Interpretation of SPECT wall motion with deep learning.

OBJECTIVES: We sought to develop a novel deep learning (DL) workflow to interpret single-photon emission computed tomography (SPECT) wall motion. BACKGROUND: Wall motion assessment with SPECT is limited by image temporal and spatial resolution. Visual interpretation of wall motion can be subjective and prone to error. Artificial intelligence (AI) may improve accuracy of wall motion assessment. METHODS: A total of 1038 patients undergoing rest electrocardiogram (ECG)-gated SPECT and echocardiography were included. Using echocardiography as truth, a DL-model (DL-model 1) was trained to predict the probability of abnormal wall motion. Of the 1038 patients, 317 were used to train a DL-model (DL-model 2) to assess regional wall motion. A 10-fold cross-validation was adopted. Diagnostic performance of DL was compared with human readers and quantitative parameters. RESULTS: The area under the receiver operating characteristic curve (AUC) and accuracy (ACC) of DL model (AUC: .82 [95% CI: .79-.85]; ACC: .88) were higher than human (AUC: .77 [95% CI: .73-.81]; ACC: .82; P < .001) and quantitative parameter (AUC: .74 [95% CI: .66-.81]; ACC: .78; P < .05). The net reclassification index (NRI) was 7.7%. The AUC and accuracy of DL model for per-segment and per-vessel territory diagnosis were also higher than human reader. The DL model generated results within 30 seconds with operable guided user interface (GUI) and therefore could provide preliminary interpretation. CONCLUSIONS: DL can be used to improve interpretation of rest SPECT wall motion as compared with current human readers and quantitative parameter diagnosis.

Insights into vertebral band pair deposition rate in the juvenile common thresher shark (Alopias vulpinus) in the northeastern Pacific Ocean.

Validation of band pair deposition rates in elasmobranch vertebrae is essential for accurate age estimation using band pair counting techniques. We present a validation study of the vertebral band pair deposition rate for juvenile common thresher sharks Alopias vulpinus in the northeastern Pacific Ocean (NEPO) using tag and recapture with oxytetracycline (OTC) injection. A total of 14 juvenile A. vulpinus marked with OTC from 1998 through 2013 were recaptured with times at liberty ranging from 1.08 to 3.81 years with an average of 2.14 years (±0.97 years standard deviation, SD). Shark size ranged from 80 to 128 cm fork length (LF) at the time of OTC injection and from 112 to 168 cm LF for those measured at recapture. The slopes of the relationships between band pairs post OTC and years at liberty for each reader ranged from 0.84 to 0.95, slightly lower than the 1.0 slope expected from annual band pair formation. These findings preliminarily support previous age and growth assumptions based on a one band pair per year deposition rate. However, high variation in band pair deposition rates between samples, coupled with regression slopes falling just under one band pair per year, indicates that further investigation is needed to refine band pair deposition rate estimates.

Population Histories of the United States Revealed through Fine-Scale Migration and Haplotype Analysis.

The population of the United States is shaped by centuries of migration, isolation, growth, and admixture between ancestors of global origins. Here, we assemble a comprehensive view of recent population history by studying the ancestry and population structure of more than 32,000 individuals in the US using genetic, ancestral birth origin, and geographic data from the National Geographic Genographic Project. We identify migration routes and barriers that reflect historical demographic events. We also uncover the spatial patterns of relatedness in subpopulations through the combination of haplotype clustering, ancestral birth origin analysis, and local ancestry inference. Examples of these patterns include substantial substructure and heterogeneity in Hispanics/Latinos, isolation-by-distance in African Americans, elevated levels of relatedness and homozygosity in Asian immigrants, and fine-scale structure in European descents. Taken together, our results provide detailed insights into the genetic structure and demographic history of the diverse US population.

Exponential dosing to standardize myocardial perfusion image quality with rubidium-82 PET.

BACKGROUND: 82Rb PET is commonly performed using the same injected activity in all patients, resulting in lower image quality in larger patients. This study compared 82Rb dosing with exponential vs proportional functions of body weight on the standardization of myocardial perfusion image (MPI) quality. METHODS: Two sequential cohorts of N = 60 patients were matched by patient weight. Rest and dipyridamole stress 82Rb PET was performed using 0.1 MBq·kg-2 exponential and 9 MBq·kg-1 proportional dosing. MPI scans were compared qualitatively with visual image quality scoring (IQS) and quantitatively using the myocardium-to-blood contrast-to-noise ratio (CNR) and blood background signal-to-noise ratio (SNR) as a function of body weight. RESULTS: Average (min-max) patient body weight was 81 ± 18 kg (46-137 kg). Proportional dosing resulted in decreasing CNR, SNR, and visual IQS with increasing body weight (P < 0.05). Exponential dosing eliminated the weight-dependent decreases in these image quality metrics that were observed in the proportional dosing group. CONCLUSION: 82Rb PET dosing as an exponential (squared) function of body weight produced consistent stress perfusion image quality over a wide range of patient weights. Dramatically lower doses can be used in lighter patients, with the equivalent population dose shifted toward the heavier patients to standardize diagnostic image quality.

Ambulatory care in interventional radiology: a framework for radiology day-case.

AIM: To describe a governance framework for setting up an ambulatory care unit in the interventional radiology setting. MATERIALS AND METHODS: Guidance from NHS England, Getting it right first time, The kings fund, NHS modernisation agency, NHS Improvement, The General Medical Council, The Royal college of Radiologists, The British society of interventional radiology, The Care Quality Commission, and the British Association of Day Surgery was reviewed and referenced as evidence for the governance pathway for day-case patients. RESULTS: A complete pathway for ambulatory care of patients in interventional radiology from referral to discharge is outlined with a discussion of examples of quality and safety. CONCLUSION: Successful implementation of an ambulatory care unit in interventional radiology requires a collaborative, multidisciplinary approach that links in with the NHS improvements ethos for more day-case procedures.

Comparison of the marine soundscape before and during the COVID-19 pandemic in dolphin habitat in Sarasota Bay, FL.

During the COVID-19 pandemic, changes in vessel activity and associated noise have been reported globally. Sarasota Bay is home to a large and increasing number of recreational vessels as well as a long-term resident community of bottlenose dolphins, Tursiops truncatus. Data were analyzed from two hydrophones to compare the soundscape during the COVID-19 pandemic to previous years (March-May 2020 and 2018/2019). Hourly metrics were calculated: vessel passes, 95th percentile sound levels [125 Hz and 16 kHz third octave bands (TOBs), and two broader bands: 88-1122 Hz and 1781-17 959 Hz], and dolphin whistle detection to understand changes in vessel activity and the effect on wildlife. Vessel activity increased during COVID-19 restrictions by almost 80% at one site and remained the same at the other site. Of the four sound level measures, only the 125 Hz TOB and 88-1122 Hz band increased with vessel activity at both sites, suggesting that these may be appropriate measures of noise from rapid pass-bys of small vessels in very shallow (<10 m) habitats. Dolphin whistle detection decreased during COVID-19 restrictions at one site but remained the same at the site that experienced increased vessel activity. The results suggest that pandemic effects on wildlife should not be viewed as homogeneous globally.

Measuring SPECT myocardial blood flow at the University of Ottawa Heart Institute.

The introduction of new cardiac SPECT cameras has made it practical to do dynamic SPECT imaging and opened the door to performing myocardial blood flow (MBF) imaging with SPECT. In this paper, we describe in detail our approach to dynamic SPECT MBF imaging using a multi-pinhole cardiac SPECT camera and commercially available kinetic analysis software. We use a 1-day rest/stress protocol with 370 MBq injected at rest and 1,000 MBq at stress with a 1- to 2-hour interval between rest and stress imaging. The tracer is injected mechanically over 30 seconds using a syringe pump. Projection data are acquired in listmode for a duration of 11 minutes and then reframed into a dynamic series. Each image is reconstructed independently using vendor-supplied software. The dynamic images are corrected for residual activity and manually corrected for motion using rigid-body translation. The uptake rate constant, K1, is calculated using a 1-tissue-compartment kinetic model and converted to MBF using a previously determined extraction fraction correction.

Reduced acquisition times for measurement of myocardial blood flow with 99mTc-tetrofosmin and solid-state detector SPECT.

BACKGROUND: Measurement of myocardial blood flow (MBF) is feasible using SPECT imaging but the acquisition requires more time than usual. Our study assessed the impact of reducing acquisition times on the accuracy and repeatability of the uptake rate constant (K1). METHODS: Twenty-nine patients underwent two rest/stress studies with Tc-99m-tetrofosmin 18 ± 13 days apart, using a one-day rest/stress dynamic SPECT imaging protocol with a solid-state cardiac camera. A 5-minute static image was acquired prior to tracer injection for subtraction of residual activity, followed immediately by 11-minute of list-mode data collection. Static image acquisition times of 0.5, 1, and 3 minutes and dynamic imaging times of 5, 7, and 9 minutes were simulated by truncating list-mode data. Images were reconstructed with/without attenuation correction and with/without motion correction. Kinetic parameters were calculated using a 1-tissue-compartment model. RESULTS: K1 increased with reduced dynamic but not static imaging time (P < 0.001). The increase in K1 for a 9-minute scan was small (4.7 ± 5.3%) compared with full-length studies. The repeatability of K1 did not change significantly (13 ± 12%, P > 0.17). CONCLUSIONS: A shortened imaging protocol of 3-minute (rest) or 30-second (stress) static image acquisition and 9 minutes of dynamic image acquisition altered K1 by less than 5% compared to a previously validated 11-minute acquisition.

Noise heterogeneity in attenuation-corrected cardiac SPECT images increases perfusion value uncertainty near the base of the heart.

BACKGROUND: Dedicated cardiac SPECT cameras which employ multi-pinhole detectors have variable photon sensitivity within the camera's field-of-view such that a lower number of photon counts is typically detected from the base of the heart than from the apex. Consequently, the noise in a reconstructed image is expected to be higher at the base than at the apex of the heart. METHODS: Patient emission images were resampled to create statistical replicates which were reconstructed with and without attenuation correction. Noise images were computed using one standard deviation of the replicated images. These were evaluated for 93 patients with normal study results, each imaged with both a dual-headed parallel-hole camera and a multi-pinhole camera. Statistics for a normal database (NDB) of images from the 93 patients were also calculated. RESULTS: Image noise (1.7-fold) and NDB uncertainty (1.3-fold) increase significantly from the apex-to-the base of the heart in attenuation-corrected multi-pinhole SPECT images. The differences for non-attenuation-corrected images or those acquired with a parallel-hole camera were not significant. CONCLUSIONS: For best interpretation of attenuation-corrected images acquired with multi-pinhole cameras, knowledge of NDB uncertainty gradients should be taken into consideration.

Patient-specific SPECT imaging protocols to standardize image noise.

BACKGROUND: In addition to acquired photon counts, image noise depends on the image reconstruction algorithm. This work develops patient-specific activity or acquisition time protocols to standardize the average noise in a reconstructed image for different patients, cameras, and reconstruction algorithms. METHODS: Image noise was calculated for images from 43 patients acquired on both a conventional and a multiple-pinhole cardiac SPECT camera. Functions were found to relate image noise to radiotracer activity, scan time, and body mass and were validated by normalizing the image noise in a test set of 58 patients. RESULTS: There was a 3.6-fold difference in photon sensitivity between the two cameras but a 16-fold difference in activity-scan time was necessary to match the noise levels. Image noise doubled from 45 to 128 kg for the conventional camera (12.8 minutes) and tripled for the multiple-pinhole camera (5 minutes) for 350 MBq (9.5 mCi) 99mTc-tetrofosmin. It was 16.3% and 6.1% respectively for an average sized patient. CONCLUSIONS: A linear scaling of activity with respect to the patient weight normalizes image noise but the scaling factors depend on the choice of camera and image reconstruction parameters. Therefore, equivalent numbers of acquired photon counts are not sufficient to guarantee equivalent image noise.

Acquisition, Processing, and Interpretation of PET 18F-FDG Viability and Inflammation Studies.

PURPOSE OF REVIEW: This article reviews the acquisition protocols and image interpretation for 18F-fluorodeoxyglucose (18F-FDG) imaging with positron emission tomography (PET) applied to the evaluation of myocardial viability and inflammation. RECENT FINDINGS: Cardiac PET with 18F-FDG provides essential information for the assessment of myocardial viability and inflammation and is usually combined with PET perfusion imaging using 82Rb or 13N-ammonia. Viable myocardium maintains glucose metabolism which can be detected via the uptake of 18F-FDG by PET imaging. The patient is prepared for viability imaging by shifting the metabolism of the heart to maximize the uptake of glucose and hence of 18F-FDG. Comparison of the 18F-FDG and myocardial perfusion images allows distinction between regions of the myocardium that are hibernating and thus may recover function with intervention, from those that are infarcted. Increased glucose utilization in the inflammatory cells also makes 18F-FDG a useful imaging technique in conditions such as cardiac sarcoidosis. Here, suppression of normal myocardial uptake is essential for accurate image interpretation. 18F-FDG PET broadens the scope of information potentially available through a cardiac PET study. With careful patient preparation, it provides valuable insights into myocardial viability and inflammatory processes such as sarcoidosis.

Nursery origin and population connectivity of swordfish Xiphias gladius in the North Pacific Ocean.

Element:Ca ratios in the otolith cores of young-of-the-year (YOY) swordfish, Xiphias gladius, were used as natural tracers to predict the nursery origin of subadult and adult swordfish from three foraging grounds in the North Pacific Ocean (NPO). First, the chemistry of otolith cores (proxy for nursery origin) was used to develop nursery-specific elemental signatures in YOY swordfish. Sagittal otoliths of YOY swordfish were collected from four regional nurseries in the NPO between 2000 and 2005: (1) Central Equatorial North Pacific Ocean (CENPO), (2) Central North Pacific Ocean (CNPO), (3) Eastern Equatorial North Pacific Ocean (EENPO) and (4) Western North Pacific Ocean (WNPO). Calcium (43 Ca), magnesium (24 Mg), strontium (88 Sr) and barium (138 Ba) were quantified in the otolith cores of YOY swordfish using laser ablation inductively coupled plasma mass spectrometry. Univariate tests indicated that three element:Ca ratios (Mg:Ca, Sr:Ca and Ba:Ca) were significantly different among nurseries. Overall classification success of YOY swordfish to their nursery of collection was 72% based on quadratic discriminant analysis. Next, element:Ca ratios in the otolith cores of subadults and adults collected from three foraging grounds where targeted fisheries exist (Hawaii, California and Mexico) were examined to calculate nursery-specific contribution estimates. Mixed-stock analysis indicated that the CENPO nursery contributed the majority of individuals to all three foraging grounds (Hawaii 45.6 ± 13.2%, California 84.6 ± 10.8% and Mexico 64.5 ± 15.9%). The results from this study highlight the importance of the CENPO nursery and provide researchers and fisheries managers with new information on the connectivity of the swordfish population in the NPO.

Natal origin of Pacific bluefin tuna from the California Current Large Marine Ecosystem.

Natal origin of subadult (age-1) Pacific bluefin tuna (PBT, Thunnus orientalis) from the California Current Large Marine Ecosystem (CCLME) was determined using natural tracers in ear stones (otoliths). Age-0 PBT collected from the two known spawning areas in the western Pacific Ocean (East China Sea, Sea of Japan) were used to establish baseline signatures from otolith cores over 4 years (2014-2017) based on a suite of trace elements (Li, Mg, Mn, Sr, Zn and Ba). Distinct chemical signatures existed in the otolith cores of age-0 PBT collected from the two spawning areas, with overall classification accuracy ranging 73-93% by year. Subadult PBT collected in the CCLME over the following 4 years (2015-2018) were then age-class matched to baselines using mixed-stock analysis. Natal origin of trans-Pacific migrants in the CCLME ranged 43-78% from the East China Sea and 22-57% from the Sea of Japan, highlighting the importance of both spawning areas for PBT in the CCLME. This study provides the first estimates on the natal origin of subadult PBT in this ecosystem using otolith chemistry and expands upon the application of these natural tracers for population connectivity studies for this species.

Correction to: Patient-specific SPECT imaging protocols to standardize image noise.

The originally published version of this article contained typographical errors in the units of photon sensitivity. The units of counts · MBq-1 · min-1 and kcounts · mCi-1 · min-1 were mistakenly recorded as counts · MBq · min and kcounts · mCi · min respectively. The original article has been corrected.

Chad Genetic Diversity Reveals an African History Marked by Multiple Holocene Eurasian Migrations.

Understanding human genetic diversity in Africa is important for interpreting the evolution of all humans, yet vast regions in Africa, such as Chad, remain genetically poorly investigated. Here, we use genotype data from 480 samples from Chad, the Near East, and southern Europe, as well as whole-genome sequencing from 19 of them, to show that many populations today derive their genomes from ancient African-Eurasian admixtures. We found evidence of early Eurasian backflow to Africa in people speaking the unclassified isolate Laal language in southern Chad and estimate from linkage-disequilibrium decay that this occurred 4,750-7,200 years ago. It brought to Africa a Y chromosome lineage (R1b-V88) whose closest relatives are widespread in present-day Eurasia; we estimate from sequence data that the Chad R1b-V88 Y chromosomes coalesced 5,700-7,300 years ago. This migration could thus have originated among Near Eastern farmers during the African Humid Period. We also found that the previously documented Eurasian backflow into Africa, which occurred ∼3,000 years ago and was thought to be mostly limited to East Africa, had a more westward impact affecting populations in northern Chad, such as the Toubou, who have 20%-30% Eurasian ancestry today. We observed a decline in heterozygosity in admixed Africans and found that the Eurasian admixture can bias inferences on their coalescent history and confound genetic signals from adaptation and archaic introgression.

Elements of time and place: manganese and barium in shark vertebrae reflect age and upwelling histories.

As upper-level predators, sharks are important for maintaining marine food web structure, but populations are threatened by fishery exploitation. Sustainable management of shark populations requires improved understanding of migration patterns and population demographics, which has traditionally been sought through physical and/or electronic tagging studies. The application of natural tags such as elemental variations in mineralized band pairs of elasmobranch vertebrae cartilage could also reveal endogenous and exogenous processes experienced by sharks throughout their life histories. Here, elemental profiles were characterized in vertebrae encompassing complete life histories (birth-to-death) of shortfin mako (Isurus oxyrinchus), common thresher (Alopias vulpinus) and blue shark (Prionace glauca) of known tag and recapture locations in the eastern North Pacific Ocean. All sharks were injected with oxytetracycline at initial capture, released and subsequently recaptured, with individual liberty times ranging from 215 days to 6 years. Vertebral band pairs forming over the liberty intervals were verified by counting the number of band pairs deposited since the oxytetracycline band. Regular oscillations in vertebrae manganese (Mn) content corresponded well with the number of validated band pairs, suggesting that Mn variation could be used to age sharks. Increases in vertebrae barium concentration were correlated with times when individuals occupied areas with high coastal upwelling indices, the timing and spatial intensity of which varied from year to year. Interspecific relationships were probably influenced by behavioural differences in horizontal and vertical habitat use, feeding habits and thermoregulatory physiology. These results indicate that vertebral sclerochronology has the potential to advance our knowledge of elasmobranch life history including age and growth estimation and environmental reconstruction.

Single CT for attenuation correction of rest/stress cardiac SPECT perfusion imaging.

Common practice is to use separate CT scans acquired during rest and stress for attenuation correction of SPECT myocardial perfusion imaging (MPI). We evaluated using a single CT scan to correct both rest and stress SPECT scans. Studies from 154 patients were reprocessed using one CT acquired at stress to correct both rest and stress scans (1CT) and compared to correction of each scan with its own CT (2CT). Two expert readers independently read the images and determined summed stress (SSS), rest (SRS), and difference (SDS) scores. The correlation in SRS between 2CT and 1CT was r ≥ 0.88. The concordance in SDS was ≥0.84 (kappa ≥ 0.62). The mean SDS difference between 2CT and 1CT for the averaged observer was not significantly different from zero (p > 0.31). 1CT images had a small but significant increase in SRS and an increase in SDS variability. However, the mean SDS difference was similar to the mean inter-observer SDS difference for the 2CT approach (-0.08 vs -0.23, p = 0.46) and had less uncertainty (1.02 vs 2.05, p < 0.001). Thus, the differences between 1CT and 2CT are unlikely to be clinically significant, and the 1CT approach is feasible for SPECT MPI.

Contemporary Cardiac SPECT Imaging-Innovations and Best Practices: An Information Statement from the American Society of Nuclear Cardiology.

This information statement from the American Society of Nuclear Cardiology highlights advances in cardiac SPECT imaging and supports the incorporation of new technology and techniques in laboratories performing nuclear cardiology procedures. The document focuses on the application of the latest imaging protocols and the utilization of newer hardware and software options to perform high quality, state-of-the-art SPECT nuclear cardiology procedures. Recommendations for best practices of cardiac SPECT imaging are discussed, highlighting what imaging laboratories should be doing as the standard of care in 2018 to achieve optimal results (based on the ASNC 2018 SPECT guideline [Dorbala et al., J Nucl Cardiol. 2018. https://doi.org/10.1007/s12350-018-1283-y ]).

Prophylactic RhCE and Kell antigen matching: impact on alloimmunization in transfusion-dependent patients with myelodysplastic syndromes.

BACKGROUND AND OBJECTIVES: Thirty to 80 per cent of patients with myelodysplastic syndromes (MDS) become transfusion-dependent and are at risk for red blood cell (RBC) alloimmunization. This study compared alloimmunization rates in transfusion-dependent patients with MDS at an institution with a policy of prophylactic antigen matching for RhCE and K (PAM) with those transfused at institutions without such a policy (non-PAM). MATERIALS AND METHODS: Transfusion records were retrospectively reviewed to determine total number of RBC transfusions received, whether RBC phenotyping was performed, the type and date of first alloantibody development and receipt of prophylactic antigen matching for RhCE and K. RESULTS: In 176 transfusion-dependent patients with MDS, the overall rate of new alloimmunization was 17%; the majority of patients (87%) developed at least one alloantibody to Rh or Kell antigens. The alloimmunization rate at the institution with a PAM policy was 11% compared with 23% at non-PAM institutions (P = 0·06). The rate of Rh/K alloimmunization was 7 vs. 22%, respectively (P = 0·008). No patient who received PAM developed a Rh/K alloantibody. CONCLUSION: The rate of alloimmunization was 11% at an institution with a PAM policy which was non-significantly lower than 23% at institutions without a PAM policy. However, rates of Rh/K alloimmunization were significantly lower. Such a policy should be considered in transfusion-dependent patients with MDS, although further studies on cost-effectiveness and careful consideration of resource availability in the local context are required.