The current status of CZT SPECT myocardial blood flow and reserve assessment: Tips and tricks

Zavadovsky, K. V.; Мочула, А. В.; Maltseva, A. N.; Шипулин, В. М.; Сазонова, С. И.; Gulya, Marina O.; Liga, Riccardo; Gimelli, Alessia

doi:10.1007/s12350-021-02620-y

Cited by 36 publications

(40 citation statements)

References 71 publications

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“…The main products on the market are represented by the D-SPECT and VERITIONTM cameras (Spectrum Dynamics, Palo Alto, CA, USA) and by the Discovery NM 530c and NM/CT 670 CZT NM/CT 570c cameras (GE Healthcare, Haifa, Israel). All of this equipment is capable of performing dynamic SPECT in order to assess myocardial blood flow (MBF) [62].…”

Section: Development and Application Of High-resolution Czt Camerasmentioning

confidence: 99%

Technetium-99m Radiopharmaceuticals for Ideal Myocardial Perfusion Imaging: Lost and Found Opportunities

et al. 2022

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The favorable nuclear properties in combination with the rich coordination chemistry make technetium-99m the radioisotope of choice for the development of myocardial perfusion tracers. In the early 1980s, [99mTc]Tc-Sestamibi, [99mTc]Tc-Tetrofosmin, and [99mTc]Tc-Teboroxime were approved as commercial radiopharmaceuticals for myocardial perfusion imaging in nuclear cardiology. Despite its peculiar properties, the clinical use of [99mTc]Tc-Teboroxime was quickly abandoned due to its rapid myocardial washout. Despite their widespread clinical applications, both [99mTc]Tc-Sestamibi and [99mTc]Tc-Tetrofosmin do not meet the requirements of an ideal perfusion imaging agent due to their relatively low first-pass extraction fraction and high liver absorption. An ideal radiotracer for myocardial perfusion imaging should have a high myocardial uptake; a high and stable target-to-background ratio with low uptake in the lungs, liver, stomach during the image acquisition period; a high first-pass myocardial extraction fraction and very rapid blood clearance; and a linear relationship between radiotracer myocardial uptake and coronary blood flow. Although it is difficult to reconcile all these properties in a single tracer, scientific research in the field has always channeled its efforts in the development of molecules that are able to meet the characteristics of ideality as much as possible. This short review summarizes the developments in 99mTc myocardial perfusion tracers, which are able to fulfill hitherto unmet medical needs and serve a large population of patients with heart disease, and underlines their strengths and weaknesses, the lost and found opportunities thanks to the developments of the new ultrafast SPECT technologies.

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Section: Development and Application Of High-resolution Czt Camerasmentioning

confidence: 99%

Technetium-99m Radiopharmaceuticals for Ideal Myocardial Perfusion Imaging: Lost and Found Opportunities

et al. 2022

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“…Finally, another experience from Zavadovsky et al, analysing the state-of-the-art MBF assessment with CZT SPECT and technical issues related to image acquisition, data post-processing and interpretation, concluded that standardization of acquisition and postprocessing protocols are needed in order to reduce inter-sites variability and increase the clinical relevance of CZT SPECT results [39].…”

Section: Single-photon Emission Computed Tomographymentioning

confidence: 99%

Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging

Baggiano

Italiano

Guglielmo

et al. 2022

JCM

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Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography (SE), single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) represent the functional techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. More recently, cardiac computed tomography angiography (cCTA) has been developed as a non-invasive anatomical test for a direct visualisation of coronary vessels and detailed description of atherosclerotic burden. Cardiovascular imaging techniques have dramatically enhanced our knowledge regarding physiological aspects and myocardial implications of CAD. Recently, after the publication of important trials, international guidelines recognised these changes, updating indications and level of recommendations. This review aims to summarise current standards with main novelties and specific limitations, and a diagnostic algorithm for up-to-date clinical management is also proposed.

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“…7,8,10, 12 Zavadovsky et al reported that MFR may be clinically more powerful than MBF because of several factors, including potential inaccurate extraction fraction correction, the lack of attenuation correction, differences in spatial resolution, and higher image noise. 23 Considering the attenuation of the patient was similar between stress and rest, the MFR obtained by dividing the tracer uptake during the stress scan by that during the resting scan may cancel the effects of the attenuation. Moreover, a recent study reported that the MFR value of each coronary artery obtained through CZT-SPECT correlates with invasive FFR.…”

Section: Analyzing Each Coronary Artery Territorymentioning

confidence: 99%

Quantitative Assessment Using the Compartment Model for Detecting Regional Coronary Artery Disease by Dynamic Myocardial Perfusion Single-Photon Emission Computed Tomography

Kawaguchi

Miyagawa

Okada

et al. 2022

Circ J

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Background: This study aimed to quantitatively evaluate myocardial perfusion single-photon emission computed tomography (SPECT) using an original analysis tool in the compartment model for detecting regional significant coronary artery disease (CAD). Methods and Results:This study analyzed 41 patients (median age, 76 years) with suspected or known CAD who underwent both dynamic SPECT using 99 m Tc-tetrofosmin and invasive coronary angiography. The quantitative analysis was performed using a singletissue compartment model to evaluate the diagnostic performance of the myocardial flow reserve (MFR) for regional significant CAD, excluding infarcted territories. In the regional analysis, 114 vessels were assessed, of which 31 were diagnosed as significant coronary lesions (≥70% stenosis and/or fraction flow reserve ≤0.8). The MFR of regional significant CAD was significantly lower than that of non-significant CAD (1.11 [0.97-1.31] vs. 1.74 [1.30-2.27]; P<0.001). In the receiver operating characteristic curve analysis, the MFR displayed an area under the curve (AUC) of 0.81. While analyzing each coronary artery territory, the diagnostic performance of the MFR value in the left anterior descending (LAD) artery territory was found to be significantly higher than that found in qualitative assessment (AUC: 0.84 vs. 0.61). Conclusions:A quantitative analysis of dynamic SPECT data facilitated detecting regional CAD. For the LAD artery, the MFR displayed a higher diagnostic performance than the qualitative assessment of conventional myocardial perfusion SPECT.

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The current status of CZT SPECT myocardial blood flow and reserve assessment: Tips and tricks

Cited by 36 publications

References 71 publications

Technetium-99m Radiopharmaceuticals for Ideal Myocardial Perfusion Imaging: Lost and Found Opportunities

Technetium-99m Radiopharmaceuticals for Ideal Myocardial Perfusion Imaging: Lost and Found Opportunities

Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging

Quantitative Assessment Using the Compartment Model for Detecting Regional Coronary Artery Disease by Dynamic Myocardial Perfusion Single-Photon Emission Computed Tomography

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