Stress-only or stress/rest myocardial perfusion imaging in patients undergoing evaluation for bariatric surgery

Gemignani, Anthony; Muhlebach, Stephan G.; Abbott, Brian; Roye, G. Dean; Harrington, David; Arrighi, James A.

doi:10.1007/s12350-011-9405-9

Cited by 27 publications

(16 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…20 A recent study by Ryan et al 21 suggests that rest images from prior studies can be effectively used in conjunction with more recent stressonly imaging in certain patient populations.…”

Section: Discussionmentioning

confidence: 99%

Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction

Mathur

Heller

Bateman

et al. 2013

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

Background. In selected patients, stress-only SPECT imaging has been proposed as an alternative to rest-stress SPECT imaging to improve laboratory efficiency and reduce radiation exposure. The impact of attenuation correction (AC) upon interpretation, post-test patient management and cardiac risk stratification in relation to stress-only imaging is not well understood.Objectives. The purpose of this study was to determine the clinical value for laboratory throughput and predicting outcomes of normal and abnormal stress-only SPECT imaging with AC in a consecutive series of clinically referred patients.Methods. A retrospective analysis of 1,383 consecutive patients who were scheduled for stress-only SPECT imaging for symptom assessment of suspected myocardial ischemia was performed. All images had been interpreted and categorized using the standard 17-segment model without AC followed by AC. Follow-up data for 2.1 ± 1.3 years after SPECT imaging for the occurrence of cardiac events (non-fatal MI, cardiac death, and cardiac revascularization) previously collected by routine methods were reviewed.Results. Non-AC SPECT image interpretation revealed that 58% (802/1383) of patients had abnormal stress images. AC image interpretation of the abnormal non-AC images re-classified 83% (666/802) of these as normal. Among patients with abnormal stress images after AC (136/ 1383), 63% (86/136) returned for additional rest scans, while the remaining 37% (50/136) were clinically managed without further rest images. The incidence of cardiac death or non-fatal MI was very low in patients with normal stress-only scans (0.7%).Conclusion. A strategy of stress-only imaging with AC in symptomatic patients is an efficient method which appropriately identifies at risk and low-risk patients yielding a low percentage requiring rest imaging. Clinical decisions can be made based on abnormal stress-only imaging without further rest imaging if clinically appropriate. (J Nucl Cardiol 2013;20:27-37.)

show abstract

“…20 A recent study by Ryan et al 21 suggests that rest images from prior studies can be effectively used in conjunction with more recent stressonly imaging in certain patient populations.…”

Section: Discussionmentioning

confidence: 99%

Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction

Mathur

Heller

Bateman

et al. 2013

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

show abstract

“…By contrast, image quality was significantly better from a conventional g-camera and was diagnostic in all patients. Obesity may often affect the quality of SPECT MPI scans, mainly because of reduction of test specificity by diaphragm soft-tissue attenuation and extracardiac activity (17)(18)(19)(20)(21). CT-based AC has been found to compensate at least in part for inferior soft-tissue attenuation, resulting in improved SPECT MPI diagnostic (22) and prognostic (23) accuracy.…”

Section: Discussionmentioning

confidence: 99%

Cadmium-Zinc-Telluride Myocardial Perfusion Imaging in Obese Patients

et al. 2012

View full text Add to dashboard Cite

We have evaluated the impact of increased body mass on the quality of myocardial perfusion imaging using a latest-generation g-camera with cadmium-zinc-telluride semiconductor detectors in patients with high ($40 kg/m 2 ) or very high ($45 kg/m 2 ) body mass index (BMI). Methods: We enrolled 81 patients, including 18 with no obesity (BMI , 30 kg/m 2 ), 17 in World Health Organization obese class I (BMI, 30-34.9 kg/m 2 ), 15 in class II (BMI, 35-39.9 kg/m 2 ), and 31 in class III (BMI $ 40 kg/m 2 ), including 15 with BMI $ 45 kg/m 2 . Image quality was scored as poor (1), moderate (2), good (3), or excellent (4). Patients with BMI $ 45 kg/m 2 and nondiagnostic image quality (#2) were rescanned after repositioning to better center the heart in the field of view. Receiver-operating-curve analysis was applied to determine the BMI cutoff required to obtain diagnostic image quality ($3). Results: Receiver-operating-curve analysis resulted in a cutoff BMI of 39 kg/m 2 (P , 0.001) for diagnostic image quality. In patients with BMI $ 40 kg/m 2 , image quality was nondiagnostic in 81%; after CT-based attenuation correction this decreased to 55%. Repositioning further improved image quality. Rescanning on a conventional SPECT camera resulted in diagnostic image quality in all patients with BMI $ 45 kg/m 2 . Conclusion: Patients with BMI $ 40 kg/m 2 should be scheduled for myocardial perfusion imaging on a conventional SPECT camera, as it is difficult to obtain diagnostic image quality on a cadmium-zinc-telluride camera.

show abstract

“…A growing body of literature supports the utility of stress-first SPECT imaging (24,(27)(28)(29)(30)(31)(32)(33)(34). If the stress MPI results are normal, the rest scan can be avoided, with significant savings in cost, time, and radiotracer exposure to the patient (35% dose reduction) and to the laboratory staff (40% dose reduction) (35).…”

Section: Selection Of Radiotracersmentioning

confidence: 99%

“…The pretest likelihood of CAD is calculated using the age, sex, and chest-pain characteristics (Supplemental Table 3). A stress-first imaging protocol is feasible with either exercise or pharmacologic stress and may be used in diabetic patients (27) as well as in morbidly obese patients (30). Patients with a low pretest likelihood of CAD, however, may be considered for treadmill testing alone without imaging.…”

Section: Selection Of Radiotracersmentioning

confidence: 99%

Approaches to Reducing Radiation Dose from Radionuclide Myocardial Perfusion Imaging

et al. 2015

View full text Add to dashboard Cite

Learning Objectives: On successful completion of this activity, participants should be able to (1) describe the application of appropriate use criteria for SPECT and PET myocardial perfusion imaging, (2) apply stress-only/stress-first myocardial perfusion imaging in clinical practice, and (3) list methods to perform lowradiation-dose myocardial perfusion imaging using traditional and novel technology.Financial Disclosure: Dr. Dorbala was supported by NIH-NHLBI K23HL092299, has received a research grant from Astellas Pharma (unrelated to this work), and has investment interest with General Electric. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through April 2018.Radionuclide myocardial perfusion imaging (MPI) plays a vital role in the evaluation and management of patients with coronary artery disease. However, because of a steep growth in MPI in the mid 2000s, concerns about inappropriate use of MPI and imaging-related radiation exposure increased. In response, the professional societies developed appropriate-use criteria for MPI. Simultaneously, novel technology, image-reconstruction software for traditional scanners, and dedicated cardiac scanners emerged and facilitated the performance of MPI with low-dose and ultra-low-dose radiotracers. This paper provides a practical approach to performing low-radiationdose MPI using traditional and novel technologies.

show abstract

Stress-only or stress/rest myocardial perfusion imaging in patients undergoing evaluation for bariatric surgery

Cited by 27 publications

References 26 publications

Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction

Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction

Cadmium-Zinc-Telluride Myocardial Perfusion Imaging in Obese Patients

Approaches to Reducing Radiation Dose from Radionuclide Myocardial Perfusion Imaging

Contact Info

Product

Resources

About