Clinical performance of Rb-82 myocardial perfusion PET and Tc-99m-based SPECT in patients with extreme obesity
- 178 Downloads
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.
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.
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%.
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.
KeywordsMyocardial perfusion imaging PET/CT SPECT obesity
Body mass index
Coronary artery bypass grafting
Coronary artery disease
Percutaneous coronary intervention
Positron emission tomography
Single-photon emission computed tomography
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.
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.
- 1.Go RT, Marwick TH, MacIntyre WJ, Saha GB, Neumann DR, Underwood DA, et al. A prospective comparison of rubidium-82 PET and thallium-201 SPECT myocardial perfusion imaging utilizing a single dipyridamole stress in the diagnosis of coronary artery disease. J Nucl Med 1990;31:1899-905.Google Scholar
- 8.Das SR, Alexander KP, Chen AY, Powell-Wiley TM, Diercks DB, Peterson ED, et al. Impact of body weight and extreme obesity on the presentation, treatment, and in-hospital out- comes of 50,149 patients with ST-segment elevation myocardial infarction: Results from the NCDR (National Cardiovascular Data Registry). J Am Coll Cardiol 2011;58:2642-50.CrossRefGoogle Scholar
- 12.Dilsizian V, Bacharach SL, Beanlands RS, Bergmann SR, Delbeke D, Dorbala S, et al. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Med 2016;23(5):1187-226.Google Scholar
- 19.Cerqueira MD, Weissman NJ, Dilsizian V, Dilsizian V, Jacobs AK, Kaul S, et al. Standardized myocardial segmentation and nonmenclature for tomographic imaging of the heart. Int J Cardiovasc Imaging 2002;18:539-42.Google Scholar
- 30.Elhendy A, Schinkel AF, van Domburg RT, Bax JJ, Valkema R, Biagini E, et al. Prognostic stratification of obese patients by stress 99mTc-tetrofosmin myocardial perfusion imaging. J Nucl Med 2006;47:1302-6.Google Scholar