Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease: a review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM)

Abstract

The trade-off between resolution and count sensitivity dominates the performance of standard gamma cameras and dictates the need for relatively high doses of radioactivity of the used radiopharmaceuticals in order to limit image acquisition duration. The introduction of cadmium-zinc-telluride (CZT)-based cameras may overcome some of the limitations against conventional gamma cameras. CZT cameras used for the evaluation of myocardial perfusion have been shown to have a higher count sensitivity compared to conventional single photon emission computed tomography (SPECT) techniques. CZT image quality is further improved by the development of a dedicated three-dimensional iterative reconstruction algorithm, based on maximum likelihood expectation maximization (MLEM), which corrects for the loss in spatial resolution due to line response function of the collimator. All these innovations significantly reduce imaging time and result in a lower patient's radiation exposure compared with standard SPECT. To guide current and possible future users of the CZT technique for myocardial perfusion imaging, the Cardiovascular Committee of the European Association of Nuclear Medicine, starting from the experience of its members, has decided to examine the current literature regarding procedures and clinical data on CZT cameras. The committee hereby aims 1) to identify the main acquisitions protocols; 2) to evaluate the diagnostic and prognostic value of CZT derived myocardial perfusion, and finally 3) to determine the impact of CZT on radiation exposure.

Cadmium-zinc-telluride myocardial perfusion imaging: The dream of a single test gets nearer

“…8,9 Given their groundbreaking technical features and the differences between the two available but competing suites (D-SPECT, Spectrum Dynamics, Palo Alto, CA, USA; Discovery NM 530c or Discovery NM/CT 570c with Alcyone technology, GE Healthcare, Haifa, Israel), there are, however, ongoing developments and refinements in the application of this imaging technology to current cardiovascular practice. [10][11][12] Accordingly, the scholarly literature on CZT MPI is continuing to expand momentously, as demonstrated by the work by Jameria and colleagues published in this issue of the Journal. 13 Specifically, Jameria et al report hereby a singlecenter retrospective observational study comparing acquisition of MPI with CZT vs Anger cameras, and focusing on several protocol subtleties such as stressonly vs stress-rest acquisition, and upright vs supine positioning, while using a D-SPECT suite and relying on coronary angiography as gold standard.…”

Diagnostic implications of CZT SPECT and impact of CT attenuation correction

“…Conventional SPECT MPI has a sensitivity ranging between 0.82 and 0.91, and specificity ranging between 0.70 and 0.90. 2 During the first decade of the twenty first century, CZT SPECT systems emerged promising ultrafast acquisition, dose reduction, and similar diagnostic accuracy. The direct conversion of gamma radiation into signal by the semiconductor ensured improved image fidelity.…”

“…2 Many of these studies have assessed the diagnostic performance of MPI with CZT cameras (Table 1). 1,[3][4][5][6][7][8] Further, in a meta-analysis by Nudi et al, the sensitivity of CZT SPECT was found to be range between 0.78 and 0.89 and the specificity ranged from 0.62 to 0.76.…”

Dedicated cardiac CZT SPECT is steadily moving to achieve its destiny

“…[4][5][6] It improved image quality and patient comfort. Its diagnostic performances compare favorably with those of conventional SPECT.…”