Coronary artery disease is the leading cause of death in western society, claiming over a half million lives in the United States each year. Myocardial perfusion SPECT (Single Photon Emission Computed Tomography) imaging has demonstrated high diagnostic and prognostic value in the detection of coronary artery disease. Every year, over 3,000,000 perfusion SPECT studies are performed to evaluate cardiovascular risk in patients. Gated acquisition of perfusion SPECT offers, at minimal added cost, the opportunity to assess both myocardial perfusion and function with a single injection and a single imaging sequence. Gated SPECT images yield information on left ventricular (LV) wall motion, wall thickening, volume and ejection fraction. In addition, summed gated SPECT images yield LV perfusion information equivalent to that of standard perfusion SPECT. Despite its great potential benefits, gated SPECT imaging is not in routine clinical use due to its perceived technical complexity and difficulty of interpretation and quantitation. The overall objective of this proposal is to develop gated myocardial perfusion SPECT imaging into a technique that can be performed simply, quickly and accurately, and assess its incremental diagnostic and prognostic value over that of commonly used nuclear and non-nuclear cardiology modalities. Our ultimate goal is to make low-cost, combined myocardial perfusion/function imaging widely available to the medical community at large, as well as to identify the patient populations that can most benefit from it. This overall objective will be addressed in three separate sections: I. Development and validation of computer-based analytical tools to automatically extract and quantitate all information available from gated SPECT images; II. Development of innovative data acquisition techniques and new clinical protocols to perform gated SPECT studies faster, and to allow the use of gated SPECT in patients that are currently ill suited for it due to isotope or camera limitations; III. Assessment of the incremental diagnostic and prognostic value of gated SPECT, including cost analysis of gated SPECT in combination with and in contrast to other nuclear cardiology techniques.
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