Dynamic single-photon emission computed tomography as a method of identification of multivessel coronary artery disease

Objective. The aim of this study was to determine the informative value of dynamic tomoscintigraphy in detection of multivessel coronary artery disease (CAD).
Material and methods. Patients with multivessel CAD (n= 16) and healthy volunteers (n= 9) underwent dynamic cardiac single photon emission computed tomography with 99mТс-MIBI at rest and during pharmacological stress-test.
Processing of acquired results involved the formation of regions of interest from the cavity and the myocardium of the left ventricle used to create activity-time curves. Coronary flow reserve index was defined as a quotient of two ratios of the mean counts from the myocardial region to the integral activity in the left ventricular cavity for the studies performed during pharmacological stress test and at rest.
Results. The mean values of coronary flow reserve index were 1.86 (1.59; 2.2) in group of healthy volunteers and 1.39 (1.12; 1.69) in patients with multivessel CAD. When the value of this index was less than 1.77, the method allowed for detection of three-vessel CAD with the sensitivity and specificity rates of 81.8% and 66.7%, respectively.
Conclusion. Performing the standard myocardial perfusion scintigraphy in combination with the method of coronary flow reserve index assessment allows for enhancement of the diagnostic value of scintigraphic approach in the evaluation of coronary circulation disturbances in multivessel CAD.

1. Windecker S., Kolh P., Alfonso F. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. Heart J. 2014; 37: 2541–619.

2. Ito Y., Katoh C., Noriyasu K. et al. Estimation of myocardial blood flow reserve by 99mTc-sestamibi imaging: comparison with the results of [15O] H2O PET. Eur. J. Nucl. Med. Mol. Imag. 2003; 2: 281–7.

3. Tsukamoto Т., Ito Y., Noriyasu K. et al. Quantitative assessment of regional myocardial flow reserve using Tc-99m-sestamibi imaging comparison with results of O-15 water PET. Circ. J. 2005; 2: 188–93.

4. Fihn S.D., Blankenship J.C., Alexander K.P. et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation. 2014; 130: 1749–67.

5. IAEA. Nuclear cardiology: Guidance and Recommendations for Implementation in Developing Countries. International Atomic Energy Agency. Vienna; 2012.

6. Лишманов Ю.Б., Чернов В.И. (ред.) Национальное руководство по радионуклидной диагностике. Томск: STT; 2010; 2. [Lishmanov Yu.B., Chernov V.I. (eds) National guide on radionuclide diagnotics. Tomsk: STT; 2010; 2 (in Russ.).]

7. Мочула А.В., Завадовский К.В., Лишманов Ю.Б. Методика определения резерва миокардиального кровотока с использованием нагрузочной динамической однофотонной эмиссионной компьютерной томографии. Бюллетень экспериментальной биологии и медицины. 2015; 12: 845–8. [Mochula A.V., Zavadovskiy K.V., Lishmanov Yu.B. Myocardial blood reserve assessment by dynamic stress single-photon emission computed tomography. Byulleten' Eksperimental'noy Biologii i Meditsiny (Bulletin of Experimental Biology and Medicine, Russian journal). 2015; 12: 845–8 (in Russ.).]

8. Vrublevsky A.V., Boshchenko A.A., Karpov R.S. Simultaneous transeosophageal doppler assessment of coronary flow reserve in the left anterior descending artery and coronary sinus allows differentiation between proximal and nonproximal left anterior descending artery stenosis. Eur. Heart J. Cardiovasc. Imag. 2004; 1: 25–33.

9. Larock M.P., Braat S.H., Sochor H. et al. New developments in myocardial imaging technetium 99mTc SESTAMIBI. London; 1993.

10. Ben-Haim S., Murthy V.L., Breault С. et al. Quantification of myocardial perfusion reserve using dynamic SPECT imaging in humans: a feasibility study. J. Nucl. Med. 2013; 6: 873–9.

11. Hsu B., Chen F.C., Wu T.C. et al. Quantitation of myocardial blood flow and myocardial flow reserve with 99mTc-sestamibi dynamic SPECT/CT to enhance detection of coronary artery disease. Eur. J. Nucl. Med. Mol. Imag. 2014; 12: 2294–306.

12. Liu C., Sinusas A.J. Is assessment of absolute myocardial perfusion with SPECT ready for prime time? J. Nucl. Med. 2014; 10: 1573–5.

13. Palyo R., Sinusas A., Liu Y.H. Highsensitivity and high-resolution SPECT/CT systems provide substantial dose reduction without compromising quantitative precision for assessment of myocardial perfusion or function. J. Nucl. Med. 2016; 51: 147–8.

14. Koss J.E., Kirch D., Little E.P. Advantages of list-mode acquisition of dynamic cardiac data [ECG-gated nuclear medicine imaging]. IEEE Transact. Nucl. Sci. 1998; 44: 2431–8.

15. Лишманов Ю.Б., Завадовский К.В., Ефимова И.Ю., Кривоногов Н.Г., Веснина Ж.В., Сазонова С.И. и др. Возможности ядерной медицины в диагностике сердечно-сосудистых заболеваний. Сибирский медицинский журнал. 2015; 2: 21–9. [Lishmanov Yu.B., Zavadovskiy K.V., Efimova I.Yu., Krivonogov N.G., Vesnina Zh.V., Sazonova S.I. et al. Prospects of nuclear medicine for the diagnosis of cardiovascular diseases. Sibirskiy Meditsinskiy Zhurnal (Siberian Medical Journal, Russian journal). 2015; 2: 21–9 (in Russ.).]

16. Scanlon P.J., Faxon D.P., Audet A.-M. et al. ACC/AHA Guidelines for Coronary Angiography: Executive Summary and Recommendations. Circulation. 1999; 99: 2345–57.

17. Hesse B., Tagil K., Cuocolo A. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur. J. Nucl. Med. Mol. Imag. 2005; 32: 855–97.

18. Лишманов Ю.Б., Ефимова И.Ю., Чернов В.И., Веснина Ж.В., Кривоногов Н.Г., Макарова Е.В. и др. Сцинтиграфия как инструмент диагностики, прогнозирования и мониторинга лечения болезней сердца. Сибирский медицинский журнал. 2007; 3: 74–7. [Lishmanov Yu.B., Efimova I.Yu., Chernov V.I., Vesnina Zh.V., Krivonogov N.G., Makarova E.V. et al. Scintigraphy as a tool of diagnosis, prevention and monitoring of cardiac diseases treatment. Sibirskiy Meditsinskiy Zhurnal (Siberian Medical Journal, Russian journal). 2007; 3: 74–7 (in Russ.).]

19. Henzlova M.J., Cerqueira M.D., Mahmarian J.J. et al. Stress protocols and tracers. J. Nucl. Cardiol. 2006; 6: 80–90.

20. Le Guludec D., Lautamäki R., Knuuti J., Bax J.J., Bengel F.M. Present and future of clinical cardiovascular PET imaging in Europe – a position statement by the European Council of Nuclear Cardiology (ECNC). Eur. J. Nucl. Med. Mol. Imag. 2008; 35 (9): 1709–24.

21. Melikian N., Bondt P., Tonino P. et al. Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC: Cardiovasc. Interv. 2010; 3 (3): 307–14.

22. Завадовский К.В., Гуля М.О., Саушкин В.В., Саушкина Ю.В., Лишманов Ю.Б. Совмещенная однофотонная эмиссионная и рентгеновская компьютерная томография сердца: методические аспекты. Вестник рентгенологии и радиологии. 2016; 97 (4): 235–42. [Zavadovsky K.V., Gulya M.O., Saushkin V.V., Saushkina Yu.V., Lishmanov Yu.B. Superimposed single-photon emission computed tomography and X-ray computed tomography of the heart: Methodical aspects. Vestnik Rentgenologii i Radiologii (Russian Journal of Radiology). 2016; 97 (4): 235–42 (in Russ.).]