Clinical value of supine and upright myocardial perfusion imaging in obese patients using the D-SPECT camera

Abstract

Supine stress MPI is inadequate in obese patients. The addition of upright imaging significantly increases the ability to interpret scans as diagnostic and may reduce considerably the need for rest imaging.

Serum copeptin level can be a helpful biomarker in evaluation of myocardial perfusion scintigraphy results

“…Equivocal test results are frequently encountered in clinical practice and can lead physician to apply further non-invasive and invasive diagnostic tests. Although several technical and patient related interventions have been introduced to handle this problem, but none of them has ability to solve the problem totally [5][6][7][8]. Here, we introduced another aspect of copeptin use.…”

“…Guided by these results, physicians can be forced to apply invasive diagnostic tests. In such false positive cases, application of gated studies, attenuation correction algorithms, and prone imaging technique can promote diagnostic accuracy but cannot be enough to solve the problem all the time [6][7][8].…”

Diagnostic implications of CZT SPECT and impact of CT attenuation correction

“…6 Supine and upright imaging with CZT in obese patients has also demonstrated diagnostic accuracy for CAD. 13,14 Although these techniques have been used, more recently hybrid SPECT/CT systems allow for high-quality attenuation maps due to improved signal-to-noise ratio and better resolution. 15 CTAC for conventional SPECT imaging has been validated to improve diagnostic accuracy and risk stratification compared with non-attenuation (NAC) corrected imaging.…”

Myocardial perfusion imaging in extreme obesity: Leveraging modern technologies to meet a modern challenge

“…Beyond the use of ECG gating (to corroborate regional wall motion abnormalities with regions of apparent fixed defect), 8 one of the simplest approaches involves the use of positional proning of patients during standard SPECT acquisition, usually following stress supine imaging. 9 Direct correction for attenuation can be achieved using either line sources or CT. 10 More recently, solid-state cadmium zinc telluride (CZT) cameras, some with upright imaging capability, 11 have allowed improved image resolution and higher count rate, enabling improved diagnostic accuracy with lower effective radiation dose, even in obese patients. 12 Given that one or more of these techniques is widely available and endorsed for best practices, 13 a contemporary comparison of the clinical performance of cardiac PET/CT vs SPECT, especially in obese patients, would ideally utilize some form of attenuation correction for SPECT.…”