Feasibility of dynamic stress 201Tl/rest 99mTc-tetrofosmin single photon emission computed tomography for quantification of myocardial perfusion reserve in patients with stable coronary artery disease

  • Sangwon Han
  • Young-Hak Kim
  • Jung-Min Ahn
  • Soo-Jin Kang
  • Jungsu S. Oh
  • Eonwoo Shin
  • Changhwan Sung
  • Sun Young Chae
  • Seung-Jung Park
  • Gillan Grimberg
  • Gil Kovalski
  • Dae Hyuk MoonEmail author
Original Article



We evaluated the feasibility of dynamic stress 201Tl/rest 99mTc-tetrofosmin SPECT imaging using a cardiac camera equipped with cadmium-zinc-telluride detectors for the quantification of myocardial perfusion reserve (MPR).


Subjects with stable known or suspected coronary artery disease (CAD) who had undergone or were scheduled to undergo fractional flow reserve (FFR) measurement were prospectively enrolled. Dynamic stress 201Tl/rest 99mTc-tetrofosmin SPECT imaging was performed using a dedicated multiple pinhole SPECT camera with cadmium-zinc-telluride detectors. MPR was derived using Corridor4DM software.


A total of 34 subjects were enrolled (25 men and 9 women; mean age 60.4 years). FFR was measured in 65 coronary arteries with intermediate lesions. The average global MPR was 2.58 ± 1.03. Global MPR was associated with the extent of CAD (P = 0.028) and global summed stress score (r = −0.60, P < 0.001). Regional MPR showed a significant correlation with diameter stenosis (r = −0.57, P < 0.001), minimum lumen diameter (r = 0.50, P < 0.001), summed stress score (r = −0.52, P < 0.001) and FFR (r = 0.52, P < 0.001). The area under the receiver operating characteristic curve of MPR for the diagnosis of functionally significant stenosis (FFR ≤0.8) was 0.79 (P < 0.001). The sensitivity and specificity of regional MPR were 67% and 83%, respectively, using a cut-off value of 2.0.


Dynamic stress 201Tl/rest 99mTc-tetrofosmin SPECT imaging and quantification of MPR is feasible in patients with stable CAD. The preliminary results of this study in a small number of patients require confirmation in a larger cohort to determine their implications for bolstering the role of SPECT imaging in the diagnosis and risk prediction of CAD.


Cadmium-zinc-telluride Single photon emission computed tomography Myocardial perfusion reserve Fractional flow reserve 



This study was supported by the Radiation Technology Development Program funded by the Ministry of Science, ICT, and Future Planning (grant number: NRF-2016M2A2A7A03913219 to Dae Hyuk Moon).

Compliance with ethical standards

Conflicts of interest

Dae Hyuk Moon has received research grants from GE Healthcare. All other authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 principles of the Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

259_2018_4057_MOESM1_ESM.pdf (326 kb)
ESM 1 (PDF 325 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sangwon Han
    • 1
  • Young-Hak Kim
    • 2
  • Jung-Min Ahn
    • 2
  • Soo-Jin Kang
    • 2
  • Jungsu S. Oh
    • 1
  • Eonwoo Shin
    • 1
  • Changhwan Sung
    • 1
  • Sun Young Chae
    • 1
  • Seung-Jung Park
    • 2
  • Gillan Grimberg
    • 3
  • Gil Kovalski
    • 3
  • Dae Hyuk Moon
    • 1
    Email author
  1. 1.Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Cardiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  3. 3.GE HealthcareHaifaIsrael

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