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Comparison between N13NH3-PET and 99mTc-Tetrofosmin-CZT SPECT in the evaluation of absolute myocardial blood flow and flow reserve

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

PET/CT is the standard for quantitative assessments of myocardial blood flow (MBF), but it requires short-lived-tracers, costly, and not widely available. SPECT with Cadmium Zinc Telluride (CZT) detectors allows dynamic acquisition and quantitation of MBF. The study aims were to compare MBF measurements by 99mTc-tetrofosmin-CZT to N13NH3 PET/CT after regadenoson-induced coronary hyperemia and to evaluate the effect of attenuation correction (AC).

Methods

54 patients were evaluated at rest and during vasodilation by 99mTc-tetrofosmin-CZT and N13NH3 PET/CT within 2 weeks. MBF and MBF reserve (MFR) were measured by CZT with or without AC (NAC).

Results

The global rest MBF was 0.76 ± 0.19 mL/min/gr by PET and 0.76 ± 0.24 by AC-CZT (P = NS) and 1.14 ± 0.4 by NAC-CZT (P < 0.001 vs PET and AC-CZT). Stress MBF was higher when measured by PET than AC-CZT (1.87 ± 0.45 vs 1.62 ± 0.68 mL/min/gr, P < 0.0008), but lower than NAC-CZT (2.36 ± 1.1, P < 0.0003). The MBF reserve ratio (MFR) was higher by PET than AC-CZT (2.52 ± 0.56 vs 2.22 ± 1 (P < 0.009) and NAC-CZT (2.18 ± 1.0, P < 0.004). Linear regression was better between PET (MFR and stress MBF) and AC-CZT than between PET and NAC-CZT. ROC curve analysis showed the significant ability of AC-CZT to predict MFR < 2 and stress MBF < 1.7 (AUC = 0.75 and 0.82 respectively) and to differentiate between normal and CAD patients (AUC = 0.747 and 0.892 for MFR and stress MBF, respectively).

Conclusions

Our data show a reasonable correlation between MBF and MFR measured by N13NH3-PET and 99mTc-Tetrofosmin-CZT SPECT. NAC-CZT overestimates MBF. AC is recommended when using CZT for measuring MBF.

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Abbreviations

CZT:

Cadmium-zinc-telluride single photon emission tomography

PE:

Positron emission tomography

CT:

Computed tomography

MPI:

Myocardial perfusion imaging

MBF:

Myocardial blood flow

MFR:

Myocardial blood flow reserve

AC:

Attenuation correction

NAC:

Non attenuation correction

MI:

Myocardial infarction

CAD:

Coronary artery disease

CABG:

Coronary artery bypass graft

PCI:

Percutaneous coronary intervention

TAC:

Time activity curve

AUC:

Area under the ROC curve

N13NH3 :

N13-ammonia

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Disclosures

Raffaele Giubbini, Mattia Bonacina, Rexhep Durmo, Domenico Albano, Pompilio Faggiano, Elisa Milan, Francesco Bertagna, Carlo Rodella, Barbara Paghera, Marina Gazzilli, Elisabetta Cerudelli, Francesco Bertagna, and Luca Camoni declare that they do not have conflicts of interest concerning this paper. Eli Stern is a research manager of GE Healthcare, Haifa, Israel.

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Authors and Affiliations

  1. Chair of Nuclear Medicine, University of Brescia, Piazza Spedali Civili, 1, Brescia, Italy

    Raffaele Giubbini MD, Rexhep Durmo MD, Mattia Bonacina MD, Domenico Albano MD, Elisabetta Cerudelli MD, Marina Gazzilli MD, Francesco Dondi MD & Francesco Bertagna MD

  2. Nuclear Medicine Unit, ASST-Spedali Civili, Brescia, Italy

    Mattia Bertoli MD, Alessia Peli MD, Barbara Paghera MD & Luca Camoni MD

  3. Cardiology Department, ASST-Spedali Civili, Brescia, Italy

    Ilio Faggiano MD

  4. Health Physics Department, ASST-Spedali Civili, Brescia, Italy

    Carlo Rodella PhD

  5. Nuclear Medicine Department, Treviso Hospital, Treviso, Italy

    Elisa Milan MD

  6. GE Healthcare, Haifa, Israel

    Eli Stern PhD

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  1. Raffaele Giubbini MD
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  2. Mattia Bertoli MD
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Correspondence to Raffaele Giubbini MD.

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Giubbini, R., Bertoli, M., Durmo, R. et al. Comparison between N13NH3-PET and 99mTc-Tetrofosmin-CZT SPECT in the evaluation of absolute myocardial blood flow and flow reserve. J. Nucl. Cardiol. 28, 1906–1918 (2021). https://doi.org/10.1007/s12350-019-01939-x

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