Current Status of Myocardial Perfusion

Imaging With New SPECT/CT Cameras

Eve Piekarski, MD,*,†,z Alain Manrique, MD, PhD,x,ǁ,{ François Rouzet, MD, PhD,*,†,z and
Dominique Le Guludec, MD, PhD*,†,z

Myocardial perfusion imaging (MPI) with Single-Photon Emission Computed Tomography

(SPECT) has a major role in the management of coronary artery disease. Recent technologi-
cal advances regarding SPECT detectors with the use of solid-state detectors has allowed
for improved imaging quality since a decade with dramatic dose and/or time reduction of
imaging protocols due to improved sensitivity and spatial resolution, and is now performed
as a routine exam. Interestingly, this new technology has modified our everyday practice,
from acquisition protocols (low dose and ultra-fast protocols) to image semiology. Numer-
ous studies have shown how these technical advances have allowed for improved patient
management, with similar or improved diagnostic and prognostic information derived from
MPI. These improvements have also led to the straightforward implementation of myocar-
dial blood flow measurement. This article reviews the current status of MPI using new
SPECT and SPECT/CT cameras.
Semin Nucl Med 50:219-226 © 2020 Elsevier Inc. All rights reserved.

Introduction Technical Specificities of CZT

Systems
M yocardial perfusion imaging (MPI) with Single-Photon
Emission Computed Tomography (SPECT) has been
playing a central role in the management of coronary artery
Solid-State Detectors
For decades, cardiac SPECT cameras have consisted of Anger
disease for decades. Recent technological advances with the
cameras comprised of a single non pixelated scintillation
use of solid-state detectors has allowed for improved imaging
(NaI(Tl)) crystal with an array of large photomultiplier tubes
quality with dramatic dose and/or time reduction of imaging
and a parallel-hole collimator. Recently, alternative SPECT
protocols due to improved sensitivity and spatial resolution,
systems based on small semiconductor detector modules
and is now performed as a routine exam. Interestingly, this
have been introduced.1,2 Solid-state detectors directly detect
new technology has modified our everyday practice, from
the gamma rays without the use of scintillation crystal:
acquisition protocols (low dose protocols, use of hybrid sys-
gamma rays are absorbed into the semiconductor material,
tems with computed tomography (CT), dedicated cardiac sys-
and generate electron-hole pairs that are pulled to the end
tems, patient positioning . . .) to image semiology. This article
plates through an applied electric field. The collected charge
reviews the current status of MPI using new SPECT and
from the electron-hole pairs is used to determine the location
SPECT/CT cameras.
and energy of the gamma ray.3,4 Currently, these detectors
are made of Cadmium Zinc Telluride (CZT). Direct conver-
sion detectors offer great advantages as compared with the
*Nuclear Medicine Department, Bichat Hospital, AP-HP, Paris, France. design of Anger cameras, such as increased photon detection
y
z
Universite de Paris, Paris, France. efficiency and improved energy resolution.5-7
Laboratory for Vascular Translational Science, INSERM, Paris, France.
x
Normandie Univ, UNICAEN, Caen, France.
ǁ
Medecine Nucleaire, CHU de Caen, Caen, France.
{
GIP Cyceron, Campus Jules Horowitz, Caen, France. Dedicated Cardiac Systems
Address reprint requests to Dominique Le Guludec, MD, PhD, Department
of Nuclear Medicine, Bichat Hospital, 46 rue Henri Huchard, Paris Two vendors have developed dedicated cardiac cameras
75018, France. E-mail: [email protected] using semi-conductor detectors: Spectrum Dynamics with

https://doi.org/10.1053/j.semnuclmed.2020.02.009 219
0001-2998/© 2020 Elsevier Inc. All rights reserved.

Downloaded for Anonymous User (n/a) at Ankara Etlik City Hospital from ClinicalKey.com by Elsevier on December 04,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
220 E. Piekarski et al.

the DSPECT and General Electric with the Discovery NM Patient’s Positioning & Quality Control
530c. Both systems are based on improved detection parame- Dedicated cardiac CZT cameras can allow for upright imag-
ters in the heart region, with semi-circular shape detectors ing. This patient’s positioning offers great advantages such as
centered on the heart region and truncated field-of-view.8 improved image quality in obese patients, easier patient’s
The DSPECT camera uses 9 mobile blocks of pixelated positioning, and improved patient’s comfort. When neces-
CZT detectors (pixel size, 2.5 £ 2.5 mm; thickness 5 mm) sary (suspicion of attenuation artifact after stress imaging),
associated with a wide-angle square-hole tungsten collimator the first stress acquisition can be supplemented by another
(offering high sensitivity but limited geometric resolution). A patient’s positioning imaging since each acquisition (upright/
total of 120 projections are recorded by each block through a supine) is quite rapid thanks to the system’s high sensitivity,
region-centric acquisition to optimize detection of counts improving specificity of MPI.10-12,29-32 Two-position proto-
emanating from the heart, and reconstructed with a specific cols add no radiation exposure. Although the shape of the
algorithm of iterative reconstruction to compensate for the detectors ensures a close contact between the detector and
collimator-related loss in spatial resolution. the patient’s chest, thus limiting motion during acquisition,
The Discovery NM 530c camera uses 19 fixed detectors such artefacts may sometime occur and it is mandatory to
orientated to focus on the heart region placed over an 180° check the quality control panel (Fig. 1).
arc, each detector involving 4 modules of 32 £ 32 CZT pixels
(pixel size, 2.5 £ 2.5 mm) is associated with a tungsten pin-
hole collimator with an effective aperture of 5.1 mm. Nine-
teen projections are thus recorded, and an iterative Image Interpretation
reconstruction allows modeling for collimator geometry.
These new cameras offer improvement in both sensitivity
Performances for MPI
(from 5 to 8 times higher) and image resolution (up to 2 times Since its beginnings, SPECT MPI using solid-state detectors has
higher).9-12 Iterative reconstruction allows for improved spa- shown comparable or improved diagnostic accuracy in compar-
tial resolution by modeling detector and collimator geometry ison with Anger cameras in several large-scale validation studies,
in the reconstruction process (resolution recovery during sensitivity and specificity of CZT SPECT ranging from 84% to
reconstruction). Further improvements in spatial resolution 65% and 37% to 93%, respectively.12,22,33-41 A recent meta-
can be achieved through the use of an anatomical model for analysis42 of 20 studies representing 2350 patients showed
the heart. Since CZT cameras have heterogeneous field-of- 84% sensitivity and 72% specificity. However, the decrease of
view sensibility compared to Anger cameras, dedicated nor- the diagnostic value related to attenuation artifacts persists with
mal limits database for quantitative parameters are needed CZT SPECT with a different impact: while attenuation translates
for each camera system.13-16 into a lower specificity on Anger cameras, a recent study
reported a lower sensitivity in a population prone to attenuation
artifacts (men with Body Mass Index 25 and women).43 It
seems that the greater distance between detector and myocar-
Solid-State SPECT/CT Systems dium in obese patients and in case of breast attenuation might
The dedicated cardiac solid-state camera system with multi pin- provoke a blurring of mild perfusion defects.
hole can be combined with CT for Attenuation Correction (AC) Several large-cohort studies have shown its prognostic value,
and coronary calcium score;17 but only a limited number of including recent studies demonstrating a raise in the number of
dedicated cardiac cameras are equipped with CT. However, cardiac events even in patients with limited defects on CZT
general purpose CZT cameras coupled with diagnostic-quality imaging,44 reinforcing the clinical utility for sensitive systems
CT can be used for MPI, as showed by several studies, with such as CZT cameras. Those studies also showed the great nega-
improved quality results using AC images.18-20 tive predictive value of a normal SPECT MPI on CZT cameras,
comparable to that of a normal scan on Anger camera. Perfusion
defect size and extent of ischemia were associated with clinical
Dose and Time Reduction outcome in several studies.45,46 A large, multi-center, interna-
One of the great advantages of solid-state detectors is the tional registry (REgistry of Fast Myocardial Perfusion Imaging
increase in count sensitivity, therefore allowing dramatic with NExt generation SPECT: REFINE SPECT registry47) has
reduction of injected dose and/or acquisition time, with diag- been developed with collected prognostic data for more than
nostic image quality. Regarding dose reduction, several stud- 20,000 solid-state MPI scans to date.
ies have shown that a reduction of 15 to 30% of standard
dose can achieve comparable image quality,21-25 and even
some studies suggest that in selected patients CZT cameras Information From Gated Images
can lead to substantial reductions in effective radiation expo- Several studies have shown that gated CZT images allows for
sure, to as low as 1 mSv per study.26 Several studies have accurate evaluation of Left Ventricular Ejection Fraction, segmen-
also demonstrated that CZT systems allows for significant tal wall thickening and wall motion,48-50 as validated against
time reduction, even with low-dose protocols, to as low as 3 MRI;51 with higher diagnostic accuracy than gated images on
minutes for stress imaging.27,28 Time reduction improves Anger cameras with both improved regional sensitivity and higher
patient comfort and limits motion artifacts. diagnostic performance in multivessel disease patients (possibly

Downloaded for Anonymous User (n/a) at Ankara Etlik City Hospital from ClinicalKey.com by Elsevier on December 04,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
Current Status of MPI with New SPECT/CT Cameras 221

Figure 1 Myocardial perfusion study with (A) and without (B) patient motion during acquisition. Post-stress acquisition
shows abnormal perfusion image around the apex (A) but the pattern does not match with coronary circulation. The
quality control panel (C) confirms the presence of vertical motion at the end of the first half and mainly during the sec-
ond half of the acquisition. The acquisition has been repeated, showing a completely normal perfusion pattern (B), and
the absence of motion on the quality control panel (D).

due to higher spatial resolution and reduction of attenuation arte- Finally, since some iterative reconstruction algorithms use
facts with cardiac-centered acquisition). As conventional SPECT, a cardiac shape model, wall thickness can be underestimated
CZT can be used to evaluate cardiac function with a low dose and patients with hypertrophic cardiomyopathy may not be
protocol, by evaluating LV volumes and systolic function; and recognized.56
segmental wall motion and wall thickness analysis could be used
to identify the extent of myocardial fibrotic scar. Combined analy-
sis of perfusion and gated images allows for improved detection of
multi-vessel disease which has historically been a main drawback Dual Isotope Imaging
of SPECT MPI; with however contrasted results, studies showing
Since energy resolution is greater with CZT than NaI detectors,
diagnostic accuracy from 25% to 83%52,53 in this setting.
simultaneous dual-acquisition isotope is feasible with better sepa-
ration of photons from different isotopes and cross-talk correc-
tion. Therefore, several clinical applications using dual isotope
Semiologic Specificities of CZT Systems— acquisitions have emerged such as MPI with combined stress/rest
Potential Pitfalls protocol with 99mTc labeled tracers and 201Thallium, or com-
Since CZT systems dedicated for cardiac imaging have a het- bined MPI with innervation imaging using 123I-MIBG. Simulta-
erogeneous spatial distribution of sensitivity, and that patient neous dual isotope acquisitions offer several advantages:
positioning may differ (upright acquisition) from conven- reduction of imaging duration (and therefore limitation artefacts
tional Anger camera acquisition protocols, semiologic differ- due to patients’ movements during imaging acquisition) and reli-
ences between these cameras may be observed, and the able image co-registration.
reader must take into account those particularities in order
to interpret correctly MPI. In CZT camera, attenuation arti-
facts seem to be’ shifted from the inferolateral wall to the lat- Perfusion Imaging
eral wall as compared to a conventional camera.54 Two- Simultaneous dual isotope perfusion imaging using 201Thal-
position protocols may allow for detection of position-related lium and 99mTc labeled tracer does not achieve diagnostic
artifacts. The extent of the attenuation artifact seems to be image quality on conventional Anger cameras because of sub-
significantly larger for the CZT camera compared to the con- stantial cross-talk between the two isotopes.57 This limit can be
ventional Anger camera. overcome using solid-state detector SPECT since energy resolu-
Also, since there is nonuniform count sensitivity in the field tion is improved with these systems. A first study demonstrated
of view, patient positioning is critical. Patients with significantly the feasibility in phantoms of simultaneous dual perfusion
abnormal cardiac anatomy may not be well imaged or obese imaging with 201Thallium and 99mTc labeled tracer using iter-
patients may require re-positioning or multiple positions imag- ative deconvolution58 by reducing cross-talk and scatter effects.
ing to ensure diagnostic quality due to increased space between Then several studies have shown good results in patients using
the chest wall and cardiac border.29,55 sequential dual isotope acquisition with 201Thallium stress and

Downloaded for Anonymous User (n/a) at Ankara Etlik City Hospital from ClinicalKey.com by Elsevier on December 04,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
222 E. Piekarski et al.

Figure 2 Sequential dual-isotope perfusion SPECT in a 68-year-old patient with multiple risk factors including Body Mass
Index = 31. (A) Post-stress acquisition shows a homogeneous Thallium uptake except in the inferior wall. After administra-
tion of 99mTc-sestamibi, rest acquisition shows a similar uptake pattern. (B) the left ventricular end-diastolic, end-systolic
volumes and ejection fraction are very similar irrespectively of the isotope on ECG-gated images.

99mTcMIBI rest10,59,60 or simultaneous acquisition with response of epicardial coronary arteries and the microvascu-
99mTc MIBI stress and 201Thallium rest61 (Fig. 2). The main lar vasomotion. Under physiological conditions, the myocar-
limitations of simultaneous dual-isotope acquisition is the pres- dial blood flow is autoregulated and is proportional to the
ence of downscatter of 99mTc in the 201Tl window, increasing increase of the rate-pressure product that reflects the increase
with body mass index and potentially leading to a marked in cardiac metabolic demand.
underestimation of the perfusion defect size.43 Quantitative analysis of myocardial blood flow and flow
Although dual isotope imaging lowers global examination reserve provides useful additional information to conven-
duration time, this protocol does not allow for optimal dose tional myocardial perfusion analysis. Hyperemic blood flow
reduction62 which is one of the main advantages of CZT cameras. and MFR help identify patients with multivessel disease.69
An abnormal MFR is also associated with a poor prognosis
outcome PET studies demonstrated reduced heart failure and
Dual Perfusion-Innervation Imaging cardiac death in patients with low global coronary flow
Several studies have shown the feasibility of simultaneous reserve undergoing early revascularization using percutane-
dual isotope acquisition for both perfusion (either 201Thal- ous coronary intervention or CABG.70,71
lium63 or 99mTc-tetrofosmin64-67) and innervation (123I- In a context of limited access to cardiac perfusion PET,
MIBG), with some studies65,67 showing a good correlation new high-efficiency CZT SPECT cameras specifically
between heart-to-mediastinum ratio (HMR) derived from designed for cardiac imaging may be an alternative solu-
planar images as compared to tomographic images after cor- tion for quantification of myocardial blood flow. Espe-
rection factors.66 Simultaneous acquisition enables straight- cially, the commercially available stationary detector
forward assessment of innervation and perfusion mismatch systems allow dynamic acquisitions of perfusion studies.
(Fig. 3). There is still a need for standardization of HMR68 Since Ben-Haim et al72 demonstrated the feasibility of this
when using simultaneous dual 123I-MIBG / 99mTc-labelled technique in a series of patients referred for perfusion
perfusion tracer on CZT cameras and for evaluation in a studies, several studies were performed that validated
larger population. MBF and MFR quantification against various reference
techniques, including perfusion PET and FFR.73-80
Despite the compensation of the limitation of myocardial
extraction of 99mTc-labelled radiotracers at high flow
Myocardial Blood Flow and Flow rates, there is a roll-off phenomenon that potentially
affects flow quantification. Agostini et al78 compared
Reserve 99mTc-sestamibi CZT SPECT to 15O-water PET and FFR
Myocardial flow reserve (MFR), that is, the ratio of hyper- in 30 patients. Both stress and rest MBF were underesti-
emic to rest blood flow, relies on both the hemodynamic mated using CZT SPECT but MFR was similar to PET

Downloaded for Anonymous User (n/a) at Ankara Etlik City Hospital from ClinicalKey.com by Elsevier on December 04,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
Current Status of MPI with New SPECT/CT Cameras 223

Figure 3 Simultaneous Iodine-123 / Thallium-201 acquisition in a patient with Tranthyretin cardiac amyloidosis. On
planar acquisiton performed 4 hours after MIBG administration the heart-to-mediastinum ratio was 1.56. (A) The
dual-isotope acquisition shows the sympathetic denervation predominates in the inferior and lateral walls of the left
ventricule while Thallium uptake is completely normal (mismatch).

Figure 4 Example of a 66 y/o female patient with dilated cardiomyopathy referred for dynamic perfusion study. The
conventional CZT SPECT showed a non-reversible perfusion defect in the lateral wall. The dynamic acquisition dem-
onstrated a global impairment of myocardial flow reserve, and the coronary angiogram confirmed a 3-vessel disease.

with a high diagnostic accuracy for detecting reduced Conclusion

MFR. In this study, the CZT SPECT cut-off value was 2.1
ml/min/g to detect ischemia on PET defined by PET MFR Since their first use a decade ago, solid-state detectors with
< 2 ml/min/g (Fig. 4). Importantly, Wells et al docu- CZT have allowed for improvement in MPI by limiting
mented that although motion correction is mandatory for patient’s radiation exposure and improving patient’s comfort
flow quantification, AC has only a limited impact, 76 with dose and time reduction acquisition protocols, while
which is an important finding as only a few of installed improving image quality, with high sensitivity detectors
CZT systems have AC capabilities. and collimation systems, and improved spatial resolution

Downloaded for Anonymous User (n/a) at Ankara Etlik City Hospital from ClinicalKey.com by Elsevier on December 04,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
224 E. Piekarski et al.

through modelization of collimation and geometry of detec- 16. Jensen MM, Schmidt U, Huang C, et al: Gated tomographic radionuclide
tion in the reconstruction process. angiography using cadmium-zinc-telluride detector gamma-camera; com-
parison to traditional gamma cameras. J Nucl Cardiol 21:384-396, 2014
Those technological improvements can now be used for
17. Ito S, Endo A, Okada T, et al: Comparison of CTAC and prone imaging
the development of new techniques such as simultaneous for the detection of coronary artery disease using CZT SPECT. Ann
dual isotope imaging including for dual perfusion-innerva- Nucl Med 31:629-635, 2017
tion protocols, but also for determination of myocardial 18. Gimelli A, Liga R, Bertasi M, et al: Head-to-head comparison of a CZT-
blood flow, improving CAD diagnostic. based all-purpose SPECT camera and a dedicated CZT cardiac device
With the recent development of whole-body CZT cameras, for myocardial perfusion and functional analysis. J Nucl Cardiol 2019.
https://doi.org/10.1007/s12350-019-01835-4
new protocols and clinical applications might emerge within 19. Morelle M, Bellevre D, Hossein-Foucher C, et al: First comparison of
the next years. performances between the new whole-body cadmium-zinc-telluride
SPECT-CT camera and a dedicated cardiac CZT camera for myocardial
perfusion imaging: Analysis of phantom and patients. J Nucl Cardiol
2019. https://doi.org/10.1007/s12350-019-01702-2
References 20. van Dijk JD, Mouden M, Ottervanger JP, et al: Value of attenuation cor-
1. Dorbala S, Ananthasubramaniam K, Armstrong IS, et al: Single photon rection in stress-only myocardial perfusion imaging using CZT-SPECT.
emission computed tomography (SPECT) myocardial perfusion imaging J Nucl Cardiol 24(2):395-401, 2017
guidelines: Instrumentation, acquisition, processing, and interpretation. 21. Duvall WL, Croft LB, Ginsberg ES, et al: Reduced isotope dose and
J Nucl Cardiol 25:1784-1846, 2018 imaging time with a high-efficiency CZT SPECT camera. J Nucl Cardiol
2. Patton JA, Slomka PJ, Germano G, et al: Recent technologic advances in 18:847-857, 2011
nuclear cardiology. J Nucl Cardiol 14:501-513, 2007 22. Duvall WL, Sweeny JM, Croft LB, et al: Reduced stress dose with rapid
3. Myronakisa ME, Darambara DG: Monte Carlo investigation of charge- acquisition CZT SPECT MPI in a non-obese clinical population: Com-
transport effects on energy resolution and detection efficiency of pixe- parison to coronary angiography. J Nucl Cardiol 19:19-27, 2012
lated CZT detectors for SPECT/PET applications. Med Phys 38:455- 23. Taqueti VR, Dorbala S, Wolinsky D, et al: Myocardial perfusion imaging
467, 2011 in women for the evaluation of stable ischemic heart disease-state-of-
4. Imbert L, Poussier S, Franken PR, et al: Compared performance of high- the-evidence and clinical recommendations. J Nucl Cardiol 24:1402-
sensitivity cameras dedicated to myocardial perfusion SPECT: A com- 1426, 2017
prehensive analysis of phantom and human images. J Nucl Med 24. Thompson RC, O’Keefe JH, McGhie AI, et al: Reduction of SPECT MPI
53:1897-1903, 2012 radiation dose using contemporary protocols and technology. JACC
5. Erlandsson K, Kacperski K, van Gramberg D, et al: Performance evalua- Cardiovasc Imaging 11(2 Pt 1):282-283, 2018
tion of D-SPECT: A novel SPECT system for nuclear cardiology. Phys 25. Nakazato R, Berman DS, Hayes SW, et al: Myocardial perfusion imaging
Med Biol 54:2635-2649, 2009 with a solid-state camera: Simulation of a very low dose imaging proto-
6. Gambhir SS, Berman DS, Ziffer J, et al: A novel high sensitivity rapid- col. J Nucl Med 54:373-379, 2013
acquisition single-photon cardiac imaging camera. J Nucl Med 50:635- 26. Einstein AJ, Blankstein R, Andrews H, et al: Comparison of image qual-
643, 2009 ity, myocardial perfusion, and left ventricular function between stan-
7. Volokh L, Hugg J, Blevis I, et al: Effect of detector energy response on dard imaging and single-injection ultra-low-dose imaging using a high-
image quality of myocardial perfusion SPECT. NSS’08 IEEE efficiency SPECT camera: The MILLISIEVERT study. J Nucl Med
2008:4043-4046, 2008 55:1430-1437, 2014
8. Ben-Haim S, Kennedy J, Keidar Z: Novel cadmium zinc telluride devices 27. Herzog BA, Buechel RR, Katz R, et al: Nuclear myocardial perfusion
for myocardial perfusion imaging-technological aspects and clinical imaging with a cadmium-zinc-telluride detector technique: Optimized
applications. Semin Nucl Med 46:273-285, 2016 protocol for scan time reduction. J Nucl Med 51:46-51, 2010
9. Sharir T, Slomka PJ, Hayes SW, et al: Multicenter trial of high-speed 28. Buechel RR, Herzog BA, Husmann L, et al: Ultrafast nuclear myocardial
versus conventional single photon emission computed tomography perfusion imaging on a new gamma camera with semiconductor detec-
imaging: quantitative results of myocardial perfusion and left ventricular tor technique: first clinical validation. Eur J Nucl Med Mol Imaging
function. J Am Coll Cardiol 55:1965-1974, 2010 37:773-778, 2010
10. Nakazato R, Tamarappoo BK, Kang X, et al: Quantitative upright-supine 29. Nakazato R, Slomka PJ, Fish M, et al: Quantitative high-efficiency cad-
high-speed SPECT myocardial perfusion imaging for detection of coro- mium-zinc-telluride SPECT with dedicated parallel-hole collimation
nary artery disease: Correlation with invasive coronary angiography. J system in obese patients: results of a multi-center study. J Nucl Cardiol
Nucl Med 51:1724-1731, 2010 22:266-275, 2015
11. Duvall WL, Slomka PJ, Gerlach JR, et al: High-efficiency SPECT MPI: 30. Athar MW, Waqar F, Dwivedi AK, et al: Effects of gender and defect
Comparison of automated quantification, visual interpretation, and cor- reversibility on detection of coronary disease with an upright and supine
onary angiography. J Nucl Cardiol 20:763-773, 2013 cadmium-zinc-telluride camera. J Nucl Cardiol 2019. https://doi.org/
12. Nishiyama Y, Miyagawa M, Kawaguchi N, et al: Combined supine and 10.1007/s12350-019-01878-7
prone myocardial perfusion single-photon emission computed tomog- 31. Budzy nska A, Osiecki S, Mazurek A, et al: Feasibility of myocardial perfu-
raphy with a cadmium zinc telluride camera for detection of coronary sion imaging studies in morbidly obese patients with a cadmium-zinc-tel-
artery disease. Circ J 78:1169-1175, 2014 luride cardiac camera. Nucl Med Rev Cent East Eur 22:18-22, 2019
13. Hu LH, Sharir T, Miller RJH, et al: Upper reference limits of transient 32. Goto K, Takebayashi H, Kihara Y: Impact of combined supine and
ischemic dilation ratio for different protocols on new-generation cad- prone myocardial perfusion imaging using an ultrafast cardiac gamma
mium zinc telluride cameras: A report from REFINE SPECT registry. J camera for detection of inferolateral coronary artery disease. Int J Car-
Nucl Cardiol 2019. https://doi.org/10.1007/s12350-019-01730-y diol 174:313-317, 2014. 15
14. Bailliez A, Blaire T, Mouquet F, et al: Segmental and global left ventricular 33. Agostini D, Marie, Ben-Haim PY, et al: Performance of cardiac cad-
function assessment using gated SPECT with a semiconductor Cadmium mium-zinc-telluride gamma camera imaging in coronary artery disease:
Zinc Telluride (CZT) camera: phantom study and clinical validation vs car- A review from the cardiovascular committee of the European Associa-
diac magnetic resonance. J Nucl Cardiol 21:712-722, 2014 tion of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging
15. Bailliez A, Lairez O, Merlin C, et al: Left ventricular function assessment 43:2423-2432, 2016
using two different cadmium zinc telluride (CZT) cameras compared to 34. Gimelli A, Bottai M, Giorgetti A, et al: Comparison between ultrafast and
gamma camera with cardiofocal collimators: dynamic cardiac phantom standard SPECT in patients with coronary artery disease: A pilot study.
study and clinical validation. J Nucl Med 57:1370-1375, 2016 Circul Cardiovasc Imag 4:51-58, 2011

Downloaded for Anonymous User (n/a) at Ankara Etlik City Hospital from ClinicalKey.com by Elsevier on December 04,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
Current Status of MPI with New SPECT/CT Cameras 225

35. Chowdhury FU, Vaidyanathan S, Bould M, et al: Rapid-acquisition impairment on cadmium-zinctelluride imaging. Eur J Nucl Med Mol
myocardial perfusion scintigraphy (MPS) on a novel gamma camera Imaging 42:994-1003, 2015
using multipinhole collimation and miniaturized cadmium-zinc-tellu- 54. Oddstig J, Martinsson E, J€ogi J, et al: Differences in attenuation pattern
ride (CZT) detectors: Prognostic value and diagnostic accuracy in a in myocardial SPECT between CZT and conventional gamma cameras. J
‘real-worls’ nuclear cardiology service. Eur Heart J Cardiovasc Imag Nucl Cardiol 2018. https://doi.org/10.1007/s12350-018-1296-6
15:275-283, 2014 55. Fiechter M, Gebhard C, Fuchs TA, et al: Cadmium-zinc-telluride myocar-
36. Einstein AJ, Johnson LL, DeLuca AJ, et al: Radiation dose and prognosis dial perfusion imaging in obese patients. J Nucl Med 53:1401-1406, 2012
of ultra-low-dose stress-first myocardial perfusion SPECT in patients 56. Tsuboi K, Nagaki A, Shibutani T, et al: Optimal choice of OSEM and SD
with chest pain using a highefficiency camera. J Nucl Med 56:545-551, reconstruction algorithms in CZT SPECT for hypertrophic cardiomyop-
2015 athy patients. J Nucl Cardiol 2019. https://doi.org/10.1007/s12350-
37. Yokota S, Mouden M, Ottervanger JP, et al: Prognostic value of normal 019-01677-0
stress-only myocardial perfusion imaging: a comparison between con- 57. Kiat H, Germano G, Friedman J, et al: Comparative feasibility of separate or
ventional and CZT-based SPECT. Eur J Nucl Med Mol Imaging 43:296- simultaneous rest thallium-201/stress technetium-99m-sestamibi dual-iso-
301, 2016 tope myocardial perfusion SPECT. J Nucl Med 35:542-548, 1994
38. Nudi F, Iskandrian AE, Schillaci O, et al: Diagnostic accuracy of myo- 58. Kacperski K, Erlandsson K, Ben-Haim S, et al: Iterative deconvolution of
cardial perfusion imaging with CZT technology: Systemic review and simultaneous dual radionuclide projections for CdZnTe based cardiac
meta-analysis of comparison with invasive coronary angiography. JACC SPECT. IEEE NSS’08 2008:5260-5263, 2008
Cardiovasc Imaging 10:787-794, 2017 59. Berman DS, Kang X, Tamarappoo B, et al: Stress thallium-201/rest tech-
39. Lima R, Peclat T, Soares T, et al: Comparison of the prognostic value of netium-99m sequential dual isotope high-speed myocardial perfusion
myocardial perfusion imaging using a CZT-SPECT camera with a con- imaging. JACC Cardiovasc Imaging 2:273-282, 2009
ventional anger camera. J Nucl Cardiol 24:245-251, 2017 60. Barone-Rochette G, Leclere M, Calizzano A, et al: Stress thallium-201/
40. Betancur J, Otaki Y, Motwani M, et al: Prognostic value of combined rest technetium-99m sequential dual-isotope high-speed myocardial
clinical and myocardial perfusion imaging data using machine learning. perfusion imaging validation versus invasive coronary angiography. J
JACC Cardiovasc Imaging 11:1000-1009, 2018 Nucl Cardiol 22:513-522, 2015
41. Verger A, Djaballah W, Fourquet N, et al: Comparison between stress 61. Ben-Haim S, Kacperski K, Hain S, et al: Simultaneous dual-radionuclide
myocardial perfusion SPECT recorded with cadmium-zinc-telluride and myocardial perfusion imaging with a solid-state dedicated cardiac cam-
Anger cameras in various study protocols. Eur J Nucl Med Mol Imaging era. Eur J Nucl Med Mol Imaging 37:1710-1721, 2010
40:331-340, 2013 62. Henzlova MJ, Duvall WL: Return of dual-isotope SPECT myocardial
42. Zhang YQ, Jiang YF, Hong L, et al: Diagnostic value of cadmium-zinc- perfusion imaging? Not so fast. . .. J Nucl Cardiol 22:523-525, 2015
telluride myocardial perfusion imaging versus coronary angiography in 63. D’Estanque E, Hedon C, Lattuca B, et al: Optimization of a simultaneous
coronary artery disease: A PRISMA-compliant meta-analysis. Medicine dual-isotope (201)Tl/(123)I-MIBG myocardial SPECT imaging protocol
(Baltimore) 98:e14716, 2019 with a CZT camera for trigger zone assessment after myocardial infarc-
43. Hyafil F, Chequer R, Sorbets E, et al: Head-to-head comparison of the tion for routine clinical settings: Are delayed acquisition and scatter cor-
diagnostic performances of Rubidium-PET and SPECT with CZT cam- rection necessary? J Nucl Cardiol 24:1361-1369, 2017
era for the detection of myocardial ischemia in a population of women 64. Gimelli A, Liga R, Giorgetti A, et al: Assessment of myocardial adrener-
and overweight individuals. J Nucl Cardiol 2018. https://doi.org/ gic innervation with a solid-state dedicated cardiac cadmium-zinc-tellu-
10.1007/s12350-018-01557-z ride camera: first clinical experience. Eur Heart J Cardiovasc Imag
44. Otaki Y, Betancur J, Sharir T, et al: 5-Year prognostic value of quantita- 15:575-585, 2014
tive versus visual MPI in subtle perfusion defects: Results from REFINE 65. Bellevre D, Manrique A, Legallois D, et al: First determination of the
SPECT. JACC Cardiovasc Imaging 2019. https://doi.org/10.1016/j. heart-to-mediastinum ratio using cardiac dual isotope ((123)I-MIBG/
jcmg.2019.02.028 (99m)Tc-tetrofosmin) CZT imaging in patients with heart failure: the
45. Oldan JD, Shaw LK, Hofmann P, et al: Prognostic value of the cad- ADRECARD study. Eur J Nucl Med Mol Imaging 42:1912-1919,
mium-zinc-telluride camera: a comparison with a conventional (Anger) 2015
camera. J Nucl Cardiol 24:245-251, 2015 66. Blaire T, Bailliez A, Ben Bouallegue F, et al: First assessment of simulta-
46. Engbers EM, Timmer JR, Mouden M, et al: Prognostic value of myocar- neous dual isotope ((123)I/(99m)Tc) cardiac SPECT on two different
dial perfusion imaging with a cadmium-zinc-telluride SPECT camera in CZT cameras: A phantom study. J Nucl Cardiol 25:1692-1704, 2018
patients suspected of having coronary artery disease. J Nucl Med 67. Blaire T, Bailliez A, Ben Bouallegue F, et al: Determination of the heart-
58:1459-1463, 2017 to-mediastinum ratio of 123I-MIBG uptake using dual-isotope (123I-
47. Slomka PJ, Betancur J, Liang JX, et al: Rationale and design of the REgis- MIBG/99mTc-Tetrofosmin) multipinhole cadmium-zinc-telluride
try of Fast Myocardial Perfusion Imaging with NExt generation SPECT SPECT in patients with heart failure. J Nucl Med 59:251-258, 2018
(REFINE SPECT). J Nucl Cardiol 2018. https://doi.org/10.1007/ 68. Nakajima K, Okuda K, Matsuo S: et al: The time has come to standard-
s12350-018-1326-4 ize 123-I-MIBG heart-to-mediastinum ratios including planar and
48. Cochet H, Bullier E, Gerbaud E, et al: Absolute quantification of left SPECT methods. Eur J Nucl Med Mol Imag 43:386-388, 2016
ventricular global and regional function at nuclear MPI using ultrafast 69. Fiechter M, Ghadri JR, Gebhard C, et al: Diagnostic value of 13N-ammo-
CZT SPECT: Initial validation versus cardiac MRI. J Nucl Med 54:556- nia myocardial perfusion PET: Added value of myocardial flow reserve. J
563, 2013 Nucl Med 53:1230-1234, 2012
49. Claudin M, Imbert L, Djaballah W, et al: Routine evaluation of left ven- 70. Taqueti VR, Everett BM, Murthy VL, et al: Interaction of impaired coro-
tricular function using CZT-SPECT, with low injected activities and lim- nary flow reserve and cardiomyocyte injury on adverse cardiovascular
ited recording times. J Nucl Cardiol 25:249-256, 2018 outcomes in patients without overt coronary artery disease. Circulation
50. Coupez E, Merlin C, Tuyisenge V, et al: Validation of cadmium-zinc-tel- 131:528-535, 2015
luride camera for measurement of left ventricular systolic performance. 71. Patel KK, Spertus JA, Chan PS, et al: Myocardial blood flow reserve
J Nucl Cardiol 25:1029-1036, 2018 assessed by positron emission tomography myocardial perfusion imag-
51. Gimelli A, Bottai M, Giorgetti A: Comparison between ultrafast and ing identifies patients with a survival benefit from early revasculariza-
standard SPECT in patients with coronary artery disease: A pilot study. tion. Eur Heart J 2019. https://doi.org/10.1093/eurheartj/ehz389
Circul Cardiovasc Imag 4:51-58, 2011 72. Ben-Haim S, Murthy VL, Breault C, et al: Quantification of myocardial
52. Schindler TH: CZT camera: moving beyond classical CAD detection? perfusion reserve using dynamic SPECT imaging in humans: A feasibil-
Eur J Nucl Med Mol Imaging 42:991-993, 2015 ity study. J Nucl Med 54:873-879, 2013
53. Gimelli A, Liga R, Giorgetti A, et al: Relationships between myocardial 73. Ben Bouallegue F, Roubille F, Lattuca B, et al: SPECT myocardial perfu-
perfusion abnormalities and poststress left ventricular functional sion reserve in patients with multivessel coronary disease: Correlation

Downloaded for Anonymous User (n/a) at Ankara Etlik City Hospital from ClinicalKey.com by Elsevier on December 04,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.
226 E. Piekarski et al.

with angiographic findings and invasive fractional flow reserve measure- coronary artery disease. Eur J Nucl Med Mol Imaging 45:2173-2180,
ments. J Nucl Med 56:1712-1717, 2015 2018
74. Nkoulou R, Fuchs TA, Pazhenkottil AP, et al: Absolute myocardial 78. Agostini D, Roule V, Nganoa C, et al: First validation of myocardial
blood flow and flow reserve assessed by gated SPECT with cadmium- flow reserve assessed by dynamic 99mTc-sestamibi CZT-SPECT
zinc-telluride detectors using 99mTc-tetrofosmin: Head-to-head com- camera: Head to head comparison with 15 O-water PET and frac-
parison with 13N-ammonia PET. J Nucl Med 57:1887-1892, 2016 tional flow reserve in patients with suspected coronary artery dis-
75. Miyagawa M, Nishiyama Y, Uetani T, et al: Estimation of myocardial ease. The WATERDAY study. Eur J Nucl Med Mol Imaging
flow reserve utilizing an ultrafast cardiac SPECT: Comparison with cor- 45:1079-1090, 2018
onary angiography, fractional flow reserve, and the SYNTAX score. Int J 79. Zavadovsky KV, Mochula AV, Boshchenko AA, et al: Absolute myocar-
Cardiol 244:347-353, 2017 dial blood flows derived by dynamic CZT scan vs invasive fractional
76. Wells RG, Marvin B, Poirier M, et al: Optimization of SPECT measure- flow reserve: Correlation and accuracy. J Nucl Cardiol 2019. https://doi.
ment of myocardial blood flow with corrections for attenuation, motion, org/10.1007/s12350-019-01678-z
and blood binding compared with PET. J Nucl Med 58:2013-2019, 2017 80. de Souza ACDAH, Gonçalves BKD: Quantification of myocardial flow
77. Han S, Kim YH, Ahn JM, et al: Feasibility of dynamic stress 201Tl/rest reserve using a gamma camera with solid-state cadmium-zinc-telluride
99mTc-tetrofosmin single photon emission computed tomography for detectors: Relation to angiographic coronary artery disease. J Nucl Car-
quantification of myocardial perfusion reserve in patients with stable diol 2019. https://doi.org/10.1007/s12350-019-01775-z

Downloaded for Anonymous User (n/a) at Ankara Etlik City Hospital from ClinicalKey.com by Elsevier on December 04,
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.