title: Absolute Myocardial Blood Flow and Flow Reserve Assessed by Gated SPECT with Cadmium-Zinc-Telluride Detectors Using 99mTc-Tetrofosmin: Head-to-Head Comparison with 13N-Ammonia PET.
abstract: Recent advances in SPECT technology including cadmium-zinc-telluride (CZT) semiconductor detector material may pave the way for absolute myocardial blood flow (MBF) measurements by SPECT. The aim of the present study was to compare K1uptake rate constants as surrogates of absolute MBF and myocardial flow reserve index (MFRi) in humans as assessed with a CZT SPECT camera versus PET.
  
  
  METHODS
  Absolute MBF was assessed in 28 consecutive patients undergoing adenosine stress-rest myocardial perfusion imaging (MPI) by99mTc-tetrofosmin CZT SPECT and13N-ammonia PET, and MFR was calculated as a ratio of hyperemic over resting MBF. Results from both MPI methods were compared, and correlation coefficients were calculated. The diagnostic accuracy of CZT MFRi to predict an abnormal MFR defined as PET MFR less than 2 was assessed using a receiver-operator-characteristic curve.
  
  
  RESULTS
  Median MBF at rest was comparable between CZT and PET (0.89 [interquartile range (IQR), 0.77-1.00] vs. 0.92 [IQR, 0.78-1.06] mL/g/min; P = not significant) whereas it was significantly lower at stress in CZT than PET (1.11 [IQR, 1.00-1.26] vs. 2.06 [IQR, 1.48-2.56] mL/g/min; P < 0.001). This resulted in median MFRi values of 1.32 (IQR, 1.13-1.52) by CZT and 2.36 (IQR, 1.57-2.71) by PET (P < 0.001). The receiver-operator-characteristic curve revealed a cutoff for CZT MFRi at 1.26 to predict an abnormal PET MFR yielding an accuracy of 75%.
  
  
  CONCLUSIONS
  The estimation of absolute MBF index values by CZT SPECT MPI with99mTc-tetrofosmin is technically feasible, although hyperemic values are significantly lower than from PET with13N-ammonia, resulting in a substantial underestimation of MFR. Nevertheless, CZT MFRi may confer diagnostic value.
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Rene
authors.initials: R
authors.lastname: Nkoulou
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Tobias A
authors.initials: TA
authors.lastname: Fuchs
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Aju P
authors.initials: AP
authors.lastname: Pazhenkottil
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Silke M
authors.initials: SM
authors.lastname: Kuest
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Jelena R
authors.initials: JR
authors.lastname: Ghadri
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Stehli
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Fiechter
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Bernhard A
authors.initials: BA
authors.lastname: Herzog
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Gaemperli
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
authors.forename: Ronny R
authors.initials: RR
authors.lastname: Buechel
authors.affiliation: Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich and University of Zurich, Zurich, Switzerland pak@usz.ch.
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
mesh_terms: D000241:Adenosine / Q000494:pharmacology; D000368:Aged; D000641:Ammonia; D002104:Cadmium; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009590:Nitrogen Radioisotopes; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D049268:Positron-Emission Tomography; D012372:ROC Curve; D012146:Rest; D013312:Stress, Physiological / Q000187:drug effects; D013691:Tellurium; D015032:Zinc
chemical_list: C474490:CdZnTe; D009590:Nitrogen Radioisotopes; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D002104:Cadmium; C078700:technetium tc-99m tetrofosmin; D000641:Ammonia; D015032:Zinc; D000241:Adenosine; D013691:Tellurium
keywords: 13N-ammonia PET; cadmium zinc telluride (CZT) SPECT; myocardial blood flow (MBF); myocardial flow reserve (MFR)