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Myocardial blood flow evaluation with dynamic cadmium-zinc-telluride single-photon emission computed tomography:

Adriana D'Antonio1, Roberta Assante1, Emilia Zampella1

  • 1Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy.

Diagnostic and Interventional Imaging
|February 16, 2023
PubMed

Insights

Dynamic cadmium-zinc-telluride (CZT) SPECT offers a promising non-invasive method for assessing myocardial blood flow (MBF) and myocardial perfusion reserve (MPR). However, standardizing protocols is crucial for widespread clinical adoption and accurate coronary artery disease evaluation.

Area of Science:

  • Cardiovascular Imaging
  • Nuclear Cardiology
  • Medical Physics

Background:

  • Non-invasive assessment of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) is vital for evaluating coronary artery disease (CAD) severity and extent.
  • Cardiac positron emission tomography-computed tomography (PET-CT) is the gold standard for coronary function assessment but is limited by cost and complexity.
  • Cardiac-dedicated cadmium-zinc-telluride (CZT) cameras have reignited interest in quantitative myocardial perfusion imaging using single-photon emission computed tomography (SPECT).

Purpose of the Study:

  • To review the current state of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) evaluation using dynamic CZT-SPECT.
  • To outline the challenges and areas for optimization in dynamic CZT-SPECT for clinical routine use.
  • To compare the diagnostic performance of CZT-SPECT with PET-CT in detecting significant coronary artery stenosis.

Main Methods:

  • Review of existing studies evaluating MBF and MPR using dynamic CZT-SPECT in patients with suspected or known CAD.
  • Comparison of quantitative values obtained by CZT-SPECT and PET-CT.
  • Analysis of factors influencing MBF/MPR quantitation, including camera types, protocols, tracers, and software.

Main Results:

  • Numerous studies have assessed MPR and MBF using dynamic CZT-SPECT, showing good correlation with PET-CT in detecting significant coronary stenosis.
  • Discrepancies in diagnostic cut-off values between CZT-SPECT and PET-CT highlight the need for standardization.
  • Variability in cameras, protocols, tracers, and software packages complicates the comparison and clinical implementation of CZT-SPECT.

Conclusions:

  • Dynamic CZT-SPECT shows potential for accurate MBF and MPR quantification, aiding in CAD assessment.
  • Lack of standardized acquisition, reconstruction, and analysis protocols hinders inter-study comparability and clinical adoption.
  • Addressing technical and methodological issues is essential to fully realize the clinical benefits of dynamic CZT-SPECT for myocardial perfusion imaging.

Keywords:
CZT-SPECTCoronary vascular functionDynamic acquisitionMyocardial blood flowMyocardial perfusion reserve

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