title: Quantification of Myocardial Perfusion Reserve Using Dynamic SPECT Imaging in Humans: A Feasibility Study.
abstract: Myocardial perfusion imaging (MPI) is well established in the diagnosis and workup of patients with known or suspected coronary artery disease (CAD); however, it can underestimate the extent of obstructive CAD. Quantification of myocardial perfusion reserve with PET can assist in the diagnosis of multivessel CAD. We evaluated the feasibility of dynamic tomographic SPECT imaging and quantification of a retention index to describe global and regional myocardial perfusion reserve using a dedicated solid-state cardiac camera.
  
  
  METHODS
  Ninety-five consecutive patients (64 men and 31 women; median age, 67 y) underwent dynamic SPECT imaging with (99m)Tc-sestamibi at rest and at peak vasodilator stress, followed by standard gated MPI. The dynamic images were reconstructed into 60-70 frames, 3-6 s/frame, using ordered-subsets expectation maximization with 4 iterations and 32 subsets. Factor analysis was used to estimate blood-pool time-activity curves, used as input functions in a 2-compartment kinetic model. K1 values ((99m)Tc-sestamibi uptake) were calculated for the stress and rest images, and K2 values ((99m)Tc-sestamibi washout) were set to zero. Myocardial perfusion reserve (MPR) index was calculated as the ratio of the stress and rest K1 values. Standard MPI was evaluated semiquantitatively, and total perfusion deficit (TPD) of at least 5% was defined as abnormal.
  
  
  RESULTS
  Global MPR index was higher in patients with normal MPI (n = 51) than in patients with abnormal MPI (1.61 [interquartile range (IQR), 1.33-2.03] vs. 1.27 [IQR, 1.12-1.61], P = 0.0002). By multivariable regression analysis, global MPR index was associated with global stress TPD, age, and smoking. Regional MPR index was associated with the same variables and with regional stress TPD. Sixteen patients undergoing invasive coronary angiography had 20 vessels with stenosis of at least 50%. The MPR index was 1.11 (IQR, 1.01-1.21) versus 1.30 (IQR, 1.12-1.67) in territories supplied by obstructed and nonobstructed arteries, respectively (P = 0.02). MPR index showed a stepwise reduction with increasing extent of obstructive CAD (P = 0.02).
  
  
  CONCLUSIONS
  Dynamic tomographic imaging and quantification of a retention index describing global and regional perfusion reserve are feasible using a solid-state camera. Preliminary results show that the MPR index is lower in patients with perfusion defects and in regions supplied by obstructed coronary arteries. Further studies are needed to establish the clinical role of this technique as an aid to semiquantitative analysis of MPI.
authors.affiliation: Institute of Nuclear Medicine, University College London Hospitals, NHS Trust, London, United Kingdom. simona.ben-haim@sheba.health.gov.il
authors.forename: Simona
authors.initials: S
authors.lastname: Ben-Haim
authors.forename: Venkatesh L
authors.initials: VL
authors.lastname: Murthy
authors.forename: Christopher
authors.initials: C
authors.lastname: Breault
authors.forename: Rayjanah
authors.initials: R
authors.lastname: Allie
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Sitek
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Roth
authors.forename: Jolene
authors.initials: J
authors.lastname: Fantony
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Moore
authors.forename: Mi-Ae
authors.initials: MA
authors.lastname: Park
authors.forename: Marie
authors.initials: M
authors.lastname: Kijewski
authors.forename: Athar
authors.initials: A
authors.lastname: Haroon
authors.forename: Piotr
authors.initials: P
authors.lastname: Slomka
authors.forename: Kjell
authors.initials: K
authors.lastname: Erlandsson
authors.forename: Rafael
authors.initials: R
authors.lastname: Baavour
authors.forename: Yoel
authors.initials: Y
authors.lastname: Zilberstien
authors.forename: Jamshed
authors.initials: J
authors.lastname: Bomanji
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
mesh_terms: D000368:Aged; D002104:Cadmium; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000295:instrumentation / Q000379:methods*; D012680:Sensitivity and Specificity; D013691:Tellurium; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation / Q000379:methods*; D015032:Zinc
chemical_list: C474490:CdZnTe; D002104:Cadmium; D015032:Zinc; D013691:Tellurium
keywords: coronary artery disease; dynamic SPECT; myocardial perfusion imaging; quantification; solid-state camera