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Enhanced detection of reversible perfusion defects by Tc-99m sestamibi compared to Tc-99m tetrofosmin during vasodilator stress SPECT imaging in mild-to-moderate coronary artery disease

Prem Soman, MD, PhD, MRCP^*, Raymond Taillefer, MD, FRCP(C), E. Gordon DePuey, MD, FACC, James E. Udelson, MD, FACC and Avijit Lahiri, MBBS, MSc, MRCP, FESC, FACC^*

^* Department of Cardiovascular Medicine, Northwick Park & St. Marks Hospitals, NHS Trust and Institute of Medical Research, Harrow, United Kingdom
Department of Nuclear Medicine, Hotel-Dieu De Montreal, Quebec, Canada
Division of Nuclear Medicine, St. Luke’s-Roosevelt Hospital Center, New York, New York, USA
Division of Cardiology, New England Medical Center, Boston, Massachusetts, USA

View larger version (83K): [in a new window]   Figure 1 Representative horizontal and vertical long axes slices from the Tc-99m tetrofosmin (TETRO) and Tc-99m sestamibi (MIBI) stress (S) and rest (R) SPECT images of a 67-year-old female patient with a 50% stenosis of her mid left anterior descending coronary artery and 90% stenosis of the proximal left circumflex coronary artery. There are infero-apical and lateral defects in the Tc-99m sestamibi scan while the Tc-99m tetrofosmin scan is only mildly abnormal.

View larger version (85K): [in a new window]   Figure 2 Representative horizontal and vertical long axes, and short axis slices from the Tc-99m tetrofosmin (TETRO) and Tc-99m sestamibi (MIBI) stress (S) and rest (R) SPECT images of a 64-year-old man with 90% stenosis of the proximal left anterior descending coronary artery. The perfusion abnormality involving the apex, septum, and anterior walls is more severe and extensive on the Tc-99m sestamibi scan.

View larger version (11K): [in a new window]   Figure 3 Detection of perfusion defects in two vascular territories in the 29 patients with two-vessel coronary artery disease (p = 0.02 by McNemar’s test).