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Postexercise Lung Uptake of ^99mTc-Sestamibi Determined by a New Automatic Technique: Validation and Application in Detection of Severe and Extensive Coronary Artery Disease and Reduced Left Ventricular Function

Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles
Department of Medicine, School of Medicine, University of California Los Angeles, Los Angeles, California

Correspondence: For correspondence or reprints contact: Daniel S. Berman, MD, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Rm. A041. Los Angeles, CA 90048.

ABSTRACT

This study validated a new automatic algorithm for assessment of lung-to-heart ratio (L/H) of radiotracers in myocardial perfusion SPECT and assessed the diagnostic value of ^99mTc-sestamibi L/H after exercise. Methods: The new technique extracts a left ventricular region of interest (ROI) from a summed anterior projection image and generates a lung ROI by reshaping and translating the left ventricular ROI. This algorithm was applied to 230 patients who underwent exercise ^99mTc-sestamibi SPECT (gated SPECT, n = 88) with first-pass ventriculography. Normal values were established in 26 patients in whom the likelihood of coronary artery disease (CAD) was 5% or less. An abnormality threshold for detecting severe and extensive CAD was defined in a subgroup of 109 patients who underwent coronary angiography and was validated in a prospective group (n = 72). Results: The success rate of the automatic algorithm was 97%. Excellent correlation was found between automatic and manual L/H values (r = 0.95; P < 0.001). The mean L/H was higher in patients with a peak exercise ejection fraction (EF) less than 40% versus 40% or more (0.51 ± 0.07 versus 0.43 ± 0.05, P < 0.001) and in patients with a poststress EF less than 40% versus 40% or more (0.50 ± 0.07 versus 0.44 ± 0.06, P < 0.01). A threshold of L/H greater than 0.44 yielded a sensitivity and specificity of 63% and 81%, respectively, for identifying severe and extensive CAD in the prospective group and a sensitivity of 86% in identifying stenosis of 90% or more in the proximal left anterior descending artery. Conclusion: The new automatic algorithm for assessing L/H correlated well with manually derived L/H for ^99mTc-sestamibi as well as ²⁰¹Tl SPECT. An increased postexercise ^99mTc-sestamibi L/H adds significant diagnostic value to study myocardial perfusion SPECT as a marker of severe and extensive CAD and reduced ventricular function.

Key Words: ^99mTc-sestamibi • lung uptake • automatic technique • coronary artery disease • left ventricular function

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				W. D. Leslie, S. A. Tully, M. S. Yogendran, L. M. Ward, K. A. Nour, and C. J. Metge Prognostic Value of Lung Sestamibi Uptake in Myocardial Perfusion Imaging of Patients With Known or Suspected Coronary Artery Disease J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1676 - 1682. [Abstract] [Full Text] [PDF]