Evaluation of myocardial viability with technetium-99m hexakis-2-methoxyisobutyl isonitrile and iodine-123 phenylpentadecanoic acid and single photon emission tomography (original) (raw)
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Journal of Nuclear Medicine, 1997
25. Kobayashi 11. Asano R. Oka T. et al. Simultaneous evaluation of myocardial perfusion and fatty acid metabolism using dynamic SPECT with single injection of ‘23I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP). Jpn J Nuci Med 1995:32:19-29. 26. Tamaki N. Tadamura E. Kawamoto M. et al. Decreased uptake of iodinated branched fatty acid analog indicates metabolic alterations in ischemic myocardium. J Nuci Med 1995:36:1974-1980. 27. Schwaiger M. Schelbert HR. Ellison D. et al. Sustained regional abnormalities in cardiac metabolism after transient ischemia in the chronic dog model. J Am Coil Cardiol1985;6:336 -346. 28. Nienaber CA. Brunken RC. Sherman CT. et al. Metabolic and functional recovery of ischemic human myocardium after coronary angioplasty. J Am Coil Girdioi 1991🔞 966-978. 29. Matsuzaki M. Gallagher KP. Kemper WS. White F. Ross J Jr.
Journal of the American College of Cardiology, 1995
ObJectives. This study sought to develop a dual-isotope singleacquisition single-photon emission computed tomographic (SPECT) protocol using a multihead SPECT camera equipped with an ultra-high energy collimator to evaluate rest metabolism/ stress perfusion simultaneously with fluorine-18 (F-18) deoxyglucose/ technetium-99m (Tc-99m) 2-hexakis-2-methoxy-2-methylpropyl isonitrile (MIBI). Background. The most accurate and logistic method of identifying injured but viable myocardium remains a diagnostic challenge. Methods. Sixty-five patients were given 25 to 50 g of glucose and, after-60 min, an injection of 370 MBq (10 mCi) of F-18 fluorodeoxyglucose. After a 35-min distribution phase, patients underwent exercise or pharmacologic stress followed by administration of 925 MBq (25 mCi) of Tc-99m MIBI. Five patients underwent F-18 fluorodeoxyglucose positron emission tomography before dualisotope SPECT. Results. With a window of 20% for both photopeaks and a technetium-99m/fluorine-18 concentration of 3.2:1, the "spiliover" from fluorine-18 into the technetium-99m window is <6% of the total counts in the window in patients with a normal distribution of both radiopharmaceuticals. Phantom images clearly demonstrated cardiac defects measuring 2 x 1 and 2 x 0.5 cm. There was no significant difference in the images of the five patients who underwent both positron emission tomography and SPECT. Fiftyseven patients (mean [+SD] age 55 + 15 years, range 25 to 83; 38 men, 19 women) had satisfactory images and were included in the study. Twenty-one patients had normal study results; 15 had mismatched defects; 14 had matched defects; and 7 had both matched and mismatched defects. Twenty.three patients (mean age 54-+ 6 years, range 30 to 83; 14 men, 9 women) underwent coronary angiography within 3 months of dual-isotope SPECT. There were seven normal studies, eight with mismatched defects, one with a matched defect and seven with matched and mismatched defects. When stenosis >70% was used as the criterion for a diagnosis of coronary artery disease, dual-isotope SPECT had a sensitivity of 100%, specificity of 88%, positive predictive value of 93%, negative predictive value of 100% and an accuracy of 96%. Conclusions. Dual-isotope SPECT may provide an alternative, accurate, cost-effective method to nitrogen-13 ammonia/F-18 fluorodeoxyglucose positron emission tomography or thallium-201 reinjection for identifying injured or dysfunctional but viable myocardium.
Nuclear Medicine Communications, 2003
Dual isotope simultaneous acquisition single photon emission computed tomography (DISA SPECT) offers the advantage of obtaining information on myocardial perfusion using 99m Tc-sestamibi (99m Tc-MIBI) and metabolism using 18 F-fluorodeoxyglucose (18 F-FDG) in a single study. The prerequisite is that the 99m Tc-MIBI images are not degraded by scattered 511 keV photons or poor count statistics due to the lower efficiency of the extra high energy (EHE) collimator. Therefore, we compared the registered 99mTc-MIBI uptake and image quality of DISA and single isotope acquisition. Furthermore, we investigated whether DISA yields additional information for the assessment of myocardial viability in comparison with rest± stress 99m Tc-MIBI. Nineteen patients with known coronary artery disease and irreversible perfusion defects on previous rest±stress MIBI test studies were investigated. After oral glucose loading and simultaneous injection of 600 MBq of 99m Tc-MIBI and 185 MBq of 18 F-FDG at rest, DISA was performed using energy windows of 140 (+15%), 170 (+20%) and 511 keV (+15%). Planar 140 keV images were corrected for scatter by subtraction using the 170 keV window. The single and dual isotope 99m Tc-MIBI images were both displayed in a polar map with 128 segments normalized to maximum counts. 18 F-FDG and 99m Tc-MIBI images were visually scored for a perfusion±metabolism mismatch pattern using nine regions per heart. There was an excellent correlation (r = 0.93, P50.0001) between the 99m Tc-MIBI uptake detected in the single and dual isotope acquisition. The average difference between the dual and single isotope 99mTc-MIBI uptake was 71.2% (not significantly different from zero) and the coefficient of variation of the difference was 8.7%. Of the 79 regions with irreversible perfusion defects on previous rest±stress 99m Tc-MIBI, six regions in five patients showed a perfusion±metabolism mismatch pattern. We conclude that DISA does not affect the quality of the 99mTc-MIBI images. Furthermore, 18 F-FDG-99m Tc-MIBI DISA may show viability in a small but significant (7.6%, P50.0034) number of regions with irreversible perfusion defects on rest±stress 99m Tc-MIBI. (# 2003 Lippincott Williams & Wilkins)
European Journal of Nuclear Medicine, 1992
We tested the possibility of identifying areas of hibernating myocardium by the combined assessment of perfusion and metabolism using single photon emission tomography (SPET) with technetium-99m hexakis 2-methoxyisobutylisonitrile (99mTc-MIBI) and positron emission tomography (PET) with fluorine-18 fluoro-2-deoxy-d-glucose (18F-FDG). Segmental wall motion, perfusion and 18F-FDG uptake were scored in 5 segments in 14 patients with coronary artery disease (CAD), for a total number of 70 segments. Each subject underwent the following studies prior to and following coronary arterybypass grafting (CABG): first-pass radionuclide angiography, electrocardiography gated planar perfusion scintigraphy and SPET perfusion scintigraphy with 99mTc-MIBI and, after 16 h fasting, 18F-FDG/PET metabolic scintigraphy. Wall motion impairment was either decreased or completely reversed by CABG in 95% of the asynergic segments which exhibited 18F-FDG uptake, whereas it was unmodified in 80% of the asynergic segments with no 18-FDG uptake. A stepwise multiple logistic analysis was carried out on the asynergic segments to estimate the postoperative probability of wall motion improvement on the basis of the preoperative regional perfusion and metabolic scores. The segments with the highest probability (96%) of functional recovery from preoperative asynergy after revascularization were those with a marked 18F-FDG uptake prior to CABG. High probabilities of functional recovery were also estimated for the segments presenting with moderate and low 18F-FDG uptake (92% and 79%, respectively). A low probability of functional recovery (13 %) was estimated in the segments with no 18F-FDG uptake. Despite the potential limitations due to the semiquantitative analysis of the images, the method appears to provide reliable information for the diagnostic and prognostic evaluation of patients with CAD undergoing CABG and confirms that the identification of hibernating myocardium with 18F-FDG is of paramount importance in the diagnosis of patients undergoing CABG.
International Journal of Cardiology, 2003
Background: Myocardial perfusion (MP) can be assessed in real time when using a low mechanical index (MI) and harmonic imaging following an intravenous injection of contrast agent. The aim of the study was to determine the feasibility and accuracy of the real-time imaging of contrast echocardiography (MCE) for detecting myocardial perfusion defects at rest and during dobutamine stress 99m echocardiography (DE) compared with Tc MIBI SPECT. The study group consisted of 44 patients (24 men, 20 women, mean age 58.967.8) with suspected coronary artery disease (CAD). All patients underwent DE. Wall motion (WM) and segmental perfusion were estimated in real time before and at peak stress using a low MI (0.4) after 0.3 ml bolus injections of intravenous Optison. All patients 99m underwent a rest and exercise Tc MIBI SPECT study (SPECT). A 16-segment model of the left ventricle was used for the analysis of MP, WM and SPECT by a blinded reviewer. All patients underwent coronary angiography. Significant coronary artery disease was defined as .60% luminal diameter stenosis. Results: All patients had significant CAD. Twenty-nine patients had single-vessel and 15 patients had double-vessel disease. For all patients, agreement between MCE and SPECT was 89%, between MCE and WM 286%, and between SPECT and WM 282%. The agreement between MCE and SPECT for LAD, RCA and Cx territories was 81, 91 and 73%, respectively. The sensitivity of MCE and SPECT for detecting perfusion defects due to significant CAD (confirmed angiographically) was 97% and 93%, respectively, and the specificity was 93 and 84%, respectively. Conclusion: MCE in real-time imaging with Optison has significant potential for the identification of MP abnormalities. MCE correlates very well with SPECT images.
A comparison of resting images from two myocardial perfusion tracers
European Journal of Nuclear Medicine, 1995
We have compared stress-redistribution and delayed rest thallium-201 with rest technetium-99m methoxyisobutylisonitrile (MIBI) tomograms in order to compare the tracers for the assessment of myocardial viability and to validate a rapid protocol combining the two tracers. We studied 30 consecutive patients with known or suspected coronary artery disease [group 1:16 with normal left ventricular function, mean left ventricular ejection fraction (LVEF) 55%, SD 6%; group 2:14 with abnormal function, mean LVEF 28%, SD 8%]. 2°1T1 was injected during infusion of adenosine followed by acquisition of conventional stress and redistribution tomograms. On a separate day, 201T1 was injected at rest with imaging 4 h later. 99mTc-MIBI was then given at rest and imaging was performed. Three images were compared: redistribution 20IT1, rest 2°IT1, and rest 99mTc-MIBI. Tracer activity was classified visually and quantitatively in nine segments and segments with>50% activity were defined as containing clinically significant viable myocardium. Mean (___SD) global tracer uptake as a percentage of maximum was similar in group 1 (rest 20~T1 69%___12%, redistribution 201T1 69%_+15%, rest 99mTc-MIBI 70%___13%, ANOVA P>0.05), but in group 2 mean tracer uptake was significantly greater in the rest 2°1T1 images (59%_+16%) than in redistribution 20IT1 images (53%_+17%) or rest 99mTc-MIBI images (53%_+19%) (ANOVA P=0.02). Overall agreement for regional uptake score was excellent (~c from 0.79 to 0.84), although there were a significant number of segments with less uptake shown by redistribution 201T1 and by rest 99mTc-MIBI than by rest 20iT1 in group 2 (P<0.001). The number of segments with significant viable myocardium in group 1 was very similar between the three images (P>0.05) but in group 2 rest 20~T1 identified significantly more segments as viable than the other images (McNemar P<0.001). Thus 201T1 and 99mTc-MIBI provide similar information in patients without prior infarction and with normal left ventricular function (group Correspondence to: S.R. Underwood, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, UK 1), and a rapid protocol with stress 2°IT1 injection and imaging followed immediately by rest 99mTc-MIBI injection and imaging is feasible. In patients with abnormal left ventricular function and prior infarction (group 2), 99mTc-MIBI may underestimate the extent of clinically significant viable myocardium.
The American Journal of Cardiology, 1990
extraction and prolonged myocardial retention of @Tc sestamibi, results in a higher imaging count density on single-photon emission computed tomography (SPEC!') than can be obtained with @°‘Tl. Higher counts result in improved SPEC!' image quality, a principal advantage of @â€oe@Tc-sestamibi. In general, @‘@Tc-sestamibi produces higher-qualityimages than @°‘11, thus increasing observer certainty and the probability that other laboratories can reproduce the results of reported clinical trials (1â€"3). Another important characteristic of @â€oe@Tc-sestamibi is its slow myocardial washout (4), which ameliorates con cern regardingthe prolongedimagingtimes associated with SPEC!'. If, for example, the patient moves during the initial @9'c-sestamibi SPEC!' study, the acquisition can be repeated without major compromise to the amount of clinical information obtained. Conversely, with 201'fl,the possibility of early redistribution decreases the reliability of a repeat acquisition.