Prospective multicenter evaluation of rapid, gated SPECT myocardial perfusion upright imaging

doi:10.1007/s12350-009-9063-3

Journal of Nuclear Cardiology

Volume 16, Issue 3, June 2009, Pages 351-357

https://doi.org/10.1007/s12350-009-9063-3 Get rights and content

Abstract

Background

A novel three-dimensional (3D) iterative image reconstruction method (3D-OSEM) has been developed that in phantom studies yielded comparable image quality at one half the imaging time. In this study, we compared standard (STD) and rapid (nSPEED) protocols for diagnostic quality of images and quantitation of end-diastolic volume (EDV), end-systolic volume (ESV), left ventricular ejection fraction (LVEF), and perfusion defect severity.

Methods

At 11 US community centers, 448 patients prospectively underwent rest–stress-gated SPECT imaging using Tc-99m-labeled agent. The difference in quality and diagnostic equivalence of STD and nSPEED images were blindly evaluated by three experts. Defect intensity was quantitated as %normal in the three coronary artery territories.

Results

Studies were abnormal in 40% of patients. In 98.7% of stress and 98% of rest images, the nSPEED image quality was identical to or better than the STD images. nSPEED images were diagnostically equivalent to the STD in 444/448 (99%) patients. A high correlation was observed between nSPEED and STD studies for measurement of EDV (Y = 0.957X, R² = 0.99), ESV (Y = 0.962X, R² = 0.99), and LVEF (Y = 1.005X, R² = 0.96). STD and nSPEED studies were not significantly different (P = ns) for quantitative perfusion defect severity.

Conclusion

Rapid, gated rest–stress myocardial perfusion upright SPECT imaging may be achieved without compromising perfusion and function information.

Section snippets

Study Population

A total of 448 patients were enrolled in this prospectively designed study from 11 US nuclear cardiology laboratories in community practices (Table 1). Patients underwent rest–gated stress SPECT imaging using a Tc-99m-labeled agent. All patients were referred for clinically indicated rest–stress myocardial perfusion SPECT imaging. There were 297 males (ranging in age from 30 to 89 years, mean = 67 years) and 151 females (ranging in age from 25 to 95, mean = 68 years).

Stress-Testing Procedures

Patients underwent a

Results

By consensus visual analysis, 269/448 (60%) of the studies were normal and the remaining 177/448 (40%) were abnormal. The proportion of normal and abnormal studies is representative of that generally encountered in office-based nuclear cardiology practices. Body surface area of the study population ranged from 1.40 to 2.80 m² (2.01 ± 0.26 m²).

Discussion

In this study, we observed a very high qualitative and quantitative correlation between nSPEED and STD SPECT images. As the number of iterations of the OSEM algorithm and choice of post-filters in nSPEED will influence image results, in a separate pilot study we had optimized the nSPEED package to make the nSPEED half-time images equivalent to the conventional 2D-OSEM full-time images, both qualitatively and quantitatively.

In this study, for nSPEED reconstruction, Butterworth cutoff frequency

Conclusion

This study demonstrated that, as compared to 2D-OSEM iterative reconstruction, 3D-OSEM image reconstruction technique allows reduction of imaging time to one half and yields diagnostically equivalent images for rest and stress studies, reliable measurement of EDV, ESV, and LVEF from gated stress SPECT images, and reliable quantitation of perfusion defect severity on stress and rest SPECT images.

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In another clinical trial it was shown that adaptive noise control with WBR improves uniformity of myocardium compared to FBP techniques, and results in improved diagnostic certainty while preserving normalcy and accuracy.20 In yet another large multicenter trial using half-time upright SPECT acquisition reconstructed with another version of resolution recovery, it was shown this methodology yielded results similar to conventional full acquisition times without compromising perfusion and function information.21 In general, it can be concluded from the results of these and other clinical trials that half time acquisitions reconstructed with resolution recovery improve image quality over FBP or standard OSEM and provide perfusion information, which is very similar to FBP.
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Using the IQ SPECT cardio-focused collimator in conjunction with 3D Flash reduced count density reconstruction software (Siemens Medical Solution) and attenuation correction, Vija et al44 demonstrated in Data Spectrum phantoms studies and one clinical patient example that myocardial perfusion SPECT image quality was comparable in 4-minute IQ SPECT scans as compared with standard 20-minute acquisitions acquired with a LEHR collimator45 (Fig. 19). In a prospective, multicenter trial of 448 patients in whom full-time gated SPECT acquisitions and simulated “half-time” acquisitions were compared qualitatively and quantitatively regarding perfusion defect characteristics and functional parameters, Maddahi et al46 reported the results of reduced-time myocardial perfusion SPECT acquired on the Cardius upright camera employing CsI solid-state detectors and reduced count density nSPEED software, incorporating OSEM reconstruction and resolution recovery (Digirad, Inc). They demonstrated that reduced-time acquisition image quality was at least as good as and often superior to that obtained with full-time acquisitions.
New software methods that incorporate iterative reconstruction, resolution recovery, and noise compensation now provide the ability to maintain or improve myocardial perfusion SPECT image quality with conventional sodium iodide cameras. Despite lower image counting statistics associated with significantly decreased injected radiopharmaceutical doses or shortened acquisition times or both, image quality is preserved or even improved compared with conventional processing methods. The ability to prescribe a desired myocardial count density by preselecting a SPECT acquisition time now avoids additional patient radiation exposure associated with “weight-based” dosing. More recent advancements, including temporal correlation among the gated perfusion frames and higher resolution SPECT acquisitions, hold promise to further improve image quality and diagnostic accuracy. Phase analysis of gated perfusion SPECT provides the ability to assess cardiac dyssynchrony and to select those patients who will most benefit from resynchronization therapy. In combination with the higher counting statistics afforded by the new solid-state dedicated cardiac cameras, these software advancements allow for even further decreased patient radiation doses or acquisition times or both. List-mode software allows for refinement of myocardial perfusion SPECT by interrogating particular data from selected cardiac cycles. Rejection of frames degraded by arrhythmic cardiac cycles or excessive extracardiac uptake can be excluded for reconstruction. Respiratory gating, which diminishes cardiac motion and potentially decreases diaphragmatic attenuation, has been demonstrated to improve diagnostic specificity. With high-count first-pass list-mode acquisitions at rest and during pharmacologic vasodilatation, it may be possible to measure global and regional myocardial perfusion reserve to more accurately diagnose coronary artery disease and avoid false-negative studies owing to balanced ischemia.
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: Financial support for this study was partly provided by Digirad Corporation, Poway, CA.

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Original ArticleProspective multicenter evaluation of rapid, gated SPECT myocardial perfusion upright imaging

Abstract

Background

Methods

Results

Conclusion

Section snippets

Study Population

Stress-Testing Procedures

Results

Discussion

Conclusion

J Am Coll Cardiol Imaging

J Nucl Cardiol

J Nucl Cardiol

J Nucl Cardiol

J Nucl Cardiol

Original Article
Prospective multicenter evaluation of rapid, gated SPECT myocardial perfusion upright imaging