OBJECTIVES: This study sought to develop a dual-isotope single-acquisition 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 approximately 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 position emission tomography before dual-isotope SPECT: RESULTS: With a window of 20% for both photopeaks and a technetium-99m/fluorine-18 concentration of 3.2:1, the "spillover" 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: Fifty-seven 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.
OBJECTIVES: This study sought to develop a dual-isotope single-acquisition 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 approximately 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 position emission tomography before dual-isotope SPECT: RESULTS: With a window of 20% for both photopeaks and a technetium-99m/fluorine-18 concentration of 3.2:1, the "spillover" 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: Fifty-seven 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.
Authors: Robert J Gropler; Rob S B Beanlands; Vasken Dilsizian; E Douglas Lewandowski; Flordeliza S Villanueva; Maria Cecilia Ziadi Journal: J Nucl Med Date: 2010-05-01 Impact factor: 10.057
Authors: J J Bax; J H Cornel; F C Visser; P M Fioretti; J M Huitink; A van Lingen; G W Sloof; C A Visser Journal: J Nucl Cardiol Date: 1997 Jul-Aug Impact factor: 5.952
Authors: Riemer H J A Slart; Jeroen J Bax; Dirk J van Veldhuisen; Ernst E van der Wall; Rudi A J O Dierckx; Pieter L Jager Journal: Int J Cardiovasc Imaging Date: 2005-12-13 Impact factor: 2.357
Authors: Vasken Dilsizian; Stephen L Bacharach; Rob S Beanlands; Steven R Bergmann; Dominique Delbeke; Sharmila Dorbala; Robert J Gropler; Juhani Knuuti; Heinrich R Schelbert; Mark I Travin Journal: J Nucl Cardiol Date: 2016-07-08 Impact factor: 5.952
Authors: Riemer H J A Slart; Jeroen J Bax; Jaep de Boer; Antoon T M Willemsen; Piet H Mook; Matthijs Oudkerk; Ernst E van der Wall; Dirk J van Veldhuisen; Pieter L Jager Journal: Eur J Nucl Med Mol Imaging Date: 2005-04-12 Impact factor: 9.236
Authors: A F L Schinkel; J J Bax; F B Sozzi; E Boersma; R Valkema; A Elhendy; J R T C Roelandt; D Poldermans Journal: Heart Date: 2002-08 Impact factor: 5.994