EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision

Abstract

Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/publications/guidelines/2015_07_EANM_FINAL_myocardial_perfusion_guideline.pdf.

A joint procedural position statement on imaging in cardiac sarcoidosis: from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology

“…[63][64][65][66] PET MPI has advantages over SPECT for the identification of small perfusion defects, as seen in patients with cardiac sarcoidosis. When SPECT imaging is used, attenuation correction and gated imaging are recommended to avoid interpreting segments with attenuation artifacts as segments of true mismatch.…”

It’s about time we think about lowering radiation dose in obese patients too

“…17 This issue is so multifaceted that the authors of the 2015 European Association of Nuclear Medicine Guidelines for MPI state that ''it is not possible to make precise recommendations regarding injected activities as hard evidence documenting superior results with certain activities is not available.'' 18 The most recent ASNC SPECT Imaging Guidelines are also noncommittal with regard to dosing strategies for obese patients. 19 The guidelines suggest, ''as a strategy to be considered,'' a two-day protocol for patients weighing more than 250 lbs.…”

Impact of imaging protocol on left ventricular ejection fraction using gated-SPECT myocardial perfusion imaging

“…21 Our results are in agreement with those previously obtained in 1089 patients from a subgroup analysis of the J-ACCESS study, were a drop in LVEF greater than 5% did not predict events. 19 The selection of a SD or a DD protocol is related to local logistics and patients preferences; however, in terms of patients' and operators' radiation exposition, the SD protocol, requiring a 3:1 activity ratio between rest and stress studies 6 seems unfavorable compared to the DD approach.…”

“…6 The time interval between tracer injection during stress and image acquisition, the type of stressor used (exercise vs vasodilator stress), and the study protocol could affect the relationship between ischemia and left ventricular (LV) ejection fraction (EF) and conceivably outcome prediction. 7 -9 The aim of this study was to examine the differential impact of these variables on myocardial perfusion and LV EF and volumes using a propensity matching analysis of a large cohort of patients enrolled in a multicenter study in whom coronary angiographic data were also available.…”