Cardiac Hybrid Imaging (PET/CT and SPECT/CT): Assessment of CAD

  • Gabriel Vorobiof
  • Zohar Keidar
  • Sharmila Dorbala
  • Marcelo F. Di Carli


The field of nuclear cardiology is witnessing a rapid growth in the installed base of hybrid SPECT/CT and PET/CT scanners. Although the CT component in the original hybrid SPECT/CT scanners was conceived only as a tool for performing attenuation correction (AC), this is now rapidly evolving into a multi-detector CT configuration that allows acquisition of diagnostic anatomic information including coronary calcium scoring (CCS) and coronary CT angiography (CCTA). A similar evolution has occurred with PET/CT devices. Original scanners were designed only for oncologic imaging and fitted with single- or two-slice CT scanners.1 However, this has evolved very rapidly, and 16-slice or higher CT configuration is common across all manufacturers.


Positron Emission Tomography Myocardial Perfusion Left Anterior Descend Attenuation Correction Coronary Compute Tomography Angiography 
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  1. 1.
    Beyer T, Townsend DW, Brun T, Kinahan PE, Charron M, Roddy R, Jerin J, Young J, Byars L, Nutt R. A combined PET/CT scanner for clinical oncology. J Nucl Med 2000;41:1369–1379.PubMedGoogle Scholar
  2. 2.
    O'Connor MK, Kemp B, Anstett F, Christian P, Ficaro EP, Frey E, Jacobs M, Kritzman JN, Pooley RA, Wilk M. A multicenter evaluation of commercial attenuation compensation techniques in cardiac SPECT using phantom models. J Nucl Cardiol 2002;9:361–376.CrossRefPubMedGoogle Scholar
  3. 3.
    Stone CD, McCormick JW, Gilland DR, Greer KL, Coleman RE, Jaszczak RJ. Effect of registration errors between transmission and emission scans on a SPECT system using sequential scanning. J Nucl Med 1998;39:365–373.PubMedGoogle Scholar
  4. 4.
    Garcia EV. SPECT attenuation correction: an essential tool to realize nuclear cardiology's manifest destiny. J Nucl Cardiol Jan 2007;14:16–24.CrossRefGoogle Scholar
  5. 5.
    Sampson UK, Dorbala S, Limaye A, Kwong R, Di Carli MF. Diagnostic accuracy of rubidium-82 myocardial perfusion imaging with hybrid positron emission tomography/computed tomography in the detection of coronary artery disease. J Am Coll Cardiol 2007;49:1052–1058.CrossRefPubMedGoogle Scholar
  6. 6.
    Di Carli MF, Dorbala S, Meserve J, El Fakhri G, Sitek A, Moore SC. Clinical myocardial perfusion PET/CT. J Nucl Med 2007;48:783–793.CrossRefPubMedGoogle Scholar
  7. 7.
    Earls JP, Berman EL, Urban BA, Curry CA, Lane JL, Jennings RS, McCulloch CC, Hsieh J, Londt JH. Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose. Radiology 2008;246:742–753.CrossRefPubMedGoogle Scholar
  8. 8.
    Di Carli MF, Dorbala S. Detection and evaluation of coronary artery disease with myocardial perfusion-gated SPECT imaging. In St. John Sutton MG RJ (ed): Clinical cardiovascular imaging: A companion to Braunwald's heart disease. Philadelphia: Elsevier Saunders, 2004; 115–125.Google Scholar
  9. 9.
    Chow BJ, Beanlands RS, Lee A, DaSilva J, deKemp R, Alkahtani A, Ruddy T. Treadmill exercise produces larger perfusion defects than dipyridamole stress N-13 ammonia positron emission tomography. J Am Coll Cardiol 2006;47:411–416.CrossRefPubMedGoogle Scholar
  10. 10.
    Gould KL, Pan T, Loghin C, Guha A, Sdringola S. Frequent diagnostic errors in cardiac PET/CT due to misregistration of CT attenuation and emission PET images: a definitive analysis of causes, consequences, and corrections. J Nucl Med 2007;48:1112–1121.CrossRefPubMedGoogle Scholar
  11. 11.
    Klocke FJ, Baird MG, Lorell BH et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging – executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol 2003;42:1318–1333.CrossRefPubMedGoogle Scholar
  12. 12.
    Di Carli MF, Hachamovitch R. New technology for noninvasive evaluation of coronary artery disease. Circulation 2007;115:1464–1480.CrossRefPubMedGoogle Scholar
  13. 13.
    Hacker M, Jakobs T, Matthiesen F, Vollmar C, Nikolaou K, Becker C, Knez A, Pfluger T, Reiser M, Hahn K, Tiling R. Comparison of spiral multidetector CT angiography and myocardial perfusion imaging in the noninvasive detection of functionally relevant coronary artery lesions: First clinical experience. J Nucl Med 2005;46:1294–1300.PubMedGoogle Scholar
  14. 14.
    Schuijf JD, Wijns W, Jukema JW, Atsma D, de Roos A, Lamb H, Stokkel M, Dibbets-Schneider P, Decramer I, De Bondt P. Relationship between noninvasive coronary angiography with multi-slice computed tomography and myocardial perfusion imaging. J Am Coll Cardiol 2006;48:2508–2514.CrossRefPubMedGoogle Scholar
  15. 15.
    Gaemperli O, Schepis T, Kalff V, Namdar M, Valenta I, Stefani L, Desbiolles L, Leschka S,  Husmann L, Alkadhi H, Kaufmann PA. Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography. Eur J Nucl Med Mol Imaging 2007;34:1097–1106.CrossRefPubMedGoogle Scholar
  16. 16.
    Gaemperli O, Schepis T, Valenta I, Husmann L, Scheffel H, Duerst V, Eberli FR, Luscher TF, Alkadhi H, Kaufmann PA. Cardiac image fusion from stand-alone SPECT and CT: Clinical experience. J Nucl Med May 2007;48:696–703.CrossRefGoogle Scholar
  17. 17.
    Di Carli MF, Dorbala S, Curillova Z, Kwong R, Goldhaber S, Rybicki F, Hachamovitch R. Relationship between CT coronary angiography and stress perfusion imaging in patients with suspected ischemic heart disease assessed by integrated PET-CT imaging. J Nucl Cardiol 2007;14:799–809.CrossRefPubMedGoogle Scholar
  18. 18.
    Rispler S, Keidar Z, Ghersin E, Roguin A, Soil A, Dragu R, Litmanovich D, Frenkel A, Aronson D, Engel A. Integrated single-photon emission computed tomography and computed tomography coronary angiography for the assessment of hemodynamically significant coronary artery lesions. J Am Coll Cardiol 2007;49:1059–1067.CrossRefPubMedGoogle Scholar
  19. 19.
    Delbeke D, Keidar Z, Kronenberg MW, Churchwell K, Brenner R, Patton JA, Rispler S, Israel O, Sandler MP. Integrated rest/stress myocardial perfusion SPECT (MPS) and 64-slice coronary CTA: Impact on management in patients with intermediate likelihood of CAD. Annual meeting of SNM, June 14–18, 2008, New Orleans, LA. J Nucl Med 2008; 49 (suppl 1):205PGoogle Scholar
  20. 20.
    Hacker M, Jakobs T, Hack N, Nikolaou K, Becker C, von Ziegler F, Knez A, König A, Klauss V, Reiser M,  Hahn K, Tiling R. Sixty-four slice spiral CT angiography does not predict the functional relevance of coronary artery stenoses in patients with stable angina. Eur J Nucl Med Mol Imaging 2007;34:4–10.CrossRefPubMedGoogle Scholar
  21. 21.
    Schenker MP, Dorbala S, Hong EC, Rybicki FJ, Hachamovitch R, Kwong RY, Di Carli MF. Interrelation of coronary calcification, myocardial ischemia, and outcomes in patients with intermediate likelihood of coronary artery disease: A combined positron emission tomography/computed tomography study. Circulation 2008;117:1693–1700.CrossRefPubMedGoogle Scholar
  22. 22.
    Min JK, Shaw LJ, Devereux RB, Okin P, Weinsaft J, Russo D, Lippolis N, Berman D, Callister T. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J Am Coll Cardiol. 2007;50:1161–1170.CrossRefPubMedGoogle Scholar
  23. 23.
    Shaw LJ, Hachamovitch R, Berman DS, Marwick TH, Lauer MS, Heller GV, Iskandrian AE, Kesler KL, Travin MI, Lewin HC, Hendel RC, Borges-Neto S, Miller DD, and for the Economics of Noninvasive Diagnosis (END) Multicenter Study Group. The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group. J Am Coll Cardiol 1999;33:661–669.CrossRefPubMedGoogle Scholar
  24. 24.
    Budoff MJ, Shaw LJ, Liu ST, Weinstein S, Mosler T, Tseng P, Flores F,. Callister T, Raggi P, Berman D. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol 2007;49:1860–1870.CrossRefPubMedGoogle Scholar
  25. 25.
    Greenland P, Bonow RO, Brundage BH et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 2007;49:378–402.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Gabriel Vorobiof
    • 1
  • Zohar Keidar
    • 2
  • Sharmila Dorbala
    • 3
  • Marcelo F. Di Carli
    • 4
  1. 1.Department of Cardiovascular ImagingYale UniversityNew HavenUSA
  2. 2.Department of Nuclear MedicineB. and R. Rappaport School of Medicine Rambam Health Care CampusHaifaIsrael
  3. 3.Department of Radiology and MedicineBrigham and Women’s Hospital, Harvard UniversityBostonUSA
  4. 4.Department of Medicine and Radiology, Division of Nuclear Medicine-PETBrigham and Women’s HospitalBostonUSA

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