EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology

Abstract

The European procedural guidelines for radionuclide imaging of myocardial perfusion and viability are presented in 13 sections covering patient information, radiopharmaceuticals, injected activities and dosimetry, stress tests, imaging protocols and acquisition, quality control and reconstruction methods, gated studies and attenuation-scatter compensation, data analysis, reports and image display, and positron emission tomography. If the specific recommendations given could not be based on evidence from original, scientific studies, we tried to express this state-of-art. The guidelines are designed to assist in the practice of performing, interpreting and reporting myocardial perfusion SPET. The guidelines do not discuss clinical indications, benefits or drawbacks of radionuclide myocardial imaging compared to non-nuclear techniques, nor do they cover cost benefit or cost effectiveness.

Impact of ACE and ApoE polymorphisms on myocardial perfusion: correlation with myocardial single photon emission computed tomographic imaging

“…40 In addition, the calculation of SSS, SRS and SDS parameters, comprises the only widely accepted quantitative method for the myocardial SPECT interpretation and an objective evaluation of myocardial perfusion, with a reported diagnostic and prognostic value. 12 SSS reflects the severity of a perfusion defect at stress, which is related to ischemia severity (in patients without myocardial necrosis), whereas SDS is a marker of defect reversibility which could reflect the improvement of myocardial perfusion at rest. Our study has some potential limitations.…”

“…12,13 Before testing, all patients gave informed consent for their complete participation according to the Hospital Ethical Committee, which approved this study, and the ethical standards laid down in the 1964 Declaration of Helsinki, and a brief structured interview from which we obtained data on symptoms, medications, previous cardiac events, coronary risk factors and cardiac or non-cardiac diagnoses.…”

“…7,12,13 Acquisition and processing protocols used in our department of Nuclear Medicine for Tl-201 and Tc-99m-tetrofosmin SPECT studies have been described in detail elsewhere, according to EANM/ESC procedural guidelines. 12,13 In the unprocessed anterior projection image of Tl-201 studies, acquired as part of the initial imaging process, the lung/heart ratio (LHR) of Tl-201 activity was measured, as described in a previous report, and values o0.55 were considered to be normal.…”

“…7,12,13 Acquisition and processing protocols used in our department of Nuclear Medicine for Tl-201 and Tc-99m-tetrofosmin SPECT studies have been described in detail elsewhere, according to EANM/ESC procedural guidelines. 12,13 In the unprocessed anterior projection image of Tl-201 studies, acquired as part of the initial imaging process, the lung/heart ratio (LHR) of Tl-201 activity was measured, as described in a previous report, and values o0.55 were considered to be normal. 19 We carried out polar and three-dimensional mapping in all studies (with Tl-201 or Tc-99m tetrofosmin) and calculated the transient ischemic dilation (TID) index (Sopha medical Vision software), which is determined as an index of the pathologic dilation of the left ventricle at stress, as compared with rest (normal values o1.2).…”

“…Both the LHR and TID indexes are considered to be indexes of severe myocardial ischemia. 12 For SPECT interpretation, the myocardium of the left ventricle was divided into 17 segments, according to previous reports. 20,21 Two independent experienced observers blindly evaluated the reconstructed images, the polar maps and the three-dimensional images of both stress and rest studies by scoring the radiotracer uptake in each of the 17 regions, using a 5-point scoring system (0: normal uptake; 1: mildly reduced uptake; 2: moderately reduced uptake; 3: severely reduced uptake and 4: no uptake).…”