Comparison of SPECT using technetium-99m agents and thallium-201 and PET for the assessment of myocardial perfusion and viability (original) (raw)
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diagnosis and prognosis of coronary artery disease and evaluating thehemodynamic significance of documented coronary stenoses (1â€"3). Although [201Tl]thallous chloride shows excellent physiologic characteristics for imaging myocardial perfusion and viability, its physical character istics are suboptimal for dosimetry and scintillation cam era imaging. During the last decade, research has focused on development of myocardial perfusion agents labeled with 99mTc Different 99mTclabeled agents have been syn thesized and have demonstrated interesting myocardial uptake and clearance properties. Technetium-99m-labeled isonitrile compounds (4) and boronic acid adducts of 99mTc dioxime (BATO) compounds (5,6) are two classes of radiopharmaceuticals that have been more extensively evaluated in humans. Two new 99mTc@labeledmyocardial perfusion imaging agents are now available for clinical use: 99mTc@@mibi (Cardiolite from DuPont) and 99mTc@te@
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...
The American Journal of Cardiology, 1993
with the Technical Assistance of Technetiunr99m (To99m) tetrofosmin, a new myocardiai perfusion imaging agent, was evaluated at exercise and rest in 50 patients with documented coronary artery disease to determine myocardiai kinetics, redistribution and ideal imaging time. Planar imagmg was performed at $30, 60,90,120 and 240 minutes after an injection of Tc-99m tetrofosmin (8 to 10 mCi) at peak graded ergometric exercise. Reinjection (24 to 30 mCi) was performed at rest, 4 hours after the stress injection and also on a separate day, and ima@ng was repeated. All patients underwent thallium201 (R-201) exercise and redistribution @-hour) imaging. Perfusion defect to normal, and heart to lung ratios were calculated for exercise Tc-99m tetrofosmin images at each time point. The mean f SD defect to normal ratios were 0.
Clinical utility of technetium-99m-teboroxime myocardial washout imaging
Jnm the Journal of Nuclear Medicine, 1994
on the imagingtable, vasodilator infusion, tracer injection and repeat imaging can be accomplished in a rapid se quence (7). Also, the patient can be monitored without interruption for the entire duration of the test. The observation of differentialflow dependent regional uptake of @â€oeTc-teboroxime is used for diagnosis of coro nary artery disease. Comparison of the stress and rest images, which requires administration of two doses of the tracer, is used for further characterization of the stress induced perfusion defects. It has also been suggested that differentialregional washout of @‘@‘Fc-teboroxime can be used to distinguish ischemia from scar (48). This approach requires injection of one dose of the tracer only, similar to 201T1 imaging. However, the sequential @Tc-teboroxime images are obtained in a rapid succession. The first goal of our study was to test the logistical feasibility and image quality of this approach to myocardial perfusion imaging. The second goal was to compare the characterization of stress perfusion defects as fixed or re versible by the two-injection method (stress-rest) to the single-injectionmethod (stress-washout). METhODS Patlenta We studied 56 patients (29 males and 27 females), with a mean ageof 68 ±10yr (range40â€"88 yr). The indicationforthe myo cardial perfusionstudy was screeningfor the presence of coro naly artery disease in 35 patients (62%). Sixteen patients had chestpainsuggestiveof ischemicoriginand19hadmultiplerisk factors, the most frequent being peripheral vascular disease, ce rebrovascular disease,diabetesmellitusandhypertension. In 21 patients (38%), the indication was for evaluation of severity of knowncoronaiyarteiydisease.Thediagnosis wasestablished by documentedhistoryof a myocardialinfarction(n = 10),coronazy angioplasty(n = 3), coronaiy artery bypass graft surgeiy (n =5) and/orpresenceof a 0-wave on the rest ECO(n = 7).Allpatients were taking medicationchronically:18 (32%)were taking beta blockers, 24(43%)calcium channelbiockers, 23(41%) nitrates, 14 (25%)diuretics,8 (14%)angiotensin-converting-enzymeinhibitors and6 (11%)were takingdigoxin. Onlysix patients(11%)were not taking any ofthe above drugs. All patientswere unable to exercise adequately on a treadmill. Patients with unstable anginal symp toms, history or clinicalfindingof broncho-constrictionand pa tients currentlytreatedwith methyixanthinesor oraldipyridamole were excluded.Consumption of caffeine-containing beverages was discontinued forat least12hr.Allpatientssignedan institu tionally approved informedconsent for this study.
International journal of cardiac imaging, 1992
A series of 30 patients (25 males, 5 females, age = 28-73 years) with a clinical indication of thallium-201 stress/4 hours redistribution scintigraphy has been studied using stress/rest (n = 7) or rest/stress (n = 23) protocols with technetium-99m teboroxime (CARDIOTEC, Squibb Diagnostics) in order to assess the clinical usefulness of this new molecule and to compare it to thallium. In all cases coronary artery disease was known or highly suspected, with a history of myocardial infarction in 18 cases (subacute n = 6, remote n = 12) and/or previous by-pass surgery or PTCA in 5 cases. Medical treatment was not discontinued at the time of stress testing. Coronary angiography was available for 27 patients. Exercise tests for both tracers were carried out on an ergometric bicycle during the same day and the levels of exercise achieved for the thallium studies were very similar to those achieved for teboroxime. Imaging was performed in three planar projections and sudies were evaluated us...
Journal of Nuclear Medicine
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.
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.
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.