Adding attenuation corrected images in myocardial perfusion imaging reduces the need for a rest study

Trägårdh, Elin; Valind, Sven; Edenbrandt, Lars

doi:10.1186/1471-2342-13-14

Cited by 15 publications

(8 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Yet, the necessity for rest imaging varied between those studies which is most likely due to different study designs and populations. Heller et al reported a reduced necessity for additional rest imaging from 77 to 43%,6 which is in agreement with the study by Trägårdh et al showing a decrease from 49% to 32% when using AC 7. The latter study shows similar results to our study, although we used a more sensitive CZT-based camera associated with a lower need for rest imaging with similar follow-up 9.…”

Section: Discussionsupporting

confidence: 93%

Value of attenuation correction in stress-only myocardial perfusion imaging using CZT-SPECT

Dijk

Mouden

Ottervanger

et al. 2017

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

BackgroundAttenuation correction (AC) improves the diagnostic outcome of stress-only myocardial perfusion imaging (MPI) using conventional SPECT. Our aim was to determine the value of AC using a cadmium zinc telluride-based (CZT)-SPECT camera.Methods and resultsWe retrospectively included 107 consecutive patients who underwent stress-optional rest MPI CZT-SPECT/CT. Next, we created three types of images for each patient; (1) only displaying reconstructed data without the CT-based AC (NC), (2) only displaying AC, and (3) with both NC and AC (NC + AC). Next, two experienced physicians visually interpreted these 321 randomized images as normal, equivocal, or abnormal. Image outcome was compared with all hard events over a mean follow-up time of 47.7 ± 9.8 months. The percentage of images interpreted as normal increased from 45% using the NC images to 72% using AC and to 67% using NC + AC images (P < .001). Hard event hazard ratios for images interpreted as normal were not different between using NC and AC (1.01, P = .99), or NC and NC + AC images (0.97, P = .97).ConclusionsAC lowers the need for additional rest imaging in stress-first MPI using CZT-SPECT, while long-term patient outcome remained identical. Use of AC reduces the need for additional rest imaging, decreasing the mean effective dose by up to 1.2 mSv.

show abstract

Section: Discussionsupporting

confidence: 93%

Value of attenuation correction in stress-only myocardial perfusion imaging using CZT-SPECT

Dijk

Mouden

Ottervanger

et al. 2017

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

show abstract

“…Mathur et al [19] found that stress-only imaging with attenuation correction in symptomatic patients is an efficient method which appropriately identifies at-risk and low-risk patients, yielding a low percentage requiring rest imaging. A previous study from our group also demonstrated that adding attenuation correction stress-only images to non-attenuation-corrected stress-only images reduced the need for unnecessary rest studies substantially [20]. …”

Section: Resultsmentioning

confidence: 99%

Prognosis of patients without perfusion defects with and without rest study in myocardial perfusion scintigraphy

2013

Self Cite

View full text Add to dashboard Cite

BackgroundStress myocardial perfusion scintigraphy (MPS) is widely regarded as a useful imaging modality for diagnosing patients with suspected ischemic heart disease. Current European guidelines recommend stress study to be performed first since rest study can be omitted if stress study is interpreted as normal. Thus, a rest study should only be performed in patients with equivocal or abnormal studies. The aim of the present study was to investigate the prognosis of a normal stress-only MPS compared to a normal stress-rest MPS in a retrospective manner and also with regard to normal/abnormal left ventricular function data.MethodsAll 4,820 patients who underwent 99mTc MPS at Skåne University Hospital in Malmö, Sweden, in 2004 to 2007, for suspected or management of known ischemic heart disease were considered. The physician in clinical charge of the investigation decided whether a rest study was necessary or not. Based on the final report according to clinical routine, only patients with a normal perfusion study (no infarction or inducible ischemia) were included. The endpoints were non-fatal acute coronary syndrome or death from ischemic cardiac origin.ResultsA total of 3,426 patients with a normal perfusion study were included. Of these, 2,215 patients had a stress-only study and 1,211 patients had both stress and rest studies. Mean follow-up was 6.2 years. The lowest event rate was found in the normal stress-only group (0.56% for normal stress-only patients vs. 1.42% for normal stress-rest patients; p < 0.0001). When dividing patients according to sex and stress type, the best prognosis was also found in the normal stress-only group (p < 0.0001 for all comparisons). Regarding left ventricular function data, we did not find any significant difference in event rate between normal vs. abnormal ejection fraction (EF), normal vs. abnormal end-diastolic volume (EDV) or normal EF, and EDV vs. abnormal EF or EDV for either the normal stress-only patients or the normal stress-rest patients.ConclusionsPatients with a normal stress-only study had an excellent prognosis over a mean follow-up time of 6 years. Thus, omitting the rest study if the stress study is normal is a safe procedure.

show abstract

“…4 Moreover, applying attenuation correction can further reduce this dose by an additional 16% due to an increase in normalcy rate and lower need for additional rest imaging. [5][6][7] In addition, multiple studies showed that the introduction of a new generation cadmium zinc telluride (CZT)-based SPECT cameras allows further dose reductions. [8][9][10] However, these studies did not determine the minimal product of tracer activity and scan time (PAST) that does not affect the diagnostic outcome in CZT-SPECT MPI.…”

Section: Introductionmentioning

confidence: 99%

Effect of a patient-specific minimum activity in stress myocardial perfusion imaging using CZT-SPECT: Prognostic value, radiation dose, and scan outcome

Dijk

Borren

Mouden

et al. 2018

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

Background. SPECT Myocardial perfusion imaging (MPI) is associated with a relatively high radiation burden and decreasing image quality in heavy patients. Patient-specific low-activity protocols (PLAPs) are suggested but follow-up data is lacking. Our aim was to compare the use of a standard fixed-activity protocol (FAP) with a PLAP in cadmium zinc telluride (CZT)-SPECT MPI.Methods. We retrospectively included 1255 consecutive patients who underwent CZT-SPECT stress-optional rest MPI. 668 Patients were scanned using FAP (370 MBq) and 587 patients using PLAP (2.25 MBq·kg −1 ). Percentage of scans interpreted as normal, radiation dose, and 1-year follow-up including hard event rates (all-cause death or non-fatal myocardial infarction) were collected and compared.Results. The percentage of scans interpreted as normal was 67% in FAP and 70% in PLAP groups (P = .29). The annualized hard event rates in these patients were 1.0% in the FAP and 0.9% in the PLAP group (P = .86). However, the mean radiation dose decreased by 23% for stress-only and by 15% to 2.6 mSv for stress-optional rest MPI after introduction of the PLAP (p<0.001).Conclusions. Introduction of a patient-specific low-activity protocol does not affect the percentage of scans interpreted as normal or prognosis but significantly lowers the radiation dose for CZT-SPECT MPI. (J Nucl Cardiol 2018;25:26-35.) Spanish AbstractAntecedentes. El estudio de imagen de perfusión miocárdica con SPECT (MPI, por sus siglas en ingles) se asocia con una carga de radiación relativamente alta y una menor calidad de imagen en pacientes obesos. Se sugieren protocolos de baja actividad específica para cada pacientes (PBAP), sin embargo faltan datos de seguimiento. Nuestro objetivo fue comparar el uso de un protocolo con actividad fija estándar (PAF) con un PBAP en un estudio de perfusión miocárdica con SPECT CZT cadmio-zinc-telurio. Métodos. Incluimos de manera retrospectiva 1255 pacientes consecutivos que se sometieron a un SPECT CZT de estrés con fase de reposo de manera opcional. 668 pacientes fueron escaneados usando un PAF (370 MBq) y 587 pacientes utilizando un PBAP (2.25 MBq/kg). Los porcentajes de exploraciones interpretadas como normales, dosis de radiación y seguimiento de un año incluyendo tasas de eventos duros (muerte por todas las causas o infarto de miocardio no fatal) fueron recolectados y comparados.Resultados. El porcentaje de exploraciones interpretadas como normales fue de 67% en el PAF y de 70% en el PBAP (p = 0.29). Las tasas de eventos duros anuales en estos pacientes fueron del 1.0% en el PAF y del 0.9% en el PBAP (p = 0.86). Sin embargo, la dosis de radiación media disminuyó en un 23% para los estudios de solo estrés y en un 15% para 2.6 mSv en el estudio de estrés con reposo opcional después de la introducción del PBAP (p <0,001).Conclusiones. La introducción de un protocolo de baja actividad específica para el paciente no afecta el porcentaje de estudios interpretados como normal o el pronóstico, sin embargo reduce significativamente la dosis de ra...

show abstract

Adding attenuation corrected images in myocardial perfusion imaging reduces the need for a rest study

Cited by 15 publications

References 18 publications

Value of attenuation correction in stress-only myocardial perfusion imaging using CZT-SPECT

Value of attenuation correction in stress-only myocardial perfusion imaging using CZT-SPECT

Prognosis of patients without perfusion defects with and without rest study in myocardial perfusion scintigraphy

Effect of a patient-specific minimum activity in stress myocardial perfusion imaging using CZT-SPECT: Prognostic value, radiation dose, and scan outcome

Contact Info

Product

Resources

About