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Upper reference limits of transient ischemic dilation ratio for different protocols on new-generation cadmium zinc telluride cameras: A report from REFINE SPECT registry

  • Lien-Hsin Hu
  • Tali Sharir
  • Robert J. H. Miller
  • Andrew J. Einstein
  • Mathews B. Fish
  • Terrence D. Ruddy
  • Sharmila Dorbala
  • Marcelo Di Carli
  • Philipp A. Kaufmann
  • Albert J. Sinusas
  • Edward J. Miller
  • Timothy M. Bateman
  • Julian Betancur
  • Guido Germano
  • Joanna X. Liang
  • Frederic Commandeur
  • Peyman N. Azadani
  • Heidi Gransar
  • Yuka Otaki
  • Balaji K. Tamarappoo
  • Damini Dey
  • Daniel S. Berman
  • Piotr J. SlomkaEmail author
Original Article
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Abstract

Background

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).

Methods

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.

Results

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).

Conclusions

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.

Keywords

Coronary artery disease single-photon emission computed tomography myocardial perfusion imaging perfusion agents vasodilators image analysis 

Abbreviations

CAD

Coronary artery disease

CZT

Cadmium-zinc-telluride

LLk

Low likelihood

MPI

Myocardial perfusion imaging

SD

Standard deviations

SPECT

Single-photon emission computed tomography

TID

Transient ischemic dilation

Notes

Acknowledgements

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.

Disclosures

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.

Supplementary material

12350_2019_1730_MOESM1_ESM.pptx (2.8 mb)
Supplementary material 1 (PPTX 2874 kb)

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Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • Lien-Hsin Hu
    • 1
    • 2
  • Tali Sharir
    • 3
    • 4
  • Robert J. H. Miller
    • 1
  • Andrew J. Einstein
    • 5
  • Mathews B. Fish
    • 6
  • Terrence D. Ruddy
    • 7
  • Sharmila Dorbala
    • 8
  • Marcelo Di Carli
    • 8
  • Philipp A. Kaufmann
    • 9
  • Albert J. Sinusas
    • 10
  • Edward J. Miller
    • 10
  • Timothy M. Bateman
    • 11
  • Julian Betancur
    • 1
  • Guido Germano
    • 1
  • Joanna X. Liang
    • 1
  • Frederic Commandeur
    • 1
  • Peyman N. Azadani
    • 1
  • Heidi Gransar
    • 1
  • Yuka Otaki
    • 1
  • Balaji K. Tamarappoo
    • 1
  • Damini Dey
    • 1
  • Daniel S. Berman
    • 1
  • Piotr J. Slomka
    • 1
    Email author
  1. 1.Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical SciencesCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of Nuclear MedicineTaipei Veterans General HospitalTaipeiTaiwan
  3. 3.Department of Nuclear CardiologyAssuta Medical CenterTel AvivIsrael
  4. 4.Ben Gurion University of the NegevBeer ShebaIsrael
  5. 5.Division of Cardiology, Department of Medicine, and Department of RadiologyColumbia University Irving Medical Center and New York-Presbyterian HospitalNew YorkUSA
  6. 6.Oregon Heart and Vascular Institute, Sacred Heart Medical CenterSpringfieldUSA
  7. 7.Division of CardiologyUniversity of Ottawa Heart InstituteOttawaCanada
  8. 8.Division of Nuclear Medicine and Molecular Imaging, Department of RadiologyBrigham and Women’s HospitalBostonUSA
  9. 9.Department of Nuclear Medicine, Cardiac ImagingUniversity Hospital ZurichZurichSwitzerland
  10. 10.Section of Cardiovascular Medicine, Department of Internal MedicineYale University School of MedicineNew HavenUSA
  11. 11.Cardiovascular Imaging Technologies LLCKansas CityUSA

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