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Significance of Defect Severity in Technetium-99m-MIBI SPECT at Rest to Assess Myocardial Viability: Comparison with Fluorine-18-FDG PET

Departments of Nuclear Medicine and Medical Clinic I, University Hospital, Technical University Aachen, Germany
Cardiovascular Research and Training Center, University of Washington, Seattle, Washington

Correspondence: For correspondence or reprints contact: Carsten Altehoefer, MD, Department of Nuclear Medicine, Technical University, Pauwelsstrasse 30, D-52057 Aachen, Germany.

ABSTRACT

The pathophysiological significance of ^99mTc-MIBI uptake at rest for assessing myocardial viability in patients with coronary artery disease (CAD) is still controversial. Therefore, we studied the relationship of ^99mTc-MIBI uptake at rest and preserved or absent uptake of ¹⁸FDG as assessed with PET in 111 consecutive patients after overnight withdrawal of their antianginal medication. Methods: Each ventricle was evaluated in 13 segments derived from 25 regions of interest (ROIs) in short-axis cuts and ¹⁸FDG uptake was normalized to the intraindividual normal reference ROI (ROI with maximal = 100% ^99mTc-MIBI uptake). Segments with a normalized ¹⁸FDG uptake >70% were defined as viable while segments with a ¹⁸FDG uptake <50% were defined as nonviable. Results: Five to 11% of segments with ^99mTc-MIBI uptake at rest 30% of peak activity were viable and 80%–84% nonviable. Of moderate to severe ^99mTc-MIBI defects at rest (31%–70% of peak), 13%–61% were viable. Segmental ^99mTc-MIBI uptake and normalized ¹⁸FDG uptake were linearly correlated (r = 0.61, n = 1443, p < 0.001). In segments revealing severely reduced ^99mTc-MIBI uptake (50% of peak) the correlation was considerably lower (r = 0.44, n = 295, p < 0.001). Conclusions: In patients with CAD, ^99mTc-MIBI uptake underestimates myocardial viability in comparison to ¹⁸FDG-PET. Myocardial ^99mTc-MIBI uptake therefore appears to reflect myocardial blood flow rather than myocardial viability. Patients with moderate and severe ^99mTc-MIBI defects at rest may benefit from additional metabolic PET imaging prior to final therepeutic decisions.

Key Words: technetium-99m-MIBI SPECT • ¹⁸FDG-PET • coronary artery disease

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