PURPOSE: Effective doses of 14 mSv or higher are currently being attained in patients having stress and rest myocardial perfusion imaging (MPI) single photon emission computed tomography (SPECT) performed on the same day with conventional protocols. This study aimed to assess the actual reduction in effective doses as well as diagnostic performances for MPI routinely planned with: (1) high-sensitivity cadmium zinc telluride (CZT) cameras, (2) very low injected activities and (3) a stress-first protocol where the normality of stress images may lead to avoiding rest imaging. METHODS: During a 1-year period, 2,845 patients had MPI on a CZT camera, a single-day stress-first protocol and low injected activities (120 MBq of (99m)Tc-sestamibi at stress for 75 kg body weight and threefold higher at rest). The ability to detect > 50% coronary stenosis was assessed in a subgroup of 149 patients who also had coronary angiography, while the normalcy rate was assessed in a subgroup of 128 patients with a low pretest likelihood of coronary artery disease (<10%). RESULTS: Overall, 33% of patients had abnormal MPI of which 34% were women and 34% were obese. The mean effective doses and the percentage of exams involving only stress images were: (1) 3.53 ± 2.10 mSv and 37% in the overall population, (2) 4.83 ± 1.56 mSv and 5% in the subgroup with angiography and (3) 1.96 ± 1.52 mSv and 71 % in the low-probability subgroup. Sensitivity and global accuracy for identifying the 106 patients with coronary stenosis were 88 and 80%, respectively, while the normalcy rate was 97 %. CONCLUSION: When planned with a low-dose stress-first protocol on a CZT camera, MPI provides high diagnostic performances and a dramatic reduction in patient radiation doses. This reduction is even greater in low-risk subgroups with high rates of normal stress images, thus allowing the mean radiation dose to be balanced against cardiac risk in targeted populations.
PURPOSE: Effective doses of 14 mSv or higher are currently being attained in patients having stress and rest myocardial perfusion imaging (MPI) single photon emission computed tomography (SPECT) performed on the same day with conventional protocols. This study aimed to assess the actual reduction in effective doses as well as diagnostic performances for MPI routinely planned with: (1) high-sensitivity cadmium zinc telluride (CZT) cameras, (2) very low injected activities and (3) a stress-first protocol where the normality of stress images may lead to avoiding rest imaging. METHODS: During a 1-year period, 2,845 patients had MPI on a CZT camera, a single-day stress-first protocol and low injected activities (120 MBq of (99m)Tc-sestamibi at stress for 75 kg body weight and threefold higher at rest). The ability to detect > 50% coronary stenosis was assessed in a subgroup of 149 patients who also had coronary angiography, while the normalcy rate was assessed in a subgroup of 128 patients with a low pretest likelihood of coronary artery disease (<10%). RESULTS: Overall, 33% of patients had abnormal MPI of which 34% were women and 34% were obese. The mean effective doses and the percentage of exams involving only stress images were: (1) 3.53 ± 2.10 mSv and 37% in the overall population, (2) 4.83 ± 1.56 mSv and 5% in the subgroup with angiography and (3) 1.96 ± 1.52 mSv and 71 % in the low-probability subgroup. Sensitivity and global accuracy for identifying the 106 patients with coronary stenosis were 88 and 80%, respectively, while the normalcy rate was 97 %. CONCLUSION: When planned with a low-dose stress-first protocol on a CZT camera, MPI provides high diagnostic performances and a dramatic reduction in patient radiation doses. This reduction is even greater in low-risk subgroups with high rates of normal stress images, thus allowing the mean radiation dose to be balanced against cardiac risk in targeted populations.
Authors: Tali Sharir; Piotr J Slomka; Sean W Hayes; Marcelo F DiCarli; Jack A Ziffer; William H Martin; Dalia Dickman; Simona Ben-Haim; Daniel S Berman Journal: J Am Coll Cardiol Date: 2010-05-04 Impact factor: 24.094
Authors: Michael Fiechter; Jelena R Ghadri; Silke M Kuest; Aju P Pazhenkottil; Mathias Wolfrum; Rene N Nkoulou; Robert Goetti; Oliver Gaemperli; Philipp A Kaufmann Journal: Eur J Nucl Med Mol Imaging Date: 2011-07-15 Impact factor: 9.236
Authors: N David; P Y Marie; M Angioi; R M Rodriguez; N Hassan; P Olivier; A Grentzinger; G Karcher; O Claudon; Y Juillière; N Danchin; A Bertrand Journal: Eur J Nucl Med Date: 2000-07
Authors: Akhil Kapur; Katherine A Latus; Glyn Davies; Rhanju T Dhawan; Sian Eastick; Peter H Jarritt; George Roussakis; Melanie C Young; Constantinos Anagnostopoulos; Jimmy Bomanji; Durval C Costa; Dudley J Pennell; Elizabeth M Prvulovich; Peter J Ell; S Richard Underwood Journal: Eur J Nucl Med Mol Imaging Date: 2002-10-11 Impact factor: 9.236
Authors: Axel Schmermund; Mohamed Marwan; Jörg Hausleiter; Sebastian Barth; Oliver Bruder; Sebastian Kerber; Grigorius Korosoglou; Alexander Leber; Werner Moshage; Stephen Schröder; Steffen Schneider; Jochen Senges; Stephan Achenbach Journal: Clin Res Cardiol Date: 2017-07-19 Impact factor: 5.460