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01-04-2021 | Arterial Diseases | Original Article

Diagnostic performance of myocardial perfusion imaging with conventional and CZT single-photon emission computed tomography in detecting coronary artery disease: A meta-analysis

Authors: Valeria Cantoni, PhD, Roberta Green, PhD, Wanda Acampa, MD, PhD, Emilia Zampella, MD, PhD, Roberta Assante, MD, PhD, Carmela Nappi, MD, PhD, Valeria Gaudieri, MD, PhD, Teresa Mannarino, MD, Renato Cuocolo, MD, Eugenio Di Vaia, MD, Mario Petretta, MD, FAHA, Alberto Cuocolo, MD

Published in: Journal of Nuclear Cardiology | Issue 2/2021

Abstract

Background

We performed a meta-analysis to compare the diagnostic performance of conventional SPECT (C-SPECT) and cadmium-zinc-telluride (CZT)-SPECT systems in detecting angiographically proven coronary artery disease (CAD).

Methods

Studies published between January 2000 and February 2018 were identified by database search. We included studies assessing C-SPECT or CZT-SPECT as a diagnostic test to evaluate patients for the presence of CAD, defined as at least 50% diameter stenosis on invasive coronary angiography. A study was eligible regardless of whether patients were referred for suspected or known CAD.

Results

We identified 40 eligible articles (25 C-SPECT and 15 CZT-SPECT studies) including 7334 patients (4997 in C-SPECT and 2337 in CZT-SPECT studies). The pooled sensitivity and specificity were 85% and 66% for C-SPECT and 89% and 69% for CZT-SPECT imaging studies. The area under the curve was slightly higher for CZT-SPECT (0.89) compared to C-SPECT (0.83); accordingly, the summary diagnostic OR was 17 for CZT-SPECT and 11 for C-SPECT. The accuracy of the two tests slightly differs between C-SPECT and CZT-SPECT (chi-square 11.28, P < .05). At meta-regression analysis, no significant association between both sensitivity and specificity and demographical and clinical variables considered was found for C-SPECT and CZT-SPECT studies.

Conclusions

C-SPECT and CZT-SPECT have good diagnostic performance in detecting angiographic proven CAD, with a slightly higher accuracy for CZT-SPECT. This result supports the use of the novel gamma cameras in clinical routine practices also considering the improvements in acquisition time and radiation exposure reduction.

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Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study. Lancet 1997;349:1498-504.PubMedCrossRef

Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: A report from the American Heart Association. Circulation 2018;137:e67-492.PubMedCrossRef

Gibbons RJ. Noninvasive diagnosis and prognosis assessment in chronic coronary artery disease: Stress testing with and without imaging perspective. Circ Cardiovasc Imaging 2008;1:257-69.PubMedCrossRef

Green R, Cantoni V, Petretta M, Acampa W, Panico M, Buongiorno P, et al. Negative predictive value of stress myocardial perfusion imaging and coronary computed tomography angiography: A meta-analysis. J Nucl Cardiol 2018;25:1588-97.PubMedCrossRef

Neill J, Prvulovich EM, Fish MB, Berman DS, Slomka PJ, Sharir T, et al. Initial multicenter experience of high-speed myocardial perfusion imaging: Comparison between high-speed and conventional single-photon emission computed tomography with angiographic validation. Eur J Nucl Med Mol Imaging 2013;40:1084-94.PubMedCrossRef

Berman DS, Kang X, Tamarappoo B, Wolak A, Hayes SW, Nakazato R, et al. Stress thallium-201/rest technetium-99 m sequential dual isotope high-speed myocardial perfusion imaging. JACC Cardiovasc Imaging 2009;2:273-82.PubMedCrossRef

Esteves FP, Raggi P, Folks RD, Keidar Z, Askew JW, Rispler S, et al. Novel solid-state-detector dedicated cardiac camera for fast myocardial perfusion imaging: Multicenter comparison with standard dual detector cameras. J Nucl Cardiol 2009;16:927-34.PubMedPubMedCentralCrossRef

Slomka PJ, Patton JA, Berman DS, Germano G. Advances in technical aspects of myocardial perfusion SPECT imaging. J Nucl Cardiol 2009;16:255-76.PubMedCrossRef

Duvall WL, Croft LB, Ginsberg ES, Einstein AJ, Guma KA, George T, et al. Reduced isotope dose and imaging time with a high-efficiency CZT SPECT camera. J Nucl Cardiol 2011;18:847-57.PubMedCrossRef

10.

Herzog BA, Buechel RR, Katz R, Brueckner M, Husmann L, Burger IA, et al. Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: Optimized protocol for scan time reduction. J Nucl Med 2010;51:46-51.PubMedCrossRef

11.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009;6:e1000097.PubMedPubMedCentralCrossRef

12.

Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011;155:529-36.PubMedCrossRef

13.

Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005;58:982-90.PubMedCrossRef

14.

Hanley JA, McNeil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983;148:839-43.PubMedCrossRef

15.

Rosman AS, Korsten MA. Application of summary receiver operating characteristics (sROC) analysis to diagnostic clinical testing. Adv Med Sci 2007;52:76-82.PubMed

16.

Van Houwelingen HC, Zwinderman KH. Stijnen T A bivariate approach to meta-analysis. Stat Med 1993;12:2273-84.PubMedCrossRef

17.

Takwoingi Y. Meta-analysis of test accuracy studies in Stata: A bivariate model approach. Version 1.1. April 2016. https://methods.cochrane.org/sdt/software-meta-analysis-dta-studies.

18.

Lijmer JG, Mol BW, Heisterkamp S, Bonsel GJ, Prins MH, van der Meulen JH, et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 1999;282:1061-6.PubMedCrossRef

19.

Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 2005;58:882-93.PubMedCrossRef

20.

Elhendy A, Sozzi FB, Valkema R, van Domburg RT, Bax JJ, Roelandt JR. Dobutamine technetium-99m tetrofosmin SPECT imaging for the diagnosis of coronary artery disease in patients with limited exercise capacity. J Nucl Cardiol 2000;7:649-54.PubMedCrossRef

21.

Smart SC, Bhatia A, Hellman R, Stoiber T, Krasnow A, Collier BD, et al. Dobutamine-atropine stress echocardiography and dipyridamole sestamibi scintigraphy for the detection of coronary artery disease: Limitations and concordance. J Am Coll Cardiol 2000;36:1265-73.PubMedCrossRef

22.

Kapur A, Latus KA, Davies G, et al. A comparison of three radionuclide myocardial perfusion tracers in clinical practice: The ROBUST study. Eur J Nucl Med Mol Imaging. 2002;29:1608-16.PubMedCrossRef

23.

Miller TD, Hodge DO, Christian TF, Milavetz JJ, Bailey KR, Gibbons RJ. Effects of adjustment for referral bias on the sensitivity and specificity of single photon emission computed tomography for the diagnosis of coronary artery disease. Am J Med 2002;112:290-7.PubMedCrossRef

24.

Tsai MF, Kao PF, Tzen KY. Improved diagnostic performance of thallium-201 myocardial perfusion scintigraphy in coronary artery disease: From planar to single photon emission computed tomography imaging. Chang Gung Med J 2002;25:522-30.PubMed

25.

Banzo I, Pena FJ, Allende RH, Quirce R, Carril JM. Prospective clinical comparison of non-corrected and attenuation- and scatter-corrected myocardial perfusion SPECT in patients with suspicion of coronary artery disease. Nucl Med Commun 2003;24:995-1002.PubMedCrossRef

26.

Doyle M, Fuisz A, Kortright E, Biederman RW, Walsh EG, Martin ET, et al. The impact of myocardial flow reserve on the detection of coronary artery disease by perfusion imaging methods: An NHLBI WISE study. J Cardiovasc Magn Reson 2003;5:475-85.PubMedCrossRef

27.

Groutars RG, Verzijlbergen JF, Tiel-van Buul MM, Zwinderman AH, Ascoop CA, van Hemel NM, et al. The accuracy of 1-day dual-isotope myocardial SPECT in a population with high prevalence of coronary artery disease. Int J Cardiovasc Imaging 2003;19:229-38.PubMedCrossRef

28.

Peltier M, Vancraeynest D, Pasquet A, Ay T, Roelants V, D’hondt AM, et al. Assessment of the physiologic significance of coronary disease with dipyridamole real-time myocardial contrast echocardiography. Comparison with technetium-99m sestamibi single-photon emission computed tomography and quantitative coronary angiography. J Am Coll Cardiol 2004;43:257-64.PubMedCrossRef

29.

Senior R, Lepper W, Pasquet A, Chung G, Hoffman R, Vanoverschelde JL, et al. Myocardial perfusion assessment in patients with medium probability of coronary artery disease and no prior myocardial infarction: Comparison of myocardial contrast echocardiography with 99mTc single-photon emission computed tomography. Am Heart J 2004;147:1100-5.PubMedCrossRef

30.

Sakuma H, Suzawa N, Ichikawa Y, Makino K, Hirano T, Kitagawa K, et al. Diagnostic accuracy of stress first-pass contrast-enhanced myocardial perfusion MRI compared with stress myocardial perfusion scintigraphy. AJR Am J Roentgenol 2005;185:95-102.PubMedCrossRef

31.

Squires SR, Bushnell DL, Menda Y, Graham MM. Comparison of cardiac to hepatic uptake of 99mTc-tetrofosmin with and without adenosine infusion to predict the presence of haemodynamically significant coronary artery disease. Nucl Med Commun 2005;26:513-8.PubMedCrossRef

32.

Lin SL, Chiou KR, Huang WC, Peng NJ, Tsay DG, Liu CP. Detection of coronary artery disease using real-time myocardial contrast echocardiography: A comparison with dual-isotope resting thallium-201/stress technectium-99m sestamibi single-photon emission computed tomography. Heart Vessels 2006;21:226-35.PubMedCrossRef

33.

Berman DS, Kang X, Nishina H, Slomka PJ, Shaw LJ, Hayes SW, et al. Diagnostic accuracy of gated Tc-99m sestamibi stress myocardial perfusion SPECT with combined supine and prone acquisitions to detect coronary artery disease in obese and nonobese patients. J Nucl Cardiol 2006;13:191-201.PubMedCrossRef

34.

Jeetley P, Hickman M, Kamp O, Lang RM, Thomas JD, Vannan MA, et al. Myocardial contrast echocardiography for the detection of coronary artery stenosis: A prospective multicenter study in comparison with single-photon emission computed tomography. J Am Coll Cardiol 2006;47:141-5.PubMedCrossRef

35.

Korosoglou G, Dubart AE, DaSilva KG Jr, Labadze N, Hardt S, Hansen A, et al. Real-time myocardial perfusion imaging for pharmacologic stress testing: Added value to single photon emission computed tomography. Am Heart J 2006;151:131-8.PubMedCrossRef

36.

Matsumoto N, Sato Y, Suzuki Y, Yoda S, Kunimasa T, Kato M, et al. Usefulness of rapid low-dose/high-dose 1-day 99mTc-sestamibi ECG-gated myocardial perfusion single-photon emission computed tomography. Circ J 2006;70:1585-9.PubMedCrossRef

37.

Weinsaft JW, Gade CL, Wong FJ, Kim HW, Min JK, Manoushagian SJ, et al. Diagnostic impact of SPECT image display on assessment of obstructive coronary artery disease. J Nucl Cardiol 2007;14:659-68.PubMedCrossRef

38.

Yeih DF, Huang PJ, Ho YL. Enhanced diagnosis of coronary artery disease in women by dobutamine thallium-201 ST-segment/heart rate slope and thallium-201 myocardial SPECT. J Formos Med Assoc 2007;106:832-9.PubMedCrossRef

39.

Lipiec P, Wejner-Mik P, Krzemińska-Pakuła M, Kuśmierek J, Płachcińska A, Szumiński R, et al. Accelerated stress real-time myocardial contrast echocardiography for the detection of coronary artery disease: Comparison with 99mTc single photon emission computed tomography. J Am Soc Echocardiogr 2008;21:941-7.PubMedCrossRef

40.

Tadehara F, Yamamoto H, Tsujiyama S, Hinoi T, Matsuo S, Matsumoto N, et al. Feasibility of a rapid protocol of 1-day single-isotope rest/adenosine stress Tc-99m sestamibi ECG-gated myocardial perfusion imaging. J Nucl Cardiol 2008;15:35-41.PubMedCrossRef

41.

Wu MC, Chin KC, Lin KH, Chiu NT. Diagnostic efficacy of a low-dose 32-projection SPECT 99mTc-sestamibi myocardial perfusion imaging protocol in routine practice. Nucl Med Commun 2009;30:140-7.PubMedCrossRef

42.

Shin JH, Pokharna HK, Williams KA, Mehta R, Ward RP. SPECT myocardial perfusion imaging with prone-only acquisitions: Correlation with coronary angiography. J Nucl Cardiol 2009;16:590-6.PubMedCrossRef

43.

Patil HR, Bateman TM, McGhie AI, Burgett EV, Courter SA, Case JA, et al. Diagnostic accuracy of high-resolution attenuation-corrected Anger-camera SPECT in the detection of coronary artery disease. J Nucl Cardiol 2014;21:127-34.PubMedCrossRef

44.

Ueki Y, Izawa A, Kashiwagi D, Nishiyama S, Aso S, Suzuki C, et al. Diagnostic advantage of stress computed tomography myocardial perfusion over single-photon emission computed tomography for the assessment of myocardial ischemia. J Cardiol 2017;70:147-54.PubMedCrossRef

45.

Fiechter M, Ghadri JR, Kuest SM, Pazhenkottil AP, Wolfrum M, Nkoulou RN, et al. Nuclear myocardial perfusion imaging with a novel cadmium-zinc-telluride detector SPECT/CT device: First validation versus invasive coronary angiography. Eur J Nucl Med Mol Imaging 2011;38:2025-30.PubMedCrossRef

46.

Duvall WL, Sweeny JM, Croft LB, Barghash MH, Kulkarni NK, Guma KA, et al. Comparison of high efficiency CZT SPECT MPI to coronary angiography. J Nucl Cardiol 2011;18:595-604.PubMedCrossRef

47.

Duvall WL, Sweeny JM, Croft LB, Ginsberg E, Guma KA, Henzlova MJ. Reduced stress dose with rapid acquisition CZT SPECT MPI in a non-obese clinical population: Comparison to coronary angiography. J Nucl Cardiol 2012;19:19-27.PubMedCrossRef

48.

Chowdhury FU, Vaidyanathan S, Bould M, Marsh J, Trickett C, Dodds K, et al. Rapid-acquisition myocardial perfusion scintigraphy (MPS) on a novel gamma camera using multipinhole collimation and miniaturized cadmium-zinc-telluride (CZT) detectors: Prognostic value and diagnostic accuracy in a ‘real-world’ nuclear cardiology service. Eur Heart J Cardiovasc Imaging 2014;15:275–83.PubMedCrossRef

49.

Perrin M, Djaballah W, Moulin F, Claudin M, Veran N, Imbert L, et al. Stress-first protocol for myocardial perfusion SPECT imaging with semiconductor cameras: High diagnostic performances with significant reduction in patient radiation doses. Eur J Nucl Med Mol Imaging 2015;42:1004-11.PubMedCrossRef

50.

Nishiyama Y, Miyagawa M, Kawaguchi N, Nakamura M, Kido T, Kurata A, et al. Combined supine and prone myocardial perfusion single-photon emission computed tomography with a cadmium zinc telluride camera for detection of coronary artery disease. Circ J 2014;78:1169-75.PubMedCrossRef

51.

Barone-Rochette G, Leclere M, Calizzano A, Vautrin E, Céline GC, Broisat A, et al. Stress thallium-201/rest technetium-99m sequential dual-isotope high-speed myocardial perfusion imaging validation versus invasive coronary angiography. J Nucl Cardiol 2015;22:513-22.PubMedCrossRef

52.

Gimelli A, Liga R, Duce V, Kusch A, Clemente A, Marzullo P. Accuracy of myocardial perfusion imaging in detecting multivessel coronary artery disease: A cardiac CZT study. J Nucl Cardiol 2017;24:687-95.PubMedCrossRef

53.

Sharir T, Pinskiy M, Pardes A, Rochman A, Prokhorov V, Kovalski G, et al. Comparison of the diagnostic accuracies of very low stress-dose with standard-dose myocardial perfusion imaging: Automated quantification of one-day, stress-first SPECT using a CZT camera. J Nucl Cardiol 2016;23:11-20.PubMedCrossRef

54.

Caobelli F, Akin M, Thackeray JT, Brunkhorst T, Widder J, Berding G, et al. Diagnostic accuracy of cadmium-zinc-telluride-based myocardial perfusion SPECT: Impact of attenuation correction using a co-registered external computed tomography. Eur Heart J Cardiovasc Imaging 2016;17:1036-43.PubMedCrossRef

55.

Makita A, Matsumoto N, Suzuki Y, Hori Y, Kuronuma K, Yoda S, et al. Clinical feasibility of simultaneous acquisition rest (99m)Tc/stress (201)Tl dual-isotope myocardial perfusion single-photon emission computed tomography with semiconductor camera. Circ J 2016;80:689-95.PubMedCrossRef

56.

Miyagawa M, Nishiyama Y, Uetani T, Ogimoto A, Ikeda S, Ishimura H, et al. Estimation of myocardial flow reserve utilizing an ultrafast cardiac SPECT: Comparison with coronary angiography, fractional flow reserve, and the SYNTAX score. Int J Cardiol 2017;244:347-53.PubMedCrossRef

57.

Mouden M, Ottervanger JP, Knollema S, Timmer JR, Reiffers S, Oostdijk AH, et al. Myocardial perfusion imaging with a cadmium zinc telluride-based gamma camera versus invasive fractional flow reserve. Eur J Nucl Med Mol Imaging 2014;41:956-62.PubMedCrossRef

58.

Liu CJ, Wu YW, Ko KY, Chen YC, Cheng MF, Yen RF, et al. Incremental diagnostic performance of combined parameters in the detection of severe coronary artery disease using exercise gated myocardial perfusion imaging. PLoS ONE 2015;10:e0134485.PubMedPubMedCentralCrossRef

59.

Shiraishi S, Sakamoto F, Tsuda N, Yoshida M, Tomiguchi S, Utsunomiya D, et al. Prediction of left main or 3-vessel disease using myocardial perfusion reserve on dynamic thallium-201 single-photon emission computed tomography with a semiconductor gamma camera. Circ J 2015;79:623-31.PubMedCrossRef

60.

Megna R, Zampella E, Assante R, Nappi C, Gaudieri V, Mannarino T, et al. Temporal trends of abnormal myocardial perfusion imaging in a cohort of Italian subjects: Relation with cardiovascular risk factors. J Nucl Cardiol 2019. https://doi.org/10.1007/s12350-019-01630-1.CrossRefPubMed

61.

Thomas GS, Miyamoto MI, Morello AP, Majmundar H, Thomas JJ, Sampson CH, et al. Technetium 99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting. The nuclear utility in the Community (NUC) study. J Am Coll Cardiol 2004;43:213-23.PubMedCrossRef

62.

Seo Y, Mari C, Hasegawa BH. Technological development and advances in single-photon emission computed tomography/computed tomography. Semin Nucl Med 2008;38:177-98.PubMedPubMedCentralCrossRef

63.

Giorgetti A, Rossi M, Stanislao M, Valle G, Bertolaccini P, Maneschi A, et al. Feasibility and diagnostic accuracy of a gated SPECT early-imaging protocol: A multicenter study of the Myoview Imaging Optimization Group. J Nucl Med 2007;48:1670-5.PubMedCrossRef

64.

Agostini D, Marie PY, Ben-Haim S, Rouzet F, Songy B, Giordano A, et al. Performance of cardiac cadmium-zinc-telluride gamma camera imaging in coronary artery disease: A review from the cardiovascular committee of the European Association of Nuclear Medicine (EANM). Eur J Nucl Med Mol Imaging 2016;43:2423-32.PubMedCrossRef

65.

Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomized controlled trials. BMJ 2011;343:4002.CrossRef

66.

Gimelli A, Bottai M, Giorgetti A, Genovesi D, Kusch A, Ripoli A, et al. Comparison between ultrafast and standard SPECT in patients with coronary artery disease: A pilot study. Circul Cardiovasc Imag 2011;4:51-8.CrossRef

67.

Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM. The diagnostic odds ratio: A single indicator of test performance. J Clin Epidemiol 2003;56:1129-35.PubMedCrossRef

Title: Diagnostic performance of myocardial perfusion imaging with conventional and CZT single-photon emission computed tomography in detecting coronary artery disease: A meta-analysis
Authors: Valeria Cantoni, PhD
Roberta Green, PhD
Wanda Acampa, MD, PhD
Emilia Zampella, MD, PhD
Roberta Assante, MD, PhD
Carmela Nappi, MD, PhD
Valeria Gaudieri, MD, PhD
Teresa Mannarino, MD
Renato Cuocolo, MD
Eugenio Di Vaia, MD
Mario Petretta, MD, FAHA
Alberto Cuocolo, MD
Publication date: 01-04-2021
Publisher: Springer International Publishing
Keyword: Arterial Diseases
Published in: Journal of Nuclear Cardiology / Issue 2/2021
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-019-01747-3

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Diagnostic performance of myocardial perfusion imaging with conventional and CZT single-photon emission computed tomography in detecting coronary artery disease: A meta-analysis

Abstract

Background

Methods

Results

Conclusions

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