ASNC imaging guidelines for nuclear cardiology procedureMyocardial perfusion and function: Single photon emission computed tomography
Section snippets
Acquisition protocols
Protocols for the various nuclear cardiology single photon emission computed tomography (SPECT) acquisition studies are presented in the following pages (Table 1, Table 2, Table 3, Table 4, Table 5, Table 6). For each of the protocols, the acquisition parameters are listed along with their corresponding value for exercise and rest. Implementation of these protocol acquisition parameters has been shown to provide acceptable images of good quality for routine clinical interpretation and
Processing protocols
- 1
Filtering. Image filtering is a very complex topic that encompasses techniques for image enhancement, reconstruction, and feature extraction.12, 13 The main area of concern for an interpreter of SPECT studies is image enhancement by reducing noise prior to image reconstruction. All forms of imaging are plagued by statistical variation in the acquired image counts commonly referred to as noise. The quality of an image can be described as the signal-to-noise ratio, which describes the relative
Perfusion quantitation
The display medium and translation table employed can have a significant impact on image interpretation, going as far as to make a normal perfusion scan appear abnormal or vice versa. Quantitative analysis is a direct way of measuring relative uptake of a perfusion tracer that is independent of the display medium and translation table and can thus greatly reduce variations in interpretation due to subjective analysis and inconsistent image display. Quantitative analysis also allows for the
Gated SPECT
Acquisition. The introduction of technetium-based perfusion tracers has resulted in images with sufficient count density to allow for cardiac gating adding parameters of wall motion, wall thickening, and EF to myocardial perfusion imaging.20, 21, 22, 23 Gating requires a stable and consistent heart rhythm as well as sufficient temporal resolution to correctly characterize the cardiac cycle. A stable heart rate and rhythm can be achieved by rejecting heartbeats that fall out of range at the
General Comments
The interpretation of myocardial perfusion SPECT images should be performed in a systematic fashion to include (1) repeat evaluation of the raw tomographic images to determine the presence of technical sources of abnormalities and extracardiac activity; (2) interpretation of images with respect to the location, size, severity, and reversibility of defects as well as chamber sizes and, for Tl-201, presence or absence of pulmonary uptake; (3) incorporation of the results of quantitative analysis;
Gated myocardial perfusion SPECT
Because of the comparatively low additional cost and substantial benefit of the information obtained, gated studies of ventricular function should be a routine part of myocardial perfusion SPECT.20 A systematic approach to display and interpretation of the ventricular function derived from gated SPECT is important.
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Gated SPECT display. Multiple ventricular slices should be evaluated. At a minimum, a quad-screen display of apical and mid-basal short-axis, a mid-ventricular horizontal long-axis,
Acknowledgment
We acknowledge the excellent editorial assistance of Patricia Upchurch, Director of Quality Assurance, American Society of Nuclear Cardiology.
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