Myocardial perfusion SPECT imaging, a practical guide / UNI-MED Science (PDF)

5.2.4. Acquisition strategies for gated SPECT 59 5.2.5. Preparation for gated SPECT 61 5.2.6. Gated SPECT acquisition protocols for a dual-head camera 61 5.2.6.1. Acquisition protocol with acceptance window and extra files 61 5.2.6.2. Acquisition protocol without extra files 62 5.2.6.3. Tracking - following the heart rate 62 5.2.6.4. Sampling with 8 or 16 gates 63 5.2.6.5. Gated SPECT and extrasystoles 64 5.2.6.6. Gated SPECT and absolute arrhythmia 65 5.2.6.7. Gated SPECT with Tl-201 or Tc-99m radiopharmaceuticals 65 5.2.6.8. Gated SPECT: prone or supine position? 65 5.3. Attenuation and attenuation correction 66 5.3.1. Physical basis 66 5.3.2. Absorption problems 66 5.3.3. Principle of attenuation correction and artefacts 67 5.3.4. Clinical value of attenuation correction 69 6. Processing 74 6.1. Raw data check 74 6.2. Filtered back projection 74 6.3. Iterative reconstruction 76 6.4. Reorientation 76 6.5. Evaluation of gated SPECT 77 6.5.1. Quality control 77 6.5.2. Display of results and normal values 78 6.5.3. Digression: partial volume effect 79 6.5.4. Accuracy of volumes and LVEF 80 7. Gated SPECT - why and when? 82 7.1. Motivation for gated SPECT 82 7.2. Gated rest, gated stress - or both? 83 7.3. Impact of gated SPECT on diagnosis 85 8. Findings and documentation 88 8.1. Image display 88 8.2. Polar tomograms 88 8.3. Bases of reporting 89 8.4. Quantitative perfusion analysis 90 8.5. Additional findings 92 8.5.1. Transient ischaemic dilatation 92 8.5.2. Lung-heart quotient 93 9. Diagnostic accuracy of myocardial perfusion SPECT imaging 96 9.1. Sensitivity, specificity, likelihood ratios 96 9.2. The false-positive myocardial perfusion scan 97 10. Risk assessment and prognosis 100 10.1. Objective of risk stratification 100 10.2. Cardiac risk categories 100 10.3. Prognostic value of a normal study 100 10.4. Prognostic value of an abnormal study 102 10.5. Prognosis in high pretest CAD likelihood 102 10.6. Incremental prognostic value of cardiac SPECT imaging 103 10.7. Relationsship between ischaemia and infarction 104 10.8. Added value of gated SPECT 105 10.9. Digression: posttest referral bias in prognostic studies 107 11. Myocardial perfusion imaging and treatment decisions 110 11.1. Setting the course with the summed difference score 110 11.2. Patient management 112 12. Special patient groups 116 12.1. Diabetes mellitus 116 12.1.1. Diagnosis and risk stratification in diabetic patients 116 12.1.2. Evaluation of the asymptomatic diabetic patient 118 12.2. Women 120 12.3. Left-bundle branch block 122 13. Key elements of reporting 126 14. References 130 Index 140