ABSTRACT
After Turkish Society of Nuclear Medicine “Cardiology Group” had first published “Nuclear Cardiology Practice Guidelines” in 2001, in line particular with the technological developments, significant changes both in the hardware, software and also in the protocols have occurred in the era of nuclear cardiology. Besides many new clinical uses in nuclear cardiology and specific developments in both single photon emission computerized tomography and positron emission tomography systems, such as specific cardiac gamma camera systems and blood flow studies, myocardial perfusion scintigraphy (MPS), which is still performed today mostly with conventional gamma camera systems, ranks first among both nuclear cardiology and also general conventional nuclear medicine procedures in almost all nuclear medicine clinics. The aim of this guideline is to assist nuclear medicine physicians in MPS studies, in terms of indications, application, imaging methods, evaluation and reporting stages. The recommendations in this guide has been prepared by “Turkish Society of Nuclear Medicine Cardiology Task Group” to ensure the standardization of the MPS applications in our country in the light of international studies and current guidelines.
Keywords:
Myocardial perfusion, SPECT, SPECT/CT
References
1
Akincioğlu Ç, Atasever T CB et al. Nükleer Kardiyoloji Uygulama Kılavuzu. Turk J Nucl Med 2001;10 Suppl:S41-56.
2
Dorbala S, Ananthasubramaniam K, Armstrong IS, et al. Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation. J Nucl Cardiol [Internet] Springer US 2018;25:1784-1846.
3
Corbett JR, Friedman JD, Goldstein RA, et al. American Society of IMAGING GUIDELINES FOR NUCLEAR CARDIOLOGY PROCEDURES A Report of The American Society of Nuclear Cardiology Quality Assurance Committee Editor Writing Group Chairs. J Nucl Cardiol 2006;21-171.
4
Knuuti J, Wijns W, Saraste A. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology 2019;00:1-71.
5
Ronan G. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multi- modality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease. J Nucl Cardiol 2014; 63:380-406.
6
Yalçın H, Canbaz Tosun F, Koroner Arter Hastalığı Tanı ve Yönetiminde Nükleer Kardiyoloji, Nükleer Tıp Seminerleri 2019;4:80-95.
7
Seitun S, De Lorenzi C, Cademartiri F, et al. CT myocardial perfusion imaging: A new frontier in cardiac imaging. Biomed Res Int 2018;7295460.
8
Duncker DJ, Koller A, Merkus D, et al. Regulation of coronary blood flow in health and ischemic heart disease. Prog Cardiovasc Dis 2015; 57:409-422.
9
Hesse B, Tägil K, Cuocolo A, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005;32:855-897.
10
Verberne HJ, Acampa W, Anagnostopoulos C, et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 2015;42:1929-1940.
11
Acar E KG. No Title. Acar E, Kaya GÇ. Kardiyak Stres Testleri, Yeni Ajanlar. J Nucl Med-Special Topics 20151:57-63.
12
Daly P, Kayse R, Rudick S, et al. Feasibility and safety of exercise stress testing using an anti-gravity tredmill with Tc-99m tetrofosmin single-photon emission computed tomography (SPECT) myocardial perfusion imaging: A pilot non-randomized controlled study. J Nucl Cardiol 2018;25:1092-1097.
13
Garner KK, Pomeroy W AJ. No Titl Exercise Stress Testing: Indications and Common Questions.e. Am Fam Physician 2017;96:293-299.
14
Dilsizian V, Gewirtz H, Paivanas N, et al. Serious and potentially life threatening complications of cardiac stress testing: Physiological mechanisms and management strategies. J Nucl Cardiol 2015;22:1198-1213.
15
Pagnanelli RA, Camposano HL. Pharmacologic stress testing with myocardial perfusion imaging. J Nucl Med Technol 2017;45:249-252.
16
Henzlova MJ, Duvall WL, Einstein AJ, et al. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol 2016;23:606-639.
17
Prvulovich E. Myocardial perfusion scintigraphy. Clin Med J R Coll Physicians London 2006;6:263-266.
18
Mettler FGM, Guiberteau MJ. Cardiovascular System In: Essentials of Nuclear Medicien, 7th Edition. Elsevier - Health Sciences Division 2019;116-129.
19
Ben-Haim S, Almukhailed O, Neill J, et al. Clinical value of supine and upright myocardial perfusion imaging in obese patients using the D-SPECT camera. J Nucl Cardiol 2014;21:478-485.
20
Blaire T, Bailliez A, Bouallegue F Ben, et al. Left ventricular function assessment using 123I/99mTc dual-isotope acquisition with two semi-conductor cadmium–zinc–telluride (CZT) cameras: a gated cardiac phantom study. EJNMMI Phys 2016;3:27
21
Hansen CL. Digital image processing for clinicians, part I: Basics of image formation. J Nucl Cardiol 2002;9:343-349.
22
King MA, Glick SJ, Penney BC, et al. Interactive visual optimization of SPECT prereconstruction filtering. J Nucl Med 1987;28:1192-1198.
23
Hansen CL. Digital image processing for clinicians, part II: Filtering. J Nucl Cardiol 2002;9:429-437.
24
DePuey EG. Advances in SPECT camera software and hardware: Currently available and new on the horizon. J. Nucl. Cardiol 2012;19:551-581.
25
DePuey EG, Gadiraju R, Clark J, et al. Ordered subset expectation maximization and wide beam reconstruction “half-time” gated myocardial perfusion SPECT functional imaging: A comparison to “full-time” filtered backprojection. J Nucl Cardiol 2008;15:547-563.
26
Hansen CL. The role of the translation table in cardiac image display. J Nucl Cardiol 2006;13:571-575.
27
Weiss AT, Berman DS, Lew AS, et al. Transient ischemic dilation of the left ventricle on stress thallium-201 scintigraphy: A marker of severe and extensive coronary artery disease. J Am Coll Cardiol 1987;9:752-759.
28
McLaughlin MG, Danias PG. Transient ischemic dilation: A powerful diagnostic and prognostic finding of stress myocardial perfusion imaging. J Nucl Cardiol 2002;9:663-667.
29
Xu Y, Arsanjani R, Clond M, et al. Transient ischemic dilation for coronary artery disease in quantitative analysis of same-day sestamibi myocardial perfusion SPECT. J Nucl Cardiol 2012;19:465-473.
30
Hansen CL, Sangrigoli R, Nkadi E, et al. Comparison of pulmonary uptake with transient cavity dilation after exercise thallium-201 perfusion imaging. J Am Coll Cardiol 1999;33:1323-1327.
31
Hansen CL, Cen P, Sanchez B, et al. Comparison or pulmonary uptake with transient cavity dilation after dipyridamole Tl-201 perfusion imaging. J Nucl Cardiol 2002;9:47-51.
32
Chouraqui P, Rodrigues EA, Berman DS, et al. Significance of dipyridamole-lnduced transient dilation of the left ventricle during thallium-201 scintigraphy in suspected coronary artery disease. Am J Cardiol 1990;9:265-271.
33
Abidov A, Bax JJ, Hayes SW, 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.
34
Slomka PJ, Berman DS, Germano G. Normal limits for transient ischemic dilation with 99mTc myocardial perfusion SPECT protocols. J Nucl Cardiol 2017;24:1709-1711.
35
Germano G, Berman DS. Clinical Gated Cardiac SPECT. Wiley-Blackwell; 2 edition 2006.
36
Gill JB, Ruddy TD, Newell JB, et al. Prognostic importance of thallium uptake by the lungs during exercise in coronary artery disease. N Engl J Med 1987;317:1485-1489.
37
Higgins JP, Phil M. Increased right ventricular uptake on stress SPECTmyocardial perfusion images in a patient withsevere coronary artery disease. J Nucl Cardiol 2006;13:725-727.
38
Wackers FJT. On the bright right side. J Nucl Cardiol 2005;12:378-380.
39
Williams KA, Schneider CM. Increased stress right ventricular activity on dual isotope perfusion SPECT: A sign of multivessel and/or left main coronary artery disease. J Am Coll Cardiol 1999; 34:420-427.
40
Cerqueira MD, Weissman NJ, Dilsizian V, 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. J Nucl Cardiol 2002;29;105:539-542.
41
Tilkemeier PL, Bourque J, Doukky R, et al. ASNC imaging guidelines for nuclear cardiology procedures: Standardized reporting of nuclear cardiology procedures. J Nucl Cardiol 2017;24:2064-2128.
42
Berman DS, Kang X, Van Train KF, et al. Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single- photon emission computed tomography. J Am Coll Cardiol 1998; 32:1987-1995.
43
Arsanjani R, Xu Y, Hayes SW, et al. Comparison of fully automated computer analysis and visual scoring for detection of coronary artery disease from myocardial perfusion SPECT in a large population. J Nucl Med 2013;54:221-228.
44
Rubeaux M, Xu Y, Germano G, et al. Normal Databases for the Relative Quantification of Myocardial Perfusion. Curr Cardiovasc Imaging Rep 2016;9:22.
45
Xu Y, Hayes S, Ali I, et al. Automatic and visual reproducibility of perfusion and function measures for myocardial perfusion SPECT. J Nucl Cardiol 2010;17:1050-1057.
46
Berman DS, Kang X, Gransar H, et al. Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis. J Nucl Cardiol 2009;16:45-53.
47
Iskandrian AE, Garcia EV, Faber T, et al. Automated assessment of serial SPECT myocardial perfusion images. J Nucl Cardiol 2009;16;6-9.
48
Mahmarian JJ, Cerqueira MD, Iskandrian AE, et al. Regadenoson Induces Comparable Left Ventricular Perfusion Defects as Adenosine. A Quantitative Analysis From the ADVANCE MPI 2 Trial. JACC Cardiovasc Imaging 2009;2:959-968.
49
Nakazato R, Berman DS, Gransar H, et al. Prognostic value of quantitative high-speed myocardial perfusion imaging. J Nucl Cardiol 2012;19:1113-1123.
50
Slomka PJ, Nishina H, Berman DS, et al. Automatic quantification of myocardial perfusion stress-rest change: A new measure of ischemia. J Nucl Med 2004;45:183-191.
51
Cullom SJ, Case JA, Bateman TM. Electrocardiographically gated myocardial perfusion SPECT: Technical principles and quality control considerations. J Nucl Cardiol 1998;5:418-425.
52
Sharir T, Kang X, Germano G, et al. Prognostic value of poststress left ventricular volume and ejection fraction by gated myocardial perfusion SPECT in women and men: Gender-related differences in normal limits and outcomes. J Nucl Cardiol 2006;13:495-506.
53
Hesse B, Lindhardt TB, Acampa W, et al. EANM/ESC guidelines for radionuclide imagingof cardiac function. Eur J Nucl Med Mol Imaging 2008;35:851-885.
54
Carvalho PA, Aguiar PM, Grossman GB, et al. Prognostic implications of the difference between left ventricular ejection fractions after stress and at rest in addition to the quantification of myocardial perfusion abnormalities obtained with gated SPECT. Clin Nucl Med 2012;37:748-754.
55
Sharma A, Sampath S, Sood A, Bhattacharya A, Mittal B. Post stress fall in LVEF as a predictor of reversibility of perfusion defects on myocardial perfusion scintigraphy. J Nucl Med May 2013;54(Suppl 2):1725.
56
Choi JY, Lee KH, Kim SJ, et al. Gating provides improved accuracy for differentiating artifacts from true lesions in equivocal fixed defects on technetium 99m tetrofosmin perfusion SPECT. J Nucl Cardiol 1998;5:395-401.
57
Seo Y, Mari C, Hasegawa BH. Technological Development and Advances in Single-Photon Emission Computed Tomography/Computed Tomography. Semin Nucl Med 2008;38:177-198.
58
Chen J, Garcia EV, Folks RD, et al. Onset of left ventricular mechanical contraction as determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: Development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. J Nucl Cardiol 2005;12:687-695.
59
Henneman MM, Chen J, Dibbets-Schneider P, et al. Can LV dyssynchrony as assessed with phase analysis on gated myocardial perfusion SPECT predict response to CRT? J Nucl Med 2007;48:1104-1111.
60
Heydari B, Jerosch-Herold M, KwongB Raymond, et al. Imaging for planning of cardiac resynchronization therapy. JACC Cardiovasc Imaging 2012;5:93-110.
61
Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013;128:e240-327.
62
Bax JJ, Van Der Wall EE, Harbinson M. Radionuclide techniques for the assessment of myocardial viability and hibernation. Heart 2004;90(Suppl 5):v26-33.
63
Delbeke D, Bax JJ, Martin WH SM. Evaluation of myocardial viability. In: Nuclear Cardiology and Correlative Imaging: A teaching file. Eds: Springer Verlag, New York 2004;205.
64
Dilsizian V, Rocco TP, Freedman NM, et al. Enhanced detection of ischemic but viable myocardium by the reinjection of thallium after stress-redistribution imaging. N Engl J Med 1990;323:141-146.
65
Dilsizian V, Bonow RO. Current diagnostic techniques of assessing myocardial viability in patients with hibernating and stunned myocardium. Circulation 1993;87:1-20.
66
Uebleis C, Hellweger S, Laubender RP, et al. The amount of dysfunctional but viable myocardium predicts long-term survival in patients with ischemic cardiomyopathy and left ventricular dysfunction. Int J Cardiovasc Imaging 2013;29:1645-1653.
67
Thomas GS, Cullom SJ, Kitt TM, et al. The EXERRT trial: “EXErcise to Regadenoson in Recovery Trial”: A phase 3b, open-label, parallel group, randomized, multicenter study to assess regadenoson administration following an inadequate exercise stress test as compared to regadenoson without exerc. J Nucl Cardiol 2017;24:788-802.
68
Askew JW, Miller TD, Ruter RL, et al. Early image acquisition using a solid-state cardiac camera for fast myocardial perfusion imaging. J Nucl Cardiol 2011;18:840-846.
69
Nabi F, Kassi M, Muhyieddeen K, et al. Optimizing evaluation of patients with low-to-intermediate-risk acute chest pain: A randomized study comparing stress myocardial perfusion tomography incorporating stress-only imaging versus cardiac CT. J Nucl Med 2016;57:378-384.
70
Thompson RC, Allam AH. More risk factors, less ischemia, and the relevance of MPI testing. J Nucl Cardiol 2015;22:552-554.
71
Mahmarian JJ. Implementation of stress-only imaging: What will it take? J Nucl Cardiol 2017;17:529-535.
72
Nkoulou R, Fuchs TA, Pazhenkottil AP, et al. Absolute myocardial blood flow and flow reserve assessed by gated SPECT with cadmium-zinc-telluride detectors using 99mTc-tetrofosmin: Head-to-head comparison with 13N-ammonia PET. J Nucl Med 2016;57:1887-1892.
73
Guner LA, Caliskan B, Isik I, et al. Evaluating the role of routine prone acquisition on visual evaluation of SPECT images. J Nucl Med Technol 2015;43:282-288.
74
Heller GV, Bateman TM, Johnson LL, et al. Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging. J Nucl Cardiol 2004;1:263-272.
75
Duvall WL, Baber U, Levine EJ, et al. A model for the prediction of a successful stress-first Tc-99m SPECT MPI. J Nucl Cardiol 2012;19:1124-1134.
76
Gowdar S, Chaudhry W, Ahlberg AW, et al. Triage of patients for attenuation-corrected stress-first Tc-99m SPECT MPI using a simplified clinical pre-test scoring model. J Nucl Cardiol 2018;25:1178-1187.
77
Chang SM, Nabi F, Xu J, et al. Normal Stress-Only Versus Standard Stress/Rest Myocardial Perfusion Imaging. Similar Patient Mortality With Reduced Radiation Exposure. J Am Coll Cardiol 2010;55:221-230.
78
Gemignani AS, Muhlebach SG, Abbott BG, et al. Stress-only or stress/rest myocardial perfusion imaging in patients undergoing evaluation for bariatric surgery. J Nucl Cardiol 2011;18:886-892.
79
Mathur S, Heller GV, Bateman TM, et al. Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction. J Nucl Cardiol 2013;20:27-37.
80
ICRP. Human alimentary tract model for radiological protection. ICRP Publication 100. A report of The International Commission on Radiological Protection. Ann ICRP 2006;36(1-2):25-327.
81
ICRP. The 2007 Recommendations of the International Commission on radiological protection. ICRP publication 103. Ann ICRP 2007;37:1-332.
82
ICRP. Adult reference computational phantoms. ICRP Publication 110. Ann ICRP. 2009;39(2).
83
Andersson M, Johansson L, Minarik D, Leide-Svegborn S, Mattsson S. Effective dose to adult patients from 338 radiopharma ceuticals estimated using ICRP biokinetic data, ICRP/ICRU computational reference phantoms and ICRP 2007 tissue weighting factors. EJNMMI Phys 2014;1:9.
84
ICRP Publication 53. Radiation dose to patients from radio pharmaceuticals. Annals of ICRP, 18. Oxford: Pergamon Press; 1987. p. 1–4.No Title. Piepsz A, Hahn K, Roca I, et al. A radiopharmaceuticals schedule for imaging in paediatrics. Eur J Nucl Med 1990;17:127-129.
85
van Dijk JD, Jager PL, Ottervanger JP, et al. Development and validation of a patient-tailored dose regime in myocardial perfusion imaging using conventional SPECT. J Nucl Cardiol 2016;23:134-142.
86
Herzog BA, Buechel RR, Katz R, et al. Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: Optimized protocol for scan time reduction. J Nucl Med 2010;51:46-51.
