Left atrial (LA) strain marks a highly valuable clinical parameter for discrimination of various cardiovascular diseases as consolidated by a plethora of literature. However LA strain assessment by cardiovascular magnetic resonance feature tracking (CMR-FT) is conventionally based on 2-chamber (2Ch) and 4-chamber (4Ch) cine acquisitions, which are aligned for left ventricular (LV) imaging. These slice positions are hypothesized inadequate for identifying the longest LA dimensions required for accurate LA strain quantification. LA strain was assessed in 21 patients (48.3 ± 15.2 years, 10 females) with various cardiovascular diseases by CMR-FT. Two different planning procedures were compared: (1) the standard planning procedure using the cine steady-state free-precession (SSFP) 2Ch and 4Ch views aligned to the LV and (2) the optimized planning procedure based on cine SSFP 2Ch and 4Ch views, however, aligned to the LA. Strain analysis was performed using CVI42® software. Paired Student's t-test or Wilcoxon test and Bland Altman statistics were used to evaluate differences between both planning procedures. Indexed maximum, minimum LA volumes and LA volumes before atrial contraction were significantly elevated for optimized planning compared to standard planning (P < 0.001). In contrast, global longitudinal reservoir, conduit and booster LA strain and consecutively strain rates were found reduced for the optimized planning procedure compared to the standard planning procedure (P < 0.007). The total and passive LA ejection fractions remained unchanged, whereas the booster LA ejection fractions was significantly lower for the optimized planning procedure (P = 0.034). Optimized LA planning procedure for assessment of the longest LA dimensions results in significant alterations in CMR quantifications with increased chamber volumetrics and decreased strain and strain rates compared to standard procedure.

This paper presents the results of the 10th survey of myocardial perfusion SPECT (MPS) from the year 2024. A total of 198 questionnaires were evaluated, comprising 115 practices (PR), 57 hospitals (HO) and 26 university hospitals (UH). The results of the previous survey 2021 are shown in squared brackets. MPS data from 128.707 [133.057] patients (–3.3%) with 125.175 [131.868] stress and 102.903 [106.546] rest MPS were analysed. A comparison with official data revealed that 53% of all MPS were recorded. From 2018 to 2024, official data showed an increase in MPS every year. In 2024, on average, 650 [610] MPS patients (+7%) were examined in each department. Of the participating departments, 69% [74%] reported an increase or no changes in their patient numbers. As always ambulatory care cardiologists represented the major referral group (68% [69%]). Pharmacological stress was performed more frequently than ergometry (43% [42%]). Regadenoson was mostly used. The use of the different protocols remained almost unchanged. Two-day protocols were predominantly applied (49% [49%]). Multi-head cameras were used in (56% [58%] of the departments and SPECT-CT systems in (31% [28%]). Attenuation correction was performed in 35% [33%] of all MPS. 95% [89%] of all stress, 93% [88%] of all rest and 92% [87%] of all stress and rest scan were acquired as gated SPECT. 84% [72%] of the departments performed scoring by default. The proportion of departments not scoring decreased to 4% [13%]. The MPS 2024 survey indicates that the long-term positive development of MPS imaging is continuing. The procedural and technical details of MPS imaging demonstrate a high level of conformity with guidelines, with a slight improvement observed from 2021 to 2024.

BACKGROUND:The topic of the effect of the patient table on attenuation in myocardial perfusion imaging (MPI) SPECT is gaining new relevance due to deep learning methods. Existing studies on this effect are old, rare and only consider phantom measurements, not patient studies. This study investigates the effect of the patient table on attenuation based on the difference between reconstructions of phantom scans and polar maps of patient studies. METHODS:Jaszczak phantom scans are acquired according to quality control and MPI procedures. An algorithm is developed to automatically remove the patient table from the CT for attenuation correction. The scans are then reconstructed with attenuation correction either with or without the patient table in the CT. The reconstructions are compared qualitatively and on the basis of their percentage difference. In addition, a small retrospective cohort of 15 patients is examined by comparing the resulting polar maps. Polar maps are compared qualitatively and based on the segment perfusion scores. RESULTS:The phantom reconstructions look qualitatively similar in both the quality control and MPI procedures. The percentage difference is highest in the lower part of the phantom, but it always remains below 17.5%. Polar maps from patient studies also look qualitatively similar. Furthermore, the segment scores are not significantly different (p=0.83). CONCLUSIONS:The effect of the patient table on attenuation in MPI SPECT is negligible.

Aim Digitalization in the healthcare sector is becoming increasingly widespread. Yet, the degree of digitalization in nuclear medicine has not been systematically investigated. The "Digitalization and AI" working group of the German Society of Nuclear Medicine conducted a survey to assess the status quo of digitalization of the nuclear medicine health infrastructure in Germany. Methods 100 questions were defined on eleven topics covering the main work processes in nuclear medicine. The survey primarily included single-select multiple-choice questions, yes-no questions on the availability of specific digital structures and processes, and questions assessing the degree of digitalization of certain processes and current satisfaction. The level of satisfaction was measured with an ordinal scale (1, very good to 5, poor). Results In most subject areas, processes relied on a combination of paper-based and electronic procedures for the topics analyzed. Differences in satisfaction regarding the different types of processes for any of the questions were not observed, and the overall level of satisfaction among responding sites was quite high. Conclusion The survey did not reveal a clear need of the responding sites for complete digitalization of clinical processes. Yet, the participants highlighted the lack of proper Wi-Fi (60%) and the desire for a platform for communication between hospitals, registered doctors and patients (74%). Nevertheless, it is important to take a focused and unbiased look at the daily clinical procedures in every institution and place it in the frame of the existing tools or solutions of peer institutions to discover aspects of digitalization that can create added value in terms of time efficiency, integrity and sustainability.

OBJECTIVES:This study evaluates the potential of the computed tomography-derived total psoas volume index (TPVI) as a screening tool for frailty and investigates the relationship between sarcopenia, defined by the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, and postoperative outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). Given the impact of frailty and sarcopenia on complications and mortality, and the lack of standardized screening tools, TPVI may be useful in clinical assessment. DESIGN:A retrospective, single-center study. SETTING:Institute for Anesthesiology and Pain Therapy at the Heart and Diabetes Center NRW, Bad Oeynhausen. PARTICIPANTS:Cohort of 197 patients (≥65 years) undergoing elective TAVI between July 2020 and December 2021. MEASUREMENTS AND MAIN RESULTS:Frailty was assessed using the Fried phenotype, and sarcopenia was determined based on EWGSOP criteria (TPVI, handgrip strength, timed up-and-go test) to form a comprehensive score. Postoperative outcomes, including complications and 1-year mortality, were recorded. Statistical analyses included a fourfold table, receiver operating characteristic curves, Kaplan-Meier survival analysis, and multivariate tests. TPVI demonstrated high specificity (84%) but low sensitivity (28%) in detecting frailty. The area under the curve for predicting frailty was 0.384 for males and 0.393 for females. Sarcopenia was not significantly associated with immediate postoperative complications but was linked to increased 1-year mortality (log-rank test, p = 0.026). CONCLUSIONS:While TPVI is not suitable as a frailty screening tool due to its low sensitivity, it may assist in identifying non-frail patients and optimizing resource allocation. Sarcopenia was significantly associated with higher 1-year mortality, emphasizing the need for multifaceted assessments in older TAVI patients.

Digitalization in the healthcare sector is becoming increasingly widespread. Yet, the degree of digitalization in nuclear medicine has not been systematically investigated. The "Digitalization and AI" working group of the German Society of Nuclear Medicine conducted a survey to assess the status quo of digitalization of the nuclear medicine health infrastructure in Germany.100 questions were defined on eleven topics covering the main work processes in nuclear medicine. The survey primarily included single-select multiple-choice questions, yes-no questions on the availability of specific digital structures and processes, and questions assessing the degree of digitalization of certain processes and current satisfaction. The level of satisfaction was measured with an ordinal scale (1, very good to 5, poor).In most subject areas, processes relied on a combination of paper-based and electronic procedures for the topics analyzed. Differences in satisfaction regarding the different types of processes for any of the questions were not observed, and the overall level of satisfaction among responding sites was quite high.The survey did not reveal a clear need of the responding sites for complete digitalization of clinical processes. Yet, the participants highlighted the lack of proper Wi-Fi (60%) and the desire for a platform for communication between hospitals, registered doctors and patients (74%). Nevertheless, it is important to take a focused and unbiased look at the daily clinical procedures in every institution and place it in the frame of the existing tools or solutions of peer institutions to discover aspects of digitalization that can create added value in terms of time efficiency, integrity and sustainability.

AIM:The present study evaluated with myocardial perfusion SPECT (MPS) the diagnostic accuracy of an artificial intelligence-enabled vectorcardiography system (Cardisiography, CSG) for detection of perfusion abnormalities.METHODS:We studied 241 patients, 155 with suspected CAD and 86 with known CAD who were referred for MPS. The CSG was performed after the MPS acquisition. The CSG results (1) p-factor (perfusion, 0: normal, 1: mildly, 2: moderately, 3: highly abnormal) and (2) s-factor (structure, categories as p-factor) were compared with the MPS scores. The CSG system was not trained during the study.RESULTS:Considering the p-factor alone, a specificity of >78% and a negative predictive value of mostly >90% for all MPS variables were found. The sensitivities ranged from 17 to 56%, the positive predictive values from 4 to 38%. Combining the p- and the s-factor, significantly higher specificity values of about 90% were reached. The s-factor showed a significant correlation (p=0.006) with the MPS ejection fraction.CONCLUSIONS:The CSG system is able to exclude relevant perfusion abnormalities in patients with suspected or known CAD with a specificity and a negative predictive value of about 90% combining the p- and the s-factor. Since it is a learning system there is potential for further improvement before routine use.

Right ventricular (RV) strain offers crucial diagnostic insights in cardiovascular and pulmonary disorders. Nonetheless, the absence of established reference values impedes its clinical implementation. Utilizing CMR-feature tracking, age- and gender-dependent RV strains were systematically assessed in 175 heart-healthy Caucasians, 97 females, median 32.5 years. RV global longitudinal strain (GLS) was greater in females than males (median -26.8

Impaired diastolic function is associated with a variety of diseases such as myocarditis or dilated cardiomyopathy. Currently, echocardiography is the standard method for assessing diastolic function. Recently, it has been postulated that cardiovascular magnetic resonance (CMR) is an at least equivalent or superior alternative to echocardiography. To assess CMR-based age- and gender-dependent diastolic functional normal reference values, pulmonary venous and transmitral blood-flow parameters were examined in heart-healthy test persons. Flow-sensitive phase-contrast CMR imaging was performed in the right upper pulmonary vein (RUPV) and at the level of the mitral valve (MV) in 183 healthy subjects (age 10–70 years; 97 women, 86 men). The data was distributed as evenly as possible across all groups. Strong age-dependence was observed for PV S/D; r = 0.718, p < 0.001 (Pearson product–moment correlation) and for transmitral MV E/A; ρ = −0.736, p < 0.001 (Spearman’s Rho correlation). Moderate age-dependence was found for PV slope D-wave; r = 0.394, p < 0.001. Except for MV slope E-wave (male −292 cm/s2 interquartile range (IQR) −338; −243 vs. female −319 ± 82 cm/s2; p = 0.047), no gender-related differences were observed. In a subgroup (N = 100), CMR data were compared with echocardiographic data. Strong correlation was found between CMR and echocardiography for PV S/D; r = 0.545, p < 0.001 and MV E/A; ρ = 0.692, p < 0.001. Diastolic functional parameters change with age, while gender-differences are small. CMR and echocardiography showed similar PV S/D and MV E/A ratios, making CMR a promising alternative for assessing diastolic function.

Ziel/Aim The use of CT images for attenuation correction of myocardial perfusion SPECT images increases the reliability of diagnoses. However, SPECT/CT systems are less common than SPECT-only systems, and even when a SPECT/CT system is available, misalignment between SPECT and CT is common due to patient motion. Therefore, a current research objective is to approximate CT-based attenuation maps from non-attenuation-corrected SPECT images using deep learning. The purpose of this publications is to investigate whether it is possible to approximate attenuation maps using only photopeak-window SPECT images acquired with a Siemens Symbia Intevo SPECT/CT scanner equipped with a cardiofocal collimator.

Background: Right ventricular (RV) strain has provided valuable prognostic information for patients with cardiac amyloidosis (CA). However, the extent to which RV strain and strain rate can differentiate CA is not yet clinically established. CA underdiagnosis delays treatment strategies and exacerbates patient prognosis.Aims: Evaluation of cardiac magnetic resonance (CMR) quantified RV global and regional strain of CA and HCM patients along with CA subtypes.Methods: CMR feature tracking attained longitudinal, radial and circumferential global and regional strain in 47 control subjects (CTRL), 43 CA-, 20 hypertrophic cardiomyopathy-(HCM) patients. CA patients were subdivided in 21 transthyretin-related amyloidosis (ATTR) and 20 acquired immunoglobulin light chain (AL) patients. Strain data and baseline clinical parameters were statistically analysed with respect to diagnostic performance and discriminatory power between the different clinical entities.Results: Effective differentiation of CA from HCM patients was achieved utilizing global longitudinal (GLS: 16.5 +/- 3.9% vs.-21.3 +/- 6.7%, p = 0.032), radial (GRS: 11.7 +/- 5.3% vs. 16.5 +/- 7.1%, p < 0.001) and circumferential (GCS:-7.6 +/- 4.0% vs.-9.4 +/- 4.4%, p = 0.015) right ventricular strain. Highest strain-based hypertrophic phenotype differentiation was attained using GRS (AUC = 0.86). Binomial regression found right ventricular ejection fraction (RV-EF) (p = 0.017) to be a significant predictor of CA-HCM differentiation. CA subtypes had comparable cardiac strains.Conclusion: CMR-derived RV global strains and various regional longitudinal strains provide discriminative radiological features for CA-HCM differentiation. However, in terms of feasibility, cine-derived RV-EF quanti-fication may suffice for efficient differential diagnostic support.

Purpose This paper summarises the results of 4 national surveys on the numbers, utilisation and technique of myocardial perfusion SPECT (MPS) from 2012 to 2021. Methods A one-page questionnaire for information on MPS in 2012, 2015, 2018 and 2021 was sent to German centres practising nuclear medicine. To check for representativeness, the numbers obtained were related to official annual data and furthermore to the numbers of invasive coronary angiography procedures (ICA). Results MPS examinations increased by > 40% from 2012 to 2021 and showed a centralisation with increasing MPS per centre. In 2020, a mild impact of the COVID-19 pandemic could be observed in the form of only a slight MPS increase, which was compensated in the following year. Outpatient care cardiologists represent the most important referrer (70%). Mostly, 2-day protocols were used. One-day protocols and stress-only protocols showed insignificant changes. The use of exercise stress decreased steadily. In 2021, exercise stress was replaced by pharmacological stress as the most frequent stress modality. Camera systems showed a shift to more SPECT-CT systems. The use of gated SPECT increased to almost 90%. Quantitative scoring showed an increasing acceptance. The ratio of invasive coronary angiographies (ICA) to MPS was between 3.9 and 4.5. A significant proportion of ICA in the context of CCS (chronic coronary syndrome) was performed without prior testing for ischaemia. Conclusion The 2012 to 2021 MPS surveys reveal a continuously growing number of examinations with only a mild temporary effect of the COVID-19 pandemic and a centralisation with increasing numbers per centre. Performance and technical data reveal a high-grade adherence of MPS practice to the current ESC guideline. A large potential of non-invasive diagnostics remains for the future.

BackgroundCardiac magnetic resonance (CMR) imaging allows for multiparametric assessment of healthy pulmonary artery (PA) hemodynamics. Gender- and aging-associated PA stiffness and pressure alterations have remained clinically unestablished, however may demonstrate epidemiological differences in disease development. The aim of this study is to evaluate the role of CMR as a surrogate for catheter examinations by providing a comprehensive CMR assessment of sex- and age-related reference values for PA stiffness, flow, and pressure.Methods and ResultsPA hemodynamics were studied between gender and age groups (>/<50 years) using phase-contrast CMR. Corresponding correlation analyses were performed. 179 healthy volunteers with a median age of 32.6 years (range 11.3–68.2) were examined. Males demonstrated increased PA compliance (median [interquartile range] or mean ± standard deviation) (20.8 mm2/mmHg [16.6; 25.8] vs. 19.2 ± 7.1 mm2/mmHg; P < 0.033), higher pulse wave velocity (2.00 m/s [1.35; 2.87] vs. 1.73 m/s [1.19; 2.34]; P = 0.018) and a reduced full width half maximum (FWHM) (219 ± 22 ms vs. 235 ± 23 ms; P < 0.001) than females. Mean, systolic, diastolic PA pressure and pulmonary proportional pulse pressure were significantly elevated for males compared to females (P < 0.001). Older subjects (>50 years) exhibited reduced PA elasticity (41.7% [31.0; 52.9] vs. 66.4% [47.7; 83.0]; P < 0.001), reduced PA compliance (15.4 mm2/mmHg [12.3; 20.7] vs. 21.3 ± 6.8 mm2/mmHg; P < 0.001), higher pulse wave velocity (2.59 m/s [1.57; 3.59] vs. 1.76 m/s [1.24; 2.34]; P < 0.001) and a reduced FWHM (218 ± 29 ms vs. 231 ± 21 ms; P < 0.001) than younger subjects.ConclusionsVelocity-time profiles are dependent on age and gender. PA stiffness indices deteriorate with age. CMR has potential to serve as a surrogate for right heart catheterization.

Ziel/Aim Die Produktion von Ga-68 mittels Flüssigkeitstarget konnte bereits für die routinemäßige Herstellung von [68Ga]Ga-PSMA und [68Ga]Ga-DOTA-TOC etabliert werden. Ziel war das Portfolio an Ga-68-markierten Radiotracern zu erweitern und ein routinetaugliches Verfahren zur Herstellung von [68Ga]Ga-FAPI-46 zu entwickeln. FAPI-46 ist ein auf Chinolin basierender Fibroblasten-Aktivierungsprotein (FAP)-Zielradiotracer und kann für die Tumorbildgebung (PET) bei einer Vielzahl von Krebsarten eingesetzt werden.

Background: Hindered by its unspecific clinical and phenotypical presentation, cardiac sarcoidosis (CS) remains a challenging diagnosis. Objective: Utilizing cardiac magnetic resonance imaging (CMR), we acquired multi-chamber volumetrics and strain feature tracking for a support vector machine learning (SVM)-based diagnostic approach to CS. Method: Forty-five CMR-negative (CMR(−), 56.5(53.0;63.0)years), eighteen CMR-positive (CMR(+), 64.0(57.8;67.0)years) sarcoidosis patients and forty-four controls (CTRL, 56.5(53.0;63.0)years)) underwent CMR examination. Cardiac parameters were processed using the classifiers of logistic regression, KNN(K-nearest-neighbor), DT (decision tree), RF (random forest), SVM, GBoost, XGBoost, Voting and feature selection. Results: In a three-cluster analysis of CTRL versus vs. CMR(+) vs. CMR(−), RF and Voting classifier yielded the highest prediction rates (81.82%). The two-cluster analysis of CTRL vs. all sarcoidosis (All Sarc.) yielded high prediction rates with the classifiers logistic regression, RF and SVM (96.97%), and low prediction rates for the analysis of CMR(+) vs. CMR(−), which were augmented using feature selection with logistic regression (89.47%). Conclusion: Multi-chamber cardiac function and strain-based supervised machine learning provides a non-contrast approach to accurately differentiate between healthy individuals and sarcoidosis patients. Feature selection overcomes the algorithmically challenging discrimination between CMR(+) and CMR(−) patients, yielding high accuracy predictions. The study findings imply higher prevalence of cardiac involvement than previously anticipated, which may impact clinical disease management.

Abstract Aim This paper presents the results of the 9th survey of myocardial perfusion SPECT (MPS) from the reporting year 2021. Methods 218 questionnaires (131 practices (PR), 58 hospitals (HO), 29 university hospitals (UH)) were evaluated. Results of the last survey 2018 are set in squared brackets. Results MPS data from a total of 133,057 [145,930] patients (–8.8%) with 131,868 [143,707] stress and 106,546 [121,899] rest MPS were analysed. A comparison with official data revealed that 54% all MPS were recorded. From 2018 to 2021, official data showed a every year an increase in MPS numbers. On average, 610 [502] MPS patients (+22%) were examined in each department. 74% [69%] of the responders reported an increase or no changes in their MPS patient numbers. Ambulatory care cardiologists represented as always, the mayor referral group (68% [69%]). For the first time, pharmacological stress was more frequently applied than ergometry (42% [51]). Regadenoson was mostly used. The use of the different protocols remained nearly unchanged. Two-day protocols were predominantly applied (49% [48%]). A shift from multi-headed cameras (58% [72%]) to SPECT-CT systems (24% [17%]) was found. Attenuation correction was performed in 33% [26%] of all MPS. 88% [86%] of all stress, 88% [87%] of all rest and 87% [83%] of all stress and rest MPS were acquired as gated SPECT. 72% [67%] of all departments performed scoring by default. The number of departments without scoring decreased to 13% [16%]. Conclusions The MPS Study 2021 shows that the long-term positive development of MPS imaging in Germany is continuing. The COVID-19 pandemia did not change this trend. The procedural and technical details of MPS imaging reveal a high level of guideline conformity.

The use of CT images for attenuation correction of myocardial perfusion imaging with single photon emission computer tomography (SPECT) increases diagnostic confidence. However, acquiring a CT image registered to a SPECT image is often not possible because most scanners are SPECT-only. It is possible to approximate attenuation maps using deep learning, but this has not yet been shown to work for a SPECT scanner with an IQ · SPECT collimator. This study investigates whether it is possible to approximate attenuation maps from non-attenuation-corrected (nAC) reconstructions acquired with a SPECT scanner equipped with an IQ · SPECT collimator. Attenuation maps and reconstructions were acquired retrospectively for 150 studies. A U–Net was trained to predict attenuation maps from nAC reconstructions using the conditional generative adversarial network framework. Predicted attenuation maps are compared to real attenuation maps using the normalized mean absolute error (NMAE). Attenuation-corrected reconstructions were computed, and the resulting polar maps were compared by pixel and by average perfusion per segment using the absolute percent error (APE). The training and evaluation code is available at https://gitlab.ub.uni-bielefeld.de/thuxohl/mu-map . Predicted attenuation maps are similar to real attenuation maps, achieving an NMAE of 0.020±0.007. The same is true for polar maps generated from reconstructions with predicted attenuation maps compared to CT-based attenuation maps. Their pixel-wise absolute distance is 3.095±3.199, and the segment-wise APE is 1.155±0.769. It is feasible to approximate attenuation maps from nAC reconstructions acquired by a scanner with an IQ · SPECT collimator using deep learning.

PurposeThis paper presents the results of the first joint survey on the use of SPECT and PET myocardial perfusion imaging (MPI) and cardiac amyloidosis imaging in Austria, Germany, and Switzerland of the year 2021.MethodsA questionnaire was sent in 2022 to centres practicing nuclear medicine.ResultsData from 14 Austrian (10,710 SPECT), 218 German (133,047 SPECT), and 16 Swiss centres (11,601 MPI (6,879 SPECT, 4722 PET)) were analysed. In Austria and Germany, the PET MPI numbers were close to zero and not considered. Official MPS numbers from 2015 to 2021 from Austria and Germany revealed a decline in Austria by about 40% in the pandemic years 2020 to 2021, but an increase in Germany by 9%. Ambulatory care cardiologists represented the major referral group (56-71%). Mostly, stress tests were performed pharmacologically (58-92%). Contrary to Germany, a 1-day protocol was predominant (58-97%) in Austria and Switzerland. The leading camera systems were SPECT-CT in Austria and Switzerland (57-79%) and multi-head systems in Germany (58%). Switzerland had the highest proportion of SPECT MPI with attenuation correction (84%), followed by Austria (43%), and Germany (33%). Electrocardiogram-gated SPECT MPI showed an overall high penetration of 87-99%. Scoring was most frequently applied in Germany (72%), followed by Austria (64%), and Switzerland (60%). Related to the population, the number of cardiac amyloidosis imaging was highest in Austria, followed by Switzerland and Germany.ConclusionsThis first joint survey of 2021 shows considerable differences among the countries. The Swiss situation is outstanding due to the wide use of PET MPI. In terms of camera equipment, Switzerland is also leading, followed by Austria and Germany. Despite the differences in procedural issues, the results reveal an overall high standard of MPI imaging.