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Wells RG, Small GR, Ruddy TD. Myocardial blood flow quantification with SPECT. J Med Imaging Radiat Sci 2024; 55:S51-S58. [PMID: 38553299 DOI: 10.1016/j.jmir.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION The addition of absolute myocardial blood flow (MBF) data improves the diagnostic and prognostic accuracy of relative perfusion imaging with nuclear medicine. Cardiac-specific gamma cameras allow measurement of MBF with SPECT. METHODS This paper reviews the evidence supporting the use of SPECT to measure myocardial blood flow (MBF). Studies have evaluated SPECT MBF in large animal models and compared it in humans with invasive angiographic measurements and against the clinical standard of PET MBF. The repeatability of SPECT MBF has been determined in both single-site and multi-center trials. RESULTS SPECT MBF has excellent correlation with microspheres in an animal model, with the number of stenoses and fractional flow reserve, and with PET-derived MBF. The inter-user coefficient of variability is ∼20% while the COV of test-retest MBF is ∼30%. SPECT MBF improves the sensitivity and specificity of the detection of multi-vessel disease over relative perfusion imaging and provides incremental value in predicting adverse cardiac events. CONCLUSION SPECT MBF is a promising technique for providing clinically valuable information in the assessment of coronary artery disease.
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Affiliation(s)
- R Glenn Wells
- Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Gary R Small
- Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Terrence D Ruddy
- Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Ruddy TD, Davies RA, Kiess MC. Development and evolution of nuclear cardiology and cardiac PET in Canada. J Med Imaging Radiat Sci 2024; 55:S3-S9. [PMID: 38637261 DOI: 10.1016/j.jmir.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
Gated radionuclide angiography and myocardial perfusion imaging were developed in the United States and Europe in the 1970's and soon adopted in Canadian centers. Much of the early development of nuclear cardiology in Canada was in Toronto, Ontario and was quickly followed by new programs across the country. Clinical research in Canada contributed to the further development of nuclear cardiology and cardiac PET. The Canadian Nuclear Cardiology Society (CNCS) was formed in 1995 and became the Canadian Society of Cardiovascular Nuclear and CT Imaging (CNCT) in 2014. The CNCS had a major role in education and advocacy for cardiovascular nuclear medicine testing. The CNCS established the Dr Robert Burns Lecture and CNCT named the Canadian Society of Cardiovascular Nuclear and CT Imaging Annual Achievement Award for Dr Michael Freeman in memoriam of these two outstanding Canadian leaders in nuclear cardiology. The future of nuclear cardiology in Canada is exciting with the expanding use of SPECT imaging to include Tc-99m-pyrophosphate for diagnosis of transthyretin cardiac amyloidosis and the ongoing introduction of cardiac PET imaging.
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Affiliation(s)
- Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Ross A Davies
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marla C Kiess
- Division of Cardiology, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Ruddy TD, Wells RG. Shortening the acquisition times of CZT SPECT imaging for measurement of myocardial blood flow. J Nucl Cardiol 2024; 34:101847. [PMID: 38467185 DOI: 10.1016/j.nuclcard.2024.101847] [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: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - R Glenn Wells
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Mochula A, Maltseva A, Kopeva K, Grakova E, Mochula O, Zavadovsky K. The Influence of Kinetic Models and Attenuation Correction on Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography (CZT SPECT)-Derived Myocardial Blood Flow and Reserve: Correlation with Invasive Angiography Data. J Clin Med 2024; 13:1271. [PMID: 38592092 PMCID: PMC10932033 DOI: 10.3390/jcm13051271] [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: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The objective of this study was to determine the optimal post-processing model for dynamic cadmium-zinc-telluride single-photon emission computed tomography (CZT-SPECT). (2) Methods: A total of 235 patients who underwent diagnostic invasive coronary angiography within three months of the SPECT and those who had coronary computed tomography angiography (CCTA) before SPECT (within 3 months) were enrolled in this study. Each SPECT study was processed to obtain global and regional stress myocardial blood flow (sMBF), rest-MBF (rMBF), myocardial flow reserve (MFR) and flow difference (FD) estimates obtained with 1-tissue-compartment (1TCM) and net retention (NR) modes, both with and without attenuation correction. (3) Results: The use of AC led to significantly higher sMBF, rMBF and DF values obtained by 1TCM compared those values derived by 1TCM with NAC; the lowest values of stress MBF and rest MBF were obtained by 1TCM_NAC. The resting flow, MFR and DF were significantly (p < 0.005) higher in the AC model than in NAC. All quantitative variables were significantly (p < 0.05) higher in NR_NAC than in the 1TC_NAC model. Finally, sMBF, rMBF and FD showed significantly (p < 0.05) higher values by using 1TMC_AC compared to NR_AC. (4) Conclusions: We suggested that 1-compartment and net retention models correctly reflect coronary microcirculation and can be used for clinical practice for evaluating quantitative myocardial perfusion by dynamic SPECT. Attenuation correction is an important step in post-processing dynamic SPECT data, which increases the consistency and diagnostic accuracy of models.
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Affiliation(s)
- Andrey Mochula
- Nuclear Department, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (A.M.); (A.M.); (K.Z.)
| | - Alina Maltseva
- Nuclear Department, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (A.M.); (A.M.); (K.Z.)
| | - Kristina Kopeva
- Department of Myocardial Pathology, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia;
| | - Elena Grakova
- Department of Myocardial Pathology, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia;
| | - Olga Mochula
- Department of Radiology and Tomography, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia;
| | - Konstantin Zavadovsky
- Nuclear Department, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia; (A.M.); (A.M.); (K.Z.)
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Usanase N, Uzun B, Ozsahin DU, Ozsahin I. A look at radiation detectors and their applications in medical imaging. Jpn J Radiol 2024; 42:145-157. [PMID: 37733205 DOI: 10.1007/s11604-023-01486-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023]
Abstract
The effectiveness and precision of disease diagnosis and treatment have increased, thanks to developments in clinical imaging over the past few decades. Science is developing and progressing steadily in imaging modalities, and effective outcomes are starting to show up as a result of the shorter scanning periods needed as well as the higher-resolution images generated. The choice of one clinical device over another is influenced by technical disparities among the equipment, such as detection medium, shorter scan time, patient comfort, cost-effectiveness, accessibility, greater sensitivity and specificity, and spatial resolution. Lately, computational algorithms, artificial intelligence (AI), in particular, have been incorporated with diagnostic and treatment techniques, including imaging systems. AI is a discipline comprised of multiple computational and mathematical models. Its applications aided in manipulating sophisticated data in imaging processes and increased imaging tests' accuracy and precision during diagnosis. Computed tomography (CT), positron emission tomography (PET), and Single Photon Emission Computed Tomography (SPECT) along with their corresponding radiation detectors have been reviewed in this study. This review will provide an in-depth explanation of the above-mentioned imaging modalities as well as the radiation detectors that are their essential components. From the early development of these medical instruments till now, various modifications and improvements have been done and more is yet to be established for better performance which calls for a necessity to capture the available information and record the gaps to be filled for better future advances.
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Affiliation(s)
- Natacha Usanase
- Operational Research Centre in Healthcare, Near East University, Mersin 10, Nicosia, Turkey.
| | - Berna Uzun
- Operational Research Centre in Healthcare, Near East University, Mersin 10, Nicosia, Turkey
- Department of Statistics, Carlos III Madrid University, Getafe, Madrid, Spain
| | - Dilber Uzun Ozsahin
- Operational Research Centre in Healthcare, Near East University, Mersin 10, Nicosia, Turkey
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ilker Ozsahin
- Operational Research Centre in Healthcare, Near East University, Mersin 10, Nicosia, Turkey
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, 10065, USA
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Zhang J, Xie J, Li M, Fang W, Hsu B. SPECT myocardial blood flow quantitation for the detection of angiographic stenoses with cardiac-dedicated CZT SPECT. J Nucl Cardiol 2023; 30:2618-2632. [PMID: 37491508 DOI: 10.1007/s12350-023-03334-z] [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: 02/11/2023] [Accepted: 06/16/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE CZT SPECT with the enhanced imaging characteristic facilitates SPECT myocardial blood flow (MBF) quantitation moving toward a clinical utility to uncover myocardial ischemia. The purpose of this study was to investigate the diagnostic performance of stress MBF, myocardial flow reserve (MFR) and myocardial flow capacity (MFC) derived from CZT SPECT in the detection of coronary artery disease (CAD). METHODS One-hundred and eighty patients underwent two-day rest/adenosine-stress scans for SPECT MBF quantitation. All dynamic SPECT images were reconstructed and corrected with necessary corrections. The one-tissue two-compartment kinetic model was utilized to fit kinetic parameters (K1, k2 and FBV) by numeric optimization and converted to MBF from K1. Rest MBF, stress MBF and MFR in left ventricle and coronary territories were calculated from flow polar maps. MFC was assessed by extents of moderately and severely abnormal flow statuses using an integrated flow diagram. Per-patient and per-vessel analyses were performed to determine cutoff values for the detection of angiographically obstructive and flow-limited CAD. RESULTS Using the threshold of ≥ 50% stenosis, 149 patients (82.78%) were classified to have obstructive lesions in 355 vessels (65.74%). Using the threshold of ≥ 70% stenosis, 113 patients (62.78%) were classified to have flow-limited lesions in 282 vessels (52.22%). On per-patient analysis, the optimal cutoff values of stress MBF and MFR to detect ≥ 50% stenosis were (1.44 ml/min/g, 1.96) and (1.34 ml/min/g and 1.75) to detect ≥ 70% stenosis. The optimal cutoff values for severely and combined moderately severely abnormal MFC extents were (2.3-2.5%, 23.1%) and (7.5%, 29.4%), respectively. The overall sensitivity of MFC (0.84-0.86, 0.86-0.90) to detect ≥ 50% and ≥ 70% lesions surpassed those of stress MBF (0.78. 0.78) and MFR (0.80, 0.75) (all p < 0.05) with similar specificity (MFC = 0.84-0.90, 0.87-0.91; stress MBF = 0.87, 0.91; MFR = 0.84, 0.89) (all p≥ 0.05). CONCLUSION The non-invasive SPECT MBF quantitation using CZT SPECT is a reliable method to detect angiographically obstructive and flow-limited CAD. Myocardial flow capacity can outperform with higher diagnostic sensitivity than stress MBF or MFR alone.
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Affiliation(s)
- Jie Zhang
- Department of Nuclear Medicine, Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jian Xie
- Department of Nuclear Medicine, Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Muwei Li
- Department of Nuclear Medicine, Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, E2433 Lafferre Hall, Columbia, MO, 65211, USA.
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Dai N, Zhang B, Gong Z, Dong Z, Tang X, Yu H, Gu T, Duan S, Qian J, Shi H, Ge J. Quantitative flow ratio derived pullback pressure gradient and CZT-SPECT measured longitudinal flow gradient for hemodynamically significant coronary artery disease. J Nucl Cardiol 2023; 30:1992-2002. [PMID: 36929292 DOI: 10.1007/s12350-023-03245-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 02/22/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Whether physiological coronary diffuseness assessed by quantitative flow reserve (QFR) pullback pressure gradient (PPG) correlates with longitudinal myocardial blood flow (MBF) gradient and improves diagnostic performances for myocardial ischemia remains unknown. METHODS AND RESULTS MBF was measured in mL g-1 min-1 with 99mTc-MIBI CZT-SPECT at rest and stress, corresponding myocardial flow reserve (MFR = MBF stress/MBF rest) and relative flow reserve (RFR = MBF stenotic area/MBF reference) were calculated. Longitudinal MBF gradient was defined as apical and basal left ventricle MBF gradient. △longitudinal MBF gradient was calculated by longitudinal MBF gradient at stress and rest. QFR-PPG was acquired from virtual QFR pullback curve. QFR-PPG significantly correlated with hyperemic longitudinal MBF gradient (r = 0.45, P = 0.007) and △longitudinal MBF gradient (stress-rest) (r = 0.41, P = 0.016). Vessels with lower RFR had lower QFR-PPG (0.72 vs. 0.82, P = 0.002), hyperemic longitudinal MBF gradient (1.14 vs. 2.22, P = 0.003) and △longitudinal MBF gradient (0.50 vs. 1.02, P = 0.003). QFR-PPG, hyperemic longitudinal MBF gradient and △longitudinal MBF gradient showed comparable diagnostic performances for predicting decreased RFR (area under curve [AUC]: 0.82 vs. 0.81 vs. 0.75, P = NS) or QFR (AUC: 0.83 vs. 0.72 vs. 0.80, P = NS). In addition, QFR-PPG and QFR in combination showed incremental value compared with QFR for predicting RFR (AUC = 0.83 vs. 0.73, P = 0.046, net reclassification index = 0.508, P = 0.001). CONCLUSION QFR-PPG significantly correlated with longitudinal MBF gradient and △longitudinal MBF gradient when used for physiological coronary diffuseness assessment. All three parameters had high accuracy in predicting RFR or QFR. Adding physiological diffuseness assessment increased accuracy for predicting myocardial ischemia.
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Affiliation(s)
- Neng Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Buchun Zhang
- Department of Cardiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Zifan Gong
- The Second Clinical Medical School of Nanjing Medical University, Nanjing, China
| | - Zheng Dong
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xianglin Tang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Haojun Yu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Taoying Gu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | | | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- National Clinical Research Center for Interventional Medicine, Shanghai, China.
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Wells RG, Bengel FM, Camoni L, Cerudelli E, Cuddy-Walsh SG, Diekmann J, Han L, Kadoya Y, Kawaguchi N, Keng YJF, Miyagawa M, Ratner H, Teng XF, Ruddy TD. Multicenter Evaluation of the Feasibility of Clinical Implementation of SPECT Myocardial Blood Flow Measurement: Intersite Variability and Imaging Time. Circ Cardiovasc Imaging 2023; 16:e015009. [PMID: 37800325 DOI: 10.1161/circimaging.122.015009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 09/17/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Single-center studies have shown that single photon emission computed tomography myocardial blood flow (MBF) measurement is accurate compared with MBF measured with microspheres in a porcine model, positron emission tomography, and angiography. Clinical implementation requires consistency across multiple sites. The study goal is to determine the intersite processing repeatability of single photon emission computed tomography MBF and the additional camera time required. METHODS Five sites (Canada, Italy, Japan, Germany, and Singapore) each acquired 25 to 35 MBF studies at rest and with pharmacological stress using technetium-99m-tetrofosmin on a pinhole-collimated cadmium-zinc-telluride-based cardiac single photon emission computed tomography camera with standardized list-mode imaging and processing protocols. Patients had intermediate to high pretest probability of coronary artery disease. MBF was measured locally and at a core laboratory using commercially available software. The time a room was occupied for an MBF study was compared with that for a standard rest/stress myocardial perfusion study. RESULTS With motion correction, the overall correlation in MBF between core laboratory and local site was 0.93 (range, 0.87-0.97) at rest, 0.90 (range, 0.84-0.96) at stress, and 0.84 (range, 0.70-0.92) for myocardial flow reserve. The local-to-core difference in global MBF (bias-MBF) was 5.4% (-3.8% to 14.8%; median [interquartile range]) at rest and 5.4% (-6.2% to 19.4%) at stress. Between the 5 sites, bias-MBF ranged from -1.6% to 11.0% at rest and from -1.9% to 16.3% at stress; the interquartile range in bias-MBF was between 9.3% (4.8%-14.0%) and 22.3% (-10.3% to 12.0%) at rest and between 17.0% (-11.3% to 5.6%) and 33.3% (-10.4% to 22.9%) at stress and was not significantly different between most sites. Both bias and interquartile range were like previously reported interobserver variability and less than the SD of the test-retest difference of 30%. The overall difference in myocardial flow reserve was 1.52% (-10.6% to 11.3%). There were no significant differences between with and without motion correction. The average additional acquisition time varied between sites from 44 to 79 minutes. CONCLUSIONS The average bias-MBF and bias-MFR values were small with standard deviations substantially less than the test-retest variability. This demonstrates that MBF can be measured consistently across multiple sites and further supports that this technique can be reliably implemented. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03427749.
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Affiliation(s)
- R Glenn Wells
- Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (R.G.W., S.G.C.-W., L.H., Y.K., T.D.R.)
| | - Frank M Bengel
- Medizinische Hochschule Hannover, Hannover, Germany (F.M.B., J.D.)
| | - Luca Camoni
- Nuclear Medicine, Università & Spedali Civili, Brescia, Italy (L.C., E.C.)
| | | | - Sarah G Cuddy-Walsh
- Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (R.G.W., S.G.C.-W., L.H., Y.K., T.D.R.)
| | - Johanna Diekmann
- Medizinische Hochschule Hannover, Hannover, Germany (F.M.B., J.D.)
| | - Lewis Han
- Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (R.G.W., S.G.C.-W., L.H., Y.K., T.D.R.)
| | - Yoshito Kadoya
- Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (R.G.W., S.G.C.-W., L.H., Y.K., T.D.R.)
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Ehime, Japan (N.K., M.M.)
| | | | - Masao Miyagawa
- Department of Radiology, Ehime University Graduate School of Medicine, Ehime, Japan (N.K., M.M.)
| | | | - Xue Fen Teng
- Cardiology, National Heart Center Singapore, Singapore (Y.J.F.K., X.F.T.)
| | - Terrence D Ruddy
- Cardiology, University of Ottawa Heart Institute, Ottawa, Canada (R.G.W., S.G.C.-W., L.H., Y.K., T.D.R.)
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Mallet F, Poitrasson-Rivière A, Mariano-Goulart D, Agostini D, Manrique A. Measuring myocardial blood flow using dynamic myocardial perfusion SPECT: artifacts and pitfalls. J Nucl Cardiol 2023; 30:2006-2017. [PMID: 36598748 DOI: 10.1007/s12350-022-03165-4] [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: 07/04/2022] [Accepted: 11/09/2022] [Indexed: 01/05/2023]
Abstract
Dynamic acquisition allows absolute quantification of myocardial perfusion and flow reserve, offering an alternative to overcome the potential limits of relative quantification, especially in patients with balanced multivessel coronary artery disease. SPECT myocardial perfusion is widely available, at lower cost than PET. Dynamic cardiac SPECT is now feasible and has the potential to be the next step of comprehensive perfusion imaging. In order to help nuclear cardiologists potentially interested in using dynamic perfusion SPECT, we sought to review the different steps of acquisition, processing, and reporting of dynamic SPECT studies in order to enlighten the potentially critical pitfalls and artifacts. Both patient-related and technical artifacts are discussed. Key parameters of the acquisition include pharmacological stress, radiopharmaceuticals, and injection device. When it comes to image processing, attention must be paid to image-derived input function, patient motion, and extra-cardiac activity. This review also mentions compartment models, cameras, and attenuation correction. Finally, published data enlighten some facets of dynamic cardiac SPECT while several issues remain. Harmonizing acquisition and quality control procedures will likely improve its performance and clinical strength.
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Affiliation(s)
- Florian Mallet
- Department of Nuclear Medicine, CHU de Caen Normandie, Normandie Univ, UNICAEN UR 4650 PSIR, 14000, Caen, France
- Department of Nuclear Medicine, Jean Perrin Cancer Center, Clermont-Ferrand, France
| | | | - Denis Mariano-Goulart
- Department of Nuclear Medicine, CHU of Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Denis Agostini
- Department of Nuclear Medicine, CHU de Caen Normandie, Normandie Univ, UNICAEN UR 4650 PSIR, 14000, Caen, France
| | - Alain Manrique
- Department of Nuclear Medicine, CHU de Caen Normandie, Normandie Univ, UNICAEN UR 4650 PSIR, 14000, Caen, France.
- GIP Cyceron, Campus Jules Horowitz, Boulevard Henri Becquerel, BP 5229, 14074, Caen, France.
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10
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Krakovich A, Gelbart E, Moalem I, Naimushin A, Rozen E, Scheinowitz M, Goldkorn R. Dose-consistent dynamic SPECT. J Nucl Cardiol 2023; 30:1341-1351. [PMID: 36477896 DOI: 10.1007/s12350-022-03160-9] [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: 08/15/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronary flow reserve (CFR) values measured by dynamic SPECT systems are typically consistent with other modalities (e.g., PET). However, large discrepancies are often observed for individual patients. Positioning of the region-of-interest (ROI), representing the arterial input function (AIF) could explain some of these discrepancies. We explored the possibility of positioning the ROI in a manner that evaluates its consistency with patient-based injected radiotracer doses. METHODS Dose-consistent dynamic SPECT methodology was introduced, and its application was demonstrated in a twenty-patient clinical study. The effect of various ROI positions was investigated and comparison to myocardial perfusion imaging was performed. RESULTS Mean AIF ratios were consistent with the injected dose ratios for all examined ROI positions. Good agreement (> 80%) between total perfusion deficit and CFR was found in the detection of obstructive CAD patients for all ROIs considered. However, for individual patients, significant dependence on ROI position was observed (altering CFR by typically 30%). The proposed methodology's uncertainty was evaluated (~ 7%) and found to be smaller than the variability due to choice of ROI position. CONCLUSION Dose-consistent dynamic SPECT may contribute to evaluating uncertainty of CFR measurements and may potentially decrease uncertainty by allowing improved ROI positioning for individual patients.
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Affiliation(s)
- A Krakovich
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel.
| | - E Gelbart
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - I Moalem
- Nuclear Cardiology Center, Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - A Naimushin
- Nuclear Cardiology Center, Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - E Rozen
- Nuclear Cardiology Center, Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - M Scheinowitz
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - R Goldkorn
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Nuclear Cardiology Center, Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
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Djaïleb L, De Leiris N, Canu M, Sy OP, Seiller A, Leenhardt J, Charlon C, Faure M, Caillard J, Broisat A, Borel AL, Lablanche S, Betry C, Ghezzi C, Vanzetto G, Fagret D, Riou LM, Barone-Rochette G. Regional CZT myocardial perfusion reserve for the detection of territories with simultaneously impaired CFR and IMR in patients without obstructive coronary artery disease: a pilot study. J Nucl Cardiol 2023; 30:1656-1667. [PMID: 36813934 DOI: 10.1007/s12350-023-03206-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/06/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To assess the diagnostic performances of CZT myocardial perfusion reserve (MPR) for the detection of territories with simultaneous impaired coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients without obstructive coronary artery disease. METHODS Patients were prospectively included before being referred for coronary angiography. All patients underwent CZT MPR before invasive coronary angiography (ICA) and coronary physiology assessment. Rest and dipyridamole-induced stress myocardial blood flow (MBF) and MPR were quantified using 99mTc-SestaMIBI and a CZT camera. Fractional flow reserve (FFR), Thermodilution CFR, and IMR were assessed during ICA. RESULTS Between December 2016 and July 2019, 36 patients were included. 25/36 patients presented no obstructive coronary artery disease. A complete functional assessment was performed in 32 arteries. No territory presented a significant ischemia on CZT myocardial perfusion imaging. A moderate yet significant correlation was observed between regional CZT MPR and CFR (r = 0.4, P = .03). Sensitivity, specificity, positive and negative predictive value, and accuracy of regional CZT MPR versus the composite invasive criterion (impaired CFR and IMR) were 87 [47% to 99%], 92% [73% to 99%], 78% [47% to 93%], 96% [78% to 99%], and 91% [75% to 98%], respectively. All territories with a regional CZT MPR ≤ 1.8 showed a CFR < 2. Regional CZT MPR values were significantly higher in arteries with CFR ≥ 2 and IMR < 25 (negative composite criterion, n = 14) than in those with CFR < 2 and IMR ≥ 25 (2.6 [2.1 to 3.6] versus 1.6 [1.2 to 1.8]), P < .01). CONCLUSION Regional CZT MPR presented excellent diagnostic performances for the detection of territories with simultaneously impaired CFR and IMR reflecting a very high cardiovascular risk in patients without obstructive coronary artery disease.
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Affiliation(s)
- Loïc Djaïleb
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France.
| | - Nicolas De Leiris
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Marjorie Canu
- Cardiology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Olivier Phan Sy
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Alexandre Seiller
- Clinical Investigation Center-Technological Innovation, INSERM CIC1406, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Julien Leenhardt
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Clémence Charlon
- Cardiology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Marine Faure
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Jessica Caillard
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Alexis Broisat
- INSERM, LRB, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Anne-Laure Borel
- Endocrinology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Sandrine Lablanche
- Endocrinology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Cécile Betry
- Endocrinology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | | | - Gérald Vanzetto
- Cardiology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Daniel Fagret
- Nuclear Medicine Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Laurent M Riou
- INSERM, LRB, Univ. Grenoble Alpes, 38000, Grenoble, France
| | - Gilles Barone-Rochette
- Cardiology Department, LRB, INSERM, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000, Grenoble, France
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12
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Ruddy TD, Tavoosi A, Taqueti VR. Role of nuclear cardiology in diagnosis and risk stratification of coronary microvascular disease. J Nucl Cardiol 2023; 30:1327-1340. [PMID: 35851643 DOI: 10.1007/s12350-022-03051-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
Abstract
Coronary flow reserve (CFR) with positron emission tomography/computed tomography (PET/CT) has an important role in the diagnosis of coronary microvascular disease (CMD), aids risk stratification and may be useful in monitoring therapy. CMD contributes to symptoms and a worse prognosis in patients with coronary artery disease (CAD), nonischemic cardiomyopathies, and heart failure. CFR measurements may improve our understanding of the role of CMD in symptoms and prognosis in CAD and other cardiovascular diseases. The clinical presentation of CAD has changed. The prevalence of nonobstructive CAD has increased to about 50% of patients with angina undergoing angiography. Ischemia with nonobstructive arteries (INOCA) is recognized as an important cause of symptoms and has an adverse prognosis. Patients with INOCA may have ischemia due to CMD, epicardial vasospasm or diffuse nonobstructive CAD. Reduced CFR in patients with INOCA identifies a high-risk group that may benefit from management strategies specific for CMD. Although measurement of CFR by PET/CT has excellent accuracy and repeatability, use is limited by cost and availability. CFR measurement with single-photon emission tomography (SPECT) is feasible, validated, and would increase availability and use of CFR. Patients with CMD can be identified by reduced CFR and selected for specific therapies.
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Affiliation(s)
- Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| | - Anahita Tavoosi
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Viviany R Taqueti
- Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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13
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D'Antonio A, Assante R, Zampella E, Mannarino T, Buongiorno P, Cuocolo A, Acampa W. Myocardial blood flow evaluation with dynamic cadmium-zinc-telluride single-photon emission computed tomography: Bright and dark sides. Diagn Interv Imaging 2023; 104:323-329. [PMID: 36797156 DOI: 10.1016/j.diii.2023.02.001] [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: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/16/2023]
Abstract
Myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) assessment with non-invasive techniques represent an important tool to evaluate both coronary artery disease severity and extent. Currently, cardiac positron emission tomography-computed tomography (PET-CT) is the "gold standard" for the assessment of coronary function and provides accurate estimations of baseline and hyperemic MBF and MFR. Nevertheless, due to the high cost and complexity, PET-CT is not widely used in clinical practice. The introduction of cardiac-dedicated cadmium-zinc-telluride (CZT) cameras has renewed researchers' interest on MBF quantitation by single-photon emission computed tomography (SPECT). Indeed, many studies evaluated MPR and MBF measurements by dynamic CZT-SPECT in different cohorts of patients with suspected or overt coronary artery disease. As well, many others have compared the values obtained by CZT-SPECT to the ones by PET-CT, showing good correlations in detecting significant stenosis, although with different and non-standardized cut-off values. Nevertheless, the lack of standardized protocol for acquisition, reconstruction and elaboration makes more difficult to compare different studies and to further assess the real advantages of MBF quantitation by dynamic CZT-SPECT in clinical routine. Many are the issues involved in the bright and dark sides of dynamic CZT-SPECT. They include different type of CZT cameras, different execution protocols, different tracers with different myocardial extraction fraction and distribution, different software packages with different tools and algorithms, often requiring manual post-processing elaboration. This review article provides a clear summary of the state of the art on MBF and MPR evaluation by dynamic CZT-SPECT and outlines the major issues to solve to optimize this technique.
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Affiliation(s)
- Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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14
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Wang L, Zheng Y, Zhang J, Wang M, Wu D, Wang Y, Qiu H, Hsu B, Fang W. Diagnostic value of quantitative myocardial blood flow assessment by NaI(Tl) SPECT in detecting significant stenosis: a prospective, multi-center study. J Nucl Cardiol 2023; 30:769-780. [PMID: 35971031 DOI: 10.1007/s12350-022-03085-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/20/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES The aim of this prospective multi-center study was to investigate the diagnostic value of myocardial blood flow (MBF) quantification using NaI(Tl)-based single-photon emission computed tomography (SPECT) for determining coronary artery disease (CAD) defined by quantitative coronary angiography (QCA). BACKGROUND Absolute quantitation of MBF and myocardial flow reserve (MFR) using SPECT is clinically feasible; however, whether flow quantification using NaI(Tl) SPECT is superior to commonly performed SPECT myocardial perfusion imaging (MPI) in determining CAD has not been evaluated. METHODS Patients with suspected or known CAD underwent pharmacological stress/rest dynamic SPECT imaging and routine SPECT MPI followed by QCA. Obstructive disease was defined as ≥ 50% reduction in luminal diameter on QCA. RESULTS One hundred fifty-four patients (462 vessels) were included in the analysis. Obstructive CAD was detected in 76/154 patients (49.4%) and 112/462 vessels (24.2%). Optimal cut-off values were 1.86 mL/min/g for stress MBF and 1.95 for MFR, respectively. Stress MBF and MFR were more sensitive than MPI in both individual patients (stress MBF vs MPI: 81.6% vs 51.3%; MFR vs MPI: 72.4% vs 51.3%) and in coronary vascular regions (stress MBF vs MPI: 78.6% vs 31.3%; MFR vs MPI: 75.9% vs 31.3%; all P < .01). In receiver operating characteristic curve analysis, quantification revealed a significantly greater area under the curve than MPI at the patient (stress MBF vs MPI: 0.761 vs 0.641; MFR vs MPI: 0.770 vs 0.641) and the vessel (stress MBF vs MPI: 0.745 vs 0.613; MFR vs MPI: 0.756 vs 0.613; all P < .05) levels. Integrating quantitative SPECT measures with MPI significantly increased the area under the curve and improved the discriminatory and reclassification capacity. CONCLUSION Flow quantification using NaI(Tl) SPECT provides superior sensitivity and discriminatory capacity to MPI in detecting significant stenosis. Clinical trial registration NCT03637725.
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Affiliation(s)
- Lei Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Yumin Zheng
- Department of Nuclear Medicine, China-Japan Friendship Hospital, National Center for Respiratory Diseases, Beijing, China
| | - Jie Zhang
- Department of Nuclear Medicine, Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Meng Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Dayong Wu
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Yawen Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Hong Qiu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China.
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15
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Alam L, Omar AMS, Patel KK. Improved Performance of PET Myocardial Perfusion Imaging Compared to SPECT in the Evaluation of Suspected CAD. Curr Cardiol Rep 2023; 25:281-293. [PMID: 36826689 DOI: 10.1007/s11886-023-01851-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE OF REVIEW Myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) has played a central role in the non-invasive evaluation of patients with obstructive coronary artery disease (CAD) for decades. In this review, we discuss the key differences and advantages of positron emission tomography (PET) MPI over SPECT MPI as it relates to the diagnosis, prognosis, as well as clinical decision-making in patients with suspected CAD. RECENT FINDINGS Stress-induced perfusion abnormalities on SPECT help estimate presence, extent, and location of ischemia and flow-limiting obstructive CAD, help with risk stratification, and serve as a gatekeeper to identify patients who will benefit from downstream revascularization versus medical management. Some of the major limitations of SPECT include soft-tissue attenuation artifacts, underestimation of ischemia due to reliance on relative perfusion assessment, and longer protocols with higher radiation dose when performed with traditional equipment. PET MPI addresses most of these limitations and offers better quality images, higher diagnostic accuracy along with shorter protocols and lower radiation dose to the patient. A special advantage of PET scanning lies in the ability to quantify absolute myocardial blood flow and assess true extent of epicardial involvement along with identifying non-obstructive phenotypes of CAD such as diffuse atherosclerosis and microvascular dysfunction. In addition, stress acquisition at/near peak stress with PET allows us to measure left ventricular ejection fraction reserve and myocardial blood flow reserve, which help with identifying patients at a higher risk of future cardiac events and optimally select candidates for revascularization. The several technical advantages of PET MPI position as a superior method to diagnose obstructive and non-obstructive phenotypes of ischemic heart disease affecting the entirety of the coronary circulation offer incremental value for risk stratification and guide post-test management strategy for patients with suspected CAD.
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Affiliation(s)
- Loba Alam
- Department of Cardiology, Mount Sinai Morningside, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alaa Mabrouk Salem Omar
- Department of Cardiology, Mount Sinai Morningside, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Krishna K Patel
- Department of Cardiology, Mount Sinai Morningside, New York, NY, USA.
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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16
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Mannarino T, Assante R, D'Antonio A, Zampella E, Cuocolo A, Acampa W. Radionuclide Tracers for Myocardial Perfusion Imaging and Blood Flow Quantification. Cardiol Clin 2023; 41:141-150. [PMID: 37003672 DOI: 10.1016/j.ccl.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Myocardial perfusion imaging by nuclear cardiology is widely validated for the diagnosis, risk stratification, and management of patients with suspected or known coronary artery disease. Numerous radiopharmaceuticals are available for single-photon emission computed tomography and PET modalities. Each tracer shows advantages and limitations that should be taken into account in performing an imaging examination. This review aimed to summarize the state-of-the-art radiotracers used for myocardial perfusion imaging and blood flow quantification, highlighting the new technologic advances and promising possible applications.
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Affiliation(s)
- Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples 80131, Italy.
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17
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Advances in Single-Photon Emission Computed Tomography. Cardiol Clin 2023; 41:117-127. [PMID: 37003670 DOI: 10.1016/j.ccl.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The clinical presentation of coronary artery disease (CAD) has changed during the last 20 years with less ischemia on stress testing and more nonobstructive CAD on coronary angiography. Single-photon emission computed tomography (SPECT) myocardial perfusion imaging should include the measurement of myocardial flow reserve and assessment of coronary calcium for the diagnosis of nonobstructive CAD and coronary microvascular disease. SPECT/CT systems provide reliable attenuation correction for better specificity and low-dose CT for coronary calcium evaluation. SPECT MFR measurement is accurate, well validated, and repeatable.
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18
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Bailly M, Thibault F, Metrard G, Courtehoux M, Angoulvant D, Ribeiro MJ. Precision of Myocardial Blood Flow and Flow Reserve Measurement During CZT SPECT Perfusion Imaging Processing: Intra- and Interobserver Variability. J Nucl Med 2023; 64:260-265. [PMID: 36109180 PMCID: PMC9902854 DOI: 10.2967/jnumed.122.264454] [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: 05/27/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of this study was to evaluate the reproducibility of myocardial blood flow (MBF) and myocardial flow reserve (MFR) measurement in patients referred for dynamic SPECT. Methods: We retrospectively analyzed patients referred for myocardial perfusion imaging. SPECT data were acquired on a cadmium zinc telluride-based pinhole cardiac camera in list mode using a stress (251 ± 15 MBq)/rest (512 ± 26 MBq) 1-d 99mTc-tetrofosmin protocol. Kinetic analyses were done with software using a 1-tissue-compartment model and converted to MBF using a previously determined extraction fraction correction. MFR was analyzed and compared globally and regionally. Motion detection was applied, but not attenuation correction. Results: In total, 124 patients (64 male, 60 female) were included, and SPECT acquisitions were twice reconstructed by the same nuclear medicine board-certified physician for 50 patients and by 2 different physicians for 74. Both intra- and interobserver measurements of global MFR had no significant bias (-0.01 [P = 0.94] and 0.01 [P = 0.67], respectively). However, rest MBF and stress MBF were significantly different in global left ventricular evaluation (P = 0.001 and P = 0.002, respectively) and in the anterior territory (P < 0.0001) on interuser analysis. The average coefficient of variation was 15%-30% of the mean stress MBF if the analysis was performed by the same physician or 2 different physicians and was around 20% of the mean MFR independently of the processing physician. Using the MFR threshold of 2, we noticed good intrauser agreement, whereas it was moderate when the users were different (κ = 0.75 [95% CI, 0.56-0.94] vs. 0.56 [95% CI, 0.36-0.75], respectively). Conclusion: Repeated measurements of global MFR by the same physician or 2 different physicians were similar, with an average coefficient of variation of 20%. Better reproducibility was achieved for intrauser MBF evaluation. Automation of processing is needed to improve reproducibility.
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Affiliation(s)
- Matthieu Bailly
- Nuclear Medicine Department, CHR Orleans, Orleans, France; .,UMR 1253, iBrain, Université de Tours, INSERM, Tours, France
| | | | - Gilles Metrard
- Nuclear Medicine Department, CHR Orleans, Orleans, France
| | | | - Denis Angoulvant
- Cardiology Department, CHRU Tours, Tours, France; and,EA4245 T2i, Tours University, Tours, France
| | - Maria Joao Ribeiro
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France;,Nuclear Medicine Department, CHRU Tours, Tours, France
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Affiliation(s)
- Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
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20
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Cuddy-Walsh SG, deKemp RA, Ruddy TD, Wells RG. Improved precision of SPECT myocardial blood flow using a net tracer retention model. Med Phys 2022; 50:2009-2021. [PMID: 36565461 DOI: 10.1002/mp.16186] [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: 04/20/2022] [Revised: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Noninvasive quantification of absolute myocardial blood flow (MBF) and myocardial flow reserve (MFR) provides incremental benefit to relative myocardial perfusion imaging (MPI) to diagnose and manage heart disease. MBF can be measured with single-photon emission computed tomography (SPECT) but the uncertainty in the measured values is high. Standardization and optimization of protocols for SPECT MBF measurements will improve the consistency of this technique. One element of the processing protocol is the choice of kinetic model used to analyze the dynamic image series. PURPOSE This study evaluates if a net tracer retention model (RET) will provide a better fit to the acquired data and greater test-retest precision than a one-compartment model (1CM) for SPECT MBF, with (+MC) and without (-MC) manual motion correction. METHODS Data from previously acquired rest-stress MBF studies (31 SPECT-PET and 30 SPECT-SPECT) were reprocessed ± MC. Rate constants (K1) were extracted using 1CM and RET, +/-MC, and compared pairwise with standard PET MBF measurements using cross-validation to obtain calibration parameters for converting SPECT rate constants to MBF and to assess the goodness-of-fit of the calibration curves. Precision (coefficient of variation of test re-test relative differences, COV) of flow measurements was computed for 1CM and RET ± MC using data from the repeated SPECT MBF studies. RESULTS Both the RET model and MC improved the goodness-of-fit of the SPECT MBF calibration curves to PET. All models produced minimal bias compared with PET (mean bias < 0.6%). The SPECT-SPECT MBF COV significantly improved from 34% (1CM+MC) to 28% (RET+MC, P = 0.008). CONCLUSION The RET+MC model provides a better calibration of SPECT to PET and blood flow measurements with better precision than the 1CM, without loss of accuracy.
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Affiliation(s)
- Sarah G Cuddy-Walsh
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert A deKemp
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - R Glenn Wells
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
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21
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Lima RSL, Bezerra A, Andrade M, Domenico C, De Lorenzo A. Improved detection of coronary artery disease by CZT regional coronary blood flow evaluation. FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2022; 2:1072729. [PMID: 39354966 PMCID: PMC11440858 DOI: 10.3389/fnume.2022.1072729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/29/2022] [Indexed: 10/03/2024]
Abstract
Introduction CZT cameras have enabled the noninvasive quantification of myocardial flow reserve (MFR), an important physiologic measure. This study aimed to compare myocardial perfusion SPECT (MPS) with or without MFR evaluation for the detection of obstructive coronary artery disease (CAD). Methods 48 patients with CAD (>50% obstruction) detected at invasive coronary angiography or CT angiography underwent dipyridamole MPS and MFR evaluation within 30 days. A 1-day protocol (rest-stress) was used to quantify MFR. The acquisition of dynamic rest and stress images was initiated simultaneously to 99mTc sestamibi injection (370 and 1,110 MBq, respectively), both lasting for 11 min, followed by 5-min imaging. Pharmacologic stress with dipyridamole (0.56 mg/kg for 4 min) was performed with the patient positioned in the CZT camera. The images were processed and time-activity curves were generated, calculating global and regional MFR in a semiautomatic software. A global or regional MFR <2 was considered abnormal. MPS perfusion images were classified as normal or abnormal. The images were interpreted by experienced physicians blinded to the results of MFR and coronary angiography/CT. Results Mean age of the population was 61 ± 9 years, 54.2% female. Twenty patients (41.7%) had single-vessel CAD, 22 (45.8%) 2-vessel CAD and 6 (12.5%), triple-vessel CAD. Among the 82 vessels with obstruction, 48 had perfusion abnormalities in MPS and 60 had reduced MFR, while among the normal vessels, had 54 normal MPS and 52 had preserved MFR. The sensitivity of MFR (69%) was higher than that of MPS (55.2%), without significant changes in specificity (86 vs. 83.7%). Conclusions MFR in the CZT camera is more sensitive for the detection of CAD than perfusion abnormalities in MPS, especially in patients with multivessel CAD.
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Affiliation(s)
- R S L Lima
- Nuclear Medicine Department, Fonte Imagem, Rio de Janeiro, Brazil
- Cardiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Bezerra
- Cardiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M Andrade
- Cardiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - C Domenico
- Cardiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - A De Lorenzo
- Cardiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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22
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Myocardial blood flow quantitation with the SPECT technique: Is it ready to be a substitute for PET myocardial blood flow quantitation? J Nucl Cardiol 2022. [PMID: 34180028 DOI: 10.1007/s12350-021-02697-5.10.1007/s12350-021-02697-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Fang W, Hsu B. Myocardial blood flow quantitation with the SPECT technique: Is it ready to be a substitute for PET myocardial blood flow quantitation? J Nucl Cardiol 2022; 29:3152-3154. [PMID: 34180028 DOI: 10.1007/s12350-021-02697-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA.
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24
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Zavadovsky KV, Mochula AV, Maltseva AN, Shipulin VV, Sazonova SI, Gulya MO, Liga R, Gimelli A. The current status of CZT SPECT myocardial blood flow and reserve assessment: Tips and tricks. J Nucl Cardiol 2022; 29:3137-3151. [PMID: 33939162 DOI: 10.1007/s12350-021-02620-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 01/18/2023]
Abstract
Cardiac PET-derived measurements of myocardial blood flow (MBF) and myocardial flow reserve (MFR) are proven robust indexes of the severity of coronary artery disease (CAD). They facilitate the diagnosis of diffuse epicardial and microvascular disease and are also of prognostic significance. However, low availability and high cost have limited their wide clinical implementation. Over the last 15 years, cadmium zinc telluride (CZT)-based detectors have been implemented into SPECT imaging devices. Myocardial perfusion scintigraphy can be performed faster and with less radiation exposure as compared with standard gamma cameras. Rapid dynamic SPECT studies with higher count rates can be performed. This technological breakthrough has renewed the interest in SPECT MBF assessment in patients with CAD. Currently, two cardiac-centered CZT gamma cameras are available commercially-Discovery NM530c and D-SPECT. They differ in parameters such as collimator design, number of detectors, sensitivity, spatial resolution and image reconstruction. A number of publications have focused on the feasibility of dynamic CZT SPECT and on the correlation with cardiac PET and invasive coronary angiography measurements of fractional flow reserve. Current study reviews the present status of MBF and MFR assessment with CZT SPECT. It also aims to provide an overview of specific issues related to acquisition, processing and interpretation of quantitative studies in patients with CAD.
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Affiliation(s)
- Konstantin V Zavadovsky
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia.
- Siberian State Medical University, Tomsk, Russia.
| | - Andrew V Mochula
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia
| | - Alina N Maltseva
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia
| | - Vladimir V Shipulin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia
| | - Svetlana I Sazonova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia
| | - Marina O Gulya
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya Str 111A, Tomsk, 634012, Russia
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Renaud JM, Poitrasson-Rivière A, Hagio T, Moody JB, Arida-Moody L, Ficaro EP, Murthy VL. Myocardial flow reserve estimation with contemporary CZT-SPECT and 99mTc-tracers lacks precision for routine clinical application. J Nucl Cardiol 2022; 29:2078-2089. [PMID: 34426935 DOI: 10.1007/s12350-021-02761-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/17/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND PET myocardial flow reserve (MFR) has established diagnostic and prognostic value. Technological advances have now enabled SPECT MFR quantification. We investigated whether SPECT MFR precision is sufficient for clinical categorization of patients. METHODS Validation studies vs invasive flow measurements and PET MFR were reviewed to determine global SPECT MFR thresholds. Studies vs PET and a SPECT MFR repeatability study were used to establish imprecision in SPECT MFR measurements as the standard deviation of the difference between SPECT and PET MFR, or test-retest SPECT MFR. Simulations were used to evaluate the impact of SPECT MFR imprecision on confidence of clinically relevant categorization. RESULTS Based on validation studies, the typical PET MFR categories were used for SPECT MFR classification (< 1.5, 1.5-2.0, > 2.0). Imprecision vs PET MFR ranged from 0.556 to 0.829, and test-retest imprecision was 0.781-0.878. Simulations showed correct classification of up to only 34% of patients when 1.5 ≤ true MFR ≤ 2.0. Categorization with high confidence (> 80%) was only achieved for extreme MFR values (< 1.0 or > 2.5), with correct classification in only 15% of patients in a typical lab with MFR of 1.8 ± 0.5. CONCLUSIONS Current SPECT-derived estimates of MFR lack precision and require further optimization for clinical risk stratification.
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Affiliation(s)
- Jennifer M Renaud
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA.
| | | | - Tomoe Hagio
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA
| | - Jonathan B Moody
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA
| | - Liliana Arida-Moody
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine (Department of Internal Medicine) and Division of Nuclear Medicine (Department of Radiology), University of Michigan, Ann Arbor, MI, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, 3025 Boardwalk Dr., Suite 200, Ann Arbor, MI, 48108, USA
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine (Department of Internal Medicine) and Division of Nuclear Medicine (Department of Radiology), University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine (Department of Internal Medicine) and Division of Nuclear Medicine (Department of Radiology), University of Michigan, Ann Arbor, MI, USA
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26
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Zavadovsky KV, Vorobyeva DA, Mochula OV, Mochula AV, Maltseva AN, Bayev AE, Gulya MO, Gimelli A, Ryabov VV. Myocardial Blood Flow and Flow Reserve in Patients With Acute Myocardial Infarction and Obstructive and Non-Obstructive Coronary Arteries: CZT SPECT Study. FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2022; 2:935539. [PMID: 39354978 PMCID: PMC11440855 DOI: 10.3389/fnume.2022.935539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/31/2022] [Indexed: 10/03/2024]
Abstract
Background To assess single-photon emission computed tomography cadmium-zinc-telluride (SPECT CZT)-derived myocardial blood flow (MBF) flow reserve (MFR) and flow difference (FD) in patients with acute myocardial infarction (AMI) and to compare this data with serum cardiac troponin and cardiac magnetic resonance (CMR) findings. Methods A total of 31 patients with AMI underwent invasive coronary angiography (ICA), serial high-sensitivity serum cardiac troponin I (cTnI) measurement, and CZT SPECT with visual and quantitative (MBF, MFR, and FD) perfusion parameters, and contrast-enhanced CMR. All patients with AMI were divided into two groups: (1) with non-obstructive coronary arteries (MINOCA), n = 10; (2) with obstructive coronary artery disease (MICAD), n = 21. Results The values of SSS and SRS were significantly (p < 0.01) higher whereas global stress MBF, MFR significantly lower in patients with MICAD as compared to MINOCA - 5.0 (3.0; 5.0) vs. 9.0 (5.0; 13.0); 2.0 (1.0; 3.0) vs. 6.0 (3.0; 11.0); 2.02 (1.71; 2.37) vs. 0.86 (0.72; 1.02) ml/min/g; and 2.61 (2.23; 3.14) vs. 1.67 (1.1; 1.9), respectively. Stress MBF correlated with cTnI at 24 h and day 4: ρ = -0.39; p = 0.03 and ρ = -0.47; p = 0.007, respectively. FD correlated with cTnI at 24 h and day 4: ρ = -0.39; p = 0.03 and ρ = -0.46; p = 0.009. CMR analysis showed that infarct size, MVO and myocardial edema in patients with MICAD were significantly (< 0.05) higher as compared to MINOCA: 19.4 (10.4; 29.7) vs. 1.8 (0.0; 6.9); 0.1 (0.0; 0.7) vs. 0.0 (0.0; 0.0) and 19.5 (12.0;30.0) vs. 3.0 (0.0; 12.0), respectively. According to vessel-based analysis of CMR data, acute myocardial injury (defined as late gadolinium enhancement and myocardial edema) was observed more frequently in patients with MICAD compared to MINOCA: 34(37%) vs. 5(5%) p = 0.005, respectively. The values of regional stress MBF, MFR and FD were significantly decreased in LV territories characterized by myocardial injury compared to those without: 0.98 (0.73; 1.79) vs. 1.33 (0.94; 2.08) p < 0.01, 1.64 (1.0; 2.36) vs. 2.0 (1.53; 2.89) p < 0.01 and 0.33 (0.05; 0.57) vs. 0.56 (0.36; 1.32) p> 0.01, respectively. Conclusion In patients with AMI, SPECT CZT-derived flow measures were associated with the high-sensitivity troponin I as well as the extent of edema, microvascular obstruction, and infarct size detected by CMR. On the regional level, quantitative SPECT CZT measures were significantly lower in vessel territories characterized by myocardial injury.
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Affiliation(s)
- Konstantin V. Zavadovsky
- Tomsk National Research Medical Centre, Cardiology Research Institute, Russian Academy of Sciences, Moscow, Russia
| | - Darya A. Vorobyeva
- Tomsk National Research Medical Centre, Cardiology Research Institute, Russian Academy of Sciences, Moscow, Russia
| | - Olga V. Mochula
- Tomsk National Research Medical Centre, Cardiology Research Institute, Russian Academy of Sciences, Moscow, Russia
| | - Andrew V. Mochula
- Tomsk National Research Medical Centre, Cardiology Research Institute, Russian Academy of Sciences, Moscow, Russia
| | - Alina N. Maltseva
- Tomsk National Research Medical Centre, Cardiology Research Institute, Russian Academy of Sciences, Moscow, Russia
| | - Andrew E. Bayev
- Tomsk National Research Medical Centre, Cardiology Research Institute, Russian Academy of Sciences, Moscow, Russia
| | - Marina O. Gulya
- Tomsk National Research Medical Centre, Cardiology Research Institute, Russian Academy of Sciences, Moscow, Russia
| | | | - Vyacheslav V. Ryabov
- Tomsk National Research Medical Centre, Cardiology Research Institute, Russian Academy of Sciences, Moscow, Russia
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27
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de Souza ACDAH, Harms HJ, Martell L, Bibbo C, Harrington M, Sullivan K, Hainer J, Dorbala S, Blankstein R, Taqueti VR, Foley Kijewski M, Park MA, Meretta A, Breault C, Roth N, Poitrasson-Rivière A, Soman P, Gullberg GT, Di Carli MF. Accuracy and Reproducibility of Myocardial Blood Flow Quantification by Single Photon Emission Computed Tomography Imaging in Patients With Known or Suspected Coronary Artery Disease. Circ Cardiovasc Imaging 2022; 15:e013987. [PMID: 35674051 DOI: 10.1161/circimaging.122.013987] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Single photon emission computed tomography (SPECT) has limited ability to identify multivessel and microvascular coronary artery disease. Gamma cameras with cadmium zinc telluride detectors allow the quantification of absolute myocardial blood flow (MBF) and myocardial flow reserve (MFR). However, evidence of its accuracy is limited, and of its reproducibility is lacking. We aimed to validate 99mTc-sestamibi SPECT MBF and MFR using standard and spline-fitted reconstruction algorithms compared with 13N-ammonia positron emission tomography in a cohort of patients with known or suspected coronary artery disease and to evaluate the reproducibility of this technique. METHODS Accuracy was assessed in 34 participants who underwent dynamic 99mTc-sestamibi SPECT and 13N-ammonia positron emission tomography and reproducibility in 14 participants who underwent 2 99mTc-sestamibi SPECT studies, all within 2 weeks. A rest/pharmacological stress single-day SPECT protocol was performed. SPECT images were reconstructed using a standard ordered subset expectation maximization (OSEM) algorithm with (N=21) and without (N=30) application of spline fitting. SPECT MBF was quantified using a net retention kinetic model' and MFR was derived as the stress/rest MBF ratio. RESULTS SPECT global MBF with splines showed good correlation with 13N-ammonia positron emission tomography (r=0.81, P<0.001) and MFR estimates (r=0.74, P<0.001). Correlations were substantially weaker for standard reconstruction without splines (r=0.61, P<0.001 and r=0.34, P=0.07, for MBF and MFR, respectively). Reproducibility of global MBF estimates with splines in paired SPECT scans was good (r=0.77, P<0.001), while ordered subset expectation maximization without splines led to decreased MBF (r=0.68, P<0.001) and MFR correlations (r=0.33, P=0.3). There were no significant differences in MBF or MFR between the 2 reproducibility scans independently of the reconstruction algorithm (P>0.05 for all). CONCLUSIONS MBF and MFR quantification using 99mTc-sestamibi cadmium zinc telluride SPECT with spatiotemporal spline fitting improved the correlation with 13N-ammonia positron emission tomography flow estimates and test/retest reproducibility. The use of splines may represent an important step toward the standardization of SPECT flow estimation.
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Affiliation(s)
- Ana Carolina do A H de Souza
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Hendrik J Harms
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Laurel Martell
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Courtney Bibbo
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.).,Spectrum Dynamics Medical, Caesarea, Israel (C.B., N.R.)
| | - Meagan Harrington
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Kyle Sullivan
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Marie Foley Kijewski
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Mi-Ae Park
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Alejandro Meretta
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina (A.M.)
| | - Christopher Breault
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
| | - Nathaniel Roth
- Spectrum Dynamics Medical, Caesarea, Israel (C.B., N.R.)
| | | | - Prem Soman
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA (P.S.)
| | - Grant T Gullberg
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA (G.T.G.)
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (A.C.d.A.H.d.S., H.J.H., L.M., C.B., M.H., K.S., J.H., S.D., R.B., V.R.T., M.F., M.-A.P., M.F.D.C.)
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Fang W, Hsu B. Myocardial blood flow quantitation with the SPECT technique: Where do we stand? J Nucl Cardiol 2022; 29:630-632. [PMID: 33025470 DOI: 10.1007/s12350-020-02373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA.
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29
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Brana Q, Thibault F, Courtehoux M, Metrard G, Ribeiro MJ, Angoulvant D, Bailly M. Regadenoson versus dipyridamole: Evaluation of stress myocardial blood flow response on a CZT-SPECT camera. J Nucl Cardiol 2022; 29:113-122. [PMID: 32651801 DOI: 10.1007/s12350-020-02271-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Regadenoson is a selective adenosine receptor agonist. It is currently unclear if the level of hyperemia differs between stress agents. We compared Myocardial Blood Flow (MBF) and Myocardial Flow Reserve (MFR) response on CZT-SPECT Myocardial Perfusion Imaging (MPI) to evaluate if dipyridamole and regadenoson could induce the same level of hyperemia. METHODS 228 patients with dynamic CZT-SPECT MPI were retrospectively analyzed (66 patients stressed with regadenoson and 162 with dipyridamole) in terms of MBF and MFR. To rule out confounding factors, two groups of 41 patients were matched for clinical characteristics in a sub-analysis, excluding high cardiovascular risk patients. RESULTS Overall stress MBF was higher in regadenoson patients (1.71 ± 0.73 vs. 1.44 ± 0.55 mL·min-1·g-1 for regadenoson and dipyridamole, respectively, p < .05). However, when confounding factors were ruled out, stress MBF (1.57 ± 0.56 vs. 1.61 ± 0.62 mL·min-1·g-1 for dipyridamole and regadenoson, respectively, p = .88) and MFR (2.62 ± 0.77 vs. 2.46 ± 0.76 for dipyridamole and regadenoson, respectively, p = .40) were not different between regadenoson and dipyridamole. CONCLUSIONS Our results suggest that dipyridamole and regadenoson induce equivalent hyperemia in dynamic SPECT with similar stress MBF and MFR in comparable patients.
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Affiliation(s)
- Quentin Brana
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
- Nuclear Medicine Department, CHRU TOURS, Tours, France
| | - Frédérique Thibault
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
| | | | - Gilles Metrard
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
| | | | - Denis Angoulvant
- Cardiology Department, CHRU TOURS & EA4245 T2i, Tours University, Tours, France
| | - Matthieu Bailly
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France.
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30
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Imbert L, Marie PY. Dedicated CZT gamma cameras for nuclear cardiology. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00080-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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31
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Ishimura H. [[SPECT] 2. Myocardial Flow Reserve Quantification Software and Cadmium-Zinc-Telluride Detector Cardiac SPECT System]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:664-670. [PMID: 35718457 DOI: 10.6009/jjrt.2022-2043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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32
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Imbert L, Bahloul A, Verger A, Marie PY. 360° CZT gamma cameras for nuclear medicine and molecular imaging. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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33
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Case JA. 3D iterative reconstruction can do so much more than reduce dose. J Nucl Cardiol 2021; 28:2633-2637. [PMID: 31376003 DOI: 10.1007/s12350-019-01827-4] [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: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
Recent advances in software and hardware for cardiac SPECT have the potential to revolutionize nuclear cardiology. It is easy to use these technologies to maintain the status quo and lower radiation dose, despite the fact there is very little evidence that lowering patient dose in already low dose imaging protocols confers any benefit to patients. Cardiac SPECT has tremendous potential for risk stratification, molecular tracers, and high temporal resolution management of patients with electrophysiological disorders. In addition, these new reconstruction techniques can offer spatial resolution that is comparable and sometimes even superior to PET. Lastly, recent research has also held out the potential for performing absolute blood flow qualification using SPECT instrumentation. As these new technologies become available, the goal should be to make images better and improve patient care first, then optimize the dose.
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Affiliation(s)
- James A Case
- Cardiovascular Imaging Technologies, 4320 Wornall Road Suite 114, Kansas City, MO, 64111, USA.
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34
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Bailly M, Thibault F, Courtehoux M, Metrard G, Ribeiro MJ. Impact of attenuation correction for CZT-SPECT measurement of myocardial blood flow. J Nucl Cardiol 2021; 28:2560-2568. [PMID: 32080802 DOI: 10.1007/s12350-020-02075-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/04/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Most of cardiac dedicated CZT-SPECT systems are not equipped with CT, whereas PET systems are. We evaluated the impact of AC correction on CZT-SPECT myocardial blood flow (MBF) and myocardial flow reserve (MFR) measurements. METHODS 104 patients were included. SPECT data were acquired on cadmium zinc telluride (CZT)-based pinhole cardiac camera in listmode using a stress (250 ± 17 MBq)/rest (511 ± 23 MBq) 1-day Tc-99m-tetrofosmin protocol. Low-dose CT was acquired on another SPECT/CT camera in the same position. All analysis was performed using Corridor4DM. RESULTS Stress and rest MBF were significantly lower when AC was applied (P < 0.001). For regional and global MFR, there was no significant difference between AC and NAC measurements (P > 0.25 at least). Mean global LV MFR was 2.43 ± 0.87 and 2.33 ± 0.89, respectively, for NAC and AC measurements. Using a threshold of 2, 86 patients (83%) remained classified as normal and abnormal regarding global LV MFR whether AC was applied or not. Mean difference between NAC and AC values for the 18 other patients was 0.3. CONCLUSION AC correction does not significantly affect MFR measurement both in regional and global LV analyses.
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Affiliation(s)
- Matthieu Bailly
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France.
| | - Frédérique Thibault
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
- Nuclear Medicine Department, CHRU TOURS, Tours, France
| | | | - Gilles Metrard
- Nuclear Medicine Department, CHR ORLEANS, 14 Avenue de l'Hôpital, 45100, Orleans, France
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35
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Feher A, Sinusas AJ. Evaluation of cardiac allograft vasculopathy by positron emission tomography. J Nucl Cardiol 2021; 28:2616-2628. [PMID: 33389637 DOI: 10.1007/s12350-020-02438-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/04/2020] [Indexed: 12/22/2022]
Abstract
Cardiac allograft vasculopathy (CAV) remains one of the most important late occurring complications in heart transplant (HT) recipients significantly effecting graft survival. Recently, there has been tremendous focus on the development of effective and safe non-invasive diagnostic strategies for the diagnosis of CAV employing a wide range of imaging technologies. During the past decade multiple studies have been published using positron emission tomography (PET) myocardial perfusion imaging, establishing the value of PET myocardial blood flow quantification for the evaluation of CAV. These independent investigations demonstrate that PET can be successfully used to establish the diagnosis of CAV, can be utilized for prognostication and may be used for serial monitoring of HT recipients. In addition, molecular imaging techniques have started to emerge as new tools to enhance our knowledge to better understand the pathophysiology of CAV.
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Affiliation(s)
- Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520, USA.
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
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36
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Acampa W, Zampella E, Assante R, Genova A, De Simini G, Mannarino T, D'Antonio A, Gaudieri V, Nappi C, Buongiorno P, Mainolfi CG, Petretta M, Cuocolo A. Quantification of myocardial perfusion reserve by CZT-SPECT: A head to head comparison with 82Rubidium PET imaging. J Nucl Cardiol 2021; 28:2827-2839. [PMID: 32383083 DOI: 10.1007/s12350-020-02129-w] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/28/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND We measured myocardial blood flow (MBF) and perfusion reserve (MPR) by dynamic CZT-SPECT and 82Rb-PET in patients with suspected or known coronary artery disease (CAD) and compared the accuracy of the two methods in predicting obstructive CAD. METHODS Twenty-five patients with available coronary angiography data underwent 99mTc-sestamibi CZT-SPECT and 82Rb-PET cardiac imaging. Stress and rest MBF and MPR were calculated by both methods and compared. Diagnostic accuracies of CZT-SPECT and PET were also assessed using a receiver-operator-characteristic curve. RESULTS CZT-SPECT yielded similar baseline MBF, but higher hyperemic MBF and MPR values compared to PET. There was a modest correlation between the two methods for MPR (r = 0.56, P < .01). MPR by CZT-SPECT showed a good ability in identify a reduced MPR by PET, with an area under the curve of 0.85. A MPR cut-off of 2.5 was identified by CZT-SPECT for detection of abnormal MPR by PET, with a sensitivity, specificity and accuracy of 86%, 73% and 80%. The area under the curve for the identification of obstructive CAD by regional MPR were 0.83 for CZT-SPECT and 0.84 for PET (P = .90). At CZT-SPECT, a regional MPR of 2.1 provided the best trade-off between sensitivity and specificity for identifying obstructive CAD. Diagnostic accuracy of CZT-SPECT and PET using respective cut-off values was comparable (P = .62). CONCLUSION Hyperemic MBF and MPR values obtained by CZT-SPECT are higher than those measured by 82Rb-PET imaging, with a moderate correlation between the two methods. CZT-SPECT shows good diagnostic accuracy for the identification of obstructive CAD. These findings may encourage the use of this new technique to a better risk stratification and patient management.
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Affiliation(s)
- Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Andrea Genova
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Giovanni De Simini
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Ciro Gabriele Mainolfi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
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37
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Giubbini R, Cerudelli E, Camoni L. Myocardial blood flow reserve and absolute myocardial blood flow for the assessment of patients with coronary artery disease with or without microvascular dysfunction. J Nucl Cardiol 2021; 28:3007-3009. [PMID: 32754895 DOI: 10.1007/s12350-020-02297-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Raffaele Giubbini
- Imaging Department and Nuclear Medicine Unit, University and Spedali Civili of Brescia, Brescia, Italy.
- Nuclear Medicine Department, Piazza Spedali Civili, 1, Brescia, Italy.
| | - Elisabetta Cerudelli
- Imaging Department and Nuclear Medicine Unit, University and Spedali Civili of Brescia, Brescia, Italy
| | - Luca Camoni
- Imaging Department and Nuclear Medicine Unit, University and Spedali Civili of Brescia, Brescia, Italy
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38
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Guerraty MA, Metzler SD, Bravo PE. SPECT quantification of myocardial blood flow: Another step toward widespread availability. J Nucl Cardiol 2021; 28:2840-2844. [PMID: 32476107 DOI: 10.1007/s12350-020-02207-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Marie A Guerraty
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Scott D Metzler
- Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paco E Bravo
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
- Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, 11-154 South Pavilion, Philadelphia, PA, 19104, USA.
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39
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Do J, Ruddy TD, Wells RG. Reduced acquisition times for measurement of myocardial blood flow with 99mTc-tetrofosmin and solid-state detector SPECT. J Nucl Cardiol 2021; 28:2518-2529. [PMID: 32026329 DOI: 10.1007/s12350-020-02048-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Measurement of myocardial blood flow (MBF) is feasible using SPECT imaging but the acquisition requires more time than usual. Our study assessed the impact of reducing acquisition times on the accuracy and repeatability of the uptake rate constant (K1). METHODS Twenty-nine patients underwent two rest/stress studies with Tc-99m-tetrofosmin 18 ± 13 days apart, using a one-day rest/stress dynamic SPECT imaging protocol with a solid-state cardiac camera. A 5-minute static image was acquired prior to tracer injection for subtraction of residual activity, followed immediately by 11-minute of list-mode data collection. Static image acquisition times of 0.5, 1, and 3 minutes and dynamic imaging times of 5, 7, and 9 minutes were simulated by truncating list-mode data. Images were reconstructed with/without attenuation correction and with/without motion correction. Kinetic parameters were calculated using a 1-tissue-compartment model. RESULTS K1 increased with reduced dynamic but not static imaging time (P < 0.001). The increase in K1 for a 9-minute scan was small (4.7 ± 5.3%) compared with full-length studies. The repeatability of K1 did not change significantly (13 ± 12%, P > 0.17). CONCLUSIONS A shortened imaging protocol of 3-minute (rest) or 30-second (stress) static image acquisition and 9 minutes of dynamic image acquisition altered K1 by less than 5% compared to a previously validated 11-minute acquisition.
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Affiliation(s)
- Jeffrey Do
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Canada
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Canada
| | - R Glenn Wells
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Canada.
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40
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Bailly M, Ribeiro MJ, Angoulvant D. Combining flow and reserve measurement during myocardial perfusion imaging: A new era for myocardial perfusion scintigraphy? Arch Cardiovasc Dis 2021; 114:818-827. [PMID: 34801410 DOI: 10.1016/j.acvd.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022]
Abstract
Myocardial flow reserve represents the ratio of myocardial blood flow between stress and rest, giving functional information about both macrocirculation and microcirculation; it has been reported extensively in positron emission tomography, with an increase in diagnostic performance, providing important prognostic information and being a powerful tool to guide therapy. Advances in single photon emission computed tomography, with the widespread availability of "cadmium zinc telluride" single photon emission computed tomography cameras, raise the question of myocardial flow reserve use in daily clinical practice. In this article, we review the pathophysiology of myocardial blood flow and myocardial flow reserve, and the initial data available from single photon emission computed tomography myocardial blood flow and myocardial flow reserve evaluation; we also discuss potential limitations to the wider implementation of flow evaluation in single photon emission computed tomography.
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Affiliation(s)
- Matthieu Bailly
- Nuclear Medicine Department, CHR Orleans, 14, Avenue de l'Hôpital, 45100 Orleans, France; UMR 1253, iBrain, Université de Tours, Inserm, 37000 Tours, France.
| | - Maria Joao Ribeiro
- UMR 1253, iBrain, Université de Tours, Inserm, 37000 Tours, France; Nuclear Medicine Department, CHRU Tours, 37000 Tours, France
| | - Denis Angoulvant
- Cardiology Department, CHRU Tours, 37000 Tours, France; EA4245, T2i, Tours University, 37000 Tours, France
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41
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Krakovich A, Zaretsky U, Moalem I, Naimushin A, Rozen E, Scheinowitz M, Goldkorn R. A new cardiac phantom for dynamic SPECT. J Nucl Cardiol 2021; 28:2299-2309. [PMID: 31997101 DOI: 10.1007/s12350-020-02028-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/19/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND In recent years, with the advance of myocardial blood flow (MBF) measurement capability in dynamic single photon emission computerized tomography (SPECT) systems, significant effort has been devoted to validation of the new capability. Unfortunately, the mechanical phantoms available for the validation process lack essential features-they either have a constant radiotracer concentration or they have rigid (static) walls unable to simulate cardiac beating. METHODS AND RESULTS We have developed a mechanical cardiac phantom that is able to mimic physiological radiotracer variation in the left ventricle (LV) cavity and in the myocardium (M), while performing beating-like motion. We have also developed a mathematical model of the phantom, allowing a description of the radiotracer concentrations in both regions (LV, M) as a function of time, which served as a tool for experiment planning and to accurately mimic physiological-like time-activity curves (TACs). A net retention model for the phantom was also developed, which served to compute the theoretical (i.e., expected) MBF of the phantom from measured quantities only, and thus validate the MBF reported by the SPECT system. In this paper, phantom experiments were performed on a GE Discovery NM 530c SPECT system. CONCLUSIONS A novel dynamic cardiac phantom for emission tomography has been developed. The new phantom is capable of producing a wide range of TACs that can mimic physiological (and potentially in the future, pathological) curves, similar to those observed in dynamic SPECT systems. SPECT-reported MBF values were validated against known (measured) activity of the injected radiotracer from phantom experiments, which allowed to determine the accuracy of the GE Discovery 530c SPECT system.
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Affiliation(s)
- A Krakovich
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel.
| | - U Zaretsky
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel
| | - I Moalem
- Nuclear Cardiology Unit, Lev Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - A Naimushin
- Nuclear Cardiology Unit, Lev Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - E Rozen
- Nuclear Cardiology Unit, Lev Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - M Scheinowitz
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel
| | - R Goldkorn
- Nuclear Cardiology Unit, Lev Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
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42
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Giubbini R, Bertoli M, Durmo R, Bonacina M, Peli A, Faggiano I, Albano D, Milan E, Stern E, Paghera B, Rodella C, Cerudelli E, Gazzilli M, Dondi F, Bertagna F, Camoni L. Comparison between N 13NH 3-PET and 99mTc-Tetrofosmin-CZT SPECT in the evaluation of absolute myocardial blood flow and flow reserve. J Nucl Cardiol 2021; 28:1906-1918. [PMID: 31728817 DOI: 10.1007/s12350-019-01939-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND PET/CT is the standard for quantitative assessments of myocardial blood flow (MBF), but it requires short-lived-tracers, costly, and not widely available. SPECT with Cadmium Zinc Telluride (CZT) detectors allows dynamic acquisition and quantitation of MBF. The study aims were to compare MBF measurements by 99mTc-tetrofosmin-CZT to N13NH3 PET/CT after regadenoson-induced coronary hyperemia and to evaluate the effect of attenuation correction (AC). METHODS 54 patients were evaluated at rest and during vasodilation by 99mTc-tetrofosmin-CZT and N13NH3 PET/CT within 2 weeks. MBF and MBF reserve (MFR) were measured by CZT with or without AC (NAC). RESULTS The global rest MBF was 0.76 ± 0.19 mL/min/gr by PET and 0.76 ± 0.24 by AC-CZT (P = NS) and 1.14 ± 0.4 by NAC-CZT (P < 0.001 vs PET and AC-CZT). Stress MBF was higher when measured by PET than AC-CZT (1.87 ± 0.45 vs 1.62 ± 0.68 mL/min/gr, P < 0.0008), but lower than NAC-CZT (2.36 ± 1.1, P < 0.0003). The MBF reserve ratio (MFR) was higher by PET than AC-CZT (2.52 ± 0.56 vs 2.22 ± 1 (P < 0.009) and NAC-CZT (2.18 ± 1.0, P < 0.004). Linear regression was better between PET (MFR and stress MBF) and AC-CZT than between PET and NAC-CZT. ROC curve analysis showed the significant ability of AC-CZT to predict MFR < 2 and stress MBF < 1.7 (AUC = 0.75 and 0.82 respectively) and to differentiate between normal and CAD patients (AUC = 0.747 and 0.892 for MFR and stress MBF, respectively). CONCLUSIONS Our data show a reasonable correlation between MBF and MFR measured by N13NH3-PET and 99mTc-Tetrofosmin-CZT SPECT. NAC-CZT overestimates MBF. AC is recommended when using CZT for measuring MBF.
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Affiliation(s)
- Raffaele Giubbini
- Chair of Nuclear Medicine, University of Brescia, Piazza Spedali Civili, 1, Brescia, Italy.
| | - Mattia Bertoli
- Nuclear Medicine Unit, ASST-Spedali Civili, Brescia, Italy
| | - Rexhep Durmo
- Chair of Nuclear Medicine, University of Brescia, Piazza Spedali Civili, 1, Brescia, Italy
| | - Mattia Bonacina
- Chair of Nuclear Medicine, University of Brescia, Piazza Spedali Civili, 1, Brescia, Italy
| | - Alessia Peli
- Nuclear Medicine Unit, ASST-Spedali Civili, Brescia, Italy
| | - Ilio Faggiano
- Cardiology Department, ASST-Spedali Civili, Brescia, Italy
| | - Domenico Albano
- Chair of Nuclear Medicine, University of Brescia, Piazza Spedali Civili, 1, Brescia, Italy
| | - Elisa Milan
- Nuclear Medicine Department, Treviso Hospital, Treviso, Italy
| | | | | | - Carlo Rodella
- Health Physics Department, ASST-Spedali Civili, Brescia, Italy
| | - Elisabetta Cerudelli
- Chair of Nuclear Medicine, University of Brescia, Piazza Spedali Civili, 1, Brescia, Italy
| | - Marina Gazzilli
- Chair of Nuclear Medicine, University of Brescia, Piazza Spedali Civili, 1, Brescia, Italy
| | - Francesco Dondi
- Chair of Nuclear Medicine, University of Brescia, Piazza Spedali Civili, 1, Brescia, Italy
| | - Francesco Bertagna
- Chair of Nuclear Medicine, University of Brescia, Piazza Spedali Civili, 1, Brescia, Italy
| | - Luca Camoni
- Nuclear Medicine Unit, ASST-Spedali Civili, Brescia, Italy
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43
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Bajaj NS, Bhambhvani P. SPECT-derived absolute myocardial perfusion measures: A step in the right direction. J Nucl Cardiol 2021; 28:1919-1922. [PMID: 31802385 DOI: 10.1007/s12350-019-01972-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Navkaranbir S Bajaj
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affair Medical Center, Birmingham, AL, USA
- Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JT 777, Birmingham, AL, 35249, USA
| | - Pradeep Bhambhvani
- Division of Molecular Imaging and Therapeutics, Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JT 777, Birmingham, AL, 35249, USA.
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Wells RG, Marvin B. Measuring SPECT myocardial blood flow at the University of Ottawa Heart Institute. J Nucl Cardiol 2021; 28:1298-1303. [PMID: 32236841 DOI: 10.1007/s12350-020-02102-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
The introduction of new cardiac SPECT cameras has made it practical to do dynamic SPECT imaging and opened the door to performing myocardial blood flow (MBF) imaging with SPECT. In this paper, we describe in detail our approach to dynamic SPECT MBF imaging using a multi-pinhole cardiac SPECT camera and commercially available kinetic analysis software. We use a 1-day rest/stress protocol with 370 MBq injected at rest and 1,000 MBq at stress with a 1- to 2-hour interval between rest and stress imaging. The tracer is injected mechanically over 30 seconds using a syringe pump. Projection data are acquired in listmode for a duration of 11 minutes and then reframed into a dynamic series. Each image is reconstructed independently using vendor-supplied software. The dynamic images are corrected for residual activity and manually corrected for motion using rigid-body translation. The uptake rate constant, K1, is calculated using a 1-tissue-compartment kinetic model and converted to MBF using a previously determined extraction fraction correction.
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Affiliation(s)
- R Glenn Wells
- Cardiac Imaging Program, University of Ottawa Heart Institute, Ottawa, Canada.
| | - Brian Marvin
- Cardiac Imaging Program, University of Ottawa Heart Institute, Ottawa, Canada
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Cuddy-Walsh SG, Wells RG. Noise heterogeneity in attenuation-corrected cardiac SPECT images increases perfusion value uncertainty near the base of the heart. J Nucl Cardiol 2021; 28:1284-1293. [PMID: 31332658 DOI: 10.1007/s12350-019-01821-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/09/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dedicated cardiac SPECT cameras which employ multi-pinhole detectors have variable photon sensitivity within the camera's field-of-view such that a lower number of photon counts is typically detected from the base of the heart than from the apex. Consequently, the noise in a reconstructed image is expected to be higher at the base than at the apex of the heart. METHODS Patient emission images were resampled to create statistical replicates which were reconstructed with and without attenuation correction. Noise images were computed using one standard deviation of the replicated images. These were evaluated for 93 patients with normal study results, each imaged with both a dual-headed parallel-hole camera and a multi-pinhole camera. Statistics for a normal database (NDB) of images from the 93 patients were also calculated. RESULTS Image noise (1.7-fold) and NDB uncertainty (1.3-fold) increase significantly from the apex-to-the base of the heart in attenuation-corrected multi-pinhole SPECT images. The differences for non-attenuation-corrected images or those acquired with a parallel-hole camera were not significant. CONCLUSIONS For best interpretation of attenuation-corrected images acquired with multi-pinhole cameras, knowledge of NDB uncertainty gradients should be taken into consideration.
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Affiliation(s)
- Sarah G Cuddy-Walsh
- Department of Physics, Carleton University, Ottawa, ON, Canada.
- Division of Cardiology, University of Ottawa Heart Institute, H2243 - 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| | - R Glenn Wells
- Department of Physics, Carleton University, Ottawa, ON, Canada
- Division of Cardiology, University of Ottawa Heart Institute, H2243 - 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
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46
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Otaki Y, Manabe O, Miller RJH, Manrique A, Nganoa C, Roth N, Berman DS, Germano G, Slomka PJ, Agostini D. Quantification of myocardial blood flow by CZT-SPECT with motion correction and comparison with 15O-water PET. J Nucl Cardiol 2021; 28:1477-1486. [PMID: 31452085 PMCID: PMC7042031 DOI: 10.1007/s12350-019-01854-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/16/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND We compared quantification of MBF and myocardial flow reserve (MFR) with a 99mTc-sestamibi CZT-SPECT to 15O-water PET. METHODS SPECT MBF for thirty patients in the WATERDAY study was re-analyzed by QPET software with motion correction and optimal placement of the arterial input function. 15O-water PET MBF was re-quantified using dedicated software. Inter-operator variability was assessed using repeatability coefficients (RPC). RESULTS Significant correlations were observed between global (r = 0.91, P < 0.001) and regional MBF (r = 0.86, P < 0.001) with SPECT compared to PET. Global MBF (rest 0.95 vs 1.05 ml/min/g, P = 0.07; stress 2.62 vs 2.68 mL/min/g, P = 0.17) and MFR (2.65 vs 2.75, P = 0.86) were similar between SPECT and PET. Rest (0.81 vs 0.98 mL/min/g, P = 0.03) and stress MBF (1.98 vs 2.61 mL/min/g, P = 0.01) in right coronary artery (RCA) were lower with SPECT compared to PET. However, MFR in the RCA territory was similar (2.54 vs 2.77, P = 0.21). The SPECT-PET RPC for global MBFs and MFR were 0.95 mL/min/g and 0.94, with inter-observer RPC of 0.59 mL/min/g and 0.74, respectively. CONCLUSIONS MBF and MFR derived from CZT-SPECT with motion correction and optimal placement of the arterial input function showed good agreement with 15O-water PET, as well as low inter-operator variability.
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Affiliation(s)
- Yuka Otaki
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Osamu Manabe
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Nuclear Medicine, Hokkaido University of Graduate School of Medicine, Sapporo, Japan
| | - Robert J H Miller
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alain Manrique
- Department of Nuclear Medicine, CHU Cote de Nacre, Normandy University, Caen, France
| | - Catherine Nganoa
- Department of Nuclear Medicine, CHU Cote de Nacre, Normandy University, Caen, France
| | | | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Guido Germano
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Denis Agostini
- Department of Nuclear Medicine, CHU Cote de Nacre, Normandy University, Caen, France
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Pelletier-Galarneau M, Ruddy TD. A big step towards clinical implementation of myocardial blood flow quantification with CZT SPECT. J Nucl Cardiol 2021; 28:1487-1489. [PMID: 31535294 DOI: 10.1007/s12350-019-01894-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Matthieu Pelletier-Galarneau
- Department of Medical Imaging, Montreal Heart Institute, Montreal, QC, Canada
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
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48
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Duvall WL, Case J, Lundbye J, Cerqueira M. Efficiency of tetrofosmin versus sestamibi achieved through shorter injection-to-imaging times: A systematic review of the literature. J Nucl Cardiol 2021; 28:1381-1394. [PMID: 32236839 PMCID: PMC8421307 DOI: 10.1007/s12350-020-02093-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/19/2020] [Indexed: 11/20/2022]
Abstract
Based on superior image quality, more accurate gated images, and lower radiation exposure to patients, Technetium-99m (Tc-99m) based tracers are preferred over Thallium-201 for SPECT myocardial perfusion imaging. The two Tc-99m tracers, sestamibi and tetrofosmin, have many similar characteristics but there are differences in blood and liver clearance rates, as well as the recommended time after injection for imaging to achieve optimal image quality. Because published peer-reviewed studies examining optimal times between injection and imaging are limited, it can be difficult to identify evidence-based opportunities to optimize imaging protocols. Using systematic literature review methods, this study was designed to identify and consolidate the available evidence on the use of sestamibi compared to tetrofosmin for variable injection to imaging times in regard to test efficiency, including test length and re-scan rates, and image quality, including overall quality and cardiac to extra-cardiac ratios. The composite of this data shows that earlier imaging with tetrofosmin is equivalent to later imaging with sestamibi when assessing subjective image quality or when quantifying heart-to-extra-cardiac ratios. Image quality and heart-to-extra-cardiac ratios comparing early versus later imaging with tetrofosmin were comparable if not equivalent to each other. The equivalency of the imaging quality occurs with 15 minutes (on average) earlier imaging compared to sestamibi and 30 minutes compared to standard time tetrofosmin. The subjective findings of equivalent image quality are also shown with objective measurements of heart-to-extra-cardiac ratios. In this review, the significantly shorter injection-to-acquisition times with tetrofosmin compared to sestamibi resulted in better efficiency and less waiting times for patients; in addition, significantly higher re-scan rates with sestamibi compared to tetrofosmin due to hepatic activity contributed to better throughput with tetrofosmin.
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Affiliation(s)
- W Lane Duvall
- Hartford Hospital, Heart and Vascular Institute, 80 Seymour Street, Hartford, CT, 06102, USA.
| | - James Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
| | - Justin Lundbye
- The Greater Waterbury Health Network, Waterbury, CT, USA
| | - Manuel Cerqueira
- Department of Nuclear Medicine, Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Wells RG, Clackdoyle R. Feasibility of attenuation map alignment in pinhole cardiac SPECT using exponential data consistency conditions. Med Phys 2021; 48:4955-4965. [PMID: 34174089 DOI: 10.1002/mp.15058] [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: 01/13/2021] [Revised: 05/27/2021] [Accepted: 06/16/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Dedicated cardiac SPECT systems do not typically include an integrated CT scanner and thus attenuation correction requires registration of separately acquired transmission scans. Data consistency conditions are equations that express the redundancy between projections while taking into account the attenuation effects. This study assessed the feasibility of applying exponential data consistency conditions to rebinned pinhole projections for attenuation-map registration in pinhole cardiac SPECT. METHODS Simulations of an anthropomorphic computer phantom with three different tracer activity distributions were performed with and without clinical levels of noise in the projection data. The first activity distribution contained activity only within the myocardium which satisfied the assumptions of the data consistency conditions. The other two distributions violated these assumptions by adding background activity and uptake in the liver. Simulations included acquisitions with 360, 31, and 9 pinhole projections and detector pixel sizes of 0.75 and 2.5 mm. A metric based on the average difference between pairs of exponential projections was used to evaluate registration accuracy. RESULTS When activity is restricted to the myocardium, the registration error was 3.0 mm for 31 noisy pinhole projections with a detector size of 2.5 mm. When activity is added to the background and the liver, a correction for the extra-cardiac activity is needed but when applied, a registration error of 6.0 mm was achieved. CONCLUSION These results suggest that it may be feasible to use exponential data consistency conditions to register pinhole cardiac SPECT and CT transmission data. Taxonomy: 8-6 (IM-SPECT/Registration).
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Affiliation(s)
- R Glenn Wells
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rolf Clackdoyle
- Univ. Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
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50
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Bailly M, Thibault F, Courtehoux M, Metrard G, Angoulvant D, Ribeiro MJ. Myocardial Flow Reserve Measurement During CZT-SPECT Perfusion Imaging for Coronary Artery Disease Screening: Correlation With Clinical Findings and Invasive Coronary Angiography-The CFR-OR Study. Front Med (Lausanne) 2021; 8:691893. [PMID: 34150820 PMCID: PMC8212953 DOI: 10.3389/fmed.2021.691893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose: The aim of this study was to assess the results of cadmium zinc telluride (CZT)- single-photon emission computed tomography (SPECT) myocardial flow reserve (MFR) in coronary artery disease (CAD) screening regarding clinical risk and its correlation to invasive coronary angiography (ICA). Methods: A total of 137 patients (61 male and 76 female) referred for CAD screening myocardial perfusion imaging (MPI) between November 2018 and April 2020 were included in the CFR-OR prospective trial. The 10-year risk of cardiovascular death according to the European Society of Cardiology (SCORE) was calculated. SPECT 1-day 99mTc-tetrofosmin protocol was acquired on CZT cardiac-dedicated pinhole cameras. Low-dose thoracic CT was used for coronary calcium score (CCS) evaluation. ICA, when performed within 3 months, was also analyzed. Results: Mean SCORE and mean global MFR were, respectively, 4 ± 3.1% and 2.50 ± 0.74; 34 patients had impaired CFR (using a threshold of 2). There was a significant inverse correlation between MFR and SCORE (p = 0.006), gender (p = 0.019), and number of cardiovascular risk factors (p = 0.01). MFR was significantly reduced in patients with CCS above 1 (p = 0.01). No significant correlation was found between MFR and individual cardiovascular risk factors (dyslipidemia, hypertension, diabetes, or family history of CAD). A total of 23 patients underwent ICA. Global MFR SPECT sensitivity and specificity were 83.3 and 100 %, respectively, with an area under the curve of 0.94. Conclusion: Adding MFR to SPECT MPI for CAD screening on CZT camera may contribute to high-risk patient identification and enhance diagnostic performances. MFR could help physician decision to perform ICA.
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Affiliation(s)
| | | | | | - Gilles Metrard
- Nuclear Medicine Department, CHR ORLEANS, Orleans, France
| | - Denis Angoulvant
- Cardiology Department, CHRU TOURS, Tours, France
- EA4245 T2i, Tours University, Tours, France
| | - Maria Joao Ribeiro
- Nuclear Medicine Department, CHRU TOURS, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
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