Coronary Angiography and Thallium-201 Single Photon Emission Computed Tomography in Multiple Vessel Coronary Artery Disease

Svane, Bertil; Bone, D.; Holmgren, A.

doi:10.1177/028418519003100402

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…The sensitivity for detection of individual coronary artery stenosis by quantitative analysis of thallium-201 SPECT has, in some studies, been shown to be rather high 56-92% depending on the extent of disease [32]. Other studies, especially in multiple vessel disease, obtained lower figures [33]. Identification of stenotic vessels by the localization of the uptake reductions in the thallium-201 SPECT was not possible in the present trial (results not presented).…”

Section: Discussioncontrasting

confidence: 50%

Additional value of thallium-201 SPECT to a conventional exercise test for the identification of severe coronary lesions after an episode of unstable coronary artery disease

et al. 1995

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The additional value of thallium-201 SPECT to a conventional exercise test for the identification of patients with severe coronary lesions was evaluated in 170 men, one month after an episode of unstable coronary artery disease. Severe coronary lesions at coronary angiography--defined as three vessel disease, left main stenosis or proximal left anterior descending artery stenosis as part of two vessel disease--were observed in 45.9%. In the SPECT image, the left ventricular myocardium was divided into nine segments and each segment was classified as either normal (= 0), reduced uptake (= 1) or uptake defect (= 2). The sum of gradings in all segments post-exercise was denoted "SPECT score". The patients were divided into nine different groups regarding ST-depression during exercise (no ST-depression, ST-depression in 1-2 leads or > or = 3 leads) and "SPECT score" (no SPECT score, 1-3 scores or > or = 4 scores). Severe coronary lesions were, in 68% identified by SPECT score > or = 4 and in 65% by ST-depression in > or = 1 lead at exercise test. The specificity for identification of severe coronary lesions was, for both tests, 65%. SPECT score > or = 4 and/or ST-depression in > or = 3 leads identified 82% of the patients with severe coronary lesions with a specificity of 63%. Furthermore, SPECT score > or = 3 identified more patients with isolated proximal left anterior descending artery stenosis than ST-depression alone at exercise test.

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Section: Discussioncontrasting

confidence: 50%

Additional value of thallium-201 SPECT to a conventional exercise test for the identification of severe coronary lesions after an episode of unstable coronary artery disease

et al. 1995

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“…The primary aim of the CORE320 study was to diagnose an angiographic stenosis causing a myocardial perfusion deficit by using a combination of coronary CT angiography and myocardial CT perfusion imaging and compare findings with those of the combined standard of reference of coronary angiography and SPECT. Although the combination of coronary angiography and SPECT is a rigorous standard of reference for defining hemodynamically significant stenosis and is used daily in clinical practice, this study and others demonstrated that SPECT can be limited in the setting of left main and multivessel CAD (19,20). Because a normal SPECT study in the setting of left main and multivessel disease would have made the reference standard normal, this may have had a substantial effect on the measured specificity and PPV of combined CT angiography and CT perfusion imaging in the primary CORE320 study (5).…”

Section: Discussionmentioning

confidence: 80%

“…Technetium-based tracers are susceptible to the roll-off phenomenon, which limits the ability to differentiate differences in flow at higher levels owing to its limited extraction fraction (21). This typically affects the diagnosis of stenoses of 50%-70% more subtle subendocardial ischemia may be seen at CT but may not be appreciated at SPECT (19,20).…”

Section: Discussionmentioning

confidence: 99%

Myocardial CT Perfusion Imaging and SPECT for the Diagnosis of Coronary Artery Disease: A Head-to-Head Comparison from the CORE320 Multicenter Diagnostic Performance Study

George¹,

Mehra²,

Chen³

et al. 2014

Radiology

107

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Purpose:To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography. Materials and Methods:This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (A z ). Sensitivity and specificity were calculated with use of prespecified cutoffs.The reference standard was a stenosis of at least 50% at coronary angiography as determined with quantitative methods. Results:CAD was diagnosed in 229 of the 381 patients (60%). The per-patient sensitivity and specificity for the diagnosis of CAD (stenosis 50%) were 88% (202 of 229 patients) and 55% (83 of 152 patients), respectively, for CT perfusion imaging and 62% (143 of 229 patients) and 67% (102 of 152 patients) for SPECT, with A z values of 0.78 (95% confidence interval: 0.74, 0.82) and 0.69 (95% confidence interval: 0.64, 0.74) (P = .001). The sensitivity of CT perfusion imaging for single-and multivessel CAD was higher than that of SPECT, with sensitivities for left main, threevessel, two-vessel, and one-vessel disease of 92%, 92%, 89%, and 83%, respectively, for CT perfusion imaging and 75%, 79%, 68%, and 41%, respectively, for SPECT. Conclusion:The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis 50%), as demonstrated with the A z , was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease.q RSNA, 2014

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“…Despite this, the estimated frequency of false negatives of SPECT-TL has been reported to be around 11% and, according to some series, the ability of this phenomenon to correctly localize the ischemic region and calculate the extent of myocardial involvement can be as low as 20% in patients with triple vessel disease. 21 In a recent sub-analysis of the J-ACCESS study, 293 out of a total of 2,383 patients undergoing exercise testing with myocardial perfusion imaging were noted to have ischemic electrocardiographic changes with no reversible abnormalities. 22 …”

Section: Discussionmentioning

confidence: 99%

Triple Vessel Coronary Artery Disease Presenting as a Markedly Positive Stress Electrocardiographic Test and a Negative SPECT-TL Scintigram: A Case of Balanced Ischemia

Aziz

Javed

Alviar

et al. 2011

Heart International

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The presence of false negative nuclear stress test in the settings of positive electrocardiographic changes is a very unusual phenomenon and is usually secondary to balanced ischemia of the myocardial segments evaluated by SPECT-TL. We present a case of an 81-year old post-menopausal female who presented to her primary care physician for evaluation of a 6-week dyspnea on exertion and was referred to our institution for exercise stress test with Thallium SPECT with the objective of ruling out coronary artery disease and identifying possible areas of myocardial ischemia. The resting electrocardiogram was unremarkable and stress test evaluation was made. The patient was admitted to the cardiac care unit and coronary artery bypass grafting was successfully performed. The presence of false negative nuclear stress test in the settings of positive electrocardiographic changes is a very unusual phenomenon and is usually secondary to balanced ischemia of the myocardial segments evaluated by SPECT-TL. Patients undergoing stress tests with these characteristics should undergo careful evaluation and a high level of suspicion should be adopted for further diagnostic assessment of coronary artery disease.

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Coronary Angiography and Thallium-201 Single Photon Emission Computed Tomography in Multiple Vessel Coronary Artery Disease

Cited by 5 publications

References 20 publications

Additional value of thallium-201 SPECT to a conventional exercise test for the identification of severe coronary lesions after an episode of unstable coronary artery disease

Additional value of thallium-201 SPECT to a conventional exercise test for the identification of severe coronary lesions after an episode of unstable coronary artery disease

Myocardial CT Perfusion Imaging and SPECT for the Diagnosis of Coronary Artery Disease: A Head-to-Head Comparison from the CORE320 Multicenter Diagnostic Performance Study

Triple Vessel Coronary Artery Disease Presenting as a Markedly Positive Stress Electrocardiographic Test and a Negative SPECT-TL Scintigram: A Case of Balanced Ischemia

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