Incremental prognostic value of coronary flow reserve assessed with single-photon emission computed tomography

Abstract

Myocardial perfusion findings and CFR at SPECT imaging are both independent predictors of cardiac events. Estimated CFR provides incremental prognostic information over those obtained from clinical and myocardial perfusion data, particularly in patients with normal perfusion findings.

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

“…This explains why the model for correction of 13 N-ammonia MBF values may not provide a satisfying fit for 99m Tc-tetrofosmin. Our results are in perfect agreement with the notion (6) that contrast between stress and resting flow will be lower for 99m Tc tracers (23,29) than typically seen with PET (17).…”

“…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).…”

Incremental prognostic value of coronary flow reserve assessed with single-photon emission computed tomography

“…MI; HR C 3.3) and MACE (HR C 2.4; 1-year median follow-up) in patients with normal or abnormal stress MPI. 22 The current study by Stephania et al 23 builds on these previous findings using 99m Tc-SPECT, which is more widely available as the clinical standard for MPI. The authors use first-pass planar imaging followed by conventional SPECT MPI to estimate a retention index of MBF and corresponding global flow reserve.…”

Dynamic SPECT: evolution of a widely available tool for the assessment of coronary flow reserve

“…This technique has shown a generally good correlation with PETmeasured flow, but CFR is underestimated at high flow rates [13]. The use of a retention index to estimate CFR using this method compared to absolute MBF from PET results in an underestimation of CFR values in the SPECT-based technique, since tracer retention decreases with increasing blood flow [14].…”

“…PET enables quantitative assessment of myocardial blood flow (MBF, in millilitres per gram per minute) and coronary flow reserve (CFR), and quantification with 15 O-water, 13 N-ammonia and recently 82 Rb has been validated over a wide range of blood flows in animal models and humans [1][2][3][4]. Quantitative assessment of MBF has been shown to improve the diagnostic accuracy of conventional MPI with SPECT or PET, to improve cardiac risk assessment and to predict outcome [5][6][7].…”