Quantitative myocardial-perfusion SPECT: Comparison of three state-of-the-art software packages

Wolak, Arik; Slomka, Piotr J.; Fish, Mathews B.; Lorenzo, Santiago; Acampa, Wanda; Berman, Daniel S.; Germano, Guido

doi:10.1016/j.nuclcard.2007.09.020

Cited by 55 publications

(50 citation statements)

References 12 publications

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“…The results of Wolak et al 17 and Ather et al 18 are not an absolute novelty. In 1997, preliminary data of a comparison of quantification of SPECT defect sizes by four different software programs, as well classification of defect abnormalities by four well-known laboratories and experts found a reasonable overall correlation of quantitative and visual defect sizes but demonstrated a substantial spread at Bland-Altman analysis of individual data points particularly for large defects.…”

Section: Quantitative Spect Myocardial Perfusion Imagingmentioning

confidence: 87%

“…11 There are limited data on the degree of agreement between these methods in quantifying the perfusion pattern and LV function. Wolak et al 17 performed a detailed comparison of these three software tools with respect to automation and diagnostic performance in the detection of coronary artery disease in a large group of patients with available coronary angiography results and in patients with a low likelihood of disease. Normalcy rate was higher for QPS and 4DM vs ECTb, at 91% and 94% vs 77%, respectively (P = .02).…”

Section: Quantitative Spect Myocardial Perfusion Imagingmentioning

confidence: 99%

“…Therefore, there were significant differences in myocardial perfusion quantification, diagnostic performance, and degree of automation of software packages. 17 Ather et al 18 more recently examined the correlation and agreement among these three programs in assessing perfusion defect size and reversible defect size (by polar maps) as well as LV ejection fraction, end-diastolic volume, end-systolic volume, and mass. Data were collected from 120 consecutive patients who had abnormal regadenoson SPECT myocardial perfusion imaging with a visually derived summed stress score C4 at Birmingham Medical Center (University of Alabama).…”

Section: Quantitative Spect Myocardial Perfusion Imagingmentioning

confidence: 99%

“…Both studies by Wolak et al 17 and Ather et al 18 only considered data without attenuation correction. Although some studies reported an increase in the diagnostic accuracy for the detection of coronary artery disease when myocardial perfusion SPECT is attenuation corrected, [21][22][23] only a few investigations addressed the accuracy of attenuation correction without any visual interpretation of corrected and non-corrected data.…”

Section: Impact Of Attenuation Correctionmentioning

confidence: 99%

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Quantification of myocardial perfusion in clinical trials

Petretta

Nappi

Cuocolo

2015

Journal of Nuclear Cardiology

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In the current era of comparative effectiveness and outcomes research, 1 it is mandatory to have robust estimators of disease, also useful for risk stratification and healthy decision-making.2 Myocardial perfusion imaging with electrocardiographic gated single-photon emission computed tomography (SPECT) is widely used for diagnostic purpose and for risk stratification of patients with suspected or known coronary artery disease.3 However, improving nuclear cardiology practice is required to maximize its role in the presence of multiple concurrent imaging modalities. REGADENOSON SPECT MYOCARDIAL PERFUSION IMAGINGThe United States Food and Drug Administration approved the use of regadenoson, a selective adenosine A2A receptor agonist, on April 10, 2008 for SPECT myocardial perfusion imaging as vasodilator stress agent. 4 In patients undergoing SPECT myocardial perfusion imaging, regadenoson induces an increase in coronary blood flow similar to adenosine. Advantages of regadenoson over adenosine and dipyridamole include its rapid onset of maximal hyperemia (\1 minute), short duration of action, and fixed-dose bolus administration. 5In clinical settings, these advantages translate to a shorter stress protocol and more rapid patient throughput. In addition, regadenoson may be used safely in patients with asthma, chronic obstructive pulmonary disease, and end-stage kidney, and liver disease. Cerqueira et al 7 combined data from two identical double-blind, randomized, active comparator, double dummy, multicenter phase three trials, the ADVANCE MPI (ADenoscan Versus regAdenosoN Comparative Evaluation for Myocardial Perfusion Imaging) 1 and 2 designed to show the strength of agreement between sequential adenosine-regadenoson images. Using visual assessment of serial SPECT images for detection of ischemia relative to adenosine, non-inferiority of regadenoson was demonstrated for all patients and detection of ischemia was also comparable in specific subgroups. However, the average agreement rate between adenosineadenosine and adenosine-regadenoson were 0.62 ± 0.03 and 0.63 ± 0.02 (P = NS). Agreement was less for both agents in women vs men with moderate and large areas of ischemia. This is not surprising based on the significantly greater variability associated with visual as compared to quantitative analysis of SPECT images. 8 In a subsequent study, 9 the same group of investigators used quantitative SPECT analysis to determine the total left ventricular (LV) perfusion defect size and extent of ischemia in patients enrolled in the ADVANCE MPI 2 study randomized in a 2:1 ratio to either regadenoson (n = 495) or a second adenosine SPECT (n = 260) after a standard gated SPECT myocardial perfusion imaging. A single observer who was blinded to randomization and image sequence performed quantification. In this analysis, applying quantitative analysis, regadenoson induced virtually identical scintigraphic results as adenosine regarding the size and severity of LV perfusion defects and the extent of scintigraphic ischemia. In this...

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Section: Quantitative Spect Myocardial Perfusion Imagingmentioning

confidence: 87%

Section: Quantitative Spect Myocardial Perfusion Imagingmentioning

confidence: 99%

Section: Quantitative Spect Myocardial Perfusion Imagingmentioning

confidence: 99%

Section: Impact Of Attenuation Correctionmentioning

confidence: 99%

See 2 more Smart Citations

Quantification of myocardial perfusion in clinical trials

Petretta

Nappi

Cuocolo

2015

Journal of Nuclear Cardiology

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“…10 In addition, our group has recently demonstrated fully automated analysis (QPET) applied to 3D PET/CT 82 Rb analysis on a different scanner, achieving similar results to Kaster et al (sensitivity 93%, specificity 77%) without incorporation of TID into the quantification. 11 Although these software tools may differ in performance when directly compared, 12 the three reported to date 82 Rb PET studies show similar accuracy for automated analysis. From our SPECT experience in a recent large study (n = 995 cases), the accuracy of the automated analysis is equal to that of visual 17-segment scoring by expert observers, 13 and is more reproducible.…”

Section: Quantitative Softwarementioning

confidence: 99%

Low-dose 3D 82Rb PET

Slomka

Berman

Germano

2012

Journal of Nuclear Cardiology

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3D PET TECHNOLOGY3D PET systems were introduced for oncological imaging almost a decade ago and are now universally used. The principal advantage of the 3D PET acquisition (accepting photons from all angles) over the 2D PET with parallel septa is much higher sensitivity (4-6 times) for photon detection, albeit at the cost of increased scatter fraction and more complex image reconstruction. 1 3D 82 Rb PET acquisition has presented image quality problems due to increased random events when previous generation 2D-3D BGO scanners were used. 2 Furthermore, until recently, the interference of prompt gamma emission during 82 Rb decay with scatter correction on 3D systems was not fully recognized. 3 Most literature in cardiac PET imaging describes studies performed in 2D mode. 4 However, currently the users of new PET/CT equipment are unable to acquire images in 2D since almost all new scanners operate in 3D mode only and come without septa. Therefore, the optimal use of such 3D PET/CT for cardiac imaging and in particular for 82 Rb imaging is of great interest to the nuclear cardiology community. IMPORTANCE OF LOW-DOSE PETThe increased sensitivity of the new 3D PET/CT systems can be utilized to reduce radiation exposure to the patient during the myocardial perfusion imaging scan. Although the true effect of radiation exposures lower than 100 mSv on cancer risk is unknown as the risk estimates are extrapolated linearly from higher doses, 5,6 radiation exposure and discussion of cardiac imaging's contribution to hypothetical (but possible) cancer have been recently highlighted. Therefore, from the patient's perspective, radiation exposure ''as low as reasonably achievable'' is very desirable. ARTICLEThe accuracy of low-dose 3D PET/CT for detecting coronary artery disease (CAD) was assessed in an article by Kaster et al in this issue of the Journal of Nuclear Cardiology. 7 The authors evaluated a total of 70 patients with coronary angiography correlation and 77 patients with low likelihood (LLk) of CAD to assess the diagnostic accuracy of low-dose 3D 82 Rb-PET (weight-dependent 10 MBq/kg, translating from the SI units for the US audience, approximately 0.12 mCi/lb). Automatic relative quantification (with automatically derived summed stress scores) and quantification of transient ischemic dilation (TID) were used, without absolute flow measurements and without visual reading by the physicians. They report that by automated analysis they achieved perfect sensitivity (100%) and 48% specificity for the detection of obstructive stenosis in the angiographic group. The specificity improved to 78% without sensitivity loss in a subgroup (n = 45) excluding patients with acute myocardial infarction and low ejection fraction. It should be noted that to achieve 100% sensitivity, the authors modify perfusion abnormality thresholds depending on the TID variable. The sensitivity was 95% by perfusion analysis alone. The receiver operator characteristics areas under-curve (ROC-AUC) ranged from 0.92 to 0.97. As expected with relative perfu...

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Comparison of automated beam hardening correction (ABHC) algorithms for myocardial perfusion imaging using computed tomography

Levi¹,

Wu²,

Eck³

et al. 2020

Medical Physics

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Purpose Myocardial perfusion imaging using computed tomography (MPI‐CT) and coronary CT angiography (CTA) have the potential to make CT an ideal noninvasive imaging gatekeeper exam for invasive coronary angiography. However, beam hardening can prevent accurate blood flow estimation in dynamic MPI‐CT and can create artifacts that resemble flow deficits in single‐shot MPI‐CT. In this work, we compare four automatic beam hardening correction algorithms (ABHCs) applied to CT images, for their ability to produce accurate single images of contrast and accurate MPI flow maps using images from conventional CT systems, without energy sensitivity. Methods Previously, we reported a method, herein called ABHC‐1, where we iteratively optimized a cost function sensitive to beam hardening artifacts in MPI‐CT images and used a low order polynomial correction on projections of segmentation‐processed CT images. Here, we report results from two new algorithms with higher order polynomial corrections, ABHC‐2 and ABHC‐3 (with three and seven free parameters, respectively), having potentially better correction but likely reduced estimability. Additionally, we compared results to an algorithm reported by others in the literature (ABHC‐NH). Comparisons were made on a digital static phantom with simulated water, bone, and iodine regions; on a digital dynamic anthropomorphic phantom, with simulated blood flow; and on preclinical porcine experiments. We obtained CT images on a prototype spectral detector CT (Philips Healthcare) scanner that provided both conventional and virtual keV images, allowing us to quantitatively compare corrected CT images to virtual keV images. To test these methods’ parameter optimization sensitivity to noise, we evaluated results on images obtained using different mAs. Results In images of the static phantom, ABHC‐2 reduced beam hardening artifacts better than our previous ABHC‐1 algorithm, giving artifacts smaller than 1.8 HU, even in the presence of high noise which should affect parameter optimization. Taken together, the quality of static phantom results ordered ABHC‐2> ABHC‐3> ABHC‐1>> ABHC‐NH. In an anthropomorphic MPI‐CT simulator with homogeneous myocardial blood flow of 100 ml⋅min−1⋅100 g−1, blood flow estimation results were 122 ± 24 (FBP), 135 ± 24 (ABHC‐NH), 104 ± 14 (ABHC‐1), 100 ± 12 (ABHC‐2), and 108 ± 18 (ABHC‐3) ml⋅min−1⋅100 g−1, showing ABHC‐2 as a clear winner. Visual and quantitative evaluations showed much improved homogeneity of myocardial flow with ABHC‐2, nearly eliminating substantial artifacts in uncorrected flow maps which could be misconstrued as flow deficits. ABHC‐2 performed universally better than ABHC‐1, ABHC‐3, and ABHC‐NH in simulations with different acquisitions (varying noise and kVp values). In the presence of a simulated flow deficit, all ABHC methods retained the flow deficit, and ABHC‐2 gave the most accurate flow ratio and homogeneity. ABHC‐3 corrected phantom flow values were slightly better than ABHC‐2, in noiseless images, suggesting that reduced quality in noisy ima...

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Quantitative myocardial-perfusion SPECT: Comparison of three state-of-the-art software packages

Abstract: There are differences in myocardial-perfusion quantification, diagnostic performance, and degree of automation of software packages.

Cited by 55 publications

References 12 publications

Quantification of myocardial perfusion in clinical trials

Quantification of myocardial perfusion in clinical trials

Low-dose 3D 82Rb PET

Comparison of automated beam hardening correction (ABHC) algorithms for myocardial perfusion imaging using computed tomography

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