Feasibility and Diagnostic Accuracy of a Gated SPECT Early-Imaging Protocol: A Multicenter Study of the Myoview Imaging Optimization Group

Abstract

The aim of this study was to investigate whether early (time 1, or T1) myocardial tetrofosmin imaging is feasible and as accurate in detecting coronary artery disease as is standard delayed (time 2, or T2) imaging. Methods: One hundred twenty patients (100 men and 20 women; mean age 6 SD, 61 6 10 y) with anginal symptoms underwent tetrofosmin gated SPECT. Stress/rest T1 imaging was performed at 15 min and T2 at 45 min after injection. Image quality was visually evaluated using a 4-point scale (from 0 5 poor to 3 5 optimal). Myocardial perfusion analysis was performed on a 20-segment model using quantitative perfusion SPECT software, and reversible ischemia was scored as a summed difference score (SDS). Coronary angiography was performed within 1 mo on all patients, and stenosis of more than 50% of the diameter was considered significant. Results: Overall, quality was scored as optimal or good for 94% of T1 images and 95% of T2 images (P 5 not statistically significant). Heart, lung, liver, and subdiaphragmatic counts did not differ for stress and rest T1 and T2 imaging. A good linear relationship was seen between T1 and T2 SDS (r 5 0.69; P , 0.0001), and Bland-Altman analysis showed good agreement between the 2 conditions. In terms of global diagnostic accuracy, areas under the receiver-operating-characteristic curve were comparable between T1 and T2 (0.80 vs. 0.81, P 5 not statistically significant). Discrepancies between T1 and T2 SDS were observed in 44% of patients (T1 2 T2 SDS . 2). Linear regression analysis showed a good correlation between T1 and T2 SDS (r 5 0.67; P , 0.0001), whereas the Bland-Altman method showed a shift in the mean value of the difference of 12.67 6 2.73. In patients with a T1 2 T2 SDS of more than 2, areas under the receiveroperating-characteristic curves were significantly higher for T1 than for T2 images (0.79 vs. 0.70, P , 0.001). Conclusion: T1 imaging is feasible and as accurate as T2 imaging in identifying coronary artery disease. However, in a discrete subset of patients, early acquisition strengthens the clinical message of defect reversibility by permitting earlier, more accurate identification of more severe myocardial ischemia.

Nuclear myocardial perfusion imaging with a novel cadmium-zinc-telluride detector SPECT/CT device: first validation versus invasive coronary angiography

“…Finally, Giorgetti et al [22] have found differential wash-out of Tc-tetrofosmin from normal versus ischemic myocardial regions advocating a short interval from injection to SPECT scanning, whereas we used a 45-60 minutes interval (according to EANM guidelines [7] …”

Single-Shot Cardiorenal Scintigraphy with 99mTc-Tetrofosmin: A Dynamic Characterization at Rest and During Adenosine Infusion

“…One can shorten the dual study by performing a 15-min renal acquisition during a gated SPECT fast imaging protocol (15). Cardiorenal scintigraphy with 99m Tc-tetrofosmin may thus be proposed especially in those patients undergoing gated SPECT in whom a significant risk of overt or subclinical renal disease exists.…”

“…Compared with 99m Tc-sestamibi, 99m Tc-tetrofosmin is cleared more quickly from both lungs and liver, allowing earlier imaging (12)(13)(14)(15) as is widely used in gated SPECT.…”

Downstream resource utilization following hybrid cardiac imaging with an integrated cadmium-zinc-telluride/64-slice CT device

“…This was followed by acquisition of rest MPI with the identical acquisition protocol several minutes 6 [14] after administration of a three times higher dose of 99m Tc-tetrofosmin (955±169 MBq). MPI scans were acquired using a multipinhole collimator (effective diameter aperture of 5.1 mm) and 19 stationary detectors simultaneously imaging 19 different views of the heart as previously reported.…”