Usefulness of Myocardial Perfusion Imaging With Exercise Testing in Children

Abstract

Myocardial perfusion imaging (MPI) provides additional clinical information on children with cardiac disease but will not benefit children with chest pain and normal cardiac studies. This study reviewed all technetium-99 m ((99m)Tc) sestamibi stress MPI studies between 2004 and 2010 performed in association with graded exercise testing (86% with bicycle ergometer, 14% with treadmill). A positive test was defined as a perfusion defect or abnormal ventricular function response. Clinical records were reviewed, including follow-up assessment to determine accuracy of MPI interpretation. False-positive and false-negative rates were recorded. A total of 197 patients (mean age, 13.4 ± 3.6 years, 70% male) underwent 218 MPI studies. Group A had 42 patients (43 studies) with isolated chest pain and normal studies. Of the 43 studies, 39 had negative results, and 4 had false-positive results. Group B had 155 patients (175 studies) with known or suspected cardiac disease, and 39 tests (33 patients) had positive results. Whereas 32 studies were considered true-positive, 7 were false-positive. There was one false-negative test. According to the findings, (99m)Tc sestamibi MPI studies are clinically useful but not perfect tests in the setting of known or suspected cardiac disease based on clinical evaluation, electrocardiography (ECG), or echocardiography. Children who had isolated chest pain with a normal ECG and echocardiogram often have false-positive studies.

A Phase I–II, Open-Label, Multicenter Trial to Determine the Dosimetry and Safety of 99mTc-Sestamibi in Pediatric Subjects

“…Among the radiotracers used, 99m Tc-sestamibi (Cardiolite; Lantheus Medical Imaging) has shown superior characteristics as a tracer for myocardial perfusion imaging with SPECT. The role of this tracer is less established in the pediatric population because of the relatively smaller sample sizes and lack of data regarding dosing (1). Myocardial perfusion imaging is used in children primarily to identify coronary perfusion abnormalities such as occur in Kawasaki disease, anomalous left coronary artery from pulmonary artery, and transposition of the great arteries among other conditions (2,3).…”

Cardiovascular Response to Exercise Testing in Children and Adolescents Late After Kawasaki Disease According to Coronary Condition Upon Onset

“…Furthermore, because of the ethical issue of exposing healthy children to radiation, perfusion scan studies in pediatrics (including the present report) lack a control group to validate the identified prevalence of perfusion defects. However, a recent study reported myocardial perfusion imaging results in children with isolated chest pain and normal ECG and echocardiography [20]. Among the 42 children tested, four (9.5 %) had myocardial perfusion defects which all proved to be false-positive upon follow-up.…”

Myocardial Functional Imaging in Pediatric Nuclear Cardiology

“…The disease involves both distal and proximal coronary arteries and is associated with functional anomalies such as systolic dysfunction and increased filling pressures. Alongside cardiac catheterization, which is the recommended method, but is invasive and uses radiation, nuclear imaging can be used in follow-up [ 3 , 16 , 17 ].…”