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Comparison of coronary flow reserve estimated by dynamic radionuclide SPECT and multi-detector x-ray CT
Cecilia Marini1, Sara Seitun2, Camilla Zawaideh3
1CNR Institute of Bioimaging and Molecular Physiology, Milan, Section of Genoa, Italy.
Insights
Multi-detector computed tomography (MDCT) shows promise for assessing coronary flow reserve (CFR) in patients with coronary artery disease (CAD). While MDCT CFR slightly underestimates high values compared to SPECT, it correlates well and can assess the significance of CAD.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Advances in multi-detector computed tomography (MDCT) enable coronary flow reserve (CFR) assessment.
- Coronary artery disease (CAD) diagnosis and management benefit from accurate CFR evaluation.
Purpose of the Study:
- To compare regional CFR measurements using dynamic SPECT and dynamic MDCT.
- To correlate CFR findings with the severity of coronary artery stenosis.
Main Methods:
- 35 patients with suspected or known CAD underwent dipyridamole stress imaging.
- CFR was calculated using both dynamic SPECT and dynamic MDCT.
- Myocardial perfusion findings were correlated with CT coronary angiography (CTCA) results.
Main Results:
- Mean CFR values from SPECT and MDCT were comparable (1.51 vs. 1.50).
- A fair correlation (r²=0.39) was observed between segmental CFR by SPECT and MDCT.
- MDCT systematically underestimated higher CFR ranges compared to SPECT.
- CFR was significantly higher in normal coronary artery territories than in those with non-obstructive or obstructive CAD for both methods.
Conclusions:
- MDCT CFR demonstrates potential for evaluating the pathophysiological impact of anatomical CAD.
- Despite a tendency to underestimate high CFR values, MDCT offers a promising tool for CAD assessment.
Background:
Recent technical advances in multi-detector computed tomography (MDCT) allow for assessment of coronary flow reserve (CFR). We compared regional CFR by dynamic SPECT and by dynamic MDCT in patients with suspected or known coronary artery disease (CAD).
Methods:
Thirty-five patients, (29 males, mean age 69 years) with greater than average Framingham risk of CAD, underwent dipyridamole vasodilator stress imaging. CFR was estimated using dynamic SPECT and dynamic MDCT imaging in the same patients. Myocardial perfusion findings were correlated with obstructive CAD (≥50% luminal narrowing) on CT coronary angiography (CA).
Results:
Mean CFR estimated by SPECT and MDCT in 595 myocardial segments was not different (1.51 ± 0.46 vs. 1.50 ± 0.37, p = NS). Correlation of segmental CFR by SPECT and MDCT was fair (r 2 = 0.39, p < 0.001). Bland-Altman analysis revealed that MDCT in comparison to SPECT systematically underestimated CFR in higher CFR ranges. By CTCA, 12 patients had normal CA, 11 had non-obstructive, and 12 had obstructive CAD. CFR by both techniques was significantly higher in territories of normal CA than in territories subtended by non-obstructive or obstructive CAD. SPECT CFR was also significantly different in territories subtended by non-obstructive and obstructive CAD, whereas MDCT CFR was not.
Conclusion:
Despite relative underestimation of high CFR values, MDCT CFR shows promise for assessing the pathophysiological significance of anatomic CAD.
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