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van Assen M, Duguay TM, Litwin SE, Bayer RR, Nance JW, Suranyi P, De Cecco CN, Varga-Szemes A, Jacobs BE, Johnson AA, Tesche C, Schoepf UJ. The Feasibility, Tolerability, Safety, and Accuracy of Low-radiation Dynamic Computed Tomography Myocardial Perfusion Imaging With Regadenoson Compared With Single-photon Emission Computed Tomography. J Thorac Imaging 2021; 36:345-352. [PMID: 32205821 DOI: 10.1097/rti.0000000000000502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Computed tomography (CT) myocardial perfusion imaging (CT-MPI) with hyperemia induced by regadenoson was evaluated for the detection of myocardial ischemia, safety, relative radiation exposure, and patient experience compared with single-photon emission computed tomography (SPECT) imaging. MATERIALS AND METHODS Twenty-four patients (66.5 y, 29% male) who had undergone clinically indicated SPECT imaging and provided written informed consent were included in this phase II, IRB-approved, and FDA-approved clinical trial. All patients underwent coronary CT angiography and CT-MPI with hyperemia induced by the intravenous administration of regadenoson (0.4 mg/5 mL). Patient experience and findings on CT-MPI images were compared to SPECT imaging. RESULTS Patient experience and safety were similar between CT-MPI and SPECT procedures and no serious adverse events due to the administration of regadenoson occurred. SPECT resulted in a higher number of mild adverse events than CT-MPI. Patient radiation exposure was similar during the combined coronary computed tomography angiography and CT-MPI (4.4 [2.7] mSv) and SPECT imaging (5.6 [1.7] mSv) (P-value 0.401) procedures. Using SPECT as the reference standard, CT-MPI analysis showed a sensitivity of 58.3% (95% confidence interval [CI]: 27.7-84.8), a specificity of 100% (95% CI: 73.5-100), and an accuracy of 79.1% (95% CI: 57.9-92.87). Low apparent sensitivity occurred when the SPECT defects were small and highly suspicious for artifacts. CONCLUSIONS This study demonstrated that CT-MPI is safe, well tolerated, and can be performed with comparable radiation exposure to SPECT. CT-MPI has the benefit of providing both complete anatomic coronary evaluation and assessment of myocardial perfusion.
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Affiliation(s)
- Marly van Assen
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging.,Department of Radiology, Center for Medical Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Taylor M Duguay
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Sheldon E Litwin
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging.,Department of Medicine, Medical University of South Carolina, Division of Cardiology, Charleston, SC
| | - Richard R Bayer
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging.,Department of Medicine, Medical University of South Carolina, Division of Cardiology, Charleston, SC
| | - John W Nance
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Pal Suranyi
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging.,Department of Medicine, Medical University of South Carolina, Division of Cardiology, Charleston, SC
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Brian E Jacobs
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Addison A Johnson
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging
| | - Christian Tesche
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging.,Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging.,Department of Medicine, Medical University of South Carolina, Division of Cardiology, Charleston, SC
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Carrió I. Ernest V. Garcia, PhD (Born 1948). J Nucl Cardiol 2020; 27:1919-1922. [PMID: 32914321 DOI: 10.1007/s12350-020-02352-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ignasi Carrió
- Hospital Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
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3
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EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2020; 48:1040-1069. [PMID: 33135093 PMCID: PMC7603916 DOI: 10.1007/s00259-020-05046-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed.
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Piccinelli M. Multimodality image fusion, moving forward. J Nucl Cardiol 2020; 27:973-975. [PMID: 30693427 PMCID: PMC6661216 DOI: 10.1007/s12350-019-01607-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA.
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AlBadri A, Piccinelli M, Cho SG, Lee JM, Jaber W, De Cecco CN, Samady H, Koo BK, Bom HS, Garcia EV. Rationale and design of the quantification of myocardial blood flow using dynamic PET/CTA-fused imagery (DEMYSTIFY) to determine physiological significance of specific coronary lesions. J Nucl Cardiol 2020; 27:1030-1039. [PMID: 32026327 PMCID: PMC7332386 DOI: 10.1007/s12350-020-02052-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronary physiology assessments have been shown by multiple trials to add clinical value in detecting significant coronary artery disease and predicting cardiovascular outcomes. Fractional flow reserve (FFR) obtained during invasive coronary angiography (ICA) has become the new reference standard for hemodynamic significance detection. Absolute myocardial blood flow (MBF) quantification by means of dynamic positron emission tomography (dPET) has high diagnostic and prognostic values. FFR is an invasive measure and as such cannot be applied broadly, while MBF quantification is commonly performed on standard vascular territories intermixing normal flow from normal regions with abnormal flow from abnormal regions and consequently limiting its diagnostic power. OBJECTIVE The aim of this study is to provide physicians with reliable software tools for the non-invasive assessment of lesion-specific physiological significance for the entire coronary tree by combining PET-derived absolute flow data and coronary computed tomography angiography (CTA)-derived anatomy and coronary centerlines. METHODS The dynamic PET/CTA myocardial blood flow assessment with fused imagery (DEMYSTIFY) study is an observational prospective clinical study to develop algorithms and software tools to fuse coronary anatomy data obtained from CTA with dPET data to non-invasively measure absolute MBF, myocardial flow reserve, and relative flow reserve across specific coronary lesions. Patients (N = 108) will be collected from 4 institutions (Emory University Hospital, USA; Chonnam National University Hospital, South Korea; Samsung Medical Center, South Korea; Seoul National University Hospital, South Korea). These results will be compared to those obtained invasively in the catheterization laboratory and to a relatively novel non-invasive technique to estimate FFR based on CTA and computational fluid dynamics. CONCLUSIONS Success of these developments should lead to the following benefits: (1) eliminate unnecessary invasive coronary angiography in patients with no significant lesions, (2) avoid stenting physiologically insignificant lesions, (3) guide percutaneous coronary interventions process to the location of significant lesions, (4) provide a flow-color-coded 3D roadmap of the entire coronary tree to guide bypass surgery, and (5) use less radiation and lower the cost from unnecessary procedures. TRIAL REGISTRY The DEMYSTIFY study has been registered on ClinicalTrials.gov with registration number NCT04221594.
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Affiliation(s)
- Ahmed AlBadri
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, Korea
| | - Wissam Jaber
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Carlo N De Cecco
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Shibutani T, Okuda K, Ichikawa H, Kato T, Miwa K, Tsushima H, Onoguchi M, Nagaki A. Imaging technology for myocardial perfusion single-photon emission computed tomography 2018 in Japan. Jpn J Radiol 2020; 38:274-282. [PMID: 31919636 DOI: 10.1007/s11604-019-00915-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022]
Abstract
AIM Recently, nuclear cardiology has dramatically advanced by a new technology development such as the device, short-term acquisition system, image reconstruction algorithm and image analysis. Although these innovations have been gradually employed in routine examinations, we did not investigate the current use of image acquisition, image reconstruction, and image analysis with myocardial perfusion single-photon emission computed tomography (MPS). We investigated the current status of MPS imaging technology in Japan. METHODS We carried out a survey using a Web-based questionnaire system, the opening of which was announced via e-mail, and it was available on a website for 3 months. We collected data on the current use of MPS with 201Tl and/or 99mTc agents with respect to routine protocols, image acquisition, image reconstruction, and image analysis. RESULTS We received responses to the Web-based questionnaire from 178 and 174 people for 99mTc and 201Tl MPS, respectively. The routine protocols of MPS of stress-rest and rest-stress MPS on 1-day protocols with 99mTc were 41.2% and 14.5%, respectively, and the rest-only scan response rate was 23.7%, whereas that of 201Tl MPS was 65.9% with stress-rest MPS, 19.0% with rest-only MPS, and 10.9% with stress-rest MPS adding a rest scan 24 h after injection. The filtered back projection (FBP) method is most commonly used image reconstruction method, yielding 70.5% for 99mTc MPS and 76.8% for 201Tl MPS, including combined FBP and ordered subset expectation maximization method. The results for no-correction (NC) images were 49.2% with 99mTc MPS and 55.2% with 201Tl MPS including the response of NC and combined attenuation correction (AC) and scatter correction (SC) (i.e., ACSC) images. The AC or ACSC images of 99mTc and 201Tl were provided by 30-40% of the institutions surveyed. CONCLUSIONS We investigated the current status of MPS imaging technology in Japan, and found that although the use of various technical developments has been reported, some of these technologies have not been utilized effectively. Hence, we expect that nuclear medicine technology will be used more effectively to improve diagnosis.
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Affiliation(s)
- Takayuki Shibutani
- Department of Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa, Japan.
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Kahoku, Japan
| | - Hajime Ichikawa
- Department of Radiology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Toyohiro Kato
- Department of Radiology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Kenta Miwa
- Department of Radiological Sciences, School of Health Sciences, International University of Health and Welfare, Ohtawara, Japan
| | - Hiroyuki Tsushima
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa, Japan
| | - Akio Nagaki
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki, Japan
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Nishiyama H, Tanabe Y, Kido T, Kurata A, Uetani T, Kido T, Ikeda S, Miyagawa M, Mochizuki T. Incremental diagnostic value of whole-heart dynamic computed tomography perfusion imaging for detecting obstructive coronary artery disease. J Cardiol 2019; 73:425-431. [DOI: 10.1016/j.jjcc.2018.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/19/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
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Caobelli F. Left ventricular segmentation in myocardial perfusion positron emission tomography: tailor-made or prêt-à-porter? Eur Heart J Cardiovasc Imaging 2019; 20:502-503. [DOI: 10.1093/ehjci/jey216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Federico Caobelli
- Department of Nuclear Medicine, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH Basel, Switzerland
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9
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Bom MJ, Schumacher SP, Driessen RS, Raijmakers PG, Everaars H, van Diemen PA, Lammertsma AA, van de Ven PM, van Rossum AC, Knuuti J, Mäki M, Danad I, Knaapen P. Impact of individualized segmentation on diagnostic performance of quantitative positron emission tomography for haemodynamically significant coronary artery disease. Eur Heart J Cardiovasc Imaging 2018; 20:525-532. [DOI: 10.1093/ehjci/jey201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Michiel J Bom
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku, Finland
| | - Maija Mäki
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku, Finland
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, HZ Amsterdam, The Netherlands
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Pazhenkottil AP, Benz DC, Gräni C, Madsen MA, Mikulicic F, von Felten E, Fuchs TA, Moch BH, Stehli J, Lüscher TF, Gaemperli O, Buechel RR, Kaufmann PA. Hybrid SPECT Perfusion Imaging and Coronary CT Angiography: Long-term Prognostic Value for Cardiovascular Outcomes. Radiology 2018; 288:694-702. [DOI: 10.1148/radiol.2018171303] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Aju P. Pazhenkottil
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Dominik C. Benz
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Christoph Gräni
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Michael A. Madsen
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Fran Mikulicic
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Elia von Felten
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Tobias A. Fuchs
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Beatrice Hirt Moch
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Julia Stehli
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Thomas F. Lüscher
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Oliver Gaemperli
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Ronny R. Buechel
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
| | - Philipp A. Kaufmann
- From the Department of Nuclear Medicine (A.P.P., D.C.B., C.G., M.A.M., F.M., E.v.F., T.A.F., B.H.M., J.S., O.G., R.R.B., P.A.K.) and Department of Cardiology, University Heart Center (A.P.P., T.F.L., O.G.), University Hospital Zurich, Ramistr 100, NUK D 6, CH-8091 Zurich, Switzerland
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Slomka P. Hybrid quantitative imaging: Will it enter clinical practice? J Nucl Cardiol 2018; 25:1387-1389. [PMID: 28390041 DOI: 10.1007/s12350-017-0868-1] [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: 02/16/2017] [Accepted: 02/16/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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12
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Piccinelli M, Santana C, Sirineni GKR, Folks RD, Cooke CD, Arepalli CD, Aguade-Bruix S, Keidar Z, Frenkel A, Israel O, Candell-Riera J, Garcia EV. Diagnostic performance of the quantification of myocardium at risk from MPI SPECT/CTA 2G fusion for detecting obstructive coronary disease: A multicenter trial. J Nucl Cardiol 2018; 25:1376-1386. [PMID: 28194728 DOI: 10.1007/s12350-017-0819-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 12/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The effective non-invasive identification of coronary artery disease (CAD) and its proper referral for invasive treatment are still unresolved issues. We evaluated our quantification of myocardium at risk (MAR) from our second generation 3D MPI/CTA fusion framework for the detection and localization of obstructive coronary disease. METHODS Studies from 48 patients who had rest/stress MPI, CTA, and ICA were analyzed from 3 different institutions. From the CTA, a 3D biventricular surface of the myocardium with superimposed coronaries was extracted and fused to the perfusion distribution. Significant lesions were identified from CTA readings and positioned on the fused display. Three estimates of MAR were computed on the 3D LV surface on the basis of the MPI alone (MARp), the CTA alone (MARa), and the fused information (MARf). The extents of areas at risk were used to generate ROC curves using ICA anatomical findings as reference standard. RESULTS Areas under the ROC curve (AUC) for CAD detection using MARf was 0.88 (CI = 0.75-0.95) and for MARp and MARa were, respectively 0.82 (CI = 0.69-0.92) and 0.75 (CI = 0.60-0.86) using the ≥70% stenosis criterion. AUCs for CAD localization (all vessels) using MARf showed significantly higher performance than either MARa or MARp or both. CONCLUSIONS Using ICA as the reference standard, MAR as the quantitative parameter, and AUC to measure diagnostic performance, MPI-CTA fusion imaging provided incremental diagnostic information compared to MPI or CTA alone for the diagnosis and localization of CAD.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA.
| | - Cesar Santana
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | | | - Russell D Folks
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | - C David Cooke
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | - Chesnal D Arepalli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | | | | | | | - Ora Israel
- Rambam Health Care Campus, Haifa, Israel
| | | | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
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The incremental clinical value of cardiac hybrid SPECT/CTA imaging in coronary artery disease. Nucl Med Commun 2018; 39:469-478. [PMID: 29652747 DOI: 10.1097/mnm.0000000000000838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Coronary artery disease (CAD) is a major cause of death worldwide. It is significantly important to assess the coronary lesion and its pathophysiological relevance comprehensively. Coronary computed tomography angiography (CTA) or myocardial perfusion imaging alone suffers from some limitations in the evaluation of CAD. Through the integration and spatial colocalization of complementary morphological and functional information, the results of published hybrid single-photon emission computed tomography (SPECT)/CTA studies in patients with CAD are promising for detecting functionally relevant coronary artery lesion and evaluating the relationship between diseased coronary artery, coronary artery anomaly, myocardial bridging, or coronary calcification and myocardial ischemia. Compared with other diagnostic procedures, such as CTA, myocardial perfusion imaging alone, and side-by-side SPECT-CTA analysis, SPECT/CTA imaging has incremental value in the evaluation of CAD. Hybrid SPECT/CTA imaging can provide the physicians with more clinical evidence that helps with the treatment strategy decision-making process, thus acting as a gatekeeper to reduce unnecessary invasive examinations and revascularization procedures. In addition, follow-up SPECT/CTA fusion imaging plays a role in predicting prognosis by displaying clearly the relationship between postoperative vessel and myocardial blood supply. However, several limitations should be considered, including the increased radiation exposure, the limited number of patients, and the lack of a uniform gold standard. More data are needed to better specify the role of hybrid SPECT/CTA imaging in the management of CAD.
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Giannopoulos AA, Gaemperli O. Hybrid Imaging in Ischemic Heart Disease. ACTA ACUST UNITED AC 2018; 71:382-390. [PMID: 29329818 DOI: 10.1016/j.rec.2017.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/22/2017] [Indexed: 01/21/2023]
Abstract
Hybrid imaging for ischemic heart disease refers to the fusion of information from a single or usually from multiple cardiovascular imaging modalities enabling synergistic assessment of the presence, the extent, and the severity of coronary atherosclerotic disease along with the hemodynamic significance of lesions and/or with evaluation of the myocardial function. A combination of coronary computed tomography angiography with myocardial perfusion imaging, such as single-photon emission computed tomography and positron emission tomography, has been adopted in several centers and implemented in international coronary artery disease management guidelines. Interest has increased in novel hybrid methods including coronary computed tomography angiography-derived fractional flow reserve and computed tomography perfusion and these techniques hold promise for the imminent diagnostic and management approaches of patients with coronary artery disease. In this review, we discuss the currently available hybrid noninvasive imaging modalities used in clinical practice, research approaches, and exciting potential future technological developments.
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Affiliation(s)
- Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
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Piccinelli M, Cooke DC, Garcia EV. Multimodality Image Fusion for Coronary Artery Disease Detection: Concepts and Latest Developments. ACTA ACUST UNITED AC 2018; 4:74-78. [PMID: 31890460 DOI: 10.17996/anc.18-00065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The debate on the role of anatomy and function in the assessment of coronary artery disease has been progressing for decades. While each imaging modality brings its own strengths and weaknesses, a multimodality image fusion approach combining an anatomical acquisition with a functional one has the potential of providing all the complementary information necessary to select the proper treatment. The technology has been available to physicians for a decade, but the recent introduction of positron emission tomography-derived absolute myocardial blood flow has further advanced the case for an image fusion diagnostic approach.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Science, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, Georgia, 30322, United States
| | - David C Cooke
- Department of Radiology and Imaging Science, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, Georgia, 30322, United States
| | - Ernest V Garcia
- Department of Radiology and Imaging Science, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, Georgia, 30322, United States
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Abstract
Noninvasive cardiac imaging has witnessed tremendous advances in the recent past, particularly with regard to coronary computed tomography angiography (CCTA) where substantial improvements in image quality have been achieved while at the same time patients' radiation dose exposure has been reduced to the sub-millisievert range. Similarly, for single-photon emission computed tomography (SPECT) the introduction of novel cadmium-zinc-telluride-based semiconductor detectors has significantly improved system sensitivity and image quality, enabling fast image acquisition within less than 2-3 min or reduction of radiation dose exposure to less than 5 mSv. However, neither imaging modality alone is able to fully cover the two aspects of coronary artery disease (CAD), that is, morphology and function. Both modalities have distinct advantages and shortcomings: While CCTA may prove a superb modality for excluding CAD through its excellent negative predictive value, it does not allow for assessment of hemodynamic relevance if obstructive coronary lesions are detected. Conversely, SPECT myocardial perfusion imaging cannot provide any information on the presence or absence of subclinical coronary atherosclerosis. This article aims to highlight the great potential of cardiac hybrid imaging that allows for a comprehensive evaluation of CAD through combination of both morphological and functional information by fusing SPECT with CCTA.
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Affiliation(s)
- P A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - R R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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Song Y, Zhang RF, Liu Y. 2D-STI combined with gated 99Tc m-MIBI MPI for the diagnosis of myocardial ischemia in hypercholesterolemia patients. Exp Ther Med 2017; 14:981-994. [PMID: 28810550 PMCID: PMC5526078 DOI: 10.3892/etm.2017.4602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/24/2017] [Indexed: 01/09/2023] Open
Abstract
This study aimed to investigate the reliability of ultrasound two-dimensional speckle tracking imaging (2D-STI) for the evaluation of myocardial ischemia in familial hypercholesterolemia (FH) patients. We recruited 28 patients clinically diagnosed with homozygous familial hypercholesterolemia (HoFH) and subjected them to 2D-STI, gated transthoracic Doppler echocardiography (TTDE), and 99Tcm-methoxyisobutylisonitrile myocardial perfusion imaging (99Tcm-MIBI MPI). The sensitivity, specificity and diagnostic accordance rate of TTDE and 2D-STI for myocardial ischemia in HoFH patients were compared with the 99Tcm-MIBI scores. According to the diagnosis of ischemia in the three main coronary arteries (LAD, LCX, and RCA) by MPI, patients were further divided into different groups for comparing segmental strain by 2D-STI. The total correlation between TTDE and 99Tcm-MIBI MPI for evaluation of myocardial ischemia was r=0.483 and between 2D-STI and 99Tcm-MIBI MPI was 0.786. The total correlation index for ejection fraction (EF) between TTDE and 99Tcm-MIBI MPI was r=0.606 and for 2D-STI and 99Tcm-MIBI MPI was r=0.919. TTDE indicated that differences among LVDd, LVDs, IVS, LVPW, AO Vmax, PG, E/e', and DT were statistically significant. STI indicated that the total strain of the ischemia group was lower than that of the non-ischemia group. The total systolic strain and total early diastolic strain of the ischemia group were lower than that of the non-ischemia group. TTDE can be used for primary observation and evaluation of ventricular wall ischemia for HoFH patients. Ultrasound 2D-STI is better than TTDE in the evaluation of myocardial ischemia in HoFH patients. Ultrasound 2D-STI shows the same effectiveness as 99Tcm-MIBI MPI for the detection of myocardial ischemia, serving as good tool for prognosis and treatment evaluation in HoFH patients.
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Affiliation(s)
- Yi Song
- Department of Medical Ultrasonics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Rui-Fang Zhang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yu Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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Case JA. Minimizing the radiation dose of CT attenuation correction while improving image quality: The case for innovation. J Nucl Cardiol 2016; 23:1080-1085. [PMID: 26100578 DOI: 10.1007/s12350-015-0182-8] [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: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- James A Case
- Cardiovascular Imaging Technologies, University of Missouri, Columbia, Kansas City, MO, USA.
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Abstract
Coronary atherosclerosis and the precipitation of acute myocardial infarction are highly complex processes, which makes accurate risk prediction challenging. Rapid developments in invasive and noninvasive imaging technologies now provide us with detailed, exquisite images of the coronary vasculature that allow direct investigation of a wide range of these processes. These modalities include sophisticated assessments of luminal stenoses and myocardial perfusion, complemented by novel measures of the atherosclerotic plaque burden, adverse plaque characteristics, and disease activity. Together, they can provide comprehensive, individualized assessments of coronary atherosclerosis as it occurs in patients. Not only can this information provide important pathological insights, but it can also potentially be used to guide personalized treatment decisions. In this Review, we describe the latest advances in both established and emerging imaging techniques, focusing on the strengths and weakness of each approach. Moreover, we discuss how these technological advances might be translated from attractive images into novel imaging strategies and definite improvements in clinical risk prediction and patient outcomes. This process will not be easy, and the many potential barriers and difficulties are also reviewed.
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Greulich S, Sechtem U. Multimodality imaging in coronary artery disease - "The more the better?". COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Verberne HJ, Acampa W, Anagnostopoulos C, Ballinger J, Bengel F, De Bondt P, Buechel RR, Cuocolo A, van Eck-Smit BLF, Flotats A, Hacker M, Hindorf C, Kaufmann PA, Lindner O, Ljungberg M, Lonsdale M, Manrique A, Minarik D, Scholte AJHA, Slart RHJA, Trägårdh E, de Wit TC, Hesse B. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 2015; 42:1929-40. [PMID: 26290421 PMCID: PMC4589547 DOI: 10.1007/s00259-015-3139-x] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 01/18/2023]
Abstract
Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/publications/guidelines/2015_07_EANM_FINAL_myocardial_perfusion_guideline.pdf.
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Affiliation(s)
- Hein J Verberne
- Department of Nuclear Medicine, F2-238, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Wanda Acampa
- Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy
| | - Constantinos Anagnostopoulos
- Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Jim Ballinger
- Department of Nuclear Medicine, Guy's Hospital - Guy's & St Thomas' Trust Foundation, London, UK
| | - Frank Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Pieter De Bondt
- Department of Nuclear Medicine, OLV Hospital, Aalst, Belgium
| | - Ronny R Buechel
- Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Berthe L F van Eck-Smit
- Department of Nuclear Medicine, F2-238, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Cecilia Hindorf
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
| | | | - Oliver Lindner
- Heart and Diabetes Center North Rhine-Westphalia, Institute for Radiology, Nuclear Medicine and Molecular Imaging, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michael Ljungberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Markus Lonsdale
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alain Manrique
- Department of Nuclear Medicine, Service Commun Investigations chez l'Homme, GIP Cyceron, Caen University Hospital, Caen, France
| | - David Minarik
- Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden
| | - Tim C de Wit
- Department of Nuclear Medicine, F2-238, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Birger Hesse
- Department of Clinical Physiology and Nuclear Medicine & PET, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Rodríguez-Palomares JF, Aguadé-Bruix S. Nuclear cardiology: role in the world of multimodality cardiac imaging. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2015; 68:460-464. [PMID: 25944190 DOI: 10.1016/j.rec.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/04/2015] [Indexed: 06/04/2023]
Affiliation(s)
- José F Rodríguez-Palomares
- Servei de Cardiologia, Hospital Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
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Thomassen A, Petersen H, Johansen A, Braad PE, Diederichsen ACP, Mickley H, Jensen LO, Gerke O, Simonsen JA, Thayssen P, Høilund-Carlsen PF. Quantitative myocardial perfusion by O-15-water PET: individualized vs. standardized vascular territories. Eur Heart J Cardiovasc Imaging 2015; 16:970-6. [PMID: 25944051 DOI: 10.1093/ehjci/jev111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/30/2015] [Indexed: 12/19/2022] Open
Abstract
AIMS Reporting of quantitative myocardial blood flow (MBF) is typically performed in standard coronary territories. However, coronary anatomy and myocardial vascular territories vary among individuals, and a coronary artery may erroneously be deemed stenosed or not if territorial demarcation is incorrect. So far, the diagnostic consequences of calculating individually vs. standardly assessed MBF values have not been reported. We examined whether individual reassignment of vascular territories would improve the diagnostic accuracy of MBF with regard to the detection of significant coronary artery disease (CAD). METHODS AND RESULTS Forty-four patients with suspected CAD were included prospectively and underwent coronary CT-angiography and quantitative MBF assessment with O-15-water PET followed by invasive, quantitative coronary angiography, which served as reference. MBF was calculated in the vascular territories during adenosine stress according to a standardized 17-segment American Heart Association model and an individualized model, using CT-angiography to adjust the coronary territories to their feeding vessels. Individually defined territories deviated from standard territories in 52% of patients. However, MBF in the three coronary territories defined by standard and individualized models did not differ significantly, except in one patient, in whom the MBF of an individualized coronary territory deviated sufficiently as to change the test from a false positive to a true negative result in this particular territory. CONCLUSION Disparity between standardized and individualized vascular territories was present in half of the patients, but had little clinical impact. Still, caution should be taken not always to rely on standard territories, as this may at times cause misinterpretation.
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Affiliation(s)
- Anders Thomassen
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
| | - Henrik Petersen
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
| | - Allan Johansen
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
| | - Poul-Erik Braad
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
| | | | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Jane Angel Simonsen
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
| | - Per Thayssen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Pizzi M, Aguadé-Bruix S, Roque A, Cuéllar-Calabria H, Romero-Farina G, García del Blanco B, Castell-Conesa J, García-Dorado D, Candell-Riera J. SPECT, coronary angio-CT, invasive coronary angiography and fusion images in stable coronary disease. Rev Esp Med Nucl Imagen Mol 2015. [DOI: 10.1016/j.remnie.2015.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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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Diagnostic performance of dual-energy CT stress myocardial perfusion imaging: direct comparison with cardiovascular MRI. AJR Am J Roentgenol 2015; 203:W605-13. [PMID: 25415725 DOI: 10.2214/ajr.14.12644] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the diagnostic performance of stress perfusion dual-energy CT (DECT) and its incremental value when used with coronary CT angiography (CTA) for identifying hemodynamically significant coronary artery disease. SUBJECTS AND METHODS One hundred patients with suspected or known coronary artery disease without chronic myocardial infarction detected with coronary CTA underwent stress perfusion DECT, stress cardiovascular perfusion MRI, and invasive coronary angiography (ICA). Stress perfusion DECT and cardiovascular stress perfusion MR images were used for detecting perfusion defects. Coronary CTA and ICA were evaluated in the detection of ≥50% coronary stenosis. The diagnostic performance of coronary CTA for detecting hemo-dynamically significant stenosis was assessed before and after stress perfusion DECT on a per-vessel basis with ICA and cardiovascular stress perfusion MRI as the reference standard. RESULTS The performance of stress perfusion DECT compared with cardiovascular stress perfusion MRI on a per-vessel basis in the detection of perfusion defects was sensitivity, 89%; specificity, 74%; positive predictive value, 73%; negative predictive value, 90%. Per segment, these values were sensitivity, 76%; specificity, 80%; positive predictive value, 63%; and negative predictive value, 88%. Compared with ICA and cardiovascular stress perfusion MRI per vessel territory the sensitivity, specificity, positive predictive value, and negative predictive value of coronary CTA were 95%, 61%, 61%, and 95%. The values for stress perfusion DECT were 92%, 72%, 68%, and 94%. The values for coronary CTA and stress perfusion DECT were 88%, 79%, 73%, and 91%. The ROC AUC increased from 0.78 to 0.84 (p=0.02) with the use of coronary CTA and stress perfusion DECT compared with coronary CTA alone. CONCLUSION Stress perfusion DECT plays a complementary role in enhancing the accuracy of coronary CTA for identifying hemodynamically significant coronary stenosis.
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Kauling RM, Post MC, Rensing BJWM, Verzijlbergen JF, Schaap J. Hybrid SPECT/CCTA Imaging in the Work-up of Patients with Suspected Coronary Artery Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-014-9316-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pizzi MN, Aguadé-Bruix S, Roque A, Cuéllar-Calabria H, Romero-Farina G, García del Blanco B, Castell-Conesa J, García-Dorado D, Candell-Riera J. [SPECT, coronary angio-CT, invasive coronary angiography and fusion images in stable coronary disease]. Rev Esp Med Nucl Imagen Mol 2015; 34:173-80. [PMID: 25555322 DOI: 10.1016/j.remn.2014.11.004] [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: 09/04/2014] [Revised: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the usefulness of the information obtained with SPECT, coronary angio-CT and fusion images, in patients with stable ischemic disease who need invasive coronary angiography (IA). MATERIAL AND METHODS Forty-six patients (65.98±8.3 years) with coronary disease were prospectively included. The fusion images generated after undergoing IA were used to evaluate the performance of these techniques in the diagnosis of multi-vessel coronary disease, the detection of the culprit vessel and the therapeutic management of these patients. RESULTS In the IA, 29 of the 46 patients (63%) had multi-vessel disease. SPECT could detect it in 48.2% and coronary angio-CT could detect it in 89.6%. Concordance between coronary angio-CT and IA in the diagnosis of the culprit vessel was 77% (kappa 0.6), and between SPECT and IA it was 73% (kappa 0.56). Although fusion images could have been obtained prior to IA, they would not have changed the therapeutic approach derived from SPECT and IA. CONCLUSIONS Coronary angio-CT has a high ability for the diagnosis of multi-vessel disease and the culprit lesion, and SPECT is a good functional complement of the IA in the detection of the most ischemic territory. However, the performance of fusion images in patients with stable ischemic disease, who have undergone a SPECT as the first non-invasive study and need IA, does not seem indicated because they would not have changed the therapeutic management derived from SPECT and IA information.
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Affiliation(s)
- M N Pizzi
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, España.
| | - S Aguadé-Bruix
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, España
| | - A Roque
- Servicio de Radiología, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, España
| | - H Cuéllar-Calabria
- Servicio de Radiología, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, España
| | - G Romero-Farina
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, España
| | - B García del Blanco
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, España
| | - J Castell-Conesa
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, España
| | - D García-Dorado
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, España
| | - J Candell-Riera
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, España
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Molecular imaging of plaques in coronary arteries with PET and SPECT. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:259-73. [PMID: 25278976 PMCID: PMC4178519 DOI: 10.11909/j.issn.1671-5411.2014.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 08/15/2014] [Accepted: 08/19/2014] [Indexed: 01/26/2023]
Abstract
Coronary artery disease remains a major cause of mortality. Presence of atherosclerotic plaques in the coronary artery is responsible for lumen stenosis which is often used as an indicator for determining the severity of coronary artery disease. However, the degree of coronary lumen stenosis is not often related to compromising myocardial blood flow, as most of the cardiac events that are caused by atherosclerotic plaques are the result of vulnerable plaques which are prone to rupture. Thus, identification of vulnerable plaques in coronary arteries has become increasingly important to assist identify patients with high cardiovascular risks. Molecular imaging with use of positron emission tomography (PET) and single photon emission computed tomography (SPECT) has fulfilled this goal by providing functional information about plaque activity which enables accurate assessment of plaque stability. This review article provides an overview of diagnostic applications of molecular imaging techniques in the detection of plaques in coronary arteries with PET and SPECT. New radiopharmaceuticals used in the molecular imaging of coronary plaques and diagnostic applications of integrated PET/CT and PET/MRI in coronary plaques are also discussed.
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Abstract
Cardiac multimodality (hybrid) imaging can be obtained from a variety of techniques, such as nuclear medicine with single photon emission computed tomography (SPECT) and positron emission tomography (PET), or radiology with multislice computed tomography (CT), magnetic resonance (MR) and echography. They are typically combined in a side-by-side or fusion mode in order to provide functional and morphological data to better characterise coronary artery disease, with more proven efficacy than when used separately. The gained information is then used to guide revascularisation procedures. We present an up-to-date comprehensive overview of multimodality imaging already in clinical use, as well as a combination of techniques with promising or developing applications.
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Direct comparison of stress- and rest-dual-energy computed tomography for detection of myocardial perfusion defect. Int J Cardiovasc Imaging 2014; 30 Suppl 1:41-53. [DOI: 10.1007/s10554-014-0410-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
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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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Piccinelli M, Faber TL, Arepalli CD, Appia V, Vinten-Johansen J, Schmarkey SL, Folks RD, Garcia EV, Yezzi A. Automatic detection of left and right ventricles from CTA enables efficient alignment of anatomy with myocardial perfusion data. J Nucl Cardiol 2014; 21:96-108. [PMID: 24185581 PMCID: PMC5207024 DOI: 10.1007/s12350-013-9812-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 10/15/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accurate alignment between cardiac CT angiographic studies (CTA) and nuclear perfusion images is crucial for improved diagnosis of coronary artery disease. This study evaluated in an animal model the accuracy of a CTA fully automated biventricular segmentation algorithm, a necessary step for automatic and thus efficient PET/CT alignment. METHODS AND RESULTS Twelve pigs with acute infarcts were imaged using Rb-82 PET and 64-slice CTA. Post-mortem myocardium mass measurements were obtained. Endocardial and epicardial myocardial boundaries were manually and automatically detected on the CTA and both segmentations used to perform PET/CT alignment. To assess the segmentation performance, image-based myocardial masses were compared to experimental data; the hand-traced profiles were used as a reference standard to assess the global and slice-by-slice robustness of the automated algorithm in extracting myocardium, LV, and RV. Mean distances between the automated and the manual 3D segmented surfaces were computed. Finally, differences in rotations and translations between the manual and automatic surfaces were estimated post-PET/CT alignment. The largest, smallest, and median distances between interactive and automatic surfaces averaged 1.2 ± 2.1, 0.2 ± 1.6, and 0.7 ± 1.9 mm. The average angular and translational differences in CT/PET alignments were 0.4°, -0.6°, and -2.3° about x, y, and z axes, and 1.8, -2.1, and 2.0 mm in x, y, and z directions. CONCLUSIONS Our automatic myocardial boundary detection algorithm creates surfaces from CTA that are similar in accuracy and provide similar alignments with PET as those obtained from interactive tracing. Specific difficulties in a reliable segmentation of the apex and base regions will require further improvements in the automated technique.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, 101 Woodruff Circle, Room 1203C, Atlanta, GA, 30322, USA,
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Cardiac hybrid SPECT/CTA imaging to detect "functionally relevant coronary artery lesion": a potential gatekeeper for coronary revascularization? Ann Nucl Med 2013; 28:88-93. [PMID: 24343677 DOI: 10.1007/s12149-013-0790-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/17/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Combination of both morphological and functional information has gained more and more appreciation with the concept of "functionally relevant coronary artery lesion (FRCAL)" and "functional revascularization". This has paved the way for non-invasive single-photon emission computed tomography (SPECT)/computed tomography angiography (CTA) hybrid imaging. We aimed at assessing the value of cardiac hybrid imaging on the detection of FRCAL and its potential as a gatekeeper for invasive examination and treatment. METHODS In Two hundred and thirty-eight patients with known or suspected coronary artery disease (CAD) underwent CTA and myocardial perfusion imaging (MPI) using SPECT on a dual system scanner in one session before treatment. 78 patients underwent invasive coronary angiography (CAG) within 1 month. Detection of FRCAL by the combination of SPECT/CTA was compared with SPECT/CAG, which served as a standard of reference. According to the both combination results, treatment decision (revascularization or medical treatment) was chosen in the catheterization laboratory. RESULTS Sensitivity, specificity, accuracy, positive and negative prediction rate by SPECT/CTA vs. SPECT/CAG for the detection of flow-limiting coronary stenosis on patient- and vessel-based analysis were 94.33, 72.00, 87.18, 87.71, 85.71 % and 88.71, 92.44, 91.45, 80.89, 95.78 %, respectively. No revascularization procedures were performed in patients without flow-limiting stenosis. However, more than one-third (25/67, 37 %) of revascularized vessels were not associated with ischemia on MPI. CONCLUSIONS The cardiac SPECT/CTA hybrid imaging can accurately detect FRCAL and thereby it may be used as a gatekeeper for CAG and revascularization procedures.
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Kirişli HA, Gupta V, Shahzad R, Al Younis I, Dharampal A, Geuns RJV, Scholte AJ, de Graaf MA, Joemai RM, Nieman K, van Vliet L, van Walsum T, Lelieveldt B, Niessen WJ. Additional Diagnostic Value of Integrated Analysis of Cardiac CTA and SPECT MPI Using the SMARTVis System in Patients with Suspected Coronary Artery Disease. J Nucl Med 2013; 55:50-7. [DOI: 10.2967/jnumed.113.119842] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Piccinelli M, Garcia E. Multimodality image fusion for diagnosing coronary artery disease. J Biomed Res 2013; 27:439-51. [PMID: 24285942 PMCID: PMC3841469 DOI: 10.7555/jbr.27.20130138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 09/16/2013] [Indexed: 11/17/2022] Open
Abstract
Coronary artery disease (CAD) is one of the leading causes of death in the US and a substantial health-care burden in all industrialized societies. In recent years we have witnessed a constant strive towards the development and the clinical application of novel or improved detection methods as well as therapies. Particularly, noninvasive imaging is a decisive component in the cardiovascular field. Image fusion is the ability of combining into a single integrated display the anatomical as well as the physiological data retrieved by separated modalities. Clinical evidence suggests that it represents a promising strategy in CAD assessment and risk stratification by significantly improving the diagnostic power of each modality independently considered and of the traditional side-by-side interpretation. Numerous techniques and approaches taken from the image registration field have been implemented and validated in the context of CAD assessment and management. Although its diagnostic power is widely accepted, additional technical developments are still needed to become a routinely used clinical tool.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, Atlanta 30322, GA, USA.
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Danad I, Raijmakers PG, Knaapen P. Diagnosing coronary artery disease with hybrid PET/CT: it takes two to tango. J Nucl Cardiol 2013; 20:874-90. [PMID: 23842709 DOI: 10.1007/s12350-013-9753-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The noninvasive diagnosis of coronary artery disease (CAD) is a challenging task. Although a large armamentarium of imaging modalities is available to evaluate the functional consequences of the extent and severity of CAD, cardiac perfusion positron emission tomography (PET) is considered the gold standard for this purpose. Alternatively, noninvasive anatomical imaging of coronary atherosclerosis with coronary computed tomography angiography (CCTA) has recently been successfully implemented in clinical practice. Although each of these diagnostic approaches has its own merits and caveats, functional and morphological imaging techniques provide fundamentally different insights into the disease process and should be considered to be complementary rather than overlapping. Hybrid imaging with PET/CT offers the possibility to evaluate both aspects nearly simultaneously, and studies have demonstrated that such a comprehensive assessment results in superior diagnostic accuracy, better prognostication, and helps in guiding clinical patient management. The aim of this review is to discuss the value of stand-alone CCTA and PET in CAD, and to summarize the available data on the surplus value of hybrid PET/CT including its strengths and limitations.
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Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Dorbala S, Di Carli MF, Delbeke D, Abbara S, DePuey EG, Dilsizian V, Forrester J, Janowitz W, Kaufmann PA, Mahmarian J, Moore SC, Stabin MG, Shreve P. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med 2013; 54:1485-507. [PMID: 23781013 DOI: 10.2967/jnumed.112.105155] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Choo KS, Hwangbo L, Kim JH, Park YH, Kim JS, Kim J, Chun KJ, Jeong DW, Lim SJ. Adenosine-stress low-dose single-scan CT myocardial perfusion imaging using a 128-slice dual-source CT: a comparison with fractional flow reserve. Acta Radiol 2013; 54:389-95. [PMID: 23550182 DOI: 10.1177/0284185113475440] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coronary CT angiography (CCTA) allows accurate evaluation of coronary artery stenosis but has limitations in information on hemodynamic significance of stenotic lesions. PURPOSE To determine the feasibility of adenosine-stress low-dose single-scan CT myocardial perfusion imaging (MPI) using a 128-slice dual-source CT scanner for the diagnosis of hemodynamically significant coronary artery stenosis as defined by fractional flow reserve (FFR). MATERIAL AND METHODS This study was proved by the Institutional Review Board and informed consent was obtained from the patients before enrollment in the study. Ninety-seven patients with chest pain and low-to-intermediate pretest probability of coronary artery disease were prospectively enrolled. Adenosine-stress CCTA using ECG-correlated maximum tube current modulation (Mindose(®)) with 128-slice dual-source CT was performed in all 97 patients. In 37 patients (38.1%; 28 men, nine women; mean age, 61.7 ± 20.5 years; mean heart rate, 74.6 ± 2.8 bpm) with significant stenosis at CCTA (lumen diameter reduction >50%), FFR was performed after CCTA, as a reference standard for the evaluation of myocardial perfusion. FFR value ≤0.75 was considered as positive. CTMPI and CCTA were read by two experienced radiologists with consensus, respectively. RESULTS The effective radiation dose of adenosine-stress single-scan CTMPI was 4.63 ± 2.57 mSv. Compared with FFR, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying significant coronary stenoses were 93.1%, 82.7%, 75.0%, and 95.6%, respectively, on CCTA and 93.1%, 90.3%, 84.4%, and 95.9%, respectively, on CTMPI. On combined CCTA and CTMPI, sensitivity, specificity, PPV, and NPV were 93.1%, 94.2%, 90.0%, and 96.0%, respectively. CONCLUSION Adenosine-stress low-dose single scan CTMPI using a 128-slice dual-source CT can provide complementary information on the hemodynamical significance of coronary artery stenosis as well as anatomical information of coronary arteries.
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Affiliation(s)
- Ki Seok Choo
- Department of Radiology, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine
| | - Lee Hwangbo
- Department of Radiology, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine
| | - June Hong Kim
- Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine
| | - Yong Hyun Park
- Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine
| | - Jeong Su Kim
- Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine
| | - Jun Kim
- Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine
| | - Kook Jin Chun
- Department of Cardiology, Medical Research Institute, Pusan National University Yangsan hospital, Pusan National University, School of Medicine
| | - Dong Wook Jeong
- Department of Family Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine
| | - Soo Jin Lim
- Department of Cardiology, Kim Hae Jungang Hospital, Korea
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Dörr R, Kadalie CT, Franke WG, Gutberlet M. [Hybrid imaging in diagnostics and therapy of chronic myocardial ischemia. Clinical value]. Herz 2013; 38:367-75. [PMID: 23604108 DOI: 10.1007/s00059-013-3785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Clinical studies have consistently shown that there is only a very weak correlation between the angiographically determined severity of coronary artery disease (CAD) and disturbance of regional coronary perfusion. On the other hand, the results of randomized trials with a fractional flow reserve (FFR)-guided coronary intervention (DEFER, FAME I, FAME II) showed that it is not the angiographically determined morphological severity of coronary artery disease but the functional severity determined by FFR that is critical for prognosis and the indications for revascularization. A non-invasive method combining the morphological image of the coronary anatomy with functional imaging of myocardial ischemia is therefore particularly desirable. An obvious solution is the combination of coronary computed tomography angiography (CCTA) with a functional procedure, such as perfusion positron emission tomography (PET), perfusion single photon emission computed tomography (SPECT) or perfusion magnetic resonance imaging (MRI). This can be performed with fusion imaging or with hybrid imaging using PET-CT or SPECT-CT. First trial results with PET CCTA and SPECT CCTA carried out as cardiac hybrid imaging on a 64 slice CT showed a major effect to be a decrease in the number of false positive results, significantly increasing the specificity of CCTA and SPECT. Although the results are promising, due to the previously high costs, low availability and the additional radiation exposure, current data is not yet sufficient to give clear recommendations for the use of hybrid imaging in patients with a low to intermediate risk of CAD. Ongoing prospective studies such as the SPARC or EVINCI trials will bring further clarification here.
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Affiliation(s)
- R Dörr
- Praxisklinik Herz und Gefäße,AkademischeLehrpraxisklinik der TU Dresden, Forststrasse 3, Dresden, Germany.
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Schaap J, Kauling RM, Boekholdt SM, Nieman K, Meijboom WB, Post MC, Van der Heyden JA, de Kroon TL, van Es HW, Rensing BJ, Verzijlbergen JF. Incremental diagnostic accuracy of hybrid SPECT/CT coronary angiography in a population with an intermediate to high pre-test likelihood of coronary artery disease. Eur Heart J Cardiovasc Imaging 2013; 14:642-9. [DOI: 10.1093/ehjci/jes303] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Danad I, Raijmakers PG, Appelman YE, Harms HJ, de Haan S, van den Oever ML, Heymans MW, Tulevski II, van Kuijk C, Hoekstra OS, Lammertsma AA, Lubberink M, van Rossum AC, Knaapen P. Hybrid Imaging Using Quantitative H215O PET and CT-Based Coronary Angiography for the Detection of Coronary Artery Disease. J Nucl Med 2012; 54:55-63. [DOI: 10.2967/jnumed.112.104687] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Koukouraki S, Pagonidis K, Perisinakis K, Klinaki I, Stathaki M, Damilakis J, Karantanas A, Karkavitsas N. Hybrid cardiac imaging: insights in the dilemma of the appropriate clinical management of patients with suspected coronary artery disease. Eur J Radiol 2012. [PMID: 23177185 DOI: 10.1016/j.ejrad.2012.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM To evaluate the potential of SPECT myocardial perfusion imaging (MPI)-computed tomography coronary angiography (CTCA) hybrid fusion imaging to improve the diagnostic performance of cardiac SPECT/MPI and CTCA alone in order to act as more accurate gate keeper to further investigation invasive or not. METHODS AND RESULTS Twenty-five patients were subjected to SPECT/MPI and CTCA within a period of 1 month without any medical treatment modification. A fusion software package was used for cardiac SPECT-CTCA image fusion. Semiquantitative analysis was performed for cardiac SPECT, CTCA and SPECT/MPI-CTCA fusion images. Patients were classified in 2 groups according to the clinical decision for further investigation (group A), or not (group B). Statistically significant differences were observed when SPECT/MPI-CTCA fusion images were used instead of cardiac SPECT alone (p<0.05). No statistically significant differences were observed comparing CTCA alone to SPECT/MPI-CTCA fusion images (p=0.25). A mid-term follow-up (mean 3.58 ± 0.24 years) showed that all patients classified in group A based on the interpretation of SPECT MPI-CTCA fused images underwent conventional coronary angiography with further necessity for PTCA or CABG whereas absence of major or minor cardiac events was revealed for all patients of group B. CONCLUSION In patients suspected for coronary artery disease, cardiac SPECT/MPI-CTCA fusion imaging was found to considerably alter the clinical decision for referral to further investigation derived from SPECT/MPI.
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Affiliation(s)
- S Koukouraki
- Department of Nuclear Medicine, Faculty of Medicine, University of Crete, Greece.
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Ghadri JR, Fiechter M, Fuchs TA, Scherrer A, Stehli J, Gebhard C, Klaser B, Gaemperli O, Luscher TF, Templin C, Kaufmann PA. Registry for the Evaluation of the PROgnostic value of a novel integrated imaging approach combining Single Photon Emission Computed Tomography with coronary calcification imaging (REPROSPECT). Eur Heart J Cardiovasc Imaging 2012; 14:374-80. [DOI: 10.1093/ehjci/jes224] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Mc Ardle B, Ziadi MC, Ruddy TD, Beanlands RS. Nuclear perfusion imaging for functional evaluation of patients with known or suspected coronary artery disease: the future is now. Future Cardiol 2012; 8:603-22. [DOI: 10.2217/fca.12.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nuclear imaging, with both single-photon emission computed tomography and PET, has a well-established role in the assessment of patients with known or suspected coronary artery disease. There is a large body of evidence regarding the diagnostic accuracy and prognostic value of these modalities, however, they continue to evolve rapidly with advances in camera and tracer technology, as well as changes in imaging protocols to increase lab efficiency, improve image quality and to decrease radiation exposure to patients. Nuclear imaging also provides insights into atherogenesis at a molecular level and can be combined with other imaging modalities, providing both functional and structural data and complimentary information on the presence of coronary disease and its functional implications.
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Affiliation(s)
- Brian Mc Ardle
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Maria Cecilia Ziadi
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Terrence D Ruddy
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rob S Beanlands
- The National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Nakazato R, Dey D, Alexánderson E, Meave A, Jiménez M, Romero E, Jácome R, Peña M, Berman DS, Slomka PJ. Automatic alignment of myocardial perfusion PET and 64-slice coronary CT angiography on hybrid PET/CT. J Nucl Cardiol 2012; 19:482-91. [PMID: 22419224 PMCID: PMC3527130 DOI: 10.1007/s12350-012-9528-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 02/02/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hybrid PET/CT allows for acquisition of cardiac PET and coronary CT angiography (CCTA) in one session. However, PET and CCTA are acquired with differing breathing protocols and require software registration. We aimed to validate automatic correction for breathing misalignment between PET and CCTA acquired on hybrid scanner. METHODS Single-session hybrid PET/CT studies of rest/stress (13)N-ammonia PET and CCTA in 32 consecutive patients were considered. Automated registration of PET left ventricular (LV) surfaces with CCTA volumes was evaluated by comparing with expert manual alignment by two observers. RESULTS The average initial misalignments between the position of LV on PET and CCTA were 27.2 ± 11.8, 13.3 ± 11.5, and 14.3 ± 9.1 mm in x, y, and z axes on rest, and 26.3 ± 10.2, 11.1 ± 9.5, and 11.7 ± 7.1 mm in x, y, and z axes on stress, respectively. The automated PET-CCTA co-registration had 95% agreement as judged visually. Compared with expert manual alignment, the translation errors of the algorithm were 5.3 ± 2.8 mm (rest) and 6.0 ± 3.5 mm (stress). 3D visualization of combined coronary vessel anatomy and hypoperfusion from PET could be made without further manual adjustments. CONCLUSION Software co-registration of CCTA and PET myocardial perfusion imaging on hybrid PET/CT scanners is necessary, but can be performed automatically, facilitating integrated 3D display on PET/CT.
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Affiliation(s)
- Ryo Nakazato
- Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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