title: 99Tcm-methoxy-isobutyl-isonitrile SPECT to evaluate a perfusion index from regional myocardial uptake after exercise and at rest. Results of a four hour protocol in patients with coronary heart disease and in controls.
abstract: In 70 patients with angiographically confirmed coronary heart disease and in 10 controls, a 4 h exercise (E) (injection of 150 MBq 99Tcm-MIBI) rest (R) (800 MBq) protocol was employed. Of these, 10 patients with 21 myocardial defects after E received a third injection 24 h after. SPECT was used to image myocardial distribution, and visual findings separated three patterns of perfusion defects after E v. R (reversible [REV], partial reversible (PREV), irreversible (IRR)). Relative regional uptake was obtained from a target-like (33 ROIs) evaluation of short-axis cuts, establishing a perfusion index (PI) by relating the defect uptake to individual maximum uptake (100%) after exercise (PIE), at rest (PIR) and the respective differences Delta PI (PIR-PIE, i.e. filling in by the second 99Tcm-MIBI injection). Visually, the sensitivity was 86% in patients or 69% in involved vessels (stenoses of greater than 33%). Vascular supply areas revealed minimal PIE values of 74.7 +/- 10.6% (control), 62.4 +/- 9.2% (REV), 46.1 +/- 7.7% (PREV) and 33.5 +/- 9.9% (IRR) (p less than 0.01). Delta PI was +13.2% or +10.1% in REV or PREV (n.s.) and +2.1% in IRR (p less than 0.01) or -0.2% in controls. PIE values did not correlate to the degree of stenosis. In areas with old myocardial infarction, the same sequence of significant decrease of PIE with reversibility occurred, independent of the patency of the supplying vessel. 33 of 35 IRR defects (94.3%) revealed PIE of less than 45%, thus predicting IRR already after the E examination. PIR values from the 4 h protocol correlated to PIR values 24 h thereafter with r = 0.94 (n = 21). 99Tcm-MIBI may be employed in a short one day E-R protocol in clinical routine. Evaluation of PI seems to be a promising tool to quantify visual defects aimed at describing the perfusional state of the terminal vascular supply area.
authors.affiliation: Department of Nuclear Medicine, Technical University of Aachen Hospital, FRG.
authors.forename: U
authors.initials: U
authors.lastname: Buell
authors.forename: F
authors.initials: F
authors.lastname: Dupont
authors.forename: R
authors.initials: R
authors.lastname: Uebis
authors.forename: H J
authors.initials: HJ
authors.lastname: Kaiser
authors.forename: E
authors.initials: E
authors.lastname: Kleinhans
authors.forename: S N
authors.initials: SN
authors.lastname: Reske
authors.forename: P
authors.initials: P
authors.lastname: Hanrath
mesh_terms: D000328:Adult; D000368:Aged; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009570:Nitriles; D015609:Organotechnetium Compounds; D005082:Physical Exertion; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D009570:Nitriles; D015609:Organotechnetium Compounds; D017256:Technetium Tc 99m Sestamibi