Diagnostic efficiency of quantification of myocardial blood flow and coronary flow reserve with CZT dynamic SPECT imaging for patients with suspected coronary artery disease: a comparative study with traditional semi-quantitative evaluation

Jiao Wang; Shuai Li; Weiqiang Chen; Yue Chen; Zekun Pang; Jianming Li

doi:10.21037/cdt-20-728

Diagnostic efficiency of quantification of myocardial blood flow and coronary flow reserve with CZT dynamic SPECT imaging for patients with suspected coronary artery disease: a comparative study with traditional semi-quantitative evaluation

Cardiovasc Diagn Ther. 2021 Feb;11(1):56-67. doi: 10.21037/cdt-20-728.

Authors

Jiao Wang¹, Shuai Li¹, Weiqiang Chen², Yue Chen¹, Zekun Pang¹, Jianming Li¹

Affiliations

¹ Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, China.
² Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, China.

Abstract

Background: Myocardial blood flow (MBF) quantitation with cadmium-zinc-telluride (CZT) dynamic single-photon emission computed tomography (SPECT) is being increasingly investigated toward clinical utilization.

Methods: In this prospective study, forty-nine patients with suspected or known coronary artery disease (CAD) underwent a rest/adenosine triphosphate (ATP) stress dynamic and routine gated myocardial perfusion imaging (MPI) by CZT SPECT and then received coronary angiography (CAG). Quantitative diagnosis from the dynamic SPECT and a flow diagram was automatically obtained by the dedicated software and compared with the result of semi-quantitative analysis with gated MPI using the angiographic stenosis as the reference standard.

Results: When stenosis ≥50% was considered at the participant level, the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) and accuracy (AC) of the quantitative diagnosis were higher than semi-quantitative method as (84.4% vs. 65.6%, 88.2% vs. 70.6%, 93.1% vs. 80.8%, 75.0% vs. 52.2%, 85.7% vs. 67.3%) (all P<0.05). The receiver operating characteristic (ROC) curve analysis generated the optimal critical value as 1.86 and 1.61 mL/min/g for stress MBF (sMBF) and MFR, respectively. The diagnosis performance of the quantitative diagnosis was higher than semi-quantitative method as (78.9% vs. 68.4%, 63.3% vs. 60.0%, 57.7% vs. 52.0%, 82.6% vs. 75.0%, 69.4% vs. 63.3%) for the criteria of ≥75% stenosis on CAG (all P<0.05) with optimal critical values as 1.71 and 1.15 mL/min/g. There was no significant difference between sMBF and MFR.

Conclusions: The diagnostic efficiency by using the quantitative method of CZT dynamic SPECT imaging is superior to traditional semi-quantitative gated MPI for the diagnosis of CAD, which improved the diagnostic specificity and accuracy when the critical was stenosis ≥50%.

Keywords: Cadmium-zinc-telluride (CZT); coronary artery disease (CAD); diagnostic efficiency; myocardial blood flow (MBF); single-photon emission computed tomography (SPECT).