Different techniques have been introduced for full automatic processing of myocardial perfusion i... more Different techniques have been introduced for full automatic processing of myocardial perfusion imaging with single-photon emission tomography. We tried to evaluate the accuracy of one of these commercial automatic processing methods. The study was performed in 300 patients during 18 months. Two post-stress acquisitions in supine and prone positions and one acquisition at rest , were performed for every patient. All images were processed both automatically and interactively and the results were compared to each other. The automatic method matched the interactive method in 95.22% for left ventricle isolation, in 99.54% for excluding extra-cardiac activity and in 98.22% for reorientation of a single projected data. The automatic method was also successful in complete processing of 81.33% sets of stress (supine)-rest and 79.77% sets of stress (prone)-rest images as compared to the interactive method. In conclusion, the fully automated processing method matches the interactive method in...
Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is not only... more Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is not only a precious means of evaluation of ischemic heart disease, but also it may contribute to incidental detection of different important abnormal non-cardiac findings. However, it should be considered that all of these abnormal extracardiac accumulations might not lead to a significant pathologic underlying. Therefore, thorough inspection of rotating raw and low-dose computed tomographic (CT) images is of great importance. We report a case with transient multifocal pulmonary uptake with no concordant abnormal CT findings, suggestive of iatrogenic microemboli of radiotracer in SPECT MPI.
Objectives: Diabetes mellitus type 2 (DM2) is one of the leading causes of morbidity and mortalit... more Objectives: Diabetes mellitus type 2 (DM2) is one of the leading causes of morbidity and mortality owing to its role in the development of cardiovascular disease. This study sought to evaluate the relationship between diabetic retinopathy (DR) and myocardial ischemia using myocardial perfusion imaging (MPI). Materials and Methods: Thirty-three patients with DM2 (age =59 ± 8 years) were examined for evidence of DR. The subjects were divided into two groups on the basis of the presence DR(+) or absence DR(-) of diabetic retinopathy. MPI was performed for all the patients as well. Results: Eighteen and fifteen patients were categorized as DR(+) and DR(-), respectively. Ischemia was significantly more frequent in the DR(+) group than in the DR(-) group (p <0.05). There was also a positive association between the grade of retinopathy and the grade of ischemia (odds ratio (OR)confidence interval (CI)95% =7.1 1.7-29.6, p =0.007). Severe nonproliferative/proliferative DR was independentl...
Figure 1. (a) Diffusely decreased radiotracer uptake in the left lung along with multiple wedge-s... more Figure 1. (a) Diffusely decreased radiotracer uptake in the left lung along with multiple wedge-shaped pleural-based segmental pulmonary perfusion defects in both lungs. Planar images from different angles (POST, posterior; ANT, anterior) (b) Oblique coronal reconstructed view of CT pulmonary angiography (CTPA). Remarkable post-radiation right upper lobe pulmonary fibrosis (thin arrow) accompanied by extensive mediastinal and bihilar fibrotic changes. Significant ostial stenosis of bilateral lower lobar arteries (thick arrows) as well as thromboemboli in left upper lobe segmental arterial branch (curved arrow). Complete occlusion of the right upper lobar arterial branch was noted. (c) Anterior–posterior view of pulmonary angiography. Significant ostial stenosis of the left lower lobe artery depicted in b (d) Oblique coronal reconstructed view of CTPA. Right side mastectomy and significant ostial stenosis of the right lower lobe pulmonary vein (RLL PV) (e) Coronal view of CTPA. Exten...
Background: Blunted heart rate response (BHR) during dipyridamole stress testing has been reporte... more Background: Blunted heart rate response (BHR) during dipyridamole stress testing has been reported to be related to higher cardiac death. This study was performed to assess the association between BHR and perfusion abnormalities in diabetic patients undergoing dipyridamole stress ECG-gated myocardial perfusion imaging (MPI) as compared with nondiabetic patients. Methods: A total of 2172 subjects (1602 women and 570 men) at a mean age of 61 ± 11 years who were referred for MPI to our department were studied. The subjects were divided into 2 groups on the basis of the presence or absence of diabetes mellitus (849 diabetic vs 1323 nondiabetic subjects). Results: Dipyridamole-related BHR was noted in 471 (67.7%) patients, demonstrating a significantly higher incidence in the diabetic patients than in the nondiabetic subjects (P < 0.05). Both basal systolic and peak systolic blood pressures were significantly higher in the patients with diabetes mellitus (P < 0.05). However, no sig...
Journal of Mazandaran University of Medical Sciences, 2016
Background and purpose: Viable tissue detection after STEMI can lead to successful revascularizat... more Background and purpose: Viable tissue detection after STEMI can lead to successful revascularization for reversing myocardial dysfunction. The purpose of this study was to compare the Thallium-201 SPECT and MRI findings in viability assessment. Materials and methods: A cross-sectional study was performed on 17 patients with STEMI. In addition to Thallium SPECT, contrast enhanced MRI imaging was done. Viability was determined as more than 50 percent thallium uptake after 4 hours in SPECT and lower than 50 percent gadolinium enhancement after 10 minutes in each segments in CMRI. Results: Two hundred eighty nine segments were studied using both methods. TL SPECT showed 15.6% of the segments as non-viable tissue while MRI showed 35% non-viable tissue. There was a substantial agreement between these methods in apical septal and apical segments (k: 0.653, k: 0.757, respectively). Conclusion: The percentage of non-viable myocardium in MRI was found to be higher than that of Thallium SPECT ...
Introduction: Myocardial perfusion imaging using gated SPECT and phase analysis is an effective t... more Introduction: Myocardial perfusion imaging using gated SPECT and phase analysis is an effective tool in evaluation of mechanical dyssynchrony. The purpose of this study was to determine the normal ranges of global and regional phase parameters. Methods: A total of 100 patients with normal resting and stress electrocardiograms, low pretest likelihood for coronary artery disease and a normal gated MPI study were recruited in the study. All of the patients underwent a standard 2-day stress/rest gated MPI study according to standard protocols. The reconstructed images were further analyzed by Cedar-Sinai’s quantitative gated SPECT. Left ventricular phase indices were provided both globally and regionally for both genders and the normal interquartile range of these parameters were defined. Results:Normal ranges of global and wall-based regional phase parameters are presented both in unisex and in gender-specific formats. Both global (P<0.001) and major LV regional phase parameters (P&...
Objectives:Previous studies have demonstrated that Quantitative Rest-Redistribution Thallium Imag... more Objectives:Previous studies have demonstrated that Quantitative Rest-Redistribution Thallium Imaging is one of the most accurate protocols for the assessment of myocardial viability. This study was conducted to evaluate the alteration of the relative segmental activity of quantification analysis in patients undergoing theRest-Redistribution Thallium-201 Study via theSingle Photon Emission Computed Tomography(SPECT) method for the assessment of viability before(NC)and after introducing CT-based attenuation correction (CTAC). Materials and Methods:Forty-two patients with left ventricular dysfunction who were referred for viability assessment with Thallium-201 Rest-Redistribution protocol were included. A series of two acquisitions, comprising twenty-minute rest and four-hour redistribution acquisitions, were performed for all the patients. CT acquisition of the same region of the SPECT acquisition was performed for attenuation correction, immediately after the completion of each SPECT...
Objective Myocardial perfusion imaging (MPI) by gated single-photon emission computed tomography ... more Objective Myocardial perfusion imaging (MPI) by gated single-photon emission computed tomography (SPECT) is a feasible method in the evaluation of left ventricular perfusion and function. The purpose of this study was to determine the threshold and grading of left ventricular (LV) diastolic dysfunction (LVDD) using gated SPECT MPI. Methods A total of 149 patients were recruited in the study. All of the patients underwent a standard 2-day stress/rest gated MPI study and transthoracic echocardiography within 2 weeks. The reconstructed rest-only images were analyzed by Cedar-Sinai’s quantitative gated SPECT and the LV diastolic parameters, including peak filling rate (PFR), time to PFR (TTPF) and secondary PFR (PFR2) to PFR ratio were provided and compared to echocardiographic data. Results 68 (45.6%) and 81 (54.4%) of patients were categorized in LVDD-absent and LVDD-present groups on the basis of LVDD evidence in echocardiography, respectively. receiver-operating-characteristic analy...
Quantitative analysis of myocardial perfusion Single photon emission computerized tomography (SPE... more Quantitative analysis of myocardial perfusion Single photon emission computerized tomography (SPECT) images is increasingly applied in modern nuclear cardiology practice, assisting in the interpretation of myocardial perfusion images (MPI). There are different extensively validated state-of-the-art software packages, including QPS (cedars-Sinai), Corridor 4DM (University of Michigan) and Emory cardiac toolbox (Emory university), providing highly accurate and reproducible data. However, these software packages may suffer from potential artifacts related to patient or technical factors. By recognizing the source of such artifacts, the interpreting physician can avoid misinterpretation of MPI study. In this review, we discuss some of technical pitfalls that may occur in Quantitative Perfusion SPECT software (QPS, cedars-Sinai Medical center).
Different techniques have been introduced for full automatic processing of myocardial perfusion i... more Different techniques have been introduced for full automatic processing of myocardial perfusion imaging with single-photon emission tomography. We tried to evaluate the accuracy of one of these commercial automatic processing methods. The study was performed in 300 patients during 18 months. Two post-stress acquisitions in supine and prone positions and one acquisition at rest , were performed for every patient. All images were processed both automatically and interactively and the results were compared to each other. The automatic method matched the interactive method in 95.22% for left ventricle isolation, in 99.54% for excluding extra-cardiac activity and in 98.22% for reorientation of a single projected data. The automatic method was also successful in complete processing of 81.33% sets of stress (supine)-rest and 79.77% sets of stress (prone)-rest images as compared to the interactive method. In conclusion, the fully automated processing method matches the interactive method in...
Respiratory-related cardiac motion could have considerable effects on myocardial perfusion imagin... more Respiratory-related cardiac motion could have considerable effects on myocardial perfusion imaging, leading to misinterpretation of the images. In this study, we examined the influence of respiratory correction on ECG-gated myocardial perfusion SPECT (RC-GSPECT) concerning regional myocardial perfusion and function. Using the NCAT phantom, a typical torso phantom was generated. SimSET, a Monte Carlo simulator, was used to image the photon emerging from the phantom. Twenty-six patients underwent a 2-day stress-rest ECG-gated myocardial perfusion SPECT (GSPECT) imaging. A separate study was also performed by simultaneous respiratory and cardiac triggering with the real-time position management (RPM) for respiratory correction (RC). In simulation study, count density in the inferior and inferoseptal walls increased in the lower bin of the respiratory cycle. On the other hand, there was a higher correlation between RC-GSPECT and echocardiography for left ventricular ejection fraction (LVEF) (r = 0.95, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01 vs r = 0.88, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01 for GSPECT). We proposed a new approach for respiratory and cardiac-gated SPECT to eliminate respiratory motion artifacts. RC-GSPECT is a feasible method in MPI studies and may play an important role to improve the quality of MPI images, particularly in the inferior wall.
The effectiveness of metoclopramide in reducing gastrointestinal-induced artifacts in myocardial ... more The effectiveness of metoclopramide in reducing gastrointestinal-induced artifacts in myocardial perfusion imaging (MPI) is a subject of debate. We examined the significance of this pharmacological intervention in the quality of images obtained from MPI studies. A total of 211 suspected or known cases with coronary artery disease routinely referred to our nuclear medicine department for MPI were randomly assigned to group A and group B. Group A (N=125) comprised patients who received 10 mg of metoclopramide orally after the injection of the radiotracer [technetium-99m-labeled methoxyisobutyl isonitril (99mTc-MIBI)] 1 h before image acquisition, and group B (N=86) comprised patients who did not receive any pharmacological intervention and were considered the control group. All the scans in each group were assessed in the rest phase of a routine 2-day protocol. The single-photon emission computerized tomography (SPECT) images were visually evaluated in terms of extracardiac activities and their effects on image quality by three nuclear medicine physicians, who were blinded to the details of the protocol. Of the 125 patients who had received metoclopramide, 16 (13%) had nonacceptable, 72 (57.6%) had acceptable (interpretable), and 37 (29.6%) had good image quality. The image quality in group B was nonacceptable in 10 (11.23%), acceptable in 48 (50.23%), and good in 28 (33.56%) patients. The overall interobserver agreement was good (κ: 0.6-0.9, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) among the three readers. There was no statistically significant difference in terms of MPI-SPECT image quality between patients who received metoclopramide and those in the control group. Metoclopramide, therefore, did not exert a remarkable effect on the quality of our MPI scans.
Different techniques have been introduced for full automatic processing of myocardial perfusion i... more Different techniques have been introduced for full automatic processing of myocardial perfusion imaging with single-photon emission tomography. We tried to evaluate the accuracy of one of these commercial automatic processing methods. The study was performed in 300 patients during 18 months. Two post-stress acquisitions in supine and prone positions and one acquisition at rest , were performed for every patient. All images were processed both automatically and interactively and the results were compared to each other. The automatic method matched the interactive method in 95.22% for left ventricle isolation, in 99.54% for excluding extra-cardiac activity and in 98.22% for reorientation of a single projected data. The automatic method was also successful in complete processing of 81.33% sets of stress (supine)-rest and 79.77% sets of stress (prone)-rest images as compared to the interactive method. In conclusion, the fully automated processing method matches the interactive method in...
Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is not only... more Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is not only a precious means of evaluation of ischemic heart disease, but also it may contribute to incidental detection of different important abnormal non-cardiac findings. However, it should be considered that all of these abnormal extracardiac accumulations might not lead to a significant pathologic underlying. Therefore, thorough inspection of rotating raw and low-dose computed tomographic (CT) images is of great importance. We report a case with transient multifocal pulmonary uptake with no concordant abnormal CT findings, suggestive of iatrogenic microemboli of radiotracer in SPECT MPI.
Objectives: Diabetes mellitus type 2 (DM2) is one of the leading causes of morbidity and mortalit... more Objectives: Diabetes mellitus type 2 (DM2) is one of the leading causes of morbidity and mortality owing to its role in the development of cardiovascular disease. This study sought to evaluate the relationship between diabetic retinopathy (DR) and myocardial ischemia using myocardial perfusion imaging (MPI). Materials and Methods: Thirty-three patients with DM2 (age =59 ± 8 years) were examined for evidence of DR. The subjects were divided into two groups on the basis of the presence DR(+) or absence DR(-) of diabetic retinopathy. MPI was performed for all the patients as well. Results: Eighteen and fifteen patients were categorized as DR(+) and DR(-), respectively. Ischemia was significantly more frequent in the DR(+) group than in the DR(-) group (p <0.05). There was also a positive association between the grade of retinopathy and the grade of ischemia (odds ratio (OR)confidence interval (CI)95% =7.1 1.7-29.6, p =0.007). Severe nonproliferative/proliferative DR was independentl...
Figure 1. (a) Diffusely decreased radiotracer uptake in the left lung along with multiple wedge-s... more Figure 1. (a) Diffusely decreased radiotracer uptake in the left lung along with multiple wedge-shaped pleural-based segmental pulmonary perfusion defects in both lungs. Planar images from different angles (POST, posterior; ANT, anterior) (b) Oblique coronal reconstructed view of CT pulmonary angiography (CTPA). Remarkable post-radiation right upper lobe pulmonary fibrosis (thin arrow) accompanied by extensive mediastinal and bihilar fibrotic changes. Significant ostial stenosis of bilateral lower lobar arteries (thick arrows) as well as thromboemboli in left upper lobe segmental arterial branch (curved arrow). Complete occlusion of the right upper lobar arterial branch was noted. (c) Anterior–posterior view of pulmonary angiography. Significant ostial stenosis of the left lower lobe artery depicted in b (d) Oblique coronal reconstructed view of CTPA. Right side mastectomy and significant ostial stenosis of the right lower lobe pulmonary vein (RLL PV) (e) Coronal view of CTPA. Exten...
Background: Blunted heart rate response (BHR) during dipyridamole stress testing has been reporte... more Background: Blunted heart rate response (BHR) during dipyridamole stress testing has been reported to be related to higher cardiac death. This study was performed to assess the association between BHR and perfusion abnormalities in diabetic patients undergoing dipyridamole stress ECG-gated myocardial perfusion imaging (MPI) as compared with nondiabetic patients. Methods: A total of 2172 subjects (1602 women and 570 men) at a mean age of 61 ± 11 years who were referred for MPI to our department were studied. The subjects were divided into 2 groups on the basis of the presence or absence of diabetes mellitus (849 diabetic vs 1323 nondiabetic subjects). Results: Dipyridamole-related BHR was noted in 471 (67.7%) patients, demonstrating a significantly higher incidence in the diabetic patients than in the nondiabetic subjects (P < 0.05). Both basal systolic and peak systolic blood pressures were significantly higher in the patients with diabetes mellitus (P < 0.05). However, no sig...
Journal of Mazandaran University of Medical Sciences, 2016
Background and purpose: Viable tissue detection after STEMI can lead to successful revascularizat... more Background and purpose: Viable tissue detection after STEMI can lead to successful revascularization for reversing myocardial dysfunction. The purpose of this study was to compare the Thallium-201 SPECT and MRI findings in viability assessment. Materials and methods: A cross-sectional study was performed on 17 patients with STEMI. In addition to Thallium SPECT, contrast enhanced MRI imaging was done. Viability was determined as more than 50 percent thallium uptake after 4 hours in SPECT and lower than 50 percent gadolinium enhancement after 10 minutes in each segments in CMRI. Results: Two hundred eighty nine segments were studied using both methods. TL SPECT showed 15.6% of the segments as non-viable tissue while MRI showed 35% non-viable tissue. There was a substantial agreement between these methods in apical septal and apical segments (k: 0.653, k: 0.757, respectively). Conclusion: The percentage of non-viable myocardium in MRI was found to be higher than that of Thallium SPECT ...
Introduction: Myocardial perfusion imaging using gated SPECT and phase analysis is an effective t... more Introduction: Myocardial perfusion imaging using gated SPECT and phase analysis is an effective tool in evaluation of mechanical dyssynchrony. The purpose of this study was to determine the normal ranges of global and regional phase parameters. Methods: A total of 100 patients with normal resting and stress electrocardiograms, low pretest likelihood for coronary artery disease and a normal gated MPI study were recruited in the study. All of the patients underwent a standard 2-day stress/rest gated MPI study according to standard protocols. The reconstructed images were further analyzed by Cedar-Sinai’s quantitative gated SPECT. Left ventricular phase indices were provided both globally and regionally for both genders and the normal interquartile range of these parameters were defined. Results:Normal ranges of global and wall-based regional phase parameters are presented both in unisex and in gender-specific formats. Both global (P<0.001) and major LV regional phase parameters (P&...
Objectives:Previous studies have demonstrated that Quantitative Rest-Redistribution Thallium Imag... more Objectives:Previous studies have demonstrated that Quantitative Rest-Redistribution Thallium Imaging is one of the most accurate protocols for the assessment of myocardial viability. This study was conducted to evaluate the alteration of the relative segmental activity of quantification analysis in patients undergoing theRest-Redistribution Thallium-201 Study via theSingle Photon Emission Computed Tomography(SPECT) method for the assessment of viability before(NC)and after introducing CT-based attenuation correction (CTAC). Materials and Methods:Forty-two patients with left ventricular dysfunction who were referred for viability assessment with Thallium-201 Rest-Redistribution protocol were included. A series of two acquisitions, comprising twenty-minute rest and four-hour redistribution acquisitions, were performed for all the patients. CT acquisition of the same region of the SPECT acquisition was performed for attenuation correction, immediately after the completion of each SPECT...
Objective Myocardial perfusion imaging (MPI) by gated single-photon emission computed tomography ... more Objective Myocardial perfusion imaging (MPI) by gated single-photon emission computed tomography (SPECT) is a feasible method in the evaluation of left ventricular perfusion and function. The purpose of this study was to determine the threshold and grading of left ventricular (LV) diastolic dysfunction (LVDD) using gated SPECT MPI. Methods A total of 149 patients were recruited in the study. All of the patients underwent a standard 2-day stress/rest gated MPI study and transthoracic echocardiography within 2 weeks. The reconstructed rest-only images were analyzed by Cedar-Sinai’s quantitative gated SPECT and the LV diastolic parameters, including peak filling rate (PFR), time to PFR (TTPF) and secondary PFR (PFR2) to PFR ratio were provided and compared to echocardiographic data. Results 68 (45.6%) and 81 (54.4%) of patients were categorized in LVDD-absent and LVDD-present groups on the basis of LVDD evidence in echocardiography, respectively. receiver-operating-characteristic analy...
Quantitative analysis of myocardial perfusion Single photon emission computerized tomography (SPE... more Quantitative analysis of myocardial perfusion Single photon emission computerized tomography (SPECT) images is increasingly applied in modern nuclear cardiology practice, assisting in the interpretation of myocardial perfusion images (MPI). There are different extensively validated state-of-the-art software packages, including QPS (cedars-Sinai), Corridor 4DM (University of Michigan) and Emory cardiac toolbox (Emory university), providing highly accurate and reproducible data. However, these software packages may suffer from potential artifacts related to patient or technical factors. By recognizing the source of such artifacts, the interpreting physician can avoid misinterpretation of MPI study. In this review, we discuss some of technical pitfalls that may occur in Quantitative Perfusion SPECT software (QPS, cedars-Sinai Medical center).
Different techniques have been introduced for full automatic processing of myocardial perfusion i... more Different techniques have been introduced for full automatic processing of myocardial perfusion imaging with single-photon emission tomography. We tried to evaluate the accuracy of one of these commercial automatic processing methods. The study was performed in 300 patients during 18 months. Two post-stress acquisitions in supine and prone positions and one acquisition at rest , were performed for every patient. All images were processed both automatically and interactively and the results were compared to each other. The automatic method matched the interactive method in 95.22% for left ventricle isolation, in 99.54% for excluding extra-cardiac activity and in 98.22% for reorientation of a single projected data. The automatic method was also successful in complete processing of 81.33% sets of stress (supine)-rest and 79.77% sets of stress (prone)-rest images as compared to the interactive method. In conclusion, the fully automated processing method matches the interactive method in...
Respiratory-related cardiac motion could have considerable effects on myocardial perfusion imagin... more Respiratory-related cardiac motion could have considerable effects on myocardial perfusion imaging, leading to misinterpretation of the images. In this study, we examined the influence of respiratory correction on ECG-gated myocardial perfusion SPECT (RC-GSPECT) concerning regional myocardial perfusion and function. Using the NCAT phantom, a typical torso phantom was generated. SimSET, a Monte Carlo simulator, was used to image the photon emerging from the phantom. Twenty-six patients underwent a 2-day stress-rest ECG-gated myocardial perfusion SPECT (GSPECT) imaging. A separate study was also performed by simultaneous respiratory and cardiac triggering with the real-time position management (RPM) for respiratory correction (RC). In simulation study, count density in the inferior and inferoseptal walls increased in the lower bin of the respiratory cycle. On the other hand, there was a higher correlation between RC-GSPECT and echocardiography for left ventricular ejection fraction (LVEF) (r = 0.95, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01 vs r = 0.88, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01 for GSPECT). We proposed a new approach for respiratory and cardiac-gated SPECT to eliminate respiratory motion artifacts. RC-GSPECT is a feasible method in MPI studies and may play an important role to improve the quality of MPI images, particularly in the inferior wall.
The effectiveness of metoclopramide in reducing gastrointestinal-induced artifacts in myocardial ... more The effectiveness of metoclopramide in reducing gastrointestinal-induced artifacts in myocardial perfusion imaging (MPI) is a subject of debate. We examined the significance of this pharmacological intervention in the quality of images obtained from MPI studies. A total of 211 suspected or known cases with coronary artery disease routinely referred to our nuclear medicine department for MPI were randomly assigned to group A and group B. Group A (N=125) comprised patients who received 10 mg of metoclopramide orally after the injection of the radiotracer [technetium-99m-labeled methoxyisobutyl isonitril (99mTc-MIBI)] 1 h before image acquisition, and group B (N=86) comprised patients who did not receive any pharmacological intervention and were considered the control group. All the scans in each group were assessed in the rest phase of a routine 2-day protocol. The single-photon emission computerized tomography (SPECT) images were visually evaluated in terms of extracardiac activities and their effects on image quality by three nuclear medicine physicians, who were blinded to the details of the protocol. Of the 125 patients who had received metoclopramide, 16 (13%) had nonacceptable, 72 (57.6%) had acceptable (interpretable), and 37 (29.6%) had good image quality. The image quality in group B was nonacceptable in 10 (11.23%), acceptable in 48 (50.23%), and good in 28 (33.56%) patients. The overall interobserver agreement was good (κ: 0.6-0.9, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05) among the three readers. There was no statistically significant difference in terms of MPI-SPECT image quality between patients who received metoclopramide and those in the control group. Metoclopramide, therefore, did not exert a remarkable effect on the quality of our MPI scans.
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