title: Technetium-99m-sestamibi redistribution after exercise stress test identified by a novel cardiac gamma camera: two case reports.
abstract: Single photon emission computer tomography (SPECT) myocardial perfusion imaging (MPI) employing technetium-99m (Tc-99m)-based imaging tracers is the mainstay of nuclear cardiology for the detection of myocardial ischemia. Current guidelines for same day rest/stress Tc-99m-sestamibi SPECT MPI recommend image acquisition 15-60 minutes after the stress testing. A novel sensitive SPECT imaging technique, D-SPECT, allows fast acquisition of images and captures rapid changes in radiotracer distribution. Here we report 2 cases of SPECT MPI in patients with angiographically confirmed coronary artery disease (CAD) where Tc-99m-sestamibi exhibited marked redistribution between early (6-8 min) and late (60-70 min) post-stress imaging leading to an underestimation of the extent and severity of ischemia on late images. These observations suggest that early imaging maybe more sensitive for CAD detection. Fast SPECT imaging techniques, such as D-SPECT, will facilitate similar studies in the future as they will allow fast image acquisition at several time points after the stress test.
authors.affiliation: Division of Nuclear Medicine/PET, Department of Radiology, and Noninvasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Sheikine
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015897:Comorbidity; D003937:Diagnosis, Differential; D005080:Exercise Test; D015902:Gamma Cameras; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D017256:Technetium Tc 99m Sestamibi