Investigation of perfusion reserve using 99Tcm-MIBI in the lower limbs of diabetic patients

Abstract

This study aimed to investigate the microvascular pathology in the lower limbs of diabetic patients without symptoms or findings of peripheral ischaemia by measuring perfusion reserve scintigraphically. It was carried out in 47 female subjects who had no evidence of peripheral arterial disease in their history, physical examination or Doppler ultrasonography. The diabetic group consisted of 25 women (mean age 54.2 +/- 3.54 years) with type II diabetes mellitus of more than 10 years' duration. A control group consisted of 22 healthy non-diabetic women (mean age 50.14 +/- 6.75 years). Each subject flexed their right foot maximally both dorsally and plantar 60 times. In the middle of this exercise, 370 MBq technetium-99m-methoxyisobutylisonitrile (99Tc(m)-MIBI) was injected intravenously. Ten minutes after the injection, a posterior image of both calves was obtained using a gamma camera. Rectangular regions of interest were symmetrically drawn over both calves. The total count in the resting calf was subtracted from the total count in the exercising calf, and the percentage increase, termed the perfusion reserve, was determined. A significant difference was found between the perfusion reserves of the diabetic and control groups (76.04 +/- 12.96% and 95.91 +/- 12.83%, respectively; P<0.001). In conclusion, microvascular pathology may be determined scintigraphically by measuring the perfusion reserve in the lower limb muscles in diabetic patients. This method may also be used to evaluate perfusion abnormalities in other circulatory disorders.

A pilot study of regional perfusion and oxygenation in calf muscles of individuals with diabetes with a noninvasive measure

“…29 Reduced perfusion reserve was clearly observed in patients with DM without peripheral arterial disease, using 99m Tc-MIBI. 30 Our SMBF data are in general agreement with these findings. Furthermore, we have observed that the gastrocnemius muscle appeared to have greater reduction in SMBF reserve than the soleus muscle (43% vs 25% reduction) in patients with DM.…”

“…This is possibly due to the disparity of muscle fiber type (fast-twitch vs slow-twitch), capillary density, oxygen metabolism (anaerobic vs oxidative metabolism), and/or greater fat infiltration in the gastrocnemius compared with the soleus in patients with DM. 29,30 The exact underlying mechanism is unknown, and future study needs to isolate each factor to elucidate the pathway of oxidation dysfunction in different muscle groups of patients with DM.…”

Tc-99m sestamibi lower extremity muscle scan, is it a useful screening tool for assessment of preclinical atherosclerosis in rheumatoid arthritis patients?

“…Celen and his colleagues had also concluded that microvascular pathology may be determined scintigraphically by measuring the PR of the lower-limb muscles, not only in diabetic patients but also in other disorders associated with vascular pathologies [9]. Our study is the first to use the concept of PR measurement with Tc-99m sestamibi to assess preclinical atherosclerosis in RA patients and compare it with well-matched healthy controls.…”

“…Clinical history and physical examination are the traditional methods used in the clinical evaluation of peripheral vascular disease, while Doppler ultrasonography, contrast angiography, and venography are the standard imaging modalities used today [9]. In the general population, carotid ultrasound has been used for cardiovascular risk stratification as intimal-medial thickness (IMT) and plaque are associated with clinical cardiovascular disease and have independent prognostic value for such events [10].…”

The own method and program of isotopic quantitative assessment of perfusion in muscles of upper limbs

“…The size of muscles perfusion of upper and lower limbs, as a physiological process, should have quantitative parameters that would define its normal values range. Nuclear medicine has markers and methods that allow for the assessment of muscle perfusion size with radiopharmaceutical Tc-MIBI which accumulation in muscles is proportional to their perfusion [3][4][5][6][7]. The sensitivity and specificity of the examination with 99m Tc-MIBI is assessed for 81% and 90% in the detection of disturbances of the perfusion in the muscles of lower limbs [8][9][10].…”