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Clinical performance of Rb-82 myocardial perfusion PET and Tc-99m-based SPECT in patients with extreme obesity

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We evaluated the performance of stress imaging with technetium-99m-labeled tetrofosmin single-photon emission computed tomography (SPECT) and rubidium-82 positron emission tomography (PET) in patients with extreme obesity, defined as body mass index ≥40 kg/m2.

Methods

We identified patients with extreme obesity who underwent angiography in our center and either stress SPECT or PET within the previous six months. Cohorts of patients with extreme obesity and a <5% pretest likelihood of CAD who underwent SPECT (N = 25) or PET (N = 25) were also included.

Results

In total, 108 patients who underwent SPECT (N = 57) or PET (N = 51) were identified. Scan interpretation was classified as definitely normal or abnormal in 83.3% of PET and 60.5% of SPECT scans, respectively (P < .01). PET demonstrated higher diagnostic accuracy and normalcy rate. PET was found to have higher specificity for the pooled cohort. Similar findings were observed using stenosis cut-offs of ≥50% and ≥70%.

Conclusions

In patients with extreme obesity, PET enabled more definitive scan interpretation with less artifact compared to SPECT. PET provided higher diagnostic accuracy and specificity in the detection of obstructive coronary artery disease.

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Abbreviations

AC:

Attenuation correction

BMI:

Body mass index

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

PCI:

Percutaneous coronary intervention

PET:

Positron emission tomography

Rb-82:

Rubidium-82

SPECT:

Single-photon emission computed tomography

Tc-99m:

Technetium-99m

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Acknowledgements

The authors would like to thank Lyanne Fuller BSc and Ann Guo BEng for their assistance with data collection, as well as May Aung CNMT, Kim Gardner CNMT, Patty Irvine CNMT, Monique Pacquette RN, and Patricia Grant RN.

Disclosures

SH reports receiving an honorarium from GE Healthcare. BM was a research fellow support by the Molecular Function and Imaging Heart and Stroke Foundation of Ontario Program Grant (No. PRG6242) and The University of Ottawa Heart Institute’s Whit & Heather Tucker Endowed Research Fellowship in Cardiology Award. BC is University of Ottawa Heart Institute Goldfarb Chair in Cardiac Imaging. RdK is a consultant for and has received grant funding from Jubilant DraxImage. RdK receives revenues from Rubidium-82 generator technology licensed to Jubilant DraxImage and from sales of FlowQuant software. TR has collaborated with and received research funding from GE Healthcare, Advanced Accelerator Applications, and AstraZeneca. BC has received grants from CV Diagnostix and research support from TeraRecon. RB is a Career Investigator supported by the Heart and Stroke Foundation of Canada; the University of Ottawa Heart Institute Vered Chair in Cardiology, and Tier 1 Chair in Cardiovascular Research from the University of Ottawa. RB is or has been a consultant for and receives grant funding from GE Healthcare, Lantheus Medical Imaging, Jubilant DraxImage. None of the other authors had disclosures relevant to this work.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada

    David T. Harnett MD, Samir Hazra MD, Brian A. Mc Ardle MB, BCh, Ali Alenazy MD, Ellen Henry MB, BCh, Girish Dwivedi MD, PhD, Robert A. deKemp PhD, Ross A. Davies MD, Terrence D. Ruddy MD, Benjamin J. W. Chow MD & Rob S. Beanlands MD

  2. CAPITAL Research Group, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada

    Ronnen Maze MD, Trevor Simard MD, Christopher Glover MD & Benjamin Hibbert MD, PhD

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  1. David T. Harnett MD
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Corresponding author

Correspondence to Benjamin Hibbert MD, PhD.

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The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on http://www.SpringerLink.com.

David T. Harnett and Samir Hazra Shared first authors. David T. Harnett was co-supervised by Benjamin Hibbert and Rob S Beanlands. Samir Hazra was supervised by Benjamin Hibbert.

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Harnett, D.T., Hazra, S., Maze, R. et al. Clinical performance of Rb-82 myocardial perfusion PET and Tc-99m-based SPECT in patients with extreme obesity. J. Nucl. Cardiol. 26, 275–283 (2019). https://doi.org/10.1007/s12350-017-0855-6

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  • DOI: https://doi.org/10.1007/s12350-017-0855-6

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