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The aim of this retrospective study was to compare the heart-to-mediastinum ratio (HMR) of 123 I-metaiodobenzylguanidine ( 123 I-MIBG) uptake obtained using a multipinhole cadmium-zinc-telluride (CZT) camera with that obtained using conventional planar imaging. Methods: Forty consecutive heart failure patients underwent planar acquisition 4 h after 123 I-MIBG injection (191 ± 41 [mean ± SD] MBq). To localize the heart using the CZT camera, 99m Tc-tetrofosmin (358 ± 177 MBq) was administered and dual-isotope acquisition was performed. The HMRs were calculated with conventional planar imaging (HMR planar ), with anterior reprojection images using the CZT camera (HMR reproj ), and with transaxial reconstructed images using the CZT camera (HMR transaxial ). In a phantom study, we estimated a linear model fitting the CZT camera data to the planar data, and we applied it to provide corrected CZT camera-determined HMRs in patients (cHMR reproj and cHMR transaxial ). Results: Thirty-four men and 6 women (71 ± 9 y old) with ischemic (22 patients) and nonischemic (18 patients) heart failure completed the study. For 22 of the 40 patients (55%), the New York Heart Association classification was class II and the ejection fraction was 35% ± 9%. HMR reproj (1.12 ± 0.19) and HMR transaxial (1.35 ± 0.34) were lower than HMR planar (1.44 ± 0.14) ( P &lt; 0.0001 and P &lt; 0.01, respectively). cHMR reproj (1.54 ± 0.09) and cHMR transaxial (1.45 ± 0.14) were significantly different ( P &lt; 0.0001). Lin concordance correlation and Bland-Altman analysis demonstrated an almost perfect concordance and a high agreement between HMR planar and cHMR transaxial ( P was not significant) but not between HMR planar and cHMR reproj ( P &lt; 0.0001). Conclusion: This study demonstrated that determination of the late HMR of cardiac 123 I-MIBG uptake using dual-isotope ( 123 I and 99m Tc) acquisition on a multipinhole CZT camera was feasible in patients with heart failure. However, this determination should be performed using transaxial reconstructed images and linear correction based on phantom data acquisitions.

the journal of nuclear medicine

Determination of the Heart-to-Mediastinum Ratio of 123I-MIBG Uptake Using Dual-Isotope (123I-MIBG/99mTc-Tetrofosmin) Multipinhole Cadmium-Zinc-Telluride SPECT in Patients with Heart Failure