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Dietz M, Bochaton T, Al Mansour L, Tordo J, Flaus A. Identification of lipomatous metaplasia on computed tomography images helps confirm prior silent myocardial infarction associated with equivocal perfusion abnormality on single-photon emission computed tomography/computed tomography imaging. J Nucl Cardiol 2024; 32:101812. [PMID: 38246257 DOI: 10.1016/j.nuclcard.2024.101812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/14/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Matthieu Dietz
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France; INSERM U1060, CarMeN Laboratory, University of Lyon, Lyon, France.
| | - Thomas Bochaton
- INSERM U1060, CarMeN Laboratory, University of Lyon, Lyon, France; Cardiac Intensive Care Unit, Cardiovascular Hospital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Laure Al Mansour
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France
| | - Jeremie Tordo
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France
| | - Anthime Flaus
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France; Lyon Neuroscience Research Center, UMR5292, INSERM U1028/CNRS, Lyon, France
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Ashrafinia S, Dalaie P, Schindler TH, Pomper MG, Rahmim A. Standardized Radiomics Analysis of Clinical Myocardial Perfusion Stress SPECT Images to Identify Coronary Artery Calcification. Cureus 2023; 15:e43343. [PMID: 37700937 PMCID: PMC10493172 DOI: 10.7759/cureus.43343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
PURPOSE Myocardial perfusion (MP) stress single-photon emission computed tomography (SPECT) is an established diagnostic test for patients suspected of coronary artery disease (CAD). Meanwhile, coronary artery calcification (CAC) scoring obtained from diagnostic CT is a highly sensitive test, offering incremental diagnostic information in identifying patients with significant CAD yet normal MP stress SPECT (MPSS) scans. However, after decades of wide utilization of MPSS, CAC is not commonly reimbursed (e.g. by the CMS), nor widely deployed in community settings. We studied the potential of complementary information deduced from the radiomics analysis of normal MPSS scans in predicting the CAC score. METHODS We collected data from 428 patients with normal (non-ischemic) MPSS (99mTc-sestamibi; consensus reading). A nuclear medicine physician verified iteratively reconstructed images (attenuation-corrected) to be free from fixed perfusion defects and artifactual attenuation. Three-dimensional images were automatically segmented into four regions of interest (ROIs), including myocardium and three vascular segments (left anterior descending [LAD]-left circumference [LCX]-right coronary artery [RCA]). We used our software package, standardized environment for radiomics analysis (SERA), to extract 487 radiomic features in compliance with the image biomarker standardization initiative (IBSI). Isotropic cubic voxels were discretized using fixed bin-number discretization (eight schemes). We first performed blind-to-outcome feature selection focusing on a priori usefulness, dynamic range, and redundancy of features. Subsequently, we performed univariate and multivariate machine learning analyses to predict CAC scores from i) selected radiomic features, ii) 10 clinical features, and iii) combined radiomics + clinical features. Univariate analysis invoked Spearman correlation with Benjamini-Hotchberg false-discovery correction. The multivariate analysis incorporated stepwise linear regression, where we randomly selected a 15% test set and divided the other 85% of data into 70% training and 30% validation sets. Training started from a constant (intercept) model, iteratively adding/removing features (stepwise regression), invoking the Akaike information criterion (AIC) to discourage overfitting. Validation was run similarly, except that the training output model was used as the initial model. We randomized training/validation sets 20 times, selecting the best model using log-likelihood for evaluation in the test set. Assessment in the test set was performed thoroughly by running the entire operation 50 times, subsequently employing Fisher's method to verify the significance of independent tests. RESULTS Unsupervised feature selection significantly reduced 8×487 features to 56. In univariate analysis, no feature survived the false-discovery rate (FDR) to directly correlate with CAC scores. Applying Fisher's method to the multivariate regression results demonstrated combining radiomics with the clinical features to enhance the significance of the prediction model across all cardiac segments. Conclusions: Our standardized and statistically robust multivariate analysis demonstrated significant prediction of the CAC score for all cardiac segments when combining MPSS radiomic features with clinical features, suggesting radiomics analysis can add diagnostic or prognostic value to standard MPSS for wide clinical usage.
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Affiliation(s)
- Saeed Ashrafinia
- Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Pejman Dalaie
- Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Martin G Pomper
- Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Arman Rahmim
- Physics and Astronomy, University of British Columbia, Vancouver, CAN
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Kiss J, Balkay L, Kukuts K, Miko M, Forgacs A, Trencsenyi G, Krizsan AK. 3D printed anthropomorphic left ventricular myocardial phantom for nuclear medicine imaging applications. EJNMMI Phys 2022; 9:34. [PMID: 35503184 PMCID: PMC9065219 DOI: 10.1186/s40658-022-00461-3] [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: 10/14/2021] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background Anthropomorphic torso phantoms, including a cardiac insert, are frequently used to investigate the imaging performance of SPECT and PET systems. These phantom solutions are generally featuring a simple anatomical representation of the heart. 3D printing technology paves the way to create cardiac phantoms with more complex volume definition. This study aimed to describe how a fillable left ventricular myocardium (LVm) phantom can be manufactured using geometry extracted from a patient image. Methods The LVm of a healthy subject was segmented from 18F-FDG attenuation corrected PET image set. Two types of phantoms were created and 3D printed using polyethylene terephthalate glycol (PETG) material: one representing the original healthy LVm, and the other mimicking myocardium with a perfusion defect. The accuracy of the LVm phantom production was investigated by high-resolution CT scanning of 3 identical replicas. 99mTc SPECT acquisitions using local cardiac protocol were performed, without additional scattering media (“in air” measurements) for both phantom types. Furthermore, the healthy LVm phantom was inserted in the commercially available DataSpectrum Anthropomorphic Torso Phantom (“in torso” measurement) and measured with hot background and hot liver insert. Results Phantoms were easy to fill without any air-bubbles or leakage, were found to be reproducible and fully compatible with the torso phantom. Seventeen segments polar map analysis of the "in air” measurements revealed that a significant deficit in the distribution appeared where it was expected. 59% of polar map segments had less than 5% deviation for the "in torso” and "in air” measurement comparison. Excluding the deficit area, neither comparison had more than a 12.4% deviation. All the three polar maps showed similar apex and apical region values for all configurations. Conclusions Fillable anthropomorphic 3D printed phantom of LVm can be produced with high precision and reproducibility. The 3D printed LVm phantoms were found to be suitable for SPECT image quality tests during different imaging scenarios. The flexibility of the 3D printing process presented in this study provides scalable and anthropomorphic image quality phantoms in nuclear cardiology imaging.
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Affiliation(s)
- Janos Kiss
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., Debrecen, 4032, Hungary.
| | - Laszlo Balkay
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., Debrecen, 4032, Hungary
| | - Kornel Kukuts
- ScanoMed Nuclear Medicine Centers, Nagyerdei krt. 98., Debrecen, 4032, Hungary
| | - Marton Miko
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., Debrecen, 4032, Hungary
| | - Attila Forgacs
- ScanoMed Nuclear Medicine Centers, Nagyerdei krt. 98., Debrecen, 4032, Hungary.,Mediso Ltd., Laborc Utca 3., Budapest, 1037, Hungary
| | - Gyorgy Trencsenyi
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98., Debrecen, 4032, Hungary
| | - Aron K Krizsan
- ScanoMed Nuclear Medicine Centers, Nagyerdei krt. 98., Debrecen, 4032, Hungary
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Julien HM, Bravo PE. Thick and thin: Bridging the gap to a better understanding of apical thinning. J Nucl Cardiol 2020; 27:461-464. [PMID: 30288681 DOI: 10.1007/s12350-018-1451-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Howard M Julien
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 11-154 South Pavilion, Philadelphia, PA, 19104, USA
| | - Paco E Bravo
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 11-154 South Pavilion, Philadelphia, PA, 19104, USA.
- Divisions of Nuclear Medicine and Cardiology, Departments of Radiology and Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 11-154 South Pavilion, Philadelphia, PA, 19104, USA.
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Steffen DA, Giannopoulos AA, Grossmann M, Messerli M, Schwyzer M, Gräni C, Gebhard C, Pazhenkottil AP, Kaufmann PA, Buechel RR. "Apical thinning": Relations between myocardial wall thickness and apical left ventricular tracer uptake as assessed with positron emission tomography myocardial perfusion imaging. J Nucl Cardiol 2020; 27:452-460. [PMID: 30109592 DOI: 10.1007/s12350-018-1397-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/27/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND A reduction in left ventricular apical tracer uptake (apical thinning) is frequently observed in myocardial perfusion imaging (MPI), yet its cause remains a matter of debate, particularly in perfusion emission tomography (PET). This analysis sought to determine whether apical thinning in PET-MPI is attributable to true anatomical thinning of the left ventricular apical myocardium. METHODS AND RESULTS We retrospectively analyzed 57 patients without any history or signs of apical myocardial infarction who underwent rest PET-MPI with 13N-ammonia and contrast-enhanced cardiac computed tomography (CT). Semi-quantitative normalized percent apical 13N-ammonia uptake at rest, myocardial blood flow (MBF), and k2 wash-out rate constants were compared to apical myocardial wall thickness measurements derived from CT and base-to-apex gradients were calculated. Apical thinning was found in 93% of patients and in 74% when analysis of normalized apical tracer uptake was confined to end-systole. No significant correlation was found between apical myocardial thickness and apical tracer uptake (r = - 0.080, P = .553), MBF (r = - 0.211, P = .115), or k2 wash-out rate (r = - 0.023, P = .872), nor between apical myocardial thickness and any gradients. A statistically significant but small difference in apical myocardial thickness was observed in patients with moderately to severely reduced apical tracer uptake vs patients with normal to mildly reduced uptake (4.3 ± 0.7 mm vs 4.7 ± 0.7 mm; P = .043). CONCLUSIONS Apical thinning is a highly prevalent finding during 13N-ammonia PET-MPI that is not solely attributable to true anatomical apical wall thickness or the partial volume effect. Other factors that yet need to be identified seem to have a more prominent impact.
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Affiliation(s)
- Dominik A Steffen
- 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
| | - Marvin Grossmann
- 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
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Cathérine Gebhard
- 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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Yamamoto K, Mori S, Fukuzawa K, Miyamoto K, Toba T, Izawa Y, Tanaka H, Kono AK, Hirata KI. Revisiting the prevalence and diversity of localized thinning of the left ventricular apex. J Cardiovasc Electrophysiol 2020; 31:915-920. [PMID: 32090387 DOI: 10.1111/jce.14386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The left ventricular apex commonly has a paper-thin structure. However, available data about its structure are limited to variable samples, methodologies, and results. OBJECTIVE To investigate the structural anatomy of the left ventricular apex using living heart datasets with the latest computed tomography scanner. METHODS One hundred thirty-one consecutive patients (median age, 73 years; 58% men) who underwent cardiac computed tomography were retrospectively analyzed. Patients with severe aortic stenosis were analyzed separately. Thickness and diameters of the thinnest part of the left ventricular apex during mid-diastole were measured using orthogonal multiplanar reconstruction images. The area of thinning was estimated using the formula for the ellipse. RESULTS In 88 patients without severe aortic stenosis, the median thickness of the thinnest area of the left ventricular apex was only 0.9 mm. Among them, 74%, 99%, and 100% of cases displayed a left ventricular apex thinner than 1.0, 3.0, and 5.0 mm, respectively. The median area of the thinnest region was 5.6 mm2 . In 43 patients with severe aortic stenosis, the median thickness of the thinnest area of the left ventricular apex was 1.2 mm. Among them, 51%, 93%, and 100% of cases displayed a left ventricular apex thinner than 1.0, 3.0, and 5.0 mm, respectively. The median area of the thinnest region was 3.9 mm2 . CONCLUSIONS Localized thinning of the left ventricular apex is unexceptional, regardless of aortic stenosis with concentric left ventricular hypertrophy, thus highlighting the need for a reappreciation of this feature to avoid inadvertent catastrophic complications.
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Affiliation(s)
- Kyoko Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Miyamoto
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi K Kono
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Okuda K, Nakajima K, Yoneyama H, Shibutani T, Onoguchi M, Matsuo S, Hashimoto M, Kinuya S. Impact of iterative reconstruction with resolution recovery in myocardial perfusion SPECT: phantom and clinical studies. Sci Rep 2019; 9:19618. [PMID: 31873141 PMCID: PMC6928019 DOI: 10.1038/s41598-019-56097-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/05/2019] [Indexed: 11/11/2022] Open
Abstract
The corrections of photon attenuation, scatter, and depth-dependent blurring improve image quality in myocardial perfusion single-photon emission computed tomography (SPECT) imaging; however, the combined corrections induce artifacts. Here, we present the single correction method of depth-dependent blurring and its impact for myocardial perfusion distribution in phantom and clinical studies. The phantom and clinical patient images were acquired with two conditions: circular and noncircular orbits of gamma cameras yielded constant and variable depth-dependent blurring, respectively. An iterative reconstruction with the correction method of depth-dependent was used to reconstruct the phantom and clinical patient images. We found that the single correction method improved the robustness of phantom images whether the images contained constant or variable depth-dependent blurring. The myocardial perfusion databases generated from 72 normal patients exhibited uniform perfusion distribution of whole myocardium. In summary, the single correction method of depth-dependent blurring with iterative reconstruction is helpful for myocardial perfusion SPECT.
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Affiliation(s)
- Koichi Okuda
- Department of Physics, Kanazawa Medical University, Uchinada, Japan.
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan
| | - Hiroto Yoneyama
- Department of Radiological Technology, Kanazawa University Hospital, Kanazawa, Japan
| | - Takayuki Shibutani
- Department of Quantum Medical Technology, Kanazawa University, Kanazawa, Japan
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Kanazawa University, Kanazawa, Japan
| | - Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | | | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan
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Wu KY, Timmerman NP, McPhedran R, Hossain A, Beanlands RSB, Chong AY, deKemp RA. Differential association of diabetes mellitus and female sex with impaired myocardial flow reserve across the spectrum of epicardial coronary disease. Eur Heart J Cardiovasc Imaging 2019; 21:576-584. [DOI: 10.1093/ehjci/jez163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Indexed: 12/14/2022] Open
Abstract
Abstract
Aims
Diabetes mellitus (DM) affects the macro- and microvasculature, leading to impairment in coronary vascular reactivity. Microvascular dysfunction is more prevalent in females compared to males, leading to increased cardiovascular risk in women. The purpose of this study was to quantify the association between diabetes and female sex on myocardial flow reserve (MFR) across the spectrum of epicardial coronary artery disease (CAD).
Methods and results
In 222 patients with known or suspected CAD (63.7 ± 10.7 years, 66 females, 85 with diabetes) who had rubidium-82 positron emission tomography (PET) and invasive coronary angiography within 6 months, a multiple linear regression model was developed to predict MFR based on clinical risk factors and imaging results across a spectrum of regional epicardial disease. A significant interaction effect suggested that impairment of MFR is accelerated in diabetics with increasing severity of epicardial disease. Furthermore, female sex (−13%), decade of age (−6%), ischaemia on electrocardiogram (−10%), resting rate-pressure product (−3%), and rest end-diastolic volume (−0.2%) were associated with reductions in MFR independent of the combined extent and severity of epicardial disease.
Conclusion
In the presence of significant obstructive epicardial disease, MFR decreases more rapidly in patients with DM compared to those without. Additional patient demographics and risk factors such as female sex and older age, and stress PET functional parameters should also be considered in the clinical interpretation of MFR. This has implications for the diagnosis and management of CAD patients with these and other risk factors for microvascular disease.
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Affiliation(s)
- Kai Yi Wu
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H-1215, K1Y0N5, Ottawa, Ontario K1Y 4W7, Canada
| | - Nicholas P Timmerman
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H-1215, K1Y0N5, Ottawa, Ontario K1Y 4W7, Canada
| | - Rachel McPhedran
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H-1215, K1Y0N5, Ottawa, Ontario K1Y 4W7, Canada
| | - Alomgir Hossain
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H-1215, K1Y0N5, Ottawa, Ontario K1Y 4W7, Canada
| | - Rob S B Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H-1215, K1Y0N5, Ottawa, Ontario K1Y 4W7, Canada
| | - Aun-Yeong Chong
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H-1215, K1Y0N5, Ottawa, Ontario K1Y 4W7, Canada
| | - Robert A deKemp
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H-1215, K1Y0N5, Ottawa, Ontario K1Y 4W7, Canada
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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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10
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Takamura T, Horiguchi Y, Kanna M, Matsushita H, Sudo Y, Kikuchi S, Ueda T, Sasaki R, Morita Y. Validation of prone myocardial perfusion SPECT with a variable-focus collimator versus supine myocardial perfusion SPECT with or without computed tomography-derived attenuation correction. Ann Nucl Med 2015; 29:890-6. [PMID: 26307758 DOI: 10.1007/s12149-015-1019-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/12/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate whether prone myocardial perfusion single-photon emission computed tomography (MPS) with thallium-201 acquired through a variable-focus collimator (IQ-SPECT) can correct for soft-tissue attenuation. METHODS Thirty-nine patients underwent thallium-201 stress MPS with IQ-SPECT. Delayed images acquired with the patients in the prone position were compared with delayed images obtained with the patients in the supine position with computed tomography-derived attenuation correction (CTAC) (S-CTAC images) or without CTAC (S-NCTAC images). Quantitative tracer uptake (QTU) and semi-quantitative defect scores were determined for the 17 standard myocardial segments. Segments were categorized into anterior-anteroseptal, lateral, inferior, and apex, and areas with defect decision were determined by using the defect scores. RESULTS Image quality in the prone images was similar to that of S-NCTAC and S-CTAC images. In male patients, QTU in prone images was equivalent to that in S-CTAC images in the anterior-anteroseptal area, but was significantly lower than that in S-CTAC images in the inferior area. In female patients, QTU in prone images was similar to that in S-CTAC images in the anterior-anteroseptal, lateral, and inferior areas. In male and in female patients, QTU in the apex was significantly greater in the prone images than that in the S-CTAC images. In the combined male and female patient group, the defect decision for prone images was similar to that for S-CTAC images in the anterior-anteroseptal, lateral, and inferior areas. Apical defects were observed more frequently in S-CTAC images than in prone or S-NCTAC images. CONCLUSIONS Fewer artificial defects were observed in the apex of images acquired by prone imaging than by S-CTAC imaging. Prone images improved attenuation and had similar defect decision as S-CTAC images in the anterior-anteroseptal, lateral, and inferior areas.
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Affiliation(s)
- Tomoko Takamura
- Department of Cardiology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa, 252-0392, Japan
| | - Yoriko Horiguchi
- Department of Cardiology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa, 252-0392, Japan.
| | - Masahiko Kanna
- Department of Cardiology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa, 252-0392, Japan
| | - Hirooki Matsushita
- Department of Cardiology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa, 252-0392, Japan
| | - Yuta Sudo
- Department of Cardiology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa, 252-0392, Japan
| | - Shinnosuke Kikuchi
- Department of Cardiology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa, 252-0392, Japan
| | - Tomohiro Ueda
- Department of Radiology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Ryo Sasaki
- Department of Radiology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yukiko Morita
- Department of Cardiology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa, 252-0392, Japan
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Savvopoulos CA, Spyridonidis T, Papandrianos N, Vassilakos PJ, Alexopoulos D, Apostolopoulos DJ. CT-based attenuation correction in Tl-201 myocardial perfusion scintigraphy is less effective than non-corrected SPECT for risk stratification. J Nucl Cardiol 2014; 21:519-31. [PMID: 24532033 DOI: 10.1007/s12350-014-9867-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Previous studies advocate the use of attenuation correction in myocardial perfusion scintigraphy (MPS) for patient risk stratification. METHODS Six-hundred and thirty-seven unselected patients underwent Tl-201 MPS by a hybrid SPECT/CT system. Attenuation-corrected (AC) and non-corrected (NAC) images were interpreted blindly and summed stress scores (SSS) were calculated. Study endpoints were all-cause mortality and the composites of death/non-fatal acute myocardial infarction (AMI) and death/AMI/late revascularization. RESULTS During a follow-up of 42.3 ± 12.8 months 24 deaths, 13 AMIs and 28 revascularizations were recorded. SSS groups formed according to event rate distribution across SSS values were: 0-4, 5-13, >13 for NAC and 0-2, 3-9, >9 for AC. Kaplan-Meier functions were statistically significant between NAC SSS groups for all study endpoints. AC discriminated only between SSS 0-2 and >9 for death/AMI and between 0-2 and 3-9 for death/AMI/revascularization. In the univariate Cox regression abnormal NAC (SSS > 4) was accompanied with much higher hazards ratios than abnormal AC (SSS > 2). In the multivariate model abnormal AC yielded no significance for either endpoint whereas abnormal NAC proved independent from other covariates for the composite endpoints. CONCLUSION Our results challenge the effectiveness of CT-based AC for risk stratification of patients referred for MPS.
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Affiliation(s)
- Christos A Savvopoulos
- Department of Nuclear Medicine, University Hospital of Patras, University of Patras, Medical School, Rion, 26500, Patras, Greece
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van der Wall EE, Scholte AJ, Bax JJ. Gated myocardial SPECT imaging; true additional value in AMI? Int J Cardiovasc Imaging 2010; 26:893-6. [PMID: 20532632 PMCID: PMC2991157 DOI: 10.1007/s10554-010-9650-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 05/27/2010] [Indexed: 12/01/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - A. J. Scholte
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
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van der Wall EE, Schuijf JD, Bax JJ, Jukema JW, Schalij MJ. CT perfusion angiography; beware of artifacts! Int J Cardiovasc Imaging 2009; 26:355-8. [PMID: 20033784 PMCID: PMC2846328 DOI: 10.1007/s10554-009-9559-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/04/2009] [Indexed: 12/21/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. D. Schuijf
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. W. Jukema
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - M. J. Schalij
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
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Attenuation correction of myocardial SPECT by scatter-photopeak window method in normal subjects. Ann Nucl Med 2009; 23:501-6. [PMID: 19412655 DOI: 10.1007/s12149-009-0258-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 03/09/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Segmentation with scatter and photopeak window data using attenuation correction (SSPAC) method can provide a patient-specific non-uniform attenuation coefficient map only by using photopeak and scatter images without X-ray computed tomography (CT). The purpose of this study is to evaluate the performance of attenuation correction (AC) by the SSPAC method on normal myocardial perfusion database. METHODS A total of 32 sets of exercise-rest myocardial images with Tc-99 m-sestamibi were acquired in both photopeak (140 keV +/- 10%) and scatter (7% of lower side of the photopeak window) energy windows. Myocardial perfusion databases by the SSPAC method and non-AC (NC) were created from 15 female and 17 male subjects with low likelihood of cardiac disease using quantitative perfusion SPECT software. Segmental myocardial counts of a 17-segment model from these databases were compared on the basis of paired t test. RESULTS AC average myocardial perfusion count was significantly higher than that in NC in the septal and inferior regions (P < 0.02). On the contrary, AC average count was significantly lower in the anterolateral and apical regions (P < 0.01). Coefficient variation of the AC count in the mid, apical and apex regions was lower than that of NC. CONCLUSIONS The SSPAC method can improve average myocardial perfusion uptake in the septal and inferior regions and provide uniform distribution of myocardial perfusion. The SSPAC method could be a practical method of attenuation correction without X-ray CT.
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