Positron emission tomography detects evidence of viability in rest technetium-99m sestamibi defects

Stephen Sawada, Kevin C. Allman, Otto Muzik, Rob S B Beanlands, Edwin R. Wolfe, Milton Gross, Lorraine Fig, Markus Schwaiger

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Abstract

Objectives. The purpose of this study was to determine the relative value of single-photon emission computed tomographic (SPECT) imaging at rest using technetium-99m methoxyisobutyl isonitrile (technetium-99m sestamibi) with positron emission tomography for detection of viable myocardium. Background. Recent studies comparing positron emission tomography and thallium-201 reinjection with rest technetium-99m sestamibi imaging have suggested that the latter technique underestimates myocardial viability. Methods. Twenty patients with a previous myocardial infarction underwent rest technetium-99m sestamibi imaging and positron emission tomography using fluorine (F)-18 deoxyglucose and nitrogen (N)-13 ammonia. In each patient, circumferential profile analysis was used to determine technetium-99m sestamibi, F-18 deoxyglucose and N-13 ammonia activity (expressed as percent of peak activity) in nine cardiac segments and in the perfusion defect defined by the area having technetium-99m sestamibi activity <60%. Technetium-99m sestamibi defects were graded as moderate (50% to 59% of peak activity) and severe (<50% of peak activity). Estimates of perfusion defect size were compared between technetium-99m sestamibi and N-13 ammonia. Results. Sixteen (53%) of 30 segments with moderate defects and 16 (47%) of 34 segments with severe defects had ≥60% F-18 deoxyglocose activity considered indicative of viability. Fluorine-18 deoxyglucose evidence of viability was still present in 50% of segments with technetium-99m sestamibi activity <40%. There was no significant difference in the mean (± SD) technetium-99m sestamibi activity in segments with viable (40 ± 7%) and nonviable segments (49 ± 7%, p = 0.84). Of the 18 patients who had adequate F-18 deoxyglucose studies, the area of the technetium-99m sestamibi defect was viable in 5 (28%). In 16 patients (80%), perfusion defect size determined by technetium-99m sestamibi exceeded that measured by N-13 ammonia. The difference in defect size between technetium-99m sestamibi and N-13 ammonia was significantly greater in patients with viable (21 ± 9%) versus nonviable segments (7 ± 9%, p = 0.007). Conclusions. Moderate and severe rest technetium-99m sestamibi defects frequently have metabolic evidence of viability. Technetium-99m sestamibi SPECT yields larger perfusion defects than does N-13 ammonia positron emission tomography when the same threshold values are used.

Original languageEnglish
Pages (from-to)92-98
Number of pages7
JournalJournal of the American College of Cardiology
Volume23
Issue number1
DOIs
StatePublished - 1994
Externally publishedYes

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Technetium Tc 99m Sestamibi
Positron-Emission Tomography
Ammonia
Deoxyglucose
Perfusion
Fluorine
Photons
Thallium
Technetium

ASJC Scopus subject areas

  • Nursing(all)

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Positron emission tomography detects evidence of viability in rest technetium-99m sestamibi defects. / Sawada, Stephen; Allman, Kevin C.; Muzik, Otto; Beanlands, Rob S B; Wolfe, Edwin R.; Gross, Milton; Fig, Lorraine; Schwaiger, Markus.

In: Journal of the American College of Cardiology, Vol. 23, No. 1, 1994, p. 92-98.

Research output: Contribution to journalArticle

Sawada, Stephen ; Allman, Kevin C. ; Muzik, Otto ; Beanlands, Rob S B ; Wolfe, Edwin R. ; Gross, Milton ; Fig, Lorraine ; Schwaiger, Markus. / Positron emission tomography detects evidence of viability in rest technetium-99m sestamibi defects. In: Journal of the American College of Cardiology. 1994 ; Vol. 23, No. 1. pp. 92-98.
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title = "Positron emission tomography detects evidence of viability in rest technetium-99m sestamibi defects",
abstract = "Objectives. The purpose of this study was to determine the relative value of single-photon emission computed tomographic (SPECT) imaging at rest using technetium-99m methoxyisobutyl isonitrile (technetium-99m sestamibi) with positron emission tomography for detection of viable myocardium. Background. Recent studies comparing positron emission tomography and thallium-201 reinjection with rest technetium-99m sestamibi imaging have suggested that the latter technique underestimates myocardial viability. Methods. Twenty patients with a previous myocardial infarction underwent rest technetium-99m sestamibi imaging and positron emission tomography using fluorine (F)-18 deoxyglucose and nitrogen (N)-13 ammonia. In each patient, circumferential profile analysis was used to determine technetium-99m sestamibi, F-18 deoxyglucose and N-13 ammonia activity (expressed as percent of peak activity) in nine cardiac segments and in the perfusion defect defined by the area having technetium-99m sestamibi activity <60{\%}. Technetium-99m sestamibi defects were graded as moderate (50{\%} to 59{\%} of peak activity) and severe (<50{\%} of peak activity). Estimates of perfusion defect size were compared between technetium-99m sestamibi and N-13 ammonia. Results. Sixteen (53{\%}) of 30 segments with moderate defects and 16 (47{\%}) of 34 segments with severe defects had ≥60{\%} F-18 deoxyglocose activity considered indicative of viability. Fluorine-18 deoxyglucose evidence of viability was still present in 50{\%} of segments with technetium-99m sestamibi activity <40{\%}. There was no significant difference in the mean (± SD) technetium-99m sestamibi activity in segments with viable (40 ± 7{\%}) and nonviable segments (49 ± 7{\%}, p = 0.84). Of the 18 patients who had adequate F-18 deoxyglucose studies, the area of the technetium-99m sestamibi defect was viable in 5 (28{\%}). In 16 patients (80{\%}), perfusion defect size determined by technetium-99m sestamibi exceeded that measured by N-13 ammonia. The difference in defect size between technetium-99m sestamibi and N-13 ammonia was significantly greater in patients with viable (21 ± 9{\%}) versus nonviable segments (7 ± 9{\%}, p = 0.007). Conclusions. Moderate and severe rest technetium-99m sestamibi defects frequently have metabolic evidence of viability. Technetium-99m sestamibi SPECT yields larger perfusion defects than does N-13 ammonia positron emission tomography when the same threshold values are used.",
author = "Stephen Sawada and Allman, {Kevin C.} and Otto Muzik and Beanlands, {Rob S B} and Wolfe, {Edwin R.} and Milton Gross and Lorraine Fig and Markus Schwaiger",
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T1 - Positron emission tomography detects evidence of viability in rest technetium-99m sestamibi defects

AU - Sawada, Stephen

AU - Allman, Kevin C.

AU - Muzik, Otto

AU - Beanlands, Rob S B

AU - Wolfe, Edwin R.

AU - Gross, Milton

AU - Fig, Lorraine

AU - Schwaiger, Markus

PY - 1994

Y1 - 1994

N2 - Objectives. The purpose of this study was to determine the relative value of single-photon emission computed tomographic (SPECT) imaging at rest using technetium-99m methoxyisobutyl isonitrile (technetium-99m sestamibi) with positron emission tomography for detection of viable myocardium. Background. Recent studies comparing positron emission tomography and thallium-201 reinjection with rest technetium-99m sestamibi imaging have suggested that the latter technique underestimates myocardial viability. Methods. Twenty patients with a previous myocardial infarction underwent rest technetium-99m sestamibi imaging and positron emission tomography using fluorine (F)-18 deoxyglucose and nitrogen (N)-13 ammonia. In each patient, circumferential profile analysis was used to determine technetium-99m sestamibi, F-18 deoxyglucose and N-13 ammonia activity (expressed as percent of peak activity) in nine cardiac segments and in the perfusion defect defined by the area having technetium-99m sestamibi activity <60%. Technetium-99m sestamibi defects were graded as moderate (50% to 59% of peak activity) and severe (<50% of peak activity). Estimates of perfusion defect size were compared between technetium-99m sestamibi and N-13 ammonia. Results. Sixteen (53%) of 30 segments with moderate defects and 16 (47%) of 34 segments with severe defects had ≥60% F-18 deoxyglocose activity considered indicative of viability. Fluorine-18 deoxyglucose evidence of viability was still present in 50% of segments with technetium-99m sestamibi activity <40%. There was no significant difference in the mean (± SD) technetium-99m sestamibi activity in segments with viable (40 ± 7%) and nonviable segments (49 ± 7%, p = 0.84). Of the 18 patients who had adequate F-18 deoxyglucose studies, the area of the technetium-99m sestamibi defect was viable in 5 (28%). In 16 patients (80%), perfusion defect size determined by technetium-99m sestamibi exceeded that measured by N-13 ammonia. The difference in defect size between technetium-99m sestamibi and N-13 ammonia was significantly greater in patients with viable (21 ± 9%) versus nonviable segments (7 ± 9%, p = 0.007). Conclusions. Moderate and severe rest technetium-99m sestamibi defects frequently have metabolic evidence of viability. Technetium-99m sestamibi SPECT yields larger perfusion defects than does N-13 ammonia positron emission tomography when the same threshold values are used.

AB - Objectives. The purpose of this study was to determine the relative value of single-photon emission computed tomographic (SPECT) imaging at rest using technetium-99m methoxyisobutyl isonitrile (technetium-99m sestamibi) with positron emission tomography for detection of viable myocardium. Background. Recent studies comparing positron emission tomography and thallium-201 reinjection with rest technetium-99m sestamibi imaging have suggested that the latter technique underestimates myocardial viability. Methods. Twenty patients with a previous myocardial infarction underwent rest technetium-99m sestamibi imaging and positron emission tomography using fluorine (F)-18 deoxyglucose and nitrogen (N)-13 ammonia. In each patient, circumferential profile analysis was used to determine technetium-99m sestamibi, F-18 deoxyglucose and N-13 ammonia activity (expressed as percent of peak activity) in nine cardiac segments and in the perfusion defect defined by the area having technetium-99m sestamibi activity <60%. Technetium-99m sestamibi defects were graded as moderate (50% to 59% of peak activity) and severe (<50% of peak activity). Estimates of perfusion defect size were compared between technetium-99m sestamibi and N-13 ammonia. Results. Sixteen (53%) of 30 segments with moderate defects and 16 (47%) of 34 segments with severe defects had ≥60% F-18 deoxyglocose activity considered indicative of viability. Fluorine-18 deoxyglucose evidence of viability was still present in 50% of segments with technetium-99m sestamibi activity <40%. There was no significant difference in the mean (± SD) technetium-99m sestamibi activity in segments with viable (40 ± 7%) and nonviable segments (49 ± 7%, p = 0.84). Of the 18 patients who had adequate F-18 deoxyglucose studies, the area of the technetium-99m sestamibi defect was viable in 5 (28%). In 16 patients (80%), perfusion defect size determined by technetium-99m sestamibi exceeded that measured by N-13 ammonia. The difference in defect size between technetium-99m sestamibi and N-13 ammonia was significantly greater in patients with viable (21 ± 9%) versus nonviable segments (7 ± 9%, p = 0.007). Conclusions. Moderate and severe rest technetium-99m sestamibi defects frequently have metabolic evidence of viability. Technetium-99m sestamibi SPECT yields larger perfusion defects than does N-13 ammonia positron emission tomography when the same threshold values are used.

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