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Kinetic Analysis of ¹²⁵I-Iodorotenone as a Deposited Myocardial Flow Tracer: Comparison with ^99mTc-Sestamibi

Center for Functional Imaging, E.O. Lawrence Berkeley National Laboratory, University of California, Berkeley; Martinez Veterans Affairs, Northern California Health Care System, Martinez, California

The goal of this investigation was to assess the accuracy of 7'-Z-[¹²⁵I]iodorotenone (¹²⁵I-iodorotenone) as a new deposited myocardial flow tracer and compare the results with those for ^99mTc-sestamibi. Methods: The kinetics of these two flow tracers were evaluated in 25 isolated, erythrocyte- and albumin-perfused rabbit hearts over a flow range relevant to patients. The two flow tracers and a vascular reference tracer (¹³¹I-albumin) were introduced simultaneously as a compact bolus through a port just above the aortic cannula in the absence of tracer recirculation. Myocardial extraction, retention, washout, and uptake parameters were computed from the venous outflow curves using the multiple-indicator dilution technique and spectral analysis. Results: The extraction of ¹²⁵I-iodorotenone was much higher than the extraction of ^99mTc-sestamibi (0.84 ± 0.05 vs. 0.48 ± 0.10, respectively, P < 0.001). ¹²⁵I-iodorotenone extraction was also less affected by flow than was ^99mTc-sestamibi (P < 0.001). Net retention of ¹²⁵I-iodorotenone was significantly greater than ^99mTc-sestamibi net retention at 1 min (0.77 ± 0.08 vs. 0.41 ± 0.11, respectively, P < 0.001) and 26 min (0.46 ± 0.13 vs. 0.27 ± 0.11, respectively, P < 0.001) after tracer injection. Flow had less effect on ¹²⁵I-iodorotenone net retention than on ^99mTc-sestamibi net retention 1 min after tracer injection (P < 0.04). However, at 26 min, flow had an equivalent effect on the retention of both flow tracers (P < 0.4). The relationship between ¹²⁵I-iodorotenone and ^99mTc-sestamibi washout was complex and depended on elapsed time after isotope introduction and perfusion rate. Reflecting the favorable extraction and retention characteristics of ¹²⁵I-iodorotenone, both its maximum myocardial uptake and its 26-min uptake were more closely related to flow than were those of ^99mTc-sestamibi (P < 0.001 for both comparisons). Conclusion: The extraction and retention of ¹²⁵I-iodorotenone were greater than those of ^99mTc-sestamibi, making ¹²⁵I-iodorotenone the superior flow tracer in the isolated rabbit heart.

Key Words: PET • SPECT • myocardial perfusion

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