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(Circulation. 1998;97:843-850.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

[¹⁸F]Fluorodeoxyglucose Single Photon Emission Computed Tomography

Can It Replace PET and Thallium SPECT for the Assessment of Myocardial Viability?

Gopal Srinivasan, MD; Anastasia N. Kitsiou, MD; Stephen L. Bacharach, PhD; Marissa L. Bartlett, PhD; Claiborne Miller-Davis, RN; ; Vasken Dilsizian, MD

From the Cardiology Branch, National Heart, Lung, and Blood Institute and the Department of Nuclear Medicine, National Institutes of Health, Bethesda, Md.

Correspondence to Gopal Srinivasan, MD, National Institutes of Health, 10 Center Dr, MSC 1650, Cardiology Branch, NHLBI, Building 10, Room 7B-15, Bethesda, MD 20892-1650.

Background—New high-energy collimators for single photon emission computed tomography (SPECT) cameras have made imaging of positron-emitting tracers, such as [¹⁸F]fluorodeoxyglucose (¹⁸FDG), possible. We examined differences between SPECT and PET technologies and between ¹⁸FDG and thallium tracers to determine whether ¹⁸FDG SPECT could be adopted for assessment of myocardial viability.

Methods and Results—Twenty-eight patients with chronic coronary artery disease (mean left ventricular ejection fraction [LVEF]=33±15% at rest) underwent ¹⁸FDG SPECT, ¹⁸FDG PET, and thallium SPECT studies. Receiver operating characteristic curves showed overall good concordance between SPECT and PET technologies and thallium and ¹⁸FDG tracers for assessing viability regardless of the level of ¹⁸FDG PET cutoff used (40% to 60%). However, in the subgroup of patients with LVEF25%, at 60% ¹⁸FDG PET threshold value, thallium tended to underestimate myocardial viability. In a subgroup of regions with severe asynergy, there were considerably more thallium/¹⁸FDG discordances in the inferior wall than elsewhere (73% versus 27%, P<.001), supporting attenuation of thallium as a potential explanation for the discordant observations. When uptake of ¹⁸FDG by SPECT and PET was compared in 137 segments exhibiting severely irreversible thallium defects (scarred by thallium), 59 (43%) were viable by ¹⁸FDG PET, of which 52 (88%) were also viable by ¹⁸FDG SPECT. However, of the 78 segments confirmed to be nonviable by ¹⁸FDG PET, 57 (73%) were nonviable by ¹⁸FDG SPECT (P<.001).

Conclusions—Although ¹⁸FDG SPECT significantly increases the sensitivity for detection of viable myocardium in tissue declared nonviable by thallium (to 88% of the sensitivity achievable by PET), it will occasionally (27% of the time) result in falsely identifying as viable tissue that has been identified as nonviable by both PET and thallium.

Key Words: myocardium • coronary disease • tomography • radioisotopes • nuclear medicine

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