Single-photon Emission Computed Tomography Protocol Research Articles

The Nurseʼs Role in Delivery of Radioisotope for Ictal SPECT Scan

The Medical College of Georgia Hospital and Clinics (MCG) was one of the first centers in the United States (US) to institute a video electroencephalography (EEG) epilepsy monitoring unit and epilepsy surgery program. In order to surgically remove the area in the brain giving rise to seizures, the epileptogenic zone must be identified and localized. One of the newer methods used to identify the epileptogenic seizure focus is the ictal Single Photon Emission Computed Tomography (SPECT) scan, which MCG began performing in 1993. The nurses staffing the six bed Epilepsy Monitoring Unit (EMU) are trained by the Nuclear Radiology Department and Radiation Safety Officer to bandle the radioisotope during mixing, calibration and injection. The bedside nursing protocol developed assures patient and staff radiation safety and efficacious injection. Over 300 patients have been injected by nurses with a high degree of safety to patients and staff. This has resulted in positive scans that aid diagnosis. The success of the ictal SPECT protocol can be attributed to the active collaboration of our multidisciplinary team.

Clinical implication of down-scatter in attenuation-corrected myocardial SPECT

Background. Interpretation of myocardial perfusion single photon emission computed tomography (SPECT) studies is hampered by attenuation artifacts. Attenuation correction methods with simultaneous emission and transmission are now commercially available. However, it has been observed in clinical practice that attenuation correction without down-scatter correction in a 1-day rest/stress myocardial perfusion protocol may lead to serious interpretation errors. Therefore the aim of this study was to study errors resulting from down-scatter under realistic conditions, thus providing a background for the assessment of further corrections. Methods and Results. Forty-six patients underwent myocardial perfusion scintigraphy in a 1-day technetium 99m-tetrofosmin rest-stress SPECT protocol, with a moving 153Gd line-source device for attenuation correction without down-scatter correction. Short-axis slices were quantified as inferior/anterior, septal/lateral, and apical/remainder count ratios. The changes at rest (350 MBq) and exercise (900 MBq) induced by attenuation correction were studied. Attenuation correction gave differences in apparent perfusion between rest and exercise not seen before correction. The gender differences in inferior-anterior ratio were greatly reduced after correction at rest but remained at exercise. A torso phantom study indicated that these results were due to under-correction at exercise because of down-scatter. Conclusions. Down-scatter results in an underestimation of attenuation in simultaneous emission and transmission, if not accurately accounted for. Particularly, a high-dose study compared with a low-dose study, as in the 1-day protocol, might cause serious interpretation errors.

Clinical application of rest thallium-201/Stress technetium-99m sestamibi dual isotope myocardial perfusion single-photon emission computed tomography.

Stress radionuclide myocardial perfusion imaging is a commonly used modality to evaluate patients with known or suspected coronary artery disease. The dual isotope rest thallium-201/stress technetium-99m sestamibi gated single-photon emission computed tomography protocol has gained increasing popularity for these applications. By combining the use of thallium-201, the optimal radioisotope for assessment of viability, with technetium-99m, a radionuclide agent that permits optimal image resolution and simultaneous assessment of viability information, maximization of clinical information can be achieved. Recent publications have demonstrated the efficacy of this imaging approach for both the identification of the presence of coronary artery disease and risk stratification.

Present assessment of myocardial viability by nuclear imaging

Prospective delineation of viable from nonviable myocardium in patients with coronary artery disease in an important factor in deciding whether a patient should be revascularized or treated medically. Two common techniques--single-photon emission computed tomography (SPECT) and positron-emission computed tomography (PET)--are used in nuclear medicine using various radiopharmaceuticals for the detection of myocardial viability in patients. Thallium-201 (201Tl) and technetium-99m (99mTc)-sestamibi are the common radiopharmaceuticals used in different protocols using SPECT, whereas fluoride-18 (18F)-fluorodeoxyglucose (FDG) and rubidium-82 (82Rb) are most widely used in PET. The SPECT protocols involve stress/redistribution, stress/redistribution/reinjection, and rest/redistribution imaging techniques. Many studies have compared the results of 201Tl and (99mTc)-sestamibi SPECT with those of FDG PET; in some studies, concordant results have been found between delayed thallium and FDG results, indicating that 201Tl, although considered a perfusion agent, shows myocardial viability. Discordant results in a number of studies have been found between sestamibi and FDG, suggesting that the efficacy of sestamibi as a viability marker has yet to be established. Radiolabeled fatty acids such as iodine-123 (123I)-para-iodophenylpentadecanoic acid and carbon-11 (11C)-palmitic acid have been used for the assessment of myocardial viability with limited success. 11C-labeled acetate is a good marker of oxidative metabolism in the heart and has been used to predict the reversibility of wall motion abnormalities. (18F)-FDG is considered the marker of choice for myocardial viability, although variable results are obtained under different physiological conditions. Detection of myocardial viability can be greatly improved by developing new equipment and radiopharmaceuticals of better quality.

Adenosine technetium-99m sestamibi myocardial perfusion SPECT in women: Diagnostic efficacy in detection of coronary artery disease

Objectives. This study sought to assess the diagnostic efficacy of adenosine technetium-99m (Tc-99m) sestamibi myocardial perfusion single-photon emission computed tomography (SPECT) in a consecutive series of female patients.Background. The utility of adenosine myocardial perfusion SPECT for the detection of coronary artery disease is not well defined in women because most studies have described a predominantly male population with a high prevalence of coronary artery disease.Methods. Of the 201 consecutive female patients in the study group who had undergone adenosine Tc-99m sestamibi myocardial perfusion SPECT, 130 had coronary angiography within 2 months of the nuclear test, and the other 71 had a low likelihood (<10%, mean [±SD] 5 ± 3%) of coronary artery disease. The SPECT protocol used separate acquisition of rest thallium-201 and adenosine Tc-99m sestamibi and was visually analyzed in 20 segments with a semiquantitative five-point scoring system (0 = normal; 4 = absent uptake).Results. The normaley rate in patients with a low likelihood of coronary artery disease was 93% (66 of 71). Among the catheterized group, the overall sensitivity, specificity and predictive accuracy of adenosine sestamibi SPECT for detecting coronary artery disease (⪰50% diameter stenosis) were 93% (87 of 94), 78% (28 of 36) and 88% (115 of 130), respectively. In the 103 patients without a prior myocardial infarction, the sensitivity, specificity and predictive accuracy were 91% (61 of 67), 78% (28 of 36) and 86% (89 of 103), respectively, for detecting ⪰50% diameter stenosis. Of particular interest, the sensitivity and specificity were as high in patients with nonanginal symptoms (93% and 69%, respectively) as in patients with angina (92% and 83%, respectively, p = NS). The sensitivity and specificity among patients with a relatively low (<25%), intermediate (between 25% and 75%) or high prescan likelihood of coronary artery disease (>75%) were similar: 82% and 82%, 93% and 73%, and 95% and 100%, respectively. The sensitivity and specificity for detecting individual diseased vessels (⪰50% diameter stenosis) were, respectively, 76% and 81% for the left anterior descending coronary artery, 44% and 90% for the left circumflex coronary artery and 75% and 77% for the right coronary artery.Conclusions. Adenosine Tc-99m sestamibi SPECT is an efficient protocol with high sensitivity and specificity for the detection of coronary artery disease in women irrespective of presenting symptoms or pretest likelihood of coronary artery disease and a high normaley rate. These findings are of particular clinical relevance because chest pain, anginal or otherwise, has been shown to be a frequent but a less specific marker for coronary artery disease among female patients.

Demonstration of human motor cortex activation using SPECT.

Recent advances in single photon emission computed tomography (SPECT) have allowed improved image resolution with lower doses of labelled tracer. Capitalizing on these improvements, the authors have developed a new SPECT protocol for imaging neuronal activation. We outline this technique and describe how it can demonstrate increased human motor cortex activity in normal subjects performing a motor task. The ability to accurately demonstrate neuronal activation with SPECT using this method may have important scientific and clinical implications.