Can upright myocardial perfusion imaging be used alone with a solid-state dedicated cardiac camera?

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Solid-state cardiac cameras offer fast, high-resolution imaging.
• The D-SPECT camera allows semi-reclining (upright) positioning for patient comfort and reduced motion during myocardial perfusion imaging.
• Physician familiarity with supine imaging may pose diagnostic challenges with upright positioning.

Purpose of the Study:

• To compare the diagnostic ability of upright versus supine myocardial perfusion imaging.
• To assess physician confidence in interpreting upright images.
• To identify and characterize artefacts in upright D-SPECT imaging.

Main Methods:

• Fifty-five patients underwent myocardial perfusion imaging using the D-SPECT camera in both upright and supine positions.
• Diagnostic equivalence was determined when both imaging techniques showed identical defects.
• Artefacts were defined as defects present in only one imaging set and were recorded for location and cause.

Main Results:

• 13/55 patients had equally diagnostic images with both techniques.
• Supine images showed artefacts in 24/55 patients, often due to high BMI, motion, or gut uptake.
• Upright images were non-diagnostic in 18/55 patients, primarily due to infero-apical defects in 16/18, particularly in overweight female patients (14/16).

Conclusions:

• Upright D-SPECT myocardial perfusion imaging reveals a common infero-apical artefact in up to one-third of cases, predominantly in overweight women.
• Understanding this artefact can enhance physician confidence, similar to conventional supine imaging.
• Upright imaging may be sufficient for diagnosis, with dual supine/upright imaging reserved for overweight patients to optimize throughput.