The Relationship Between Quantitative Perfusion and Functional Results and Acquisition Time With Reduced Administered Activity for 99mTc Tetrofosmin Myocardial Gated-SPECT

Leva, Lucia; Brambilla, Marco; Matheoud, Roberta; Vigna, L.; Marino, Paolo; Inglese, Eugenio

doi:10.1097/rlu.0b013e31823ea42c

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…Since phase variables can be obtained fully automatically with high reproducibility [ 31 ], those can be readily incorporated into clinical PET-MPI reporting. In addition, phase entropy was consistently associated prognosis in patients undergoing SPECT and PET-MPI [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Incremental prognostic value of stress phase entropy over standard PET myocardial perfusion imaging variables

Kuronuma

Miller

Kriekinge

et al. 2023

Eur J Nucl Med Mol Imaging

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Purpose Phase analysis can assess left ventricular dyssynchrony. The independent prognostic value of phase variables over positron emission tomography myocardial perfusion imaging (PET-MPI) variables including myocardial flow reserve (MFR) has not been studied. The aim of this study was to explore the prognostic value of phase variables for predicting mortality over standard PET-MPI variables. Methods Consecutive patients who underwent pharmacological stress-rest 82Rb PET study were enrolled. All PET-MPI variables including phase variables (phase entropy, phase bandwidth, and phase standard deviation) were automatically obtained by QPET software (Cedars-Sinai, Los Angeles, CA). Cox proportional hazard analyses were used to assess associations with all-cause mortality (ACM). Results In a total of 3963 patients (median age 71 years; 57% male), 923 patients (23%) died during a median follow-up of 5 years. Annualized mortality rates increased with stress phase entropy, with a 4.6-fold difference between the lowest and highest decile groups of entropy (2.6 vs. 12.0%/year). Abnormal stress phase entropy (optimal cutoff value, 43.8%) stratified ACM risk in patients with normal and impaired MFR (both p < 0.001). Among three phase variables, only stress phase entropy was significantly associated with ACM after the adjustment of standard clinical and PET-MPI variables including MFR and stress-rest change of phase variables, whether modeled as binary variables (adjusted hazard ratio, 1.44 for abnormal entropy [> 43.8%]; 95%CI, 1.18–1.75; p < 0.001) or continuous variables (adjusted hazard ratio, 1.05 per 5% increase; 95%CI, 1.01–1.10; p = 0.030). The addition of stress phase entropy to the standard PET-MPI variables significantly improved the discriminatory power for ACM prediction (p < 0.001), but the other phase variables did not (p > 0.1). Conclusion Stress phase entropy is independently and incrementally associated with ACM beyond standard PET-MPI variables including MFR. Phase entropy can be obtained automatically and included in clinical reporting of PET-MPI studies to improve patient risk prediction.

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Section: Discussionmentioning

confidence: 99%

Incremental prognostic value of stress phase entropy over standard PET myocardial perfusion imaging variables

Kuronuma

Miller

Kriekinge

et al. 2023

Eur J Nucl Med Mol Imaging

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“…A dissincronia do VE tem sido avaliada por várias modalidades de imagem cardiovascular, incluindo ecocardiograma com Doppler tecidual ou mesmo strain 18 , 19 ou ressonância magnética; 20 e imagem nuclear por meio de ventriculografia radioisotópica ou SPECT. 21 A contração do VE foi inicialmente analisada com sucesso por ventriculografia radionuclídica, mas, com a adição de análise de fase para gated SPECT e sua subsequente validação, esta técnica tem demonstrado excelente potencial na determinação da dissincronia mecânica do VE. A gated SPECT permite a avaliação da dissincronia do VE usando as funções harmônicas de Fourier para estimar o espessamento da parede ao longo do ciclo cardíaco e determinar o momento do início regional da contração mecânica do ventrículo, obtendo uma análise quantitativa tridimensional de todo o VE.…”

Section: Discussionunclassified

“…Os valores de corte de 135º para alargamento da banda (HBW) e 43º para o DP podem predizer a resposta clínica. 8 , 21 , 22 No presente estudo, encontramos uma média de 92,5º e 31º antes da ressincronização para HBW e DP de fase, respectivamente.…”

Section: Discussionunclassified

Viabilidade do Implante de Eletrodo Ventricular Esquerdo na Terapia de Ressincronização Cardíaca Guiada por Gated SPECT e Remodelamento Ventricular

Nascimento¹,

Fernandes²,

Mira³

et al. 2023

Arquivos Brasileiros De Cardiologia

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Fundamento: A terapia de ressincronização cardíaca (TRC) pode beneficiar pacientes com insuficiência cardíaca (IC) avançada. O índice de excentricidade anormal por gated SPECT está relacionado a alterações estruturais e funcionais do ventrículo esquerdo (VE). Objetivo: O objetivo do presente estudo foi avaliar a viabilidade do implante de eletrodos do VE guiado por análise de fase e sua relação com o remodelamento ventricular. Métodos: Dezoito pacientes com indicação de TRC foram submetidos à cintilografia miocárdica para orientar o implante, avaliando-se os parâmetros de excentricidade e forma ventricular. P < 0,05 foi adotado como significância estatística. Resultados: Na linha de base do estudo, a maioria dos pacientes foi classificada como NYHA 3 (n = 12). Após a TRC, 11 dos 18 pacientes foram reclassificados para um menor grau de limitação funcional. Além disso, a qualidade de vida dos pacientes melhorou após a TRC. Foram observadas reduções significativas na duração do QRS, intervalo PR, índice de forma diastólica final, índice de forma sistólica final, volume sistólico e massa miocárdica pós-TRC. O eletrodo do VE da TRC foi posicionado concordante, adjacente e discordante em 11 (61,1%), 5 (27,8%) e 2 (11,1%) pacientes, respectivamente. A excentricidade sistólica e diastólica final demonstrou remodelamento reverso após a TRC. Conclusões: O implante de eletrodo do VE em TRC guiado por cintilografia gated SPECT é viável. A colocação do eletrodo concordante ou adjacente ao último segmento a se contrair foi um determinante do remodelamento reverso.

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“…However, this study did not directly compare between standard dose and half dose data in the same group of patients. Another recent patient study 15 demonstrated that GSPECT using imaging dose with 31% reduction can yield comparable results to standard dose in terms of myocardial perfusion and left ventricular ejection fraction scores. A numerical observer study also suggested that there is some room to reduce either acquisition time or injected activity without degrading performance of myocardial perfusion defect detection using 3D reconstruction with better imaging models.…”

Section: Introductionmentioning

confidence: 95%

4D reconstruction for low-dose cardiac gated SPECT

Niu

et al. 2013

Med. Phys.

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Purpose: Due to the combination of high-frequency use and relatively high diagnostic radiation dose (>9 mSv for one scan), there is a need to lower the radiation dose used in myocardial perfusion imaging (MPI) studies in cardiac gated single photon emission computed tomography (GSPECT) in order to reduce its population based cancer risk. The aim of this study is to assess quantitatively the potential utility of advanced 4D reconstruction for GSPECT for significantly lowered imaging dose. Methods: For quantitative evaluation, Monte Carlo simulation with the 4D NURBS-based cardiactorso (NCAT) phantom is used for GSPECT imaging at half and quarter count levels in the projections emulating lower injected activity (dose) levels. Both 4D and 3D reconstruction methods are applied at these lowered dose levels, and compared with standard clinical spatiotemporal reconstruction (ST121) at full dose using a number of metrics on the reconstructed images: (1) overall reconstruction accuracy of the myocardium, (2) regional bias-variance analysis of the left ventricle (LV) wall, (3) uniformity of the LV wall, (4) accuracy of the time activity curve (TAC) of the LV wall, and (5) detectability of perfusion defects using channelized Hotelling observer. As a preliminary demonstration, two sets of patient data acquired in list-mode are used to illustrate the conservation of both image quality and LV ejection fraction (LVEF) by 4D reconstruction where only a portion of the acquired counts at each projection angle are used to mimic low-dose acquisitions. Results: Compared to ST121 at standard dose, even at quarter dose 4D achieved better performance on overall reconstruction accuracy of the myocardium (28.7% improvement on relative root mean square error: standard vs 4D quarter p-value < 10 −30 ), regional bias-variance analysis, and similar performance on accuracy of the TAC of the LV wall and detectability of perfusion defects. A slight degradation in uniformity of the LV wall was observed in 4D at quarter dose due to use of scatter correction which increases reconstruction variance. The reconstructed images from simulated and patient data show that 4D at quarter dose is visually comparable to ST121 at standard dose, if not better. Compared to ST121 and 3D, 4D images exhibit less noise artifacts and better definition of the LV wall. The 4D images are also observed to be more consistent between half dose and quarter dose. 4D also yields more consistent LVEF results at different count levels on the patient data. Conclusions: With various quantitative metrics 4D reconstruction is demonstrated to achieve better or comparable performance at quarter dose (∼2.25 mSv, 75% dose reduction) compared to conventional clinical reconstruction at standard dose (∼9 mSv). Preliminary results from two patient datasets also show that 4D at an equivalent quarter dose can achieve better performance than clinical and 3D methods at higher dose levels. Such a significant dose reduction (75%) has not been demonstrated quantitatively in previous studies in GS...

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The Relationship Between Quantitative Perfusion and Functional Results and Acquisition Time With Reduced Administered Activity for 99mTc Tetrofosmin Myocardial Gated-SPECT

Cited by 8 publications

References 19 publications

Incremental prognostic value of stress phase entropy over standard PET myocardial perfusion imaging variables

Incremental prognostic value of stress phase entropy over standard PET myocardial perfusion imaging variables

Viabilidade do Implante de Eletrodo Ventricular Esquerdo na Terapia de Ressincronização Cardíaca Guiada por Gated SPECT e Remodelamento Ventricular

4D reconstruction for low-dose cardiac gated SPECT

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