Lima R S L, Bezerra A, Andrade M, Domenico C, De Lorenzo A
Nuclear Medicine Department, Fonte Imagem, Rio de Janeiro, Brazil.
Cardiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Front Nucl Med. 2022 Dec 21;2:1072729. doi: 10.3389/fnume.2022.1072729. eCollection 2022.
CZT cameras have enabled the noninvasive quantification of myocardial flow reserve (MFR), an important physiologic measure. This study aimed to compare myocardial perfusion SPECT (MPS) with or without MFR evaluation for the detection of obstructive coronary artery disease (CAD).
48 patients with CAD (>50% obstruction) detected at invasive coronary angiography or CT angiography underwent dipyridamole MPS and MFR evaluation within 30 days. A 1-day protocol (rest-stress) was used to quantify MFR. The acquisition of dynamic rest and stress images was initiated simultaneously to 99mTc sestamibi injection (370 and 1,110 MBq, respectively), both lasting for 11 min, followed by 5-min imaging. Pharmacologic stress with dipyridamole (0.56 mg/kg for 4 min) was performed with the patient positioned in the CZT camera. The images were processed and time-activity curves were generated, calculating global and regional MFR in a semiautomatic software. A global or regional MFR <2 was considered abnormal. MPS perfusion images were classified as normal or abnormal. The images were interpreted by experienced physicians blinded to the results of MFR and coronary angiography/CT.
Mean age of the population was 61 ± 9 years, 54.2% female. Twenty patients (41.7%) had single-vessel CAD, 22 (45.8%) 2-vessel CAD and 6 (12.5%), triple-vessel CAD. Among the 82 vessels with obstruction, 48 had perfusion abnormalities in MPS and 60 had reduced MFR, while among the normal vessels, had 54 normal MPS and 52 had preserved MFR. The sensitivity of MFR (69%) was higher than that of MPS (55.2%), without significant changes in specificity (86 vs. 83.7%).
MFR in the CZT camera is more sensitive for the detection of CAD than perfusion abnormalities in MPS, especially in patients with multivessel CAD.
CZT相机已实现心肌血流储备（MFR）的无创定量分析，这是一项重要的生理指标。本研究旨在比较有无MFR评估的心肌灌注单光子发射计算机断层显像（MPS）对阻塞性冠状动脉疾病（CAD）的检测能力。
48例在有创冠状动脉造影或CT血管造影中检测出CAD（阻塞>50%）的患者在30天内接受了双嘧达莫MPS和MFR评估。采用1天方案（静息-负荷）对MFR进行定量分析。在注射99mTc司他米比（分别为370和1110 MBq）的同时开始采集动态静息和负荷图像，两者均持续11 min，随后进行5 min成像。患者在CZT相机中接受双嘧达莫（0.56 mg/kg，持续4 min）药物负荷试验。对图像进行处理并生成时间-活性曲线，在半自动软件中计算整体和局部MFR。整体或局部MFR<2被认为异常。MPS灌注图像分为正常或异常。图像由对MFR和冠状动脉造影/CT结果不知情的经验丰富的医生解读。
研究人群的平均年龄为61±9岁，女性占54.2%。20例患者（41.7%）为单支血管CAD，22例（45.8%）为双支血管CAD，6例（12.5%）为三支血管CAD。在82支有阻塞的血管中，48支在MPS中有灌注异常，60支MFR降低，而在正常血管中，54支MPS正常，52支MFR正常。MFR的敏感性（69%）高于MPS（55.2%），特异性无显著变化（86%对83.7%）。
CZT相机中的MFR对CAD的检测比MPS中的灌注异常更敏感，尤其是在多支血管CAD患者中。
