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Martineau PJ, Pelletier-Galarneau M, Slomka P, Goertzen AL, Leslie WD. Optimizing stress-only myocardial perfusion imaging: a clinical prediction model to improve patient selection. Nucl Med Commun 2023; 44:1087-1093. [PMID: 37706261 PMCID: PMC466936 DOI: 10.1097/mnm.0000000000001768] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Stress-only single photon emission computed tomography myocardial perfusion imaging (MPI) offers numerous advantages in terms of improved workflow, cost and radiation reduction but is currently not widely utilized due to challenges in selecting appropriate patients for this technique. METHODS Data from 5959 individuals were used to derive (N = 4018) and validate (N = 1941) a binomial logistic regression model to predict normal stress MPI studies (stress total perfusion deficit < 4%, ejection fraction ≥ 50%). Model performance was analyzed using receiver operator characteristic curves. A simplified point-scoring system was developed and its impact on imaging workflow was assessed. RESULTS Significant predictors of abnormal vs. normal stress MPI included male sex, age > 65 years, cardiomyopathy, congestive heart failure, myocardial infarction, angina, and pharmacological stress. The final model and simplified scoring system were associated with areas under the curve of 0.81 (95% CI 0.79-0.83) and 0.80 (95% CI 0.79-0.82) in the validation group, respectively. Use of the scoring system was estimated to result in a decrease of 56.5% in the number of non-contributory imaging studies acquired with minimal patient rescheduling. CONCLUSION A prediction tool derived from simple clinical information can identify candidates for stress-only MPI studies with a beneficial impact on departmental workflow.
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Affiliation(s)
- Patrick J Martineau
- Department of Radiology, University of British Columbia,
- BC Cancer, Vancouver, British Columbia, Canada,
| | - Matthieu Pelletier-Galarneau
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA,
- Department of Medical Imaging, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada,
| | - Piotr Slomka
- Cedars-Sinai Medical Center, Los Angeles, California, USA,
| | | | - William D Leslie
- Department of Radiology, University of Manitoba and
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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2
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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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3
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McMahon SR, Patel EK, Duvall WL. Stress-First Myocardial Perfusion Imaging. Cardiol Clin 2023; 41:163-175. [PMID: 37003674 DOI: 10.1016/j.ccl.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Stress-first approaches to myocardial perfusion imaging provide diagnostically and prognostically accurate perfusion data equivalent to a full rest-stress study while saving time in the imaging laboratory and reducing the radiation exposure to patients and laboratory staff. Unfortunately, implementing a stress-first approach in a nuclear cardiology laboratory involves significant challenges such as the need for attenuation correction, triage of patients to an appropriate protocol, real-time review of stress images, and consideration of differential reimbursement. Despite it being best practice for both the patient and the laboratory, these impediments have kept the proportions of studies performed stress-first relatively unchanged in North America and world-wide in the last 10 years.
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Affiliation(s)
- Sean R McMahon
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Etee K Patel
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - W Lane Duvall
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
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4
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Liu H, Wu J, Shi L, Liu Y, Miller E, Sinusas A, Liu YH, Liu C. Post-reconstruction attenuation correction for SPECT myocardium perfusion imaging facilitated by deep learning-based attenuation map generation. J Nucl Cardiol 2022; 29:2881-2892. [PMID: 34671940 DOI: 10.1007/s12350-021-02817-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/09/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Attenuation correction can improve the quantitative accuracy of single-photon emission computed tomography (SPECT) images. Existing SPECT-only systems normally can only provide non-attenuation corrected (NC) images which are susceptible to attenuation artifacts. In this work, we developed a post-reconstruction attenuation correction (PRAC) approach facilitated by a deep learning-based attenuation map for myocardial perfusion SPECT imaging. METHODS In the PRAC method, new projection data were estimated via forwardly projecting the scanner-generated NC image. Then an attenuation map, generated from NC image using a pretrained deep learning (DL) convolutional neural network, was incorporated into an offline reconstruction algorithm to obtain the attenuation-corrected images from the forwardly projected projections. We evaluated the PRAC method using 30 subjects with a DL network trained with 40 subjects, using the vendor-generated AC images and CT-based attenuation maps as the ground truth. RESULTS The PRAC methods using DL-generated and CT-based attenuation maps were both highly consistent with the scanner-generated AC image. The globally normalized mean absolute errors were 1.1% ± .6% and .7% ± .4% and the localized absolute percentage errors were 8.9% ± 13.4% and 7.8% ± 11.4% in the left ventricular (LV) blood pool, respectively, and - 1.3% ± 8.0% and - 3.8% ± 4.5% in the LV myocardium for PRAC methods using DL-generated and CT-based attenuation maps, respectively. The summed stress scores after PRAC using both attenuation maps were more consistent with the ground truth than those of the NC images. CONCLUSION We developed a PRAC approach facilitated by deep learning-based attenuation maps for SPECT myocardial perfusion imaging. It may be feasible for this approach to provide AC images for SPECT-only scanner data.
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Affiliation(s)
- Hui Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, 06520, USA.
- Department of Engineering Physics, Tsinghua University, Beijing, 100084, China.
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University), Ministry of Education, Beijing, China.
| | - Jing Wu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, 06520, USA
- Center for Advanced Quantum Studies and Department of Physics, Beijing Normal University, Beijing, China
| | - Luyao Shi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Yaqiang Liu
- Department of Engineering Physics, Tsinghua University, Beijing, 100084, China
- Key Laboratory of Particle & Radiation Imaging (Tsinghua University), Ministry of Education, Beijing, China
| | - Edward Miller
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, 06520, USA
- Department of Internal Medicine (Cardiology), Yale University, New Haven, CT, USA
| | - Albert Sinusas
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, 06520, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Department of Internal Medicine (Cardiology), Yale University, New Haven, CT, USA
| | - Yi-Hwa Liu
- Department of Internal Medicine (Cardiology), Yale University, New Haven, CT, USA
- Department of Biomedical Imaging and Radiological Sciences, National Yangming Jiaotong University, Taipei, Taiwan
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, 06520, USA.
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
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5
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Al-Mallah MH, Bateman TM, Branch KR, Crean A, Gingold EL, Thompson RC, McKenney SE, Miller EJ, Murthy VL, Nieman K, Villines TC, Yester MV, Einstein AJ, Mahmarian JJ. 2022 ASNC/AAPM/SCCT/SNMMI guideline for the use of CT in hybrid nuclear/CT cardiac imaging. J Nucl Cardiol 2022; 29:3491-3535. [PMID: 36056224 DOI: 10.1007/s12350-022-03089-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 01/29/2023]
Affiliation(s)
- Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Timothy M Bateman
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kelley R Branch
- Division of Cardiovascular, University of Washington, Seattle, WA, USA
| | - Andrew Crean
- Division of Cardiovascular Medicine, Ottawa Heart Institute, Ottawa, ON, Canada
| | - Eric L Gingold
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Randall C Thompson
- Department of Cardiology, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sarah E McKenney
- Department of Radiology, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Koen Nieman
- Departments of Cardiovascular Medicine and Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Todd C Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Michael V Yester
- Department of Radiology, School of Medicine, University of Alabama Medical Center, Birmingham, AL, USA
| | - Andrew J Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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6
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Singhvi A, Suacier S, Verma I, Felpel K, Gabriel A, Tandon T, Tushak Z, Mather J, McMahon S, Duvall WL. Impact of Gd-153 scanning line source attenuation correction on downstream invasive testing. J Nucl Cardiol 2022; 29:1832-1842. [PMID: 33825139 DOI: 10.1007/s12350-021-02565-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 01/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Attenuation correction (AC) using hardware and software solutions has been shown to increase the specificity of SPECT MPI by decreasing false positive results and improving prognostic ability. Theoretically this should reduce downstream testing and unnecessary costs. We sought to assess the consequences of the use of Gd-153 scanning line source attenuation correction during SPECT myocardial perfusion imaging (MPI) on downstream invasive testing. METHODS All patients who underwent a clinically indicated Tc-99m stress SPECT MPI study from 2013 to 2015 at five hospitals (2 with AC and 3 without) were retrospectively reviewed. Patient demographics, results of testing, subsequent coronary angiography within 3 months, and revascularization were recorded. The results of the MPI studies, downstream angiogram utilization, and results of angiography were compared and a propensity matched subgroup analysis was performed. RESULTS A total of 9968 patients underwent SPECT MPI during the study time period (6106 performed with AC and 3862 without). Out of 3928 patients included in the propensity matched cohort, there was no difference in the proportion of abnormal MPI results between the two groups (31.5% vs 30.4%, P = 0.47), however, more patients underwent coronary angiography within 90 days in the AC group (10.6% vs 8.7%, P = 0.05). There was no significant difference in the proportion of patients with angiographically significant obstructive disease (53.4% vs 56.1%, P = 0.19), however, fewer patients in the AC group with obstructive coronary disease were revascularized (36.1% vs 46.8%, P = 0.04). The findings remained consistent after sub-group analysis in patients without known coronary disease. CONCLUSION The use of scanning line source AC did not meaningfully influence the rate of abnormal MPI results or downstream invasive testing in this cohort. The clinical utility of scanning line source AC may be limited to facilitating stress-first imaging protocols.
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Affiliation(s)
- Aditi Singhvi
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Stephanie Suacier
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Isha Verma
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Kevin Felpel
- Department of Medicine, University of Connecticut Medical Center, Farmington, CT, USA
| | - Andre Gabriel
- Department of Medicine, University of Connecticut Medical Center, Farmington, CT, USA
| | - Tarun Tandon
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Zackary Tushak
- Department of Medicine, University of Connecticut Medical Center, Farmington, CT, USA
| | - Jeffrey Mather
- Department of Research Administration, Hartford Hospital, Hartford, CT, USA
| | - Sean McMahon
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA
| | - W Lane Duvall
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
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7
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Pretorius PH, Ramon AJ, King MA, Konik A, Dahlberg ST, Parker MW, Botkin NF, Johnson KL, Yang Y, Wernick MN. Retrospective fractional dose reduction in Tc-99m cardiac perfusion SPECT/CT patients: A human and model observer study. J Nucl Cardiol 2021; 28:624-637. [PMID: 31077073 PMCID: PMC6842418 DOI: 10.1007/s12350-019-01743-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/13/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND In the ongoing efforts to reduce cardiac perfusion dose (injected radioactivity) for conventional SPECT/CT systems, we performed a human observer study to confirm our clinical model observer findings that iterative reconstruction employing OSEM (ordered-subset expectation-maximization) at 25% of the full dose (quarter-dose) has a similar performance for detection of hybrid cardiac perfusion defects as FBP at full dose. METHODS One hundred and sixty-six patients, who underwent routine rest-stress Tc-99m sestamibi cardiac perfusion SPECT/CT imaging and clinically read as normally perfused, were included in the study. Ground truth was established by the normal read and the insertion of hybrid defects. In addition to the reconstruction of the 25% of full-dose data using OSEM with attenuation (AC), scatter (SC), and spatial resolution correction (RC), FBP and OSEM (with AC, SC, and RC) both at full dose (100%) were done. Both human observer and clinical model observer confidence scores were obtained to generate receiver operating characteristics (ROC) curves in a task-based image quality assessment. RESULTS Average human observer AUC (area under the ROC curve) values of 0.725, 0.876, and 0.890 were obtained for FBP at full dose, OSEM at 25% of full dose, and OSEM at full dose, respectively. Both OSEM strategies were significantly better than FBP with P values of 0.003 and 0.01 respectively, while no significant difference was recorded between OSEM methods (P = 0.48). The clinical model observer results were 0.791, 0.822, and 0.879, respectively, for the same patient cases and processing strategies used in the human observer study. CONCLUSIONS Cardiac perfusion SPECT/CT using OSEM reconstruction at 25% of full dose has AUCs larger than FBP and closer to those of full-dose OSEM when read by human observers, potentially replacing the higher dose studies during clinical reading.
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Affiliation(s)
- P Hendrik Pretorius
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Albert Juan Ramon
- Illinois Institute of Technology, Medical Imaging Research Center, Chicago, IL, USA
| | - Michael A King
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Arda Konik
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Seth T Dahlberg
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Mathew W Parker
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Naomi F Botkin
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Karen L Johnson
- Department of Radiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Yongyi Yang
- Illinois Institute of Technology, Medical Imaging Research Center, Chicago, IL, USA
| | - Miles N Wernick
- Illinois Institute of Technology, Medical Imaging Research Center, Chicago, IL, USA
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8
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Tawakol AE, Tantawy HM, Elashmawy RE, Abdelhafez YG, Elsayed YM. Added Value of CT Attenuation Correction and Prone Positioning in Improving Breast and Subdiaphragmatic Attenuation in Myocardial Perfusion Imaging. J Nucl Med Technol 2020; 49:23-29. [PMID: 33361179 DOI: 10.2967/jnmt.120.255943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/22/2020] [Indexed: 11/16/2022] Open
Abstract
Soft-tissue attenuation of γ-photons is the most common source of artifacts and remains an intricate problem for myocardial perfusion imaging (MPI) by SPECT. Breast and subdiaphragmatic artifacts are the most frequent cause of false-positive findings in women. Many methods of overcoming attenuation artifacts have been introduced, including prone positioning to avoid breast attenuation or use of hybrid SPECT/CT systems. The purpose of this study was to evaluate the role of prone images in attenuation correction (AC) when CT AC is compared with MPI. Methods: Forty-four patients were initially included in the study. Statistical analysis was done for 30 patients with suspected or confirmed ischemic heart disease. All patients underwent ordinary supine stress/rest SPECT MPI followed by additional stress/rest prone SPECT and stress/rest SPECT/CT. Each study was interpreted separately, and their results were compared. Results: It was found that 58% (31/53) of the depicted defects were attributable to attenuation artifacts; the CT AC imaging technique was able to correct 52%, versus 49% for prone imaging. Sensitivity, specificity, and diagnostic accuracy were 100%, 90.3%, and 94%, respectively, for CT AC, versus 100%, 83.8%, and 91%, respectively, for prone imaging. Inferior wall defects were more common in men (95%), in whom CT AC performed better than prone imaging (i.e., 92.9% in CT AC vs. 90.9% in prone imaging). On the other hand, anterior wall defects were more common in women (83.3%), in whom prone imaging was better than CT AC. Conclusion: Both CT AC and prone imaging increased the specificity and diagnostic accuracy of MPI without affecting the sensitivity.
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Affiliation(s)
- Ahmed E Tawakol
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hazem M Tantawy
- Department of Nuclear Medicine Technology, Inaya Medical College, Riyadh, Saudi Arabia; and
| | - Rana E Elashmawy
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser G Abdelhafez
- Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Yasser M Elsayed
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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9
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Hendel RC, Crawford MJ. Stress-Only SPECT Myocardial Perfusion Imaging for All? JACC Cardiovasc Imaging 2020; 13:2203-2205. [DOI: 10.1016/j.jcmg.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/26/2022]
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10
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Ferreira MJV, Cerqueira MD. Clinical Applications of Nuclear Cardiology. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_5] [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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11
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Abbott BG, Case JA, Dorbala S, Einstein AJ, Galt JR, Pagnanelli R, Bullock-Palmer RP, Soman P, Wells RG. Contemporary Cardiac SPECT Imaging-Innovations and Best Practices: An Information Statement from the American Society of Nuclear Cardiology. Circ Cardiovasc Imaging 2019; 11:e000020. [PMID: 30354679 DOI: 10.1161/hci.0000000000000020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Brian G Abbott
- Warren Alpert Medical School, Brown University, Providence, RI (B.G.A.)
| | - James A Case
- Cardiovascular Imaging Technologies, Kansas City, MO (J.A.C.)
| | - Sharmila Dorbala
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA (S.D.)
| | - Andrew J Einstein
- Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY (A.J.E.)
| | - James R Galt
- Emory University School of Medicine, Atlanta, GA (J.R.G.)
| | | | | | - Prem Soman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA (P.S.)
| | - R Glenn Wells
- University of Ottawa Heart Institute, Ottawa, Canada (R.G.W.)
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12
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Abstract
Cardiac SPECT continues to play a critical role in detecting and managing cardiovascular disease, in particularly coronary artery disease (CAD) (Jaarsma et al 2012 J. Am. Coll. Cardiol. 59 1719-28), (Agostini et al 2016 Eur. J. Nucl. Med. Mol. Imaging 43 2423-32). While conventional dual-head SPECT scanners using parallel-hole collimators and scintillation crystals with photomultiplier tubes are still the workhorse of cardiac SPECT, they have the limitations of low photon sensitivity (~130 count s-1 MBq-1), poor image resolution (~15 mm) (Imbert et al 2012 J. Nucl. Med. 53 1897-903), relatively long acquisition time, inefficient use of the detector, high radiation dose, etc. Recently our field observed an exciting growth of new developments of dedicated cardiac scanners and collimators, as well as novel imaging algorithms for quantitative cardiac SPECT. These developments have opened doors to new applications with potential clinical impact, including ultra-low-dose imaging, absolute quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR), multi-radionuclide imaging, and improved image quality as a result of attenuation, scatter, motion, and partial volume corrections (PVCs). In this article, we review the recent advances in cardiac SPECT instrumentation and imaging methods. This review mainly focuses on the most recent developments published since 2012 and points to the future of cardiac SPECT from an imaging physics perspective.
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Affiliation(s)
- Jing Wu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, United States of America
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13
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Abbott BG, Case JA, Dorbala S, Einstein AJ, Galt JR, Pagnanelli R, Bullock-Palmer RP, Soman P, Wells RG. Contemporary Cardiac SPECT Imaging-Innovations and Best Practices: An Information Statement from the American Society of Nuclear Cardiology. J Nucl Cardiol 2018; 25:1847-1860. [PMID: 30143954 DOI: 10.1007/s12350-018-1348-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This information statement from the American Society of Nuclear Cardiology highlights advances in cardiac SPECT imaging and supports the incorporation of new technology and techniques in laboratories performing nuclear cardiology procedures. The document focuses on the application of the latest imaging protocols and the utilization of newer hardware and software options to perform high quality, state-of-the-art SPECT nuclear cardiology procedures. Recommendations for best practices of cardiac SPECT imaging are discussed, highlighting what imaging laboratories should be doing as the standard of care in 2018 to achieve optimal results (based on the ASNC 2018 SPECT guideline [Dorbala et al., J Nucl Cardiol. 2018. https://doi.org/10.1007/s12350-018-1283-y ]).
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Affiliation(s)
- Brian G Abbott
- Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - James A Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
| | - Sharmila Dorbala
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew J Einstein
- Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - James R Galt
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Prem Soman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - R Glenn Wells
- University of Ottawa Heart Institute, Ottawa, Canada
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14
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Dorbala S, Ananthasubramaniam K, Armstrong IS, Chareonthaitawee P, DePuey EG, Einstein AJ, Gropler RJ, Holly TA, Mahmarian JJ, Park MA, Polk DM, Russell R, Slomka PJ, Thompson RC, Wells RG. Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation. J Nucl Cardiol 2018; 25:1784-1846. [PMID: 29802599 DOI: 10.1007/s12350-018-1283-y] [Citation(s) in RCA: 212] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Sharmila Dorbala
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | - Andrew J Einstein
- Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | | | - Thomas A Holly
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John J Mahmarian
- Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA
| | | | - Donna M Polk
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - R Glenn Wells
- University of Ottawa Heart Institute, Ottawa, Canada
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15
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Gowdar S, Chaudhry W, Ahlberg AW, Henzlova MJ, Duvall WL. Triage of patients for attenuation-corrected stress-first Tc-99m SPECT MPI using a simplified clinical pre-test scoring model. J Nucl Cardiol 2018; 25:1178-1187. [PMID: 28290100 DOI: 10.1007/s12350-017-0832-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/10/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stress-only Tc-99m SPECT MPI saves time and reduces radiation exposure while a normal study has a benign prognosis. However, no guidelines exist as to which patients should undergo stress-first MPI. The purpose of this study was to validate a previously published pre-test prediction scoring model and refine the stress-first triage process further if possible. METHODS We retrospectively reviewed all patients who underwent an attenuation-corrected Tc-99m SPECT MPI over a 39-month period. Based on 17-segment model semi-quantitative scoring, a successful stress-first MPI was defined as a summed stress attenuation-corrected score ≤ 1. Based on results from multivariate analysis, the previously published prediction score (comprised eight clinical and demographic variables) was compared to triage based on coronary artery disease (CAD) status alone and with the addition of other highly associated variables. Logistic regression and Chi-squared analyses were used to determine the magnitude of variable effect and to compare model results. RESULTS A total of 2,277 patients were included, and the prediction score successfully stratified patients into low-risk (91.1% successful stress-first), intermediate-risk (79.4%), and high-risk (50.7%) groups. Comparing the use of the prediction score to the use of a history of CAD as the only triage factor, 69.0% of patients would be accurately triaged using the prediction score with a cutoff of 7 (maximized sensitivity and specificity), while 78.6% were correctly triaged with CAD status alone (P < .0001). The addition of variables highly associated with a successful stress-first protocol (congestive heart failure [OR 3.4] and an abnormal resting ECG [OR 2.1]) to CAD status further enhanced triage accuracy to 81% (P < .0001). CONCLUSIONS While the previously described prediction score effectively identifies patients who can successfully undergo stress-first MPI, it is cumbersome. Triaging based solely on CAD status and with the addition of other key variables is practical and provides improved predictive accuracy for successful stress-first MPI. Utilizing this simplified pre-test scoring model may allow for wider adoption of stress-first imaging protocols which have clear advantages over traditional rest-stress protocols.
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Affiliation(s)
- Shreyas Gowdar
- Division of Cardiology, Heart and Vascular Institute, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Waseem Chaudhry
- Division of Cardiology, Maine Medical Center, Portland, ME, USA
| | - Alan W Ahlberg
- Division of Cardiology, Heart and Vascular Institute, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Milena J Henzlova
- Mount Sinai Division of Cardiology, Mount Sinai Heart, New York, NY, USA
| | - W Lane Duvall
- Division of Cardiology, Heart and Vascular Institute, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
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16
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Parker MW, Heller GV. Time to get on the stress-only bandwagon? J Nucl Cardiol 2018; 25:817-819. [PMID: 27743295 DOI: 10.1007/s12350-016-0691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Matthew W Parker
- Division of Cardiovascular Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Gary V Heller
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA.
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17
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Gutstein A, Bental T, Solodky A, Mats I, Zafrir N. Prognosis of stress-only SPECT myocardial perfusion imaging with prone imaging. J Nucl Cardiol 2018; 25:809-816. [PMID: 27671493 DOI: 10.1007/s12350-016-0617-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/16/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stress-only single-photon emission computed tomography myocardial perfusion imaging (SO SPECT MPI) is associated with similarly benign prognosis as stress-rest SPECT MPI. However, previous studies have used attenuation correction rather than prone imaging to increase the rate of SO studies. OBJECTIVES To assess the prognosis of SO SPECT MPI performed with prone imaging. METHODS We performed a retrospective cohort analysis of all patients who underwent a Tc-99m gated SPECT MPI over a 58-month period. RESULTS Two thousand four hundred and sixty five patients were followed up. Of them, 1114 (45.2%) patients had a SO supine test, 388 (15.7%) underwent a SO supine and prone test, and the remaining 963 (39.1%) patients underwent a full stress-rest SPECT MPI. There was a similar annual mortality rate between the SO supine/prone group (1.3%), the SO supine (1.5%), and the stress-rest (1.5%) group (P = 0.47). Patients in the stress-rest group were significantly more likely to suffer from myocardial infarction (MI) as compared to the other two groups with an annual rate of 0.7% as compared to 0.4% (P = 0.049). CONCLUSIONS Normal supine-prone SO SPECT MPI is associated with a similarly benign prognosis as stress-rest SPECT MPI. The adjunction of prone imaging to the stress supine significantly increases the rate of SO SPECT MPI.
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Affiliation(s)
- Ariel Gutstein
- Rabin Medical Center, Tel-Aviv University, Petach Tikva, Israel.
| | - Tamir Bental
- Rabin Medical Center, Tel-Aviv University, Petach Tikva, Israel
| | | | - Israel Mats
- Rabin Medical Center, Tel-Aviv University, Petach Tikva, Israel
| | - Nili Zafrir
- Rabin Medical Center, Tel-Aviv University, Petach Tikva, Israel.
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18
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Wells RG, Trottier M, Premaratne M, Vanderwerf K, Ruddy TD. Single CT for attenuation correction of rest/stress cardiac SPECT perfusion imaging. J Nucl Cardiol 2018; 25:616-624. [PMID: 27858346 DOI: 10.1007/s12350-016-0720-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
Common practice is to use separate CT scans acquired during rest and stress for attenuation correction of SPECT myocardial perfusion imaging (MPI). We evaluated using a single CT scan to correct both rest and stress SPECT scans. Studies from 154 patients were reprocessed using one CT acquired at stress to correct both rest and stress scans (1CT) and compared to correction of each scan with its own CT (2CT). Two expert readers independently read the images and determined summed stress (SSS), rest (SRS), and difference (SDS) scores. The correlation in SRS between 2CT and 1CT was r ≥ 0.88. The concordance in SDS was ≥0.84 (kappa ≥ 0.62). The mean SDS difference between 2CT and 1CT for the averaged observer was not significantly different from zero (p > 0.31). 1CT images had a small but significant increase in SRS and an increase in SDS variability. However, the mean SDS difference was similar to the mean inter-observer SDS difference for the 2CT approach (-0.08 vs -0.23, p = 0.46) and had less uncertainty (1.02 vs 2.05, p < 0.001). Thus, the differences between 1CT and 2CT are unlikely to be clinically significant, and the 1CT approach is feasible for SPECT MPI.
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Affiliation(s)
- R Glenn Wells
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
| | - Mikael Trottier
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Manuja Premaratne
- Frankston Hospital, Frankston, Australia
- Monash University, Clayton, VIC, Australia
| | - Karen Vanderwerf
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Division of Nuclear Medicine, Ottawa Hospital, Ottawa, ON, Canada
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19
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van Dijk JD, Borren NM, Mouden M, van Dalen JA, Ottervanger JP, Jager PL. Effect of a patient-specific minimum activity in stress myocardial perfusion imaging using CZT-SPECT: Prognostic value, radiation dose, and scan outcome. J Nucl Cardiol 2018; 25:26-35. [PMID: 28822102 DOI: 10.1007/s12350-017-1011-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND SPECT Myocardial perfusion imaging (MPI) is associated with a relatively high radiation burden and decreasing image quality in heavy patients. Patient-specific low-activity protocols (PLAPs) are suggested but follow-up data is lacking. Our aim was to compare the use of a standard fixed-activity protocol (FAP) with a PLAP in cadmium zinc telluride (CZT)-SPECT MPI. METHODS We retrospectively included 1255 consecutive patients who underwent CZT-SPECT stress-optional rest MPI. 668 Patients were scanned using FAP (370 MBq) and 587 patients using PLAP (2.25 MBq·kg-1). Percentage of scans interpreted as normal, radiation dose, and 1-year follow-up including hard event rates (all-cause death or non-fatal myocardial infarction) were collected and compared. RESULTS The percentage of scans interpreted as normal was 67% in FAP and 70% in PLAP groups (P = .29). The annualized hard event rates in these patients were 1.0% in the FAP and 0.9% in the PLAP group (P = .86). However, the mean radiation dose decreased by 23% for stress-only and by 15% to 2.6 mSv for stress-optional rest MPI after introduction of the PLAP (p<0.001). CONCLUSIONS Introduction of a patient-specific low-activity protocol does not affect the percentage of scans interpreted as normal or prognosis but significantly lowers the radiation dose for CZT-SPECT MPI.
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Affiliation(s)
- J D van Dijk
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - N M Borren
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - M Mouden
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - J A van Dalen
- Department of Medical Physics, Isala Hospital, Zwolle, The Netherlands
| | - J P Ottervanger
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - P L Jager
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
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20
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Stress-only myocardial perfusion scintigraphy: a prospective study on the accuracy and observer agreement with quantitative coronary angiography as the gold standard. Nucl Med Commun 2017; 38:904-911. [PMID: 28885540 DOI: 10.1097/mnm.0000000000000739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patients with normal stress perfusion have an excellent prognosis. Prospective studies on the diagnostic accuracy of stress-only scans with contemporary, independent examinations as gold standards are lacking. PATIENTS AND METHODS A total of 109 patients with typical angina and no previous coronary artery disease underwent a 2-day stress (exercise)/rest, gated, and attenuation-corrected (AC), 99m-technetium-sestamibi perfusion study, followed by invasive coronary angiography. The stress datasets were evaluated twice by four physicians with two different training levels (expert and novice): familiar and unfamiliar with AC. The two experts also made a consensus reading of the integrated stress-rest datasets. The consensus reading and quantitative data from the invasive coronary angiography were applied as reference methods. RESULTS The sensitivity/specificity were 0.92-1.00/0.73-0.90 (reference: expert consensus reading), 0.93-0.96/0.63-0.82 (reference: ≥1 stenosis>70%), and 0.75-0.88/0.70-0.88 (reference: ≥1 stenosis>50%). The four readers showed a high and fairly equal sensitivity independent of their familiarity with AC. The expert familiar with AC had the highest specificity independent of the reference method. The intraobserver and interobserver agreements on the stress-only readings were good (readers without AC experience) to excellent (readers with AC experience). CONCLUSION AC stress-only images yielded a high sensitivity independent of the training level and experience with AC of the nuclear physician, whereas the specificity correlated positively with both. Interobserver and intraobserver agreements tended to be the best for physicians with AC experience.
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21
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Taqueti VR, Dorbala S, Wolinsky D, Abbott B, Heller GV, Bateman TM, Mieres JH, Phillips LM, Wenger NK, Shaw LJ. Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease-state-of-the-evidence and clinical recommendations. J Nucl Cardiol 2017; 24:1402-1426. [PMID: 28585034 PMCID: PMC5942593 DOI: 10.1007/s12350-017-0926-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 12/21/2022]
Abstract
This document from the American Society of Nuclear Cardiology represents an updated consensus statement on the evidence base of stress myocardial perfusion imaging (MPI), emphasizing new developments in single-photon emission tomography (SPECT) and positron emission tomography (PET) in the clinical evaluation of women presenting with symptoms of stable ischemic heart disease (SIHD). The clinical evaluation of symptomatic women is challenging due to their varying clinical presentation, clinical risk factor burden, high degree of comorbidity, and increased risk of major ischemic heart disease events. Evidence is substantial that both SPECT and PET MPI effectively risk stratify women with SIHD. The addition of coronary flow reserve (CFR) with PET improves risk detection, including for women with nonobstructive coronary artery disease and coronary microvascular dysfunction. With the advent of PET with computed tomography (CT), multiparametric imaging approaches may enable integration of MPI and CFR with CT visualization of anatomical atherosclerotic plaque to uniquely identify at-risk women. Radiation dose-reduction strategies, including the use of ultra-low-dose protocols involving stress-only imaging, solid-state detector SPECT, and PET, should be uniformly applied whenever possible to all women undergoing MPI. Appropriate candidate selection for stress MPI and for post-MPI indications for guideline-directed medical therapy and/or invasive coronary angiography are discussed in this statement. The critical need for randomized and comparative trial data in female patients is also emphasized.
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Affiliation(s)
- Viviany R Taqueti
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, ASBI-L1 037-G, 75 Francis Street, Boston, MA, 02115, USA.
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sharmila Dorbala
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, ASBI-L1 037-G, 75 Francis Street, Boston, MA, 02115, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Wolinsky
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston, FL, USA
| | - Brian Abbott
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Cardiovascular Institute, The Miriam and Newport Hospitals, Providence, RI, USA
| | - Gary V Heller
- Gagnon Cardiovascular Center, Morristown Medical Center, Morristown, NJ, USA
| | - Timothy M Bateman
- Saint Luke's Health System, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Lawrence M Phillips
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Leslee J Shaw
- Division of Cardiology, Department of Medicine, Emory University Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
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22
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Pazhenkottil AP, Kaufmann PA, Gaemperli O. Attenuation correction in stress-only myocardial perfusion imaging. J Nucl Cardiol 2017; 24:402-404. [PMID: 26829954 DOI: 10.1007/s12350-016-0406-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 01/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Aju P Pazhenkottil
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Philipp A Kaufmann
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Gaemperli
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
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23
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van Dijk JD, Mouden M, Ottervanger JP, van Dalen JA, Knollema S, Slump CH, Jager PL. Value of attenuation correction in stress-only myocardial perfusion imaging using CZT-SPECT. J Nucl Cardiol 2017; 24:395-401. [PMID: 26780528 PMCID: PMC5413515 DOI: 10.1007/s12350-015-0374-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/30/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Attenuation correction (AC) improves the diagnostic outcome of stress-only myocardial perfusion imaging (MPI) using conventional SPECT. Our aim was to determine the value of AC using a cadmium zinc telluride-based (CZT)-SPECT camera. METHODS AND RESULTS We retrospectively included 107 consecutive patients who underwent stress-optional rest MPI CZT-SPECT/CT. Next, we created three types of images for each patient; (1) only displaying reconstructed data without the CT-based AC (NC), (2) only displaying AC, and (3) with both NC and AC (NC + AC). Next, two experienced physicians visually interpreted these 321 randomized images as normal, equivocal, or abnormal. Image outcome was compared with all hard events over a mean follow-up time of 47.7 ± 9.8 months. The percentage of images interpreted as normal increased from 45% using the NC images to 72% using AC and to 67% using NC + AC images (P < .001). Hard event hazard ratios for images interpreted as normal were not different between using NC and AC (1.01, P = .99), or NC and NC + AC images (0.97, P = .97). CONCLUSIONS AC lowers the need for additional rest imaging in stress-first MPI using CZT-SPECT, while long-term patient outcome remained identical. Use of AC reduces the need for additional rest imaging, decreasing the mean effective dose by up to 1.2 mSv.
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Affiliation(s)
- J D van Dijk
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - M Mouden
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - J P Ottervanger
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - J A van Dalen
- Department of Medical Physics, Isala Hospital, Zwolle, The Netherlands
| | - S Knollema
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - C H Slump
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - P L Jager
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
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24
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Tamam M, Mulazimoglu M, Edis N, Ozpacaci T. The Value of Attenuation Correction in Hybrid Cardiac SPECT/CT on Inferior Wall According to Body Mass Index. World J Nucl Med 2016; 15:18-23. [PMID: 26912974 PMCID: PMC4729009 DOI: 10.4103/1450-1147.167586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The purpose of this study was to evaluate the diagnostic value of attenuation-corrected single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) on the inferior wall compared to uncorrected (NC) SPECT MPI between obese and nonobese patients. A total of 157 consecutive patients (122 males and 35 females, with median age: 57.4 ± 11 years) who underwent AC technetium 99m-methoxyisobutylisonitrile (AC Tc99m-sestamibi) SPECT MPI were included to the study. A hybrid SPECT and transmission computed tomography (CT) system was used for the diagnosis with 1-day protocol, and stress imaging was performed first. During attenuation correction (AC) processing on a Xeleris Workstation using Myovation cardiac software with ordered subset expectation maximization (OSEM), iterative reconstruction with attenuation correction (IRAC) and NC images filtered back projection (FBP) were used. For statistical purposes, P < 0.05 was considered significant. This study included 73 patients with body mass index (BMI) <30 and 84 patients with BMI ≥ 30. In patients with higher BMI, increased amount of both visual and semiquantitative attenuation of the inferior wall was detected. IRAC reconstruction corrects the diaphragm attenuation of the inferior wall better than FBP. AC with OSEM iterative reconstruction significantly improves the diagnostic value of stress-only SPECT MPI in patients with normal weight and those who are obese, but the improvements are significantly greater in obese patients. Stress-only SPECT imaging with AC provides shorter and lower radiation exposure.
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Affiliation(s)
- Muge Tamam
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Mulazimoglu
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Nurcan Edis
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Tevfik Ozpacaci
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, Istanbul, Turkey
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25
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Normal values and standardization of parameters in nuclear cardiology: Japanese Society of Nuclear Medicine working group database. Ann Nucl Med 2016; 30:188-99. [PMID: 26897008 PMCID: PMC4819542 DOI: 10.1007/s12149-016-1065-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 01/31/2016] [Indexed: 11/16/2022]
Abstract
As a 2-year project of the Japanese Society of Nuclear Medicine working group activity, normal myocardial imaging databases were accumulated and summarized. Stress-rest with gated and non-gated image sets were accumulated for myocardial perfusion imaging and could be used for perfusion defect scoring and normal left ventricular (LV) function analysis. For single-photon emission computed tomography (SPECT) with multi-focal collimator design, databases of supine and prone positions and computed tomography (CT)-based attenuation correction were created. The CT-based correction provided similar perfusion patterns between genders. In phase analysis of gated myocardial perfusion SPECT, a new approach for analyzing dyssynchrony, normal ranges of parameters for phase bandwidth, standard deviation and entropy were determined in four software programs. Although the results were not interchangeable, dependency on gender, ejection fraction and volumes were common characteristics of these parameters. Standardization of 123I-MIBG sympathetic imaging was performed regarding heart-to-mediastinum ratio (HMR) using a calibration phantom method. The HMRs from any collimator types could be converted to the value with medium-energy comparable collimators. Appropriate quantification based on common normal databases and standard technology could play a pivotal role for clinical practice and researches.
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26
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Caobelli F, Akin M, Thackeray JT, Brunkhorst T, Widder J, Berding G, Burchert I, Bauersachs J, Bengel FM. Diagnostic accuracy of cadmium-zinc-telluride-based myocardial perfusion SPECT: impact of attenuation correction using a co-registered external computed tomography. Eur Heart J Cardiovasc Imaging 2015; 17:1036-43. [PMID: 26628617 DOI: 10.1093/ehjci/jev312] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/29/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Computed tomography (CT)-based attenuation correction (AC) improves the accuracy of standard myocardial perfusion SPECT. Most dedicated cadmium-zinc-telluride (CZT) SPECT cameras are not equipped with an integrated CT component. We aimed to determine the impact of AC on diagnostic performance of CZT SPECT using co-registration with an external low-dose CT. METHODS Sixty patients underwent CZT SPECT (GE Discovery 530c) with (99m)Tc-sestamibi at rest and following regadenoson stress. Using commercial software, SPECT images were co-registered with a low-dose CT acquired on a separate system (GE Discovery 670NMCT). Attenuation corrected and non-corrected (NC) images were reconstructed using an iterative algorithm. Accuracy was measured in 44 patients who had undergone invasive angiography within 6 months. Normalcy was compared in the remaining 16 patients who had a low pre-test likelihood (<5%) of coronary artery disease (CAD). RESULTS Summed stress and rest scores were significantly lower in AC images (9 ± 8 vs. 13 ± 9 and 6 ± 7 vs. 10 ± 9, P = 0.01), while summed difference score did not differ. According to angiography, 38 patients had significant CAD in 71 vascular territories. Attenuation correction improved accuracy globally (P = 0.03) and in RCA territory (P = 0.008). Specificity improved both globally (100 vs. 40%, P < 0.05) and in each individual territory (LAD: 63 vs. 36%, LCX: 70 vs. 33%, RCA: 81 vs. 19%, P < 0.01). Normalcy was 100% for AC and 62.5% for NC images (P < 0.05). CONCLUSION Attenuation correction with a co-registered external CT is feasible using CZT cameras and improves diagnostic accuracy mostly by improving specificity over uncorrected images.
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Affiliation(s)
- Federico Caobelli
- Department of Nuclear Medicine, Hannover Medical School, Carl Neuberg Strasse, 1, 30625 Hannover, Germany
| | - Muharrem Akin
- Department of Clinical Cardiology, Hannover Medical School, Hannover, Germany
| | - James T Thackeray
- Department of Nuclear Medicine, Hannover Medical School, Carl Neuberg Strasse, 1, 30625 Hannover, Germany
| | - Thomas Brunkhorst
- Department of Nuclear Medicine, Hannover Medical School, Carl Neuberg Strasse, 1, 30625 Hannover, Germany
| | - Julian Widder
- Department of Clinical Cardiology, Hannover Medical School, Hannover, Germany
| | - Georg Berding
- Department of Nuclear Medicine, Hannover Medical School, Carl Neuberg Strasse, 1, 30625 Hannover, Germany
| | - Ina Burchert
- Department of Nuclear Medicine, Hannover Medical School, Carl Neuberg Strasse, 1, 30625 Hannover, Germany
| | - Johann Bauersachs
- Department of Clinical Cardiology, Hannover Medical School, Hannover, Germany
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Carl Neuberg Strasse, 1, 30625 Hannover, Germany
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27
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Abstract
Stress-first approaches to myocardial perfusion imaging provide diagnostically and prognostically accurate perfusion data equivalent to a full rest-stress study, save time in the imaging laboratory, and reduce the radiation exposure to patients and laboratory staff. Converting a nuclear cardiology laboratory from a conventional rest-stress strategy to a stress-first approach involves challenges such as the need for attenuation correction, triage of patients to an appropriate protocol, real-time review of stress images, and consideration of differential reimbursement.
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Affiliation(s)
- Nasir Hussain
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Matthew W Parker
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Milena J Henzlova
- Mount Sinai Heart, Mount Hospital, One Gustave L Levy Place, New York, NY 10029, USA
| | - William Lane Duvall
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
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Is Attenuation Correction for Myocardial Perfusion Imaging Underutilized? CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9346-9] [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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Bateman TM. Twelfth annual Mario S. Verani, MD memorial lecture: Vision, leadership, and change-A reflection on the challenges and opportunities in the community-based practice of nuclear cardiology. J Nucl Cardiol 2015; 22:435-49. [PMID: 25894058 DOI: 10.1007/s12350-015-0126-3] [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: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 12/23/2022]
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Dorbala S, Blankstein R, Skali H, Park MA, Fantony J, Mauceri C, Semer J, Moore SC, Di Carli MF. Approaches to reducing radiation dose from radionuclide myocardial perfusion imaging. J Nucl Med 2015; 56:592-9. [PMID: 25766891 DOI: 10.2967/jnumed.112.115097] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/27/2015] [Indexed: 11/16/2022] Open
Abstract
Radionuclide myocardial perfusion imaging (MPI) plays a vital role in the evaluation and management of patients with coronary artery disease. However, because of a steep growth in MPI in the mid 2000s, concerns about inappropriate use of MPI and imaging-related radiation exposure increased. In response, the professional societies developed appropriate-use criteria for MPI. Simultaneously, novel technology, image-reconstruction software for traditional scanners, and dedicated cardiac scanners emerged and facilitated the performance of MPI with low-dose and ultra-low-dose radiotracers. This paper provides a practical approach to performing low-radiation-dose MPI using traditional and novel technologies.
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Affiliation(s)
- Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ron Blankstein
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hicham Skali
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mi-Ae Park
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jolene Fantony
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Charles Mauceri
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - James Semer
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephen C Moore
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marcelo F Di Carli
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, the Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
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Nair SU, Ahlberg AW, Katten DM, Heller GV. Does risk for major adverse cardiac events in patients undergoing vasodilator stress with adjunctive exercise differ from patients undergoing either standard exercise or vasodilator stress with myocardial perfusion imaging? J Nucl Cardiol 2015; 22:22-35. [PMID: 25124828 DOI: 10.1007/s12350-014-9967-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND In patients with functional limitations, the use of adjunctive exercise with vasodilator stress has advantages over vasodilator stress alone in single photon emission computed tomography myocardial perfusion imaging (MPI) for technical reasons and with regards to more effective cardiac risk stratification. Whether patients who undergo vasodilator with adjunctive exercise stress MPI possess clinical characteristics and cardiac risk that differs from those who undergo standard exercise or vasodilator stress MPI is unknown. METHODS Prospectively collected data on 19,367 consecutive patients referred for stress MPI to a tertiary care center (9,331 [48%] underwent exercise-only, 3,793 [20%] underwent vasodilator plus exercise, and 6,243 [32%] underwent vasodilator-only) were analyzed. Perfusion data were scored using the ASNC 17-segment with a summed stress score (SSS) < 4 = normal, 4-8 = mildly abnormal, and > 8 = moderate to severely abnormal. Patients were followed a mean of 1.96 ± 0.95 years. Demographics, clinical characteristics, and the occurrence of major adverse cardiac events (cardiac death or nonfatal myocardial infarction) were compared between the three stress modality groups. RESULTS Comparison of demographics and clinical characteristics revealed significant differences in gender, age, cardiac risk factors, and stress MPI between the three stress modality groups (P < .001). In follow-up, cardiac event-free survival of patients in the vasodilator plus exercise stress group was significantly higher than those in the vasodilator-only group but lower than those in the exercise-only group (P < .001). Annualized cardiac event rates of patients in the vasodilator plus exercise stress group were significantly lower than those in the vasodilator-only group for all three categories of the SSS (P < .001). After multivariable adjustment, with exercise-only as reference category, vasodilator plus exercise and vasodilator-only stress emerged as independent predictors (more likely occurrence) of cardiac death, while vasodilator-only stress emerged as an independent predictor (more likely occurrence) of cardiac death or nonfatal myocardial infarction. With vasodilator-only as the reference category, exercise-only and vasodilator plus exercise stress emerged as independent predictors (less likely occurrence) of cardiac death as well as of cardiac death or nonfatal myocardial infarction. CONCLUSIONS Patients undergoing vasodilator plus exercise stress MPI possess clinical characteristics and cardiac risk that differs significantly from those undergoing either standard exercise or vasodilator stress MPI and places them in a lower risk category compared to vasodilator stress alone.
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Affiliation(s)
- Sanjeev U Nair
- Division of Cardiology, Lehigh Valley Health Network/University of South Florida College of Medicine, 1250 S Cedar Crest Blvd, Suite 300, Allentown, PA, USA.
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Gowd BMP, Heller GV, Parker MW. Stress-only SPECT myocardial perfusion imaging: a review. J Nucl Cardiol 2014; 21:1200-12. [PMID: 25005348 DOI: 10.1007/s12350-014-9944-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/10/2014] [Indexed: 11/26/2022]
Abstract
Myocardial perfusion imaging (MPI) has enjoyed considerable success for decades due to its diagnostic accuracy and wealth of prognostic data. Despite this success several limitations such as lengthy protocols and radiation exposure remain. Advancements to address these shortcomings include abbreviated stress-only MPI (SO MPI) protocols, PET and both hardware and software methods to reduce radiation exposure and time. SO MPI has advantages in protocol time and radiation reduction with a wealth of supporting data in terms of diagnostic validity and prognostic value. Newer technologies such as attenuation correction, and advanced camera technologies have enabled SO MPI to be more efficient in reducing the time of acquisition and radiation dose and improving accuracy. This review examines the literature available, regarding accuracy, patient outcomes, implementation strategies, and newer developments associated with SO MPI.
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Affiliation(s)
- B M Pampana Gowd
- Henry Low Heart Center, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA,
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Mahmarian JJ, Chang S, Nabi F. Nuclear Cardiology: 2014 Innovations and Developments. Methodist Debakey Cardiovasc J 2014; 10:163-71. [DOI: 10.14797/mdcj-10-3-163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Savvopoulos CA, Spyridonidis T, Papandrianos N, Vassilakos PJ, Alexopoulos D, Apostolopoulos DJ. CT-based attenuation correction in Tl-201 myocardial perfusion scintigraphy is less effective than non-corrected SPECT for risk stratification. J Nucl Cardiol 2014; 21:519-31. [PMID: 24532033 DOI: 10.1007/s12350-014-9867-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Previous studies advocate the use of attenuation correction in myocardial perfusion scintigraphy (MPS) for patient risk stratification. METHODS Six-hundred and thirty-seven unselected patients underwent Tl-201 MPS by a hybrid SPECT/CT system. Attenuation-corrected (AC) and non-corrected (NAC) images were interpreted blindly and summed stress scores (SSS) were calculated. Study endpoints were all-cause mortality and the composites of death/non-fatal acute myocardial infarction (AMI) and death/AMI/late revascularization. RESULTS During a follow-up of 42.3 ± 12.8 months 24 deaths, 13 AMIs and 28 revascularizations were recorded. SSS groups formed according to event rate distribution across SSS values were: 0-4, 5-13, >13 for NAC and 0-2, 3-9, >9 for AC. Kaplan-Meier functions were statistically significant between NAC SSS groups for all study endpoints. AC discriminated only between SSS 0-2 and >9 for death/AMI and between 0-2 and 3-9 for death/AMI/revascularization. In the univariate Cox regression abnormal NAC (SSS > 4) was accompanied with much higher hazards ratios than abnormal AC (SSS > 2). In the multivariate model abnormal AC yielded no significance for either endpoint whereas abnormal NAC proved independent from other covariates for the composite endpoints. CONCLUSION Our results challenge the effectiveness of CT-based AC for risk stratification of patients referred for MPS.
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Affiliation(s)
- Christos A Savvopoulos
- Department of Nuclear Medicine, University Hospital of Patras, University of Patras, Medical School, Rion, 26500, Patras, Greece
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Ben-Haim S, Almukhailed O, Neill J, Slomka P, Allie R, Shiti D, Berman DS, Bomanji J. Clinical value of supine and upright myocardial perfusion imaging in obese patients using the D-SPECT camera. J Nucl Cardiol 2014; 21:478-85. [PMID: 24477404 DOI: 10.1007/s12350-014-9853-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/22/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE We have assessed whether additional upright imaging increases the confidence of interpretation of stress only supine myocardial perfusion imaging (MPI) in obese patients. METHODS AND RESULTS Tc-MIBI stress MPI of 101 consecutive patients (M = 49, 62 ± 12 years) with BMI ≥30 scanned on the D-SPECT cardiac camera were assessed. Images were interpreted as diagnostic or equivocal and the need for a rest study was recorded. Stress supine MPI was interpreted first, then gated and finally upright data were added. Defects on supine but not on upright were defined as artefacts and defects seen on both as abnormal. The total perfusion deficit (TPD) was also quantified. There were 27 normal, 22 abnormal, and 52 equivocal supine scans. The median EF was 52%, unaffecting the need for rest imaging. Upright imaging reclassified 32/52 (62%) equivocal studies as normal and 6/52 (11%) as abnormal (P < 0.001). Rest scan was deemed needed in 74/101 patients on supine vs 42/101 on supine/upright (P < 0.001). Supine TPD was normal in 53 and supine/upright TPD was normal in 70 patients (P < 0.001). CONCLUSION Supine stress MPI is inadequate in obese patients. The addition of upright imaging significantly increases the ability to interpret scans as diagnostic and may reduce considerably the need for rest imaging.
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Affiliation(s)
- Simona Ben-Haim
- Institute of Nuclear Medicine, University College London Hospitals, NHS Trust, London, UK,
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Ardestani A, Ahlberg AW, Katten DM, Santilli K, Polk DM, Bateman TM, Heller GV. Risk stratification using line source attenuation correction with rest/stress Tc-99m sestamibi SPECT myocardial perfusion imaging. J Nucl Cardiol 2014; 21:118-26. [PMID: 24259152 DOI: 10.1007/s12350-013-9816-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although line source attenuation correction (AC) in SPECT MPI studies improves diagnostic accuracy, its prognostic value is less understood. METHODS Consecutive patients (n = 6,513) who underwent rest/stress AC ECG-gated SPECT MPI were followed for cardiac death or non-fatal myocardial infarction (MI). A 17-segment model and AC summed stress score (SSS) were used to classify images. RESULTS Of the 6,513 patients, cardiac death or non-fatal MI occurred in 267 (4.1%), over 2.0 ± 1.4 years. The AC-SSS in patients with a cardiac event (5.6 ± 7.8) was significantly higher than in those without (1.9 ± 4.6, P < .001). The annualized cardiac event rate in patients with an AC-SSS 1-3 (3.6%) was significantly higher than in those with an AC-SSS = 0 (1.1%, P < .001) but similar to that in those with an AC-SSS 4-8 (2.9%, P = .4). Accordingly, patients were classified to AC-SSS = 0, 1-8, and >8 with annualized cardiac event rates of 1.1%, 3.2%, and 8.5%, respectively (P < .0001). In multivariate analysis, an AC-SSS 1-8 and >8 emerged as independent predictors of cardiac events (P < .02 and P < .0001, respectively). CONCLUSION Rest/stress ECG-gated SPECT MPI with line source AC provides highly effective and incremental risk stratification for future cardiac events.
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Affiliation(s)
- Afrooz Ardestani
- Division of Cardiology, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06034, USA,
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Heller GV. Nuclear cardiology in the present and beyond: can we meet the challenges? J Nucl Cardiol 2013; 20:510-8. [PMID: 23709279 DOI: 10.1007/s12350-013-9727-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Gary V Heller
- University of Connecticut School of Medicine, Farmington, CT, USA.
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Edenbrandt L, Ohlsson M, Trägårdh E. Prognosis of patients without perfusion defects with and without rest study in myocardial perfusion scintigraphy. EJNMMI Res 2013; 3:58. [PMID: 23902737 PMCID: PMC3733807 DOI: 10.1186/2191-219x-3-58] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 07/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stress myocardial perfusion scintigraphy (MPS) is widely regarded as a useful imaging modality for diagnosing patients with suspected ischemic heart disease. Current European guidelines recommend stress study to be performed first since rest study can be omitted if stress study is interpreted as normal. Thus, a rest study should only be performed in patients with equivocal or abnormal studies. The aim of the present study was to investigate the prognosis of a normal stress-only MPS compared to a normal stress-rest MPS in a retrospective manner and also with regard to normal/abnormal left ventricular function data. METHODS All 4,820 patients who underwent (99m)Tc MPS at Skåne University Hospital in Malmö, Sweden, in 2004 to 2007, for suspected or management of known ischemic heart disease were considered. The physician in clinical charge of the investigation decided whether a rest study was necessary or not. Based on the final report according to clinical routine, only patients with a normal perfusion study (no infarction or inducible ischemia) were included. The endpoints were non-fatal acute coronary syndrome or death from ischemic cardiac origin. RESULTS A total of 3,426 patients with a normal perfusion study were included. Of these, 2,215 patients had a stress-only study and 1,211 patients had both stress and rest studies. Mean follow-up was 6.2 years. The lowest event rate was found in the normal stress-only group (0.56% for normal stress-only patients vs. 1.42% for normal stress-rest patients; p < 0.0001). When dividing patients according to sex and stress type, the best prognosis was also found in the normal stress-only group (p < 0.0001 for all comparisons). Regarding left ventricular function data, we did not find any significant difference in event rate between normal vs. abnormal ejection fraction (EF), normal vs. abnormal end-diastolic volume (EDV) or normal EF, and EDV vs. abnormal EF or EDV for either the normal stress-only patients or the normal stress-rest patients. CONCLUSIONS Patients with a normal stress-only study had an excellent prognosis over a mean follow-up time of 6 years. Thus, omitting the rest study if the stress study is normal is a safe procedure.
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Affiliation(s)
- Lars Edenbrandt
- Clinical Physiology and Nuclear Medicine Unit, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Mattias Ohlsson
- Computational Biology and Biological Physics, Lund University, Lund, Sweden
| | - Elin Trägårdh
- Clinical Physiology and Nuclear Medicine Unit, Lund University, Skåne University Hospital, Malmö, Sweden
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Prognosis of normal stress-only gated-SPECT myocardial perfusion imaging: a single center study. Int J Cardiovasc Imaging 2013; 29:1639-44. [DOI: 10.1007/s10554-013-0245-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 05/24/2013] [Indexed: 10/26/2022]
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Henzlova MJ, Croft LB, Duvall WL. Stress-only imaging: faster, cheaper, less radiation. So what's the hold up? J Nucl Cardiol 2013; 20:17-9. [PMID: 23151754 DOI: 10.1007/s12350-012-9652-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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