Fluorine-18 deoxyglucose PET for assessment of viable myocardium in perfusion defects in 99mTc-MIBI SPET: a comparative study in patients with coronary artery disease

Abstract

Extent and frequency of viable tissue in myocardial segments yielding a perfusion defect on technetium-99m methoxyisobutylisonitrile (99mTc-MIBI), single photon emission tomography (SPET) at rest was prospectively investigated with 2-18F-2-deoxyglucose (18FDG) positron emission tomography (PET) in 46 patients with chronic coronary artery disease (CAD). Of these, 43 had a history of old myocardial infarction. For comparative visual and quantitative evaluation of identical anatomical slices, PET image files were converted into the SPET file structure and into the same matrix size. SPET and PET images were documented and visually (9 segments/patient) or semiquantitatively evaluated by a target-like polar map. Relative perfusion was expressed in percentage of peak 99mTc-MIBI uptake. Sample 18FDG uptake was related to the 18FDG uptake in the area of such maximal perfusion (18FDG uptake was 100% at the 100% 99mTc-MIBI uptake area). Of 414 segments, 167 (40%) revealed a resting perfusion defect. 18FDG uptake was present in 38 (23%) of the defects, while another 40 (24%) segments yielded 18FDG uptake in the periphery of the defect. When grouped according to the degree of 99mTc-MIBI uptake-reduction (in percentage of peak activity), 80% of severe defects (less than or equal to 30% of peak uptake), 48% of moderate (31%-50% of peak uptake) and 31% of mild (greater than 50% of peak uptake) defects were considered as non-viable on the basis of 18FDG uptake. Complete viability was found in none of the severe defects in contrast to 29% of moderate and 35% of mild perfusion defects.(ABSTRACT TRUNCATED AT 250 WORDS)

Myocardial metabolic imaging by means of fluorine-18 deoxyglucose/technetium-99m sestamibi dual-isotope single-photon emission tomography

“…nitrogen-13 ammonia, and thus compares perfusion and metabolism of the myocardium [4]. In recent studies technetium-99m sestamibi (MIBI) has been used as a perfusion marker because it shows ideal properties for use in combination with FDG [6,12,13]. It is virtually free from redistribution and its gamma radiation can be easily distinguished from the emission of FDG due to the low gamma-ray energy (140 keV).…”

Additive value of low‐dose dobutamine to technetium‐99m sestamibi‐gated single‐photon emission computed tomography for prediction of wall motion improvement in patients undergoing coronary artery bypass graft

“…[16][17][18][19][20][21][22][23] Some showed that the use of a 51% sestamibi threshold, as accepted, with thallium 201 underestimates the extent of viable myocardium. 23,24 By contrast, Udelson et al 22 reported that after rest injection, quantified sestamibi activity paralleled thallium redistribution activity.…”

“…The use of technetium-99m ( 99m Tc)-labeled sestamibi, which has been found to have a metabolic impact on myocardial uptake, 14,15 is somewhat controversial. [16][17][18][19][20][21][22][23][24] Several studies have reported that the use of sestamibi leads to an underestimation of the extent of wall motion improvement after revascularization when compared with both thallium 24 and FDG. 23 By contrast, according to others, sestamibi injection under nitrate administration improves viability assessment; this is also true for low-dose dobutamine.…”

The value of Tc-99m MIBI SPECT during isosorbide dinitrate infusion in assessment of viable myocardium in patients with myocardial infarction

“…1° But the role of Tc-99m MIBI myocardial SPECT for the identification of myocardial viability is still under investigation." -" Altchoefer et al 6 have demonstrated that Tc99m MIBI at rest underestimated the amount of viable myocardium by 23%. In order to improve the ability to detect myocardial viability by resting Tc-99m MIBI myocardial SPECT, a study of Tc-99m MIBI myocardial SPECT during isosorbide dinitrate (ISDN) infusion was performed in 37 patients with previous myocardial infarction.…”