Quant Imaging Med Surg. 2026 Sep 1;16(9):715. doi: 10.21037/qims-2026-1-0321. Epub 2026 Aug 11.
ABSTRACT
BACKGROUND: Dynamic imaging with cardiac-dedicated cadmium-zinc-telluride single-photon emission computed tomography (CZT-SPECT) enables both the absolute quantification of myocardial blood flow (MBF) and the semi-quantitative assessment of myocardial perfusion imaging (MPI). This study aimed to investigate and compare differences in quantitative and semi-quantitative outcomes between technetium-99m-tetrofosmin (99mTc-TF; TF group) and technetium-99m-sestamibi (99mTc-MIBI; MIBI group) using a continuous rapid dynamic acquisition protocol.
METHODS: Patients with no or mild coronary artery disease (CAD) who underwent myocardial flow reserve (MFR) assessment using a CZT-SPECT continuous rapid dynamic acquisition protocol were retrospectively enrolled in the study (n=100 per group). Quantitative perfusion parameters [rest MBF (rMBF), stress MBF (sMBF), and MFR] were compared between groups for each coronary territory and the whole left ventricle (LV). Within-group coefficients of variation (CVs) and multivariate linear regression analyses were performed. Semi-quantitative perfusion indices and left ventricular functional parameters were also compared. MPI image quality was scored for both groups. Comparisons of scores and assessments of interobserver reproducibility were performed.
RESULTS: No significant differences were observed in the baseline demographic and clinical characteristics between the TF and MIBI groups (all P>0.05). Quantitative flow analysis revealed no significant between-group differences in rMBF for the left circumflex (LCX) artery, right coronary artery (RCA), or the global LV (all P>0.05). In contrast, significant between-group differences were observed in rMBF in the left anterior descending (LAD) artery, as well as in sMBF and MFR across all coronary territories and global LV values (all values were higher in the MIBI group than in the TF group; all P<0.05). The within-group CVs were consistently lower in the TF group than in the corresponding MIBI group. Additionally, the CVs for rMBF were lower than those for sMBF and MFR in both groups across all coronary territories and global LV values. Multivariate linear regression analysis showed negative beta (β) coefficients for TF relative to MIBI. No significant differences were found in the semi-quantitative MPI perfusion indices or the left ventricular functional parameters between groups (all P>0.05). Image quality scores differed significantly in both between-group comparisons and within-group comparisons between stress and rest imaging (all P<0.05). Scores were lower in the TF group than in the MIBI group, suggesting better MPI image quality with TF. Additionally, rest image scores were lower than stress image scores in both groups. The intraclass correlation coefficients (ICCs) were excellent (0.869-0.957, all P<0.05).
CONCLUSIONS: Under a continuous rapid dynamic acquisition protocol, 99mTc-TF provides conventional semi-quantitative perfusion parameters and left ventricular functional indices comparable to those obtained with 99mTc-MIBI, while offering superior MPI image quality. Differences in quantitative flow measurements were observed between the two tracers. These findings suggest that further head-to-head studies using positron emission tomography (PET) as the reference standard are warranted to establish TF-specific quantitative parameters.
PMID:42701568 | PMC:PMC13545601 | DOI:10.21037/qims-2026-1-0321