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Minimal rest activity for SPECT myocardial perfusion imaging in a one-day stress-first protocol

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Guidelines propose different rest–stress activity ratios (RSAR) for one-day stress-first SPECT myocardial perfusion imaging (MPI), but evidence is limited. Our aim was to determine and validate the minimal RSAR resulting in the same diagnostic outcome in one-day stress-first SPECT MPI.

Methods

Forty-seven patients referred for rest after stress CZT-SPECT/CT MPI were prospectively included. Rest acquisitions were performed 3 h after stress. In addition to the stress and rest acquisitions, the first 22 patients underwent an additional acquisition prior to the rest injection to determine the remaining stress activity. Next, we simulated six RSARs varying from 1.0 to 3.5 in both patients and a phantom and compared the images to those using the reference RSAR of 4.0. Differences in summed difference score (SDS) >2 or ischemic defect interpretation were considered to significantly influence diagnostic outcome. After deriving the minimal RSAR, it was validated in 25 additional patients by comparing it to a RSAR of 4.0.

Results

After 3 h only 26% of the stress activity was still present in the myocardium. SDS differences >2 were found in one (4%) patient using RSAR of 3.5, 2.5 and 2.0, in three (12%) using 1.5 and in five (20%) using SRAR of 1.0. These results were consistent with the phantom study showing SDS differences >2 for RSARs ≤1.5 and with the visual interpretation which showed an increased number of deviating scans for RSAR 1.0. Validating the RSAR of 2.0 resulted in a different SDS in one patient (SDS of 30 versus 11). Moreover, two scans were interpreted as ischemic instead of normal when using RSAR 2.0 and in two other scans the opposite was the case.

Conclusions

A RSAR of 2.0 in one-day stress-first MPI SPECT seems sufficient to obtain accurate diagnostic outcomes and is therefore recommended to reduce radiation exposure.

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Abbreviations

CT:

Computer tomography

iTPD:

Ischemic total perfusion deficit

MPI:

Myocardial perfusion imaging

SDS:

Summed difference score

SPECT:

Single photon emission computed tomography

RSAR:

Rest-stress activity ratio

TPD:

Total perfusion deficit

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Authors and Affiliations

  1. Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands

    J. D. van Dijk, S. Knollema & P. L. Jager

  2. Department of Medical Physics, Isala Hospital, Zwolle, The Netherlands

    J. A. van Dalen

  3. Department of Cardiology, Isala Hospital, Zwolle, The Netherlands

    M. Mouden & J. P. Ottervanger

Authors
  1. J. D. van Dijk
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  2. J. A. van Dalen
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  3. S. Knollema
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  4. M. Mouden
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  5. J. P. Ottervanger
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  6. P. L. Jager
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Corresponding author

Correspondence to J. D. van Dijk.

Ethics declarations

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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None of the authors have anything to disclose.

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van Dijk, J.D., van Dalen, J.A., Knollema, S. et al. Minimal rest activity for SPECT myocardial perfusion imaging in a one-day stress-first protocol. Eur J Nucl Med Mol Imaging 46, 1248–1256 (2019). https://doi.org/10.1007/s00259-018-4206-x

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  • DOI: https://doi.org/10.1007/s00259-018-4206-x

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