title: Can carbonated lime drink intake prior to myocardial perfusion imaging with Tc-99m MIBI reduce the extracardiac activity that degrades the image quality and leads to fallacies in interpretation?
abstract: BACKGROUND
  During myocardial perfusion imaging with Tc-99m sestamibi, intestinal and hepatic radiotracer activity commonly interfere with visualization of the inferior wall of the myocardium leading to difficulties in interpretation. This study was undertaken to assess if carbonated lime drink ingestion prior to imaging prevents the said interference and improves the quality of images.
  
  
  METHODS
  The study group comprised 33 consecutive patients including 26 males (age range: 30-80 years) and 7 females (42-62 years) who were referred for myocardial perfusion imaging. Of 33 patients, 21 (18 males, 3 females) were imaged at rest, 5 patients (3 males, 2 females) underwent physical stress, and 7 patients (5 males, 2 females) had pharmacological stress with adenosine. Five to 10 minutes after intravenous injection of 296 to 444 MBq (8-12 mCi) Tc-99m MIBI, anterior, and left anterior oblique (LAO) 45 degree planar views were acquired with a gamma camera using LEHR collimator. Each view was acquired for 100 seconds in a 256 x 256 matrix in all patients. Thereafter each patient was administered about 250 mL of a carbonated lime drink and repeat views were acquired within 5 minutes with the same parameters. Quantitative assessment of counts in the inferior wall of myocardium (M) to those in adjacent abdomen (A) was performed on both pre- and postintervention studies by drawing an ROI of about 50 +/- 5 pixels. M/A ratios were recorded for each patient in both the groups. The student t test was performed to evaluate the significance of difference between pre- and postintervention images. P < 0.05 was considered significant. All patients underwent myocardial perfusion single photon emission computed tomography.
  
  
  RESULTS
  It was found that the inferior wall of the myocardium was better visualized, and there was no interference from gut or hepatic tracer activity in postintervention planar and single photon emission computed tomography reconstructed views as compared with preintervention images in all patients. The M/A ratio expressed as mean +/- SD was significantly higher in the postintervention group, viz. 2.19 +/- 0.71 in the anterior and 2.07 +/- 0.70 in the LAO45 views as compared with those of preintervention values of 1.50 +/- 0.59 in the anterior and 1.41 +/- 0.49 in the LAO 45 views, respectively (P < 0.001).
  
  
  CONCLUSIONS
  We conclude that intake of carbonated lime drink is a simple and an effective technique to improve the image quality of the inferior wall of the myocardium on myocardial perfusion imaging with Tc-99m MIBI. This technique may also help in reducing the time interval between injection of radiotracer and imaging, which is otherwise delayed in routine practice.
authors.affiliation: Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Jerbai Wadia Road, Parel, Mumbai, India. maloonucmed@yahoo.com
authors.forename: Gaurav
authors.initials: G
authors.lastname: Malhotra
authors.forename: Trupti S
authors.initials: TS
authors.lastname: Upadhye
authors.forename: Ashish
authors.initials: A
authors.lastname: Nabar
authors.forename: Ramesh V
authors.initials: RV
authors.lastname: Asopa
authors.forename: Uday N
authors.initials: UN
authors.lastname: Nayak
authors.forename: M G Ramakrishna
authors.initials: MG
authors.lastname: Rajan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D002253:Carbonated Beverages; D032082:Citrus aurantiifolia / Q000737:chemistry*; D004326:Drinking; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011786:Quality Control; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D017256:Technetium Tc 99m Sestamibi