Comparison of Myocardial Perfusion Imaging Using Thallium-201 Between a New Cadmium-Zinc-Telluride Cardiac Camera and a Conventional SPECT Camera

Songy, Bernard; Lussato, David; Guernou, Mohamed; Queneau, Mathieu; Geronazzo, Ricardo

doi:10.1097/rlu.0b013e31821a294e

Cited by 39 publications

(24 citation statements)

References 16 publications

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“…Myocardial activity, corresponding to exercise-only injection, was then obtained after subtraction of residual myocardial activity from rest injection. This residual activity was obtained with the myocardial activity that was measured on the previous rest SPECT (in countsÁs 21 ) and corrected for decay.…”

Section: Performance Parametersmentioning

confidence: 99%

“…These improved systems enhance the sensitivity of count detection and thereby enable recording times or tracer doses to be reduced, a property that has highly favorable consequences on patient comfort and radiation exposure (1)(2)(3)(4). This enhancement is based mainly on acquisitions that are heart-centric but obtained with very different technologies: first, for the IQÁSPECT system (Siemens Medical Solutions (5-8)), an Anger camera equipped with collimators convergent on the image center (astigmatic collimators); second, for the DSPECT system (Spectrum Dynamics (9-13)), mobile columns of CZT detectors with wide parallel-hole collimators; and third, for the Discovery NM 530c system (GE Healthcare (14)(15)(16)(17)(18)(19)(20)(21)), fixed CZT detectors with multipinhole collimators.…”

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confidence: 99%

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Compared Performance of High-Sensitivity Cameras Dedicated to Myocardial Perfusion SPECT: A Comprehensive Analysis of Phantom and Human Images

et al. 2012

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Differences in the performance of cadmium-zinc-telluride (CZT) cameras or collimation systems that have recently been commercialized for myocardial SPECT remain unclear. In the present study, the performance of 3 of these systems was compared by a comprehensive analysis of phantom and human SPECT images. Methods: We evaluated the Discovery NM 530c and DSPECT CZT cameras, as well as the Symbia Anger camera equipped with an astigmatic (IQÁSPECT) or parallel-hole (conventional SPECT) collimator. Physical performance was compared on reconstructed SPECT images from a phantom and from comparable groups of healthy subjects. Results: Classifications were as follows, in order of performance. For count sensitivity on cardiac phantom images (countsÁs 21 ÁMBq 21 ), DSPECT had a sensitivity of 850; Discovery NM 530c, 460; IQÁSPECT, 390; and conventional SPECT, 130. This classification was similar to that of myocardial counts normalized to injected activities from human images (respective mean values, in countsÁs 21 ÁMBq 21 : 11.4 6 2.6, 5.6 6 1.4, 2.7 6 0.7, and 0.6 6 0.1). For central spatial resolution: Discovery NM 530c was 6.7 mm; DSPECT, 8.6 mm; IQÁSPECT, 15.0 mm; and conventional SPECT, 15.3 mm, also in accordance with the analysis of the sharpness of myocardial contours on human images (in cm 21 : 1.02 6 0.17, 0.92 6 0.11, 0.64 6 0.12, and 0.65 6 0.06, respectively). For contrast-to-noise ratio on the phantom: Discovery NM 530c had a ratio of 4.6; DSPECT, 4.1; IQÁSPECT, 3.9; and conventional SPECT, 3.5, similar to ratios documented on human images (5.2 6 1.0, 4.5 6 0.5, 3.9 6 0.6, and 3.4 6 0.3, respectively). Conclusion: The performance of CZT cameras is dramatically higher than that of Anger cameras, even for human SPECT images. However, CZT cameras differ in that spatial resolution and contrast-to-noise ratio are better with the Discovery NM 530c, whereas count sensitivity is markedly higher with the DSPECT.Key Words: CZT-cameras; high-speed SPECT; myocardial perfusion imaging; count sensitivity St ress myocardial SPECT has been markedly enhanced by the recent commercialization of cameras with semiconductor (cadmium-zinc-telluride [CZT]) detectors or new collimation systems. These improved systems enhance the sensitivity of count detection and thereby enable recording times or tracer doses to be reduced, a property that has highly favorable consequences on patient comfort and radiation exposure (1-4). This enhancement is based mainly on acquisitions that are heart-centric but obtained with very different technologies: first, for the IQÁSPECT system (Siemens Medical Solutions (5-8)), an Anger camera equipped with collimators convergent on the image center (astigmatic collimators); second, for the DSPECT system (Spectrum Dynamics (9-13)), mobile columns of CZT detectors with wide parallel-hole collimators; and third, for the Discovery NM 530c system (GE Healthcare (14-21)), fixed CZT detectors with multipinhole collimators.The respective performance of these new cameras and collimation systems has been analyzed, but ...

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Section: Performance Parametersmentioning

confidence: 99%

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Compared Performance of High-Sensitivity Cameras Dedicated to Myocardial Perfusion SPECT: A Comprehensive Analysis of Phantom and Human Images

et al. 2012

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“…A recent study by Songy et al assessed the prognostic value of a low-activity protocol in stress-only CZT-SPECT imaging with a follow-up of 38.4 months. 29 They reported annualized cardiac event rates including revascularization of 0.55% in 1400 patients with a scan interpreted as normal using a PAST 18.5 MBq·min-ute·kg −1 . This is higher than the hard cardiac event rates we encountered using a comparable PAST of 18.0 MBq·minute·kg −1 , but we did not include revascularizations.…”

Section: Discussionmentioning

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

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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...

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“…9 Songy et al compared images with similar standard doses of Tl-201 on a high-efficiency camera with 5-minute acquisition and a conventional SPECT camera with 10-to 15-minute acquisition. 10 Other previous work has raised concerns about the accuracy of gated images with lower dose of Tl-201 on high-efficiency cameras. 11 Finally, the correct dose of Tl-201 on highefficiency SPECT cameras must also be put into perspective with the future possibility of calculating coronary flow reserve.…”

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Tl-201 dosing for CZT SPECT: More new information

Henzlova

Duvall

2018

Journal of Nuclear Cardiology

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Thallium-201 was the original and the only myocardial perfusion imaging (MPI) tracer, first for planar (1973) and later for SPECT imaging (1980s), for almost 15 years. Introduction of Tc-99m-based tracers (sestamibi-1984, tetrofosmin-1989) knocked Tl-201 from the pedestal. The advantages of Tc-99m-based agents became obvious: higher energy (140 keV vs 69-80 keV), shorter half-life (6 hours vs 72 hours), flexibility of imaging protocols (due to lack of meaningful Tc-99m redistribution), and local production of the tracer (using molybdenum generator vs dose delivery of . The higher energy Tc-99m gamma rays and a shorter half-life increased the acquired count density, and thus improved the quality of both perfusion and gated images compared to Tl-201.The advent of coronary CT angiography (CTA) and the exponential increase of MPI volume unleashed the previously non-existent debate pointing to possible longterm harmful effects of low-dose radiation used for diagnostic imaging. 1 CTA technology evolved and answered rapidly with a substantial decrease in radiation exposure. 2 Migration from Tl-201 to Tc-99m by the nuclear cardiology community was driven more by the ease of use of Tc-99m-based tracers, rather than by fear of substantially higher per study radiation exposure of Tl-201 (15 mSv vs 9-11 mSv). Most recently, the majority of criticism was aimed at dual-isotope protocols (Tl-201 rest/Tc-99m stress), which result in the highest radiation exposure per study (22-23 mSV) not offset by a relatively modest decrease of the length of the test. 3 Using standard imaging technology (Anger camera) and standard Tl-201 doses (3-4 mCi), some advantageous Tl-201 characteristics remain:(1) Tl-201 is by design ''stress-first imaging.'' 4 Immediate review of stress images may reveal normal perfusion or an unexpectedly abnormal result such that the rest/redistribution portion of the test may then be avoided. This would significantly decrease the length of the test (from 4-6 hours to 1 hour) and additionally decrease radiation exposure to the laboratory personnel and to accompanying visitors. 5 (2) As Tl-201 is excreted by the kidneys, high subdiaphragmatic tracer accumulation is not an issue, compared to the gastrointestinal excretion of Tc-99m. (3) Flow to uptake linearity is better preserved with Tl-201 compared to Tc-99m-labeled tracers. This is of particular importance with the use of coronary vasodilators. Coronary blood flow increases by non-physiologic amounts (200-300%) with vasodilators, compared to approximately 100% with moderate exercise. (4) Tl-201 remains a preferred ''viability tracer'' due to its ability to visualize severely dysfunctional myocytes. Tl-201 crosses the cellular membrane, while Tc-99m tracers are transported into the mitochondria, an organelle more susceptible to ischemic damage. (5) Because of early post-stress imaging, Tl-201 lung uptake can be quantified and used as a surrogate for pulmonary capillary wedge pressure. (6) Past and likely future Tc-99m shortages will lead either to the abandonmen...

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Comparison of Myocardial Perfusion Imaging Using Thallium-201 Between a New Cadmium-Zinc-Telluride Cardiac Camera and a Conventional SPECT Camera

Abstract: This new dedicated cardiac CZT camera allows with thallium-201 five minutes acquisitions with an increased image quality and a reliable diagnosis quality.

Cited by 39 publications

References 16 publications

Compared Performance of High-Sensitivity Cameras Dedicated to Myocardial Perfusion SPECT: A Comprehensive Analysis of Phantom and Human Images

Compared Performance of High-Sensitivity Cameras Dedicated to Myocardial Perfusion SPECT: A Comprehensive Analysis of Phantom and Human Images

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

Tl-201 dosing for CZT SPECT: More new information

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