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Dundara Debeljuh D, Matheoud R, Zoccarato O, Pribanić I, Brambilla M, Jurković S. Characterization of myocardial perfusion imaging systems - an extension of quality metrics. Phys Med 2024; 125:104510. [PMID: 39216312 DOI: 10.1016/j.ejmp.2024.104510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 04/15/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE The aim of this study was to evaluate the performance of myocardial perfusion imaging (MPI) systems in detecting perfusion defects (PDs). The defect perfusion index (DPI) was introduced to extend and further advance the current MPI quality metrics. METHODS An anthropomorphic phantom simulating normal and pathological myocardial perfusion conditions was imaged by various NaI-crystal detector systems with and without corrections for scatter (SC) and attenuation (AC) (Symbia, Symbia + SC, Symbia IQ + SCAC, Symbia IQ), and cadmium-zinc-telluride detector systems without corrections (DSPECT, D530c). The extent of PD and the summed score (SS) were obtained by comparing polar maps with ad hoc normal databases created for each MPI system by using phantom polar maps with normal perfusion. The segmental uptake (SU) and the global uniformity (GU) were evaluated. The DPI was calculated on segments included in the PD to minimize attenuation artifacts outside the PD. The 17 segmental model was used. RESULTS The highest level of uniformity of polar map was obtained for Symbia IQ + SCAC. D530c showed the highest extent of PD and dependence of the extent on the PD position. It showed in general the lowest SU values and the highest GU due to attenuation artifacts. Nevertheless, D530c outperforms other MPI systems in terms of PD detection, showing the highest DPI value. DSPECT system showed the lowest SS value, and DPI values comparable to NaI-crystal detector systems. CONCLUSION The DPI can be evaluated to investigate the intrinsic ability of MPI systems to detect PDs, whatever the quantitative post-processing software used.
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Affiliation(s)
- Dea Dundara Debeljuh
- Medical Physics and Radiation Protection Department, University Hospital Rijeka, Croatia; Radiology Department, General Hospital Pula, Pula, Croatia; Department of Medical Physics and Biophysics, Faculty of Medicine, University of Rijeka, Croatia
| | - Roberta Matheoud
- Department of Medical Physics, University Hospital "Maggiore della Carità", Novara, Italy
| | - Orazio Zoccarato
- Unit of Nuclear Medicine and Department of Cardiology, S. Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, NO, Italy
| | - Ivan Pribanić
- Medical Physics and Radiation Protection Department, University Hospital Rijeka, Croatia; Department of Medical Physics and Biophysics, Faculty of Medicine, University of Rijeka, Croatia
| | - Marco Brambilla
- Department of Medical Physics, University Hospital "Maggiore della Carità", Novara, Italy
| | - Slaven Jurković
- Medical Physics and Radiation Protection Department, University Hospital Rijeka, Croatia; Department of Medical Physics and Biophysics, Faculty of Medicine, University of Rijeka, Croatia.
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Ding X, Cui L, Li J, Cao J, Ding M, Wang H, Zhang F, Wang H. Assessing the diagnostic value of left ventricular synchrony indices derived from phase analysis by D-SPECT in identifying obstructive coronary artery disease. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03182-z. [PMID: 38960945 DOI: 10.1007/s10554-024-03182-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/28/2024] [Indexed: 07/05/2024]
Abstract
This study aimed to assess the diagnostic efficacy of left ventricular synchrony (LVS) for detecting coronary artery disease (CAD). We explored whether the LVS index derived from phase analysis of D-SPECT provides superior diagnostic value compared to conventional perfusion analysis in identifying obstructive CAD. Patients with suspected or confirmed CAD underwent drug-stress/rest gated D-SPECT myocardial perfusion imaging (MPI) and coronary angiography (CAG). A 50% stenosis was set as the threshold for obstructive CAD. 110 participants were enrolled in this analysis. There were significant differences in phase standard deviation (PSD), phase histogram bandwidth (PHB) and entropy among the four groups. Patients without cardiac disease and those with mild-moderate stenosis exhibited no noticeable contraction asynchrony. However, LVS indices demonstrated a gradual increase with the progression of coronary stenosis when compared to NC (P < 0.001). Obstructive CAD was identified in 43 out of 110 participants (39%). Optimal cutoff values for diagnosing obstructive CAD during stress were determined as 7.6° for PSD, 24° for PHB, and 37% for entropy, respectively. Notably, PSD, PHB, and entropy indices exhibited higher sensitivity compared to MPI. The integration of the stress-induced LVS indices into routine MPI analysis resulted in a significantly greater area under the curve (AUC), leading to improved diagnostic performance and enhanced differential capacity. Stress-induced LVS indices increase with the severity of coronary artery stenosis by D-SPECT phase analysis. Further, the indices-derived phase analysis exhibits superior sensitivity and discriminatory ability compared to MPI in detecting obstructive CAD.
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Affiliation(s)
- Xinhua Ding
- Department of Nuclear Medicine, Gansu Province, Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Lanlan Cui
- PET/CT Center, Gansu Provincial Hospital, Lanzhou, China
| | - Jianfeng Li
- Department of Cardiology, Gansu Province, Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China
| | - Jiancang Cao
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
| | - Mingjia Ding
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Haiyong Wang
- Department of Ultrasound, Gansu Provincial Hospital, Lanzhou, China
| | - Fu Zhang
- Department of Cardiology, Gansu Province, Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China.
| | - Haijun Wang
- Department of Nuclear Medicine, Gansu Province, Gansu Provincial Hospital, 204 Donggang West Road, Chengguan District, Lanzhou, 730000, China.
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3
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Ochoa-Figueroa M, Valera-Soria C, Pagonis C, Ressner M, Norberg P, Sanchez-Rodriguez V, Frias-Rose J, Good E, Davidsson A. Diagnostic performance of a novel deep learning attenuation correction software for MPI using a cardio dedicated CZT camera. Experience in the clinical practice. Rev Esp Med Nucl Imagen Mol 2024; 43:23-30. [PMID: 37748688 DOI: 10.1016/j.remnie.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of a novel deep learning attenuation correction software (DLACS) for myocardial perfusion imaging (MPI) using a cadmium-zinc-telluride (CZT) cardio dedicated camera with invasive coronary angiography (ICA) correlation for the diagnosis of coronary artery disease (CAD) in a high-risk population. METHODS Retrospective study of 300 patients (196 males [65%], mean age 68 years) from September 2014 to October 2019 undergoing MPI, followed by ICA and evaluated by means of quantitative angiography software, within six months after the MPI. The mean pre-test probability score for coronary disease according to the European Society of Cardiology criteria was 37% for the whole cohort. The MPI was performed in a dedicated CZT cardio camera (D-SPECT Spectrum Dynamics) with a two-day protocol, according to the European Association of Nuclear Medicine guidelines. MPI was retrospectively evaluated with and without the DLACS. RESULTS The overall diagnostic accuracy of MPI without DLACS to identify patients with any obstructive CAD at ICA was 87%, sensitivity 94%, specificity 57%, Positive Predictive Value 91% and Negative Predictive Value 64%. Using DLACS the overall diagnostic accuracy was 90%, sensitivity 91%, specificity 86%, Positive Predictive Value 97% and Negative Predictive Value 66%. CONCLUSION Use of the novel DLACS enhances performance of the MPI using the CZT D-SPECT camera and achieves improved results, especially avoiding artefacts and reducing the number of false positive results.
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Affiliation(s)
- Miguel Ochoa-Figueroa
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden; Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Carlos Valera-Soria
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Christos Pagonis
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcus Ressner
- Department of Medical Physics, Linköping University Hospital, Linköping, Sweden
| | - Pernilla Norberg
- Department of Medical Physics, Linköping University Hospital, Linköping, Sweden
| | - Veronica Sanchez-Rodriguez
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden; Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jeronimo Frias-Rose
- Department of Pathology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Elin Good
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anette Davidsson
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
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Chopra S, Singh SS, Sood A, Parmar M, Parihar AS, Vadi SK, Mittal BR. Comparison of positional artifacts in myocardial perfusion imaging in supine and semi-reclining position using dedicated D-SPECT cardiac camera: validation using CT based attenuation correction. J Nucl Cardiol 2023; 30:1782-1793. [PMID: 36849635 DOI: 10.1007/s12350-023-03210-w] [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: 05/19/2022] [Accepted: 01/14/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Soft-tissue attenuation remains a major limitation of SPECT-MPI which interferes with the diagnosis of CAD. The current study aims to evaluate the pattern of attenuation artifacts in supine and semi-reclining positions on CZT cardiac camera and their interaction with gender, BMI and stress protocols. METHODS We prospectively analysed 150 patients acquired in supine and semi-reclining positions on CZT camera. The images were evaluated for severity and extent of defect using 17-segment model. An additional CT scan was acquired to generate AC image in the first 50 patients studied to assist investigator learning for comparison of artifact vs true defects in the two SPECT systems. The defects present in one position or showing change in severity within two positions were considered as positional artifacts and further validated using CTAC supine image. RESULTS In overall analysis, higher extent and severity of positional artifacts were observed more in semi-reclining position affecting the apex, apico-inferior, inferolateral and inferoseptal segments. Females showed more positional artifacts than males with inferior wall attenuation in the semireclining position and anterior wall attenuation in the supine position. A positive correlation of the extent and severity of positional artifacts was noted with an increasing BMI. In patients with BMI > 30, mid inferior and inferolateral segments were most affected followed by anterior wall segments. Highest correction of artifactual perfusion defects by CTAC was noted in inferior wall followed by inferolateral segments. CONCLUSION The incidence of positional artifacts was greater in semi-reclining position in females, higher BMI groups and adenosine stress subsets. Knowledge of the pattern of positional artifacts appears to be a reliable alternative of CTAC for correct interpretation of myocardial perfusion images.
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Affiliation(s)
- Sejal Chopra
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shashank Shekhar Singh
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Madan Parmar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwin Singh Parihar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shelvin Kumar Vadi
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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5
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Ochoa-Figueroa M, Frias-Rose J, Good E, Sanchez-Rodriguez V, Davidsson A, Pagonis C. Diagnostic performance of different cardiac stress protocols for myocardial perfusion imaging for the diagnosis of coronary artery disease using a cadmium-zinc-telluride camera with invasive coronary angiography correlation. Rev Esp Med Nucl Imagen Mol 2023; 42:281-288. [PMID: 36103979 DOI: 10.1016/j.remnie.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/08/2021] [Accepted: 01/23/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of three different cardiac stress protocols for myocardial perfusion imaging (MPI) using a cadmium-zinc-telluride (CZT) camera with invasive coronary angiography (ICA) correlation for the diagnosis of coronary artery disease in a high risk population. METHODS Retrospective study of 263 patients (96 women and 167 males, mean age 68 years) from which 119 patients performed a bicycle stress test (BST), 113 pharmacological stress test (PST) and 31 a combination of the two (CST) between September 2014 and December 2018. The patients then underwent myocardial perfusion imaging (MPI), followed by ICA and evaluated by means of quantitative angiography software, within six months after the MPI. The mean pre-test probability score for coronary disease according to the European Society of Cardiology criteria was 36% for the whole population. The MPI was performed in a dedicated CZT cardio camera (D-SPECT Spectrum Dynamics) with a two-day protocol, according to the European Association of Nuclear Medicine guidelines. RESULTS No significant difference was observed between the three stress protocols in terms of diagnostic accuracy (BST 85%, PST 88%, CST 84%). The overall diagnostic accuracy of MPI to identify patients with any obstructive CAD at ICA was 86%, Sensitivity 93%, Specificity 54%, PPV 90% and NPV 63%. CONCLUSION The CZT D-SPECT camera achieves overall satisfactory results in the diagnosis of CAD, observing no significant differences in the diagnostic performance when the stress test was performed as a BST, PST or CST.
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Affiliation(s)
- Miguel Ochoa-Figueroa
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden; Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Jeronimo Frias-Rose
- Department of Pathology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Elin Good
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden; Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Veronica Sanchez-Rodriguez
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden; Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anette Davidsson
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Christos Pagonis
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Hage FG, Einstein AJ, Ananthasubramaniam K, Bourque JM, Case J, DePuey EG, Hendel RC, Henzlova MJ, Shah NR, Abbott BG, Al Jaroudi W, Better N, Doukky R, Duvall WL, Malhotra S, Pagnanelli R, Peix A, Reyes E, Saeed IM, Sanghani RM, Slomka PJ, Thompson RC, Veeranna V, Williams KA, Winchester DE. Quality metrics for single-photon emission computed tomography myocardial perfusion imaging: an ASNC information statement. J Nucl Cardiol 2023; 30:864-907. [PMID: 36607538 DOI: 10.1007/s12350-022-03162-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Fadi G Hage
- Section of Cardiology, Birmingham VA Medical Center, Birmingham, AL, USA.
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 446 GSB, 520 19Th Street South, Birmingham, AL, 35294, USA.
| | - Andrew J Einstein
- Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine and Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Jamieson M Bourque
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - James Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
| | - E Gordon DePuey
- Mount Sinai Morningside Hospital, New York, NY, USA
- Bay Ridge Medical Imaging, Brooklyn, NY, USA
| | - Robert C Hendel
- Department of Medicine, Division of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Nishant R Shah
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Brian G Abbott
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Wael Al Jaroudi
- Division of Cardiovascular Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nathan Better
- Department of Nuclear Medicine and Cardiology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - W Lane Duvall
- Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | - Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology and Cardiovascular Surgery, La Habana, Cuba
| | - Eliana Reyes
- Nuclear Medicine Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ibrahim M Saeed
- Virginia Heart, Falls Church, VA, USA
- INOVA Heart and Vascular Institute, Falls Church, VA, USA
- University of Missouri, Kansas City, MO, USA
| | - Rupa M Sanghani
- Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - Randall C Thompson
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Vikas Veeranna
- Division of Cardiology, Department of Medicine, New England Heart and Vascular Institute, Manchester, NH, USA
| | - Kim A Williams
- Department of Medicine, University of Louisville Department of Medicine, Louisville, KY, USA
| | - David E Winchester
- Malcom Randall VA Medical Center, Gainesville, FL, USA
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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7
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Mansour N, Nekolla SG, Reyes E, Angelidis G, Georgoulias P, Anagnostopoulos C, Bravo P, Bruno I, Flotats A, Fuentes-Ocampo F, Sciagrà R, Keng F, Kessler L, Papathanasiou M, Soman P, Rischpler C. Multi-center study of inter-rater reproducibility, image quality, and diagnostic accuracy of CZT versus conventional SPECT myocardial perfusion imaging. J Nucl Cardiol 2023; 30:528-539. [PMID: 35799039 PMCID: PMC10125926 DOI: 10.1007/s12350-022-03054-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cadmium-zinc-telluride (CZT)-based detectors exhibit higher diagnostic sensitivity in myocardial perfusion imaging (MPI) than conventional Anger-MPI for detection of coronary artery disease (CAD); however, reduced specificity and diagnostic accuracy of CZT-MPI were observed. This study aims to compare these different camera systems and to examine the degree of inter-rater reproducibility among readers with varying experience in MPI. METHODS 83 patients who underwent double stress/rest examinations using both a CZT and conventional SPECT cameras within one visit were included. Anonymized and randomized MPI-images were distributed to 15 international readers using a standardized questionnaire. Subsequent coronary angiography findings of ten patients served as a reference for analysis of sensitivity and specificity. RESULTS Image quality was significantly better in CZT-MPI with significantly lower breast attenuation (P < 0.05). CZT-MPI exhibited higher sensitivity than Anger-MPI (87.5% vs. 62.5%) and significantly reduced specificity (40% vs. 100%). Readers experienced with both camera systems had the highest inter-rater agreement indicating higher reproducibility (CZT 0.54 vs. conv. 0.49, P < 0.05). CONCLUSIONS Higher diagnostic sensitivity of CZT-MPI offers advantages in detection of CAD yet potentially of at the cost of reduced specificity, therefore it requires special training and a differentiated evaluation approach, especially for non-experienced readers with such camera systems.
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Affiliation(s)
- Nabeel Mansour
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Eliana Reyes
- Royal Brompton and Harefield NHS Trust, London, UK
| | - George Angelidis
- Department of Nuclear Medicine, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Panagiotis Georgoulias
- Department of Nuclear Medicine, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | | | - Paco Bravo
- Divisions of Nuclear Medicine and Cardiology, Departments of Radiology and Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Isabella Bruno
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco Fuentes-Ocampo
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roberto Sciagrà
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Felix Keng
- National Heart Centre, Singapore, Singapore
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Maria Papathanasiou
- Department of Cardiology, West German Heart and Vascular Center, University Hospital, Essen, Germany
| | - Prem Soman
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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8
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Imbert L, Marie PY. Dedicated CZT gamma cameras for nuclear cardiology. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00080-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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9
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Yang J, Shi L, Wang R, Miller EJ, Sinusas AJ, Liu C, Gullberg GT, Seo Y. Direct Attenuation Correction Using Deep Learning for Cardiac SPECT: A Feasibility Study. J Nucl Med 2021; 62:1645-1652. [PMID: 33637586 PMCID: PMC8612332 DOI: 10.2967/jnumed.120.256396] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/16/2021] [Indexed: 11/16/2022] Open
Abstract
Dedicated cardiac SPECT scanners with cadmium-zinc-telluride cameras have shown capabilities for shortened scan times or reduced radiation doses, as well as improved image quality. Since most dedicated scanners do not have integrated CT, image quantification with attenuation correction (AC) is challenging and artifacts are routinely encountered in daily clinical practice. In this work, we demonstrated a direct AC technique using deep learning (DL) for myocardial perfusion imaging (MPI). Methods: In an institutional review board-approved retrospective study, 100 cardiac SPECT/CT datasets with 99mTc-tetrofosmin, obtained using a scanner specifically with a small field of view, were collected at the Yale New Haven Hospital. A convolutional neural network was used for generating DL-based attenuation-corrected SPECT (SPECTDL) directly from noncorrected SPECT (SPECTNC) without undergoing an additional image reconstruction step. The accuracy of SPECTDL was evaluated by voxelwise and segmentwise analyses against the reference, CT-based AC (SPECTCTAC), using the 17-segment myocardial model of the American Heart Association. Polar maps of representative (best, median, and worst) cases were visually compared to illustrate potential benefits and pitfalls of the DL approach. Results: The voxelwise correlations with SPECTCTAC were 92.2% ± 3.7% (slope, 0.87; R2 = 0.81) and 97.7% ± 1.8% (slope, 0.94; R2 = 0.91) for SPECTNC and SPECTDL, respectively. The segmental errors of SPECTNC scattered from -35% to 21% (P < 0.001), whereas the errors of SPECTDL stayed mostly within ±10% (P < 0.001). The average segmental errors (mean ± SD) were -6.11% ± 8.06% and 0.49% ± 4.35% for SPECTNC and SPECTDL, respectively. The average absolute segmental errors were 7.96% ± 6.23% and 3.31% ± 2.87% for SPECTNC and SPECTDL, respectively. Review of polar maps revealed successful reduction of attenuation artifacts; however, the performance of SPECTDL was not consistent for all subjects, likely because of different amounts of attenuation and different uptake patterns. Conclusion: We demonstrated the feasibility of direct AC using DL for SPECT MPI. Overall, our DL approach reduced attenuation artifacts substantially compared with SPECTNC, justifying further studies to establish safety and consistency for clinical applications in stand-alone SPECT systems suffering from attenuation artifacts.
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Affiliation(s)
- Jaewon Yang
- Physics Research Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California;
| | - Luyao Shi
- Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Rui Wang
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
- Department of Engineering Physics, Tsinghua University, Beijing, China; and
| | - Edward J Miller
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
- Internal Medicine (Cardiology), Yale University, New Haven, Connecticut
| | - Albert J Sinusas
- Biomedical Engineering, Yale University, New Haven, Connecticut
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
- Internal Medicine (Cardiology), Yale University, New Haven, Connecticut
| | - Chi Liu
- Biomedical Engineering, Yale University, New Haven, Connecticut
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Grant T Gullberg
- Physics Research Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Youngho Seo
- Physics Research Laboratory, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
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10
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Karahan Şen NP, Bekis R, Şentürk B, Akdeniz B. The Comparison of Quantitative Evaluation Results of the MPS SPECT/CT and Coronary Angiography: Determining the Most Valuable Quantitative Evaluation Score. Mol Imaging Radionucl Ther 2021; 30:169-176. [PMID: 34658498 PMCID: PMC8522523 DOI: 10.4274/mirt.galenos.2021.26056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: This study aimed to determine the most important perfusion score in patient selection for coronary angiography (CA) by quantitatively evaluating myocardial perfusion scintigraphy (MPS). Methods: Patients who underwent MPS single-photon emission computerized tomography/computed tomograph imaging in our clinic between December 2017 and January 2019, without coronary artery disease (CAD) history, followed by CA were included in the study. CA was considered positive when there is a stenosis of 70% or more in at least one coronary vessel. The summed stress score, rest score, and differential score; total perfusion deficit (TPD); and the defect’s extent obtained from non-attenuation-corrected (NC) and attenuation-corrected (AC) images of 80 patients were evaluated using the Mann-Whitney U test. A p value of <0.05 was considered significant. Receiver operating characteristic (ROC) analysis was performed. Results: The scores obtained from NC and AC images showed a significant difference between the two groups for all scores except for the extent and TPD scores at rest from AC images. The applied ROC curves’ highest diagnostic value was determined as the TPD score at stress (TPDS) obtained from NC images (area under the curve: 0.880, 95% confidence interval, 0.807-0.952, p<0.001). The cut-off value obtained for the TPDS from the ROC curve was found to be 5.5. Conclusion: The scores obtained from NC images have more power to detect CAD than those obtained from AC images. Patients with no prior CAD history with TPDS score higher than 5 in MPS should be referred for CA with priority.
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Affiliation(s)
| | - Recep Bekis
- Dokuz Eylül University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey
| | - Bihter Şentürk
- Dokuz Eylül University Faculty of Medicine, Department of Cardiology, İzmir, Turkey
| | - Bahri Akdeniz
- Dokuz Eylül University Faculty of Medicine, Department of Cardiology, İzmir, Turkey
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11
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Yoneyama H, Nakajima K, Taki J, Wakabayashi H, Konishi T, Shibutani T, Okuda K, Onoguchi M. Comparison of Myocardial Ischemia Detection Between Semiconductor and Conventional Anger-type Three-detector SPECT. ANNALS OF NUCLEAR CARDIOLOGY 2021; 7:49-56. [PMID: 36994142 PMCID: PMC10040939 DOI: 10.17996/anc.21-00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/05/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
Objective: Although semiconductor single-photon emission computed tomography (D-SPECT) has been used for myocardial perfusion imaging, few studies have compared its ability to detect myocardial ischemia with that of 3-detector SPECT (GCA9300R). This study used invasive coronary angiography to determine whether the detectability of myocardial ischemia differs between D-SPECT and GCA9300R. Materials and methods: This study included 24 patients who were assessed by coronary angiography within 60 days of myocardial perfusion D-SPECT and GCA9300R. Two nuclear medicine physicians interpreted myocardial perfusion D-SPECT and GCA9300R images with five grades of confidence, then defined regions of ischemia on polar maps. The gold standard was determined by another nuclear cardiology specialist based on integrated assessment of the coronary angiography findings and other clinical information derived from medical charts. The concordance rate and the Cohen kappa (κ) between D-SPECT and GCA9300R were calculated. Results: The sensitivity, specificity, negative and positive predictive values, and the accuracy of patient-based diagnoses were 66.7%, 91.7%, 89.2%, 72.8%, and 85.5%, respectively, for GCA9300R, and 83.3%, 83.3%, 93.7%, 62.4%, and 83.3%, respectively, for D-SPECT. Interpretations of ischemia did not uncover any significant differences between D-SPECT and GCA9300R. The Cohen κ values of D-SPECT and GCA9300 agreed substantially, moderately and marginally for the left circumflex coronary artery (LCX) (0.68), right coronary artery (RCA) (0.43), and left anterior descending coronary artery (LAD) (0.39), respectively. Conclusions: The detectability of myocardial ischemia is comparable between D-SPECT and GCA9300R. Sensitivity is better for D-SPECT than GCA9300R. However, false-positive D-SPECT findings, especially in the apex and inferior wall should be interpreted with caution.
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Affiliation(s)
- Hiroto Yoneyama
- Department of Radiological Technology, Kanazawa University Hospital
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University
| | - Junichi Taki
- Department of Biotracer Medicine, Graduate School of Medical Science
| | | | - Takahiro Konishi
- Department of Radiological Technology, Kanazawa University Hospital
| | - Takayuki Shibutani
- Department of Health Science, Graduate School of Medical Science, Kanazawa University
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University
| | - Masahisa Onoguchi
- Department of Health Science, Graduate School of Medical Science, Kanazawa University
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12
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Baumgarten R, Cerci RJ, de Nadai Costa A, Pereira-Neto CC, Prado P, Zapparoli M, Masukawa M, Cerci JJ, Vitola JV, Fernandes-Silva MM. Radiation exposure after myocardial perfusion imaging with Cadmium-Zinc-Telluride camera versus conventional camera. J Nucl Cardiol 2021; 28:992-999. [PMID: 32410061 DOI: 10.1007/s12350-020-02146-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patient exposure to radiation during the management of coronary heart disease (CHD) can be reduced with more efficient technologies in nuclear medicine, such as the Cadmium-Zinc-Telluride (CZT) gamma-camera for myocardial perfusion imaging (MPI) studies. However, it has been suggested that CZT has lower specificity, which might lead to more downstream radiological procedures, particularly among obese individuals. METHODS AND RESULTS We evaluated 244 patients with suspected CHD who underwent CZT-SPECT and matched 1:1 according to sex, age, and body mass index (BMI) with those undergoing MPI study with the Anger gamma-camera (Anger-SPECT). The outcome was the total radiation exposure from the MPI study added to the radiation exposure from all subsequent cardiac examinations during a 90-day follow-up. The total radiation dose after 90 days was significantly lower in the CZT-SPECT group (6.4 ± 4.8 vs 9.5±4.9 mSv, P < .001). After adjusting for potential confounders, CZT-SPECT remained associated with lower total radiation dose, but it significantly attenuated among obese individuals (Beta coefficient - 3.73 ± 0.86 for BMI < 30 vs - 2.30 ± 0.92 for BMI ≥ 30 Kg/m2, P for interaction < 0.032). CONCLUSIONS CZT-SPECT was associated with lower total radiation doses compared to Anger-SPECT, albeit this benefit may be attenuated in obese individuals.
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Affiliation(s)
- Ricardo Baumgarten
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - Rodrigo Julio Cerci
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - Amanda de Nadai Costa
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | | | - Pedro Prado
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - Marcello Zapparoli
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - Margaret Masukawa
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - Juliano Julio Cerci
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
| | - João Vicente Vitola
- Quanta Diagnóstico por Imagem, 1000 Almirante Tamandare street, Curitiba, PR, 80045170, Brazil
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13
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Tsuboi K, Nagaki A, Shibutani T, Onoguchi M. Optimal choice of OSEM and SD reconstruction algorithms in CZT SPECT for hypertrophic cardiomyopathy patients. J Nucl Cardiol 2021; 28:236-244. [PMID: 30847855 DOI: 10.1007/s12350-019-01677-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 02/21/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The spectrum dynamics (SD) algorithm is a cardiac reconstruction algorithm of D-SPECT, which improves spatial resolution compared with the ordered-subsets expectation maximization (OSEM) algorithm. We evaluated the wall thickness and left ventricular (LV) volume in patients with hypertrophic cardiomyopathy (HCM) using the SD algorithm. METHODS In a phantom study, the myocardial wall was scanned with varying wall thicknesses (10-40 mm). In the clinical study, 30 and 27 normal and HCM patients underwent myocardial perfusion imaging. RESULTS In a phantom study, LV volume using the SD algorithm was increased by thickening the wall of the phantom. In the clinical study, the wall thickness and LV volume of OSEM and SD algorithms showed a difference between HCM and normal groups. The wall thickness using OSEM and SD algorithms were 19.4 ± 2.0 and 16.7 ± 1.5 mm in patients with normal, and 27.9 ± 4.9 and 21.8 ± 2.6 mm in patients with HCM. CONCLUSION The SD algorithm in cases of HCM may not be able to correctly assess wall thickness and LV volume. Our study suggests that the OSEM is more suitable in cases of HCM than the SD algorithm.
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Affiliation(s)
- Kunihito Tsuboi
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki, Japan.
| | - Akio Nagaki
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki, Japan
- Department of Quantum Medical Technology, Kanazawa University, Kanazawa, Japan
| | - Takayuki Shibutani
- Department of Quantum Medical Technology, Kanazawa University, Kanazawa, Japan
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Kanazawa University, Kanazawa, Japan
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14
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Johnson RD, Bath NK, Rinker J, Fong S, St James S, Pampaloni MH, Hope TA. Introduction to the D-SPECT for Technologists: Workflow Using a Dedicated Digital Cardiac Camera. J Nucl Med Technol 2020; 48:297-303. [PMID: 33020236 DOI: 10.2967/jnmt.120.254870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
The D-SPECT is a dedicated cardiac camera that incorporates a solid-state semiconductor detector. This camera differs greatly from conventional SPECT/CT systems, resulting in significant differences in patient imaging. This continuing education article focuses on the specifications of both SPECT/CT and D-SPECT systems, radiopharmaceutical dosing requirements, imaging workflows, and some disadvantages of using each camera system. When used properly, the D-SPECT system can provide high-quality cardiac images with lower doses and faster exam times than conventional SPECT/CT systems.
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Affiliation(s)
- Robert D Johnson
- Department of Radiology, San Francisco VA Medical Center, San Francisco, California
| | - Navkanwal Kaur Bath
- Department of Radiology, San Francisco VA Medical Center, San Francisco, California
| | - Jeffrey Rinker
- Department of Radiology, San Francisco VA Medical Center, San Francisco, California
| | - Stephen Fong
- Department of Radiology, San Francisco VA Medical Center, San Francisco, California
| | - Sara St James
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California; and
| | - Miguel Hernandez Pampaloni
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Thomas A Hope
- Department of Radiology, San Francisco VA Medical Center, San Francisco, California .,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
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15
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Pagnanelli R, Borges-Neto S. How low can we go? J Nucl Cardiol 2020; 27:573-574. [PMID: 30569410 DOI: 10.1007/s12350-018-01559-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: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Affiliation(s)
| | - Salvador Borges-Neto
- Division of Nuclear Medicine, Duke University School of Medicine, Duke University Health System, Durham, USA.
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16
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Left ventricular mechanical dyssynchrony assessment in obese patients using the cadmium-zinc telluride SPECT camera. Int J Cardiovasc Imaging 2020; 36:757-765. [PMID: 31919704 DOI: 10.1007/s10554-019-01762-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
The use of phase analysis techniques to assess left ventricular mechanical dyssynchrony (LVMD) has been well documented. However, artifacts have reduced the accuracy of the assessment due to soft tissue attenuation, so little information is available about the effects of obesity on LVMD. The aim of this study was to evaluate LVMD in patients with simple obesity by SPECT with a new cadmium-zinc telluride (CZT) detector and to explore the effects of obesity on left ventricular wall motion. We retrospectively analyzed 95 patients with myocardial perfusion imaging (MPI) images without perfusion defects, of which 55 were diagnosed with simple obesity (BMI > 30), and 40 non-obese patients (BMI < 25) matched for age and sex were used as controls. The five-point method was used to analyze the MPI images of the two groups, and the complete cardiac function parameters including phase bandwidth (PBW) and phase standard deviation (PSD) were obtained. Although the PBW values of the two groups were within the normal range (cut-off value > 90°), the PBW (35.4 ± 28 vs 24.9 ± 7.5, P < .001; 36.6 ± 18.4 vs 28.7 ± 9.1, P = 0.01) and PSD (8.7 ± 7.6 vs 5.9 ± 2, P = 0.02; 9.2 ± 4.9 vs 7.1 ± 2.7, P = 0.01) of the obese group were larger than the control group under both stressing and resting, and the difference was statistically significant. CZT-SPECT can effectively assess LVMD in obese patients, and they are more likely to develop LVMD, which may be related to their left ventricular volume.
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17
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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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18
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Salvadori J, Petegnief Y, Sabbah R, Morel O, Boulahdour H, Karcher G, Marie PY, Imbert L. Compared vulnerabilities to small cardiac motions between different cameras used for myocardial perfusion imaging. J Nucl Cardiol 2019; 26:1313-1322. [PMID: 29327252 DOI: 10.1007/s12350-017-1175-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/08/2017] [Indexed: 10/18/2022]
Abstract
This phantom-based study was aimed to determine whether cardiac CZT-cameras, which provide an enhanced spatial resolution and image contrast compared to Anger cameras, are similarly affected by small cardiac motions. Translations of a left ventricular (LV) insert at half-SPECT acquisitions through six possible orthogonal directions and with 5- or 10-mm amplitude were simulated on the Discovery NM-530c and DSPECT CZT-cameras and on an Anger Symbia T2 camera equipped with an astigmatic (IQ.SPECT) or conventional parallel-hole collimator (Conv.SPECT). SPECT images were initially reconstructed as currently recommended for clinical routine. The heterogeneity in recorded activity from the 17 LV segments gradually increased between baseline and motions simulated at 5- and 10-mm amplitudes with all cameras, although being higher for Anger- than CZT-cameras at each step and resulting in a higher mean number of artifactual abnormal segments (at 10-mm amplitude, Conv.SPECT: 3.7; IQ.SPECT: 1.8, Discovery: 0.7, DSPECT: 0). However, this vulnerability to motion was markedly (1) decreased for Conv.SPECT reconstructed without the recommended Resolution Recovery algorithm and (2) increased for DSPECT reconstructed without the recommended cardiac model. CZT-cameras and especially the DSPECT appear less vulnerable to small cardiac motions than Anger-cameras although these differences are strongly dependent on reconstruction parameters.
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Affiliation(s)
- Julien Salvadori
- Institut de Cancérologie de Lorraine, Université de Lorraine, 54000, Nancy, France
| | - Yolande Petegnief
- CHU-Besançon, Université de Franche-Comté, Service de Médecine Nucléaire, 25000, Besançon, France
| | - Remi Sabbah
- CHU-Besançon, Université de Franche-Comté, Service de Médecine Nucléaire, 25000, Besançon, France
| | - Olivier Morel
- CHU-Besançon, Université de Franche-Comté, Service de Médecine Nucléaire, 25000, Besançon, France
| | - Hatem Boulahdour
- CHU-Besançon, Université de Franche-Comté, Service de Médecine Nucléaire, 25000, Besançon, France
| | - Gilles Karcher
- CHRU-Nancy, Université de Lorraine, Plateforme Nancyclotep, 54000, Nancy, France
- Médecine Nucléaire, Hôpital de Brabois, CHRU-Nancy, Université de Lorraine, Service de Médecine Nucléaire, 54000, Nancy, France
| | - Pierre-Yves Marie
- CHRU-Nancy, Université de Lorraine, Plateforme Nancyclotep, 54000, Nancy, France
- Médecine Nucléaire, Hôpital de Brabois, CHRU-Nancy, Université de Lorraine, Service de Médecine Nucléaire, 54000, Nancy, France
- Université de Lorraine, INSERM, UMR-1116 DCAC, 54000, Nancy, France
| | - Laetitia Imbert
- Institut de Cancérologie de Lorraine, Université de Lorraine, 54000, Nancy, France.
- CHRU-Nancy, Université de Lorraine, Plateforme Nancyclotep, 54000, Nancy, France.
- Université de Lorraine, INSERM, UMR-947 IADI, 54000, Nancy, France.
- Médecine Nucléaire, Hôpital de Brabois, CHRU-Nancy, Allée du Morvan, 54500, Nancy, Vandœuvre-lès-Nancy, France.
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19
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Hyafil F, Gimelli A, Slart RHJA, Georgoulias P, Rischpler C, Lubberink M, Sciagra R, Bucerius J, Agostini D, Verberne HJ. EANM procedural guidelines for myocardial perfusion scintigraphy using cardiac-centered gamma cameras. Eur J Hybrid Imaging 2019; 3:11. [PMID: 34191169 PMCID: PMC8218102 DOI: 10.1186/s41824-019-0058-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/10/2019] [Indexed: 01/28/2023] Open
Abstract
An increasing number of Nuclear Medicine sites in Europe are using cardiac-centered gamma cameras for myocardial perfusion scintigraphy (MPS). Three cardiac-centered gamma cameras are currently the most frequently used in Europe: the D-SPECT (Spectrum Dynamics), the Alcyone (Discovery NM 530c and Discovery NM/CT 570c; General Electric Medical Systems), and the IQ-SPECT (Siemens Healthcare). The increased myocardial count sensitivity of these three cardiac-centered systems has allowed for a decrease in the activities of radiopharmaceuticals injected to patients for myocardial perfusion imaging and, consequently, radiation exposure of patients. When setting up protocols for MPS, the overall objective should be to maintain high diagnostic accuracy of MPS, while injecting the lowest activities reasonably achievable to reduce the level of radiation exposure of patient and staff. These guidelines aim at providing recommendations for acquisition protocols and image interpretation using cardiac-centered cameras. As each imaging system has specific design and features for image acquisition and analysis, these guidelines have been separated into three sections for each gamma camera system. These recommendations have been written by the members of the Cardiovascular Committee of EANM and were based on their own experience with each of these systems and on the existing literature.
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Affiliation(s)
- Fabien Hyafil
- Department of Nuclear Medicine; Bichat University Hospital, Assistance Publique - Hôpitaux de Paris; Inserm UMR 1148, Paris Diderot-Paris 7 University, 46 rue Henri Huchard, 75018, Paris, France.
| | | | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
- TechMed Centre, Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Panagiotis Georgoulias
- Department of Nuclear Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Mark Lubberink
- Department of Medical Physics and PET Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Roberto Sciagra
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Jan Bucerius
- Department of Nuclear Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Denis Agostini
- Department of Nuclear Medicine, CHU Caen Normandy University, Caen, France
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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20
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Perrin M, Roch V, Claudin M, Verger A, Boutley H, Karcher G, Baumann C, Veran N, Marie PY, Imbert L. Assessment of Myocardial CZT SPECT Recording in a Forward-Leaning Bikerlike Position. J Nucl Med 2019; 60:824-829. [PMID: 30389818 PMCID: PMC6581225 DOI: 10.2967/jnumed.118.217695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/15/2018] [Indexed: 01/04/2023] Open
Abstract
This prospective randomized study assessed myocardial perfusion imaging with the high-sensitivity D.SPECT cadmium-zinc-telluride camera in a forward-leaning bikerlike position, which may potentially lower diaphragmatic attenuation and reduce breathing-related cardiac motion, in a manner comparable to the prone position proposed with other SPECT cameras. Methods: Patients referred for a stress-rest 99mTc-sestamibi protocol and positioned in the biker position, with the chest leaning forward on the D.SPECT camera-head at 35° from vertical, had an additional resting D.SPECT recording in the supine position (n = 40) or in the sitting position with the back rearward at 30° from vertical (n = 40). Segments with attenuation artifacts were defined as those with less than 65% uptake but with strictly normal contractility at gated SPECT and no defect reversibility from stress images. Results: The biker position was associated with lower heart-to-detector distances than the supine or sitting positions (both P < 0.001); lower cardiac motion amplitudes, assessed on panograms, than the supine position (P < 0.001); and fewer segments with attenuation artifacts than the supine position (on average, 1.10 ± 1.01 vs. 1.90 ± 1.74, P = 0.010) or the sitting position (0.75 ± 0.93 vs. 1.38 ± 1.60, P = 0.011). Conclusion: Myocardial perfusion images from D.SPECT are enhanced for patients positioned in a forward-leaning bikerlike position comparatively to sitting or supine positions, with a notably lower rate of attenuation artifacts.
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Affiliation(s)
- Mathieu Perrin
- Department of Nuclear Medicine, CHRU-Nancy, Nancy, France
| | - Véronique Roch
- Department of Nuclear Medicine, CHRU-Nancy, Nancy, France
| | - Marine Claudin
- Department of Nuclear Medicine, CHRU-Nancy, Nancy, France
| | - Antoine Verger
- Department of Nuclear Medicine, CHRU-Nancy, Nancy, France
- Nancyclotep Molecular Imaging Platform, CHRU-Nancy, Nancy, France
- Université de Lorraine, INSERM, UMR 1254, Nancy, France
| | - Henri Boutley
- Laboratoire de Biophysique and Nancyclotep Molecular Imaging Platform, Université de Lorraine, Nancy, France
| | - Gilles Karcher
- Department of Nuclear Medicine, CHRU-Nancy, Nancy, France
- Nancyclotep Molecular Imaging Platform, CHRU-Nancy, Nancy, France
- Laboratoire de Biophysique and Nancyclotep Molecular Imaging Platform, Université de Lorraine, Nancy, France
| | - Cédric Baumann
- Clinical Research Support Platform, Université de Lorraine, CHRU-Nancy, Nancy, France; and
| | - Nicolas Veran
- Department of Nuclear Medicine, CHRU-Nancy, Nancy, France
| | - Pierre-Yves Marie
- Department of Nuclear Medicine, CHRU-Nancy, Nancy, France
- Nancyclotep Molecular Imaging Platform, CHRU-Nancy, Nancy, France
- Université de Lorraine, INSERM, UMR 1116, Nancy, France
| | - Laetitia Imbert
- Department of Nuclear Medicine, CHRU-Nancy, Nancy, France
- Nancyclotep Molecular Imaging Platform, CHRU-Nancy, Nancy, France
- Université de Lorraine, INSERM, UMR 1254, Nancy, France
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21
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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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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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Nudi F, Biondi-Zoccai G. Cadmium-zinc-telluride myocardial perfusion imaging: The dream of a single test gets nearer. J Nucl Cardiol 2018; 25:550-554. [PMID: 28251505 DOI: 10.1007/s12350-017-0833-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Francesco Nudi
- Service of Hybrid Cardio Imaging, Madonna della Fiducia Clinic, Via Giuseppe Mantellini 3, 00179, Rome, Italy.
- Ostia Radiologica, Rome, Italy.
- ETISAN, Rome, Italy.
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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24
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Nakaya K, Onoguchi M, Nishimura Y, Kiso K, Otsuka H, Nouno Y, Shibutani T, Yasuda E. Comparison Between Prone and Upright Imaging of the Inferior Wall Using 201TlCl Myocardial Perfusion SPECT. J Nucl Med Technol 2017; 45:304-308. [PMID: 29042470 DOI: 10.2967/jnmt.117.197632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/11/2017] [Indexed: 11/16/2022] Open
Abstract
Because it suppresses attenuation artifacts from the diaphragm, prone SPECT is suitable for evaluating the cardiac inferior wall. A solid-state dedicated cardiac camera allows upright imaging, which can also be used to avoid attenuation artifacts from the diaphragm. We compared prone and upright imaging for inferior wall evaluation using 201TlCl myocardial perfusion SPECT (MPS). Methods: The study targeted 45 patients. The prone imaging group included 23 subjects who underwent additional prone imaging because supine imaging indicated that the inferior wall had reduced uptake. The upright imaging group included 22 subjects who, in the past, had shown reduced uptake in the inferior wall during supine imaging. Using the MPS stress images and analysis software, we created a polar map showing the incorporation of the radioisotope throughout the whole of the myocardium; this polar map was then classified into 17 segments. The percentage uptake ratios of the inferior/anterior wall were calculated for the prone and upright acquisitions. These ratios were used as the ratio of percentage uptake in each segment of the anterior wall to percentage uptake in each segment of the inferior wall. In addition, 6 reviewers visually evaluated the uniformity within the inferior wall for both the prone and the upright imaging. Results: There was a significant difference in percentage uptake ratios between the prone and upright images in segments 4/1 (basal inferior/basal anterior; P < 0.05), 11/12 (mid inferolateral/mid anterolateral; P < 0.001), and 15/13 (apical inferior/apical anterior; P < 0.05). There were no significant differences between the prone and upright images in visual evaluations of uniformity within the inferior wall. Conclusion: In comparison with upright imaging, prone imaging has a higher rate of suppression of attenuation artifacts from the diaphragm. However, this difference does not seem to affect the images visually. Therefore, upright and prone imaging can be used interchangeably to evaluate the inferior wall.
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Affiliation(s)
- Koji Nakaya
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan.,Department of Radiological Technology, Faculty of Health Science, Suzuka University of Medical Science, Mie, Japan.,Department of Radiology and Nuclear Medicine, National Cerebral and Cardiovascular Center Hospital, Osaka, Japan; and
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
| | - Yoshihiro Nishimura
- Department of Radiology and Nuclear Medicine, National Cerebral and Cardiovascular Center Hospital, Osaka, Japan; and
| | - Keisuke Kiso
- Department of Radiology and Nuclear Medicine, National Cerebral and Cardiovascular Center Hospital, Osaka, Japan; and
| | - Hideki Otsuka
- Department of Medical Imaging/Nuclear Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Yoshifumi Nouno
- Department of Radiology and Nuclear Medicine, National Cerebral and Cardiovascular Center Hospital, Osaka, Japan; and
| | - Takayuki Shibutani
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
| | - Eisuke Yasuda
- Department of Radiological Technology, Faculty of Health Science, Suzuka University of Medical Science, Mie, Japan
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Nekolla SG, van Marwick S, Schachoff S, Kunze KP, Rischpler C. Cardiovascular PET/MRI: Technical Considerations and Outlook. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Nudi F, Iskandrian AE, Schillaci O, Peruzzi M, Frati G, Biondi-Zoccai G. Diagnostic Accuracy of Myocardial Perfusion Imaging With CZT Technology: Systemic Review and Meta-Analysis of Comparison With Invasive Coronary Angiography. JACC Cardiovasc Imaging 2017; 10:787-794. [PMID: 28330657 DOI: 10.1016/j.jcmg.2016.10.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/29/2016] [Accepted: 10/05/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study sought to summarize the evidence on stress myocardial perfusion imaging (MPI) using cadmium-zinc-telluride (CZT) technology for the diagnosis of obstructive coronary artery disease (CAD). The CZT cameras are newly introduced, and comparative data with the conventional Anger technology (Anger-MPI) are lacking. BACKGROUND The diagnostic accuracy of Anger-MPI for detection of angiographically significant CAD is well established; however, less evidence is available on the diagnostic accuracy of CZT-MPI. METHODS Clinical studies comparing CZT-MPI and invasive coronary angiography were systematically searched and abstracted. Calculations of diagnostic accuracy, including sensitivity, specificity, likelihood ratios, and diagnostic odds ratio, were obtained with fixed and random effects, reporting point estimates and 95% confidence intervals. RESULTS Based on our search, a total of 16 studies (N = 2,092) were included. The sensitivity of CZT-MPI was 0.84 (95% confidence interval [CI]: 0.78 to 0.89), whereas the specificity of 0.69 (95% CI: 0.62 to 0.76) was significantly reduced. The positive likelihood ratio was 2.73 (95% CI: 2.21 to 3.39), the negative likelihood ratio was 0.24 (95% CI: 0.17 to 0.31), and the diagnostic odds ratio was 11.93 (95% CI: 7.84 to 17.42). At subgroup and meta-regression analyses, the diagnostic accuracy between D-SPECT and Discovery cameras was similar (p = 0.711) and not impacted upon by smaller sample size studies (p = 0.573). CONCLUSIONS CZT-MPI has satisfactory sensitivity for angiographically significant CAD, but its suboptimal specificity warrants further development and research.
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Affiliation(s)
- Francesco Nudi
- Service of Hybrid Cardio Imaging, Madonna della Fiducia Clinic, Rome, Italy; Ostia Radiologica, Ostia, Italy; Etisan, Rome, Italy
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Alabama
| | - Orazio Schillaci
- Department of Nuclear Medicine, Tor Vergata University, Rome, Italy
| | - Mariangela Peruzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
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Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease: a review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging 2016; 43:2423-2432. [PMID: 27542010 DOI: 10.1007/s00259-016-3467-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
The trade-off between resolution and count sensitivity dominates the performance of standard gamma cameras and dictates the need for relatively high doses of radioactivity of the used radiopharmaceuticals in order to limit image acquisition duration. The introduction of cadmium-zinc-telluride (CZT)-based cameras may overcome some of the limitations against conventional gamma cameras. CZT cameras used for the evaluation of myocardial perfusion have been shown to have a higher count sensitivity compared to conventional single photon emission computed tomography (SPECT) techniques. CZT image quality is further improved by the development of a dedicated three-dimensional iterative reconstruction algorithm, based on maximum likelihood expectation maximization (MLEM), which corrects for the loss in spatial resolution due to line response function of the collimator. All these innovations significantly reduce imaging time and result in a lower patient's radiation exposure compared with standard SPECT. To guide current and possible future users of the CZT technique for myocardial perfusion imaging, the Cardiovascular Committee of the European Association of Nuclear Medicine, starting from the experience of its members, has decided to examine the current literature regarding procedures and clinical data on CZT cameras. The committee hereby aims 1) to identify the main acquisitions protocols; 2) to evaluate the diagnostic and prognostic value of CZT derived myocardial perfusion, and finally 3) to determine the impact of CZT on radiation exposure.
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28
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Kao YH, Better N. D-SPECT: New technology, old tricks. J Nucl Cardiol 2016; 23:311-2. [PMID: 26407951 DOI: 10.1007/s12350-015-0290-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/04/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Yung Hsiang Kao
- Department of Nuclear Medicine, The Royal Melbourne Hospital, Ground Floor, Clinical Sciences Building, Grattan Street, Parkville, Melbourne, VIC, 3050, Australia
| | - Nathan Better
- Department of Nuclear Medicine, The Royal Melbourne Hospital, Ground Floor, Clinical Sciences Building, Grattan Street, Parkville, Melbourne, VIC, 3050, Australia.
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.
- University of Melbourne, Melbourne, Australia.
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