Comparison of 99mTc-sestamibi/18FDG DISA SPECT with PET for the detection of viability in patients with coronary artery disease and left ventricular dysfunction

Purpose: Dual-isotope simultaneous acquisition (DISA) single-photon emission computed tomography ( SPECT) is an attractive technique as it permits assessment of both myocardial glucose metabolism and perfusion within a single session, but few data on its accuracy for the assessment of viability are available as yet. In the present study, DISA SPECT was compared with positron emission tomography ( PET) for the detection of myocardial viability in normal and dysfunctional left ventricular (LV) myocardium. Methods: Fifty-eight patients with chronic coronary artery disease and LV dysfunction ( LV ejection fraction 33 +/- 12%) were studied. Patients underwent a 1-day dipyridamole stress Tc-99m-sestamibi/F-18-fluorodeoxyglucose ((18)FDG) DISA SPECT and N-13-ammonia/(18)FDG PET protocol. Within 1 week, resting MRI was performed to assess contractile function. Comparison of PET and SPECT data was performed using both visual and quantitative analysis. Results: The correlation of normalised activities of the flow tracers Tc-99m-sestamibi and N-13-ammonia was good (r = 0.82; p< 0.001). The correlation between the two 18FDG studies was also good (r = 0.83; p< 0.001). The agreement for the assessment of viability for all segments between DISA SPECT and PET was 82%, with a kappa-statistic of 0.59 (95% CI 0.53 - 0.64), without a significant difference; in dysfunctional segments only, the agreement was 82%, with a kappa-statistic of 0.63 ( 95% CI 0.56 - 0.70), without a significant difference. When the DISA SPECT data were analysed visually, the agreement between DISA SPECT and PET was 83%, with a kappa-statistic of 0.58 (95% CI 0.52 - 0.63), without a significant difference. Moreover, there was no significant difference between visual and quantitative DISA SPECT analysis for the detection of viability. Conclusion: This study shows an overall good agreement between Tc-99m-sestamibi/(18)FDG DISA SPECT and PET for the assessment of myocardial viability in patients with severe LV dysfunction. Quantitative or visual analysis of the SPECT data did not influence the agreement with PET, suggesting that visual assessment may be sufficient for clinical purposes.