Research ArticleThe State of the Art

Solid-State Detector SPECT Myocardial Perfusion Imaging

Piotr J. Slomka, Robert J.H. Miller, Lien-Hsin Hu, Guido Germano and Daniel S. Berman
Journal of Nuclear Medicine September 2019, 60 (9) 1194-1204; DOI: https://doi.org/10.2967/jnumed.118.220657

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Three novel collimator designs used in solid-state camera systems. (A) High-sensitivity parallel collimators, as used in D-SPECT camera system. Collimators are square with parallel holes, each coupled to a single detector. (B) Multipinhole collimator design, as used in Discovery NM 530c camera system. (C) Collimator design of new general-purpose Veriton for 3-dimensional body contouring.

  • FIGURE 2.
    FIGURE 2.

    Count sensitivity expressed as percentage of incoming photons for several nuclear imaging systems. Solid-state SPECT cameras (fast MPI) have almost 8 times higher count sensitivity than conventional Anger cameras. Therefore, count sensitivity is more similar to 2-dimensional PET than to conventional SPECT camera.

  • FIGURE 3.
    FIGURE 3.

    Patient with abnormal perfusion in low-dose simulation study performed by Nakazato et al. (18). TPD, which is quantitative measure of ischemia, was not significantly different except in simulations representing effective radiation dose < 0.5 mSv. (Reprinted from (18).)

  • FIGURE 4.
    FIGURE 4.

    Two-position imaging. In this case, combination of supine and prone imaging offers superior visual interpretation, but findings were still interpreted as abnormal. Quantitative perfusion analysis is also improved by integrating supine TPD (S-TPD), and prone TPD (P-TPD) into single, combined measure (C-TPD), which shows no perfusion deficit. Patient had no significant coronary disease on invasive coronary angiography. Case is from REFINE SPECT.

  • FIGURE 5.
    FIGURE 5.

    SPECT MBF assessments with and without AC compared with PET. SPECT MBF measurements at rest or with stress were not significantly different from PET values, with or without AC. Similar results were obtained with MFR measurements. BB = binding to red blood cells; MC = motion correction. (Reprinted from (59).)

  • FIGURE 6.
    FIGURE 6.

    SPECT MBF information. One-day 99mTc sestamibi stress/rest protocol (259 MBq for stress and 777 MBq for rest) was used. Stress and rest flows are computed from early dynamic imaging for each vascular territory, by deriving regional time–activity curves for myocardium and for input blood in left atrium or left ventricle and applying compartmental models. These values can be used to calculate MFR as ratio between stress and rest MBF. Reduced MFR (<2.0) may be useful to identify presence of multivessel disease leading to balanced ischemia. This patient had normal regional myocardial perfusion but decreased MFR and was ultimately found to have obstructive triple-vessel disease on coronary angiography. LAD = left anterior descending; LCx = left circumflex; LV = left ventricle; RCA = right coronary artery; Rst = rest; Str = stress. (Courtesy of Dr. Alejandro Meretta, Instituto Cardiovascular de Buenos Aires.)

  • FIGURE 7.
    FIGURE 7.

    Prognostic value of quantitative perfusion analysis from REFINE SPECT with solid-state MPI. Quantitative perfusion assessments with TPD provide fine gradation of cardiovascular risk. Each increase in TPD extent, including <1% ischemia compared with no ischemia, was associated with significant increase in combined outcome of death, nonfatal myocardial infarction, unstable angina, or late revascularization. MACE = major adverse cardiovascular events. (Reprinted with permission of (67).)

Tables

  • TABLE 1

    Human Validation Studies of MBF Quantification with Solid-State SPECT Cameras

    StudyCases (n)SystemTracerValidated with…Model used
    Ben-Haim (57)95D-SPECTSestamibiPerfusion angiographyFactor analysis
    Ben Bouallègue (63)23Discovery 530cTetrofosminiFFR1TC
    Nkoulou (62)28Discovery 570cTetrofosmin13N-ammonia1TC
    Miyagawa (73)69Discovery 530cTetrofosmin/sestamibiiFFR1TC
    Wells (59)31Discovery 530cTetrofosmin82Rb or 13N-ammonia1TC
    Agostini (58)30D-SPECTSestamibi15O-water iFFRNet retention model
    Han (60)34Discovery 530cThallium/tetrofosminiFFR1TC
    Ma (61)40Discovery 530cSestamibiRRG vs. solid-state1TC
    Zavadovsky (74)23Discovery 570cSestamibiiFFRNet retention model

    • iFFR = invasive fractional flow reserve; 1TC = 1-tissue-compartment model; RRG = rapid rotating gantry.

  • TABLE 2

    Major Diagnostic (n > 100) and Prognostic (n > 1,000) Validation Studies for Solid-State SPECT MPI

    StudyCases (n)SystemComparatorTracerDoseStress/rest time (min)
    Diagnostic validation
     Nakazato (20)56 ICA, 86 LLkD-SPECTICASestamibi, dual-isotopeSD2/4
     Gimelli (15)137Discovery 530cICATetrofosminLD7/6
     Duvall (22)160Discovery 530cICASestamibiLD, SD3–5/3–5
     Mouden (75)100Discovery 570ciFFRTetrofosminSD5/4
     Nakazato (21)67 ICA, 51 LLkD-SPECTICASestamibi, dual-isotopeSD2–6/6–12
     Chikamori (76)102Discovery 530cICA/iFFRTetrofosmin, sestamibiLD10/6
     Sharir (25)208 ICA, 76 LLkDiscovery 530cICASestamibiLD vs. SDLD: 5–7/5–7; SD: 5/3
     Betancur (45)1,160D-SPECTICASestamibiLD, SD4–6/6–10
     Betancur (68)1,638D-SPECT, Discovery 530c or 570cICASestamibi, tetrofosmin, dual-isotopeLD, SD4–6/6–10
     Gimelli (77)1,161Discovery 530cICATetrofosminLD7/6
    Prognostic validation
     Nakazato (78)1,613D-SPECTAll-cause mortalitySestamibi, dual-isotopeSDSestamibi: 2/4; dual: 6/4
     Chowdhury (79)1,109 (165 with ICA)Discovery 530cMACE, ICATetrofosminSD3–6/3–6
     De Lorenzo (80)1,396Discovery 530cAll-cause mortalitySestamibiSD4/8
     Yokota (81)1,288 solid-state, 362 conventionalDiscovery 570cMACETetrofosminLD5/—
     Engbers (82)4,057Discovery 570cMACETetrofosminSD5/4
     Lima (83)3,554Discovery 530cMACESestamibiLD3/6
     Lima (84)2,930Discovery 530cMACESestamibiSD, LD3/6
     Betancur (85)2,619D-SPECTMACESestamibiSD4–6/6–10
     van Dijk (86)1,255Discovery 570cMACETetrofosminSD vs. LDSD: 5/4; LD: 8/6
     Otaki (67)19,495D-SPECT, Discovery 530cMACETetrofosmin, sestamibi, dual-isotopeLD, SD4–6/6–10

    • ICA = invasive coronary angiography; LLk = low likelihood of coronary artery disease; SD = standard dose; LD = low-dose; iFFR = invasive fractional flow reserve; MACE = major adverse cardiac events.

    • Overall effective dose of test is LD if dose is ≤6 mSv; SD if above 6 mSv. Acquisition time is for default view if more than 1 position is taken.

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