Reducing radiation dose from myocardial perfusion imaging in subjects with complex congenital heart disease
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The prevalence of defects and effective radiation dose from various myocardial perfusion imaging (MPI) strategies in congenital heart disease (CHD) is unknown.
We studied 75 subjects with complex CHD (ages 5 to 80 years) referred for MPI between 2002 and 2015. A rest and exercise or pharmacologic stress MPI was performed using 99mTechnetium sestamibi, 82rubidium or 13N-ammonia, and Sodium iodide SPECT (single-photon emission computed tomography), SPECT/CT or Cadmium zinc telluride (CZT) SPECT or PET (positron emission tomography)/CT scanners. Deidentified images were interpreted semi-quantitatively in three batches: stress only MPI, stress/rest MPI, and stress/rest MPI with taking into account a history of ventricular septal defect repair. Effective radiation dose was estimated for stress/rest MPI and predicted for 1-day stress-first (normal stress scans), and for 2-day stress/rest MPI (abnormal stress scans).
The median age was 18.6 years. The most common type of CHD was transposition of the great arteries (63%). Rest/stress MPI was abnormal in 43% of subjects and 25% of the abnormal scans demonstrated reversible defects. Of the subjects with abnormal MPI, 33% had significant underlying anatomic coronary artery obstruction. Estimated mean effective radiation dose ranged from 2.1 ± 0.6 mSv for 13N-ammonia PET/CT to 12.5 ± 0.9 mSv for SPECT/CT. Predicted effective radiation dose was significantly lower for stress-first MPI and for 2-day stress/rest protocols.
Due to the relatively high prevalence of abnormal stress MPI, tailored protocols with a stress-first MPI as well as the use of 2-day protocols and advanced imaging technologies including CZT SPECT, novel image reconstruction software, and PET MPI could substantially reduce radiation dose in complex CHD.
KeywordsComplex congenital heart disease Radiation SPECT PET Myocardial perfusion imaging
Congenital heart disease
Cardiac magnetic resonance
Cadmium zinc telluride
Myocardial perfusion imaging
Positron emission tomography
Single-photon emission computed tomography
Ventricular septal defect
Sharmila Dorbala has received consulting fees from GE and research support from Pfizer. Ron Blankstein has received research support from Astellas Inc. and Amgen Inc. Marcelo F. DiCarli has received research support from Spectrum Dynamics and Gilead. Hicham Skali has received stock options in Optimize Rx for consulting role. Viviany R. Taqueti, Anne Marie Valente, Sara L. Partington, John Bruyere, Dillenia Rosica, Keri M. Shafer, Michael J. Landzberg, Neha Kwatra, and Frederick D. Grant have nothing to disclose.
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