Abstract
High efficiency cadmium–zinc–telluride (CZT) cameras provide an opportunity to lower the injected activities of radiopharmaceuticals for single photon emission tomography (SPECT) myocardial perfusion imaging (MPI). The limits for reducing activities of thallium have not been determined, particularly in obese patients. After an injection of 0.7 megabecquerel (MBq) of thallium/kg, we collected an average 1.5 million counts for the 10-min acquisition in a pilot cohort of ten patients. After extrapolation, we reduced the administered activity to 0.5 MBq/kg to obtain the expected 1 million counts. We studied the image quality in 124 patients (86 men, 43 obese with body mass index over 30 kg/m2) referred for MPI. The quality of images was assessed by a number of recorded counts and visually by a four-grade scale (one-poor quality, four-excellent quality). In non-obese and obese patients, the average number of recorded counts was 1.1 vs. 1.07 million counts for the 10-min stress acquisition, 1.04 vs. 1.06 million counts for the 13-min rest acquisition, and the average quality score was 3.97 vs. 3.90, respectively (p = NS).The mean administered activity was 39.2 ± 7 MBq for non-obese and 48.7 ± 6 for obese patients (p < 0.0001), and the calculated effective dose was 4.0 ± 0.7 and 4.9 ± 0.6 mSv respectively (p < 0.0001). The ultra-low-dose thallium stress-redistribution protocol, including post-stress prone imaging, provides good quality of images with a low radiation burden, even in obese patients.
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References
Slomka PJ, Patton JA, Berman DS, Germano G (2009) Advances in technical aspects of myocardial perfusion SPECT imaging. J Nucl Cardiol 16:255–276
Imbert L, Poussier S, Franken PR et al (2012) Compared performance of high-sensitivity cameras dedicated to myocardial perfusion SPECT: a comprehensive analysis of phantom and human images. J Nucl Med 53:1897–1903
Nakazato R, Berman DS, Hayes SW et al (2013) Myocardial perfusion imaging with a solid-state camera: simulation of a very low dose imaging protocol. J Nucl Med 54(3):373–379
Songy B, Guernou M, Lussato D, Queneau M, Geronazzo R (2012) Low-dose thallium-201 protocol with a cadmium-zinc-telluride cardiac camera. Nucl Med Commun 33(5):464–469
Tanaka H, Chikamori T, Tanaka N et al (2014) Diagnostic performance of a novel cadmium-zinc-telluride gamma camera system assessed using fractional flow reserve. Circ J 78(11):2727–2734
Verberne HJ, Acampa W, Anagnostopoulos C et al (2015) EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 42:1929–1940
Sharir T, Pinskiy M, Pardes A et al (2016) 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 23(1):11–20
Askew JW, Miller TD, Ruter RL et al (2011) Early image acquisition using a solid-state cardiac camera for fast myocardial perfusion imaging. J Nucl Cardiol 18:840–846
Esteves FP, Raggi P, Folks RD et al (2009) Novel solid-state-detector dedicated cardiac camera for fast myocardial perfusion imaging: multicenter comparison with standard dual detector cameras. J Nucl Cardiol 16:927–934
Herzog BA, Buechel RR, Katz R et al (2010) Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: optimized protocol for scan time reduction. J Nucl Med 51:46–51
Buechel RR, Herzog BA, Husmann L et al (2010) Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: first clinical validation. Eur J Nucl Med Mol Imaging 37:773–778
Einstein AJ, Blankstein R, Andrews H et al (2014) Comparison of image quality, myocardial perfusion, and left ventricular function between standard imaging and single-injection ultra-low-dose imaging using a high-efficiency SPECT camera: the MILLISIEVERT study. J Nucl Med 55:1430–1437
Nakazato R, Slomka PJ, Fish M et al (2015) Quantitative high-efficiency cadmium-zinc-telluride SPECT with dedicated parallel-hole collimation system in obese patients: results of a multi-center study. J Nucl Cardiol 22(2):266–275
Bradley-Moore PR, Lebowitz E, Greene MW, Atkins HL, Ansari AN (1975) Thallium-201 for medical use. II: Biologic behavior. J Nucl Med 16:156–160
Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) 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 105:539–542
Andersson M, Johansson L, Minarik D et al (2014) Effective dose to adult patients from 338 radiopharmaceuticals estimated using ICRP biokinetic data, ICRP/ICRU computational reference phantoms and ICRP 2007 tissue weighting factors. EJNMMI Phys 1(1):9
Leppo JA, Meerdink DJ (1989) Comparison of the myocardial uptake of a technetium-labeled isonitrile analogue and thallium. Circ Res 65:632–639
Berman DS, Kang X, Tamarappoo B et al (2009) Stress thallium-201/rest technetium-99m sequential dual isotope high-speed myocardial perfusion imaging. JACC Cardiovasc Imaging 2(3):273–282
Matsunari I, Böning G, Ziegler SI et al (1998) Attenuation-corrected rest thallium-201/stress technetium 99m sestamibi myocardial SPECT in normals. J Nucl Cardiol 5(1):48–55
Duvall WL, Guma KA, Kamen J et al (2013) Reduction in occupational and patient radiation exposure from myocardial perfusion imaging: impact of stress-only imaging and high-efficiency SPECT camera technology. J Nucl Med 54(8):1251–1257
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Supported by European Regional Development Fund—Project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123) and by the Project No. LQ1605 from the National Program of Sustainability II (MEYS CR).
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Kincl, V., Kamínek, M., Vašina, J. et al. Feasibility of ultra low-dose thallium stress-redistribution protocol including prone imaging in obese patients using CZT camera. Int J Cardiovasc Imaging 32, 1463–1469 (2016). https://doi.org/10.1007/s10554-016-0919-8
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DOI: https://doi.org/10.1007/s10554-016-0919-8