title: Direct imaging of exercise-induced myocardial ischemia with fluorine-18-labeled deoxyglucose and Tc-99m-sestamibi in coronary artery disease.
abstract: BACKGROUND
  Scintigraphic myocardial perfusion imaging is the most widely used noninvasive modality for the detection of coronary artery disease (CAD). A technique for direct imaging of exercise-induced myocardial ischemia is highly desirable and preferable over perfusion imaging but is presently unavailable. We evaluated the feasibility and diagnostic accuracy of direct imaging of exercise-induced myocardial ischemia with fluorine-18-2-deoxyglucose (18FDG).
  
  
  RESULTS
  Twenty-six patients with known or suspected CAD and no prior myocardial infarction underwent simultaneous myocardial perfusion and ischemia imaging after the intravenous injection of Tc-99m-sestamibi (99mTc-sestamibi) and 18FDG at peak exercise. Rest perfusion imaging was carried out separately. All patients underwent coronary angiography. Exercise 18FDG myocardial images were compared with exercise-rest 99mTc-sestamibi images and coronary angiography. Of 22 patients with > or =50% narrowing of > or =1 coronary arteries, 18 had perfusion abnormalities (sensitivity 82%) whereas 20 had abnormal myocardial 18FDG uptake (sensitivity 91%, P=NS). Perfusion abnormalities were seen in myocardial segments corresponding to 25 vascular territories of a total of 51 vessels with > or =50% luminal narrowing in 22 patients (sensitivity 49%), whereas increased 18FDG uptake was seen in 34 vascular territories (sensitivity 67%, P=0.008). 18FDG images were of high quality and easy to interpret but required simultaneous perfusion images for localizing abnormal myocardial 18FDG uptake.
  
  
  CONCLUSIONS
  Exercise-induced myocardial ischemia can be imaged directly with 18FDG. Combined exercise 18FDG-99mTc-sestamibi imaging provides a better assessment of exercise-induced myocardial ischemia compared with exercise-rest perfusion imaging. Direct ischemia imaging eliminates some of the limitations of presently used myocardial perfusion imaging. Large-scale clinical studies are warranted.
authors.affiliation: Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Zuo-Xiang
authors.initials: ZX
authors.lastname: He
authors.forename: Rong-Fang
authors.initials: RF
authors.lastname: Shi
authors.forename: Yong-Jian
authors.initials: YJ
authors.lastname: Wu
authors.forename: Yue-Qin
authors.initials: YQ
authors.lastname: Tian
authors.forename: Xiu-Jie
authors.initials: XJ
authors.lastname: Liu
authors.forename: Shi-Wen
authors.initials: SW
authors.lastname: Wang
authors.forename: Rui
authors.initials: R
authors.lastname: Shen
authors.forename: Xue-Wen
authors.initials: XW
authors.lastname: Qin
authors.forename: Run-Lin
authors.initials: RL
authors.lastname: Gao
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
authors.forename: Diwakar
authors.initials: D
authors.lastname: Jain
mesh_terms: D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology; D005080:Exercise Test / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi / Q000493:pharmacokinetics
chemical_list: D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi