392 to -02860 (P<0.05) and the combination of DS and CFR also enhanced the predictive ability, with an NRI of 0.0313-1.0758 (P<0.01). In conclusion, both regional DS and CFR had diagnostic values for coronary stenosis, but the diagnostic abilities differed in distinguishing between different degrees of stenosis, and the efficiency was improved with a combination of DS and CFR.
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Affiliation(s)
- Zhang Fang
- Department of Cardiology, People's Hospital of Jiangsu Province, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wenyi Cai
- Department of Cardiology, People's Hospital of Jiangsu Province, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Bei Chen
- Department of Cardiology, People's Hospital of Jiangsu Province, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Chunxiang Li
- Department of Cardiology, People's Hospital of Jiangsu Province, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Jihong Zhao
- Department of Cardiology, People's Hospital of Jiangsu Province, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Zhiqiang Tian
- Department of Cardiology, People's Hospital of Jiangsu Province, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Limei Chen
- Department of Cardiology, People's Hospital of Jiangsu Province, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Ju Bu
- Department of Cardiology, People's Hospital of Jiangsu Province, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Zhongqiang Zhao
- Department of Cardiology, People's Hospital of Jiangsu Province, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Dianfu Li
- Department of Cardiology, People's Hospital of Jiangsu Province, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Nguyen AT, Kim HK. Recent Developments in PET and SPECT Radiotracers as Radiopharmaceuticals for Hypoxia Tumors. Pharmaceutics 2023; 15:1840. [PMID: 37514026 PMCID: PMC10385036 DOI: 10.3390/pharmaceutics15071840] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Hypoxia, a deficiency in the levels of oxygen, is a common feature of most solid tumors and induces many characteristics of cancer. Hypoxia is associated with metastases and strong resistance to radio- and chemotherapy, and can decrease the accuracy of cancer prognosis. Non-invasive imaging methods such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT) using hypoxia-targeting radiopharmaceuticals have been used for the detection and therapy of tumor hypoxia. Nitroimidazoles are bioreducible moieties that can be selectively reduced under hypoxic conditions covalently bind to intracellular macromolecules, and are trapped within hypoxic cells and tissues. Recently, there has been a strong motivation to develop PET and SPECT radiotracers as radiopharmaceuticals containing nitroimidazole moieties for the visualization and treatment of hypoxic tumors. In this review, we summarize the development of some novel PET and SPECT radiotracers as radiopharmaceuticals containing nitroimidazoles, as well as their physicochemical properties, in vitro cellular uptake values, in vivo biodistribution, and PET/SPECT imaging results.
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Affiliation(s)
- Anh Thu Nguyen
- Department of Nuclear Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Hee-Kwon Kim
- Department of Nuclear Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
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Nguyen AT, Kim HK. Recent Advances of 68Ga-Labeled PET Radiotracers with Nitroimidazole in the Diagnosis of Hypoxia Tumors. Int J Mol Sci 2023; 24:10552. [PMID: 37445730 DOI: 10.3390/ijms241310552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Positron emission tomography (PET) is a noninvasive molecular imaging method extensively applied in the detection and treatment of various diseases. Hypoxia is a common phenomenon found in most solid tumors. Nitroimidazole is a group of bioreducible pharmacophores that selectively accumulate in hypoxic regions of the body. Over the past few decades, many scientists have reported the use of radiopharmaceuticals containing nitroimidazole for the detection of hypoxic tumors. Gallium-68, a positron-emitting radioisotope, has a favorable half-life time of 68 min and can be conveniently produced by 68Ge/68Ga generators. Recently, there has been significant progress in the preparation of novel 68Ga-labeled complexes bearing nitroimidazole moieties for the diagnosis of hypoxia. This review provides a comprehensive overview of the current status of developing 68Ga-labeled radiopharmaceuticals with nitroimidazole moieties, their pharmacokinetics, and in vitro and in vivo studies, as well as PET imaging studies for hypoxic tumors.
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Affiliation(s)
- Anh Thu Nguyen
- Department of Nuclear Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Hee-Kwon Kim
- Department of Nuclear Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
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9
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Garcia EV, Piccinelli M. Preparing for the Artificial Intelligence Revolution in Nuclear Cardiology. Nucl Med Mol Imaging 2023; 57:51-60. [PMID: 36998588 PMCID: PMC10043081 DOI: 10.1007/s13139-021-00733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022] Open
Abstract
A major opportunity in nuclear cardiology is the many significant artificial intelligence (AI) applications that have recently been reported. These developments include using deep learning (DL) for reducing the needed injected dose and acquisition time in perfusion acquisitions also due to DL improvements in image reconstruction and filtering, SPECT attenuation correction using DL without need for transmission images, DL and machine learning (ML) use for feature extraction to define myocardial left ventricular (LV) borders for functional measurements and improved detection of the LV valve plane and AI, ML, and DL implementations for MPI diagnosis, prognosis, and structured reporting. Although some have, most of these applications have yet to make it to widespread commercial distribution due to the recency of their developments, most reported in 2020. We must be prepared both technically and socio-economically to fully benefit from these and a tsunami of other AI applications that are coming.
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Affiliation(s)
- Ernest V. Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 1203, GA 30322 Atlanta, USA
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 1203, GA 30322 Atlanta, USA
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10
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Bansal A, Ananthasubramaniam K. Cardiovascular positron emission tomography: established and emerging role in cardiovascular diseases. Heart Fail Rev 2023; 28:387-405. [PMID: 36129644 DOI: 10.1007/s10741-022-10270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/26/2022]
Abstract
Cardiac positron emission tomography (PET) imaging has established themselves firmly as excellent and reliable functional imaging modalities in assessment of the spectrum of coronary artery disease. With the explosion of technology advances and the dream of flow quantification now a reality, the value of PET is now well realized. Cardiac PET has proved itself as precise imaging modality that provides functional imaging of the heart in addition to anatomical imaging. It has established itself as one of the best available techniques for evaluation of myocardial viability. Hybrid PET/computed tomography provides simultaneous integration of coronary anatomy and function with myocardial perfusion and metabolism, thereby improving characterization of the dysfunctional area and chronic coronary artery disease. The availability of quantitative myocardial blood flow evaluation with PET provides additional prognostic information and increases diagnostic accuracy in the management of patients with coronary artery disease. Hybrid imaging seems to hold immense potential in optimizing management of cardiovascular diseases and furthering clinical research.
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Affiliation(s)
- Amit Bansal
- UHS Wilson Medical Center, Johnson City, NY, USA
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11
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Improving Detection of CAD and Prognosis with PET/CT Quantitative Absolute Myocardial Blood Flow Measurements. Curr Cardiol Rep 2022; 24:1855-1864. [PMID: 36348147 DOI: 10.1007/s11886-022-01805-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of the role of PET MPI in the detection of CAD, focussing on the added value of MBF for diagnosis and prognostication. RECENT FINDINGS Positron emission tomography (PET) myocardial perfusion imaging (MPI) is increasingly used for the risk stratification of patients with suspected or established coronary artery disease (CAD). PET MPI provides accurate and reproducible non-invasive quantification of myocardial blood flow (MBF) at rest and during hyperemia, providing incremental information over conventional myocardial perfusion alone. Inclusion of MBF in PET MPI interpretation improves both its sensitivity and specificity. Moreover, quantitative MBF measurements have repeatedly been shown to offer incremental and independent prognostic information over conventional clinical markers in a broad range of conditions, including in CAD. Quantitative MBF measurement is now an established and powerful tool enabling accurate risk stratification and guiding patients' management. The role of PET MPI and flow quantification in cardiac allograft vasculopathy (CAV), which represents a particular form of CAD, will also be reviewed.
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12
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Liu FS, Wang SY, Shiau YC, Wu YW. Integration of quantitative absolute myocardial blood flow estimates from dynamic CZT-SPECT improves the detection of coronary artery disease. J Nucl Cardiol 2022; 29:2311-2321. [PMID: 34240342 DOI: 10.1007/s12350-021-02713-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Balanced ischemia with multi-vessel coronary artery disease (CAD) is difficult to diagnose with semiquantitative single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Dynamic cardiac SPECT provides quantitative estimations of stenosis severity and ischemic burden by assessing myocardial flow reserve (MFR) and myocardial blood flow (MBF). The aim of this study was to evaluate the incremental value of dynamic SPECT in multi-vessel coronary artery disease (CAD). METHODS Patients with suspected CAD who underwent dynamic ECG-gated dipyridamole MPI and coronary angiography within 6 months were retrospectively reviewed. The performance of summed stress, rest and difference scores (SSS, SRS, SDS), post-stress and resting MBF (MBFs, MBFr) and MFR were compared at both patient level and vessel level. RESULTS In 32 patients with 39 stenotic vessels, 12 had three-vessel disease (38%). Globally increased SSS and impaired MBF values were significantly associated with significant CAD at the patient level, but SDS and MFR were not. Regional increases in SSS and reductions in both MBFs and MBFr were significantly associated with stenotic vessels. The best cutoff value of global MBFs to predict CAD was 3.5 ml·g-1·min-1 (area under the curve, AUC = .84, P = .002). The best cutoff value of regional MBFs to detect significant stenosis was 3.6 ml·g-1·min-1 (AUC = .74, P < .001). However, the best possible cut-off values of MFR were not found. Sex-difference in both global and regional MBFr but MBFs was found, which might result in the non-significance in MFR. CONCLUSIONS This study validated a clinically available method to quantify MFR using dynamic CZT-SPECT. This method improved the detectability of multi-vessel CAD, and absolute MBFs was superior to MFR and other semiquantitative MPI parameters.
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Affiliation(s)
- Fang-Shin Liu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Yu-Chien Shiau
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
- National Yang-Ming University School of Medicine, Taipei City, Taiwan.
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
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Cantoni V, Green R, D'Antonio A, Cuocolo A. Dynamic CZT-SPECT in coronary artery disease: Where are we now? J Nucl Cardiol 2022; 29:1698-1701. [PMID: 34350552 DOI: 10.1007/s12350-021-02752-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Roberta Green
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
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Nappi C, Ponsiglione A, Falzarano M, Imbriaco M, Klain M, Cuocolo A. Insights into Myocardial Perfusion PET Imaging: the Coronary Flow Capacity. CURRENT CARDIOVASCULAR IMAGING REPORTS 2022. [DOI: 10.1007/s12410-022-09568-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose of Review
The present work summarizes the clinical relevance of coronary flow capacity (CFC) with an eye on future perspectives.
Recent findings
CFC concept has been recently introduced providing a comprehensive framework for coronary physiology evaluation.
Summary
It has been widely demonstrated that coronary artery disease (CAD) is a complex disease with a multifactorial etiology resulting from different pathogenic mechanisms. Cardiac positron emission tomography (PET) currently represents the gold standard for CAD assessment, providing absolute myocardial perfusion data including coronary flow reserve (CFR), calculated as the ratio of hyperemic to rest absolute myocardial blood flows. CFC can be obtained from dynamic PET images by plotting the primary stress perfusion data and CFR values for each pixel on a graph of predefined exact ranges. The routine evaluation of this parameter may add diagnostic and prognostic value to clinical and conventional imaging data.
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Ullah F, Chen X, Rajab K, Al Reshan MS, Shaikh A, Hassan MA, Rizwan M, Davidekova M. An Efficient Machine Learning Model Based on Improved Features Selections for Early and Accurate Heart Disease Predication. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:1906466. [PMID: 39376533 PMCID: PMC11458322 DOI: 10.1155/2022/1906466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/20/2022] [Indexed: 10/09/2024]
Abstract
Coronary heart disease has an intense impact on human life. Medical history-based diagnosis of heart disease has been practiced but deemed unreliable. Machine learning algorithms are more reliable and efficient in classifying, e.g., with or without cardiac disease. Heart disease detection must be precise and accurate to prevent human loss. However, previous research studies have several shortcomings, for example,take enough time to compute while other techniques are quick but not accurate. This research study is conducted to address the existing problem and to construct an accurate machine learning model for predicting heart disease. Our model is evaluated based on five feature selection algorithms and performance assessment matrix such as accuracy, precision, recall, F1-score, MCC, and time complexity parameters. The proposed work has been tested on all of the dataset'sfeatures as well as a subset of them. The reduction of features has an impact on theperformance of classifiers in terms of the evaluation matrix and execution time. Experimental results of the support vector machine, K-nearest neighbor, and logistic regression are 97.5%,95 %, and 93% (accuracy) with reduced computation timesof 4.4, 7.3, and 8seconds respectively.
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Affiliation(s)
- Farhat Ullah
- School of Automation, China University of Geosciences, Wuhan 430074, China
| | - Xin Chen
- School of Automation, China University of Geosciences, Wuhan 430074, China
| | - Khairan Rajab
- College of Computer Science and Information Systems Najran University, Najra 61441, Saudi Arabia
| | - Mana Saleh Al Reshan
- College of Computer Science and Information Systems Najran University, Najra 61441, Saudi Arabia
| | - Asadullah Shaikh
- College of Computer Science and Information Systems Najran University, Najra 61441, Saudi Arabia
| | - Muhammad Abul Hassan
- Department of Computing and Technology, Abasyn University Peshawar, Peshawar 25000, Pakistan
| | - Muhammad Rizwan
- Secure Cyber Systems Research Group, WMG, University of Warwick, Coventry CV4 7AL, UK
| | - Monika Davidekova
- Information Systems Department, Faculty of Management Comenius University in Bratislava Odbojárov 10, Bratislava 82005 25, Slovakia
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16
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Heart diseases by Ammonia. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ahmed AI, Han Y, Al Rifai M, Alnabelsi T, Nabi F, Chang SM, Chamsi-Pasha MA, Nasir K, Mahmarian JJ, Cainzos-Achirica M, Al-Mallah MH. Added prognostic value of plaque burden to computed tomography angiography and myocardial perfusion imaging. Atherosclerosis 2021; 334:9-16. [PMID: 34450557 DOI: 10.1016/j.atherosclerosis.2021.08.032] [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: 06/01/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Cardiac computed tomographic angiography (CCTA) - derived measures of coronary artery disease (CAD) burden have been shown to independently predict incident cardiovascular events. We aimed to compare the added prognostic value of plaque burden to CCTA anatomic assessment and single photon emission computed tomography (SPECT) physiologic assessment in a cohort with high prevalence of risk factors undergoing both tests. METHODS Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD were included. Stenosis severity and segment involvement score (SIS - number of segments with plaque irrespective of stenosis) were determined from CCTA, and presence of ischemia was determined from SPECT. Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.) RESULTS: A total of 956 patients were included (mean age 61.1 ± 14.2 years, 54% men, 89% hypertension, 81% diabetes, 84% dyslipidemia). Obstructive stenosis (left main ≥50%, all other coronary segments ≥70%) and ischemia were observed in a similar number of patients (14%). In multivariable Cox regression models, SIS significantly predicted outcomes and improved risk discrimination in models with CCTA obstructive stenosis (HR 1.15, p ≤ 0.001; Harrel's C 0.74, p = 0.008) and SPECT ischemia (HR 1.14, p < 0.001; Harrel's C 0.76, p = 0.019). CONCLUSIONS Our results suggest that in patients with suspected CAD and a high prevalence of risk-factors, plaque burden adds incremental prognostic value over established CCTA and SPECT measures to predict incident cardiovascular outcomes.
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Affiliation(s)
| | - Yushui Han
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | | | - Talal Alnabelsi
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | - Faisal Nabi
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | - Su Min Chang
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | | | - Khurram Nasir
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | - John J Mahmarian
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, USA.
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Xu J, Cai F, Geng C, Wang Z, Tang X. Diagnostic Performance of CMR, SPECT, and PET Imaging for the Identification of Coronary Artery Disease: A Meta-Analysis. Front Cardiovasc Med 2021; 8:621389. [PMID: 34026862 PMCID: PMC8138058 DOI: 10.3389/fcvm.2021.621389] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/23/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Myocardial perfusion imaging modalities, such as cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET), are well-established non-invasive diagnostic methods to detect hemodynamically significant coronary artery disease (CAD). The aim of this meta-analysis is to compare CMR, SPECT, and PET in the diagnosis of CAD and to provide evidence for further research and clinical decision-making. Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched. Studies that used CMR, SPECT, and/or PET for the diagnosis of CAD were included. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio with their respective 95% confidence interval, and the area under the summary receiver operating characteristic (SROC) curve were calculated. Results: A total of 203 articles were identified for inclusion in this meta-analysis. The pooled sensitivity values of CMR, SPECT, and PET were 0.86, 0.83, and 0.85, respectively. Their respective overall specificity values were 0.83, 0.77, and 0.86. Results in subgroup analysis of the performance of SPECT with 201Tl showed the highest pooled sensitivity [0.85 (0.82, 0.88)] and specificity [0.80 (0.75, 0.83)]. 99mTc-tetrofosmin had the lowest sensitivity [0.76 (0.67, 0.82)]. In the subgroup analysis of PET tracers, results indicated that 13N had the lowest pooled sensitivity [0.83 (0.74, 0.89)], and the specificity was the highest [0.91 (0.81, 0.96)]. Conclusion: Our meta-analysis indicates that CMR and PET present better diagnostic performance for the detection of CAD as compared with SPECT.
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Affiliation(s)
- Jianfeng Xu
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China.,JYAMS PET Research and Development Limited, Nanjing, China
| | - Fei Cai
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China.,JYAMS PET Research and Development Limited, Nanjing, China
| | - Changran Geng
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zheng Wang
- JYAMS PET Research and Development Limited, Nanjing, China
| | - Xiaobin Tang
- Department of Nuclear Sciences and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
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19
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Wang J, Li S, Chen W, Chen Y, Pang Z, Li J. Diagnostic efficiency of quantification of myocardial blood flow and coronary flow reserve with CZT dynamic SPECT imaging for patients with suspected coronary artery disease: a comparative study with traditional semi-quantitative evaluation. Cardiovasc Diagn Ther 2021; 11:56-67. [PMID: 33708478 DOI: 10.21037/cdt-20-728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Myocardial blood flow (MBF) quantitation with cadmium-zinc-telluride (CZT) dynamic single-photon emission computed tomography (SPECT) is being increasingly investigated toward clinical utilization. Methods In this prospective study, forty-nine patients with suspected or known coronary artery disease (CAD) underwent a rest/adenosine triphosphate (ATP) stress dynamic and routine gated myocardial perfusion imaging (MPI) by CZT SPECT and then received coronary angiography (CAG). Quantitative diagnosis from the dynamic SPECT and a flow diagram was automatically obtained by the dedicated software and compared with the result of semi-quantitative analysis with gated MPI using the angiographic stenosis as the reference standard. Results When stenosis ≥50% was considered at the participant level, the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and accuracy (AC) of the quantitative diagnosis were higher than semi-quantitative method as (84.4% vs. 65.6%, 88.2% vs. 70.6%, 93.1% vs. 80.8%, 75.0% vs. 52.2%, 85.7% vs. 67.3%) (all P<0.05). The receiver operating characteristic (ROC) curve analysis generated the optimal critical value as 1.86 and 1.61 mL/min/g for stress MBF (sMBF) and MFR, respectively. The diagnosis performance of the quantitative diagnosis was higher than semi-quantitative method as (78.9% vs. 68.4%, 63.3% vs. 60.0%, 57.7% vs. 52.0%, 82.6% vs. 75.0%, 69.4% vs. 63.3%) for the criteria of ≥75% stenosis on CAG (all P<0.05) with optimal critical values as 1.71 and 1.15 mL/min/g. There was no significant difference between sMBF and MFR. Conclusions The diagnostic efficiency by using the quantitative method of CZT dynamic SPECT imaging is superior to traditional semi-quantitative gated MPI for the diagnosis of CAD, which improved the diagnostic specificity and accuracy when the critical was stenosis ≥50%.
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Affiliation(s)
- Jiao Wang
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, China
| | - Shuai Li
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, China
| | - Weiqiang Chen
- Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, China
| | - Yue Chen
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, China
| | - Zekun Pang
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, China
| | - Jianming Li
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, China
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20
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Diagnostic analysis of new quantitative parameters of low-dose dynamic myocardial perfusion imaging with CZT SPECT in the detection of suspected or known coronary artery disease. Int J Cardiovasc Imaging 2020; 37:367-378. [PMID: 32914404 PMCID: PMC7878253 DOI: 10.1007/s10554-020-01962-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
The goal of this study is to explore and evaluate the diagnostic values of myocardial blood flow (MBF), myocardial flow reserve (MFR) and relative flow reserve (RFR) obtained with low-dose dynamic CZT SPECT for patients with suspected or known coronary artery disease (CAD). Fifty-seven consecutive patients who underwent low-dose dynamic CZT SPECT and CAG were enrolled. MBF, MFR and RFR were calculated on the vessel level with dedicated quantitative software, and the difference and correlation of each parameter was compared according to the reference standard of stenosis ≥ 50% or ≥ 75% on CAG, respectively. ROC curves were made by stress MBF (sMBF), rest MBF (rMBF), MFR and RFR. The optimal cut-off values and corresponding diagnostic efficacy were obtained and compared with each other. Results indicated that when stenosis ≥ 50% or ≥ 75% on CAG was used as the reference standard at the vessel level, there was no statistically significant difference in rMBF between the negative group and the positive group (P > 0.05), and the sMBF and MFR in positive groups were significantly lower than that in the negative group (all P < 0.05). There was a moderate to significant correlation between sMBF and MFR, sMBF and RFR, MFR and RFR (all P < 0.0001). These results indicate that low-dose dynamic CZT SPECT imaging can easily obtain the sMBF, MFR and RFR, and there is a good correlation among the three parameters, which has a certain diagnostic value for patients with suspected or known CAD, and is a useful supplement to the conventional qualitative or semi-quantitative diagnostic methods.
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21
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Hirschfeld CB, Dondi M, Pascual TNB, Mercuri M, Vitola J, Karthikeyan G, Better N, Mahmarian JJ, Bouyoucef SE, Hee-Seung Bom H, Lele V, Magboo VPC, Alexánderson E, Allam AH, Al-Mallah MH, Flotats A, Jerome S, Kaufmann PA, Luxenburg O, Underwood SR, Rehani MM, Vassileva J, Paez D, Einstein AJ. Worldwide Diagnostic Reference Levels for Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging: Findings From INCAPS. JACC Cardiovasc Imaging 2020; 14:657-665. [PMID: 32828783 DOI: 10.1016/j.jcmg.2020.06.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). BACKGROUND Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT MPI have previously been derived from national or regional registries. To date there have been no multiregional reports of DRLs for SPECT MPI from a single standardized dataset. METHODS Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study), a cross-sectional, multinational registry of MPI protocols. A total of 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data. RESULTS The aggregated worldwide DRLs for rest-stress or stress-rest studies employing technetium Tc 99m-labeled radiopharmaceuticals were 11.2 mCi (first dose) and 32.0 mCi (second dose) for 1-day protocols, and 23.0 mCi (first dose) and 24.0 mCi (second dose) for multiday protocols. Corresponding AAAs were 10.1 mCi (first dose) and 28.0 mCi (second dose) for 1-day protocols, and 17.8 mCi (first dose) and 18.7 mCi (second dose) for multiday protocols. For stress-only technetium Tc 99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26% to 92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions. CONCLUSIONS This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory protocols to regional trends. Organizations should continue to focus on establishing standardized reporting methods to improve the validity and comparability of regional DRLs.
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Affiliation(s)
- Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Maurizio Dondi
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Thomas N B Pascual
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - 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
| | - Joao Vitola
- Quanta Diagnóstico e Terapia, Curitiba, Brazil
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nathan Better
- Department of Nuclear Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Salah E Bouyoucef
- Department of Nuclear Medicine, Centre Hospitalo-Universitaire de Bab El Ouéd, Alger, Algeria
| | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Vikram Lele
- Department of Nuclear Medicine and PET-CT, Jaslok Hospital and Research Centre, Mumbai, India
| | - Vincent Peter C Magboo
- Department of Physical Sciences and Mathematics, University of the Philippines, Quezon City, Philippines; Department of Nuclear Medicine, University of Santo Tomas Hospital, Manila, Philippines
| | - Erick Alexánderson
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico; Department of Physiology, School of Medicine, Universidad Nacional Autónoma de México, 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
| | - 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, USA; Division of Cardiovascular Medicine, Department of Medicine, 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, Jerusalem, Israel; Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - 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, Boston, Massachusetts, USA
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- 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 and NewYork-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
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Mitochondrial electron transport chain: Oxidative phosphorylation, oxidant production, and methods of measurement. Redox Biol 2020; 37:101674. [PMID: 32811789 PMCID: PMC7767752 DOI: 10.1016/j.redox.2020.101674] [Citation(s) in RCA: 543] [Impact Index Per Article: 135.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 12/14/2022] Open
Abstract
The mitochondrial electron transport chain utilizes a series of electron transfer reactions to generate cellular ATP through oxidative phosphorylation. A consequence of electron transfer is the generation of reactive oxygen species (ROS), which contributes to both homeostatic signaling as well as oxidative stress during pathology. In this graphical review we provide an overview of oxidative phosphorylation and its inter-relationship with ROS production by the electron transport chain. We also outline traditional and novel translational methodology for assessing mitochondrial energetics in health and disease.
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Braganza A, Annarapu GK, Shiva S. Blood-based bioenergetics: An emerging translational and clinical tool. Mol Aspects Med 2020; 71:100835. [PMID: 31864667 PMCID: PMC7031032 DOI: 10.1016/j.mam.2019.100835] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/27/2019] [Accepted: 12/11/2019] [Indexed: 12/16/2022]
Abstract
Accumulating studies demonstrate that mitochondrial genetics and function are central to determining the susceptibility to, and prognosis of numerous diseases across all organ systems. Despite this recognition, mitochondrial function remains poorly characterized in humans primarily due to the invasiveness of obtaining viable tissue for mitochondrial studies. Recent studies have begun to test the hypothesis that circulating blood cells, which can be obtained by minimally invasive methodology, can be utilized as a biomarker of systemic bioenergetic function in human populations. Here we present the available methodologies for assessing blood cell bioenergetics and review studies that have applied these techniques to healthy and disease populations. We focus on the validation of this methodology in healthy subjects, as well as studies testing whether blood cell bioenergetics are altered in disease, correlate with clinical parameters, and compare with other methodology for assessing human mitochondrial function. Finally, we present the challenges and goals for the development of this emerging approach into a tool for translational research and personalized medicine.
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Affiliation(s)
- Andrea Braganza
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, Pittsburgh, PA, USA
| | - Gowtham K Annarapu
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, Pittsburgh, PA, USA
| | - Sruti Shiva
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, Pittsburgh, PA, USA; Department of Pharmacology & Chemical Biology, Pittsburgh, PA, USA; Center for Metabolism and Mitochondrial Medicine (C3M), University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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