Diagnostic Efficiency of Quantification of Myocardial Blood Flow and Coronary Flow Reserve with CZT Dynamic SPECT Imaging for Patients with Suspected Coronary Artery Disease: a Comparative Study with Traditional Semi-quantitative Evaluation

Overview

Journal Cardiovasc Diagn Ther

Publisher AME Publishing Company

Specialty Cardiology & Vascular Diseases

Date 2021 Mar 12

PMID 33708478

Citations 9

Authors

Jiao Wang

Shuai Li

Weiqiang Chen

Yue Chen

Zekun Pang

Jianming Li

Affiliations

Soon will be listed here.

Abstract

Background: Myocardial blood flow (MBF) quantitation with cadmium-zinc-telluride (CZT) dynamic single-photon emission computed tomography (SPECT) is being increasingly investigated toward clinical utilization.

Methods: In this prospective study, forty-nine patients with suspected or known coronary artery disease (CAD) underwent a rest/adenosine triphosphate (ATP) stress dynamic and routine gated myocardial perfusion imaging (MPI) by CZT SPECT and then received coronary angiography (CAG). Quantitative diagnosis from the dynamic SPECT and a flow diagram was automatically obtained by the dedicated software and compared with the result of semi-quantitative analysis with gated MPI using the angiographic stenosis as the reference standard.

Results: When stenosis ≥50% was considered at the participant level, the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and accuracy (AC) of the quantitative diagnosis were higher than semi-quantitative method as (84.4% 65.6%, 88.2% 70.6%, 93.1% 80.8%, 75.0% 52.2%, 85.7% 67.3%) (all P<0.05). The receiver operating characteristic (ROC) curve analysis generated the optimal critical value as 1.86 and 1.61 mL/min/g for stress MBF (sMBF) and MFR, respectively. The diagnosis performance of the quantitative diagnosis was higher than semi-quantitative method as (78.9% 68.4%, 63.3% 60.0%, 57.7% 52.0%, 82.6% 75.0%, 69.4% 63.3%) for the criteria of ≥75% stenosis on CAG (all P<0.05) with optimal critical values as 1.71 and 1.15 mL/min/g. There was no significant difference between sMBF and MFR.

Conclusions: The diagnostic efficiency by using the quantitative method of CZT dynamic SPECT imaging is superior to traditional semi-quantitative gated MPI for the diagnosis of CAD, which improved the diagnostic specificity and accuracy when the critical was stenosis ≥50%.

Citing Articles

Myocardial Blood Flow and Flow Reserve in Patients With Acute Myocardial Infarction and Obstructive and Non-Obstructive Coronary Arteries: CZT SPECT Study.

Zavadovsky K, Vorobyeva D, Mochula O, Mochula A, Maltseva A, Bayev A Front Nucl Med. 2024; 2:935539.

PMID: 39354978 PMC: 11440855. DOI: 10.3389/fnume.2022.935539.

Assessing the diagnostic value of left ventricular synchrony indices derived from phase analysis by D-SPECT in identifying obstructive coronary artery disease.

Ding X, Cui L, Li J, Cao J, Ding M, Wang H Int J Cardiovasc Imaging. 2024; 40(9):1919-1930.

PMID: 38960945 DOI: 10.1007/s10554-024-03182-z.

Coronary microvascular dysfunction and myocardial area at risk assessed by cadmium zinc telluride single photon emission computed tomography after primary percutaneous coronary intervention in acute myocardial infarction patients.

Cui L, Wang Y, Chen W, Huang P, Tang Z, Wang J Quant Imaging Med Surg. 2024; 14(6):3816-3827.

PMID: 38846287 PMC: 11151247. DOI: 10.21037/qims-23-1260.

The Influence of Kinetic Models and Attenuation Correction on Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography (CZT SPECT)-Derived Myocardial Blood Flow and Reserve: Correlation with Invasive Angiography Data.

Mochula A, Maltseva A, Kopeva K, Grakova E, Mochula O, Zavadovsky K J Clin Med. 2024; 13(5).

PMID: 38592092 PMC: 10932033. DOI: 10.3390/jcm13051271.

Exploring coronary microvascular function by quantitative CZT-SPECT: a small step or giant leap for INOCA patients?.

DAntonio A, Mannarino T Eur J Nucl Med Mol Imaging. 2023; 50(13):3806-3808.

PMID: 37535108 DOI: 10.1007/s00259-023-06358-2.

References

Ito S, Endo A, Okada T, Nakamura T, Sugamori T, Takahashi N . Comparison of CTAC and prone imaging for the detection of coronary artery disease using CZT SPECT. Ann Nucl Med. 2017; 31(8):629-635. PMC: 5622918. DOI: 10.1007/s12149-017-1194-z. View

Berman D, Kang X, Slomka P, Gerlach J, De Yang L, Hayes S . Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease. J Nucl Cardiol. 2007; 14(4):521-8. DOI: 10.1016/j.nuclcard.2007.05.008. View

Miyagawa M, Nishiyama Y, Uetani T, Ogimoto A, Ikeda S, Ishimura H . Estimation of myocardial flow reserve utilizing an ultrafast cardiac SPECT: Comparison with coronary angiography, fractional flow reserve, and the SYNTAX score. Int J Cardiol. 2017; 244:347-353. DOI: 10.1016/j.ijcard.2017.06.012. View

Chen L, Hung H, Jong B, Lin S, Yeh C, Ku C . A method to measure the extent of myocardial ischemia and steal with SPECT myocardial blood flow quantitation. Ann Nucl Med. 2020; 34(9):682-690. DOI: 10.1007/s12149-020-01493-4. View

Giubbini R, Bertoli M, Durmo R, Bonacina M, Peli A, Faggiano I . Comparison between NNH-PET and Tc-Tetrofosmin-CZT SPECT in the evaluation of absolute myocardial blood flow and flow reserve. J Nucl Cardiol. 2019; 28(5):1906-1918. DOI: 10.1007/s12350-019-01939-x. View

Dorbala S, Ananthasubramaniam K, Armstrong I, Chareonthaitawee P, DePuey E, Einstein A . Single Photon Emission Computed Tomography (SPECT) Myocardial Perfusion Imaging Guidelines: Instrumentation, Acquisition, Processing, and Interpretation. J Nucl Cardiol. 2018; 25(5):1784-1846. DOI: 10.1007/s12350-018-1283-y. View

Al Badarin F, Malhotra S . Diagnosis and Prognosis of Coronary Artery Disease with SPECT and PET. Curr Cardiol Rep. 2019; 21(7):57. DOI: 10.1007/s11886-019-1146-4. View

Murthy V, Naya M, Foster C, Hainer J, Gaber M, Di Carli G . Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation. 2011; 124(20):2215-24. PMC: 3495106. DOI: 10.1161/CIRCULATIONAHA.111.050427. View

Ghadri J, Pazhenkottil A, Nkoulou R, Goetti R, Buechel R, Husmann L . Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI. Heart. 2011; 97(12):998-1003. DOI: 10.1136/hrt.2010.217281. View

10.

Kwon O, Hwang H, Koo H, Yang D, Kang H, Kim J . Ischemic burden assessment of myocardial perfusion CT, compared with SPECT using semi-quantitative and quantitative approaches. Int J Cardiol. 2018; 278:287-294. DOI: 10.1016/j.ijcard.2018.12.046. View

11.

Schuijf J, Poldermans D, Shaw L, Jukema J, Lamb H, de Roos A . Diagnostic and prognostic value of non-invasive imaging in known or suspected coronary artery disease. Eur J Nucl Med Mol Imaging. 2005; 33(1):93-104. DOI: 10.1007/s00259-005-1965-y. View

12.

Ma R, Wang L, Wu D, Wang M, Sun X, Hsu B . Myocardial blood flow quantitation in patients with congestive heart failure: head-to-head comparison between rapid-rotating gantry SPECT and CZT SPECT. J Nucl Cardiol. 2019; 27(6):2287-2302. DOI: 10.1007/s12350-019-01621-2. View

13.

Carolina do A H de Souza A, Goncalves B, Tedeschi A, Lima R . Quantification of myocardial flow reserve using a gamma camera with solid-state cadmium-zinc-telluride detectors: Relation to angiographic coronary artery disease. J Nucl Cardiol. 2019; 28(3):876-884. DOI: 10.1007/s12350-019-01775-z. View

14.

Di Carli M, Dorbala S, Meserve J, El Fakhri G, Sitek A, Moore S . Clinical myocardial perfusion PET/CT. J Nucl Med. 2007; 48(5):783-93. DOI: 10.2967/jnumed.106.032789. View

15.

Ben-Haim S, Murthy V, Breault C, Allie R, Sitek A, Roth N . Quantification of Myocardial Perfusion Reserve Using Dynamic SPECT Imaging in Humans: A Feasibility Study. J Nucl Med. 2013; 54(6):873-9. PMC: 3951831. DOI: 10.2967/jnumed.112.109652. View

16.

Taqueti V, Di Carli M . Radionuclide myocardial perfusion imaging for the evaluation of patients with known or suspected coronary artery disease in the era of multimodality cardiovascular imaging. Prog Cardiovasc Dis. 2015; 57(6):644-53. PMC: 5926794. DOI: 10.1016/j.pcad.2015.03.004. View

17.

Nkoulou R, Fuchs T, Pazhenkottil A, Kuest S, Ghadri J, Stehli J . Absolute Myocardial Blood Flow and Flow Reserve Assessed by Gated SPECT with Cadmium-Zinc-Telluride Detectors Using 99mTc-Tetrofosmin: Head-to-Head Comparison with 13N-Ammonia PET. J Nucl Med. 2016; 57(12):1887-1892. DOI: 10.2967/jnumed.115.165498. View

18.

Shiraishi S, Sakamoto F, Tsuda N, Yoshida M, Tomiguchi S, Utsunomiya D . Prediction of left main or 3-vessel disease using myocardial perfusion reserve on dynamic thallium-201 single-photon emission computed tomography with a semiconductor gamma camera. Circ J. 2015; 79(3):623-31. DOI: 10.1253/circj.CJ-14-0932. View

19.

Wells R, Timmins R, Klein R, Lockwood J, Marvin B, deKemp R . Dynamic SPECT measurement of absolute myocardial blood flow in a porcine model. J Nucl Med. 2014; 55(10):1685-91. DOI: 10.2967/jnumed.114.139782. View

20.

Nudi F, Iskandrian A, Schillaci O, Peruzzi M, Frati G, Biondi-Zoccai G . Diagnostic Accuracy of Myocardial Perfusion Imaging With CZT Technology: Systemic Review and Meta-Analysis of Comparison With Invasive Coronary Angiography. JACC Cardiovasc Imaging. 2017; 10(7):787-794. DOI: 10.1016/j.jcmg.2016.10.023. View