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Quantitative Analysis of Planar Technetium-99m-Sestamibi Myocardial Perfusion Images Using Modified Background Subtraction

Yale University School of Medicine, Cardiovascular Nuclear Imaging Laboratory, Department of Diagnostic Radiology, Department of Internal Medicine (Section of Cardiology), New Haven, Connecticut

Correspondence: For reprints contact: Frans J. Th. Wackers, MD, Director, Cardiovascular Nuclear Imaging and Exercise Laboratories, Yale University School of Medicine, 333 Cedar Street, TE-2, New Haven, CT 06510.

ABSTRACT

Standard interpolative background subtraction, as used for thallium-201 (²⁰¹Tl), may create artifacts when applied to planar technetium-99m-Sestamibi (^99mTc-Sestamibi) images, apparently because of the oversubtraction of relatively high extra-cardiac activity. A modified background subtraction algorithm was developed and compared to standard background subtraction in 16 patients who had both exercise-delayed ²⁰¹Tl and exercise-rest ^99mTc-Sestamibi imaging. Furthermore, a new normal data base was generated. Normal ^99mTc-Sestamibi distribution was slightly different compared to ²⁰¹Tl. Using standard background subtraction, mean defect reversibility was significantly underestimated by ^99mTc-Sestamibi compared to ²⁰¹Tl (2.8 ± 4.9 versus –1.8 ± 8.4, p < 0.05). Using the modified background subtraction, mean defect reversibility on ²⁰¹Tl and ^99mTc-Sestamibi images was comparable (2.8 ± 4.9 versus 1.7 ± 5.2, p = NS). We conclude, that for quantification of ^99mTc-Sestamibi images a new normal data base, as well as a modification of the interpolative background subtraction method should be employed to obtain quantitative results comparable to those with ²⁰¹Tl.

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