Usefulness of technetium-99m-MIBI and thallium-201 in tomographic imaging combined with high-dose dipyridamole and handgrip exercise for detecting coronary artery disease.
Forty-two patients with known stable coronary artery disease, referred for coronary angiography, were examined with technetium-99m-hexakis-2-methoxy-2-methylpropyl-isonitrile (MIBI) tomography combined with a high-dose dipyridamole infusion (0.7 mg/kg) and handgrip stress. MIBI tomography was unable to show coronary artery disease only in 2 patients, thus yielding a sensitivity figure of 95%. MIBI tomography correctly identified 27 (82%) of 33 stenotic lesions (greater than or equal to 50% diameter stenosis) of the left anterior descending artery, 17 (61%) of 28 of those of the left circumflex artery, and 28 (90%) of 31 of those of the right coronary artery. The overall vessel sensitivity was 78%. The computed lumen diameter stenoses were more advanced in cases detected than in those not detected with MIBI tomography: 87 +/- 14 vs 76 +/- 14% (p less than 0.01). The 50 to 69% stenoses did not show any tendency to produce less positive findings than those with greater than or equal to 70% stenoses. In the subgroup of 21 patients who also presented for thallium scintigraphy, the overall diseased vessel identification rate was 76% for thallium tomography and 83% for MIBI tomography (p = not significant). Minor noncardiac side effects related to the dipyridamole-handgrip test occurred only in 5% of 63 study sessions. A high-dose dipyridamole combined with isometric exercise is a safe stress method, and when used during scintigraphy, MIBI tomography is at least as efficient a tool as thallium tomography in detecting diseased vessel territories in patients in coronary artery disease.
Kettunen
R
R
Department of Internal Medicine, Oulu University Central Hospital, Finland.
Huikuri
H V
HV
Heikkilä
J
J
Takkunen
J T
JT
D000368:Aged; D000792:Angiography; D003287:Contrast Media; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D004176:Dipyridamole; D005260:Female; D006225:Hand / Q000502:physiology*; D006801:Humans; D007537:Isometric Contraction / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009570:Nitriles; D015609:Organotechnetium Compounds; D005082:Physical Exertion / Q000502:physiology*; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D014055:Tomography, Emission-Computed
D003287:Contrast Media; D009570:Nitriles; D015609:Organotechnetium Compounds; D013794:Thallium Radioisotopes; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi