Abstract
BackgroundQuantitative SPECT enables absolute quantification of uptake in perfusion defects. The aim of this experimental study is to assess quantitative accuracy and precision of a novel iterative reconstruction technique (Evolution; GE Healthcare) for the potential application of response monitoring using 99mTc-tetrofosmin SPECT/CT in patients with coronary artery disease (CAD).MethodsAcquisitions of an anthropomorphic torso phantom with cardiac insert containing defects (with varying sizes), filled with 99mTc-pertechnetate, were performed on a SPECT/CT (Discovery 670 Pro, GE Healthcare). Subsequently, volumes of interest of the defects were manually drawn on CT to assess the recovery coefficient (RC). Bull’s eye plots were composed to evaluate the uptake per segment. Finally, 99mTc-tetrofosmin SPECT/CT scans of 10 CAD patients were used to illustrate clinical application.ResultsThe phantom study indicated that Evolution showed convergence after 7 iterations and 10 subsets. The average repeatability deviation of all configurations was 2.91% and 3.15% (%SD mean) for filtered (Butterworth) and unfiltered data, respectively. The accuracy after post-filtering was lower compared to the unfiltered data with a mean (SD) RC of 0.63 (0.05) and 0.70 (0.07), respectively (p < 0.05). More artificial defects were found on Bull’s eye plots created with the unfiltered data compared to filtered data. Eight out of ten patients showed significant changes in uptake before and after treatment (p < 0.05).ConclusionQuantification of 99mTc-tetrofosmin SPECT/CT seems feasible for CAD patients when 7 iterations (10 subsets), Butterworth post-filtering (cut off frequency 0.52 in cycles/cm, order of 5) and manual CT-delineation are applied. However, future prospective patient studies are required for clinical application.
Highlights
Myocardial perfusion imaging is used to evaluate the presence and severity of coronary artery disease (CAD) [1, 2]
Myocardial perfusion scintigraphy (MPS) is based on visual interpretation of relative myocardial perfusion and might underestimate the severity of ischemia due to global hypoperfusion [5]
With 7 or more iterations, the filtered data showed a lower noise level compared to the unfiltered data
Summary
Myocardial perfusion imaging is used to evaluate the presence and severity of coronary artery disease (CAD) [1, 2]. MPS is based on visual interpretation of relative myocardial perfusion and might underestimate the severity of ischemia due to global hypoperfusion [5]. It is worth investigating how quantitative SPECT may enable measurement of uptake in perfusion defects to improve evaluation of response to anti-ischemic therapies using myocardial perfusion scans. Quantitative SPECT enables absolute quantification of uptake in perfusion defects The aim of this experimental study is to assess quantitative accuracy and precision of a novel iterative reconstruction technique (Evolution; GE Healthcare) for the potential application of response monitoring using 99mTctetrofosmin SPECT/CT in patients with coronary artery disease (CAD)
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