Abstract
PurposeWe assessed the feasibility of myocardial blood flow (MBF) and flow reserve (MFR) estimation using dynamic SPECT with a novel CZT camera in patients with stable CAD, in comparison with 15O–water PET and fractional flow reserve (FFR).MethodsThirty patients were prospectively included and underwent FFR measurements in the main coronary arteries (LAD, LCx, RCA). A stenosis ≥50% was considered obstructive and a FFR abnormal if ≤0.8. All patients underwent a dynamic rest/stress 99mTc-sestamibi CZT-SPECT and 15O–water PET for MBF and MFR calculation. Net retention kinetic modeling was applied to SPECT data to estimate global uptake values, and MBF was derived using Leppo correction. Ischemia by PET and CZT-SPECT was considered present if MFR was lower than 2 and 2.1, respectively.ResultsCZT-SPECT yielded higher stress and rest MBF compared to PET for global and LAD and LCx territories, but not in RCA territory. MFR was similar in global and each vessel territory for both modalities. The sensitivity, specificity, accuracy, positive and negative predictive value of CZT-SPECT were, respectively, 83.3, 95.8, 93.3, 100 and 85.7% for the detection of ischemia and 58.3, 84.6, 81.1, 36.8 and 93% for the detection of hemodynamically significant stenosis (FFR ≤ 0.8).ConclusionsDynamic 99mTc-sestamibi CZT-SPECT was technically feasible and provided similar MFR compared to 15O–water PET and high diagnostic value for detecting impaired MFR and abnormal FFR in patients with stable CAD.
Highlights
D-SPECT, a high-sensitivity dedicated cardiac CZT-SPECT camera, allows dynamic acquisition of tomographic images suitable for in vivo assessment of radiotracer kinetics and opens up a new era for myocardial flow and flow reserve measurement using SPECT imaging [1,2,3].Positron emission tomography (PET) using oxygen-15labeled water (15O–water) is the gold standard for noninvasive assessment of myocardial perfusion, as 15O–water is freely diffusible with an extraction fraction independent of flow rate [4]. 15O–water PET has been validated in animal models [5, 6] and is highly reproducible in humans [7, 8]
Recent preliminary data demonstrated the feasibility of SPECT measurement of myocardial flow reserve (MFR); no quantitative estimates of MFR obtained with dynamic 99mTc-sestamibi CZT-SPECT have been compared to invasive fractional flow reserve (FFR) and 15O–water PET in patients with suspected of coronary artery disease (CAD)
Exclusion criteria were: absence of ≥50% stenosis of at least one artery at invasive coronary angiography (ICA), absence of FFR measurements on the 3 main epicardial arteries, delay greater than 30 days between both PET and SPECT imaging and the ICA, patient with a recent history of acute coronary syndrome, patient with extra-cardiac disease whose prognosis can interfere with the treatment decision, pregnant or lactating women, allergy to angiographic contrast media, patient with renal failure with a modification of diet in renal disease (MDRD) clearance less than 60 ml/ min, patient under guardianship, or unable to understand the purpose of the study
Summary
D-SPECT, a high-sensitivity dedicated cardiac CZT-SPECT camera, allows dynamic acquisition of tomographic images suitable for in vivo assessment of radiotracer kinetics and opens up a new era for myocardial flow and flow reserve measurement using SPECT imaging [1,2,3].Positron emission tomography (PET) using oxygen-15labeled water (15O–water) is the gold standard for noninvasive assessment of myocardial perfusion, as 15O–water is freely diffusible with an extraction fraction independent of flow rate [4]. 15O–water PET has been validated in animal models [5, 6] and is highly reproducible in humans [7, 8]. Positron emission tomography (PET) using oxygen-15labeled water (15O–water) is the gold standard for noninvasive assessment of myocardial perfusion, as 15O–water is freely diffusible with an extraction fraction independent of flow rate [4]. Fractional flow reserve (FFR) has emerged as a standard of care for clinical decision making in patients with ≥50% coronary artery stenosis who are candidates for percutaneous intervention [10, 11]. Recent preliminary data demonstrated the feasibility of SPECT measurement of MFR; no quantitative estimates of MFR obtained with dynamic 99mTc-sestamibi CZT-SPECT have been compared to invasive FFR and 15O–water PET in patients with suspected of coronary artery disease (CAD)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
