Brightview

All patients were referred for a resting protocol of MPS after at least 12 months of CRT. Under bi-ventricular pacing, ECG-gated MPS was performed using a dual-head SPECT camera (BrightView, Philips Healthcare, Cleveland, Ohio) 1 h after intravenous injection of 20 mCi of ^99mTc-sestamibi. The images were acquired with a step-and-shoot acquisition, 25 s per stop, 32 stops over the 180° orbit, 64 × 64 matrix with 6.4 mm per pixel, and 8-bin gating. The images were reconstructed using standard iterative reconstruction (ordered subsets expectation maximization with 3 iterations and 8 subsets) and Butterworth filtering (cut-off frequency 0.4 cm per cycle and power of 10).
After reconstruction, Emory Cardiac Toolbox with phase analysis was used for generating quantitative parameters, including LVEF, myocardial scar (total areas with myocardial activity < 50% of maximal normalized activity on polar map), phase standard deviation (phase SD), and bandwidth as the previously used protocol.^{13 (link)}

The lymphoscintigraphy images were obtained at 1 and 2 h after subcutaneous injection of ^99mTc-phytate (100 nm, filtered) into the second and/or third web space of both hands with a dose of 37 MBq/0.1 mL per web space. After ^99mTc-phytate injection, patients were instructed to exercise (clench and unclench) with rubber balls for 30 min to increase lymphatic flow. Anterior and posterior whole body images were acquired in a 256 × 1024 matrix with the patient in a supine position. One of three different dual-head gamma camera system devices was used: BrightView (Philips Healthcare, Best, Netherlands), Infinia (GE Healthcare, Waukesha, WI, USA), or Symbia Evo Excel (Siemens Healthineers, Erlangen, Germany), with a low-energy high-resolution parallel whole collimator at a scan speed of 13 cm/minute.

^99mTc-GSA scintigraphy was performed for all subjects before surgery using PRISM-IRIX (Picker Corp., Cleveland, Ohio, USA/Shimadzu Corp., Kyoto, Japan) until October 2012 and then BrightView (Philips Medical Systems, Cleveland, OH) thereafter. These were carefully calibrated to obtain the same result when the systems were changed over. All patients received 185 MBq of ⁹⁹mTc-GSA (3 mg of GSA; Nihon Medi-Physics, Nishinomiya, Japan). After administration, single-photon emission computed tomography (SPECT) and dynamic imaging were performed. The scintigraphy requires approximately 40–50 min in total for each patient. There were no apparent contraindications when performing this test. Liver function in ^99mTc-GSA scintigraphy included the HH15, LHL15, LU15, and the GSA indices. Of these indices, the LHL15, LU15, and GSA gave higher values with improved liver function, whereas the HH15 showed lower values with improved liver function. Both total liver and FLR of these indices were obtained, except for the HH15. The HH15 can be calculated only for the total liver. The FLR count of ^99mTc-GSA scintigraphy was calculated by fusing the 3D computed tomography images and ^99mTc-GSA scintigraphy using a volume analyzer system (Synapse Vincent, Fujifilm, Japan). A case of fusion is shown in Fig 2.

All DPD scans were performed by using either a hybrid single-photon emission CT (SPECT)/CT gamma camera (Philips BrightView, Blue Bell, Pennsylvania) or a SPECT gamma camera (Symbia, Siemens Healthineers USA, Malvern, Pennsylvania) following the injection of 700 MBq DPD. The imaging protocol consisted of an early and late (5 min and 3 h, respectively) planar whole-body image, with a SPECT/CT scan or SPECT scan only of the chest at 3 h. DPD scans were reported by 2 experienced clinicians using the Perugini grading system (28 (link)), with grade 0 being negative and grades 1 to 3 increasingly positive. DPD scan findings were independently reviewed by the National Amyloidosis Centre (London, United Kingdom). All patients with a positive DPD scan were discussed with the managing clinicians and, where appropriate, referred to the National Amyloidosis Centre for further review.