tellurium and Ventricular-Dysfunction--Left

The use of phase analysis techniques to assess left ventricular mechanical dyssynchrony (LVMD) has been well documented. However, artifacts have reduced the accuracy of the assessment due to soft tissue attenuation, so little information is available about the effects of obesity on LVMD. The aim of this study was to evaluate LVMD in patients with simple obesity by SPECT with a new cadmium-zinc telluride (CZT) detector and to explore the effects of obesity on left ventricular wall motion. We retrospectively analyzed 95 patients with myocardial perfusion imaging (MPI) images without perfusion defects, of which 55 were diagnosed with simple obesity (BMI > 30), and 40 non-obese patients (BMI < 25) matched for age and sex were used as controls. The five-point method was used to analyze the MPI images of the two groups, and the complete cardiac function parameters including phase bandwidth (PBW) and phase standard deviation (PSD) were obtained. Although the PBW values of the two groups were within the normal range (cut-off value > 90°), the PBW (35.4 ± 28 vs 24.9 ± 7.5, P < .001; 36.6 ± 18.4 vs 28.7 ± 9.1, P = 0.01) and PSD (8.7 ± 7.6 vs 5.9 ± 2, P = 0.02; 9.2 ± 4.9 vs 7.1 ± 2.7, P = 0.01) of the obese group were larger than the control group under both stressing and resting, and the difference was statistically significant. CZT-SPECT can effectively assess LVMD in obese patients, and they are more likely to develop LVMD, which may be related to their left ventricular volume.

Topics: Adult; Aged; Artifacts; Body Mass Index; Cadmium; Equipment Design; Female; Gamma Cameras; Humans; Male; Middle Aged; Obesity; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Tellurium; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left; Ventricular Function, Left; Zinc

To compare, vs CMR, four softwares: quantitative gated SPECT (QGS), myometrix (MX), corridor 4DM (4DM), and Emory toolbox (ECTb) to evaluate left ventricular ejection fraction (LVEF), end-systolic (ESV), and end-diastolic volumes (EDVs) by gated MPI CZT-SPECT.. 48 patients underwent MPI CZT-SPECT and CMR 6 weeks after STEMI, LV parameters were measured with four softwares at MPI CZT-SPECT vs CMR. We evaluated (i) concordance and correlation between MPI CZT-SPECT and CMR, (ii) concordance MPI CZT-SPECT/CMR for the categorical evaluation of the left ventricular dysfunction, and (iii) impacts of perfusion defects > 3 segments on concordance.. LVEF: LCC QGS/CMR = 0.81 [+ 2.2% (± 18%)], LCC MX/CMR = 0.83 [+ 1% (± 17.5%)], LCC 4DM/CMR = 0.73 [+ 3.9% (± 21%)], LCC ECTb/CMR = 0.69 [+ 6.6% (± 21.1%)]. ESV: LCC QGS/CMR = 0.90 [- 8 mL (± 40 mL)], LCC MX/CMR = 0.90 [- 9 mL (± 36 mL)], LCC 4DM/CMR = 0.89 [+ 4 mL (± 45 mL)], LCC ECTb/CMR = 0.87 [- 3 mL (± 45 mL)]. EDV: LCC QGS/CMR = 0.70 [- 16 mL (± 67 mL)], LCC MX/CMR = 0.68 [- 21 mL (± 63 mL], LCC 4DM/CMR = 0.72 [+ 9 mL (± 73 mL)], LCC ECTb/CMR = 0.69 [+ 10 mL (± 70 mL)].. QGS and MX were the two best-performing softwares to evaluate LVEF after recent STEMI.

Topics: Adult; Aged; Cadmium; Diastole; Female; Gated Blood-Pool Imaging; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Software; ST Elevation Myocardial Infarction; Stroke Volume; Technetium Tc 99m Sestamibi; Tellurium; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left; Ventricular Function, Left; Zinc

Single-photon emission computed-tomography (SPECT) allows the quantification of LV eccentricity index (EI), a measure of cardiac remodeling. We sought to evaluate the feasibility of EI measurement with SPECT myocardial perfusion imaging and its interactions with relevant LV functional and structural parameters.. Four-hundred and fifty-six patients underwent myocardial perfusion imaging on a Cadmium-Zinc-Telluride (CZT) camera. The summed rest, stress, and difference scores were calculated. From rest images, the LV end-diastolic (EDV) and end-systolic volumes, ejection fraction (EF), and peak filling rate (PFR) were calculated. In every patient, the EI, ranging from 0 (sphere) to 1 (line), was computed using a dedicated software (QGS/QPS; Cedars-Sinai Medical Center). Three-hundred and thirty-eight/456 (74%) patients showed a normal EF (>50%), while 26% had LV systolic dysfunction. The EI was computed from CZT images with excellent reproducibility (interclass correlation coefficient: 0.99, 95% CI 0.98-0.99). More impaired EI values correlated with the presence of a more abnormal LV perfusion (P < .001), function (EF and PFR, P < .001), and structure (EDV, P < .001). On multivariate analysis, higher EDV (P < .001) and depressed EF (P = .014) values were independent predictors of abnormal EI.. The evaluation of LV eccentricity is feasible on gated CZT images. Abnormal EI associates with significant cardiac structural and functional abnormalities.

Topics: Aged; Aged, 80 and over; Cadmium; Feasibility Studies; Female; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Reproducibility of Results; Stroke Volume; Tellurium; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left; Ventricular Remodeling; Zinc

We previously validated the use of a data-driven cardiac respiratory-motion (RM) correction method (REGAT) applicable to CZT SPECT myocardial perfusion imaging (MPI). In this study, we adapted the same process used with REGAT for RM to generate data-driven cardiac contraction triggers and corresponding cardiac contraction-gated SPECT studies (GSPECT-DD). We aimed to study its feasibility and compare its performances to GSPECT studies generated with ECG monitor-based triggers (GSPECT-ECG).. We found almost perfect agreement between cardiac contraction triggers generated with data-driven and ECG monitor-based methods. As compared to GSPECT-ECG, GSPECT-DD provided comparable and well-correlated LV global systolic function parameters and similar cine image quality at both stress and rest.. Data-driven cardiac contraction gating using REGAT is feasible with low-dose and high-dose MPI CZT SPECT. It provides GSPECT-DD studies comparable to GSPECT-ECG.

Topics: Aged; Cadmium; Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; Coronary Artery Disease; Electrocardiography; Exercise Test; Feasibility Studies; Female; Heart; Heart Ventricles; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Motion; Myocardial Perfusion Imaging; Nuclear Medicine; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Radiopharmaceuticals; Respiration; Tellurium; Ventricular Dysfunction, Left; Zinc

An interaction between coronary anatomy, myocardial perfusion, and left ventricular (LV) functional parameters in the development of mechanical LV dyssynchrony (LVD) has been suggested. This study examined the correlates of LVD in a large sample size of patients with known or suspected coronary artery disease (CAD) using cadmium-zinc-telluride camera.. Six-hundred and fifty-seven consecutive patients who underwent myocardial perfusion imaging (MPI) and coronary angiography were included. Coronary stenosis >70% was considered significant. LV perfusion and functional parameters were computed from MPI images. The presence of significant LVD was evaluated by phase standard deviation and histogram bandwidth.. 415/657 (63%) patients had significant CAD. LVD was present in 247 (38%) patients and was associated with the presence of a higher CAD burden (P < .001), more impaired measures of LV perfusion (P < .001), contractile function (P < .001), and larger LV volumes (P < .001). By multivariate analysis, the LV end-systolic volume index (P < .001) and ischemic burden (P < .001) were the strongest predictors of LVD independent of CAD extent and LV systolic dysfunction.. LVD is frequent in patients undergoing MPI for suspected or known CAD. Its presence is independent of CAD burden and LV systolic dysfunction, but is dependent on the presence of myocardial perfusion abnormalities and LV end-systolic volume.

Topics: Aged; Cadmium; Causality; Comorbidity; Coronary Artery Disease; Exercise Test; Female; Humans; Italy; Male; Myocardial Perfusion Imaging; Radionuclide Imaging; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Stroke Volume; Tellurium; Ventricular Dysfunction, Left; Zinc

This study compared two SPECT cameras with cadmium-zinc-telluride (CZT) detectors to a conventional Anger camera with cardiofocal collimators for the assessment of left ventricular (LV) function in a phantom and patients.. A gated dynamic cardiac phantom was used. Eighteen acquisitions were processed on each CZT camera and the conventional camera. The total number of counts within a myocardial volume of interest varied from 0.25 kcts to 1.5 Mcts. Ejection fraction was set to 33%, 45%, or 60%. Volume, LV ejection fraction (LVEF), regional wall thickening, and motion (17-segment model) were assessed. One hundred twenty patients with a low pretest likelihood of coronary artery disease and normal findings on stress perfusion SPECT were retrospectively analyzed to provide the reference limits for end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction, and regional function for each camera model.. In the phantom study, for each ejection fraction value, volume was higher for the CZT cameras than for the conventional camera, resulting in a decreased but more accurate LVEF (all P < 0.001). In clinical data, body-surface-indexed EDV and ESV (mL/m(2)) were higher for one of the CZT cameras (Discovery NM 530c) than for the other (D-SPECT) or the conventional camera (respectively, 40.5 ± 9.2, 37 ± 7.9, and 35.8 ± 6.8 for EDV [P < 0.001] and 12.5 ± 5.3, 9.4 ± 4.2, and 8.3 ± 4.4 for ESV [P < 0.001]), resulting in a significantly decreased LVEF: 70.3% ± 9.1% vs. 75.2% ± 8.1% vs. 77.8% ± 9.3%, respectively (P < 0.001).. The new CZT cameras yielded global LV function results different from those yielded by the conventional camera. LV volume was higher for the Discovery NM 530c than for the D-SPECT or the conventional camera, leading to decreased LVEF in healthy subjects. These differences should be considered in clinical practice and warrant the collection of a specific reference database.

Topics: Cadmium Compounds; Equipment Design; Equipment Failure Analysis; Female; Gamma Cameras; Humans; Male; Middle Aged; Phantoms, Imaging; Reproducibility of Results; Sensitivity and Specificity; Stroke Volume; Tellurium; Tomography, Emission-Computed, Single-Photon; Transducers; Ventricular Dysfunction, Left; Zinc Compounds

This study described a method for tracking and compensating respiratory motion in cadmium-zinc-telluride (CZT) cameras. We evaluated motion effects on myocardial perfusion imaging and assessed the usefulness of motion compensation in phantom and clinical studies.. SPECT studies were obtained from an oscillating heart phantom and 552 patients using CZT cameras with list-mode acquisition. Images were reformatted in 500-ms frames, and the activity centroid was calculated as respiratory signal. The myocardial perfusion, left ventricular (LV) wall thickness, and LV volume were assessed before and after the motion compensation technique.. In phantom studies, we documented only minimal bias between simulated and measured shifts. Significantly reduced tracer activity, increased wall thickness and decreased volume in scans with 15 mm or more axial shifts were noted. In clinical studies, there was a higher prevalence of significant motion after treadmill exercise. The motion compensation technique could successfully compensate those motion artifacts.. The described method allows for tracking and compensating respiratory motion in CZT cameras. Significant respiratory motion is still not uncommon using CZT cameras, especially in patients who underwent treadmill tests. Motion blurring can be compensated using image processing techniques and image quality could be significantly improved.

Topics: Aged; Algorithms; Artifacts; Cadmium Compounds; Equipment Design; Equipment Failure Analysis; Female; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Information Storage and Retrieval; Male; Middle Aged; Motion; Phantoms, Imaging; Reproducibility of Results; Respiratory Mechanics; Respiratory-Gated Imaging Techniques; Sensitivity and Specificity; Tellurium; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

The aim of this study was to evaluate the possible impact of stress-induced left ventricular (LV) diastolic dysfunction at cadmium-zinc-telluride (CZT) imaging, on the detection of significant coronary artery disease (CAD).. Four hundred and twenty-five consecutive patients underwent myocardial perfusion imaging at rest and after stress with a low-dose CZT protocol and the evaluation of coronary anatomy by invasive or computed coronary angiography. The summed difference score (SDS) was calculated in every patient. Left ventricular ejection fraction and peak filling rate (PFR) at baseline and after stress were derived from gated CZT images and the '% stress-to-rest' PFR difference, as an indicator of stress-induced diastolic dysfunction, determined. In the study population, the mean SDS was 5 ± 4, while mean stress PFR and rest PFR were 2.5 ± 0.8 end-diastolic volumes (EDV)/s and 2.5 ± 0.7 EDV/s, respectively. There was a strict correlation between the presence and extent of CAD and both myocardial SDS and '% stress-to-rest' PFR (P < 0.001 for both). Interestingly, while myocardial SDS and '% stress-to-rest' PFR were significantly correlated (P < 0.001), they resulted independent predictors of the presence of significant CAD (P < 0.001 and P < 0.032, respectively). Of note, at receiving operating characteristic analysis, a '% stress-to-rest' PFR ≤3 showed 71% sensitivity in unmasking the presence of significant coronary luminal narrowings.. The present study shows that the assessment of stress-induced diastolic dysfunction with an ultrafast scintigraphic protocol can improve the accuracy in detection of significant ischaemic heart disease.

Topics: Aged; Aged, 80 and over; Cadmium; Cohort Studies; Confidence Intervals; Coronary Angiography; Coronary Artery Disease; Disease Progression; Exercise Test; Female; Follow-Up Studies; Humans; Logistic Models; Male; Middle Aged; Myocardial Ischemia; Myocardial Perfusion Imaging; Odds Ratio; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Severity of Illness Index; Stroke Volume; Tellurium; Tomography, X-Ray Computed; Ventricular Dysfunction, Left; Zinc

Recent advances in nuclear myocardial perfusion imaging (MPI) have made it possible to develop a dual-isotope protocol for high-speed acquisition with image quality and radiation delivery comparable to that obtained with conventional single isotope protocols. So far, no study has compared dual-isotope high-speed MPI to invasive coronary angiography (ICA) in a large cohort using a Cadmium-zinc-telluride SPECT system.. Over a 1-year period (May 2011 to April 2012), 1366 patients underwent dual-isotope high-speed MPI. Patients with ICA within 3 months after dual-isotope high-speed MPI were included together with patients with a low likelihood of coronary artery disease (CAD) in order to assess normalcy rate. Global summed stress score (SSS) and summed rest score (SRS) were calculated, and ICA results were analyzed independently. The main end point was a patient-based assessment of the diagnostic performance of dual-isotope high-speed MPI in detecting or ruling out significant CAD (>70% reduction in lumen diameter).. Inclusion criteria were fulfilled for 214 patients (143 men; age 60 ± 14 years; ICA, n = 104; low likelihood for CAD, n = 110). An exercise stress test was performed in 62% of patients and a pharmacological stress test was performed with either dipyridamole (32%) or dobutamine (6%). Average examination duration was 22.4 ± 4.5 minutes. Mean SSS, SRS, and SDS were 8.0 ± 4.9, 3.1 ± 4.3, and 5.0 ± 3.2, respectively. Prevalence of angiographic CAD was 75%. ICA detected stenosis in the left main trunk, left anterior descending artery, left circumflex artery, and right coronary artery in 4, 33, 31, and 42 patients, respectively. Sensitivity of dual-isotope high-speed MPI was 94%, normalcy rate was 92%, and accuracy was 83% for detecting CAD.. Dual-isotope high-speed MPI is reliable at detecting or ruling out CAD. NCT01785589.

Topics: Adult; Aged; Aged, 80 and over; Angina, Unstable; Cadmium; Cardiomyopathies; Cohort Studies; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease; Exercise Test; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Perfusion Imaging; Nuclear Medicine; Radiopharmaceuticals; Rest; Sensitivity and Specificity; Technetium Tc 99m Sestamibi; Tellurium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left; Zinc

To evaluate the interplay between myocardial ischaemic burden and poststress left ventricular (LV) systolic and diastolic abnormalities in patients with suspected or known coronary artery disease (CAD).. A total of 471 patients underwent myocardial perfusion imaging by cadmium-zinc-telluride scintigraphy and coronary angiography. A fast imaging protocol was used with stress imaging performed 10 - 15 min after tracer injection. The summed difference score (SDS) and the percent stress-to-rest ratios for LV ejection fraction and peak filling rate (PFR), measures of stress-induced systolic and diastolic impairment, were computed from scintigraphic images. A SDS of >3 was considered abnormal and >7 a marker of moderate-to-severe ischaemia.. Of the 471 patients, 321 (68%) showed significant CAD in one (27%), two (23%) or three (18%) vessels. The extent of CAD associated with gradual alterations in SDS (P < 0.001). Interestingly, while impairment in the percent stress-to-rest PFR ratio paralleled the increase in the extent of CAD (P < 0.001 for trend), the occurrence of significant stress-induced systolic dysfunction was limited to patients with multivessel disease (P < 0.001 vs. patients without CAD, and P = 0.002 vs. patients with single-vessel disease). Similarly, while a strict correlation between percent stress-to-rest PFR ratio and myocardial ischaemic burden was evident (P < 0.001), significant stress-induced LV systolic impairment was limited to patients with moderate-to-severe ischaemia (P < 0.001 vs. patients with no or mild ischaemia).. Stress-induced LV diastolic impairment is associated with a less extensive ischaemic burden and CAD extent than poststress systolic dysfunction, which is limited to patients with multivessel CAD.

Topics: Aged; Cadmium; Coronary Artery Disease; Exercise Test; Female; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Tellurium; Ventricular Dysfunction, Left; Zinc

Topics: Cadmium; Coronary Artery Disease; Female; Humans; Male; Myocardial Perfusion Imaging; Tellurium; Ventricular Dysfunction, Left; Zinc

To evaluate the relationships among myocardial sympathetic innervation, perfusion and mechanical synchronicity assessed with cardiac cadmium-zinc-telluride (CZT) scintigraphy.. A group of 29 patients underwent an evaluation of myocardial perfusion with (99m)Tc-tetrofosmin CZT scintigraphy and adrenergic innervation with (123)I-metaiodobenzylguanidine (MIBG) CZT scintigraphy. The summed rest score (SRS), motion score (SMS) and thickening score (STS), as well as the summed (123)I-MIBG defect score (SS-MIBG), were determined. Regional tracer uptake for both (99m)Tc-tetrofosmin and (123)I-MIBG was also calculated. Finally, the presence of significant myocardial mechanical dyssynchrony was evaluated in phase analysis on gated CZT images and the region of latest mechanical activation identified.. Significant mechanical dyssynchrony was present in 17 patients (59 %) and associated with higher SRS (P = 0.030), SMS (P < 0.001), STS (P = 0.003) and early SS-MIBG (P = 0.037) as well as greater impairments in left ventricular ejection fraction (P < 0.001) and end-diastolic volume (P < 0.001). In multivariate analysis a higher end-diastolic volume remained the only predictor of mechanical dyssynchrony (P = 0.047). Interestingly, while in the whole population regional myocardial perfusion and adrenergic activity were strongly correlated (R = 0.68), in patients with mechanical dyssynchrony the region of latest mechanical activation was predicted only by greater impairment in regional (123)I-MIBG uptake (P = 0.012) that overwhelmed the effect of depressed regional perfusion.. Left ventricular mechanical dyssynchrony is associated with greater depression in contractile function and greater impairments in regional myocardial perfusion and sympathetic activity. In patients with dyssynchrony, the region of latest mechanical activation is characterized by a significantly altered adrenergic tone.

Topics: 3-Iodobenzylguanidine; Aged; Cadmium; Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; Female; Gamma Cameras; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Perfusion Imaging; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Stroke Volume; Sympathetic Fibers, Postganglionic; Tellurium; Ventricular Dysfunction, Left; Zinc

Estimation of left ventricular ejection fraction (LVEF) with equilibrium 99MTc-HSA equilibrium radionuclide angiography (MUGA) is frequently used for assessing cardiac function. The purpose of this study was to compare intra- and interobserver variation between three different gamma cameras.. Eighty-two patients, scanned in the same sequential order on the three cameras. Each acquisition was analyzed twice by two technologists. Inter- and intraobserver variations were calculated as the coefficient of variation and the 95% confidence interval for limits of agreement between each sequence of analyses for each of the three cameras.. The lowest intraobserver variations in LVEF for the two NaI-detector cameras were 3.1% (-4.0% to 3.5%) for the planar and 3.4% (-4.2% to 4.5%) for SPECT (P ≤ 0.001-0.019), the highest result for the CZT SPECT camera was 2.6% (-2.9% to 3.1%). Similarly, interobserver variation was 4.8% (-4.8% to 6.4%) and 4.9% (-5.4% to 7.5%), respectively, for each of the NaI-detector cameras and 3.3% (-3.4% to 4.3%) for the CZT SPECT camera (P ≤ 0.001-0.008).. The CZT detector camera was superior to both NaI detector cameras regarding intra- and interobserver variation. The CZT SPECT camera may identify changes in LVEF with greater certainty than its NaI detector-equipped counterparts.

Topics: Cadmium Compounds; Equipment Design; Equipment Failure Analysis; Female; Gamma Cameras; Gated Blood-Pool Imaging; Humans; Image Enhancement; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Tellurium; Ventricular Dysfunction, Left; Zinc

To evaluate the relationships between measures of left ventricular (LV) filling dynamics at cadmium-zinc-telluride (CZT) imaging and indexes of LV diastolic function at transthoracic echocardiography.. Two hundred and forty-seven patients underwent myocardial perfusion imaging at rest and after stress with a low-dose CZT protocol and a baseline transthoracic echocardiography study. All patients were submitted to invasive or computed coronary angiography. The peak filling rate (PFR) and the time to PFR (TPFR) were derived from gated CZT images as measures of LV filling dynamics. LV diastolic function was also evaluated at echocardiography and the presence of significantly increased LV filling pressures determined. Increased LV filling pressures at transthoracic echocardiography were evident in 103 (42%) patients. Interestingly, independently from the presence of coronary artery disease, there was a strict correlation between the presence and severity of LV diastolic dysfunction at echocardiography and CZT-derived measures of filling dynamics, i.e., PFR (P = 0.001) and TPFR (P = 0.001). At receiving operating characteristic analysis, a composite index of reduced PFR (≤2.11 end-diastolic volume s(-1)) and increased TPFR (>234 ms) showed a sensitivity of 84% and a specificity of 67% in unmasking the presence of elevated LV filling pressures at echocardiography.. CZT-derived measures of LV filling dynamics correlate with echocardiographic parameters of diastolic function and may identify the presence of increased LV filling pressures.

Topics: Aged; Cadmium; Coronary Angiography; Coronary Artery Disease; Echocardiography, Doppler; Exercise Test; Female; Humans; Image Interpretation, Computer-Assisted; Male; Myocardial Perfusion Imaging; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tellurium; Ventricular Dysfunction, Left; Zinc

To evaluate the reproducibility of serial re-acquisitions of gated Tl-201 and Tc-99m sestamibi left ventricular ejection fraction (LVEF) measurements obtained on a new generation solid-state cardiac camera system during myocardial perfusion imaging and the importance of manual operator optimization of left ventricular wall tracking.. Resting blinded automated (auto) and manual operator optimized (opt) LVEF measurements were measured using ECT toolbox (ECT) and Cedars-Sinai QGS software in two separate cohorts of 55 Tc-99m sestamibi (MIBI) and 50 thallium (Tl-201) myocardial perfusion studies (MPS) acquired in both supine and prone positions on a cadmium zinc telluride (CZT) solid-state camera system. Resting supine and prone automated LVEF measurements were similarly obtained in a further separate cohort of 52 gated cardiac blood pool scans (GCBPS) for validation of methodology and comparison. Appropriate use of Bland-Altman, chi-squared and Levene's equality of variance tests was used to analyse the resultant data comparisons.. For all radiotracer and software combinations, manual checking and optimization of valve planes (+/- centre radius with ECT software) resulted in significant improvement in MPS LVEF reproducibility that approached that of planar GCBPS. No difference was demonstrated between optimized MIBI/Tl-201 QGS and planar GCBPS LVEF reproducibility (P = .17 and P = .48, respectively). ECT required significantly more manual optimization compared to QGS software in both supine and prone positions independent of radiotracer used (P < .02).. Reproducibility of gated sestamibi and Tl-201 LVEF measurements obtained during myocardial perfusion imaging with ECT toolbox or QGS software packages using a new generation solid-state cardiac camera with improved image quality approaches that of planar GCBPS however requires visual quality control and operator optimization of left ventricular wall tracking for best results. Using this superior cardiac technology, Tl-201 reproducibility also appears at least equivalent to sestamibi for measuring LVEF.

Topics: Automation; Cadmium; Cardiology; Gated Blood-Pool Imaging; Heart; Humans; Image Processing, Computer-Assisted; Myocardial Perfusion Imaging; Radiopharmaceuticals; Reproducibility of Results; Software; Stroke Volume; Technetium Tc 99m Sestamibi; Tellurium; Thallium; User-Computer Interface; Ventricular Dysfunction, Left; Ventricular Function, Left; Zinc

To validate the ultrafast assessment of left ventricular (LV) dyssynchrony by phase analysis using high-speed nuclear myocardial perfusion imaging (MPI) on a new gamma camera with cadmium-zinc-telluride (CZT) solid-state detector technology.. In 46 patients rest MPI with 960 MBq (99m)Tc-tetrofosmin was acquired on a dual-head detector SPECT camera (Ventri, GE Healthcare) and an ultrafast CZT camera (Discovery NM 530c, GE Healthcare) with acquisition times of 15 and 5 min, respectively. LV dyssynchrony was assessed using the Emory Cardiac Toolbox with established values for histogram bandwidth (male <62.4°; female <49.7°) and standard deviations (male <24.4°; female <22.1°) as the gold standard. Evaluating CZT scan times of 0.5, 1, 2, 3 and 5 min (list mode) in 16 patients revealed the preferred scan time to be 5 min, which was then applied in all 46 patients. Intraclass correlation and the level of agreement in dyssynchrony detection between the CZT and Ventri cameras were assessed.. In LV dyssynchrony the mean histogram bandwidths with the CZT camera (n = 8) and the Ventri camera (n = 9) were 123.3 ± 50.6° and 130.2 ± 43.2° (p not significant) and 42.4 ± 13.6° vs. 43.2 ± 12.7° (p not significant). Normal bandwidths and SD obtained with the CZT camera (35.9 ± 7.7°, 12.6 ± 3.5°) and the Ventri camera (34.8 ± 6.6°, 11.1 ± 2.1°, both p not significant) excluded dyssynchrony in 38 and 37 patients, respectively. Intraclass correlation and the level of agreement between the CZT camera with a 5-min scan time and the Ventri camera were 0.94 (p < 0.001, SEE 14.4) and 96% for histogram bandwidth and 0.96 (p < 0.001, SEE 3.9) and 98% for SD.. This ultrafast CZT camera allows accurate assessment of LV dyssynchrony with a scan time of only 5 min, facilitating repeat measurements which would potentially be helpful for parameter optimization for cardiac resynchronization therapy.

Topics: Aged; Cadmium; Female; Gamma Cameras; Humans; Linear Models; Male; Myocardial Perfusion Imaging; Reproducibility of Results; Retrospective Studies; Tellurium; Time Factors; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left; Zinc