Department of Nuclear Medicine, CHU Caen, CHU Cote de Nacre, Caen, France.
Normandy University, EA 4650, Caen, France.
Eur J Nucl Med Mol Imaging. 2018 Jul;45(7):1079-1090. doi: 10.1007/s00259-018-3958-7. Epub 2018 Mar 1.
We assessed the feasibility of myocardial blood flow (MBF) and flow reserve (MFR) estimation using dynamic SPECT with a novel CZT camera in patients with stable CAD, in comparison with O-water PET and fractional flow reserve (FFR).
Thirty patients were prospectively included and underwent FFR measurements in the main coronary arteries (LAD, LCx, RCA). A stenosis ≥50% was considered obstructive and a FFR abnormal if ≤0.8. All patients underwent a dynamic rest/stress Tc-sestamibi CZT-SPECT and O-water PET for MBF and MFR calculation. Net retention kinetic modeling was applied to SPECT data to estimate global uptake values, and MBF was derived using Leppo correction. Ischemia by PET and CZT-SPECT was considered present if MFR was lower than 2 and 2.1, respectively.
CZT-SPECT yielded higher stress and rest MBF compared to PET for global and LAD and LCx territories, but not in RCA territory. MFR was similar in global and each vessel territory for both modalities. The sensitivity, specificity, accuracy, positive and negative predictive value of CZT-SPECT were, respectively, 83.3, 95.8, 93.3, 100 and 85.7% for the detection of ischemia and 58.3, 84.6, 81.1, 36.8 and 93% for the detection of hemodynamically significant stenosis (FFR ≤ 0.8).
Dynamic Tc-sestamibi CZT-SPECT was technically feasible and provided similar MFR compared to O-water PET and high diagnostic value for detecting impaired MFR and abnormal FFR in patients with stable CAD.
我们评估了使用新型 CZT 相机的动态 SPECT 评估稳定型 CAD 患者心肌血流 (MBF) 和血流储备 (MFR) 的可行性，与 O-水 PET 和血流储备分数 (FFR) 进行比较。
前瞻性纳入 30 例患者，并对主要冠状动脉（LAD、LCx、RCA）进行 FFR 测量。≥50%的狭窄被认为是阻塞性的，如果 FFR≤0.8，则认为是异常的。所有患者均接受动态静息/应激 Tc-sestamibi CZT-SPECT 和 O-水 PET 以计算 MBF 和 MFR。应用净保留动力学模型对 SPECT 数据进行分析，以估计全局摄取值，并使用 Leppo 校正法计算 MBF。如果 MFR 分别低于 2 和 2.1，则认为 PET 和 CZT-SPECT 存在缺血。
与 PET 相比，CZT-SPECT 可提供更高的应激和静息 MBF，用于全球和 LAD 和 LCx 区域，但在 RCA 区域则不然。两种方式的全球和每个血管区域的 MFR 均相似。CZT-SPECT 检测缺血的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为 83.3%、95.8%、93.3%、100%和 85.7%，检测血流动力学显著狭窄（FFR≤0.8）的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为 58.3%、84.6%、81.1%、36.8%和 93%。
动态 Tc-sestamibi CZT-SPECT 技术上是可行的，与 O-水 PET 相比，可提供相似的 MFR，并为检测稳定型 CAD 患者的受损 MFR 和异常 FFR 提供高诊断价值。
