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Measurement of absolute myocardial blood flow in humans using dynamic cardiac SPECT and 99mTc-tetrofosmin: Method and validation

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The objective of this study was to measure myocardial blood flow (MBF) in humans using 99mTc-tetrofosmin and dynamic single-photon emission computed tomography (SPECT).

Methods

Dynamic SPECT using 99mTc-tetrofosmin and dynamic positron emission tomography (PET) was performed on a group of 16 patients. The SPECT data were reconstructed using a 4D-spatiotemporal iterative reconstruction method. The data corresponding to 9 patients were used to determine the flow-extraction curve for 99mTc-tefrofosmin while data from the remaining 7 patients were used for method validation. The nonlinear tracer correction parameters A and B for 99mTc-tefrofosmin were estimated for the 9 patients by fitting the flow-extraction curve \( K_{1} = F\left( {1 - A \exp \left( { - \frac{B}{F}} \right)} \right) \) for K 1 values estimated with 99mTc-tefrofosmin using SPECT and MBF values estimated with 13N-NH3 using PET. These parameters were then used to calculate MBF and coronary flow reserve (CFR) in three coronary territories (LAD, RCA, and LCX) using SPECT for an independent cohort of 7 patients. The results were then compared with that estimated with 13N-NH3 PET. The flow-dependent permeability surface-area product (PS) for 99mTc-tefrofosmin was also estimated.

Results

The estimated flow-extraction parameters for 99mTc-tefrofosmin were found to be A = 0.91 ± 0.11, B = 0.34 ± 0.20 (R 2 = 0.49). The range of MBF in LAD, RCA, and LCX was 0.44-3.81 mL/min/g. The MBF between PET and SPECT in the group of independent cohort of 7 patients showed statistically significant correlation, r = 0.71 (P < .001). However, the corresponding CFR correlation was moderate r = 0.39 yet statistically significant (P = .037). The PS for 99mTc-tefrofosmin was (0.019 ± 0.10)*MBF + (0.32 ± 0.16).

Conclusions

Dynamic cardiac SPECT using 99mTc-tetrofosmin and a clinical two-headed SPECT/CT scanner can be a useful tool for estimation of MBF.

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Abbreviations

MBF:

Myocardial blood flow

MPI:

Myocardial perfusion imaging

CAD:

Coronary artery disease

CFR:

Coronary flow reserve

MPI:

Myocardial perfusion index

PCI:

Percutaneous coronary intervention

CABG:

Coronary artery bypass graft

LEHR:

Low-energy high-resolution

PSF:

Point-spread-function

TACs:

Time activity curves

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Acknowledgments

Authors would like to thank nuclear medicine technologists and clinical staff at the UCSF Imaging Center at China Basin local facility for conducting patient scans and Astellas Pharma US and GE Healthcare for providing Lexiscan and 99mTc-tetrofosmin, respectively. The study was supported by the National Institutes of Health under Grant R01HL50663, and by the Director, Office of Science, Office of Biological, and Environmental Research of the U.S. Department of Energy under Contract DEAC02-05CH11231.

Disclosure

The authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., Suite 350, San Francisco, CA, 94143-0946, USA

    Uttam Shrestha PhD, Fares Alhassen PhD, Justin Ellin BS, Emily Verdin BS, Youngho Seo PhD, Elias H. Botvinick MD & Grant T. Gullberg PhD

  2. Division of Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, CA, USA

    Uttam Shrestha PhD, Youngho Seo PhD & Grant T. Gullberg PhD

  3. Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA

    Maria Sciammarella MD, Yerem Yeghiazarians MD, Andrew Boyle MD, PhD & Elias H. Botvinick MD

  4. School of Medicine and Public Health, University of Newcastle, Newcastle, Australia

    Andrew Boyle MD, PhD

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  1. Uttam Shrestha PhD
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  2. Maria Sciammarella MD
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  3. Fares Alhassen PhD
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  9. Elias H. Botvinick MD
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Corresponding author

Correspondence to Uttam Shrestha PhD.

Additional information

See related editorial, doi:10.1007/s12350-015-0386-y.

All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Daniel Berman, MD.

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Shrestha, U., Sciammarella, M., Alhassen, F. et al. Measurement of absolute myocardial blood flow in humans using dynamic cardiac SPECT and 99mTc-tetrofosmin: Method and validation. J. Nucl. Cardiol. 24, 268–277 (2017). https://doi.org/10.1007/s12350-015-0320-3

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  • DOI: https://doi.org/10.1007/s12350-015-0320-3

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