title: Normal qualitative and quantitative Tc-99m sestamibi myocardial SPECT: spectrum of intramyocardial distribution during exercise and at rest.
abstract: Exercise myocardial perfusion imaging with Tc-99m sestaMIBI is routinely used to detect underlying coronary stenoses. Ischemia is diagnosed in regions that display decreased tracer uptake during exercise as compared to rest. Tc-99m sestaMIBI SPECT images of 42 healthy volunteers were assessed both qualitatively (tomographic slices) and quantitatively (sectored polar map) for potential sources of misinterpretation. On the myocardial tomographic slices, the most common culprit artifacts were diaphragmatic attenuation and bowel interposition, which caused fixed or reversible "perfusion defects" in the inferior and posterior regions (in 19/35 abnormal segments), and artifacts related to the presence and shift of hot spots (observed in 11/28 men; in women, they were more difficult to demonstrate because of the overriding effect of breast attenuation). Hot spots shifts between exercise and rest usually resulted in pseudo-reversible defects in the anterolateral and lateral walls. The quantified polar map display of the myocardium showed a physiologic decrease in sestaMIBI activity in the basal anterolateral and basal posterolateral areas in men during exercise. There are many normal variants that may mimic coronary artery disease on tomographic sestaMIBI images. Before reporting an area of decreased activity as either a fixed or reversible perfusion defect, the interpreter should ensure that it does not represent an artifact or a normal variation in the intramyocardial distribution of sestaMIBI during exercise.
authors.affiliation: Maisonneuve Hospital, Montreal, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Lette
authors.forename: M
authors.initials: M
authors.lastname: Caron
authors.forename: M
authors.initials: M
authors.lastname: Cerino
authors.forename: D
authors.initials: D
authors.lastname: McNamara
authors.forename: S
authors.initials: S
authors.lastname: Metayer
authors.forename: S
authors.initials: S
authors.lastname: D'Aoust
authors.forename: M C
authors.initials: MC
authors.lastname: Eybalin
authors.forename: A
authors.initials: A
authors.lastname: Levesseur
authors.forename: J
authors.initials: J
authors.lastname: Grégoire
authors.forename: A
authors.initials: A
authors.lastname: Arsenault
mesh_terms: D000328:Adult; D016477:Artifacts; D003327:Coronary Disease / Q000000981:diagnostic imaging; D015444:Exercise; D005080:Exercise Test; D005189:False Positive Reactions; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging; D012016:Reference Values; D012146:Rest; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D017256:Technetium Tc 99m Sestamibi