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Effect of reduced photon count levels and choice of normal data on semi-automated image assessment in cardiac SPECT

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The SMARTZOOM multifocal collimator from Siemens Healthcare was developed to improve the γ-photon sensitivity in myocardial perfusion imaging without truncating the field of view. As part of the IQ-SPECT package, it may be used to reduce radiopharmaceutical dose to patients, as well as acquisition time. The aim of this study was twofold: (1) to evaluate the influence of dose reduction in semi-automated MPI scoring, with focus on different strategies for the choice of normal data (count-matched, full-count), and (2) to evaluate the effect of dose reduction afforded by Siemens’ IQ-SPECT package.

Methods

50 patients underwent Tc-99m-sestamibi one-day stress/rest SPECT/CT. Multiple levels of count reduction were generated using binomial thinning. Using Corridor 4DM, summed stress score (SSS) was calculated using either count-matched or full-count normal data. Studies were classified as low-risk (SSS < 4) or intermediate/high-risk (SSS ≥ 4).

Results

Count reduction using count-matched normal data increases false-normal rate and decreases sensitivity. With full-count normal data, count reduction increases false-hypoperfusion rate, leading to decreased specificity. Altogether, rate of reclassification was significant at roughly 67% dose and below.

Conclusion

Significant bias results from count level of normal data relative to actual patient data. Compared to standard LEHR, IQ-SPECT should allow for significant dose reduction.

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Notes

  1. As noted above, reducing dose is not strictly the same as imaging time, as physiological factors such as tracer kinetics and patient motion will differ between the two cases. Nevertheless, from the perspective of counts acquired, the two processes may be considered equivalent.

  2. For example, Caobelli et al46 had a time interval of approximately three minutes between the SPECTs, which should render tracer kinetics to be negligible.

Abbreviations

MPI:

Myocardial perfusion imaging

TPD:

Total perfusion deficit

SSS:

Summed stress score

SRS:

Summed rest score

AT:

Acquisition time

IT:

Imaging time

CPP:

Counts per pixel

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Acknowledgements

The present work was performed in (partial) fulfillment of the requirements for obtaining the degree “Dr. med.”

Disclosure

Matthias Wetzl has nothing to declare. James C. Sanders has been supported in the past by a collaboration agreement with Siemens Molecular Imaging that is not directly related to this project. Torsten Kuwert has received honoraria for lectures on behalf of Siemens Molecular Imaging. Torsten Kuwert and Philipp Ritt: the Clinic of Nuclear Medicine in Erlangen has a research cooperation with Siemens on the field of SPECT/CT, but not related to the data contained in this manuscript.

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Authors and Affiliations

  1. Clinic of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany

    Matthias Wetzl, James C. Sanders MSc, Torsten Kuwert MD & Philipp Ritt PhD

  2. Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany

    James C. Sanders MSc

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  1. Matthias Wetzl
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Wetzl, M., Sanders, J.C., Kuwert, T. et al. Effect of reduced photon count levels and choice of normal data on semi-automated image assessment in cardiac SPECT. J. Nucl. Cardiol. 27, 1469–1482 (2020). https://doi.org/10.1007/s12350-018-1272-1

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