Dual Single Photon Emission Computed Tomography Research Articles

Four Atypical Parathyroid Adenomas Detected by Dual Phase Tc-99m MIBI SPECT

We report a case of a 55-year-old female with tertiary hyperparathyroidism and osteoporosis who had end stage renal disease and a history of hemodialysis for 15 years. Patient’s informed is taken. Neck ultrasonography showed multinodular goiter together with a hypoechoic lesion compatible with a parathyroid adenoma. Dual phase technetium (Tc) Tc-99m MIBI single photon emission computed tomography (SPECT) showed pathological uptake in four parathyroid gland locations. Total thyroidectomy and subtotal parathyroidectomy revealed nodular hyperplasia and atypical adenomas in four parathyroid glands. Atypical parathyroid adenoma is a rare clinical entity. Multiple atypical adenomas are even less frequent. A very rare condition, detection of atypical adenomas in four of the parathyroid glands by dual phase Tc-99m MIBI SPECT, is presented in this case.

Comparison of Different Attenuation Correction Methods for Dual Gating Myocardial Perfusion SPECT/CT

Dual respiratory-cardiac gating realizes motion-freeze myocardial perfusion single photon emission computed tomography (SPECT). The aim of this paper is to evaluate the performance of various attenuation maps for dual gating cardiac SPECT. We used extended cardiac-torso phantom with Tc-99m-sestamibi distribution to generate a dataset with both respiratory and cardiac motion and then grouped them based on six respiratory and eight cardiac phases. The corresponding attenuation correction (AC) maps were used to simulate different CT protocols: dual gating CT (DCT), respiratory gated CT (RCT), cine average CT (ACT), interpolated CT (ICT), helical CTs at end-inspiration (HCT-in), end-expiration (HCT-ex), and mid-respiration (HCT-mid), respectively. One hundred and twenty noise-free and realistic noisy projections were generated over 180° from RAO to LPO and reconstructed by OS-EM method using different AC maps. The reconstructed images in different respiratory phases were registered to one reference end-expiration phase and summed up as a cardiac image for each cardiac phase. The corresponding polar maps were generated and further analyzed using 17-segment plots. Relative difference (RD) of the average intensity was computed in each segment using the polar maps with DCT-AC as reference. Substantial artifacts could be found in HCT-in AC images in every cardiac phase. For all eight noise-free cardiac phases, the average RDmax for AC with ACT, HCT-ex, HCT-in, HCT-mid, RCT, and ICT comparing to DCT were 4.76%, 4.95%, 10.54%, 4.23%, 2.39%, and 2.76%, respectively. For all eight noisy cardiac phases, the average RDmax for AC with ACT, HCT-ex, HCT-in, HCT-mid, RCT, and ICT comparing to DCT were 4.09%, 5.04%, 9.24%, 4.02%, 3.22%, and 2.85%, respectively. The ICT and RCT have the best AC performance for dual gating SPECT, while HCT-ex, HCT-in, HCT-mid, and ACT show inferior results. Since RCT and DCT are not commonly used in clinics due to complex implementation and radiation concern, ICT is recommended, followed by HCT-mid or HCT-ex for AC in dual gating cardiac SPECT with good accuracy and relative low radiation dose.

Optimization of a SPECT system for imaging of 90Y in liver using Monte Carlo method

Introduction: Acquiring a high quality image has assigned an important concern for obtaining accurate diagnosis in nuclear medicine. Detector and collimator are critical component of Single Photon Emission Computed Tomography (SPECT) imaging system for giving accurate information from exact pattern of radionuclide distribution in the target organ. The images are strongly affected by the attenuation, scattering, and response of the detector and collimator. Method and material: The Planar and SPECT scans of a Y90 point source and also an extended Cardiac- Torso(XCAT) computerized phantom with the experiment and simulated systems were prepared. The SIMIND Monte Carlo program was used for simulating Siemen’s dual head variable angle SPECT imaging system with 4 detectors and 10 collimators. After verification and validation of the simulated system, the similar scans of the phantoms were compared from the point of view of image quality for 4 scintillator crystals including: NaI(Tl), BGO, LuAG: Ce, LaBr3 and also 10 collimators: Pb, Pb-Sb, Pb-Sb3, Pb-bi-Sn19, Pb-bi Sn375, Pb-bi-Sn50, Pb-bi-Sn-cd10, Pb-bi-Sn-cd125, Pt and Pt-Co. The parameters of energy and spatial resolution, and sensitivity of the systems were compared. Images were analyzed qualitatively by two nuclear medicine specialists. RESULTS: FWHM of the mentioned crystals and collimators obtained where: NaI (Pb, 0.3853) and BGO (Pb-Sb, 0.406), (Pb-Bi-Sn375, 0.405), (Pb-Bi-Sn-cd125, 0.375), and LuAG: Ce crystal (Pb-Sb, 0.425), (Pb- Bi-Sn19, 0.407), (Pb-Bi-Sn375, 0.417) and also LaBr3 (Pb-Bi-Sn375, 0.407), (Pb-Bi-Sn50, 0.430), (Pt-Co, 0.355). Medical diagnosis of the SPECT images of the phantom showed that the system with NaI(Tl)and LaBr3 by Pb-Sn3 collimator potentially provides a better detectability for hot lesions in the liver of XCAT phantom. CONCLUSIONS: The results showed that crystal NaI(Tl)and LaBr3 by Pb-Sn3 collimator has a high sensitivity and resolution, and also provides a better lesion detectability from the point of view of image quality on XCAT phantom.

Dual SPECT imaging of 111In and 67Ga to simultaneously determine in vivo the pharmacokinetics of different radiopharmaceuticals: a quantitative tool in pre-clinical research

Dual-isotope (DI) studies offer a number of advantages in pre-clinical imaging. These include: reducing study times when compared with sequential scans, reducing the number of animals required for any given study, and most importantly, producing images perfectly registered in space and time that provide simultaneous information about two distinct body functions. The ability of single photon emission computed tomography (SPECT) to measure and differentiate energies of the emitted photons makes it well suited for DI imaging. However, since scattered photons originating from one radioisotope may be detected in the energy window of the other and thus degrade image quality and quantitative accuracy, scatter and crosstalk corrections must be applied.The decay characteristics of 111In and 67Ga, which are suitable for quantitative DI imaging for up to 2 weeks post-injection, led us to investigate the performance of simultaneous 111In/67Ga SPECT imaging using a small-animal pre-clinical scanner. A series of phantom experiments were performed to investigate image quality and accuracy of activity quantification in 111In/67Ga images acquired with three different collimators and reconstructed from different photopeak combinations. The triple energy window (TEW) method was used to correct for scatter and crosstalk. Based on these phantom studies, the optimal selection of collimator and energy window settings was determined. When using these optimal settings, submillimeter-size structures were distinguishable in the reconstructed images and quantification errors below 20% were achieved for both isotopes. The optimal parameters were subsequently applied to an in vivo animal study. The determination of the distinct pharmacokinetic profiles of two polymer radiopharmaceuticals injected simultaneously, but by different administration routes (intravenously and intraperitoneally) into a single animal demonstrated the feasibility of simultaneous 111In/67Ga SPECT.

Effects of the attenuation correction and reconstruction method parameters on conventional cardiac dynamic SPECT.

Nuclear cardiology has not witnessed development of new tracers or hardware for many years. Hence there is a need for the development of improvised techniques. Dynamic cardiac single photon emission computed tomography (SPECT) is one such technique that has a potential to overcome the limitations of conventional myocardial SPECT including the absolute quantification of blood flow. The main goal of this study is to evaluate the effect of attenuation correction (AC) on estimation of the washout parameters extracted from dynamic SPECT using a conventional protocol. The effect of the postprocessing on quantitative evaluation of dynamic SPECT is also assessed.A physical phantom was employed to physically simulate the dynamic behavior of a heart in the thorax. Using a dual detector SPECT system, 180° tomographic data in every 90 seconds were acquired. The SPECT data were reconstructed using ordered subset expectation maximization (OSEM) method while different iterations and a Butterworth filter with different cut-off frequencies were applied. Estimated washout parameter of the time activity curves (TACs) was compared with applying AC or without it.Results show that AC can improve the bias of computed washout parameter in normal regions (average bias reduction in normal ROI: 7%). Moreover, the postreconstruction filtering and reducing the number of iterations in reconstructing phase can reduce the variance of the computed washout values in normal regions (from 3.99% for cut-off frequency 0.5 cycle/cm and 32 times update in OSEM to 2.05% for cut-off frequency 0.35 cycle/cm and 16 times update in OSEM). They also reduce the actual size of the defect region (13% reduction in defect extent for above change in reconstruction parameters).According to the results, the AC and postprocessing filtration can directly affect the standard deviation of washout value acquired by cardiac dynamic SPECT. These parameters also showed a direct effect on the defect extent in final results. The study showed that the AC may partly improve the bias of calculated normal washout value. The effect of attenuation correction on the defective washout value could not be answered comprehensively in this paper.

A Study on Determination of an Optimized Detector for Single Photon Emission Computed Tomography.

The detector is a critical component of the single photon emission computed tomography (SPECT) imaging system for giving accurate information from the exact pattern of radionuclide distribution in the target organ. The SIMIND Monte Carlo program was utilized for the simulation of a Siemen's dual head variable angle SPECT imaging system with a low energy high resolution (LEHR) collimator. The Planar and SPECT scans for a 99mTc point source and a Jaszczak Phantom with the both experiment and simulated systems were prepared and after verification and validation of the simulated system, the similar scans of the phantoms were compared (from the point of view of the images’ quality), namely, the simulated system with the detectors including bismuth germanate (BGO), yttrium aluminum garnet (YAG:Ce), Cerium-doped yttrium aluminum garnet (YAG:Ce), yttrium aluminum perovslite (YAP:Ce), lutetium aluminum garnet (LuAG:Ce), cerium activated lanthanum bromide (LaBr3), cadmium zinc telluride (CZT), and sodium iodide activated with thallium [NaI(Tl)]. The parameters of full width at half maximum (FWHM), energy and special resolution, sensitivity, and also the comparison of images’ quality by the structural similarity (SSIM) algorithm with the Zhou Wang and Rouse/Hemami methods were analyzed. FWHMs for the crystals were calculated at 13.895, 14.321, 14.310, 14.322, 14.184, and 14.312 keV and the related energy resolutions obtained 9.854, 10.229, 10.221, 10.230, 10.131, and 10.223 %, respectively. Finally, SSIM indexes for comparison of the phantom images were calculated at 0.22172, 0.16326, 0.18135, 0.17301, 0.18412, and 0.20433 as compared to NaI(Tl). The results showed that BGO and LuAG: Ce crystals have high sensitivity and resolution, and better image quality as compared to other scintillation crystals.

Microvascular obstruction on delayed enhancement cardiac magnetic resonance imaging after acute myocardial infarction, compared with myocardial 201Tl and 123I-BMIPP dual SPECT findings

BackgroundThe hypo-enhanced regions within the hyper-enhanced infarct areas detected by cardiac magnetic resonance (CMR) imaging reflect microvascular obstruction (MO) after acute myocardial infarction (AMI). The combined myocardial thallium-201 (201Tl)/iodine-123-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (123I-BMIPP) dual single-photon emission computed tomography (SPECT) is a useful tool for detecting myocardial reversibility after AMI. We evaluated whether MO could be an early predictor of irreversible myocardial damage in comparison with 201Tl and 123I-BMIPP dual SPECT findings in AMI patients. MethodsSixty-two patients with initial AMI who successfully underwent coronary revascularization were enrolled. MO was defined by CMR imaging. Patients were divided into 2 groups as follows: MO group (n=32) and non-MO group (n=30). Scintigraphic defect scores were calculated using a 17-segment model with a 5-point scoring system. The mismatch score (MMS) was calculated as follows: the total sum of (Σ) 123I-BMIPP defect score minus Σ201Tl defect score. The percentage mismatch score (%MMS) was calculated as follows: MMS/(Σ123I-BMIPP score)×100 (%). ResultsThe percentage infarct size (%IS) was significantly greater in the MO group than in the non-MO group (32.2±13.8% vs. 18.3±12.1%, p<0.001). The %MMS significantly correlated with the %IS and the percentage MO (r=−0.26, p=0.03; r=−0.45, p<0.001, respectively). The %MMS was significantly greater in the non-MO group than in the MO group (45.4±42.4% vs. 13.3±28.0%, p=0.001), and was an independent predictor for MO (OR 0.97, 95%CI 0.94–0.99, p=0.02). ConclusionsOur results reconfirm that, in comparison with myocardial dual scintigraphy, MO is an important structural abnormality. CMR imaging is useful for the early detection of irreversible myocardial damage after AMI.

Magnetically Decorated Multi-Walled Carbon Nanotubes as Dual MRI and SPECT Contrast Agents.

Carbon nanotubes (CNTs) have been proposed as one of the most promising nanomaterials to be used in biomedicine for their applications in drug/gene delivery as well as biomedical imaging. The present study developed radio-labeled iron oxide decorated multi-walled CNTs (MWNT) as dual magnetic resonance (MR) and single photon emission computed tomography (SPECT) imaging agents. Hybrids containing different amounts of iron oxide were synthesized by in situ generation. Physicochemical characterisations revealed the presence of superparamagnetic iron oxide nanoparticles (SPION) granted the magnetic properties of the hybrids. Further comprehensive examinations including high resolution transmission electron microscopy (HRTEM), fast Fourier transform simulations (FFT), X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS) assured the conformation of prepared SPION as γ-Fe2O3. High r2 relaxivities were obtained in both phantom and in vivo MRI compared to the clinically approved SPION Endorem®. The hybrids were successfully radio-labeled with technetium-99m through a functionalized bisphosphonate and enabled SPECT/CT imaging and γ-scintigraphy to quantitatively analyze the biodistribution in mice. No abnormality was found by histological examination and the presence of SPION and MWNT were identified by Perls stain and Neutral Red stain, respectively. TEM images of liver and spleen tissues showed the co-localization of SPION and MWNT within the same intracellular vesicles, indicating the in vivo stability of the hybrids after intravenous injection. The results demonstrated the capability of the present SPION-MWNT hybrids as dual MRI and SPECT contrast agents for in vivo use.

Simultaneous dual-isotope imaging based on an artificial neural network for evaluating myocardial perfusion and fatty acid metabolism

BackgroundWe contrived a scatter correction method based on an artificial neural network (ANN) and applied it to the simultaneous evaluation of myocardial perfusion and fatty acid metabolism in single-photon emission computed tomography (SPECT). MethodsThe count data of three energy windows were used as inputs of the ANN. The count ratios of the estimated primary-to-total photons for 99mTc and 123I, which were used to reconstruct 99mTc and 123I images, were calculated using the ANN. In a phantom study, single- and dual-isotope imaging with 99mTc/123I and 201Tl/123I was performed by means of a cardiac phantom simulating patients with and without obesity. In a human study, five normal volunteers and ten patients with myocardial infarction underwent myocardial perfusion and fatty acid metabolism imaging with single and dual SPECT with combinations of 99mTc-methoxyisobutylisonitrile/123I-beta-methyl(p-iodophenyl)pentadecanoic acid (BMIPP) and 201Tl/123I-BMIPP as tracers. ResultsTechnetium-99m yielded more homogeneous images than 201Tl because of the lower degree of photon attenuation, especially in the condition of obese patients, resulting in clearer visualization of the perfusion-metabolism mismatch. Dual 99mTc/123I SPECT offered comparable images with single SPECT in assessing myocardial damage. ConclusionsThe method effectively separated 99mTc and 123I primary photons and proved applicable to 99mTc/123I dual-isotope myocardial SPECT.

Multimodal sentinel lymph node mapping with single-photon emission computed tomography (SPECT)/computed tomography (CT) and photoacoustic tomography

The identification of cancer cells in the lymph nodes surrounding a tumor is important in establishing a prognosis. Optical detection techniques such as fluorescence and photoacoustic tomography (PAT) have been reported in preclinical studies for noninvasive sentinel lymph node (SLN) mapping. A method for validation of these techniques is needed for clinical trials. We report the use of a multimodal optical-radionuclear contrast agent as a validation tool for PAT in a preclinical model. Methylene blue (MB) was radiolabeled with (125)I for multimodal SLN mapping and used in conjunction with MB to assess the feasibility of multimodal SLN mapping in a rat model by PAT and single-photon emission computed tomography (SPECT). MB provided sufficient contrast for identifying SLNs noninvasively with a PAT system adapted from a clinical ultrasound imaging system. The signal location was corroborated by SPECT using (125)I labeled MB. The translation of PAT into the clinic can be facilitated by a direct comparison with established imaging methods using a clinically relevant dual SPECT and photoacoustic imaging agent. The new high-resolution PAT is a promising technology for the sensitive and accurate SLN detection in cancer patients.

Peptide-conjugated polymeric micellar nanoparticles for Dual SPECT and optical imaging of EphB4 receptors in prostate cancer xenografts

EphB4, a member of the largest family of receptor tyrosine kinases, is overexpressed in numerous tumors. In this study, we developed a new class of multimodal nanoplatform for dual single photon emission computed tomography (SPECT) and near-infrared fluorescence imaging of EphB4. EphB4-binding peptide TNYL-FSPNGPIARAW (TNYL-RAW) was conjugated to polyethylene glycol-coated, core-crosslinked polymeric micelles (CCPM) dually labeled with near-infrared fluorescence fluorophores (Cy7) and a radioisotope (indium 111). In vitro, TNYL-RAW-CCPM selectively bound to EphB4-positive PC-3M prostate cancer cells, but not to EphB4-negative A549 lung cancer cells. In vivo, PC-3M tumors were clearly visualized by both SPECT and near-infrared fluorescence tomography after intravenous administration of 111In-labeled TNYL-RAW-CCPM. In contrast, there was little signal in A549 tumors of mice injected with 111In-labeled TNYL-RAW-CCPM or in PC-3M tumors of mice injected with 111In-labeled CCPM. The high accumulation of 111In-labeled TNYL-RAW-CCPM in PC-3M tumor could be significantly reduced after co-injection with an excess amount of TNYL-RAW peptide. Immunohistochemical analysis showed that fluorescence signal from the nanoparticles correlated with their radioactivity count, and co-localized with the EphB4 expressing region. 111In-labeled TNYL-RAW-CCPM allowed visualization of cancer cells overexpressing EphB4 by both nuclear and optical techniques. The complementary information acquired with multiple imaging techniques should be advantageous in early detection of cancer.

Correlation of left ventricular dyssynchrony with myocardial stunning using dual single photon emission computed tomography of 123iodine-β-methyl iodophenyl pentadecanoic acid and 201thallium scintigraphy after reperfusion therapy

Left ventricular (LV) dyssynchrony after reperfusion therapy has been closely examined as a cause of chronic remodeling, but the details have not been clarified. The present study measured LV dyssynchrony appearing immediately after reperfusion therapy using real-time three-dimensional echocardiography (RT-3DE), and assessed the significance of this phenomenon in relation to dual single photon emission computed tomography (SPECT) of (123)iodine beta methyliodophenyl pentadecanoic acid ((123)I-BMIPP) and (201)thallium ((201)Tl). Subjects comprised 58 patients with first-time acute myocardial infarction who received reperfusion therapy and underwent RT-3DE and dual SPECT of (123)I-BMIPP and (201)Tl within two weeks of onset. Two dyssynchrony parameters were measured using RT-3DE in the acute phase and six months later. After evaluating the correlation of these dyssynchrony parameters to resting (201)Tl uptake, (201)Tl washout, (123)I-BMIPP uptake, and (201)Tl-(123)I-BMIPP discrepancy (Tl-BMIPP discrepancy), we compared scintigraphic parameters in the chronic phase between groups with improved dyssynchrony and those without. Acute dyssynchrony exhibited a significant positive correlation to Tl-BMIPP discrepancy and it was significantly increased in the group with improved dyssynchrony in the chronic phase, revealing close relationship between dyssynchrony and Tl-BMIPP discrepancy. Then the subjects were divided into positive Tl-BMIPP discrepancy and negative discrepancy groups, and the parameters of cardiac function were compared between them. In the chronic phase, improved cardiac function was observed in the group with positive Tl-BMIPP discrepancy compared to negative discrepancy. LV dyssynchrony after reperfusion therapy correlates positively with Tl-BMIPP discrepancy, reflecting acute myocardial stunning, in which ventricular contraction improves during the chronic phase.

Comparison of pinhole and SPECT 99mTc-MIBI imaging in primary hyperparathyroidism

This study aims to compare dual tracer, dual phase pinhole technetium-99m labelled 2-methoxyisobutylisonitrile (Tc-MIBI) imaging (including oblique imaging), with single photon emission computed tomography (SPECT) and dual phase planar Tc-MIBI images, and combined SPECT, dual phase planar Tc-MIBI images and anterior pinhole thyroid images for the localization of parathyroid adenomas in the neck in primary hyperparathyroidism. Sixty-two patients underwent Tc-MIBI dual phase, anterior and anterior oblique pinhole images of the neck, anterior planar images of the neck and chest and early phase neck/chest SPECT followed by [Tc] pertechnetate anterior and anterior oblique pinhole thyroid images. Images were reviewed by consensus in three combinations - dual phase anterior and anterior oblique pinhole Tc-MIBI images and pinhole thyroid images; SPECT and dual phase planar Tc-MIBI images and combined SPECT, dual phase planar Tc-MIBI images and anterior pinhole thyroid images. For 52 parathyroid adenomas in 50 patients, the sensitivity of dual phase anterior and anterior oblique pinhole Tc-images and pinhole thyroid images was 81%. Significantly lower sensitivities were observed with SPECT and dual phase planar Tc-MIBI images (54%, P=0.0005) and combined SPECT, dual phase planar Tc-MIBI images and anterior pinhole thyroid images (65%, P=0.0209). The positive predictive value for all imaging combinations was 88-92%. Dual phase anterior and anterior oblique pinhole Tc-MIBI images and pinhole thyroid images are significantly more sensitive than imaging combinations that included SPECT and remains the optimal imaging protocol for the localization of parathyroid adenomas in the neck in primary hyperparathyroidism.

Stunned myocardium in transient left ventricular apical ballooning: A serial study of dual I-123 BMIPP and Tl-201 SPECT

This study was designed to assess the influence of coronary endothelial function and the serial changes of dual myocardial single photon emission computed tomography (SPECT) imaging in transient left ventricular (LV) apical ballooning. We evaluated 35 consecutive patients (8 men and 27 women; mean age, 71 +/- 13 years) with transient LV apical ballooning. All patients underwent coronary angiography with acetylcholine provocation 1 month after onset. Iodine 123 beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) and thallium 201 dual myocardial SPECT was serially performed on day 1 of admission and 1 month and 6 months later. In 8 of 35 patients (23%), epicardial coronary spasm was induced by acetylcholine infusion. At the peak acetylcholine dose (100 microg), diffuse coronary vasoconstriction developed in 19 of 35 patients (54%). Of 19 patients, 13 had diffuse coronary vasoconstriction with chest pain and ST-segment depression. The total defect score of I-123 BMIPP and Tl-201 SPECT showed marked perfusion-fatty acid metabolic mismatches (13.7 +/- 3.6 vs 8.7 +/- 2.3, P < .001) at the LV apex during the acute phase but few mismatched areas (2.1 +/- 1.1 vs 1.5 +/- 1.4, P = not significant) at 6 months. Transient LV apical ballooning might be caused by stress-induced coronary epicardial spasm or endothelial dysfunction, resulting in myocardial stunning.

Prediction of Cardiac Death in Hemodialysis Patients by Myocardial Fatty Acid Imaging

The aim was to evaluate the potential of single-photon emission computed tomography (SPECT) to predict cardiac death in chronic hemodialysis patients using the iodinated fatty acid analogue iodine-123 123I-beta-methyl iodophenyl-pentadecanoic acid (BMIPP). We previously reported that BMIPP SPECT could detect asymptomatic coronary artery disease with high sensitivity in hemodialysis patients. We prospectively enrolled 375 asymptomatic hemodialysis patients who had undergone dual SPECT using 123I-BMIPP and 201thallium (Tl) chloride. Patients who had a clinical history of myocardial infarction and/or coronary revascularization were excluded from the study. Uptake on SPECT images was graded in 17 segments on a 5-point scale (0 normal, 4 absent) and assessed as summed BMIPP or Tl scores. During a 3.6 +/- 1.0-year follow-up, 57 patients who had undergone coronary revascularization within 60 days of SPECT were excluded from the analysis. Among the remaining 318 patients (male/female: 170/148; 64 +/- 12 years of age), 50 died of cardiac events (acute myocardial infarction 22, congestive heart failure 17, cardiac sudden death 11). Stepwise Cox hazard analysis associated cardiac death with age (> or =70 years) and with severely abnormal BMIPP SPECT images (BMIPP summed scores > or =12: hazard ratio 21.894; p < 0.0001). Kaplan-Meier analysis showed that the cardiac death-free survival rates at 3 years were 61% and 98% in patients with BMIPP summed scores of > or =12 and <12, respectively. Severely impaired myocardial fatty acid metabolism, which might mainly reflect repetitive myocardial ischemia, can identify a high-risk group of cardiac death among hemodialysis patients.

Geometric characterization of multi-axis multi-pinhole SPECT

A geometric model and calibration process are developed for single photon emission computed tomography (SPECT) imaging with multiple pinholes and multiple mechanical axes. Unlike the typical situation where pinhole collimators are mounted directly to rotating gamma ray detectors, this geometric model allows for independent rotation of the detectors and pinholes, for the case where the pinhole collimator is physically detached from the detectors. This geometric model is applied to a prototype small animal SPECT device with a total of 22 pinholes and which uses dual clinical SPECT detectors. All free parameters in the model are estimated from a calibration scan of point sources and without the need for a precision point source phantom. For a full calibration of this device, a scan of four point sources with 360 degrees rotation is suitable for estimating all 95 free parameters of the geometric model. After a full calibration, a rapid calibration scan of two point sources with 180 degrees rotation is suitable for estimating the subset of 22 parameters associated with repositioning the collimation device relative to the detectors. The high accuracy of the calibration process is validated experimentally. Residual differences between predicted and measured coordinates are normally distributed with 0.8 mm full width at half maximum and are estimated to contribute 0.12 mm root mean square to the reconstructed spatial resolution. Since this error is small compared to other contributions arising from the pinhole diameter and the detector, the accuracy of the calibration is sufficient for high resolution small animal SPECT imaging.

Dual-isotope myocardial SPECT in patients with redefined myocardial infarction

Background According to the redefinition of myocardial infarction (MI) by the ESC/ACC Committee, patients with unstable angina (UA) without significant elevation of creatine kinase (CK) but with elevation of troponin T should be diagnosed as MI. Methods One hundred and forty-six consecutive patients formerly diagnosed as UA, with peak CK levels<twice upper normal level, who underwent myocardial Thallium-201 (Tl; perfusion tracer) and 123I-15-iodophenyl 3-methyl pentadecanoic acid (BMIPP; metabolism tracer) dual isotope single-photon emission computed tomography (SPECT), were retrospectively reclassified into redefined MI and UA groups according to the redefinition (troponin T: rapid bedside assay positive or quantitative level >0.10 ng/ml). Dual SPECT findings were analyzed qualitatively and quantitatively in blinded manner. Results Forty-seven patients (32%) were redefined as MI and 99 patients (68%) were redefined as UA. On admission, there were small but statistically significant elevations in laboratory parameters such as white blood cell count, C-reactive protein, CK and CK-MB in the redefined MI group compared with the redefined UA group. The proportion of patients with perfusion and metabolic abnormalities was significantly higher in the redefined MI group (Tl defect 36% vs. 4%, odds ratio: 13.5, p<0.001; BMIPP defect 64% vs. 23%, odds ratio: 5.8, p<0.001). Semi-quantitative evaluation revealed that the total Tl and BMIPP scores were significantly higher in the redefined MI patients ( p<0.001). Conclusions In the redefined MI patients, perfusion and metabolic abnormalities occurred frequently and more extensively. However, Tl/BMIPP dual SPECT had limited ability to detect minor myocardial infarcts classified as redefined MI. A more sensitive stratification combined with troponin T directed assignment should be established to incorporate the ongoing minor infarcts which could not be assessed by serial dual-scintigraphic evaluations.

Incremental Value of Regional Wall Motion Analysis Immediately After Exercise for the Detection of Single-Vessel Coronary Artery Disease

Although the detection of wall motion abnormalities gives incremental value to myocardial perfusion single-photon emission computed tomography (SPECT) in the diagnosis of extensive coronary artery disease (CAD) and high-grade single-vessel CAD, whether or not it is useful in the diagnosis of mild, single-vessel CAD has not been studied previously. Separate acquisition, dual isotope ECG-gated SPECT was performed in 97 patients with a low likelihood of CAD (Group 1) and 46 patients with single-vessel CAD (Group 2). Mild CAD was defined by stenosis of 50-75% (Group 2a, n=22) and moderate to severe CAD was defined by stenosis >/=76% (Group 2b, n=24). Myocardial perfusion and wall motion were graded by a 5 point-scale, 20-segment model. The sensitivity of myocardial perfusion alone was 50% for Group 2a, 83% for Group 2b and 67% for Group 2 as a whole. The overall specificity was 90%. When the wall motion analysis was combined, the sensitivity was increased to 82% in Group 2a and 92% in Group 2b. The ability to detect a wall motion abnormality immediately after exercise gives incremental diagnostic value to myocardial perfusion SPECT in the identification of mild, single-vessel CAD.

Myocardial scintigraphy using a fatty acid analogue detects coronary artery disease in hemodialysis patients

Coronary artery disease contributes significantly to mortality in end-stage renal disease (ESRD) patients. Single-photon emission computed tomography (SPECT) using an iodinated fatty acid analogue, iodine-123-methyl iodophenylpentadecanoic acid (123I-BMIPP), can assess fatty acid metabolism in the myocardium. We investigated the ability of 123I-BMIPP SPECT to detect coronary artery disease in hemodialysis patients compared with 201thallium chloride (201Tl) SPECT. We prospectively studied 130 ESRD patients undergoing hemodialysis for a mean of 88.6 months (male/female, 77/53; mean age, 63.8 years). Dual SPECT using 123I-BMIPP and 201Tl was performed, followed by coronary angiography. SPECT findings were graded in 17 segments on a five-point scale (0, normal uptake; 4, none) and assessed as a summed score. By coronary angiography, 71.5% of patients (93/130) had significant coronary stenosis (> or =75%), and five patients showed coronary spasm without coronary stenosis. When a BMIPP summed score of 6 or more was defined as abnormal, sensitivity, specificity, and accuracy for detecting coronary artery disease by BMIPP SPECT were 98.0%, 65.6%, and 90.0%, respectively; in contrast, these parameters for detecting coronary artery disease by Tl SPECT were 84.7%, 46.9%, and 75.0%, respectively, when a Tl summed score of 1 or more was defined as abnormal. In receiver operating characteristic analysis, the area under the curve was 0.895 in BMIPP and 0.727 in Tl SPECT, respectively. Resting BMIPP SPECT is superior to Tl SPECT for detecting coronary lesions, and provides safe screening for coronary artery disease among maintenance hemodialysis patients.

Latent abnormal fatty acid metabolism in apparently normal perfusion during stress in patients with restenosis after coronary angioplasty: assessment by exercise stress thallium-201 and iodine-123-labeled 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid-dual myocardial single-photon emission computed tomography

Restenosis is a major problem in patients undergoing coronary angioplasty. Reduced uptake of iodine-123-labeled 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (I-BMIPP-123) relatively to thallium-201 (Tl-201) has been attributed to the metabolic damage in the myocardium in patients with coronary artery disease. Therefore, we performed exercise stress Tl-201 and I-BMIPP-123 dual myocardial single-photon emission computed tomography (SPECT) to detect coronary restenosis in 48 patients (35 men and 13 women, mean age 66 ± 8 years), followed by coronary angiography at follow-up. Patients were divided into 2 groups: those with (n = 24) and without (n = 24) restenosis. Redistribution of Tl-201 was seen more frequently in the restenosis group than in no-restenosis group (58% [14 of 24] vs 8% [2 of 24], p <0.05). Five of 10 patients (50%) with restenosis but without Tl-201 redistribution had Tl-201/I-BMIPP-123 discrepancy during stress. In patients without restenosis, only 1 patient had this discrepancy during stress. Incorporation of Tl-201/I-BMIPP-123 uptake discrepancy during stress significantly improved the sensitivity (58% [14 of 24] to 79% [19 of 24]) with preserved specificity (92% [22 of 24] to 88% [21 of 24]). Exercise stress Tl-201 and I-BMIPP-123 dual myocardial SPECT revealed that latent abnormal fatty acid metabolism may exist in apparently normal perfusion during stress in patients with restenosis after coronary angioplasty. Use of I-BMIPP-123 together with Tl-201 during stress SPECT substantially improved the diagnostic accuracy of restenosis based on Tl-201 redistribution (from 75% to 83%).