Comparison of the diagnostic accuracies of very low stress-dose with standard-dose myocardial perfusion imaging: Automated quantification of one-day, stress-first SPECT using a CZT camera

Abstract

One-day stress-first MPI with 50% radiation reduction and a very low stress-dose (<2 mSv) using CZT technology and quantitative supine and prone analysis provided a high diagnostic value, similar to standard-dose MPI.

PET should not replace routine SPECT MPS for the assessment of patients with known or suspected CAD

“…Two cardiac cameras are currently available commercially, DSPECT (Spectrum Dynamics Inc) and the Discovery NM530c (General Electric Healthcare), with both offering improvements in spatial and energy resolution and the capability to reduce imaging time, injected activity, or both. Stress-only imaging with technetium-99m tracers is now feasible at an effective dose of \2 mSv, 22 which compares favorably with the effective dose from 82 Rb PET MPS. The spatial resolution of these systems is in the region of 5 mm, which is better than with 82 Rb.…”

Improving cardiac SPECT accuracy: Old robustness for a new gold standard

“…In fact, other experiences, using mainly visual analysis of perfusion images, have reported higher accuracies of CZT imaging in detecting CAD with sensitivities and specificities in the range of 70% to 80%. 13,22 Therefore, a direct comparison of the accuracies of automatic vs visual analysis of CZT perfusion images in a larger patients' population is needed.…”

“…Finally, the study by Gregoire et al underscores how some of the peculiar strengths of CZT imaging are still infrequently exploited, possibly limiting the diffusion of CZT imaging in clinical practice. In particular, these high-end cameras allow a radical reduction of the radiotracer's injected dose, with a significant decrease of the test's global radiation burden, 13,20,22 making CZT imaging the new reference standard for MPI in current clinical practice.…”

Combined assessment of myocardial perfusion and left ventricular function by nuclear cardiology: The value of high-efficiency SPECT

“…Previous studies demonstrated the feasibility and diagnostic accuracy of half-dose protocols, using either rest-stress or stress-first imaging sequence, at the expense of slight prolongation of imaging time. [13][14][15][16] The feasibility of a low-dose early post-stress imaging is questionable, even using a CZT camera. Obviously, acquisition time would need to be longer than two minutes, and a half-dose protocol will dictate doubling imaging time to 4 minutes.…”

“…In addition, the short acquisition time allows high patient throughput, lower rate of motion artifacts, and the ability to perform routine, prone imaging in every patient to improve specificity, even in very busy nuclear laboratories. 15 Low-dose protocols have been validated, leading to a significant reduction in patient radiation exposure, and the ability to meet the ASNC recommendation. 12 The high image quality of low-dose images facilitated the use of stress-first protocols, involving a low stress dose, with the optional conversion to stress-only after a normal stress.…”