Impact of incomplete ventricular coverage on diagnostic performance of myocardial perfusion imaging.

In the context of myocardial perfusion imaging (MPI) with cardiac magnetic resonance (CMR), there is ongoing debate on the merits of using technically complex acquisition methods to achieve whole-heart spatial coverage, rather than conventional 3-slice acquisition. An adequately powered comparative study is difficult to achieve given the requirement for two separate stress CMR studies in each patient. The aim of this work is to draw relevant conclusions from SPECT MPI by comparing whole-heart versus simulated 3-slice coverage in a large existing dataset. SPECT data from 651 patients with suspected coronary artery disease who underwent invasive angiography were analyzed. A computational approach was designed to model 3-slice MPI by retrospective subsampling of whole- heart data. For both whole-heart and 3-slice approaches, the diagnostic performance and the stress total perfusion deficit (TPD) score-a measure of ischemia extent/severity-were quantified and compared. Diagnostic accuracy for the 3-slice and whole-heart approaches were similar (area under the curve: 0.843 vs. 0.855, respectively; P = 0.07). The majority (54%) of cases missed by 3-slice imaging had primarily apical ischemia. Whole-heart and 3-slice TPD scores were strongly correlated (R2 = 0.93, P < 0.001) but 3-slice TPD showed a small yet significant bias compared to whole-heart TPD (- 1.19%; P < 0.0001) and the 95% limits of agreement were relatively wide (- 6.65% to 4.27%). Incomplete ventricular coverage typically acquired in 3-slice CMR MPI does not significantly affect the diagnostic accuracy. However, 3-slice MPI may fail to detect severe apical ischemia and underestimate the extent/severity of perfusion defects. Our results suggest that caution is required when comparing the ischemic burden between 3-slice and whole-heart datasets, and corroborate the need to establish prognostic thresholds specific to each approach

Diagnostic value of nuclear cardiology in coronary artery disease

This thesis investigates the diagnostic value of cardiac positron emission tomography when compared to single photon emission computed tomography for detection of coronary artery disease. This prospective study involves comparison of myocardial perfusion single photon emission computed tomography with coronary calcium scores; optimization of nuclear cardiac protocols in cardiac phantom experiments; and determination of diagnostic performance of cardiac positron emission tomography in the evaluation of myocardial viability in patients with significant coronary disease

New nuclear medicine techniques for the assessment of myocardial viability

Een dotterbehandeling of een bypassoperatie heeft alleen zin als er nog voldoende hartspierweefsel over is dat zich kan herstellen. Momenteel wordt de vitaliteit van de hartspier voor de ingreep nog onderzocht met een PET-scan, maar deze techniek is duur en maar in een paar ziekenhuizen in Nederland aanwezig. Riemer Slart constateert in zijn proefschrift dat een goedkopere scan het succes van een bypass of dotteren ook kan voorspellen.