Diagnostic efficiency of quantification of myocardial blood flow and coronary flow reserve with CZT dynamic SPECT imaging for patients with suspected coronary artery disease: a comparative study with traditional semi-quantitative evaluation

Abstract

Background: Myocardial blood flow (MBF) quantitation with cadmium-zinc-telluride (CZT) dynamic single-photon emission computed tomography (SPECT) is being increasingly investigated toward clinical utilization.Methods: In this prospective study, forty-nine patients with suspected or known coronary artery disease (CAD) underwent a rest/adenosine triphosphate (ATP) stress dynamic and routine gated myocardial perfusion imaging (MPI) by CZT SPECT and then received coronary angiography (CAG). Quantitative diagnosis from the dynamic SPECT and a flow diagram was automatically obtained by the dedicated software and compared with the result of semi-quantitative analysis with gated MPI using the angiographic stenosis as the reference standard.Results: When stenosis ≥50% was considered at the participant level, the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and accuracy (AC) of the quantitative diagnosis were higher than semi-quantitative method as (84.4% vs. 65.6%, 88.2% vs. 70.6%, 93.1% vs. 80.8%, 75.0% vs. 52.2%, 85.7% vs. 67.3%) (all P<0.05). The receiver operating characteristic (ROC) curve analysis generated the optimal critical value as 1.86 and 1.61 mL/min/g for stress MBF (sMBF) and MFR, respectively. The diagnosis performance of the quantitative diagnosis was higher than semi-quantitative method as (78.9% vs. 68.4%, 63.3% vs. 60.0%, 57.7% vs. 52.0%, 82.6% vs. 75.0%, 69.4% vs. 63.3%) for the criteria of ≥75% stenosis on CAG (all P<0.05) with optimal critical values as 1.71 and 1.15 mL/min/g. There was no significant difference between sMBF and MFR. Conclusions:The diagnostic efficiency by using the quantitative method of CZT dynamic SPECT imaging is superior to traditional semi-quantitative gated MPI for the diagnosis of CAD, which improved the diagnostic specificity and accuracy when the critical was stenosis ≥50%.

Myocardial Blood Flow and Flow Reserve in Patients With Acute Myocardial Infarction and Obstructive and Non-Obstructive Coronary Arteries: CZT SPECT Study

“…In line with the previous study by Stewart et al where the comparison in rest and stress MBF (by PET with 13 N-ammonia) were performed on the day 9 after PCI in infarct-related and reference artery (5), we found out significantly reduced MBF, MFR and FD (both AC and NAC) (8,9,11,20), invasive angiography (19,(35)(36)(37) and invasive FFR (8,(38)(39)(40).…”

High technology by CZT cameras: It is time to join forces

“…19 Another point to emphasize is that, although the optimal cut-off values for MBF and MFR were validated using regadenoson as stress agent, 15 several studies observed that dipyridamole, regadenoson, and adenosine can induce an equivalent level of hyperemia and similar performance in the detection of CAD. 14,18,20 In the current study, Liu et al 17 confirmed the feasibility of dipyridamole as stress agent finding a positive correlation between the change of heart rates from rest to stress state and the global MFR as well as DMBF.…”

Prevalence and characteristics of coronary microvascular dysfunction in post-percutaneous coronary intervention patients with recurrent chest pain

“…The value of nuclear medicine MPI in the noninvasive function evaluation of CAD has been recognized internationally (15). With the continuous innovation of nuclear medicine imaging equipment as a novel technology, CZT-SPECT quantitative myocardial flow technique shows a great application prospect in clinical MFR evaluation (10,15). Thus far, data from extensive sample epidemiological studies on CMD remain lacked (3).…”

“…However, in routine outpatient follow-up, considerable post-PCI patients with recurrent chest pain had normal CAG, as recognized by doctors as "non-cardiogenic chest pain" and ignored, thereby causing repeated visits without adequate treatment (18). CZT-SPECT-based MFR could help doctors differentiate and identify high-risk patients, thereby being worthy of widespread clinical application (10,19). Figure 3 illustrates a typical case.…”

“…The stress blood flow of vasodilating drugs was not required to be corrected, while the rest blood flow measurement method was corrected according to RPP (the product of heart rate and blood pressure, i.e., the effect of the heart at rest, when RPP ≥1,000, the coefficient of 10,000/RPP was used for correction). For specific methods, please refer to reference (10). All patients discontinued vasoactive drugs, calcium antagonists, dipyridamole, adenosines, theophylline, as well as tea, coffee, or caffeinated beverages at least 24 h before the test.…”