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Mansour N, Nekolla SG, Reyes E, Angelidis G, Georgoulias P, Anagnostopoulos C, Bravo P, Bruno I, Flotats A, Fuentes-Ocampo F, Sciagrà R, Keng F, Kessler L, Papathanasiou M, Soman P, Rischpler C. Multi-center study of inter-rater reproducibility, image quality, and diagnostic accuracy of CZT versus conventional SPECT myocardial perfusion imaging. J Nucl Cardiol 2023; 30:528-539. [PMID: 35799039 PMCID: PMC10125926 DOI: 10.1007/s12350-022-03054-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cadmium-zinc-telluride (CZT)-based detectors exhibit higher diagnostic sensitivity in myocardial perfusion imaging (MPI) than conventional Anger-MPI for detection of coronary artery disease (CAD); however, reduced specificity and diagnostic accuracy of CZT-MPI were observed. This study aims to compare these different camera systems and to examine the degree of inter-rater reproducibility among readers with varying experience in MPI. METHODS 83 patients who underwent double stress/rest examinations using both a CZT and conventional SPECT cameras within one visit were included. Anonymized and randomized MPI-images were distributed to 15 international readers using a standardized questionnaire. Subsequent coronary angiography findings of ten patients served as a reference for analysis of sensitivity and specificity. RESULTS Image quality was significantly better in CZT-MPI with significantly lower breast attenuation (P < 0.05). CZT-MPI exhibited higher sensitivity than Anger-MPI (87.5% vs. 62.5%) and significantly reduced specificity (40% vs. 100%). Readers experienced with both camera systems had the highest inter-rater agreement indicating higher reproducibility (CZT 0.54 vs. conv. 0.49, P < 0.05). CONCLUSIONS Higher diagnostic sensitivity of CZT-MPI offers advantages in detection of CAD yet potentially of at the cost of reduced specificity, therefore it requires special training and a differentiated evaluation approach, especially for non-experienced readers with such camera systems.
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Affiliation(s)
- Nabeel Mansour
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Eliana Reyes
- Royal Brompton and Harefield NHS Trust, London, UK
| | - George Angelidis
- Department of Nuclear Medicine, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Panagiotis Georgoulias
- Department of Nuclear Medicine, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | | | - Paco Bravo
- Divisions of Nuclear Medicine and Cardiology, Departments of Radiology and Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Isabella Bruno
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco Fuentes-Ocampo
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roberto Sciagrà
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Felix Keng
- National Heart Centre, Singapore, Singapore
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Maria Papathanasiou
- Department of Cardiology, West German Heart and Vascular Center, University Hospital, Essen, Germany
| | - Prem Soman
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Arvidsson I, Davidsson A, Overgaard NC, Pagonis C, Åström K, Good E, Frias-Rose J, Heyden A, Ochoa-Figueroa M. Deep learning prediction of quantitative coronary angiography values using myocardial perfusion images with a CZT camera. J Nucl Cardiol 2023; 30:116-126. [PMID: 35610536 DOI: 10.1007/s12350-022-02995-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Evaluate the prediction of quantitative coronary angiography (QCA) values from MPI, by means of deep learning. METHODS 546 patients (67% men) undergoing stress 99mTc-tetrofosmin MPI in a CZT camera in the upright and supine position were included (1092 MPIs). Patients were divided into two groups: ICA group included 271 patients who performed an ICA within 6 months of MPI and a control group with 275 patients with low pre-test probability for CAD and a normal MPI. QCA analyses were performed using radiologic software and verified by an expert reader. Left ventricular myocardium was segmented using clinical nuclear cardiology software and verified by an expert reader. A deep learning model was trained using a double cross-validation scheme such that all data could be used as test data as well. RESULTS Area under the receiver-operating characteristic curve for the prediction of QCA, with > 50% narrowing of the artery, by deep learning for the external test cohort: per patient 85% [95% confidence interval (CI) 84%-87%] and per vessel; LAD 74% (CI 72%-76%), RCA 85% (CI 83%-86%), LCx 81% (CI 78%-84%), and average 80% (CI 77%-83%). CONCLUSION Deep learning can predict the presence of different QCA percentages of coronary artery stenosis from MPIs.
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Affiliation(s)
- Ida Arvidsson
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Anette Davidsson
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, 581 85, Linköping, Sweden
| | | | - Christos Pagonis
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kalle Åström
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Elin Good
- Department of Cardiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Jeronimo Frias-Rose
- Department of Pathology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Heyden
- Centre for Mathematical Sciences, Lund University, Lund, Sweden
| | - Miguel Ochoa-Figueroa
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, 581 85, Linköping, Sweden.
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
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Gimelli A, Pugliese NR, Buechel RR, Bertasi M, Coceani M, Marzullo P. Changes in left ventricle myocardial volume during stress test using cadmium-zinc-telluride cardiac imaging: Implications in coronary artery disease. J Nucl Cardiol 2021; 28:1623-1633. [PMID: 31650497 DOI: 10.1007/s12350-019-01930-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cadmium-zinc-telluride (CZT) SPECT allows the estimation of left ventricle myocardial volume (LVMV). We tested the clinical relevance of rest-stress LVMV changes (Δ LVMV) in detecting coronary artery disease (CAD, coronary stenosis > 70%), using CZT-SPECT. METHODS We prospectively enrolled 512 consecutive patients with known or suspected CAD (mean age: 70.3 ± 9.2 years, 72% male) for stress-rest myocardial perfusion imaging (MPI, single-day stress-rest protocol). We quantified summed stress scores (SSS), summed rest scores, and summed difference scores, together with LVMV and ejection fraction (EF) after stress and at rest. All patients underwent coronary angiography within 30 days. RESULTS Two hundred seventy-two patients had CAD at coronary angiography. ΔLVMV ≤ 5 mL, corresponding to 6% of change from rest LVMV, was the best predictor of CAD (AUC = 0.831, 79% sensitivity, 82% specificity), irrespective of the stress protocol (dipyridamole or exercise stress) and independently of MPI-SSS, LV EF, and clinical history (P = 0.004). Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) were significant for the addition of ΔLVMV ≤ 5 mL (IDI = 6.1%, P < 0.0001; NRI = 29.7%, P = 0.02) to MPI-SSS, whereas the other parameters were not. CONCLUSIONS The evaluation of ΔLVMV using CZT-SPECT can improve the diagnostic accuracy in predicting the presence of CAD when added to conventional MPI.
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Affiliation(s)
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Fondazione CNR/Regione Toscana "Gabriele Monasterio", via Moruzzi n.1, 56124, Pisa, Italy.
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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Gimelli A, Pugliese NR, Bertasi M, Airò E, Bauleo C, Formichi B, Prediletto R, Marzullo P, Monti S. Cardio-pulmonary involvement in pulmonary arterial hypertension: A perfusion and innervation scintigraphic evaluation. J Nucl Cardiol 2021; 28:546-556. [PMID: 30903609 DOI: 10.1007/s12350-019-01689-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is characterized by the right ventricle (RV) remodeling and pulmonary endothelial dysfunction. We studied cardiac perfusion and innervation in PAH with a cadmium-zinc-telluride (CZT) scanner and lung uptake impairment of 123I-metaiodobenzylguanidine (123I-MIBG). METHODS In 13 patients with newly diagnosed PAH and 11 dilated cardiomyopathies (DCM, for comparative purposes), we assessed early and delayed 123I-MIBG uptake ratios of lung-to-mediastinum (L/M) and heart-to-mediastinum (H/M) on anterior planar images. A quantitative myocardial innervation with 123I-MIBG and perfusion with 99mTc-tetrofosmin using CZT-SPECT was performed. All patients underwent right heart catheterization. RESULTS Early and delayed L/M ratios in PAH were lower than DCM (1.47 ± 0.14 vs 1.98 ± 0.11 and 1.40 ± 0.13 vs 1.83 ± 0.09; P < .001), while early and delayed H/M were impaired but not different (1.73 ± 0.20 vs 1.65 ± 0.18 and 1.73 ± 0.27 vs 1.58 ± 0.19). RV perfusion and early innervation were significantly higher in PAH compared to DCM (68.4 ± 13.4 vs 28.6 ± 4.1 and 58.8 ± 9.3 vs 27 ± 2.2; P < .001); delayed RV innervation was not evaluable. RV/LV perfusion and innervation ratios were significantly related (R = 0.74; P < .0001) and had a significant correlation with clinical, hemodynamic, and morpho-functional parameters, including L/M ratios. CONCLUSION Cardio-pulmonary scintigraphy through a perfusion and innervation study is feasible and may identify pulmonary vascular and RV remodeling, as in PAH.
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Affiliation(s)
| | - Nicola Riccardo Pugliese
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
- Fondazione CNR/Regione Toscana "Gabriele Monasterio", via Moruzzi n.1, 56124, Pisa, Italy.
| | | | | | | | - Bruno Formichi
- Fondazione Toscana G. Monasterio, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Renato Prediletto
- Fondazione Toscana G. Monasterio, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
| | - Simonetta Monti
- Fondazione Toscana G. Monasterio, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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Kennedy JA, Brodov Y, Weinstein AL, Israel O, Frenkel A. The effect of CT-based attenuation correction on the automatic perfusion score of myocardial perfusion imaging using a dedicated cardiac solid-state CZT SPECT/CT. J Nucl Cardiol 2019; 26:236-245. [PMID: 28462467 DOI: 10.1007/s12350-017-0905-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/18/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Data regarding cardiac cadmium-zinc-telluride (CZT)-specific augmented databases and their impact on CT-based attenuation correction (AC) perfusion scores in myocardial perfusion imaging (MPI) were obtained on a multiple-pinhole CZT SPECT/CT. METHODS AND RESULTS Summed stress (SSS) and rest scores (SRS) were measured using automated software in three independent patient groups: group 1 (n = 80) underwent MPI on both CZT and conventional sodium iodide (NaI) devices, group 2 (n = 80) with low coronary artery disease likelihood and normal MPI provided reference CZT databases; and group 3 (n = 152) served to compare AC and non-AC (NAC) scores on CZT. Group 1 CZT and NaI scores gave a significant 1:1 linear correlation for CZT scores referenced to the custom database vs NaI scores referenced to the default database, but these were not concordant when CZT scores were referenced to the default database. AC significantly decreased average SSS and SRS in men vs NAC, 4.29 ± 6.30 vs 5.37 ± 7.26 (P < 0.001) and 2.37 ± 4.72 vs 3.13 ± 5.85 (P < 0.001), but not in women, 2.28 ± 3.42 vs 2.28 ± 3.08 (p NS) and 0.46 ± 1.51 vs 0.61 ± 1.86, (p NS), respectively. CONCLUSIONS Specifically designed databases for solid-state CZT cardiac SPECT provide accurate quantitation of perfusion scores concordant with those previously validated for conventional SPECT. AC and NAC CZT scores differed significantly, especially in men.
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Affiliation(s)
- John A Kennedy
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 31096, Haifa, Israel.
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel.
| | - Yafim Brodov
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 31096, Haifa, Israel
| | - Adam L Weinstein
- B. and R. Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ora Israel
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 31096, Haifa, Israel
- B. and R. Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Alex Frenkel
- Department of Nuclear Medicine, Rambam Health Care Campus, P.O.B. 9602, 31096, Haifa, Israel
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Zoccarato O, Marcassa C, Lizio D, Leva L, Lucignani G, Savi A, Scabbio C, Matheoud R, Lecchi M, Brambilla M. Differences in polar-map patterns using the novel technologies for myocardial perfusion imaging. J Nucl Cardiol 2017; 24:1626-1636. [PMID: 27233252 DOI: 10.1007/s12350-016-0500-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND New technologies are available in MPI. Our aim was to evaluate their impact on the uniformity of normal myocardial uptake in the polar-map representation, over different count statistics, with and without the attenuation (AC) and scatter corrections (SC). METHODS A phantom study was performed using 5 Anger gamma cameras with filtered back projection or iterative reconstruction with resolution recovery (IRR), with or without SCAC; a D530c, with or without AC; and a D-SPECT. Count statistics ranged up to a quarter of the reference for the conventional gamma cameras and up to one half for the advanced scanners. Using polar maps, the segmental uptakes and their uncertainties, the 'global uniformity' of polar maps expressed as the coefficient of variation (COV) among the segmental uptakes and the anterior/inferior (ANT/INF) ratio were calculated. RESULTS Both segmental uptakes and their uncertainties did not depend on the count statistics in the range studied. An increase in the segmental uptakes was found from IRR to IRR + SCAC (78.0% ± 13.5% vs 86.1% ± 9.4%; P < .0001). COV was lower for D-SPECT (10.1% ± 0.5%) and after SCAC for both conventional (9.9% ± 3.0%) and advanced systems (8.9% ± 1.7%). The ANT/INF ratio was above 1 for IRR (1.12 ± 0.07) and fell slightly below 1 for IRR + SCAC (0.97 ± 0.05). CONCLUSIONS To compare data from the analysis of polar maps across different systems will require the adoption of specific normality databases, developed for each system and reconstruction method employed.
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Affiliation(s)
- Orazio Zoccarato
- Unit of Nuclear Medicine and Department of Cardiology, S. Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, NO, Italy
| | - Claudio Marcassa
- Unit of Nuclear Medicine and Department of Cardiology, S. Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, NO, Italy
| | - Domenico Lizio
- Departments of Medical Physics and Nuclear Medicine, University Hospital 'Maggiore della Carità', Novara, Italy
| | - Lucia Leva
- Departments of Medical Physics and Nuclear Medicine, University Hospital 'Maggiore della Carità', Novara, Italy
| | - Giovanni Lucignani
- Department of Health Sciences, University of Milan and Nuclear Medicine Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Annarita Savi
- Nuclear Medicine Department, IRCCS San Raffaele Hospital, Milan, Italy
| | - Camilla Scabbio
- Department of Health Sciences, University of Milan and Nuclear Medicine Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Roberta Matheoud
- Departments of Medical Physics and Nuclear Medicine, University Hospital 'Maggiore della Carità', Novara, Italy
| | - Michela Lecchi
- Department of Health Sciences, University of Milan and Nuclear Medicine Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Marco Brambilla
- Departments of Medical Physics and Nuclear Medicine, University Hospital 'Maggiore della Carità', Novara, Italy.
- Medical Physics Department, University Hospital of Novara, Novara, Italy.
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Meyer C, Weinmann P. Validation of early image acquisitions following Tc-99 m sestamibi injection using a semiconductors camera of cadmium-zinc-telluride. J Nucl Cardiol 2017; 24:1149-1156. [PMID: 27098337 DOI: 10.1007/s12350-016-0499-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 03/25/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cadmium-zinc-telluride (CZT) cameras allow to decrease significantly the acquisition time of myocardial perfusion imaging (MPI), but the duration of the examination is still long. Therefore, this study was performed to test the feasibility of early imaging following injection of Tc-99 m sestamibi using a CZT camera. METHODS Seventy patients underwent both an early and a delayed image acquisition after exercise stress test (n = 30), dipyridamole stress test (n = 20), and at rest (n = 20). After injection of Tc-99 m sestamibi, the early image acquisition started on average within 5 minutes for the exercise and rest groups, and 3 minutes 30 seconds for the dipyridamole group. Two independent observers evaluated image quality and extracardiac uptake on four-point scales. The difference between early and later images for each patient was scored on a five-point scale. RESULTS The image quality and extracardiac uptake of early and delayed image acquisitions were not different for the three groups (P > .05). There was no significant difference between early and delayed image acquisitions in the exercise, dipyridamole, and rest groups, respectively, in 63%, 40%, and 80% of cases. In the exercise group and rest group, a defect was only present in early MPI, respectively, in 13% and 20% of cases. A defect was only present in delayed images in 10% of cases in the exercise group and in 45% of cases in the dipyridamole group. CONCLUSIONS There was no difference between early and later image acquisitions in terms of quality. This protocol reduces the length of the procedure for the patient. Beginning with early image acquisitions may help to overcome the artifacts that are observed at the delayed time.
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Affiliation(s)
- Celine Meyer
- European Hospital Georges Pompidou, AP-HP, Nuclear Medicine, Université Paris Descartes, Paris, France.
| | - Pierre Weinmann
- European Hospital Georges Pompidou, AP-HP, Nuclear Medicine, Université Paris Descartes, Paris, France
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Nudi F, Iskandrian AE, Schillaci O, Peruzzi M, Frati G, Biondi-Zoccai G. Diagnostic Accuracy of Myocardial Perfusion Imaging With CZT Technology: Systemic Review and Meta-Analysis of Comparison With Invasive Coronary Angiography. JACC Cardiovasc Imaging 2017; 10:787-794. [PMID: 28330657 DOI: 10.1016/j.jcmg.2016.10.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/29/2016] [Accepted: 10/05/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study sought to summarize the evidence on stress myocardial perfusion imaging (MPI) using cadmium-zinc-telluride (CZT) technology for the diagnosis of obstructive coronary artery disease (CAD). The CZT cameras are newly introduced, and comparative data with the conventional Anger technology (Anger-MPI) are lacking. BACKGROUND The diagnostic accuracy of Anger-MPI for detection of angiographically significant CAD is well established; however, less evidence is available on the diagnostic accuracy of CZT-MPI. METHODS Clinical studies comparing CZT-MPI and invasive coronary angiography were systematically searched and abstracted. Calculations of diagnostic accuracy, including sensitivity, specificity, likelihood ratios, and diagnostic odds ratio, were obtained with fixed and random effects, reporting point estimates and 95% confidence intervals. RESULTS Based on our search, a total of 16 studies (N = 2,092) were included. The sensitivity of CZT-MPI was 0.84 (95% confidence interval [CI]: 0.78 to 0.89), whereas the specificity of 0.69 (95% CI: 0.62 to 0.76) was significantly reduced. The positive likelihood ratio was 2.73 (95% CI: 2.21 to 3.39), the negative likelihood ratio was 0.24 (95% CI: 0.17 to 0.31), and the diagnostic odds ratio was 11.93 (95% CI: 7.84 to 17.42). At subgroup and meta-regression analyses, the diagnostic accuracy between D-SPECT and Discovery cameras was similar (p = 0.711) and not impacted upon by smaller sample size studies (p = 0.573). CONCLUSIONS CZT-MPI has satisfactory sensitivity for angiographically significant CAD, but its suboptimal specificity warrants further development and research.
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Affiliation(s)
- Francesco Nudi
- Service of Hybrid Cardio Imaging, Madonna della Fiducia Clinic, Rome, Italy; Ostia Radiologica, Ostia, Italy; Etisan, Rome, Italy
| | - Ami E Iskandrian
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Alabama
| | - Orazio Schillaci
- Department of Nuclear Medicine, Tor Vergata University, Rome, Italy
| | - Mariangela Peruzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
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9
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Gimelli A, Liga R, Duce V, Kusch A, Clemente A, Marzullo P. Accuracy of myocardial perfusion imaging in detecting multivessel coronary artery disease: A cardiac CZT study. J Nucl Cardiol 2017; 24:687-695. [PMID: 26846367 DOI: 10.1007/s12350-015-0360-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/23/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) performed on traditional single-photon emission computed-tomography cameras has been shown to have a sub-optimal accuracy in detecting multivessel coronary artery disease (CAD). METHODS Six-hundred and ninety-five patients were submitted to MPI on a novel cadmium-zinc-telluride (CZT) camera and coronary angiography. A coronary stenosis >70% was considered obstructive. In every patient, the summed stress score (SSS) was computed. Moreover, the regional stress scores were also calculated for every coronary territory. RESULTS Four-hundred and forty-one patients had obstructive CAD in one (28%), two (19%), or three (17%) vessels. At per-patient analysis, the SSS showed a significant accuracy in detecting obstructive CAD (AUC 0.87, P < .001). Specifically, its accuracy was maintained also in patients with double (AUC 0.83; P < .001) or triple-vessels disease (AUC 0.79, P < .001), where CZT was able to correctly identify CAD extent in 64% of patients. On a per-vessel basis, CZT confirmed its high accuracy in detecting obstructive CAD (AUC 0.88, P < .001), independently from the involved coronary vessel. CONCLUSIONS MPI performed on a CZT camera is highly accurate in detecting obstructive CAD, independently from the coronary artery involved and the overall disease burden.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Riccardo Liga
- Cardio-thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
| | - Valerio Duce
- Cardio-thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Annette Kusch
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Alberto Clemente
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Paolo Marzullo
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, 56124, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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10
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Alenazy AB, Wells RG, Ruddy TD. New solid state cadmium-zinc-telluride technology for cardiac single photon emission computed tomographic myocardial perfusion imaging. Expert Rev Med Devices 2017; 14:213-222. [PMID: 28276752 DOI: 10.1080/17434440.2017.1296763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is well established as diagnostic test for patients with suspected or known coronary artery disease. New camera systems have been developed with cadmium-zinc-telluride (CZT) detectors, novel collimator designs and reconstruction software. Areas covered: We review the current state of cardiac SPECT, advances in conventional camera technology and the development and clinical validation of solid-state CZT cameras. Expert commentary: The development of CZT systems is timely and addresses current issues for clinical SPECT imaging. These systems have a significant increase in photon sensitivity, permitting much lower radiation patient doses at a time when the lay and medical communities are very concerned about the radiation doses resulting from medical imaging. The increased count sensitivity permits shorter acquisition times and greater patient throughput which may address the ongoing and increasing issue of decreased funding for healthcare and, particularly, diagnostic imaging. The improved image resolution should improve diagnostic accuracy and increase the value of SPECT imaging for management of patients with CAD at a time of significant competition from other imaging modalities.
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Affiliation(s)
- Ali B Alenazy
- a Department of Medicine , University of Ottawa , Ottawa , Canada.,b Division of Cardiology , University of Ottawa Heart Institute , Ottawa , Canada
| | - R Glenn Wells
- a Department of Medicine , University of Ottawa , Ottawa , Canada.,b Division of Cardiology , University of Ottawa Heart Institute , Ottawa , Canada
| | - Terrence D Ruddy
- a Department of Medicine , University of Ottawa , Ottawa , Canada.,b Division of Cardiology , University of Ottawa Heart Institute , Ottawa , Canada
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Miao TL, Kansal V, Glenn Wells R, Ali I, Ruddy TD, Chow BJW. Adopting new gamma cameras and reconstruction algorithms: Do we need to re-establish normal reference values? J Nucl Cardiol 2016; 23:807-17. [PMID: 26304955 DOI: 10.1007/s12350-015-0172-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The impact of adopting new single photon emission computed tomography (SPECT) cameras and new reconstruction algorithms on left ventricular (LV) volumes has not been well established. We sought to understand the impact of hardware and software changes on normal LV reference ranges. METHODS Consecutive patients who underwent stress Tc-99m tetrofosmin 8-frame gated SPECT MPI were screened. Patients with a history of myocardial infarction, coronary revascularization, abnormal MPI, or known LV dysfunction/reduced ejection fraction were excluded. A total of 1953 consecutive normal patients, with rest LV end-diastolic volume (EDV) and end-systolic volume (ESV) measurements were analyzed. After stratifying according to sex, LV volumes indexed to body surface area were compared across the different gamma cameras. RESULTS In a normal population, measurements with CZT were different from those obtained by the dual-headed NaI gamma cameras for LV EDVi (men: 53.6 ± 10.4 vs 48.3 ± 10.2 mL/m(2) and women: 43.3 ± 8.9 vs 37.8 ± 9.3 mL/m(2); P < 0.001) and LV ESVi (men: 21.7 ± 7.0 vs 16.9 ± 6.2 mL/m(2) and women: 13.4 ± 5.3 vs 10.6 ± 4.7 mL/m(2); P < 0.001). Inter- and intra-observer reliability for all measures was excellent. These findings were verified in a prospectively collected cohort. A sub-analysis of LV measurements comparing new resolution recovery and standard reconstruction software revealed no significant differences in LV measures. CONCLUSION This study demonstrates that normal references ranges of LV volumes vary between SPECT cameras and confirms the need for establishing reference values that are camera specific.
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Affiliation(s)
- Timothy L Miao
- Department of Medicine (Cardiology and Nuclear Medicine), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Vinay Kansal
- Department of Medicine (Cardiology and Nuclear Medicine), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - R Glenn Wells
- Department of Medicine (Cardiology and Nuclear Medicine), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Iftikhar Ali
- Department of Medicine (Cardiology and Nuclear Medicine), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Terrence D Ruddy
- Department of Medicine (Cardiology and Nuclear Medicine), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Benjamin J W Chow
- Department of Medicine (Cardiology and Nuclear Medicine), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
- Department of Radiology, University of Ottawa, Ottawa, Canada.
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Abstract
Although the new solid-state dedicated cardiac cameras provide excellent spatial and energy resolution and allow for markedly reduced SPECT acquisition times and/or injected radiopharmaceutical activity, they have some distinct disadvantages compared to traditional sodium iodide SPECT cameras. They are expensive. Attenuation correction is not available. Cardio-focused collimation, advantageous to increase depth-dependent resolution and myocardial count density, accentuates diaphragmatic attenuation and scatter from subdiaphragmatic structures. Although supplemental prone imaging is therefore routinely advised, many patients cannot tolerate it. Moreover, very large patients cannot be accommodated in the solid-state camera gantries. Since data are acquired simultaneously with an arc of solid-state detectors around the chest, no temporally dependent "rotating" projection images are obtained. Therefore, patient motion can be neither detected nor corrected. In contrast, traditional sodium iodide SPECT cameras provide rotating projection images to allow technologists and physicians to detect and correct patient motion and to accurately detect the position of soft tissue attenuators and to anticipate associated artifacts. Very large patients are easily accommodated. Low-dose x-ray attenuation correction is widely available. Also, relatively inexpensive low-count density software is provided by many vendors, allowing shorter SPECT acquisition times and reduced injected activity approaching that achievable with solid-state cameras.
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Affiliation(s)
- E Gordon DePuey
- Icahn School of Medicine, Mt. Sinai St. Luke's and Mt. Sinai West Hospitals, New York, NY, USA.
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Gimelli A, Liga R, Giorgetti A, Favilli B, Pasanisi EM, Marzullo P. Determinants of left ventricular mechanical dyssynchrony in patients submitted to myocardial perfusion imaging: A cardiac CZT study. J Nucl Cardiol 2016; 23:728-36. [PMID: 26338425 DOI: 10.1007/s12350-015-0247-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/19/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND An interaction between coronary anatomy, myocardial perfusion, and left ventricular (LV) functional parameters in the development of mechanical LV dyssynchrony (LVD) has been suggested. This study examined the correlates of LVD in a large sample size of patients with known or suspected coronary artery disease (CAD) using cadmium-zinc-telluride camera. METHODS Six-hundred and fifty-seven consecutive patients who underwent myocardial perfusion imaging (MPI) and coronary angiography were included. Coronary stenosis >70% was considered significant. LV perfusion and functional parameters were computed from MPI images. The presence of significant LVD was evaluated by phase standard deviation and histogram bandwidth. RESULTS 415/657 (63%) patients had significant CAD. LVD was present in 247 (38%) patients and was associated with the presence of a higher CAD burden (P < .001), more impaired measures of LV perfusion (P < .001), contractile function (P < .001), and larger LV volumes (P < .001). By multivariate analysis, the LV end-systolic volume index (P < .001) and ischemic burden (P < .001) were the strongest predictors of LVD independent of CAD extent and LV systolic dysfunction. CONCLUSIONS LVD is frequent in patients undergoing MPI for suspected or known CAD. Its presence is independent of CAD burden and LV systolic dysfunction, but is dependent on the presence of myocardial perfusion abnormalities and LV end-systolic volume.
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Affiliation(s)
- Alessia Gimelli
- Fondazione Toscana G. Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
| | | | | | - Brunella Favilli
- Fondazione Toscana G. Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
| | | | - Paolo Marzullo
- Fondazione Toscana G. Monasterio, Via Moruzzi 1, 56124, Pisa, Italy
- CNR, Institute of Clinical Physiology, Pisa, Italy
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Nakazato R, Slomka PJ, Fish M, Schwartz RG, Hayes SW, Thomson LE, Friedman JD, Lemley M, Mackin ML, Peterson B, Schwartz AM, Doran JA, Germano G, Berman DS. Quantitative high-efficiency cadmium-zinc-telluride SPECT with dedicated parallel-hole collimation system in obese patients: results of a multi-center study. J Nucl Cardiol 2015; 22:266-75. [PMID: 25388380 PMCID: PMC4355061 DOI: 10.1007/s12350-014-9984-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Obesity is a common source of artifact on conventional SPECT myocardial perfusion imaging (MPI). We evaluated image quality and diagnostic performance of high-efficiency (HE) cadmium-zinc-telluride parallel-hole SPECT MPI for coronary artery disease (CAD) in obese patients. METHODS AND RESULTS 118 consecutive obese patients at three centers (BMI 43.6 ± 8.9 kg·m(-2), range 35-79.7 kg·m(-2)) had upright/supine HE-SPECT and invasive coronary angiography > 6 months (n = 67) or low likelihood of CAD (n = 51). Stress quantitative total perfusion deficit (TPD) for upright (U-TPD), supine (S-TPD), and combined acquisitions (C-TPD) was assessed. Image quality (IQ; 5 = excellent; < 3 nondiagnostic) was compared among BMI 35-39.9 (n = 58), 40-44.9 (n = 24) and ≥45 (n = 36) groups. ROC curve area for CAD detection (≥50% stenosis) for U-TPD, S-TPD, and C-TPD were 0.80, 0.80, and 0.87, respectively. Sensitivity/specificity was 82%/57% for U-TPD, 74%/71% for S-TPD, and 80%/82% for C-TPD. C-TPD had highest specificity (P = .02). C-TPD normalcy rate was higher than U-TPD (88% vs 75%, P = .02). Mean IQ was similar among BMI 35-39.9, 40-44.9 and ≥45 groups [4.6 vs 4.4 vs 4.5, respectively (P = .6)]. No patient had a nondiagnostic stress scan. CONCLUSIONS In obese patients, HE-SPECT MPI with dedicated parallel-hole collimation demonstrated high image quality, normalcy rate, and diagnostic accuracy for CAD by quantitative analysis of combined upright/supine acquisitions.
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Affiliation(s)
- Ryo Nakazato
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA
- Cardiovascular Center, St Luke’s International Hospital, Tokyo, Japan
| | - Piotr J. Slomka
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mathews Fish
- Department of Cardiology, Peacehealth Sacred Heart Medical Center, Springfield, OR
| | - Ronald G. Schwartz
- Departments of Medicine (Cardiology Division) and Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - Sean W. Hayes
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - John D. Friedman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark Lemley
- Department of Cardiology, Peacehealth Sacred Heart Medical Center, Springfield, OR
| | - Maria L. Mackin
- Departments of Medicine (Cardiology Division) and Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - Benjamin Peterson
- Departments of Medicine (Cardiology Division) and Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - Arielle M. Schwartz
- Departments of Medicine (Cardiology Division) and Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - Jesse A. Doran
- Departments of Medicine (Cardiology Division) and Imaging Sciences, University of Rochester Medical Center, Rochester, NY
| | - Guido Germano
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Daniel S. Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA
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