How is gated myocardial perfusion single-photon emission computed tomography (SPECT) performed in the workup of myocardial ischemia?

Answer

As previously noted, gated images are obtained after the stress test is performed. With the use of a single-headed camera, a 180° acquisition is usually obtained with 32 stops. ECG gating is used, even when the patient has a cardiac arrhythmia, such as atrial fibrillation. After image acquisition, processing generates cine images that show wall motion and wall thickening. In addition, ventricular volumes and polar maps are generated.^{[27, 28, 29, 30, 36, 45, 10, 17]}

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Aggarwal A, Brown KA, LeWinter MM. Diastolic dysfunction: pathophysiology, clinical features, and assessment with radionuclide methods. J Nucl Cardiol. 2001 Jan-Feb. 8(1):98-106. [Medline].
Eggers KM, Oldgren J, Nordenskjöld A, Lindahl B. Combining different biochemical markers of myocardial ischemia does not improve risk stratification in chest pain patients compared to troponin I alone. Coron Artery Dis. 2005 Aug. 16(5):315-9. [Medline].
Berman DS, Germano G. Nuclear cardiology: where do we stand? Part 1. Available online at www.fac.org.ar/cvirtual/cvirteng/cienteng/mneng/mnm3007i/iberman/berman.htm. Accessed April 25, 2003. [Full Text].
American Society of Nuclear Cardiology. About Nuclear Cardiology. ASNC. Available at https://www.asnc.org/content.asp?contentid=6. 2019; Accessed: August 7, 2019.
Gomez J, Doukky R, Germano G, Slomka P. New Trends in Quantitative Nuclear Cardiology Methods. Curr Cardiovasc Imaging Rep. 2018 Jan. 11 (1):[Medline].
[Guideline] Tilkemeier PL, Bourque J, Doukky R, Sanghani R, Weinberg RL. ASNC imaging guidelines for nuclear cardiology procedures : Standardized reporting of nuclear cardiology procedures. J Nucl Cardiol. 2017 Dec. 24 (6):2064-2128. [Medline]. [Full Text].
Milanesi O, Stellin G, Zucchetta P. Nuclear Medicine in Pediatric Cardiology. Semin Nucl Med. 2017 Mar. 47 (2):158-169. [Medline].
Lee WW. Recent Advances in Nuclear Cardiology. Nucl Med Mol Imaging. 2016 Sep. 50 (3):196-206. [Medline].
Osborne MT, Hulten EA, Murthy VL, Skali H, Taqueti VR, Dorbala S, et al. Patient preparation for cardiac fluorine-18 fluorodeoxyglucose positron emission tomography imaging of inflammation. J Nucl Cardiol. 2017 Feb. 24 (1):86-99. [Medline].
Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol. 2016 Jun. 23 (3):606-39. [Medline].
Dorbala S, Ananthasubramaniam K, Armstrong IS, Chareonthaitawee P, DePuey EG, Einstein AJ, et al. Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation. J Nucl Cardiol. 2018 Oct. 25 (5):1784-1846. [Medline].
Fang W, Liu S. New 99mTc Radiotracers for Myocardial Perfusion Imaging by SPECT. Curr Radiopharm. 2019 Feb 5. [Medline].
Alzahrani T, Zeltser R. Adenosine SPECT Thallium Imaging. 2019 Jan. [Medline]. [Full Text].
Manabe O, Kikuchi T, Scholte AJHA, et al. Radiopharmaceutical tracers for cardiac imaging. J Nucl Cardiol. 2018 Aug. 25 (4):1204-1236.:1204.
Driessen RS, Raijmakers PG, Stuijfzand WJ, et al. Myocardial perfusion imaging with PET. Int J Cardiovasc Imaging. 2017 Jul;33(7):1021-1031.
Slart RH, Zeebregts CJ, Hillege HL, et al. Myocardial perfusion reserve after a PET-driven revascularization procedure: a strong prognostic factor. J Nucl Med. 2011 Jun. 52(6):873-9. [Medline].
Daou D, Sabbah R, Coaguila C, Alattar Y, Boulahdour H. A new era in gated myocardial perfusion imaging: Feasibility of data-driven cardiac contraction gating with multiple pinhole CZT SPECT. J Nucl Cardiol. 2018 Feb. 25 (1):257-268. [Medline].
Kapetanopoulos A, Ahlberg AW, Taub CC, Katten DM, Heller GV. Regional wall-motion abnormalities on post-stress electrocardiographic-gated technetium-99m sestamibi single-photon emission computed tomography imaging predict cardiac events. J Nucl Cardiol. 2007 Nov-Dec. 14(6):810-7. [Medline].
Petretta M, Costanzo P, Acampa W, Imbriaco M, Ferro A, Filardi PP, et al. Noninvasive assessment of coronary anatomy and myocardial perfusion: going toward an integrated imaging approach. J Cardiovasc Med (Hagerstown). 2008 Oct. 9(10):977-86. [Medline].
Taqueti VR, Di Carli MF. Radionuclide Myocardial Perfusion Imaging for the Evaluation of Patients with Known or Suspected Coronary Artery Disease in the Era of Multimodality Cardiovascular Imaging. Prog Cardiovasc Dis. 2015 Mar 11. [Medline].
Hori Y, Yoda S, Nakanishi K, Tano A, Suzuki Y, Matsumoto N, et al. Myocardial ischemic reduction evidenced by gated myocardial perfusion imaging after treatment results in good prognosis in patients with coronary artery disease. J Cardiol. 2015 Apr. 65(4):278-84. [Medline].
Gordon DePuey E 3rd. Advances in cardiac processing software. Semin Nucl Med. 2014 Jul. 44(4):252-73. [Medline].
Slomka PJ, Berman DS, Germano G. New cardiac cameras: single-photon emission CT and PET. Semin Nucl Med. 2014 Jul. 44(4):232-51. [Medline].
Sogbein OO, Pelletier-Galarneau M, Schindler TH, Wei L, Wells RG, Ruddy TD. New SPECT and PET radiopharmaceuticals for imaging cardiovascular disease. Biomed Res Int. 2014. 2014:942960. [Medline]. [Full Text].
Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med. 1979 Jun 14. 300(24):1350-8. [Medline].
Sanz GA. [Risk stratification in acute coronary syndromes: an unresolved issue]. Rev Esp Cardiol. 2007 Oct. 60 Suppl 3:23-30. [Medline].
Hachamovitch R, Kang X, Amanullah AM, Abidov A, Hayes SW, Friedman JD, et al. Prognostic implications of myocardial perfusion single-photon emission computed tomography in the elderly. Circulation. 2009 Dec 1. 120(22):2197-206. [Medline].
Uebleis C, Becker A, Griesshammer I, Cumming P, Becker C, Schmidt M, et al. Stable coronary artery disease: prognostic value of myocardial perfusion SPECT in relation to coronary calcium scoring--long-term follow-up. Radiology. 2009 Sep. 252(3):682-90. [Medline].
Machecourt J, Longère P, Fagret D, Vanzetto G, Wolf JE, Polidori C, et al. Prognostic value of thallium-201 single-photon emission computed tomographic myocardial perfusion imaging according to extent of myocardial defect. Study in 1,926 patients with follow-up at 33 months. J Am Coll Cardiol. 1994 Apr. 23(5):1096-106. [Medline].
Berman DS, Germano G. An approach to the interpretation and reporting of gated myocardial perfusion SPECT. Germano G, Berman DS, eds. Clinical Gated Cardiac SPECT. Armonk, NY: Futura Publishing Co; 1999. 147-82.
Steel K, Broderick R, Gandla V, Larose E, Resnic F, Jerosch-Herold M, et al. Complementary prognostic values of stress myocardial perfusion and late gadolinium enhancement imaging by cardiac magnetic resonance in patients with known or suspected coronary artery disease. Circulation. 2009 Oct 6. 120(14):1390-400. [Medline]. [Full Text].
Wilson PW, D''Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998 May 12. 97(18):1837-47. [Medline]. [Full Text].
Mark DB, Hlatky MA, Harrell FE Jr, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med. 1987 Jun. 106(6):793-800. [Medline].
Mark DB, Shaw L, Harrell FE Jr, Hlatky MA, Lee KL, Bengtson JR, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991 Sep 19. 325(12):849-53. [Medline].
Egred M, Waiter GD, Redpath TW, Semple SK, Al-Mohammad A, Walton S. Blood oxygen level-dependent (BOLD) MRI: A novel technique for the assessment of myocardial ischemia as identified by nuclear imaging SPECT. Eur J Intern Med. 2007 Dec. 18(8):581-6. [Medline].
van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W, et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol. 2009 Feb 17. 53(7):623-32. [Medline].
Hashimoto A, Nakata T, Wakabayashi T, Kusuoka H, Nishimura T. Incremental prognostic value of stress/rest gated perfusion SPECT in patients with coronary artery disease--subanalysis of the J-ACCESS study. Circ J. 2009 Dec. 73(12):2288-93. [Medline].
Muzaffar R, Raslan O, Ahmed F, Goldfarb L, Sterkel B, Osman MM. Incidental Findings on Myocardial Perfusion SPECT Images. J Nucl Med Technol. 2017 Sep. 45 (3):175-180. [Medline].
Smulders MW, Jaarsma C, Nelemans PJ, Bekkers SCAM, Bucerius J, Leiner T, et al. Comparison of the prognostic value of negative non-invasive cardiac investigations in patients with suspected or known coronary artery disease-a meta-analysis. Eur Heart J Cardiovasc Imaging. 2017 Sep 1. 18 (9):980-987. [Medline]. [Full Text].
Scheuermeyer FX, Innes G, Grafstein E, Kiess M, Boychuk B, Yu E, et al. Safety and efficiency of a chest pain diagnostic algorithm with selective outpatient stress testing for emergency department patients with potential ischemic chest pain. Ann Emerg Med. 2012 Apr. 59(4):256-264.e3. [Medline].
Jain D, He ZX. Direct imaging of myocardial ischemia: a potential new paradigm in nuclear cardiovascular imaging. J Nucl Cardiol. 2008 Sep-Oct. 15(5):617-30. [Medline].
Garcia E, Slomka P, Moody J, Germano G, Ficaro E. Quantitative Clinical Nuclear Cardiology: Part 1 - Established Applications. J Nucl Med. 2019 Aug 2. [Medline].
Baghdasarian SB, Heller GV. Patient preparation for nuclear imaging: when should anti-ischemic medications be withheld?. J Nucl Cardiol. 2007 Nov-Dec. 14(6):775-81. [Medline].
Lertsburapa K, Ahlberg AW, Bateman TM, Katten D, Volker L, Cullom SJ, et al. Independent and incremental prognostic value of left ventricular ejection fraction determined by stress gated rubidium 82 PET imaging in patients with known or suspected coronary artery disease. J Nucl Cardiol. 2008 Nov-Dec. 15(6):745-53. [Medline].
[Guideline] Henzlova M, Duval WJ, Eionstein AJ, et al. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. ASNC. Available at https://www.asnc.org/files/Guidelines%20and%20Quality/ASNC%20SPECT%20ProtocolsTracers%20Guidelines2016.pdf. June 2016; Accessed: August 7, 2019.
Canty JM Jr, Fallavollita JA. Chronic hibernation and chronic stunning: a continuum. J Nucl Cardiol. 2000 Sep-Oct. 7(5):509-27. [Medline].
Bateman TM, Dilsizian V, Beanlands RS. American Society of Nuclear Cardiology and Society of Nuclear Medicine and Molecular Imaging Joint Position Statement on the Clinical Indications for Myocardial Perfusion PET. J Nucl Med. 2016 Oct. ;57(10):1654-1656:
Motwani M, Dey D, Berman DS, et al. Machine learning for prediction of all-cause mortality in patients with suspected coronary artery disease: a 5-year multicentre prospective registry analysis. Eur Heart J. 2017 Feb 14. 38 (7):500-507. [Medline].
Yoda S, Nakanishi K, Tano A, Hori Y, Suzuki Y, Matsumoto N, et al. Major cardiac event risk scores estimated with gated myocardial perfusion imaging in Japanese patients with coronary artery disease. J Cardiol. 2016 Jan. 67 (1):64-70. [Medline]. [Full Text].
Yoda S, Nakanishi K, Tano A, Hori Y, Hayase M, Mineki T, et al. Prognostic Value of Major Cardiac Event Risk Score Estimated With Gated Myocardial Perfusion Imaging in Japanese Patients With Coronary Artery Disease. Int Heart J. 2016 Jul 27. 57 (4):408-16. [Medline]. [Full Text].

Media Gallery

The risk of coronary artery disease (CAD) can quickly be stratified by determining whether the patient's pain is nonanginal, atypical, or typical. For men in their 30s with nonanginal chest pain, the pretest probability of disease is approximately 5%; however, men in their 30s with typical chest pain have a 70% likelihood of disease (a 14-fold increase).
In women, the risk of CAD can quickly be stratified on the basis of the type of chest pain. For example, a woman in her 50s with nonanginal chest pain has a pretest probability of disease of approximately 10%, whereas a woman in her 50s with typical chest pain has a pretest likelihood of approximately 80%; this rate is an 8-fold increase.
An exercise stress test is inadequate for excluding CAD when the pretest probability of disease is intermediate to high. Of 1000 American men older than 60 years who have nonanginal chest pain, the exercise stress test causes clinicians to miss almost one third of CAD cases.
Adding nuclear cardiac imaging to the stress ECG test greatly increases the clinical value of the test. Of 1000 American men older than 60 years who have nonanginal chest pain, CAD is misdiagnosed in 25 of the 281 men who have the disease; however, of these 25 patients, the annual rate of severe cardiac events (myocardial infarction or cardiac death) is still less than 1% per year.
Normal perfusion on a single-photon emission computed tomography (SPECT) perfusion study.
A SPECT perfusion study in a patient with a large degree of tracer redistribution affecting the left anterior descending and right coronary artery territories.
This study in a patient with normal findings on myocardial perfusion scanning represents the value of gated imaging in nuclear cardiac scans. The gated images show akinesis of the distal anterior wall along with a reduced left ventricular ejection fraction and an elevated end-systolic volume.
Polar maps can help identify abnormal findings on nuclear cardiac images. The polar map shows fairly good end-diastolic perfusion, a decreased regional ejection fraction and motion by the septum, and fairly normal thickening.

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