PMC:7417201 / 5450-8255 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7417201","sourcedb":"PMC","sourceid":"7417201","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7417201","text":"Myocardial perfusion imaging\nPatients underwent stress-optional rest 99mTc sestamibi-gated stress SPECT-MPI by physical exercise or dipyridamole stress test, according to the recommendations of the European Association of Nuclear Medicine [11]. During the pandemic, pharmacological stress was preferred to exercise stress test and criteria to prioritize patients were implemented, according to the recommendations of the American Society of Nuclear Cardiology and Society of Nuclear Medicine and Molecular Imaging [4]. Decisions were made based on clinical judgment on expected benefit to guide management, on the urgency of the test, and in discussion with the referring clinician. SPECT-MPI was performed as scheduled: (1) for evaluation of ischemia in moderate- to high-risk patients considered for urgent coronary revascularization, (2) in patients with intermediate pretest CAD likelihood or when suspicion of CAD was high but coronary angiography had greater risk, and (3) for evaluation of ischemia in moderate- to high-risk patients in whom surgical procedure was urgent and revascularization was an option. On the other hand, the test was postponed by 2–4 months for evaluation of ischemia follow-up when there was no urgent revascularization plan.\nAt peak exercise, or 4 min after completion of dipyridamole infusion, a bolus of 155 MBq of 99mTc-sestamibi was intravenously injected [12, 13]. For stress imaging studies, recordings were obtained by cadmium-zinc telluride (CZT)-SPECT (D-SPECT, Spectrum Dynamics, Caesarea, Israel) system using 9 pixilated CZT crystal detector columns mounted vertically spanning a 90° geometry [14]. Each of the columns consists of 1024 (16 × 64) 5-mm thick CZT crystal elements (2.46 × 2.46 mm). Square hole tungsten collimators are fitted to each of the detectors, which are shorter than conventional low-energy, high-resolution collimators, yielding significantly better geometric speed. Data were acquired focusing on the heart by the detectors rotating in synchrony and saved in list mode. Images were obtained with the patient in a semi-recumbent position. A 10-s pre-scan acquisition was performed to identify the location of the heart and to set the angle limits of scanning for each detector (region of interest-centric scanning). Using the myocardial count rate from the pre-scan acquisition, the time per projection was set to target the recording of 1000 myocardial kcounts. For rest-optional images, a second intravenous bolus of 370 MBq of 99mTc-sestamibi was injected followed by rest imaging recording. The duration of the scans was less than 10 min for stress and 4 min for rest. Summed and gated projections were reconstructed with an iterative maximum likelihood expectation maximization algorithm using 7 and 4 iterations, respectively 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