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Journal of Nuclear Cardiology
Published in: Journal of Nuclear Cardiology 1/2020

01-02-2020 | Review Article

Quantitative Clinical Nuclear Cardiology, Part 1: Established Applications

Authors: Ernest V. Garcia, PhD, Piotr Slomka, PhD, Jonathan B. Moody, PhD, Guido Germano, PhD, Edward P. Ficaro, PhD

Published in: Journal of Nuclear Cardiology | Issue 1/2020

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Abstract

Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has attained widespread clinical acceptance as a standard of care for patients with known or suspected coronary artery disease (CAD). A significant contribution to this success has been the use of computer techniques to provide objective quantitative assessment in the standardization of the interpretation of these studies. Software platforms have been developed as a pipeline to provide the quantitative algorithms researched, developed and validated to be clinically useful so diagnosticians everywhere can benefit from these tools. The goal of this CME article (PART 1) is to describe the many quantitative tools that are clinically established and more importantly how clinicians should use them routinely in the interpretation, clinical management and therapy guidance of patients with CAD.
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Literature
1.
Iskandrian AE, Garcia EV, editors. Nuclear Cardiac Imaging. 5th ed. New York, NY: Oxford University Press; 2016.
2.
Dorbala S, Ananthasubramaniam K, Armstrong IS, et al. Single Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging guidelines: instrumentation, acquisition, processing, and interpretation. J Nucl Cardiol. 2018;25:1784–846.PubMed
3.
Dilsizian V, Bacharach SL, Beanlands RS, et al. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol. 2016;23:1187–226.PubMed
4.
Garcia EV, Van Train K, Maddahi J, et al. Quantification of rotational thallium-201 myocardial tomography. J Nucl Med. 1985;26:17–26.PubMed
5.
Van Train KF, Areeda J, Garcia EV, et al. Quantitative same-day rest-stress technetium-99m-sestamibi SPECT: definition and validation of stress normal limits and criteria for abnormality. J Nucl Med. 1993;34:1494–502.PubMed
6.
Nakajima K, Matsumoto N, Kasai T, Matsuo S, Kiso K, Okuda K. Normal values and standardization of parameters in nuclear cardiology: Japanese Society of Nuclear Medicine working group database. Ann Nucl Med. 2016;30:188–99.PubMedPubMedCentral
7.
Gambhir SS, Berman DS, Ziffer J, et al. A novel high-sensitivity rapid-acquisition single-photon cardiac imaging camera. J Nucl Med. 2009;50:635–43.PubMed
8.
Esteves FP, Raggi P, Folks RD, et al. Novel solid-state-detector dedicated cardiac camera for fast myocardial perfusion imaging: multicenter comparison with standard dual detector cameras. J Nucl Cardiol. 2009;16:927–34.PubMedPubMedCentral
9.
Bai C, Conwell R, Kindem J, et al. Phantom evaluation of a cardiac SPECT/VCT system that uses a common set of solid-state detectors for both emission and transmission scans. J Nucl Cardiol. 2010;17:459–69.PubMedPubMedCentral
10.
Bocher M, Blevis IM, Tsukerman L, Shrem Y, Kovalski G, Volokh L. A fast cardiac gamma camera with dynamic SPECT capabilities: design, system validation and future potential. Eur J Nucl Med Mol Imaging. 2010;37:1887–902.PubMedPubMedCentral
11.
Imbert L, Poussier S, Franken PR, et al. Compared performance of high-sensitivity cameras dedicated to myocardial perfusion SPECT: a comprehensive analysis of phantom and human images. J Nucl Med. 2012;53:1897–903.PubMed
12.
Duvall WL, Croft LB, Godiwala T, Ginsberg E, George T, Henzlova MJ. Reduced isotope dose with rapid SPECT MPI imaging: initial experience with a CZT SPECT camera. J Nucl Cardiol. 2010;17:1009–14.PubMed
13.
Lecchi M, Martinelli I, Zoccarato O, Maioli C, Lucignani G, Del Sole A. Comparative analysis of full-time, half-time, and quarter-time myocardial ECG-gated SPECT quantification in normal-weight and overweight patients. J Nucl Cardiol. 2017;24:876–87.PubMed
14.
Lyon MC, Foster C, Ding X, et al. Dose reduction in half-time myocardial perfusion SPECT-CT with multifocal collimation. J Nucl Cardiol. 2016;23:657–67.PubMed
15.
Nakazato R, Berman DS, Hayes SW, et al. Myocardial perfusion imaging with a solid-state camera: simulation of a very low dose imaging protocol. J Nucl Med. 2013;54:373–9.PubMedPubMedCentral
16.
Sharir T, Pinskiy M, Pardes A, et al. Comparison of the diagnostic accuracies of very low stress-dose with standard-dose myocardial perfusion imaging: automated quantification of one-day, stress-first SPECT using a CZT camera. J Nucl Cardiol. 2016;23:11–20.PubMed
17.
Wetzl M, Sanders JC, Kuwert T, Ritt P. Effect of reduced photon count levels and choice of normal data on semi-automated image assessment in cardiac SPECT. J Nucl Cardiol. April 13, 2018
18.
Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105:539–42.PubMed
19.
Berman DS, Hachamovitch R, Kiat H, et al. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1995;26:639–47.PubMed
20.
Slomka PJ, Nishina H, Berman DS, et al. Automated quantification of myocardial perfusion SPECT using simplified normal limits. J Nucl Cardiol. 2005;12:66–77.PubMed
21.
Klein JL, Garcia EV, DePuey EG, et al. Reversibility bullseye: a new polar bull’s-eye map to quantify reversibility of stress induced SPECT Tl-201 myocardial perfusion defects. J Nucl Med. 1990;31:1240–6.PubMed
22.
Garcia EV, DePuey EG, Sonnemaker RE, et al. Quantification of the reversibility of stress induced SPECT thallium-201 myocardial perfusion defects: a multicenter trial using bull’s-eye polar maps and standard normal limits. J Nucl Med. 1990;31:1761–5.PubMed
23.
Jain D, He ZH, Lele V, Aronow WS. Direct myocardial ischemia imaging: a new cardiovascular nuclear imaging paradigm. Clin Cardiol. 2015;38:124–30.PubMed
24.
Berman DS, Kang X, Van Train KF, et al. Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1998;32:1987–95.PubMed
25.
Hachamovitch R, Rozanski A, Shaw LJ, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J. 2011;32:1012–1024PubMed
26.
Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman D. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107:2900–7.
27.
Tamaki S, Nakajima H, Murakami T, et al. Estimation of infarct size by myocardial emission computed tomography with thallium-201 and its relation to creatine kinase-MB release after myocardial infarction in man. Circulation. 1982;66:994–1001.PubMed
28.
Gibbons RJ, Verani MS, Behrenbeck T, et al. Feasibility of tomographic 99mTc-hexalis-2-methoxy2-methylpropyl-isonitrile imaging for the assessment of myocardial area at risk and the effect of treatment in acute myocardial infarction. Circulation. 1989;80:1277–86.PubMed
29.
Christian TF. The use of perfusion imaging in acute myocardial infarction: applications for clinical trials and clinical care. J Nucl Cardiol. 1995;2:423–36.PubMed
30.
Slomka PJ, Fieno D, Thomson L, et al. Automatic detection and size quantification of infarcts by myocardial perfusion SPECT: clinical validation by delayed-enhancement MRI. J Nucl Med. 2005;46:728–35.PubMed
31.
Dilsizian V, Arrighi JA, Diodati JG, et al. Myocardial viability in patients with chronic coronary artery disease: comparison of 99mTc-sestamibi with thallium reinjection and [18F]fluorodeoxyglucose. Circulation. 1994;89:578–87.PubMed
32.
Tillisch J, Brunken R, Marshall R, et al. Reversibility of cardiac wall-motion abnormalities predicted by positron tomography. N Engl J Med. 1986;314:884–8.PubMed
33.
Schelbert HR, Beanlands R, Bengel F, et al. PET myocardial perfusion and glucose metabolism imaging: part 2—guidelines for interpretation and reporting. J Nucl Cardiol. 2003;10:557–71.PubMed
34.
Santana CA, Faber TL, Soler-Peter M, et al. Prognostic performance of quantitative PET tools for stratification of patients with ischemic cardiomyopathy undergoing myocardial viability assessment. Nucl Med Commun. 2008;29:970–81.PubMed
35.
Allman KC. Noninvasive assessment myocardial viability: current status and future directions. J Nucl Cardiol. 2013;20:618–37.PubMed
36.
Ficaro EP, Lee BC, Kritzman JN, Corbett JR. Corridor4DM: the Michigan method for quantitative nuclear cardiology. J Nucl Cardiol. 2007;14:455–65.PubMed
37.
Garcia EV, Faber TL, Cooke CD, Folks RD, Chen J, Santana C. The increasing role of quantification in clinical nuclear cardiology: the Emory approach. J Nucl Cardiol. 2007;14:420–32.PubMed
38.
Germano G, Kavanagh PB, Slomka PJ, Van Kriekinge SD, Pollard G, Berman DS. Quantitation in gated perfusion SPECT imaging: the Cedars-Sinai approach. J Nucl Cardiol. 2007;14:433–54.PubMed
39.
Slomka PJ, Germano G, Berman DS. Gated SPECT MPI processing and quantitation. In: Iskandrian AE, Garcia EV, editors. Nuclear Cardiac Imaging. 5th ed. New York, NY: Oxford University Press; 2016. p. 109–36.
40.
Stegger L, Lipke CSA, Kies P, et al. Quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPECT: validation of an elastic surface model approach in comparison to cardiac magnetic resonance imaging, 4D-MSPECT and QGS. Eur J Nucl Med Mol Imaging. 2007;34:900–9.PubMed
41.
Soneson H, Hedeer F, Arévalo C, et al. Development and validation of a new automatic algorithm for quantification of left ventricular volumes and function in gated myocardial perfusion SPECT using cardiac magnetic resonance as reference standard. J Nucl Cardiol. 2011;18:874–85.PubMed
42.
Schaefer WM, Lipke CSA, Standke D, et al. Quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPECT: MRI validation and comparison of the Emory Cardiac Tool Box with QGS and 4D-MSPECT. J Nucl Med. 2005;46:1256–63.PubMed
43.
Schaefer WM, Lipke CS, Nowak B, et al. Validation of QGS and 4D-MSPECT for quantification of left ventricular volumes and ejection fraction from gated 18F-FDG PET: comparison with cardiac MRI. J Nucl Med. 2004;45:74–9.PubMed
44.
Cooke CD, Garcia EV, Cullom SJ, Faber TL, Pettigrew RI. Determining the accuracy of calculating systolic wall thickening using a fast Fourier transform approximation: a simulation study based on canine and patient data. J Nucl Med. 1994;35:1185–92.PubMed
45.
Sharir T, Kang X, Germano G, et al. Prognostic value of poststress left ventricular volume and ejection fraction by gated myocardial perfusion SPECT in women and men: gender-related differences in normal limits and outcomes. J Nucl Cardiol. 2006;13:495–506.PubMed
46.
Akincioglu C, Berman DS, Nishina H, et al. Assessment of diastolic function using 16-frame 99mTc-sestamibi gated myocardial perfusion SPECT: normal values. J Nucl Med. 2005;46:1102–8.PubMed
47.
Nakajima K, Taki J, Kawano M, et al. Diastolic dysfunction in patients with systemic sclerosis detected by gated myocardial perfusion SPECT: an early sign of cardiac involvement. J Nucl Med. 2001;42:183–8.PubMed
48.
Kuroiwa Y, Nagamachi S, Miyati T, et al. The agreement of left ventricular function parameters between 99mTc-tetrofosmin gated myocardial SPECT and gated myocardial MRI. Ann Nucl Med. 2012;26:147–63.PubMed
49.
Yamamoto A, Takahashi N, Abe K, Kobayashi Y, Tamai J, Munakata K. Regional left-ventricular diastolic wall motion assessed by a new program for ECG-gated myocardial perfusion SPECT in early-stage heart failure. J Nucl Cardiol. 2008;15:375–82.PubMed
50.
Gimelli A, Liga R, Magro S, et al. Evaluation of left ventricular mass on cadmium-zinc-telluride imaging: validation against cardiac magnetic resonance. J Nucl Cardiol. 2019;26:899–905.PubMed
51.
Abidov A, Slomka PJ, Nishina H, et al. Left ventricular shape index assessed by gated stress myocardial perfusion SPECT: initial description of a new variable. J Nucl Cardiol. 2006;13:652–9.PubMed
52.
Mazzanti M, Germano G, Kiat H, et al. Identification of severe and extensive coronary artery disease by automatic measurement of transient ischemic dilation of the left ventricle in dual-isotope myocardial perfusion SPECT. J Am Coll Cardiol. 1996;27:1612–20.PubMed
53.
Faber TL, Cooke CD, Folks RD, et al. Left ventricular function and perfusion from gated SPECT perfusion images: an integrated method. J Nucl Med. 1999;40:650–9.PubMed
54.
Okwuosa TM, Hampole CV, Ali J, Williams KA. Left ventricular mass from gated SPECT myocardial perfusion imaging: comparison with cardiac computed tomography. J Nucl Cardiol. 2009;16:775–83.PubMed
55.
Xu Y, Arsanjani R, Clond M, et al. Transient ischemic dilation for coronary artery disease in quantitative analysis of same-day sestamibi myocardial perfusion SPECT. J Nucl Cardiol. 2012;19:465–73.PubMedPubMedCentral
56.
Abidov A, Bax JJ, Hayes SW, et al. Transient ischemic dilation ratio of the left ventricle is a significant predictor of future cardiac events in patients with otherwise normal myocardial perfusion SPECT. J Am Coll Cardiol. 2003;42:1818–25.PubMed
57.
Abidov A, Germano G, Berman DS. Transient ischemic dilation ratio: a universal high-risk diagnostic marker in myocardial perfusion imaging. J Nucl Cardiol. 2007;14:497–500.PubMed
58.
Slomka PJ, Betancur J, Liang JX, et al. Rationale and design of the REgistry of Fast Myocardial Perfusion Imaging with NExt generation SPECT (REFINE SPECT). J Nucl Cardiol. June 19, 2018
59.
Hu LH, Sharir T, Miller RJH, et al. Upper reference limits of transient ischemic dilation ratio for different protocols on new-generation cadmium zinc telluride cameras: a report from REFINE SPECT registry. J Nucl Cardiol. May 13, 2019
60.
Shi H, Santana CA, Rivero A, et al. Normal values and prospective validation of transient ischemic dilation index in Rb-82 PET myocardial perfusion imaging. Nucl Med Commun. 2007;28:859–63.PubMed
61.
Esteves FP, Santana CA, Raggi P, Garcia EV. Myocardial perfusion SPECT/CT: The added value of CT imaging. In: Iskandrian AE, Garcia EV, editors. Atlas of Nuclear Cardiology: Companion to Braunwald’s Heart Disease. Philadelphia, PA: Saunders; 2012. p. 390–416.
62.
Sarwar A, Shaw LJ, Shapiro MD, et al. Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging. 2009;2:675–88.PubMed
63.
Galt JR, Garcia EV, Robbins W. Effects of myocardial wall thickness on SPECT quantification. IEEE Trans Med Imaging. 1990;9:144–50.PubMed
64.
Slomka PJ, Berman DS, Xu Y, et al. Fully automated wall motion and thickening scoring system for myocardial perfusion SPECT: method development and validation in large population. J Nucl Cardiol. 2012;19:291–302. PubMedPubMedPubMedCentral
65.
Arsanjani R, Xu Y, Hayes SW, et al. Comparison of fully automated computer analysis and visual scoring for detection of coronary artery disease from myocardial perfusion SPECT in a large population. J Nucl Med. 2013;54:221–8.PubMedPubMedCentral
66.
Nakazato R, Berman DS, Gransar H, et al. Prognostic value of quantitative high-speed myocardial perfusion imaging. J Nucl Cardiol. 2012;19:1113–23.PubMedPubMedCentral
67.
Santana CA, Folks RD, Garcia EV, et al. Quantitative Rb-82 PET/CT development and validation of myocardial perfusion database. J Nucl Med. 2007;48:1122–8.PubMed
68.
Slomka PJ, Dey D, Sitek A, Motwani M, Berman DS, Germano G. Cardiac imaging: working towards fully-automated machine analysis & interpretation. Expert Rev Med Devices. 2017;14:197–212.PubMedPubMedCentral
69.
Xu Y, Fish M, Gerlach J, et al. Combined quantitative analysis of attenuation corrected and non-corrected myocardial perfusion SPECT: method development and clinical validation. J Nucl Cardiol. 2010;17:591–9.PubMedPubMedCentral
70.
Germano G, Kavanagh PB, Ruddy TD, et al. “Same-patient processing” for multiple cardiac SPECT studies. 2. Improving quantification repeatability. J Nucl Cardiol. 2016;23:1442–1453PubMedPubMedCentral
71.
Xu Y, Kavanagh P, Fish M, et al. Automated quality control for segmentation of myocardial perfusion SPECT. J Nucl Med. 2009;50:1418–26.PubMedPubMedCentral
72.
Motwani M, Leslie WD, Goertzen AL, et al. Fully automated analysis of attenuation-corrected SPECT for the long-term prediction of acute myocardial infarction. J Nucl Cardiol. 2018;25:1353–60.PubMed
73.
Ficaro EP, Fessler JA, Shreve PD, Kritzman JN, Rose PA, Corbett JR. Simultaneous transmission/emission myocardial perfusion tomography: diagnostic accuracy of attenuation-corrected 99mTc-sestamibi single-photon emission computed tomography. Circulation. 1996;93:463–73.PubMed
74.
Garcia EV. Quantitative nuclear cardiology: we are almost there! J Nucl Cardiol. 2012;19:424–37.PubMed
75.
Slomka PJ, Fish MB, Lorenzo S, et al. Simplified normal limits and automated quantitative assessment for attenuation-corrected myocardial perfusion SPECT. J Nucl Cardiol. 2006;13:642–51.PubMed
76.
Grossman GB, Garcia EV, Bateman TM, et al. Quantitative Tc-99m sestamibi attenuation-corrected SPECT: development and multicenter trial validation of myocardial perfusion stress gender-independent normal database in an obese population. J Nucl Cardiol. 2004;11:263–72.PubMed
77.
Hayes SW, De Lorenzo A, Hachamovitch R, et al. Prognostic implications of combined prone and supine acquisitions in patients with equivocal or abnormal supine myocardial perfusion SPECT. J Nucl Med. 2003;44:1633–40.PubMed
78.
Nishina H, Slomka PJ, Abidov A, et al. Combined supine and prone quantitative myocardial perfusion SPECT: method development and clinical validation in patients with no known coronary artery disease. J Nucl Med. 2006;47:51–8.PubMed
79.
Slomka PJ, Nishina H, Abidov A, et al. Combined quantitative supine-prone myocardial perfusion SPECT improves detection of coronary artery disease and normalcy rates in women. J Nucl Cardiol. 2007;14:44–52.PubMed
80.
Nakazato R, Tamarappoo BK, Kang X, et al. Quantitative upright-supine high-speed SPECT myocardial perfusion imaging for detection of coronary artery disease: correlation with invasive coronary angiography. J Nucl Med. 2010;51:1724–31.PubMedPubMedCentral
81.
Leslie WD, Tully SA, Yogendran MS, Ward LM, Nour KA, Metge CJ. Prognostic value of automated quantification of Tc-99m-sestamibi myocardial perfusion imaging. J Nucl Med. 2005;46:204–11.PubMed
Metadata
Title
Quantitative Clinical Nuclear Cardiology, Part 1: Established Applications
Authors
Ernest V. Garcia, PhD
Piotr Slomka, PhD
Jonathan B. Moody, PhD
Guido Germano, PhD
Edward P. Ficaro, PhD
Publication date
01-02-2020
Publisher
Springer International Publishing
Published in
Journal of Nuclear Cardiology / Issue 1/2020
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI
https://doi.org/10.1007/s12350-019-01906-6

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