Efficacy of full-fat milk and diluted lemon juice in reducing infra-cardiac activity of 99mTc sestamibi during myocardial perfusion imaging

Abstract

BackgroundWhen using 99mTc sestamibi for myocardial perfusion imaging, increased splanchnic activity creates a problem in the visual and quantitative interpretation of the inferior and infero-septal walls of the left ventricle. We sought to determine whether the administration of diluted lemon juice or full-fat milk would be effective in reducing interfering infra-cardiac activity and therefore result in an improvement in image quality. We compared the administration of full-fat milk and diluted lemon juice to a control group that had no intervention.MethodsThe study was carried out prospectively. All patients referred to our institution for myocardial perfusion imaging from November 2009 to May 2012 were invited to be enrolled in the study. A total of 630 patients were randomised into three groups. Group 0 (G0), 246 patients, were given diluted lemon juice, group 1 (G1), 313 patients, were given full-fat milk, and group 2 (G2), 71 patients, had no intervention (control group). A routine two-day protocol was used and the patients were given the same intervention on both days. Raw data of both the stress and rest images were visually assessed for the presence of infra-cardiac activity, and quantitative grading of the relative intensity of myocardial activity to infra-cardiac activity was determined. The physicians were blinded to the intervention received and the data were reviewed simultaneously.ResultsThe overall incidence of interfering infra-cardiac activity at stress was 84.1, 84.5 and 96.6% in G0, G1 and G2, respectively (p = 0.005). At rest it was 91.7, 90.1 and 100% in G0, G1 and G2, respectively (p = 0.0063). The visual and quantitative results favoured both milk and lemon juice in reducing the amount of interfering infra-cardiac activity versus no intervention.ConclusionThe administration of milk or lemon juice resulted in a significant decrease in the intensity of infra-cardiac activity compared to the control group. This reduction in intensity was even more significant in the milk group for patients assessed during rest myocardial perfusion imaging.

Image Quality and Interpretation of [18F]-FES-PET: Is There any Effect of Food Intake?

“…This might potentially be achieved by stimulating gall bladder contraction with a (fatty) meal around the time of tracer injection, which would result in faster passage of the tracer from the liver to duodenum. This method is commonly used in nuclear medicine for myocardial perfusion imaging [ 5 , 6 , 7 , 8 , 9 ]. Several high-fat meals have been investigated in the field of myocardial perfusion, such as milkshakes [ 6 ], full-fat milk [ 7 , 8 ], and chocolate [ 9 ].…”

“…This method is commonly used in nuclear medicine for myocardial perfusion imaging [ 5 , 6 , 7 , 8 , 9 ]. Several high-fat meals have been investigated in the field of myocardial perfusion, such as milkshakes [ 6 ], full-fat milk [ 7 , 8 ], and chocolate [ 9 ]. Our hospital uses chocolate as a fatty meal between injection and myocardial perfusion imaging, and therefore chocolate was selected for this study as well.…”

Pharmaceutical interviews to overcome digestive artefacts on [ 99m Tc]Tc‐tetrofosmin myocardial perfusion scintigraphy

“…Still, their respective pharmacokinetic and pharmacological interactions with other medications remain poorly studied. To prevent artefacts, different volumes of carbonated water, 3 soda, 4 lime, 5 lemon juice, 6 milk, 7 caffeine 8 or several of them combined 9 have already been empirically experimented as more or less efficient and accessible corrective actions. Their benefits were either attributed to acidity‐related increased hepatobiliary excretion or to gastric distension, lowering the radiotracer uptake.…”

The effect of fatty meal and water on interfering extracardiac activity in myocardial perfusion single-photon emission computed tomography

“…The study by Boz et al indicates that eating solid and liquid foods before the resting stage reduced intestinal activity in Tc-99m tetrofosmin myocardial perfusion [19,20]. Also, Purbhoo et al showed that diluted lemon juice and milk reduced significantly infracardiac radiation in myocardial perfusion scan with radiopharmaceuticals Tc-99m sestamibi, which this reduction in the milk group had been more prominent [21]. The purpose of our studies was to determine what steps should be taken before resting the SPECT myocardium so that we can reduce the side effects of the liver, intestine, and stomach interactions.…”