title: First determination of the heart-to-mediastinum ratio using cardiac dual isotope (¹²³I-MIBG/⁹⁹mTc-tetrofosmin) CZT imaging in patients with heart failure: the ADRECARD study.
abstract: OBJECTIVE
  Cardiac innervation is assessed using the heart-to-mediastinum ratio (HMR) of metaiodobenzylguanidine (MIBG) on planar imaging using Anger single photon emission computed tomography (A-SPECT). The aim of the study was to determine the HMR of MIBG obtained using a CZT-based camera (D-SPECT; Spectrum Dynamics, Israel) in comparison with that obtained using conventional planar imaging.
  
  
  METHODS
  The ADRECARD study prospectively evaluated 44 patients with heart failure. They underwent planar acquisition using the A-SPECT camera 4 h after (123)I-MIBG injection (236.4 ± 39.7 MBq). To localize the heart using D-SPECT, (99m)Tc-tetrofosmin (753 ± 133 MBq) was administered and dual isotope acquisition was performed using the D-SPECT system. HMR was calculated using both planar A-SPECT imaging and front view D-SPECT cine data. In a phantom study, we estimated a model fitting the A-SPECT and the D-SPECT data that was further applied to correct for differences between the cameras.
  
  
  RESULTS
  A total of 44 patients (39 men and 5 women, aged 60 ± 11 years) with ischaemic (31 patients) and nonischaemic (13 patients) cardiomyopathy completed the study. Most patients (28 of 44) were NYHA class II, and the mean left ventricular ejection fraction was 33 ± 7 %. The mean HMR values were 1.34 ± 0.15 and 1.45 ± 0.27 from A-SPECT and D-SPECT, respectively (p < 0.0001). After correction, Lin's concordance correlation showed an almost perfect concordance between corrected D-SPECT HMR and A-SPECT HMR, and Bland-Altman analysis demonstrated a high agreement between the two measurements.
  
  
  CONCLUSIONS
  The ADRECARD study demonstrated that determination of late HMR during cardiac MIBG imaging using dual isotope ((123)I and (99m)Tc) acquisition on a CZT camera (D-SPECT) is feasible in patients with heart failure. A linear correction based on the phantom study yielded a high agreement between (123)I MIBG HMR obtained using a CZT camera and that from conventional planar imaging.
authors.affiliation: Department of Nuclear Medicine, CHU Côte de Nacre, Caen, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Bellevre
authors.affiliation: Department of Nuclear Medicine, CHU Côte de Nacre, Caen, France.|EA 4650, Normandie Université, Caen, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Manrique
authors.affiliation: EA 4650, Normandie Université, Caen, France.|Cardiology Department, CHU Côte de Nacre, Caen, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Legallois
authors.affiliation: Spectrum Dynamics, Biosensors, Caesarea, Israel.
authors.forename: Samy
authors.initials: S
authors.lastname: Bross
authors.affiliation: Spectrum Dynamics, Biosensors, Caesarea, Israel.
authors.forename: Rafael
authors.initials: R
authors.lastname: Baavour
authors.affiliation: Spectrum Dynamics, Biosensors, Caesarea, Israel.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Roth
authors.affiliation: EA 4650, Normandie Université, Caen, France.|Nuclear Medicine Department, IRIS, Polyclinique du Bois, Lille, France.
authors.forename: Tanguy
authors.initials: T
authors.lastname: Blaire
authors.affiliation: Department of Nuclear Medicine, CHU Côte de Nacre, Caen, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Desmonts
authors.affiliation: EA 4650, Normandie Université, Caen, France.|Nuclear Medicine Department, IRIS, Polyclinique du Bois, Lille, France.
authors.forename: Alban
authors.initials: A
authors.lastname: Bailliez
authors.affiliation: Department of Nuclear Medicine, CHU Côte de Nacre, Caen, France. agostini-de@chu-caen.fr.|EA 4650, Normandie Université, Caen, France. agostini-de@chu-caen.fr.
authors.forename: Denis
authors.initials: D
authors.lastname: Agostini
mesh_terms: D019797:3-Iodobenzylguanidine; D000328:Adult; D000368:Aged; D005260:Female; D015902:Gamma Cameras; D006321:Heart / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019047:Phantoms, Imaging; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation*
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019797:3-Iodobenzylguanidine; C078700:technetium tc-99m tetrofosmin
keywords: CZT; D-SPECT; Dual isotope; Heart failure; Heart-to-mediastinum ratio; MIBG