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Roberts G, Lloyd JJ, Jefferson E, Kane JPM, Durcan R, Lawley S, Petrides GS, Howe K, Haq I, O'Brien JT, Thomas AJ. Uniformity of cardiac 123I-MIBG uptake on SPECT images in older adults with normal cognition and patients with dementia. J Nucl Cardiol 2021; 28:2151-2163. [PMID: 31820410 PMCID: PMC8648658 DOI: 10.1007/s12350-019-01977-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/24/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Some studies report that assessing regional 123I-cardiac MIBG uptake can aid in the diagnosis of Lewy body disease, but others report heterogeneity in healthy controls. We aimed to evaluate regional cardiac MIBG uptake patterns in healthy older adults and patients with dementia. METHODS 31 older adults with normal cognition, 15 Alzheimer's disease (AD), and 17 Dementia with Lewy bodies (DLB) patients were recruited. 5 individuals had previous myocardial infarction. Participants with sufficient cardiac uptake for regional SPECT analysis (29/31 controls, 15/15 AD, 5/17 DLB) had relative uptake pattern recorded. Controls were assessed for risk of future cardiovascular events using QRISK2, a validated online tool. RESULTS In controls uptake was reduced in the inferior wall (85%), apex (23%), septum (15%), and lateral wall (8%). AD and DLB showed similar patterns to controls. Lung or liver interference was present in 61% of cases. Myocardial infarction cases showed regional reductions in uptake, but normal/borderline planar uptake. In controls, there was no relationship between cardiovascular risk score and uptake pattern. CONCLUSIONS Significant variability of regional cardiac 123I-MIBG uptake is common in cases with normal planar cardiac uptake. Heterogeneity of regional uptake appears non-specific and unlikely to aid in the diagnosis of Lewy body disease.
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Affiliation(s)
- Gemma Roberts
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK.
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - Jim J Lloyd
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Elizabeth Jefferson
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Rory Durcan
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
| | - Sarah Lawley
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
| | - George S Petrides
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Kim Howe
- Nuclear Medicine Department, Leazes Wing, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Iftikhar Haq
- Cardiology Department, Royal Victoria Infirmary, Richardson Road, Newcastle upon Tyne, NE1 4LP, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK
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Kim HJ, Park HJ, Oh JB, Chang MJ, Kang SB, Kim YK, Oh SH, Chang CB. Retrospective study of relationship between vastus medialis volume on SPECT-CT and outcome of unilateral total knee arthroplasty. Medicine (Baltimore) 2021; 100:e24138. [PMID: 33429788 PMCID: PMC7793406 DOI: 10.1097/md.0000000000024138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/08/2020] [Indexed: 01/05/2023] Open
Abstract
Although the importance of quadriceps femoris function was reported previously, little is known about volume-related factors and their effects on clinical outcomes after total knee arthroplasty (TKA). We sought to determine whether there was a bilateral difference in vastus medialis muscle volume measured on single-photon emission computed tomography-computed tomography (SPECT-CT) in patients who underwent unilateral TKA. We also aimed to determine whether vastus medialis volume was related to osteoarthritis (OA) severity or scintigraphic uptake degree around the knee joint on SPECT-CT. And finally, we attempted to investigate the factors, such as vastus medialis volume and scintigraphic uptake degree, associated with the functional outcomes of TKA.This retrospective study included 50 patients (41 female, 9 male) undergone unilateral TKA due to primary OA. The maximal cross-sectional area of the vastus medialis was measured on axial SPECT-CT images. Scintigraphic uptake degrees and Kellgren-Lawrence (K-L) grade at the tibiofemoral joints were assessed. We compared maximal cross-sectional area of the vastus medialis on SPECT-CT for difference of bilateral lower limbs. We also analyzed the relationship between volume of vastus medialis and scintigraphic uptake measured on SPECT-CT and the severity of OA on conventional radiographs. The clinical outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at baseline and at 1 and 2 years after surgery. The relationship between preoperative muscle volume and scintigraphic uptake on SPECT-CT and WOMAC index was analyzed.The amount of muscle volume measured on SPECT-CT was smaller in operated limb in patients who underwent unilateral TKA. Preoperative vastus medialis muscle volume was not related to preoperative OA severity measured on conventional radiographs and scintigraphic uptake on SPECT-CT. However, a decreased vastus medialis muscle volume was related to worse clinical outcomes after TKA (P = .045), whereas the degree of scintigraphic uptake on SPECT-CT was not associated with postoperative clinical outcomes.Muscle volume of vastus medialis was decreased in the operated knee than in the nonoperated knee, and that was correlated with worse postoperative results. Even if the preoperative volume of vastus medialis were not related to OA severity on conventional radiographs and scintigraphic uptake on SPECT-CT, preservation and improvement of the muscle mass of the knee undergoing TKA is important.
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Affiliation(s)
| | | | | | | | | | | | - So Hee Oh
- Department of Biostatistics, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Lou J, Liu Z, Xu B, Wang YK, Liu CJ, Liu M, Liu XD. Evaluation of 99mTC-ECD SPECT/CT brain Imaging with NeuroGam analysis in Moyamoya disease after surgical revascularization. Medicine (Baltimore) 2019; 98:e16525. [PMID: 31725599 PMCID: PMC6867761 DOI: 10.1097/md.0000000000016525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To evaluate the clinical value of NeuroGam software in assessing the brain foci perfusion changes by TC-ECD single photon emission computed tomography/computed tomography (SPECT/CT) brain imaging in patients with Moyamoya Disease (MMD).Seventy-two patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass combined with encephalo-duro-myo-synangiosis (EDMS) surgical revascularization were included. Baseline and follow-up TC-ECD SPECT/CT brain scans were performed on all patients at least twice before and after operation. Pre- and post-SPECT dicom images were reoriented into Talairach space using NeuroGam Software package. Additional visual analysis was performed. Differences mean pixel value between pre- and post- operation brain perfusion were assessed with paired t test and McNemar test.Significant differences in the number of hypoperfusion foci were found between visual assessment and NeuroGam aided assessment. More hypoperfusion foci were found by NeuroGam software aided assessment in the frontal, parietal, temporal, occipital lobe, thalamus, basal ganglia and cerebellum before and after surgery (P < .0001). According to NeuroGam software assessment, the perfusion of frontal, parietal, temporal lobe, anterior and middle cerebral regions on the operative side significantly improved before and after surgery (t = -3.734, t = -3.935, t = -5.099, t = -4.006, t = -5.170, all P < .001). However, no significant differences were found in the occipital lobe (t = -1.962, P = .054), thalamus (t = 1.362, P = .177), basal ganglia (t = -2.394, P = .019), and cerebellum (t = 1.383, P = .171) before and after surgery.The NeuroGam software provides a quantitative approach for monitoring surgical effect of MMD in a variable time (3-12 months after surgery). It could discover the perfusion changes that are neglected in conventional visual assessment.
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Affiliation(s)
- Jingjing Lou
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
- Universal Medical Imaging Diagnostic Center
| | - Zhuang Liu
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuan-Kai Wang
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
| | - Cong-Jin Liu
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
| | - Miao Liu
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
| | - Xing-Dang Liu
- Department of Nuclear Medicine of Huashan Hospital, Fudan University
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Egloff C, Huber L, Wurm M, Pagenstert G. No added value using SPECT/CT to analyze persistent symptoms after anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 2019; 139:807-816. [PMID: 30637504 DOI: 10.1007/s00402-019-03117-7] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the diagnostic and clinical value of SPECT/CT compared to the standard algorithm for patients with persistent symptoms after anterior cruciate ligament reconstructions. The standard algorithm uses clinical information, conventional radiographs, MRI and CT scan, while the trial algorithm uses the same information but SPECT/CT in addition. METHODS In a diagnostic comparative trial three experienced surgeons evaluated 23 consecutive patients with persistent symptoms after ACL reconstruction using first standard and second the trial algorithm with a time interval. Each rater had to establish a diagnosis and therapeutic decision with each algorithm. On MRI, graft continuity, bone marrow edema, chondral and meniscal lesions, femoral notch osteophytes were evaluated. Bone tracer uptake in SPECT/CT was anatomically analyzed and compared with MRI findings. MRI findings and SPECT/CT tracer uptake were correlated using Spearman's rho test. RESULTS Additional SPECT/CT analysis did not change diagnosis in any case and did not correlate with clinical graft integrity. Treatment decisions remained unchanged as well. Chondral lesions, arthritic changes, meniscal lesions, graft impingement are best visualized in MRI and showed correspondent tracer uptake in SPECT/CT. Tunnel position was well classified with standard CT scan and showed no correlation with SPECT/CT tracer uptake. CONCLUSION Information derived by SPECT/CT in addition to the standard algorithm using clinical information, X-rays, MRI, and CT scan did not change the diagnosis or treatment plan. There is currently no justification to implement SPECT/CT for patients with persistent symptoms after anterior cruciate ligament reconstructions. LEVEL OF EVIDENCE Level II: diagnostic comparative study.
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Affiliation(s)
- Christian Egloff
- Department of Orthopedics and Traumatology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | | | - Markus Wurm
- Department of Orthopaedic Sports Medicine, Technische Universität München (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Schanzenstr. 55, 4056, Basel, Switzerland
- Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Foehrenstr. 2, 4054, Basel, Switzerland
- Knee Institute Basel, Mittlere Str. 129, 4056, Basel, Switzerland
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Masoomi MA, Al-Shammeri I, Kalafallah K, Elrahman HM, Ragab O, Ahmed E, Al-Shammeri J, Arafat S. Wiener filter improves diagnostic accuracy of CAD SPECT images-comparison to angiography and CT angiography. Medicine (Baltimore) 2019; 98:e14207. [PMID: 30681596 PMCID: PMC6358408 DOI: 10.1097/md.0000000000014207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Many discrepancy in selection of proper filter and its parameters for individual cases exists. The authors investigate the impact of the most common filters on patient NM images with coronary artery disease (CAD), and compare the results with the computerized tomography (CT)-Angio and angiography for accuracy.The investigation initiated by performing various single photon emission computerized tomography (SPECT)/CT scan of the national electrical manufacturers association chest phantoms having hot and cold inserts. Data acquired on GE 670 PRO SPECT/CT; 360Ø, 64 frames, 60 seconds, low energy high resolution (LEHR) 128, low energy general purpose (LEGP) with CT attenuation (120 kV and 170 mA). The images reconstructed with filtered back projection and ITERATIVE ordered-subset expectation maximization utilizing filters; Hann, Butterworth, Metz, Hamming, and Wiener. The Image contrast was calculated to assess absolute nearness of the inserts. Based on the preliminary results, then scans of 92 patients with CAD; 64 males and 28 females, age 41 to 77 years old, who had been reported earlier reprocessed with the nominated filter and were reported by 2 NM expert. The results compared to the earlier reports and to the CT-Angio and angiography.The optimization suggested 3 filters; Wiener (Wi), Metz and Butterworth (But) provide the highest contrast (99- 66.4%) and (81- 32%) for the cold and hot inserts respectively, with the (Wi) filter to be the better option. The reprocessed patients scan with the (Wi) presented an elevated diagnostic accuracy, correlated well with the CT-Angio and angiography results (P < .001 and r = 0.79 for [Wi] and P = .004 and r = 0.39 for [But]). The percentage of the false negative for moderate to severe CAD cases reported using Wi filter reduced from 27% to 7% and similarly for mild CAD cases from 7% to 1%.It appears the Wiener filter could produce results with the highest contrast for phantom imaging of various cold and hot spheres and for the patient data which is more consistent with angiography results, with much-elevated accuracy in intermediate cases (r = 0.79 for Wiener and r = 0.39 for Butterworth vs angiography). However, the optimum parameters obtained for the filters have no relation with the resolution of the imaging system, but the details of the objects could be improved.
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Affiliation(s)
- Michael A. Masoomi
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
| | - Iman Al-Shammeri
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
| | - Khaled Kalafallah
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
- Department of Nuclear Medicine, Kuwait Cancer Control Centre, Sabah Medical District, Shuwaikh
| | - Hany M.A. Elrahman
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
| | - Osama Ragab
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
| | - Ebba Ahmed
- Department of Nuclear Medicine and Molecular Imaging, Adan HospitalHadiya, KW
| | - Jehan Al-Shammeri
- Department of Nuclear Medicine, Faculty of Medicine, Heath Science Centre, Kuwait University
| | - Sharif Arafat
- Department of Cardiology, Dabbous Cardiac Centre, Adan Hospital, Hadiya, Kuwait
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De Laroche R, Simon E, Suignard N, Williams T, Henry MP, Robin P, Abgral R, Bourhis D, Salaun PY, Dubrana F, Querellou S. Clinical interest of quantitative bone SPECT-CT in the preoperative assessment of knee osteoarthritis. Medicine (Baltimore) 2018; 97:e11943. [PMID: 30170388 PMCID: PMC6393116 DOI: 10.1097/md.0000000000011943] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to evaluate the interest of quantitative bone SPECT-CT in the preoperative assessment of knee osteoarthritis (OA) before unicompartmental knee arthroplasty (UKA).Patients eligible for UKA were prospectively included in 2 centers and underwent a preoperative SPECT-CT. Images were reconstructed with an OSEM, an OSCGM (allowing SUV quantification) and an enhanced OSCGM (containing uptakes to bones) algorithms. Visual analysis and quantification (SUVmax) were performed for each compartment (medial compartment [MC], lateral compartment [LC], and patellofemoral compartment [PFC]). Clinical data were preoperatively assessed. The gold standard was the per-operative OA staging (International Cartilage Repair Society [ICRS] scale). Spearman's correlation coefficient was used for correlations. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy of SPECT-CT were assessed.One hundred three patients (50 women, 53 men, mean age = 64.5 ± 10.3 y/o, 120 preoperative knees) were analyzed. There was no correlation between SUVmax and clinical data. There was a correlation between ICRS staging and SUVmax with both OSCGM (MC [rs = 0.25], LC [rs = 0.51], and PFC [rs = 0.27]), and enhanced OSCGM, except in the PFC (MC [rs = 0.22], LC [rs = 0.62], and PFC [rs = 0.03]). The Se, Sp, PPV, NPV, and accuracy of SPECT-CT were, respectively, 0.99, 0.67, 0.98, 0.80, 0.97 for the MC; 0.50, 0.85, 0.42, 0.89, 0.79 for the LC; and 0.23, 0.86, 0.50, 0.64, 0.62 for the PFC.Bone SPECT-CT SUVmax is correlated with per-operative OA staging. Despite the low sensitivity of SPECT-CT in the LC, its high specificity in the LC should prompt the surgeon to be vigilant before UKA surgery.
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Affiliation(s)
- Romain De Laroche
- Nuclear Medicine Department, University Hospital Morvan, Brest Cedex
| | - Erwan Simon
- Orthopedic Surgery Department, Private Hospital of “La Baie”, La vierge noire, Morlaix
| | - Nicolas Suignard
- Orthopedic Surgery Department, University Hospital Cavale Blanche, Boulevard Tanguy Prigent, Brest Cedex
| | - Thomas Williams
- Orthopedic Surgery Department, University Hospital Cavale Blanche, Boulevard Tanguy Prigent, Brest Cedex
| | - Marc-Pierre Henry
- Orthopedic Surgery Department, University Hospital Cavale Blanche, Boulevard Tanguy Prigent, Brest Cedex
| | - Philippe Robin
- Nuclear Medicine Department, University Hospital Morvan, Brest Cedex
- EA 3878 GETBO IFR 148, Brest
- University of Bretagne Occidentale, France
| | - Ronan Abgral
- Nuclear Medicine Department, University Hospital Morvan, Brest Cedex
- EA 3878 GETBO IFR 148, Brest
- University of Bretagne Occidentale, France
| | - David Bourhis
- Nuclear Medicine Department, University Hospital Morvan, Brest Cedex
- EA 3878 GETBO IFR 148, Brest
- University of Bretagne Occidentale, France
| | - Pierre-Yves Salaun
- Nuclear Medicine Department, University Hospital Morvan, Brest Cedex
- EA 3878 GETBO IFR 148, Brest
- University of Bretagne Occidentale, France
| | - Frédéric Dubrana
- Orthopedic Surgery Department, University Hospital Cavale Blanche, Boulevard Tanguy Prigent, Brest Cedex
- University of Bretagne Occidentale, France
| | - Solène Querellou
- Nuclear Medicine Department, University Hospital Morvan, Brest Cedex
- EA 3878 GETBO IFR 148, Brest
- University of Bretagne Occidentale, France
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Travin MI, Henzlova MJ, van Eck-Smit BLF, Jain D, Carrió I, Folks RD, Garcia EV, Jacobson AF, Verberne HJ. Assessment of 123I-mIBG and 99mTc-tetrofosmin single-photon emission computed tomographic images for the prediction of arrhythmic events in patients with ischemic heart failure: Intermediate severity innervation defects are associated with higher arrhythmic risk. J Nucl Cardiol 2017; 24:377-391. [PMID: 26791866 DOI: 10.1007/s12350-015-0336-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 08/27/2015] [Accepted: 10/28/2015] [Indexed: 01/08/2023]
Abstract
RATIONALE 123I-mIBG planar image heart-to-mediastinum ratios effectively risk-stratify heart failure (HF) patients. The value of single-photon emission computed tomographic (SPECT) imaging for identifying increased risk of ventricular arrhythmias is less clear. This study sought to determine if findings from simultaneous interpretation of 123I-mIBG and 99mTc-tetrofosmin SPECT are predictive of arrhythmic events (ArEs). METHODS 123I-mIBG SPECT images from 622 patients with ischemic HF were presented in standard displays alongside 99mTc-tetrofosmin images. Consensus interpretations using a 17-segment model produced summed scores. Cox proportional hazards analyses related findings to adjudicated ArEs over 2 years. RESULTS 471 patients had images adequate for total 17-segment scoring. There were 48 ArEs (10.2%). Neither 123I-mIBG nor 99mTc-tetrofosmin SPECT summed scores were univariate predictors. On multivariate proportional hazards analysis, the 123I-mIBG SPECT score was independently predictive of ArEs (HR: 0.975, 95% CI 0.951-0.999, P = 0.042), but HR<1 indicated that risk decreased with increasing score. This occurred because patients with intermediately abnormal SPECT studies had a higher likelihood of ArEs compared to patients with extensive abnormalities. CONCLUSIONS The presumption of a monotonic increase in ArE risk with increasing summed 123I-mIBG SPECT score may not be correct as ischemic HF patients with abnormalities of intermediate extent appear at highest risk.
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Affiliation(s)
- Mark I Travin
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East-210th Street, Bronx, NY, 10467-2490, USA.
| | | | - Berthe L F van Eck-Smit
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Diwakar Jain
- Division of Cardiology, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Ignasi Carrió
- Department of Nuclear Medicine, Hospital Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Russell D Folks
- Department of Radiology, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Ernest V Garcia
- Department of Radiology, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, USA
| | - Arnold F Jacobson
- Diagram Consulting, Kihei, HI, USA
- Formerly Employed by GE Healthcare, Kihei, HI, USA
| | - Hein J Verberne
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Engbers EM, Timmer JR, Ottervanger JP, Mouden M, Oostdijk AHJ, Knollema S, Jager PL. Sequential SPECT/CT imaging for detection of coronary artery disease in a large cohort: evaluation of the need for additional imaging and radiation exposure. J Nucl Cardiol 2017; 24:212-223. [PMID: 26396025 DOI: 10.1007/s12350-015-0243-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 05/01/2015] [Revised: 06/26/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Performing both single photon emission computerized tomography (SPECT) and coronary computed tomography angiography (CCTA) in patients suspected for coronary artery disease (CAD) leads to increased radiation exposure. We evaluated the need for additional imaging and following implications for radiation exposure of a sequential SPECT/computed tomography (CT) algorithm. METHODS AND RESULTS 5018 consecutive patients without history of CAD were referred for stress-first SPECT and coronary artery calcium (CAC) scoring. If stress SPECT was abnormal, additional rest SPECT and, if feasible, CCTA were acquired. Stress SPECT was normal in 2617 patients (52%). CCTA was not performed in 1289 of the 2401 patients referred for additional imaging (54%), mainly because of severe CAC (47%) or fast/irregular heart rate (22%). 642 patients with abnormal SPECT underwent CCTA, which excluded significant CAD in 378 patients (59%). Mean radiation dose was 4.5 ± 0.3 mSv for stress-only imaging and 13.2 ± 3.3 mSv for additional imaging (P < 0.001). CONCLUSIONS Half of the patients do not require additional imaging in our sequential SPECT/CT algorithm, which is accompanied with low radiation exposure. CCTA cannot be performed in half of the patients who undergo additional imaging because of (relative) contra-indications. CCTA is able to correct for false-positive SPECT findings in our algorithm.
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Affiliation(s)
- Elsemiek M Engbers
- Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
- Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
| | - Jorik R Timmer
- Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
| | - Jan Paul Ottervanger
- Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Mohamed Mouden
- Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
- Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Ad H J Oostdijk
- Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Siert Knollema
- Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Pieter L Jager
- Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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Qureshi WT, Alirhayim Z, Khalid F, Al-Mallah MH. Prognostic value of extracardiac incidental findings on attenuation correction cardiac computed tomography. J Nucl Cardiol 2016; 23:1266-1274. [PMID: 26202878 DOI: 10.1007/s12350-015-0223-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 03/12/2015] [Accepted: 06/23/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Attenuation corrected computed tomography (CTAC) is often performed to improve the specificity of single-photon emission tomography imaging. Extracardiac incidental findings are frequently observed. It is unclear whether these findings have any prognostic value. METHODS Consecutive patients (n = 1139) at a tertiary care center were retrospectively evaluated for incidental findings on CTAC. Clinically significant incidental findings were defined as findings warranting physician follow-up. Information regarding subsequent resource utilization was obtained by chart review. Cox proportional hazard model adjusted for demographic and clinical variables was used to evaluate association of these incidental findings with all-cause and cancer-specific mortality. RESULTS A total of 135 (12%) patients with incidental findings were identified, 83 of whom (68%) were newly diagnosed. Lung nodules were the most common finding, present in 92 (68%) patients. Over a median follow-up of 468 days, incidental findings were not significantly associated with increased risk of all-cause mortality (HR 1.34; 95% CI 0.77-2.33, P = 0.29) but was significantly associated with cancer-specific mortality (HR 3.21; 95% CI 1.26-8.14, P = 0.01). This association remained statistically significant when the analysis was limited to newly diagnosed incidental findings. Among patients with incidental findings, follow-up radiographic studies were conducted in 87%, and invasive procedures performed in 32%. Physician office-based follow-up of these findings occurred in 42% of patients and incidental finding-related hospitalization occurred in 14%. CONCLUSIONS This study shows that incidental findings are common and were associated with all-cause and cancer-specific mortality but only the later remained statistically significant after multivariable adjustment.
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Affiliation(s)
- Waqas T Qureshi
- Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA
| | - Zaid Alirhayim
- Henry Ford Hospital/Wayne State University, 2799 W. Grand Blvd., Detroit, MI, 48202, USA
- The University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Fatima Khalid
- Wake Forest University School of Medicine, Winston Salem, NC, 27157, USA
| | - Mouaz H Al-Mallah
- Henry Ford Hospital/Wayne State University, 2799 W. Grand Blvd., Detroit, MI, 48202, USA.
- Wayne State University, 540 E Canfield St., Detroit, MI, 48201, USA.
- King Abdul-Aziz Cardiac Center, King Abdul-Aziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, MC 1413, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
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