Simplified normal limits and automated quantitative assessment for attenuation-corrected myocardial perfusion SPECT

Slomka, Piotr J.; Fish, Mathews B.; Lorenzo, Santiago; Nishina, Hidetaka; Gerlach, James; Berman, Daniel S.; Germano, Guido

doi:10.1016/j.nuclcard.2006.06.131

Cited by 50 publications

(53 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Separate male and female normal limits were created for standard summed perfusion data from summed short-axis images and for MF MPS data using 16-frame gated MPS data. Normal limits were created for the general population and were not BMImatched; however, we have previously shown that normal limits for high and low BMI groups are not significantly different (3).…”

Section: Patient Population and Acquisition Protocolsmentioning

confidence: 99%

Motion-Frozen Myocardial Perfusion SPECT Improves Detection of Coronary Artery Disease in Obese Patients

Suzuki¹,

Slomka²,

Wolak³

et al. 2008

J Nucl Med

View full text Add to dashboard Cite

In this study, we compared the diagnostic performance of the standard SPECT with motion-frozen (MF) myocardial perfusion SPECT (MPS) in obese patients. Methods: A total of 90 consecutive obese patients (body mass index, 30.1-46.8, average, 34.3 6 3.6; age, 63 6 12 y; 30% women) underwent standard supine rest 201 Tl/stress 99m Tc dual-isotope gated MPS and cardiac catheterization within 3 mo. MF images were obtained by nonlinear warping of cardiac phases to the end-diastolic position. Total perfusion deficit (TPD) was obtained for summed (S-TPD) and motion-frozen (MF-TPD) datasets with sex-specific standard and MF normal limits. Results: The area under the receiver-operatingcharacteristic (ROC) curve for detection of coronary artery disease (CAD) by MF-TPD was significantly larger than that for S-TPD (0.93 6 0.25 vs. 0.88 6 0.32, P , 0.05). MF-TPD had higher specificity (77% vs. 55%, P , 0.05) and accuracy (89% vs. 80%, P , 0.05) than did S-TPD. Conclusion: MF processing of MPS improves CAD detection in obese patients. Wehaveprevi ously shown that it is feasible to correct gated myocardial perfusion SPECT (MPS) for cardiac motion using the motion-frozen (MF) technique (1). This technique tracks the left ventricle (LV) through all cardiac phases and subsequently shifts the counts from most phases of the cardiac cycle (excluding the systolic frames) to the end-diastolic (ED) position by means of nonlinear image warping. Such warped images are summed to provide perfusion images registered to the ED phase. We have shown that with the MF approach we can obtain higher-quality images than with the standard summation of gated frames (1).In obese patients, image quality of summed MPS images is often problematic because of count-poor perfusion images in each phase (blurring caused by cardiac motion), which is further complicated by differences between systolic and diastolic phase photon attenuation. Therefore, we hypothesized that the use of the MF technique in the obese population with body mass index (BMI) greater than or equal to 30 could improve the diagnostic performance of quantitative MPS for detection of coronary artery disease (CAD). MATERIALS AND METHODS Patient Population and Acquisition ProtocolsHealthy Database Population. Normal limits were obtained retrospectively from a group of 80 patients (40 women, 40 men) with a very low likelihood of CAD (,5%) as previously described (2). Separate male and female normal limits were created for standard summed perfusion data from summed short-axis images and for MF MPS data using 16-frame gated MPS data. Normal limits were created for the general population and were not BMImatched; however, we have previously shown that normal limits for high and low BMI groups are not significantly different (3).Test Patient Population. We studied 90 consecutive obese patients (BMI, average, 34.3 6 3.6) without known CAD, who underwent both standard supine rest 201 Tl/stress 99m Tc dual-isotope gated MPS and cardiac catheterization within 3 mo. Clinical characteristics are listed in T...

show abstract

Section: Patient Population and Acquisition Protocolsmentioning

confidence: 99%

Motion-Frozen Myocardial Perfusion SPECT Improves Detection of Coronary Artery Disease in Obese Patients

Suzuki¹,

Slomka²,

Wolak³

et al. 2008

J Nucl Med

View full text Add to dashboard Cite

show abstract

“…Previously reported PET performance for detection of CAD (sensitivity, specificity, and accuracy) may indeed be different with CT-based systems. The CT misalignment problem may be one of the reasons why in the recent PET/CT study, the data specificity obtained with a PET/CT system (14) was both lower (specificity, 54%) than that previously reported with the PET transmission systems by visual analysis (specificity, 88%) and also slightly lower than that reported for the relative quantification of SPECT with transmission AC (specificity, 80%) for detection of greater than or equal to 70% stenosis (13).…”

Section: Discussionmentioning

confidence: 76%

“…One implication of this finding is that the same normal-limit databases should not be exchanged between these 2 types of AC, because the interstudy variation in normal limits is in the 5%27% range in most segments (13,14). Previously reported PET performance for detection of CAD (sensitivity, specificity, and accuracy) may indeed be different with CT-based systems.…”

Section: Discussionmentioning

confidence: 95%

Comparison of Myocardial Perfusion ⁸²Rb PET Performed with CT- and Transmission CT–Based Attenuation Correction

Slomka¹,

Meunier²,

Hayes³

et al. 2008

J Nucl Med

View full text Add to dashboard Cite

CT-based attenuation correction (AC) for myocardial perfusion PET studies is challenging because of respiratory motion. Our study aimed to compare the transmission CT (TCT)-based and CT-based AC for myocardial perfusion PET/CT images with a direct semiquantitative approach comparing differences in segmental count distribution. Methods: Stress and rest 82 Rb PET scans from 54 consecutive patients acquired on a PET/CT scanner with dual CTbased and TCT-based AC were considered. TCT-and CT-based AC images were automatically registered to each other, and direct voxel-based and American Heart Association segment-based estimation of positive and negative changes between these scans was performed. Additionally, visual quality control (QC) of CT map alignment with PET emission data was performed by 2 expert observers, and studies with significant ($5 mm) misalignment were reprocessed with corrected CT alignment. Results: We used the 17-segment American Heart Association model for TCT-to-CT regional change analysis in all patients and found that 4 segments on rest and 4 segments on stress scans differed more than 3% between CT-and TCT-corrected images for studies without significant misalignments (,5 mm); only 1 differed by more than 5%. In cases with significant misalignment of greater than or equal to 3% TCT-CT AC, changes were observed on 14 rest and 10 stress segments; after alignment, these differences were still seen in 13 rest segments and 11 stress segments. Visual QC revealed that 46% of rest and 54% of stress PET scans were misaligned by greater than or equal to 5 mm with the CT maps acquired during normal breathing. The range of the reported PET/CT misalignment was 0-15 mm in x, 0-16 mm in y, and 0-20 mm in z directions. The overall agreement in visual QC of PET/CT alignment between the observers was 72.2% Conclusion: There are significant differences between TCT and CT AC applied to cardiac PET/CT studies, which remain after alignment of CT maps to emission data. Myocardi al perfusion PET is an established cardiac modality that is regarded as more accurate than SPECT in the diagnosis of coronary artery disease (CAD) (1). A key strength of PET, compared with SPECT, that is reflected in better diagnostic performance is the availability of accurate attenuation correction (AC), which has been traditionally performed with transmission sources. However, with the evolution of PET/CT in the oncologic arena (2), most PET scanners are currently sold in the hybrid PET/CT configuration, in which the CT-based AC has replaced the traditional transmission CT (TCT)-based AC technique. A low-dose CT-based AC has been proposed instead of the TCT-based approach for PET (3). None of the PET/CT systems offered today allows for TCT-based AC.CT-based AC for PET studies has proven challenging because of the effects of possible respiratory motion in general (4) and for myocardial perfusion studies more specifically (5,6). To date, regional perfusion differences between TCT-and CT-based AC have not been directly compared for the same m...

show abstract

“…Although some studies reported an increase in the diagnostic accuracy for the detection of coronary artery disease when myocardial perfusion SPECT is attenuation corrected, [21][22][23] only a few investigations addressed the accuracy of attenuation correction without any visual interpretation of corrected and non-corrected data. [24][25][26][27] To avoid any possible bias associated with visual interpretation, in another study Wolak et al 28 evaluated the performance of attenuation correction in 2,624 women by using automated quantitative analysis of myocardial perfusion with QPS. The authors showed no significant diagnostic differences between studies processed with and without attenuation correction.…”

Section: Impact Of Attenuation Correctionmentioning

confidence: 99%

Quantification of myocardial perfusion in clinical trials

Petretta

Nappi

Cuocolo

2015

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

In the current era of comparative effectiveness and outcomes research, 1 it is mandatory to have robust estimators of disease, also useful for risk stratification and healthy decision-making.2 Myocardial perfusion imaging with electrocardiographic gated single-photon emission computed tomography (SPECT) is widely used for diagnostic purpose and for risk stratification of patients with suspected or known coronary artery disease.3 However, improving nuclear cardiology practice is required to maximize its role in the presence of multiple concurrent imaging modalities. REGADENOSON SPECT MYOCARDIAL PERFUSION IMAGINGThe United States Food and Drug Administration approved the use of regadenoson, a selective adenosine A2A receptor agonist, on April 10, 2008 for SPECT myocardial perfusion imaging as vasodilator stress agent. 4 In patients undergoing SPECT myocardial perfusion imaging, regadenoson induces an increase in coronary blood flow similar to adenosine. Advantages of regadenoson over adenosine and dipyridamole include its rapid onset of maximal hyperemia (\1 minute), short duration of action, and fixed-dose bolus administration. 5In clinical settings, these advantages translate to a shorter stress protocol and more rapid patient throughput. In addition, regadenoson may be used safely in patients with asthma, chronic obstructive pulmonary disease, and end-stage kidney, and liver disease. Cerqueira et al 7 combined data from two identical double-blind, randomized, active comparator, double dummy, multicenter phase three trials, the ADVANCE MPI (ADenoscan Versus regAdenosoN Comparative Evaluation for Myocardial Perfusion Imaging) 1 and 2 designed to show the strength of agreement between sequential adenosine-regadenoson images. Using visual assessment of serial SPECT images for detection of ischemia relative to adenosine, non-inferiority of regadenoson was demonstrated for all patients and detection of ischemia was also comparable in specific subgroups. However, the average agreement rate between adenosineadenosine and adenosine-regadenoson were 0.62 ± 0.03 and 0.63 ± 0.02 (P = NS). Agreement was less for both agents in women vs men with moderate and large areas of ischemia. This is not surprising based on the significantly greater variability associated with visual as compared to quantitative analysis of SPECT images. 8 In a subsequent study, 9 the same group of investigators used quantitative SPECT analysis to determine the total left ventricular (LV) perfusion defect size and extent of ischemia in patients enrolled in the ADVANCE MPI 2 study randomized in a 2:1 ratio to either regadenoson (n = 495) or a second adenosine SPECT (n = 260) after a standard gated SPECT myocardial perfusion imaging. A single observer who was blinded to randomization and image sequence performed quantification. In this analysis, applying quantitative analysis, regadenoson induced virtually identical scintigraphic results as adenosine regarding the size and severity of LV perfusion defects and the extent of scintigraphic ischemia. In this...

show abstract

Simplified normal limits and automated quantitative assessment for attenuation-corrected myocardial perfusion SPECT

Abstract: Automated detection of CAD by AC and NC MPS demonstrated similar sensitivity, specificity, and normalcy rates. Some gender differences were noted for AC normal limits.

Cited by 50 publications

References 20 publications

Motion-Frozen Myocardial Perfusion SPECT Improves Detection of Coronary Artery Disease in Obese Patients

Motion-Frozen Myocardial Perfusion SPECT Improves Detection of Coronary Artery Disease in Obese Patients

Comparison of Myocardial Perfusion ⁸²Rb PET Performed with CT- and Transmission CT–Based Attenuation Correction

Quantification of myocardial perfusion in clinical trials

Contact Info

Product

Resources

About

Simplified normal limits and automated quantitative assessment for attenuation-corrected myocardial perfusion SPECT

Abstract: Automated detection of CAD by AC and NC MPS demonstrated similar sensitivity, specificity, and normalcy rates. Some gender differences were noted for AC normal limits.

Cited by 50 publications

References 20 publications

Motion-Frozen Myocardial Perfusion SPECT Improves Detection of Coronary Artery Disease in Obese Patients

Motion-Frozen Myocardial Perfusion SPECT Improves Detection of Coronary Artery Disease in Obese Patients

Comparison of Myocardial Perfusion 82Rb PET Performed with CT- and Transmission CT–Based Attenuation Correction

Quantification of myocardial perfusion in clinical trials

Contact Info

Product

Resources

About

Comparison of Myocardial Perfusion ⁸²Rb PET Performed with CT- and Transmission CT–Based Attenuation Correction