Factors affecting the myocardial activity acquired during exercise SPECT with a high-sensitivity cardiac CZT camera as compared with conventional Anger camera

Verger, Antoine; Imbert, Laëtitia; Yagdigul, Yalcine; Fay, Renaud; Djaballah, W.; Rouzet, François; Fourquet, N.; Poussier, Sylvain; Roch, Véronique; Guludec, Dominique Le; Karcher, Gilles; Marie, Pierre-Yves

doi:10.1007/s00259-013-2617-2

Cited by 32 publications

(29 citation statements)

References 22 publications

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“…The tomographic count sensitivity is an additional critical parameter influencing both the acquisition time and the tracer's activity needing to be injected. This sensitivity is rather low on current SPECT-cameras, with only a fraction (10 −6 ) of the injected activities being detected within the myocardial area [6,14]. On Anger cameras, this fraction may be increased using a collimator with convergent geometry.…”

Section: Design Of the Czt Camerasmentioning

confidence: 99%

Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease: a review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM)

Denis

Marie

Ben‐Haim

et al. 2016

Eur J Nucl Med Mol Imaging

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The trade-off between resolution and count sensitivity dominates the performance of standard gamma cameras and dictates the need for relatively high doses of radioactivity of the used radiopharmaceuticals in order to limit image acquisition duration. The introduction of cadmium-zinc-telluride (CZT)-based cameras may overcome some of the limitations against conventional gamma cameras. CZT cameras used for the evaluation of myocardial perfusion have been shown to have a higher count sensitivity compared to conventional single photon emission computed tomography (SPECT) techniques. CZT image quality is further improved by the development of a dedicated three-dimensional iterative reconstruction algorithm, based on maximum likelihood expectation maximization (MLEM), which corrects for the loss in spatial resolution due to line response function of the collimator. All these innovations significantly reduce imaging time and result in a lower patient's radiation exposure compared with standard SPECT. To guide current and possible future users of the CZT technique for myocardial perfusion imaging, the Cardiovascular Committee of the European Association of Nuclear Medicine, starting from the experience of its members, has decided to examine the current literature regarding procedures and clinical data on CZT cameras. The committee hereby aims 1) to identify the main acquisitions protocols; 2) to evaluate the diagnostic and prognostic value of CZT derived myocardial perfusion, and finally 3) to determine the impact of CZT on radiation exposure.

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Section: Design Of the Czt Camerasmentioning

confidence: 99%

Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease: a review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM)

Denis

Marie

Ben‐Haim

et al. 2016

Eur J Nucl Med Mol Imaging

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“…More importantly, the conventional cameras have very poor count sensitivity, which is further amplified by the poor extraction fraction of Tc99m. In a recent study by Verger et al, 19 it has been demonstrated that the conventional dual head scanner with high-sensitivity parallel hole collimators detects less than 1 ppm of the injected Tc-99m activity during the myocardial perfusion study. This is further exacerbated in the study by Klein et al by the use of stress-first low dose protocols (10 mCi stress dose).…”

Section: Is Conventional Mps Scanner Good Enough?mentioning

confidence: 99%

Absolute myocardial blood flow quantification with SPECT/CT: Is it possible?

Slomka

Berman

Germano

2014

Journal of Nuclear Cardiology

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“…These improvements, in addition to allowing focused imaging of the heart and the use of new reconstruction algorithms, enable dynamic SPECT with kinetic analysis of 99m Tc-MIBI myocardial concentrations to be performed in animals and humans [17][18][19][20], providing incremental diagnostic information over perfusion data alone [17]. Further studies are needed to assess whether availability of transmission to correct for attenuation may enable better modelling of 99m Tc-labelled tracer kinetics.…”

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confidence: 99%

Dynamic SPECT: evolution of a widely available tool for the assessment of coronary flow reserve

Ben‐Haim

Denis

2014

Eur J Nucl Med Mol Imaging

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Myocardial perfusion imaging (MPI) SPECT is well established in the diagnosis, monitoring response to treatment and risk stratification in patients with known or suspected coronary artery disease (CAD). PET enables quantitative assessment of myocardial blood flow (MBF, in millilitres per gram per minute) and coronary flow reserve (CFR), and quantification with 15 O-water, 13 N-ammonia and recently 82 Rb has been validated over a wide range of blood flows in animal models and humans [1][2][3][4]. Quantitative assessment of MBF has been shown to improve the diagnostic accuracy of conventional MPI with SPECT or PET, to improve cardiac risk assessment and to predict outcome [5][6][7]. Quantitation of MBF enables absolute assessment of myocardial flow and vasodilator reserve without the assumption of a normal reference region [8]. Therefore, the limitation of conventional MPI (underestimation of the extent and severity of multivessel CAD, when tracer uptake in the best-perfused myocardial region does not represent normally perfused myocardium) can be overcome by the use of absolute quantitation [9].Whereas PET is very costly and complex, SPECT systems are widely used for the assessment of myocardial perfusion in patients for the diagnosis and management of CAD. However, quantitative assessment with SPECT has been limited. To enable quantitation with SPECT a multidetector system is required to permit fast acquisition of dynamic data in 5 -10 s, and a suitable SPECT tracer is necessary. Transmission imaging for attenuation correction will allow accurate quantitation. Quantification of myocardial perfusion reserve has been attempted using SPECT and 201 Tl in dogs [10] and 99m Tc-labelled tracers [10][11][12]. Dynamic SPECT imaging using multidetector SPECT systems and kinetic modelling of 99m Tc-teboroxime has shown good correlation with microsphere-determined blood flow. However, limitations in detector sensitivity and temporal resolution of conventional SPECT systems prohibit further assessment [10,11].Another SPECT technique based on first-pass planar imaging followed by conventional SPECT MPI has been used to estimate a retention index of MBF and CFR [12]. This technique has shown a generally good correlation with PETmeasured flow, but CFR is underestimated at high flow rates [13]. The use of a retention index to estimate CFR using this method compared to absolute MBF from PET results in an underestimation of CFR values in the SPECT-based technique, since tracer retention decreases with increasing blood flow [14]. Spatial and timing resolution are poorer with SPECT and the tracer retention index underestimates CFR compared to quantitative PET. SPECT is indeed simpler than PET but this technique, unlike PET, does not include dynamic acquisition of tomographic data. In addition, the technique works only for tracers that act like microspheres, showing a constant extraction over a large range of flow rates and showing no washout from the time of injection to the time of measurement.Conventional SPECT systems are limi...

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Factors affecting the myocardial activity acquired during exercise SPECT with a high-sensitivity cardiac CZT camera as compared with conventional Anger camera

Cited by 32 publications

References 22 publications

Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease: a review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM)

Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease: a review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM)

Absolute myocardial blood flow quantification with SPECT/CT: Is it possible?

Dynamic SPECT: evolution of a widely available tool for the assessment of coronary flow reserve

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