Combined analysis of resting regional wall thickening and stress perfusion with electrocardiographic-gated technetium 99m-labeled sestamibi single-photon emission computed tomography: Prediction of stress defect reversibility

Abstract

Visual evidence of wall thickening by poststress ECG-gated SPECT sestamibi imaging in the territory of a stress-induced perfusion defect correlates highly with stress defect reversibility on rest imaging and may obviate the need to perform rest imaging, thereby potentially reducing the time and cost involved in myocardial perfusion imaging. The absence of visually apparent wall thickening, however, underestimates the prevalence of stress defect reversibility on rest imaging; in such instances, rest imaging must be performed to differentiate ischemia from infarction in the territory of a stress perfusion defect.

Single Tc99m Sestamibi injection, double acquisition gated SPECT after stress and during low-dose dobutamine infusion: a new suggested protocol for evaluation of myocardial perfusion

“…Marzullo et al [17] and few other groups [2,6,7,[18][19][20] used ECG-gated post-stress 99m Tc-MIBI images for the detection of wall motion abnormalities and reversibility of stress induced perfusion defects. The common advantage in all these studies was the use of single injection as well as single image acquisition for the detection of CAD.…”

“…The common advantage in all these studies was the use of single injection as well as single image acquisition for the detection of CAD. Although most of these studies have reported a good accuracy for the diagnosis of CAD by single-phase stress gated SPECT [17,20], a few others have revealed some conflicting results, particularly in patients with pasthistory of myocardial infarction [6,7]. One of the main reasons for such conflicts is the presence of myocardial stunning or hibernation, which results in abnormal myocardial motion/thickening with normal or abnormal perfusion [2,13,19,21].…”

“…Electrocardiographic gated single-photon emission computed tomography (ECG-gated SPECT) provides assessment of both myocardial perfusion and function abnormalities induced by pharmacological or exertional stress. Although in some previous reports the nuclear physicians have used wall thickening on stress ECG-gated SPECT to predict reversibility or non-reversibility of myocardial perfusion abnormalities [2][3][4][5], some other studies revealed considerable discordance in detecting reversibility [6,7] and therefore this protocol of single injection ECG-gated SPECT did not achieve global acceptance for routine use in daily practice of nuclear medicine. Despite inherent advantages of gated stress-only SPECT, modification of this method seems to be necessary to eliminate drawbacks and improve accuracy.…”

Comparative study of single-injection, single-acquisition 99mTc-MIBI gated SPET and stress-rest perfusion SPET for the evaluation of myocardial viability after bypass surgery in coronary artery disease

“…Gated myocardial perfusion SPET with 99m Tc-MIBI has been proposed as a method to identify viable myocardium [4,7]. The relative preservation of wall thickening in the area of perfusion defects may be the result of the maintenance of regional function despite chronic ischaemia or repeated stunning.…”

“…Snapper et al [7] concluded that visual evidence of wall thickening on post-stress 99m Tc-MIBI ECG-gated SPET imaging in the territory of a stress-induced perfusion defect correlates highly with stress defect reversibility on rest imaging and that this may obviate the need to perform rest imaging. This correlation potentially reduces the time for resting perfusion SPET.…”