The diagnostic efficacy and safety of stress-only supine and prone myocardial perfusion imaging with a dedicated cardiac gamma camera in patients with suspected or known coronary artery disease
Abstract
BACKGROUND: Myocardial perfusion scintigraphy remains one of the substantial noninvasive diagnostic methods in coronary artery disease. Recent technological advancement allowed to create novel semiconductor, dedicated cardiac gamma camera with better spatial resolution and higher energy resolution, resulting in the reduction of radiation burden and acquisition time. The aim of this study was to evaluate the efficacy and safety of stress-only supine and prone MPS with a cardiac gamma camera in patients with suspected or known coronary artery disease.
MATERIAL AND METHODS: A total number of 203 consecutive patients with suspected or known coronary artery disease, who underwent MPS were enrolled in the study. The patients without perfusion abnormalities on stress supine and prone MPS scans had no rest MPS, in the remaining patients two-day stress-rest imaging was performed. The group of 160 patients with one-year follow up was subjected to final analysis.
RESULTS: Stress-only protocol of myocardial perfusion imaging was performed in 72 patients, 88 patients underwent two-day stress and rest myocardial perfusion scintigraphy. In 46 out of 72 stress-only group of patients, prone study did not affect further proceedings. However, in over 1/3 of cases (26/72), prone scans resulted in abstaining from rest imaging. One year follow-up revealed no sudden cardiac deaths or myocardial infarctions in both (stress-only and stress-rest) groups. Revascularization was performed most often in the double-positive group — patients with significant ischaemia on myocardial perfusion images and chest pain or electrocardiographic changes or both during the stress test. In this double-positive group, all 11 patients had coronary angiography (two of them prior to myocardial perfusion scintigraphy), nine of them had subsequent revascularization.
CONCLUSIONS: In patients with no significant perfusion abnormalities on stress scans omitting rest study is safe with very good one-year risk prognosis of acute cardiac events and allows to limit the radiation exposure and procedure duration. Additional prone acquisitions are valuable supplements in determining the decision of safe early completion of myocardial perfusion imaging.
Keywords: myocardial perfusion scintigraphydedicated cardiac gamma camera
References
- Slomka PJ, Berman DS, Germano G. New Imaging Protocols for New Single Photon Emission CT Technologies. Curr Cardiovasc Imaging Rep. 2010; 3(3): 162–170.
- Edenbrandt L, Ohlsson M, Trägårdh E. Prognosis of patients without perfusion defects with and without rest study in myocardial perfusion scintigraphy. EJNMMI Res. 2013; 3: 58.
- Yokota S, Mouden M, Ottervanger JP, et al. Prognostic value of normal stress-only myocardial perfusion imaging: a comparison between conventional and CZT-based SPECT. Eur J Nucl Med Mol Imaging. 2016; 43(2): 296–301.
- Goto K, Takebayashi H, Kihara Y, et al. Impact of combined supine and prone myocardial perfusion imaging using an ultrafast cardiac gamma camera for detection of inferolateral coronary artery disease. Int J Cardiol. 2014; 174(2): 313–317.
- Nishiyama Y, Miyagawa M, Kawaguchi N, et al. Combined Supine and Prone Myocardial Perfusion Single-Photon Emission Computed Tomography With a Cadmium Zinc Telluride Camera for Detection of Coronary Artery Disease. Circulation Journal. 2014; 78(5): 1169–1175.
- Piszczek S, Dziuk M, Giżewska-Krasowska A, et al. Inferior wall attenuation artifact on CZT gamma camera. Is prone imaging better than stand-alone CT attenuation correction (CTAC)? Eur J Nucl Med Mol Imaging. 2013; 40(Suppl 2): S1–S477.
- Montalescot G, Sechtem U, Achenbach S, et al. Task Force Members, ESC Committee for Practice Guidelines, Document Reviewers. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013; 34(38): 2949–3003.
