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SPECT myocardial blood flow quantitation for the detection of angiographic stenoses with cardiac-dedicated CZT SPECT

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Purpose

CZT SPECT with the enhanced imaging characteristic facilitates SPECT myocardial blood flow (MBF) quantitation moving toward a clinical utility to uncover myocardial ischemia. The purpose of this study was to investigate the diagnostic performance of stress MBF, myocardial flow reserve (MFR) and myocardial flow capacity (MFC) derived from CZT SPECT in the detection of coronary artery disease (CAD).

Methods

One-hundred and eighty patients underwent two-day rest/adenosine-stress scans for SPECT MBF quantitation. All dynamic SPECT images were reconstructed and corrected with necessary corrections. The one-tissue two-compartment kinetic model was utilized to fit kinetic parameters (K1, k2 and FBV) by numeric optimization and converted to MBF from K1. Rest MBF, stress MBF and MFR in left ventricle and coronary territories were calculated from flow polar maps. MFC was assessed by extents of moderately and severely abnormal flow statuses using an integrated flow diagram. Per-patient and per-vessel analyses were performed to determine cutoff values for the detection of angiographically obstructive and flow-limited CAD.

Results

Using the threshold of ≥ 50% stenosis, 149 patients (82.78%) were classified to have obstructive lesions in 355 vessels (65.74%). Using the threshold of ≥ 70% stenosis, 113 patients (62.78%) were classified to have flow-limited lesions in 282 vessels (52.22%). On per-patient analysis, the optimal cutoff values of stress MBF and MFR to detect ≥ 50% stenosis were (1.44 ml/min/g, 1.96) and (1.34 ml/min/g and 1.75) to detect ≥ 70% stenosis. The optimal cutoff values for severely and combined moderately severely abnormal MFC extents were (2.3-2.5%, 23.1%) and (7.5%, 29.4%), respectively. The overall sensitivity of MFC (0.84-0.86, 0.86-0.90) to detect ≥ 50% and ≥ 70% lesions surpassed those of stress MBF (0.78. 0.78) and MFR (0.80, 0.75) (all p < 0.05) with similar specificity (MFC = 0.84-0.90, 0.87-0.91; stress MBF = 0.87, 0.91; MFR = 0.84, 0.89) (all p≥ 0.05).

Conclusion

The non-invasive SPECT MBF quantitation using CZT SPECT is a reliable method to detect angiographically obstructive and flow-limited CAD. Myocardial flow capacity can outperform with higher diagnostic sensitivity than stress MBF or MFR alone.

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Abbreviations

SPECT:

Single photon emission computed tomography

CZT:

Cadmium–zinc–telluride

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

PET:

Positron emission tomography

CAD:

Coronary artery disease

FFR:

Factional flow reserve

MFC:

Myocardial flow capacity

AC:

Attenuation correction

TAC:

Time activity curves

FBV:

Fractional blood volume

MOA:

Moderately abnormal

IS:

Ischemic

ST:

Steal

IF:

Infarct

ROC:

Receiver operating characteristic

PPV:

Positive predictive values

NPV:

Negative predictive values

AUC:

Area under the curve

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Authors and Affiliations

  1. 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, Jian Xie & Muwei Li

  2. Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Wei Fang

  3. Nuclear Science and Engineering Institute, University of Missouri-Columbia, E2433 Lafferre Hall, Columbia, MO, 65211, USA

    Bailing Hsu

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Correspondence to Bailing Hsu.

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Zhang, J., Xie, J., Li, M. et al. SPECT myocardial blood flow quantitation for the detection of angiographic stenoses with cardiac-dedicated CZT SPECT. J. Nucl. Cardiol. 30, 2618–2632 (2023). https://doi.org/10.1007/s12350-023-03334-z

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