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Annals of Nuclear Medicine

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01.02.2014 | Original Article

Cardiac hybrid SPECT/CTA imaging to detect “functionally relevant coronary artery lesion”: a potential gatekeeper for coronary revascularization?

verfasst von: Wei Dong, Qian Wang, Shanshan Gu, Hang Su, Jian Jiao, Ying Fu

Erschienen in: Annals of Nuclear Medicine | Ausgabe 2/2014

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Abstract

Objective

Combination of both morphological and functional information has gained more and more appreciation with the concept of “functionally relevant coronary artery lesion (FRCAL)” and “functional revascularization”. This has paved the way for non-invasive single-photon emission computed tomography (SPECT)/computed tomography angiography (CTA) hybrid imaging. We aimed at assessing the value of cardiac hybrid imaging on the detection of FRCAL and its potential as a gatekeeper for invasive examination and treatment.

Methods

In Two hundred and thirty-eight patients with known or suspected coronary artery disease (CAD) underwent CTA and myocardial perfusion imaging (MPI) using SPECT on a dual system scanner in one session before treatment. 78 patients underwent invasive coronary angiography (CAG) within 1 month. Detection of FRCAL by the combination of SPECT/CTA was compared with SPECT/CAG, which served as a standard of reference. According to the both combination results, treatment decision (revascularization or medical treatment) was chosen in the catheterization laboratory.

Results

Sensitivity, specificity, accuracy, positive and negative prediction rate by SPECT/CTA vs. SPECT/CAG for the detection of flow-limiting coronary stenosis on patient- and vessel-based analysis were 94.33, 72.00, 87.18, 87.71, 85.71 % and 88.71, 92.44, 91.45, 80.89, 95.78 %, respectively. No revascularization procedures were performed in patients without flow-limiting stenosis. However, more than one-third (25/67, 37 %) of revascularized vessels were not associated with ischemia on MPI.

Conclusions

The cardiac SPECT/CTA hybrid imaging can accurately detect FRCAL and thereby it may be used as a gatekeeper for CAG and revascularization procedures.

Kaufmann PA. Cardiac hybrid imaging: state-of-the-art. Ann Nucl Med. 2009;23:325–31.PubMedCrossRef

Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–36.PubMedCrossRef

Gaemperli O, Schepis T, Kalff V, Namdar M, Valenta I, Stefani L, et al. Validation of new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography. Eur J Nucl Med Mol Imaging. 2007;34:1097–106.PubMedCrossRef

Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24.PubMedCrossRef

Pijls NH, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van’t Veer M, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007;49:2105–11.PubMedCrossRef

Kadokami T, Ando S, Momii H, Yoshida M, Narita S, Fukunaga T, et al. Diagnostic performance of cardiac fusion images from myocardial perfusion imaging and multislice computed tomography coronary angiography for assessment of hemodynamically significant coronary artery lesions: an observational study. Nucl Med Commun. 2012;33:60–8.PubMedCrossRef

Schaap J, de Groot J, Nieman K, Meijboom W, Boekholdt S, Van der Heyden J, et al. Advanced Imaging in Assessment of CAD & Atherosclerosis Treatment decisions based on hybrid myocardial perfusion SPECT and CT coronary angiography. J Nucl Med. 2012;53(Supplement 1):243.

Judkins MP. Percutaneous transfemoral selective coronary arteriography. Radiol Clin N Am. 1968;6:467–92.PubMed

Judkins MP. Selective coronary arteriography. I. A percutaneous transfemoral technic. Radiology. 1967;89:815–24.PubMed

10.

Gaemperli O, Husmann L, Schepis T, Koepfli P, Valenta I, Jenni W, et al. Coronary CT angiography and myocardial perfusion imaging to detect flow-limiting stenoses: a potential gatekeeper for coronary revascularization? Eur Heart J. 2009;30:2921–9.PubMedCrossRef

11.

Windecker S, Remondino A, Eberli FR, Juni P, Raber L, Wenaweser P, et al. Sirolimus-eluting and paclitaxel-eluting stents for coronary revascularization. N Engl J Med. 2005;353:653–62.PubMedCrossRef

12.

Sun D, Wang J, Tian Y, Narsinh K, Wang H, Li C, et al. Multimodality imaging evaluation of functional and clinical benefits of percutaneous coronary intervention in patients with chronic total occlusion lesion. Theranostics. 2012;2(8):788–800.PubMedCentralPubMedCrossRef

13.

Pazhenkottil AP, Nkoulou RN, Ghadri JR, Herzog BA, Küest SM, Husmann L, et al. Impact of cardiac hybrid single-photon emission computed tomography/computed tomography imaging on choice of treatment strategy in coronary artery disease. Eur Heart J. 2011;32:2824–9.PubMedCrossRef

14.

Pazhenkottil AP, Nkoulou RN, Ghadri JR, Herzog BA, Buechel RR, Küest SM, et al. Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary computed tomography angiography. Eur Heart J. 2011;32:1465–71.PubMedCrossRef

15.

Flotats A, Knuuti J, Gutberlet M, Marcassa C, Bengel FM, Kaufmann PA, Cardiovascular Committee of the EANM, the ESCR and the ECNC, et al. Hybrid cardiac imaging: SPECT/CT and PET/CT. A joint position statement by the European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC). Eur J Nucl Med Mol Imaging. 2011;38:201–12.PubMedCrossRef

16.

Schindler TH, Magosaki N, Jeserich M, Oser U, Krause T, Fischer R, et al. Fusion imaging: combined visualization of 3D reconstructed coronary artery tree and 3D myocardial scintigraphic image in coronary artery disease. Int J Card Imaging. 1999;15:357–68 (discussion 369–70).PubMedCrossRef

17.

Rispler S, Aronson D, Abadi S, Roguin A, Engel A, Beyar R, et al. Integrated SPECT/CT for assessment of haemodynamically significant coronary artery lesions in patients with acute coronary syndrome. Eur J Nucl Med Mol Imaging. 2011;38:1917–25.PubMedCrossRef

18.

Santana CA, Garcia EV, Faber TL, Sirineni GK, Esteves FP, Sanyal R, et al. Diagnostic performance of fusion of myocardial perfusion imaging and computed tomography coronary angiography. J Nucl Cardiol. 2009;16:201–11.PubMedCentralPubMedCrossRef

19.

Pazhenkottil AP, Herzog BA, Husmann L, Buechel RR, Burger IA, Valenta I, et al. Non-invasive assessment of coronary artery disease with CT coronary angiography and SPECT: a novel dose-saving fast-track algorithm. Eur J Nucl Med Mol Imaging. 2010;37:522–7.PubMedCrossRef

20.

Achenbach S, Marwan M, Ropers D, Schepis T, Pflederer T, Anders K, et al. Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J. 2010;31:340–6.PubMedCrossRef

Titel: Cardiac hybrid SPECT/CTA imaging to detect “functionally relevant coronary artery lesion”: a potential gatekeeper for coronary revascularization?
verfasst von: Wei Dong
Qian Wang
Shanshan Gu
Hang Su
Jian Jiao
Ying Fu
Publikationsdatum: 01.02.2014
Verlag: Springer Japan
Erschienen in: Annals of Nuclear Medicine / Ausgabe 2/2014
Print ISSN: 0914-7187
Elektronische ISSN: 1864-6433
DOI: https://doi.org/10.1007/s12149-013-0790-9

Springer Medizin

Abstract

Objective

Methods

Results

Conclusions

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