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Nakajima K, Shibutani T, Massanes F, Shimizu T, Yoshida S, Onoguchi M, Kinuya S, Vija AH. Myocardial perfusion imaging with retrospective gating and integrated correction of attenuation, scatter, respiration, motion, and arrhythmia. J Nucl Cardiol 2023; 30:2773-2789. [PMID: 37758961 PMCID: PMC10682219 DOI: 10.1007/s12350-023-03374-5] [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] [Accepted: 07/31/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Absolute quantitative myocardial perfusion SPECT requires addressing of aleatory and epistemic uncertainties in conjunction with providing image quality sufficient for lesion detection and characterization. Iterative reconstruction methods enable the mitigation of the root causes of image degradation. This study aimed to determine the feasibility of a new SPECT/CT method with integrated corrections attempting to enable absolute quantitative cardiac imaging (xSPECT Cardiac; xSC). METHODS We compared images of prototype xSC and conventional SPECT (Flash3DTM) acquired at rest from 56 patients aged 71 ± 12 y with suspected coronary heart disease. The xSC prototype comprised list-mode acquisitions with continuous rotation and subsequent iterative reconstructions with retrospective electrocardiography (ECG) gating. Besides accurate image formation modeling, patient-specific CT-based attenuation and energy window-based scatter correction, additionally we applied mitigation for patient and organ motion between views (inter-view), and within views (intra-view) for both the gated and ungated reconstruction. We then assessed image quality, semiquantitative regional values, and left ventricular function in the images. RESULTS The quality of all xSC images was acceptable for clinical purposes. A polar map showed more uniform distribution for xSC compared with Flash3D, while lower apical count and higher defect contrast of myocardial infarction (p = 0.0004) were observed on xSC images. Wall motion, 16-gate volume curve, and ejection fraction were at least acceptable, with indication of improvements. The clinical prospectively gated method rejected beats ≥20% in 6 patients, whereas retrospective gating used an average of 98% beats, excluding 2% of beats. We used the list-mode data to create a product equivalent prospectively gated dataset. The dataset showed that the xSC method generated 18% higher count data and images with less noise, with comparable functional variables of volume and LVEF (p = ns). CONCLUSIONS Quantitative myocardial perfusion imaging with the list-mode-based prototype xSPECT Cardiac is feasible, resulting in images of at least acceptable image quality.
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Affiliation(s)
- Kenichi Nakajima
- Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, 920-8640, Japan.
| | - Takayuki Shibutani
- Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Francesc Massanes
- Siemens Medical Solutions USA, Inc. Molecular Imaging, Hoffman Estates, IL, USA
| | - Takeshi Shimizu
- Siemens Medical Solutions USA, Inc. Molecular Imaging, Hoffman Estates, IL, USA
| | - Shohei Yoshida
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Masahisa Onoguchi
- Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University, Kanazawa, Japan
| | - A Hans Vija
- Siemens Medical Solutions USA, Inc. Molecular Imaging, Hoffman Estates, IL, USA
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2
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AlJaroudi W. Gastric wall uptake and attenuation artifact in 99m-Tc sestamibi SPECT: Hold the proton pump inhibitors! J Nucl Cardiol 2022; 29:1562-1565. [PMID: 33939160 DOI: 10.1007/s12350-021-02528-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Wael AlJaroudi
- Division of Cardiovascular Medicine, Augusta University-Medical College of Georgia, Augusta, GA, USA.
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3
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Vachatimanont S, Sirisalipoch S, Chantadisai M. Comparison of the Diagnostic Performance of Myocardial Perfusion Scintigraphy with and Without Attenuation Correction. Mol Imaging Radionucl Ther 2022; 31:130-138. [PMID: 35771002 PMCID: PMC9246313 DOI: 10.4274/mirt.galenos.2021.27880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: Myocardial perfusion scintigraphy (MPS) is an important diagnostic test for detecting of coronary artery stenosis (CAS); however, tissue attenuation can lead to a difference in accuracy. We evaluated the diagnostic accuracy of attenuation-corrected (AC) and non-attenuation-corrected (NC) MPS for the detection of CAS. Methods: We retrospectively recruited patients who underwent invasive coronary angiography within 10 months after Tc-99m sestamibi MPS. The AC and NC perfusion images were analyzed separately, and each myocardial segment was scored based on relative uptake from 0 to 4. The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were calculated. The diagnostic performances were analyzed using the area under the curve (AUC) of the receiver operating characteristic curve. Results: From 117 patients, significant coronary stenosis was present in 66 patients (56%). The SSS and SRS obtained from NC-images were higher than those from AC, supporting the presence of attenuation artifacts in NC images. The AUC of SSS and SDS were significantly higher than those of SRS in both AC- and NC-images, but no significant difference was found between the AUC of SSS, and those of SDS. The optimal cut-offs were >12 for AC-SSS, >15 for NC-SSS, >4 for AC-SDS and >3 for NC-SDS. There was no statistically significant difference in the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy among AC-SSS, NC-SSS, AC-SDS, and NC-SDS. Conclusion: NC-based Tc-99m-sestamibi MPS promised comparable accuracy to AC images by using different cut-off values for diagnosis.
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Affiliation(s)
- Sira Vachatimanont
- Chulalongkorn University and King Chulalongkorn Memorial Hospital, Department of Radiology, Division of Nuclear Medicine, Bangkok, Thailand
| | - Sasitorn Sirisalipoch
- Chulalongkorn University and King Chulalongkorn Memorial Hospital, Department of Radiology, Division of Nuclear Medicine, Bangkok, Thailand
| | - Maythinee Chantadisai
- Chulalongkorn University and King Chulalongkorn Memorial Hospital, Department of Radiology, Division of Nuclear Medicine, Bangkok, Thailand
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4
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Hagio T, Poitrasson-Rivière A, Moody JB, Renaud JM, Arida-Moody L, Shah RV, Ficaro EP, Murthy VL. "Virtual" attenuation correction: improving stress myocardial perfusion SPECT imaging using deep learning. Eur J Nucl Med Mol Imaging 2022; 49:3140-3149. [PMID: 35312837 DOI: 10.1007/s00259-022-05735-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/13/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) is widely used for coronary artery disease (CAD) evaluation. Although attenuation correction is recommended to diminish image artifacts and improve diagnostic accuracy, approximately 3/4ths of clinical MPI worldwide remains non-attenuation-corrected (NAC). In this work, we propose a novel deep learning (DL) algorithm to provide "virtual" DL attenuation-corrected (DLAC) perfusion polar maps solely from NAC data without concurrent computed tomography (CT) imaging or additional scans. METHODS SPECT MPI studies (N = 11,532) with paired NAC and CTAC images were retrospectively identified. A convolutional neural network-based DL algorithm was developed and trained on half of the population to predict DLAC polar maps from NAC polar maps. Total perfusion deficit (TPD) was evaluated for all polar maps. TPDs from NAC and DLAC polar maps were compared to CTAC TPDs in linear regression analysis. Moreover, receiver-operating characteristic analysis was performed on NAC, CTAC, and DLAC TPDs to predict obstructive CAD as diagnosed from invasive coronary angiography. RESULTS DLAC TPDs exhibited significantly improved linear correlation (p < 0.001) with CTAC (R2 = 0.85) compared to NAC vs. CTAC (R2 = 0.68). The diagnostic performance of TPD was also improved with DLAC compared to NAC with an area under the curve (AUC) of 0.827 vs. 0.780 (p = 0.012) with no statistically significant difference between AUC for CTAC and DLAC. At 88% sensitivity, specificity was improved by 18.9% for DLAC and 25.6% for CTAC. CONCLUSIONS The proposed DL algorithm provided attenuation correction comparable to CTAC without the need for additional scans. Compared to conventional NAC perfusion imaging, DLAC significantly improved diagnostic accuracy.
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Affiliation(s)
- Tomoe Hagio
- INVIA Medical Imaging Solutions, 3025 Boardwalk St, Suite 200, Ann Arbor, MI, 48108, USA.
| | | | - Jonathan B Moody
- INVIA Medical Imaging Solutions, 3025 Boardwalk St, Suite 200, Ann Arbor, MI, 48108, USA
| | - Jennifer M Renaud
- INVIA Medical Imaging Solutions, 3025 Boardwalk St, Suite 200, Ann Arbor, MI, 48108, USA
| | - Liliana Arida-Moody
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ravi V Shah
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, 3025 Boardwalk St, Suite 200, Ann Arbor, MI, 48108, USA.,Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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5
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Elder JB, Tilkemeier PL, Ewing JA. Insights into Nuclear Cardiology in the United States from the first 3 years of the ImageGuide Registry. J Nucl Cardiol 2022; 29:166-176. [PMID: 32342300 DOI: 10.1007/s12350-020-02112-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Data registries facilitate knowledge acquisition and quality improvement. ImageGuide is a registry developed by the American Society of Nuclear Cardiology collecting data since 2015, providing insight into current nuclear cardiology practice. METHODS AND RESULTS HIPAA de-identified data on > 100 practice- and patient-related variables from 19 US practices were obtained from ImageGuide. Continuous variables are reported as the mean ± standard deviation; discrete variables are reported as N (%). Practices were from 12 states; 9520 studies were submitted. The average patient was a 66-year-old man. Chest pain was the most common indication; 96% of studies were appropriate. Rest/stress 1-day studies were most common; stress/rest 1- and 2-day studies comprised < 5%. Tc-99 m was the most common radiopharmaceutical. Tl-201 was used in 14% of rest studies. Most studies were not corrected for attenuation. 89% were of good or better quality. 62% of studies were normal. CONCLUSIONS Practice diversity is limited, but patient demographics are reflective of reported current practice. Most studies are appropriate and may obviate the need for invasive testing. Radiation dosimetry could be decreased with wider adoption of stress/rest studies and avoidance of Tl-201. ImageGuide will be an important tool to guide non-invasive cardiac imaging in the future.
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Affiliation(s)
- Joshua B Elder
- Division of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Peter L Tilkemeier
- Department of Internal Medicine, 5th Floor Support Tower, Prisma Health-Upstate, and the University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA.
| | - Joseph A Ewing
- Quality Management Department, Prisma Health-Upstate, Greenville, SC, USA
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6
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Tung RT, Heyns J. Incidental Detection of Massive Left Ventricular Calcification by Myocardial Perfusion Imaging: A Case of Imaging Illustrations. Kans J Med 2021; 14:256-258. [PMID: 34671442 PMCID: PMC8523104 DOI: 10.17161/kjm.vol14.15359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Robert T Tung
- Cardiology Section, Department of Veterans Affairs, Eastern Kansas HealthCare System, Topeka, KS
| | - Johannes Heyns
- Radiology Department, Department of Veterans Affairs, Eastern Kansas HealthCare System, Topeka, KS
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7
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Chipeya LR, van Rensburg MJ, Vangu MDT. Experiences and Perceptions of Nuclear Medicine Technologists in the Assessment of Myocardial Perfusion Image Quality. J Nucl Med Technol 2021; 49:226-231. [PMID: 33820863 DOI: 10.2967/jnmt.120.255125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
Nuclear medicine technologists (NMTs) are experts in the acquisition of myocardial perfusion (MP) images, in addition to the many other types of images acquired in nuclear medicine departments. NMTs are expected to ensure that images are of optimal quality in order to facilitate accurate interpretation by nuclear medicine physicians (NMPs). However, ensuring optimal image quality is a shared responsibility between NMTs and NMPs. The shared responsibilities have resulted in inconsistences in the assessment of MP image quality among NMTs in different departments. Little is known about the perceptions and experiences of NMTs on the assessment of MP image quality. Therefore, the focus of this research study was NMTs. The aim of this qualitative study was to explore and describe the perceptions and experiences of NMTs on the assessment of MP image quality. The research question was, "How do NMTs perform the responsibility of ensuring MP image quality?" Methods: The study followed a qualitative explorative approach using focus groups as a means of collecting data. Nineteen NMTs from 4 academic hospitals were purposefully selected to participate. A semistructured questionnaire was used to conduct the focus groups. The collected data were managed using a computer-aided qualitative data analysis software program to formulate codes, categories, and themes. Results: Two overarching themes emerged from the data: the management of MP images, and the resources required to support NMTs. NMTs differed in their management of MP images because of the prevailing circumstances in their respective departments. In addition, the results suggested that NMTs' level of involvement in the assessment of MP image quality was influenced by the availability of resources required for processing and assessing image quality. Conclusion: Despite the shared responsibility in the assessment of MP image quality with NMPs, NMTs considered themselves as playing a major role. However, resources to facilitate the assessment of image quality are considered necessary and should be available to support NMTs in submitting images of optimal quality for interpretation.
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Affiliation(s)
- Lucky R Chipeya
- Department of Medical Imaging and Radiation Sciences, University of Johannesburg, Johannesburg, South Africa; and
| | - Madri Jansen van Rensburg
- Department of Medical Imaging and Radiation Sciences, University of Johannesburg, Johannesburg, South Africa; and
| | - Mboyo-Di-Tamba Vangu
- Division of Nuclear Medicine, Department of Radiation Science, University of Witwatersrand, Johannesburg, South Africa
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8
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Tung RT, Heyns J. Incidental Findings of Malignancy of the Chest by Single Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT-CT MPI): One Year Follow-Up Report. Kans J Med 2020; 13:280-284. [PMID: 33312410 PMCID: PMC7725129 DOI: 10.17161/kjm.vol13.13822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction We recently reported six cases of pulmonary/hilar malignancies as the result of incidental findings (IF) on CT attenuation correction (CTAC) during Single Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT-CT MPI). In this study, clinical features, diagnostic procedures, and clinical outcomes were examined on all patients who had malignancies or significant IF that required further follow-up. Methods Of 1,098 consecutive patients who underwent cardiac SPECT-CT MPI from September 1, 2017 to August 31, 2018, their MPI and CTAC were reviewed contemporaneously. Patients with known history of prior pulmonary or chest malignancy were excluded. Results A total of 79 (7.2%) patients were identified to have significant IF on CTAC. After diagnostic CT, 47 patients had significant findings that warranted further follow-up and included in this study. Eight of 1,098 patients (0.73%) and 8/79 patients (10.1%) were found to have malignancy of the chest because of IF on the CTAC. There were no statistically significant differences in baseline characteristics and cancer risk factors among patients who had cancer versus those without. At the time of diagnosis, four patients had cancer at an advanced stage, resulting in death within 12 months. Three others had early stage lung cancer and one had mantle cell lymphoma; they were alive at a mean follow-up of 17.5+/−2.1 months. Biopsy for tissue diagnosis was performed safely with needle biopsy. Major complication occurred in one patient (1/9 or 11.1%) with needle biopsy; none with surgical biopsy. Conclusion This study underscored the importance of reviewing CTAC images obtained during cardiac SPECT-CT MPI to detect clinically important IF.
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Affiliation(s)
- Robert T Tung
- Cardiology Section, Department of Veterans Affairs (VA), Eastern Kansas HealthCare System, Topeka, KS
| | - Johannes Heyns
- Radiology Department, Department of Veterans Affairs (VA), Eastern Kansas HealthCare System, Topeka, KS
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9
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Van den Wyngaert T, Elvas F, De Schepper S, Kennedy JA, Israel O. SPECT/CT: Standing on the Shoulders of Giants, It Is Time to Reach for the Sky! J Nucl Med 2020; 61:1284-1291. [PMID: 32620702 DOI: 10.2967/jnumed.119.236943] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022] Open
Abstract
Twenty years ago, SPECT/CT became commercially available, combining the strengths of both techniques: the diagnostic sensitivity of SPECT and the anatomic detail of CT. Other benefits initially included attenuation correction of SPECT reconstructions, ultimately evolving to correction techniques that would enable absolute tracer uptake quantification. Recent developments in SPECT hardware include solid-state digital systems with higher sensitivity and resolution, using novel collimator designs based on tungsten. Similar advances in CT technology have been introduced in hybrid SPECT/CT systems, replacing low-end x-ray tubes with high-end multislice CT scanners equipped with iterative reconstruction, metal artifact reduction algorithms, and dual-energy capabilities. More recently, the design of whole-body SPECT/CT systems has taken another major leap with the introduction of a ring-shaped gantry equipped with multiple movable detectors surrounding the patient. These exciting developments have fueled efforts to develop novel SPECT radiopharmaceuticals, creating new chelators and prosthetic groups for radiolabeling. Innovative SPECT radionuclide pairs have now become available for radiolabeling with the potential for use as theranostic agents. The growth of precision medicine and the associated need for accurate radionuclide treatment dosimetry will likely drive the use of SPECT/CT in the near future. In addition, expanding clinical applications of SPECT/CT in other areas such as orthopedics offer exciting opportunities. Although it is true that the SPECT/CT ecosystem has seen several challenges during its development over the past 2 decades, it is now a feature-rich and mature tool ready for clinical prime time.
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Affiliation(s)
- Tim Van den Wyngaert
- Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium .,Integrated Personalized and Precision Oncology Network, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Filipe Elvas
- Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Integrated Personalized and Precision Oncology Network, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Stijn De Schepper
- Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Integrated Personalized and Precision Oncology Network, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - John A Kennedy
- Department of Nuclear Medicine, Rambam Healthcare Campus, Haifa, Israel; and.,Rappaport School of Medicine, Israel Institute of Technology, Haifa, Israel
| | - Ora Israel
- Rappaport School of Medicine, Israel Institute of Technology, Haifa, Israel
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10
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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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11
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Peters A, Kumar J, Patil PV. Diagnostic implications of CZT SPECT and impact of CT attenuation correction. J Nucl Cardiol 2019; 26:246-249. [PMID: 28646293 DOI: 10.1007/s12350-017-0961-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew Peters
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, 9th Floor Parkinson Pavilion, 3401 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Jeevan Kumar
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, 9th Floor Parkinson Pavilion, 3401 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Pravin V Patil
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, 9th Floor Parkinson Pavilion, 3401 N. Broad Street, Philadelphia, PA, 19140, USA.
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12
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Denisova NV, Ansheles AA. A study of false apical defects in myocardial perfusion imaging with SPECT/CT. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aae414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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13
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Abbott BG, Case JA, Dorbala S, Einstein AJ, Galt JR, Pagnanelli R, Bullock-Palmer RP, Soman P, Wells RG. Contemporary Cardiac SPECT Imaging-Innovations and Best Practices: An Information Statement from the American Society of Nuclear Cardiology. J Nucl Cardiol 2018; 25:1847-1860. [PMID: 30143954 DOI: 10.1007/s12350-018-1348-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This information statement from the American Society of Nuclear Cardiology highlights advances in cardiac SPECT imaging and supports the incorporation of new technology and techniques in laboratories performing nuclear cardiology procedures. The document focuses on the application of the latest imaging protocols and the utilization of newer hardware and software options to perform high quality, state-of-the-art SPECT nuclear cardiology procedures. Recommendations for best practices of cardiac SPECT imaging are discussed, highlighting what imaging laboratories should be doing as the standard of care in 2018 to achieve optimal results (based on the ASNC 2018 SPECT guideline [Dorbala et al., J Nucl Cardiol. 2018. https://doi.org/10.1007/s12350-018-1283-y ]).
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Affiliation(s)
- Brian G Abbott
- Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - James A Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
| | - Sharmila Dorbala
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew J Einstein
- Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - James R Galt
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Prem Soman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - R Glenn Wells
- University of Ottawa Heart Institute, Ottawa, Canada
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14
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Bengel F, Burchert W, Dörr R, Hacker M, Schäfer W, Schäfers MA, Schmidt M, Schwaiger M, Dahl JV, Zimmermann R, Lindner O. Myokard-Perfusions-SPECT. Nuklearmedizin 2018; 56:115-123. [DOI: 10.3413/nukmed-2017040001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 12/13/2022]
Abstract
ZusammenfassungDie S1-Leitlinie Myokard-Perfusions-SPECT wurde überarbeitet und bei der Arbeitsgemeinschaft der wissenschaftlichen Fachgesellschaften (AWMF) online publiziert. Sie ist in ihrer aktuellen Fassung bis 2/2022 gültig. Dieser Beitrag gibt in gekürzter Form und mit Kommentaren versehen die Kapitel und Unterkapitel wieder, in denen Änderungen und Ergänzungen vorgenommen wurden.
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15
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Ljungberg M, Pretorius PH. SPECT/CT: an update on technological developments and clinical applications. Br J Radiol 2018; 91:20160402. [PMID: 27845567 PMCID: PMC5966195 DOI: 10.1259/bjr.20160402] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/28/2016] [Accepted: 11/10/2016] [Indexed: 12/20/2022] Open
Abstract
Functional nuclear medicine imaging with single-photon emission CT (SPECT) in combination with anatomical CT has been commercially available since the beginning of this century. The combination of the two modalities has improved both the sensitivity and specificity of many clinical applications and CT in conjunction with SPECT that allows for spatial overlay of the SPECT data on good anatomy images. Introduction of diagnostic CT units as part of the SPECT/CT system has also potentially allowed for a more cost-efficient use of the equipment. Most of the SPECT systems available are based on the well-known Anger camera principle with NaI(Tl) as a scintillation material, parallel-hole collimators and multiple photomultiplier tubes, which, from the centroid of the scintillation light, determine the position of an event. Recently, solid-state detectors using cadmium-zinc-telluride became available and clinical SPECT cameras employing multiple pinhole collimators have been developed and introduced in the market. However, even if new systems become available with better hardware, the SPECT reconstruction will still be affected by photon attenuation and scatter and collimator response. Compensation for these effects is needed even for qualitative studies to avoid artefacts leading to false positives. This review highlights the recent progress for both new SPECT cameras systems as well as for various data-processing and compensation methods.
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Affiliation(s)
- Michael Ljungberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - P Hendrik Pretorius
- Division of Nuclear Medicine, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
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16
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Assa S, Kuipers J, Ettema E, Gaillard CAJM, Krijnen WP, Hummel YM, Voors AA, van Melle JP, Westerhuis R, Willemsen A, Slart RHJA, Franssen CFM. Effect of isolated ultrafiltration and isovolemic dialysis on myocardial perfusion and left ventricular function assessed with 13N-NH 3 positron emission tomography and echocardiography. Am J Physiol Renal Physiol 2017; 314:F445-F452. [PMID: 29117996 DOI: 10.1152/ajprenal.00368.2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hemodialysis is associated with a fall in myocardial perfusion and may induce regional left ventricular (LV) systolic dysfunction. The pathophysiology of this entity is incompletely understood, and the contribution of ultrafiltration and diffusive dialysis has not been studied. We investigated the effect of isolated ultrafiltration and isovolemic dialysis on myocardial perfusion and LV function. Eight patients (7 male, aged 55 ± 18 yr) underwent 60 min of isolated ultrafiltration and 60 min of isovolemic dialysis in randomized order. Myocardial perfusion was assessed by 13N-NH3 positron emission tomography before and at the end of treatment. LV systolic function was assessed by echocardiography. Regional LV systolic dysfunction was defined as an increase in wall motion score in ≥2 segments. Isolated ultrafiltration (ultrafiltration rate 13.6 ± 3.9 ml·kg-1·h-1) induced hypovolemia, whereas isovolemic dialysis did not (blood volume change -6.4 ± 2.2 vs. +1.3 ± 3.6%). Courses of blood pressure, heart rate, and tympanic temperature were comparable for both treatments. Global and regional myocardial perfusion did not change significantly during either isolated ultrafiltration or isovolemic dialysis and did not differ between treatments. LV ejection fraction and the wall motion score index did not change significantly during either treatment. Regional LV systolic dysfunction developed in one patient during isolated ultrafiltration and in three patients during isovolemic dialysis. In conclusion, global and regional myocardial perfusion was not compromised by 60 min of isolated ultrafiltration or isovolemic dialysis. Regional LV systolic dysfunction developed during isolated ultrafiltration and isovolemic dialysis, suggesting that, besides hypovolemia, dialysis-associated factors may be involved in the pathogenesis of hemodialysis-induced regional LV dysfunction.
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Affiliation(s)
- Solmaz Assa
- Department of Nephrology, University Medical Center Groningen , Groningen , The Netherlands.,Department of Cardiology, University Medical Center Groningen , Groningen , The Netherlands
| | | | - Esmée Ettema
- Department of Nephrology, University Medical Center Groningen , Groningen , The Netherlands
| | - Carlo A J M Gaillard
- Department of Nephrology, University Medical Center Groningen , Groningen , The Netherlands
| | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University Groningen , Groningen , The Netherlands
| | - Yoran M Hummel
- Department of Cardiology, University Medical Center Groningen , Groningen , The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen , Groningen , The Netherlands
| | - Joost P van Melle
- Department of Cardiology, University Medical Center Groningen , Groningen , The Netherlands
| | | | - Antoon Willemsen
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.,University of Twente, Faculty of Science and Technology, Department of Biomedical Photonic Imaging , Enschede , The Netherlands
| | - Casper F M Franssen
- Department of Nephrology, University Medical Center Groningen , Groningen , The Netherlands
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Kuşlu D, Öztürk E. A Comparison of Iterative Reconstruction and Prone Imaging in Reducing the Inferior Wall Attenuation in Tc-99m Sestamibi Myocardial Perfusion SPECT. Mol Imaging Radionucl Ther 2017; 26:110-115. [PMID: 28976333 PMCID: PMC5643938 DOI: 10.4274/mirt.83007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Prone positioning, iterative reconstruction (IR-OSEM) and electrocardiography (ECG) gating have been demonstrated to improve the specificity of myocardial perfusion SPECT (MPS) in the diagnosis of coronary artery disease. Methods: The gated supine and prone MPS images of 45 patients were reconstructed with both IR-OSEM [supine (SIR) and prone (PIR)] FBPs [supine (SFBP), prone (PFBP)] for comparison. Perfusion, wall motion (WM) and wall thickening were also interpreted semi-quantitatively. Two groups were generated as those with normal or abnormal findings. Segmental myocardial tracer uptake values were noted from four of the reconstructed images from 17 segment model of bullseye. Results: The difference between mean values and the standard deviations of the % tracer uptakes of inferior wall segments were statistically significant in all images. The normalcy rates were highest in PIR images, followed by PFBP and SIR images. The number of patients with any perfusion abnormality were 42, 12, 32, and 6, in SFBP, PFBP, SIR and PIR images, respectively. The six patients with perfusion abnormality in PIR images were re-evaluated with rest images and were diagnosed with a fixed perfusion defect. There was positive correlation between WM and either PFBP or PIR images. Sixteen patients’ WM were evaluated as abnormal while only 6 patients’ perfusions were abnormal in PIR. Conclusion: Prone imaging in addition to a supine perfusion SPECT improves imaging quality of the inferior wall, especially when reconstructed with iterative methods. If prone imaging can not be performed, ECG-gating can also be used as a beneficial method.
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Affiliation(s)
- Duygu Kuşlu
- Antalya Training and Research Hospital, Clinic of Nuclear Medicine, Antalya, Turkey
| | - Emel Öztürk
- Memorial Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
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Kroiss AS, Nekolla SG, Dobrozemsky G, Grubinger T, Shulkin BL, Schwaiger M. CT-based SPECT attenuation correction and assessment of infarct size: results from a cardiac phantom study. Ann Nucl Med 2017; 31:764-772. [PMID: 28936780 DOI: 10.1007/s12149-017-1211-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022]
Abstract
RATIONALE Myocardial perfusion SPECT is a commonly performed, well established, clinically useful procedure for the management of patients with coronary artery disease. However, the attenuation of photons from myocardium impacts the quantification of infarct sizes. CT-Attenuation Correction (AC) potentially resolves this problem. This contention was investigated by analyzing various parameters for infarct size delineation in a cardiac phantom model. METHODS A thorax phantom with a left ventricle (LV), fillable defects, lungs, spine and liver was used. The defects were combined to simulate 6 infarct sizes (5-20% LV). The LV walls were filled with 100120 kBq/ml 99mTc and the liver with 10-12 kBq/ml 99mTc. The defects were filled with water of 50% LV activity to simulate transmural and non-transmural infarction, respectively. Imaging of the phantom was repeated for each configuration in a SPECT/CT system. The defects were positioned in the anterior as well as in the inferior wall. Data were acquired in two modes: 32 views, 30 s/view, 180° and 64 views, 15 s/view, 360° orbit. Images were reconstructed iteratively with scatter correction and resolution recovery. Polar maps were generated and defect sizes were calculated with variable thresholds (40-60%, in 5% steps). The threshold yielding the best correlation and the lowest mean deviation from the true extents was considered optimal. RESULTS AC data showed accurate estimation of transmural defect extents with an optimal threshold of 50% [non attenuation correction (NAC): 40%]. For the simulation of non-transmural defects, a threshold of 55% for AC was found to yield the best results (NAC: 45%). The variability in defect size due to the location (anterior versus inferior) of the defect was reduced by 50% when using AC data indicating the benefit from using AC. No difference in the optimal threshold was observed between the different orbits. CONCLUSION Cardiac SPECT/CT shows an improved capability for quantitative defect size assessment in phantom studies due to the positive effects of attenuation correction.
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Affiliation(s)
- Alexander Stephan Kroiss
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria.
- Nuklearmedizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
| | - Stephan Gerhard Nekolla
- Nuklearmedizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Georg Dobrozemsky
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Thomas Grubinger
- Department of Medical Statistics, Medical University Innsbruck, Innsbruck, Austria
| | - Barry Lynn Shulkin
- Department of Radiological Science, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Markus Schwaiger
- Nuklearmedizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Ito S, Endo A, Okada T, Nakamura T, Sugamori T, Takahashi N, Yoshitomi H, Tanabe K. Comparison of CTAC and prone imaging for the detection of coronary artery disease using CZT SPECT. Ann Nucl Med 2017; 31:629-635. [PMID: 28695497 PMCID: PMC5622918 DOI: 10.1007/s12149-017-1194-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/05/2017] [Indexed: 11/25/2022]
Abstract
Background Cadmium-zinc-telluride (CZT) cameras have improved the evaluation of patients with chest pain. However, inferior/inferolateral attenuation artifacts similar to those seen with conventional Anger cameras persist. We added prone acquisitions and CT attenuation correction (CTAC) to the standard supine image acquisition and analyzed the resulting examinations. Methods and results Seventy-two patients referred for invasive coronary angiography (CAG), and who also underwent rest/stress myocardial perfusion imaging (MPI) on a CZT camera in the supine and prone positions plus CTAC imaging, to examine known or suspected CAD between April 2013 and March 2014 were included. A sixteen-slice CT scan acquired on a SPECT/CT scanner between rest and stress imaging provided data for iterative reconstruction. Sensitivity, specificity, accuracy, and positive and negative likelihood ratios (LRs) were calculated to compare MPI with CAG on a per-patient basis. Per-patient sensitivity, specificity, and accuracy of supine images to predict coronary abnormalities on CAG were 35% [95% confidence interval (CI) 19–52], 86% (95% CI 80–92), and 74% (95% CI 66–82); those of prone imaging were 65% (95% CI 45–81), 82% (95% CI 76–87), and 78% (95% CI 68–85); and those of CTAC were 59% (95% CI 41–71), 93% (95% CI 87–97), and 85% (95% CI 76–91), respectively. Conclusions Prone acquisition and CTAC images improve the ability to assess the inferior/inferolateral area.
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Affiliation(s)
- Shimpei Ito
- Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, 693-8501, Japan.
| | - Akihiro Endo
- Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, 693-8501, Japan
| | - Taiji Okada
- Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, 693-8501, Japan
| | - Taku Nakamura
- Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, 693-8501, Japan
| | - Takashi Sugamori
- Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, 693-8501, Japan
| | - Nobuyuki Takahashi
- Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, 693-8501, Japan
| | - Hiroyuki Yoshitomi
- Clinical Laboratory Department, Shimane University Hospital, Izumo, Japan
| | - Kazuaki Tanabe
- Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, 693-8501, Japan
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Case JA. Minimizing the radiation dose of CT attenuation correction while improving image quality: The case for innovation. J Nucl Cardiol 2016; 23:1080-1085. [PMID: 26100578 DOI: 10.1007/s12350-015-0182-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- James A Case
- Cardiovascular Imaging Technologies, University of Missouri, Columbia, Kansas City, MO, USA.
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Raza H, Jadoon LK, Mushtaq S, Jabeen A, Maqbool M, Ain MU, Ahmed B, Memon MA. Comparison of non-attenuation corrected and attenuation corrected myocardial perfusion SPECT. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lee WW. Recent Advances in Nuclear Cardiology. Nucl Med Mol Imaging 2016; 50:196-206. [PMID: 27540423 DOI: 10.1007/s13139-016-0433-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/24/2016] [Indexed: 11/24/2022] Open
Abstract
Nuclear cardiology is one of the major fields of nuclear medicine practice. Myocardial perfusion studies using single-photon emission computed tomography (SPECT) have played a crucial role in the management of coronary artery diseases. Positron emission tomography (PET) has also been considered an important tool for the assessment of myocardial viability and perfusion. However, the recent development of computed tomography (CT)/magnetic resonance imaging (MRI) technologies and growing concerns about the radiation exposure of patients remain serious challenges for nuclear cardiology. In response to these challenges, remarkable achievements and improvements are currently in progress in the field of myocardial perfusion imaging regarding the applicable software and hardware. Additionally, myocardial perfusion positron emission tomography (PET) is receiving increasing attention owing to its unique capability of absolute myocardial blood flow estimation. An F-18-labeled perfusion agent for PET is under clinical trial with promising interim results. The applications of F-18 fluorodeoxyglucose (FDG) and F-18 sodium fluoride (NaF) to cardiovascular diseases have revealed details on the basic pathophysiology of ischemic heart diseases. PET/MRI seems to be particularly promising for nuclear cardiology in the future. Restrictive diseases, such as cardiac sarcoidosis and amyloidosis, are effectively evaluated using a variety of nuclear imaging tools. Considering these advances, the current challenges of nuclear cardiology will become opportunities if more collaborative efforts are devoted to this exciting field of nuclear medicine.
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Affiliation(s)
- Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 Korea ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, South Korea
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Ghaly M, Du Y, Links JM, Frey EC. Collimator optimization in myocardial perfusion SPECT using the ideal observer and realistic background variability for lesion detection and joint detection and localization tasks. Phys Med Biol 2016; 61:2048-66. [PMID: 26895287 DOI: 10.1088/0031-9155/61/5/2048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In SPECT imaging, collimators are a major factor limiting image quality and largely determine the noise and resolution of SPECT images. In this paper, we seek the collimator with the optimal tradeoff between image noise and resolution with respect to performance on two tasks related to myocardial perfusion SPECT: perfusion defect detection and joint detection and localization. We used the Ideal Observer (IO) operating on realistic background-known-statistically (BKS) and signal-known-exactly (SKE) data. The areas under the receiver operating characteristic (ROC) and localization ROC (LROC) curves (AUCd, AUCd+l), respectively, were used as the figures of merit for both tasks. We used a previously developed population of 54 phantoms based on the eXtended Cardiac Torso Phantom (XCAT) that included variations in gender, body size, heart size and subcutaneous adipose tissue level. For each phantom, organ uptakes were varied randomly based on distributions observed in patient data. We simulated perfusion defects at six different locations with extents and severities of 10% and 25%, respectively, which represented challenging but clinically relevant defects. The extent and severity are, respectively, the perfusion defect's fraction of the myocardial volume and reduction of uptake relative to the normal myocardium. Projection data were generated using an analytical projector that modeled attenuation, scatter, and collimator-detector response effects, a 9% energy resolution at 140 keV, and a 4 mm full-width at half maximum (FWHM) intrinsic spatial resolution. We investigated a family of eight parallel-hole collimators that spanned a large range of sensitivity-resolution tradeoffs. For each collimator and defect location, the IO test statistics were computed using a Markov Chain Monte Carlo (MCMC) method for an ensemble of 540 pairs of defect-present and -absent images that included the aforementioned anatomical and uptake variability. Sets of test statistics were computed for both tasks and analyzed using ROC and LROC analysis methodologies. The results of this study suggest that collimators with somewhat poorer resolution and higher sensitivity than those of a typical low-energy high-resolution (LEHR) collimator were optimal for both defect detection and joint detection and localization tasks in myocardial perfusion SPECT for the range of defect sizes investigated. This study also indicates that optimizing instrumentation for a detection task may provide near-optimal performance on the more challenging detection-localization task.
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Affiliation(s)
- Michael Ghaly
- The Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD 21287, USA
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25
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Guner LA, Caliskan B, Isik I, Aksoy T, Vardareli E, Parspur A. Evaluating the Role of Routine Prone Acquisition on Visual Evaluation of SPECT Images. J Nucl Med Technol 2015; 43:282-8. [DOI: 10.2967/jnmt.115.165936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022] Open
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Investigation of attenuation correction in SPECT using textural features, Monte Carlo simulations, and computational anthropomorphic models. Nucl Med Commun 2015; 36:952-61. [DOI: 10.1097/mnm.0000000000000345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nappi C, Acampa W, Pellegrino T, Petretta M, Cuocolo A. Beyond ultrasound: advances in multimodality cardiac imaging. Intern Emerg Med 2015; 10:9-20. [PMID: 25037458 DOI: 10.1007/s11739-014-1106-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
Abstract
The rapid technological evolution accomplished in noninvasive cardiac imaging techniques over the past few decades has provided physicians with a large armamentarium for the evaluation of patients with known or suspected coronary heart disease. Noninvasive assessment of coronary artery calcium or noninvasive coronary angiography may be performed using computed tomography or magnetic resonance imaging. These techniques evaluate the presence of atherosclerosis rather than ischemia. Conversely, nuclear cardiology is the most widely used noninvasive approach for the assessment of myocardial perfusion and function. These techniques coupled with the development of dedicated image fusion software packages to merge data sets from different modalities have paved the way for hybrid imaging. This article provides a description of the available noninvasive imaging techniques in the assessment of coronary anatomy, myocardial perfusion, and cardiac function in patients with known or suspected coronary heart disease.
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Affiliation(s)
- Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, 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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Tootell AK, Szczepura K, Hogg P. Comparison of effective dose and lifetime risk of cancer incidence of CT attenuation correction acquisitions and radiopharmaceutical administration for myocardial perfusion imaging. Br J Radiol 2014; 87:20140110. [PMID: 24998249 PMCID: PMC4453143 DOI: 10.1259/bjr.20140110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/27/2014] [Accepted: 07/02/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To measure the organ dose and calculate effective dose from CT attenuation correction (CTAC) acquisitions from four commonly used gamma camera single photon emission CT/CT systems. METHODS CTAC dosimetry data was collected using thermoluminescent dosemeters on GE Healthcare's Infinia™ Hawkeye™ (GE Healthcare, Buckinghamshire, UK) four- and single-slice systems, Siemens Symbia™ T6 (Siemens Healthcare, Erlangen, Germany) and the Philips Precedence (Philips Healthcare, Amsterdam, Netherlands). Organ and effective dose from the administration of (99m)Tc-tetrofosmin and (99m)Tc-sestamibi were calculated using International Commission of Radiological Protection reports 80 and 106. Using these data, the lifetime biological risk was calculated. RESULTS The Siemens Symbia gave the lowest CTAC dose (1.8 mSv) followed by the GE Infinia Hawkeye single-slice (1.9 mSv), GE Infinia Hawkeye four-slice (2.5 mSv) and Philips Precedence v. 3.0. Doses were significantly lower than the calculated doses from radiopharmaceutical administration (11 and 14 mSv for (99m)Tc-tetrofosmin and (99m)Tc-sestamibi, respectively). Overall lifetime biological risks were lower, which suggests that using CTAC data posed minimal risk to the patient. Comparison of data for breast tissue demonstrated a higher risk than that from the radiopharmaceutical administration. CONCLUSION CTAC doses were confirmed to be much lower than those from radiopharmaceutical administration. The localized nature of the CTAC exposure compared to the radiopharmaceutical biological distribution indicated dose and risk to the breast to be higher. ADVANCES IN KNOWLEDGE This research proved that CTAC is a comparatively low-dose acquisition. However, it has been shown that there is increased risk for breast tissue especially in the younger patients. As per legislation, justification is required and CTAC should only be used in situations that demonstrate sufficient net benefit.
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Affiliation(s)
- A K Tootell
- The University of Salford, Directorate of Radiography, Salford, Greater Manchester, UK
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Ben-Haim S, Almukhailed O, Neill J, Slomka P, Allie R, Shiti D, Berman DS, Bomanji J. Clinical value of supine and upright myocardial perfusion imaging in obese patients using the D-SPECT camera. J Nucl Cardiol 2014; 21:478-85. [PMID: 24477404 DOI: 10.1007/s12350-014-9853-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/22/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE We have assessed whether additional upright imaging increases the confidence of interpretation of stress only supine myocardial perfusion imaging (MPI) in obese patients. METHODS AND RESULTS Tc-MIBI stress MPI of 101 consecutive patients (M = 49, 62 ± 12 years) with BMI ≥30 scanned on the D-SPECT cardiac camera were assessed. Images were interpreted as diagnostic or equivocal and the need for a rest study was recorded. Stress supine MPI was interpreted first, then gated and finally upright data were added. Defects on supine but not on upright were defined as artefacts and defects seen on both as abnormal. The total perfusion deficit (TPD) was also quantified. There were 27 normal, 22 abnormal, and 52 equivocal supine scans. The median EF was 52%, unaffecting the need for rest imaging. Upright imaging reclassified 32/52 (62%) equivocal studies as normal and 6/52 (11%) as abnormal (P < 0.001). Rest scan was deemed needed in 74/101 patients on supine vs 42/101 on supine/upright (P < 0.001). Supine TPD was normal in 53 and supine/upright TPD was normal in 70 patients (P < 0.001). CONCLUSION Supine stress MPI is inadequate in obese patients. The addition of upright imaging significantly increases the ability to interpret scans as diagnostic and may reduce considerably the need for rest imaging.
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Affiliation(s)
- Simona Ben-Haim
- Institute of Nuclear Medicine, University College London Hospitals, NHS Trust, London, UK,
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Ferreira AM, Marques H, Gonçalves PA, Cardim N. Cost-effectiveness of different diagnostic strategies in suspected stable coronary artery disease in Portugal. Arq Bras Cardiol 2014; 102:391-402. [PMID: 24844876 PMCID: PMC4023916 DOI: 10.5935/abc.20140042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 12/10/2013] [Indexed: 11/20/2022] Open
Abstract
Background Cost-effectiveness is an increasingly important factor in the choice of a
test or therapy. Objective To assess the cost-effectiveness of various methods routinely used for the
diagnosis of stable coronary disease in Portugal. Methods Seven diagnostic strategies were assessed. The cost-effectiveness of each
strategy was defined as the cost per correct diagnosis (inclusion or
exclusion of obstructive coronary artery disease) in a symptomatic patient.
The cost and effectiveness of each method were assessed using Bayesian
inference and decision-making tree analyses, with the pretest likelihood of
disease ranging from 10% to 90%. Results The cost-effectiveness of diagnostic strategies was strongly dependent on the
pretest likelihood of disease. In patients with a pretest likelihood of
disease of ≤50%, the diagnostic algorithms, which include cardiac computed
tomography angiography, were the most cost-effective. In these patients,
depending on the pretest likelihood of disease and the willingness to pay
for an additional correct diagnosis, computed tomography angiography may be
used as a frontline test or reserved for patients with positive/inconclusive
ergometric test results or a calcium score of >0. In patients with a
pretest likelihood of disease of ≥ 60%, up-front invasive coronary
angiography appears to be the most cost-effective strategy. Conclusions Diagnostic algorithms that include cardiac computed tomography angiography
are the most cost-effective in symptomatic patients with suspected stable
coronary artery disease and a pretest likelihood of disease of ≤50%. In
high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive
coronary angiography appears to be the most cost-effective strategy. In all
pretest likelihoods of disease, strategies based on ischemia appear to be
more expensive and less effective compared with those based on anatomical
tests.
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Yamauchi Y, Kanzaki Y, Otsuka K, Hayashi M, Okada M, Nogi S, Morita H, Komori T, Ishizaka N. Novel attenuation correction of SPECT images using scatter photopeak window data for the detection of coronary artery disease. J Nucl Cardiol 2014; 21:109-17. [PMID: 24185582 DOI: 10.1007/s12350-013-9814-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Attenuation correction using segmentation with scatter and photopeak window data (SSPAC) may enable evaluation of the attenuation map in a patient-specific manner without the need for additional radiation exposure and more acquisition time. We examined the feasibility of SSPAC and compared the sensitivity, specificity, and accuracy of this new correction method with that of conventional non-corrected myocardial perfusion single-photon emission computed tomography (SPECT) among patients with suspected or diagnosed coronary artery disease. METHODS AND RESULTS One hundred sixty-one patients who underwent both (99m)Tc-tetrofosmin stress/rest SPECT examination and invasive coronary angiography were enrolled in the study. Data from the SSPAC-corrected and non-corrected methods were analyzed quantitatively using summed stress scores. Attenuation maps were obtained successfully for 150 (93%) of the patients. The SSPAC-corrected and non-corrected methods accurately predicted coronary artery disease defined as >50% luminal stenosis verified by coronary artery angiography and/or prior myocardial infarction, for 91% and 77% patients, respectively (P < .05). For diagnosis of coronary artery disease, SSPAC improved sensitivity in the left anterior descending artery territory and specificity in the right coronary artery territory. CONCLUSIONS Attenuation correction with SSPAC may be a feasible method of correction for myocardial perfusion SPECT and in some cases may provide better accuracy for diagnosing coronary artery disease.
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Affiliation(s)
- Yohei Yamauchi
- Department of Cardiology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, 569-8686, Japan
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The origins of SPECT and SPECT/CT. Eur J Nucl Med Mol Imaging 2013; 41 Suppl 1:S3-16. [PMID: 24218098 DOI: 10.1007/s00259-013-2606-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
Abstract
Single photon emission computed tomography (SPECT) has a long history of development since its initial demonstration by Kuhl and Edwards in 1963. Although clinical utility has been dominated by the rotating gamma camera, there have been many technological innovations with the recent popularity of organ-specific dedicated SPECT systems. The combination of SPECT and CT evolved from early transmission techniques used for attenuation correction with the initial commercial systems predating the release of PET/CT. The development and acceptance of SPECT/CT has been relatively slow with continuing debate as to what cost/performance ratio is justified. Increasingly, fully diagnostic CT is combined with SPECT so as to facilitate optimal clinical utility.
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Oliveira ML, Seren MEG, Rocha FC, Brunetto SQ, Ramos CD, Button VLSN. Attenuation correction effects on SPECT/CT procedures: phantoms studies. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:2324-7. [PMID: 24110190 DOI: 10.1109/embc.2013.6610003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Attenuation correction is widely used in SPECT/CT (Single Photon Emission Computed Tomography) procedures, especially for imaging of the thorax region. Different compensation methods have been developed and introduced into clinical practice. Most of them use attenuation maps obtained using transmission scanning systems. However, this gives extra dose of radiation to the patient. The purpose of this study was to identify when attenuation correction is really important during SPECT/CT procedures.For this purpose, we used Jaszczak phantom and phantom with three line sources, filled with technetium ((99m)-Tc), with scattering materials, like air, water and acrylic, in different detectors configurations. In all images acquired were applied analytic and iterative reconstruction algorithms; the last one with or without attenuation correction. We analyzed parameters such as eccentricity, contrast and spatial resolution in the images.The best reconstruction algorithm on average was iterative, for images with 128 × 128 and 64 × 64 matrixes. The analytical algorithm was effective only to improve eccentricity in 64 × 64 matrix and matrix in contrast 128 × 128 with low statistics. Turning to the clinical routine examinations, on average, for 128 × 128 matrix and low statistics counting, the best algorithm was the iterative, without attenuation correction,improving in 150% the three parameters analyzed and, for the same matrix size, but with high statistical counting, iterative algorithm with attenuation correction was 25% better than that without correction. We can conclude that using the iterative algorithm with attenuation correction in the water, and its extra dose given, is not justified for the procedures of low statistic counting, being relevant only if the intention is to prioritize contrast in acquisitions with high statistic counting.
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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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Lindner O, Burchert W, Hacker M, Schaefer W, Schmidt M, Schober O, Schwaiger M, vom Dahl J, Zimmermann R, Schäfers M. [Myocardial perfusion scintigraphy - short form of the German guideline]. Nuklearmedizin 2013; 52:51-63; quiz N22. [PMID: 23370730 DOI: 10.3413/nukmed-0550-12-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/08/2013] [Indexed: 11/20/2022]
Abstract
This guideline is a short summary of the guideline for myocardial perfusion scintigraphy published by the Association of the Scientific Medical Societies in Ger-many (AWMF). The purpose of this guideline is to provide practical assistance for indication and examination procedures as well as image analysis and to present the state-of-the-art of myocardial-perfusion-scintigraphy. After a short introduction on the fundamentals of imaging, precise and detailed information is given on the indications, patient preparation, stress testing, radiopharmaceuticals, examination protocols and techniques, radiation exposure, data reconstruction as well as information on visual and quantitative image analysis and interpretation. In addition possible pitfalls, artefacts and key elements of reporting are described.
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Affiliation(s)
- O Lindner
- Universitätsklinikum der Ruhr-Universität Bochum, Institut für Radiologie, Nuklearmedizin und Molekulare Bildgebung, Georgstr. 11, 32545 Bad Oeynhausen.
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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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Keereman V, Fierens Y, Vanhove C, Lahoutte T, Vandenberghe S. Magnetic Resonace–Based Attenuation Correction for Micro–Single-Photon Emission Computed Tomography. Mol Imaging 2012. [DOI: 10.2310/7290.2011.00036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Attenuation correction is necessary for quantification in micro–single-photon emission computed tomography (micro-SPECT). In general, this is done based on micro–computed tomographic (micro-CT) images. Derivation of the attenuation map from magnetic resonance (MR) images is difficult because bone and lung are invisible in conventional MR images and hence indistinguishable from air. An ultrashort echo time (UTE) sequence yields signal in bone and lungs. Micro-SPECT, micro-CT, and MR images of 18 rats were acquired. Different tracers were used: hexamethylpropyleneamine oxime (brain), dimercaptosuccinic acid (kidney), colloids (liver and spleen), and macroaggregated albumin (lung). The micro-SPECT images were reconstructed without attenuation correction, with micro-CT-based attenuation maps, and with three MR-based attenuation maps: uniform, non-UTE-MR based (air, soft tissue), and UTE-MR based (air, lung, soft tissue, bone). The average difference with the micro-CT-based reconstruction was calculated. The UTE-MR-based attenuation correction performed best, with average errors ≤ 8% in the brain scans and ≤ 3% in the body scans. It yields nonsignificant differences for the body scans. The uniform map yields errors of ≤ 6% in the body scans. No attenuation correction yields errors ≥ 15% in the brain scans and ≥ 25% in the body scans. Attenuation correction should always be performed for quantification. The feasibility of MR-based attenuation correction was shown. When accurate quantification is necessary, a UTE-MR-based attenuation correction should be used.
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Affiliation(s)
- Vincent Keereman
- From MEDISIP, Department of Electronics and Information Systems, Ghent University-IBBT-IBiTech, Ghent, Belgium, and Radiology/BEFY, In-Vivo Cellular and Molecular Imaging Center, and Department of Nuclear Medicine, UZ Brussel, Brussels, Belgium
| | - Yves Fierens
- From MEDISIP, Department of Electronics and Information Systems, Ghent University-IBBT-IBiTech, Ghent, Belgium, and Radiology/BEFY, In-Vivo Cellular and Molecular Imaging Center, and Department of Nuclear Medicine, UZ Brussel, Brussels, Belgium
| | - Christian Vanhove
- From MEDISIP, Department of Electronics and Information Systems, Ghent University-IBBT-IBiTech, Ghent, Belgium, and Radiology/BEFY, In-Vivo Cellular and Molecular Imaging Center, and Department of Nuclear Medicine, UZ Brussel, Brussels, Belgium
| | - Tony Lahoutte
- From MEDISIP, Department of Electronics and Information Systems, Ghent University-IBBT-IBiTech, Ghent, Belgium, and Radiology/BEFY, In-Vivo Cellular and Molecular Imaging Center, and Department of Nuclear Medicine, UZ Brussel, Brussels, Belgium
| | - Stefaan Vandenberghe
- From MEDISIP, Department of Electronics and Information Systems, Ghent University-IBBT-IBiTech, Ghent, Belgium, and Radiology/BEFY, In-Vivo Cellular and Molecular Imaging Center, and Department of Nuclear Medicine, UZ Brussel, Brussels, Belgium
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Abstract
Myocardial perfusion single photon emission-computed tomography (MPS) has been one of the most important and common non-invasive diagnostic cardiac test. Gated MPS provides simultaneous assessment of myocardial perfusion and function with only one study. With appropriate attention to the MPS techniques, appropriate clinical utilization and effective reporting, gated MPS will remain a useful diagnostic test for many years to come. The aim of this article is to review the basic techniques of MPS, a simplified systematic approach for study interpretation, current clinical indications and reporting. After reading this article the reader should develop an understanding of the techniques, interpretation, current clinical indications and reporting of MPS studies.
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Affiliation(s)
- Ahmed Fathala
- Department of Cardiac Imaging and Nuclear Medicine, Medical Imaging Service, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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The value of attenuation correction by hybrid SPECT/CT imaging on infarct size quantification in male patients with previous inferior myocardial infarct. Nucl Med Commun 2011; 32:1026-32. [DOI: 10.1097/mnm.0b013e32834b4575] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Beyer AM, Gutterman DD. Regulation of the human coronary microcirculation. J Mol Cell Cardiol 2011; 52:814-21. [PMID: 22033434 DOI: 10.1016/j.yjmcc.2011.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 09/16/2011] [Accepted: 10/04/2011] [Indexed: 01/17/2023]
Abstract
Atherosclerosis of conduit epicardial arteries is the principal culprit behind the complications of coronary heart disease, but a growing body of literature indicates that the coronary microcirculation also contributes substantially to the pathophysiology of cardiovascular disease. An understanding of mechanisms regulating microvascular function in humans is an essential foundation for understanding the role in disease, especially since these regulatory mechanisms vary substantially across species and vascular beds. In fact all subjects whose coronary tissue was used in the studies described have medical conditions that warrant cardiac surgery, thus relevance to the normal human must be inferential and is based on tissue from subjects without known arteriosclerotic disease. This review will focus on recent advances in the physiological and pathological mechanisms of coronary microcirculatory control, describing a robust plasticity in maintaining endothelial control over dilation, including mechanisms that are most relevant to the human heart. This article is part of a Special Issue entitled "Coronary Blood Flow".
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Affiliation(s)
- Andreas M Beyer
- Department of Medicine, Cardiology Division Medical College of Wisconsin, Milwaukee, WI 53226, United States.
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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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Nye JA, Faber TL. Current state of hybrid imaging: attenuation correction and fusion. J Nucl Cardiol 2011; 18:729-40. [PMID: 21553160 DOI: 10.1007/s12350-011-9380-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/11/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Jonathon A Nye
- Department of Radiology and Imaging Sciences, Emory University, Emory University Hospital, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA.
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45
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Clinical usefulness of a collimator distance dependent resolution recovery in myocardial perfusion SPECT: a clinical report from a single institute. Ann Nucl Med 2010; 25:133-7. [DOI: 10.1007/s12149-010-0436-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 09/29/2010] [Indexed: 11/26/2022]
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47
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Iida H, Nakagawara J, Hayashida K, Fukushima K, Watabe H, Koshino K, Zeniya T, Eberl S. Multicenter evaluation of a standardized protocol for rest and acetazolamide cerebral blood flow assessment using a quantitative SPECT reconstruction program and split-dose 123I-iodoamphetamine. J Nucl Med 2010; 51:1624-31. [PMID: 20847163 DOI: 10.2967/jnumed.110.078352] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED SPECT can provide valuable diagnostic and treatment response information in large-scale multicenter clinical trials. However, SPECT has been limited in providing consistent quantitative functional parametric values across the centers, largely because of a lack of standardized procedures to correct for attenuation and scatter. Recently, a novel software package has been developed to reconstruct quantitative SPECT images and assess cerebral blood flow (CBF) at rest and after acetazolamide challenge from a single SPECT session. This study was aimed at validating this technique at different institutions with a variety of SPECT devices and imaging protocols. METHODS Twelve participating institutions obtained a series of SPECT scans on physical phantoms and clinical patients. The phantom experiments included the assessment of septal penetration for each collimator used and of the accuracy of the reconstructed images. Clinical studies were divided into 3 protocols, including intrainstitutional reproducibility, a comparison with PET, and rest-rest study consistency. The results from 46 successful studies were analyzed. RESULTS Activity concentration estimation (Bq/mL) in the reconstructed SPECT images of a uniform cylindric phantom showed an interinstitution variation of ±5.1%, with a systematic underestimation of concentration by 12.5%. CBF values were reproducible both at rest and after acetazolamide on the basis of repeated studies in the same patient (mean ± SD difference, -0.4 ± 5.2 mL/min/100 g, n = 44). CBF values were also consistent with those determined using PET (-6.1 ± 5.1 mL/min/100 g, n = 6). CONCLUSION This study demonstrates that SPECT can quantitatively provide physiologic functional images of rest and acetazolamide challenge CBF, using a quantitative reconstruction software package.
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Affiliation(s)
- Hidehiro Iida
- Dual-Table Autoradiography SPECT Research Group in Japan, Osaka, Japan.
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Wakabayashi Y, Imai K, Morozumi K, Takahashi Y, Shibasaki M. Evaluation of (99m)Tc-myocardial Perfusion SPECT Attenuation Correction by Hybrid SPECT/CT-Examination by Quantitative Analysis-. Nihon Hoshasen Gijutsu Gakkai Zasshi 2010; 66:371-378. [PMID: 20625224 DOI: 10.6009/jjrt.66.371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A non-uniform attenuation correction is necessary for the myocardial perfusion image (MPI) SPECT that is one of the images of the trunk. Simultaneous non-uniform attenuation correction during the process of SPECT reconstruction was enabled by developing hybrid SPECT/CT. Image acquisition of (99m)Tc MPI with hybrid SPECT/CT was performed in a phantom study and clinical cases. We evaluated the effect of non-uniform attenuation correction by Filtered Back Projection (FBP) or Ordered Subsets-Expectation Maximization (OS-EM) using visual analysis and quantitative analysis with a 17-segment model. The phantom study and the clinical cases differed somewhat as follows. In the phantom study, the count increased significantly with non-uniform attenuation correction in visual analysis and quantitative analysis. In the clinical cases, non-uniform attenuation correction increased the quantitative count in the basal and middle layer of the heart, and visual uniformity of the whole heart improved. However, the visual and quantitative count in the apex decreased with non-uniform attenuation correction. As a result, diagnostic performance for coronary heart disease is expected to be improved by this new technique using hybrid SPECT/CT.
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Affiliation(s)
- Yasuharu Wakabayashi
- Depertment of Technical Radiology, Saitama Cardiovascular and Respiratory Center, Japan
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Mastouri R, Sawada SG, Mahenthiran J. Current noninvasive imaging techniques for detection of coronary artery disease. Expert Rev Cardiovasc Ther 2010; 8:77-91. [PMID: 20030023 DOI: 10.1586/erc.09.164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The development and widespread use of noninvasive imaging techniques have contributed to the improvement in evaluation of patients with known or suspected coronary artery disease. Stress echocardiography and single-photon computed tomography are well-established noninvasive techniques with a proven track record for the diagnosis of coronary atherosclerosis. These modalities are generally widely available and provide a relatively high sensitivity and specificity along with an incremental value over clinical risk factors for detection of coronary artery disease. PET has a high diagnostic performance but continues to have limited clinical use because of the high expense of the dedicated equipment and difficulties in obtaining adequate radionuclides. Cardiac MRI and multislice computed tomography constitute the most recent addition to the cardiac imaging armamentarium. Cardiac MRI offers a comprehensive cardiac evaluation, which includes wall-motion analysis, myocardial tissue morphology, rest and stress first-pass myocardial perfusion, as well as ventricular systolic function. Cardiac computed tomography allows coronary calcium scanning along with noninvasive anatomic assessment of the coronary tree. It can be combined with functional imaging to provide a complete evaluation of the presence and physiological significance of the atherosclerotic coronary disease. No single imaging modality has been proven to be superior overall. Available tests all have advantages and drawbacks, and none can be considered suitable for all patients. The choice of the imaging method should be tailored to each person based on the clinical judgment of the a priori risk of cardiac event, clinical history and local expertise.
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Affiliation(s)
- Ronald Mastouri
- Indiana University, Indianapolis, 1801 North Senate Boulevard, IN 46202, USA
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Chang W, Ordonez CE, Liang H, Li Y, Liu J. C-SPECT - a Clinical Cardiac SPECT/Tct Platform: Design Concepts and Performance Potential. IEEE TRANSACTIONS ON NUCLEAR SCIENCE 2009; 56:2659-2671. [PMID: 23885129 PMCID: PMC3718566 DOI: 10.1109/tns.2009.2028138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Because of scarcity of photons emitted from the heart, clinical cardiac SPECT imaging is mainly limited by photon statistics. The sub-optimal detection efficiency of current SPECT systems not only limits the quality of clinical cardiac SPECT imaging but also makes more advanced potential applications difficult to be realized. We propose a high-performance system platform - C-SPECT, which has its sampling geometry optimized for detection of emitted photons in quality and quantity. The C-SPECT has a stationary C-shaped gantry that surrounds the left-front side of a patient's thorax. The stationary C-shaped collimator and detector systems in the gantry provide effective and efficient detection and sampling of photon emission. For cardiac imaging, the C-SPECT platform could achieve 2 to 4 times the system geometric efficiency of conventional SPECT systems at the same sampling resolution. This platform also includes an integrated transmission CT for attenuation correction. The ability of C-SPECT systems to perform sequential high-quality emission and transmission imaging could bring cost-effective high-performance to clinical imaging. In addition, a C-SPECT system could provide high detection efficiency to accommodate fast acquisition rate for gated and dynamic cardiac imaging. This paper describes the design concepts and performance potential of C-SPECT, and illustrates how these concepts can be implemented in a basic system.
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Affiliation(s)
- Wei Chang
- Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL 60612, USA
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