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Hybrid SPECT-CT and PET-CT: Current Concepts and Developments

  • Cardiac Computed Tomography (Stephan Achenbach, Section Editor)
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Abstract

Cardiac hybrid imaging combines different modalities in order to obtain complementary anatomical and functional information in a single imaging study. Coronary CT angiography (CTA) and myocardial perfusion imaging with single photon emission computed tomography (SPECT) or positron emission tomography (PET) are established noninvasive modalities for the diagnosis of coronary artery disease (CAD). Hybrid SPECT-CT or PET-CT is a promising tool for evaluation of CAD since it allows visualization of coronary atherosclerotic lesions and their consequences on myocardial blood flow in a single study. This appears to offer superior diagnostic accuracy for the detection of flow-limiting stenosis in patients with intermediate risk for CAD as compared with stand-alone imaging, especially by improving the positive predictive value. This article will review the concepts and currently available clinical experiences from cardiac hybrid imaging as well as discuss potential future applications.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Schroeder S, Achenbach S, Bengel F, Burgstahler C, Cademartiri F, de Feyter P, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J. 2008;29:531–56.

    Article  PubMed  Google Scholar 

  2. Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2010;31:2501–55.

    Article  PubMed  Google Scholar 

  3. Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117:1283–91.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. Tonino PA, Fearon WF, De Bruyne B, Oldroyd KG, Leesar MA, Ver Lee PN, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol. 2010;55:2816–21.

    Article  PubMed  Google Scholar 

  6. Gould KL. Identifying and measuring severity of coronary artery stenosis. Quantitative coronary arteriography and positron emission tomography. Circulation. 1988;78:237–45.

    Article  PubMed  CAS  Google Scholar 

  7. Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR, van Mieghem CA, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol. 2008;52:2135–44.

    Article  PubMed  Google Scholar 

  8. Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–36.

    Article  PubMed  CAS  Google Scholar 

  9. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008;52:1724–32.

    Article  PubMed  Google Scholar 

  10. Mark DB, Berman DS, Budoff MJ, Carr JJ, Gerber TC, Hecht HS, et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation. 2010;121:2509–43.

    Article  PubMed  Google Scholar 

  11. Flotats A, Knuuti J, Gutberlet M, Marcassa C, Bengel FM, Kaufmann PA, et al. Hybrid cardiac imaging: SPECT/CT and PET/CT. A joint position statement by the European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC). Eur J Nucl Med Mol Imaging. 2011;38:201–12.

    Article  PubMed  Google Scholar 

  12. Schuijf JD, Wijns W, Jukema JW, et al. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol. 2006;48:2508–14.

    Article  PubMed  Google Scholar 

  13. Hacker M, Jakobs T, Hack N, et al. Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina. Eur J Nucl Med Mol Imaging. 2007;34:4–10.

    Article  PubMed  Google Scholar 

  14. Sato A, Tamura M, Ohigashi H, et al. Quantitative measures of coronary stenosis severity by 64-slice CT angiography and relation to physiologic significance of perfusion in nonobese patients: comparison with stress myocardial perfusion imaging. J Nucl Med. 2008;49:564–72.

    Article  PubMed  Google Scholar 

  15. Gaemperli O, Schepis T, Velenta I, et al. Functionally relevant coronary artery disease: comparison of 64-section CT angiography with myocardial perfusion SPECT. Radiology. 2008;248:414–23.

    Article  PubMed  Google Scholar 

  16. Leber AW, Knez A, von Ziegler F, et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol. 2005;46:147–54.

    Article  PubMed  Google Scholar 

  17. Mejiboom WB, van Mieghem CA, Mollet NR, et al. 64-slice computed tomography coronary angiography in patients with high-intermediate, or low pretest probability of significant coronary artery disease. J Am Coll Cardiol. 2007;50:1469–75.

    Article  Google Scholar 

  18. Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging–executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol. 2003;42:1318–33.

    Article  PubMed  Google Scholar 

  19. Underwood SR, Anagnostopoulos C, Cerqueira M, Ell PJ, Flint EJ, Harbinson M, et al. Myocardial perfusion scintigraphy: the evidence. Eur J Nucl Med Mol Imaging. 2004;31:261–91.

    Article  PubMed  CAS  Google Scholar 

  20. Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998;97:535–43.

    PubMed  CAS  Google Scholar 

  21. Di Carli MF, Hachamovitch R. New technology for noninvasive evaluation of coronary artery disease. Circulation. 2007;115:1464–80.

    Article  PubMed  Google Scholar 

  22. Knuuti J, Kajander S, Maki M, Ukkonen H. Quantification of myocardial blood flow will reform the detection of cad. J Nucl Cardiol. 2009;16:497–506.

    Article  PubMed  Google Scholar 

  23. Stone GW, Maehara A, Lansky AJ, de Bruyne B, Cristea E, Mintz GS, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011;364:226–35.

    Article  PubMed  CAS  Google Scholar 

  24. Bergmann SR, Fox KA, Rand AL, McElvany KD, Welch MJ, Markham J, et al. Quantification of regional myocardial blood flow in vivo with H 152 O. Circulation. 1984;70:724–33.

    Article  PubMed  CAS  Google Scholar 

  25. Hutchins GD, Schwaiger M, Rosenspire KC, Krivokapich J, Schelbert H, Kuhl DE. Noninvasive quantification of regional blood flow in the human heart using N-13 ammonia and dynamic positron emission tomographic imaging. J Am Coll Cardiol. 1990;15:1032–42.

    Article  PubMed  CAS  Google Scholar 

  26. Parkash R, de Kemp RA, Ruddy TD, Kitsikis A, Hart R, Beauchesne L, et al. Potential utility of rubidium 82 pet quantification in patients with 3-vessel coronary artery disease. J Nucl Cardiol. 2004;11:440–9.

    Article  PubMed  CAS  Google Scholar 

  27. Yoshinaga K, Katoh C, Noriyasu K, Iwado Y, Furuyama H, Ito Y, et al. Reduction of coronary flow reserve in areas with and without ischemia on stress perfusion imaging in patients with coronary artery disease: a study using oxygen 15-labeled water pet. J Nucl Cardiol. 2003;10:275–83.

    Article  PubMed  Google Scholar 

  28. Gaemperli O, Schepis T, Valenta I, Husmann L, Scheffel H, Duerst V, et al. Cardiac image fusion from standalone SPECT and CT: clinical experience. J Nucl Med. 2007;48:696–703.

    Article  PubMed  Google Scholar 

  29. Santana CA, Garcia EV, Faber TL, Sirineni GK, Esteves FP, Sanyal R, et al. Diagnostic performance of fusion of myocardial perfusion imaging (MPI) and computed tomography coronary angiography. J Nucl Cardiol. 2009;16:201–11.

    Article  PubMed  Google Scholar 

  30. Slomka PJ, Cheng VY, Dey D, Woo J, Ramesh A, Van Kriekinge S, et al. Quantitative analysis of myocardial perfusion SPECT anatomically guided by coregistered 64-slice coronary CT angiography. J Nucl Med. 2009;50:1621–30.

    Article  PubMed  Google Scholar 

  31. Kalbfleisch H, Hort W. Quantitative study on the size of coronary artery supplying areas postmortem. Am Heart J. 1977;94:183–8.

    Article  PubMed  CAS  Google Scholar 

  32. Javadi MS, Lautamaki R, Merrill J, Voicu C, Epley W, McBride G, et al. Definition of vascular territories on myocardial perfusion images by integration with true coronary anatomy: a hybrid PET/CT analysis. J Nucl Med. 2010;51:198–203.

    Article  PubMed  Google Scholar 

  33. Namdar M, Hany TF, Koepfli P, Siegrist PT, Burger C, Wyss CA, et al. Integrated PET/CT for the assessment of coronary artery disease: a feasibility study. J Nucl Med. 2005;46:930–5.

    PubMed  Google Scholar 

  34. Rispler S, Keidar Z, Ghersin E, Roguin A, Soil A, Dragu R, et al. Integrated single-photon emission computed tomography and computed tomography coronary angiography for the assessment of hemodynamically significant coronary artery lesions. J Am Coll Cardiol. 2007;49:1059–67.

    Article  PubMed  Google Scholar 

  35. Groves AM, Speechly-Dick ME, Kayani I, Pugliese F, Endozo R, McEwan J, et al. First experience of combined cardiac PET/64-detector CT angiography with invasive angiographic validation. Eur J Nucl Med Mol Imaging. 2009;36:2027–33.

    Article  PubMed  Google Scholar 

  36. •• Kajander S, Joutsiniemi E, Saraste M, Pietila M, Ukkonen H, Saraste A, et al. Cardiac positron emission tomography/computed tomography imaging accurately detects anatomically and functionally significant coronary artery disease. Circulation 2010;122:603–13. Demonstrated the clinical feasibility and improved diagnostic accuracy of integrated CTA and PET perfusion imaging over either imaging modality alone for the detection of hemodynamically significant coronary stenosis defined by invasive angiography and FFR measurements in patients with intermediate risk of CAD.

  37. Sato A, Nozato T, Hikita H, Miyazaki S, Takahashi Y, Kuwahara T, et al. Incremental value of combining 64-slice computed tomography angiography with stress nuclear myocardial perfusion imaging to improve noninvasive detection of coronary artery disease. J Nucl Cardiol. 2010;17:19–26.

    Article  PubMed  Google Scholar 

  38. •• van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W, et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol 2009;53:623–32. Demonstrated the prognostic value of combined CTA and perfusion imaging over myocardial perfusion imaging alone in patients at intermediate risk of CAD.

  39. Schepis T, Gaemperli O, Koepfli P, Namdar M, Valenta I, Scheffel H, et al. Added value of coronary artery calcium score as an adjunct to gated SPECT for the evaluation of coronary artery disease in an intermediate-risk population. J Nucl Med. 2007;48:1424–30.

    Article  PubMed  Google Scholar 

  40. Schenker MP, Dorbala S, Hong EC, Rybicki FJ, Hachamovitch R, Kwong RY, et al. Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: a combined positron emission tomography/computed tomography study. Circulation. 2008;117:1693–700.

    Article  PubMed  Google Scholar 

  41. Pundziute G, Schuijf JD, Jukema JW, Boersma E, de Roos A, van der Wall EE, et al. Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease. J Am Coll Cardiol. 2007;49:62–70.

    Article  PubMed  Google Scholar 

  42. Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50:319–26.

    Article  PubMed  Google Scholar 

  43. Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ. Radiation dose to patients from cardiac diagnostic imaging. Circulation. 2007;116:1290–305.

    Article  PubMed  Google Scholar 

  44. Hausleiter J, Meyer T, Hermann F, Hadamitzky M, Krebs M, Gerber TC, et al. Estimated radiation dose associated with cardiac CT angiography. JAMA. 2009;301:500–7.

    Article  PubMed  CAS  Google Scholar 

  45. Leipsic J, Labounty TM, Heilbron B, Min JK, Mancini GB, Lin FY, et al. Estimated radiation dose reduction using adaptive statistical iterative reconstruction in coronary CT angiography: the ERASIR study. AJR Am J Roentgenol. 2010;195:655–60.

    Article  PubMed  Google Scholar 

  46. Knuuti J Kaufmann PA. Hybrid imaging: PET–CT and SPECT–CT. In: Zamorano JL, Bax JJ, Rademakers FE, Knuuti J. Springer (eds.) The ESC textbook of cardiovascular imaging. 2009.

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Acknowledgments

The authors acknowledge financial support from The Academy of Finland Centre of Excellence in Molecular Imaging in Cardiovascular and Metabolic Research, Helsinki, Finland and The Turku Collegium for Science and Medicine of University of Turku, Turku, Finland.

Disclosure

J. Knuuti: consultant to Lantheus Medical; A. Saraste: none.

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Correspondence to Juhani Knuuti.

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Knuuti, J., Saraste, A. Hybrid SPECT-CT and PET-CT: Current Concepts and Developments. Curr Cardiovasc Imaging Rep 4, 468–475 (2011). https://doi.org/10.1007/s12410-011-9109-1

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