tellurium and Coronary-Stenosis

This study sought to summarize the evidence on stress myocardial perfusion imaging (MPI) using cadmium-zinc-telluride (CZT) technology for the diagnosis of obstructive coronary artery disease (CAD). The CZT cameras are newly introduced, and comparative data with the conventional Anger technology (Anger-MPI) are lacking.. The diagnostic accuracy of Anger-MPI for detection of angiographically significant CAD is well established; however, less evidence is available on the diagnostic accuracy of CZT-MPI.. Clinical studies comparing CZT-MPI and invasive coronary angiography were systematically searched and abstracted. Calculations of diagnostic accuracy, including sensitivity, specificity, likelihood ratios, and diagnostic odds ratio, were obtained with fixed and random effects, reporting point estimates and 95% confidence intervals.. Based on our search, a total of 16 studies (N = 2,092) were included. The sensitivity of CZT-MPI was 0.84 (95% confidence interval [CI]: 0.78 to 0.89), whereas the specificity of 0.69 (95% CI: 0.62 to 0.76) was significantly reduced. The positive likelihood ratio was 2.73 (95% CI: 2.21 to 3.39), the negative likelihood ratio was 0.24 (95% CI: 0.17 to 0.31), and the diagnostic odds ratio was 11.93 (95% CI: 7.84 to 17.42). At subgroup and meta-regression analyses, the diagnostic accuracy between D-SPECT and Discovery cameras was similar (p = 0.711) and not impacted upon by smaller sample size studies (p = 0.573).. CZT-MPI has satisfactory sensitivity for angiographically significant CAD, but its suboptimal specificity warrants further development and research.

Topics: Aged; Cadmium; Chi-Square Distribution; Coronary Angiography; Coronary Artery Disease; Coronary Circulation; Coronary Stenosis; Coronary Vessels; Equipment Design; Female; Humans; Likelihood Functions; Male; Middle Aged; Myocardial Perfusion Imaging; Odds Ratio; Predictive Value of Tests; Proportional Hazards Models; Reproducibility of Results; Tellurium; Zinc

Evaluate the prediction of quantitative coronary angiography (QCA) values from MPI, by means of deep learning.. 546 patients (67% men) undergoing stress 99mTc-tetrofosmin MPI in a CZT camera in the upright and supine position were included (1092 MPIs). Patients were divided into two groups: ICA group included 271 patients who performed an ICA within 6 months of MPI and a control group with 275 patients with low pre-test probability for CAD and a normal MPI. QCA analyses were performed using radiologic software and verified by an expert reader. Left ventricular myocardium was segmented using clinical nuclear cardiology software and verified by an expert reader. A deep learning model was trained using a double cross-validation scheme such that all data could be used as test data as well.. Area under the receiver-operating characteristic curve for the prediction of QCA, with > 50% narrowing of the artery, by deep learning for the external test cohort: per patient 85% [95% confidence interval (CI) 84%-87%] and per vessel; LAD 74% (CI 72%-76%), RCA 85% (CI 83%-86%), LCx 81% (CI 78%-84%), and average 80% (CI 77%-83%).. Deep learning can predict the presence of different QCA percentages of coronary artery stenosis from MPIs.

Topics: Cadmium; Coronary Angiography; Coronary Artery Disease; Coronary Stenosis; Deep Learning; Female; Humans; Male; Myocardial Perfusion Imaging; Perfusion; Tellurium; Tomography, Emission-Computed, Single-Photon

The goal of this study is to explore and evaluate the diagnostic values of myocardial blood flow (MBF), myocardial flow reserve (MFR) and relative flow reserve (RFR) obtained with low-dose dynamic CZT SPECT for patients with suspected or known coronary artery disease (CAD). Fifty-seven consecutive patients who underwent low-dose dynamic CZT SPECT and CAG were enrolled. MBF, MFR and RFR were calculated on the vessel level with dedicated quantitative software, and the difference and correlation of each parameter was compared according to the reference standard of stenosis ≥ 50% or ≥ 75% on CAG, respectively. ROC curves were made by stress MBF (sMBF), rest MBF (rMBF), MFR and RFR. The optimal cut-off values and corresponding diagnostic efficacy were obtained and compared with each other. Results indicated that when stenosis ≥ 50% or ≥ 75% on CAG was used as the reference standard at the vessel level, there was no statistically significant difference in rMBF between the negative group and the positive group (P > 0.05), and the sMBF and MFR in positive groups were significantly lower than that in the negative group (all P < 0.05). There was a moderate to significant correlation between sMBF and MFR, sMBF and RFR, MFR and RFR (all P < 0.0001). These results indicate that low-dose dynamic CZT SPECT imaging can easily obtain the sMBF, MFR and RFR, and there is a good correlation among the three parameters, which has a certain diagnostic value for patients with suspected or known CAD, and is a useful supplement to the conventional qualitative or semi-quantitative diagnostic methods.

Topics: Aged; Cadmium; Coronary Artery Disease; Coronary Circulation; Coronary Stenosis; Coronary Vessels; Female; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Predictive Value of Tests; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Sestamibi; Tellurium; Tomography, Emission-Computed, Single-Photon; Zinc

To evaluate the impact of diabetes mellitus (DM) on the accuracy of myocardial perfusion scintigraphy (MPS) in detecting coronary artery disease (CAD).. Two hundred and sixteen patients with DM and 432 matched controls were submitted to MPS on a dedicated cardiac camera equipped with cadmium-zinc-telluride (CZT) detectors and coronary angiography. Exercise stress was performed in 442 (68%) patients, while the remainders underwent vasodilator stress. Exercise level was determined as the percentage of the predicted maximal workload that was attained (%Wattmax). The summed difference score was derived from CZT images. A coronary stenosis >70% was considered obstructive. The prevalence of obstructive CAD was 59.7% in patients with DM and 56.2% in controls (P = NS). The accuracy of MPS in detecting CAD was similar in patients with and without DM [area under the ROC curve (AUC) 0.77 vs. 0.78, P = NS]. An interaction between the accuracy of MPS and cardiac stress-protocol was revealed. In fact, in patients with DM exercise stress CZT had a lower accuracy than vasodilator-stress (AUC 0.70 vs. 0.89, P < 0.001), because of a lower specificity (45% vs. 69%), while in the control group the accuracy of MPS was similar regardless of the stress-protocol adopted. Patients with DM attained a significantly lower %Wattmax during exercise than controls (76 ± 27% vs. 82 ± 26%, P = 0.038), which resulted an independent predictor of reduced specificity (P = 0.026).. The accuracy of CZT imaging in patients with DM is elevated, and it is quite comparable to the one obtained in patients without DM. However, a reduced specificity can be expected in the case of exercise stress CZT, because of an impaired exercise capacity.

Topics: Aged; Aged, 80 and over; Cadmium; Case-Control Studies; Coronary Angiography; Coronary Stenosis; Diabetes Mellitus; Exercise Test; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Radiographic Image Enhancement; Reference Values; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Tellurium; Tomography, Emission-Computed, Single-Photon; Video Recording; Zinc

Despite the introduction of the novel cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) in Japan; its diagnostic value in clinical practice remains largely unknown.. The Semiconductor SPECT Study group is a multicenter Japanese registry which registered 1000 patients to evaluate the diagnostic utility of the CZT camera system (Discovery NM530c; GE Healthcare, Haifa, Israel). The patients underwent stress myocardial SPECT and coronary angiography within a 3-month interval. A significant stenosis was defined as ≥75% diameter narrowing based on the American Heart Association classification.. Technetium (. The novel CZT SPECT system facilitated a short scan time with reduced radiotracer dose, yielding an acceptable diagnostic performance for angiographical coronary artery disease, although the low sensitivity for LAD detection with

Topics: Adult; Aged; Aged, 80 and over; Cadmium; Coronary Angiography; Coronary Stenosis; Exercise Test; Female; Humans; Japan; Male; Middle Aged; Radiopharmaceuticals; Registries; Sensitivity and Specificity; Technetium; Tellurium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents; Zinc

Topics: Aged; Aged, 80 and over; Cadmium; Coronary Stenosis; Female; Fractional Flow Reserve, Myocardial; Gamma Cameras; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Tellurium; Zinc

Although stress single-photon emission computed tomography (SPECT) using a cadmium-zinc-telluride (CZT) camera facilitates radiation dose reduction, only a few studies have evaluated its diagnostic accuracy in Japanese patients by applying fractional flow reserve (FFR) measurements.. We prospectively evaluated 102 consecutive patients with suspected or known coronary artery disease with a low-dose stress/rest protocol ((99m)Tc radiotracer 185/370 MBq) using CZT SPECT. Within 3 months, coronary angiography was performed and a significant stenosis was defined as ≥90% diameter narrowing on visual estimation, or as a lesion of <90% and ≥ 50% stenosis with FFR ≤0.80. To detect individual coronary stenosis, the respective sensitivity, specificity, and accuracy were 86%, 75%, and 82% for left anterior descending artery stenosis, 76%, 81%, and 79% for left circumflex artery stenosis, and 87%, 92%, and 90% for right coronary artery stenosis. When limited to 92 intermediate stenotic lesions in which FFR was measured, stress SPECT showed 77% sensitivity, 91% specificity, and 84% accuracy, whereas the diagnostic value decreased to 52% sensitivity, 68% specificity, and 58% accuracy based only on visual estimation of ≥75% diameter narrowing.. CZT SPECT demonstrated a good diagnostic yield in detecting hemodynamically significant coronary stenoses as assessed by FFR, even when using a low-dose (99m)Tc protocol with an effective dose ≤5 mSv. (Circ J 2016; 80: 1217-1224).

Topics: Cadmium; Coronary Artery Disease; Coronary Stenosis; Fractional Flow Reserve, Myocardial; Humans; Prospective Studies; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Sestamibi; Tellurium; Tomography, Emission-Computed, Single-Photon; Zinc

Although the novel cadmium-zinc-telluride (CZT) camera system provides excellent image quality, its diagnostic value using thallium-201 as assessed on coronary angiography (CAG) and fractional flow reserve (FFR) has not been validated. METHODS AND RESULTS: To evaluate the diagnostic accuracy of the CZT ultrafast camera system (Discovery NM 530c), 95 patients underwent stress thallium-201 single-photon emission computed tomography (SPECT) and then CAG within 3 months. Image acquisition was performed in the supine and prone positions after stress for 5 and 3 min, respectively, and in the supine position at rest for 10 min. Significant stenosis was defined as ≥90% diameter narrowing on visual estimation, or a lesion with <90% and ≥50% stenosis and FFR ≤0.75. To detect individual coronary stenosis, the respective sensitivity, specificity, and accuracy were 90%, 64%, and 78% for left anterior descending coronary artery stenosis, 78%, 84%, and 81% for left circumflex stenosis, and 83%, 47%, and 60% for right coronary artery (RCA) stenosis. The combination of prone and supine imaging had a higher specificity for RCA disease than supine imaging alone (65% vs. 47%), with an improvement in accuracy from 60% to 72%.. Using thallium-201 with short acquisition time, combined with prone imaging, CZT SPECT had a high diagnostic yield in detecting significant coronary stenosis as assessed using FFR.

Topics: Blood Flow Velocity; Cadmium; Coronary Angiography; Coronary Stenosis; Female; Humans; Male; Middle Aged; Sensitivity and Specificity; Tellurium; Tomography, Emission-Computed, Single-Photon; Zinc