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

Hsu, Bailing; Chen, Fu-Chung; Wu, Tsu‐Juey; Huang, Wen‐Sheng; Hou, Po-Nien; Chen, Chien‐Cheng; Hung, Guang-Uei

doi:10.1007/s00259-014-2881-9

Cited by 72 publications

(52 citation statements)

References 42 publications

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“…Our results demonstrate that quantification of dynamic SPECT MPI on modern CZT cameras is technically feasible but without specific correction for the different extraction fraction and metabolism of Previous studies exploring quantification of MBF with dynamic planar scintigraphy in humans (18)(19)(20)(21)(22)(23)(24)(25) and with dynamic SPECT in experimental animals (26)(27)(28) have documented the limitations of conventional g-cameras for the dynamic acquisition of datasets required for MBF quantification. The introduction of CZT cameras without the need of detector rotation has allowed proving the concept of dynamic image acquisition for MBF quantification in a recent animal study using microspheres as a standard of reference (6).…”

Section: Discussionmentioning

confidence: 83%

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

et al. 2016

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Recent advances in SPECT technology including cadmium-zinctelluride (CZT) semiconductor detector material may pave the way for absolute myocardial blood flow (MBF) measurements by SPECT. The aim of the present study was to compare K 1 uptake rate constants as surrogates of absolute MBF and myocardial flow reserve index (MFRi) in humans as assessed with a CZT SPECT camera versus PET. Methods: Absolute MBF was assessed in 28 consecutive patients undergoing adenosine stress-rest myocardial perfusion imaging (MPI) by 99m Tc-tetrofosmin CZT SPECT and 13 N-ammonia PET, and MFR was calculated as a ratio of hyperemic over resting MBF. Results from both MPI methods were compared, and correlation coefficients were calculated. The diagnostic accuracy of CZT MFRi to predict an abnormal MFR defined as PET MFR less than 2 was assessed using a receiver-operator-characteristic curve. The definition of coronary artery disease (CAD) was originally based on the presence of anatomic luminal narrowing greater than 50%. Over the past decades, however, many advances in imaging techniques have enhanced our pathophysiologic understanding of CAD. It has been recognized that many factors beyond luminal narrowing may determine whether or not an anatomic coronary lesion induces ischemia. Because this cannot be comprehensively addressed by coronary angiography alone, nuclear myocardial perfusion imaging (MPI) has been well established as a tool for providing proof of ischemia. This is mandatory for prognostically relevant target lesion revascularization in chronic stable CAD. Because revascularization of a non-flow-limiting coronary stenosis is not beneficial to the patient, neither from a prognostic nor from a symptomatic point of view, nuclear MPI has been suggested as a gatekeeper for invasive coronary angiography (1-3). MPI studies with PET have demonstrated that absolute myocardial blood flow (MBF) and flow reserve (MFR) provide incremental diagnostic (4) and prognostic (5) information over relative perfusion alone. Quantitative assessment of MBF is difficult with standard SPECT for which detectors need to rotate around the patient and for which unfavorable properties of the currently available flow tracers hamper accurate MBF quantification because of nonlinear extraction fraction with roll-off at higher flow values. The recent advances in SPECT technology including semiconductor detector material (cadmium zinc telluride [CZT]) allow acquisition in a nonrotating mode and therefore acquisition of time-activity curves. This may enable absolute MBF and MFR estimation by SPECT as recently shown in experimental animal models (6), which may pave the way for its implementation in clinical routine (7). More knowledge on the impact of the tracer properties on the values obtained from quantification is crucial.The aim of the present study was a head-to-head comparison in humans of indices of absolute MBF and MFR as assessed with 99m Tc-tetrofosmin on a CZT SPECT camera versus MBF and MFR measured with 13 N-ammonia on a PET scanner. MATERIALS AND...

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Section: Discussionmentioning

confidence: 83%

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

et al. 2016

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“…Although quantitative perfusion protocols using classic Anger cameras have recently been described and validated (26,27), state-of-theart dedicated cardiac cameras, for which clinical performance has clearly been demonstrated (28)(29)(30), appear as the natural tool for the development of steady myocardial perfusion quantitation in SPECT.…”

Section: Discussionmentioning

confidence: 99%

SPECT Myocardial Perfusion Reserve in Patients with Multivessel Coronary Disease: Correlation with Angiographic Findings and Invasive Fractional Flow Reserve Measurements

et al. 2015

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Quantification of myocardial perfusion reserve (MPR) is an emerging topic in nuclear cardiology with an expected diagnostic and prognostic incremental value, especially for patients with severe coronary artery disease. The advent of new dedicated solid-state cameras has opened new perspectives for perfusion quantitation in SPECT. We appraised the feasibility of perfusion reserve estimation using a cadmium zinc telluride camera in a cohort of multivessel patients and its pertinence with respect to angiographic data. Methods: Twenty-three patients with known multivessel coronary artery disease were prospectively enrolled. Dynamic SPECT acquisitions using 99m Tc-tetrofosmin at rest and after vasodilator stress were performed using a dedicated cadmium zinc telluride camera. Reconstructed frames were automatically segmented to extract the vascular input function and the myocardial uptake curve. Onecompartment kinetic modeling was used to estimate global and regional uptake values, and then myocardial blood flow was derived using the Renkin-Crone equation. Global and regional MPR was assessed using flow difference (stress − rest) and flow ratio (stress/rest). All patients underwent control coronary angiography within 4 wk, which served as the reference for MPR index assessment. Relevant angiographic findings included maximal stenosis and (for a subgroup of 26 vessels) invasive measurement of fractional flow reserve (FFR). A stenosis was considered obstructive if greater than 50% and an FFR abnormal if lower than 0.8. Results: Global MPR correlated well with number of obstructed vessels (P , 0.001). After multivariate analysis, both regional flow ratio and flow difference were significantly associated with maximal stenosis (P , 0.001) and FFR (P , 0.001). Regional MPR indices were significantly different in obstructed and nonobstructed vessels (P , 0.001) and in vessels with normal and abnormal FFR (P , 0.001). With a cutoff of 2, the sensitivity, specificity, and accuracy of regional flow ratio were, respectively, 80%, 85%, and 81% for the detection of obstructed vessels and 89%, 82%, and 85% for the detection of abnormal FFR. Conclusion: Scintigraphic estimations of global and regional MPR in multivessel patients using a cadmium zinc telluride camera appear to correlate well with invasive angiographic findings, including maximal stenosis and FFR measurements.

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“…2,3 It does not directly mean that it can be accepted as a clinical tool in daily practice. Measuring MBF and CFR by cardiac PET is a mature technology but is not widely used in clinics.…”

Section: Measurement Of Mbf and Cfrmentioning

confidence: 99%

The tools are ready, are we?

Cho

Jabin

Lee

et al. 2019

Journal of Nuclear Cardiology

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In this issue of the Journal of Nuclear Cardiology, Lee and colleagues elegantly review the recent advances in the instrumentations for nuclear cardiac imaging. 1 Solid-state radiation detectors incorporating cadmium zinc telluride (CZT) become the detector of choice for dedicated cardiac imaging systems. CZT single-photon emission computed tomography (SPECT) has improved image quality and shortened acquisition time of myocardial perfusion imaging (MPI) thanks to its direct energy conversion mechanism, narrow energy resolution, and pixelated nature of electrical circuit. The measurement of absolute myocardial blood flow (MBF) as well as coronary flow reserve (CFR) using CZT SPECT is now under active investigation and is showing clinical feasibility. Multimodality imaging systems which hybridized SPECT and positron emission tomography (PET) with CT widened clinical application of cardiac imaging studies. Quantitative SPECT/CT provides additive information of coronary calcium burden, attenuation correction for both visual and quantitative assessment of myocardial perfusion, and enables quantification of myocardial blood flow and flow reserve. Cardiac PET is also an active progress. Adoption of silicon photomultipliers (SiPMs) leads to enhancements in image quality and count rates. The application of accurate time-of-flight (TOF) information reduced emission-transmission mismatch artifacts. Information of the extracted coronary arteries from CT angiography allows non-linear motion correction of PET plaque images. Replacement of photomultiplier tubes with semiconductor photosensors such as the avalanche photodiode (APD) and SiPM has made it possible to integrate PET with magnetic resonance (MR). PET/MR system is now clinically available in hybrid as well as parallel camera structure.The recently introduced nuclear cardiac imaging tools are ready to provide more information in better quality than ever before. It is fair to question whether we are ready to apply these tools in clinical fields. There are challenges to overcome before we can use the state-ofthe-art imaging tools. MEASUREMENT OF MBF AND CFRSeveral studies showed clinical feasibility of measuring MBF and CFR by dynamic image acquisition using Tc-99m sestamibi and CZT SPECT/CT cameras. 2,3 It does not directly mean that it can be accepted as a clinical tool in daily practice. Measuring MBF and CFR by cardiac PET is a mature technology but is not widely used in clinics. Several obstacles are noted. 4 First of all, resting MBF is variable according to hemodynamic and metabolic changes. MBF and CFR cannot differentiate epicardial obstructive and microvascular diseases or provide anatomical localization of coronary obstruction. The complex interplay among different MBF parameters has not been fully unveiled. Different MBF parameters stand for different coronary pathophysiologies, and are not interchangeable. 5 For example, a relative MBF ratio namely relative flow reserve (RFR) could be more suitable for the diagnosis of focal significant coronary stenosis in ...

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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

Abstract: 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.

Cited by 72 publications

References 42 publications

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

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

SPECT Myocardial Perfusion Reserve in Patients with Multivessel Coronary Disease: Correlation with Angiographic Findings and Invasive Fractional Flow Reserve Measurements

The tools are ready, are we?

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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

Abstract: 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.

Cited by 72 publications

References 42 publications

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

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

SPECT Myocardial Perfusion Reserve in Patients with Multivessel Coronary Disease: Correlation with Angiographic Findings and Invasive Fractional Flow Reserve Measurements

The tools are ready, are we?

Contact Info

Product

Resources

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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

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