Feasibility and operator variability of myocardial blood flow and reserve measurements with 99mTc-sestamibi quantitative dynamic SPECT/CT imaging

Klein, Ran; Hung, Guang-Uei; Wu, Tsu‐Juey; Huang, Wen‐Sheng; Li, Dianfu; deKemp, Robert A.; Hsu, Bailing

doi:10.1007/s12350-014-9971-8

Cited by 58 publications

(45 citation statements)

References 43 publications

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“…Since there is another risk of contamination in this 9 non-CAD patients. Third, we did not correct the baseline flow values for the rate-pressure product, thus our data was highly variable compared to other studies (8,9). Forth, we need to acquire the image for 4 times in this protocol, which may interfere throughput of the test.…”

Section: Discussionmentioning

confidence: 97%

“…Earlier studies suggested the possibility of quantifying the MFR on dynamic planar acquisition following conventional SPECT acquired with conventional SPECT cameras (6,8,9).…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have reported the possibilities of CFR measurements using first-pass planar scintigraphy in humans (6)(7)(8)(9). On the contrary, recent reports have established the measurement of the MBF and myocardial flow reserve (MFR) using novel cadmium zinc-telluride (CZT) SPECT scanners (10)(11)(12) They also suggested the stable measurements using the effective half-life correction and ordered subset expectation maximization (OSEM).…”

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confidence: 99%

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Diagnostic Utility of Quantifying Myocardial Flow Reserve with <sup>99m</sup>Tc-Sestamibi Dynamic SPECT Using a Standard Dual-Head SPECT Camera

Fukuyama

Kitagawa

Hiraoka

2017

Annals of Nuclear Cardiology

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Section: Discussionmentioning

confidence: 97%

“…Earlier studies suggested the possibility of quantifying the MFR on dynamic planar acquisition following conventional SPECT acquired with conventional SPECT cameras (6,8,9).…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Diagnostic Utility of Quantifying Myocardial Flow Reserve with <sup>99m</sup>Tc-Sestamibi Dynamic SPECT Using a Standard Dual-Head SPECT Camera

Fukuyama

Kitagawa

Hiraoka

2017

Annals of Nuclear Cardiology

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“…2,3 It does not directly mean that it can be accepted as a clinical tool in daily practice. Measuring MBF and CFR by cardiac PET is a mature technology but is not widely used in clinics.…”

Section: Measurement Of Mbf and Cfrmentioning

confidence: 99%

The tools are ready, are we?

Cho

Jabin

Lee

et al. 2019

Journal of Nuclear Cardiology

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In this issue of the Journal of Nuclear Cardiology, Lee and colleagues elegantly review the recent advances in the instrumentations for nuclear cardiac imaging. 1 Solid-state radiation detectors incorporating cadmium zinc telluride (CZT) become the detector of choice for dedicated cardiac imaging systems. CZT single-photon emission computed tomography (SPECT) has improved image quality and shortened acquisition time of myocardial perfusion imaging (MPI) thanks to its direct energy conversion mechanism, narrow energy resolution, and pixelated nature of electrical circuit. The measurement of absolute myocardial blood flow (MBF) as well as coronary flow reserve (CFR) using CZT SPECT is now under active investigation and is showing clinical feasibility. Multimodality imaging systems which hybridized SPECT and positron emission tomography (PET) with CT widened clinical application of cardiac imaging studies. Quantitative SPECT/CT provides additive information of coronary calcium burden, attenuation correction for both visual and quantitative assessment of myocardial perfusion, and enables quantification of myocardial blood flow and flow reserve. Cardiac PET is also an active progress. Adoption of silicon photomultipliers (SiPMs) leads to enhancements in image quality and count rates. The application of accurate time-of-flight (TOF) information reduced emission-transmission mismatch artifacts. Information of the extracted coronary arteries from CT angiography allows non-linear motion correction of PET plaque images. Replacement of photomultiplier tubes with semiconductor photosensors such as the avalanche photodiode (APD) and SiPM has made it possible to integrate PET with magnetic resonance (MR). PET/MR system is now clinically available in hybrid as well as parallel camera structure.The recently introduced nuclear cardiac imaging tools are ready to provide more information in better quality than ever before. It is fair to question whether we are ready to apply these tools in clinical fields. There are challenges to overcome before we can use the state-ofthe-art imaging tools. MEASUREMENT OF MBF AND CFRSeveral studies showed clinical feasibility of measuring MBF and CFR by dynamic image acquisition using Tc-99m sestamibi and CZT SPECT/CT cameras. 2,3 It does not directly mean that it can be accepted as a clinical tool in daily practice. Measuring MBF and CFR by cardiac PET is a mature technology but is not widely used in clinics. Several obstacles are noted. 4 First of all, resting MBF is variable according to hemodynamic and metabolic changes. MBF and CFR cannot differentiate epicardial obstructive and microvascular diseases or provide anatomical localization of coronary obstruction. The complex interplay among different MBF parameters has not been fully unveiled. Different MBF parameters stand for different coronary pathophysiologies, and are not interchangeable. 5 For example, a relative MBF ratio namely relative flow reserve (RFR) could be more suitable for the diagnosis of focal significant coronary stenosis in ...

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“…In recent years, several different SPECT system designs have become available that do not physically rotate around the patient, but rather collect data simultaneously from all projections over a 1808 arc about the patient's thorax. 14 While it is possible to quantify myocardial blood flow from dynamic SPECT data acquired with a conventional rotating Ager camera, 15 the advent of the newer SPECT system designs, and especially those incorporating solid state detectors for which counting efficiency is 3-5 times that of conventional Anger cameras, 14 have the prospect of enabling absolute quantification of myocardial blood flow derived from dynamic SPECT acquisitions, such as with agents such as T-99m-tetrofosmin, 16 in a manor analogous to the way in which rest/stress Rb-82 PET dynamic data currently are used to quantify blood flow. If that is the case, additional QA data processing procedures will be needed, including those designed to verify correct timing of bolus injections, adequacy of tracer delivery, and sufficiency of radiotracer curve clearance.…”

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confidence: 99%

Gated SPECT myocardial perfusion imaging quality assurance in current and future practice

Nichols

Tosh

2017

Journal of Nuclear Cardiology

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Journal of Nuclear Cardiology, Malek et al 2 review some of the important elements of QA procedures required to produce reliable computations of left ventricular (LV) perfusion and function parameters from gated SPECT myocardial perfusion imaging (MPI) data for the Cedars-Sinai QGS program, 3 which is a commonly used commercially available MPI analysis software package. While other algorithms operate on somewhat different principles and LV modeling assumptions, 4,5 all MPI software packages have in common the automated identification of the LV outflow tract valve plane, endocardial and epicardial borders. As the authors remind us, failure to ensure the appropriate locations of LV limits can compromise the validity of summed stress scores, summed rest scores, ejection fractions, LV volumes, LV mass, lung:heart count ratios, and transient ischemic dilatation, among other parameters.Additional parameters that can be compromised by sub-optimal LV valve plane placement include phase maps and the computed phase parameters derived from them, including phase histogram bandwidth (BW), phase standard deviation (SD), skewness, and kurtosis metrics. 6 If the LV valve plane is placed too far out beyond the end of the basal myocardium, the algorithms will misinterpret random variations of background counts as contributing to the number of pixels with contractions far from the actual phase at which the majority of regional LV contractions occurred, thereby leading to the false impression of asynchronous LAD and/or RCA territories, and an inaccurate broadening of the phase histogram curve with subsequent incorrectly large values of phase BW and SD. As phase measurements are a relatively recent extension of MPI study computations, establishing reliable values of these is important to enable capitalizing on the added dimension this has provided when evaluating patients with CAD. 7 When first presented with a newly acquired MPI dataset to be processed, users of analysis software packages frequently will first be presented with screens displaying the automated attempts to localize the LV centers and boundaries. As Malek et al 2 point out, it is important to verify that these initial automated definitions are correct, or to modify them to best conform to the visual impression of optimally appropriate choices.

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Feasibility and operator variability of myocardial blood flow and reserve measurements with 99mTc-sestamibi quantitative dynamic SPECT/CT imaging

Abstract: MBF and reserve measurements using (99m)Tc-sestamibi on a traditional, two-headed camera with fast rotation and with quantitative dynamic SPECT appears to be feasible, warranting further investigation.

Cited by 58 publications

References 43 publications

Diagnostic Utility of Quantifying Myocardial Flow Reserve with <sup>99m</sup>Tc-Sestamibi Dynamic SPECT Using a Standard Dual-Head SPECT Camera

Diagnostic Utility of Quantifying Myocardial Flow Reserve with <sup>99m</sup>Tc-Sestamibi Dynamic SPECT Using a Standard Dual-Head SPECT Camera

The tools are ready, are we?

Gated SPECT myocardial perfusion imaging quality assurance in current and future practice

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