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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

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Journal of Nuclear Cardiology Aims and scope

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.

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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

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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.

Author information

Authors and Affiliations

  1. Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Ste. A047N, Los Angeles, CA, 90048, USA

    Lien-Hsin Hu MD, Robert J. H. Miller MD, Julian Betancur PhD, Guido Germano PhD, Joanna X. Liang BA, Frederic Commandeur PhD, Peyman N. Azadani MD, Heidi Gransar MS, Yuka Otaki MD, Balaji K. Tamarappoo MD, Damini Dey PhD, Daniel S. Berman MD & Piotr J. Slomka PhD

  2. Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Lien-Hsin Hu MD

  3. Department of Nuclear Cardiology, Assuta Medical Center, Tel Aviv, Israel

    Tali Sharir MD

  4. Ben Gurion University of the Negev, Beer Sheba, Israel

    Tali Sharir MD

  5. Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA

    Andrew J. Einstein MD, PhD

  6. Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield, OR, USA

    Mathews B. Fish MD

  7. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada

    Terrence D. Ruddy MD

  8. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    Sharmila Dorbala MD & Marcelo Di Carli MD

  9. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland

    Philipp A. Kaufmann MD

  10. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Albert J. Sinusas MD & Edward J. Miller MD, PhD

  11. Cardiovascular Imaging Technologies LLC, Kansas City, MO, USA

    Timothy M. Bateman MD

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  1. Lien-Hsin Hu MD
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Correspondence to Piotr J. Slomka PhD.

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This research was supported in part by Grant R01HL089765 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NHLBI/NIH) (PI: Piotr Slomka). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Hu received the funding from Taipei Veterans General Hospital-National Yang-Ming University Excellent Physician Scientists Cultivation Program, No. 106-V-A-007.

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Hu, LH., Sharir, T., Miller, R.J.H. et al. Upper reference limits of transient ischemic dilation ratio for different protocols on new-generation cadmium zinc telluride cameras: A report from REFINE SPECT registry. J. Nucl. Cardiol. 27, 1180–1189 (2020). https://doi.org/10.1007/s12350-019-01730-y

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