共查询到20条相似文献,搜索用时 31 毫秒
1.
Ines Valenta Valerie Treyer Lars Husmann Oliver Gaemperli Michael J. Schindler Bernhard A. Herzog Patrick Veit-Heibach Ronny R. Buechel René Nkoulou Aju P. Pazhenkottil Philipp A. Kaufmann 《European journal of nuclear medicine and molecular imaging》2010,37(4):750-757
Purpose
Shortening scan time and/or reducing radiation dose at maintained image quality are the main issues of the current research in radionuclide myocardial perfusion imaging (MPI). We aimed to validate a new iterative reconstruction (IR) algorithm for SPECT MPI allowing shortened acquisition time (HALF time) while maintaining image quality vs. standard full time acquisition (FULL time).Methods
In this study, 50 patients, referred for evaluation of known or suspected coronary artery disease by SPECT MPI using 99mTc-Tetrofosmin, underwent 1-day adenosine stress 300 MBq/rest 900 MBq protocol with standard (stress 15 min/rest 15 min FULL time) immediately followed by short emission scan (stress 9 min/rest 7 min HALF time) on a Ventri SPECT camera (GE Healthcare). FULL time scans were processed with IR, short scans were additionally processed with a recently developed software algorithm for HALF time emission scans. All reconstructions were subsequently analyzed using commercially available software (QPS/QGS, Cedars Medical Sinai) with/without X-ray based attenuation correction (AC). Uptake values (percent of maximum) were compared by regression and Bland-Altman (BA) analysis in a 20-segment model.Results
HALF scans yielded a 96% readout and 100% clinical diagnosis concordance compared to FULL. Correlation for uptake in each segment (n?=?1,000) was r?=?0.87at stress (p?<?0.001) and r?=?0.89 at rest (p?<?0.001) with respective BA limits of agreement of ?11% to 10% and ?12% to 11%. After AC similar correlation (r?=?0.82, rest; r?=?0.80, stress, both p?<?0.001) and BA limits were found (?12% to 10%; ?13% to 12%).Conclusion
With the new IR algorithm, SPECT MPI can be acquired at half of the scan time without compromising image quality, resulting in an excellent agreement with FULL time scans regarding to uptake and clinical conclusion. 相似文献2.
Simona Ben-Haim Krzysztof Kacperski Sharon Hain Dean Van Gramberg Brian F. Hutton Kjell Erlandsson Tali Sharir Nathaniel Roth Wendy A. Waddington Daniel S. Berman Peter J. Ell 《European journal of nuclear medicine and molecular imaging》2010,37(9):1710-1721
Purpose
We compared simultaneous dual-radionuclide (DR) stress and rest myocardial perfusion imaging (MPI) with a novel solid-state cardiac camera and a conventional SPECT camera with separate stress and rest acquisitions.Methods
Of 27 consecutive patients recruited, 24 (64.5±11.8 years of age, 16 men) were injected with 74 MBq of 201Tl (rest) and 250 MBq 99mTc-MIBI (stress). Conventional MPI acquisition times for stress and rest are 21 min and 16 min, respectively. Rest 201Tl for 6 min and simultaneous DR 15-min list mode gated scans were performed on a D-SPECT cardiac scanner. In 11 patients DR D-SPECT was performed first and in 13 patients conventional stress 99mTc-MIBI SPECT imaging was performed followed by DR D-SPECT. The DR D-SPECT data were processed using a spill-over and scatter correction method. DR D-SPECT images were compared with rest 201Tl D-SPECT and with conventional SPECT images by visual analysis employing the 17-segment model and a five-point scale (0 normal, 4 absent) to calculate the summed stress and rest scores. Image quality was assessed on a four-point scale (1 poor, 4 very good) and gut activity was assessed on a four-point scale (0 none, 3 high).Results
Conventional MPI studies were abnormal at stress in 17 patients and at rest in 9 patients. In the 17 abnormal stress studies DR D-SPECT MPI showed 113 abnormal segments and conventional MPI showed 93 abnormal segments. In the nine abnormal rest studies DR D-SPECT showed 45 abnormal segments and conventional MPI showed 48 abnormal segments. The summed stress and rest scores on conventional SPECT and DR D-SPECT were highly correlated (r=0.9790 and 0.9694, respectively). The summed scores of rest 201Tl D-SPECT and DR-DSPECT were also highly correlated (r=0.9968, p<0.0001 for all). In six patients stress perfusion defects were significantly larger on stress DR D-SPECT images, and five of these patients were imaged earlier by D-SPECT than by conventional SPECT.Conclusion
Fast and high-quality simultaneous DR MPI is feasible with D-SPECT in a single imaging session with comparable diagnostic performance and image quality to conventional SPECT and to a separate rest 201Tl D-SPECT acquisition. 相似文献3.
John A. Kennedy PhD Ora Israel MD Alex Frenkel PhD 《Journal of nuclear cardiology》2014,21(3):443-452
Background
A solid-state cadmium zinc telluride (CZT) SPECT device provides ultrafast myocardial perfusion imaging (MPI) with a spherical field-of-view (FOV). This study aims at determining the spatial resolution and sensitivity throughout this FOV as a guide for patient positioning.Methods and Results
For this CZT camera (Discovery 570c, GE Healthcare), the iteratively reconstructed spatial resolution along 3 Cartesian axes was compared (average resolution 6.9 ± 1.0 mm full-width at half-maximum) using a 2 dimensional array of point sources in air which was aligned with a transverse plane shifted throughout the FOV. Sensitivity was plotted in the central transverse slice and axially in locations comparable to the placement of the heart in 266 rest/stress cardiac studies (M 78, age 63 ± 13 years). The average sensitivity was 0.46 ± 0.19 kc/s/MBq with a transverse gradient of 0.039 ± 0.001 kc/s/MBq/cm (8.9% of the sensitivity per cm). Reconstructed relative activity was uniform (uniformity <9%) and count rate was linear (R = 0.999) over 3 orders of magnitude.Conclusions
The CZT SPECT camera offers good resolution, sensitivity, and uniformity, and provides linearity in count rate. A gradient of >8%/cm in sensitivity justifies the crucial role of patient positioning with the heart closest to the detector. 相似文献4.
Maria Maj Jensen MD Ulla Schmidt MD Chenxi Huang MS Bo Zerahn MD 《Journal of nuclear cardiology》2014,21(2):384-396
Purpose
Estimation of left ventricular ejection fraction (LVEF) with equilibrium 99MTc-HSA equilibrium radionuclide angiography (MUGA) is frequently used for assessing cardiac function. The purpose of this study was to compare intra- and interobserver variation between three different gamma cameras.Materials and Methods
Eighty-two patients, scanned in the same sequential order on the three cameras. Each acquisition was analyzed twice by two technologists. Inter- and intraobserver variations were calculated as the coefficient of variation and the 95% confidence interval for limits of agreement between each sequence of analyses for each of the three cameras.Results
The lowest intraobserver variations in LVEF for the two NaI-detector cameras were 3.1% (?4.0% to 3.5%) for the planar and 3.4% (?4.2% to 4.5%) for SPECT (P ≤ 0.001-0.019), the highest result for the CZT SPECT camera was 2.6% (?2.9% to 3.1%). Similarly, interobserver variation was 4.8% (?4.8% to 6.4%) and 4.9% (?5.4% to 7.5%), respectively, for each of the NaI-detector cameras and 3.3% (?3.4% to 4.3%) for the CZT SPECT camera (P ≤ 0.001-0.008).Discussion
The CZT detector camera was superior to both NaI detector cameras regarding intra- and interobserver variation. The CZT SPECT camera may identify changes in LVEF with greater certainty than its NaI detector-equipped counterparts. 相似文献5.
Antoine Verger Laetitia Imbert Yalcine Yagdigul Renaud Fay Wassila Djaballah François Rouzet Nicolas Fourquet Sylvain Poussier Véronique Roch Dominique Le Guludec Gilles Karcher Pierre-Yves Marie 《European journal of nuclear medicine and molecular imaging》2014,41(3):522-528
Purpose
Injected doses are difficult to optimize for exercise SPECT since they depend on the myocardial fraction of injected activity (MFI) that is detected by the camera. The aim of this study was to analyse the factors affecting MFI determined using a cardiac CZT camera as compared with those determined using conventional Anger cameras.Methods
Factors affecting MFI were determined and compared in patients who had consecutive exercise SPECT acquisitions with 201Tl (84 patients) or 99mTc-sestamibi (87 patients) with an Anger or a CZT camera. A predictive model was validated in a group of patients routinely referred for 201Tl (78 patients) or 99mTc-sestamibi (80 patients) exercise CZT SPECT.Results
The predictive model involved: (1) camera type, adjusted mean MFI being ninefold higher for CZT than for Anger SPECT, (2) tracer type, adjusted mean MFI being twofold higher for 201Tl than for 99mTc-sestamibi, and (3) logarithm of body weight. The CZT SPECT model led to a +1?±?26 % error in the prediction of the actual MFI from the validation group. The mean MFI values estimated for CZT SPECT were more than twofold higher in patients with a body weight of 60 kg than in patients with a body weight of 120 kg (15.9 and 6.8 ppm for 99mTc-sestamibi and 30.5 and 13.1ppm for 201Tl, respectively), and for a 14-min acquisition of up to one million myocardial counts, the corresponding injected activities were only 80 and 186 MBq for 99mTc-sestamibi and 39 and 91 MBq for 201Tl, respectively.Conclusion
Myocardial activities acquired during exercise CZT SPECT are strongly influenced by body weight and tracer type, and are dramatically higher than those obtained using an Anger camera, allowing very low-dose protocols to be planned, especially for 99mTc-sestamibi and in non-obese subjects. 相似文献6.
W. Lane Duvall MD Usman Baber MD Elliot J. Levine MD Lori B. Croft MD Milena J. Henzlova 《Journal of nuclear cardiology》2012,19(6):1124-1134
Background
Stress-only Tc-99m MPI saves time, radiation exposure, and a normal study has a benign prognosis. However, a stress-first protocol is relatively labor intensive requiring pre-test screening for suitability and early post-stress image review to determine the need for rest imaging. The purpose of this study was to develop a simple clinical score used prior to a patient??s myocardial perfusion imaging (MPI) study to determine if they should undergo a stress-first protocol.Methods
We reviewed all patients who underwent Tc-99m SPECT MPI over a 27-month period and divided them into derivation and validation cohorts. Patients were categorized as having a successful stress-first protocol based on a summed stress score ??1, with or without attenuation correction. We generated a multivariable model from the derivation cohort to identify demographic and clinical correlates of successful stress-first imaging. Two validation cohorts using a CZT and a conventional SPECT camera were then used to test the performance of the model.Results
The derivation cohort included 1,996 patients and the validation cohort consisted of 1,005 CZT SPECT patients and 2,430 conventional SPECT patients. The following variables were associated with unsuccessful (i.e., abnormal) stress-first imaging: age >65?years (1 point), diabetes (2 points), typical chest pain (2 points), congestive heart failure (3 points), abnormal ECG (4 points), male gender (4 points), and documented CAD (5 points). Emergency Department location (?2 points) was negatively associated with an unsuccessful protocol. An increasing score showed a strong association with an unsuccessful stress-first protocol in both the derivation and the validation cohorts (P?<?.0001) and dividing the cohorts into low (<5), intermediate (??5 and <10), and high (??10) risk scores accurately stratified patients based on their frequencies of unsuccessful stress-first imaging. ROC curve analysis showed excellent prediction in both the derivation and the validation cohorts with an area under the curve of 0.82 and 0.75-0.83, respectively.Conclusions
This pre-test scoring tool accurately identifies patients who can successfully undergo a stress-first imaging protocol without the need for rest imaging and may allow for wider adoption of stress-first imaging protocols. 相似文献7.
Tochi M. Okwuosa DO Chetan V. Hampole MD Javid Ali CNMT NCT Kim A. Williams MD FASNC FACC FAHA 《Journal of nuclear cardiology》2009,16(5):775-783
Background
Increased left ventricular mass (LVM) has been correlated with adverse cardiac events, such as sudden cardiac death. However, LVM quantitation with widely utilized gated SPECT myocardial perfusion imaging (MPI) software, has little validation and clinical application. Thus, we compared LVM from two commonly employed gated SPECT packages [4D-MSPECT® (4DM) and Quantitative Perfusion SPECT® (QPS)] with the 3-dimensional reference standard, CT angiography (CTA).Methods
Comparisons were made in 56 patients (mean age 61.4 ± 14.6; 32% female) referred for dual-isotope or low-dose/high-dose Tc-99m-tetrofosmin rest/stress MPI and cardiac CTA (mean 1.5 ±4.5 months apart). LVM measurement was performed for both CTA and MPI by two independent observers blinded to clinical information.Results
Correlation with CTA was best for post-stress MPI than at rest; thus, post-stress values are reported. Values obtained with each of the techniques were very highly reproducible (interobserver correlation r = 0.99 for each technique). The mean LVM values were 142 g by CTA, 145 g by 4DM, and 135 g by QPS (P = NS for CTA vs SPECT, but P < .001 for 4DM vs QPS). There was moderately good correlation between CTA and SPECT LVM data (r = 0.74 and 0.72 for 4DM and QPS, respectively; both P < .001). However, on Bland-Altman analysis there was significant overestimation of lower values and underestimation of higher CT LVM values by both QPS and 4DM (both r = 0.68 and 0.69, P < .001). The limits of agreement relative to CT LVM were wide (?52.1 g to 64.1 g for QPS; and ?60.0 g to 53.5 g for 4DM).Conclusions
SPECT and CTA give reproducible measures of LVM. Using CTA as the reference standard, the mean SPECT LVM values are similar, but lower values are overestimated and higher values are underestimated. Thus, the SPECT values are not substitutable for CTA without mathematical correction. 相似文献8.
Mohamed Mouden Jan Paul Ottervanger Siert Knollema Jorik R. Timmer Stoffer Reiffers Ad H. J. Oostdijk Menko-Jan de Boer Pieter L. Jager 《European journal of nuclear medicine and molecular imaging》2014,41(5):956-962
Purpose
Recently introduced ultrafast cardiac SPECT cameras with cadmium zinc telluride-based (CZT) detectors may provide superior image quality allowing faster acquisition with reduced radiation doses. Although the level of concordance between conventional SPECT and invasive fractional flow reserve (FFR) measurement has been studied, that between FFR and CZT-based SPECT is not yet known. Therefore, we aimed to assess the level of concordance between CZT SPECT and FFR in a large patient group with stable coronary artery disease.Methods
Both invasive FFR and myocardial perfusion imaging with a CZT-based SPECT camera, using Tc-tetrofosmin as tracer, were performed in 100 patients with stable angina and intermediate grade stenosis on invasive coronary angiography. A cut-off value of <0.75 was used to define abnormal FFR.Results
The mean age of the patients was 64?±?11 years, and 64 % were men. SPECT demonstrated ischaemia in 31 % of the patients, and 20 % had FFR <0.75. The concordance between CZT SPECT and FFR was 73 % on a per-patient basis and 79 % on a per-vessel basis. Discordant findings were more often seen in older patients and were mainly (19 %) the result of ischaemic SPECT findings in patients with FFR ≥0.75, whereas only 8 % had an abnormal FFR without ischaemia as demonstrated by CZT SPECT.Conclusion
Only 20 – 30 % of patients with intermediate coronary stenoses had significant ischaemia as assessed by CZT SPECT or invasive FFR. CZT SPECT showed a modest degree of concordance with FFR, which is comparable with previous results with conventional SPECT. Further investigations are particularly necessary in patients with normal SPECT and abnormal FFR, especially to determine whether these patients should undergo revascularization. 相似文献9.
Chien-Cheng Chen Thau-Yun Shen Ming-Che Chang Guang-Uei Hung Wan-Chen Chen Chia-Hung Kao Ji Chen 《European journal of nuclear medicine and molecular imaging》2012,39(12):1904-1909
Purpose
In 201Tl SPECT myocardial perfusion imaging (MPI) data are acquired shortly after the stress injection to assess early post-stress left ventricle (LV) function. The purpose of this study was to use 201Tl SPECT MPI to investigate whether stress-induced myocardial ischemia is associated with LV mechanical dyssynchrony.Methods
Enrolled in the study were 75 patients who were referred for dipyridamole stress and rest 201Tl gated SPECT MPI. The early post-stress scan was started 5?min after injection, and followed by the rest scan 4?h later. The patients were divided into three groups: ischemia group (N?=?25, summed stress score, SSS, ≥5, summed rest score, SRS, <5), infarct group (N?=?16, SSS ≥5, SRS ≥5) and normal group (N?=?34, SSS <5, SRS <5). LV dyssynchrony parameters were calculated by phase analysis, and compared between the stress and rest images.Results
In the ischemia group, LV dyssynchrony was significantly larger during stress than during rest. On the contrary, LV dyssynchrony during stress was significantly smaller than during rest in the normal and infarct groups. LV dyssynchrony during rest was significantly larger in the infarct group than in the normal and ischemia groups. There were no significant differences in LV dyssynchrony during rest between the normal and ischemia groups.Conclusion
Stress-induced myocardial ischemia caused dyssynchronous contraction in the ischemic region, leading to a deterioration in LV synchrony. Normal myocardium had more synchronous contraction during stress. The different dyssynchrony pattern between ischemic and normal myocardium early post-stress may aid the diagnosis of coronary artery disease using 201Tl gated SPECT MPI. 相似文献10.
Flotats A Bravo PE Fukushima K Chaudhry MA Merrill J Bengel FM 《European journal of nuclear medicine and molecular imaging》2012,39(8):1233-1239
Purpose
We compared the quality, interpretive confidence and interreader agreement between SPECT and PET myocardial perfusion imaging (MPI) in the same group of patients.Methods
The study group comprised 27 patients (age 55?±?8.5?years, 12 men) with known or suspected coronary artery disease (CAD) who had undergone gated rest/stress MPI with 99mTc-labelled agent SPECT (with and without attenuation correction, AC), and subsequent clinical confirmation with 82Rb PET. Three experienced readers blinded to the clinical information interpreted all MPI studies.Results
Interreader agreement was significantly superior for PET studies than for SPECT studies. Following consensus interpretation, the quality of 22?% of the non-AC SPECT studies, 33?% of the AC SPECT studies and 63?% of the PET studies was assessed as excellent or good (p?=?0.016). Interpretations were definitely normal or abnormal in 7?% of non-AC SPECT studies, 30?% of AC SPECT studies and 85?% of PET studies (p?=?0.046). In 13 patients who had received either invasive coronary angiography or CT angiography with no significant CAD, the true-positive rate for significant CAD was higher for PET, and the true-negative rate was equal for PET and AC SPECT, and lower for non-AC SPECT.Conclusion
82Rb PET MPI, used as a confirmatory test after SPECT, offers improved image quality, interpretive confidence and interreader agreement. 相似文献11.
Antoine?Verger Wassila?Djaballah Nicolas?Fourquet Fran?ois?Rouzet Grégoire?Koehl Laetitia?Imbert Sylvain?Poussier Renaud?Fay Véronique?Roch Dominique?Le?Guludec Gilles?Karcher Pierre-Yves?Marie
Purpose
The results of stress myocardial perfusion SPECT could be enhanced by new cadmium-zinc-telluride (CZT) cameras, although differences compared to the results with conventional Anger cameras remain poorly known for most study protocols. This study was aimed at comparing the results of CZT and Anger SPECT according to various study protocols while taking into account the influence of obesity.Methods
The study population, which was from three different institutions equipped with identical CZT cameras, comprised 276 patients referred for study using protocols involving 201Tl (n?=?120) or 99mTc-sestamibi injected at low dose at stress (99mTc-Low; stress/rest 1-day protocol; n?=?110) or at high dose at stress (99mTc-High; rest/stress 1-day or 2-day protocol; n?=?46). Each Anger SPECT scan was followed by a high-speed CZT SPECT scan (2 to 4 min).Results
Agreement rates between CZT and Anger SPECT were good irrespective of the study protocol (for abnormal SPECT, 201Tl 92 %, 99mTc-Low 86 %, 99mTc-High 98 %), although quality scores were much higher for CZT SPECT with all study protocols. Overall correlations were high for the extent of myocardial infarction (r?=?0.80) and a little lower for ischaemic areas (r?=?0.72), the latter being larger on Anger SPECT (p?<?0.001). This larger extent was mainly observed in 50 obese patients who were in the 201Tl or 99mTc-Low group and in whom stress myocardial counts were particularly low with Anger SPECT (228?±?101 kcounts) and dramatically enhanced with CZT SPECT (+279?±?251 %).Conclusion
Concordance between the results of CZT and Anger SPECT is good regardless of study protocol and especially when excluding obese patients who have low-count Anger SPECT and for whom myocardial counts are dramatically enhanced on CZT SPECT.12.
J. D. van Dijk MSc P. L. Jager MD PhD M. Mouden MD C. H. Slump PhD J. P. Ottervanger MD PhD J. de Boer MD PhD A. H. J. Oostdijk MD J. A. van Dalen PhD 《Journal of nuclear cardiology》2014,21(6):1158-1167
Background
Guidelines for SPECT myocardial perfusion imaging (MPI) traditionally recommend a fixed tracer dose. Yet, clinical practice shows degraded image quality in heavier patients. The aim was to optimize and validate the tracer dose and scan time to obtain a constant image quality less dependent on patients’ physical characteristics.Methods
125 patients underwent Cadmium Zinc Telluride (CZT)-SPECT stress MPI using a fixed Tc-99m-tetrofosmin tracer dose. Image quality was scored by three physicians on a 4-point grading scale and related to the number of photon counts normalized to tracer dose and scan time. Counts were correlated with various patient-specific parameters dealing with patient size and weight to find the best predicting parameter. From these data, a formula to provide constant image quality was derived, and subsequently tested in 92 new patients.Results
Degradation in image quality and photon counts was observed for heavier patients for all patients’ specific parameters (P < .01). We found body weight to be the best-predicting parameter for image quality and derived a new dose formula. After applying this new body weight-depended tracer dose and scan time in a new group, image quality was found to be constant (P > .19) in all patients.Conclusions
Also in CZT SPECT image quality decreases with weight. The use of a tracer dose and scan time that depends linearly on patient’s body weight corrected for the varying image quality in CZT-SPECT MPI. This leads to better radiation exposure justification. 相似文献13.
W. Lane Duvall MD Piotr J. Slomka PhD Jim R. Gerlach CNMT Joseph M. Sweeny MD Usman Baber MD Lori B. Croft MD Krista A. Guma CNMT Titus George CNMT Milena J. Henzlova MD 《Journal of nuclear cardiology》2013,20(5):763-773
Background
Recently introduced high-efficiency (HE) SPECT cameras with solid-state CZT detectors have been shown to decrease imaging time and reduce radiation exposure to patients. An automated, computer-derived quantification of HE MPI has been shown to correlate well with coronary angiography on one HE SPECT camera system (D-SPECT), but has not been compared to visual interpretation on any of the HE SPECT platforms.Methods
Patients undergoing a clinically indicated Tc-99m sestamibi HE SPECT (GE Discovery 530c with supine and prone imaging) study over a 1-year period followed by a coronary angiogram within 2 months were included. Only patients with a history of CABG surgery were excluded. Both MPI studies and coronary angiograms were reinterpreted by blinded readers. One hundred and twenty two very low (risk of CAD < 5%) or low (risk of CAD < 10%) likelihood subjects with normal myocardial perfusion were used to create normal reference limits. Computer-derived quantification of the total perfusion deficit at stress and rest was obtained with QPS software. The visual and automated MPI quantification were compared to coronary angiography (≥70% luminal stenosis) by receiver operating curve (ROC) analysis.Results
Of the 3,111 patients who underwent HE SPECT over a 1-year period, 160 patients qualified for the correlation study (66% male, 52% with a history of CAD). The ROC area under the curve (AUC) was similar for both the automated and the visual interpretations using both supine only and combined supine and prone images (0.69-0.74). Using thresholds determined from sensitivity and specificity curves, the automated reads showed higher specificity (59%-67% vs 27%-60%) and lower sensitivity (71%-72% vs 79%-93%) than the visual reads. By including prone images sensitivity decreased slightly but specificity increased for both. By excluding patients with known CAD and cardiomyopathies, AUC and specificity increased for both techniques (0.72-0.82). The use of a difference score to evaluate ischemic burden resulted in lower sensitivities but higher specificities for both automated and visual quantification. There was good agreement between the visual interpretation and automated quantification in the entire cohort of 160 unselected consecutive patients (r = 0.70-0.81, P < .0001).Conclusions
Automated and visual quantification of high-efficiency SPECT MPI with the GE Discovery camera provides similar overall diagnostic accuracy when compared to coronary angiography. There was good correlation between the two methods of assessment. Combined supine and prone stress imaging provided the best diagnostic accuracy. 相似文献14.
Fiechter M Ghadri JR Wolfrum M Kuest SM Pazhenkottil AP Nkoulou RN Herzog BA Gebhard C Fuchs TA Gaemperli O Kaufmann PA 《European journal of nuclear medicine and molecular imaging》2012,39(3):430-436
Purpose
Low yield of invasive coronary angiography and unnecessary coronary interventions have been identified as key cost drivers in cardiology for evaluation of coronary artery disease (CAD). This has fuelled the search for noninvasive techniques providing comprehensive functional and anatomical information on coronary lesions. We have evaluated the impact of implementation of a novel hybrid cadmium-zinc-telluride (CZT)/64-slice CT camera into the daily clinical routine on downstream resource utilization.Methods
Sixty-two patients with known or suspected CAD were referred for same-day single-session hybrid evaluation with CZT myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA). Hybrid MPI/CCTA images from the integrated CZT/CT camera served for decision-making towards conservative versus invasive management. Based on the hybrid images patients were classified into those with and those without matched findings. Matched findings were defined as the combination of MPI defect with a stenosis by CCTA in the coronary artery subtending the respective territory. All patients with normal MPI and CCTA as well as those with isolated MPI or CCTA finding or combined but unmatched findings were categorized as ??no match??.Results
All 23 patients with a matched finding underwent invasive coronary angiography and 21 (91%) were revascularized. Of the 39 patients with no match, 5 (13%, p?0.001 vs matched) underwent catheterization and 3 (8%, p?0.001 vs matched) were revascularized.Conclusion
Cardiac hybrid imaging in CAD evaluation has a profound impact on patient management and may contribute to optimal downstream resource utilization. 相似文献15.
16.
Fabio P. Esteves MD James R. Galt Russell D. Folks Liudmila Verdes Ernest V. Garcia 《Journal of nuclear cardiology》2014,21(1):158-165
Background
We set out to develop normal databases and prospectively validate abnormality criteria for a low-dose Tc-99m tetrofosmin myocardial perfusion SPECT protocol using the 530c CZT camera.Methods
All patients received 6 mCi rest/20 mCi stress doses of Tc-99m tetrofosmin. Rest and stress images were obtained over 7-9 and 5-7 minutes according to the chest size. Low-dose CT of the chest was obtained on a standalone CT scanner. Forty patients with very low likelihood (LLK) of coronary artery disease (CAD) were used to define the normal count distributions. The abnormality criteria were prospectively validated in 55 patients who had coronary angiography and in 40 patients with LLK of CAD.Results
The results for quantitative non-attenuation-corrected (AC) and AC analysis and visual analysis were as follows: sensitivity of 79%, 85%, and 92% (P = NS) and specificity of 44%, 75%, and 56% (P = NS), respectively. The normalcy rates for quantitative non-AC and AC analyses and visual analysis were 95%, 98%, and 98% (P = NS).Conclusions
We have developed non-AC and AC normal databases for low-dose rest/stress Tc-99m tetrofosmin myocardial perfusion SPECT protocol using the 530c CZT camera. The per-patient diagnostic performance of quantitative analyses is not significantly different from visual analysis by an experienced reader. 相似文献17.
Mouden M Timmer JR Ottervanger JP Reiffers S Oostdijk AH Knollema S Jager PL 《European journal of nuclear medicine and molecular imaging》2012,39(6):1048-1055
Purpose
The new ultrafast cardiac single photon emission computed tomography (SPECT) cameras with cadmium-zinc-telluride (CZT)-based detectors are faster and produce higher quality images as compared to conventional SPECT cameras. We assessed the need for additional imaging, total imaging time, tracer dose and 1-year outcome between patients scanned with the CZT camera and a conventional SPECT camera. 相似文献18.
Christian Wenning Kambiz Rahbar Alexis Vrachimis Otmar Schober Michael Schäfers Lars Stegger 《European journal of nuclear medicine and molecular imaging》2013,40(7):1069-1076
Purpose
Coronary artery calcium scoring can complement myocardial perfusion imaging (MPI). The purpose of this study was to evaluate the feasibility and accuracy of using the CalciumScore-CT derived from a combined SPECT/CT device also for SPECT attenuation correction (AC).Methods
The study group comprised 99 patients who underwent both post-stress and rest MPI using a two-slice SPECT/CT system. For AC, one of the two scans was accompanied by a CalciumScore-CT scan (CalciumScore-CTAC) and the other by a conventional spiral CT (AttenCorr-CT) scan (AttenCorr-CTAC). In 48 patients the CalciumScore-CT scan was acquired with the post-stress scan and the AttenCorr-CT scan with the rest scan, and in 51 patients the order was reversed. The accuracy of the images based on AC was determined qualitatively by consensus reading with respect to the clinical diagnoses as well as quantitatively by comparing the perfusion summed stress scores (SSS) and the summed rest scores (SRS) between attenuation-corrected and uncorrected images.Results
In comparison to the uncorrected images CalciumScore-CTAC led to regional inaccuracies in 14 of 51 of studies (27.5 %) versus 12 of 48 studies (25 %) with AttenCorr-CTAC for the stress studies and in 5 of 48 (10 %) versus 1 of 51 (2 %) for the rest studies, respectively. This led to intermediate and definite changes in the final diagnosis (ischaemia and/or scarring) in 12 % of the studies (12 of 99) and in 7 % of the studies (7 of 99) with CalciumScore-CTAC and in 9 % of the studies (9 of 99) and 4 % of the studies (4 of 99) with AttenCorr-CTAC. Differences in SSS and SRS with respect to the uncorrected images were greater for the CalciumScore-CTAC images than for the AttenCorr-CTAC images (ΔSSS 4.5?±?5.6 and 2.1?±?4.4, p?=?0.023; ΔSRS 4.2?±?4.9 and 1.6?±?3.2, p?=?0.004, respectively).Conclusion
Using the same CT scan for calcium scoring and SPECT AC is feasible. Image interpretation must, however, include uncorrected images since CT-based AC relatively often introduces artefacts into the myocardial perfusion images. This effect is somewhat more pronounced with CalciumScore-CTAC than with AttenCorr-CTAC. 相似文献19.
Assuero Giorgetti Pier Giorgio Masci Gavino Marras Yasmine K. Rustamova Alessia Gimelli Dario Genovesi Massimo Lombardi Paolo Marzullo 《European journal of nuclear medicine and molecular imaging》2013,40(12):1869-1875
Purpose
CZT technology allows ultrafast low-dose myocardial scintigraphy but its accuracy in assessing left ventricular function is still to be defined.Methods
The study group comprised 55 patients (23 women, mean age 63?±?9 years) referred for myocardial perfusion scintigraphy. The patients were studied at rest using a CZT camera (Discovery NM530c; GE Healthcare) and a low-dose 99mTc-tetrofosmin clinical protocol (mean dose 264?±?38 MBq). Gated SPECT imaging was performed as a 6-min list-mode acquisition, 15 min after radiotracer injection. Images were reformatted (8-frame to 16-frame) using Lister software on a Xeleris workstation (GE Healthcare) and then reconstructed with a dedicated iterative algorithm. Analysis was performed using Quantitative Gated SPECT (QGS) software. Within 2 weeks patients underwent cardiac magnetic resonance imaging (cMRI, 1.5-T unit CVi; GE Healthcare) using a 30-frame acquisition protocol and dedicated software for analysis (MASS 6.1; Medis).Results
The ventricular volumes obtained with 8-frame QGS showed excellent correlations with the cMRI volumes (end-diastolic volume (EDV), r?=?0.90; end-systolic volume (ESV), r?=?0.94; p?<?0.001). However, QGS significantly underestimated the ventricular volumes (mean differences: EDV, ?39.5?±?29 mL; ESV, ?15.4?±?22 mL; p?<?0.001). Similarly, the ventricular volumes obtained with 16-frame QGS showed an excellent correlations with the cMRI volumes (EDV, r?=?0.92; ESV, r?=?0.95; p?<?0.001) but with significant underestimations (mean differences: EDV, ?33.2?±?26 mL; ESV, ?17.9?±?20 mL; p?<?0.001). Despite significantly lower values (47.9?±?16 % vs. 51.2?±?15 %, p?<?0.008), 8-frame QGS mean ejection fraction (EF) was closely correlated with the cMRI values (r?=?0.84, p?<?0.001). The mean EF with 16-frame QGS showed the best correlation with the cMRI values (r?=?0.91, p?<?0.001) and was similar to the mean cMRI value (49.6?±?16 %, p not significant). Regional analysis showed a good correlation between both 8-frame and 16-frame QGS and cMRI wall motion score indexes (8-frame WMSI, r?=?0.85; 16-frame WMSI, r?=?0.89; p?<?0.01).Conclusion
Low-dose gated SPECT with a CZT camera provides ventricular volumes that correlate well with cMRI results despite significant underestimation in the measure values. EF estimation appeared to be more accurate with 16-frame reformatted images than with 8-frame images. 相似文献20.
Shimpei Ito Akihiro Endo Taiji Okada Taku Nakamura Takashi Sugamori Nobuyuki Takahashi Hiroyuki Yoshitomi Kazuaki Tanabe 《Annals of nuclear medicine》2017,31(8):629-635