Andrew J Einstein1, Ron Blankstein2, Howard Andrews3, Mathews Fish4, Richard Padgett4, Sean W Hayes5, John D Friedman5, Mehreen Qureshi6, Harivony Rakotoarivelo6, Piotr Slomka7, Ryo Nakazato8, Sabahat Bokhari6, Marcello Di Carli2, Daniel S Berman5. 1. Department of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York andrew.einstein@columbia.edu. 2. Department of Medicine, Cardiology Division, Brigham and Women's Hospital, Boston, Massachusetts. 3. Department of Biostatistics, Columbia University, New York, New York. 4. Oregon Heart and Vascular Institute, Springfield, Oregon. 5. Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and. 6. Department of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York. 7. Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. 8. Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan.
Abstract
UNLABELLED: SPECT myocardial perfusion imaging plays a central role in coronary artery disease diagnosis, but concerns exist regarding its radiation burden. Compared with standard Anger SPECT (A-SPECT) cameras, new high-efficiency (HE) cameras with specialized collimators and solid-state cadmium-zinc-telluride detectors offer potential to maintain image quality (IQ), while reducing administered activity and thus radiation dose to patients. No previous study has compared IQ, interpretation, total perfusion deficit (TPD), or ejection fraction (EF) in patients receiving both ultra-low-dose (ULD) imaging on an HE SPECT camera and standard low-dose (SLD) A-SPECT imaging. METHODS: We compared ULD HE SPECT with SLD A-SPECT imaging by dividing the rest dose in 101 patients at 3 sites scheduled to undergo clinical A-SPECT myocardial perfusion imaging using a same day rest-stress (99m)Tc protocol. Patients underwent HE SPECT imaging after an initial approximately 130-MBq (3.5 mCi) dose and SLD-A-SPECT imaging after the remainder of the planned dose. Images were scored visually by 2 masked readers for IQ and summed rest score. TPD and EF were assessed quantitatively. RESULTS: Mean activity was 134 MBq (3.62 mCi) for ULD HE SPECT (effective dose, 1.15 mSv) and 278 MBq (7.50 mCi, 2.39 mSv) for SLD A-SPECT. Overall IQ was superior for ULD HE SPECT (P < 0.0001), with twice as many studies graded excellent quality. Extracardiac activity and overall perfusion assessment were similar. Between-method correlations were high for summed rest score (r = 0.87), TPD (r = 0.91), and EF (r = 0.88). CONCLUSION: ULD HE SPECT rest imaging correlates highly with SLD A-SPECT. It has improved image quality, comparable extracardiac activity, and achieves radiation dose reduction to 1 mSv for a single injection.
UNLABELLED: SPECT myocardial perfusion imaging plays a central role in coronary artery disease diagnosis, but concerns exist regarding its radiation burden. Compared with standard Anger SPECT (A-SPECT) cameras, new high-efficiency (HE) cameras with specialized collimators and solid-state cadmium-zinc-telluride detectors offer potential to maintain image quality (IQ), while reducing administered activity and thus radiation dose to patients. No previous study has compared IQ, interpretation, total perfusion deficit (TPD), or ejection fraction (EF) in patients receiving both ultra-low-dose (ULD) imaging on an HE SPECT camera and standard low-dose (SLD) A-SPECT imaging. METHODS: We compared ULD HE SPECT with SLD A-SPECT imaging by dividing the rest dose in 101 patients at 3 sites scheduled to undergo clinical A-SPECT myocardial perfusion imaging using a same day rest-stress (99m)Tc protocol. Patients underwent HE SPECT imaging after an initial approximately 130-MBq (3.5 mCi) dose and SLD-A-SPECT imaging after the remainder of the planned dose. Images were scored visually by 2 masked readers for IQ and summed rest score. TPD and EF were assessed quantitatively. RESULTS: Mean activity was 134 MBq (3.62 mCi) for ULD HE SPECT (effective dose, 1.15 mSv) and 278 MBq (7.50 mCi, 2.39 mSv) for SLD A-SPECT. Overall IQ was superior for ULD HE SPECT (P < 0.0001), with twice as many studies graded excellent quality. Extracardiac activity and overall perfusion assessment were similar. Between-method correlations were high for summed rest score (r = 0.87), TPD (r = 0.91), and EF (r = 0.88). CONCLUSION: ULD HE SPECT rest imaging correlates highly with SLD A-SPECT. It has improved image quality, comparable extracardiac activity, and achieves radiation dose reduction to 1 mSv for a single injection.
Authors: Piotr J Slomka; Hidetaka Nishina; Daniel S Berman; Cigdem Akincioglu; Aiden Abidov; John D Friedman; Sean W Hayes; Guido Germano Journal: J Nucl Cardiol Date: 2005 Jan-Feb Impact factor: 5.952
Authors: Daniel S Berman; Xingping Kang; Balaji Tamarappoo; Arik Wolak; Sean W Hayes; Ryo Nakazato; Louise E J Thomson; Faith Kite; Ishac Cohen; Piotr J Slomka; Andrew J Einstein; John D Friedman Journal: JACC Cardiovasc Imaging Date: 2009-03
Authors: Alan Rozanski; Heidi Gransar; Sean W Hayes; James Min; John D Friedman; Louise E J Thomson; Daniel S Berman Journal: J Am Coll Cardiol Date: 2013-03-12 Impact factor: 24.094
Authors: F J Wackers; D S Berman; J Maddahi; D D Watson; G A Beller; H W Strauss; C A Boucher; M Picard; B L Holman; R Fridrich Journal: J Nucl Med Date: 1989-03 Impact factor: 10.057
Authors: Fabio P Esteves; Paolo Raggi; Russell D Folks; Zohar Keidar; J Wells Askew; Shmuel Rispler; Michael K O'Connor; Liudmilla Verdes; Ernest V Garcia Journal: J Nucl Cardiol Date: 2009-08-18 Impact factor: 5.952
Authors: João V Vitola; Fernando Mut; Erick Alexánderson; Thomas N B Pascual; Mathew Mercuri; Ganesan Karthikeyan; Nathan Better; Madan M Rehani; Ravi Kashyap; Maurizio Dondi; Diana Paez; Andrew J Einstein Journal: J Nucl Cardiol Date: 2016-02-22 Impact factor: 5.952
Authors: James A Case; Robert A deKemp; Piotr J Slomka; Mark F Smith; Gary V Heller; Manuel D Cerqueira Journal: J Nucl Cardiol Date: 2017-05-16 Impact factor: 5.952
Authors: Sharmila Dorbala; Karthik Ananthasubramaniam; Ian S Armstrong; Panithaya Chareonthaitawee; E Gordon DePuey; Andrew J Einstein; Robert J Gropler; Thomas A Holly; John J Mahmarian; Mi-Ae Park; Donna M Polk; Raymond Russell; Piotr J Slomka; Randall C Thompson; R Glenn Wells Journal: J Nucl Cardiol Date: 2018-10 Impact factor: 5.952