Upper reference limits of transient ischemic dilation ratio for different protocols on new-generation cadmium zinc telluride cameras: A report from REFINE SPECT registry
- 1 Downloads
Upper reference limits for transient ischemic dilation (TID) have not been rigorously established for cadmium-zinc-telluride (CZT) camera systems. We aimed to derive TID limits for common myocardial perfusion imaging protocols utilizing a large, multicenter registry (REFINE SPECT).
One thousand six hundred and seventy-two patients with low likelihood of coronary artery disease with normal perfusion findings were identified. Images were processed with Quantitative Perfusion SPECT software (Cedars-Sinai Medical Center, Los Angeles, CA). Non-attenuation-corrected, camera-, radiotracer-, and stress protocol-specific TID limits in supine position were derived from 97.5th percentile and mean + 2 standard deviations (SD). Reference limits were compared for different solid-state cameras (D-SPECT vs. Discovery), radiotracers (technetium-99m-sestamibi vs. tetrofosmin), different types of stress (exercise vs. four different vasodilator-based protocols), and different vasodilator-based protocols.
TID measurements did not follow Gaussian distribution in six out of eight subgroups. TID limits ranged from 1.18 to 1.52 (97.5th percentile) and 1.18 to 1.39 (mean + 2SD). No difference was noted between D-SPECT and Discovery cameras (P = 0.71) while differences between exercise and vasodilator-based protocols (adenosine, regadenoson, or regadenoson-walk) were noted (all P < 0.05).
We used a multicenter registry to establish camera-, radiotracer-, and protocol-specific upper reference limits of TID for supine position on CZT camera systems. Reference limits did not differ between D-SPECT and Discovery camera.
KeywordsCoronary artery disease single-photon emission computed tomography myocardial perfusion imaging perfusion agents vasodilators image analysis
Coronary artery disease
Myocardial perfusion imaging
Single-photon emission computed tomography
Transient ischemic dilation
The authors want to thank all the people whose efforts allowed us to collect, process, and analyze the data in the National Institutes of Health-sponsored REFINE SPECT registry.
Drs. Germano, Berman, and Slomka participate in software royalties for QPS software at Cedars-Sinai Medical Center. Dr. Slomka has received research grant support from Siemens Medical Systems. Drs. Berman, Dorbala, Einstein, and EJ Miller have served as consultants for GE Healthcare. Dr. Dorbala has served as a consultant to Bracco Diagnostics; her institution has received grant support from Astellas. Dr. Di Carli has received research grant support from Spectrum-Dynamics and consulting honoraria from Sanofi and GE Healthcare. Dr. Ruddy has received research grant support from GE Healthcare and Advanced Accelerator Applications. Dr. Einstein and his institution have received research support from GE Healthcare, Philips Healthcare, and Toshiba America Medical Systems. Dr. EJ Miller has served as a consultant for Bracco Inc, and he and his institution have received grant support from Bracco Inc. Dr. Berman’s institution has received grant support from HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 3.Mazzanti M, Germano G, Kiat H, Kavanagh PB, Alexanderson E, Friedman JD, 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.CrossRefGoogle Scholar
- 5.Abidov A, Bax JJ, Hayes SW, Cohen I, Nishina H, Yoda S, et al. Integration of automatically measured transient ischemic dilation ratio into interpretation of adenosine stress myocardial perfusion SPECT for detection of severe and extensive CAD. J Nucl Med 2004;45:1999-2007.Google Scholar
- 9.Doukky R, Frogge N, Bayissa YA, Balakrishnan G, Skelton JM, Confer K, et al. The prognostic value of transient ischemic dilatation with otherwise normal SPECT myocardial perfusion imaging: A cautionary note in patients with diabetes and coronary artery disease. J Nucl Cardiol 2013;20:774-84.CrossRefGoogle Scholar
- 16.Golzar Y, Olusanya A, Pe N, Dua SG, Golzar J, Gidea C, et al. The significance of automatically measured transient ischemic dilation in identifying severe and extensive coronary artery disease in regadenoson, single-isotope technetium-99m myocardial perfusion SPECT. J Nucl Cardiol 2015;22:526-34.CrossRefGoogle Scholar
- 18.Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, 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. Int J Cardiovasc Imaging 2002;18:539-42.Google Scholar
- 19.Horowitz GL, Altaie S, Boyd JC, Ceriotti F, Garg U, Horn P, et al EP28-A3c Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory: Clinical and Laboratory Standards Institute; 2010.Google Scholar
- 20.Dodge Y. The Concise Encyclopedia of Statistics. New York: Springer; 2008. p. 437-9.Google Scholar
- 28.Rivero A, Santana C, Folks RD, Esteves F, Verdes L, Esiashvili S, et al. Attenuation correction reveals gender-related differences in the normal values of transient ischemic dilation index in rest-exercise stress sestamibi myocardial perfusion imaging. J Nucl Cardiol 2006;13:338-44.CrossRefGoogle Scholar
- 35.Movahed A, Gnanasegaran G, Buscombe JR, Hall M. Integrating cardiology for nuclear medicine physicians: A guide to nuclear medicine physicians. New York: Springer; 2008.Google Scholar
- 36.Heller GV, Mann A, Hendel RC. Nuclear cardiology technical applications. New York: McGraw-Hill Education; 2009.Google Scholar