1
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Tadesse GF, Geramifar P, Abbasi M, Tsegaw EM, Amin M, Salimi A, Mohammadi M, Teimourianfard B, Ay MR. Attenuation Correction for Dedicated Cardiac SPECT Imaging Without Using Transmission Data. Mol Imaging Radionucl Ther 2023; 32:42-53. [PMID: 36818953 PMCID: PMC9950684 DOI: 10.4274/mirt.galenos.2022.55476] [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: 02/24/2023] Open
Abstract
Objectives Attenuation correction (AC) using transmission scanning-like computed tomography (CT) is the standard method to increase the accuracy of cardiac single-photon emission computed tomography (SPECT) images. Recently developed dedicated cardiac SPECT do not support CT, and thus, scans on these systems are vulnerable to attenuation artifacts. This study presented a new method for generating an attenuation map directly from emission data by segmentation of precisely non-rigid registration extended cardiac-torso (XCAT)-digital phantom with cardiac SPECT images. Methods In-house developed non-rigid registration algorithm automatically aligns the XCAT- phantom with cardiac SPECT image to precisely segment the contour of organs. Pre-defined attenuation coefficients for given photon energies were assigned to generate attenuation maps. The CT-based attenuation maps were used for validation with which cardiac SPECT/CT data of 38 patients were included. Segmental myocardial counts of a 17-segment model from these databases were compared based on the basis of the paired t-test. Results The mean, and standard deviation of the mean square error and structural similarity index measure of the female stress phase between the proposed attenuation maps and the CT attenuation maps were 6.99±1.23% and 92±2.0%, of the male stress were 6.87±3.8% and 96±1.0%. Proposed attenuation correction and computed tomography based attenuation correction average myocardial perfusion count was significantly higher than that in non-AC in the mid-inferior, mid-lateral, basal-inferior, and lateral regions (p<0.001). Conclusion The proposed attenuation maps showed good agreement with the CT-based attenuation map. Therefore, it is feasible to enable AC for a dedicated cardiac SPECT or SPECT standalone scanners.
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Affiliation(s)
- Getu Ferenji Tadesse
- Research Center for Molecular and Cellular Imaging (RCMCI), Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences (TUMS), Tehran, Iran,Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran,St. Paul’s Hospital Millennium Medical College, Department of Internal Medicine, Addis Ababa, Ethiopia
| | - Parham Geramifar
- Tehran University of Medical Sciences, Shariati Hospital, Research Center for Nuclear Medicine, Tehran, Iran
| | - Mehrshad Abbasi
- Tehran University of Medical Sciences, Department of Nuclear Medicine, Vali-Asr Hospital, Tehran, Iran
| | - Eyachew Misganew Tsegaw
- Debre Tabor University Faculty of Natural and Computational Sciences, Department of Physics, Debre Tabor, Ethiopia
| | - Mohammad Amin
- Shahed University Faculty of Science, Department of Computer Science, Tehran, Iran
| | - Ali Salimi
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohammadi
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammed Reza Ay
- Research Center for Molecular and Cellular Imaging (RCMCI), Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences (TUMS), Tehran, Iran,Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran,* Address for Correspondence: Research Center for Molecular and Cellular Imaging (RCMCI), Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences (TUMS); Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran Phone: +989125789765 E-mail:
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2
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Waqar F, Athar MW, Dwivedi AK, Ahmad S, Sanghvi S, Scott E, Khan N, Gerson MC. Visual patterns of breast attenuation artifacts in women and men with an upright and supine cadmiun-zinc-telluride camera. J Nucl Cardiol 2022; 29:1976-1984. [PMID: 33948890 DOI: 10.1007/s12350-021-02632-8] [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: 01/05/2021] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Breast attenuation artifacts occurring with upright cadmium-zinc-telluride (CZT) cardiac imaging systems have not been well characterized. METHODS 216 consecutive patients with Single Photon Emission Computerized Tomography myocardial perfusion imaging and no angiographically significant obstructive coronary artery disease were identified. All upright and supine SPECT images as well as coronary angiograms were reviewed and analyzed in blinded fashion. RESULTS In women imaged upright, more visual false positive defects were noted in the inferior wall compared to the anterior wall (26 vs. 10 at rest, p = 0.006, and 33 vs. 13 at stress, p < 0.001). Visual inferior wall defects were more common in the upright than supine position at stress (33 vs. 23, p = 0.018) and rest (26 vs. 14, p = 0.011), and most apparent in non-obese women (13 vs. 8, at stress, p = 0.059 and 11 vs. 5, at rest, p = 0.014). CONCLUSIONS With upright CZT myocardial perfusion imaging, women often have visible inferior wall attenuation artifact defects, likely from pendant breast tissue. These inferior wall attenuation artifacts may be seen in non-obese female patients.
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Affiliation(s)
- Fahad Waqar
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert B. Sabin Way ML 0542, Cincinnati, OH, USA
| | - Muhammad W Athar
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert B. Sabin Way ML 0542, Cincinnati, OH, USA
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Saad Ahmad
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert B. Sabin Way ML 0542, Cincinnati, OH, USA
| | - Saagar Sanghvi
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elonia Scott
- Division of Nuclear Medicine, Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Naseer Khan
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert B. Sabin Way ML 0542, Cincinnati, OH, USA
| | - Myron C Gerson
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert B. Sabin Way ML 0542, Cincinnati, OH, USA.
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Bailly M, Thibault F, Courtehoux M, Metrard G, Ribeiro MJ. Impact of attenuation correction for CZT-SPECT measurement of myocardial blood flow. J Nucl Cardiol 2021; 28:2560-2568. [PMID: 32080802 DOI: 10.1007/s12350-020-02075-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/04/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Most of cardiac dedicated CZT-SPECT systems are not equipped with CT, whereas PET systems are. We evaluated the impact of AC correction on CZT-SPECT myocardial blood flow (MBF) and myocardial flow reserve (MFR) measurements. METHODS 104 patients were included. SPECT data were acquired on cadmium zinc telluride (CZT)-based pinhole cardiac camera in listmode using a stress (250 ± 17 MBq)/rest (511 ± 23 MBq) 1-day Tc-99m-tetrofosmin protocol. Low-dose CT was acquired on another SPECT/CT camera in the same position. All analysis was performed using Corridor4DM. RESULTS Stress and rest MBF were significantly lower when AC was applied (P < 0.001). For regional and global MFR, there was no significant difference between AC and NAC measurements (P > 0.25 at least). Mean global LV MFR was 2.43 ± 0.87 and 2.33 ± 0.89, respectively, for NAC and AC measurements. Using a threshold of 2, 86 patients (83%) remained classified as normal and abnormal regarding global LV MFR whether AC was applied or not. Mean difference between NAC and AC values for the 18 other patients was 0.3. CONCLUSION AC correction does not significantly affect MFR measurement both in regional and global LV analyses.
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Affiliation(s)
- Matthieu Bailly
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France.
| | - Frédérique Thibault
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
- Nuclear Medicine Department, CHRU TOURS, Tours, France
| | | | - Gilles Metrard
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
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4
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Huang JY, Huang CK, Yen RF, Chien KL, Wu YW. Diagnostic Effect of Attenuation Correction in Myocardial Perfusion Imaging in Different Coronary Arteries: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:756060. [PMID: 34712715 PMCID: PMC8545877 DOI: 10.3389/fcvm.2021.756060] [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] [Received: 08/10/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The aim of this study was to determine whether, and if so how, attenuation correction (AC) improves the diagnostic performance of myocardial perfusion imaging (MPI) in different coronary artery-supplied territories, using coronary angiography as the reference standard. Methods: PubMed and EMBASE were searched until December 2020 for studies evaluating AC MPI for the diagnosis of coronary artery disease (CAD) with vessel-based data. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. For each study, the sensitivity, specificity, diagnostic odds ratios and areas under summary receiver operating characteristic curves (AUC) with 95% confidence intervals were calculated to determine the diagnostic accuracy of AC compared to non-AC MPI. A bivariate mixed-effects model was used to pool the data. Subgroup analyses considering the type of radiotracer and type of AC were performed. Results: A total of 264 articles were screened, of which 22 studies (2,608 patients) were enrolled. Significant improvements in specificity [0.78 vs. 0.58 in overall CAD, 0.87 vs. 0.61 in right coronary artery (RCA)] and diagnostic odds ratios (16 vs. 8 in overall CAD, 18 vs. 7 in RCA) after AC were shown in overall CAD at a patient level and RCA stenosis. Improvements in AUC were also noted. MPI had a similar diagnostic performance for detecting left anterior descending and left circumflex coronary artery stenosis with or without AC. There were trends of decreased sensitivity after AC, but none were significant. Diagnostic odds ratio showed significant improvement after AC only in the technetium-99m subgroup. Conclusion: The results of this study suggest that AC should be applied to MPI to improve the diagnosis of CAD regardless of which type of radiotracer, and that AC MPI can improve the specificity of detecting RCA stenosis.
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Affiliation(s)
- Jei-Yie Huang
- Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Kai Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,National Yang Ming Chao Tung University School of Medicine, Taipei, Taiwan
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5
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Nakamura Y, Kangai Y, Abe T, Nakahara Y. [Improvement of Standardized Uptake Value Accuracy in the 99mTc Body SPECT and SPECT/CT: Optimization of the Phantom for Calculating Becquerel Calibration Factor and Correction Method]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:921-931. [PMID: 34544916 DOI: 10.6009/jjrt.2021_jsrt_77.9.921] [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] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the best phantom for calculating the becquerel calibration factor (BCF) and correction method to obtain the improvement of standardized uptake value (SUV) accuracy in both single photon emission computed tomography (SPECT) and SPECT/CT. METHOD A SPECT/CT scanner was used in this study. BCFs were calculated using four phantoms with different cross sections including National Electrical Manufacturers Association International Electrotechnical Commission body phantom (NEMA IEC body phantom) filled with 99mTcO4-, and five correction methods were used for reconstruction. SUVs were calculated by the NEMA IEC body phantom and pediatric phantom in house with these BCFs. We then measured SUVmean in the background region of the NEMA IEC body phantom, SUVmax and SUVpeak of the 37-mm-diameter sphere. RESULTS In the SPECT scanner, SUVmean and SUVmax measured 1.04 and 4.02, respectively, in the case of BCF calculation and SUV measurement using NEMA IEC body phantoms without corrections. In the SPECT/CT scanner, SUVmean with CT attenuation correction (AC) was in agreement with the theoretical values using each phantom. SUVmax showed the same trend. CONCLUSION In the SPECT scanner, it is possible to obtain a highly accurate SUV by using a phantom that matches the size of the subject for BCF calculation and without correction. In the SPECT/CT scanner, highly accurate SUVs can be obtained by using CT-based attenuation correction, and these values do not depend on the size of the BCF calculation phantom.
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Affiliation(s)
- Yuto Nakamura
- Department of Radiological Technology, Yamaguchi University Hospital
| | - Yoshiharu Kangai
- Department of Radiological Technology, Yamaguchi University Hospital
| | - Toshinori Abe
- Department of Radiological Technology, Kawasaki Medical School Hospital
| | - Yuki Nakahara
- Department of Radiological Technology, Yamaguchi University Hospital
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Cuddy-Walsh SG, Wells RG. Noise heterogeneity in attenuation-corrected cardiac SPECT images increases perfusion value uncertainty near the base of the heart. J Nucl Cardiol 2021; 28:1284-1293. [PMID: 31332658 DOI: 10.1007/s12350-019-01821-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/09/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dedicated cardiac SPECT cameras which employ multi-pinhole detectors have variable photon sensitivity within the camera's field-of-view such that a lower number of photon counts is typically detected from the base of the heart than from the apex. Consequently, the noise in a reconstructed image is expected to be higher at the base than at the apex of the heart. METHODS Patient emission images were resampled to create statistical replicates which were reconstructed with and without attenuation correction. Noise images were computed using one standard deviation of the replicated images. These were evaluated for 93 patients with normal study results, each imaged with both a dual-headed parallel-hole camera and a multi-pinhole camera. Statistics for a normal database (NDB) of images from the 93 patients were also calculated. RESULTS Image noise (1.7-fold) and NDB uncertainty (1.3-fold) increase significantly from the apex-to-the base of the heart in attenuation-corrected multi-pinhole SPECT images. The differences for non-attenuation-corrected images or those acquired with a parallel-hole camera were not significant. CONCLUSIONS For best interpretation of attenuation-corrected images acquired with multi-pinhole cameras, knowledge of NDB uncertainty gradients should be taken into consideration.
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Affiliation(s)
- Sarah G Cuddy-Walsh
- Department of Physics, Carleton University, Ottawa, ON, Canada.
- Division of Cardiology, University of Ottawa Heart Institute, H2243 - 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| | - R Glenn Wells
- Department of Physics, Carleton University, Ottawa, ON, Canada
- Division of Cardiology, University of Ottawa Heart Institute, H2243 - 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
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7
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Grossman GB, Baptista IS. Quantitative analysis: Specific normal database for the best practice. J Nucl Cardiol 2021; 28:1294-1297. [PMID: 31646468 DOI: 10.1007/s12350-019-01902-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 08/12/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Gabriel Blacher Grossman
- Nuclear Medicine Department, Hospital Moinhos de Vento, Porto Alegre, Brazil.
- Cardionuclear, Instituto de Cardiologia, Porto Alegre, Brazil.
| | - Ilo S Baptista
- Nuclear Medicine Department, Hospital Moinhos de Vento, Porto Alegre, Brazil
- Cardionuclear, Instituto de Cardiologia, Porto Alegre, Brazil
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8
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Tantawy HM, Abdelhafez YG, Helal NL, Saad IE. Variation of Contrast Values for Myocardial Perfusion Imaging in Single-photon Emission Computed Tomography/Computed Tomography Hybrid Systems with Different Correction Methods. J Clin Imaging Sci 2020; 10:58. [PMID: 33024613 PMCID: PMC7533088 DOI: 10.25259/jcis_123_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/27/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives: Single-photon emission computed tomography/computed tomography (SPECT/CT) hybrid systems have the advantage of performing various scans using the same imaging setting. Absorption and scattering of the gamma rays by the patient’s body significantly affect images obtained from scintigraphy, especially in myocardial perfusion imaging. An important parameter for image quality in SPECT is image contrast which is defined as the difference in density between regions of the image corresponding to different levels of radioactive uptake in the patient. The objective of the study was to evaluate the influence of applying different correction methods on image contrast of myocardial SPECT/CT images. Material and Methods: A total of 114 patients, 43 females and 71 males, patient’s raw data were processed and analyzed using attenuation correction (AC), scatter correction (SC), both attenuation and scatter correction together (ACSC), and no correction (NC). The short axis (coronal) slices resulted from the raw data reconstruction were chosen to perform the processing for hot and cold spheres for contrast values measurement. Statistical analysis was made for the measured contrast values for AC, SC, ACSC, and NC to determine the best image contrast. Results: When applying SC alone, it yields better contrast value (0.834), compared to AC (0.677) and ACSC (0.739). Both ACSC and AC had better image contrast compared to NC (0.592). Conclusion: The intercomparison study between the correction conditions indicates that the counts in SPECT/ CT are highly affected by all correction methods. The image contrast has been significantly improved by using SC, AC, and ACSC when compared with the NC image. Furthermore, SC is superior in the image contrast than the other correction conditions in the reconstruction of SPECT/CT MPI.
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Affiliation(s)
- Hazem M. Tantawy
- Department of Nuclear Medicine Technology, Inaya Medical Colleges, Riyadh, Saudi Arabia,
| | - Yasser G. Abdelhafez
- Department of Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Assiut, Egypt,
| | - Nadia L. Helal
- Department of Radiation Safety, Egyptian Nuclear and Radiological Regulatory Authority, Cairo, Egypt,
| | - Ibrahim E. Saad
- Department of Nuclear Medicine Technology, Inaya Medical Colleges, Riyadh, Saudi Arabia,
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9
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Grossman GB. Myocardial perfusion imaging in overweight patients and women: Is it CZT good enough? J Nucl Cardiol 2020; 27:769-773. [PMID: 30963418 DOI: 10.1007/s12350-019-01656-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Gabriel Blacher Grossman
- Nuclear Medicine Department, Hospital Moinhos de Vento, Porto Alegre, Brazil.
- Cardionuclear, Instituto de Cardiologia, Porto Alegre, Brazil.
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10
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Grossmann M, Giannopoulos AA, Bechtiger FA, Messerli M, Schwyzer M, Benz DC, Kudura K, Gebhard C, Gräni C, Pazhenkottil AP, Kaufmann PA, Buechel RR. Ultra-low-dose computed tomography for attenuation correction of cadmium-zinc-telluride single photon emission computed tomography myocardial perfusion imaging. J Nucl Cardiol 2020; 27:228-237. [PMID: 29923103 DOI: 10.1007/s12350-018-1303-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The applicability of ultra-low-dose computed tomography (CT) for attenuation correction (AC) of single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI) remains elusive. METHODS AND RESULTS One-hundred patients underwent one-day 99mTc-tetrofosmin stress-rest MPI and non-contrast enhanced cardiac CT with 120, 80, and 70 kilovolt peak (kVp) tube voltage and tube current of 200 milliamperes for creation of AC maps. Normalized percent myocardial uptake from SPECT-MPI using 80 kVp scans for AC showed excellent correlation vs AC from 120 kVp scans for stress [intraclass correlation (ICC) = 0.988, 95% CI = 0.986-0.989, P < .001] and rest (ICC = 0.985, 95% CI = 0.983-0.987, P < .001) with narrow Bland-Altman limits of agreement (BA-LA) (- 5.3% to 4.5% and - 5.4% to 4.4%, respectively) and minimal bias (- 0.4% and - 0.5%, respectively). Correlation of AC SPECT-MPI based on 70 vs 120 kVp scans was excellent for stress (ICC = 0.988, 95% CI = 0.986-0.989, P < .001) and rest (ICC = 0.986, 95% CI = 0.984-0.987, P < .001) with narrow BA-LA (- 5.3% to 4.4% and - 5.2% to 4.5%, respectively) and small bias (- 0.4% and - 0.3%, respectively). Mean effective radiation dose for the 120, 80 and 70 kVp scans were 0.58 ± 0.07, 0.19 ± 0.02, and 0.12 ± 0.01 mSv, respectively. CONCLUSIONS Attenuation maps for MPI obtained from ultra-low radiation dose CT scans are interchangeable with attenuation maps from standard-dose CT while offering a substantial reduction in radiation dose exposure.
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Affiliation(s)
- Marvin Grossmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Fabiola A Bechtiger
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Moritz Schwyzer
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ken Kudura
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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11
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Garcia EV, Slomka P, Moody JB, Germano G, Ficaro EP. Quantitative Clinical Nuclear Cardiology, Part 1: Established Applications. J Nucl Cardiol 2020; 27:189-201. [PMID: 31654215 DOI: 10.1007/s12350-019-01906-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has attained widespread clinical acceptance as a standard of care for patients with known or suspected coronary artery disease (CAD). A significant contribution to this success has been the use of computer techniques to provide objective quantitative assessment in the standardization of the interpretation of these studies. Software platforms have been developed as a pipeline to provide the quantitative algorithms researched, developed and validated to be clinically useful so diagnosticians everywhere can benefit from these tools. The goal of this CME article (PART 1) is to describe the many quantitative tools that are clinically established and more importantly how clinicians should use them routinely in the interpretation, clinical management and therapy guidance of patients with CAD.
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Affiliation(s)
- Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, 101 Woodruff Circle, Room 1203, Atlanta, GA, 30322, USA.
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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12
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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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13
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Garcia EV, Slomka P, Moody JB, Germano G, Ficaro EP. Quantitative Clinical Nuclear Cardiology, Part 1: Established Applications. J Nucl Med 2019; 60:1507-1516. [PMID: 31375569 DOI: 10.2967/jnumed.119.229799] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/11/2019] [Indexed: 01/10/2023] Open
Abstract
SPECT myocardial perfusion imaging has attained widespread clinical acceptance as a standard of care for patients with known or suspected coronary artery disease. A significant contribution to this success has been the use of computer techniques to provide objective quantitative assessment in the standardization of the interpretation of these studies. Software platforms have been developed as a pipeline to provide the quantitative algorithms researched, developed and validated to be clinically useful so diagnosticians everywhere can benefit from these tools. The goal of this continuing medical education article (part 1) is to describe the many quantitative tools that are clinically established and, more importantly, how clinicians should use them routinely in interpretation, clinical management, and therapy guidance for patients with coronary artery disease.
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Affiliation(s)
- Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, Ann Arbor, Michigan; and.,Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Scabbio C, Zoccarato O, Malaspina S, Lucignani G, Del Sole A, Lecchi M. Impact of non-specific normal databases on perfusion quantification of low-dose myocardial SPECT studies. J Nucl Cardiol 2019; 26:775-785. [PMID: 29043555 DOI: 10.1007/s12350-017-1079-5] [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: 07/05/2017] [Accepted: 09/16/2017] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the impact of non-specific normal databases on the percent summed rest score (SR%) and stress score (SS%) from simulated low-dose SPECT studies by shortening the acquisition time/projection. METHODS Forty normal-weight and 40 overweight/obese patients underwent myocardial studies with a conventional gamma-camera (BrightView, Philips) using three different acquisition times/projection: 30, 15, and 8 s (100%-counts, 50%-counts, and 25%-counts scan, respectively) and reconstructed using the iterative algorithm with resolution recovery (IRR) AstonishTM (Philips). Three sets of normal databases were used: (1) full-counts IRR; (2) half-counts IRR; and (3) full-counts traditional reconstruction algorithm database (TRAD). The impact of these databases and the acquired count statistics on the SR% and SS% was assessed by ANOVA analysis and Tukey test (P < 0.05). RESULTS Significantly higher SR% and SS% values (> 40%) were found for the full-counts TRAD databases respect to the IRR databases. For overweight/obese patients, significantly higher SS% values for 25%-counts scans (+19%) are confirmed compared to those of 50%-counts scan, independently of using the half-counts or the full-counts IRR databases. CONCLUSIONS AstonishTM requires the adoption of the own specific normal databases in order to prevent very high overestimation of both stress and rest perfusion scores. Conversely, the count statistics of the normal databases seems not to influence the quantification scores.
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Affiliation(s)
| | - Orazio Zoccarato
- Unit of Nuclear Medicine, I.C.S. Maugeri S.p.A. SB, Scientific Institute of Veruno IRCCS, Veruno, NO, Italy
| | - Simona Malaspina
- Nuclear Medicine Unit, Department of Diagnostic Services, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giovanni Lucignani
- Nuclear Medicine Unit, Department of Diagnostic Services, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Angelo Del Sole
- Nuclear Medicine Unit, Department of Diagnostic Services, ASST Santi Paolo e Carlo, Milan, Italy.
- Department of Health Sciences, University of Milan, Milan, Italy.
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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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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: 211] [Impact Index Per Article: 35.2] [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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Slomka P, Germano G. Factors affecting appearance of a normal myocardial perfusion scan. J Nucl Cardiol 2018; 25:1655-1657. [PMID: 28361475 DOI: 10.1007/s12350-017-0857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Piotr Slomka
- Department of Medicine, Cedars-Sinai Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, USA.
| | - Guido Germano
- Department of Medicine, Cedars-Sinai Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, USA
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Okuda K, Nakajima K, Matsuo S, Kondo C, Sarai M, Horiguchi Y, Konishi T, Onoguchi M, Shimizu T, Kinuya S. Creation and characterization of normal myocardial perfusion imaging databases using the IQ·SPECT system. J Nucl Cardiol 2018; 25:1328-1337. [PMID: 28050865 DOI: 10.1007/s12350-016-0770-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 12/10/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Image acquisition by short-time single-photon emission-computed tomography (SPECT) has been made feasible by IQ·SPECT. The aim of this study was to generate normal databases (NDBs) of thallium-201 (201Tl) myocardial perfusion imaging for IQ·SPECT, and characterize myocardial perfusion distribution. METHODS AND RESULTS We retrospectively enrolled 159 patients with a low likelihood of cardiac diseases from four hospitals in Japan. All patients underwent short-time 201Tl myocardial perfusion IQ·SPECT with or without attenuation and scatter correction (ACSC) in either supine or prone position. The mean myocardial counts were calculated using 17-segment polar maps. Three NDBs were derived from supine and prone images as well as supine images with ACSC. Differences between the supine and prone positions were observed in the uncorrected sex-segregated NDBs in the mid-inferolateral counts (p ≤ 0.016 for males and p ≤ 0.002 for females). Differences between IQ·SPECT and conventional SPECT were also observed in the mid-anterior, inferolateral, and apical lateral counts (p ≤ 0.009 for males and p ≤ 0.003 for females). Apical low counts attributed to myocardial thinning were observed in the apical anterior and apex segments in the supine IQ·SPECT NDB with ACSC. CONCLUSIONS There were significant differences between uncorrected supine and prone NDBs, between uncorrected supine NDB and supine NDB with ACSC, and between uncorrected supine NDB and conventional SPECT NDB. Understanding the pattern of normal distribution in IQ-SPECT short-time acquisitions with and without ACSC will be helpful for interpretation of imaging findings in patients with coronary artery disease (CAD) or low likelihood of CAD and the NDBs will aid in quantitative analysis.
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Affiliation(s)
- Koichi Okuda
- Department of Physics, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Chisato Kondo
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University Hospital, Aichi, Japan
| | - Yoriko Horiguchi
- Department of Cardiology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Takahiro Konishi
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Kanazawa University, Kanazawa, Japan
| | - Takeshi Shimizu
- Department of Molecular Imaging, Siemens Healthcare K.K., Tokyo, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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Galt JR. New techniques, distinctive population, unique normal databases. J Nucl Cardiol 2018; 25:1338-1341. [PMID: 28474193 DOI: 10.1007/s12350-017-0876-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Affiliation(s)
- James R Galt
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, Atlanta, Georgia, 30322, USA.
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Zoccarato O, Marcassa C, Lizio D, Leva L, Lucignani G, Savi A, Scabbio C, Matheoud R, Lecchi M, Brambilla M. Differences in polar-map patterns using the novel technologies for myocardial perfusion imaging. J Nucl Cardiol 2017; 24:1626-1636. [PMID: 27233252 DOI: 10.1007/s12350-016-0500-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND New technologies are available in MPI. Our aim was to evaluate their impact on the uniformity of normal myocardial uptake in the polar-map representation, over different count statistics, with and without the attenuation (AC) and scatter corrections (SC). METHODS A phantom study was performed using 5 Anger gamma cameras with filtered back projection or iterative reconstruction with resolution recovery (IRR), with or without SCAC; a D530c, with or without AC; and a D-SPECT. Count statistics ranged up to a quarter of the reference for the conventional gamma cameras and up to one half for the advanced scanners. Using polar maps, the segmental uptakes and their uncertainties, the 'global uniformity' of polar maps expressed as the coefficient of variation (COV) among the segmental uptakes and the anterior/inferior (ANT/INF) ratio were calculated. RESULTS Both segmental uptakes and their uncertainties did not depend on the count statistics in the range studied. An increase in the segmental uptakes was found from IRR to IRR + SCAC (78.0% ± 13.5% vs 86.1% ± 9.4%; P < .0001). COV was lower for D-SPECT (10.1% ± 0.5%) and after SCAC for both conventional (9.9% ± 3.0%) and advanced systems (8.9% ± 1.7%). The ANT/INF ratio was above 1 for IRR (1.12 ± 0.07) and fell slightly below 1 for IRR + SCAC (0.97 ± 0.05). CONCLUSIONS To compare data from the analysis of polar maps across different systems will require the adoption of specific normality databases, developed for each system and reconstruction method employed.
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Affiliation(s)
- Orazio Zoccarato
- Unit of Nuclear Medicine and Department of Cardiology, S. Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, NO, Italy
| | - Claudio Marcassa
- Unit of Nuclear Medicine and Department of Cardiology, S. Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, NO, Italy
| | - Domenico Lizio
- Departments of Medical Physics and Nuclear Medicine, University Hospital 'Maggiore della Carità', Novara, Italy
| | - Lucia Leva
- Departments of Medical Physics and Nuclear Medicine, University Hospital 'Maggiore della Carità', Novara, Italy
| | - Giovanni Lucignani
- Department of Health Sciences, University of Milan and Nuclear Medicine Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Annarita Savi
- Nuclear Medicine Department, IRCCS San Raffaele Hospital, Milan, Italy
| | - Camilla Scabbio
- Department of Health Sciences, University of Milan and Nuclear Medicine Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Roberta Matheoud
- Departments of Medical Physics and Nuclear Medicine, University Hospital 'Maggiore della Carità', Novara, Italy
| | - Michela Lecchi
- Department of Health Sciences, University of Milan and Nuclear Medicine Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Marco Brambilla
- Departments of Medical Physics and Nuclear Medicine, University Hospital 'Maggiore della Carità', Novara, Italy.
- Medical Physics Department, University Hospital of Novara, Novara, Italy.
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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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Lyon MC, Foster C, Ding X, Dorbala S, Spence D, Bhattacharya M, Vija AH, DiCarli MF, Moore SC. Dose reduction in half-time myocardial perfusion SPECT-CT with multifocal collimation. J Nucl Cardiol 2016; 23:657-67. [PMID: 27033352 DOI: 10.1007/s12350-016-0471-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent technological advances in myocardial perfusion imaging may warrant the use of lower injected activity. We evaluated whether quantitative measures of stress myocardial perfusion defects using Tc-99m sestamibi and low-energy high-resolution (LEHR) collimators are equivalent to lower dose SPECT-CT with cardiac multifocal collimators and software (IQ·SPECT). METHODS 93 patients underwent one-day rest-stress gated SPECT-CT. Following conventional rest imaging, 925-1100 MBq (25-30 mCi) of Tc-99m sestamibi was injected during stress testing. Stress SPECT-CT images were acquired two ways: with LEHR (13 minutes) and IQ·SPECT (7 minutes). Low-dose IQ·SPECT stress was simulated by subsampling the full-dose data to half-, quarter-, and eighth-count levels. Abnormalities were quantified using the total perfusion deficit (TPD) score and dose-specific databases. RESULTS The mean ± SD of the differences between LEHR and IQ·SPECT TPD scores were -1.01 ± 5.36%, -0.10 ± 5.81%, 1.78 ± 4.81%, and 1.75 ± 6.05% at full, half, quarter, and eighth doses, respectively. Differences were statistically significant for quarter and eighth doses. Correlation between LEHR and IQ·SPECT was excellent at all doses (R ≥ 0.93). Bland-Altman plots demonstrated minimal bias. CONCLUSIONS With IQ·SPECT, quantitative stress SPECT-CT imaging is possible with half of the standard injected activity in half the time.
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Affiliation(s)
- Morgan C Lyon
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Radiology, Harvard Medical School, Boston, MA, USA.
- inviCRO, 27 Drydock Ave, Boston, MA, 02210, USA.
| | - Courtney Foster
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Xinhong Ding
- Molecular Imaging, Siemens Medical Solutions USA, Inc., Hoffman Estates, IL, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Don Spence
- Molecular Imaging, Siemens Medical Solutions USA, Inc., Hoffman Estates, IL, USA
| | | | - A Hans Vija
- Molecular Imaging, Siemens Medical Solutions USA, Inc., Hoffman Estates, IL, USA
| | - Marcelo F DiCarli
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Stephen C Moore
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW Myocardial perfusion imaging (MPI) with SPECT is performed clinically worldwide to detect and monitor coronary artery disease (CAD). MPI allows an objective quantification of myocardial perfusion at stress and rest. This established technique relies on normal databases to compare patient scans against reference normal limits. In this review, we aim to introduce the process of MPI quantification with normal databases and describe the associated perfusion quantitative measures that are used. RECENT FINDINGS New equipment and new software reconstruction algorithms have been introduced which require the development of new normal limits. The appearance and regional count variations of normal MPI scan may differ between these new scanners and standard Anger cameras. Therefore, these new systems may require the determination of new normal limits to achieve optimal accuracy in relative myocardial perfusion quantification. Accurate diagnostic and prognostic results rivaling those obtained by expert readers can be obtained by this widely used technique. SUMMARY Throughout this review, we emphasize the importance of the different normal databases and the need for specific databases relative to distinct imaging procedures. use of appropriate normal limits allows optimal quantification of MPI by taking into account subtle image differences due to the hardware and software used, and the population studied.
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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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Aggarwal NR, Drozdova A, Askew JW, Kemp BJ, Chareonthaitawee P. Feasibility and diagnostic accuracy of exercise treadmill nitrogen-13 ammonia PET myocardial perfusion imaging of obese patients. J Nucl Cardiol 2015; 22:1273-80. [PMID: 25777780 DOI: 10.1007/s12350-015-0073-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Treadmill exercise nitrogen-13 ((13)N)-ammonia positron emission tomography (PET) has logistical challenges and limited literature. We aimed to assess its feasibility, image quality, and diagnostic accuracy in obese and nonobese patients. METHODS AND RESULTS Between 2009 and 2012, 10,804 patients were referred for myocardial perfusion imaging, including 300 for treadmill PET, of whom 265 were included in this study. Treadmill testing and PET were performed using standard procedures. Image quality, perfusion, and summed stress score (SSS) were assessed. Invasive coronary angiography was performed within 90 days of PET in 43 patients. Mean ± SD body mass index (BMI) was 35.7 ± 7.7 kg/m(2) (range 19.5-63.5 kg/m(2)). Feasibility of treadmill (13)N-ammonia PET was 100%. Exercise duration was less for obese patients than nonobese patients (P < .001). Image quality was rated good for 96.9% of obese and 100% of nonobese patients. For all patients, sensitivity was 86.4% and specificity was 74.4%. Diagnostic accuracy did not change significantly with increasing BMI. SSS remained significant in predicting angiographic coronary artery disease after adjustment for age, sex, and Duke treadmill score. CONCLUSIONS Treadmill (13)N-ammonia PET is highly feasible, yields good image quality, and has moderately high diagnostic accuracy in a small subset of obese and nonobese patients who are deemed able to perform treadmill exercise.
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Affiliation(s)
- Niti R Aggarwal
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Adela Drozdova
- International Clinical Research Center - Center of Molecular Imaging, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - J Wells Askew
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Bradley J Kemp
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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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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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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Petretta M, Nappi C, Cuocolo A. Quantification of myocardial perfusion in clinical trials. J Nucl Cardiol 2015; 22:262-5. [PMID: 25287736 DOI: 10.1007/s12350-014-0003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
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Abstract
The American Society of Nuclear Cardiology has recently published documents that encourage laboratories to take all the appropriate steps to greatly decrease patient radiation dose and has set the goal of 50% of all myocardial perfusion studies performed with an associated radiation exposure of 9mSv by 2014. In the present work, a description of the major software techniques readily available to shorten procedure time and decrease injected activity is presented. Particularly new reconstruction methods and their ability to include means for resolution recovery and noise regularization are described. The use of these improved reconstruction algorithms results in a consistent reduction in acquisition time, injected activity and consequently in the radiation dose absorbed by the patient. The clinical implications to the use of these techniques are also described in terms of maintained and even improved study quality, accuracy and sensitivity for the detection of heart disease.
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Esteves FP, Travin MI. The Role of Nuclear Cardiology in the Diagnosis and Risk Stratification of Women With Ischemic Heart Disease. Semin Nucl Med 2014; 44:423-38. [DOI: 10.1053/j.semnuclmed.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Is computed tomography attenuation correction more efficient than gated single photon emission computed tomography analysis in improving the diagnostic performance of myocardial perfusion imaging in patients with low prevalence of ischemic heart disease? Nucl Med Commun 2014; 36:69-77. [PMID: 25279709 DOI: 10.1097/mnm.0000000000000218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to compare computed tomography (CT)-based attenuation correction (AC) using a hybrid single photon emission computed tomography (SPECT)-CT system and quantitative analysis of wall thickening using gated SPECT with regard to the diagnostic accuracy of myocardial perfusion imaging. MATERIALS AND METHODS We prospectively included 70 patients with low prevalence of acute coronary artery disease who underwent a myocardial stress-rest SPECT study. Interpretation was based on supine nongated SPECT data with (AC) or without (NC) CT-based attenuation correction, and on gated SPECT data without attenuation correction (GNC). The scintigraphic diagnosis was obtained using standard automated quantitative analysis software and compared with a 23±14 months' clinical follow-up for 57 patients or with the results of a coronary angiography for 13 patients. RESULTS The sensitivity, specificity, and overall accuracy were, respectively, 77, 60, and 63% for NC SPECT, 67, 81, and 79% for AC SPECT, and 69, 98, and 93% for GNC SPECT. The initial diagnosis was modified in about one-third of the cases for both AC and GNC, this rate being independent of any clinical parameter (including BMI) except sex (two to four times more artifact correction in men). CONCLUSION Its widespread availability, cost effectiveness, safety in terms of radiation exposure, and ability to significantly improve myocardial perfusion imaging specificity and accuracy make gated SPECT a self-sufficient modality for coronary artery disease screening and follow-up, whereas CT-AC should be discussed on a case-by-case basis.
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Esteves FP, Galt JR, Folks RD, Verdes L, Garcia EV. Diagnostic performance of low-dose rest/stress Tc-99m tetrofosmin myocardial perfusion SPECT using the 530c CZT camera: quantitative vs visual analysis. J Nucl Cardiol 2014; 21:158-65. [PMID: 24287713 DOI: 10.1007/s12350-013-9827-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/07/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND We set out to develop normal databases and prospectively validate abnormality criteria for a low-dose Tc-99m tetrofosmin myocardial perfusion SPECT protocol using the 530c CZT camera. METHODS All patients received 6 mCi rest/20 mCi stress doses of Tc-99m tetrofosmin. Rest and stress images were obtained over 7-9 and 5-7 minutes according to the chest size. Low-dose CT of the chest was obtained on a standalone CT scanner. Forty patients with very low likelihood (LLK) of coronary artery disease (CAD) were used to define the normal count distributions. The abnormality criteria were prospectively validated in 55 patients who had coronary angiography and in 40 patients with LLK of CAD. RESULTS The results for quantitative non-attenuation-corrected (AC) and AC analysis and visual analysis were as follows: sensitivity of 79%, 85%, and 92% (P = NS) and specificity of 44%, 75%, and 56% (P = NS), respectively. The normalcy rates for quantitative non-AC and AC analyses and visual analysis were 95%, 98%, and 98% (P = NS). CONCLUSIONS We have developed non-AC and AC normal databases for low-dose rest/stress Tc-99m tetrofosmin myocardial perfusion SPECT protocol using the 530c CZT camera. The per-patient diagnostic performance of quantitative analyses is not significantly different from visual analysis by an experienced reader.
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Affiliation(s)
- Fabio P Esteves
- Department of Radiology, Emory University School of Medicine, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA,
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Case JA, Bateman TM. Taking the perfect nuclear image: quality control, acquisition, and processing techniques for cardiac SPECT, PET, and hybrid imaging. J Nucl Cardiol 2013; 20:891-907. [PMID: 23868070 DOI: 10.1007/s12350-013-9760-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nuclear Cardiology for the past 40 years has distinguished itself in its ability to non-invasively assess regional myocardial blood flow and identify obstructive coronary disease. This has led to advances in managing the diagnosis, risk stratification, and prognostic assessment of cardiac patients. These advances have all been predicated on the collection of high quality nuclear image data. National and international professional societies have established guidelines for nuclear laboratories to maintain high quality nuclear cardiology services. In addition, laboratory accreditation has further advanced the goal of the establishing high quality standards for the provision of nuclear cardiology services. This article summarizes the principles of nuclear cardiology single photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging and techniques for maintaining quality: from the calibration of imaging equipment to post processing techniques. It also will explore the quality considerations of newer technologies such as cadmium zinc telleride (CZT)-based SPECT systems and absolute blood flow measurement techniques using PET.
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Affiliation(s)
- James A Case
- Saint-Luke's Mid America Heart Institute, Kansas City, MO, USA,
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Arsanjani R, Xu Y, Hayes SW, Fish M, Lemley M, Gerlach J, Dorbala S, Berman DS, Germano G, Slomka P. Comparison of fully automated computer analysis and visual scoring for detection of coronary artery disease from myocardial perfusion SPECT in a large population. J Nucl Med 2013; 54:221-8. [PMID: 23315665 DOI: 10.2967/jnumed.112.108969] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED We compared the performance of fully automated quantification of attenuation-corrected (AC) and noncorrected (NC) myocardial perfusion SPECT (MPS) with the corresponding performance of experienced readers for detection of coronary artery disease (CAD). METHODS Rest-stress (99m)Tc-sestamibi MPS studies (n = 995; 650 consecutive cases with coronary angiography and 345 with likelihood of CAD < 5%) were obtained by MPS with AC. The total perfusion deficit (TPD) for AC and NC data was compared with the visual summed stress and rest scores of 2 experienced readers. Visual reads were performed in 4 consecutive steps with the following information progressively revealed: NC data, AC + NC data, computer results, and all clinical information. RESULTS The diagnostic accuracy of TPD for detection of CAD was similar to both readers (NC: 82% vs. 84%; AC: 86% vs. 85%-87%; P = not significant) with the exception of the second reader when clinical information was used (89%, P < 0.05). The receiver-operating-characteristic area under the curve (ROC AUC) for TPD was significantly better than visual reads for NC (0.91 vs. 0.87 and 0.89, P < 0.01) and AC (0.92 vs. 0.90, P < 0.01), and it was comparable to visual reads incorporating all clinical information. The per-vessel accuracy of TPD was superior to one reader for NC (81% vs. 77%, P < 0.05) and AC (83% vs. 78%, P < 0.05) and equivalent to the second reader (NC, 79%; and AC, 81%). The per-vessel ROC AUC for NC (0.83) and AC (0.84) for TPD was better than that for the first reader (0.78-0.80, P < 0.01) and comparable to that of the second reader (0.82-0.84, P = not significant) for all steps. CONCLUSION For detection of ≥70% stenoses based on angiographic criteria, a fully automated computer analysis of NC and AC MPS data is equivalent for per-patient and can be superior for per-vessel analysis, when compared with expert analysis.
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Affiliation(s)
- Reza Arsanjani
- Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Trägårdh E, Sjöstrand K, Edenbrandt L. Normal stress databases in myocardial perfusion scintigraphy--how many subjects do you need? Clin Physiol Funct Imaging 2012; 32:455-62. [PMID: 23031066 DOI: 10.1111/j.1475-097x.2012.01149.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 06/08/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Commercial normal stress databases in myocardial perfusion scintigraphy (MPS) commonly consist of 30-40 individuals. The aim of the study was to determine how many subjects are needed. METHODS Four normal stress databases were developed using patients who underwent 99mTc MPS: non-corrected images (NC) for male, NC for female, attenuation-corrected images (AC) for male and AC for female subjects. 126 male and 205 female subjects were included. The normal database was created by alternatingly computing the mean of all normal subjects and normalizing the subjects with respect to this mean, until convergence. Coefficients of variation (CV) were created for increasing number of included patients in the four different normal stress databases. RESULTS Normal stress databases with < 35 subjects had a high CV. Mean CV -2 standard deviations (SD) decreased with 28% between two and five included subjects, 71% between two and 35 subjects and 83% between two and 100 included subjects for NC man. CONCLUSIONS We conclude that the commonly used 30-40 individuals for making a normal stress database might not be enough due to the high CV. We propose that normal stress databases should consist of more than 30-40 individuals, preferably more than 50 individuals, both for NC and AC studies.
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Affiliation(s)
- Elin Trägårdh
- Clinical Physiology and Nuclear Medicine Unit, Skåne University Hospital, Lund University, Malmö, Sweden
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Garcia EV. Quantitative Nuclear Cardiology: we are almost there! J Nucl Cardiol 2012; 19:424-37. [PMID: 22466989 DOI: 10.1007/s12350-012-9551-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 03/09/2012] [Indexed: 02/02/2023]
Affiliation(s)
- Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Rd, NE, Atlanta, GA 30322, USA.
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Willowson K, Bailey D, Schembri G, Baldock C. CT-based quantitative SPECT for the radionuclide ²⁰¹Tl: experimental validation and a standardized uptake value for brain tumour patients. Cancer Imaging 2012; 12:31-40. [PMID: 22375306 PMCID: PMC3335331 DOI: 10.1102/1470-7330.2012.0005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We have previously reported on a method for reconstructing quantitative data from 99mTc single photon emission computed tomography (SPECT) images based on corrections derived from X-ray computed tomography, producing accurate results in both experimental and clinical studies. This has been extended for use with the radionuclide ²⁰¹Tl. Accuracy was evaluated with experimental phantom studies, including corrections for partial volume effects where necessary. The quantitative technique was used to derive standardized uptake values (SUVs) for ²⁰¹Tl evaluation of brain tumours. A preliminary study was performed on 26 patients using ²⁰¹Tl SPECT scans to assess residual tumor after surgery and then to monitor response to treatment, with a follow-up time of 18 months. Measures of SUVmax were made following quantitative processing of the data and using a threshold grown volume of interest around the tumour. Phantom studies resulted in the calculation of concentration values consistently within 4% of true values. No continuous relation was found between SUVmax (post-resection) and patient survival. Choosing an SUVmax cut-off of 1.5 demonstrated a difference in survival between the 2 groups of patients after surgery. Patients with an SUVmax<1.5 had a 70% survival rate over the first 10 months, compared with a 47% survival rate for those with SUVmax>1.5. This difference did not achieve significance, most likely due to the small study numbers. By 18 months follow-up this difference had reduced, with corresponding survival rates of 40% and 27%, respectively. Although this study involves only a small cohort, it has succeeded in demonstrating the possibility of an SUV measure for SPECT to help monitor response to treatment of brain tumours and predict survival.
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Affiliation(s)
- Kathy Willowson
- Institute of Medical Physics, School of Physics, University of Sydney, Camperdown, NSW 2006, Australia.
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Zafrir N, Shafir G, Kovalski G, Mats I, Bouhnik JP, Battler A, Solodky A. Yield of a novel ultra-low-dose computed tomography device mounted on a dedicated cardiac SPECT system in improving the accuracy of myocardial perfusion imaging and the detection of chest abnormalities. J Nucl Cardiol 2012; 19:303-10. [PMID: 22203447 DOI: 10.1007/s12350-011-9498-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND To examine the yield of an ultra-low-dose computed tomography (CT) transmission module for attenuation-correction (AC) on a dedicated cardiac camera in evaluation of SPECT-myocardial perfusion imaging (MPI) in the diagnosis of CAD and for additional chest abnormalities. METHODS The study group included 150 patients with known or suspected CAD referred for technetium sestamibi SPECT MPI. CT transmission scanning (effective radiation 0.17 mSv) was performed after each gated SPECT scan. AC and non-corrected (NC) SPECT scans were evaluated on a 5-point scale using a 17-segment model, and the sum stress score (SSS) and sum rest score (SRS) were calculated for each condition. Overall image quality, sensitivity and normalcy rate (51 patients) and processing of 28 CT slices were screened for chest findings. RESULTS CT-based AC significantly improved image quality (P = .01). Mean SSS was 3.8 ± 5.8 with AC and 6.1 ± 7.1 with NC (P < .001); the respective SRS values were 2.6 ± 6.3 and 3.9 ± 7.7 (P < .001). The sensitivity of detecting ≥70% stenosis was 71% and 86% (P = NS) and the normalcy rate was 30% and 89% (P < .0001) in NC and AC SPECT MPI, respectively. Chest CT: lung abnormalities in 31%, aortic calcifications in 27%, and hiatus hernia in 5%. CONCLUSIONS Ultra-low-dose CT for AC of SPECT-MPI improves image quality, diagnostic accuracy and suggests detection of chest findings.
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Affiliation(s)
- Nili Zafrir
- Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
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Nakazato R, Berman DS, Dey D, Le Meunier L, Hayes SW, Fermin JS, Cheng VY, Thomson LEJ, Friedman JD, Germano G, Slomka PJ. Automated quantitative Rb-82 3D PET/CT myocardial perfusion imaging: normal limits and correlation with invasive coronary angiography. J Nucl Cardiol 2012; 19:265-76. [PMID: 22203445 PMCID: PMC3383786 DOI: 10.1007/s12350-011-9496-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 12/02/2011] [Indexed: 01/28/2023]
Abstract
BACKGROUND We aimed to characterize normal limits and to determine the diagnostic accuracy for an automated quantification of 3D 82-Rubidium (Rb-82) PET/CT myocardial perfusion imaging (MPI). METHODS We studied 125 consecutive patients undergoing Rb-82 PET/CT MPI, including patients with suspected coronary artery disease (CAD) and invasive coronary angiography, and 42 patients with a low likelihood (LLk) of CAD. Normal limits for perfusion and function were derived from LLk patients. QPET software was used to quantify perfusion abnormality at rest and stress expressed as total perfusion deficit (TPD). RESULTS Relative perfusion databases did not differ in any of the 17 segments between males and females. The areas under the receiver operating characteristic curve for detection of CAD were 0.86 for identification of ≥50% and ≥70% stenosis. The sensitivity/specificity was 86%/86% for detecting ≥50% stenosis and 93%/77% for ≥70% stenosis, respectively. In regard to normal limits, mean rest and stress left ventricular ejection fraction (LVEF) were 67% ± 10% and 75% ± 9%, respectively. Mean transient ischemic dilation ratio was 1.06 ± 0.14 and mean increase in LVEF with stress was 7.4% ± 6.1% (95th percentile of 0%). CONCLUSION Normal limits have been established for 3D Rb-82 PET/CT analysis with QPET software. Fully automated quantification of myocardial perfusion PET data shows high diagnostic accuracy for detecting obstructive CAD.
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Affiliation(s)
- Ryo Nakazato
- Departments of Imaging and Medicine, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Abstract
OBJECTIVES Decreases in apical and apex activities - namely, 'apical thinning' - are a well-known phenomenon in attenuation-corrected (AC) myocardial perfusion. The aim of this study was to compare actual myocardial thickness derived from a multidetector-row computed tomography with AC myocardial perfusion count from a hybrid single-photon emission computed tomography/computed tomography to investigate the cause of apical thinning. METHODS We enrolled 21 participants with a low likelihood of coronary artery disease (mean age 65 ± 21 years, 13 men) from 185 consecutive patients and 11 healthy volunteers, who independently underwent ⁹⁹mTc-sestamibi single-photon emission computed tomography/computed tomography and 64-slice multidetector-row computed tomography scans. AC and non-AC myocardial perfusion counts and thickness were measured on the basis of a 17-segment model and averaged at the apex, apical, mid, and basal walls. RESULTS Myocardial thickness at the apex was significantly thinner than that at the apical and mid walls (5.1 ± 1.3, 7.3 ± 1.3, and 9.9 ± 2.4 mm, respectively; P<0.005). AC count at the apex was significantly lower than that at the apical and mid regions (76.0 ± 5.5, 82.8 ± 4.7, and 85.6 ± 3.8, respectively; P<0.002). Moderate relationship was observed between myocardial thickness and AC count (y=-10.5 + 0.22x, r=0.54, P<0.0001. No relationship was found between thickness and non-AC count (r=0.16, P=0.263). CONCLUSION The low apex and apical counts were caused by anatomical thinning of the myocardium in AC myocardial perfusion imaging. Attenuation correction provided an accurate relationship between myocardial count and thickness because of the partial volume effect.
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Trägårdh E, Sjöstrand K, Jakobsson D, Edenbrandt L. Small average differences in attenuation corrected images between men and women in myocardial perfusion scintigraphy: a novel normal stress database. BMC Med Imaging 2011; 11:18. [PMID: 21967548 PMCID: PMC3205014 DOI: 10.1186/1471-2342-11-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 10/03/2011] [Indexed: 11/15/2022] Open
Abstract
Background The American Society of Nuclear Cardiology and the Society of Nuclear Medicine state that incorporation of attenuation-corrected (AC) images in myocardial perfusion scintigraphy (MPS) will improve image quality, interpretive certainty, and diagnostic accuracy. However, commonly used software packages for MPS usually include normal stress databases for non-attenuation corrected (NC) images but not for attenuation-corrected (AC) images. The aim of the study was to develop and compare different normal stress databases for MPS in relation to NC vs. AC images, male vs. female gender, and presence vs. absence of obesity. The principal hypothesis was that differences in mean count values between men and women would be smaller with AC than NC images, thereby allowing for construction and use of gender-independent AC stress database. Methods Normal stress perfusion databases were developed with data from 126 male and 205 female patients with normal MPS. The following comparisons were performed for all patients and separately for normal weight vs. obese patients: men vs. women for AC; men vs. women for NC; AC vs. NC for men; and AC vs. NC for women. Results When comparing AC for men vs. women, only minor differences in mean count values were observed, and there were no differences for normal weight vs. obese patients. For all other analyses major differences were found, particularly for the inferior wall. Conclusions The results support the hypothesis that it is possible to use not only gender independent but also weight independent AC stress databases.
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Affiliation(s)
- Elin Trägårdh
- Clinical Physiology and Nuclear Medicine Unit, Skåne University Hospital, Lund University, Malmö, Sweden.
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Cuocolo A. Attenuation correction for myocardial perfusion SPECT imaging: still a controversial issue. Eur J Nucl Med Mol Imaging 2011; 38:1887-9. [PMID: 21874324 DOI: 10.1007/s00259-011-1898-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022]
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Pazhenkottil AP, Ghadri JR, Nkoulou RN, Wolfrum M, Buechel RR, Küest SM, Husmann L, Herzog BA, Gaemperli O, Kaufmann PA. Improved outcome prediction by SPECT myocardial perfusion imaging after CT attenuation correction. J Nucl Med 2011; 52:196-200. [PMID: 21270455 DOI: 10.2967/jnumed.110.080580] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The aim of this study was to determine the impact of attenuation correction with CT (CT-AC) on the prognostic value of SPECT myocardial perfusion imaging (SPECT MPI). METHODS The summed stress score (SSS; 20-segment model) was obtained from filtered backprojection (FBP) and iterative reconstruction with CT-AC in 876 consecutive patients undergoing a 1-d stress-rest (99m)Tc-tetrofosmin SPECT MPI study for the evaluation of known or suspected coronary artery disease. Survival free of major adverse cardiac events (MACEs; cardiac death or nonfatal myocardial infarction) and survival free of any adverse cardiac events (including cardiac hospitalization, unstable angina, and late coronary revascularization) were analyzed by Kaplan-Meier analysis. RESULTS At a mean follow-up of 2.3 ± 0.6 y, a total of 184 adverse events occurred in 145 patients, including 35 MACEs (16 cardiac deaths [rate, 1.8%] and 19 nonfatal myocardial infarctions [rate, 2.2%]). With FBP, an SSS of 0-3 best distinguished patients with a low MACE rate (0.6%), followed by an SSS of 4-8 (4.3%), with increased MACE rate, and an SSS of 9-13 (3.8%), which was comparable. By contrast, with CT-AC the discrimination of low from intermediate MACE rate was best observed between an SSS of 0 (0%) and an SSS of 1-3 (3.7%), with a plateau at an SSS of 4-8 (3.2%). CONCLUSION CT-AC for SPECT MPI allows improved risk stratification. The prognostically relevant SSS cutoff is shifted toward lower values.
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Cuberas-Borrós G, Aguadé-Bruix S, Boronat-de Ferrater M, Muxí-Pradas MA, Romero-Farina G, Castell-Conesa J, Aliaga V, García-Dorado D, Candell-Riera J. Normal myocardial perfusion SPECT database for the Spanish population. Rev Esp Cardiol 2011; 63:934-42. [PMID: 20738938 DOI: 10.1016/s1885-5857(10)70187-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aims of this study were to create a Spanish database of normal myocardial perfusion SPECT (single-photon emission computed tomography) data, termed the normal Spanish database, and to compare it with a database of normal data from the North American population. METHODS We selected 104 healthy volunteers (45 female, mean age 42+/-14 years) who underwent SPECT during stress and at rest. The findings were analyzed using the 4DM-SPECT commercial software package. The resulting normal Spanish database for males and females was compared with the North American population database (from 70 men and 60 women) provided with the 4DM-SPECT software. RESULTS In the Spanish database, the highest percentage uptake during both stress and rest was observed in medial-lateral region and the lowest, in the basal-septal region. The percentage uptake in the anterior-medial region was significantly lower in women than men, while uptake in the inferior, medial-septal and apical regions was lower in men than women. Data values in the Spanish database were significantly lower for the majority of heart regions than those in the database with the 4DM-SPECT software. CONCLUSIONS A Spanish database of normal myocardial perfusion SPECT data was created and included separate data for men and women. Significant differences were observed between this database and a commercial North American database that is commonly used in semiquantitative studies.
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Affiliation(s)
- Gemma Cuberas-Borrós
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
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Holly TA, Abbott BG, Al-Mallah M, Calnon DA, Cohen MC, DiFilippo FP, Ficaro EP, Freeman MR, Hendel RC, Jain D, Leonard SM, Nichols KJ, Polk DM, Soman P. Single photon-emission computed tomography. J Nucl Cardiol 2010; 17:941-73. [PMID: 20552312 DOI: 10.1007/s12350-010-9246-y] [Citation(s) in RCA: 281] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cuberas-Borrós G, Aguadé-Bruix S, Boronat-de Ferrater M, Muxí-Pradas MÁ, Romero-Farina G, Castell-Conesa J, Aliaga V, García-Dorado D, Candell-Riera J. Base de datos de normalidad de la SPECT de perfusión miocárdica en la población española. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70205-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Xu Y, Fish M, Gerlach J, Lemley M, Berman DS, Germano G, Slomka PJ. Combined quantitative analysis of attenuation corrected and non-corrected myocardial perfusion SPECT: Method development and clinical validation. J Nucl Cardiol 2010; 17:591-9. [PMID: 20387137 PMCID: PMC2935899 DOI: 10.1007/s12350-010-9220-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 03/05/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Attenuation corrected myocardial perfusion SPECT (AC-MPS) has been demonstrated to improve the specificity of detecting coronary artery disease (CAD) by visual analysis which utilizes both non-corrected (NC) and AC data. However, the combined automated quantification of NC and AC-MPS has not been previously described. We aimed to develop a combined quantitative analysis from AC and NC data to improve the accuracy of automated detection of CAD from AC-MPS. METHODS Stress total perfusion deficit (TPD) values were generated by standard analysis for NC (NC-TPD), AC (AC-TPD) and by combined NC-AC analysis (NA-TPD), in which the hypoperfusion severity in each polar map location was defined as the average of AC and NC severity computed by comparison with separate AC and NC normal limits. Ischemic TPD was also calculated as the difference between stress TPD and rest TPD for each measure. Stress/rest Tc-99m sestamibi MPS studies in 650 patients with correlating coronary angiography and in 345 patients with a low-likelihood (LLk) of CAD were used to assess diagnostic performance of combined NC-AC analysis. RESULTS NA-TPD had a higher receiver-operator-characteristic area under the curve (ROC-AUC) (0.87) than NC-TPD (0.85; P < .01) or AC-TPD (0.85; P < .01) for detection of stenosis >or=70% in angiographic group. It also had higher specificity (75%) vs NC-TPD (65%; P < .0001), or AC-TPD (70%; P = .016). In LLk group, the normalcy rate of NA-TPD (95%) was higher than for NC-TPD (90%; P < .01) and similar to AC-TPD (94%; P = NS). NA-TPD had higher ROC-AUC than that for 17-segment expert visual scoring of stress scans in angiographic group (0.84; P = .01), comparable accuracy (81%) and similar normalcy rates (95% vs 97%; P = NS). Ischemic TPD by combined NC-AC analysis had higher ROC-AUC than that for any ischemic measure. Similar to stress NA-TPD, it also obtained the similar performance results as compared with ischemic TPD based on NC or AC and higher sensitivity (89% vs 85%; P = .0295) as compared with ischemic visual score in angiographic group. CONCLUSION Combined NC-AC MPS quantification using either stress or ischemic TPD shows significant improvements for ROC-AUC and specificity of MPS in the detection of CAD compared with standard NC-MPS or AC-MPS and comparable performance to expert visual scoring. This technique may lead to an enhancement in a fully automated quantification for the perfusion analysis by AC-MPS.
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Affiliation(s)
- Yuan Xu
- Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Taper #A047, Los Angeles, CA 90048, USA.
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Willowson K, Bailey DL, Bailey EA, Baldock C, Roach PJ. In vivovalidation of quantitative SPECT in the heart. Clin Physiol Funct Imaging 2010; 30:214-9. [DOI: 10.1111/j.1475-097x.2010.00930.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nakajima K. Normal values for nuclear cardiology: Japanese databases for myocardial perfusion, fatty acid and sympathetic imaging and left ventricular function. Ann Nucl Med 2010; 24:125-35. [PMID: 20108130 PMCID: PMC2855806 DOI: 10.1007/s12149-009-0337-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/15/2009] [Indexed: 08/30/2023]
Abstract
Myocardial normal databases for stress myocardial perfusion study have been created by the Japanese Society of Nuclear Medicine Working Group. The databases comprised gender-, camera rotation range- and radiopharmaceutical-specific data-sets from multiple institutions, and normal database files were created for installation in common nuclear cardiology software. Based on the electrocardiography-gated single-photon emission computed tomography (SPECT), left ventricular function, including ventricular volumes, systolic and diastolic functions and systolic wall thickening were also analyzed. Normal databases for fatty acid imaging using 123I-beta-methyl-iodophenyl-pentadecanoic acid and sympathetic imaging using 123I-meta-iodobenzylguanidine were also examined. This review provides lists and overviews of normal values for myocardial SPECT and ventricular function in a Japanese population. The population-specific approach is a key factor for proper diagnostic and prognostic evaluation.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan.
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