Quantitative assessment of regional myocardial blood flow with thallium-201 and SPECT

doi:10.1016/S1071-3581(98)90133-7

Journal of Nuclear Cardiology

Volume 5, Issue 3, May–June 1998, Pages 313-331

https://doi.org/10.1016/S1071-3581(98)90133-7 Get rights and content

Abstract

Thallium-201 has been used extensively as a myocardial perfusion agent and to assess myocardial viability. Unlike other ^99mTc-labeled agents such as ^99mTc-sestamibi and ^99mTc-tetrofosmine, the regional concentration of 201T1varies with time, and its kinetics make it a potential candidate for estimating absolute physiologic parameters with kinetic model analysis. This article outlines a strategy for quantitative assessment of regional myocardial blood flow in man using ²⁰¹Tl and dynamic single photon emission computed tomography (SPECT) . Quantitatively accurate SPECT images that are proportional to the true radioactivity distribution are prerequisites for model-based kinetic analysis. Our technique for quantitative SPECT includes ordered-subset maximum likelihood—expectation maximization (ML-EM) reconstruction with transmission data—based attenuation correction and transmission-dependent convolution subtraction scatter correction. A three-compartment model was found to reproduce the observed regionaltime-activity curves well, and dog experiments demonstrated that influx rate constant (K₁) sc estimated from the dynamic SPECT data correlated well with absolute myocardial blood flow determined by in vitro microspheres for a physiologically wide range of flows. Several possible strategies for simplifying the study procedures, without compromising accuracy, are also presented, which should make absolute quantitation of regional myocardial blood flow feasible using ²⁰¹Tl and a conventional SPECT camera in a clinical setting.

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Cited by (63)

A combined static-dynamic single-dose imaging protocol to compare quantitative dynamic SPECT with static conventional SPECT
2019, Journal of Nuclear Cardiology
SPECT myocardial perfusion imaging (MPI) is a clinical mainstay that is typically performed with static imaging protocols and visually or semi-quantitatively assessed for perfusion defects based upon the relative intensity of myocardial regions. Dynamic cardiac SPECT presents a new imaging technique based on time-varying information of radiotracer distribution, which permits the evaluation of regional myocardial blood flow (MBF) and coronary flow reserve (CFR). In this work, a preliminary feasibility study was conducted in a small patient sample designed to implement a unique combined static-dynamic single-dose one-day visit imaging protocol to compare quantitative dynamic SPECT with static conventional SPECT for improving the diagnosis of coronary artery disease (CAD).
Fifteen patients (11 males, four females, mean age 71 ± 9 years) were enrolled for a combined dynamic and static SPECT (Infinia Hawkeye 4, GE Healthcare) imaging protocol with a single dose of ^99mTc-tetrofosmin administered at rest and a single dose administered at stress in a one-day visit. Out of 15 patients, eleven had selective coronary angiography (SCA), 8 within 6 months and the rest within 24 months of SPECT imaging, without intervening symptoms or interventions. The extent and severity of perfusion defects in each myocardial region was graded visually. Dynamically acquired data were also used to estimate the MBF and CFR. Both visually graded images and estimated CFR were tested against SCA as a reference to evaluate the validity of the methods.
Overall, conventional static SPECT was normal in ten patients and abnormal in five patients, dynamic SPECT was normal in 12 patients and abnormal in three patients, and CFR from dynamic SPECT was normal in nine patients and abnormal in six patients. Among those 11 patients with SCA, conventional SPECT was normal in 5, 3 with documented CAD on SCA with an overall accuracy of 64%, sensitivity of 40% and specificity of 83%. Dynamic SPECT image analysis also produced a similar accuracy, sensitivity, and specificity. CFR was normal in 6, each with CAD on SCA with an overall accuracy of 91%, sensitivity of 80%, and specificity of 100%. The mean CFR was significantly lower for SCA detected abnormal than for normal patients (3.86±1.06 vs 1.94±0. 0.67, P < 0.001).
The visually assessed image findings in static and dynamic SPECT are subjective, and may not reflect direct physiologic measures of coronary lesion based on SCA. The CFR measured with dynamic SPECT is fully objective, with better sensitivity and specificity, available only with the data generated from the dynamic SPECT method.
Quantitative Assessment of Myocardial Blood Flow with SPECT
2015, Progress in Cardiovascular Diseases
Citation Excerpt :
Several researches suggested that it is possible to quantify CFR with this approach (Table 3). In particular, there are studies using dynamic planar scintigraphy in humans39–44 or dynamic SPECT in animals.34,45,46 The method used in these investigations is potentially open to implementation in most nuclear cardiology laboratories, and it could be adapted for general application (Fig 2).
The quantitative assessment of myocardial blood flow (MBF) and coronary flow reserve (CFR) may be useful for the functional evaluation of coronary artery disease, allowing judgment of its severity, tracking of disease progression, and evaluation of the anti-ischemic efficacy of therapeutic strategies. Quantitative estimates of myocardial perfusion and CFR can be derived from single-photon emission computed tomography (SPECT) myocardial perfusion images by use of equipment, tracers, and techniques that are available in most nuclear cardiology laboratories. However, this method underestimates CFR, particularly at high flow rates. The recent introduction of cardiac-dedicated gamma cameras with solid-state detectors provides very fast perfusion imaging with improved resolution, allowing fast acquisition of serial dynamic images during the first pass of a flow agent. This new technology holds great promise for MBF and CFR quantification with dynamic SPECT. Future studies will clarify the effectiveness of dynamic SPECT flow imaging.
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First validation of myocardial flow reserve assessed by dynamic <sup>99m</sup>Tc-sestamibi CZT-SPECT camera: head to head comparison with <sup>15</sup>O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study
2018, European Journal of Nuclear Medicine and Molecular Imaging
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2018, Inverse Problems
Dynamic SPECT reconstruction with temporal edge correlation
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^☆: Supported by a research grant for cardiovascular diseases (8C-5, 1996–1998) from the Ministry of Health and Welfare.

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ReviewQuantitative assessment of regional myocardial blood flow with thallium-201 and SPECT☆

Abstract

J Nucl Cardiol

Am J Cardiol

J Nucl Cardiol

J Nucl Cardiol

J Am Coll Cardiol

Semin Nucl Med

Control Engineering Practice

Dynamic cardiac SPECT computer simulations for teboroxime kinetics

IEEE Transaction of Nuclear Science

Kinetic modeling of teboroxime using dynamic SPECT imaging of a canine model

J Nucl Med

Compartmental analysis of technetium-99m-teboroxime kinetics employing fast dynamic SPECT at rest and stress

J Nucl Med

Considerations of 201T1as a myocardial radionuclide imaging agent in man

Invest Radiol

The extraction of thallium-201 by the myocardium

Circulation

Thallium-201 kinetics in nonischemic canine myocardium

Circulation

Myocardial kinetics of thallium-201 after dipyridamole infusion in normal canine myocardium and in myocardium distal to a stenosis

J Clin Invest

Distribution of thallium201 injected into rats following stress: imaging organ to plasma uptake ratios, and myocardial kinetics

J Nucl Med

Partition of thallium-201 in isolated myocardial tissue of rats previously injected at rest or after exercise

J Nucl Med

Effects of exercise and distribution of K-43 and T1-201 in isolated myocardium: concise communication

J Nucl Med

Thallium-201 for medical use. I

J Nucl Med

Thallium-201 for medical use, part 3: human distribution and physical imaging properties

J Nucl Med

Thallium-201 for medical use, II: biologic behavior

J Nucl Med

Quantitative SPECT imaging: a review and recommendations by the Focus Committee of the Society of Nuclear Medicine Computer and Instrumentation Council

J Nucl Med

A scanning line source for simultaneous emission and transmission measurements in SPECT

J Nucl Med

Quantitative emission computed tomography using simultaneous emission and transmission measurements

Scatter and attenuation correction in SPECT using density maps and Monte Carlo simulated scatter functions

J Nucl Med

A transmission dependent method for scatter correction in SPECT

J Nucl Med

A quantitative SPECT regime

Improved SPECT quantitation using compensation for scattered photons

J Nucl Med

Scatter compensation techniques for SPECT

IEEE Trans Nucl Sci

A dual-photopeak window method for scatter correction

J Nucl Med

A practical method for positiondependent Compton-scatter correction in single photon emission CT

IEEE Trans Med Imag

Accurate scatter correction in single photon emission CT

Ann Nucl Med Sci

Introduction to holospectral imaging in nuclear medicine for scatter correction

IEEE Trans Med Imag

Comparative assessment of nine scatter correction methods based on spectral analysis using Monte Carlo simulations

J Nucl Med

Subtraction of Compton-scattered photons in single-photon emission computerized tomography

J Nucl Med

Attenuation and scatter correction in SPECT for sources in a nonhomogeneous object: a Monte Carlo study

J Nucl Med

Treatment of Compton scattering in maximum likelihood expectation-maximization reconstructions of SPECT images

J Nucl Med

Improved SPECT quantitation using fully three-dimensional iterative spatially variant scatter response compensation

IEEE Trans Med Imag

Compton scatter compensation using the triple-energy window method for single- and dual-isotope SPECT

J Nucl Med

Monte Carlo and experimental evaluation of accuracy and noise properties of two scatter correction methods for SPECT

Phys Med Biol

Monte Carlo evaluation of accuracy and noise properties of two scatter correction methods for 201T1 cardiac SPECT

IEEE Trans Nucl Sci

Quantative cardiac SPECT with reduced degradation due to patient anatomy

IEEE Trans Nucl Sci

Accelerated image reconstruction using ordered subsets of projection data

IEEE Trans Med Imag

Review
Quantitative assessment of regional myocardial blood flow with thallium-201 and SPECT☆