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Cichocki P, Błaszczyk M, Cygulska K, Filipczak K, Adamczewski Z, Kuśmierek J, Lipiec P, Kasprzak JD, Płachcińska A. Inter- and Intraobserver Repeatability of Myocardial Flow Reserve Values Determined with SPECT Study Using a Discovery NM530c Camera and Corridor 4DM Software. J Pers Med 2021; 11:jpm11111164. [PMID: 34834516 PMCID: PMC8624690 DOI: 10.3390/jpm11111164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/31/2021] [Accepted: 11/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Myocardial blood flow (MBF) and flow reserve (MFR) examination, especially useful in the diagnosis of multivessel coronary artery disease (CAD), can be assessed with a cadmium-zinc-telluride (CZT) SPECT gamma camera, as an alternative to the expensive and less available PET. However, study processing is not free from subjective factors. Therefore, this paper aims to evaluate intra- and interobserver repeatability of MBF and MFR values obtained by the same operator and two independent operators. METHODS This study included 57 adult patients. MBF and MFR were assessed using a Discovery NM530c camera in a two-day, rest/dipyridamople protocol, using 99mTc-MIBI. Data were processed using Corridor4DM software, twice by one operator and once by another operator. RESULTS The repeatability of the assessed values was quite good in the whole myocardium, LAD and LCX vascular territories, but was poor in the RCA territory. CONCLUSIONS The poor repeatability of MBF and MFR in RCA vascular territory can be explained by poor automatic orientation of the heart axis during post-processing and a so-called "cardiac creep" phenomenon. Better automatic heart orientation and introduction of automatic motion correction is likely to drastically improve this repeatability. In the present state of the software, PET is better for patients requiring assessment of MFR in the RCA territory.
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Affiliation(s)
- Paweł Cichocki
- Department of Nuclear Medicine, Medical University of Lodz, 92-216 Lodz, Poland; (P.C.); (J.K.)
| | - Michał Błaszczyk
- Department of Quality Control and Radiological Protection, Medical University of Lodz, 92-216 Lodz, Poland; (M.B.); (K.F.); (A.P.)
| | - Kamila Cygulska
- Chair and Department of Cardiology, Bieganski Hospital, Medical University of Lodz, 91-347 Lodz, Poland; (K.C.); (P.L.); (J.D.K.)
| | - Krzysztof Filipczak
- Department of Quality Control and Radiological Protection, Medical University of Lodz, 92-216 Lodz, Poland; (M.B.); (K.F.); (A.P.)
| | - Zbigniew Adamczewski
- Department of Nuclear Medicine, Medical University of Lodz, 92-216 Lodz, Poland; (P.C.); (J.K.)
- Correspondence:
| | - Jacek Kuśmierek
- Department of Nuclear Medicine, Medical University of Lodz, 92-216 Lodz, Poland; (P.C.); (J.K.)
| | - Piotr Lipiec
- Chair and Department of Cardiology, Bieganski Hospital, Medical University of Lodz, 91-347 Lodz, Poland; (K.C.); (P.L.); (J.D.K.)
| | - Jarosław Damian Kasprzak
- Chair and Department of Cardiology, Bieganski Hospital, Medical University of Lodz, 91-347 Lodz, Poland; (K.C.); (P.L.); (J.D.K.)
| | - Anna Płachcińska
- Department of Quality Control and Radiological Protection, Medical University of Lodz, 92-216 Lodz, Poland; (M.B.); (K.F.); (A.P.)
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Cichocki P, Filipczak K, Adamczewski Z, Kuśmierek J, Płachcińska A. Assessment of Renal Function Based on Dynamic Scintigraphy Parameters in the Diagnosis of Obstructive Uro/Nephropathy. J Clin Med 2021; 10:529. [PMID: 33540522 PMCID: PMC7867193 DOI: 10.3390/jcm10030529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/04/2022] Open
Abstract
This study evaluates the usefulness of parameters allowing assessment of renal function in absolute values in dynamic renal scintigraphy (DRS) with 99mTc-ethylenedicysteine (99mTc-EC) uptake constant (K), mean transit time (MTT), and parenchymal transit time (PTT) in the diagnosis of obstructive uro/nephropathy. The study included 226 people: 20 healthy volunteers, for whom normative values of assessed parameters were determined, and 206 patients. Reproducibility of results obtained by two independent operators, specificity, correlation with estimated GFR (eGFR), and Cohen's kappa were used to evaluate reliability of assessed parameters. Normative values were as follows: K ≥ 1.6, MTT ≤ 250 s, and PTT ≤ 225 s. Reproducibility of determination of K (rs = 0.99) and MTT (rs = 0.98) was significantly higher than that of PTT (rs = 0.95) (p = 0.001). Specificity was 100% for K, 81% for MTT, and 91% for PTT. Correlation of eGFR with K (rs = 0.89) was significantly higher than with PTT (rs = 0.53) and with split function (SF) (rs = 0.66) (p < 0.0001). Cohen's kappa was κ = 0.89 for K, κ = 0.88 for MTT, and κ = 0.77 for PTT. In a group of patients where standard DRS parameters are unreliable (bilateral obstructive uro/nephropathy or single functioning kidney), the use of K (the most effective among assessed parameters) changed the classification of 23/79 kidneys (29%). K enables reproducible assessment of absolute, individual kidney function without modifying routine DRS protocol. Diagnostic value of MTT and PTT is limited.
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Affiliation(s)
- Paweł Cichocki
- Department of Nuclear Medicine, Medical University of Lodz, 92-216 Łódź, Poland; (P.C.); (J.K.)
| | - Krzysztof Filipczak
- Department of Quality Control and Radiation Protection, Medical University of Lodz, 92-216 Łódź, Poland; (K.F.); (A.P.)
| | - Zbigniew Adamczewski
- Department of Nuclear Medicine, Medical University of Lodz, 92-216 Łódź, Poland; (P.C.); (J.K.)
| | - Jacek Kuśmierek
- Department of Nuclear Medicine, Medical University of Lodz, 92-216 Łódź, Poland; (P.C.); (J.K.)
| | - Anna Płachcińska
- Department of Quality Control and Radiation Protection, Medical University of Lodz, 92-216 Łódź, Poland; (K.F.); (A.P.)
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Cichocki P, Filipczak K, Plachcinska A, Kusmierek J. Kidney efficiency index quantitative parameter of a dynamic renal scintigraphy. II. usefulness in the diagnosis of obstructive nephropathy. Nucl Med Rev Cent East Eur 2020; 23:84-88. [PMID: 33007095 DOI: 10.5603/nmr.2020.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND One of the main indications for DRS is a diagnosis of obstructive uro-/nephropathy. In standard practice, this study includes the assessment of sequential scintigraphic images, renographic curves and such quantitative parameters as TMAX, T1/2 and split function of each kidney (SF). Due to the relative nature of SF and limitations of diagnostic capabilities of TMAX and T1/2, DRS was expanded to include new quantitative parameters describing kidney function in absolute values. This study aims to evaluate the usefulness of kidney efficiency index (KEi) - new, in-house developed parameter proportional to the average clearance function of the kidney. MATERIAL AND METHODS The study included 156 people aged 18-84 (average 51) years. The first group, from which normative values of new parameters were determined, consisted of 20 healthy volunteers. The second group consisted of 136 patients selected retrospectively, based on archived scintigraphic data. "Normalcy rate" (percentage of normal results among selected 62 patients with a low likelihood of obstructive uro-/nephropathy) was used to evaluate the reliability of KEi. A comparative differential analysis of obstructive uro-/nephropathy, based on standard and new DRS parameters, was performed on selected 74 patients (92 kidneys) with single functioning kidney or bilateral obstructive uropathy, where SF is unreliable. RESULTS Normative values: KEi ≥ 8; Normalcy rate for KEi: 95%. In comparison with standard DRS evaluation, application of KEi changed the diagnosis in 1/3 of assessed kidneys (from uropathy to nephropathy in 27/92 kidneys and vice versa in 4 kidneys). CONCLUSIONS KEi enables reproducible, quantitative assessment of absolute kidney function without any modifications of the standard DRS protocol. Its values can be compared between independent studies (e.g. follow-up examinations). KEi corrected the diagnosis of obstructive uro-/nephropathy in cases of single functioning kidney or bilateral obstructive uropathy.
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Affiliation(s)
- Pawel Cichocki
- Department of Nuclear Medicine, Medical University of Łódź, ul. Czechosłowacka 8/10, 92-216 Łódź, Poland.
| | - Krzysztof Filipczak
- Department of Quality Control and Radiological Protection, Medical University of Łódź, ul. Czechosłowacka 8/10, 92-216 Łódź, Poland
| | - Anna Plachcinska
- Department of Quality Control and Radiological Protection, Medical University of Łódź, ul. Czechosłowacka 8/10, 92-216 Łódź, Poland
| | - Jacek Kusmierek
- Department of Nuclear Medicine, Medical University of Łódź, ul. Czechosłowacka 8/10, 92-216 Łódź, Poland
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Włodarczyk M, Kuśmierek J, Bieńkiewicz M, Filipczak K, Płachcińska A. Application of stress-only myocardial perfusion imaging. Nucl Med Rev Cent East Eur 2019; 22:74-80. [PMID: 31482560 DOI: 10.5603/nmr.a2019.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Single-photon emission computed tomography myocardial perfusion study is usually a sequence of stress and rest part. In case of a normal stress study rest part can be given up. The objective of this study was to examine factors affecting concordance of results of stress-only (SO) and stress-rest (SR) studies. MATERIAL AND METHODS SO and SR studies without and with attenuation correction (AC) of 212 selected patients (without cardiomyopathy, history of myocardial infarction or coronary artery bypass grafting) were analyzed visually. Influence of percutaneous coronary intervention (PCI) in the past, type of stress (physical/pharmacological) and application of AC (in form of combined method of non-corrected and corrected images - CM), patient body mass index (BMI) and gender on concordance rates of SO and SR studies were examined. RESULTS Neither a history of PCI, nor a type of stress affected concordance rate. AC (in form of CM) improved concordance rate significantly, from 60% to 68% (p = 0.018). Patient BMI affected concordance rates - 72% in non-obese and 59% in obese patients (p = 0.05). In the whole group, risk of overlooking patients with abnormal perfusion in SO study was small (< 2%), but it grew significantly with patient BMI. Rest study was necessary in about 20% of non-obese and in about 50% of obese patients. CONCLUSION MPS can be limited to stress part in appropriately selected, especially non-obese, patients provided that AC is applied, due to a low risk of overlooking patients with abnormal perfusion. In case of obese patients, careful analysis of exercise images for their normality is particularly important.
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Affiliation(s)
- Michał Włodarczyk
- Department of Quality Control and Radiological Protection, Medical University of Łódź, Poland.
| | - Jacek Kuśmierek
- Department of Nuclear Medicine, Medical University of Łódź, Poland
| | | | - Krzysztof Filipczak
- Department of Quality Control and Radiological Protection, Medical University of Łódź, Poland
| | - Anna Płachcińska
- Department of Quality Control and Radiological Protection, Medical University of Łódź, Poland
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Filipczak K, Kuśmierek J, Drożdż J, Chiżyński K, Kasprzak JD, Peruga JZ, Płachcińska A. Comparison of shortened gated myocardial perfusion imaging processed with „Myovation Evolution” with full time study. Nucl Med Rev 2017; 20:25-31. [DOI: 10.5603/nmr.a2016.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/25/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022] Open
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Filipczak K, Kuśmierek J, Drożdż J, Chiżyński K, Kasprzak JD, Peruga JZ, Płachcińska A. Reduced-time myocardial perfusion study processed with "Myovation Evolution" - assessment of diagnostic efficacy. Nucl Med Rev Cent East Eur 2017; 20:95-100. [PMID: 30900237 DOI: 10.5603/nmr.2017.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/29/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While assessing images using standard segmental method, we felt that some defects were either underscored or missed. So this work is intended to compare results of low count myocardial perfusion studies (MPS) processed with "Myovation Evolution", applying complete evaluation of all available slices, with full count studies and assess impact of reduction of counts on diagnostic efficacy of the study. MATERIAL AND METHODS A retrospective study was conducted in a group of 95 patients (56 males, age 62 ± 9 years, BMI 28 ± 4) with known or suspected CAD, without clinical history or any signs of a previous myocardial infarction. All patients underwent coronary angiography (CA) within 3 months of MPS. CA was used as a reference method for diagnostic performance of MPS. Patients underwent a stress/rest 2-day MPS. Both studies were performed twice, with normal (25 s) and shortened (13 s) time/projection. Studies were processed using Myovation protocol (OSEM, 2 iterations, 10 subsets) for full time (FT) studies and a Myovation Evolution protocol for half time (HT) studies (OSEM, 12 iterations, 10 subsets, Resolution Recovery). Reconstructed images, with and without attenuation correction (AC), were evaluated by 2 experienced nuclear medicine specialists (a consensus) visually, taking into account all available slices, in a 5-grade scale (normal, probably normal, equivocal, probably abnormal and abnormal). Study results were additionally dichotomized as normal or abnormal. Perfusion defects were assigned to coronary arteries. RESULTS An exact agreement between FT and HT study assessment, without AC, amounted to 66%, with AC it grew to 79%, p = 0.05. In studies without AC 10 perfusion defects were found only in HT studies in RCA area in male patients. A higher percentage of studies with perfusion defects in RCA area visible only in HT studies was found among discordant (7/25, 28%) than concordant results (3/70, 4%), p = 0.003. AC reduced this difference. HT study provided lower accuracy in detection of CAD than FT study (58% vs. 68%, p = 0.034). AC reduced this difference considerably. Dichotomized assessment agreed in 81% of studies without AC and in 87% with AC. CONCLUSIONS Myovation Evolution protocol requires application of AC otherwise perfusion defects in RCA area in male patients are falsely detected. Shortened studies reconstructed with "Myovation Evolution" package without AC reveal a tendency toward reduction of accuracy of the study in detection of CAD. AC makes up for this reduction.
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Affiliation(s)
- Krzysztof Filipczak
- Department of Quality Control and Radiological Protection, Inter-Faculty Chair of Medical Imaging and Radiology, Medical University of Lodz, ul. Pomorska 251, 92-213 Łódź, Poland.
| | - Jacek Kuśmierek
- Department of Nuclear Medicine, Inter-Faculty Chair of Medical Imaging and Radiology, Medical University of Lodz, ul. Pomorska 251, 92-213 Łódź, Poland
| | - Jarosław Drożdż
- Department of Cardiology, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, ul. Kniaziewicza 1/5, 91-347 Łódź, Poland
| | - Krzysztof Chiżyński
- Department of Intensive Cardiac Therapy, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, ul. Kniaziewicza 1/5, 91-347 Łódź, Poland
| | - Jarosław D Kasprzak
- Department of Cardiology, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, ul. Kniaziewicza 1/5, 91-347 Łódź, Poland
| | - Jan Z Peruga
- Department of Cardiology, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, ul. Kniaziewicza 1/5, 91-347 Łódź, Poland
| | - Anna Płachcińska
- Department of Quality Control and Radiological Protection, Inter-Faculty Chair of Medical Imaging and Radiology, Medical University of Lodz, ul. Pomorska 251, 92-213 Łódź, Poland
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