Lung-Ching Chen1,2, Huei-Fong Hung1,3, Bor-Hsin Jong1, Sheng-Che Lin4, Chia-Lu Yeh4, Chi-Tai Ku4, Yen-Kung Chen5,6, Bailing Hsu7,8. 1. Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. 2. School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. 3. School of Medicine, Taipei Medical University, Taipei, Taiwan. 4. Department of Nuclear Medicine, Shin Kong Wu Ho Su Memorial Hospital, No. 95, Wenchang Rd, Shilin District, Taipei, Taiwan. 5. School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. m004149@ms.skh.org.tw. 6. Department of Nuclear Medicine, Shin Kong Wu Ho Su Memorial Hospital, No. 95, Wenchang Rd, Shilin District, Taipei, Taiwan. m004149@ms.skh.org.tw. 7. Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan. bailinghsu@gmail.com. 8. Nuclear Science and Engineering Institute, University of Missouri-Columbia, E2433 Lafferre Hall, Columbia, MO, 65211, USA. bailinghsu@gmail.com.
Abstract
OBJECTIVE: We introduced a method to measure the extent of myocardial ischemia and steal with SPECT MBF quantitation. METHODS: Eighty-seven patients who received rest/Dipyridamole-stress 99mTc-Sestamibi (MIBI) dynamic SPECT scans and coronary angiography were included. Dynamic SPECT images were reconstructed with full physical corrections. The one-tissue kinetic model was utilized to quantify K1 and further converted to MBF with required corrections. Rest MBF, stress MBF and myocardial flow reserve (MFR) were converted to a flow status polar map by a flow diagram. Extents of 7 flow statuses were verified their cutoff points for detecting stenoses. The diagnostic performance (DP) was compared to that of MFR. RESULTS: Cutoff point of the extent to detect ≥ 50% stenosis was 3.01% for ischemia-steal status and 20.3% for the combined status of ischemia-steal and moderate. Using these criteria, sensitivity, specificity and accuracy to detect ≥ 50% stenosis were (80%, 75%, 79%) and (86%, 68%, 80%) for ≥ 70% stenosis. The DP was superior to that of MFR < 2.0 criterion (≥ 50%: 70%, 63%, 69%; ≥ 70%: 73%, 61%, 69%) (all p < 0.015). CONCLUSION: SPECT MBF quantitation integrated with the flow diagram can measure the extent of myocardial ischemia and steal which appeared more accurate to detect angiographic stenoses than the single MFR parameter.
OBJECTIVE: We introduced a method to measure the extent of myocardial ischemia and steal with SPECT MBF quantitation. METHODS: Eighty-seven patients who received rest/Dipyridamole-stress 99mTc-Sestamibi (MIBI) dynamic SPECT scans and coronary angiography were included. Dynamic SPECT images were reconstructed with full physical corrections. The one-tissue kinetic model was utilized to quantify K1 and further converted to MBF with required corrections. Rest MBF, stress MBF and myocardial flow reserve (MFR) were converted to a flow status polar map by a flow diagram. Extents of 7 flow statuses were verified their cutoff points for detecting stenoses. The diagnostic performance (DP) was compared to that of MFR. RESULTS: Cutoff point of the extent to detect ≥ 50% stenosis was 3.01% for ischemia-steal status and 20.3% for the combined status of ischemia-steal and moderate. Using these criteria, sensitivity, specificity and accuracy to detect ≥ 50% stenosis were (80%, 75%, 79%) and (86%, 68%, 80%) for ≥ 70% stenosis. The DP was superior to that of MFR < 2.0 criterion (≥ 50%: 70%, 63%, 69%; ≥ 70%: 73%, 61%, 69%) (all p < 0.015). CONCLUSION: SPECT MBF quantitation integrated with the flow diagram can measure the extent of myocardial ischemia and steal which appeared more accurate to detect angiographic stenoses than the single MFR parameter.
Entities:
Keywords:
Coronary artery disease; Diagnostic performance; Extent of myocardial ischemia and steal; SPECT myocardial blood flow quantitation
Authors: Konstantin V Zavadovsky; Andrew V Mochula; Alla A Boshchenko; Alexander V Vrublevsky; Andrew E Baev; Alexander L Krylov; Marina O Gulya; Evgeny A Nesterov; Riccardo Liga; Alessia Gimelli Journal: J Nucl Cardiol Date: 2019-03-07 Impact factor: 5.952