Research ArticleCLINICAL INVESTIGATIONS

Nuclear Myocardial Perfusion Imaging with a Cadmium-Zinc-Telluride Detector Technique: Optimized Protocol for Scan Time Reduction

Bernhard A. Herzog, Ronny R. Buechel, Ruth Katz, Michael Brueckner, Lars Husmann, Irene A. Burger, Aju P. Pazhenkottil, Ines Valenta, Oliver Gaemperli, Valerie Treyer and Philipp A. Kaufmann
Journal of Nuclear Medicine January 2010, 51 (1) 46-51; DOI: https://doi.org/10.2967/jnumed.109.065532

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    (A) Intraclass correlation is used to compare segmental uptake between standard γ-camera (Ventri; GE Healthcare) and ultrafast CZT camera (Discovery NM 530c; GE Healthcare). Correlation coefficient increases with prolonged scan time, but no further improvement appears after scan duration of 3 min is reached for low 99mTc-tetrofosmin dose (stress scan) and 2 min for high dose (rest scan). Thus, minimally required scan times are 2 min for high dose and 3 min for low dose. (B) Diagnostic accuracy of CZT, compared with that of standard camera, increases (and significant differences according to McNemar test disappear) after scan intervals are prolonged to 3 min for low dose (stress) and 2 min for high dose (rest). This indicates solid clinical agreement for the above scan durations, further supported by excellent Cohen κ-value (low dose, 3 min: 0.90; high dose, 2 min: 0.92).

  • FIGURE 2. 
    FIGURE 2. 

    Linear regression analysis (left) and Bland–Altman plots (right) for per territory percentage tracer uptake at minimal required scan times; that is, 3 min for low dose (stress) (A) and 2 min for high dose (rest) (B).

  • FIGURE 3. 
    FIGURE 3. 

    Torso phantom reconstructions obtained from low- and high-dose acquisitions on CZT camera (3- and 2-min scan times, respectively) and on standard γ-camera (15-min scan time each) showing concordant defect in inferolateral wall. HLA = horizontal long axis; SA = short axis; VLA = vertical long axis.

  • FIGURE 4. 
    FIGURE 4. 

    Torso phantom studies demonstrating excellent concordance of repeated measurements of percentage uptake of myocardial 99mTc activity between standard and CZT cameras for each of 20 segments for low and high doses (respective scan times as given in Fig. 3).

  • FIGURE 5. 
    FIGURE 5. 

    Nuclear myocardial perfusion images showing normal perfused myocardium as polar plot and short axis (SA), vertical long axis (VLA), and horizontal long axis (HLA). Images were obtained on standard γ-camera (Ventri; GE Healthcare) with acquisition time of 15 min for both stress (low dose) and rest (high dose) and on ultrafast CZT camera (Discovery NM 530c; GE Healthcare) with acquisition of 3 min for stress and 2 min for rest.

  • FIGURE 6. 
    FIGURE 6. 

    Nuclear myocardial perfusion images showing perfusion defect of anteroapical myocardium, with clinical agreement between standard camera (15-min acquisition) and CZT camera (3- and 2-min acquisitions).

Tables

  • TABLE 1

    Baseline Characteristics (n = 20)

    CharacteristicValue
    Male17 (85%)
    Age (y)
     Mean ± SD66 ± 9.4
     Range42–80
    BMI (kg/m2)
     Mean ± SD27.2 ± 3.9
     Range21.7–35.5
    Hypertension16 (80%)
    Dyslipidemia15 (75%)
    Diabetes5 (25%)
    Smoking8 (40%)
    Positive family history1 (5%)
    Previous cardiac events
     Myocardial infarction7 (35%)
     PCI6 (30%)
     CABG5 (25%)

    • BMI = body mass index; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft.

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