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Comparative Feasibility of Separate or Simultaneous Rest Thallium-201/Stress Technetium-99m-Sestamibi Dual-Isotope Myocardial Perfusion SPECT

The Departments of Imaging (Division of Nuclear Medicine) and Medicine (Division of Cardiology), Cedars-Sinai Medical Center, and the 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, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048.

ABSTRACT

Separate or simultaneous rest ²⁰¹Tl/stress ^99mTc-sestamibi dual-isotope SPECT are potentially efficient myocardial perfusion imaging protocols which combine the use of a high-resolution ^99mTc tracer for stress perfusion assessment and ²⁰¹Tl, the current single-photon agent of choice, for viability assessment. Methods: To investigate the feasibility of dual-isotope myocardial perfusion SPECT protocols using rest ²⁰¹Tl and stress sestamibi, ²⁰¹Tl crosstalk into the ^99mTc acquisition window (Group 1, n = 26 patients) and ^99mTc crosstalk into ²⁰¹Tl windows (Group 2, n = 25) were studied. For Group 1, treadmill exercise with sestamibi injection and poststress SPECT ("virgin" sestamibi images) were performed, followed by rest ²⁰¹Tl injection and SPECT acquisition using dual-isotope windows (contaminated or "dual" images). For Group 2, the order was reversed: rest ²⁰¹Tl SPECT (virgin ²⁰¹Tl images) was performed first, followed by exercise sestamibi injection and dual-isotope SPECT. Results: The contribution of ²⁰¹Tl scatter to the dual sestamibi images (Group 1) was measured to be 2.9% ± 2.1%, while ^99mTc crosstalk contributed 26.7% ± 13.0% to the dual ²⁰¹Tl images (Group 2). Image quality was considered good to excellent in 92% of the sestamibi (virgin and dual) images and 88% of the virgin ²⁰¹Tl SPECT, but only in 23% of the dual ²⁰¹Tl studies. Conclusions: Technetium-99m crosstalk into ²⁰¹Tl windows is substantial; therefore, simultaneous dual-isotope protocols, which involve assessment of ²⁰¹Tl images contaminated by ^99mTc, are not recommended. On the other hand, because of the small amount of ²⁰¹Tl crosstalk into the ^99mTc window, a separate acquisition dual-isotope approach employing the rest ²⁰¹Tl (virgin)/stress sestamibi sequence is acceptable.

Key Words: SPECT • technetium-99m-sestamibi • dual-isotope imaging • thallium-201

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