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Hybrid SPECT/CCTA Imaging in the Work-up of Patients with Suspected Coronary Artery Disease

  • Cardiac Nuclear Imaging (A Cuocolo, Section Editor)
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Abstract

In the past decade, hybrid single photon emission computed tomography (SPECT)/coronary computed tomography angiography (CCTA) has been demonstrated as an accurate diagnostic technique in patients suspected of significant coronary artery disease (CAD). With this combination of anatomical and functional imaging of CAD, negative and positive predictive values over 95 % were reported. The current review provides an update of recent literature on diagnostic accuracy and will position hybrid SPECT/CCTA imaging at the end of a non-invasive imaging cascade to virtually leave no diagnostic uncertainty about the presence or absence of significant CAD. Moreover, hybrid SPECT/CCTA was evaluated for its use in the process of clinical decision-making in a study that made a head-to-head comparison of actual treatment decisions based on hybrid SPECT/CCTA and routine coronary angiography. As such, the role of hybrid SPECT/CCTA in the current work-up of patients presenting with anginal complaints will be evaluated.

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References

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  1. Montalescot G, Sechtem U, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949–3003.

    Article  PubMed  Google Scholar 

  2. Fihn SD, Gardin JM, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126:e354–471.

    Article  PubMed  Google Scholar 

  3. Iskandar A, Limone B. Gender differences in the diagnostic accuracy of SPECT myocardial perfusion imaging: a bivariate meta-analysis. J Nucl Cardiol. 2013;20(1):53–63.

    Article  PubMed  Google Scholar 

  4. Meijboom WB, van Mieghem CAG, et al. Sixty-four slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease. J Am Coll Cardiol. 2007;50(15):1469–75.

    Article  PubMed  Google Scholar 

  5. Schaap J, Kauling RM, et al. Incremental diagnostic accuracy of hybrid SPECT/CT coronary angiography in a population with an intermediate to high pre-test likelihood of coronary artery disease. Eur Heart J Cardiovasc Imaging. 2013;14(7):642–9.

    Article  PubMed  Google Scholar 

  6. Gallagher MJ, Ross MA, et al. The diagnostic accuracy of 64-slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients. Ann Emerg Med. 2007;49(2):125–36.

    Article  PubMed  Google Scholar 

  7. Husmann L, Schepsis T, et al. Comparison of diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low, intermediate, and high cardiovascular risk. Acad Radiol. 2008;15(4):452–61.

    Article  PubMed  Google Scholar 

  8. Dewey M, Teige F, et al. Noninvasive detection of coronary artery stenoses with multislice computed tomography or magnetic resonance imaging. Ann Intern Med. 2006;145:407–15.

    Article  PubMed  Google Scholar 

  9. Schlatmann P, Schuetz GM et al. Influence of coronary artery disease prevalence on predictive values of coronary CT angiography: a meta-regression analysis. Eur Radiol (2011) 21:1904-1913. This study demonstrates it is reasonable to use CCTA in the rule out of CAD in patients with a low to intermediate pre-test likelihood of disease.

  10. Abdulla J, Pedersen KS, et al. Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis. Int J Cardiovasc Imaging. 2012;28:943–53.

    Article  PubMed  Google Scholar 

  11. >Rispler S, Keidar Z, et al. Integrated single-photon emission computed tomography and computed tomography coronary angiography for the assessment of hemodynamically significant coronary artery lesions. J Am Coll Cardiol. 2007;49(10):1059–67.

    Article  PubMed  Google Scholar 

  12. Sato A, Nozato T, et al. Incremental value of combining 64-slice computed tomography angiography with stress nuclear myocardial perfusion imaging to improve noninvasive detection of coronary artery disease. J Nucl Cardiol. 2010;17(1):19–26.

    Article  PubMed  Google Scholar 

  13. Abidov A, Raff GL. Value of coronary CTA in patients with known or suspected CAD and non-diagnostic initial myocardial perfusion testing: current evidence and clinical considerations. J Nucl Cardiol. 2010;17(6):1101–6.

    Article  PubMed  Google Scholar 

  14. Parker MW, Iskandar A, et al. Diagnostic accuracy of cardiac positron emission tomography versus single photon emission computed tomography for coronary artery disease: a bivariate meta-analysis. Circ Cardiovasc Imaging. 2012;5(6):700–7.

    Article  PubMed  Google Scholar 

  15. Lima RS, Watson DD, et al. Incremental value of combined perfusion and function over perfusion alone by gated SPECT myocardial perfusion imaging for detection of severe three-vessel coronary artery disease. J Am Coll Cardiol. 2003;42:64–70.

    Article  PubMed  Google Scholar 

  16. Schaap J, de Groot JA et al. Hybrid myocardial perfusion SPECT/CT coronary angiography and invasive coronary angiography in patients with stable angina pectoris lead to similar treatment decisions. Heart. 2013;99(3):188–94. This study demonstrates the applicability of hybrid SPECT/CCTA imaging in a clinical routine, it showed that patients could be accurately indicated for or deferred from revascularization based on these images.

  17. Pazhenkottil AJ, Nkoulou RN et al. Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary computed tomography angiography. Eur Heart J (2011) 32, 1465–1471. This study study demonstrates the increasing incidence of cardiovascular events in patients with normal, unmatched and matched hybrid SPECT/CCTA results respectively.

  18. Pazhenkottil AJ, Nkoulou RN, et al. Impact of cardiac hybrid single-photon emission computed tomography/computed tomography imaging on choice of treatment strategy in coronary artery disease. Eur Heart J. 2011;32:2824–9. This study demonstrates that hybrid SPECT/CCTA imaging provides an added clinical value for decision making with regard to treatment strategy for CAD.

  19. Genders TSS, Steyerberg EW, et al. A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating and extension. Eur Heart J. 2011;32(11):1316–30.

    Article  PubMed  Google Scholar 

  20. Budoff MJ, Dowe D, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52:1724–32.

    Article  PubMed  Google Scholar 

  21. Meijboom WB, Meijs, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol. 2008;52:2135–44.

    Article  PubMed  Google Scholar 

  22. Miller JM, Rochitte CE, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–36.

    Article  CAS  PubMed  Google Scholar 

  23. Iskandrian AS, Chae SC, et al. Independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease. J Am Coll Cardiol. 1993;22(3):665–70.

    Article  CAS  PubMed  Google Scholar 

  24. Notghi A, Low CS. Myocardial perfusion scintigraphy: past, present, future. Br J Radiol. 2011;84(Spec No 3):S229–36. doi:10.1259/bjr/14625142.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Abidov A, Hachamovitch R, et al. Are shades of gray prognostically useful in reporting myocardial perfusion single-photon emission computed tomography? Circ Cardiovasc Imaging. 2009;2:290–8.

    Article  PubMed  Google Scholar 

  26. Schaap J. Non-invasive imaging of coronary artery disease and its functional consequences—the hybrid SPECT and CCTA approach. Thesis. 2013.

  27. Santana CA, Garcia EC, et al. Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography. J Nucl Cardiol. 2009;16(2):201–11.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Gaemperli O, Schepis T, et al. Cardiac image fusion from stand-alone SPECT and CT: clinical experience. J Nucl Med. 2007;48:696–703.

    Article  PubMed  Google Scholar 

  29. Slomka PJ, Cheng VY, et al. Quantitative analysis of myocardial perfusion SPECT anatomically guided by co registered 64-slice coronary CT angiography. J Nucl Med. 2009;50(10):1621–30.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Gould LK. Does coronary flow trump coronary anatomy? JACC Cardiovasc Imaging. 2009;2(8):1009–23.

    Article  PubMed  Google Scholar 

  31. Dougoud S, Fuchs TA, et al. Prognostic value of coronary CT angiography on long-term follow-up of 6.9 years. Int J Cardiovasc Imaging. 2014;30(5):969–76.

    Article  PubMed  Google Scholar 

  32. Hachamovitch R, Berman DS, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998;97(6):535–43.

    Article  CAS  PubMed  Google Scholar 

  33. Meune C, Aïssou L, et al. Letter to the editor: Non-invasive decision making in stable angina. Heart. 2013;99:1136.

    Article  CAS  PubMed  Google Scholar 

  34. Schaap J, de Groot JAH, et al. Letter to the editor: Non-invasive decision making in stable angina—the response. Heart. 2013;99:1136–7.

    Article  PubMed  Google Scholar 

  35. Boden WE, O’Rourke RA, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.

    Article  CAS  PubMed  Google Scholar 

  36. Wijns W, Kolh P, et al. Guidelines on myocardial revascularization. The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-thoracic Surgery (EACTS). Eur Heart J. 2010;31(20):2501–55.

    Article  PubMed  Google Scholar 

  37. Cheng VY, Berman DS, et al. Performance of the traditional age, sex, and angina typicality-based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary computed tomographic angiography: results from the multinational coronary CT angiography evaluation for clinical outcomes: an international multicenter registry (CONFIRM). Circulation. 2011;124(22):2423–32.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Kajander S, Joutsiniemi E, et al. Cardiac positron emission tomography/computed tomography imaging accurately detects anatomically and functionally significant coronary artery disease. Circulation. 2010;122:603–13.

    Article  CAS  PubMed  Google Scholar 

  39. Knuuti J, Kajander S, et al. Quantification of myocardial blood flow will reform the detection of CAD. J Nucl Cardiol. 2009;16:497–506.

    Article  PubMed  Google Scholar 

  40. Petretta M, Soricelli A, et al. Assessment of coronary flow reserve using single photon emission computed tomography with technetium 99m-labeled tracers. J Nucl Cardiol. 2008;15(3):456–65.

    Article  PubMed  Google Scholar 

  41. Taki J, Fujino S, et al. Tc-99m sestamibi retention characteristics during pharmacological hyperemia in human myocardium: comparison with coronary flow reserve measured by Doppler flow wire. J Nucl Med. 2001;42:1457–63.

    CAS  PubMed  Google Scholar 

  42. Dey T, Backus BE, et al. Low-dose single acquisition rest (99 m)Tc/stress (201)Tl myocardial perfusion SPECT protocol: phantom studies and clinical validation. Eur J Nucl Med Mol Imaging. 2014;41(3):536–47.

    Article  PubMed  Google Scholar 

  43. Kajander S, Joutsiniemi E, et al. Cardiac positron emission tomography/computed tomography imaging accurately detects anatomically and functionally significant coronary artery disease. Circulation. 2010;122:603–13.

    Article  CAS  PubMed  Google Scholar 

  44. Danad I, Raijmakers PG, et al. Hybrid imaging using quantitative H215O PET and CT-based coronary angiography for the detection of coronary artery disease. J Nucl Med. 2013;54(1):55–63.

    Article  CAS  PubMed  Google Scholar 

  45. Gould KL, Johnson NP, et al. Anatomic versus physiologic assessment of coronary artery disease. Role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making. J Am Coll Cardiol. 2013;62(18):1639–53.

    Article  PubMed  Google Scholar 

  46. Danad I, Raijmakers PG, et al. Hybrid imaging using quantitative H215O PET and CT-based coronary angiography for the detection of coronary artery disease. J Nucl Med. 2013;54(1):55–63.

    Article  CAS  PubMed  Google Scholar 

  47. Gaemperli O, Bengel M, et al. Cardiac hybrid imaging. Eur Heart J. 2011;32:2100–8.

    Article  PubMed  Google Scholar 

  48. Achenbach S, Marwan M, et al. Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J. 2010;31:340–6.

    Article  PubMed  Google Scholar 

  49. Hausleiter J, Martinoff S, et al. Image quality and radiation exposure with a low tube voltage protocol for coronary CT angiography results of the protection II trial. JACC Cardiovasc Imaging. 2010;3:1113–23.

    Article  PubMed  Google Scholar 

  50. Buechel RR, Herzog BA, et al. Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: first clinical validation. Eur J Nucl Med Mol Imaging. 2010;37:773–8.

    Article  PubMed  Google Scholar 

  51. Husmann L, Herzog BA, et al. Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating. Eur Heart J. 2009;30:600–7.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Robert M. Kauling, Martijn C. Post, Benno J.W.M. Rensing, J. Fred Verzijlbergen, and Jeroen Schaap declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Cardiology, St. Antonius Hospital Nieuwegein, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands

    Robert M. Kauling, Martijn C. Post & Benno J. W. M. Rensing

  2. Department of Nuclear Medicine, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    J. Fred Verzijlbergen

  3. Department of Cardiology, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands

    Jeroen Schaap

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  1. Robert M. Kauling
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  2. Martijn C. Post
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Correspondence to Jeroen Schaap.

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This article is part of the Topical Collection on Cardiac Nuclear Imaging

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Kauling, R.M., Post, M.C., Rensing, B.J.W.M. et al. Hybrid SPECT/CCTA Imaging in the Work-up of Patients with Suspected Coronary Artery Disease. Curr Cardiovasc Imaging Rep 8, 2 (2015). https://doi.org/10.1007/s12410-014-9316-7

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