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Quantitation of myocardial blood flow and myocardial flow reserve with 99mTc-sestamibi dynamic SPECT/CT to enhance detection of coronary artery disease

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Abstract

Purpose

Conventional dual-head single photon emission computed tomography (SPECT)/CT systems capable of fast dynamic SPECT (DySPECT) imaging have a potential for flow quantitation. This study introduced a new method to quantify myocardial blood flow (MBF) and myocardial flow reserve (MFR) with DySPECT scan and evaluated the diagnostic performance of detecting coronary artery disease (CAD) compared with perfusion using invasive coronary angiography (CAG) as the reference standard.

Methods

This study included 21 patients with suspected or known CAD who had received DySPECT, ECG-gated SPECT (GSPECT), and CAG (13 with ≥50 % stenosis in any vessel; non-CAD group: 8 with patent arteries or <50 % stenosis). DySPECT and GSPECT scans were performed on a widely used dual-head SPECT/CT scanner. The DySPECT imaging protocol utilized 12-min multiple back-and-forth gantry rotations during injections of 99mTc-sestamibi (MIBI) tracer at rest or dipyridamole-stress stages. DySPECT images were reconstructed with full physical corrections and converted to the physical unit of becquerels per milliliter. Stress MBF (SMBF), rest MBF (RMBF), and MFR were quantified by a one-tissue compartment flow model using time-activity curves derived from DySPECT images. Perfusion images were processed for GSPECT scan and interpreted to obtain summed stress score (SSS) and summed difference score (SDS). Receiver-operating characteristic (ROC) analyses were conducted to evaluate the diagnostic performance of flow and perfusion.

Results

Using the criteria of ≥50 % stenosis as positive CAD, areas under the ROC curve (AUCs) of flow assessment were overall significantly greater than those of perfusion. For patient-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.91 ± 0.07, 0.86 ± 0.09, 0.64 ± 0.12, and 0.59 ± 0.13. For vessel-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.81 ± 0.05, 0.76 ± 0.06, 0.62 ± 0.07, and 0.56 ± 0.08, respectively.

Conclusion

The preliminary data suggest that MBF quantitation with a conventional SPECT/CT system and the flow quantitation method is a clinically effective approach to enhance CAD detection.

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Acknowledgment

The authors are thankful to Dr. Ran Klein and Dr. Robert A. deKemp from University of Ottawa Heart Institute, Cardiac PET Centre, Ottawa, Ontario, Canada for their scientific insight and experience of PET flow quantitation to help discussion of this research work. In addition, this study was supported by an internal research grant from Show Chwan Memorial Hospital (Grant Number: RD100012).

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Authors and Affiliations

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

    Bailing Hsu

  2. Section of Cardiology, Department of Internal Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan

    Fu-Chung Chen & Chien-Cheng Chen

  3. Section of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Tao-Cheng Wu

  4. Department of Medical Research & Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan

    Wen-Sheng Huang

  5. Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, 6 Lukon Road, Lukong Town, Changhua Shien, 505, Taiwan

    Po-Nien Hou & Guang-Uei Hung

  6. Department of Medical Imaging and Radiological Science, Central Taiwan University of Science and Technology, Taichung, Taiwan

    Guang-Uei Hung

  7. Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan

    Guang-Uei Hung

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  1. Bailing Hsu
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Correspondence to Chien-Cheng Chen or Guang-Uei Hung.

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Bailing Hsu and Fu-Chung Chen contributed equally to this work.

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Hsu, B., Chen, FC., Wu, TC. et al. Quantitation of myocardial blood flow and myocardial flow reserve with 99mTc-sestamibi dynamic SPECT/CT to enhance detection of coronary artery disease. Eur J Nucl Med Mol Imaging 41, 2294–2306 (2014). https://doi.org/10.1007/s00259-014-2881-9

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  • DOI: https://doi.org/10.1007/s00259-014-2881-9

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