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Measuring myocardial blood flow using dynamic myocardial perfusion SPECT: artifacts and pitfalls

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Journal of Nuclear Cardiology Aims and scope

Abstract

Dynamic acquisition allows absolute quantification of myocardial perfusion and flow reserve, offering an alternative to overcome the potential limits of relative quantification, especially in patients with balanced multivessel coronary artery disease. SPECT myocardial perfusion is widely available, at lower cost than PET. Dynamic cardiac SPECT is now feasible and has the potential to be the next step of comprehensive perfusion imaging. In order to help nuclear cardiologists potentially interested in using dynamic perfusion SPECT, we sought to review the different steps of acquisition, processing, and reporting of dynamic SPECT studies in order to enlighten the potentially critical pitfalls and artifacts. Both patient-related and technical artifacts are discussed. Key parameters of the acquisition include pharmacological stress, radiopharmaceuticals, and injection device. When it comes to image processing, attention must be paid to image-derived input function, patient motion, and extra-cardiac activity. This review also mentions compartment models, cameras, and attenuation correction. Finally, published data enlighten some facets of dynamic cardiac SPECT while several issues remain. Harmonizing acquisition and quality control procedures will likely improve its performance and clinical strength.

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Abbreviations

CZT:

Cadmium zinc telluride

CAT:

Coronary artery disease

FFR:

Fractional flow reserve

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

AC:

Attenuation correction

MC:

Motion correction

MC:

Motion correction

SC:

Scatter correction

na:

Non available

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Acknowledgements

Alain Manrique is supported by a Grant from the GCS G4 as part of the FHU-CARNAVAL, labeled by AVIESAN.

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Authors and Affiliations

  1. Department of Nuclear Medicine, CHU de Caen Normandie, Normandie Univ, UNICAEN UR 4650 PSIR, 14000, Caen, France

    Florian Mallet MD, Denis Agostini MD, PhD & Alain Manrique MD, PhD

  2. Department of Nuclear Medicine, Jean Perrin Cancer Center, Clermont-Ferrand, France

    Florian Mallet MD

  3. INVIA Medical Imaging Solutions, Ann Arbor, MI, 48103, USA

    Alexis Poitrasson-Rivière PhD

  4. Department of Nuclear Medicine, CHU of Montpellier, PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France

    Denis Mariano-Goulart MD, PhD

  5. GIP Cyceron, Campus Jules Horowitz, Boulevard Henri Becquerel, BP 5229, 14074, Caen, France

    Alain Manrique MD, PhD

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Correspondence to Alain Manrique MD, PhD.

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Florian Mallet: no conflict of interest. Alexis Poitrasson-Rivière: Employee of INVIA Medical Imaging Solutions. Denis Mariano Goulart: no conflict of interest. Denis Agostini: Scientific consultant, Spectrum Dynamics, Israel. Alain Manrique: no conflict of interest.

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Mallet, F., Poitrasson-Rivière, A., Mariano-Goulart, D. et al. Measuring myocardial blood flow using dynamic myocardial perfusion SPECT: artifacts and pitfalls. J. Nucl. Cardiol. 30, 2006–2017 (2023). https://doi.org/10.1007/s12350-022-03165-4

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