Myocardial blood flow quantitation with the SPECT technique: Where do we stand?
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Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO
Received Aug 29, 2020; accepted Aug 31, 2020 doi:10.1007/s12350-020-02373-0
See related article, https://doi.org/10.10 07/s12350-020-02293-z. Since 2013, there are numerous research studies (more than 30) reporting myocardial blood flow (MBF) quantitation with the SPECT technique. Some of them highlighted the capability of SPECT technique for detection of coronary artery disease (CAD) using rapid rotating gantry (RRG) cameras integrated with full physical corrections (e.g. corrections for attenuation, scatter, collimator blur and statistical noise).1,2 The rest majority reported the ability of CZT SPECT cameras with collimators of stationary multiple pinholes or sweeping parallel holes, and with or without attenuation correction (AC).3–8 Technical validations were properly achieved by head-to-head comparison with PET MBF quantitation on the same cohort or the diagnostic assessment for CAD utilizing coronary angiography (CAG) or factional flow reserve (FFR) as the reference standard.3–11 When the relevant physical interference in dynamic SPECT images was properly corrected, RRG and CZT cameras likely performed to the same level regardless of the CZT cameras possessing additional merits from higher count rate and less scatter by higher energy resolution.12 It has been reported that resting MBF and stress MBF can be highly overestimated (20% to 40%) for CZT cameras without AC applied as compared to PET flow quantitation.11,13,14 For RRG cameras, the impact from no AC appended to other physical factors can be even more brutal (100% to
Reprint requests: Bailing Hsu, PhD, Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
145%).15 Because myocardial flow reserve (MFR) or coronary flow reserve (CFR) can be relatively preserved within an acceptable range even missing AC, validation for SPECT MBF quantitation with invasive parameters (percentage of narrowed diameter in coronary artery and FFR) has been mainly focused on the single parameter, CFR (or MFR).3–8 The importance of stress MBF is still not yet explored for SPECT MBF quantitation due to the described limitation of SPECT systems and dedicated processing software. In the study by Li et al.,16 CFR exhibited much better diagnostic value than stress MBF in defining significant hemodynamic coronary stenosis suggested by the area under the ROC curve (AUC) for the diagnosis of abnormal FFR (CFR: 0.864 vs stress MBF: 0.673). Although authors did not further investigate this particular finding in their study, comparing the difference in diagnostic performance of these two quantitative values, stress MBF and CFR, is of physiological importance. So far, there st
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