Automated quantification of myocardial perfusion SPECT using simplified normal limits

Slomka, Piotr J.; Nishina, Hidetaka; Berman, Daniel S.; Akincioğlu, Çiğdem; Abidov, Aiden; Friedman, John D.; Hayes, Sean W.; Germano, Guido

doi:10.1016/j.nuclcard.2004.10.006

Cited by 271 publications

(239 citation statements)

References 17 publications

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“…In the phantom study, motion during myocardial perfusion images-as subtle as 11 mm-resulted in blurring of the left ventricular walls and may have mimicked perfusion defects as large as 5.5%; a cut-off that may clinically be interpreted as ischemia due to significant coronary artery disease. 7 To detect and quantify motion, the authors evolved two methods: after re-binning list-mode data to series of 30 s-images, serial 30 s-images either from (1) raw data as acquired by individual detectors or from (2) the entire three-dimensional reconstructed datasets were co-registered, and their translations to the first image were measured. Both of the applied methods reliably and consistently detected and quantified motion-with a maximum absolute error between the actual and the measured shift below 2 mm.…”

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confidence: 99%

Moving ahead with CZT technology

Benz

Buechel

2016

Journal of Nuclear Cardiology

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confidence: 99%

Moving ahead with CZT technology

Benz

Buechel

2016

Journal of Nuclear Cardiology

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“…3 As for perfusion quantification, aside from the different myocardial sampling techniques (hybrid cylindrical/spherical for ECTb, ellipsoidal for QGS/QPS), the ECTb generates normal databases using three patient populations (a normal group with low likelihood of coronary artery disease (CAD), a criteria group with a spectrum of perfusion abnormalities, and a prospective validation group), 2 whereas QGS/QPS employs a simplified approach based on a single patient population with low likelihood of CAD, in which normal limits are derived without visual scoring of abnormal scans or optimization of regional thresholds. 5 Without elaborating further, one should expect different algorithms to produce somewhat different quantitative results.…”

Section: Different Algorithms Are Based On Different Computational Tomentioning

confidence: 99%

Quantitative measurements of myocardial perfusion and function from SPECT (and PET) studies depend on the method used to perform those measurements

Germano

2018

Journal of Nuclear Cardiology

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See related article, pp. 911-924One would perhaps be justified to remark that the title of this editorial only states the obvious and that its premise ought to be accepted by any reasonable reader, even if not particularly familiar with nuclear cardiology. Nevertheless, the paper to which the editorial refers, 1 describing good concordance but also substantial differences amongst three commercially available software packages to quantify LV perfusion and function from gated myocardial SPECT, offers us the opportunity to reflect on some of the specific reasons why those differences exist. As the authors describe in their comprehensive review of the published literature, a wealth of studies exists assessing the cross-correlation of the outputs of different quantitative gated SPECT algorithms, and the current study confirms previously reported findings, albeit in a larger population of 634 consecutive patients. Let us try to interpret and clarify those findings, while framing them in a more general context. DIFFERENT ALGORITHMS ARE BASED ON DIFFERENT COMPUTATIONAL TOOLS (AND WORKING ASSUMPTIONS)The specific software packages used by Alexiou et al are Emory University's Cardiac Toolbox (ECTb), 2Cedars-Sinai's Cardiac Suite (QGS/QPS), 3 and General Electric's Myovation. This writer is not aware of any published papers detailing the technical principles on which the Myovation software is based, but the other two algorithms and their differing characteristics have been well described in the literature. As far as measurement of global function is concerned, the ECTb performs a Fourier decomposition of the time-volume (T-V) curve that describes the LV cavity volume as a function of the cardiac cycle, then takes the first Fourier harmonic to estimate end-systolic (ES) and end-diastolic (ED) volumes-as a result, T-V curve estimates are less dependent on temporal sampling, and ejection fractions (EFs), EDVs and ESVs from 8-frame and 16-frame gated acquisitions will be relatively close in value. 2 In contrast, QGS/QPS measures the actual dynamic range of the T-V curve, which is directly proportional to the frequency of temporal sampling-in other words, 8-frame ESVs will be larger, EDVs smaller, and EFs lower compared to 16-frame gated acquisitions, with a substantially uniform difference of 3-4 EF points over the entire EF range. 4 With regard to myocardial thickening, the ECTb algorithm assumes a uniform myocardial thickness of 1 cm at ED, and increases it with a 1:1 relationship to the apparent myocardial ''brightening'' from ED to ES, since partial volume effect is fairly linear for the reconstructed spatial resolutions and myocardial thicknesses of interest. 2 QGS/QPS is also based, in part, on myocardial brightening, but uses phantom calibration to estimate ED thickness, and asymmetrical Gaussian fitting with a constant myocardial mass constraint to follow the endocardium and epicardium's location throughout the cardiac cycle. 3 As for perfusion quantification, aside from the different myocardial sampling techniques (hy...

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“…17,18 A total perfusion defect (TPD) parameter were derived, designed to combine measures of defect extent, and severity based on counts in each polar map pixel relative to limits from lowlikelihood patients, expressed as a % of the myocardium, with the TPD difference between stress and rest images quantitating ischemia. 19 The aforementioned is the basis for a variety of contemporary quantitative techniques routinely applied to enhance SPECT MPI image interpretation. 20 Compared with visual assessment alone, quantitation improves interpretive reproducibility.…”

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confidence: 99%

“…21,22 Robust diagnostic accuracy is consistently shown, 15,23,24 with some studies reporting higher accuracy than visual analysis. 19,25 Quantitation should improve risk stratification, although there are few publications to date in this regard. 26,27 Nonetheless, TPD was used to measure progression or regression of myocardial ischemia in the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, 28 and is an important element of the multicenter prospective randomized ISCHEMIA study (The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) that uses a TPD ischemia score C10% as one inclusion criteria to assess invasive vs optimal medical therapy.…”

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confidence: 99%