Abstract
Dedicated CZT cardiac cameras enable dynamic stress and rest SPECT acquisitions and provide accurate measurements of absolute myocardial flow reserve (MFR). MFR have been shown to improve diagnostic performances of coronary artery disease (CAD) in cardiac positron emission tomography. We evaluated the results of SPECT global MFR measurement with the results of invasive coronary angiography (ICA). Patients referred for dynamic SPECT between September 2018 and March 2020 with ICA performed within 3 months were included. Dynamic SPECT were acquired on CZT-based pinhole cardiac cameras in listmode using a stress/rest one-day Tc-99m-tetrofosmin protocol. Kinetic analysis was done with Corridor4DMTMsoftware using a 1-tissue-compartment model and converted to MBF using a previously determined extraction fraction correction. ICA was visually assessed by the experienced interventional cardiologist responsible for the procedure and considered normal if no significant coronary artery plaque (> 10–20%) according to the angiographer conclusion. Sixty-five patients (37 male, 28 female) were included. Thirty-seven patients had already-known CAD. Mean age was 67.8 ± 10.6%; mean BMI was 29.8 ± 5.6%. Mean global MFR was 2.27 ± 1.03. Thirty-one patients had impaired MFR (using a threshold of 2); among them, 3 patients had normal ICA, but had history of diabetes with potential microvascular dysfunction. 34 patients had preserved MFR: 17 with normal ICA, 17 with history of revascularization and/or optimal medical therapy. Considering patients with 1-vessel disease successfully revascularized before SPECT as “normal”, area under curve (ROC) was 0.92 for global MFR. Using the same threshold of 2, sensitivity and specificity were respectively 100% and 85.71%. Global MFR measured during dynamic SPECT is significantly correlated to ICA results. This parameter significantly enhances SPECT diagnostic performances and could help physician decision to perform ICA.
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