Abstract
To validate functional analysis of gated SPECT in detecting myocardial viability, seventeen patients (male 15, female 2, mean age 58) with angiographically proven chronic ischemic heart disease (RCA 6, LAD 10, LCX 1) and eight normal volunteers (all male) were studied. All patients underwent18F FDG PET and99mTc tetrofosmin (TF) gated SPECT within a week. After being displayed in a polar map, myocardial perfusion was regionally determined by the mean count in 9 segments at end diastole (ED) and end systole (ES) in gated SPECT. Systolic function was determined by the count increase ratio from ED to ES (WTI: ES — ED/ED). Glucose metabolism was assessed by18F FDG PET in the segments correspondent to those defined for SPECT. TF %uptake of < 60% was defined as hypoperfusion, and FDG %uptake of < 50% was defined as reduced glucose metabolism. Results: The myocardial segments were classified into 3 categories: “normal” perfusion (n = 85), “mismatch” (reduced perfusion with reserved FDG uptake, n = 25) and “matched” reduced perfusion and metabolic reduction (n = 26). Mean WTI in “mismatch” segment was 0.38 ± 0.21, and was significantly greater than that in “matched reduced” segments, 0.15 ± 0.20 (p < 0.001). It was also greater than that in “normal” segments, 0.27 ± 0.16. Regression analysis showed that association between WTI and FDG %uptake was significant (r = 0.57, p < 0.0005) for the ischemic segments (“mismatch” + “matched”, n = 51), but the association was weak for the entire segments although it was statistically significant (r = 0.26, p = 0.02, n = 136). Conclusion: For the segments determined as infarct by perfusion image, systolic functional analysis by gated SPECT is helpful in differentiation of a viable myocardial region or artifact from a scar. Nevertheless, further clinical and technical assessment is required for ECG gating to eliminate overestimation of viability and to warrant clinical use.
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Rocco TP, Dilsizian V, Strauss HW, Broucher CA. Technetium-99m isonitrile myocardial uptake at rest. Relation to clinical markers of potential viability.J Am Coll Cardiol 14: 1678–1684, 1989.
Sawada SG, Allman KC, Muzik O, Beanlands RSB, Wolfe ER, Gross M, et al. Positron emission tomography detects evidence of viability in rest Technetium-99m sestamibi defects.J Am Coll Cardiol 23: 92–98, 1994.
Yamanouchi M, Yoshida K, Niwayama H, Nakagawa K, Aioi S, Shikama N, et al. Effect of the duration of fasting on myocardial fluorine-18-fluorodeoxyglucose positron emission tomography images in normal males.Jpn Circ J 60 (6): 319–327, 1996.
Tillisch J, Brunken R, Marshall R, Schwaiger M, Mandelkern M, Phelps M, et al. Reversibility of cardiac wall-motion abnormalities predicted by positron tomography.NEJM 314 (14): 884–888, 1986.
Tamaki N, Yonekura Y, Yamashita K, Saji H, Magata Y, Senda M, et al. Positron emission tomography using fluorine-18 deoxyglucose in evaluation of coronary artery bypass grafting.Am J Cardiol 64 (14): 860–865, 1989.
Nienaber CA, Brunken RC, Sherman CT, Yeatman LA, Gambhir SS, Krivokapich J, et al. Metabolic and functional recovery of ischemic human myocardium after coronary angioplasty.J Am Coll Cardiol 18 (4): 966–978, 1991.
Eitzman D, al-Aouar Z, Kanter HL, vom Dahl J, Kirsh M, Deeb GM, et al. Clinical outcome of patients with advanced coronary artery disease after viability studies with positron emission tomography.J Am Coll Cardiol 20 (3): 559–565, 1992.
Galt JR, Garcia EV, Robbins WL. Effect of myocardial wall thickness on SPECT quantification.IEEE Trans Med Imag 9 (2): 144–150, 1990.
Ziffer JA, Cook CD, Folks RD, et al. Quantitative myocardial thickening assessed with sestamibi: clinical evaluation of a count-based method.J Nucl Med 30 (5): 1991.
Hoffmans EJ, Huang SC, Phelps ME. Quantitation in positron emission computed tomography: 1. Effect of object size.J Comput Assist Tomogr 3: 299–308, 1979.
DePuey EG, Nichols K, Salensky H, et al. Using gated technetium-99m-sestamibi SPECT to characterize fixed myocardial defects as infarct or artifact.J Nucl Med 36: 952–955, 1995.
Kouris K, Abdel-Dayem HM, Taha B, Ballani N, Hassan IM, Constantinides C. Left ventricular ejection fraction and volumes calculated from dual gated SPECT myocardial imaging with99mTc-MIBI.Nucl Med Comm 13 (9): 648–655, 1992.
DePuey EG, Nichols K, Dobrinsky C. Left ventricular ejection fraction assessed from gated technetium-99msestamibi SPECT.J Nucl Med 34 (11): 1871–1876, 1993.
Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT.J Nucl Med 36 (11): 2138–2147, 1995.
Chua T, Kiat H, Germano G, Maurer G, van Train K, Friedman J, et al. Gated technetium-99m sestamibi for simultaneous assessment of stress myocardial perfusion, post-exercise regional ventricular function and myocardial viability. Correlation with echocardiography and rest thallium-201 scintigraphy.J Am Coll Cardiol 23 (5): 1107–1114, 1994.
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Kuwabara, Y., Watanabe, S., Nakaya, J. et al. Functional evaluation of myocardial viability by99mTc tetrofosmin gated SPECT —A quantitative comparison with18F fluorodeoxyglucose positron emission CT (18F FDG PET)—. Ann Nucl Med 13, 135–140 (1999). https://doi.org/10.1007/BF03164852
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DOI: https://doi.org/10.1007/BF03164852