Comparison of SPECT and ectomography for evaluating myocardial perfusion with technetium-99m-sestamibi (original) (raw)
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The American Journal of Cardiology, 1990
T he studyof myocardial perfusion with @°‘Tl has be come indispensable duringcoronary artery disease (CAD) evaluation, whether as a diagnostic tool or in the prognosis of such disease (1â€"3). Some of the disadvantages of @°‘Tl, such as cyclotron production, low photon energy and long half-life,which limitsthe allowabledose (4), have favored the development of technetium agents for perfusion imag ing. To date, three technetium compounds have demon strated their clinical utility: sestamibi (5), teboroxime (6) and tetrofosmin (7), but none has totally supplanted @°‘Tl, which remains the most commonly used tracer. This is partly due to the fact that @°@Tl is used both as a tracer of regional blood coronary flow distribution and as a marker of myocardial cellular viability, while technetium com plexes are pure blood flow tracers. This characteristic of 20111 is related to its redistribution.
2000
Background: The use of acute Tc-99m sestamibi imaging has provided a valuable methodology to assess myocardium at risk and collateral blood¯ow. Objective: The purpose of this study was to determine the impact of physical, physiologic, and reconstruction factors on the extent and severity of Tc-99m sestamibi images in a porcine model of coronary occlusion and reperfusion. Methods and results: Eleven pigs underwent 40 min of coronary occlusion using a balloon catheter followed by reperfusion. Radiolabeled microspheres were injected during occlusion for blood¯ow determination and 20±30 mCi of Tc-99m sestamibi was injected intravenously for cardiac imaging. Each animal underwent four modes of gamma camera imaging: a cardiac and respiratory gated SPECT study, an ungated SPECT study, a post-mortem SPECT study and an ex-situ study where the heart was sliced into ®ve short axis slices and directly imaged. All animals had extensive wall motion abnormalities at the time of imaging. Myocardial risk area by ex-situ imaging was 32 9% LV and did not signi®cantly change with the addition of a chest cavity and tomographic reconstruction (post-mortem and gated imaging) or cardiac and respiratory motion (ungated imaging). Defect severity was signi®cantly underestimated with the addition of a chest cavity and tomographic reconstruction but was unaltered by cardiac and respiratory motion. Conclusions: The assessment of risk area acutely by SPECT Tc-99m sestamibi imaging is unaected by cardiac motion obviating the necessity for gated imaging. Estimated defect severity (which has been used as a measure of collateral¯ow) is signi®cantly reduced by the chest wall and tomographic acquisition and reconstruction suggesting a role for scatter and attenuation algorithms for this measure.
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.
Nuclear medicine review. Central & Eastern Europe, 2008
The aim of this study was to evaluate the effect of the CT-derived attenuation correction on (99m)Tc-MIBI normal myocardial perfusion scintigrams. Rest perfusion scintigrams of patients in whom coronary artery disease was suspected, without a history or any signs in ECG of a myocardial infarction, were analysed. Patients were included in the material if their rest perfusion scintigrams were normal. This criterion was fulfilled by 61 patients (29 men and 32 women) aged between 40 and 74 (mean value 57) years, with body mass between 50 and 120 (mean value 70) kg. Tomographic reconstruction of a radionuclide study was performed with an iterative OSEM method (10 subsets, 2 iterations) sequentially without and with attenuation and scatter corrections on a dedicated Xeleris workstation, applying an ACQC tool to enable manual realignment of SPECT and CT images. SPECT studies were evaluated visually and semiquantitatively. Visual analysis of tomograms was performed with the aim of finding s...
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1992
Technetium-99m-sestamibi (MIBI) and 99mTc-teboroxime (TEBO) are two new myocardial perfusion imaging agents. The purpose of this prospective study was to compare MIBI and TEBO to 201TI planar imaging. Eighteen patients with significant coronary artery disease on coronary angiogram were submitted to three treadmill stress tests performed within 3 mo and were imaged with the three radiopharmaceuticals as follows. 1. TI: 2.2 mCi, immediate and delayed views (4 hr later, 8 min/view). 2. TEBO: 15-20 mCi at stress (1 min/view) and a second injection was repeated 4 hr later at rest (20-25 mCi). 3. MIBI: 15-18 mCi at stress (8 min/view) and 1-4 days later, 15-18 mCi at rest. Patients achieved similar levels of exercise. A blinded reading was performed by three observers. The left ventricle was divided into three segments/view and ischemic/normal wall ratios were also determined. Segmental comparison showed an agreement in 85% (138/162) of the segments between TI and TEBO, in 92% (149/162) b...
Automated quantification of 99mTc sestamibi myocardial perfusion compared with visual analysis
Nuclear Medicine Communications, 2004
Objectives The visual interpretation of 99m Tc sestamibi single photon emission computed tomography (SPECT) myocardial perfusion images can be challenging due to the quantity of scan information generated, the large number of normal variants, attenuation artifacts and gender differences. The development of automated, computer derived, quantitative indices of perfusion can assist in this interpretation by providing an objective measure. It is important to verify that similar results can be obtained when the software is used in centres outside those where the algorithms were initially developed. Our objective was to assess the degree of concordance between the visual and automated diagnostic assessments of 99m Tc sestamibi SPECT.