Download PDF
Nuklearmedizin 1999; 38(06): 178-185
DOI: 10.1055/s-0038-1632215
Originaler Artikel
Schattauer GmbH

Influence of Patient Position in Myocardial SPECT on the Diagnosis of CHD

Einfluß der Patientenlagerung bei der Myokard-SPECT auf die Diagnose einer KHK
P. Reuland
1   Praxis für Nuklearmedizin, Freiburg, Germany
2   Department of Nuclear Medicine, University of Tübingen, Germany
,
M. Irmer
3   Medical Clinic, University of Freiburg, Germany
4   Praxis für Kardiologie, Freiburg, Germany
,
T. Stiehr
1   Praxis für Nuklearmedizin, Freiburg, Germany
,
Aneke Schroff
1   Praxis für Nuklearmedizin, Freiburg, Germany
,
Andrea Heinzel
1   Praxis für Nuklearmedizin, Freiburg, Germany
,
H. H. Weyer
1   Praxis für Nuklearmedizin, Freiburg, Germany
› Author Affiliations
Further Information

Publication History

Received: 15 September 1998

in revised form: 08 January 1999

Publication Date:
02 February 2018 (online)

    Permissions and Reprints

Summary

Aim of the study was to show that changing patient position from supine to prone results in improved specificity of myocardial SPECT (MS). Methods: We examined the influence of patient position in MS on the diagnosis of coronary heart disease (CHD) in 151 patients. By using a Tc-99m-labeled compound (Tetrofosmin, Myoview™, Nycomed, Amersham) examinations could be performed in supine and prone position within 35 minutes. Examinations were performed as a two-day stressrest protocol with one gamma camera head and 180° rotation without absorption correction. Results: Semi-quantitative patient and heart phantom data show similar values for anterior and inferior wall in prone position in contrast to a lower count ratio of inferior to anterior wall in supine position. This demonstrates the importance of patient position with respect to artifacts specificity. Changing patient position from supine to prone mainly improves diagnostic specificity for CHD in the inferior wall in men (from 58% to 90%) and in the anterior wall in women (from 80% to 93%). Sensitivity is the same for both techniques. Conclusion: Changing patient position from supine to prone significantly improves diagnostic specificity while sensitivity remains unchanged.

Zusammenfassung

Ziel der Studie war es zu zeigen, daß die Änderung der Patientenposition von der Rückenlage in die Bauchlage die Spezifität der Myokard-SPECT (MS) verbessert. Methode: Wir haben den Einfluß der Patientenlagerung auf die Diagnosestellung einer KHK bei 151 Patienten untersucht. Durch Verwendung einer Tc-99m-Verbindung (Myoview™, Nycomed, Amersham) konnten die Aufnahmen in Rücken- und Bauchlage innerhalb von 35 Minuten durchgeführt werden. Die Untersuchungen wurden als 2-Tage-Belastungs-Ruhe-Protokoll durchgeführt mit einem Gammakamerakopf über 180° ohne Schwächungskorrektur. Ergebnisse: Semiquantitative Patienten- und Phantomdaten zeigen in Bauchlage im Gegensatz zu den Aufnahmen in Rückenlage ähnliche Werte für die Vorder- und Hinterwand, während in Rückenlage die Countraten im Bereich der Hinterwand niedriger als in der Vorderwand sind. Dies belegt die Bedeutung der Patientenlagerung für die Spezifität im Hinblick auf Artefakte. Die Änderung der Patientenposition in die Bauchlage verbessert vor allem die Spezifität für die Diagnose einer KHK im Bereich der Hinterwand bei Männern (von 58% auf 90%) sowie im Bereich der Vorderwand bei Frauen (von 80% auf 93%). Die Sensitivität ist für beide Verfahren gleich hoch. Schlußfolgerung: Durch Änderung der Patientenposition von der Rückenlage in die Bauchlage läßt sich die diagnostische Spezifität für die Diagnose einer KHK deutlich steigern, ohne daß die Sensitivität sich verändert.

Key words

Myocardial SPECT - patient positioning - CHD - artifacts

Schlüsselwörter

Myokard-SPECT - Patientenlagerung - KHK - Artefakte
 

  • REFERENCES

  • 1 Beller GA. Diagnostic accuracy of thallium-201 myocardial perfusion imaging. Circulation 1991; 84 (Suppl. 03) 11-16.
    Google Scholar
  • 2 Biedermann M, Altehoefer C, Biill U. Schwächungseffekte bei der 99mTc-MIBI Belastungsmyokard 360° SPECT: Vergleich von Rücken- und Bauchlage. Nucl Med 1994; 33: 8-14.
    Google Scholar
  • 3 Garcia E, Cooke CD, Van Train KF, Folks R. et al. Technical aspects of myocardial SPECT imaging with 99m technetium sestamibi. Am J Cardiol 1990; 66: 23-31.
    CrossrefGoogle Scholar
  • 4 DePasquale EE, Nody AC, DePuey EG, Garcia PD, Pilcher G, Bredlau C, Roubin G, Gober A, Gruentzig A, D’Amato P, Berger HJ. Quantitative rotational thallium-201 tomography for identifying and localizing coronary artery disease. Circulation 1988; 77: 316-27.
    CrossrefGoogle Scholar
  • 5 De Puey EG, Garcia EV. Optimal specificity of Thallium-201 SPECT through recognition of imaging artefacts. J Nucl Med 1989; 30: 441-9.
    Google Scholar
  • 6 De Puey EG, Guertler-Krawczynska E, Perkins JV, Robbins WL, Whelchel JD, Clements SD. Alterations in myocardial thallium-201 distribution in patients with chronic hypertension undergoing single-photon emission tomography. Am J Cardiol 1988; 62: 234-8.
    CrossrefGoogle Scholar
  • 7 DePuey EG. How to detect and avoid myocardialial perfusion SPECT artifacts. J Nucl Med 1994; 35: 699-702.
    Google Scholar
  • 8 DePuey EG, Rozanski A. Using Gated Technetium-99m-Sestamibi SPECT to Characterize Fixed Myocardial Defects as Infarct or Artifact. J Nucl Med 1995; 36: 952-95.
    Google Scholar
  • 9 Eisner R, Churchwell A, Noever T, Nowak D, Cloninger K, Dunn D, Carlson W, Oates J, Jones J, Morris D, Liberman H, Patterson R. Quantitative analysis of the tomographic thallium-201 myocardial bullseye display: critical role of correcting for patient motion. J Nucl Med 1988; 29: 91-7
    Google Scholar
  • 10 Esquerre JP, Coca FJ, Martinez SJ, Guiraud R. Prone decubitus: a solution to inferior wall attenuation in thallium-201 myocardial tomography. J Nucl Med 1989; 30: 398-401.
    Google Scholar
  • 11 Ficaro EP, Fessier JA, Ackermann RJ, Rogers WL, Corbett JR, Schwaiger M. Simultaneous Transmission-Emission Thallium-201 Cardia SPECTEffect of Attenuation Correction on myocardial Tracer Distribution. J Nucl Med 1995; 36: 921-31.
    Google Scholar
  • 12 Friedman J, Van Train K, Maddahi J, Hasegawa B, Bietendorf J, Waxman A, Berman D. “Upward creep” of the heart: a frequent source of false-positive reversible defects on Tl-201 stress-redistribution SPECT. J Nucl Med 1986; 27: 899.
    Google Scholar
  • 13 Geckle WJ, Frank TL, Links JM, Becker LC. Correction for patient and organ movement in SPECT: application to exercise thallium-201 cardiac imaging. J Nucl Med 1986; 27: A899.
    Google Scholar
  • 14 Gordon DG, Pfisterer M, Williams R, Walaski S, Ashburn W. The effect of diaphragmatic attenuation on Tl-201 images. Clin Nucl Med 1979; 4: 150-1.
    CrossrefGoogle Scholar
  • 15 Higley B, Smith FW, Smith T. et al. 1993; Technetium-99m-l,2-bis(bis(2-Ethoxyethyl) Phosphino)Ethane: Human Biodistribution. Dosimetry and Safety of a New Myocardial Perfusion Imaging Agent. J Nucl Med 34: 30-8.
    Google Scholar
  • 16 Hirzel HO, Senn M, Nuesch K, Buettner C, Pfeiffer A, Hess OM, Krayenbuehl HP. Thallium-201 scintigraphy in complete left bundle branch block. Am J Cardiol 1984; 53: 764-9.
    CrossrefGoogle Scholar
  • 17 Jacobson AF, Parker JA, Royal HD, Silverman KJ, Gervino EV, Kolodny GM. Supine versus upright anterior images comparison in Tl-201 myocardialial scintigraphy. Radiology 1987; 163 (03) 691-5.
    CrossrefGoogle Scholar
  • 18 Jain D, Wackers FJTh, Mattera J, McMahon M, Sinusas AJ, Zaret BL. 1993; Biokinetics of Technetium-99m-Tetrofosmin: Myocardial Perfusion Imaging Agent: Implications for a One-Day Imaging Protocol. J Nucl Med 34: 1254-9.
    Google Scholar
  • 19 Kiat H, Maddahi J, Roy LT, van Train TS, Friedman J, Resser K, Berman DS. comparison of 99mTc methoxy isobutyl isonitrile with 201 thallium for evaluation of coronary artery disease by planar and tomographic methods. Am Heart J 1989; 117: 1-11.
    CrossrefGoogle Scholar
  • 20 Maddahi J, Van Train KF, Wong C, Gurewitz J, Prigent F, Youngkin C, Friedman J, Berman D. Comparison of Tl-201 singlephoton emission computerized tomography (SPECT) and planar imaging for evaluation of coronary artery disease. J Nucl Med 1986; 27: 999.
    Google Scholar
  • 21 O’Gara P, Bonow RO, Maron BJ, Damske BA, Van Lingen A, Bacharach SL, Larson SM, Epstein SE. Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium-201 emission computed tomography. Circulation 1987; 76 (06) 1214-23.
    CrossrefGoogle Scholar
  • 22 Rabinovitch M, Suissa S, Elstein J, Standoff H, Tang A, Rush C, Aldis A, Tannous R, Turek M, Addas A, O’Brien C, Burgess JH, Rosenthall L. Sex-specific criteria for interpretation of thallium-201 myocardial uptake and washout studies. J Nucl Med 1986; 27: 1837-41.
    Google Scholar
  • 23 Reuland P, Inner M. Improvement of Diagnostic Specificity by Changing of Patient Position from Supine to Prone Position in Myocardial SPECT for Patients with Coronary Heart Disease. J Nucl Cardiol 1997; 1 (02) A6.
    Google Scholar
  • 24 Reuland P. Tetrofosmin: mit 99m-Technetium markierbares Radiopharmakon als Perfusionsmarker für die Myokardszintigraphie. In: Single-Photon-Emissions-Computertomographie (SPECT) des Herzens. Wieler (ed.) Berlin Heidelberg New York Tokio: Springer; 1997: 101-16.
    Google Scholar
  • 25 Segall GM, Davis MJ. Prone versus supine thallium myocardial SPECT: a method to decrease artifactual inferior wall defects. J Nucl Med 1989; 30: 548-55.
    Google Scholar
  • 26 Sridhara BS, Braat S, Rigo P, Itti R, Cload P, Lahiri A. 1993; Comparison of Myocardial Perfusion Imaging with Technetium-99m Tetrofosmin Versus Thallium-201 in Coronary Artery Disease. Am J Cardio 72: 1015-9.
    CrossrefGoogle Scholar
  • 27 Stiehr Th. 1995 Diagnostische Relevanz verschiedener Myokard-SPECT-Techniken. Medizinische Dissertation Tübingen:
    Google Scholar
  • 28 Stirner H, Biill U, Kleinhans E, Bares R, Grosse W. Myocardial kinetics of 99mTc hexakis-2-methoxy-isobutyl-isonitrile (HMIBI) in patients with coronary heart disease: a comparative study versus 201T1 with SPECT. Nucl Med Comm 1988; 9: 15-23.
    Google Scholar
  • 29 Taillefer R, Lambert R, Bisson G, Banjamin C, Phaneuf DC. Comparison between early (15 min) and delayed (60 min) myocardial 99mTc-Sestamibi SPECT imaging in detection of coronary artery disease. J Nucl Med 1992; 33: A855.
    Google Scholar
  • 30 Tamaki N, Yonekura Y, Kadota K, Kambara H, Torizuka K. Appearance of breast attenuation artifacts with thallium myocardial SPECT imaging. Clin Nucl Med 1985; 10: 694-6.
    CrossrefGoogle Scholar
  • 31 Tawahara K, Kurata C, Takahish T, Kobayashi A, Yamazaki N. Exercise testing and thallium-201 emission computed tomography in patients with interventricular conduction disturbances. Am J Cardiol 1992; 69: 97-102.
    Google Scholar
  • 32 VanTrain K, Maddahi J, Wong C, Prigent F, Friedman J, Waxman A, Berman DS. Definition of normal limits in stress 11-201 myocardial rotational tomography. J Nucl Med 1986; 27: 899.
    Google Scholar
  • 33 Zaret BL, Rigo P, Wackers FJT. et al. 1995; Myocardial Perfusion Imaging with 99mTc Tetrofosmin: Comparison to 201 T1 Imaging and Coronary Angiography in a Phase III Multicenter Trial. Circulation 91: 313-9.
    CrossrefGoogle Scholar