Pub Date : 2025-02-01DOI: 10.1016/j.nuclcard.2024.102072
Valerie Builoff BS , Cathleen Huang BA , Keiichiro Kuronuma MD, PhD , Chih-Chun Wei MS , Hidesato Fujito MD, PhD , Yuka Otaki MD, PhD , Serge D. Van Kriekinge PhD , Paul Kavanagh MS , Mark Lemley BS , Mark C. Hyun CNMT , Marcelo Di Carli MD , Daniel S. Berman MD , Piotr J. Slomka PhD
Background
Motion correction (MC) is critical for accurate quantification of myocardial blood flow (MBF) and flow reserve (MFR) from 18F-flurpiridaz positron emission tomography (PET) myocardial perfusion imaging (MPI). However, manual correction is time consuming and introduces inter-observer variability. We aimed to validate an automatic MC algorithm for 18F-flurpiridaz PET-MPI in terms of diagnostic performance for predicting coronary artery disease (CAD).
Methods
In total, 231 patients who underwent invasive coronary angiography and rest/pharmacologic stress 18F-flurpiridaz PET-MPI from the phase III Flurpiridaz trial (NCT01347710) were enrolled. For manual MC, two operators (Reader 1 and Reader 2) shifted each frame's images in three directions. The automatic MC algorithm, initially developed for 82Rb-chloride PET-MPI, was optimized for 18F-flurpiridaz. Diagnostic performance was compared using minimal segmental MBF/MFR with and without MC to predict obstructive CAD by invasive coronary angiography.
Results
Manual MC took 10 minutes per case (both stress and rest) on average, while automatic MC required <10 seconds. The area under the receiver operating characteristic curves (AUCs) for significant CAD using minimal segmental MBF were comparable between automatic and manual MC (AUC = 0.877 automatic, AUC = 0.888 Reader 1 and AUC = 0.892 Reader 2; all P > 0.05). AUCs of minimal segmental MBF with manual and automatic MC were significantly higher than without MC (P < 0.05 for both). Similar findings were observed with minimal segmental MFR.
Conclusions
Automatic MC can be performed rapidly, with diagnostic performance for predicting obstructive CAD comparable to manual MC. This method could be utilized for analysis of MBF/MFR in patients undergoing 18F-flurpiridaz PET-MPI.
背景：运动校正（MC）是 18F-flurpiridaz PET 心肌灌注成像（MPI）准确量化心肌血流（MBF）和血流储备（MFR）的关键。然而，手动校正不仅耗时，而且会造成观察者之间的差异。我们的目的是验证 18F-flurpiridaz PET-MPI 的自动 MC 算法在预测冠状动脉疾病（CAD）方面的诊断性能：共231名患者接受了有创冠状动脉造影术和静息/药物应激18F-氟匹利达PET-MPI检查，这些患者来自氟匹利达Ⅲ期试验（NCT01347710）。在手动 MC 算法中，两名操作员（阅读器 1 和阅读器 2）将每帧图像向三个方向移动。自动 MC 算法最初是为 82Rb 氯化物 PET-MPI 开发的，后针对 18F 氟匹利达进行了优化。使用最小节段 MBF/MFR（有 MC 和无 MC）比较了诊断性能，以通过血管造影预测血管狭窄≥70% 的 CAD：手动 MC 平均每例花费 10 分钟（包括压力和静息），而自动 MC 仅需 0.05 分钟。）使用手动和自动 MC 的最小节段 MBF 的 AUC 明显高于不使用 MC 的情况（p 结论：自动 MC 可以快速进行，并具有较高的成本效益：自动MC可快速进行，其预测阻塞性CAD的诊断性能与手动MC相当。这种方法可用于分析接受 18F-flurpiridaz PET-MPI 检查的患者的 MBF/MFR。
{"title":"Automatic motion correction for myocardial blood flow estimation improves diagnostic performance for coronary artery disease in 18F-flurpiridaz positron emission tomography-myocardial perfusion imaging","authors":"Valerie Builoff BS , Cathleen Huang BA , Keiichiro Kuronuma MD, PhD , Chih-Chun Wei MS , Hidesato Fujito MD, PhD , Yuka Otaki MD, PhD , Serge D. Van Kriekinge PhD , Paul Kavanagh MS , Mark Lemley BS , Mark C. Hyun CNMT , Marcelo Di Carli MD , Daniel S. Berman MD , Piotr J. Slomka PhD","doi":"10.1016/j.nuclcard.2024.102072","DOIUrl":"10.1016/j.nuclcard.2024.102072","url":null,"abstract":"<div><h3>Background</h3><div>Motion correction (MC) is critical for accurate quantification of myocardial blood flow (MBF) and flow reserve (MFR) from <sup>18</sup>F-flurpiridaz positron emission tomography (PET) myocardial perfusion imaging (MPI). However, manual correction is time consuming and introduces inter-observer variability. We aimed to validate an automatic MC algorithm for <sup>18</sup>F-flurpiridaz PET-MPI in terms of diagnostic performance for predicting coronary artery disease (CAD).</div></div><div><h3>Methods</h3><div>In total, 231 patients who underwent invasive coronary angiography and rest/pharmacologic stress <sup>18</sup>F-flurpiridaz PET-MPI from the phase III Flurpiridaz trial (NCT01347710) were enrolled. For manual MC, two operators (Reader 1 and Reader 2) shifted each frame's images in three directions. The automatic MC algorithm, initially developed for <sup>82</sup>Rb-chloride PET-MPI, was optimized for <sup>18</sup>F-flurpiridaz. Diagnostic performance was compared using minimal segmental MBF/MFR with and without MC to predict obstructive CAD by invasive coronary angiography.</div></div><div><h3>Results</h3><div>Manual MC took 10 minutes per case (both stress and rest) on average, while automatic MC required <10 seconds. The area under the receiver operating characteristic curves (AUCs) for significant CAD using minimal segmental MBF were comparable between automatic and manual MC (AUC = 0.877 automatic, AUC = 0.888 Reader 1 and AUC = 0.892 Reader 2; all <em>P</em> > 0.05). AUCs of minimal segmental MBF with manual and automatic MC were significantly higher than without MC (<em>P</em> < 0.05 for both). Similar findings were observed with minimal segmental MFR.</div></div><div><h3>Conclusions</h3><div>Automatic MC can be performed rapidly, with diagnostic performance for predicting obstructive CAD comparable to manual MC. This method could be utilized for analysis of MBF/MFR in patients undergoing <sup>18</sup>F-flurpiridaz PET-MPI.</div></div>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"44 ","pages":"Article 102072"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.nuclcard.2024.102042
Bethlehem Mengesha MD, Gary Small MD, David Ian Paterson MD, Benjamin Chow MD
Myocardial perfusion abnormalities and altered myocardial blood flow have been described in cardiac amyloidosis. Transient ischemic dilatation (TID) on perfusion imaging has been seen in the presence of multivessel coronary artery disease (CAD), hypertrophic cardiomyopathy, significant LV systolic dysfunction and hypertensive cardiomyopathy. But to our knowledge this phenomenon has not been described in cardiac amyloidosis. We present a case of cardiac amyloidosis presenting with transient ischemic dilatation on myocardial perfusion imaging.
{"title":"Transient ischemic dilatation in cardiac amyloidosis","authors":"Bethlehem Mengesha MD, Gary Small MD, David Ian Paterson MD, Benjamin Chow MD","doi":"10.1016/j.nuclcard.2024.102042","DOIUrl":"10.1016/j.nuclcard.2024.102042","url":null,"abstract":"<div><div>Myocardial perfusion abnormalities and altered myocardial blood flow have been described in cardiac amyloidosis. Transient ischemic dilatation (TID) on perfusion imaging has been seen in the presence of multivessel coronary artery disease (CAD), hypertrophic cardiomyopathy, significant LV systolic dysfunction and hypertensive cardiomyopathy. But to our knowledge this phenomenon has not been described in cardiac amyloidosis. We present a case of cardiac amyloidosis presenting with transient ischemic dilatation on myocardial perfusion imaging.</div></div>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"44 ","pages":"Article 102042"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142267680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.nuclcard.2024.102083
Chun-Yuan Khoo MBBS , Jennifer Maning DO , Richard Weinberg MD, PhD , Ryan Avery MD , Vinesh Appadurai MD , Sanjiv Shah MD , Korosh Sharain MD , Scott M. Leonard BSc , Logan Robert Linscheid BSc , Chen Chen MD , Anahita Iyer BSc , Susan Lehrer BSc , Ike S. Okwuosa MD , Paul C. Cremer MD, MS
{"title":"Correlation between technetium-99m pyrophosphate myocardial uptake and extracellular volume on cardiac magnetic resonance imaging in patients with transthyretin cardiac amyloidosis","authors":"Chun-Yuan Khoo MBBS , Jennifer Maning DO , Richard Weinberg MD, PhD , Ryan Avery MD , Vinesh Appadurai MD , Sanjiv Shah MD , Korosh Sharain MD , Scott M. Leonard BSc , Logan Robert Linscheid BSc , Chen Chen MD , Anahita Iyer BSc , Susan Lehrer BSc , Ike S. Okwuosa MD , Paul C. Cremer MD, MS","doi":"10.1016/j.nuclcard.2024.102083","DOIUrl":"10.1016/j.nuclcard.2024.102083","url":null,"abstract":"","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"44 ","pages":"Article 102083"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1016/j.nuclcard.2025.102143
Sanjay Divakaran, Hendrik J Harms, Matthew Robertson, Sai K Merugumala, Mi-Ae Park, Marie F Kijewski, Laurel B Martell, Victoria Morgan, Leanne Barrett, Anna Perillo, David Yang, Petr Jarolim, Mark W Feinberg, Marie D Gerhard-Herman, Michael Belkin, Alexander P Lin, Mark A Creager, Marc P Bonaca, Marcelo F Di Carli
Background: The pathophysiology of symptoms and reduced exercise capacity from peripheral artery disease (PAD) remains unclear. Additionally, there is limited information on blood flow and skeletal muscle energetics after walking exercise in patients with claudication in comparison to healthy individuals.
Methods: We prospectively enrolled 19 patients with claudication from PAD and 12 healthy subjects. All participants underwent rest and post-exercise perfusion imaging of the lower leg muscles via PET/CT. Participants exercised on a treadmill following the Gardner-Skinner protocol. Skeletal muscle blood flow (SMBF) was quantified in each leg at rest and immediately after exercise. Phosphocreatine (PCr) recovery and NAD+/NADH concentrations were measured pre- and post-exercise by 31P magnetic resonance spectroscopy (MRS) in a subset of participants. Comparisons were made between the legs of healthy subjects and the asymptomatic and symptomatic legs of patients with PAD.
Results: SMBF increased post-exercise in all participants. Among patients with PAD, the post-exercise/rest SMBF ratio, was higher in the symptomatic (n = 25) than asymptomatic (n = 13) legs (8.03 ± 2.84 vs 6.03 ± 2.81, P = 0.046) and higher than the post-exercise/rest SMBF ratio measured in the legs of healthy subjects (4.40 ± 1.47, P < 0.001). The post-exercise/rest PCr and NAD+/NADH ratios were lower in the legs of patients with PAD (n = 3) when compared with the legs of healthy subjects (n = 6) (0.79 ± 0.06 vs 1.00 ± 0.07 (P = 0.004) and 1.15 ± 0.43 vs 2.08 ± 0.30 (P = 0.007), respectively).
Conclusions: SMBF increased post-exercise to the greatest degree in the symptomatic legs of patients with PAD and post-exercise skeletal muscle mitochondrial function was abnormal in patients with PAD. These data suggest that the causes of symptoms and reduced exercise capacity from PAD are not limited to abnormal perfusion pressure in the legs.
{"title":"Post-walking exercise skeletal muscle perfusion and energetics in patients with symptomatic lower extremity peripheral artery disease.","authors":"Sanjay Divakaran, Hendrik J Harms, Matthew Robertson, Sai K Merugumala, Mi-Ae Park, Marie F Kijewski, Laurel B Martell, Victoria Morgan, Leanne Barrett, Anna Perillo, David Yang, Petr Jarolim, Mark W Feinberg, Marie D Gerhard-Herman, Michael Belkin, Alexander P Lin, Mark A Creager, Marc P Bonaca, Marcelo F Di Carli","doi":"10.1016/j.nuclcard.2025.102143","DOIUrl":"10.1016/j.nuclcard.2025.102143","url":null,"abstract":"<p><strong>Background: </strong>The pathophysiology of symptoms and reduced exercise capacity from peripheral artery disease (PAD) remains unclear. Additionally, there is limited information on blood flow and skeletal muscle energetics after walking exercise in patients with claudication in comparison to healthy individuals.</p><p><strong>Methods: </strong>We prospectively enrolled 19 patients with claudication from PAD and 12 healthy subjects. All participants underwent rest and post-exercise perfusion imaging of the lower leg muscles via PET/CT. Participants exercised on a treadmill following the Gardner-Skinner protocol. Skeletal muscle blood flow (SMBF) was quantified in each leg at rest and immediately after exercise. Phosphocreatine (PCr) recovery and NAD<sup>+</sup>/NADH concentrations were measured pre- and post-exercise by <sup>31</sup>P magnetic resonance spectroscopy (MRS) in a subset of participants. Comparisons were made between the legs of healthy subjects and the asymptomatic and symptomatic legs of patients with PAD.</p><p><strong>Results: </strong>SMBF increased post-exercise in all participants. Among patients with PAD, the post-exercise/rest SMBF ratio, was higher in the symptomatic (n = 25) than asymptomatic (n = 13) legs (8.03 ± 2.84 vs 6.03 ± 2.81, P = 0.046) and higher than the post-exercise/rest SMBF ratio measured in the legs of healthy subjects (4.40 ± 1.47, P < 0.001). The post-exercise/rest PCr and NAD<sup>+</sup>/NADH ratios were lower in the legs of patients with PAD (n = 3) when compared with the legs of healthy subjects (n = 6) (0.79 ± 0.06 vs 1.00 ± 0.07 (P = 0.004) and 1.15 ± 0.43 vs 2.08 ± 0.30 (P = 0.007), respectively).</p><p><strong>Conclusions: </strong>SMBF increased post-exercise to the greatest degree in the symptomatic legs of patients with PAD and post-exercise skeletal muscle mitochondrial function was abnormal in patients with PAD. These data suggest that the causes of symptoms and reduced exercise capacity from PAD are not limited to abnormal perfusion pressure in the legs.</p>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":" ","pages":"102143"},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Amyloidosis is a multisystem disease characterized by the deposition of amyloid fibrils, leading to organ dysfunction. When cardiac amyloidosis is suspected, it is essential to screen for light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR), the two most common subtypes.
Case presentation: We report a patient with advanced heart failure and mild kidney dysfunction as initial symptoms. Preliminary testing revealed a slightly abnormal light chain ratio and a strong positive Tc-99 m pyrophosphate (PYP) scan. Biopsies of the heart, bone marrow, and kidney confirmed amyloidosis. Further immunofluorescence and mass spectrometry analysis identified immunoglobulin G and lambda light chain deposits. The patient was diagnosed with multiple myeloma and heavy and light chain amyloidosis (AHL) and initiated treatment with cyclophosphamide, bortezomib, and dexamethasone, rather than tafamidis, an oral transthyretin kinetic stabilizer used for ATTR.
Conclusions: AHL amyloidosis is a rare subtype. This case demonstrates that a positive PYP scan, even with intense uptake, is not entirely specific for ATTR. Tissue confirmation is essential for a definitive diagnosis, particularly when light chain disease or other rare forms are suspected, because AL/AHL and ATTR have distinct treatments and prognoses and may coexist.
{"title":"AHL amyloidosis mimicking transthyretin amyloidosis on cardiac Tc-99 m pyrophosphate scan: A diagnostic challenge.","authors":"Ting-Jui Hsu, Chin-Te Tseng, Ling Kuo, Chih-Yu Yang, Yao-Ping Lin, Wen-Chung Yu, Der-Cherng Tarng","doi":"10.1016/j.nuclcard.2025.102147","DOIUrl":"10.1016/j.nuclcard.2025.102147","url":null,"abstract":"<p><strong>Background: </strong>Amyloidosis is a multisystem disease characterized by the deposition of amyloid fibrils, leading to organ dysfunction. When cardiac amyloidosis is suspected, it is essential to screen for light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR), the two most common subtypes.</p><p><strong>Case presentation: </strong>We report a patient with advanced heart failure and mild kidney dysfunction as initial symptoms. Preliminary testing revealed a slightly abnormal light chain ratio and a strong positive Tc-99 m pyrophosphate (PYP) scan. Biopsies of the heart, bone marrow, and kidney confirmed amyloidosis. Further immunofluorescence and mass spectrometry analysis identified immunoglobulin G and lambda light chain deposits. The patient was diagnosed with multiple myeloma and heavy and light chain amyloidosis (AHL) and initiated treatment with cyclophosphamide, bortezomib, and dexamethasone, rather than tafamidis, an oral transthyretin kinetic stabilizer used for ATTR.</p><p><strong>Conclusions: </strong>AHL amyloidosis is a rare subtype. This case demonstrates that a positive PYP scan, even with intense uptake, is not entirely specific for ATTR. Tissue confirmation is essential for a definitive diagnosis, particularly when light chain disease or other rare forms are suspected, because AL/AHL and ATTR have distinct treatments and prognoses and may coexist.</p>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":" ","pages":"102147"},"PeriodicalIF":3.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-25DOI: 10.1016/j.nuclcard.2025.102145
Albert Flotats
{"title":"Cardiac denervation and morpho-functional changes, two sides of the same coin in wild-type transthyretin amyloid cardiomyopathy?","authors":"Albert Flotats","doi":"10.1016/j.nuclcard.2025.102145","DOIUrl":"10.1016/j.nuclcard.2025.102145","url":null,"abstract":"","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":" ","pages":"102145"},"PeriodicalIF":3.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: This large-scale study analyzes factors affecting the diagnostic accuracy of low-dose myocardial perfusion imaging and correlation with coronary angiography in a real-world practice.
Methods: We compared data extracted from routine reports of (i) low-dose [99mTc]sestamibi stress-MPI performed with no attenuation correction and predominantly exercise stress testing and (ii) the corresponding coronary angiography.
Results: We considered 1070 pairs of coronary angiography/stress-MPI results reported by 11 physicians. Mean MPI effective dose was 4.5 ± 2.1 mSv. The extent of MPI-ischemia was predictive of >70% but not 50%-70% coronary stenoses. A positive test was associated with a sensitivity of 74.7% (413/553) and a specificity of 53.2% (275/517) for >70% stenosis detection. Positive predictive values were lower in patients with left bundle branch block or pacemakers (LBBB/PM) (45.6% vs 64.7%, P = .006) and markedly higher for patients with MPI-ischemia ≥3 segments or associated with ST-segment depression (75.0% (165/220)) as compared to those with <3 segments MPI-ischemia, MPI-infarction or isolated ST-segment depression (57% (248.0/435), P < .001). Negative predictive values were lower for patients with previous coronary artery disease (CAD) history (58.3%), male (61.0%), and elderly patients (59.6%) (vs 72.1%, 79.2%, and 72.4%, respectively, all P < .05).
Conclusions: Routine results from low-dose stress-MPI, predominantly associated with exercise stress testing and uncorrected for attenuation, correlate with real-world coronary angiography results. However, this correlation is lower than that achieved with conventional study designs and affected by the definition of significant CAD and context variables (LBBB/PM, CAD history, sex, and age). Better consideration of these interacting factors could improve patient monitoring.
{"title":"Diagnostic accuracy of low-dose myocardial perfusion imaging in a real-world setting.","authors":"Mathieu Perrin, Marine Claudin, Karim Djaballah, Caroline Boursier, Antoine Verger, Laetitia Imbert, Véronique Roch, Matthieu Doyen, Loïc Marie, Gilles Karcher, Batric Popovic, Zohra Lamiral, Edoardo Camenzind, Pierre-Yves Marie","doi":"10.1016/j.nuclcard.2025.102140","DOIUrl":"10.1016/j.nuclcard.2025.102140","url":null,"abstract":"<p><strong>Background: </strong>This large-scale study analyzes factors affecting the diagnostic accuracy of low-dose myocardial perfusion imaging and correlation with coronary angiography in a real-world practice.</p><p><strong>Methods: </strong>We compared data extracted from routine reports of (i) low-dose [<sup>99m</sup>Tc]sestamibi stress-MPI performed with no attenuation correction and predominantly exercise stress testing and (ii) the corresponding coronary angiography.</p><p><strong>Results: </strong>We considered 1070 pairs of coronary angiography/stress-MPI results reported by 11 physicians. Mean MPI effective dose was 4.5 ± 2.1 mSv. The extent of MPI-ischemia was predictive of >70% but not 50%-70% coronary stenoses. A positive test was associated with a sensitivity of 74.7% (413/553) and a specificity of 53.2% (275/517) for >70% stenosis detection. Positive predictive values were lower in patients with left bundle branch block or pacemakers (LBBB/PM) (45.6% vs 64.7%, P = .006) and markedly higher for patients with MPI-ischemia ≥3 segments or associated with ST-segment depression (75.0% (165/220)) as compared to those with <3 segments MPI-ischemia, MPI-infarction or isolated ST-segment depression (57% (248.0/435), P < .001). Negative predictive values were lower for patients with previous coronary artery disease (CAD) history (58.3%), male (61.0%), and elderly patients (59.6%) (vs 72.1%, 79.2%, and 72.4%, respectively, all P < .05).</p><p><strong>Conclusions: </strong>Routine results from low-dose stress-MPI, predominantly associated with exercise stress testing and uncorrected for attenuation, correlate with real-world coronary angiography results. However, this correlation is lower than that achieved with conventional study designs and affected by the definition of significant CAD and context variables (LBBB/PM, CAD history, sex, and age). Better consideration of these interacting factors could improve patient monitoring.</p>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":" ","pages":"102140"},"PeriodicalIF":3.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.nuclcard.2024.102088
Christiane Wiefels MD , Kevin Boczar MD , David Birnie MBChB , Rob Beanlands MD , Panithaya Chareonthaitawee MD
Sarcoidosis is a systemic disorder characterized by non-necrotizing granulomatous inflammation and fibrosis affecting multiple organs, notably the lungs and lymph nodes. Cardiac sarcoidosis (CS), a subset of the disease predominantly involving the heart, significantly heightens the associated morbidity and mortality of sarcoidosis. Early detection of CS is crucial for optimal management. Positron emission tomography/computed tomography (PET/CT) using 18F-fluorodeoxyglucose (18F-FDG) has emerged as an important diagnostic, prognostic, and monitoring tool for CS. Guidelines emphasize a combined approach of visual interpretation and adjunctive quantitative metrics to enhance diagnostic accuracy and treatment monitoring. Various quantitative parameters including maximum standardized uptake value (SUVmax), coefficient of variation, and texture analysis show promise as auxiliary tools diagnosing and prognosticating CS. However, standardization and validation of these quantitative methods remain challenging due to inter-center variability and technological differences. Further validation through large-scale, multi-center studies is needed to optimize their use and better delineate their role in CS diagnosis, prognostication, and therapy monitoring.
{"title":"Quantification of metabolic activity in the evaluation of cardiac sarcoidosis","authors":"Christiane Wiefels MD , Kevin Boczar MD , David Birnie MBChB , Rob Beanlands MD , Panithaya Chareonthaitawee MD","doi":"10.1016/j.nuclcard.2024.102088","DOIUrl":"10.1016/j.nuclcard.2024.102088","url":null,"abstract":"<div><div>Sarcoidosis is a systemic disorder characterized by non-necrotizing granulomatous inflammation and fibrosis affecting multiple organs, notably the lungs and lymph nodes. Cardiac sarcoidosis (CS), a subset of the disease predominantly involving the heart, significantly heightens the associated morbidity and mortality of sarcoidosis. Early detection of CS is crucial for optimal management. Positron emission tomography/computed tomography (PET/CT) using 18F-fluorodeoxyglucose (18F-FDG) has emerged as an important diagnostic, prognostic, and monitoring tool for CS. Guidelines emphasize a combined approach of visual interpretation and adjunctive quantitative metrics to enhance diagnostic accuracy and treatment monitoring. Various quantitative parameters including maximum standardized uptake value (SUVmax), coefficient of variation, and texture analysis show promise as auxiliary tools diagnosing and prognosticating CS. However, standardization and validation of these quantitative methods remain challenging due to inter-center variability and technological differences. Further validation through large-scale, multi-center studies is needed to optimize their use and better delineate their role in CS diagnosis, prognostication, and therapy monitoring.</div></div>","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"43 ","pages":"Article 102088"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.nuclcard.2024.102085
Ahmed Aljizeeri MBBS , Mouaz H. Al-Mallah MD, MSc
{"title":"Heart rate and blood pressure response to vasodilator stress: A trip back to the future","authors":"Ahmed Aljizeeri MBBS , Mouaz H. Al-Mallah MD, MSc","doi":"10.1016/j.nuclcard.2024.102085","DOIUrl":"10.1016/j.nuclcard.2024.102085","url":null,"abstract":"","PeriodicalId":16476,"journal":{"name":"Journal of Nuclear Cardiology","volume":"43 ","pages":"Article 102085"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.nuclcard.2024.102071
Xirang Zhang MS , Yongyi Yang PhD , P. Hendrik Pretorius PhD , Piotr J. Slomka PhD , Michael A. King PhD
Background
In myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT), ungated studies are used for evaluation of perfusion defects despite motion blur. We investigate the potential benefit of motion correction using a deep-learning (DL) network for evaluating perfusion defects.
Methods
We employed a DL network for cardiac motion correction in ECG-gated SPECT-MPI images, wherein the image data from different cardiac phases are combined with respect to a reference gate to reduce motion blur. For training the DL network, 197 cases were used. Given the variability of gated images during the cardiac cycle, we investigated the detectability of perfusion defects in two distinct reference gates. To assess perfusion defect detection, we performed receiver-operating characteristic (ROC) analyses on the motion-corrected images using a separate test dataset of clinical 194 subjects, in which studies were created from actual patient data with inserted simulated-lesions as ground truth. The reconstructed images were assessed by the quantitative-perfusion SPECT (QPS) software. We also evaluated the performance on reduced-count studies (by two and four folds).
Results
The quantitative results, measured by area-under-the-ROC curve (AUC), demonstrated that DL motion correction improves the detectability of perfusion defects significantly on both standard- and reduced-count studies, and that the detectability can vary with reference cardiac phases. A joint assessment from two reference phases achieved AUC = 0.841 on the quarter-count data, higher than with ungated full-count data (AUC = 0.795, P-value = 0.0054).
Conclusions
DL motion correction can benefit assessment of perfusion defects in standard- and reduced-count SPECT-MPI studies. It can also be beneficial to evaluate perfusion images over multiple cardiac phases.
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