Clinical impact of arrhythmias on gated SPECT cardiac myocardial perfusion and function assessment

Nichols, Kenneth; Yao, Siu‐Sun; Kamran, Muhammad; Faber, Tracy L.; Cooke, C. David; DePuey, E. Gordon

doi:10.1067/mnc.2001.111087

Cited by 50 publications

(32 citation statements)

References 9 publications

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“…The almost universal use of gated SPECT for myocardial perfusion imaging has been made possible by the availability of the technetium-labelled perfusion agents, the propagation of multihead gamma cameras, the increased power of computer systems and the development of dedicated software for processing of perfusion and functional data. The presence of very important arrhythmic problems remains the only reason for avoiding acquisition of a perfusion study using electrocardiographic gating [37,41,42]. It must be considered that some major gating artefacts may propagate even to the summed perfusion images and thus affect their reliability [37].…”

Section: Gated Spect Techniquementioning

confidence: 99%

“…In these subjects, the summed frames will be usable for perfusion assessment, whilst the gated data may remain valuable for a visual estimate of ventricular function. In the presence of heart rhythm disturbances, the assessment of wall thickening is the most sensitive parameter, while ejection fraction has been demonstrated to be a quite robust measurement [41,42].…”

Section: Gated Spect Techniquementioning

confidence: 99%

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The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

Sciagrà

2007

Eur J Nucl Med Mol Imaging

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Background Gating of single-photon emission computed tomography (SPECT) has significantly improved the reliability and diagnostic accuracy of myocardial perfusion imaging. The functional parameters derived from this technique, mainly left ventricular volumes and ejection fraction, have been demonstrated to be accurate and reproducible. They are able to increase the detection of severe and extensive coronary artery disease and show a significant incremental prognostic power over perfusion abnormalities. Therefore, the importance given to gated SPECT functional data has progressively grown. Discussion This circumstance has further expanded the indications for myocardial perfusion imaging and strengthened its position among the different imaging modalities. Moreover, several studies show that the evaluation of ventricular function may have a leading part in justifying the execution of perfusion scintigraphy in various clinical conditions. Aim Aim of this review is to describe this evolution of gated SPECT functional assessment from a supporting rank with respect to perfusion, to a main actor position in the field of cardiac imaging.

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Section: Gated Spect Techniquementioning

confidence: 99%

Section: Gated Spect Techniquementioning

confidence: 99%

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

Sciagrà

2007

Eur J Nucl Med Mol Imaging

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“…An additional limitation may be the particular focus of this study on perfusion parameters alone. Since gated SPECT wall motion analysis is subjective, 20 we did not include this parameter in our multivariate analysis. Ischemic cardiomyopathy is often characterized by more focal regional abnormalities, 8,14 but significant group overlap (with nonischemic cardiomyopathy) has been reported.…”

Section: Study Limitationsmentioning

confidence: 99%

Prospective validation of a quantitative method for differentiating ischemic versus nonischemic cardiomyopathy by technetium‐99m sestamibi myocardial perfusion single‐photon emission computed tomography

Yao

Qureshi

Nichols

et al. 2004

Clinical Cardiology

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SummaryBackground: Myocardial perfusion single-photon emission computed tomography (SPECT) permits assessment of stress perfusion and resting left ventricular (LV) function. Quantitative analysis of perfusion patterns among patients with LV dysfunction offers an opportunity for developing criteria to differentiate ischemic from nonischemic cardiomyopathy.Hypothesis: Quantitative assessment of SPECT may allow differentiation between ischemic and nonischemic cardiomyopathy.Methods: We evaluated 144 patients with LV ejection fraction ≤ 40%, divided into 63 patients with nonischemic and 81 with ischemic cardiomyopathy. Mean relative myocardial counts were obtained for regions drawn over defect and normal zones on rest and stress polar perfusion maps.Results: Multivariate logistic regression analysis of significant univariate SPECT predictors of ischemic cardiomyopathy revealed that the stress defect severity ratio (SDSR) was the best predictor of ischemic cardiomyopathy (p < 0.0001). By receiver operator characteristic (ROC) curve analysis, an SDSR of ≤ 45% optimized prediction of ischemic cardiomy-

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“…12 Multiple different approaches are possible in acquiring SPECT data with ECG-gating, and effects of gating errors and arrhythmias on quantified parameters have been reported. 13 By the same token, several different approaches to handle cardiac displacement to account for breathing motion are possible. With these new approaches to incorporate information regarding pulmonary motion, attention now has broadened to assessing the effects of pulmonary gating errors and breathing motion not only on myocardial perfusion but on the other parameters as well.…”

mentioning

confidence: 99%

Advances in dual respiratory and ECG-gated SPECT imaging

Nichols

Tosh

2018

Journal of Nuclear Cardiology

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In the current issue of Journal of Nuclear Cardiology, Kortelainen et al report that a new method of acquiring dual respiratory and ECG-gated SPECT myocardial perfusion data reduces artifacts due to respiratory motion while leaving asynchrony measurements derived from the data unaltered. 1 As the improvements reported were modest and only observed in a subset of subjects, a relevant question to ask is whether the additional equipment needed and patient preparation logistics would significantly improve patient outcomes. Is pulmonary motion actually a significant problem in nuclear cardiology imaging, requiring a solution?There is a long history of exploring data acquisition and processing methods to detect and compensate for the repositioning of organ systems due to breathing in scintigraphic imaging, notably for PET studies to improve the detection of tumors involved in lung cancer. 2 In the realm of cardiac imaging, it was recognized as early as 1989 that changes in breathing patterns over time could degrade Tl-201 SPECT myocardial image quality if data acquisition was initiated too early following treadmill exercise, 3 the remedy for which was to delay the start of imaging. Even with this change in technique, myocardial motion due to normal breathing patterns has been shown to degrade image quality and affect quantified myocardial perfusion. 4 In 2009, several papers appeared documenting the effect of respiratory motion on SPECT perfusion assessment and proposing solutions. [5][6][7] Now, in conjunction with protocols involving imaging the heart while it is in a stressed state, corrections for breathing motion have been shown to improve accuracy not only of relative myocardial perfusion evaluation but also of absolute myocardial blood flow quantitative measurements as derived from Rb-82 PET data. 8 There are advantages to ECG-gating both rest and stress PET data, and newer rest/stress SPECT protocols are being implemented such that the heart is in a genuinely different physiologic state during stress SPECT acquisition, 9 raising the prospect that it may become important to detect and correct for changes in breathing patterns induced by stress.Initially, the main focus of Tl-201 and Tc-99m-sestamibi SPECT imaging was relative myocardial perfusion assessment, but with ECG-gating, additional parameters can be measured as well, including LV ejection fraction, 10 volumes, wall thickening by way of partial volume effects, 11 and regional asynchrony. 12 Multiple different approaches are possible in acquiring SPECT data with ECG-gating, and effects of gating errors and arrhythmias on quantified parameters have been reported. 13 By the same token, several different approaches to handle cardiac displacement to account for breathing motion are possible. With these new approaches to incorporate information regarding pulmonary motion, attention now has broadened to assessing the effects of pulmonary gating errors and breathing motion not only on myocardial perfusion but on the other parameters as well. This account by Kort...

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Clinical impact of arrhythmias on gated SPECT cardiac myocardial perfusion and function assessment

Abstract: As with quantitative measurements, thickening is the parameter most prone to error in the presence of arrhythmias. It is important to test data for gating errors to avoid potentially erroneous measurements and visual readings.

Cited by 50 publications

References 9 publications

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

Prospective validation of a quantitative method for differentiating ischemic versus nonischemic cardiomyopathy by technetium‐99m sestamibi myocardial perfusion single‐photon emission computed tomography

Advances in dual respiratory and ECG-gated SPECT imaging

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