Document Detail


Very low-activity stress/high-activity rest, single-day myocardial perfusion SPECT with a conventional sodium iodide camera and wide beam reconstruction processing.
MedLine Citation:
PMID:  22777525     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: A stress (S)/rest (R) 1-day Tc-99m sestamibi protocol is logistically advantageous and facilitates stress-only imaging. However, with conventional 370 MBq (10 mCi) S activity and subsequent 1,110-1,295 MBq (30-35 mCi) R activity there is a risk of S-to-R "shine-through" and underestimation of defect reversibility. New software methods cope with lower counting statistics and should allow for both a reduced S activity and also less likelihood of S-to-R "shine-through." METHODS: 102 prospective patients [49 men, 53 women; mean weight 178 ± 41 lbs (range 98-265 lbs); chest 41.5″ ± 4.0″ (range 32″-52″)] received 192.4 + 18.5 MBq (5.2 ± 0.5 mCi) Tc-99m sestamibi S (25 exercise, 77 regadenoson) activity followed in 30-40 minutes by "full-time" (12 minutes) two-headed NaI camera S SPECT. Immediately thereafter, a 16-minute S SPECT acquisition was also performed in 37/102 patients. Then at 60-80 minute post-S all patients received 1328.3 + 129.5 MBq (35.9 ± 3.5 mCi) Tc-99m sestamibi, and "half-time" (7.5 minutes) R SPECT was acquired. All tomograms were processed with wide beam reconstruction (WBR, UltraSPECT Ltd.) software. A time-adjusted R/S myocardial count density ratio (MCDR) was calculated using automated software. S SPECT quality was visually graded (poor, fair, good, excellent) based upon myocardial definition, cavity contrast, RV visualization, and noise. For comparison, the S/R MCDR was calculated in 581 consecutive patients undergoing a conventional 370 MBq R/1110 MBq S (10 mCi R/30 mCi S) protocol. RESULTS: S SPECT was normal in 44 patients (43%). Image quality was good-excellent in 93 (91%) patients with 12-minute S SPECT. Also in 37 (98%) patients with 16-minute S SPECT, quality was good-excellent. In patients with >42″ chests 12-minute S SPECT quality worsened with increasing chest circumference, manifested by myocardial "blurring." Image quality improved by ≥1 grade in the 12/37 patients (32%) also undergoing 16-minute S SPECT. The time- and decay-corrected 12-minute mean R/S MCDR was 5.78, a ratio adequate to minimize S-to-R shine-through, as verified in phantom experiments, and significantly better than a 3.79 S/R ratio achieved in the 581 patients undergoing a conventional R/S protocol. CONCLUSIONS: An approximately 185 MBq (5 mCi S) Tc-99m SPECT processed with WBR provides adequate image quality. For larger patients prolonging image acquisition to 16 minutes is beneficial. For patients with normal S SPECT, a S-only protocol is feasible, affording them a very low (approximately 1.4 mSv) radiation dose. If subsequent R SPECT is necessary, it can be performed with approximately 1,332 MBq (36 mCi) with minimal S-R "shine-through."
Authors:
E Gordon Depuey; Pashmina Ata; Rick Wray; Marvin Friedman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-10
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  -     ISSN:  1532-6551     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
St. Luke's-Roosevelt Hospital and Columbia University College of Physicians and Surgeons, New York, NY, USA, EDepuey@CHPNET.ORG.
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