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Published on: August 28, 2018
Quantification of heterogeneity on 201Tl gated SPECT: evaluation of coronary artery disease
Yasuhiro Maruoka1, Michinobu Nagao, Koichiro Abe
1Department of Clinical Radiology, School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Insights
A new index measuring myocardial uptake heterogeneity on gated myocardial perfusion SPECT (GMPS) with Thallium-201 (²⁰¹Tl) can help diagnose multivessel coronary artery disease (CAD). This stress end-diastolic coefficient of variance (CV) effectively differentiates patients with severe CAD.
Area of Science:
- Nuclear Medicine
- Cardiovascular Imaging
- Radiocardiology
Background:
- Coronary artery disease (CAD) diagnosis relies on accurate assessment of myocardial perfusion.
- Gated myocardial perfusion SPECT (GMPS) with Thallium-201 (²⁰¹Tl) is a key imaging modality.
- Quantifying heterogeneity in myocardial uptake can provide further diagnostic information.
Purpose of the Study:
- To introduce a novel index for quantifying myocardial uptake heterogeneity on ²⁰¹Tl GMPS.
- To evaluate the utility of this index in diagnosing multivessel CAD.
Main Methods:
- Adenosine-stress ²⁰¹Tl GMPS and coronary angiography (CAG) were performed in 51 CAD patients.
- Myocardial uptake heterogeneity was estimated using the coefficient of variance (CV) of segmental uptake on stress and redistribution images.
- Patients were categorized into insignificant-CAD, single-vessel CAD, and multivessel CAD groups based on CAG findings.
Main Results:
- The stress end-diastolic CV was significantly higher in patients with multivessel CAD compared to single-vessel CAD and insignificant-CAD (P<0.0001).
- The stress end-systolic CV was significantly higher in multivessel CAD patients than in the insignificant-CAD group (P=0.002).
- The stress end-diastolic CV achieved 84% sensitivity, 92% specificity, and 88% accuracy in diagnosing multivessel CAD, with an AUC of 0.89.
Conclusions:
- Myocardial uptake heterogeneity on ²⁰¹Tl GMPS correlates with CAD severity.
- The stress end-diastolic CV is a promising index for differentiating multivessel CAD from less severe coronary artery disease.
Purpose:
The purpose of this study was to propose a new index that quantifies the heterogeneity of myocardial uptake on gated myocardial perfusion SPECT (GMPS) with ²⁰¹Tl and investigate its utility in diagnosing multivessel coronary artery disease (CAD).
Methods:
In 51 patients with CAD, adenosine-stress ²⁰¹Tl GMPS and coronary angiography (CAG) were performed. On the basis of the American Heart Association's 17-segment model, segmental percentage uptake on stress, and redistribution images of GMPS were measured at end-systole and end-diastole. The coefficient of variance (CV) of 17 segmental percentage uptake for each patient was used as an estimate of the heterogeneity of myocardial uptake. According to the results of CAG, patients were divided into insignificant coronary artery stenosis (insignificant-CAD), single-vessel CAD, and multivessel CAD groups. The differences in CV among the 3 groups were analyzed by 1-way analysis of variance and Tukey-Kramer test. The diagnostic capability for multivessel CAD was analyzed using the receiver operating characteristics (ROC) curve analysis.
Results:
Stress end-diastolic CV for patients with multivessel CAD [mean (SD), 18.1% (3.5%)] was significantly greater than that for single-vessel CAD [12.8% (2.9%), P<0.0001] and insignificant-CAD [10.1% (0.9%), P<0.0001]. Stress end-systolic CV for patients with multivessel CAD [23.4% (5.2%)] was significantly greater than that for insignificant-CAD [16.5% (4.1%), P=0.002], whereas there was no difference between single-vessel [20.9% (6.1%)] and multivessel CAD. Using an optimal cutoff of stress end-diastolic CV diagnosed multivessel CAD with a sensitivity of 84%, a specificity of 92%, an accuracy of 88%, and an area under the curve of 0.89.
Conclusions:
The heterogeneity of myocardial percentage uptake on ²⁰¹Tl GMPS was correlated with the severity of CAD. Stress end-diastolic CV value is a candidate index for differentiating patients with multivessel CAD from single-vessel CAD and insignificant-CAD.
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