Prediction of Left Main or 3-Vessel Disease Using Myocardial Perfusion Reserve on Dynamic Thallium-201 Single-Photon Emission Computed Tomography With a Semiconductor Gamma Camera

Shiraishi, Shinya; Sakamoto, Fumi; Tsuda, Naotake; Yoshida, Morikatsu; Tomiguchi, Seiji; Utsunomiya, Daisuke; Ogawa, Hisao; Yamashita, Yasuyuki

doi:10.1253/circj.cj-14-0932

Cited by 71 publications

(51 citation statements)

References 26 publications

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“…We compared the global mean MFR of 1 vessel disease to those of 2-3 vessel disease patients. The MFR of 1 vessel disease patients was significantly higher than that of multi vessel disease, which was compatible with earlier studies (12,20). In this study, 10 of the CAD group (n=25) had a history of CABG, and 5 of the CAD group had a history of myocardial infarction with fixed perfusion defects in the SPECT, which may affect significantly to the MFR values and complicated the results.…”

Section: Discussionsupporting

confidence: 90%

“…Furthermore, several reports showed the feasibility of quantifying the MFR with novel CZT SPECT cameras (10)(11)(12). Despite the advantage of using CZT cameras for estimating the MFR value, including high sensitivity and high resolution, it is still hard to equip these CZT systems in most clinical hospitals because of its high facility cost.…”

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). They evaluated the MFR in 29 normal subjects and only one patient with 3 vessel CAD, one with chronic heart failure.…”

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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: Discussionsupporting

confidence: 90%

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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“…11 Finally, the correct dose of Tl-201 on highefficiency SPECT cameras must also be put into perspective with the future possibility of calculating coronary flow reserve. 12 Appropriate dose and imaging time need to be individualized with emphasis on lower doses in patients with longer expected survival. An elderly patient with back (5) No information was presented about the quality of gated images (early post-stress and at rest).…”

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confidence: 99%

Tl-201 dosing for CZT SPECT: More new information

Henzlova

Duvall

2018

Journal of Nuclear Cardiology

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Thallium-201 was the original and the only myocardial perfusion imaging (MPI) tracer, first for planar (1973) and later for SPECT imaging (1980s), for almost 15 years. Introduction of Tc-99m-based tracers (sestamibi-1984, tetrofosmin-1989) knocked Tl-201 from the pedestal. The advantages of Tc-99m-based agents became obvious: higher energy (140 keV vs 69-80 keV), shorter half-life (6 hours vs 72 hours), flexibility of imaging protocols (due to lack of meaningful Tc-99m redistribution), and local production of the tracer (using molybdenum generator vs dose delivery of . The higher energy Tc-99m gamma rays and a shorter half-life increased the acquired count density, and thus improved the quality of both perfusion and gated images compared to Tl-201.The advent of coronary CT angiography (CTA) and the exponential increase of MPI volume unleashed the previously non-existent debate pointing to possible longterm harmful effects of low-dose radiation used for diagnostic imaging. 1 CTA technology evolved and answered rapidly with a substantial decrease in radiation exposure. 2 Migration from Tl-201 to Tc-99m by the nuclear cardiology community was driven more by the ease of use of Tc-99m-based tracers, rather than by fear of substantially higher per study radiation exposure of Tl-201 (15 mSv vs 9-11 mSv). Most recently, the majority of criticism was aimed at dual-isotope protocols (Tl-201 rest/Tc-99m stress), which result in the highest radiation exposure per study (22-23 mSV) not offset by a relatively modest decrease of the length of the test. 3 Using standard imaging technology (Anger camera) and standard Tl-201 doses (3-4 mCi), some advantageous Tl-201 characteristics remain:(1) Tl-201 is by design ''stress-first imaging.'' 4 Immediate review of stress images may reveal normal perfusion or an unexpectedly abnormal result such that the rest/redistribution portion of the test may then be avoided. This would significantly decrease the length of the test (from 4-6 hours to 1 hour) and additionally decrease radiation exposure to the laboratory personnel and to accompanying visitors. 5 (2) As Tl-201 is excreted by the kidneys, high subdiaphragmatic tracer accumulation is not an issue, compared to the gastrointestinal excretion of Tc-99m. (3) Flow to uptake linearity is better preserved with Tl-201 compared to Tc-99m-labeled tracers. This is of particular importance with the use of coronary vasodilators. Coronary blood flow increases by non-physiologic amounts (200-300%) with vasodilators, compared to approximately 100% with moderate exercise. (4) Tl-201 remains a preferred ''viability tracer'' due to its ability to visualize severely dysfunctional myocytes. Tl-201 crosses the cellular membrane, while Tc-99m tracers are transported into the mitochondria, an organelle more susceptible to ischemic damage. (5) Because of early post-stress imaging, Tl-201 lung uptake can be quantified and used as a surrogate for pulmonary capillary wedge pressure. (6) Past and likely future Tc-99m shortages will lead either to the abandonmen...

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“…21 Currently, heart-dedicated SPECT scanners that have cadmium-zinc-telluride detector and fixed-angle geometry are available, and it has been attempted to perform dynamic scans and to measure flow reserve using these scanners. 22,23 The efficacy of MPI SPECT-based flow reserve measurement needs to be evaluated in further studies. Additionally, it should be proved in further researches whether MPI-based flow reserve measurement is a prognostic factor and whether it can be used for selecting treatment options.…”

mentioning

confidence: 99%

Screening high-risk patients and selecting treatment options in stable coronary artery disease using myocardial perfusion imaging

Paeng

Lee

2018

Journal of Nuclear Cardiology

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Prediction of Left Main or 3-Vessel Disease Using Myocardial Perfusion Reserve on Dynamic Thallium-201 Single-Photon Emission Computed Tomography With a Semiconductor Gamma Camera

Cited by 71 publications

References 26 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

Tl-201 dosing for CZT SPECT: More new information

Screening high-risk patients and selecting treatment options in stable coronary artery disease using myocardial perfusion imaging

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