Prone Myocardial Perfusion Imaging and Breast Attenuation: A Phantom Study

Author(s): Susie Medeiros Oliveira Ramos*, Adriana Pereira Glavam, Adriana Soares Xavier de Brito, Tadeu Takao Almodovar Kubo, Gustavo Tukamoto, Debora da Cunha Pereira Sampaio, Lidia Vasconcellos de Sá.

Journal Name: Current Medical Imaging
Formerly: Current Medical Imaging Reviews

Volume 16 , Issue 1 , 2020

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Graphical Abstract:


Abstract:

Background: Soft tissue attenuation artifacts are the most common cause of misinterpretation in myocardial perfusion Imaging (MPI). Few studies assessing the value of prone imaging in women have been published. Breast attenuation artifacts can be present in up to 40% of the MPI studies in women.

Objectives: This study aimed at evaluating the potential impact of prone MPI on breast attenuation, with a critical analysis of activity optimization and breast size influence.

Methods: MPI of an Anthropomorphic Torso Phantom with silicone breast prostheses and equivalent adipose tissue was compared to a standard MPI database.

Results: A medical qualitative and semiquantitative analysis demonstrated higher uptake in the LV anterior segments in the prone position for all injected activities. An artificial myocardium lesion was diagnosable in the right segment in all images, which shows that prone positioning would not mask a true lesion and it assists the cardiologist with a more accurate analysis. These results showed that it is possible to optimize the activity to be injected by up to 55.6% when using combined supine-prone images.

Conclusion: Prone position has a high impact on the interpretation of MPI in female patients since it reduces the breast attenuation artifacts, and optimizes the radiation protection of the patient and all staff involved in the procedure, making it more cost-effective.

Keywords: Myocardial perfusion imaging, prone imaging, breast attenuation artifacts, activity optimization, breast size influence, anthropomorphic torso phantom, radiation protection.

[1]
Einstein AJ. Effects of radiation exposure from cardiac imaging: how good are the data? J Am Coll Cardiol 2012; 59(6): 553-65.
[http://dx.doi.org/10.1016/j.jacc.2011.08.079] [PMID: 22300689]
[2]
Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol 2016; 23(3): 606-39.
[http://dx.doi.org/10.1007/s12350-015-0387-x] [PMID: 26914678]
[3]
Cerqueira MD, Allman KC, Ficaro EP, et al. Recommendations for reducing radiation exposure in myocardial perfusion imaging. J Nucl Cardiol 2010; 17(4): 709-18.
[http://dx.doi.org/10.1007/s12350-010-9244-0] [PMID: 20503120]
[4]
Huang JY, Huang CK, Yen RF, et al. Diagnostic performance of attenuation-corrected myocardial perfusion imaging for coronary artery disease: a systematic review and meta-analysis. J Nucl Med 2016; 57(12): 1893-8.
[http://dx.doi.org/10.2967/jnumed.115.171462] [PMID: 27445295]
[5]
Lehner S, Sussebach C, Todica A, et al. Influence of SPECT attenuation correction on the quantification of hibernating myocardium as derived from combined myocardial perfusion SPECT and 18F-FDG PET. J Nucl Cardiol 2014; 21(3): 578-87.
[http://dx.doi.org/10.1007/s12350-014-9882-8] [PMID: 24633501]
[6]
Guo C, Wokhlu A, Wymer D, Winchester D, Taasan V, Gilland D. An image processing method for rapid interpretation of supine, prone, and attenuation corrected myocardial perfusion SPECT. J Nucl Med 2016; 57: 1981.
[7]
Esteves FP, Travin MI. The role of nuclear cardiology in the diagnosis and risk stratification of women with ischemic heart disease. seminars in nuclear medicine. Women’s health and gender-biased. Nucl Med (Stuttg) 2014; 44: 423-38.
[8]
DePuey EG III. How to detect and avoid myocardial perfusion SPECT artifacts. J Nucl Med 1994; 35(4): 699-702.
[PMID: 8151397]
[9]
DePuey EG, Garcia EV. Optimal specificity of thallium-201 SPECT through recognition of imaging artifacts. J Nucl Med 1989; 30(4): 441-9.
[PMID: 2661749]
[10]
Burrell S, MacDonald A. Artifacts and pitfalls in myocardial perfusion imaging. J Nucl Med Technol 2006; 34(4): 193-211.
[PMID: 17146108]
[11]
Wackers F. Diagnostic pitfalls of myocardial perfusion imaging in women. J Myocard Ischemia 1992; 4: 23.
[12]
Johnstone DE, Wackers FJT, Berger HJ, et al. Effect of patient positioning on left lateral thallium-201 myocardial uptake and washout studies. J Nucl Med 1979; 20: 183-8.
[PMID: 24180034]
[13]
Singh B, Bateman TM, Case JA, Heller G. Attenuation artifact, attenuation correction, and the future of myocardial perfusion SPECT. J Nucl Cardiol 2007; 14(2): 153-64.
[http://dx.doi.org/10.1016/j.nuclcard.2007.01.037] [PMID: 17386377]
[14]
Friedman TD, Greene AC, Iskandrian AS, Hakki AH, Kane SA, Segal BL. Exercise thallium-201 myocardial scintigraphy in women: correlation with coronary arteriography. Am J Cardiol 1982; 49(7): 1632-7.
[http://dx.doi.org/10.1016/0002-9149(82)90239-9] [PMID: 7081050]
[15]
Dunn RF, Wolff L, Wagner S, Botvinick EH. The inconsistent pattern of thallium defects: a clue to the false positive perfusion scintigram. Am J Cardiol 1981; 48(2): 224-32.
[http://dx.doi.org/10.1016/0002-9149(81)90600-7] [PMID: 7270432]
[16]
Goodgold HM, Rehder JG, Samuels LD, Chaitman BR. Improved interpretation of exercise Tl-201 myocardial perfusion scintigraphy in women: characterization of breast attenuation artifacts. Radiology 1987; 165(2): 361-6.
[http://dx.doi.org/10.1148/radiology.165.2.3659357] [PMID: 3659357]
[17]
Hung J, Chaitman BR, Lam J, et al. Noninvasive diagnostic test choices for the evaluation of coronary artery disease in women: a multivariate comparison of cardiac fluoroscopy, exercise electrocardiography and exercise thallium myocardial perfusion scintigraphy. J Am Coll Cardiol 1984; 4(1): 8-16.
[http://dx.doi.org/10.1016/S0735-1097(84)80312-5] [PMID: 6736458]
[18]
Doukky R, Rahaby M, Alyousef T, Vashistha R, Chawla D, Amin AP. Soft tissue attenuation patterns associated with supine acquisition spect myocardial perfusion imaging: a descriptive study. Open Cardiovasc Med J 2012; 6: 33-7.
[http://dx.doi.org/10.2174/1874192401206010033] [PMID: 22550547]
[19]
Slomka PJ, Nishina H, Abidov A, et al. Combined quantitative supine-prone myocardial perfusion SPECT improves detection of coronary artery disease and normalcy rates in women. J Nucl Cardiol 2007; 14(1): 44-52.
[http://dx.doi.org/10.1016/j.nuclcard.2006.10.021] [PMID: 17276305]
[20]
Manglos SH, Thomas FD, Hellwig BJ. The effect of non-uniform attenuation compensation on myocardial SPECT defect analysis. Phys Med Biol 1993; 38: 897.
[http://dx.doi.org/10.1088/0031-9155/38/7/002]
[21]
Movahed MR. Attenuation artifact during myocardial SPECT imaging secondary to saline and silicone breast implants. Am Heart Hosp J 2007; 5(3): 195-6.
[http://dx.doi.org/10.1111/j.1541-9215.2007.07123.x] [PMID: 17673863]
[22]
Meine TJ, Patel MR, Heitner J, et al. Cardiac imaging impaired by a silicone breast implant. Clin Nucl Med 2005; 30(4): 262-4.
[http://dx.doi.org/10.1097/01.rlu.0000156378.61359.bd] [PMID: 15764886]
[23]
Stinis CT, Lizotte PE, Movahed MR. Impaired myocardial SPECT imaging secondary to silicon- and saline-containing breast implants. Int J Cardiovasc Imaging 2006; 22(3-4): 449-55.
[http://dx.doi.org/10.1007/s10554-005-9068-1] [PMID: 16538430]
[24]
Giubbini RM, Gabanelli S, Lucchini S, et al. The value of attenuation correction by hybrid SPECT/CT imaging on infarct size quantification in male patients with previous inferior myocardial infarct. Nucl Med Commun 2011; 32(11): 1026-32.
[http://dx.doi.org/10.1097/MNM.0b013e32834b4575] [PMID: 21897308]
[25]
Katayama T, Ogata N, Tsuruya Y. Diagnostic accuracy of supine and prone thallium-201 stress myocardial perfusion single-photon emission computed tomography to detect coronary artery disease in inferior wall of left ventricle. Ann Nucl Med 2008; 22(4): 317-21.
[http://dx.doi.org/10.1007/s12149-008-0118-3] [PMID: 18535883]
[26]
Pitman AG, Kalff V, Van Every B, Risa B, Barnden LR, Kelly MJ. Contributions of subdiaphragmatic activity, attenuation, and diaphragmatic motion to inferior wall artifact in attenuation-corrected Tc-99m myocardial perfusion SPECT. J Nucl Cardiol 2005; 12(4): 401-9.
[http://dx.doi.org/10.1016/j.nuclcard.2005.04.010] [PMID: 16084428]
[27]
Stathaki M, Koukouraki S, Papadaki E, Tsaroucha A, Karkavitsas N. The benefits of prone SPECT myocardial perfusion imaging in reducing both artifact defects and patient radiation exposure. Arq Bras Cardiol 2015; 105(4): 345-52.
[http://dx.doi.org/10.5935/abc.20150122] [PMID: 26559981]
[28]
Segall GM, Davis MJ. Prone versus supine thallium myocardial SPECT: a method to decrease artifactual inferior wall defects. J Nucl Med 1989; 30(4): 548-55.
[PMID: 2661750]
[29]
Glavam AP, Lorenzo AR, Brito ASX, Lima RSL. Impact of prone position on myocardial perfusion SPECT interpretation in women with suspected coronary disease. Curr Med Imaging Rev 2016; 12: 313-9.
[http://dx.doi.org/10.2174/1573405612666160606114842]
[30]
Ramos SMO, Glavam AP, Kubo TTA, de Sá LV. Optimization of a protocol for myocardial perfusion scintigraphy by using an anthropomorphic phantom. Radiol Bras 2014; 47(4): 217-22.
[http://dx.doi.org/10.1590/0100-3984.2013.1933] [PMID: 25741088]
[31]
Hesse B, Tägil K, Cuocolo A, et al. EANM/ESC Procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med 2005; 32: 855-97.
[32]
Kehayias JJ, Heymsfield SB, LoMonte AF, Wang J, Pierson RN Jr. In vivo determination of body fat by measuring total body carbon. Am J Clin Nutr 1991; 53(6): 1339-44.
[http://dx.doi.org/10.1093/ajcn/53.6.1339] [PMID: 2035460]
[33]
Data Spectrum Corporation. Anthropomorphic torso phantom. Available from:. http://www.spect.com
[34]
Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 1979; 300(24): 1350-8.
[http://dx.doi.org/10.1056/NEJM197906143002402] [PMID: 440357]
[35]
AHA. American Heart Association. Circulation 2002; 105: 539-42.
[http://dx.doi.org/10.1161/hc0402.102975] [PMID: 11815441]
[36]
NEMA standards publication NU 2-2001. Performance measurements of positron emission tomographs. In: National Electrical Manufacturers Association. 2001; pp. 26-7.
[37]
Slomka P, Germano G. Optimizing radiation dose and imaging time with conventional myocardial perfusion SPECT: Technical aspects. J Nucl Cardiol 2017; 24(3): 888-91.
[http://dx.doi.org/10.1007/s12350-016-0455-x] [PMID: 26956877]
[38]
Lecchi M, Sole AD. The long way to dose reduction in myocardial perfusion imaging. J Nucl Cardiol 2018; 25: 2129-32.
[http://dx.doi.org/10.1007/s12350-017-0967-z] [PMID: 28667453]
[39]
Germano G, Slomka PJ, Berman DS. Supine acceptance of a conventional imaging position may make you less prone to success. J Nucl Cardiol 2010; 17(1): 16-8.
[http://dx.doi.org/10.1007/s12350-009-9187-5] [PMID: 20035389]
[40]
De Lorenzo A, Fonseca LMB, Landesmann MC, Lima RSL. Comparison between short-acquisition myocardial perfusion SPECT reconstructed with a new algorithm and conventional acquisition with filtered backprojection processing. Nucl Med Commun 2010; 31(6): 552-7.
[http://dx.doi.org/10.1097/MNM.0b013e32833841ca] [PMID: 20300043]
[41]
Depuey EG, Mahmarian JJ, Miller TD, et al. Patient-centered imaging. J Nucl Cardiol 2012; 19(2): 185-215.
[http://dx.doi.org/10.1007/s12350-012-9523-z] [PMID: 22328324]
[42]
Arsanjani R, Hayes SW, Fish M, et al. Two-position supine/prone myocardial perfusion SPECT (MPS) imaging improves visual inter-observer correlation and agreement. J Nucl Cardiol 2014; 21(4): 703-11.
[http://dx.doi.org/10.1007/s12350-014-9895-3] [PMID: 24807622]
[43]
Biros H, Holly T, Leonard S, Kansal P, Riehle L, Dillehay G. Review of myocardial perfusion confidence scores in supine and prone imaging to ameliorate protocol standards. J Nucl Med 2018; 59(1): 2129.
[44]
Worden NE, Lindower PD, Burns TL, Chatterjee K, Weiss RM. A second look with prone SPECT myocardial perfusion imaging reduces the need for angiography in patients at low risk for cardiac death or MI. J Nucl Cardiol 2015; 22(1): 115-22.
[http://dx.doi.org/10.1007/s12350-014-9934-0] [PMID: 24980454]
[45]
Esquerré JP, Coca FJ, Martinez SJ, Guiraud RF. Prone decubitus: a solution to inferior wall attenuation in thallium-201 myocardial tomography. J Nucl Med 1989; 30(3): 398-401.
[PMID: 2786940]
[46]
Nishina H, Slomka PJ, Abidov A, et al. Combined supine and prone quantitative myocardial perfusion SPECT: method development and clinical validation in patients with no known coronary artery disease. J Nucl Med 2006; 47(1): 51-8.
[PMID: 16391187]
[47]
Verberne HJ, Acampa W, Anagnostopoulos C, et al. European Association of Nuclear Medicine (EANM). EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 2015; 42(12): 1929-40.
[http://dx.doi.org/10.1007/s00259-015-3139-x] [PMID: 26290421]


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VOLUME: 16
ISSUE: 1
Year: 2020
Page: [70 - 79]
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DOI: 10.2174/1573405614666181017121453
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