Myocardial Perfusion Imaging with a Solid-State Camera: Simulation of a Very Low Dose Imaging Protocol

High-sensitivity dedicated cardiac camera systems provide an opportunity to lower the injected doses for SPECT myocardial perfusion imaging (MPI), but the exact limits for lowering doses have not been determined. List-mode data acquisition allows for reconstruction of various fractions of acquired counts, enabling a simulation of gradually lower administered dose. We aimed to determine the feasibility of very low dose MPI by exploring the minimal count level in the myocardium required for accurate MPI. Methods: Seventy-nine patients were studied (mean body mass index, 30.0 6 6.6; range, 20.2–54.0 kg/m2) who underwent 1-d standard-dose 99mTcsestamibi exercise or adenosine rest–stress MPI for clinical indications using a cadmium-zinc-telluride dedicated cardiac camera. The imaging time was 14 min, with averaged 803 6 200 MBq (21.7 6 5.4 mCi) of 99mTc injected at stress. To simulate clinical scans with a lower dose at that imaging time we reframed the list-mode raw data. Accordingly, 6 stressequivalent datasets were reconstructed containing various count fractions of the original scan. Automated quantitative perfusion and gated SPECT software was used to quantify total perfusion deficit (TPD) and ejection fraction for all 553 datasets (7 · 79). The minimal acceptable left ventricular region counts were determined on the basis of a previous report with repeatability of same-day, same-injection Anger camera studies. Pearson correlation coefficients and the SD of differences in TPD for all scans were calculated. Results: The correlations of quantitative perfusion and function analysis were excellent for both global and regional analysis between original scans and all simulated low-count scans (all r $ 0.95, P , 0.0001). The minimal acceptable counts were determined to be 1.0 million for the left ventricular region. At this count level, the SD of differences was 1.7% for TPD and 4.2% for ejection fraction. This count level would correspond to a 92.5-MBq (2.5-mCi) injected dose for the 14-min acquisition or 125.8-MBq (3.4-mCi) injected dose for the 10-min acquisition. Conclusion: 1.0 million counts appear to be sufficient to produce myocardial images that agree well with 8.0-million-count images on quantitative perfusion and function parameters. With a dedicated cardiac camera, these images can be obtained over 10 min with an effective radiation dose of less than 1 mSv without significant sacrifice of accuracy.