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SPECT myocardial blood flow quantitation toward clinical use: a comparative study with 13N-Ammonia PET myocardial blood flow quantitation

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Abstract

Objectives

The aim of this study was to evaluate the accuracy of myocardial blood flow (MBF) quantitation of 99mTc-Sestamibi (MIBI) single photon emission computed tomography (SPECT) compared with 13N-Ammonia (NH3) position emission tomography (PET) on the same cohorts.

Background

Recent advances of SPECT technologies have been applied to develop MBF quantitation as a promising tool to diagnose coronary artery disease (CAD) for areas where PET MBF quantitation is not available. However, whether the SPECT approach can achieve the same level of accuracy as the PET approach for clinical use still needs further investigations.

Methods

Twelve healthy volunteers (HVT) and 16 clinical patients with CAD received both MIBI SPECT and NH3 PET flow scans. Dynamic SPECT images acquired with high temporary resolution were fully corrected for physical factors and processed to quantify K1 using the standard compartmental modeling. Human MIBI tracer extraction fraction (EF) was determined by comparing MIBI K1 and NH3 flow on the HVT group and then used to convert flow values from K1 for all subjects. MIBI and NH3 flow values were systematically compared to validate the SPECT approach.

Results

The human MIBI EF was determined as [1.0-0.816*exp(−0.267/MBF)]. Global and regional MBF and myocardial flow reserve (MFR) of MIBI SPECT and NH3 PET were highly correlated for all subjects (global R2: MBF = 0.92, MFR = 0.78; regional R2: MBF ≥ 0.88, MFR ≥ 0.71). No significant differences for rest flow, stress flow, and MFR between these two approaches were observed (All p ≥ 0.088). Bland-Altman plots overall revealed small bias between MIBI SPECT and NH3 PET (global: ΔMBF = −0.03Lml/min/g, ΔMFR = 0.07; regional: ΔMBF = −0.07 − 0.06 , ΔMFR = −0.02 − 0.22).

Conclusions

Quantitation with SPECT technologies can be accurate to measure myocardial blood flow as PET quantitation while comprehensive imaging factors of SPECT to derive the variability between these two approaches were fully addressed and corrected.

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Abbreviations

BMI:

Body mass index

CAD:

Coronary artery disease

CAG:

Coronary angiography

CI:

Confidence interval

DBP:

Diastolic blood pressure

EF:

Extraction fraction

FFR:

Fraction flow reserve

HR:

Heart rate

HVT:

Healthy volunteers

LAD:

Left anterior descending

LCX:

Left circumflex

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

MIBI:

99mTc-Sestamibi

NH3:

13N-Ammonia

PET:

Positron emission tomography

RCA:

Right coronary artery

RMBF:

Rest MBF

SBP:

Systolic blood pressure

SD:

Standard deviation

SMBF:

Stress MBF

SPECT:

Single photon emission computed tomography

VOI:

Volume of interest

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Acknowledgments

This research was supported by government research grants from Ministry of Science and Technology, Taiwan (grant numbers: NSC 102-2623-E-758-001-NU and NSC 101-2623-E-075004-NU).

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Author notes

    Authors and Affiliations

    1. Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, Missouri, USA

      Bailing Hsu

    2. Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

      Lien-Hsin Hu, Bang-Hung Yang, Chien-Hsin Ting & Wen-Sheng Huang

    3. Division of Cardiology, Shin Kong Wu-Ho Su Memorial Hospital, Taipei, Taiwan

      Lung-Ching Chen

    4. Department of Nuclear Medicine, Shin Kong Wu-Ho Su Memorial Hospital, Taipei, Taiwan

      Yen-Kung Chen

    5. Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan

      Guang-Uei Hung

    6. Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan

      Tao-Cheng Wu

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    Correspondence to Wen-Sheng Huang or Tao-Cheng Wu.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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    All authors declare that they have no conflict of interest.

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    Bailing Hsu and Guang-Uei Hung contributed equally to this work.

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    Hsu, B., Hu, LH., Yang, BH. et al. SPECT myocardial blood flow quantitation toward clinical use: a comparative study with 13N-Ammonia PET myocardial blood flow quantitation. Eur J Nucl Med Mol Imaging 44, 117–128 (2017). https://doi.org/10.1007/s00259-016-3491-5

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