The value and appropriateness of positron emission tomography: An evolving tale

Hendel, Robert C.

doi:10.1007/s12350-014-9962-9

Cited by 6 publications

(3 citation statements)

References 37 publications

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“…In a prior publication, we demonstrated that approximately 10% of nuclear MPI at our institution are inappropriate, 5 similar to reports from other facilities. 6 We also observed a substantial proportion of patients underwent MPI despite having no symptoms at the time. We conducted the current investigation to assess the clinical utility of MPI in patients without symptoms.…”

Section: Introductionmentioning

confidence: 54%

A Cohort Study of Myocardial Perfusion Imaging in Veteran Patients Without Symptoms

et al. 2015

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Myocardial perfusion imaging (MPI) is commonly used to detect ischemia. Concerns about silent ischemia may encourage orders for MPI in asymptomatic patients. Factors contributing to this practice are poorly described and the clinical utility is questionable.We conducted a single center retrospective cohort investigation on Veterans who underwent MPI between December 2010 and July 2011. We gathered data on symptoms, baseline characteristics, results of MPI, and cardiovascular events within 1 year. MPI were categorized using 2009 appropriate use criteria (AUC).Of 592 patients, 127 (21.5%) had no symptoms at the time of MPI. Comparing symptomatic and asymptomatic patients, no differences were observed in baseline characteristics except abnormal ECG, more common in asymptomatic patients (n = 86, 67.7% vs. n = 232, 49.9% for symptomatic patients, P < 0.0001). Asymptomatic MPI were more commonly inappropriate (n = 26, 21.5% vs. n = 31, 6.7% for appropriate/uncertain, P < 0.0001). Detection of ischemia between patients with and without symptoms was not different (P = 0.86); however, among asymptomatic MPI that also demonstrated ischemia, none were inappropriate (n = 10 appropriate, n = 7 uncertain). In multivariate regression, 2 factors were associated with asymptomatic status, abnormal ECG (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.5–3.49) and age over the median (OR 0.63, 95% CI: 0.41–0.95).A substantial portion of MPI tests are ordered for patients without symptoms. When compared to symptomatic patients, MPI for asymptomatic patient were more commonly inappropriate; however, the prevalence of ischemia was similar. MPI may be clinically relevant in some asymptomatic patients and decisions to test should be based on the AUC.

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Section: Introductionmentioning

confidence: 54%

A Cohort Study of Myocardial Perfusion Imaging in Veteran Patients Without Symptoms

et al. 2015

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“…Positron Emission Tomography (PET) has enabled the in-vivo quantitative imaging of numerous radio-pharmaceutical tracers by time-coincidentally detecting two emitted gamma photons travelling through tissue in opposite directions (1,2). However, the photons may be absorbed or scattered before reaching the detectors resulting in PET signal attenuation, which is quantified by the attenuation coefficients (ACFs) (1,3).…”

Section: Introductionmentioning

confidence: 99%

Hybrid PET- and MR-driven attenuation correction for enhanced 18F-NaF and 18F-FDG quantification in cardiovascular PET/MR imaging

Karakatsanis

Abgral

Trivieri

et al. 2020

Journal of Nuclear Cardiology

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Background: The standard MR Dixon-based attenuation correction (AC) method in Positron Emission Tomography / Magnetic Resonance (PET/MR) imaging segments only the air, lung, fat and soft-tissues (4-class), thus neglecting the highly attenuating bone tissues and affecting quantification in bones and adjacent vessels. We sought to address this limitation by utilizing the distinctively high bone uptake rate constant Ki expected from 18 F-Sodium Fluoride (18 F-NaF) to segment bones from PET data and support 5-class hybrid PET/MR-driven AC for 18 F-NaF and 18 F-Fluorodeoxyglucose (18 F-FDG) PET/MR cardiovascular imaging. Methods: We introduce 5-class Ki/MR-AC for (i) 18 F-NaF studies where the bones are segmented from Patlak Ki images and added as the 5 th tissue class to the MR-Dixon 4-class AC map. Furthermore, we propose two alternative dual-tracer protocols to permit 5-class Ki/MR-AC for (ii) 18 F-FDG-only data, with a streamlined simultaneous administration of 18 F-FDG and 18 F-NaF at 4:1 ratio (R4:1), or (iii) for 18 F-FDG-only or both 18 F-FDG and 18 F-NaF dual-tracer data, by administering 18 F-NaF 90 min after an equal 18 F-FDG dosage (R1:1). The Ki-driven bone segmentation was validated against Computed Tomography (CT)-based segmentation in rabbits, followed by PET/MR validation on 108 vertebral bone and carotid wall regions in 16 human volunteers with and without prior indication of carotid atherosclerosis disease (CAD). Results: In rabbits, we observed similar (<1.2% mean difference) vertebral bone 18 F-NaF SUVmean scores when applying 5-class AC with Ki-segmented bone (5-class Ki/CT-AC) versus CT-segmented bone (5-class CT-AC) tissue. Considering the PET data corrected with continuous CT-AC maps as gold-standard, the percentage SUVmean bias was reduced by 17.6% (18 F-NaF) and 15.4% (R4:1) with 5-class Ki/CT-AC versus 4-class CT-AC. In humans without prior CAD indication, we reported 17.7% and 20% higher 18 F-NaF target-to-background ratio (TBR) at carotid bifurcations wall and vertebral bones, respectively, with 5-versus 4-class AC. In the R4:1 human cohort, the mean 18 F-FDG TBR increased by 12.2% at carotid bifurcations wall and 19.9% at vertebral bones. For the R1:1 cohort of human without CAD indication, mean TBR increased by 15.3% (18 F-FDG) and 15.5% (18 F-NaF) at carotid bifurcations and 21.6% (18 F-FDG) and 22.5% (18 F-NaF) at vertebral bones. Similar TBR enhancements were observed whe applying the proposed AC method to human subjects with prior CAD indication.. Conclusions: Ki-driven bone segmentation and 5-class hybrid PET/MR-driven AC is feasible and can significantly enhance 18 F-NaF and 18 F-FDG contrast and quantification in bone tissues and carotid walls.

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“…2,3 Many investigators from ASNC membership have reported on adherence and determinants of AUC use and the impact of AUC on patient outcomes, radiation exposure, and cost effectiveness. [4][5][6][7][8][9][10][11][12] Furthermore, cardiovascular specialists demonstrated the value of systematic implementation of CDSM to minimize the utilization of rarely appropriate cardiac imaging studies and maximize the use of appropriate medical therapy. 13 Much of this literature was, in fact, published in this very journal.…”

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confidence: 99%

PAMA implementation: The road ahead

Doukky

2019

Journal of Nuclear Cardiology

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The value and appropriateness of positron emission tomography: An evolving tale

Cited by 6 publications

References 37 publications

A Cohort Study of Myocardial Perfusion Imaging in Veteran Patients Without Symptoms

A Cohort Study of Myocardial Perfusion Imaging in Veteran Patients Without Symptoms

Hybrid PET- and MR-driven attenuation correction for enhanced 18F-NaF and 18F-FDG quantification in cardiovascular PET/MR imaging

PAMA implementation: The road ahead

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