Analysis of stress-only imaging, comparing upright and supine CZT camera acquisition to conventional gamma camera images with and without attenuation correction, with coronary angiography as a reference

Abstract

Stress-only upright and supine CZT imaging was non-inferior statistically to attenuation-corrected stress-only Anger camera imaging. Nevertheless, stress-only CZT imaging may be associated with reduced diagnostic sensitivity for some readers compared to attenuation-corrected Anger camera images, which may be less acceptable clinically compared to stress plus rest images.

Cadmium-zinc-telluride myocardial perfusion imaging: The dream of a single test gets nearer

“…[10][11][12] Accordingly, the scholarly literature on CZT MPI is continuing to expand momentously, as demonstrated by the work by Jameria and colleagues published in this issue of the Journal. 13 Specifically, Jameria et al report hereby a singlecenter retrospective observational study comparing acquisition of MPI with CZT vs Anger cameras, and focusing on several protocol subtleties such as stressonly vs stress-rest acquisition, and upright vs supine positioning, while using a D-SPECT suite and relying on coronary angiography as gold standard. 13 Notably, a total of 740 subjects underwent MPI with both D-SPECT and Anger cameras, even if only 112 (15.1%) patients had coronary angiographic details, with 48 (6.5%) of them eventually showing significant CAD at angiography.…”

“…13 Specifically, Jameria et al report hereby a singlecenter retrospective observational study comparing acquisition of MPI with CZT vs Anger cameras, and focusing on several protocol subtleties such as stressonly vs stress-rest acquisition, and upright vs supine positioning, while using a D-SPECT suite and relying on coronary angiography as gold standard. 13 Notably, a total of 740 subjects underwent MPI with both D-SPECT and Anger cameras, even if only 112 (15.1%) patients had coronary angiographic details, with 48 (6.5%) of them eventually showing significant CAD at angiography. In this series, moderate defects were predominant, and all images were interpreted independently by two different nuclear physicians, with varying experience.…”

“…Indeed, despite the possibility to use semiquantitative or quantitative scores (as with positron emission tomography [PET]), the role of the physician and his qualitative interpretation remains paramount (as in Jameria and colleagues, which highlights the operator dependency of this type of analysis). 13 Thus, a refined imaging of high visual quality continues to be a very important goal given that analysis relies significantly on such image interpretation.…”

Contemporary Cardiac SPECT Imaging—Innovations and Best Practices: An Information Statement from the American Society of Nuclear Cardiology

“…Regardless of the attenuation-compensation method used, reducing the uncertainly of attenuation in clinical images improved the confidence of the clinician in the images and is of particular importance when stress-only protocols are used because, by eliminating attenuation artifacts, they reduce the need for resting images. 36,39,45,46 Equipment for Attenuation Correction Application of attenuation correction requires a patient-specific map of the attenuating media, the attenuation map. The most practical way of measuring the attenuation map is through a transmission scan, either made with a radionuclide sealed source or through CT.…”