Diagnostic Accuracy of Cadmium Zinc Tellurite (CZT) Detector-Based Dynamic Single Photon Emission Computed Tomography (D-SPECT) Myocardial Perfusion Imaging (MPI) in the Evaluation of Coronary Artery Disease (CAD)

Q: What are the key findings of this study?

CZT detector-based dynamic SPECT MPI demonstrated excellent diagnostic accuracy for detecting coronary artery disease compared to coronary angiography, achieving a sensitivity of 87.8%, specificity of 95.9%, and an AUC of 0.919.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary Artery Disease (CAD) (n=198). Intervention: CZT detector-based dynamic SPECT MPI vs. Coronary angiography. Primary outcome: Detection of coronary artery disease (AUC 0.919, p=<0.001).

Q: What does this research mean for the field?

CZT detector-based dynamic SPECT MPI demonstrates high diagnostic accuracy for detecting coronary artery disease compared to coronary angiography, achieving a sensitivity of 87.8%, specificity of 95.9%, and an overall accuracy of 92.9%. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the diagnostic accuracy of cadmium zinc telluride (CZT) detector-based dynamic SPECT myocardial perfusion imaging (MPI) in detecting coronary artery disease, using coronary angiography as the reference standard.

Muhammad Inamullah Nouman; Zaigham Salim Dar; Muhammad Adil; Mehdi Raza

doi:10.51253/pafmj.v76isuppl-8.13354

July 16, 2026Pakistan Armed Forces Medical JournalOpen Access

Diagnostic Accuracy of Cadmium Zinc Tellurite (CZT) Detector-Based Dynamic Single Photon Emission Computed Tomography (D-SPECT) Myocardial Perfusion Imaging (MPI) in the Evaluation of Coronary Artery Disease (CAD)

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Key result

Dynamic CZT SPECT MPI accurately detects CAD vs. angiography with an AUC of ~0.92.

AUC 0.919
P<0.001
n=198

Why the study?

The diagnostic accuracy of CZT detector-based dynamic SPECT MPI for detecting CAD using coronary angiography as the reference standard was assessed.

Does Cadmium Zinc Tellurite (CZT) detector-based dynamic SPECT MPI accurately detect coronary artery disease in patients with suspected CAD compared to invasive coronary angiography?

Key Points

To evaluate the diagnostic accuracy of cadmium zinc telluride (CZT) detector-based dynamic SPECT myocardial perfusion imaging (MPI) in detecting coronary artery disease, using coronary angiography as the reference standard.
Conducted a cross-sectional observational study of 198 patients who underwent coronary angiography within three months of dynamic SPECT MPI at AFIC/NIHD in Rawalpindi, Pakistan.
Performed dynamic SPECT MPI with a CZT detector-based camera following 99mTc-Sestamibi administration during resting and adenosine-induced stress phases.
Calculated myocardial blood flow and myocardial flow reserve (MFR), defining coronary artery disease as an MFR value < 2, and compared results against invasive coronary angiography.
D-SPECT MPI diagnosed CAD in 70 patients (35.4%), whereas invasive coronary angiography confirmed CAD in 74 patients (37.4%).
Compared to gold-standard coronary angiography, D-SPECT MPI demonstrated a sensitivity of 87.8%, specificity of 95.9%, positive predictive value of 92.8%, negative predictive value of 92.9%, and diagnostic accuracy of 92.9%.
Receiver operating characteristic analysis revealed an area under the curve (AUC) of 0.919 (p-value <0.001) for discriminating between patients with and without CAD.

Study Design

Type

Cross-Sectional (n=198)

Multicenter

No

Structured PICO

Does Cadmium Zinc Tellurite (CZT) detector-based dynamic SPECT MPI accurately detect coronary artery disease in patients with suspected CAD compared to invasive coronary angiography?

P

Population

198 adult patients (mean age 56 years, 15.7% female) with suspected or known coronary artery disease who underwent both CZT-based dynamic SPECT MPI and coronary angiography.

E

Exposure

Cadmium Zinc Tellurite (CZT) detector-based dynamic Single Photon Emission Computed Tomography (D-SPECT) Myocardial Perfusion Imaging (MPI) using 99mTc-Sestamibi during rest and adenosine stress phases, with calculation of myocardial blood flow and myocardial flow reserve (MFR <2 indicating CAD).

C

Comparator

Invasive coronary angiography evaluated by two interventional cardiologists (significant CAD defined as stenosis ≥2 mm visual diameter, or ≥50% for Left Main Stem, or ≥75% for regional coronary arteries).

O

Outcome

Diagnostic accuracy (including sensitivity, specificity, positive predictive value, and negative predictive value) of D-SPECT MPI for the detection of CAD.surrogate

Main Result

Effect estimate: AUC 0.919

Absolute Event Rate: 35.4% vs 37.4%

p-value: p=<0.001

CZT detector-based dynamic SPECT MPI provides high diagnostic accuracy for coronary artery disease, serving as a rapid, lower-radiation, and cost-effective alternative to PET imaging for evaluating myocardial flow reserve.

Limitations

Relatively small sample size
Lack of direct comparison with PET-derived MFR, the gold standard
Weak correlation between stenosis severity and ischemia may have influenced diagnostic performance
Routine attenuation correction was impractical because most CZT-based SPECT cameras lack CT integration
Motion correction was not applied
Inter- and intra-observer variability and MBF/MFR reproducibility were not assessed
relatively small sample size
lack of direct comparison with PET-derived MFR
weak correlation between stenosis severity and ischemia as functional vs anatomical tests
routine attenuation correction was impractical
motion correction was not applied
inter- and intra-observer variability and MBF/MFR reproducibility were not assessed

Implication

May aid non-invasive CAD detection in similar settings; extends single-center accuracy data but leaves open prospective validation.

Abstract

Objective: To assess the diagnostic accuracy of CZT detector-based dynamic SPECT MPI for detecting coronary artery disease (CAD), using coronary angiography as the reference standard. Study Design: Cross-sectional Observational Study. Place & Duration of Study: Department of Nuclear Cardiology, AFIC/NIHD, Rawalpindi, Pakistan, from Jan to Jun 2024. Methodology: A total of 198 patients who underwent coronary angiography within three months of a D-SPECT MPI were included. Dynamic SPECT MPI was performed using a CZT detector-based camera following 99mTc-Sestamibi injection during rest and stress phases. Stress imaging incorporated Adenosine infusion. Myocardial blood flow (MBF) and myocardial flow reserve (MFR) values were calculated. An MFR value <2 indicated CAD. Coronary angiography, interpreted by two cardiologists. Results: Of 198 patients, 167 (84.3%) were males and 31 (15.7%) were females, with a mean age of 56.03 ±11.83 years. D-SPECT MPI diagnosed CAD in 70 (35.4%) patients, while the actual number of patients having CAD as diagnosed by coronary angiography was 74 (37.4%). The calculated sensitivity, specificity, PPV, NPV, and diagnostic accuracy of D-SPECT MPI, keeping coronary angiography as the gold standard, were 87.8%, 95.9%, 92.8%, 92.9%, and 92.9%, respectively. Conclusion: This single-center study demonstrates that CZT-based dynamic SPECT MPI offers shorter imaging time, less radiation exposure, and cost-effectiveness, making it a valuable non-invasive diagnostic modality. The system’s enhanced resolution and faster imaging acquisition contribute to its clinical utility.

Discussion

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Cite This Study

Nouman et al. (2026) conducted a cross-sectional in Coronary Artery Disease (CAD) (n=198). CZT detector-based dynamic SPECT MPI vs. Coronary angiography was evaluated on Detection of coronary artery disease (AUC 0.919, p=<0.001). CZT detector-based dynamic SPECT MPI demonstrated excellent diagnostic accuracy for detecting coronary artery disease compared to coronary angiography, achieving a sensitivity of 87.8%, specificity of 95.9%, and an AUC of 0.919.

synapsesocial.com/papers/6ad0fc263afa093ea9acfc9b https://doi.org/10.51253/pafmj.v76isuppl-8.13354

Topics

Coronary artery disease

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Diagnostic Accuracy of Cadmium Zinc Tellurite (CZT) Detector-Based Dynamic Single Photon Emission Computed Tomography (D-SPECT) Myocardial Perfusion Imaging (MPI) in the Evaluation of Coronary Artery Disease (CAD)

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Diagnostic Accuracy of Cadmium Zinc Tellurite (CZT) Detector-Based Dynamic Single Photon Emission Computed Tomography (D-SPECT) Myocardial Perfusion Imaging (MPI) in the Evaluation of Coronary Artery Disease (CAD)

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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