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EANM Procedural Guidelines for Radionuclide Myocardial Perfusion Imaging with SPECT and SPECT/CT

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EANM Procedural Guidelines for Radionuclide Myocardial Perfusion Imaging with SPECT and SPECT/CT EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT Chair of writing committee (responsible for the coordination of the overall process): Hein J. Verberne and Birger Hesse Authors: Hein J. Verberne, Wanda Acampa, Constantinos Anagnostopoulos, Jim Ballinger, Frank Bengel, Pieter De Bondt, Ronny R. Buechel, Alberto Cuocolo, Berthe L.F. van Eck-Smit, Albert Flotats, Marcus Hacker, Cecilia Hindorf, Philip A. Kaufmann, Oliver Lindner, Michael Ljungberg, Markus Lonsdale, Alain Manrique, David Minarik, Arthur J.H.A. Scholte, Riemer H.J.A. Slart, Elin Trägårdh, Tim C. de Wit, Birger Hesse Correspondence to: H.J. Verberne, MD PhD Department of Nuclear Medicine, F2-238 Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam The Netherlands Tel: *31-20-5669111, pager 58 436 Fax: *31-20-5669092 E-mail: [email protected] 1 Author affiliations: H.J. Verberne Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Tel: +31 20 566 9111, pager 58 436 Fax: +31 20 566 9092 E-mail: [email protected] W. Acampa Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy Tel: +39 0812203409 Fax: +39 0815457081 E-mail: [email protected] C. Anagnostopoulos Center for Experimental surgery, Clinical and Translational Research, Biomedical research foundation, Academy of Athens, Greece Tel: +30 210 65 97 126 or +30 210 65 97 067 Fax: +30 210 65 97 502 E-mail: [email protected] J. Ballinger Department of Nuclear Medicine, Guy's Hospital - Guy's & St Thomas' Trust Foundation, London, United Kingdom Tel: +44 207 188 5521 Fax: +44 207 188 4094 E-mail: [email protected] F. Bengel Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany Tel: Fax: E-mail: [email protected] P. De Bondt Department of Nuclear Medicine, OLV Hospital, Aalst, Belgium Tel: Fax: E-mail: [email protected] 2 R.R. Buechel Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland Tel: +41 44 255 1059 Fax: +41 44 255 4414 E-mail: [email protected] A. Cuocolo Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy Tel: +39 0812203187, int.209 Fax: +39 0815457081 E-mail: [email protected] B.L.F. van Eck-Smit Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Tel: Fax: +31 20 566 9092 E-mail: [email protected] A. Flotats Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain Tel: +34 93 553 7797 Fax: +34 93 553 7798 E-mail: [email protected] M. Hacker Division of Nuclear Medicine, Department of Biomedical Imaging and Image- guided Therapy, Medical University of Vienna, Vienna, Austria Tel: +43 1 40400 55300/310 Fax: +43 1 40400 55320 E-mail: [email protected] C. Hindorf Department of Radiation Physics, Skåne University Hospital, Lund, Sweden Tel: +46 46 176366 Fax: E-mail: [email protected] 3 P.A. Kaufmann Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland Tel: +41 44 255 1111 Fax: +41 44 255 4414 E-mail: [email protected] O. Linder Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Institute for Radiology, Nuclear Medicine and Molecular Imaging, Bad Oeynhausen, Germany Tel: +49 57 31 97 35 02 Fax: +49 57 31 97 21 90 E-mail: [email protected] M. Ljungberg Department of Medical Radiation Physics, Lund University, Lund, Sweden Tel: +46 46 17 35 65 Fax: +46 46 17 85 40 E-mail: [email protected] M. Lonsdale Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, Copenhagen, Denmark Tel: +45 2613 5165 Fax: +45 3531 3954 E-mail: [email protected] A. Manrique Department of Nuclear Medicine, Service Commun Investigations chez l'Homme, GIP Cyceron, Caen University Hospital, Caen, France Tel: +33 2 31 47 02 87 Fax: +33 2 31 47 01 30 E-mail: [email protected] D. Minarik Radiation physics, Skåne University Hospital, Malmö, Sweden Tel: +46 40 331083 Fax: E-mail: [email protected] 4 A.J.H.A. Scholte Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands Tel: +31 71 5262020 Fax: +31 71 5266809 E-mail: [email protected] R.H.J.A. Slart Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Tel: +31 50 3611835 Fax: +31 50 3611687 E-mail: [email protected] E. Trägårdh Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden. Tel: +46 40 33 87 24 Fax: +46 40 33 66 20 E-mail: [email protected] T.C. de Wit Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Tel: +31 20 566 4550 Fax: +31 20 566 9092 E-mail: [email protected] B. Hesse Department of Clinical Physiology and Nuclear Medicine & PET, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark Tel: +45 3545 4011 Fax: +45 3545 4015 E-mail: [email protected] 5 Abbreviations: AC: Attenuation correction ALS: Advanced life support CCTA Coronary CT angiography COPD: Chronic obstructive pulmonary disease COR: Centre of rotation DRL: Diagnostic reference levels EF: Ejection fraction FBP: Filtered back projection FDG: 18F-Fluorodeoxyglucose FOV: Field of view FWHM: Full-width at half-maximum i.v.: Intravenous LBBB Left bundle branch block LEAP: Low-energy, all-purpose (collimator) LEGP: Low-energy general purpose (collimator) LEHR: Low-energy high-resolution (collimator) LV: Left ventricular LVEF: Left ventricular ejection fraction ML-EM: Maximum likelihood expectation maximization MPI Myocardial perfusion imaging NEMA: National Electrical Manufacturers Association OS-EM: Ordered subsets expectation maximization PVC: Premature ventricular contractions QC: Quality control SA block: Sinoatrial block SDS: Summed difference score SRS: Summed rest score SSS: Summed stress score 6 Preamble The update of the European procedural guidelines for radionuclide myocardial perfusion imaging (MPI) with SPECT is developed on initiative of and approved by the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM). The guidelines summarize the views of the Cardiovascular Committee of the EANM and reflect recommendations for which the EANM cannot be held responsible. The recommendations should be taken into context of good practice of nuclear medicine and do not substitute for national and international legal or regulatory provisions. The guidelines were brought to the attention of all other EANM Committees and to the National Societies of Nuclear Medicine and have been approved by the EANM. The present guidelines are based on the guidelines from 2005 [1]. The 2015 update includes all aspects of SPECT imaging from gating to hybrid imaging, but does not include myocardial perfusion evaluated by PET, which will be updated in a separate guideline. This document also updates relevant sections of the 2008 guidelines on radionuclide imaging of cardiac function [2] and the 2011 position statement on hybrid cardiac imaging [3]. The present guidelines have been created according to the joint statement of the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the EANM on guideline development [4]. The EANM guidelines are intended to present information specifically adapted to European practice, based on evidence from original scientific studies or on previously published guidelines (i.e.: national or European guidelines for MPI, the European Society of Cardiology (ESC), and the American College of Cardiology (ACC) / American Heart Association (AHA) / American Society of Nuclear Cardiology (ASNC) guidelines). In case of lack of published evidence, opinions are based on expert consensus and are indicated as such. Where more than one solution seems to be practised, and none has been shown to be superior to the others, the committee has tried to express specifically this state of knowledge. 7 Introduction In recent years radionuclide imaging technologies have evolved rapidly with the development of new instrumentation and new agents. This has increased both the number and the complexity of choices for the clinician. The purpose of this guideline is to document the state-of-the-art applications and protocols and to disseminate this information to the European nuclear cardiology community. The guidelines are designed to assist physicians and other healthcare professionals in performing, interpreting and reporting radionuclide tomographic imaging examinations of myocardial perfusion including hybrid imaging. The guidelines do not discuss overall clinical indications for these examinations or the benefits and drawbacks of radionuclide myocardial perfusion imaging compared with other techniques, nor do they cover cost-benefit or cost-effectiveness aspects in diagnosis or prognosis. 8 List of contents Patient information and preparation Radiopharmaceuticals and CT contrast agents Injected activities, dosimetry, and radiation exposure Stress tests Instrumentation Imaging protocols Image acquisition Quality control of instrumentation and image acquisition Reconstruction methods Attenuation and scatter correction Data analysis of regional perfusion imaging Data analysis of left ventricular function Data analysis of hybrid imaging Reports, image display 9 Patient information and preparation The previous
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