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Case JA, Courter SA, McGhie AI, Patel KK, Sperry BW, Moloney E, Case KO, Burgett EV, Bateman TM. Accurate and efficient rapid acquisition early post-injection stress-first CZT SPECT myocardial perfusion imaging with tetrofosmin and attenuation correction. J Nucl Cardiol 2023; 30:2644-2654. [PMID: 37464251 DOI: 10.1007/s12350-023-03336-x] [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: 02/10/2023] [Accepted: 06/01/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Myocardial perfusion imaging (MPI) protocols have not changed significantly despite advances in instrumentation and software. We compared an early post-injection, stress-first SPECT protocol to standard delayed imaging. METHODS 95 patients referred for SPECT MPI were imaged upright and supine on a Spectrum Dynamics D-SPECT CZT system with CT attenuation correction. Patients received injection of 99mTc tetrofosmin at peak of regadenoson stress and were imaged. Early post-stress (mean 17 ± 2 minutes) and Standard 1-h delay (mean 61 ± 13 min). Three blinded readers evaluated images for overall interpretation, perceived need for rest imaging, image quality, and reader confidence. Laboratory efficiency was also evaluated. RESULTS Blinded readers had the same response for the need for rest in 77.9% of studies. Studies also had the same interpretation in 89.5% of studies. Reader confidence was high (86.0% (Early) and 90.3% (Standard p = 0.52. Image quality was good or excellent in 87.4% Early vs 96.8% Standard (p = 0.09). Time between patient check-in and end of stress imaging was 104 ± (Standard) to 60 ± 18 minutes (Early) (p < 0.001). CONCLUSION Early post-injection stress-only imaging using CZT SPECT/CT appears promising with Tc-99m tetrofosmin with similar image quality, reader confidence, diagnosis, and need for a rest scan.
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Affiliation(s)
- James A Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA.
| | | | - AIain McGhie
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Krishna K Patel
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Icahn School of Medicine at Mount Sinai Medical Center, New York, New York, USA
| | - Brett W Sperry
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Erin Moloney
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Katrina O Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
- Boston University, Boston, MA, USA
| | - Eric V Burgett
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Timothy M Bateman
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
- Mid America Heart Institute and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Duvall WL, Case J, Lundbye J, Cerqueira M. Efficiency of tetrofosmin versus sestamibi achieved through shorter injection-to-imaging times: A systematic review of the literature. J Nucl Cardiol 2021; 28:1381-1394. [PMID: 32236839 PMCID: PMC8421307 DOI: 10.1007/s12350-020-02093-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/19/2020] [Indexed: 11/20/2022]
Abstract
Based on superior image quality, more accurate gated images, and lower radiation exposure to patients, Technetium-99m (Tc-99m) based tracers are preferred over Thallium-201 for SPECT myocardial perfusion imaging. The two Tc-99m tracers, sestamibi and tetrofosmin, have many similar characteristics but there are differences in blood and liver clearance rates, as well as the recommended time after injection for imaging to achieve optimal image quality. Because published peer-reviewed studies examining optimal times between injection and imaging are limited, it can be difficult to identify evidence-based opportunities to optimize imaging protocols. Using systematic literature review methods, this study was designed to identify and consolidate the available evidence on the use of sestamibi compared to tetrofosmin for variable injection to imaging times in regard to test efficiency, including test length and re-scan rates, and image quality, including overall quality and cardiac to extra-cardiac ratios. The composite of this data shows that earlier imaging with tetrofosmin is equivalent to later imaging with sestamibi when assessing subjective image quality or when quantifying heart-to-extra-cardiac ratios. Image quality and heart-to-extra-cardiac ratios comparing early versus later imaging with tetrofosmin were comparable if not equivalent to each other. The equivalency of the imaging quality occurs with 15 minutes (on average) earlier imaging compared to sestamibi and 30 minutes compared to standard time tetrofosmin. The subjective findings of equivalent image quality are also shown with objective measurements of heart-to-extra-cardiac ratios. In this review, the significantly shorter injection-to-acquisition times with tetrofosmin compared to sestamibi resulted in better efficiency and less waiting times for patients; in addition, significantly higher re-scan rates with sestamibi compared to tetrofosmin due to hepatic activity contributed to better throughput with tetrofosmin.
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Affiliation(s)
- W Lane Duvall
- Hartford Hospital, Heart and Vascular Institute, 80 Seymour Street, Hartford, CT, 06102, USA.
| | - James Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
| | - Justin Lundbye
- The Greater Waterbury Health Network, Waterbury, CT, USA
| | - Manuel Cerqueira
- Department of Nuclear Medicine, Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Taillefer R. Myocardial perfusion imaging with 99mTc-labeled radiopharmaceuticals: How fast can a stress-rest same-day imaging protocol be completed? J Nucl Cardiol 2017; 24:1328-1331. [PMID: 27044387 DOI: 10.1007/s12350-016-0461-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Raymond Taillefer
- Département de médecine nucléaire, Hôpital du Haut-Richelieu, 920 Boulevard du Séminaire Nord, Saint-Jean-sur-Richelieu, QC, J3A 1B7, Canada.
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montréal, QC, Canada.
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Katsikis A, Theodorakos A, Kouzoumi A, Kitziri E, Georgiou E, Koutelou M. Fast myocardial perfusion imaging with 99mTc in challenging patients using conventional SPECT cameras. J Nucl Cardiol 2017; 24:1314-1327. [PMID: 26976142 DOI: 10.1007/s12350-016-0431-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/27/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND We attempted to validate the performance of a fast myocardial perfusion imaging (MPI) protocol in diagnostically challenging patients. METHODS 78 patients with ΒΜΙ > 24.9, LVH or three vessels disease underwent two sequential gated-MPI studies. The first at 15 (Early Imaging, EI) and the second at 45 (Late Imaging, LI) minutes post 99mTc-injection, at both stress and rest. Counts over heart (H), liver (Liv) and subdiaphragmatic space (Sub) and image quality, and myocardial perfusion and function parameters were compared between the two protocols. Coronary angiography was performed within 2 months from MPI, and ROC analysis was used to compare the diagnostic accuracy for the detection of ≥50% diameter luminal stenosis. RESULTS Quality was optimal-good in 93% of EI and 98% of LI studies (P = .12), H/Liv and stress H/Sub ratios were similar, but rest H/Sub ratio was lower in EI (P = .009). SSS [10 (0 to 46) vs 9 (0 to 36), P = .006] and SDS [3 (0 to 35) vs 2 (0 to 34), P = .02] were higher in EI protocol. LVEF, motion and thickening scores did not differ between the two protocols. A highly significant (P < .001) linear relationship with clinically negligible mean differences in Bland-Altman analysis was observed for all perfusion and function-related data. Sensitivity (EI 81%, LI 80%) and specificity (65% for both) did not differ (P = .23) between the two protocols. CONCLUSION The fast protocol is technically feasible and diagnostically accurate compared to the established protocol in diagnostically challenging patients.
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Affiliation(s)
- Athanasios Katsikis
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Zoodochou Pigis 54, Melissia, ZC 15127, Athens, Greece.
| | - Athanasios Theodorakos
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Zoodochou Pigis 54, Melissia, ZC 15127, Athens, Greece
| | - Anna Kouzoumi
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Zoodochou Pigis 54, Melissia, ZC 15127, Athens, Greece
| | - Elpida Kitziri
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Zoodochou Pigis 54, Melissia, ZC 15127, Athens, Greece
| | | | - Maria Koutelou
- Nuclear Medicine Department, Onassis Cardiac Surgery Center, Zoodochou Pigis 54, Melissia, ZC 15127, Athens, Greece
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Early gated SPECT adenosine myocardial perfusion imaging may influence the therapeutic management of patients with coronary artery disease. Nucl Med Commun 2015; 36:386-91. [PMID: 25569866 DOI: 10.1097/mnm.0000000000000258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aim of the study was to investigate whether myocardial perfusion imaging at 15 min after injection (T15) is more accurate in detecting coronary artery disease than that at 45 min (T45). PATIENTS AND METHODS Two-day stress/rest 99mTc-tetrofosmin gated SPECT was performed at T15 and T45 in 50 patients. Coronary angiography was considered when poststress and resting images were discordant. Tracer washout rates were calculated for the myocardium, liver, and subdiaphragmatic region. Perfusion sum difference scores were derived using QPS software. RESULTS T15 and T45 were discordant in 18/50 (36%) patients. In 16/18 patients (89%) discordant deficits were more apparent at T15. A total of 13/16 patients underwent coronary angiography, of whom 12 had coronary artery disease. Poststress, but not resting, left ventricular ejection fraction was lower at T15 (P=0.02). Sum difference scores were higher at T15 [2.2 (1.9)] than at T45 [1.6 (1.7); P<0.05]. Tracer washout rates from the liver [46 (13.3)%] and subdiaphragmatic region [36 (21.3)%] were significant (P<0.0001), but there was no change in myocardial activity. CONCLUSION T15 detected more abnormalities than did T45. The reduction in left ventricular ejection fraction after stress may result from adenosine-induced poststunning at T15. Accordingly, the T15 protocol may be useful in the assessment of hibernating myocardium. Contrasting myocardial and hepatic washout rates may be attributable to differential ABC transporter expression.
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Mut F, Giubbini R, Vitola J, Lusa L, Sobic-Saranovic D, Peix A, Bertagna F, Hang Bui D, Cunha C, Obaldo J, Rodella C, Camoni L, Paez D, Dondi M. Detection of post-exercise stunning by early gated SPECT myocardial perfusion imaging: results from the IAEA multi-center study. J Nucl Cardiol 2014; 21:1168-76. [PMID: 25213203 DOI: 10.1007/s12350-014-9983-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Transient post-ischemic LV dysfunction due to myocardial stunning in patients with coronary artery disease can be missed by conventional gated SPECT (GSPECT) acquisitions. The aim of this IAEA-sponsored multi-center study was to determine whether early post-exercise imaging is more likely to detect stunning than conventional without adversely affecting image quality or perfusion information. METHODS AND RESULTS Patients undergoing exercise/rest GSPECT were enrolled in this international multicenter study. Post-exercise studies were acquired at 15 ± 5 minutes after radiotracer injection (Stress-1) and repeated at 60 ± 15 minutes (Stress-2). Rest studies (R) were acquired at 60 minutes post injection. A core laboratory quantitatively assessed perfusion pattern and LV blinded to the acquisition time. Ischemia was defined as summed stress score (SDS) ≥4, and stunning was defined as the difference between rest and post-stress LVEF (Δ-LVEF). In the 229 patients enrolled into the study, both image quality and perfusion information were similar between Stress-1 and Stress-2. Post-stress LVEF was associated with both ischemia and time of acquisition, with a significant correlation between SDS and Δ-LVEF, which was stronger at Stress-1 than Stress-2 in the ischemic compared to the non-ischemic population (r = 0.23 vs 0.08, P = 0.10). CONCLUSIONS Early post-exercise imaging is feasible, and can potentially improve the detection of post-ischemic stunning without compromising image quality and perfusion data.
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Affiliation(s)
- Fernando Mut
- Department of Nuclear Medicine, Spanish Association Hospital, Montevideo, Uruguay
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Taillefer R. Should early post-stress imaging be performed on a routine clinical basis for myocardial perfusion studies? J Nucl Cardiol 2014; 21:1177-80. [PMID: 25213202 DOI: 10.1007/s12350-014-9972-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Raymond Taillefer
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada,
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Pirich C, Keinrath P, Rettenbacher L, Rendl G, Holzmannhofer J, Hammerer M, Schuler J, Beheshti M. 99mTc tetrofosmin myocardial perfusion scintigraphy in CAD. Performance with early and standard delayed acquisition and fractional flow reserve. Nuklearmedizin 2014; 53:111-6. [PMID: 24963973 DOI: 10.3413/nukmed-0617-13-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/02/2013] [Indexed: 11/20/2022]
Abstract
AIM Early stress imaging (15 min after injection of the radiopharmaceutical) in 99mTc tetrofosmin myocardial perfusion scintigraphy (MPS) has been shown feasible in comparison to standard imaging after 45 minutes, but the effects on image quality and diagnostic accuracy ask for further evaluation. PATIENTS, METHODS 97 patients (61 men, 36 women, age 69 ± 11 years) underwent both early (EA) and standard (SA) acquisition (after 14 ± 4 min and 43 ± 6 min, respectively) using 99mTc tetrofosmin gated SPECT with iterative reconstruction. Sub-diaphragmatic tracer activity and image quality was scored in a 4-point scale by blinded observers. Semiquantitative myocardial perfusion analysis was performed on a 17-segment model using standard cardiac quantification SPECT software (4 DM-SPECT). Stenoses of indeterminate haemodynamic significance were validated by measurement of fractional flow reserve (FFR). RESULTS Extra-cardiac tracer activity was more commonly found in EA (43%) than in SA (38%), but without any diagnostic impact in > 95% of the patients. The mean summed stress score was significantly higher for early than standard imaging (6.4 ± 6.3 vs. 5.6 ± 6.1, p = 0.009). The amount of ischaemic area was not significantly different (EA: 9.1 ± 6.7 % vs. SA: 7.8 ± 6.9 %). The mean stress ejection fraction was 52 ± 11% (EA) compared to 55 ± 11 % (SA) (p = ns). FFR was inversely related to SDS at early (r = -0.704, p < 0.05) and standard (r = -0.678, p < 0.05) acquisition. All patients with a FFR < 0.8 (considered as hemodynamically significant stenoses) revealed a positive scan. CONCLUSION Stress 99mTc tetrofosmin MPS with early acquisition is feasible and at least equally accurate when iterative reconstruction is applied.
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Affiliation(s)
- C Pirich
- Prof. Dr. Christian Pirich, Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg,, Muellner Hauptstrasse 48, 5020 Salzburg, Austria, Tel.+43/662/44 82 35 00, Fax +43/662/44 82 35 11, E-mail:
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Mariano-Goulart D, Jacquet JM, Molinari N, Bourdon A, Benkiran M, Sainmont M, Cornillet L, Macia JC, Reynes J, Ben Bouallègue F. Should HIV-infected patients be screened for silent myocardial ischaemia using gated myocardial perfusion SPECT? Eur J Nucl Med Mol Imaging 2012; 40:271-9. [DOI: 10.1007/s00259-012-2262-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/21/2012] [Indexed: 11/28/2022]
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