title: Comparative performance of gated perfusion SPECT wall thickening, delayed thallium uptake, and F-18 fluorodeoxyglucose SPECT in detecting myocardial viability.
abstract: To evaluate the comparative abilities of gated single photon emission computed tomography (SPECT) wall thickening, delayed thallium-201 (Tl-201) SPECT, and F-18 fluorodeoxyglucose (FDG) SPECT in detecting myocardial viability, 23 patients with previous myocardial infarction and clinically suspected viability were studied. Each patient had at least 1 extensive fixed perfusion defect on rest/stress technetium-99m sestamibi SPECT. A total of 41 major vascular territories had fixed defects. The mean (+/- 1 SD) left ventricular ejection fraction determined from gated perfusion SPECT was 26% +/- 11%. Wall thickening was assessed in a semiquantitative fashion by the regional increase in myocardial intensity during systole and was considered normal when a > or = 20% increase was observed. Tl-201 SPECT was acquired 4 hours after resting tracer injection was administered. Viability was considered present when regional defect Tl-201 count density, determined by quantitative analysis, was > 20% greater than that on the resting sestamibi scan. FDG SPECT was performed independently with a 10 mCi F-18 FDG dose after oral glucose loading was performed. A camera equipped with ultrahigh energy collimation was used. Quantitative criteria for viability were the same as for Tl-201. In the 23 patients viability within the fixed sestamibi defects was manifest by preserved wall thickening in 8 patients, delayed Tl-201 uptake in 10 patients, and FDG uptake in 18 patients. Nine major vascular territories with fixed defects were judged viable by wall thickening, 11 by Tl-201 SPECT, and 24 by FDG SPECT (P = .0009). We conclude that FDG SPECT demonstrates more evidence of myocardial viability than either gated sestamibi wall thickening or delayed Tl-201 SPECT.
authors.affiliation: Department of Radiology, St. Luke's-Roosevelt Hospital, New York, NY, USA.
authors.forename: E G
authors.initials: EG
authors.lastname: DePuey
authors.forename: M
authors.initials: M
authors.lastname: Ghesani
authors.forename: M
authors.initials: M
authors.lastname: Schwartz
authors.forename: M
authors.initials: M
authors.lastname: Friedman
authors.forename: K
authors.initials: K
authors.lastname: Nichols
authors.forename: H
authors.initials: H
authors.lastname: Salensky
mesh_terms: D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi