Diagnostic pathway of integrated SPECT/CT for coronary artery disease

Abstract

Treatment strategy in patients with suspected coronary artery disease (CAD) is driven by symptomatology in combination with diagnostic evaluation of the extent and/or severity of atherosclerosis in the coronary arteries and ischemia in the myocardium, i.e., the anatomic and functional correlates of CAD. Whereas multislice row computed tomography (MSCT) has the advantage of detecting coronary atherosclerosis at its earliest stages, thereby allowing initiation of appropriate therapeutic measures well before development of obstructive CAD, myocardial perfusion imaging (MPI) SPECT can clarify the hemodynamic consequences of the anatomic findings on MSCT based on a functional assessment of myocardial blood flow. There is a lack of correlation between coronary artery calcium (CAC), coronary artery stenosis, and MPI SPECT. Therefore CAC scoring and stress MPI should be thus considered complementary approaches rather than exclusionary in the evaluation of the patient at risk for CAD. The integration of anatomic and functional information may provide additional information for the clinician by the improved risk stratification and diagnostic accuracy of integrated techniques. The majority of previous studies are based on a sequential flowchart, starting with either SPECT or CAC scoring that finally directs the therapeutic strategy. Patients at low risk for CAD can be selected for primary prevention, and patients at high risk for CAD can be directly selected for coronary angiography (CAG). The remaining group of patients at intermediate risk for CAD can be substratified into lower-and higher-risk categories based on the presence or absence of stress-induced ischemia on MPI SPECT and CAC scoring. An integration of SPECT and CAC as a starting point for CAD detection in symptomatic patients at intermediate risk for CAD may facilitate a tailored diagnostic as well as therapeutic approach. Finally, using SPECT/CT, MPI SPECT, and CAC findings may be completed with CT angiography. The development of SPECT/ CT hybrid systems is therefore of important value for the nuclear cardiology armamentarium. This editorial commentary outlines a diagnostic pathway of integrated SPECT/CT for CAD assessment in symptomatic patients at intermediate risk for CAD.

The Significance of 99mTc-MAA SPECT/CT Liver Perfusion Imaging in Treatment Planning for 90Y-Microsphere Selective Internal Radiation Treatment

“…In addition to anatomic referencing, the benefit of CT coregistration is based on the attenuation correction capabilities of CT (12). The positive impact of SPECT/CT in diagnosing benign and malignant diseases has been shown in different studies (13)(14)(15)(16)(17)(18)(19)(20).…”

Computational and Experimental Biomedical Sciences: Methods and Applications

“…In cardiology, several studies have been developed, particularly in the study of chronic ischemia [20,[82][83][84][85], myocardial perfusion [18][19][20][86][87][88][89][90][91][92][93][94][95][96], atherosclerosis rate [85,97], post-transplantation [18] and cardiac nervous system. Registration of cardiac images is more complex than the registration of images of static organs, since it is a non-rigid moving organ inside a non-static body, and exhibits few easily distinguishable and accurate landmarks [18].…”

The relationship between stress-induced myocardial ischemia and coronary artery atherosclerosis measured by hybrid SPECT/CT camera

“…MPI has been an essential component in physicians' diagnostic and prognostic assessment of patients. Combined SPECT/CT acquisition in a one stop examination is more acceptable, and physicians can obtain perfusion and calcification information without any extra-cost [5]. CAC score data provide information on the rate of absolute and relative progression of calcification [19].…”

“…Recent advances in hardware using hybrid SPECT/CT have allowed the combined assessment of perfusion and coronary atherosclerosis [5]. Coronary artery calcification is a highly sensitive marker of underlying coronary atherosclerotic disease [6][7][8].…”