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The Journal of Nuclear Medicine Vol. 36 No. 6 952-955
© 1995 by Society of Nuclear Medicine
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Using Gated Technetium-99m-Sestamibi SPECT to Characterize Fixed Myocardial Defects as Infarct or Artifact

E. Gordon DePuey and Alan Rozanski

Division of Nuclear Medicine, Department of Radiology and Division of Cardiology, Department of Medicine, St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York

Correspondence: For correspondence or reprints contact: E. Gordon DePuey, MD, Division of Nuclear Medicine, St. Luke's-Roosevelt Hospital Center, Amsterdam Avenue at 114th St., New York, NY 10025.

ABSTRACT

Perfusion-scan fixed defects may result from soft tissue attenuation, decreasing test specificity for coronary disease and myocardial infarction (MI). Gated 99mTc-sestamibi SPECT may help differentiate MI from artifact since fixed defects with decreased function (wall motion and thickening) probably represent MI, whereas attenuation artifacts either have normal function or at least do not demonstrate markedly reduced function. Methods: Ungated resting and gated stress 99mTc-sestamibi SPECT was performed in 551 consecutive patients referred for evaluation of coronary disease. From resting and summed gated stress images, 180 patients (33%) were identified with isolated fixed defects. Function of the defects was assessed subjectively from gated stress images and results were correlated with clinical (history and/or ECG Q-waves) evidence of MI. Results: Of 102 patients with fixed defects and clinical MI, 98 (96%) had abnormal defect function. Of 78 patients with no clinical MI, 18 (23%) had decreased function of the defect, possibly indicating silent MI. In 60 of the 78 patients (77%) with no clinical MI, defect function was normal. Because most (91%) of fixed defects with normal systolic function occurred in women with anterior fixed defects (48%) or men with inferior fixed defects (43%), these were most likely attenuation artifacts. By reclassifying patients with fixed defects and normal function as normal, patients with unexplained fixed defects (no clinical MI) decreased from 14% to 3%. Conclusion: Gating provides a valuable adjunct to 99mTc-sestamibi SPECT in characterizing fixed defects and potentially improving test specificity.

Key Words: technetium-99m-sestamibi • single-photon emission computed tomography • attenuation artifacts • myocardial infarction • fixed defects




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