Research ArticleClinical Investigations

Comparison of Image Quality, Myocardial Perfusion, and Left Ventricular Function Between Standard Imaging and Single-Injection Ultra-Low-Dose Imaging Using a High-Efficiency SPECT Camera: The MILLISIEVERT Study

Andrew J. Einstein, Ron Blankstein, Howard Andrews, Mathews Fish, Richard Padgett, Sean W. Hayes, John D. Friedman, Mehreen Qureshi, Harivony Rakotoarivelo, Piotr Slomka, Ryo Nakazato, Sabahat Bokhari, Marcello Di Carli and Daniel S. Berman
Journal of Nuclear Medicine September 2014, 55 (9) 1430-1437; DOI: https://doi.org/10.2967/jnumed.114.138222

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Study protocol. Sites had option to perform standard clinically indicated imaging using either A-SPECT camera (option 1) or HE SPECT camera (option 2). Images obtained using HE SPECT camera are denoted with blue shading and using A-SPECT camera with green shading. Comparison is made in each of the 2 options between images circled in red; subsequent images were obtained solely for clinical purposes and not analyzed in this study.

  • FIGURE 2.
    FIGURE 2.

    Comparison of representative images between ULD HE SPECT and SLD A-SPECT imaging.

  • FIGURE 3.
    FIGURE 3.

    Comparison of SRS from consensus reading, TPD, and resting EF between SLD A-SPECT and ULD HE SPECT imaging. (A) SRS. (B) TPD (%). (C) EF (%). Top are scatterplots, and bottom are Bland–Altman plots. SEE denotes standard error of the estimate.

  • FIGURE 4.
    FIGURE 4.

    Comparison of intrareader agreement in SRS of SLD-A-SPECT to agreement between SLD A-SPECT and ULD HE SPECT imaging. (A) Intrareader agreement in SRS comparing 2 SLD A-SPECT reads, spaced 3 mo apart, for first reader. (B) Between-method agreement in SRS comparing SLD A-SPECT with ULD HE SPECT, for first reader. Top are scatterplots, and bottom are Bland–Altman plots.

Tables

  • TABLE 1

    Patient Characteristics

    CharacteristicValue
    Total subjects101
    Group
     1: intermediate/high likelihood of CAD55 (54.5)
     2: prior myocardial infarction46 (45.5)
    Site
     Cedars-Sinai49 (48.5)
     Sacred Heart39 (38.6)
     Brigham and Women’s13 (12.9)
    Mean age ± SD (y)63.8 ± 11.3
    Women47 (46.5)
    BMI (kg/m2)26.1 ± 2.8
     Range17.1–30.9
    Diabetes mellitus26 (25.7)
     On insulin7 (6.9)
     On oral medications17 (16.8)
    Hypertension74 (73.3)
    Hyperlipidemia77 (76.2)
    Current smoking13 (12.9)
    Family history of premature heart disease31 (30.7)
    No risk factors3 (3.0)
    Stress type
     Exercise: Bruce Protocol46 (45.5)
     Exercise: Modified Bruce Protocol4 (4.0)
     Adenosine25 (24.8)
     Regadenoson25 (24.8)
     Dobutamine1 (1.0)

    • Data in parentheses are percentages.

  • TABLE 2

    Activities and Radiation Effective Doses

    QuantityMeanSDRange
    ULD injection
     Administered activity in MBq198 (5.35)37 (1.00)127–275 (3.44–7.44)
     Residual activity in MBq64 (1.74)26 (0.71)6.3–144 (0.17–3.89)
     Received activity in MBq134 (3.62)28 (0.75)67–189 (1.80–5.10)
     Effective dose, received (mSv)1.150.240.57–1.63
    Supplemental injection, before SLD imaging
     Administered Activity in MBq229 (6.21)105 (2.84)120–588 (3.23–15.89)
     Residual activity in MBq65 (1.75)46 (1.24)5.9–270 (0.16–7.29)
     Received activity in MBq165 (4.46)68 (1.83)75–383 (2.04–10.34)
     Effective dose, received (mSv)1.420.580.65–3.30
    Total SLD (supplemental injection + decayed ULD injection)
     Received activity in MBq277 (7.50)74 (1.99)147–497 (3.98–13.43)
     Effective dose, received (mSv)2.390.641.27–4.29

    • Data in parentheses are mCi.

  • TABLE 3

    Image Quality and Extracardiac Activity

    QuantityULD HE SPECTSLD A-SPECT
    IQ
     Excellent4824
     Good4148
     Fair522
     Poor77
     Mean score ± SD4.29 ± 0.853.88 ± 0.85
     P (Wilcoxon)<0.0001
    Extracardiac activity
     None5540
     Minimal2735
     Mild1019
     Moderate32
     Severe65
     Mean score ± SD0.79 ± 1.120.98 ± 1.06
     P (Wilcoxon)0.05

    • Values are for consensus read.

  • TABLE 4

    Agreement in Summed Rest Scores (SRS)*

    All studiesAbnormal studies (SRS > 1)
    Reads comparedSLD A-SPECTULD HE SPECTSLD A-SPECTULD HE SPECT
    Intrareader agreement
     Reader 1, two reads0.79 (95.7)0.83 (96.7)0.74 (92.9)0.78 (93.7)
    Interreader agreement
     Reader 1 first read vs. Reader 20.82 (96.5)0.84 (97.1)0.74 (92.2)0.79 (93.4)
     Reader 1 second read vs. Reader 20.78 (95.5)0.85 (96.8)0.73 (92.5)0.80 (93.7)
    Between-method agreement
     Reader 1 first read SLD A-SPECT vs. reader 1 first read ULD HE SPECT0.69 (94.4)0.58 (87.8)
     Reader 1 second read SLD A-SPECT vs. reader 1 second read ULD HE SPECT0.63 (92.0)0.54 (87.8)
     Reader 1 first read SLD A-SPECT vs. reader 1 second read ULD HE SPECT0.65 (93.2)0.57 (87.4)
     Reader 1 second read SLD A-SPECT vs. reader 1 first read ULD HE SPECT0.62 (92.4)0.54 (87.6)
     Reader 2 SLD A-SPECT vs. reader 2 ULD HE SPECT0.61 (92.8)0.46 (83.3)
     Consensus read SLD A-SPECT vs. consensus read ULD HE SPECT0.62 (93.0)0.52 (87.4)

    • ↵* Entries denote linearly weighted κ, with percentage agreement in parentheses.

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