Separate acquisition rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion single-photon emission computed tomography: a clinical validation study

Department of Imaging (Division of Nuclear Medicine), Cedars-Sinai Medical Center, Los Angeles, California 90048.

OBJECTIVES. This study assessed the validity of a novel approach to myocardial perfusion scintigraphy that provides the opportunity to avoid the drawbacks of standard same-day rest/stress technetium-99m sestamibi myocardial perfusion studies by using separate-acquisition dual-isotope rest thallium-201 and exercise technetium-99m sestamibi single-photon emission computed tomography (SPECT). BACKGROUND. Standard same-day rest/stress technetium-99m sestamibi myocardial perfusion studies are cumbersome, associated with a potential decrease in perceived stress defect severity compared with thallium-201 due to the presence of rest technetium-99m sestamibi and may be unable to differentiate hibernating from infarcted myocardium. METHODS. The dual-isotope procedure was performed in 63 patients without previous myocardial infarction undergoing coronary angiography to evaluate sensitivity and specificity for coronary artery disease and in 107 patients with a low (< 5%) likelihood of coronary artery disease to evaluate normalcy rate. To validate defect reversibility, the dual-isotope SPECT study was compared with stress/rest technetium-99m sestamibi SPECT studies in a separate group of 31 patients with previous documented myocardial infarction who underwent a rest technetium-99m sestamibi study in addition to the dual-isotope SPECT study. RESULTS. In angiographic correlations, dual-isotope SPECT demonstrated high sensitivity for detecting patients with > or = 50% stenosis (91%, 55 patients) and > or = 70% stenosis (96%, 52 patients). In a small group of patients, high specificity was also observed (75% for < 50% stenosis [8 patients] and 82% for < 70% stenosis [11 patients]). A very high normalcy rate of 95% was also found. In the patient group assessed for defect reversibility, in zones with no previous myocardial infarction, segmental agreement for defect type between rest thallium-201 and rest technetium-99m sestamibi studies was 97% (kappa = 0.79, p < 0.001). In myocardial infarct zones, segmental agreement for defect type was 98% (kappa = 0.93, p < 0.001). Image quality was generally good to excellent. CONCLUSIONS. Our findings demonstrate that separate-acquisition dual-isotope myocardial perfusion SPECT is accurate for coronary artery disease detection, correlates well with rest-stress sestamibi studies for assessment of defect reversibility and results in good to excellent image quality. This approach provides an excellent method for the combined assessment of stress myocardial perfusion and myocardial viability.

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				C. A. Santana, E. V. Garcia, J. P. Vansant, E. G. Krawczynska, R. D. Folks, C. D. Cooke, and T. L. Faber Three-Dimensional Color-Modulated Display of Myocardial SPECT Perfusion Distributions Accurately Assesses Coronary Artery Disease J. Nucl. Med., December 1, 2000; 41(12): 1941 - 1946. [Abstract] [Full Text] [PDF]

				S. Atar, T. Nagai, B. Cercek, T. Z. Naqvi, H. Luo, and R. J. Siegel Pacing stress echocardiography: an alternative to pharmacologic stress testing J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1935 - 1941. [Abstract] [Full Text] [PDF]

				J. E. Udelson, V. Dilsizian, R. J. Laham, N. Chronos, J. Vansant, M. Blais, J. R. Galt, M. Pike, C. Yoshizawa, and M. Simons Therapeutic Angiogenesis With Recombinant Fibroblast Growth Factor-2 Improves Stress and Rest Myocardial Perfusion Abnormalities in Patients With Severe Symptomatic Chronic Coronary Artery Disease Circulation, October 3, 2000; 102(14): 1605 - 1610. [Abstract] [Full Text] [PDF]

				G. A. Beller and B. L. Zaret Contributions of Nuclear Cardiology to Diagnosis and Prognosis of Patients With Coronary Artery Disease Circulation, March 28, 2000; 101(12): 1465 - 1478. [Full Text] [PDF]

				R. J. Gibbons, D. O. Hodge, D. S. Berman, O. O. Akinboboye, J. Heo, R. Hachamovitch, K. R. Bailey, and A. E. Iskandrian Long-Term Outcome of Patients With Intermediate-Risk Exercise Electrocardiograms Who Do Not Have Myocardial Perfusion Defects on Radionuclide Imaging Circulation, November 23, 1999; 100(21): 2140 - 2145. [Abstract] [Full Text] [PDF]

				T. Sharir, D. S. Berman, H. C. Lewin, J. D. Friedman, I. Cohen, R. Miranda, R. D. Agafitei, and G. Germano Incremental Prognostic Value of Rest-Redistribution 201Tl Single-Photon Emission Computed Tomography Circulation, November 9, 1999; 100(19): 1964 - 1970. [Abstract] [Full Text] [PDF]

				F Larrazet, D Pellerin, D Daou, S Witchitz, C Fournier, A Prigent, and C Veyrat Concordance between dobutamine Doppler tissue imaging echocardiography and rest reinjection thallium-201 tomography in dysfunctional hypoperfused myocardium Heart, October 1, 1999; 82(4): 432 - 437. [Abstract] [Full Text] [PDF]

				T. Sharir, G. Germano, P. B. Kavanagh, S. Lai, I. Cohen, H. C. Lewin, J. D. Friedman, M. J. Zellweger, and D. S. Berman Incremental Prognostic Value of Post-Stress Left Ventricular Ejection Fraction and Volume by Gated Myocardial Perfusion Single Photon Emission Computed Tomography Circulation, September 7, 1999; 100(10): 1035 - 1042. [Abstract] [Full Text] [PDF]

				T. Nishioka, A. M. Amanullah, H. Luo, H. Berglund, C.-J. Kim, T. Nagai, N. Hakamata, S. Katsushika, A. Uehata, B. Takase, et al. Clinical validation of intravascular ultrasound imaging for assessment of coronary stenosis severity: Comparison with stress myocardial perfusion imaging J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1870 - 1878. [Abstract] [Full Text] [PDF]

				R. J. Gibbons, K. Chatterjee, J. Daley, J. S. Douglas, S. D. Fihn, J. M. Gardin, M. A. Grunwald, D. Levy, B. W. Lytle, R. A. O'Rourke, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2092 - 2197. [Full Text] [PDF]

				R. C. Hendel, D. S. Berman, S. J. Cullom, W. Follansbee, G. V. Heller, H. Kiat, M. W. Groch, and J. J. Mahmarian Multicenter Clinical Trial to Evaluate the Efficacy of Correction for Photon Attenuation and Scatter in SPECT Myocardial Perfusion Imaging Circulation, June 1, 1999; 99(21): 2742 - 2749. [Abstract] [Full Text] [PDF]

				D. S. Berman, X. Kang, K. F. Van Train, H. C. Lewin, I. Cohen, J. Areeda, J. D. Friedman, G. Germano, L. J. Shaw, and R. Hachamovitch Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single-photon emission computed tomography J. Am. Coll. Cardiol., December 1, 1998; 32(7): 1987 - 1995. [Abstract] [Full Text] [PDF]

				K. E. Fleischmann, M. G. M. Hunink, K. M. Kuntz, and P. S. Douglas Exercise Echocardiography or Exercise SPECT Imaging?: A Meta-analysis of Diagnostic Test Performance JAMA, September 9, 1998; 280(10): 913 - 920. [Abstract] [Full Text] [PDF]

				R. Hachamovitch, D. S. Berman, L. J. Shaw, H. Kiat, I. Cohen, J. A. Cabico, J. Friedman, and G. A. Diamond Incremental Prognostic Value of Myocardial Perfusion Single Photon Emission Computed Tomography for the Prediction of Cardiac Death : Differential Stratification for Risk of Cardiac Death and Myocardial Infarction Circulation, February 17, 1998; 97(6): 535 - 543. [Abstract] [Full Text] [PDF]

				R. Hachamovitch, D. S. Berman, H. Kiat, I. Cohen, J. A. Cabico, J. Friedman, and G. A. Diamond Exercise Myocardial Perfusion SPECT in Patients Without Known Coronary Artery Disease : Incremental Prognostic Value and Use in Risk Stratification Circulation, March 1, 1996; 93(5): 905 - 914. [Abstract] [Full Text]

				G. M. Pohost Is 31P-NMR Spectroscopic Imaging a Viable Approach to Assess Myocardial Viability? Circulation, July 1, 1995; 92(1): 9 - 10. [Full Text]

				T. Yabe, K. Mitsunami, T. Inubushi, and M. Kinoshita Quantitative Measurements of Cardiac Phosphorus Metabolites in Coronary Artery Disease by 31P Magnetic Resonance Spectroscopy Circulation, July 1, 1995; 92(1): 15 - 23. [Abstract] [Full Text]

				N. P. Alazraki Nuclear Medicine JAMA, June 7, 1995; 273(21): 1697 - 1698. [Abstract] [PDF]

				R. Hachamovitch, D. S. Berman, H. Kiat, I. Cohen, J. D. Friedman, and L. J. Shaw Value of Stress Myocardial Perfusion Single Photon Emission Computed Tomography in Patients With Normal Resting Electrocardiograms: An Evaluation of Incremental Prognostic Value and Cost-Effectiveness Circulation, February 19, 2002; 105(7): 823 - 829. [Abstract] [Full Text] [PDF]