Cerebral and cerebellar uptake of 99mTc-(d,1)-hexamethyl-propyleneamine oxime (HM-PAO) in patients with brain tumor studied by single photon emission computerized tomography

The cerebral and cerebellar distribution of ^99mTc-(d,1)-hexamethylpropyleneamine oxime (HM-PAO) was investigated by means of a rotating gamma camera in 12 patients with cerebral glioma. Using the corresponding contralateral region as control, reduced uptake of HM-PAO in the tumor region was demonstrated in 10 of the 12 patients. Reduced blood flow in a brain area remote from a circumscribed lesion reflects reduced activation following the interruption of afferent nervous pathways. Reduced HM-PAO uptake indicative of such diaschisis was demonstrated in the visual cortex contralateral to homonymous hemianopia in the two patients with this deficit. In the three patients with the most marked hemiparesis, the cerebellar hemisphere contralateral to the tumor showed significantly reduced HM-PAO uptake indicative of crossed cerebellar diaschisis. SPECT using commonly available gamma cameras and ^99mTc-HM-PAO seems capable of depicting reduced flow in functionally inactivated brain areas, and may be clinically interesting as an alternative to more specialized techniques for the investigation of local cerebral blood flow.     

A study of acetazolamide-induced changes in cerebral blood flow using99mTc HMPAO SPECT in patients with cerebrovascular disease

For semiquantification of SPECT studies we tried to calculate cerebral^99mTc-HMPAO uptake related to injected dose and estimated brain volume. The method was applied to SPECT investigations of 27 patients who had a least one ischaemic attack and a confirmed 80–100% stenosis of the corresponding internal carotid artery (ICA). Vascular reactivity was tested by parenteral administration of acetazolamide (AZ). Increase in HMPAO uptake after AZ was evident in both hemispheres, although the increase (AZ effect) was significantly lower in the affected hemisphere (+24% versus +28%). No interhemispheric uptake differences were seen in patients with largely normal SPECT studies, although local asymmetries in HMPAO deposition were visible. Patients with low density lesions on CT and with a well-demarcated lesion in the same location on SPECT revealed interhemispheric uptake differences, with lower uptake on the affected side. This was not due solely to alterations in the lesion, but also to reduced HMPAO uptake and AZ effect in the surrounding area. The AZ effect showed no correlation with angiographic findings, indicating no major haemodynamic influence of the ICA stenosis on cerebral hemisphere perfusion. Calculated cerebral HMPAO uptake changes after AZ administration were in good accordance with absolute cerebral blood flow measurements, and made interindividual comparisons possible. However, as changes in the area around an infarct or local reduction in vascular reserve may not be reproduced adequately by uptake calculations, visual inspection is still necessary.     

Clinical experience with Tc-99m HM-PAO high resolution SPECT of the brain in patients with cerebrovascular accidents

In order to evaluate the diagnostic contribution of brain SPECT imaging with 99mTc-HMPAO in cerebrovascular disease, we examined 92 stroke cases (144 lesions), 2 hematoma cases and 30 cases with transient neurologic symptoms. Abnormal tracer distribution is visible as zones of either hypoactivity or hyperactivity (border zone hyperemia or luxury perfusion). Remote vascularization changes could also be found (crossed cerebellar diaschisis or ipsilateral cortical perfusion reduction in thalamic or capsula interna lesions). Both X-ray CT and blood flow SPECT have comparable sensitivity in the exploration of cerebral infarction, with detection in, respectively, 89.5% and 87.5% of the lesions. False negative scintitomographic images are frequently recorded in small lacunar infarcts within the basal ganglia and white matter (capsula interna). Some early infarcts and asymmetry of brain perfusion in patients with transient neurologic symptoms are frequently not detected by CT. An additional advantage of blood flow SPECT is its ability to visualize remote blood flow changes and the changing pattern of vascularization of ischemic lesions and their surrounding areas including hyperemia.     

Transient seixure activity demonstrated by Tc-99m HMPAO SPECT and diffusion-weighted MR imaging

Cerebral perfusion single photon emission computed tomography (SPECT) has been used to confirm the localization of the epileptic focus and the evaluation of seizure. Recently, diffusion-weighted MR imaging (DWI) has been recognized for evaluation of seizure activity. We describe a case of transient seizure activity demonstrated by Tc-99m HMPAO SPECT and DWI. This patient was a 61-year-old woman with a 10-month history of right middle cerebral artery (MCA) infarction who had a generalized seizure during MRI. DWI immediately after seizure showed transient hyperintensity in the right frontal gray matter and the white matter, and these apparent diffusion coefficients (ADC) were transiently decreased. This transient hyperintensity on DWI corresponded to transient hyperperfusion identifying the epileptic focus on interictal Tc-99m HMPAO SPECT. Transient sustained seizure activity might cause these changes on DWI and SPECT. It was considered that interictal Tc-99m HMPAO SPECT showed the delayed hyperperfusion caused by excitatory neuronal overaction and DWI showed cytotoxic edema seizure-induced by energy failure of the membrane-bound Na/K-ATPase pump.     

Initial experience with SPECT of the brain using 99mTc-hexamethyl-propyleneamine oxime (99mTc-HM-PAO)

A recently developed ^99mTc radiocompound, hexamethyl-propyleneamine oxime (^99mTc-HM-PAO) exhibits favorable properties for regional cerebral tomograms in man utilizing conventional instrumentation (SPECT). Planar and tomographic studies using a rotating gamma camera equipped with a high sensitivity, low energy, collimator were performed in 5 normal subjects and 20 patients suffering from different cerebral diseases. SPECT abnormalities observed in patients with CVD, brain tumors and hydrocephalus were compared with results from X-ray CT. Our preliminary study demonstrates the feasibility of assessing regional brain perfusion using SPECT and a ^99mTc radiopharmaceutical which is lipid soluble and has a high extraction fraction in the brain.     

A study on attenuation correction using Tc-99m external TCT source in Tc-99m GSA liver SPECT

PURPOSE: In attenuation correction of ECT images by transmission CT (TCT) with an external 99mTc gamma-ray source, simultaneous TCT/ECT data acquisition is difficult, when the same radionuclide such as 99mTc-tetrofosmin or 99mTc-GSA is used as the tracer. In this case, TCT is usually acquired before administration of the tracer, and ECT is acquired separately after the tracer injection. However, misregistration may occur between the TCT and ECT images, and the repetition of examinations add to the mental and physical stress of the patients. In this study, to eliminate this problem, we evaluated whether attenuation correction of ECT images can be achieved by acquiring TCT and ECT simultaneously, then acquiring ECT alone, and preparing an attenuation map by subtracting the latter from the former using 99mTc-GSA liver ECT. METHOD: The ECT system used was a three-head gamma camera equipped with one cardiac fan beam collimator and two parallel beam collimators. External gamma-ray source for TCT of 99mTc was 740 MBq, and ECT of 99mTc-GSA was 185 MBq. First, pure TCT data were acquired for the original TCT-map, then, ECT/TCT data were acquired for the subtracted TCT-map, and finally, pure ECT data were acquired. The subtracted attenuation map was produced by subtracting the pure ECT image from the TCT/ECT image, and attenuation correction of the ECT image was done using both this subtracted TCT map and attenuation map from pure TCT. These two attenuation corrected images and non-corrected images were compared. Hot rods phantom, a liver phantom with a defect, and 10 patients were evaluated. RESULTS: Attenuation corrected ECT values using the subtraction attenuation map showed an error of about 5% underestimation compared with ECT values of the images corrected by original attenuation map at the defect in the liver phantom. A good correlation of y = 22.65 + 1.06x, r = 0.958 was observed also in clinical evaluation. CONCLUSION: By means of the method proposed in this study, it is possible to perform simultaneous TCT/ECT data acquisition for attenuation correction using Tc-99m external source in Tc-99m GSA liver SPECT. Moreover, it is thought that this method decreases the mental and physical stress of the patients.     

直立负荷试验脑显像诊断脑缺血病变

目的 考察直立负荷试验诊断脑缺血疾病的价值。方法 对２０例颈内动脉闭锁或狭窄及直立性低血压患者应用＾９９ｍＴｃ－六甲基丙二胺肟（ＨＭＰＡＯ）进行直立负荷试验脑血流ＳＰＥＣＴ显像。２０例患者中，５例颈内动脉闭锁或狭窄〉７５％（Ａ组），８例直立位与平卧位收缩差〉２．６７ｋＰａ（Ｂ组）；对照组７例经超声心动图及ＣＴ或ＭＲＩ检查为正常非直立性低血压患者。受试者在２－３秒内由卧位转为直立位，即刻注入＾９９     

Improvement in Tc-99m HMPAO brain SPECT findings during donepezil therapy in a patient with pure akinesia

A 58-year-old man presented with a history of disturbance in initiating gait. His history revealed meningoencephalitis five years prior to admission. Neurological examination included gait disturbance as difficulty in initiation and a hesitating speech with many freezing episodes and micrographia Magnetic resonance imaging (MRI) showed diffuse hyperintensity of frontal subcortical white matter on T2 weighted images. He was diagnosed with PA. L-Dopa up to the dosages of 1000 mg/ day and selegiline 10 mg/day were given. First brain SPECT using technetium-99m labeled D,L-hexamethylpropylene amine oxime (Tc-99m HMPAO) was performed when he was taking L-dopa and selegiline. In visual evaluation, hypoperfusion in bilateral frontoparietal cortex was seen (Fig. 2). Treatment with L-dopa and selegiline produced no benefit. Donepezil 10 mg/day was begun. This therapy regimen resulted in dramatic clinical improvement within several days that was confirmed by blinded raters who watched the patient's video recordings. During this response second brain perfusion SPECT study was repeated during donepezil therapy. Markedly increased perfusion in bilateral frontoparietal cortex was observed. This is the first case of PA to develop possibly after an episode of bacterial pneumococcal meningoencephalitis and who responded to donepezil as documented by changes in clinical findings and Tc-99m HMPAO brain SPECT studies.     

Evaluation of the effects of methylprednisolone pulse therapy in patients with systemic lupus erythematosus with brain involvement by Tc-99m HMPAO brain SPECT

Methylprednisolone pulse therapy (MPT) was introduced to avoid life-threatening complications in patients with systemic lupus erythematosus (SLE) with brain manifestations; however, the efficacy of MPT in SLE patients with brain involvement is still uncertain and needs to be objectively evaluated. We enrolled 15 female SLE patients with neuropsychiatric manifestations in this study. All patients had normal brain MRI and abnormal brain HMPAO-SPECT findings. Follow-up HMPAO-SPECT studies were conducted 2 weeks after MPT. Serum levels of anticardiolipin antibodies (ACA) and anti-ribosomal P antibodies (anti-P) were measured before and after MPT. Before MPT, 7 patients were positive for ACA and 7 patients were positive for anti-P. After MPT, none of the 15 patients demonstrated positive serologic findings or neuropsychiatric manifestations. Based on the follow up brain HMPAO-SPECT images following MPT, 13 patients showed disappearance of the perfusion defects and 2 patients showed partial recovery of rCBF. Brain HMPAO-SPECT imaging is a logical and objective tool for measuring the effects of MPT in SLE patients with brain involvement by determining of changes in rCBF.     

Semiquantitative assessment of regional cerebral perfusion using 99mTc HM-PAO and emission tomography

A method for the relative quantification of ^99mTc-HM-PAO distribution in brain SPECT is described. The method, applied in 12 normal volunteers and 150 patients suffering from different cerebral diseases, uses circumferential profiles to quantify the relative radionuclide distribution in the brain tomograms as an angular function with the origin at the center of the brain slice.Abnormal ^99mTc-HM-PAO distribution is evaluated by comparing the count content of symmetrical selected parts of the profile curve and comparing each patient's profile with the corresponding limits of normal ones, determined from the pooled profiles of 12 normal subjects.This computerized method allows an accurate, reproducible and objective assessment of the relative HM-PAO distribution in the brain.     

Assessment of changes in regional cerebral blood flow in patients with major depression using the 99mTc-HMPAO single photon emission tomography method

Regional cerebral blood flow was investigated in 14 patients with major depression diagnosed according to the DSM-III-R criteria (six patients with single and eight patients with recurrent episodes) and in ten healthy volunteers. The mean ages of the patients and the controls were 33.5 ± 2.7 and 31.6 ± 2.6 years, respectively. The severity of the depression was assessed using the 17-item Hamilton Depression Scale (mean: 23.2 ± 1.5). None of the patients was under medication. After administration of 500 MBq technetium-99m hexamethylpropylene amine oxime, a single photon emission tomography study was performed and then transaxial, sagittal and coronal slices were obtained. For the semiquantitative analysis of the data, the ratios of the mean counts/pixel to the whole slice were calculated for 24 regions on three consecutive transaxial slices in the orbitomeatal plane. Additionally, left/right and frontal/occipital ratios were calculated. Both sides of the temporal region had a significantly decreased cerebral blood flow (CBF) when compared to the controls. The left/right ratio of the prefrontal region was also significantly lower in the patients than in the controls. The Hamilton score had a negative correlation with blood flow in the anterofrontal and left prefrontal regions. According to our results, regional CBF seems to be decreased in the left prefrontal and in both temporal regions in major depression. The severity of depression is correlated with the reduction in CBF in the regions of the anterofrontal and left prefrontal cortex.     

Assessment of cerebral hemodynamics before and after revascularization in patients with occlusive cerebrovascular disease by means of quantitative IMP-SPECT with double-injection protocol

The purpose of this study was to validate a double-injection (DI) method with N-isopropyl-[123I]p-iodoamphetamine (IMP) to measure regional cerebral blood flow (rCBF) twice in a single session of dynamic SPECT and to elucidate a possible role of this method to identify patients with occlusive disease of major cerebral arteries, who might benefit from cerebral revascularization procedures (CR). MATERIALS AND METHODS: Fourteen patients with occlusion or severe stenosis of the internal carotid or middle cerebral artery were studied before and after CR to assess hemodynamic changes after revascularization treatment. We quantitatively measured rCBF before and after acetazolamide (ACZ) challenge along with cerebrovascular reserve capacity (CVR) with two injections of IMP in a single session of dynamic SPECT scans (DI method). The reliability and reproducibility of the DI method were validated by means of a simulation study and in eight patients who were examined without ACZ challenge to measure baseline rCBF twice. RESULTS: The analysis of simulated noisy data with realistic noise levels showed that the errors of the estimates for the first and the second rCBF and for the increase in rCBF were 2.6%, 8.1% and 10.4%, respectively. In the 8 patients examined by the DI method to measure baseline rCBF twice, the mean and the SD of percentage differences between the two consecutive measurements in rCBF were -1.3% and 5.5%, respectively. Eight out of 14 patients with occlusive disease had at least one region with a CVR less than 10%. They showed a significant increase in resting rCBF after CR, not only in the ipsilateral hemisphere (from 26.1 +/- 6.4 to 33.4 +/- 4.7) but also in the contralateral one (from 28.3 +/- 7.0 to 34.7 +/- 4.7) with a recovery of the ipsilateral CVR from 9.3 +/- 17.2 to 41.2 +/- 20.1%. The remaining six patients with good-moderate CVR did not show an increase in rCBF after CR (from 28.0 +/- 2.7 to 28.3 +/- 3.4). The three of them with a moderate CVR (10-25%) before CR showed normalization of CVR after CR. CONCLUSION: Patients with decreased rCBF and reduced CVR benefited from CR in terms of an increase in rCBF and recovery of CVR. The quantitative double-injection IMP-SPECT has the ability to identify those patients who may benefit from CR.     

Diagnosis of brain death with technetium 99m hexamethylpropylene amine oxime

We report on the utility of technetium 99m hexamethylpropylene amine oxime (^99mTc-HMPAO) to diagnose brain death following cardiac surgery on a 49-year-old man with triple-vessel coronary artery disease. The imaging parameters and criteria to diagnose irreversible brain damage (brain death) with ^99m-TcHMPAO are outlined. Brain imaging with this tracer seems to be more reliable than classic radionuclide angiography and has a potential value to confirm the diagnosis of brain death at an early stage. In addition, it may be used to evaluate the perfusion pattern to other vital organs with potential for transplantation.Partially presented as a poster demonstration to the 19th Annual Meeting of the BNMS. Offprint requests to: D.C. Costa     

Technetium-99m pyrophosphate/thallium-201 dual-isotope SPECT imaging predicts reperfusion injury in patients with acute myocardial infarction after reperfusion

Purpose  Microcirculatory failure after reperfusion is clinically indicated to cause reperfusion injury whereas excessive intracellular calcium ion overload is experimentally proved as a key mechanism of reperfusion injury. We hypothesized that technetium-99m (^99mTc) pyrophosphate (Tc-PYP) uptake in injured but viable infarct-related myocardium with preserved myocardial perfusion after reperfusion estimated by thallium-201 (²⁰¹Tl) uptake would be associated with final functional recovery. Methods  Dual-isotope Tc-PYP/²⁰¹Tl single-photon emission computed tomography (SPECT) was performed 2 days after successful reperfusion therapy in patients with first acute myocardial infarction, and 50 patients (63 ± 13 years old, female 22%) with preserved ²⁰¹Tl uptakes of ≥50% in reperfused myocardium was followed for 1 month. Tc-PYP uptake was assessed as the heart-to-sternum (H/S) ratio. Two-dimensional echocardiography was also performed 2 days and 1 month after reperfusion to evaluate functional recovery. Results  High Tc-PYP uptake, defined as the H/S ratio ≥0.81, was predictive of chronic phase no functional recovery (73.7% in 14 of 19 patients with high uptake vs 16.1% in five of 31 patients without those, p < 0.0001). After adjustment for potential confounding variables, including electrocardiographic persistent ST segment elevation at 1 h after reperfusion, high Tc-PYP uptake remained independently predictive of no functional recovery with odds ratio of 8.7 (95% confidential interval = 2 to 38.7; p = 0.005). Conclusion  High Tc-PYP uptake in reperfused but viable infarct-related myocardium was a powerful predictor of no functional recovery, which may reflect excessive intracellular calcium ion overload caused by reperfusion injury. Tc-PYP/²⁰¹Tl dual-isotope SPECT imaging can provide prognostic information after reperfusion.     

Estimation of coronary flow reserve with the use of dynamic planar and SPECT images of Tc-99m tetrofosmin

BACKGROUND: We developed a noninvasive method to examine coronary flow reserve with technetium 99m tetrofosmin based on the microsphere model. According to the microsphere model, myocardial blood flow (MBF) can be calculated by MBF = q / integral C(t)dt, where q is myocardial activity and C(t) is tracer concentration in blood. Because the ratio of integral C(t)dt at stress to rest is equal to the ratio of the first transit count in the pulmonary artery (PA) and attenuation factors were canceled out, we calculated the increase ratio of MBF (MBF(IR)). METHODS AND RESULTS: After injection of dipyridamole, tetrofosmin was injected as a bolus and serial dynamic planar images were obtained to measure the first transit count in PA (PAC). Myocardial single photon emission computed tomography was performed to measure the regional myocardial count (RMC). MBF(IR) was calculated as [(RMCs x PACr)/(RMCr x PACs) - 1] x 100, where r and s denote resting and stress conditions, respectively. In contrast, the increase in the myocardial uptake ratio (MUR(IR)) was defined as (RMCs x SCr/RMCr x SCs - 1) x 100, where SC is syringe count of tracer. The results were as follows: (1) The mean MBF of healthy subjects was 46.9% +/- 22.8%. (2) MBF(IR) of the infarcted region and ischemic region was significantly decreased (8.3% +/- 12.2% and 11.2% +/- 11.9%, respectively; P <.001). (3) MUR(IR) was significantly lower than MBF(IR) (14.1% +/- 21.2%; P <.001). (4) MBF(IR) decreased according to the heart rate at rest (r = 0.47; P <.05). CONCLUSIONS: MBF(IR) is a potential parameter with which to evaluate coronary flow reserve when the changes of arterial input function during stress are considered.     

Noninvasive measurements of regional cerebral blood flow using technetium-99m hexamethylprophylene amine oxime

The previously reported method for quantitative measurements of whole-brain or hemispheric-brain perfusion using technetium-99m hexamethylpropylene amine oxime (HMPAO) radionuclide angiography is now further developed so that regional cerebral blood flow (rCBF) can be measured. Lassen's correction algorithm is used for the linearization of a curve-linear relationship between the radioactivity in the brain and blood flow as seen with single-photon emission tomography (SPET) images. In this algorithm, the cerebral hemisphere was chosen as the reference region and the correction factor was adapted to rCBF in the reference region. This new method of measuring CBF from SPET has been validated in 33 normal subjects and 22 patients with cerebrovascular disease. Regional CBF values in 20 brain regions of the normal subjects were in good agreement with reported values measured by other methods. Regional CBF in the frontal cortex was greater than that in the temporal, parietal or occipital cortex for the entire age range. This hyperfrontal perfusion tended to be less pronounced with advancing age. Seventeen patients with unilateral brain infarction showed significantly lower rCBF than normal subjects. The infarct core showed a low rCBF value of 11.1 ml/ 100 g/min on average. An increase in rCBF after acetazolamide administration was observed and mesured with this method in five patients with unilateral occlusive vascular pathology. These results suggest that this non-invasive method (without any blood sampling) permits the routine measurement of rCBF from HMPAO SPET tomograms of blood flow. Correspondence to: H. Matsuda     

Initial experience with Tc-99m-HM-PAO in the study of brain tumors

A preliminary study of the distribution of the ^99mTc complex of hexamethylpropylene amine oxime (HM-PAO) in 12 patients with brain neoplasms before, during, and after radiotherapy has been performed. Untreated brain tumors were found to exhibit a range of ^99mTc-HM-PAO uptake, varying from areas of markedly increased isotope activity to photopenic areas, when compared to normal brain tissue. A ratio of ^99mTc-HM-PAO tumor uptake to contralateral normal tissue uptake was calculated prior to and during radiotherapy. This ratio tended to return towards unity in lesions responding to therapy. A predictable alteration in whole brain ^99mTc-HM-PAO uptake during radiotherapy was not demonstrated. Unlike the radiolabeled amines, ^99mTc-HM-PAO localizes in primary tumors, probably indicating that its uptake mechanism is independent of non specific amine receptors. ^99mTc-HM-PAO may be useful in the study of brain tumor physiology and response to therapy.     

Perfusion MRI before and after acetazolamide administration for assessment of cerebrovascular reserve capacity in patients with symptomatic internal carotid artery (ICA) occlusion: comparison with <Superscript>99m</Superscript>Tc-ECD SPECT

Introduction Impaired cerebral vascular reserve (CVR) in patients with symptomatic internal carotid artery (ICA) occlusion is regarded as a possible indication for performing extra-/intracranial (EC/IC) bypass surgery. As perfusion MR imaging (MRI) can demonstrate cerebral haemodynamics at capillary level, our hypothesis was that perfusion MRI could be used in these patients for the evaluation of CVR following acetazolamide challenge in a similar way to single photon emission CT (SPECT) and might provide additional information. Methods Enrolled in the study were 12 patients (mean age 61.3 years; 11 male, 1 female) with symptomatic unilateral ICA occlusion proven by angiography. Both perfusion MRI and 99m-technetium-ethyl-cysteinate dimer (^99mTc-ECD) SPECT were performed before and after injection of acetazolamide (Diamox ,1000 mg i.v.). CVR parameters including regional cerebral blood flow (rCBF) and volume (rCBV), and mean transit times (MTT) were measured by perfusion MRI. Results The patients with impaired CVR proven by SPECT (n = 9) had a negative mean rCBF increment (−46.52%), negative rCBV increment (−13.5%) and delayed MTT (mean +2.98 s), respectively, on the occluded side (Student’s t-test all P < 0.05). The patients with sufficient CVR (n = 3) had a mean rCBF increment of 1.2%, a decrement of rCBV of 10.46%, and a mean MTT shortening of 0.27 s following the acetazolamide injection. Conclusions Perfusion MRI before and after acetazolamide administration compares favourably with ^99mTc-ECD SPECT for the detection of impaired CVR. The impact that perfusion MRI studies (before and after acetazolamide administration) might have on the treatment decision in patients with ICA occlusion has yet to be determined by a prospective study. The first and second author contributed equally to this study.     

Increased cerebral blood flow in MELAS shown by Tc-99m HMPAO brain SPECT

We report cerebral SPECT studies on two siblings with the syndrome of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). Tc-99m HMPAO brain SPECT was performed 8, 19 and 30 days after a stroke-like episode in one case and 10 days after a stroke-like episode, 6 h after a partial seizure and as a follow-up study in the other. Increased blood flow was seen in both these patients with stroke-like episodes due to MELAS. The cause of the increased blood flow is uncertain, but it may be related to the decreased pH created by local increase in lactic acid. Received: 30 December 1997/Accepted: 18 March 1999     

Validation of left ventricular volume measurements by gated SPECT 99mTc-labeled sestamibi imaging

Background  Previous studies have shown that gated single photon emission computed tomography (SPECT) technetium 99-labeled sestamibi imaging provides accurate and reproducible measurement of left ventricular (LV) ejection fraction (EF), wall motion, and thickening. This study examined the reliability of gated SPECT sestamibi imaging in measuring LV end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV). Methods and Results  Gated SPECT measurements were compared with an independent nongeometric method based on thermodilution SV and first-pass radionuclide angiographic EF (using a multicrystal gamma camera). Twenty-four patients aged 58±11 years underwent cardiac catheterization and coronary angiography for evaluation of chest pain syndromes. None had primary valvular disease, intracardiac shunts, or atrial fibrillation. Results  The correlation between the two methods were as follows: EDV: r=0.89, P<.001; ESV: r=.938, P<.001; SV: r=0.557, P<.001. Bland-Altman plots showed mean differences (±standard deviation [SD]) for EDV of −14.3±33.3 mL, for ESV of −0.4±23.7 mL, and for SV of −13.9±15.2 mL. The reproducibility of measuring EDV and ESV by gated SPECT was very high (r=0.99 each). Conclusion  Gated ^99mTc-labeled sestamibi SPECT provides reproducible LV volume measurements. With validation of volume measurement, gated SPECT provides comprehensive assessment of regional and global LV function. This information is important in many patient groups such as those with ischemic cardiomyopathy, concomitant coronary and valve disease, and those who have had myocardial infarction. It will also be useful to assess the incremental value of LV volumes in risk assessment. Presented in part at the 47th Annual Meeting of the American College of Cardiology, Mar. 29–Apr. 1, 1998, Atlanta, Ga. Supported by a research grant from DuPont Pharmaceutical, Billerica, Mass. Various nuclear medicine hardware and software manufacturers have an agreement with Cedars-Sinai Medical Center through which the Medical Center receives royalties based on the distribution of the quantitative gated SPECT software.