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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2013 December;57(4):383-90


lingua: Inglese

Can upright myocardial perfusion imaging be used alone with a solid-state dedicated cardiac camera?

Hain S. F. 1, 2, Van Gramberg D. 3, Bomanji J. B. 1, Kayani I. 1, Groves A. M. 1, Ben-Haim S. 4

1 Institute of Nuclear Medicine University College London Hospitals, NHS Trust, London, UK; 2 Department of Nuclear Medicine Royal North Shore Hospital, St Leonards, NSW, Australia; 3 Siemens Ltd. Healthcare Sector, Melbourne, Australia; 4 Department Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel


Aim: The novel solid state dedicated cardiac cameras provide fast high resolution cardiac imaging. The D-SPECT camera enables semi-reclining (upright) positioning, increasing comfort and potentially reducing movement during myocardial perfusion imaging. Physicians are generally familiar with supine imaging and the different positioning in upright imaging could potentially cause diagnostic challenges. The aim of this study was to compare the upright and supine imaging for diagnostic ability to assess Physician confidence and determine any artefacts in upright imaging.
Methods: Fifty-five patients underwent myocardial perfusion imaging on the D-SPECT camera in both upright and supine positions. Where both images showed the same defects the 2 techniques were regarded as equally diagnostic. Where only one set showed a defect this was regarded as artefact and was defined as non-diagnostic. The location and cause of the artefact was recorded.
Results: In 13 /55 patients either form of imaging was regarded as equally diagnostic. In 24/55 the supine images revealed artefact affecting interpretation. The reasons for this were most frequently large BMI, motion and gut uptake. In 18/55 upright images were considered non-diagnostic. In 16/18 this was due to an infero-apical defect seen in female patients (14/16) with raised BMI and/or large breasts.
Conclusion: Upright myocardial perfusion imaging on D-SPECT shows a common artefact (in up to 1/3 of cases) in the infero-apical region mainly in overweight female patients. Getting acquainted with this artefact this may increase Physician confidence in reporting, similarly as to conventional supine imaging. Indeed, some of the artefacts seen on supine imaging appear less commonly with upright imaging. Thus, upright imaging can potentially be used alone for diagnosis with D-SPECT. Performance of both supine and upright imaging can be reserved for overweight patients thereby minimizing impact on scanning time and clinical throughput in busy departments.

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