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      EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision

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          Abstract

          Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/publications/guidelines/2015_07_EANM_FINAL_myocardial_perfusion_guideline.pdf.

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          Most cited references61

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          SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography.

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            EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology.

            The European procedural guidelines for radionuclide imaging of myocardial perfusion and viability are presented in 13 sections covering patient information, radiopharmaceuticals, injected activities and dosimetry, stress tests, imaging protocols and acquisition, quality control and reconstruction methods, gated studies and attenuation-scatter compensation, data analysis, reports and image display, and positron emission tomography. If the specific recommendations given could not be based on evidence from original, scientific studies, we tried to express this state-of-art. The guidelines are designed to assist in the practice of performing, interpreting and reporting myocardial perfusion SPET. The guidelines do not discuss clinical indications, benefits or drawbacks of radionuclide myocardial imaging compared to non-nuclear techniques, nor do they cover cost benefit or cost effectiveness.
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              Ticagrelor increases adenosine plasma concentration in patients with an acute coronary syndrome.

              This study aimed to investigate the impact of ticagrelor on adenosine plasma concentration (APC) in acute coronary syndrome (ACS) patients. Ticagrelor is a direct-acting P2Y12-adenosine diphosphate receptor blocker. The clinical benefit of ticagrelor compared with clopidogrel in ACS patients suggests that the drug has non-platelet-directed properties. Animal and in vitro models suggested that the "pleiotropic" properties of ticagrelor may be related to an interaction with adenosine metabolism. We prospectively randomized 60 ACS patients to receive ticagrelor or clopidogrel. The APC was measured by liquid chromatography. To assess the mechanism of APC variation, we measured adenosine deaminase concentration, adenosine uptake by red blood cells, and cyclic adenosine monophosphate production by cells overexpressing adenosine receptors. The P2Y12-adenosine diphosphate receptor blockade was assessed by the vasodilator-stimulated phosphoprotein index. Patients receiving ticagrelor had significantly higher APC than patients receiving clopidogrel (1.5 μM [interquartile range: 0.98 to 1.7 μM] vs. 0.68 μM [interquartile range: 0.49 to 0.78 μM]; p < 0.01). The APC was not correlated with vasodilator-stimulated phosphoprotein (p = 0.16). Serum-containing ticagrelor inhibited adenosine uptake by red blood cells compared with clopidogrel or controls (p < 0.01 for both comparisons). Adenosine deaminase activity was similar in serum of patients receiving clopidogrel or ticagrelor (p = 0.1). Ticagrelor and clopidogrel had no direct impact on adenosine receptors (p = not significant). Ticagrelor increases APC in ACS patients compared with clopidogrel by inhibiting adenosine uptake by red blood cells. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                31-20-5669111 , h.j.verberne@amc.uva.nl
                Journal
                Eur J Nucl Med Mol Imaging
                Eur. J. Nucl. Med. Mol. Imaging
                European Journal of Nuclear Medicine and Molecular Imaging
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1619-7070
                1619-7089
                21 August 2015
                21 August 2015
                2015
                : 42
                : 12
                : 1929-1940
                Affiliations
                [ ]Department of Nuclear Medicine, F2-238, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
                [ ]Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy
                [ ]Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
                [ ]Department of Nuclear Medicine, Guy’s Hospital – Guy’s & St Thomas’ Trust Foundation, London, UK
                [ ]Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
                [ ]Department of Nuclear Medicine, OLV Hospital, Aalst, Belgium
                [ ]Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
                [ ]Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
                [ ]Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
                [ ]Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
                [ ]Department of Radiation Physics, Skåne University Hospital, Lund, Sweden
                [ ]Heart and Diabetes Center North Rhine-Westphalia, Institute for Radiology, Nuclear Medicine and Molecular Imaging, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
                [ ]Department of Medical Radiation Physics, Lund University, Lund, Sweden
                [ ]Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, Copenhagen, Denmark
                [ ]Department of Nuclear Medicine, Service Commun Investigations chez l’Homme, GIP Cyceron, Caen University Hospital, Caen, France
                [ ]Radiation Physics, Skåne University Hospital, Malmö, Sweden
                [ ]Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
                [ ]Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
                [ ]Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Malmö, Sweden
                [ ]Department of Clinical Physiology and Nuclear Medicine & PET, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
                Article
                3139
                10.1007/s00259-015-3139-x
                4589547
                26290421
                d9cf1723-4a4d-4f47-b222-5a173a13406b
                © The Author(s) 2015

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 7 July 2015
                : 8 July 2015
                Categories
                Guidelines
                Custom metadata
                © Springer-Verlag Berlin Heidelberg 2015

                Radiology & Imaging
                guidelines,myocardial perfusion imaging,nuclear medicine,procedures
                Radiology & Imaging
                guidelines, myocardial perfusion imaging, nuclear medicine, procedures

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