title: Comparison of image quality, myocardial perfusion, and left ventricular function between standard imaging and single-injection ultra-low-dose imaging using a high-efficiency SPECT camera: the MILLISIEVERT study.
abstract: SPECT myocardial perfusion imaging plays a central role in coronary artery disease diagnosis, but concerns exist regarding its radiation burden. Compared with standard Anger SPECT (A-SPECT) cameras, new high-efficiency (HE) cameras with specialized collimators and solid-state cadmium-zinc-telluride detectors offer potential to maintain image quality (IQ), while reducing administered activity and thus radiation dose to patients. No previous study has compared IQ, interpretation, total perfusion deficit (TPD), or ejection fraction (EF) in patients receiving both ultra-low-dose (ULD) imaging on an HE SPECT camera and standard low-dose (SLD) A-SPECT imaging.
  
  
  METHODS
  We compared ULD HE SPECT with SLD A-SPECT imaging by dividing the rest dose in 101 patients at 3 sites scheduled to undergo clinical A-SPECT myocardial perfusion imaging using a same day rest-stress (99m)Tc protocol. Patients underwent HE SPECT imaging after an initial approximately 130-MBq (3.5 mCi) dose and SLD-A-SPECT imaging after the remainder of the planned dose. Images were scored visually by 2 masked readers for IQ and summed rest score. TPD and EF were assessed quantitatively.
  
  
  RESULTS
  Mean activity was 134 MBq (3.62 mCi) for ULD HE SPECT (effective dose, 1.15 mSv) and 278 MBq (7.50 mCi, 2.39 mSv) for SLD A-SPECT. Overall IQ was superior for ULD HE SPECT (P < 0.0001), with twice as many studies graded excellent quality. Extracardiac activity and overall perfusion assessment were similar. Between-method correlations were high for summed rest score (r = 0.87), TPD (r = 0.91), and EF (r = 0.88).
  
  
  CONCLUSIONS
  ULD HE SPECT rest imaging correlates highly with SLD A-SPECT. It has improved image quality, comparable extracardiac activity, and achieves radiation dose reduction to 1 mSv for a single injection.
authors: Department of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York andrew.einstein@columbia.edu.
authors: Andrew J
authors: AJ
authors: Einstein
authors: Department of Medicine, Cardiology Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Ron
authors: R
authors: Blankstein
authors: Department of Biostatistics, Columbia University, New York, New York.
authors: Howard
authors: H
authors: Andrews
authors: Oregon Heart and Vascular Institute, Springfield, Oregon.
authors: Mathews
authors: M
authors: Fish
authors: Oregon Heart and Vascular Institute, Springfield, Oregon.
authors: Richard
authors: R
authors: Padgett
authors: Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and.
authors: Sean W
authors: SW
authors: Hayes
authors: Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and.
authors: John D
authors: JD
authors: Friedman
authors: Department of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
authors: Mehreen
authors: M
authors: Qureshi
authors: Department of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
authors: Harivony
authors: H
authors: Rakotoarivelo
authors: Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Piotr
authors: P
authors: Slomka
authors: Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan.
authors: Ryo
authors: R
authors: Nakazato
authors: Department of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
authors: Sabahat
authors: S
authors: Bokhari
authors: Department of Medicine, Cardiology Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Marcello
authors: M
authors: Di Carli
authors: Departments of Imaging and Medicine and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; and.
authors: Daniel S
authors: DS
authors: Berman
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000592:standards*; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods* / Q000592:standards; D016277:Ventricular Function, Left
keywords: SPECT; high-efficiency camera; radiation dose reduction