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Department of Imaging (Division of Nuclear Medicine) and Medicine (Division of Cardiology), Cedars-Sinai Medical Center
Department of Medicine and the Division of Nuclear Medicine and Biophysics, Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, California
Correspondence: For correspondence or reprints contact: Daniel S. Berman, MD, Co-Director, Dept. of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048.
ABSTRACT
Technetium-99m-teboroxime is characterized by a high extraction fraction over a wide range of blood flow rates, rapid myocardial clearance and avid hepatic uptake. This study determined the imaging parameters and examined the clinical efficacy of a rapid back to back adenosine stress/rest teboroxime myocardial perfusion SPECT protocol using a triple-detector camera. Acquisition parameters were determined using cardiac phantom studies which were then applied in SPECT studies of 51 catheterized patients (22 with prior myocardial infarction) and 20 patients with a "low" (7.9% ± 4.3%) likelihood of coronary artery disease. Technetium-99m-teboroxime (20–25 mCi) was injected at the third minute of adenosine infusion. Teboroxime (20–25 mCi) was also injected at rest, 15 min later. Stress followed by rest SPECT were completed within 25 min using a triple-detector camera and sequential, 1-min continuous rotations in alternating directions. Summed raw data from the first to second (1–2 min), second to third (2–3 min) and second to fifth (2–5 min) minutes of imaging following stress teboroxime injection were reconstructed and compared for image quality, degree of liver interference, and accuracy for diagnostic efficacy. In a subgroup of 30 patients, 2–8-min summed images were also reconstructed to compare this more conventional imaging protocol with our rapid acquisition. Image quality was fair to good in 75% of the 1–2-min, 84% of the 2–3-min and 2–5-min studies and 53% of the 2–8-min scans. The frequency of severe liver interference appeared to increase with the duration of imaging time (1–2 min: 3%; 2–3 min: 7%; 2–5 min: 8%) and was greatest (30%, p = 0.08) with 2–8-min images. Three patients (4%) had uninterpretable studies due to intense hepatic uptake. Overall sensitivity (95%) and specificity (71%) were equal for the 2–3- min and 2–5-min stress images and appeared better than in the 1–2-min images (84% and 57%, respectively). For the 2–8-min scans, vessel sensitivity (69%) and specificity (63%) appeared poorer than with 2–3-min studies (83% and 81%, respectively). Normalcy rates were 89% for the 2–3-min and 2–5-min and 79% for 1–2-min images. The back to back adenosine stress/rest teboroxime SPECT can be performed in 30 min using a triple detector camera. Although overall high sensitivity and normalcy rates were achieved, the protocol is technically demanding. Interference due to intense liver uptake remains problematic.
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  K. Hatada, L. M. Riou, M. Ruiz, Y. Yamamichi, A. Duatti, R. L. Lima, A. R. Goode, D. D. Watson, G. A. Beller, and D. K. Glover 99mTc-N-DBODC5, a New Myocardial Perfusion Imaging Agent with Rapid Liver Clearance: Comparison with 99mTc-Sestamibi and 99mTc-Tetrofosmin in Rats J. Nucl. Med., December 1, 2004; 45(12): 2095 - 2101. [Abstract] [Full Text] [PDF]
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