Different software tools for quantification of myocardial perfusion SPECT (MPS) studies are routinely used. Several perfusion parameters can be computed automatically. Interpretation of the MPS should start with visual inspection of the rotating planar images, visual analysis of reconstructed SPECT slices and then quantitative analysis to confirm the visual impression. Quantification should be used routinely as complementary to visual analysis. Advantages of quantification are: greater confidence in interpretation, better reproducibility, diagnostic accuracy and measuring the degree of abnormality even subtle changes for serial comparisons. In this review, we look at the common features of such quantitative tools: 17- segment scoring system, polar maps including: raw, severity and extent polar maps, lung-to-heart ratio, transient ischemic dilation ratio, total perfusion deficit and spherecity index.

Introduction: Normal population data is necessary for the quantification of myocardial perfusion studies (MPS). In Iran, data embedded in the Cedars Cardiac Suite, from young Californian volunteers, is used. We generated an Iranian female dataset and compared it with the original one. Methods: Thirty-one females aged 20-45 years without coronary artery disease risks were recruited. They underwent two-day exercise stress (Bruce protocol) and rest gated SPECT MPS. [99mTc]Tc-MIBI was injected (15 mCi) and imaging for stress and rest phases were started 60 and 90 min later, respectively, in supine and prone positions. A dual head gamma camera was used, ProSPECT (PNP, Tehran, Iran). Polar plots were extracted and a normal database generated. Results: Visually, none of the participants presented a reversible perfusion defect. Index for transient ischemic dilation was 1. 1±, 0. 15 and 1. 1±, 0. 14, respectively for prone and supine positions,lung heart uptake ratio 0. 3±, 0. 1 and 0. 28±, 0. 1,ejection fraction 69. 8±, 7. 8 and 70±, 8,peak filling rate 2. 9±, 0. 75 and 2. 9±, 0. 95 end-diastolic volume/sec,and time to peak filling rate at 178±, 44. 5 and 203±, 49. 5 millisecond. Compared to the original prone Californian normal database, total perfusion defect for stress and rest was 12. 1±, 6. 7 and 5. 3±, 5. 2, and for the supine position 10. 1±, 0. 5. 4 and 4. 0±, 3. 4, respectively. Conclusion: Iranian normal database for MPS was generated with a remarkable difference from the original normal data.

Introduction: Peripheral Vascular Disease (PVD) is a major cause of morbidity and is associated with Coronary Artery Disease (CAD). We aimed to perform Lower Limb Perfusion Scan (LLPS) in patients referred for Myocardial Perfusion Imaging (MPI) and estimate prevalence of PVD in subgroups with normal and abnormal MPI results. We also compared quantitative indices of LLPS in patients with and without abnormal MPI results with semi-quantitative QPS indices.Methods: 120 patients referred for MPI entered the study. Exercise or dipyridamole infusion was used as stress modality. After 99mTc-MIBI injection at peak stress, whole body posterior views and planar images from thighs and calves were obtained. Gated MPI was done subsequently. Rest phase was performed the following day. LLPS was analyzed visually and quantitatively.Results: In patients with abnormal and normal MPI results, LLPS revealed 22.58% and 1.92% prevalence of PVD in exercise subgroup (P-Value=0.004) and 50.00% and 10.52% in dipyridamole subgroup (P-Value=0.013), respectively. Both of these different prevalence were statistically significant. In exercise subgroup, mean ranks of Stress Index (Is) for all lower limb regions were statistically significantly greater in patients with normal MPI result. Also, among patients who had ischemia in exercise-rest MPI, negative correlations were seen between Is and Rest Index (Ir) of all regions and QPS quantitative indices.Conclusion: LLPS with 99mTc-MIBI, combined with MPI is a feasible method to detect lower limbs ischemia, especially in patients with abnormal MPI results. Correlating quantitative indices of LLPS with MPI-QPS also reflect coexistence of CAD and PVD.

Introduction: Patients with the coronary slow flow phenomenon (SCF) frequently experience angina episodes. The purpose of this study was to determine efficacy of nicorandil in myocardial perfusion in patients with SCF.Methods: Twenty patients (50.85 ± 12.96 y) with SCF were studied. We evaluate coronary slow flow according to protracted thrombolysis in myocardial infarction (TIMI) frame count. After diagnosis of SCF, all patients underwent dipyridamole stress/rest gated 99mTc-sestamibi SPECT. Subsequently, the patients received 10 mg nicorandil BD (20 mg per day). After starting nicorandil for one month, patients underwent dipyridamole stress/rest gated 99mTc-sestamibi SPECT again. Gated SPECT images were analyzed based on 17-segment scoring system, and QPS (quantitative perfusion SPECT) and QGS (quantitative gated SPECT) softwares were used.Results: In patients with SCF subtle perfusion abnormality was noticed. With nicorandil consumption, EDV and ESV were decreased and LVEF was increased in both stress and rest gated SPECT phases (P>0.05). After nicorandil consumption, decreased in most semi-quantitative perfusion indices (Severity score; P=0.03, Extension score; P=0.06, RAW reversibility; P=0.002, severity reversibility; P=0.03 and Extension reversibility; P=0.001) except for RAW score were observed demonstrating significant difference with pre-nicorandil consumption quantities. In multi-vessels involvement with SCF, there was a trend to see more abnormality with more remarkable post-nicorandil change as compared to the patients with one vessel involvement.Conclusion: The main finding of this study was better myocardial coronary flow after nicorandil consumption in patients with SCF specially those with multi-vessel involvement.