title: Reverse perfusion pattern in myocardial perfusion imaging using technetium-99m-sestamibi in patients with intermediate risk for coronary artery disease in relation to the time of acquisition and intensity of visceral uptake as artifactual causes.
abstract: OBJECTIVE
  With respect to the equivocal value of the reverse perfusion pattern (RPP) in technetium-99m (Tc)-sestamibi myocardial perfusion imaging, a study was carried out to evaluate this pattern in association with the presence or absence of coronary artery disease (CAD) and other underlying factors, mainly the time of acquisition and the presence of intense visceral uptake.
  
  
  METHODS
  We prospectively studied 102 patients with a moderate risk of CAD (41 men and 61 women, mean age: 56.5±9.2 years) without a previous history of documented CAD, myocardial infarction, or revascularization. Myocardial perfusion imaging was performed using a 2-day dual-phase protocol with the stress and rest images, each obtained 15, 120, and 180 min after an injection of 666-814 MBq Tc-MIBI. According to the time of image acquisition, the following five protocols were defined, A: 15/15 min, B: 15/180 min, C: 180/180 min, D: 180/15 min, and E: 120/120 min for stress/rest images, respectively.
  
  
  RESULTS
  The odds of RPP were higher in the cases with more intense infradiaphragmatic visceral uptake on rest-phase images of the protocols A and D (odds ratios=1.2-7.8 and 1.2-7.5, respectively). Our results showed that RPP is related to incorrect normalization. Also, diabetes, sex, and CAD did not correlate with RPP.
  
  
  CONCLUSIONS
  This study found no relationship between RPP and CAD, diabetes mellitus, and sex; however, an association was found between RPP and incorrect normalization because of the variation of visceral uptake intensity in relation to the time of acquisition at stress and rest phases favoring the artifactual base of this pattern.
authors.affiliation: aResearch Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran bNuclear Medicine and Molecular Imaging Research Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Babak
authors.initials: B
authors.lastname: Fallahi
authors.forename: Davood
authors.initials: D
authors.lastname: Beiki
authors.forename: Yalda
authors.initials: Y
authors.lastname: Salehi
authors.forename: Alireza
authors.initials: A
authors.lastname: Emami-Ardekani
authors.forename: Armaghan
authors.initials: A
authors.lastname: Fard-Esfahani
authors.forename: Farahnaz
authors.initials: F
authors.lastname: Aghahosseini
authors.forename: Mahdi
authors.initials: M
authors.lastname: Haghighatafshar
authors.forename: Mohammad
authors.initials: M
authors.lastname: Eftekhari
mesh_terms: D000368:Aged; D016477:Artifacts; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003326:Coronary Circulation; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012307:Risk Factors; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi