{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T18:22:45Z","timestamp":1776622965125,"version":"3.51.2"},"reference-count":28,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,11,17]],"date-time":"2026-11-17T00:00:00Z","timestamp":1794873600000},"content-version":"am","delay-in-days":381,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart Lung and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005485","name":"American College of Cardiology Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005485","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005984","name":"Dr. Miriam and Sheldon G. Adelson Medical Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005984","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.elsevierhealth.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Nuclear Cardiology"],"published-print":{"date-parts":[[2025,11]]},"DOI":"10.1016\/j.nuclcard.2025.102482","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T22:13:09Z","timestamp":1757542389000},"page":"102482","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"special_numbering":"C","title":["Integrating perfusion with AI\u2013derived coronary calcium on CT attenuation scans to improve selection of low-risk studies for stress-only SPECT myocardial perfusion imaging"],"prefix":"10.1016","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4676-2433","authenticated-orcid":false,"given":"Robert J.H.","family":"Miller","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orit","family":"Barrett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aakash","family":"Shanbhag","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Rozanski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2236-6970","authenticated-orcid":false,"given":"Damini","family":"Dey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1531-880X","authenticated-orcid":false,"given":"Mark","family":"Lemley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4947-9158","authenticated-orcid":false,"given":"Serge D.","family":"Van Kriekinge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2242-1936","authenticated-orcid":false,"given":"Paul B.","family":"Kavanagh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2561-4282","authenticated-orcid":false,"given":"Attila","family":"Feher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-5962","authenticated-orcid":false,"given":"Edward J.","family":"Miller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2583-9278","authenticated-orcid":false,"given":"Andrew J.","family":"Einstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0686-5449","authenticated-orcid":false,"given":"Terrence D.","family":"Ruddy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Bateman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9451-5210","authenticated-orcid":false,"given":"Philip A.","family":"Kaufmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna X.","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3793-9578","authenticated-orcid":false,"given":"Daniel S.","family":"Berman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6110-938X","authenticated-orcid":false,"given":"Piotr J.","family":"Slomka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.nuclcard.2025.102482_bib1","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1007\/s12350-010-9210-x","article-title":"The prognosis of a normal stress-only Tc-99m myocardial perfusion imaging study","volume":"17","author":"Duvall","year":"2010","journal-title":"J Nucl Cardiol"},{"key":"10.1016\/j.nuclcard.2025.102482_bib2","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.jacc.2009.09.022","article-title":"Normal stress-only versus standard stress\/rest myocardial perfusion imaging: similar patient mortality with reduced radiation exposure","volume":"55","author":"Chang","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.nuclcard.2025.102482_bib3","first-page":"163","article-title":"Stress-first myocardial perfusion imaging","volume":"41","author":"McMahon","year":"2023","journal-title":"Cardiol Clin"},{"key":"10.1016\/j.nuclcard.2025.102482_bib4","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1007\/s12350-015-0387-x","article-title":"ASNC imaging guidelines for SPECT nuclear cardiology procedures: stress, protocols, and tracers","volume":"23","author":"Henzlova","year":"2016","journal-title":"J Nucl Cardiol"},{"key":"10.1016\/j.nuclcard.2025.102482_bib5","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s12350-012-9523-z","article-title":"Patient-centered imaging","volume":"19","author":"DePuey","year":"2012","journal-title":"J Nucl Cardiol"},{"key":"10.1016\/j.nuclcard.2025.102482_bib6","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1016\/j.jcmg.2022.03.031","article-title":"The prognostic value of CAC zero among individuals presenting with chest pain: a meta-analysis","volume":"15","author":"Agha","year":"2022","journal-title":"JACC Cardiovasc Imaging"},{"key":"10.1016\/j.nuclcard.2025.102482_bib7","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.jcmg.2020.06.048","article-title":"Warranty period of a calcium score of zero","volume":"14","author":"Dzaye","year":"2021","journal-title":"JACC Cardiovasc Imaging"},{"key":"10.1016\/j.nuclcard.2025.102482_bib8","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.115.003966","article-title":"Prognostic value of coronary artery calcium scoring in addition to single-photon emission computed tomographic myocardial perfusion imaging in symptomatic patients","volume":"9","author":"Engbers","year":"2016","journal-title":"Circ Cardiovasc Imaging"},{"key":"10.1016\/j.nuclcard.2025.102482_bib9","article-title":"Visually estimated coronary artery calcium score improves SPECT-MPI risk stratification","volume":"35","author":"Trpkov","year":"2021","journal-title":"Int J Cardiol Heart Vasc"},{"key":"10.1016\/j.nuclcard.2025.102482_bib10","doi-asserted-by":"crossref","first-page":"652","DOI":"10.2967\/jnumed.122.264423","article-title":"Deep learning coronary artery calcium scores from SPECT\/CT attenuation maps improve prediction of major adverse cardiac events","volume":"64","author":"Miller","year":"2023","journal-title":"J Nucl Med"},{"key":"10.1016\/j.nuclcard.2025.102482_bib11","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1007\/s12350-018-1326-4","article-title":"Rationale and design of the REgistry of fast myocardial perfusion imaging with NExt generation SPECT (REFINE SPECT)","volume":"27","author":"Slomka","year":"2020","journal-title":"J Nucl Cardiol"},{"key":"10.1016\/j.nuclcard.2025.102482_bib12","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.2967\/jnumed.124.268292","article-title":"The updated registry of fast myocardial perfusion imaging with next-generation SPECT (REFINE SPECT 2.0)","volume":"65","author":"Miller","year":"2024","journal-title":"J Nucl Med"},{"key":"10.1016\/j.nuclcard.2025.102482_bib13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ijcard.2020.04.012","article-title":"Prognostic significance of previous myocardial infarction and previous revascularization in patients undergoing SPECT MPI","volume":"313","author":"Miller","year":"2020","journal-title":"Int J Cardiol"},{"key":"10.1016\/j.nuclcard.2025.102482_bib14","series-title":"Comparative analysis between convolutional long short-term memory networks and vision transformers for coronary calcium scoring in non-contrast CT: SPIE","author":"Shanbhag","year":"2023"},{"key":"10.1016\/j.nuclcard.2025.102482_bib15","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1016\/j.jacc.2010.05.057","article-title":"Agreement of visual estimation of coronary artery calcium from low-dose CT attenuation correction scans in hybrid PET\/CT and SPECT\/CT with standard Agatston score","volume":"56","author":"Einstein","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.nuclcard.2025.102482_bib16","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1093\/ehjci\/jeae045","article-title":"Automated vessel-specific coronary artery calcification quantification with deep learning in a large multi-centre registry","volume":"25","author":"Williams","year":"2024","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"10.1016\/j.nuclcard.2025.102482_bib17","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.jcmg.2022.06.006","article-title":"Deep learning of coronary calcium scores from PET\/CT attenuation maps accurately predicts adverse cardiovascular events","volume":"16","author":"Pieszko","year":"2023","journal-title":"JACC Cardiovasc Imaging"},{"key":"10.1016\/j.nuclcard.2025.102482_bib18","doi-asserted-by":"crossref","DOI":"10.1016\/j.nuclcard.2025.102229","article-title":"Association of medical therapies with survival according to SPECT MPI findings","author":"Hijazi","year":"2025","journal-title":"J Nucl Cardiol"},{"key":"10.1016\/j.nuclcard.2025.102482_bib19","article-title":"The relationship between quantitative ischemia, early revascularization, and major adverse cardiovascular events","volume":"4","author":"Miller","year":"2025","journal-title":"JACC (J Am Coll Cardiol): Advances"},{"key":"10.1016\/j.nuclcard.2025.102482_bib20","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1093\/ehjci\/jez182","article-title":"Relationship between epicardial adipose tissue and coronary vascular function in patients with suspected coronary artery disease and normal myocardial perfusion imaging","volume":"20","author":"Nappi","year":"2019","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"10.1016\/j.nuclcard.2025.102482_bib21","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.2967\/jnumed.118.220657","article-title":"Solid-state detector SPECT myocardial perfusion imaging","volume":"60","author":"Slomka","year":"2019","journal-title":"J Nucl Med"},{"key":"10.1016\/j.nuclcard.2025.102482_bib22","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.1016\/j.jacc.2009.05.071","article-title":"The coronary artery calcium score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk","volume":"54","author":"Chang","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.nuclcard.2025.102482_bib23","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1038\/s41746-024-01308-0","article-title":"Artificial intelligence applied to coronary artery calcium scans (AI-CAC) significantly improves cardiovascular events prediction","volume":"7","author":"Naghavi","year":"2024","journal-title":"npj Digit Med"},{"key":"10.1016\/j.nuclcard.2025.102482_bib24","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1007\/s12350-022-03099-x","article-title":"Integration of coronary artery calcium scoring from CT attenuation scans by machine learning improves prediction of adverse cardiovascular events in patients undergoing SPECT\/CT myocardial perfusion imaging","volume":"30","author":"Feher","year":"2023","journal-title":"J Nucl Cardiol"},{"key":"10.1016\/j.nuclcard.2025.102482_bib25","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.2967\/jnumed.109.063982","article-title":"Quantitative analysis of myocardial perfusion SPECT anatomically guided by coregistered 64-slice coronary CT angiography","volume":"50","author":"Slomka","year":"2009","journal-title":"J Nucl Med"},{"key":"10.1016\/j.nuclcard.2025.102482_bib26","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.jcmg.2019.02.028","article-title":"5-year prognostic value of quantitative vs visual myocardial perfusion imaging in subtle perfusion defects: results from the REFINE SPECT registry","volume":"13","author":"Otaki","year":"2020","journal-title":"JACC Cardiovasc Imaging"},{"key":"10.1016\/j.nuclcard.2025.102482_bib27","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1148\/radiol.13122529","article-title":"Coronary artery calcium scoring to exclude flow-limiting coronary artery disease in symptomatic stable patients at low or intermediate risk","volume":"269","author":"Mouden","year":"2013","journal-title":"Radiology"},{"key":"10.1016\/j.nuclcard.2025.102482_bib28","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s12350-014-9958-5","article-title":"Combining stress-only myocardial perfusion imaging with coronary calcium scanning as a new paradigm for initial patient work-up: an exploratory analysis","volume":"22","author":"Uretsky","year":"2015","journal-title":"J Nucl Cardiol"}],"container-title":["Journal of Nuclear Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1071358125003563?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1071358125003563?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T14:48:52Z","timestamp":1773154132000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1071358125003563"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":28,"alternative-id":["S1071358125003563"],"URL":"https:\/\/doi.org\/10.1016\/j.nuclcard.2025.102482","relation":{},"ISSN":["1071-3581"],"issn-type":[{"value":"1071-3581","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Integrating perfusion with AI\u2013derived coronary calcium on CT attenuation scans to improve selection of low-risk studies for stress-only SPECT myocardial perfusion imaging","name":"articletitle","label":"Article Title"},{"value":"Journal of Nuclear Cardiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.nuclcard.2025.102482","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 American Society of Nuclear Cardiology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"102482"}}