Procedure Guidelines for Radionuclide Myocardial Perfusion Imaging (original) (raw)
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Journal of Nuclear Cardiology, 2008
Background. The American College of Cardiology Foundation/American Society of Nuclear Cardiology appropriateness criteria (AC) were created to guide responsible use of single photon emission computed tomography (SPECT). Clinical applicability of the AC has not been evaluated. Methods and Results. Indications for testing were determined in 1209 patients and categorized as having appropriate, uncertain, or inappropriate indications; the specialty of the ordering physician was noted. There were 940 (80%) appropriate, 154 (13%) inappropriate, and 79 (7%) uncertain tests; 36 tests were labeled “no category,” as these were ordered for indications not clearly addressed in the AC. Inappropriate studies had more normal and lower summed stress scores, although there remained a high proportion of abnormal SPECT studies in this group (26% of women and 50% of men). Women had lower summed stress scores and more normal tests in the appropriate and inappropriate groups. Studies ordered by anesthesiologists for preoperative evaluation were more likely to be deemed inappropriate than other specialty groups. Conclusion. In evaluating the AC in a single-center academic setting, the majority of studies are appropriate, but a large proportion of ordered SPECT studies were categorized as uncertain, inappropriate, or no category. Although the inappropriate studies showed less ischemia than other groups, especially in women, a substantial portion of these studies (32%) were abnormal.
Circulation Journal, 2011
Nuclear cardiology has played an important role in both diagnosis and risk assessments of coronary artery disease since early 1970. Among the non-invasive diagnostic tests, the great advantage of nuclear imaging is that this technique can obtain physiological information, such as myocardial perfusion, which is difficult to obtain by other techniques. When patients have inducible myocardial ischemia and sufficient viable myocardium, coronary revascularization treatment should be performed. Both stress myocardial perfusion imaging (MPI) and viability imaging provide important information. Another important aspect of stress perfusion imaging is that normal stress perfusion is associated with low risk for future cardiac events. Therefore, stress MPI plays an important role in the selection of an invasive therapeutic regime and also in avoiding unnecessary invasive procedures. As is the case for other imaging techniques, there have been many technical and instrumental developments in recent years in nuclear cardiology imaging, including new single-photon-emission computed tomography tracers, new pharmacological stress agents, a new generation of γ camera, and positron emission tomography. This review will address the advantages of nuclear cardiology in the clinical setting and recent developments in nuclear cardiology.
European journal of nuclear medicine and molecular imaging, 2015
Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM ...
European Journal of Nuclear Medicine and Molecular Imaging, 2009
Purpose This is the second of a series of surveys designed to assess myocardial perfusion scintigraphy (MPS) practice in Europe. Methods Data were collected from 258 centres in 18 countries. The number of MPS studies per million population (pmp) was estimated assuming that the nonresponding centres performed either no studies (lower estimate) or the same number as the responding centres (upper estimate). Results The responding centres served 24% of the population of their countries. The total number of noncardiac nuclear medicine studies was between 2,160 and 8,000 studies pmp. The total number of MPS studies was between 529 and 2,293 pmp. The median number of MPS studies per centre was 571 per year with 57% performing fewer than 500 studies per year and 23% of centres performing fewer than 250 studies per year. There was significant variation between countries, with higher numbers of MPS studies (lower limit of estimate above the mid-range of all countries combined) in Austria, Denmark, Hungary, Portugal and Slovenia, and lower numbers (upper limit of estimate below the mid-range of all countries) in Finland, Norway, Spain and Switzerland. The ratio of MPS to coronary angiography to revascularization procedures was 0.9 to 2.2 to 1. Pharmacological stress was used in 57% and technetium-99m-labelled tracers in 88% of studies. ECG gating was performed in 74% of studies and attenuation correction in 22%. Conclusion MPS utilization in Europe remains low compared with coronary angiography although there has been a 21% increase in the number of studies pmp in centres that reported in both 2005 and 2007. Pharmacological agents continue to be the predominant form of stress. Despite the widespread use of technetium-99m-labelled tracers, ECG gating is not universally performed. As in the 2005 survey, imaging aids such as attenuation and motion correction and prone imaging are not commonly used.
European Journal of Nuclear Medicine and Molecular Imaging, 2012
Purpose This is the second of a series of surveys designed to assess myocardial perfusion scintigraphy (MPS) practice in Europe. Methods Data were collected from 258 centres in 18 countries. The number of MPS studies per million population (pmp) was estimated assuming that the nonresponding centres performed either no studies (lower estimate) or the same number as the responding centres (upper estimate). Results The responding centres served 24% of the population of their countries. The total number of noncardiac nuclear medicine studies was between 2,160 and 8,000 studies pmp. The total number of MPS studies was between 529 and 2,293 pmp. The median number of MPS studies per centre was 571 per year with 57% performing fewer than 500 studies per year and 23% of centres performing fewer than 250 studies per year. There was significant variation between countries, with higher numbers of MPS studies (lower limit of estimate above the mid-range of all countries combined) in Austria, Denmark, Hungary, Portugal and Slovenia, and lower numbers (upper limit of estimate below the mid-range of all countries) in Finland, Norway, Spain and Switzerland. The ratio of MPS to coronary angiography to revascularization procedures was 0.9 to 2.2 to 1. Pharmacological stress was used in 57% and technetium-99m-labelled tracers in 88% of studies. ECG gating was performed in 74% of studies and attenuation correction in 22%. Conclusion MPS utilization in Europe remains low compared with coronary angiography although there has been a 21% increase in the number of studies pmp in centres that reported in both 2005 and 2007. Pharmacological agents continue to be the predominant form of stress. Despite the widespread use of technetium-99m-labelled tracers, ECG gating is not universally performed. As in the 2005 survey, imaging aids such as attenuation and motion correction and prone imaging are not commonly used.
Temporal trends in results of 9170 myocardial perfusion imaging studies (2004 to 2013)
Nuclear Medicine Review, 2015
BACKGROUND: To assess the frequency of normal and abnormal myocardial perfusion imaging (MPI) in a consecutive cohort of patients from Pakistan over a period of 8.5 years. MATERIAL AND METHODS: We assessed 9170 patients who had undergone stress-rest MPI between January 2004 and June 2013. Patients were assessed for change in demographics, risk factors, and frequency of abnormal and normal MPI. RESULTS: Overall mean age and male predominance of studied cohort was ≈ 55 years and ≈ 55:45 (M:F), respectively, with no appreciable decline or rise. Marked decline in exercise as mode of stress (from 71% to 35%, p value significant) was noted during the study period. Regarding the risk factors for CAD, only hypertension was noted to have a significant rising trend during the study period. Trend of MPI results over study period was found non-significant from 2004 till 2006 but from 2007 onward (except 2008), a marginal but significant decline in abnormal MPIs (from 45% to 42%; significant p value) and rise in normal MPI (from 55% to 58%; significant p value) was noted. CONCLUSIONS: We conclude that over the past 8.5 years, a marginal but significant decline in abnormal and a rise in normal MPIs trend have been observed. An exorbitant rise in use of vasodilator as a method of stress was also observed. We envisaged a follow-up study to ascertain lower negative predictive value of vasodilator as a possible reason and till than results of this and other such studies must be read cautiously.