Semi-automated algorithm for calculating heart-to-mediastinum ratio in cardiac Iodine-123 MIBG imaging

Okuda, Koichi; Nakajima, Kénichi; Hosoya, Tetsuo; Ishikawa, Takehiro; Konishi, Teruko; Matsubara, Kosuke; Matsuo, Shinro; Kinuya, Seigo

doi:10.1007/s12350-010-9313-4

Cited by 88 publications

(59 citation statements)

References 20 publications

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“…139 Derivation of the HMR and Washout (Figures 12, 13) As the HMR is currently the key result of a 123 ImIBG study, it is important it be derived in a standard way. While there have been attempts to automate the process, 140 at present the standard is to manually draw the cardiac and mediastinal regions of interest (ROI).…”

Section: Imaging Techniquesmentioning

confidence: 99%

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Henzlova

Duvall

Einstein

et al. 2016

Journal of Nuclear Cardiology

529

386

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Section: Imaging Techniquesmentioning

confidence: 99%

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Henzlova

Duvall

Einstein

et al. 2016

Journal of Nuclear Cardiology

529

386

View full text Add to dashboard Cite

“…The reproducibility of the HMR is good within an institution (27), although variability can be observed, depending on the selection of the ROI size and location and the operator's experience. Recently, software (smartMIBG; Fujifilm RI Pharma Co., Ltd.) became available for semiautomatic ROI settings and calculations of the HMR and WR (28). The software algorithm uses a circular heart ROI and a mediastinal ROI with a 10% width of the body and a 30% height of the mediastinum.…”

Section: Parameters Of 123 I-mibg Studiesmentioning

confidence: 99%

Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

Nakajima

Nakata

2015

J Nucl Med

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Cardiac neuroimaging with 123 I-metaiodobenzylguanidine ( 123 I-MIBG) has been officially used in clinical practice in Japan since 1992. The nuclear cardiology guidelines of the Japanese Circulation Society, revised in 2010, recommended cardiac 123 I-MIBG imaging for the management of heart failure (HF) patients, particularly for the assessment of HF severity and prognosis of HF patients. Consensus in North American and European countries regarding incorporation into clinical practice, however, has not been established yet. This article summarizes 22 y of clinical applications in Japan of 123 I-MIBG imaging in the field of cardiology; these applications are reflected in cardiology guidelines, including recent methodologic advances. A standardized cardiac 123 I-MIBG parameter, the heartto-mediastinum ratio (HMR), is the basis for clinical decision making and enables common use of parameters beyond differences in institutions and studies. Several clinical studies unanimously demonstrated its potent independent roles in prognosis evaluation and risk stratification irrespective of HF etiologies. An HMR of less than 1.6−1.8 and an accelerated washout rate are recognized as high-risk indicators of pump failure death, sudden cardiac death, and fatal arrhythmias and have independent and incremental prognostic values together with known clinical variables, such as left ventricular ejection fraction and brain natriuretic peptide. Another possible use of this imaging technique is the selection of therapeutic strategy, such as pharmacologic treatment and nonpharmacologic treatment with an implantable cardioverter-defibrillator or cardiac resynchronization device; however, this possibility remains to be investigated. Recent multiple-cohort database analyses definitively demonstrated that patients who were at low risk for lethal events and who were defined by an HMR of greater than 2.0 on 123 I-MIBG studies had a good long-term prognosis. Future investigations of cardiac 123 I-MIBG imaging will contribute to better risk stratification of low-risk and high-risk populations, to the establishment of costeffective use of this imaging technique for the management of HF patients, and to worldwide acceptance of this imaging technique in clinical cardiology practice.

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“…In the clinical and phantom studies, a semi-automatic algorithm for determining mediastinal region of interest (ROI) was used [14]. After manually setting a circular ROI on the center of the heart, a mediastinal rectangular ROI was automatically determined on the upper third of the mediastinum.…”

Section: Calculation Of H/m Ratiosmentioning

confidence: 99%

Standardization of metaiodobenzylguanidine heart to mediastinum ratio using a calibration phantom: effects of correction on normal databases and a multicentre study

Nakajima

Okuda

Matsuo

et al. 2011

Eur J Nucl Med Mol Imaging

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Purpose. This study was performed to demonstrate that the results obtained with a calibration phantom could be used as a tool for standardizing measurement of heart-tomediastinum (H/M) ratio in cardiac metaiodobenzylguanidine (MIBG) imaging.Method. Images of the phantom containing 123 I-MIBG were acquired on the cameras in 10 hospitals (11 camera types) to determine the relationship between H/M ratios using different collimators: low energy (LE) and medium-energy (ME)/low-medium-energy (LME) collimators. The effect of standardization to the ME-comparable H/M ratio was examined in two settings: a Japanese standard MIBG database (n=62) and multi-center studies (n=49). In a multi-center study, probable Alzheimer disease (AD, n=18) and probable dementia with Lewy bodies (DLB, n=31) were studied and standardized by the calibration phantom method.Results. Linear regression equations between LE and ME collimators were obtained for the phantom study in all institutions. When the H/M ratio with a LE collimator was corrected based upon the calibration phantom, the corrected values were comparable to those obtained using ME collimators. The standard database also exhibited a normal distribution after standardization as determined by skewness and goodness-of-fit test. A mixture of the 2 populations by LE and ME collimators showed significant separation of AD and DLB groups (F ratio=24.9 for the late H/M), but the corrected values resulted in higher F ratios for both early and late H/M (F ratio= 34.9 for the late H/M). Conclusion.Standardization of H/M ratios by the heart-chest calibration phantom method is feasible among different collimator types. This method could be practically used for multicenter comparison of H/M ratios.Key Words: 123 I-metaiodobenzylguanidine; heart-to-mediastinum ratio; calibration phantom; Lewy-body disease; standardization Introduction123 I-metaiodobenzylguanidine (MIBG) has been used extensively in fields of cardiology and neurology as a unique imaging method to evaluate sympathetic nerve activity and its integrity [1][2][3][4][5][6][7]. Inter-institutional differences in MIBG quantification using the heart-tomediastinum ratio (H/M) have hampered multi-center comparison of the H/M ratio, and single-center results could not easily be extrapolated to other hospitals [8]. Since the difference in collimator type has been investigated and found to be one of the major confounders of the results, a practical standardization method for quantification has been sought [9][10][11][12].In neurological studies, patients with Parkinson disease and dementia with Lewy bodies (DLB), which is categorized as Lewy-body disease demonstrated significantly lower H/ M ratios both in early and late imaging [4][5][6][7]. Since the patients with Lewy-body disease showed lower H/M values compared with those of normal populations, we used this patient group for a pilot study of the procedure for correction of H/M ratios. In addition, since a multi-center study including DLB and MIBG imaging has started in Japan, an a...

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Semi-automated algorithm for calculating heart-to-mediastinum ratio in cardiac Iodine-123 MIBG imaging

Abstract: The H/M ratio using the semi-automated method showed high reproducibility in both early and delayed imaging.

Cited by 88 publications

References 20 publications

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

Standardization of metaiodobenzylguanidine heart to mediastinum ratio using a calibration phantom: effects of correction on normal databases and a multicentre study

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Semi-automated algorithm for calculating heart-to-mediastinum ratio in cardiac Iodine-123 MIBG imaging

Abstract: The H/M ratio using the semi-automated method showed high reproducibility in both early and delayed imaging.

Cited by 88 publications

References 20 publications

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Cardiac 123I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

Standardization of metaiodobenzylguanidine heart to mediastinum ratio using a calibration phantom: effects of correction on normal databases and a multicentre study

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Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan