Stress Thallium-201/Rest Technetium-99m Sequential Dual Isotope High-Speed Myocardial Perfusion Imaging

Berman, Daniel S.; Kang, Xingping; Tamarappoo, Balaji; Wolak, Arik; Hayes, Sean W.; Nakazato, Ryo; Thomson, Louise; Kite, Faith; Cohen, Ishac; Slomka, Piotr J.; Einstein, Andrew J.; Friedman, John D.

doi:10.1016/j.jcmg.2008.12.012

Cited by 139 publications

(100 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These CZT detectors provide a dramatic improvement in image quality and, in addition, facilitate dual isotope recordings such as those involving 201 Tl and 99m Tc-labeled tracers. 7,8 However, the two CZT cameras are based on clearly different collimation systems. This constitutes the main reason why the characteristics of the myocardial perfusion images provided by these two cameras are significantly different, as confirmed by the study of Zoccarato et al 4 The Discovery NM530c camera is based on a stationary multi-pinhole collimation system.…”

Section: See Related Article Pp 885-893mentioning

confidence: 99%

CZT cameras: A technological jump for myocardial perfusion SPECT

Imbert

Marie

2016

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

Section: See Related Article Pp 885-893mentioning

confidence: 99%

CZT cameras: A technological jump for myocardial perfusion SPECT

Imbert

Marie

2016

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

“…This technology is associated with higher sensitivity and better spatial and energy resolution compared to conventional MPS and its agreement with conventional MPS using a NaI-crystal technology has been clinically validated in several studies [3][4][5][6][7]. Furthermore, the CZT camera system enables complete 3D coverage and simultaneous image acquisition of the heart by using a stationary gantry with 19 pinhole collimators.…”

Section: Introductionmentioning

confidence: 93%

“…Thus, MPS is one of the procedures in diagnostic nuclear medicine that gives the highest effective dose contribution [11,12]. Instead of using the advantages with the CZT camera systems to perform fast myocardial perfusion imaging [3,[5][6][7], this technology could be used to reduce the administered activity to decrease the effective dose to the patient. One previous study [13] indicates that reduced activity could be used but further validation is needed.…”

Section: Introductionmentioning

confidence: 99%

Reduced administered activity, reduced acquisition time, and preserved image quality for the new CZT camera

Oddstig

Hedeer

Jögi

et al. 2013

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

Reduced administered activity, reduced acquisition time, and preserved image quality for the new CZT camera. Link to publication Citation for published version (APA): Oddstig, J., Hedeer, F., Jögi, J., Carlsson, M., Hindorf, C., & Engblom, H. (2013). Reduced administered activity, reduced acquisition time, and preserved image quality for the new CZT camera. Journal of Nuclear Cardiology, 20(1), 38-44. DOI: 10.1007/s12350-012-9634-6 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Abstract BackgroundFor a 1-day myocardial perfusion SPECT (MPS) the recommendations for administered activity stated in the EANM guidelines results in an effective dose of up to 16 mSv per patient. Recently, a gamma camera system, based on cadmium zinc telluride (CZT) technology, was introduced. This technique has the potential to reduce the effective dose and scan time compared to the conventional NaI gamma camera. The aim of this study was to investigate if the effective dose can be reduced with a preserved image quality using CZT-technology in MPS. MethodsIn total, 150 patients were included in the study. All underwent a 1-day 99m Tc-tetrofosmin stress-rest protocol and were divided into three subgroups (n=50 in each group) with 4 MBq/kg, 3 MBq/kg and 2.5 MBq/kg body weight of administered activity in the stress examination, respectively. The acquisition time was increased in proportion to the decrease in administered activity. All examinations were analysed for image quality by visual grading on a 4-point scale (1 = poor, 2 = adequate, 3 = good, 4 = excellent), by two expert readers. ResultsThe total effective dose (stress + rest) decreased from 9.3 mSv to 5.8 mSv comparing 4 MBq/kg to 2.5 MBq/kg body weight. For the patients undergoing stress examination only (35%) the effective dose, administrating 2.5 MBq/kg, was 1.4 mSv. The image acquisition times for 2.5 MBq/kg body weight were 475 s and 300 s (stress and rest) compared to 900 s for each when using conventional MPS. The average image quality was 3.7±0.5, 3.8±0.5 and 3.8±0.4 for the stress images and 3.5±0.6, 3.6±0.6 and 3.5±0.6 for the rest images and showed no statistically significant difference (p=0.62) between the 4 MBq/kg, 3 MBq/kg and 2.5 MBq/kg groups. ConclusionsThe new CZT technology can be used to considerably decrease the effective dose and acquisition time for MPS with preserved high image quality. KeywordsMyocardial perfusion imaging, SPECT, CZT detector, effective dose, image quality 2 Background Myocardial p...

show abstract

“…4 Image quality, radiation dose, and study length were analyzed, but not correlation to angiography.…”

Section: See Related Article Pp 513-522mentioning

confidence: 99%

Return of dual-isotope SPECT myocardial perfusion imaging? Not so fast…

Henzlova

Duvall

2015

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

Myocardial perfusion imaging remains the most frequently used non-invasive modality for the detection and risk stratification of patients with obstructive epicardial coronary artery disease (CAD). From its inception more than 40 years ago, the mode of stressing, choice of radioactive tracers, and detection technology, have evolved: From exercise stress alone to a choice of four pharmacological stressors, from thallium-201 (Tl-201) to technetium-99m (Tc-99m) tracers, from planar to SPECT imaging, from single head to dual-head cameras, from Na-I crystals to CZT solid state cameras. Despite the long track record of diagnostic accuracy, prognostic robustness and ubiquitous availability, continued success for the modality cannot be taken for granted. With competition from the emergence of other non-invasive modalities (stress echocardiography, cardiac CT angiography, cardiac MRI) and with documented changes in the clinical manifestations of CAD, 1,2 the demands on the safety, efficiency, and convenience of myocardial perfusion imaging continue to grow.In the long absence of new tracers (Tc-99m-based agents were introduced more than 25 years ago!), the recent advent of solid state high-efficiency SPECT cameras allows for a re-assessment of by now ancient imaging protocols. Obvious and justified criticism of the length of the traditional rest-stress sequence as well as growing awareness of radiation doses to the patients and to the medical personnel can now be addressed with imagination and inventiveness.One of the novel tested approaches is described in the current issue of the Journal by authors from Grenoble, France.3 The authors propose a fast test, which was utilized in 1,336 patients, but analyzed in only 214 patients. Using the GE Discovery NM 530 high-efficiency SPECT camera (GE Healthcare), a mean dose of 82 MBq (2.2 mCi) of Tl-201 was injected at peak stress, 5 minutes stress imaging followed and a mean dose of 314 MBq (8.5 mCi) of Tc-99m was injected after stress imaging and 5 minutes rest imaging followed 2 minutes later. Thus, the whole stress-rest sequence was completed in 22.4 ± 4 minutes. Correlation with coronary angiography in 104 patients with high CAD prevalence was good. Normalcy rate in 110 patients with low pretest probability was also high.A similar protocol and tracer dosage (2-2.5 mCi of Tl-201 and 8-10 mCi of Tc-99m) was reported in 2009 by Berman et al using a different high-efficiency CZT cardiac camera (D-SPECT, Spectrum Dynamics, Israel) in 374 patients. 4 Image quality, radiation dose, and study length were analyzed, but not correlation to angiography.There are pros and cons of both Tl-201 and Tc-99m as myocardial perfusion agents, even though Tc-99m agents are currently used in the vast majority of SPECT myocardial perfusion imaging studies. Tl-201 has a rapid blood clearance half-time (\30 seconds), a high first pass extraction ([88%) and better linearity between flow und uptake.5 Tc-99m sestamibi, on the other hand, has a longer blood clearance half-time ([1 minute), smaller first pas...

show abstract

Stress Thallium-201/Rest Technetium-99m Sequential Dual Isotope High-Speed Myocardial Perfusion Imaging

Cited by 139 publications

References 15 publications

CZT cameras: A technological jump for myocardial perfusion SPECT

CZT cameras: A technological jump for myocardial perfusion SPECT

Reduced administered activity, reduced acquisition time, and preserved image quality for the new CZT camera

Return of dual-isotope SPECT myocardial perfusion imaging? Not so fast…

Contact Info

Product

Resources

About