Head-to-head comparison of the diagnostic performances of Rubidium-PET and SPECT with CZT camera for the detection of myocardial ischemia in a population of women and overweight individuals
The aim of this study was to compare the diagnostic performances for the detection of myocardial ischemia of 82-Rb-PET-MPS and 99m-Tc-SPECT-MPS in overweight individuals and women.
Methods and Results
Men with BMI ≥ 25 and women referred for MPS were considered for inclusion. All individuals underwent 99m-Tc-SPECT-MPS with CZT cameras and 82-Rb-PET-MPS in 3D-mode. Individuals with at least one positive MPS were referred for coronary angiography (CA) with FFR measurements. A criterion for positivity was a composite endpoint including significant stenosis on CA or, in the absence of CA, the occurrence of acute coronary event during the following year. 313 patients (46% women) with mean BMI of 31.8 ± 6.5 were included. Sensitivity for the detection of myocardial ischemia was higher with 82-Rb-PET-MPS compared with 99m-Tc-SPECT-MPS (85% vs. 57%, P < .05); specificity was equally high with both imaging techniques (93% vs. 94%, P > .05). 82-Rb-PET allowed for a more accurate detection of patients with a high-risk coronary artery disease (HR-CAD) than 99m-Tc-SPECT-MPS (AUC = 0.86 vs. 0.75, respectively; P = .04).
In women and overweight individuals, 82-Rb-PET-MPS provides higher sensitivity for the detection of myocardial ischemia than 99m-Tc-SPECT-MPS thanks to a better image quality and an improved detection of HR-CAD.
KeywordsSPECT MPI Diagnostic and prognostic application Myocardial blood flow CAD PET 82-Rubidium CZT camera
Coronary artery disease
Fractional flow reserve
Myocardial perfusion scintigraphy
Single Photon Emission Computed Tomography
Positron Emission Tomography
We wish to thank Souad Bani, Naima Beldjoudi, Lucile Collas, Audrey Pépin, and Sabrina Salhi who supported us in the setup and monitoring of the RUBIS study (from URC Paris Nord Val de Seine, Assistance Publique – Hôpitaux de Paris, DRCI, Paris, France), and patients who agreed to participate in this study.
Fabien Hyafil is consultant for Naogen and Curium, Dominique Le Guludec is consultant for Advanced Accelerator Applications. The authors Renata Chequer, Emmanuel Sorbets, Candice Estellat, Gregory Ducrocq, François Rouzet, Toni Alfaiate, Hamza Regaieg, Jérémie Abtan, Sébastien Leygnac, Milan Milliner, Laetitia Imbert, Samuel Burg, Rana Ben Azzouna, Louis Potier, Cédric Laouénan, Caroline Quintin, Ronan Roussel, Agnès Hartemann, Gilles Montalescot, Pierre-Yves Marie, Gabriel Steg have nothing to disclose in relation to this manuscript.
- 2.Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003;107:2900-7.CrossRefGoogle Scholar
- 3.Task Force M, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, 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;34:2949-3003.CrossRefGoogle Scholar
- 4.Shaw LJ, Bairey Merz CN, Pepine CJ, Reis SE, Bittner V, Kelsey SF, et al. Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part I: Gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. J Am Coll Cardiol 2006;47:S4-20.CrossRefGoogle Scholar
- 8.Agostini D, Marie PY, Ben-Haim S, Rouzet F, Songy B, Giordano A, et al. Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease: a review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging 2016;43:2423-32.CrossRefGoogle Scholar
- 11.Knesaurek K, Machac J, Krynyckyi BR, Almeida OD. Comparison of 2-dimensional and 3-dimensional 82Rb myocardial perfusion PET imaging. J Nucl Med 2003;44:1350-6.Google Scholar
- 12.Le Guludec D, Lautamaki R, Knuuti J, Bax JJ, Bengel FM, Bax JJ. European Council of Nuclear C. Present and future of clinical cardiovascular PET imaging in Europe: A position statement by the European Council of Nuclear Cardiology (ECNC). Eur J Nucl Med Mol Imaging 2008;35:1709-24.CrossRefGoogle Scholar
- 13.Sciagra R, Passeri A, Bucerius J, Verberne HJ, Slart RH, Lindner O, et al. Clinical use of quantitative cardiac perfusion PET: rationale, modalities and possible indications. Position paper of the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging 2016;43:1530-45.CrossRefGoogle Scholar
- 17.Dosimetry in diagnostic nuclear medicine. French Society of Medical Physics; 2001.Google Scholar
- 19.The measurement, reporting, and management of radiation dose in CT. College Park: American Association of Physicists in Medicine; 2008.Google Scholar
- 22.Perrin M, Djaballah W, Moulin F, Claudin M, Veran N, Imbert L, et al. Stress-first protocol for myocardial perfusion SPECT imaging with semiconductor cameras: High diagnostic performances with significant reduction in patient radiation doses. Eur J Nucl Med Mol Imaging 2015;42:1004-11.CrossRefGoogle Scholar
- 28.Agostini D, Roule V, Nganoa C, Roth N, Baavour R, Parienti JJ, et al. First validation of myocardial flow reserve assessed by dynamic (99 m)Tc-sestamibi CZT-SPECT camera: Head to head comparison with (15)O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study. Eur J Nucl Med Mol Imaging 2018;45:1079-90.CrossRefGoogle Scholar