3D iteratively reconstructed spatial resolution map and sensitivity characterization of a dedicated cardiac SPECT camera

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.     

Validation of attenuation correction using transmission truncation compensation with a small field of view dedicated cardiac SPECT camera system

Background  Although attenuation correction (AC) has been successfully applied to large field of view (LFOV) cameras, applicability to small field of view (SFOV) cameras is a concern due to truncation. This study compared perfusion images between a LFOV and SFOV camera with truncation compensation, using the same AC solution. Methods and Results  Seventy-eight clinically referred patients underwent rest-stress single-photon emission computed tomography (SPECT) using both a SFOV and LFOV camera in a randomized sequence. Blinded images were interpreted by a consensus of three experienced readers. The percentage of normal images for SFOV and LFOV was significantly higher with than without AC (72% vs 44% and 72% vs 49%, both P < .001). Interpretive agreement between cameras was better with than without AC (kappa = 0.736 to 0.847 vs 0.545 to 0.774). Correlation for the summed stress score was higher with than without AC (r ² = 0.892 vs 0.851, both P < 0.001) while Bland Altman analysis demonstrated narrower limits with than without AC (4.0 to −4.3 vs 5.9 to −5.6). Conclusion  Attenuation correction using truncation compensation with a SFOV camera yields similar results to a LFOV camera. The higher interpretive agreement between cameras after attenuation correction suggests that such images are preferable to non-attenuation-corrected images. This study was supported by an unrestricted educational medical grant from Philips Medical Systems, Milpitas, California. Dr. Heller receives grant support and is on the speaking board of Philips Medical Systems. Drs. Bateman, Case, and Cullom receive software royalties from Philips Medical Systems for the attenuation correction and truncation compensation software.     

Simultaneous dual-radionuclide myocardial perfusion imaging with a solid-state dedicated cardiac camera

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.     

High count rate first-pass radionuclide angiography using a digital gamma camera

In this study, first-pass radionuclide angiography (FPRNA) was performed using a digital single-crystal gamma camera. Twenty-nine men and six women (ages 43-80, mean 61 yr) underwent FPRNA in the supine position immediately prior to cardiac catheterization. Total counts/sec in the whole field-of-view in the right ventricular phase were 150,352 +/- 26,006. Background uncorrected counts in the representative cycle were 7,651 +/- 2,527 at end-diastolie and 4,904 +/- 2,314 at end-systolie. A linear correlation between FPRNA left ventricular (LV) ejection fraction and contrast LV ejection fraction gave an r = 0.95 with an s.e.e. of 0.05. Analyses of intra- and interobserver variability gave r = 0.99 and 0.98 and an s.e.e. of 0.02 and 0.03, respectively. Spearman-Rank correlation coefficients between FPRNA and contrast angiographic wall-motion scores were greater than 0.8 for all walls, while sensitivity/specificity were 0.86/0.90, 0.76/1.00, 0.76/1.00 for anterior, apical, and inferior wall-motion abnormalities, respectively. We conclude that satisfactory counting statistics for FPRNA can be obtained with a digital gamma camera, and that accurate and reproducible measurements of global and regional left ventricular function can be obtained with this technique.     

First-pass radionuclide angiography using a multiwire gamma camera and tantalum-178

A portable multiwire gamma camera (MWGC) with enhanced imaging characteristics relative to conventional sodium iodide camera has been evaluated with 178Ta, a short-lived, generator-produced radioisotope (half-life 9.3 min). First-pass radionuclide angiography (FPRA) was performed and results were compared to those obtained with FPRA using a multicrystal camera (MCC) and 99mTc in 38 patients. The overall left ventricular count sensitivity (counts/mCi/sec/millisteradians [msr]) was significantly higher with MWGC/178Ta (176 +/- 132 versus 108 +/- 49, p less than 0.001) yielding images of higher statistics with higher resolution collimation (31 versus 63 msr). Left ventricular ejection fraction was 0.54 +/- 0.18 by MWGC and 0.54 +/- 0.18 by MCC with an excellent correlation between the two techniques (r = 0.94, s.e.e. = 0.06). The detection of wall motion abnormality was virtually identical with the two techniques. Intra- and interobserver reproducibility by MWGC was excellent (r = 0.99 and 0.99, respectively). Thus, this new technology provides first-pass studies of higher statistical quality and improved resolution, affording more precise assessment of left ventricular performance and likelihood of further substantial improvement by use of even higher doses of 178Ta.     

碲锌镉心脏专用SPECT的临床应用进展

心肌灌注显像在已知或可疑冠状动脉疾病患者的诊疗过程中发挥着重要作用,应用碲锌镉探测器的心脏专用SPECT的分辨率和灵敏度均得到提高,达到了降低显像剂剂量、缩短采集时间、改善图像质量和扩展临床应用范围等目的。笔者对碲锌镉心脏专用SPECT的临床应用进展进行综述。     

Right ventricular pressure-volume loops using simultaneous radionuclide angiography with a multiwire gamma camera and right heart catheterization

BACKGROUND: The purpose of this study was to generate right ventricular (RV) pressure-volume loops (PVLs) from time-activity curves obtained by first-pass radionuclide angiography (RNA) and RV pressures obtained by right heart catheterization. METHODS AND RESULTS: Short-lived tantalum 178 was used to obtain first-pass RNA at baseline (n = 31), after nitroglycerin (n = 5), or after the conclusion of cardiac catheterization (n = 13). From the radionuclide-derived RV ejection fraction and thermodilution stroke volume, the RV end-diastolic volume and end-systolic volume were measured. Special proprietary software was developed and used to integrate the pressure and the RNA data. The mean heart rate was 80 +/- 17 beats/min; RV ejection fraction, 39% +/- 12%; RV end-diastolic volume, 217 +/- 79 mL; RV end-systolic volume, 142 +/- 74 mL; and RV end-diastolic pressure, 10 +/- 7 mm Hg. The RV PVLs were of high quality and reproducible. CONCLUSIONS: This study provides proof of concept of the feasibility of generating RV PVL; the short half-life (10 minutes) and low energy (59 keV) of Ta-178 allow the generation of multiple loops at low radiation exposure. Such studies could be performed at the bedside and provide a wealth of information that may have clinical and research merits.     

Factors affecting the myocardial activity acquired during exercise SPECT with a high-sensitivity cardiac CZT camera as compared with conventional Anger camera

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.     

心脏专用碲化镉锌相机的相关临床应用新进展

在评估缺血性心脏病的无创性方法中,SPECT心肌灌注显像（MPI）是大家公认的显像方法,但MPI受到一些因素的影响,如组织不均一性导致的衰减、扫描时间长、辐射等。近年来出现的心脏专用碲化镉锌（CZT）相机越来越受到人们的广泛关注,该设备有先进的CZT探测器、采集方法及重建算法。心脏专用CZT相机的计数率、空间分辨率和能量分辨率较传统SPECT显著提高。该文就心脏专用CZT相机的相关临床应用进展进行综述。     

Small field-of-view dedicated cardiac SPECT systems: impact of projection truncation

Purpose  

Small field-of-view (FOV) dedicated cardiac SPECT systems suffer from truncated projection data. This results in (1) neglect of liver activity that otherwise could be used to estimate (and subsequently correct) the amount of scatter in the myocardium by model-based scatter correction, and (2) distorted attenuation maps. In this study, we investigated to what extent truncation impacts attenuation correction and model-based scatter correction in the cases of ^99mTc, ²⁰¹Tl, and simultaneous ^99mTc/²⁰¹Tl studies. In addition, we evaluated a simple correction method to mitigate the effects of truncation.     

Comparison of interstudy reproducibility of equilibrium electrocardiography-gated SPECT radionuclide angiography versus planar radionuclide angiography for the quantification of global left ventricular function

BACKGROUND: Electrocardiography-gated single photon emission computed tomography (SPECT) radionuclide angiography (RNA) provides accurate measurement of both left ventricular (LV) ejection fraction (EF) and end-diastolic and end-systolic volumes. In this study we studied the interstudy precision and reliability of SPECT RNA as compared with planar RNA for the measurement of global systolic LV function. METHODS AND RESULTS: The population included 10 patients with chronic coronary artery disease having 2 sets of acquisitions, each consisting of planar and SPECT RNA. SPECT RNA was processed with SPECT-QBS and SPECT-35%. (For SPECT-35%, a manual segmentation method based on the 35% threshold of the maximum LV cavity activity is used to provide estimates of the number of voxels and the activity included in the LV cavity. The calculated LV number of voxels is then used to calculate LV volume measurement. The LV EF is calculated as the ratio of LV end-diastolic and end-systolic activity.) For LV EF, end-diastolic volume, and end-systolic volume, the interstudy precision, as reflected by the correlation coefficient, coefficient of variability, coefficient of repeatability, and within-subject coefficient of variation, and the interstudy reliability, as reflected by the intraclass correlation coefficient, were best with SPECT-35%, followed by planar RNA and then SPECT-QBS, respectively. The sample size needed to objectify a change in a parameter of LV function is lowest with SPECT-35%, followed by planar RNA and then SPECT-QBS, respectively. CONCLUSIONS: The SPECT-35% processing method provides excellent interstudy precision and reliability for LV function measurement. In this aspect it seems to be better than planar RNA and SPECT-QBS. These results need to be confirmed in a larger patient population.     

Development and validation of a novel technique for murine first-pass radionuclide angiography with a fast multiwire camera and tantalum 178

BACKGROUND: The use of genetically altered mice as a model system to study cardiovascular disease has created a need for accurate and quantitative assessment of murine ventricular function. To address this very challenging problem, we have developed a technique of murine first-pass radionuclide angiography using pinhole imaging and the short-lived isotope tantalum 178 (Ta-178) with a high-speed multiwire proportional camera (MPC). METHODS AND RESULTS. An MPC was fitted with a pinhole lens of 2-mm-diameter aperture positioned 15 cm from the camera face. The short-lived isotope Ta-178 (half-life 9.3 minutes) was generated from the tungsten 178 (W-178) (half-life 21.7 days)/Ta-178 generator and concentrated on site to an injection volume of 15 to 20 microL. Mice were imaged in the supine position with the chest wall 3 mm from the camera pinhole aperture, and images were acquired at 160 frames per second after a rapid bolus injection of Ta-178. In the absence of a true gold standard, the technology was validated with measurements in control mice and mice with surgically ligated left anterior descending arteries (LADs). In addition, the effects of pharmacologic intervention with verapamil and with dobutamine were observed. Finally, peak aortic velocity measurements obtained with this technology were compared with those obtained with echocardiographic Doppler ultrasonography, the only available quantitative comparator. There was a significant decrease in the mean left ventricular ejection fraction (LVEF) between normal mice (62% +/- 4.6% [mean +/- SEM], n = 12) and mice with experimentally induced myocardial infarction produced by surgical LAD ligation (22% +/- 2.0%, n = 41; P <.01). The LVEF decreased from 51% +/- 5.8% to 37% +/- 3.5% in a group of normal mice receiving verapamil (P <.05, n = 8) and increased from 34% +/- 2.2% to 43% +/- 2.3% in a group of LAD-ligated mice receiving dobutamine (P <.01, n = 48). Peak camera sensitivity during first pass was 25,000 cps/mCi injected. Intraobserver and interobserver variability of LVEF was studied, yielding r = 0.9639 and 0.9529 and SE of the estimate 2.6% and 3.1%, respectively. Reproducibility in serial studies was excellent (r = 0.92, SE of the estimate 5.18). CONCLUSIONS: This study demonstrates the development and use of a promising new method that uses the short-lived radioisotope Ta-178 and MPC for noninvasive quantification of murine ventricular function, that produces accurate and highly reproducible results, and that can be applied in multiple serial studies.     

Quantitative assessment of cardiac mechanical synchrony using equilibrium radionuclide angiography

Background

Data on normal parameters of cardiac mechanical synchrony is limited, variable and obtained from small cohorts till date. In most studies, software used for such assessment has not been mentioned. The aim of study is to establish normal values of mechanical synchrony with equilibrium radionuclide angiography (ERNA) in a larger population using commercially available software.

Methods

We retrospectively analysed ERNA studies of 108 patients having low pretest likelihood of coronary artery disease, no known history of cardiac disease, normal electrocardiogram and whose ERNA studies were considered normal by experienced observers. In addition, ten patients diagnosed with dilated cardiomyopathy (DCM) and having LVEF ≤ 40% underwent ERNA. Fourier first harmonic analysis of phase images was used to quantify synchrony parameters using commercially available software (XT-ERNA). Intraventricular synchrony for each ventricle was measured as the standard deviation of the LV and RV mean phase angles (SD LVmPA and SD RVmPA, respectively). Interventricular synchrony was measured as LV-RVmPA. Absolute interventricular delay was calculated as absolute difference between LV and RVmPA (without considering ± sign). All variables were expressed in milliseconds (ms) and degree (°). Intra-observer and inter-observer variabilities were assessed. Cut-off values for parameters were calculated from the normal database, and validated against patient group.

Results

On phase analysis, LVmPA was observed to be 343 ± 48.5 milliseconds (174.7° ± 18.5°), SD LVmPA was 16.3 ± 5.4 milliseconds (8.2° ± 2.5°), RVmPA was 339 ± 50.4 milliseconds (171.8° ± 18.5°) and SD RVmPA was 37.3 ± 15.7 milliseconds (18.7° ± 7.2°). LV-RVmPA was observed to be 3.9 ± 21.7 milliseconds (2.9° ± 9.6°) and absolute interventricular delay was 16.3 ± 14.8 milliseconds (7.9° ± 6.1°). The cut-off values for the presence of dyssynchrony were estimated as SD LVmPA > 27.1 milliseconds (>13.2°), SD RVmPA > 68.7 milliseconds (>33.1°) and LV-RVmPA > 47.3 milliseconds (>22.1°). There was no statistically significant intra-observer or inter-observer variability. Using these cut offs, 9 patients with DCM showed the presence of left intraventricular dyssynchrony, 5 had right intraventricular dyssynchrony and 2 had interventricular dyssynchrony.

Conclusions

ERNA phase analysis offers an objective and reproducible tool to quantify cardiac mechanical synchrony using commercially available software and can be used in routine clinical practice to assess mechanical dyssynchrony.     

Evaluating benign and malignant musculoskeletal lesions with radionuclide angiography and SPECT using Tc-99m MIBI

PURPOSE: The purpose of this study was to evaluate the use of radionuclide angiography and single photon emission computed tomography (SPECT) using Tc-99m hexakis-2-methoxyisobutylisonitrile (Tc-99m MIBI) for analyzing musculoskeletal lesions. MATERIALS AND METHODS: Radionuclide angiography and SPECT using Tc-99m MIBI were performed in 36 patients with various soft tissue and bone pathologies (18 benign and 18 malignant lesions). The ratio of the counts of the lesion to that of the contralateral normal area was calculated from the region of interest drawn on the MIBI scan. The MIBI-uptake ratio was calculated using SPECT and the MIBI-perfusion index was calculated using radionuclide angiography. RESULTS: The MIBI-uptake ratio in malignant lesions (4.80 +/- 4.43) was significantly higher (P < 0.05) than that in benign lesions (1.83+/-2.48). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the MIBI-uptake ratio for malignant lesions were 72%, 83%, 78%, 81%, and 75%, respectively. The MIBI-perfusion index in malignant lesions (17.68 +/- 21.19) was significantly higher (P < 0.05) than that in benign lesions (2.25 +/- 2.56). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the MIBI-perfusion index for malignant lesions were 87%, 75%, 81%, 77%, and 86%, respectively. CONCLUSIONS: The MIBI-uptake ratio and MIBI-perfusion index using Tc-99m MIBI can yield important additional information with which to differentiate musculoskeletal lesions.     

Comparison of biventricular ejection fractions using cadmium-zinc-telluride SPECT and planar equilibrium radionuclide angiography

Background

We compared biventricular ejection fractions (EFs) from gated blood-pool single-photon emission computed tomography (SPECT) using a cadmium-zinc-telluride camera (CZT-SPECT) with planar equilibrium radionuclide angiography (ERNA) using a NaI gamma camera (NaI-planar). We also evaluated whether imaging time can be reduced without compromising image quality using the CZT camera.

Methods

Forty-eight patients underwent NaI-planar and CZT-SPECT on the same day. CZT-SPECT datasets were re-projected at an LAO orientation similar to ERNA acquisition, forming CZT-repro planar datasets. The resulting biventricular volumetric measurements and EFs were compared.

Results

LVEF calculated from CZT-SPECT and CZT-repro correlated better with NaI-planar (r = 0.93 and 0.99, respectively) than RVEF (r = 0.76 and 0.82, respectively). Excellent intra-class correlation and low bias in intra-observer comparisons were observed for the biventricular EFs derived from three datasets. A wider limit of agreement in CZT-SPECT-derived LVEFs, lower correlation and significant bias for NaI-planar, and CZT-repro-derived RVEFs was found in the inter-observer analyses. Nonetheless, the imaging time can be reduced to 4 minutes without increasing variability in EFs using the CZT camera (P = NS).

Conclusions

LVEFs calculated from CZT-SPECT and CZT-repro correlated well with NaI-planar. CZT camera may reduce imaging time while preserving image quality in the assessment of biventricular EFs.

     

Transmission scan truncation with small-field-of-view dedicated cardiac SPECT systems: Impact and automated quality control

BACKGROUND: Small-field-of-view (FOV) dedicated cardiac single photon emission computed tomography (SPECT) systems will frequently exhibit severe transmission scan truncation that may degrade attenuation correction (AC). This study evaluated the impact of transmission scan truncation on AC and developed automated transmission scan truncation quality control (ATSTQC) for small-FOV systems. METHODS AND RESULTS: Small-FOV data were simulated from the data of 10 patients acquired by a full-FOV Philips Vertex system. AC images of the full- and small-FOV data were compared by mean and maximum absolute differences of myocardial counts, and differences in stress and rest severity scores were calculated by use of the Emory Cardiac Toolbox.small-FOV systems. ATSTQC was developed to identify critical truncation that significantly increased these indices and then tested with 18 independent patients. Left-side truncation resulted in significant distortion of the quantitative indices. ATSTQC, developed on the condition that left-side truncation is critical, showed high concordance with the qualitative assessment in identification of critical truncation. CONCLUSIONS: Identification of left-side truncation as critical truncation is necessary to judge whether accurate AC can be obtained. The developed ATSTQC can accurately detect critical truncation and will help clinicians decide whether to use AC in a particular study.