Enhanced detection of reversible perfusion defects by Tc-99m sestamibi compared to Tc-99m tetrofosmin during vasodilator stress SPECT imaging in mild-to-moderate coronary artery disease.
OBJECTIVE
We prospectively compared dipyridamole single-photon emission computed tomography (SPECT) imaging with Tc-99m sestamibi and Tc-99m tetrofosmin for the detection of reversible perfusion defects in patients with mild-to-moderate coronary artery disease.


BACKGROUND
Tc-99m tetrofosmin has a lower first-pass myocardial extraction fraction compared to Tc-99m sestamibi and thus could underestimate mild perfusion defects.


METHODS
Eighty-one patients with 50% to 90% stenosis in one or two major epicardial vessels without previous myocardial infarction, and seven with <5% probability of coronary artery disease underwent dipyridamole SPECT imaging with both agents. The SPECT data were analyzed quantitatively.


RESULTS
Tc-99m sestamibi detected reversible perfusion defects in a greater number of segments (total 363 and 285, p < 0.001, and mean +/- SD, 2.2 +/- 3.0 and 1.8 +/- 2.5 per patient, p = 0.008, for Tc-99m sestamibi and Tc-99m tetrofosmin, respectively), demonstrated a larger extent of perfusion defect (mean +/- SD, 15.8% +/- 12.3% and 12.0% +/- 11.4%, p < 0.03, for Tc-99m sestamibi and Tc-99m tetrofosmin, respectively) and more often correctly identified patients with disease in more than one coronary artery (p = 0.02). There was better defect contrast with Tc-99m sestamibi (defect/normal wall count ratios were 0.60 +/- 0.15 vs. 0.73 +/- 0.14 for Tc-99m sestamibi and Tc99m tetrofosmin, respectively, p = 0.01, for reversible defects seen in identical segments with both agents; and 0.73 +/- 0.16 vs 0.79 +/- 0.17, respectively, p <0.01, for reversible defects detected with either agent alone). There was no significant difference in diagnostic sensitivity or image quality.


CONCLUSIONS
These differences between two commonly used tracers may have significant diagnostic and prognostic implications.
Soman
P
P
Department of Cardiovascular Medicine, Northwick Park & St. Marks Hospitals, NHS Trust and Institute of Medical Research, Harrow, United Kingdom.
Taillefer
R
R
DePuey
E G
EG
Udelson
J E
JE
Lahiri
A
A
D000328:Adult; D000368:Aged; D003326:Coronary Circulation / Q000187:drug effects*; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004176:Dipyridamole; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D014665:Vasodilator Agents; C078700:technetium tc-99m tetrofosmin; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi