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Radionuclide imaging of cardiac function represents a number of well-validated techniques for accurate determination of right (RV) and left ventricular (LV) ejection fraction (EF) and LV volumes. These first European guidelines give recommendations for how and when to use first-pass and equilibrium radionuclide ventriculography, gated myocardial pe...
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... ventricular end-diastolic volume QGS and 4D-MSPECT have been shown to underestimate LV EDV compared to the corresponding measurements from cMRI with 17 and 10ml, respectively [60]. Another comparison between the three software packages, 4D- MSPECT, ECT and QGS, have shown that 4D-MSPECT and ECT calculate LV EDV values that are 14-and 10-ml higher, respectively, than those calculated with QGS in patients with normal MPS [132] (Table 6). ...
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The European procedural guidelines for radionuclide imaging of myocardial perfusion and viability are presented in 13 sections covering patient information, radiopharmaceuticals, injected activities and dosimetry, stress tests, imaging protocols and acquisition, quality control and reconstruction methods, gated studies and attenuation-scatter compe...
Background:
Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice.
Objective:
To evaluate whether the medical applications of myocardial...
Citations
... Red blood cell (RBC) labeling is a commonly employed technique to assess red blood cell volume in the diagnostic evaluation of polycythemia, to measure the left ventricular ejection fraction [1,2], for gastrointestinal bleeding scintigraphy [3] and splenic function evaluation [4,5]. The accurate determination of RBC volume plays a crucial role in confirming the diagnosis of absolute polycythemia. ...
... However, comparing software applications is still challenging and can result in different dosimetry analyses of clinical data derived from peptide receptor radionuclide therapy (PRRT) using 177 Lu-DOTATATE [11]. For over a decade, tools for automated quantifying myocardial ischemia and wall motion defects in cardiac SPECT imaging have offered valid programs and algorithms [12]. However, differences in certain features and artifacts might need to be manually corrected by the user despite automated processing [13]. ...
Background:
Several software tools have been developed for gated PET imaging that use distinct algorithms to analyze tracer uptake, myocardial perfusion, and left ventricle volumes and function. Studies suggest that different software tools cannot be used interchangeably in humans. In this study, we sought to compare the left ventricular parameters in gated 18F-FDG PET/CT imaging in mice by three commercially available software tools: PMOD, MIM, and QGS.
Methods and results:
Healthy mice underwent ECG-gated 18F-FDG imaging using a small-animal nanoPET/CT (Mediso) under isoflurane narcosis. Reconstructed gates PET images were subsequently analyzed in three different software tools, and cardiac volume and function (end-diastolic (EDV), end-systolic volumes (ESV), stroke volume (SV), and ejection fraction (EF)) were evaluated. While cardiac volumes correlated well between PMOD, MIM, and QGS, the left ventricular parameters and cardiac function differed in agreement using Bland-Altman analysis. EDV in PMOD vs. QGS: r = 0.85; p < 0.001, MIM vs. QGS: r = 0.92; p < 0.001, and MIM vs. PMOD: r = 0.88; p < 0.001, showed good correlations. Correlation was also found in ESV: PMOD vs. QGS: r = 0.48; p = 0.07, MIM vs QGS: r = 0.79; p < 0.001, and MIM vs. PMOD: r = 0.69; p < 0.01. SV showed good correlations in: PMOD vs. QGS: r = 0.73; p < 0.01, MIM vs. QGS: r = 0.86; p < 0.001, and MIM vs. PMOD: r = 0.92; p < 0.001. However, EF among correlated poorly: PMOD vs. QGS: r = -0.31; p = 0.26, MIM vs. QGS: r = 0.48; p = 0.07, and MIM vs. PMOD: r = 0.23; p = 0.41. Inter-class and intra-class correlation coefficient were > 0.9 underlining repeatability in using PMOD, MIM, and QGS for cardiac volume and function assessment.
Conclusions:
All three commercially available software tools are feasible in small animal cardiac volume assessment in gated 18F-FDG PET/CT imaging. However, due to software-related differences in agreement analysis for cardiac volumes and function, PMOD, MIM, and QGS cannot be used interchangeably in murine research.
... 47,48 In MUGA, cardiac volumes are derived from heart-centred images of the patient's own radiolabelled erythrocytes 49 and are therefore not influenced by geometric assumptions about the myocardial wall. 50 Three types of MUGA are distinguished: (i) first-pass MUGA, (ii) planar equilibrium radionuclide angiography (ERNA), and (iii) single-photon emission computed tomography (SPECT) ERNA. In practice, first-pass MUGA is limited to specific indications [right ventricular ejection fraction (RVEF) and shunt assessment 49,51 ], and only ERNA is used to assess CTRCD. ...
Cancer and cardiovascular disease often share common risk factors, and patients with cardiovascular disease who develop cancer are at high risk of experiencing major adverse cardiac events. Additionally, cancer treatment can induce short- and long-term adverse cardiovascular events. Given the improvement in oncological patients' prognosis, the burden in this vulnerable population is slowly shifting towards increased cardiovascular mortality. Consequently, the field of cardio-oncology is steadily expanding, prompting the need for new markers to stratify and monitor the cardiovascular risk in oncological patients before, during, and after the completion of treatment. Advanced noninvasive cardiac imaging has raised great interest in the early detection of cardiovascular diseases and cardiotoxicity in oncological patients. Nuclear medicine has long been a pivotal exam to robustly assess and monitor the cardiac function of patients undergoing potentially cardiotoxic chemotherapies. In addition, recent radiotracers have shown great interest in the early detection of cancer treatment-related cardiotoxicity. In this review, we summarize the current and emerging nuclear cardiology tools that can help identify cardiotoxicity and assess the cardiovascular risk in patients undergoing cancer treatments, and discuss the specific role of nuclear cardiology alongside other noninvasive imaging techniques.
... Currently, myocardial perfusion studies are acquired in a gated mode using an ECG trigger and separate computed tomography (CT) scans are performed for attenuation correction (available for SPECT/CT hybrid machines). This hybrid modality offers the evaluation of the ventricular volumes and function (including the regional contractility of the LV) with an improvement in the diagnostic accuracy of perfusion imaging [62]. ...
... Furthermore, SPECT images suffer from several artifacts that mimic perfusion defects, as in cases of left bundle branch block, which can cause an apparent defect in the septal wall, of the breast and diaphragm interposition for the anterior wall or inferior wall, respectively. Subdiaphragmatic hepatobiliary excretion of technetium-labeled agents may mimic an increased activity in the inferior wall [62]. Finally, it is a global long examination that suffers from higher radiation exposure, although newer technologies such as cardiac-specific solid-state detector cameras work at lower radiation doses [64]. ...
Coronary artery disease (CAD) is one of the major causes of mortality and morbidity worldwide, with a high socioeconomic impact. Currently, various guidelines and recommendations have been published about chronic coronary syndromes (CCS). According to the recent European Society of Cardiology guidelines on chronic coronary syndrome, a multimodal imaging approach is strongly recommended in the evaluation of patients with suspected CAD. Today, in the current practice, non-invasive imaging methods can assess coronary anatomy through coronary computed tomography angiography (CCTA) and/or inducible myocardial ischemia through functional stress testing (stress echocardiography, cardiac magnetic resonance imaging, single photon emission computed tomography—SPECT, or positron emission tomography—PET). However, recent trials (ISCHEMIA and REVIVED) have cast doubt on the previous conception of the management of patients with CCS, and nowadays it is essential to understand the limitations and strengths of each imaging method and, specifically, when to choose a functional approach focused on the ischemia versus a coronary anatomy-based one. Finally, the concept of a pathophysiology-driven treatment of these patients emerged as an important goal of multimodal imaging, integrating ‘anatomical’ and ‘functional’ information. The present review aims to provide an overview of non-invasive imaging modalities for the comprehensive management of CCS patients.
... 74 years old man, with prostatic adenocarcinoma studied with equilibrium isotope ventriculoscintigraphy with [99mTc]NaTcO4labeled red blood cells (VEQ) 1 for evaluation of cardiac function, before starting treatment with cardiotoxic drugs (Figs. 1 and 2). In the parametric image of amplitude (white arrows) and phase (red arrows), an apical focus of a different color is visualized, suggesting delayed apical filling (B-C). ...
... Because of TTE's potential limitations in women, CMR is a useful alternative [127] to assess systolic and diastolic function and determine the type of HF. In chronic HF, ERNA is another option [132,136], although no longer mentioned in the latest European Society of Cardiology guidelines [114]. In case of HFrEF, the lower rate of ischemic origin in women stresses the importance of CMR with LGE to evaluate alternative etiologies, such as DCM, HCM, VHD [142], ARVC [144], myocarditis, sarcoidosis, and infiltrative diseases. ...
... In women with dyspnea and preserved systolic LVEF, an in-depth screen-ing for HFpEF must be considered, based on the four-step algorithm previously mentioned and established by the ESC [120,130]. Abbreviations: 18 [132]. However, scintigraphy tends to underestimate the value of LVEF compared to CMR in both sexes [133]. ...
Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Although major diagnostic and therapeutic advances have significantly improved the prognosis of patients with CVD in the past decades, these advances have less benefited women than age-matched men. Noninvasive cardiac imaging plays a key role in the diagnosis of CVD. Despite shared imaging features and strategies between both sexes, there are critical sex disparities that warrant careful consideration, related to the selection of the most suited imaging techniques, to technical limitations, and to specific diseases that are overrepresented in the female population. Taking these sex disparities into consideration holds promise to improve management and alleviate the burden of CVD in women. In this review, we summarize the specific features of cardiac imaging in four of the most common presentations of CVD in the female population including coronary artery disease, heart failure, pregnancy complications, and heart disease in oncology, thereby highlighting contemporary strengths and limitations. We further propose diagnostic algorithms tailored to women that might help in selecting the most appropriate imaging modality.
... The reconstruction of both attenuation-and non-attenuation-corrected SPECT images (matrix size of 64 × 64 × 40 and voxel resolution of 6.79 × 6.79 × 6.79 mm 3 ) was performed using the ordered subset expectation maximization algorithm with 4 iterations, 10 subsets, and a postreconstruction Butterworth filter (frequency of 0.4 and power of 10). ECG-gated MPI-SPECT data were acquired using 8 frames per cardiac cycle for R-R interval length using the forward-backward gating method (Hesse et al., 2008;Sarebani et al., 2020). The deep learning-based AC models were trained and evaluated using ungated SPECT images. ...
We investigate the accuracy of direct attenuation correction (AC) in the image domain for myocardial perfusion SPECT (single-photon emission computed tomography) imaging (MPI-SPECT) using residual (ResNet) and UNet deep convolutional neural networks. MPI-SPECT 99m Tc-sestamibi images of 99 patients were retrospectively included. UNet and ResNet networks were trained using non-attenuation-corrected SPECT images as input, whereas CT-based attenuation-corrected (CT-AC) SPECT images served as reference. Chang's calculated AC approach considering a uniform attenuation coefficient within the body contour was also implemented. Clinical and quantitative evaluations of the proposed methods were performed considering SPECT CT-AC images of 19 subjects (external validation set) as reference. Image-derived metrics, including the voxel-wise mean error (ME), mean absolute error, relative error, structural similarity index (SSI), and peak signal-to-noise ratio, as well as clinical relevant indices, such as total perfusion deficit (TPD), were utilized. Overall, AC SPECT images generated using the deep learning networks exhibited good agreement with SPECT CT-AC images, substantially outperforming Chang's method. The ResNet and UNet models resulted in an ME of −6.99 ± 16.72 and −4.41 ± 11.8 and an SSI of 0.99 ± 0.04 and 0.98 ± 0.05, respectively. Chang's approach led to ME and SSI of 25.52 ± 33.98 and 0.93 ± 0.09, respectively. Similarly, the clinical evaluation revealed a mean TPD of 12.78 ± 9.22% and 12.57 ± 8.93% for 435 ResNet and UNet models, respectively, compared to 12.84 ± 8.63% obtained from SPECT CT-AC images. Conversely, Chang's approach led to a mean TPD of 16.68 ± 11.24%. The deep learning AC methods have the potential to achieve reliable AC in MPI-SPECT imaging.
... RVEF was calculated using the following formula: {ED counts − ES counts} / ES counts. 20) We compared the correlation between the primary endpoints that are the main evaluation items as prognostic factors and RVEF. Absolute hemodynamic changes were calculated using the formula {each post-BPA parameter − each pre-BPA parameter} and were shown as changes in each parameter. ...
Balloon pulmonary angioplasty (BPA) is a robust treatment and has been performed among patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). A lung perfusion scan (LPS) is required for inspection in deciding the curative effect judgment and treatment lesion of BPA. Nevertheless, the impact of BPA in the improvement of right heart system function is not well known. We investigated whether BPA improves right heart function alongside other parameters.
We studied 20 patients with CTEPH (mean age 63.6 ± 15.9 years, male 30.0%) who underwent BPA. All study sets including right heart catheter, pulmonary angiography, 6-minute walk test (6MWT), blood gas analysis, and LPS were performed before BPA treatment. All parameters using right heart catheter and oxygenation level were measured at room air temperature. Regarding LPS, right ventricular ejection fraction (RVEF) was calculated using the first-pass method. These parameters before BPA were compared with those after BPA.
In total, 120 BPAs were performed (mean number of procedures/patient; 6.0 ± 2.4 sessions). Per BPA session, 6.0 ± 2.4 areas and 10.0 ± 4.3 lesions were treated with a volume of 181.3 ± 53.5 mL of contrast media. No complication required an invasive procedure. World Health Organization functional class, 6MWT, pulmonary artery pressure, pulmonary vascular resistance, and oxygenation level were significantly improved after BPA. RVEF via LPS was also significantly improved after BPA (45.0 ± 6.2% to 50.6 ± 2.9%, P < 0.001).
In the present study, we found that RVEF via LPS was improved through appropriate BPA alongside the other parameters. It would be useful to be able to evaluate right heart function.
... An individual's EF measurement is not constant but varies, particularly as a function of the afterload and blood pressure (BP) (6)(7)(8). It is therefore generally recommended to record the bracial BP observed during individual EF measurements (9)(10)(11). ...
... Despite this limitation, EF remains extensively used to quantify LV systolic performance (1). The current recommendation therefore requires brachial BP to be reported for each EF measurement (9)(10)(11). The change in BP was a significant predictor of EF change but only for diastolic and mean BP levels. ...
Introduction: This cardiovascular magnetic resonance (CMR) study aims to determine whether changes in systemic vascular resistance (SVR), obtained from CMR flow sequences, might explain the significant long-term changes in left ventricular (LV) ejection fraction (EF) observed in subjects with no cardiac disease history.
Methods: Cohort subjects without any known cardiac disease but with high rates of hypertension and obesity, underwent CMR with phase-contrast sequences both at baseline and at a median follow-up of 5.2 years. Longitudinal changes in EF were analyzed for any concomitant changes in blood pressure and vascular function, notably the indexed SVR given by the formula: mean brachial blood pressure / cardiac output x body surface area.
Results: A total of 118 subjects (53 ± 12 years, 52% women) were included, 26% had hypertension, and 52% were obese. Eighteen (15%) had significant EF variations between baseline and follow-up (7 increased EF and 11 decreased EF). Longitudinal changes in EF were inversely related to concomitant changes in mean and diastolic blood pressures ( p = 0.030 and p = 0.027, respectively) and much more significantly to SVR ( p < 0.001). On average, these SVR changes were −8.08 ± 9.21 and +8.14 ± 8.28 mmHg.min.m ² .L ⁻¹ , respectively, in subjects with significant increases and decreases in EF, and 3.32 ± 7.53 mmHg.min.m ² .L ⁻¹ in subjects with a stable EF (overall p < 0.001).
Conclusions: Significant EF variations are not uncommon during the long-term CMR follow-up of populations with no evident health issues except for uncomplicated hypertension and obesity. However, most of these variations are linked to SVR changes and may therefore be unrelated to any intrinsic change in LV contractility. This underscores the benefits of specifically assessing LV afterload when EF is monitored in populations at risk of vascular dysfunction.
Clinical Trial Registration: ClinicalTrials.gov , identifier: NCT01716819 and NCT02430805.
... Several techniques are currently available for this monitoring of LVEF [3,6]. Equilibrium radionuclide angiography (ERNA) is a well-validated non-invasive test [7], and in particular, cadmium-zinc-telluride single-photon emission tomography (CZT SPECT) radionuclide angiography ranks high, due to practicability, operator independency, and reproducibility [8][9][10]. ...
... This study successfully tested a combination of two equations for individualised dose planning in CZT ERNA, allowing for a reduction in the mean dose of at least 50% (to a mean effective dose of 1.6 mSv (range: 0.6 to 3.6 mSv)), without compromising the ability to produce reproducible analyses of LVEF. The average dose using a target count rate of 1.7 kcps is approximately half of the current recommendation for planar nuclear angiography [7,22], and as suggested possible by Duvall et al. [9]. Additionally, we found a level of the target count rate that minimises the need for a lower dose limit. ...
The aim of the present study was to test an individualised dose without compromising the ease of analysing data when performing equilibrium radionuclide angiography (ERNA) using cadmium–zinc–telluride (CZT) SPECT. From March 2018 to January 2019, 1650 patients referred for ERNA received either an individualised dose of 99mTc-labeled human serum albumin (HSA) according to their age, sex, height, and weight (n = 1567), or a standard dose of 550 MBq (n = 83). The target count rate (CRT) was reduced every two months from 2.7 to 1.0 kcps. A final test with a CRT of 1.7 kcps was run for three months to test whether an agreement within 2% points for the determination of LVEF, on the basis of only two analyses, was obtainable in at least 95% of acquisitions. All the included ERNAs were performed on a dedicated cardiac CZT SPECT camera. When using the algorithm for an individualised dose, we found that agreement between the measured and predicted count rate was 80%. With a CRT of 1.7 kcps, the need for more than two analyses to obtain sufficient agreement for LVEF was 4.9%. Furthermore, this resulted in a mean dose reduction from 550 to 258 MBq. Patients’ weight, height, sex, and age can, therefore, be used for individualising a tracer dose while reducing the mean dose.
