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Research ArticleClinical Investigations

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

Rene Nkoulou, Tobias A. Fuchs, Aju P. Pazhenkottil, Silke M. Kuest, Jelena R. Ghadri, Julia Stehli, Michael Fiechter, Bernhard A. Herzog, Oliver Gaemperli, Ronny R. Buechel and Philipp A. Kaufmann
Journal of Nuclear Medicine December 2016, 57 (12) 1887-1892; DOI: https://doi.org/10.2967/jnumed.115.165498
Rene Nkoulou
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Tobias A. Fuchs
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Aju P. Pazhenkottil
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Silke M. Kuest
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Jelena R. Ghadri
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Julia Stehli
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Michael Fiechter
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Bernhard A. Herzog
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Oliver Gaemperli
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Ronny R. Buechel
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Philipp A. Kaufmann
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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  • FIGURE 1.
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    FIGURE 1.

    Dynamic CZT SPECT imaging during adenosine stress. (A) Short-axis (left) and vertical (middle) and horizontal long-axis (right) frames with regions of interest (ROIs) drawn in right and left ventricle and left ventricular myocardium. Dynamic acquisition sequentially illustrates right ventricular inflow (B), left ventricular inflow (C), and myocardial perfusion (D). White ROI = myocardium; light blue ROI = left ventricular cavity; dark blue ROI = right ventricular cavity; red triangle = delineation of upper and lower interventricular junction and middle of left ventricular cavity.

  • FIGURE 2.
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    FIGURE 2.

    Static 99mTc-tetrofosmin CZT SPECT (A) and 13N-ammonia PET (B) images acquired during stress (top) and at rest (bottom). Images were obtained from same patient as in Figure 1.

  • FIGURE 3.
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    FIGURE 3.

    Fit curves and polar map of a representative patient when using PET: fit curves (A) and polar map (B) at stress and fit curves (C) and polar map (D) at rest. Yellow curves = right ventricle; red curves = left ventricle; blue curves = myocardium.

  • FIGURE 4.
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    FIGURE 4.

    Fit curves and polar map of same patient as in Figure 3 when using CZT: fit curves (A) and polar map (B) at stress and fit curves (C) and polar map (D) at rest. Yellow curves = right ventricle; red curves = left ventricle; blue curves = myocardium.

  • FIGURE 5.
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    FIGURE 5.

    Head-to-head comparison of MBF values obtained from CZT SPECT versus PET, which served as standard of reference. Flattening of curve at values above 1 mL/g/min indicates underestimation by CZT SPECT particularly under high flow conditions.

  • FIGURE 6.
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    FIGURE 6.

    When cutoff value of 1.26 (as identified by receiver-operator-characteristic curve) was used for MFRi, CZT correctly identified (black circles) 14 of 18 patients (specificity, 78%) with PET MFR of 2 or greater and 7 of 10 patients (sensitivity, 70%) with PET MFR less than 2, resulting in accuracy of 75% for CZT MFRi.

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    TABLE 1

    Patient Baseline Characteristics (n = 28)

    Characteristicn
    Clinical symptoms
     Dyspnea10 (35)
     Typical chest pain7 (25)
     Atypical chest pain9 (32)
     Asymptomatic6 (21)
    Cardiovascular risk factors
     Smoking4 (14)
     Diabetes9 (32)
     Arterial hypertension17 (61)
     Dyslipidemia18 (64)
     Positive family history13 (46)
    • Values are given as absolute numbers, with percentages in parentheses.

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    TABLE 2

    MBF Values at Rest and Stress in Patients with Correctly Identified and Misidentified PET MFRi When Using SPECT CZT

    PET MFRCZT MFRinPET MBF stressPET MBF restCZT MBFi stressCZT MBFi rest
    HighHigh142.32 ± 0.450.91 ± 0.171.20 ± 0.230.87 ± 0.15
    HighLow42.39 ± 0.780.85 ± 0.221.14 ± 0.451.03 ± 0.32
    LowLow71.57 ± 0.651.06 ± 0.271.04 ± 0.140.96 ± 0.17
    LowHigh31.19 ± 0.430.90 ± 0.171.18 ± 0.170.82 ± 0.22
    • High PET MFR = myocardial flow rate ≥ 2 as assessed by PET (13N-ammonia); low PET MFR = myocardial flow rate < 2 as assessed by PET; high CZT MFRi = myocardial flow rate ≥ 1.26 as assessed by SPECT CZT (99mTc-tetrofosmin); low CZT MFRi = myocardial flow rate < 1.26 as assessed by SPECT CZT. Values are mL/g/min ± SD.

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Journal of Nuclear Medicine: 57 (12)
Journal of Nuclear Medicine
Vol. 57, Issue 12
December 1, 2016
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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
Rene Nkoulou, Tobias A. Fuchs, Aju P. Pazhenkottil, Silke M. Kuest, Jelena R. Ghadri, Julia Stehli, Michael Fiechter, Bernhard A. Herzog, Oliver Gaemperli, Ronny R. Buechel, Philipp A. Kaufmann
Journal of Nuclear Medicine Dec 2016, 57 (12) 1887-1892; DOI: 10.2967/jnumed.115.165498

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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
Rene Nkoulou, Tobias A. Fuchs, Aju P. Pazhenkottil, Silke M. Kuest, Jelena R. Ghadri, Julia Stehli, Michael Fiechter, Bernhard A. Herzog, Oliver Gaemperli, Ronny R. Buechel, Philipp A. Kaufmann
Journal of Nuclear Medicine Dec 2016, 57 (12) 1887-1892; DOI: 10.2967/jnumed.115.165498
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Keywords

  • myocardial flow reserve (MFR)
  • myocardial blood flow (MBF)
  • cadmium zinc telluride (CZT) SPECT
  • 13N-Ammonia PET
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