Clinical results of a novel wide beam reconstruction method for shortening scan time of Tc-99m cardiac SPECT perfusion studies

Borges‐Neto, Salvador; Pagnanelli, Robert; Shaw, Linda K.; Honeycutt, Emily; Shwartz, Sarit; Adams, George L.; Coleman, R. Edward

doi:10.1016/j.nuclcard.2007.04.022

Cited by 148 publications

(79 citation statements)

References 6 publications

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“…44,45 The use of time imaging software which incorporates iterative image reconstruction with resolution recovery thereby improving count statistics can decrease imaging time or decrease injected activity. 46 Stress protocol changes such as performing more ETTs, 47 developing a provisional isotope injection protocol, 38 and stress-first imaging 10 will all decrease radiation exposure to the patient by not giving it in the first place. Perhaps the greatest saving of radiation exposure and resources would be the elimination of any diagnostic testing for most of the very low-and low-risk patients (''less is more'').…”

Section: 6mentioning

confidence: 99%

A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department

Duvall

Savino

Levine

et al. 2014

Journal of Nuclear Cardiology

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Background. Recent studies have compared CTA to stress testing and MPI using older Na-I SPECT cameras and traditional rest-stress protocols, but are limited by often using optimized CTA protocols but suboptimal MPI methodology. We compared CTA to stress testing with modern SPECT MPI using high-efficiency CZT cameras and stress-first protocols in an ED population.Methods. In a retrospective, non-randomized study, all patients who underwent CTA or stress testing (ETT or Tc-99m sestamibi SPECT MPI) as part of their ED assessment in 2010-2011 driven by ED attending preference and equipment availability were evaluated for their disposition from the ED (admission vs discharge, length of time to disposition), subsequent visits to the ED and diagnostic testing (within 3 months), and radiation exposure. CTA was performed using a 64-slice scanner (GE Lightspeed VCT) and MPI was performed using a CZT SPECT camera (GE Discovery 530c). Data were obtained from prospectively acquired electronic medical records and effective doses were calculated from published conversion factors. A propensity-matched analysis was also used to compare outcomes in the two groups.Results. A total of 1,458 patients underwent testing in the ED with 192 CTAs and 1,266 stress tests (327 ETTs and 939 MPIs). The CTA patients were a lower-risk cohort based on age, risk factors, and known heart disease. A statistically similar proportion of patients was discharged directly from the ED in the stress testing group (82% vs 73%, P 5 .27), but their time to disposition was longer (11.0 ± 5 vs 20.5 ± 7 hours, P < .0001). There was no significant difference in cardiac return visits to the ED (5.7% CTA vs 4.3% stress testing, P 5 .50), but more patients had follow-up studies in the CTA cohort compared to stress testing (14% vs 7%, P 5 .001). The mean effective dose of 12.6 ± 8.6 mSv for the CTA group was higher (P < .0001) than 5.0 ± 4.1 mSv for the stress testing group (ETT and MPI). A propensity score-matched cohort showed similar results to the entire cohort.Conclusions. Stress testing with ETT, high-efficiency SPECT MPI, and stress-only protocols had a significantly lower patient radiation dose and less follow-up diagnostic testing than CTA with similar cardiac return visits. CTA had a shorter time to disposition, but there was a trend toward more revascularization than with stress testing. (J Nucl Cardiol 2014;21:305-18.)

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Section: 6mentioning

confidence: 99%

A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department

Duvall

Savino

Levine

et al. 2014

Journal of Nuclear Cardiology

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“…8 In addition to the nSPEED software developed by Digirad, there are other 3D reconstruction software packages that also claim the capability of allowing shortened scanning time while maintaining or improving image quality and quantitation. These techniques include the Wide-Beam Reconstruction (WBR) from Ultra-SPECT, 9,10 the Flash-3D from Siemens, Astonish from Philips, and Evolution from GE. The physics principle of all the 3D reconstruction packages is the same, i.e., to model the 3D depth-dependent detector spatial response and to suppress the noise to achieve the best compromise of resolution/contrast improvement and noise reduction.…”

Section: Discussionmentioning

confidence: 99%

Prospective multicenter evaluation of rapid, gated SPECT myocardial perfusion upright imaging

Maddahi

Méndez

Mahmarian

et al. 2009

Journal of Nuclear Cardiology

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Background. A novel three-dimensional (3D) iterative image reconstruction method (3D-OSEM) has been developed that in phantom studies yielded comparable image quality at one half the imaging time. In this study, we compared standard (STD) and rapid (nSPEED) protocols for diagnostic quality of images and quantitation of end-diastolic volume (EDV), endsystolic volume (ESV), left ventricular ejection fraction (LVEF), and perfusion defect severity.Methods. At 11 US community centers, 448 patients prospectively underwent rest-stressgated SPECT imaging using Tc-99m-labeled agent. The difference in quality and diagnostic equivalence of STD and nSPEED images were blindly evaluated by three experts. Defect intensity was quantitated as %normal in the three coronary artery territories.Results. Studies were abnormal in 40% of patients. In 98.7% of stress and 98% of rest images, the nSPEED image quality was identical to or better than the STD images. nSPEED images were diagnostically equivalent to the STD in 444/448 (99%) patients. A high correlation was observed between nSPEED and STD studies for measurement of EDV (Y = 0.957X, R 2 5 0.99), ESV (Y = 0.962X, R 2 5 0.99), and LVEF (Y = 1.005X, R 2 5 0.96). STD and nSPEED studies were not significantly different (P = ns) for quantitative perfusion defect severity.Conclusion. Rapid, gated rest-stress myocardial perfusion upright SPECT imaging may be achieved without compromising perfusion and function information. (J Nucl Cardiol 2009;16:351-7.)

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“…Borges-Neto et al (16) tested WBR and FBP and found no statistically significant differences in summed stress scores (SSS), summed rest scores (SRS), and summed difference scores (SDS) but did note a statistically significant difference for the EF, citing improved resolution as the probable cause. Additionally, Zoccarato et al (17) Although the acquisition times for WBR are generally described to be one half those for FBP, DePuey et al (19) examined the feasibility of reducing the acquisition times further, to one fourth those for FBP.…”

Section: Spect Mpi and Gated Spect Mpimentioning

confidence: 99%

Semiqualitative Visual and Quantitative Morphometric Evaluations of Reduced Scan Time and Wide-Beam Reconstruction in Rest-Gated Stress SPECT Myocardial Perfusion Imaging

Basso¹,

Passmore²,

Holman³

et al. 2009

Journal of Nuclear Medicine Technology

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SPECT myocardial perfusion imaging (MPI) now accounts for well over 90% of all MPI studies performed in the United States. A means of reducing the acquisition time while maintaining diagnostic-quality images would be beneficial for both patients and nuclear cardiology clinics. Wide-beam reconstruction (WBR) is a processing algorithm that attempts to address the challenge of obtaining diagnostic-quality images with shorter counting times. This study was designed to incorporate semiqualitative assessments (physician rankings of image parameters) into quantitative assessments (morphologic measurements), as other researchers have done, in an effort to compare filtered backprojection (FBP)-the gold standard-with WBR. Methods: Fortyseven MPI studies (from 34 men and 13 women) were masked to 3 physicians who qualitatively rated the images for image quality, myocardial normality, lesion reversibility, and treatment recommendation on a scale of 1-5, with 1 representing ''good'' and 5 representing ''poor.'' Quantitative values for summed stress scores, summed rest scores, summed difference scores (SDS), end-diastolic volume, end-systolic volume, and the ejection fraction were calculated and reported. Results: The semiqualitative analyses of image interpretation indicated that WBR yielded significant improvements over FBP in image quality and showed very good to moderate agreement with FBP among physicians for myocardial normality, lesion reversibility, and treatment recommendation. The quantitative analyses of the morphometric values representing myocardial perfusion, through SDS comparisons, were equivalent for the 2 reconstruction methods. Regression analysis indicated that WBR seemed to underestimate the gated stress-derived FBP ejection fraction by 9%210%. Conclusion: Overall, the WBR method was equivalent or superior to the FBP reconstruction method for MPI with a rest-gated stress sameday protocol in terms of image quality, interpretation, and SDS. Additionally, the advantage of patient comfort derived from shorter imaging times should help reduce motion artifacts and repeat acquisitions as well as enhance patient care and throughput. Gat ed SPECT myocardial perfusion imaging (MPI) has become a powerful tool in nuclear cardiology. SPECT MPI now accounts for well over 90% of all MPI studies performed in the United States. SPECT is superior to the traditional planar technique in terms of image contrast and consequent diagnostic and prognostic yields. However, compared with planar imaging, the SPECT approach involves additional acquisition and processing steps in terms of number of views acquired and tomographic image reconstruction processes, respectively (1-4). These additional steps lead to relatively long acquisition times, requiring patient cooperation and other considerations to complete a diagnostic-quality study. A means of reducing acquisition times while maintaining diagnostic-quality images would be beneficial for patients and nuclear cardiology clinics. Tomographic ReconstructionSPECT is based on the recons...

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Clinical results of a novel wide beam reconstruction method for shortening scan time of Tc-99m cardiac SPECT perfusion studies

Abstract: Our study results suggest that cardiac single photon emission computed tomography perfusion studies may be performed with the WBR algorithm using half of the scan time without compromising qualitative or quantitative imaging results.

Cited by 148 publications

References 6 publications

A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department

A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department

Prospective multicenter evaluation of rapid, gated SPECT myocardial perfusion upright imaging

Semiqualitative Visual and Quantitative Morphometric Evaluations of Reduced Scan Time and Wide-Beam Reconstruction in Rest-Gated Stress SPECT Myocardial Perfusion Imaging

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