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OtherCONTINUING EDUCATION

Myocardial Perfusion Imaging Protocols: Is There an Ideal Protocol?

Syed Sajid Husain
Journal of Nuclear Medicine Technology March 2007, 35 (1) 3-9;
Syed Sajid Husain
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  • FIGURE 1. 
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    FIGURE 1. 

    (a) Images obtained with 2-d 99mTc-sestamibi protocol. Findings are normal. (b) Images obtained with 1-d 99mTc-sestamibi protocol. Findings are normal.

  • FIGURE 2. 
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    FIGURE 2. 

    Dual-isotope imaging. Reprinted from Crawford ES, Husain SS. Nuclear Cardiac Imaging: Terminology and Technical Aspects. Reston, VA: Society of Nuclear Medicine; 2003;33.

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    FIGURE 3. 

    Images obtained with 99mTc-sestamibi (top row of each pair of rows) and 201Tl (bottom row of each pair) in dual-isotope protocol. Findings are normal.

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    FIGURE 4. 

    Normal cavity size difference between images obtained with 99mTc-sestamibi (top row of each pair of rows) and those obtained with 201Tl (bottom row of each pair) in dual-isotope protocol.

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    TABLE 1

    Comparison of First-Pass Myocardial Extraction Fractions of Various 99mTc-Labeled Agents and 201Tl

    Agent% Extraction fraction
    201Tl82–88
    99mTc-Sestamibi55–68
    99mTc-Tetrofosmin54
    99mTc-Teboroxime>90
    99mTc-NOET75–85
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    TABLE 2

    Physical and Biologic Comparisons of Myocardial Perfusion Imaging Agents

    Factor99mTc-Sestamibi or 99mTc-tetrofosmin201Tl
    Extraction fractionLowerHigher
    Myocardial retentionProlongedComparatively shorter
    Myocardial washoutSlowerRapid
    RedistributionMinimalSignificant
    Myocardial perfusion at high blood flowSameSame
    Injected doseHigherLower
    Counting statisticsBetterFair
    Physical half-life6 h73.1 h
    Photon energy140 kEv68–80 kEv (abundance), 170 kEv (∼10%), and 135 kEv (∼3%)
    Radiation dosimetryMore favorableLess favorable
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    TABLE 3

    Doses of 99mTc-Labeled Agents for Myocardial Perfusion Scintigraphy*

    ProtocolSestamibiTetrofosmin
    One-day protocol
     First dose8–10 mCi5–8 mCi
     Second dose22–30 mCi15–24 mCi
    Two-day protocol
     First dose15–30 mCi15–24 mCi
     Second dose15–30 mCi15–24 mCi
    • ↵* Reprinted from Crawford ES, Husain SS. Nuclear Cardiac Imaging: Terminology and Technical Aspects. Reston, VA: Society of Nuclear Medicine; 2003:29.

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Journal of Nuclear Medicine Technology: 35 (1)
Journal of Nuclear Medicine Technology
Vol. 35, Issue 1
March 2007
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Myocardial Perfusion Imaging Protocols: Is There an Ideal Protocol?
Syed Sajid Husain
Journal of Nuclear Medicine Technology Mar 2007, 35 (1) 3-9;

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Myocardial Perfusion Imaging Protocols: Is There an Ideal Protocol?
Syed Sajid Husain
Journal of Nuclear Medicine Technology Mar 2007, 35 (1) 3-9;
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  • Article
    • Abstract
    • RADIOPHARMACEUTICALS
    • COMPARISON OF 201TL AND 99MTC-LABELED MYOCARDIAL PERFUSION IMAGING TRACER KINETICS
    • RELATIONSHIP BETWEEN CORONARY BLOOD FLOW AND MYOCARDIAL UPTAKE OF VARIOUS RADIOTRACERS
    • PHYSICAL AND BIOLOGIC COMPARISONS OF MYOCARDIAL PERFUSION IMAGING AGENTS
    • VARIOUS IMAGING PROTOCOLS
    • CONCLUSION
    • Acknowledgments
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