The future of SPECT MPI: Time and dose reduction

Review Article


  1. 1.
    Hendel RC, Berman DS, Di Carli MF, Heidenreich PA, Henkin RE, Pellikka PA, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. Circulation 2009;119:e561-87.PubMedCrossRefGoogle Scholar
  2. 2.
    Henzlova MJ, Cerqueira MD, Hansen CL, Taillefer R, Yao SS. ASNC Imaging Guidelines for Nuclear Cardiology Procedures: Stress protocols and tracers. J Nucl Cardiol 2009;16:331.CrossRefGoogle Scholar
  3. 3.
    Nuclear Energy Agency. The supply of medical radioisotopes. 2010.
  4. 4.
    Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: Differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998;97:535-43.PubMedGoogle Scholar
  5. 5.
    Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. 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.PubMedCrossRefGoogle Scholar
  6. 6.
    Heo J, Kegel J, Iskandrian AS, Cave V, Iskandrian BB. Comparison of same-day protocols using technetium-99m-sestamibi myocardial imaging. J Nucl Med 1992;33:186-91.PubMedGoogle Scholar
  7. 7.
    Berman DS, Kiat HS, Van Train KF, Germano G, Maddahi J, Friedman JD. Myocardial perfusion imaging with technetium-99m-sestamibi: Comparative analysis of available imaging protocols. J Nucl Med 1994;35:681-8.PubMedGoogle Scholar
  8. 8.
    Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005;32:855-97.PubMedCrossRefGoogle Scholar
  9. 9.
    Gibbons RJ, Hodge DO, Berman DS, Akinboboye OO, Heo J, Hachamovitch R, et al. Long-term outcome of patients with intermediate-risk exercise electrocardiograms who do not have myocardial perfusion defects on radionuclide imaging. Circulation 1999;100:2140-5.PubMedGoogle Scholar
  10. 10.
    Shaw LJ, Hendel R, Borges-Neto S, Lauer MS, Alazraki N, Burnette J, et al. Prognostic value of normal exercise and adenosine (99m)Tc-tetrofosmin SPECT imaging: Results from the multicenter registry of 4,728 patients. J Nucl Med 2003;44:134-9.PubMedGoogle Scholar
  11. 11.
    Gal R, Ahmad M. Cost-saving approach to normal technetium-99m sestamibi myocardial perfusion scan. Am J Cardiol 1996;78:1047-9.PubMedCrossRefGoogle Scholar
  12. 12.
    Gibson PB, Demus D, Noto R, Hudson W, Johnson LL. Low event rate for stress-only perfusion imaging in patients evaluated for chest pain. J Am Coll Cardiol 2002;39:999-1004.PubMedCrossRefGoogle Scholar
  13. 13.
    Chang SM, Nabi F, Xu J, Raza U, Mahmarian JJ. Normal stress-only versus standard stress/rest myocardial perfusion imaging: Similar patient mortality with reduced radiation exposure. J Am Coll Cardiol 2010;55:221-30.PubMedCrossRefGoogle Scholar
  14. 14.
    Duvall WL, Wijetunga MN, Klein TM, Razzouk L, Godbold J, Croft LB, et al. The prognosis of a normal stress-only Tc-99m myocardial perfusion imaging study. J Nucl Cardiol 2010;17:370-7.PubMedCrossRefGoogle Scholar
  15. 15.
    Iskandrian AE. Stress-only myocardial perfusion imaging a new paradigm. J Am Coll Cardiol 2010;55:231-3.PubMedCrossRefGoogle Scholar
  16. 16.
    Buechel RR, Pazhenkottil AP, Herzog BA, Husmann L, Nkoulou RN, Burger IA, et al. Real-time breath-hold triggering of myocardial perfusion imaging with a novel cadmium-zinc-telluride detector gamma camera. Eur J Nucl Med Mol Imaging 2010;37:1903-8.PubMedCrossRefGoogle Scholar
  17. 17.
    Hendel RC, Abbott BG, Bateman TM, Blankstein R, Calnon DA, Leppo JA, et al. ASNC Information Statement: The role of radionuclide myocardial perfusion imaging for asymptomatic individuals.; 2010.
  18. 18.
    Borges-Neto S, Pagnanelli RA, Shaw LK, Honeycutt E, Shwartz SC, Adams GL, et al. Clinical results of a novel wide beam reconstruction method for shortening scan time of Tc-99m cardiac SPECT perfusion studies. J Nucl Cardiol 2007;14:555-65.PubMedCrossRefGoogle Scholar
  19. 19.
    Travin MI. Cardiac cameras. Semin Nucl Med 2011;41:182-201.PubMedCrossRefGoogle Scholar
  20. 20.
    DePuey EG, Gadiraju R, Clark J, Thompson L, Anstett F, Shwartz SC. Ordered subset expectation maximization and wide beam reconstruction “half-time” gated myocardial perfusion SPECT functional imaging: A comparison to “full-time” filtered backprojection. J Nucl Cardiol 2008;15:547-63.PubMedCrossRefGoogle Scholar
  21. 21.
    Bateman TM, Heller GV, McGhie AI, Courter SA, Golub RA, Case JA, et al. Multicenter investigation comparing a highly efficient half-time stress-only attenuation correction approach against standard rest-stress Tc-99m SPECT imaging. J Nucl Cardiol 2009;16:726-35.PubMedCrossRefGoogle Scholar
  22. 22.
    Valenta I, Treyer V, Husmann L, Gaemperli O, Schindler MJ, Herzog BA, et al. New reconstruction algorithm allows shortened acquisition time for myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 2010;37:750-7.PubMedCrossRefGoogle Scholar
  23. 23.
    Slomka PJ, Patton JA, Berman DS, Germano G. Advances in technical aspects of myocardial perfusion SPECT imaging. J Nucl Cardiol 2009;16:255-76.PubMedCrossRefGoogle Scholar
  24. 24.
    Garcia EV, Faber TL, Esteves FP. Cardiac dedicated ultrafast SPECT Cameras: New designs and clinical implications. J Nucl Med 2011;52:210-7.PubMedCrossRefGoogle Scholar
  25. 25.
    Sharir T, Ben-Haim S, Merzon K, Prochorov V, Dickman D, Berman DS. High-speed myocardial perfusion imaging initial clinical comparison with conventional dual detector anger camera imaging. JACC Cardiovasc Imaging 2008;1:156-63.PubMedCrossRefGoogle Scholar
  26. 26.
    Berman DS, Kang X, Tamarappoo B, Wolak A, Hayes SW, Nakazato R, et al. Stress thallium-201/rest technetium-99m sequential dual isotope high-speed myocardial perfusion imaging. JACC Cardiovasc Imaging 2009;2:273-82.PubMedCrossRefGoogle Scholar
  27. 27.
    Sharir T, Slomka PJ, Hayes SW, DiCarli MF, Ziffer JA, Martin WH, et al. Multicenter trial of high-speed versus conventional single-photon emission computed tomography imaging: Quantitative results of myocardial perfusion and left ventricular function. J Am Coll Cardiol 2010;55:1965-74.PubMedCrossRefGoogle Scholar
  28. 28.
    Nakazato R, Tamarappoo BK, Kang X, Wolak A, Kite F, Hayes SW, 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.PubMedCrossRefGoogle Scholar
  29. 29.
    Esteves FP, Raggi P, Folks RD, Keidar Z, Askew JW, Rispler S, 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.PubMedCrossRefGoogle Scholar
  30. 30.
    Herzog BA, Buechel RR, Katz R, Brueckner M, Husmann L, Burger IA, et al. Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: Optimized protocol for scan time reduction. J Nucl Med 2010;51:46-51.PubMedCrossRefGoogle Scholar
  31. 31.
    Buechel RR, Herzog BA, Husmann L, Burger IA, Pazhenkottil AP, Treyer V, et al. Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: First clinical validation. Eur J Nucl Med Mol Imaging 2010;37:773-8.PubMedCrossRefGoogle Scholar
  32. 32.
    Duvall WL, Sweeny JM, Croft LB, Barghash MH, Kulkarni NK, Guma KA, et al. Comparison of high efficiency CZT SPECT MPI to coronary angiography. J Nucl Cardiol 2011. doi:10.1007/s12350-011-9382-z.
  33. 33.
    Eisenberg MJ, Afilalo J, Lawler PR, Abrahamowicz M, Richard H, Pilote L. Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction. CMAJ 2011;183:430-6.PubMedCrossRefGoogle Scholar
  34. 34.
    Charles MW. LNT—an apparent rather than a real controversy? J Radiol Prot 2006;26:325-9.PubMedCrossRefGoogle Scholar
  35. 35.
    National Council on Radiation Protection and Measurements., National Council on Radiation Protection and Measurements. Scientific Committee 6-2 on Radiation Exposure of the U.S. Population. Ionizing radiation exposure of the population of the United States: Recommendations of the National Council on Radiation Protection and Measurements. Bethesda, Md.: National Council on Radiation Protection and Measurements; 2009.Google Scholar
  36. 36.
    Einstein AJ, Weiner SD, Bernheim A, Kulon M, Bokhari S, Johnson LL, et al. Multiple testing, cumulative radiation dose, and clinical indications in patients undergoing myocardial perfusion imaging. JAMA 2010;304:2137-44.PubMedCrossRefGoogle Scholar
  37. 37.
    Berrington de Gonzalez A, Kim KP, Smith-Bindman R, McAreavey D. Myocardial perfusion scans: Projected population cancer risks from current levels of use in the United States. Circulation 2010;122:2403-10.PubMedCrossRefGoogle Scholar
  38. 38.
    Chen J, Einstein AJ, Fazel R, Krumholz HM, Wang Y, Ross JS, et al. Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures: A population-based analysis. J Am Coll Cardiol 2010;56:702-11.PubMedCrossRefGoogle Scholar
  39. 39.
    Senthamizhchelvan S, Bravo PE, Esaias C, Lodge MA, Merrill J, Hobbs RF, et al. Human biodistribution and radiation dosimetry of 82Rb. J Nucl Med 2010;51:1592-9.PubMedCrossRefGoogle Scholar
  40. 40.
    Buechel RR, Husmann L, Herzog BA, Pazhenkottil AP, Nkoulou R, Ghadri JR, et al. Low-dose computed tomography coronary angiography with prospective electrocardiogram triggering: Feasibility in a large population. J Am Coll Cardiol 2011;57:332-6.PubMedCrossRefGoogle Scholar
  41. 41.
    Cerqueira MD, Allman KC, Ficaro EP, Hansen CL, Nichols KJ, Thompson RC, et al. ASNC Information Statement: Recommendations for reducing radiation exposure in myocardial perfusion imaging.; 2010
  42. 42.
    Fazel R, Shaw LJ, Dilsizian V, Einstein AJ, Ficaro EP, Henzlova M. ASNC Information Statement: Strategies for defining an optimal risk-benefit ratio for stress myocardial perfusion SPECT.; 2011.
  43. 43.
    Des Prez RD, Dahlberg ST, Einstein AJ, Grossman GB, Henzlova MJ, Mahenthiran J et al (2009) ASNC Clinical Update: Stress-only myocardial perfusion imaging.
  44. 44.
    Depuey EG, Bommireddipalli S, Clark J, Leykekhman A, Thompson LB, Friedman M. A comparison of the image quality of full-time myocardial perfusion SPECT vs wide beam reconstruction half-time and half-dose SPECT. J Nucl Cardiol 2011;18:273-80.PubMedCrossRefGoogle Scholar
  45. 45.
    Herzog BA, Husmann L, Buechel RR, Pazhenkottil AP, Burger IA, Valenta I, et al. Rapid cardiac hybrid imaging with minimized radiation dose for accurate non-invasive assessment of ischemic coronary artery disease. Int J Cardiol 2010. Sep 6 [Epub ahead of print].Google Scholar
  46. 46.
    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.PubMedCrossRefGoogle Scholar
  47. 47.
    Duvall WL, Croft LB, Ginsberg ES, Einstein AJ, Guma KA, George T, et al. Reduced isotope dose and imaging time with a high efficiency CZT SPECT camera. J Nucl Cardiol 2011. doi:10.1007/s12350-011-9379-7.
  48. 48.
    Ostrom MP, Gopal A, Ahmadi N, Nasir K, Yang E, Kakadiaris I, et al. Mortality incidence and the severity of coronary atherosclerosis assessed by computed tomography angiography. J Am Coll Cardiol 2008;52:1335-43.PubMedCrossRefGoogle Scholar
  49. 49.
    Hulten EA, Carbonaro S, Petrillo SP, Mitchell JD, Villines TC. Prognostic value of cardiac computed tomography angiography a systematic review and meta-analysis. J Am Coll Cardiol 2011;57:1237-47.PubMedCrossRefGoogle Scholar
  50. 50.
    ICRP. ICRP Publication 103: The 2007 Recommendations of the International Commission on Radiological Protection. Ann ICRP 2007;37:1-332.Google Scholar
  51. 51.
    Hausleiter J, Meyer T, Hermann F, Hadamitzky M, Krebs M, Gerber TC, et al. Estimated radiation dose associated with cardiac CT angiography. JAMA 2009;301:500-7.PubMedCrossRefGoogle Scholar
  52. 52.
    Fazel R, Krumholz HM, Wang Y, Ross JS, Chen J, Ting HH, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009;361:849-57.PubMedCrossRefGoogle Scholar
  53. 53.
    Brix G, Lechel U, Glatting G, Ziegler SI, Munzing W, Muller SP, et al. Radiation exposure of patients undergoing whole-body dual-modality 18F-FDG PET/CT examinations. J Nucl Med 2005;46:608-13.PubMedGoogle Scholar
  54. 54.
    Kim KP, Einstein AJ, Berrington de Gonzalez A. Coronary artery calcification screening: Estimated radiation dose and cancer risk. Arch Intern Med 2009;169:1188-94.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2011

Authors and Affiliations

  1. 1.Mount Sinai Division of Cardiology (Mount Sinai Heart)Mount Sinai Medical CenterNew YorkUSA

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