Query: Cadmium-zinc-telluride myocardial perfusion imaging in obese patients

Candidate papers:

abstract: We have evaluated the impact of increased body mass on the quality of myocardial perfusion imaging using a latest generation g camera with cadmium zinc telluride semiconductor detectors in patients with high =40 kg/m2) or very high =45 kg/m2) body mass index (BMI) Methods: We enrolled 81 patients, including 18 with no obesity (BMI 30 kg/m2) 17 in World Health Organization obese class I (BMI, 30 34.9 kg/m2) 15 in class II (BMI, 35 39.9 kg/m2) and 31 in class III (BMI 40 kg/m2) including 15 with BMI 45 kg/m2. Image quality was scored as poor (1) moderate (2) good (3) or excellent (4) Patients with BMI 45 kg/m2 and nondiagnostic image quality =2) were rescanned after repositioning to better center the heart in the field of view. Receiver operating curve analysis was applied to determine the BMI cutoff required to obtain diagnostic image quality =3) Results: Receiver operating curve analysis resulted in a cutoff BMI of 39 kg/m2 (P 0.001) for diagnostic image quality. In patients with BMI 40 kg/m2, image quality was nondiagnostic in 81% after CT based attenuation correction this decreased to 55% Repositioning further improved image quality. Rescanning on a conventional SPECT camera resulted in diagnostic image quality in all patients with BMI 45 kg/m2. Conclusion: Patients with BMI 40 kg/m2 should be scheduled for myocardial perfusion imaging on a conventional SPECT camera, as it is difficult to obtain diagnostic image quality on a cadmium zinc telluride camera.
author_names: Michael Fiechter

Catherine Gebhard

Tobias A Fuchs

Jelena Rima Ghadri

Julia Stehli

Egle Kazakauskaite

Bernhard Herzog

Aju P Pazhenkottil

Oliver Gaemperli

Philipp A Kaufmann
title: Cadmium Zinc Telluride Myocardial Perfusion Imaging in Obese Patients
venue: The Journal of Nuclear Medicine
year: 2012

abstract: Background: Rapid progress has been made in research of cadmium zinc telluride (CZT) technology in the last few years, which might serve as a new method to diagnose coronary artery disease. However, compared with coronary angiography, the diagnostic value of CZT is still controversial. We aimed to evaluate diagnosis value of coronary angiography versus CZT in coronary artery disease. Methods: We searched the database for eligible researches associated with CZT myocardial perfusion imaging (MPI) and invasive coronary angiography, extracted the relevant data, and rigorously screened it according to the inclusion and exclusion criteria. The accuracy indicators included sensitivity, specificity, accuracy, positive and negative likelihood ratios. Results: According to the inclusion and exclusion criteria, we finally found 20 studies containing 2350 patients in this search. Pooled results showed that sensitivity of CZT MPI was 0.84% and 95% confidence interval (95% CI) 0.78 to 0.89, specificity was 0.72, 95% CI (0.62 0.76) the specificity was lower apparently. The positive likelihood ratio was 3.0, 95% CI (2.4 3.8) the negative likelihood ratio was 0.22, 95% CI (0.16 0.31) diagnostic odds ratio was 14, 95% CI (7.84 17.42) Conclusion: This meta analysis showed that CZT MPI had satisfactory sensitivity and specificity for diagnosing coronary artery disease. Larger studies are required for further evaluation.
author_names: Yiqing Zhang

Yu-Feng Jiang

Lu Hong

Min Chen

Nan-nan Zhang

Hua-jia Yang

Yafeng Zhou
title: Diagnostic value of cadmium zinc telluride myocardial perfusion imaging versus coronary angiography in coronary artery disease
venue: Medicine
year: 2019

abstract: The aim of this study was to validate attenuation correction (AC) using low dose standard CT for myocardial perfusion imaging (MPI) on a novel ultra fast g camera with cadmium zinc telluride (CZT) detector technology. Methods: Sixty six patients (body mass index SD, 27.2 3.5 kg/m2; range, 19.1 36.0 kg/m2) underwent a 1 d 99mTc tetrofosmin adenosine stress rest imaging protocol with 15 min acquisitions on a standard dual head SPECT camera. All scans were repeated within minutes on the CZT camera, with 3 min acquisitions for stress (low dose) and 2 min acquisitions for rest (high dose) as recently established. We compared maximum myocardial uptake (20 segment model) from CZT versus standard SPECT MPI by intraclass correlation without and with CT AC. In addition, clinical agreement for each coronary territory for all scans from both devices was assessed, and Bland Altmann (BA) limits of agreement for percentage uptake were calculated. Results: The clinical agreement between CZT and standard SPECT cameras was 96% for noncorrected low and high dose images (r 0.90 and BA 18 to 15, and r 0.91 and BA 15 to 16, respectively) and agreement after AC was 96% for low and 99% for high dose images (r 0.87 and BA 16 to 14, and r 0.88 and BA 16 to 14, respectively) Conclusion: Our results support that AC of MPI on the novel CZT camera, compared with AC MPI on a conventional SPECT camera, is feasible because it provides a high correlation of segmental tracer uptake and an excellent clinical agreement.
author_names: Bernhard Herzog

Ronny R Buechel

Lars Husmann

Aju P Pazhenkottil

Irene Andrea Burger

Mathias Wolfrum

Rene Nkoulou

Ines Valenta

Jelena Rima Ghadri

Valerie Treyer

Philipp A Kaufmann
title: Validation of CT Attenuation Correction for High Speed Myocardial Perfusion Imaging Using a Novel Cadmium Zinc Telluride Detector Technique
venue: The Journal of Nuclear Medicine
year: 2010

abstract: ABSTRACT Introduction: Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is well established as diagnostic test for patients with suspected or known coronary artery disease. New camera systems have been developed with cadmium zinc telluride (CZT) detectors, novel collimator designs and reconstruction software. Areas covered: We review the current state of cardiac SPECT, advances in conventional camera technology and the development and clinical validation of solid state CZT cameras. Expert commentary: The development of CZT systems is timely and addresses current issues for clinical SPECT imaging. These systems have a significant increase in photon sensitivity, permitting much lower radiation patient doses at a time when the lay and medical communities are very concerned about the radiation doses resulting from medical imaging. The increased count sensitivity permits shorter acquisition times and greater patient throughput which may address the ongoing and increasing issue of decreased funding for healthcare and, particularly, diagnostic imaging. The improved image resolution should improve diagnostic accuracy and increase the value of SPECT imaging for management of patients with CAD at a time of significant competition from other imaging modalities.
author_names: Ali Alenazy

R Glenn Wells

Terrence D Ruddy
title: New solid state cadmium zinc telluride technology for cardiac single photon emission computed tomographic myocardial perfusion imaging
venue: Expert review of medical devices
year: 2017

abstract: PurposeRecently introduced ultrafast cardiac SPECT cameras with cadmium zinc telluride based (CZT) detectors may provide superior image quality allowing faster acquisition with reduced radiation doses. Although the level of concordance between conventional SPECT and invasive fractional flow reserve (FFR) measurement has been studied, that between FFR and CZT based SPECT is not yet known. Therefore, we aimed to assess the level of concordance between CZT SPECT and FFR in a large patient group with stable coronary artery disease.MethodsBoth invasive FFR and myocardial perfusion imaging with a CZT based SPECT camera, using Tc tetrofosmin as tracer, were performed in 100 patients with stable angina and intermediate grade stenosis on invasive coronary angiography. A cut off value of <0.75 was used to define abnormal FFR.ResultsThe mean age of the patients was 64 11 years, and 64 were men. SPECT demonstrated ischaemia in 31 of the patients, and 20 had FFR <0.75. The concordance between CZT SPECT and FFR was 73 on a per patient basis and 79 on a per vessel basis. Discordant findings were more often seen in older patients and were mainly (19 the result of ischaemic SPECT findings in patients with FFR =0.75, whereas only 8 had an abnormal FFR without ischaemia as demonstrated by CZT SPECT.ConclusionOnly 20 30 of patients with intermediate coronary stenoses had significant ischaemia as assessed by CZT SPECT or invasive FFR. CZT SPECT showed a modest degree of concordance with FFR, which is comparable with previous results with conventional SPECT. Further investigations are particularly necessary in patients with normal SPECT and abnormal FFR, especially to determine whether these patients should undergo revascularization.
author_names: Mohamed el Mouden

Jan Paul Ottervanger

Siert Knollema

Jorik R Timmer

Stoffer Reiffers

Ad H J Oostdijk

Menko Jan de Boer

Pieter L Jager
title: Myocardial perfusion imaging with a cadmium zinc telluride based gamma camera versus invasive fractional flow reserve
venue: European Journal of Nuclear Medicine and Molecular Imaging
year: 2013

abstract: The purpose of this study is to evaluate the prognostic value of myocardial perfusion SPECT obtained in CZT cameras (CZT SPECT) with multipinhole collimation in obese patients. CZT SPECT may be technically challenging in the obese, and its prognostic value remains largely unknown. Patients underwent single day, rest/stress (supine and prone) imaging. Images were visually inspected and graded as poor, fair or good/excellent. Summed stress and difference scores (SSS and SDS, respectively) were converted into percentages of total perfusion defect and of ischemic defect by division by the maximum possible score. Obesity was defined as a body mass index (BMI) 30 kg/m2 and classified as class I (BMI 30 34.9 kg/m2) II (BMI 35 39.9 kg/m2) or III (BMI 40 kg/m2) Patients were followed up by telephone interview for the occurrence of all cause death, myocardial infarction or revascularization. A Cox proportional hazards analysis was used to assess the independent predictors of death. Among 1396 patients, 365 (26.1 were obese (mean BMI 33.9 3.6; 17.5 class I, 3.4 class II, and 3.4 class III) Image quality was good/excellent in 94.5 of the obese patients. The annualized mortality rates were not significantly different among obese and non obese patients, being <1 with normal CZT SPECT, and increased with the degree of scan abnormality in both obese and non obese patients. Age, the use of pharmacologic stress and an abnormal CZT SPECT, but not obesity, were independent predictors of death. In obese patients, single day rest/stress CZT SPECT with a multipinhole camera provides prognostic discrimination with high image quality.
author_names: Andrea De Lorenzo

Thais R Peclat

Ana Carolina Amaral

Ronaldo Souza Leao Lima
title: Prognostic evaluation in obese patients using a dedicated multipinhole cadmium zinc telluride SPECT camera
venue: The International Journal of Cardiovascular Imaging
year: 2015

abstract: 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 compensation, data analysis, reports and image display, and positron emission tomography. If the specific recommendations given could not be based on evidence from original, scientific studies, we tried to express this state of art. The guidelines are designed to assist in the practice of performing, interpreting and reporting myocardial perfusion SPET. The guidelines do not discuss clinical indications, benefits or drawbacks of radionuclide myocardial imaging compared to non nuclear techniques, nor do they cover cost benefit or cost effectiveness.
author_names: Birger Hesse

Kristina Tagil

Alberto Cuocolo

Constantinos D Anagnostopoulos

Manuel Bardies

J J Bax

Frank M Bengel

Ellinor Busemann Sokole

G Davies

Maurizio Dondi

Lars Edenbrandt

Philippe R Franken

Andreas Kjaer

Juhani Knuuti

Michael Lassmann

Michael Ljungberg

C Claudio Marcassa

Pierre Yves Marie

Fergus I Mckiddie

M O'Connor

E M Prvulovich

Richard S Underwood

Blf Van Eck-Smit
title: EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology
venue: European Journal of Nuclear Medicine and Molecular Imaging
year: 2005

abstract: BACKGROUND A novel cardiac SPECT camera with cadmium zinc telluride (CZT) based technology has a fixed array of semiconductor detectors paired with pinhole collimators focused on the heart. Image acquisition in obese patients can be challenging because of much smaller detector field of view compared to conventional gamma cameras. The aim of this study was to evaluate the impact on high body mass on the feasibility of CZT myocardial perfusion imaging (MPI) The additional aim was to investigate the mechanism of the banana shaped/obesity artifact, as referred to in literature, and to attempt at simulating it on a phantom study. MATERIAL AND METHODS Study group consisted of 43 patients with morbid obesity (BMI 40 kg/m2) All these patients underwent myocardial perfusion imaging on both CZT cardiac camera and general purpose SPECT/CT gamma camera. Control group consisted of all patients who underwent myocardial perfusion imaging on CZT camera throughout one calendar year and whose BMI was lower than 40 kg/m2. In this group, all repeated studies were re analyzed for estimating the frequency of heart mispositioning in the camera field of view. The number of studies performed was 1180. A static cardiac phantom was used to simulate a banana shaped artifact. A series of phantom acquisitions during which the phantom position was altered in the camera field of view was performed. RESULTS In control group, 3.7% of all cardiac scintigrams required repetition, 18.9% of which were repeated due to wrong heart positioning; median BMI in this group of patients was 36.0. A banana shaped artifact was observed in one female patient with BMI 36.0. In morbid obesity group, 32.6% of the studies were non diagnostic with "truncation effect" on Scan Quality Control (QC) Median BMI in patients with diagnostic scans was 42.0, while in patients with not acceptable quality control test it was 45.0 (p 0.05) Banana shaped artifacts were observed in 5 non diagnostic studies. In a phantom study an artifact of banana shape was obtained when gantry was distant from the phantom and target was on the edge of the camera field of view and was slightly truncated. CONCLUSIONS Problem with heart mispositioning during imaging on the CZT camera affects less than 1% of all performed studies. Morbid obesity is not a contraindication to perform myocardia.
author_names: Anna Budzynska

Sebastian Osiecki

Andrzej Mazurek

Stanislaw Piszczek

Miroslaw Dziuk
title: Feasibility of myocardial perfusion imaging studies in morbidly obese patients with a cadmium zinc telluride cardiac camera.
venue: Nuclear medicine review. Central Eastern Europe
year: 2019

abstract: Radionuclide myocardial perfusion imaging (MPI) using single photon emission computed tomography (SPECT) or positron emission tomography (PET) for the detection of ischemia in patients with known or suspected coronary artery disease (CAD) has widespread clinical utilization and has been shown to have high accuracy and incremental prognostic value. Amidst the recent publicity regarding the increasing use of all types of ionizing radiation in the United States, patients and medical professionals are scrutinizing the need for diagnostic testing and how radiation exposure can be reduced. There are three critical questions that physicians must consider and answer with regard to radiation exposure and performing MPI in a particular patient:
author_names: Manuel D Cerqueira

Kevin C Allman

Edward P Ficaro

Christopher L Hansen

Kenneth J Nichols

Randall C Thompson

William A Van Decker

Marko Yakovlevitch
title: Recommendations for reducing radiation exposure in myocardial perfusion imaging
venue: Journal of nuclear cardiology official publication of the American Society of Nuclear Cardiology
year: 2010

abstract: Myocardial perfusion imaging (MPI) is an important imaging modality in the management of patients with cardiovascular disease. MPI plays a key role in diagnosing cardiovascular disease, establishing prognosis, assessing the effectiveness of therapy, and evaluating viability. However, MPI is a complex process, subject to a variety of artifacts and pitfalls, which may limit its clinical utility. These factors may be related to the patient (including unique aspects of the patient's heart) the nuclear medicine equipment, or the actions of the technologist. After reviewing this article, the reader should be familiar with the causes and the effects of these potential artifacts and pitfalls. The reader should develop an understanding of steps to limit these factors, actions to correct them if they do arise and, when necessary, how to incorporate their influence into the interpretation of the study.
author_names: Steven C Burrell

Anita MacDonald
title: Artifacts and pitfalls in myocardial perfusion imaging.
venue: Journal of nuclear medicine technology
year: 2006