title: Comparison of the diagnostic accuracies of very low stress-dose with standard-dose myocardial perfusion imaging: Automated quantification of one-day, stress-first SPECT using a CZT camera.
abstract: BACKGROUND
  Previous studies have demonstrated accurate diagnosis of reduced dose myocardial perfusion imaging (MPI) using Cadmium-Zinc-Telluride (CZT) technology. We compared the diagnostic performances of very low stress-dose (<2 mSv) with standard-dose stress-first, quantitative MPI using a CZT camera.
  
  
  METHODS
  Patients without known coronary artery- disease who underwent a stress-first Tc-99 m sestamibi CZT-MPI and invasive coronary angiography (ICA), and low-risk patients without ICA were included. A stress-rest standard-dose (10/30 mCi) MPI and a low-dose (5/15 mCi) MPI were compared. Normal limits for quantification were developed from 40 (20 males) low-risk patients, and total perfusion deficit (TPD) was derived.
  
  
  RESULTS
  208 patients who underwent MPI and ICA, and 76 low-risk patients were included. Of these, 128 had a standard-dose MPI and 156 had a low-dose MPI. Stress-doses in low-dose and standard-dose groups were 5.9 ± 1.2 vs 10.2 ± 0.5 mCi (1.7 ± 0.3 vs 3.0 ± 0.1 mSv), respectively, P < 0.001, and stress-rest effective radiation was 6.9 ± 1.1 vs 11.7 ± 0.4 mSv, respectively, P < 0.001. Sensitivity, specificity, and accuracy values in the low-dose and standard-dose groups were 86.1%, 76.6%, and 81.4%; and 90.6%, 78.1%, and 84.4%, respectively, P = ns. Using TPD prone, specificity values were 84.9% and 80.3%, respectively, P = ns.
  
  
  CONCLUSIONS
  One-day stress-first MPI with 50% radiation reduction and a very low stress-dose (<2 mSv) using CZT technology and quantitative supine and prone analysis provided a high diagnostic value, similar to standard-dose MPI.
authors.affiliation: Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel. tsharir@gmail.com.
authors.forename: Tali
authors.initials: T
authors.lastname: Sharir
authors.affiliation: Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel.
authors.forename: Marina
authors.initials: M
authors.lastname: Pinskiy
authors.affiliation: Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Pardes
authors.affiliation: Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel.
authors.forename: Arik
authors.initials: A
authors.lastname: Rochman
authors.affiliation: Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel.
authors.forename: Vitali
authors.initials: V
authors.lastname: Prokhorov
authors.affiliation: General Electric Healthcare, Haifa, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Kovalski
authors.affiliation: Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel.
authors.forename: Konstantine
authors.initials: K
authors.lastname: Merzon
authors.affiliation: Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Bojko
authors.affiliation: Department of Nuclear Cardiology, Assuta Medical Centers, 96 Igal Alon, C Building, 67891, Tel Aviv, Israel.|Department of Cardiology, Barzilai Medical Center, Ashkelon, Israel.|Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
authors.forename: Boris
authors.initials: B
authors.lastname: Brodkin
mesh_terms: D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004305:Dose-Response Relationship, Drug; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005080:Exercise Test / Q000295:instrumentation / Q000379:methods; D005260:Female; D015902:Gamma Cameras; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation / Q000379:methods; D000069550:Machine Learning; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000295:instrumentation* / Q000379:methods; D010363:Pattern Recognition, Automated / Q000379:methods*; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi / Q000008:administration & dosage*; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: CZT camera; Myocardial perfusion imaging; automatic quantification; coronary artery disease; low-dose; stress-first