Comparison of Simultaneous Dual-Isotope Multipinhole SPECT with Rotational SPECT in a Group of Patients with Coronary Artery Disease

Abstract

A triple-detector, multipinhole SPECT system was optimally configured to perform simultaneous 201 Tl (stress)/ 99m Tc (rest) myocardial perfusion imaging (MPI) using a protocol that permitted direct diagnostic comparison of this multipinhole SPECT system with conventional rotational SPECT. Methods: Both the rotational and the multipinhole SPECT systems used the same model g-detectors. The 2 systems were applied in tandem to study 26 patients with documented coronary status. Visual image evaluation of the MPI together with quantitative analysis using circumferential profile curves (CPC) were used for interpretation of stress/rest myocardial flow differences. A dual-peak attenuation compensation (DPAC) technique was applied to the stress 201 Tl multipinhole SPECT images by weighted combination of the images from the upper and lower peaks. Results: Detection of myocardial infarction by location and extent correlated closely, and correlation of differential flow changes between stress and rest indicated similar accuracy in terms of location and extent of myocardial blood flow differences as well. In addition, the application of DPAC clarified the multipinhole stress 201 Tl images through reduced background and increased statistics and also improved the relative superposition of the normalized CPC, especially for the inferior and more basal reconstructed regions. Conclusion: The prototype 3-detector multipinhole SPECT system achieved diagnostic results comparable to those for rotational SPECT and required only a single image-acquisition session to generate stress/rest MPI and 16-segment poststress gated studies. This reduction in acquisition time significantly improves productivity without compromising diagnostic accuracy. In addition, DPAC is a useful adjunct to the multipinhole SPECT modality because it improves both the visual clarity of the stress images and the stress/rest quantitative comparability.

Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation

“…Using multiple pinholes, however, can greatly increase the sensitivity of the system and thus provide both improved spatial resolution and sensitivity compared to conventional cameras using parallel-hole collimation. Current cardiac systems employ multiple pinholes for tomographic cardiac SPECT imaging, either as multi-pinhole collimators for conventional camera 13 or as part of a dedicated cardiac camera design (section ''System Design'').…”

Stress thallium-201/rest technetium-99m sequential dual-isotope high-speed myocardial perfusion imaging validation versus invasive coronary angiography

“…The possibility of performing a dual-isotope thallium-201 stress/rest technetium-99m protocol using a conventional three-detector Anger camera was proposed in 2008 by Steele et al 14 However, cameras based on CZT detector technology such as the D-SPECT and the DNM recently became available with improved characteristics over standard cameras. D-SPECT and DNM have more detectors and each is more efficient, making it possible to return to dual-isotope protocols.…”

Single photon-emission computed tomography

“…18 With advances in iterative image reconstruction, multi-pinhole collimators have made a come-back in nuclear cardiology. Fully tomographic myocardial SPECT imaging has been demonstrated using multi-pinhole collimators with both Anger cameras 19 and small area CZT detectors. 20 The characteristics of pinhole collimation offer the potential of both improved spatial resolution and sensitivity compared to conventional pinhole collimation with Anger cameras.…”