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Technetium‐99m‐labelled HL91 and technetium‐99m‐labelled MIBI SPECT imaging for the detection of ischaemic viable myocardium: a preliminary study
Author(s) -
Liu Min,
Ma Zhanhong,
Guo Xiaojuan,
Zhu Jianguo,
Su Jun
Publication year - 2012
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/j.1475-097x.2011.01050.x
Subject(s) - medicine , myocardial perfusion imaging , technetium 99m , perfusion , coronary artery disease , revascularization , nuclear medicine , technetium tc 99m sestamibi , technetium , technetium (99mtc) sestamibi , ischaemic heart disease , perfusion scanning , spect imaging , cardiology , radiology , scintigraphy , myocardial infarction
Summary Purpose: The assessment of myocardial viability has become an important aspect of the diagnostic and prognostic work‐up of patients with coronary artery disease. Technetium‐99m labelled sestamibi ( 99m Tc‐MIBI) myocardial perfusion imaging may underestimate the viability of ischaemic myocardium. Technetium‐99m labelled 4,9‐diaza‐3,3,10,10‐tetramethyldodecan‐2,11‐dione dioxime ( 99m Tc‐HL91) is a hypoxia‐avid agent which can identify acutely ischaemic viable myocardium in a canine model using a standard gamma camera. The aim of this study was to evaluate uptake character of ischaemic viable myocardium and diagnostic performance of single‐photon emission computed tomography (SPECT) imaging by 99m Tc‐HL91 and 99m Tc‐MIBI in detecting ischaemic viable myocardium in coronary heart disease. Methods: A total of 41 patients with coronary artery disease were recruited from March 2008 to May 2009. For detecting ischaemic viable myocardium, SPECT imaging by 99m Tc‐HL91 and 99m Tc‐MIBI were performed in all patients before coronary revascularization. Six patients with single ischaemic myocardial segment received a 2‐day SEPCT/CT imaging protocol and the uptake of 99m Tc‐HL91 in ischaemic myocardium was quantitatively analysed. The remaining 35 patients received a 1‐day 99m Tc‐HL91 and 99m Tc‐MIBI SPECT imaging protocol. Resting 99m Tc‐MIBI myocardial perfusion imaging in 3–18 months after revascularization was used as the standard methodology to evaluate the myocardial viability. Results: In 41 patients, 66 ischaemic myocardial segments were proven to be viable and 12 to be necrotic by resting 99m Tc‐MIBI myocardial perfusion imaging after coronary revascularization. Furthermore, 60 viable segments with negative uptake of 99m Tc‐MIBI showed positive uptake of 99m Tc‐HL91. The remaining six viable segments and 12 necrotic segments showed both negative uptake of 99m Tc‐HL91 and 99m Tc‐MIBI. The sensitivity, specificity, accuracy, Younden Index, positive predictive value and negative predictive value for evaluating ischaemic viable myocardium were 90·9%, 100%, 92·3%, 90·9%, 100% and 66·7%, respectively. Ischaemic viable myocardium had the negative 99m Tc‐MIBI uptake and positive 99m Tc‐HL91 uptake, which demonstrated a mismatched uptake character. Quantitative analysis indicated the uptake of 99m Tc‐HL91 in viable myocardium was increasing in the first 1–3 h and remained stable at the 3–4 h after injection. Conclusion: Functional SPECT imaging with 99m Tc‐HL91 and 99m Tc‐MIBI can be used to detect the seriously ischaemic but viable myocardium with a mismatched uptake character. The uptake of 99m Tc‐HL91 in the viable myocardium reached a stable level at 3–4 h after injection.