title: Comparison of nitrate augmented Tc-99m tetrofosmin gated SPECT imaging with FDG PET imaging for the assessment of myocardial viability in patients with severe left ventricular dysfunction.
abstract: BACKGROUND
  Of various nuclear medicine techniques, F-18/flourodeoxyglucose (FDG) positron emission tomography (PET) is considered as the best modality for the assessment of viable myocardium (VM). In this study, we compared the diagnostic accuracy of nitrate augmented Tc-99m tetrofosmin gated G-single-photon emission computed tomography (SPECT) with FDG PET.
  
  
  METHODS
  54 consecutive cases of angiographically proven CAD with severe LV dysfunction were enrolled in the study. The patients underwent Tc-99m tetrofosmin G-SPECT and FDG PET as per the standard protocols and were compared.
  
  
  RESULTS
  SPECT data analysis indicated functional abnormalities in 661/918 myocardial segments. F-18 FDG PET revealed VM in 496/661 segments. The diagnostic accuracy of baseline NAC, postnitrate NAC, baseline AC, and postnitrate AC Tc-99m tetrofosmin SPECT was 84%, 87%, 90%, and 94%, respectively. κ values for NAC baseline, NAC postnitrate, AC baseline, and AC postnitrate Tc-99m tetrofosmin G-SPECT were 0.65, 0.70, 0.77, and 0.85, respectively. Attenuation correction revealed viability additionally in 46 segments which were non-viable on NAC postnitrate study (P < .001). Nitrate augmentation showed viability additionally in 25 segments which were non-viable on AC baseline scan (P = .004). On patient-based analysis FDG PET changes the management only in 13% (7/54) of patients.
  
  
  CONCLUSIONS
  Nitrate augmented AC Tc-99m tetrofosmin G-SPECT shows excellent (κ = .85) agreement with FDG PET. FDG PET changes management only in 13% of the patients. Tc-99m tetrofosmin G-SPECT being more widely available and cheaper imaging modality can be reliably used to detect VM where FDG PET is not available.
authors.affiliation: Department of Nuclear Medicine & PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Senthil
authors.initials: S
authors.lastname: Raja
authors.forename: Baljinder
authors.initials: B
authors.lastname: Singh
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Rohit
authors.forename: Kuruva
authors.initials: K
authors.lastname: Manohar
authors.forename: Raghava
authors.initials: R
authors.lastname: Kashyap
authors.forename: Anish
authors.initials: A
authors.lastname: Bhattacharya
authors.forename: B R
authors.initials: BR
authors.lastname: Mittal
mesh_terms: D000328:Adult; D000368:Aged; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D005260:Female; D019788:Fluorodeoxyglucose F18; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D009566:Nitrates; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D009566:Nitrates; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; C078700:technetium tc-99m tetrofosmin