title: The effect of imaging time, radiopharmaceutical, full fat milk and water on interfering extra-cardiac activity in myocardial perfusion single photon emission computed tomography.
abstract: OBJECTIVE
  Extra-cardiac activity can interfere with observer interpretation of myocardial perfusion single photon emission computed tomography (SPECT) images. Fatty meals and drinks to reduce interference have been tested; however, a simple study of delayed imaging with (99m)Tc-tetrofosmin and (99m)Tc-sestamibi has not been specifically addressed. The aim was to quantify the effects of imaging time, radiopharmaceutical and oral administration of full fat milk and water on interfering activity.
  
  
  METHODS
  Myocardial perfusion SPECT images were acquired using either tetrofosmin or sestamibi. Patients were imaged at 0.5, 1 or 2 h post-injection (tetrofosmin, 59; sestamibi, 72). Additional groups of patients were imaged either with or without milk (tetrofosmin, 54; sestamibi, 45) and with milk and water (sestamibi, 30). A myocardial region was drawn on the anterior projection and a thin adjacent extra-cardiac region was generated automatically. The count density ratio was calculated and validated with a trial of five observers. A decreasing ratio correlated significantly with observer rank of increasing interference with SPECT image interpretation (r=0.95, P=0.001).
  
  
  RESULTS
  The ratio improved significantly as the imaging time increased for both tetrofosmin and sestamibi groups (P<0.05). The groups given milk or milk plus water showed no significant improvement against control groups (P > or = 0.2). There was no significant difference between tetrofosmin and sestamibi at any time point (P > or = 0.4).
  
  
  CONCLUSIONS
  Image interpretation may be improved by delayed imaging for tetrofosmin and sestamibi. However, in contrast with common practice, the administration of milk or water appears to be of no clinical value compared with delayed imaging, and there is no significant difference between interfering activity from tetrofosmin and sestamibi.
authors.affiliation: Regional Medical Physics Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK. richard.peace@nuth.northy.nhs.uk
authors.forename: Richard A
authors.initials: RA
authors.lastname: Peace
authors.forename: Jim J
authors.initials: JJ
authors.lastname: Lloyd
mesh_terms: D000284:Administration, Oral; D000818:Animals; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008892:Milk / Q000000981:diagnostic imaging / Q000378:metabolism*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014867:Water / Q000008:administration & dosage / Q000378:metabolism*
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D014867:Water; C078700:technetium tc-99m tetrofosmin; D017256:Technetium Tc 99m Sestamibi