Diagnostic accuracy of myocardial perfusion imaging with single photon emission computed tomography and positron emission tomography: a comparison with coronary angiography

Abstract

Objective The aim of this study was to compare the diagnostic accuracy of myocardial perfusion imaging (MPI) by positron emission tomography (PET) with the diagnostic accuracy of MPI by single photon emission computed tomography (SPECT) in two comparable patient cohorts, using coronary angiography (CA) as the standard of reference. Methods A ''SPECT-group'' of 80 patients (15 female, 65 male; mean age 60 ± 9 years) and a ''PET-group'' of 70 patients (14 female, 56 male; mean age 57 ± 10 years) underwent a one day stress/rest examination either with attenuation-corrected 13 N-ammonia PET or attenuation-corrected 201 TlCl SPECT or 99m Tc-hexakismethoxy-isobutyl-isonitril (MIBI) SPECT. PET and SPECT results were semiquantitatively graded using a 6-segment heart model. All patients underwent CA, and stenoses were graded as a diameter reduction C50%. Results Coronary findings between both groups did not significantly differ at CA. For the SPECTgroup overall sensitivity and specificity for localisation of stenoses was 77% and 84%. Respective values for the PET-group were 97% and 84%. The specificity of MPI by SPECT in the detection of ischemia was 74% and 91% for MPI by PET. The diagnostic accuracy of MPI improves when the individual coronary dominance and previous coronary revascularisations are taken into account. Conclusion MPI by 13 N-ammonia PET is more sensitive in the detection and localisation of coronary stenoses, and more specific in the detection of ischemia than MPI by 201 TlCl/ 99m MIBI SPECT.

SNMMI/ASNC/SCCT Guideline for Cardiac SPECT/CT and PET/CT 1.0

“…Literature is evolving to support the diagnostic and prognostic role of calcium scoring in patients without known coronary artery disease (68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83). Likewise, several studies support the complementary roles of the diagnostic and prognostic information provided by CTA and MPI in symptomatic individuals (84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95)(96)(97). A joint position statement on hybrid cardiac imaging was published by the European Association of Nuclear Medicine, the European Society of Cardiac Radiology, and the European Council of Nuclear Cardiology (11).…”

“…The combined diagnostic information from CTA with MPI can be complementary in specific clinical scenarios (84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95)(96)(97)102). Multivessel and subclinical atherosclerosis can be diagnosed accurately with CTA and add to the diagnostic value of MPI.…”

Preoperative Evaluation of Patients with Possible Coronary Artery Disease

“…PET showed a higher sensitivity for locating coronary artery stenosis compared with SPECT (95% and 77%, respectively); however, no difference in specificity was found (84% in both groups). In the detection of ischemia, the specificity of PET was 91% compared with 74% for SPECT [33].…”

“…These perfusion abnormalities can be explained by insufficient coronary blood flow based on coronary artery stenosis [31,32]. Husmann et al [33] evaluated the diagnostic accuracy of PET (13 N-ammonia PET) and SPECT (201-TICI-SPECT and MIBI-SPECT) imaging using coronary angiography as the standard of reference. PET showed a higher sensitivity for locating coronary artery stenosis compared with SPECT (95% and 77%, respectively); however, no difference in specificity was found (84% in both groups).…”

Microvascular Angina: Assessment of Coronary Blood Flow, Flow Reserve, and Metabolism

“…Because current single photon emission CT (SPECT) perfusion imaging is poor at detecting balanced ischemia from severe multivessel CAD, PET perfusion imaging is considered a more accurate test, attributable to improved resolution, intrinsic attenuation correction, and higher photon energy [50][51][52]. The intrinsic attenuation correction allows for absolute quantification of MBF, and thus the calculation of CFR, noninvasively.…”