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Quantitative high-efficiency cadmium-zinc-telluride SPECT with dedicated parallel-hole collimation system in obese patients: Results of a multi-center study

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Obesity is a common source of artifact on conventional SPECT myocardial perfusion imaging (MPI). We evaluated image quality and diagnostic performance of high-efficiency (HE) cadmium-zinc-telluride parallel-hole SPECT MPI for coronary artery disease (CAD) in obese patients.

Methods and Results

118 consecutive obese patients at three centers (BMI 43.6 ± 8.9 kg·m−2, range 35-79.7 kg·m−2) had upright/supine HE-SPECT and invasive coronary angiography > 6 months (n = 67) or low likelihood of CAD (n = 51). Stress quantitative total perfusion deficit (TPD) for upright (U-TPD), supine (S-TPD), and combined acquisitions (C-TPD) was assessed. Image quality (IQ; 5 = excellent; < 3 nondiagnostic) was compared among BMI 35-39.9 (n = 58), 40-44.9 (n = 24) and ≥45 (n = 36) groups. ROC curve area for CAD detection (≥50% stenosis) for U-TPD, S-TPD, and C-TPD were 0.80, 0.80, and 0.87, respectively. Sensitivity/specificity was 82%/57% for U-TPD, 74%/71% for S-TPD, and 80%/82% for C-TPD. C-TPD had highest specificity (P = .02). C-TPD normalcy rate was higher than U-TPD (88% vs 75%, P = .02). Mean IQ was similar among BMI 35-39.9, 40-44.9 and ≥45 groups [4.6 vs 4.4 vs 4.5, respectively (P = .6)]. No patient had a nondiagnostic stress scan.

Conclusions

In obese patients, HE-SPECT MPI with dedicated parallel-hole collimation demonstrated high image quality, normalcy rate, and diagnostic accuracy for CAD by quantitative analysis of combined upright/supine acquisitions.

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Acknowledgments

This research was partially supported in part by Grant R01-HL089765 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NHLBI/NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI.

Disclosure

Dr Piotr Slomka, Guido Germano, and Dr Daniel Berman receive royalties from the software employed in the study. Dr Mathews Fish is a medical consultant of Spectrum-Dynamics. Dr Daniel Berman is a shareholder in Spectrum-Dynamics. All others disclose no conflict of interest.

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Authors and Affiliations

  1. Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building Suite 1258, Los Angeles, CA, 90048, USA

    Ryo Nakazato MD, PhD, Piotr J. Slomka PhD, Sean W. Hayes MD, Louise E. J. Thomson MD, John D. Friedman MD, Guido Germano PhD & Daniel S. Berman MD

  2. Cardiovascular Center, St. Luke’s International Hospital, Tokyo, Japan

    Ryo Nakazato MD, PhD

  3. Department of Cardiology, Peacehealth Sacred Heart Medical Center, Springfield, OR, USA

    Mathews Fish MD & Mark Lemley Jr. BS

  4. Departments of Medicine (Cardiology Division) and Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA

    Ronald G. Schwartz MD, MS, Maria L. Mackin CNMT, RT(N), Benjamin Peterson MD, Arielle M. Schwartz BS & Jesse A. Doran MD

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  1. Ryo Nakazato MD, PhD
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  2. Piotr J. Slomka PhD
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  3. Mathews Fish MD
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  4. Ronald G. Schwartz MD, MS
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  6. Louise E. J. Thomson MD
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  7. John D. Friedman MD
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  9. Maria L. Mackin CNMT, RT(N)
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  10. Benjamin Peterson MD
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  12. Jesse A. Doran MD
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  13. Guido Germano PhD
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  14. Daniel S. Berman MD
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Corresponding author

Correspondence to Daniel S. Berman MD.

Additional information

See related editorial, doi:10.1007/s12350-014-0005-3.

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Nakazato, R., Slomka, P.J., Fish, M. et al. 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, 266–275 (2015). https://doi.org/10.1007/s12350-014-9984-3

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  • DOI: https://doi.org/10.1007/s12350-014-9984-3

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