title: High-Sensitivity and High-Resolution SPECT/CT Systems Provide Substantial Dose Reduction Without Compromising Quantitative Precision for Assessment of Myocardial Perfusion and Function.
abstract: There is increasing concern about radiation exposure from myocardial perfusion SPECT (MPS). γ-cameras with solid-state cadmium-zinc-telluride (CZT) detectors have better count sensitivity and spatial resolution than conventional sodium iodine detectors, allowing for significant reductions in radiotracer dose or acquisition time. This study aimed to demonstrate the capability of a hybrid CZT SPECT/64-slice CT system for dose reduction and to determine the maximal reduction possible without compromising image quality or the quantification precision of clinical MPS.
  
  
  
  The imaging data of patients with normal myocardial perfusion and 30 patients with mid-sized to large perfusion defects who had undergone stress (99m)Tc-tetrofosmin MPS were postprocessed. Low-dose (361 ± 60 MBq) and high-dose (725 ± 142 MBq) (99m)Tc-tetrofosmin scans were included, with 6-min and 4-min scanning times, respectively. List-mode SPECT data were reconstructed with CT-based attenuation correction and with full as well as 50% and 75% reductions in acquisition time to simulate the corresponding relative dose reductions. The reconstructed SPECT images were analyzed to calculate global MPS defect size and regional defect size for 3 coronary artery territories-left anterior descending, left circumflex, and right-as well as left ventricular (LV) volume and ejection fraction.
  
  
  
  For patients with normal MPS results, there were no differences in defect size, LV volume, or ejection fraction, regardless of whether 50% or 75% reduction was used. For patients with abnormal MPS results, at a 50% reduction there was a significant difference in global defect size but not in regional defect size in the left anterior descending, left circumflex, and right coronary artery territories, whereas at a 75% reduction the difference was statistically significant in all territories, including the difference in global defect size. Nonetheless, differences in the defect size were minimal. The LV end-diastolic and end-systolic volumes and LV ejection fraction were not significantly different, regardless of whether 50% or 75% dose reduction was used.
  
  
  
  Ultra-low-dose (<190 MBq) MPS even with short imaging times (<6 min) is feasible using a hybrid CZT SPECT/CT camera without compromising image quality or significantly altering quantification of myocardial perfusion or LV function. We demonstrated that an additional 50% reduction in the current low-dose recommendations from the American Society of Nuclear Cardiology guidelines for (99m)Tc-labeled MPS is highly feasible while retaining short imaging protocols.
authors: Nuclear Cardiology, Heart and Vascular Center, Yale-New Haven Hospital, New Haven, Connecticut.
authors: Richard J
authors: RJ
authors: Palyo
authors: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut.
authors: Albert J
authors: AJ
authors: Sinusas
authors: Nuclear Cardiology, Heart and Vascular Center, Yale-New Haven Hospital, New Haven, Connecticut Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; and Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan yi-hwa.liu@yale.edu.
authors: Yi-Hwa
authors: YH
authors: Liu
mesh_terms: D002104:Cadmium; D003326:Coronary Circulation; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000502:physiology*; D006801:Humans; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011786:Quality Control; D011829:Radiation Dosage; D012680:Sensitivity and Specificity; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods*; D013691:Tellurium; D015032:Zinc
chemical_list: C474490:CdZnTe; D002104:Cadmium; D015032:Zinc; D013691:Tellurium
keywords: SPECT quantification; dose reduction; left ventricular function; myocardial perfusion