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Akil S, Székely AE, Hedeer F, Olsson B, Engblom H, Hindorf C. Influence of different time framings, reconstruction algorithms and post-processing methods on the quantification of myocardial blood flow from 13 N-NH 3 PET images. Clin Physiol Funct Imaging 2024; 44:154-163. [PMID: 37881129 DOI: 10.1111/cpf.12861] [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: 02/14/2023] [Revised: 08/28/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The aim was to investigate to what extent the quantification of myocardial blood flow (MBF) from dynamic 13 N-NH3 positron emission tomography (PET) images is affected by time frame schemes, time-of-flight (ToF), reconstruction algorithms, blood pool volume of interest (VOI) locations and compartment models in patients with suspected chronic coronary syndrome. METHODS A standard MBF value was determined from 25 patients' rest/stress 13 N-NH3 PET/CT images reconstructed with ordered subset expectation maximization (OSEM), 5 s time frame for the first frames without ToF, subsequently analyzed using a basal VOI and the deGrado compartment model. MBFs calculated using 2 or 10 s for the first frames, ToF, block-sequential regularized expectation maximization (BSREM), apical or large VOI, Hutchins or Krivokapich compartment models were compared to MBFstandard in Bland-Altman plots (bias ± SD). RESULTS Good agreement in global rest/stress MBF (mL/min/g) was found when changing the time frame scheme or reconstruction algorithm (MBFstandard vs. MBF2s : -0.02 ± 0.06; MBF10s : 0.01 ± 0.07; MBFBSREM : 0.01 ± 0.07), while a lower level of agreement was found when altering the other factors (MBFstandard vs. MBFToF : -0.07 ± 0.10; MBFapical VOI : -0.27 ± 0.25; MBFlarge VOI : -0.11 ± 0.10; MBFHutchins : -0.08 ± 0.10; MBFKrivokapich : -0.47 ± 0.50). CONCLUSIONS Quantification of MBF from 13 N-NH3 PET images is more affected by choice of compartment models, ToF and blood pool VOIs than by different time frame schemes and reconstruction algorithms.
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Affiliation(s)
- Shahnaz Akil
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anna E Székely
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Fredrik Hedeer
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Berit Olsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Henrik Engblom
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Cecilia Hindorf
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
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Székely A, Steding-Ehrenborg K, Ryd D, Hedeer F, Valind K, Akil S, Hindorf C, Hedström E, Erlinge D, Arheden H, Engblom H. Quantitative myocardial perfusion should be interpreted in the light of sex and comorbidities in patients with suspected chronic coronary syndrome: A cardiac positron emission tomography study. Clin Physiol Funct Imaging 2024; 44:89-99. [PMID: 37642142 DOI: 10.1111/cpf.12854] [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: 03/14/2023] [Revised: 06/13/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
Diagnosis and treatment of patients with suspected chronic coronary syndrome (CCS) currently relies on the degree of coronary artery stenosis and its significance for myocardial perfusion. However, myocardial perfusion can be affected by factors other than coronary stenosis. The aim of this study was to investigate to what extent sex, age, diabetes, hypertension and smoking affect quantitative myocardial perfusion, beyond the degree of coronary artery stenosis, in patients with suspected or established CCS. Eighty-six patients [median age 69 (range 46-86) years, 24 females] planned for elective coronary angiography due to suspected or established CCS were included. All patients underwent cardiac 13 N-NH3 positron emission tomography to quantify myocardial perfusion at rest and stress. Lowest myocardial perfusion (perfusionmin ) at stress and rest and lowest myocardial perfusion reserve (MPRmin ) for all vessel territories was used as dependent variables in a linear mixed model. Independent variables were vessel territory, degree of coronary artery stenosis (as a continuous variable of 0%-100% stenosis), sex, age, diabetes, hypertension and smoking habits. Degree of coronary artery stenosis (p < 0.001), male sex (1.8 ± 0.6 vs. 2.3 ± 0.6 mL/min/g, p < 0.001), increasing age (p = 0.025), diabetes (1.6 ± 0.5 vs. 2.0 ± 0.6 mL/min/g, p = 0.023) and smoking (1.9 ± 0.6 vs. 2.1 ± 0.6 mL/min/g, p = 0.052) were independently associated with myocardial perfusionmin at stress. Degree of coronary artery stenosis (p < 0.001), age (p = 0.040), diabetes (1.8 ± 0.6 vs. 2.3 ± 0.7, p = 0.046) and hypertension (2.2 ± 0.7 vs. 2.5 ± 0.6, p = 0.033) were independently associated with MPRmin . Sex, increasing age, diabetes, hypertension and smoking affect myocardial perfusion independent of coronary artery stenosis in patients with suspected or established CCS. Thus, these factors need to be considered when assessing the significance of reduced quantitative myocardial perfusion of patients with suspected or established CCS.
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Affiliation(s)
- Anna Székely
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Daniel Ryd
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Fredrik Hedeer
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Kristian Valind
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Shahnaz Akil
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Cecilia Hindorf
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Henrik Engblom
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Hedeer F, Akil S, Oddstig J, Hindorf C, Arheden H, Carlsson M, Engblom H. Diagnostic accuracy for CZT gamma camera compared to conventional gamma camera technique with myocardial perfusion single-photon emission computed tomography: Assessment of myocardial infarction and function. J Nucl Cardiol 2023; 30:1935-1946. [PMID: 36913172 PMCID: PMC10558368 DOI: 10.1007/s12350-022-03185-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/23/2022] [Indexed: 03/14/2023]
Abstract
BACKGROUND The solid-state cadmium-zinc-telluride (CZT) gamma camera for myocardial perfusion single-photon emission computed tomography (MPS) has theoretical advantages compared to the conventional gamma camera technique. This includes more sensitive detectors and better energy resolution. We aimed to explore the diagnostic performance of gated MPS with a CZT gamma camera compared to a conventional gamma camera for detection of myocardial infarct (MI) and assessment of left ventricular (LV) volumes and ejection fraction (LVEF), using cardiac magnetic resonance (CMR) as the reference method. METHODS Seventy-three patients (26% female) with known or suspected chronic coronary syndrome were examined with gated MPS using both a CZT gamma camera and a conventional gamma camera as well as with CMR. Presence and extent of MI on MPS and late gadolinium enhancement (LGE) CMR was evaluated. For LV volumes, LVEF and LV mass, gated MPS images and cine CMR images were evaluated. RESULTS MI was found in 42 patients on CMR. The overall sensitivity, specificity, positive and negative predictive values for the CZT and the conventional gamma camera were the same (67%, 100%, 100% and 69%). For infarct size > 3% on CMR, the sensitivity was 82% for the CZT and 73% for the conventional gamma camera, respectively. LV volumes were significantly underestimated by MPS compared to CMR (P ≤ .002 for all measures). The underestimation was slightly less pronounced for the CZT compared to the conventional gamma camera (2-10 mL, P ≤ .03 for all measures). For LVEF, however, accuracy was high for both gamma cameras. CONCLUSION Differences between a CZT and a conventional gamma camera for detection of MI and assessment of LV volumes and LVEF are small and do not appear to be clinically significant.
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Affiliation(s)
- Fredrik Hedeer
- Department of Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Shahnaz Akil
- Department of Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jenny Oddstig
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Cecilia Hindorf
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
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Hedeer F, Ostenfeld E, Hedén B, Prinzen FW, Arheden H, Carlsson M, Engblom H. To what extent are perfusion defects seen by myocardial perfusion SPECT in patients with left bundle branch block related to myocardial infarction, ECG characteristics, and myocardial wall motion? J Nucl Cardiol 2021; 28:2910-2922. [PMID: 32451797 PMCID: PMC8709823 DOI: 10.1007/s12350-020-02180-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/25/2020] [Indexed: 12/04/2022]
Abstract
INTRODUCTION We investigated if uptake pattern on myocardial perfusion SPECT (MPS) in patients with left bundle branch block (LBBB) is related to myocardial fibrosis, myocardial wall motion, and electrocardiography (ECG) characteristics. METHODS Twenty-three patients (9 women) with LBBB, examined with MPS and cardiac magnetic resonance (CMR), were included. Tracer uptake on MPS was classified by visual interpretation as typical LBBB pattern (Defect+, n = 13) or not (Defect-, n = 10) and quantitatively. CMR images were evaluated for wall thickness and for myocardial wall motion both by visual assessment and by regional myocardial radial strain from feature tracking, and for presence and location of myocardial fibrosis. ECGs were analyzed regarding QRS duration and the presence of strict criteria for LBBB. RESULTS Wall thickness was slightly lower in the septum compared to the lateral wall in Defect+ patients (5.6 ± 1.1 vs 6.0 ± 1.3 mm, P = 0.03) but not in Defect- patients (5.6 ± 1.0 vs 5.6 ± 0.9 mm, P = 0.84). Defect+ patients showed a larger proportion of dyskinetic segments in the septum and hyperkinetic segments in the lateral wall compared to Defect- patients (P = 0.006 and P = 0.004, respectively). Decreased myocardial radial strain was associated with decreased tracer uptake by MPS (R = 0.37, P < 0.001). Areas of fibrosis did not match areas with uptake defect on MPS. No differences in ECG variables were seen. CONCLUSION The heterogeneous regional tracer uptake in some patients with LBBB is related to underlying regional myocardial dyskinesia, wall thickening, and wall thickness rather than stress-induced ischemia, myocardial fibrosis, or specific ECG characteristics.
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Affiliation(s)
- Fredrik Hedeer
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ellen Ostenfeld
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Bo Hedén
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden.
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Akil S, Hedeer F, Oddstig J, Olsson T, Jögi J, Erlinge D, Carlsson M, Arheden H, Hindorf C, Engblom H. Appropriate coronary revascularization can be accomplished if myocardial perfusion is quantified by positron emission tomography prior to treatment decision. J Nucl Cardiol 2021; 28:1664-1672. [PMID: 31705424 PMCID: PMC8421314 DOI: 10.1007/s12350-019-01938-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Many patients undergo percutaneous coronary intervention (PCI) without the use of non-invasive stress testing prior to treatment. The aim of this study was to determine the potential added value of guiding revascularization by quantitative assessment of myocardial perfusion prior to intervention. METHODS AND RESULTS Thirty-three patients (10 females) with suspected or established CAD who had been referred for a clinical coronary angiography (CA) with possibility for PCI were included. Adenosine stress and rest 13N-NH3 PET, cardiac magnetic resonance (CMR), and cardiopulmonary exercise test were performed 4 ± 3 weeks before and 5 ± 1 months after CA. The angiographer was blinded to the PET and CMR results. Myocardial flow reserve (MFR) < 2.0 by PET was considered abnormal. A PCI was performed in 19/33 patients. In 41% (11/27) of the revascularized vessel territories, a normal regional MFR was found prior to the PCI and no improvement in MFR was found at follow-up (P = 0.9). However, vessel territories with regional MFR < 2.0 at baseline improved significantly after PCI (P = 0.003). Of the 14 patients not undergoing PCI, four had MFR < 2.0 in one or more coronary territories. CONCLUSION Assessment of quantitative myocardial perfusion prior to revascularization could lead to more appropriate use of CA when managing patients with stable CAD.
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Affiliation(s)
- Shahnaz Akil
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden.
| | - Fredrik Hedeer
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Jenny Oddstig
- Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Thomas Olsson
- Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Jonas Jögi
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Clinical Sciences, Cardiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
| | | | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, Lund, Sweden
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Bajc M, Hedeer F, Lindqvist A, Trägårdh E. Assessment of Ventilation and Perfusion in Patients with COVID-19 Discloses Unique Information of Pulmonary Function to a Clinician: Case Reports of V/P SPECT. Clin Med Insights Circ Respir Pulm Med 2021; 15:11795484211030159. [PMID: 34349582 PMCID: PMC8295940 DOI: 10.1177/11795484211030159] [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] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/14/2021] [Indexed: 01/08/2023]
Abstract
V/P SPECT from 4 consecutive patients with COVID-19 suggests that ventilation and perfusion images may be applied to diagnose or exclude pulmonary embolism, verify nonsegmental diversion of perfusion from the ventilated areas (dead space ventilation) that may represent inflammation of the pulmonary vasculature, detect the reversed mismatch of poor ventilation and better preserved perfusion (shunt perfusion) in bilateral pulmonary inflammation and indicate redistribution of lung perfusion (antigravitational hyperperfusion) due to cardiac congestion. V/P mismatch and reversed mismatch may be extensive enough to diminish dramatically preserved matching ventilation/perfusion and to induce severe hypoxemia in COVID-19.
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Affiliation(s)
- Marika Bajc
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital Lund, 22185, Lund, Sweden
| | - Fredrik Hedeer
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital Lund, 22185, Lund, Sweden
| | - Ari Lindqvist
- Research Unit of Pulmonary Diseases, Clinical Research Institute HUCH Ltd., Helsinki University Hospital HUS and Helsinki University, Helsinki, Finland
| | - Elin Trägårdh
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital Malmö, Lund University, Lund, Sweden
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Akil S, Hedeer F, Carlsson M, Arheden H, Oddstig J, Hindorf C, Jögi J, Erlinge D, Engblom H. Qualitative assessments of myocardial ischemia by cardiac MRI and coronary stenosis by invasive coronary angiography in relation to quantitative perfusion by positron emission tomography in patients with known or suspected stable coronary artery disease. J Nucl Cardiol 2020; 27:2351-2359. [PMID: 30535919 PMCID: PMC7749089 DOI: 10.1007/s12350-018-01555-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/26/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND To relate findings of qualitative evaluation of first-pass perfusion-CMR and anatomical evaluation on coronary angiography (CA) to the reference standard of quantitative perfusion, cardiac PET, in patients with suspected or known stable coronary artery disease (CAD). METHODS AND RESULTS Forty-one patients referred for CA due to suspected stable CAD, prospectively performed adenosine stress/rest first-pass perfusion-CMR as well as 13N-NH3 PET on the same day, 4 ± 3 weeks before CA. Angiographers were blinded to PET and CMR results. Regional myocardial flow reserve (MFR) < 2.0 on PET was considered pathological. Vessel territories with stress-induced ischemia by CMR or vessels with stenosis needing revascularization had a significantly lower MFR compared to those with no regional stress-induced ischemia or vessels not needing revascularization (P < 0.001). In 4 of 123 vessel territories with stress-induced ischemia by CMR, PET showed a normal MFR. In addition, 12 of 123 vessels that underwent intervention showed normal MFR assessed by PET. CONCLUSION The limited performance of qualitative assessment of presence of stable CAD with CMR and CA, when related to quantitative 13N-NH3 cardiac PET, shows the need for fully quantitative assessment of myocardial perfusion and the use of invasive flow reserve measurements for CA, to confirm the need of elective revascularization.
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Affiliation(s)
- Shahnaz Akil
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, 22185 Lund, Sweden
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Fredrik Hedeer
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, 22185 Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, 22185 Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, 22185 Lund, Sweden
| | - Jenny Oddstig
- Radiation Physics, Skåne University Hospital, Lund, Sweden
| | | | - Jonas Jögi
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, 22185 Lund, Sweden
| | - David Erlinge
- Department of Clinical Sciences Lund, Department of Cardiology, Skane University Hospital, Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund University, 22185 Lund, Sweden
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Oddstig J, Leide Svegborn S, Almquist H, Bitzén U, Garpered S, Hedeer F, Hindorf C, Jögi J, Jönsson L, Minarik D, Petersson R, Welinder A, Wollmer P, Trägårdh E. Comparison of conventional and Si-photomultiplier-based PET systems for image quality and diagnostic performance. BMC Med Imaging 2019; 19:81. [PMID: 31640584 PMCID: PMC6805299 DOI: 10.1186/s12880-019-0377-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 09/12/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A new generation of positron emission tomography with computed tomography (PET-CT) was recently introduced using silicon (Si) photomultiplier (PM)-based technology. Our aim was to compare the image quality and diagnostic performance of a SiPM-based PET-CT (Discovery MI; GE Healthcare, Milwaukee, WI, USA) with a time-of-flight PET-CT scanner with a conventional PM detector (Gemini TF; Philips Healthcare, Cleveland, OH, USA), including reconstruction algorithms per vendor's recommendations. METHODS Imaging of the National Electrical Manufacturers Association IEC body phantom and 16 patients was carried out using 1.5 min/bed for the Discovery MI PET-CT and 2 min/bed for the Gemini TF PET-CT. Images were analysed for recovery coefficients for the phantom, signal-to-noise ratio in the liver, standardized uptake values (SUV) in lesions, number of lesions and metabolic TNM classifications in patients. RESULTS In phantom, the correct (> 90%) activity level was measured for spheres ≥17 mm for Discovery MI, whereas the Gemini TF reached a correct measured activity level for the 37-mm sphere. In patient studies, metabolic TNM classification was worse using images obtained from the Discovery MI compared those obtained from the Gemini TF in 4 of 15 patients. A trend toward more malignant, inflammatory and unclear lesions was found using images acquired with the Discovery MI compared with the Gemini TF, but this was not statistically significant. Lesion-to-blood-pool SUV ratios were significantly higher in images from the Discovery MI compared with the Gemini TF for lesions smaller than 1 cm (p < 0.001), but this was not the case for larger lesions (p = 0.053). The signal-to-noise ratio in the liver was similar between platforms (p = 0.52). Also, shorter acquisition times were possible using the Discovery MI, with preserved signal-to-noise ratio in the liver. CONCLUSIONS Image quality was better with Discovery MI compared to conventional Gemini TF. Although no gold standard was available, the results indicate that the new PET-CT generation will provide potentially better diagnostic performance.
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Affiliation(s)
- Jenny Oddstig
- Radiation Physics, Skåne University Hospital and Lund University, Carl Bertil Laurells gata 9, 20502 Malmö and Lund, Sverige
| | - Sigrid Leide Svegborn
- Radiation Physics, Skåne University Hospital and Lund University, Carl Bertil Laurells gata 9, 20502 Malmö and Lund, Sverige
| | - Helen Almquist
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, 221 85 Lund, Sweden
| | - Ulrika Bitzén
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, 221 85 Lund, Sweden
| | - Sabine Garpered
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Carl Bertil Laurells gata 9, 20502 Malmö, Sverige
| | - Fredrik Hedeer
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, 221 85 Lund, Sweden
| | - Cecilia Hindorf
- Radiation Physics, Skåne University Hospital and Lund University, Carl Bertil Laurells gata 9, 20502 Malmö and Lund, Sverige
| | - Jonas Jögi
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, 221 85 Lund, Sweden
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Carl Bertil Laurells gata 9, 20502 Malmö, Sverige
| | - Lena Jönsson
- Radiation Physics, Skåne University Hospital and Lund University, Carl Bertil Laurells gata 9, 20502 Malmö and Lund, Sverige
| | - David Minarik
- Radiation Physics, Skåne University Hospital and Lund University, Carl Bertil Laurells gata 9, 20502 Malmö and Lund, Sverige
| | - Richard Petersson
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, 221 85 Lund, Sweden
| | - Annika Welinder
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, 221 85 Lund, Sweden
| | - Per Wollmer
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Carl Bertil Laurells gata 9, 20502 Malmö, Sverige
| | - Elin Trägårdh
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Carl Bertil Laurells gata 9, 20502 Malmö, Sverige
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
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Oddstig J, Hindorf C, Hedeer F, Jögi J, Arheden H, Hansson MJ, Engblom H. The radiation dose to overweighted patients undergoing myocardial perfusion SPECT can be significantly reduced: validation of a linear weight-adjusted activity administration protocol. J Nucl Cardiol 2017; 24:1912-1921. [PMID: 27506700 DOI: 10.1007/s12350-016-0628-7] [Citation(s) in RCA: 6] [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: 11/18/2015] [Accepted: 06/25/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Large body size can cause a higher proportion of emitted photons being attenuated within the patient. Therefore, clinical myocardial perfusion SPECT (MPS) protocols often include unproportionally higher radioisotope activity to obese patients. The aim was to evaluate if a linear weight-adjusted low-dose protocol can be applied to obese patients and thereby decrease radiation exposure. METHODS AND RESULT Two hundred patients (>110 kg, BMI 18-41, [n = 69], ≤ 110 kg, BMI 31-58, [n = 131]) underwent 99mTc-tetrofosmin stress examination on a Cadmium Zinc Telluride or a conventional gamma camera using new generations of reconstruction algorithm (Resolution Recovery). Patients <110 kg were administered 2.5 MBq/kg, patients between 110 and 120 kg received 430 MBq and patients >120 kg received 570 MBq according to clinical routine. Patients >110 kg had 130% total number of counts in the images compared to patients <110 kg. Recalculating the counts to correspond to an administered activity of 2.5 MBq/kg resulted in similar number of counts across the groups. Image analyses in a subgroup with images corresponding to high activity and 2.5 MBq/kg showed no difference in image quality or ischemia quantification. CONCLUSION Linear low-dose weight-adjusted protocol of 2.5 MBq/kg in MPS can be applied over a large weight span without loss of counts or image quality, resulting in a significant reduction in radiation exposure to obese patients.
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Affiliation(s)
- Jenny Oddstig
- Department of Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Cecilia Hindorf
- Department of Radiation Physics, Skåne University Hospital and Lund University, Lund, Sweden
| | - Fredrik Hedeer
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, 221 85, Lund, Sweden
| | - Jonas Jögi
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, 221 85, Lund, Sweden
| | - Håkan Arheden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, 221 85, Lund, Sweden
| | - Magnus J Hansson
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, 221 85, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, 221 85, Lund, Sweden.
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Engblom H, Xue H, Akil S, Carlsson M, Hindorf C, Oddstig J, Hedeer F, Hansen MS, Aletras AH, Kellman P, Arheden H. Fully quantitative cardiovascular magnetic resonance myocardial perfusion ready for clinical use: a comparison between cardiovascular magnetic resonance imaging and positron emission tomography. J Cardiovasc Magn Reson 2017; 19:78. [PMID: 29047385 PMCID: PMC5648469 DOI: 10.1186/s12968-017-0388-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent studies have shown that quantification of myocardial perfusion (MP) at stress and myocardial perfusion reserve (MPR) offer additional diagnostic and prognostic information compared to qualitative and semi-quantitative assessment of myocardial perfusion distribution in patients with coronary artery disease (CAD). Technical advancements have enabled fully automatic quantification of MP using cardiovascular magnetic resonance (CMR) to be performed in-line in a clinical workflow. The aim of this study was to validate the use of the automated CMR perfusion mapping technique for quantification of MP using 13N-NH3 cardiac positron emission tomography (PET) as the reference method. METHODS Twenty-one patients with stable CAD were included in the study. All patients underwent adenosine stress and rest perfusion imaging with 13N-NH3 PET and a dual sequence, single contrast bolus CMR on the same day. Global and regional MP were quantified both at stress and rest using PET and CMR. RESULTS There was good agreement between global MP quantified by PET and CMR both at stress (-0.1 ± 0.5 ml/min/g) and at rest (0 ± 0.2 ml/min/g) with a strong correlation (r = 0.92, p < 0.001; y = 0.94× + 0.14). Furthermore, there was strong correlation between CMR and PET with regards to regional MP (r = 0.83, p < 0.001; y = 0.87× + 0.26) with a good agreement (-0.1 ± 0.6 ml/min/g). There was also a significant correlation between CMR and PET with regard to global and regional MPR (r = 0.69, p = 0.001 and r = 0.57, p < 0.001, respectively). CONCLUSIONS There is good agreement between MP quantified by 13N-NH3 PET and dual sequence, single contrast bolus CMR in patients with stable CAD. Thus, CMR is viable in clinical practice for quantification of MP.
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Affiliation(s)
- Henrik Engblom
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive, Bethesda, MD 20892 USA
| | - Shahnaz Akil
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Cecilia Hindorf
- Department of Radiation Physics, Lund University Hospital, Lund, Sweden
| | - Jenny Oddstig
- Department of Radiation Physics, Lund University Hospital, Lund, Sweden
| | - Fredrik Hedeer
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
| | - Michael S. Hansen
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive, Bethesda, MD 20892 USA
| | - Anthony H. Aletras
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
- Laboratory of Computing, Medical Informatics and Biomedical – Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 10 Center Drive, Bethesda, MD 20892 USA
| | - Håkan Arheden
- Department of Clinical Physiology, Clinical Sciences, Lund University and Lund University Hospital, Lund, Sweden
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Akil S, Sunnersjö L, Hedeer F, Hedén B, Carlsson M, Gettes L, Arheden H, Engblom H. Stress-induced ST elevation with or without concomitant ST depression is predictive of presence, location and amount of myocardial ischemia assessed by myocardial perfusion SPECT, whereas isolated stress-induced ST depression is not. J Electrocardiol 2016; 49:307-15. [PMID: 27055936 DOI: 10.1016/j.jelectrocard.2016.03.016] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Evaluation of stress-induced ST deviations constitutes a central part when interpreting the findings from an exercise test. The aim of this analysis was to assess the pathophysiologic correlate of stress-induced ST elevation and ST depression with regard to presence, amount and location of myocardial ischemia as assessed by myocardial perfusion SPECT (MPS) in patients with suspected coronary artery disease. METHODS AND RESULTS 226 patients who had undergone bicycle stress test in conjunction with MPS were included. Of these, 198 were consecutive patients while 28 patients were included on the basis of having stress-induced ST elevation mentioned in their clinical report. The amount and location of ST changes were related to MPS findings. Summed stress scores (SSS) from MPS images were used to measure the amount of stress-induced ischemia. The positive predictive values for detecting stress-induced ischemia were 28% for the consecutive patients with ST depression and 75% for patients with ST elevation. The maximum and sum of stress-induced ST elevations correlated with SSS (r(2)=0.58, p<0.001 and r(2)=0.73, p<0.001), whereas the maximum and sum of significant ST depressions did not (r(2)=0.022, p=0.08 and r(2)=0.024, p=0.10). The location of ST elevation corresponded to the location of ischemia by MPS (kappa=1.0), whereas the location of ST depression did not (kappa=0.20). CONCLUSIONS Stress-induced ST elevation, with or without concomitant ST depression, is predictive of the presence, amount and location of myocardial ischemia assessed by MPS, whereas stress-induced ST depression without concomitant ST elevation is not.
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Affiliation(s)
- Shahnaz Akil
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Lotta Sunnersjö
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Fredrik Hedeer
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Bo Hedén
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Marcus Carlsson
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Leonard Gettes
- University of North Carolina School of Medicine, Dept of Medicine/Cardiology
| | - Håkan Arheden
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden
| | - Henrik Engblom
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Skane University Hospital, Lund, Sweden.
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Hedeer F, Carlsson M, Arheden H, Engblom H. Head-to-head comparison of myocardial perfusion SPECT and CMR for assessment of myocardial ischemia. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328447 DOI: 10.1186/1532-429x-17-s1-p119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bouyoucef SE, Uusitalo V, Kamperidis V, De Graaf M, Maaniitty T, Stenstrom I, Broersen A, Scholte A, Saraste A, Bax J, Knuuti J, Furuhashi T, Moroi M, Awaya T, Masai H, Minakawa M, Kunimasa T, Fukuda H, Sugi K, Berezin A, Kremzer A, Clerc O, Kaufmann B, Possner M, Liga R, Vontobel J, Mikulicic F, Graeni C, Benz D, Kaufmann P, Buechel R, Ferreira M, Cunha M, Albuquerque A, Ramos D, Costa G, Lima J, Pego M, Peix A, Cisneros L, Cabrera L, Padron K, Rodriguez L, Heres F, Carrillo R, Mena E, Fernandez Y, Huizing E, Van Dijk J, Van Dalen J, Timmer J, Ottervanger J, Slump C, Jager P, Venuraju S, Jeevarethinam A, Yerramasu A, Atwal S, Mehta V, Lahiri A, Arjonilla Lopez A, Calero Rueda MJ, Gallardo G, Fernandez-Cuadrado J, Hernandez Aceituno D, Sanchez Hernandez J, Yoshida H, Mizukami A, Matsumura A, Smettei O, Abazid R, Sayed S, Mlynarska A, Mlynarski R, Golba K, Sosnowski M, Winther S, Svensson M, Jorgensen H, Bouchelouche K, Gormsen L, Holm N, Botker H, Ivarsen P, Bottcher M, Cortes CM, Aramayo G E, Daicz M, Casuscelli J, Alaguibe E, Neira Sepulveda A, Cerda M, Ganum G, Embon M, Vigne J, Enilorac B, Lebasnier A, Valancogne L, Peyronnet D, Manrique A, Agostini D, Menendez D, Rajpal S, Kocherla C, Acharya M, Reddy P, Sazonova I, Ilushenkova Y, Batalov R, Rogovskaya Y, Lishmanov Y, Popov S, Varlamova N, Prado Diaz S, Jimenez Rubio C, Gemma D, Refoyo Salicio E, Valbuena Lopez S, Moreno Yanguela M, Torres M, Fernandez-Velilla M, Lopez-Sendon J, Guzman Martinez G, Puente A, Rosales S, Martinez C, Cabada M, Melendez G, Ferreira R, Gonzaga A, Santos J, Vijayan S, Smith S, Smith M, Muthusamy R, Takeishi Y, Oikawa M, Goral JL, Napoli J, Montana O, Damico A, Quiroz M, Damico A, Forcada P, Schmidberg J, Zucchiatti N, Olivieri D, Jeevarethinam A, Venuraju S, Dumo A, Ruano S, Rakhit R, Davar J, Nair D, Cohen M, Darko D, Lahiri A, Yokota S, Ottervanger J, Maas A, Mouden M, Timmer J, Knollema S, Jager P, Sanja Mazic S, Lazovic B, Marina Djelic M, Jelena Suzic Lazic J, Tijana Acimovic T, Milica Deleva M, Vesnina Z, Zafrir N, Bental T, Mats I, Solodky A, Gutstein A, Hasid Y, Belzer D, Kornowski R, Ben Said R, Ben Mansour N, Ibn Haj Amor H, Chourabi C, Hagui A, Fehri W, Hawala H, Shugushev Z, Patrikeev A, Maximkin D, Chepurnoy A, Kallianpur V, Mambetov A, Dokshokov G, Teresinska A, Wozniak O, Maciag A, Wnuk J, Dabrowski A, Czerwiec A, Jezierski J, Biernacka K, Robinson J, Prosser J, Cheung G, Allan S, Mcmaster G, Reid S, Tarbuck A, Martin W, Queiroz R, Falcao A, Giorgi M, Imada R, Nogueira S, Chalela W, Kalil Filho R, Meneghetti W, Matveev V, Bubyenov A, Podzolkov V, Shugushev Z, Maximkin D, Chepurnoy A, Baranovich V, Faibushevich A, Kolzhecova Y, Volkova O, Kallianpur V, Peix A, Cabrera L, Padron K, Rodriguez L, Fernandez J, Lopez G, Mena E, Fernandez Y, Dondi M, Paez D, Butcher C, Reyes E, Al-Housni M, Green R, Santiago H, Ghiotto F, Hinton-Taylor S, Pottle A, Mason M, Underwood S, Casans Tormo I, Diaz-Exposito R, Plancha-Burguera E, Elsaban K, Alsakhri H, Yoshinaga K, Ochi N, Tomiyama Y, Katoh C, Inoue M, Nishida M, Suzuki E, Manabe O, Ito Y, Tamaki N, Tahilyani A, Jafary F, Ho Hee Hwa H, Ozdemir S, Kirilmaz B, Barutcu A, Tan Y, Celik F, Sakgoz S, Cabada Gamboa M, Puente Barragan A, Morales Vitorino N, Medina Servin M, Hindorf C, Akil S, Hedeer F, Jogi J, Engblom H, Martire V, Pis Diez E, Martire M, Portillo D, Hoff C, Balche A, Majgaard J, Tolbod L, Harms H, Bouchelouche K, Soerensen J, Froekiaer J, Gormsen L, Nudi F, Neri G, Procaccini E, Pinto A, Vetere M, Biondi-Zoccai G, Falcao A, Chalela W, Giorgi M, Imada R, Soares J, Do Val R, Oliveira M, Kalil Filho R, Meneghetti J, Tekabe Y, Anthony T, Li Q, Schmidt A, Johnson L, Groenman M, Tarkia M, Kakela M, Halonen P, Kiviniemi T, Pietila M, Yla-Herttuala S, Knuuti J, Roivainen A, Saraste A, Nekolla S, Swirzek S, Higuchi T, Reder S, Schachoff S, Bschorner M, Laitinen I, Robinson S, Yousefi B, Schwaiger M, Kero T, Lindsjo L, Antoni G, Westermark P, Carlson K, Wikstrom G, Sorensen J, Lubberink M, Rouzet F, Cognet T, Guedj K, Morvan M, El Shoukr F, Louedec L, Choqueux C, Nicoletti A, Le Guludec D, Jimenez-Heffernan A, Munoz-Beamud F, Sanchez De Mora E, Borrachero C, Salgado C, Ramos-Font C, Lopez-Martin J, Hidalgo M, Lopez-Aguilar R, Soriano E, Okizaki A, Nakayama M, Ishitoya S, Sato J, Takahashi K, Burchert I, Caobelli F, Wollenweber T, Nierada M, Fulsche J, Dieckmann C, Bengel F, Shuaib S, Mahlum D, Port S, Gemma D, Refoyo E, Cuesta E, Guzman G, Lopez T, Valbuena S, Fernandez-Velilla M, Del Prado S, Moreno M, Lopez-Sendon J, Harbinson M, Donnelly L, Einstein AJ, Johnson LL, Deluca AJ, Kontak AC, Groves DW, Stant J, Pozniakoff T, Cheng B, Rabbani LE, Bokhari S, Caobelli F, Schuetze C, Nierada M, Fulsche J, Dieckmann C, Bengel F, Aguade-Bruix S, Pizzi M, Romero-Farina G, Terricabras M, Villasboas D, Castell-Conesa J, Candell-Riera J, Brunner S, Gross L, Todica A, Lehner S, Di Palo A, Niccoli Asabella A, Magarelli C, Notaristefano A, Ferrari C, Rubini G, Sellem A, Melki S, Elajmi W, Hammami H, Ziadi M, Montero J, Ameriso J, Villavicencio R, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Barinaga Martin C, Martin Fernandez J, Alonso Rodriguez D, Iglesias Garriz I, Gemma D, Refoyo E, Cuesta E, Guzman G, Valbuena S, Rosillo S, Del Prado S, Torres M, Moreno M, Lopez-Sendon J, Taleb S, Cherkaoui Salhi G, Regbaoui Y, Ait Idir M, Guensi A, Puente A, Rosales S, Martinez C, Cabada M, Benito Gonzalez TF, Mayorga Bajo A, Gutierrez Caro R, Rodriguez Santamarta M, Alvarez Roy L, Martinez Paz E, Martin Lopez CE, Castano Ruiz M, Martin Fernandez J, Iglesias Garriz I. Poster Session 2: Monday 4 May 2015, 08:00-18:00 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hindorf C, Oddstig J, Hedeer F, Hansson MJ, Jögi J, Engblom H. Importance of correct patient positioning in myocardial perfusion SPECT when using a CZT camera. J Nucl Cardiol 2014; 21:695-702. [PMID: 24807623 DOI: 10.1007/s12350-014-9897-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/15/2014] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Myocardial perfusion single photon emission computed tomography (MPS) is one of the most widely used diagnostic methods in patients with suspected ischemic heart disease (IHD). Recently, a novel technique based on cadmium-zinc-telluride (CZT) detectors, pinhole collimators, and a stationary gantry was introduced for MPS. The aim of this work was to investigate how patient positioning affects the reconstructed MPS images using this novel technique. MATERIALS AND METHODS Eighteen patients referred for a clinical MPS due to suspected IHD were included in the study. All patients underwent MPS imaging on a GE Discovery NM 530c CZT camera. After image acquisition with the heart positioned in the center of the quality field of view (QFOV), the patients were re-imaged in different positions 5-20 mm off-center. The heart was still positioned within the limits of the QFOV during the off-center scans. The summed stress score and/or the summed rest score (SSS and/or SRS) for the acquisition performed in the center was compared to the same parameter for the acquisitions performed off-center. RESULTS There was a statistically significant increase in SSS and/or SRS when imaging was performed with the heart 5-20 mm outside the center of the QFOV compared to optimal positioning (7.7 ± 1.3 vs 6.6 ± 1.3, P = .006). The SSS and/or SRS increased with ≥2 U in 35% (14/40) of the off-center examinations. CONCLUSION It is important to carefully position the patient's heart within the center of the QFOV when performing MPS with the Discovery NM 530c CZT camera to avoid positioning-related image artifacts that could affect the diagnostic accuracy.
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Affiliation(s)
- Cecilia Hindorf
- Department of Radiation Physics, Skåne University Hospital, Lund, Sweden,
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Carlsson M, Hedeer F, Engblom H, Arheden H. Head-to-head comparison of a 2-day myocardial perfusion gated SPECT protocol and cardiac magnetic resonance late gadolinium enhancement for the detection of myocardial infarction. J Nucl Cardiol 2013; 20:797-803. [PMID: 23835903 DOI: 10.1007/s12350-013-9755-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 06/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim was to determine the sensitivity and specificity of gated myocardial perfusion SPECT (MPS) with a technetium-labelled (Tc) perfusion tracer to detect myocardial infarction (MI) in a clinical population referred for assessment of stress-induced ischemia using late gadolinium enhancement cardiac magnetic resonance (CMR) as reference method. METHODS 119 patients referred for evaluation of stress-induced ischemia with MPS were included. 108 patients (age 62 ± 10 years, 39% females) completed MPS and CMR. A 2-day protocol for MPS was used for most patients (n = 105). RESULTS MI was found in 31 patients (29%) using MPS and in 30 patients using CMR (28%). The sensitivity and specificity on a patient basis were 93% and 96%, respectively. Positive predictive value (PPV) was 90% and negative predictive value (NPV) was 97%. Per territory, the sensitivity and specificity for LAD infarcts were 83% and 97%, respectively. PPV was 77% and NPV was 98% for LAD infarcts. The sensitivity and specificity for RCA/LCx infarcts were 95% and 95%, respectively. PPV was 84% and NPV was 99% for RCA/LCx infarcts. The MI size on CMR was 12.0 ± 7.3% of the LV and mean transmurality was 66.3 ± 12.0%. All MI > 3% were detected on gated SPECT. CONCLUSION This study has demonstrated high sensitivity and specificity for gated Tc-MPS detecting subendocardial and transmural MI.
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Affiliation(s)
- Marcus Carlsson
- Department of Clinical Physiology and Nuclear Medicine, Skane University Hospital, Lund University, 221 85, Lund, Sweden,
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Akil S, Al-Mashat M, Hedén B, Hedeer F, Jögi J, Wang JJ, Wagner GS, Warren JW, Pahlm O, Horáček BM. Discrimination of ST deviation caused by acute coronary occlusion from normal variants and other abnormal conditions, using computed electrocardiographic imaging based on 12-lead ECG. J Electrocardiol 2013; 46:197-203. [DOI: 10.1016/j.jelectrocard.2013.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Indexed: 11/30/2022]
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Oddstig J, Hedeer F, Jögi J, Carlsson M, Hindorf C, Engblom H. Reduced administered activity, reduced acquisition time, and preserved image quality for the new CZT camera. J Nucl Cardiol 2013; 20:38-44. [PMID: 23143809 DOI: 10.1007/s12350-012-9634-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 09/30/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND For a 1-day myocardial perfusion SPECT (MPS) the recommendations for administered activity stated in the EANM guidelines results in an effective dose of up to 16 mSv per patient. Recently, a gamma camera system, based on cadmium zinc telluride (CZT) technology, was introduced. This technique has the potential to reduce the effective dose and scan time compared to the conventional NaI gamma camera. The aim of this study was to investigate if the effective dose can be reduced with a preserved image quality using CZT technology in MPS. METHODS In total, 150 patients were included in the study. All underwent a 1-day (99m)Tc-tetrofosmin stress-rest protocol and were divided into three subgroups (n = 50 in each group) with 4, 3, and 2.5 MBq/kg body weight of administered activity in the stress examination, respectively. The acquisition time was increased in proportion to the decrease in administered activity. All examinations were analyzed for image quality by visual grading on a 4-point scale (1 = poor, 2 = adequate, 3 = good, 4 = excellent), by two expert readers. RESULTS The total effective dose (stress + rest) decreased from 9.3 to 5.8 mSv comparing 4 to 2.5 MBq/kg body weight. For the patients undergoing stress examination only (35%) the effective dose, administrating 2.5 MBq/kg, was 1.4 mSv. The image acquisition times for 2.5 MBq/kg body weight were 475 and 300 seconds (stress and rest) compared to 900 seconds for each when using conventional MPS. The average image quality was 3.7 ± 0.5, 3.8 ± 0.5, and 3.8 ± 0.4 for the stress images and 3.5 ± 0.6, 3.6 ± 0.6, and 3.5 ± 0.6 for the rest images and showed no statistically significant difference (P = .62) among the 4, 3, and 2.5 MBq/kg groups. CONCLUSIONS The new CZT technology can be used to considerably decrease the effective dose and acquisition time for MPS with preserved high image quality.
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Affiliation(s)
- Jenny Oddstig
- Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
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Soneson H, Hedeer F, Arévalo C, Carlsson M, Engblom H, Ubachs JFA, Arheden H, Heiberg E. Development and validation of a new automatic algorithm for quantification of left ventricular volumes and function in gated myocardial perfusion SPECT using cardiac magnetic resonance as reference standard. J Nucl Cardiol 2011; 18:874-85. [PMID: 21761374 DOI: 10.1007/s12350-011-9427-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 06/28/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND By gating image acquisition in myocardial perfusion SPECT (MPS) to ECG, left ventricular (LV) volumes and function can be determined. Several previous studies have shown that existing MPS software packages underestimate LV volumes compared to cardiac magnetic resonance (CMR). The aim of this study was therefore to develop a new LV segmentation algorithm for gated MPS using CMR as reference standard. METHODS AND RESULTS A total of 126 patients with suspected coronary artery disease, who underwent both gated MPS and CMR were retrospectively included. The proposed LV segmentation algorithm (Segment) was trained in 26 patients, and tested in 100 patients in comparison to four commercially available MPS software packages (QGS, MyoMetrix, ECTb, and Exini) using CMR as reference standard. Mean bias ± SD between MPS and CMR was for EDV -5% ± 12%, -43% ± 8%, -40% ± 8%, -42% ± 9%, -32% ± 7%, for ESV 0% ± 17%, -41% ± 16%, -34% ± 15%, -54% ± 13%, -41% ± 10%, for EF -2% ± 13%, -1% ± 14%, -7% ± 15%, 17% ± 16%, 10% ± 17% for Segment, QGS, MyoMetrix, ECTb, and Exini, respectively, and for LVM 3% ± 18%, 33% ± 25%, 37% ± 24% for Segment, QGS, and ECTb, respectively. Correlation between MPS by Segment and CMR were for EDV R (2) = 0.89, for ESV R (2) = 0.92, for EF R (2) = 0.69, and for LVM R (2) = 0.72, with no difference compared to the correlation between the other MPS software packages and CMR (EDV R (2) = 0.86-0.92, ESV R (2) = 0.91-0.93, EF R (2) = 0.64-0.65, and LVM R (2) = 0.68-0.70). CONCLUSION The Segment software quantifies LV volumes and EF by MPS with similar correlation and a low bias compared to other MPS software packages, using CMR as reference standard. Hence, the Segment software shows potential to provide clinically relevant volumes and functional values from MPS.
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Affiliation(s)
- Helen Soneson
- Department of Clinical Physiology, Skåne University Hospital, Lund University, SE-22185, Lund, Sweden
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Hedeer F, Palmer J, Arheden H, Ugander M. Gated myocardial perfusion SPECT underestimates left ventricular volumes and shows high variability compared to cardiac magnetic resonance imaging -- a comparison of four different commercial automated software packages. BMC Med Imaging 2010; 10:10. [PMID: 20500866 PMCID: PMC2894738 DOI: 10.1186/1471-2342-10-10] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Accepted: 05/25/2010] [Indexed: 11/17/2022] Open
Abstract
Background We sought to compare quantification of left ventricular volumes and ejection fraction by different gated myocardial perfusion SPECT (MPS) programs with each other and to magnetic resonance (MR) imaging. Methods N = 100 patients with known or suspected coronary artery disease were examined at rest with 99 mTc-tetrofosmin gated MPS and cardiac MR imaging. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were obtained by analysing gated MPS data with four different programs: Quantitative Gated SPECT (QGS), GE MyoMetrix, Emory Cardiac Toolbox (ECTb) and Exini heart. Results All programs showed a mean bias compared to MR imaging of approximately -30% for EDV (-22 to -34%, p < 0.001 for all), ESV (-12 to -37%, p < 0.001 for ECTb, p < 0.05 for Exini, p = ns for QGS and MyoMetrix) and SV (-21 to -41%, p < 0.001 for all). Mean bias ± 2 SD for EF (% of EF) was -9 ± 27% (p < 0.01), 6 ± 29% (p = ns), 15 ± 27% (p < 0.001) and 0 ± 28% (p = ns) for QGS, ECTb, MyoMetrix, and Exini, respectively. Conclusions Gated MPS, systematically underestimates left ventricular volumes by approximately 30% and shows a high variability, especially for ESV. For EF, accuracy was better, with a mean bias between -15 and 6% of EF. It may be of value to take this into consideration when determining absolute values of LV volumes and EF in a clinical setting.
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Affiliation(s)
- Fredrik Hedeer
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
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