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[18Fluoro-FDG SPECT for the demonstration of hibernating myocardium: an interim account]
C Alexander1, A Schaefer, L Trampert
1Abteilung für Nuklearmedizin Universitätskliniken des Saarlandes, Homburg, Deutschland.
Insights
Fluorodeoxyglucose-positron emission tomography (FDG-PET) and Fluorodeoxyglucose-single photon emission computed tomography (FDG-SPECT) show high segmental agreement for assessing coronary heart disease (CHD). However, FDG-PET offers a more accurate assessment of myocardial hibernation for revascularization decisions.
Area of Science:
- Nuclear medicine
- Cardiovascular imaging
- Medical diagnostics
Background:
- Coronary heart disease (CHD) management relies on accurate assessment of myocardial viability.
- Fluorodeoxyglucose-positron emission tomography (FDG-PET) and Fluorodeoxyglucose-single photon emission computed tomography (FDG-SPECT) are nuclear imaging techniques used to evaluate myocardial perfusion and viability.
Purpose of the Study:
- To perform an intraindividual comparison of FDG-PET and FDG-SPECT in patients with CHD.
- To evaluate the concordance and discrepancies between FDG-PET and FDG-SPECT in assessing myocardial hibernation and guiding revascularization decisions.
Main Methods:
- Thirty patients with CHD scheduled for revascularization underwent both FDG-PET and FDG-SPECT.
- Myocardial perfusion was assessed using 99mTc-MIBI SPECT.
- The myocardium was divided into 25 segments for comparison by two experienced observers.
Main Results:
- Segmental concordance between FDG-PET and FDG-SPECT was high at 94.1%.
- FDG-PET identified a greater percentage of hibernating myocardium (8.9% vs. 5.7%) and fewer matched defects (11.5% vs. 16.0%) compared to FDG-SPECT.
- While 22 patients had identical revascularization assessments, FDG-PET suggested intervention in 6 cases versus 2 for FDG-SPECT in the remaining 8 patients.
Conclusions:
- FDG-PET and FDG-SPECT demonstrate significant segmental concordance in evaluating CHD.
- Differences in assessing myocardial hibernation between FDG-PET and FDG-SPECT can lead to variations in patient management and revascularization strategies.
Aim:
The present investigation demonstrates an intraindividual comparison of FDG-PET and FDG-SPECT.
Material And Methods:
Thirty patients with CHD and planed revascularisation underwent both modalities. Myocardial perfusion was evaluated by 99mTc-MIBI SPECT. The myocardium was divided into 25 segments and the results were compared by two experienced observers.
Results:
Segmental concordance of FDG-PET and -SPECT was 94.1%. PET indicated a higher percentage of hibernating myocardium (8.9% vs. 5.7%) and a lower rate of matched defects (11.5% vs. 16.0%). In 22 cases the need for revascularisation was assessed identically. In the remaining 8 patients FDG-PET and FDG-SPECT required an intervention in 6 and 2 cases, respectively.
Conclusion:
The results of FDG-PET and FDG-SPECT showed a high segmental concordance, but the individual assessment of hibernation worthwhile for revascularisation demonstrated important differences in patient management.
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