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Comparison of nitrate augmented Tc-99m tetrofosmin gated SPECT imaging with FDG PET imaging for the assessment of myocardial viability in patients with severe left ventricular dysfunction

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Of various nuclear medicine techniques, F-18/flourodeoxyglucose (FDG) positron emission tomography (PET) is considered as the best modality for the assessment of viable myocardium (VM). In this study, we compared the diagnostic accuracy of nitrate augmented Tc-99m tetrofosmin gated G-single-photon emission computed tomography (SPECT) with FDG PET.

Methods

54 consecutive cases of angiographically proven CAD with severe LV dysfunction were enrolled in the study. The patients underwent Tc-99m tetrofosmin G-SPECT and FDG PET as per the standard protocols and were compared.

Results

SPECT data analysis indicated functional abnormalities in 661/918 myocardial segments. F-18 FDG PET revealed VM in 496/661 segments. The diagnostic accuracy of baseline NAC, postnitrate NAC, baseline AC, and postnitrate AC Tc-99m tetrofosmin SPECT was 84%, 87%, 90%, and 94%, respectively. κ values for NAC baseline, NAC postnitrate, AC baseline, and AC postnitrate Tc-99m tetrofosmin G-SPECT were 0.65, 0.70, 0.77, and 0.85, respectively. Attenuation correction revealed viability additionally in 46 segments which were non-viable on NAC postnitrate study (P < .001). Nitrate augmentation showed viability additionally in 25 segments which were non-viable on AC baseline scan (P = .004). On patient-based analysis FDG PET changes the management only in 13% (7/54) of patients.

Conclusions

Nitrate augmented AC Tc-99m tetrofosmin G-SPECT shows excellent (κ = .85) agreement with FDG PET. FDG PET changes management only in 13% of the patients. Tc-99m tetrofosmin G-SPECT being more widely available and cheaper imaging modality can be reliably used to detect VM where FDG PET is not available.

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Authors and Affiliations

  1. Department of Nuclear Medicine & PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Senthil Raja MD, Baljinder Singh PhD, Kuruva Manohar MD, Raghava Kashyap MD, Anish Bhattacharya DNB & B. R. Mittal MD

  2. Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Manoj Kumar Rohit MD

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  1. Senthil Raja MD
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  2. Baljinder Singh PhD
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  3. Manoj Kumar Rohit MD
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Correspondence to Baljinder Singh PhD.

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Raja, S., Singh, B., Rohit, M.K. et al. Comparison of nitrate augmented Tc-99m tetrofosmin gated SPECT imaging with FDG PET imaging for the assessment of myocardial viability in patients with severe left ventricular dysfunction. J. Nucl. Cardiol. 19, 1176–1181 (2012). https://doi.org/10.1007/s12350-012-9607-9

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