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Kinetics of Iodine-123-BMIPP in Patients with Prior Myocardial Infarction: Assessment with Dynamic Rest and Stress Images Compared with Stress Thallium-201 SPECT

Departments of Radiology and Internal Medicine, Fukui Prefectural Hospital, Fukui
Department of Nuclear Medicine, Kanazawa University School of Medicine, Kanazawa, Japan

Correspondence: For correspondence and reprints contact: Ichiro Matsunari, MD, Department of Radiology, Fukui Prefectural Hospital, 2-8-1, Yotsui, Fukui-city, 910, Japan.

ABSTRACT

Myocardial kinetics of ¹²³I-labeled 15-(p-iodophenyl)3R, S-methylpentadecanoic acid (BMIPP) were evaluated with dynamic SPECT, and stress and rest BMIPP images were directly compared in conjunction with stress ²⁰¹Tl. Methods: We studied 26 patients with prior myocardial infarction. Two minutes after injection of BMIPP, dynamic data acquisition with a three-headed SPECT was started and continued for 12 min. Conventional SPECT images were obtained at 20 min and 3 hr after injection. On a separate day, exercise, stress ²⁰¹Tl SPECT was performed at 10 min and 3 hr after injection. Exercise stress-BMIPP imaging was performed in 15 of the patients, and static SPECT images were obtained. Results: With dynamic SPECT, early clearance of BMIPP from the myocardium was observed in the segments with reversible ²⁰¹Tl defects, suggesting enhanced contribution of backdiffusion from BMIPP. In myocardial segments with reversible ²⁰¹Tl defects, 20-min BMIPP images showed a higher frequency of reduced uptake when compared to 3-hr ²⁰¹Tl (90/163) imaging. Conclusion: With BMIPP dynamic SPECT, an enhanced contribution of backdiffusion in the early phase from ischemic myocardium was suggested. When exercise stress BMIPP images were obtained, a more severe defect was observed than on rest BMIPP and stress ²⁰¹Tl imaging, possibly due to decreased coronary blood flow and impaired fatty acid uptake induced by ischemia during exercise.

Key Words: iodine-123-BMIPP • dynamic SPECT • myocardial infarction • exercise thallium-201 imaging

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