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Stress-first protocol for myocardial perfusion SPECT imaging with semiconductor cameras: high diagnostic performances with significant reduction in patient radiation doses

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Effective doses of 14 mSv or higher are currently being attained in patients having stress and rest myocardial perfusion imaging (MPI) single photon emission computed tomography (SPECT) performed on the same day with conventional protocols. This study aimed to assess the actual reduction in effective doses as well as diagnostic performances for MPI routinely planned with: (1) high-sensitivity cadmium zinc telluride (CZT) cameras, (2) very low injected activities and (3) a stress-first protocol where the normality of stress images may lead to avoiding rest imaging.

Methods

During a 1-year period, 2,845 patients had MPI on a CZT camera, a single-day stress-first protocol and low injected activities (120 MBq of 99mTc-sestamibi at stress for 75 kg body weight and threefold higher at rest). The ability to detect > 50 % coronary stenosis was assessed in a subgroup of 149 patients who also had coronary angiography, while the normalcy rate was assessed in a subgroup of 128 patients with a low pretest likelihood of coronary artery disease (<10 %).

Results

Overall, 33 % of patients had abnormal MPI of which 34 % were women and 34 % were obese. The mean effective doses and the percentage of exams involving only stress images were: (1) 3.53 ± 2.10 mSv and 37 % in the overall population, (2) 4.83 ± 1.56 mSv and 5 % in the subgroup with angiography and (3) 1.96 ± 1.52 mSv and 71 % in the low-probability subgroup. Sensitivity and global accuracy for identifying the 106 patients with coronary stenosis were 88 and 80 %, respectively, while the normalcy rate was 97 %.

Conclusion

When planned with a low-dose stress-first protocol on a CZT camera, MPI provides high diagnostic performances and a dramatic reduction in patient radiation doses. This reduction is even greater in low-risk subgroups with high rates of normal stress images, thus allowing the mean radiation dose to be balanced against cardiac risk in targeted populations.

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Acknowledgments

The authors thank Pierre Pothier for critical review of the manuscript and the Nancyclotep experimental imaging platform for organizational support.

Compliance with ethical standards

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Conflicts of interest

None.

Statement of human rights

For this type of study formal consent from participants is not required.

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Authors and Affiliations

  1. Department of Nuclear Medicine, CHU-Nancy, Nancy, France

    Mathieu Perrin, Wassila Djaballah, Marine Claudin, Nicolas Veran, Laetitia Imbert, Sylvain Poussier, Olivier Morel, Cyril Besseau, Antoine Verger, Henri Boutley, Gilles Karcher & Pierre-Yves Marie

  2. Nancyclotep Experimental Imaging Platform, Nancy, France

    Mathieu Perrin, Wassila Djaballah, Marine Claudin, Nicolas Veran, Laetitia Imbert, Sylvain Poussier, Olivier Morel, Cyril Besseau, Antoine Verger, Henri Boutley, Gilles Karcher & Pierre-Yves Marie

  3. INSERM U947 and Université de Lorraine, Nancy, France

    Wassila Djaballah, Sylvain Poussier & Antoine Verger

  4. Department of Cardiology, CHU-Nancy, Nancy, France

    Frédéric Moulin

  5. UMR 7039 CRAN and Université de Lorraine, Nancy, France

    Laetitia Imbert & Gilles Karcher

  6. INSERM U1116 and Université de Lorraine, Nancy, France

    Pierre-Yves Marie

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  1. Mathieu Perrin
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  2. Wassila Djaballah
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  10. Antoine Verger
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Correspondence to Mathieu Perrin.

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Perrin, M., Djaballah, W., Moulin, F. et al. Stress-first protocol for myocardial perfusion SPECT imaging with semiconductor cameras: high diagnostic performances with significant reduction in patient radiation doses. Eur J Nucl Med Mol Imaging 42, 1004–1011 (2015). https://doi.org/10.1007/s00259-015-3016-7

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  • DOI: https://doi.org/10.1007/s00259-015-3016-7

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