Technetium-99m sestamibi scintigraphy for the assessment of lower extremity ischaemia in peripheral arterial disease

Abstract

Technetium-99m sestamibi was used for functional investigation of the muscle perfusion of lower extremities in 35 patients with peripheral vascular disease. The aim was to test what useful information could be obtained by additional imaging of the legs in patients referred for risk stratification with dipyridamole myocardial scanning. Posterior images were acquired over the thighs and calves after postocclusive reactive hyperaemia and at rest. Inter- and intraextremity ratios and differences between the stress and rest data were used for the assessment of abnormal circulation. Arteriography was performed in every case, and surgical procedures or transluminal angioplasty in 31 patients. To estimate diagnostic accuracy, the results of 99mTc-sestamibi scintigraphy were compared with those of angiography and the functional consequences of revascularization procedures. The sensitivity and specificity of 99mTc-sestamibi scintigraphy were 55% and 25%, respectively, with an overall accuracy of 50%. Apparently methodological error was not responsible for these poor results. Instead, a paradoxically high uptake of the radiopharmaceutical in muscles supplied by significantly stenosed vessels was identified as the main source of both false-negative and false-positive results. The phenomenon resembles the findings of a previous study involving delayed administration of thallium-201 after exercise. In conclusion, 99mTc-sestamibi scintigraphy has not proved sufficiently reliable to help in the management strategy for patients with peripheral vascular disease.

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

“…Tc-99m sestamibi has several advantages and gives high quality images when compared to Tl-201, therefore many researchers have preferred its use [11,[13][14][15]. 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].…”

“…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]. Various nuclear medicine techniques may also be used [11]; Technetium-99m Methoxyisobutyl isonitrile (Tc-99m sestamibi) is one of the radiopharmaceutical agents used for scintigraphic studies in the evaluation of coronary artery disease as a myocardial perfusion agent [12] and has been frequently used for the investigation of peripheral vascular disease by evaluating the perfusion reserve (PR) in the lower limbs [11,[13][14][15]. Though its cellular uptake is proportional to the regional blood flow, it is also related to mitochondrial activity and cellular viability [16].…”

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

“…The impairment of perfusion in muscles in the initial stage of the disease is symptomless and difficult to recognize both for the patient and the doctor [1,2]. However, the lack of clinical symptoms doesn't mean that there are no perfusion disturbances in circulatory system.…”

“…Our researches have been published many times [11,12]. All scientific and clinical studies that deal with the issues of muscle perfusion are worth attention [13][14][15][16][17][18][19][20][21][22][23]. There are still trials to find safe and highly sensitive diagnostic tests that would assess muscle perfusion quantitatively not only in the area of lower limbs.…”

13N-Ammonia PET as a Measurement of Hindlimb Perfusion in a Mouse Model of Peripheral Artery Occlusive Disease

“…Noninvasive imaging technologies already play an important role in our ability to assess the success of such therapies, but certain limitations must be overcome for their use in small rodents (13). In the clinical setting, Doppler ultrasonography, contrast angiography, and venography are the standard imaging modalities used today, but various nuclear medicine techniques have also been used (14)(15)(16)(17). Experimentally, hindlimb perfusion is frequently assessed by laser Doppler perfusion imaging (18), a technique that can be useful to detect superficial flow deficits but is unlikely to provide reliable information when considering subtle changes in blood flow.…”