Skip to main content

Advertisement

SpringerLink
Log in

A combined static-dynamic single-dose imaging protocol to compare quantitative dynamic SPECT with static conventional SPECT

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

SPECT myocardial perfusion imaging (MPI) is a clinical mainstay that is typically performed with static imaging protocols and visually or semi-quantitatively assessed for perfusion defects based upon the relative intensity of myocardial regions. Dynamic cardiac SPECT presents a new imaging technique based on time-varying information of radiotracer distribution, which permits the evaluation of regional myocardial blood flow (MBF) and coronary flow reserve (CFR). In this work, a preliminary feasibility study was conducted in a small patient sample designed to implement a unique combined static-dynamic single-dose one-day visit imaging protocol to compare quantitative dynamic SPECT with static conventional SPECT for improving the diagnosis of coronary artery disease (CAD).

Methods

Fifteen patients (11 males, four females, mean age 71 ± 9 years) were enrolled for a combined dynamic and static SPECT (Infinia Hawkeye 4, GE Healthcare) imaging protocol with a single dose of 99mTc-tetrofosmin administered at rest and a single dose administered at stress in a one-day visit. Out of 15 patients, eleven had selective coronary angiography (SCA), 8 within 6 months and the rest within 24 months of SPECT imaging, without intervening symptoms or interventions. The extent and severity of perfusion defects in each myocardial region was graded visually. Dynamically acquired data were also used to estimate the MBF and CFR. Both visually graded images and estimated CFR were tested against SCA as a reference to evaluate the validity of the methods.

Results

Overall, conventional static SPECT was normal in ten patients and abnormal in five patients, dynamic SPECT was normal in 12 patients and abnormal in three patients, and CFR from dynamic SPECT was normal in nine patients and abnormal in six patients. Among those 11 patients with SCA, conventional SPECT was normal in 5, 3 with documented CAD on SCA with an overall accuracy of 64%, sensitivity of 40% and specificity of 83%. Dynamic SPECT image analysis also produced a similar accuracy, sensitivity, and specificity. CFR was normal in 6, each with CAD on SCA with an overall accuracy of 91%, sensitivity of 80%, and specificity of 100%. The mean CFR was significantly lower for SCA detected abnormal than for normal patients (3.86±1.06 vs 1.94±0. 0.67, P < 0.001).

Conclusions

The visually assessed image findings in static and dynamic SPECT are subjective, and may not reflect direct physiologic measures of coronary lesion based on SCA. The CFR measured with dynamic SPECT is fully objective, with better sensitivity and specificity, available only with the data generated from the dynamic SPECT method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

Abbreviations

SCA:

Selective Coronary angiography

CABG:

Coronary bypass graft surgery

CAD:

Coronary artery disease

CFR:

Coronary flow reserve

MBF:

Myocardial blood flow

MPI:

Myocardial perfusion imaging

PCI:

Percutaneous coronary intervention

PET:

Positron emission tomography

SPECT:

Single-photon emission computed tomography

CT:

Computed Tomography

References

  1. Shaw LJ, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol. 2004;11:171-85.

    Article  PubMed  Google Scholar 

  2. Sciagra R, Leoncini M. Gated single-photon emission computed tomography. The present-day “one-stop-shop” for cardiac imaging. Q J Nucl Med Mol Imaging. 2005;49:19-29.

    CAS  PubMed  Google Scholar 

  3. Beller GA, Bergmann SR. Myocardial perfusion imaging agents: SPECT and PET. J Nucl Cardiol. 2004;11:71-86.

    Article  PubMed  Google Scholar 

  4. Huang JY, Huang CK, Yen RF, Wu HY, Tu YK, Cheng MF, et al. Diagnostic performance of attenuation-corrected myocardial perfusion imaging for coronary artery disease: A systematic review and meta-analysis. J Nucl Med. 2016;57:1893-8.

    Article  PubMed  Google Scholar 

  5. Shrestha U, Sciammarella M, Alhassen F, Yeghiazarians Y, Ellin J, Verdin E, et al. Measurement of absolute myocardial blood flow in humans using dynamic cardiac SPECT and 99mTc-tetrofosmin: Method and validation. J Nucl Cardiol. 2017;24:268-77.

    Article  PubMed  Google Scholar 

  6. Jin M, Yang Y, King MA. Reconstruction of dynamic gated cardiac SPECT. Med Phys. 2006;33:4384-94.

    Article  PubMed  Google Scholar 

  7. Iida H, Eberl S. Quantitative assessment of regional myocardial blood flow with Thallium-201 and SPECT. J Nucl Cardiol. 1998;5:313-31.

    Article  CAS  PubMed  Google Scholar 

  8. Alhassen F, Nguyen N, Bains S, Gould RG, Seo Y, Bacharach SL, et al. Myocardial blood flow measurement with a conventional dual-head SPECT/CT with spatiotemporal iterative reconstructions—a clinical feasibility study. Am J Nucl Med Mol Imaging. 2013;4:53-9.

    PubMed  PubMed Central  Google Scholar 

  9. Chen LC, Lin CY, Chen IJ, Ku CT, Chen YK, Hsu B. SPECT myocardial blood flow quantitation concludes equivocal myocardial perfusion SPECT studies to increase diagnostic benefits. Clin Nucl Med. 2016;41:e60–2.

    Article  PubMed  Google Scholar 

  10. Hsu B, Hu LH, Yang BH, Chen LC, Chen YK, Ting CH, et al. SPECT myocardial blood flow quantitation toward clinical use: A comparative study with 13N-ammonia PET myocardial blood flow quantitation. Eur J Nucl Med Mol Imaging. 2017;44:117-28.

    Article  CAS  PubMed  Google Scholar 

  11. Nkoulou R, Fuchs TA, Pazhenkottil AP, Kuest SM, Ghadri JR, Stehli J, et al. Absolute myocardial blood flow and flow reserve assessed by gated SPECT with cadmium-zinc-telluride detectors using 99mTc-tetrofosmin: Head-to-head comparison with 13N-ammonia PET. J Nucl Med. 2016;57:1887-92.

    Article  CAS  PubMed  Google Scholar 

  12. Gullberg GT, Reutter BW, Sitek A, Maltz JS, Budinger TF. Dynamic single photon emission computed tomography—basic principles and cardiac applications. Phys Med Biol. 2010;55:R111-91.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ben-Haim S, Murthy VL, Breault C, Allie R, Sitek A, Roth N, et al. Quantification of myocardial perfusion reserve using dynamic SPECT imaging in humans: A feasibility study. J Nucl Med. 2013;54:873-9.

    Article  CAS  PubMed  Google Scholar 

  14. Ziadi MC, Dekemp RA, Williams K, Guo A, Renaud JM, Chow BJ, et al. Does quantification of myocardial flow reserve using rubidium-82 positron emission tomography facilitate detection of multivessel coronary artery disease? J Nucl Cardiol. 2012;19:670-80.

    Article  PubMed  Google Scholar 

  15. Beanlands RS, Ziadi MC, Williams K. Quantification of myocardial flow reserve using positron emission imaging the journey to clinical use. J Am Coll Cardiol. 2009;54:157-9.

    Article  PubMed  Google Scholar 

  16. Murthy VL, Naya M, Foster CR, Hainer J, Gaber M, Di Carli G, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation. 2011;124:2215-24.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Herzog BA, Husmann L, Valenta I, Gaemperli O, Siegrist PT, Tay FM, et al. Long-term prognostic value of 13N-ammonia myocardial perfusion positron emission tomography added value of coronary flow reserve. J Am Coll Cardiol. 2009;54:150-6.

    Article  PubMed  Google Scholar 

  18. Slomka PJ, Berman DS, Germano G. Absolute myocardial blood flow quantification with SPECT/CT: Is it possible? J Nucl Cardiol. 2014;21:1092-5.

    Article  PubMed  Google Scholar 

  19. Slomka P, Berman DS, Germano G. Myocardial blood flow from SPECT. J Nucl Cardiol. 2016;24:278-81.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wells RG, Timmins R, Klein R, Lockwood J, Marvin B, deKemp RA, et al. Dynamic SPECT measurement of absolute myocardial blood flow in a porcine model. J Nucl Med. 2014;55:1685-91.

    Article  CAS  PubMed  Google Scholar 

  21. Shepp LA, Vardi Y. Maximum likelihood reconstruction for emission tomography. IEEE Trans Med Imaging. 1982;1:113-22.

    Article  CAS  PubMed  Google Scholar 

  22. Shrestha UM, Seo Y, Botvinick EH, Gullberg GT. Image reconstruction in higher dimensions: Myocardial perfusion imaging of tracer dynamics with cardiac motion due to deformation and respiration. Phys Med Biol. 2015;60:8275-301.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Winant CD, Aparici CM, Zelnik YR, Reutter BW, Sitek A, Bacharach SL, et al. Investigation of dynamic SPECT measurements of the arterial input function in human subjects using simulation, phantom and human studies. Phys Med Biol. 2012;57:375-93.

    Article  PubMed  Google Scholar 

  24. Hudson HM, Larkin RS. Accelerated image reconstruction using ordered subsets of projection data. IEEE Trans Med Imaging. 1994;13:601-9.

    Article  CAS  PubMed  Google Scholar 

  25. Legrand V, Hodgson JM, Bates ER, Aueron FM, Mancini GB, Smith JS, et al. Abnormal coronary flow reserve and abnormal radionuclide exercise test results in patients with normal coronary angiograms. J Am Coll Cardiol. 1985;6:1245-53.

    Article  CAS  PubMed  Google Scholar 

  26. Gould KL, Johnson NP, Bateman TM, Beanlands RS, Bengel FM, Bober R, 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;62:1639-53.

    Article  PubMed  Google Scholar 

  27. Yoshinaga K, Manabe O, Tamaki N. Absolute quantification of myocardial blood flow. J Nucl Cardiol. 2016;48:1783.

    Google Scholar 

  28. Schelbert HR, Phelps ME, Hoffman E, Huang SC, Kuhl DE. Regional myocardial blood flow, metabolism and function assessed noninvasively with positron emission tomography. Am J Cardiol. 1980;46:1269-77.

    Article  CAS  PubMed  Google Scholar 

  29. Schindler TH, Facta AD, Prior JO, Campisi R, Inubushi M, Kreissl MC, et al. Pet-measured heterogeneity in longitudinal myocardial blood flow in response to sympathetic and pharmacologic stress as a non-invasive probe of epicardial vasomotor dysfunction. Eur J Nucl Med Mol Imaging. 2006;33:1140-9.

    Article  PubMed  Google Scholar 

  30. Garcia EV. Are SPECT measurements of myocardial blood flow and flow reserve ready for clinical use? Eur J Nucl Med Mol Imaging. 2014;41:2291-3.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Petretta M, Storto G, Pellegrino T, Bonaduce D, Cuocolo A. Quantitative assessment of myocardial blood flow with SPECT. Prog Cardiovasc Dis. 2015;57:607-14.

    Article  PubMed  Google Scholar 

  32. Timmins R, Klein R, Petryk J, Marvin B, Wei L, deKemp RA, et al. Reduced dose measurement of absolute myocardial blood flow using dynamic SPECT imaging in a porcine model. Med Phys. 2015;42:5075-83.

    Article  PubMed  Google Scholar 

  33. Nose N, Fukushima K, Lapa C, Werner RA, Javadi MS, Taki J, et al. Assessment of coronary flow reserve using a combination of planar first-pass angiography and myocardial SPECT: Comparison with myocardial 15O-water PET. Int J Cardiol. 2016;222:209-12.

    Article  PubMed  Google Scholar 

  34. Wang L, Wu D, Yang Y, Chen IJ, Lin CY, Hsu B, et al. Avoiding full corrections in dynamic SPECT images impacts the performance of SPECT myocardial blood flow quantitation. J Nucl Cardiol. 2016. doi:10.1007/s12350-016-0513-4.

    Article  PubMed  Google Scholar 

  35. Joutsiniemi E, Saraste A, Pietila M, Maki M, Kajander S, Ukkonen H, et al. Absolute flow or myocardial flow reserve for the detection of significant coronary artery disease? Eur Heart J Cardiovas Imaging. 2014;15:659-65.

    Article  Google Scholar 

  36. Parker MW, Iskandar A, Limone B, Perugini A, Kim H, Jones C, 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;5:700-7.

    Article  PubMed  Google Scholar 

  37. Chareonthaitawee P, Kaufmann PA, Rimoldi O, Camici PG. Heterogeneity of resting and hyperemic myocardial blood flow in healthy humans. Cardiovasc Res. 2001;50:151-61.

    Article  CAS  PubMed  Google Scholar 

  38. Beller GA, Zaret BL. Contributions of nuclear cardiology to diagnosis and prognosis of patients with coronary artery disease. Circulation. 2000;101:1465-78.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank nuclear medicine technologists at the UCSF Imaging Center at China Basin for conducting patient scans. The study was supported in part by the National Institutes of Health under grant R01 HL050663.

Disclosure

The authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA

    Maria Sciammarella MD & Elias H. Botvinick MD

  2. Department of Radiology and Biomedical Imaging, University of California, 185 Berry St., Suite 350, San Francisco, CA, 94143-0946, USA

    Uttam M. Shrestha PhD, Youngho Seo PhD, Grant T. Gullberg PhD & Elias H. Botvinick MD

Authors
  1. Maria Sciammarella MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Uttam M. Shrestha PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Youngho Seo PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Grant T. Gullberg PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elias H. Botvinick MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Uttam M. Shrestha PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sciammarella, M., Shrestha, U.M., Seo, Y. et al. A combined static-dynamic single-dose imaging protocol to compare quantitative dynamic SPECT with static conventional SPECT. J. Nucl. Cardiol. 26, 763–771 (2019). https://doi.org/10.1007/s12350-017-1016-7

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-017-1016-7

Keywords

Search

Navigation