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Diagnostic value of quantitative myocardial blood flow assessment by NaI(Tl) SPECT in detecting significant stenosis: a prospective, multi-center study

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Journal of Nuclear Cardiology Aims and scope

Abstract

Objectives

The aim of this prospective multi-center study was to investigate the diagnostic value of myocardial blood flow (MBF) quantification using NaI(Tl)-based single-photon emission computed tomography (SPECT) for determining coronary artery disease (CAD) defined by quantitative coronary angiography (QCA).

Background

Absolute quantitation of MBF and myocardial flow reserve (MFR) using SPECT is clinically feasible; however, whether flow quantification using NaI(Tl) SPECT is superior to commonly performed SPECT myocardial perfusion imaging (MPI) in determining CAD has not been evaluated.

Methods

Patients with suspected or known CAD underwent pharmacological stress/rest dynamic SPECT imaging and routine SPECT MPI followed by QCA. Obstructive disease was defined as ≥ 50% reduction in luminal diameter on QCA.

Results

One hundred fifty-four patients (462 vessels) were included in the analysis. Obstructive CAD was detected in 76/154 patients (49.4%) and 112/462 vessels (24.2%). Optimal cut-off values were 1.86 mL/min/g for stress MBF and 1.95 for MFR, respectively. Stress MBF and MFR were more sensitive than MPI in both individual patients (stress MBF vs MPI: 81.6% vs 51.3%; MFR vs MPI: 72.4% vs 51.3%) and in coronary vascular regions (stress MBF vs MPI: 78.6% vs 31.3%; MFR vs MPI: 75.9% vs 31.3%; all P < .01). In receiver operating characteristic curve analysis, quantification revealed a significantly greater area under the curve than MPI at the patient (stress MBF vs MPI: 0.761 vs 0.641; MFR vs MPI: 0.770 vs 0.641) and the vessel (stress MBF vs MPI: 0.745 vs 0.613; MFR vs MPI: 0.756 vs 0.613; all P < .05) levels. Integrating quantitative SPECT measures with MPI significantly increased the area under the curve and improved the discriminatory and reclassification capacity.

Conclusion

Flow quantification using NaI(Tl) SPECT provides superior sensitivity and discriminatory capacity to MPI in detecting significant stenosis.

Clinical trial registration NCT03637725.

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Abbreviations

SPECT:

Single-photon emission computed tomography

PET:

Positron emission tomography

MPI:

Myocardial perfusion imaging

CAD:

Coronary arterial disease

CZT:

Cadmium zinc telluride

MFR:

Myocardial flow reserve

MBF:

Myocardial blood flow

QCA:

Quantitative coronary angiography

ROC:

The receiver operating characteristic

AUC:

Area under the curve

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Authors and Affiliations

  1. Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China

    Lei Wang MD, Meng Wang MD, Dayong Wu MD, Yawen Wang MD & Wei Fang MD

  2. Department of Nuclear Medicine, China-Japan Friendship Hospital, National Center for Respiratory Diseases, Beijing, China

    Yumin Zheng MD

  3. Department of Nuclear Medicine, Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China

    Jie Zhang MD

  4. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China

    Hong Qiu MD

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

    Bailing Hsu PhD

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  1. Lei Wang MD
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Correspondence to Wei Fang MD.

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The work was supported by Beijing Municipal Science and Technology Plan Project Funding (Z191100006619017).

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Wang, L., Zheng, Y., Zhang, J. et al. Diagnostic value of quantitative myocardial blood flow assessment by NaI(Tl) SPECT in detecting significant stenosis: a prospective, multi-center study. J. Nucl. Cardiol. 30, 769–780 (2023). https://doi.org/10.1007/s12350-022-03085-3

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  • DOI: https://doi.org/10.1007/s12350-022-03085-3

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