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Feasibility and Image Quality of Dual-Isotope SPECT Using ¹⁸F-FDG and ^99mTc-Tetrofosmin After Acipimox Administration

¹ Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
² Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
³ Thoraxcentre, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
⁴ Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands

Currently, with the rapidly increasing number of patients with heart failure due to chronic coronary artery disease, the need for viability studies to guide treatment in these patients is increasing. The most accurate method for viability assessment is metabolic imaging with ¹⁸F-FDG with PET or SPECT. To obtain excellent image quality in all patients, the ¹⁸F-FDG studies should be performed during hyperinsulinemic euglycemic clamping. However, this approach is time-consuming and is not feasible in busy nuclear medicine laboratories. Recently, the use of a nicotinic acid derivative, acipimox, has been suggested, but limited data are available on the image quality of the ¹⁸F-FDG studies using this approach. Methods: We evaluated the feasibility and image quality of ¹⁸F-FDG SPECT (with dual-isotope simultaneous acquisition (DISA) using ^99mTc-tetrofosmin to assess perfusion) after acipimox administration in 50 nondiabetic patients. The image quality of both ¹⁸F-FDG and ^99mTc-tetrofosmin was assessed visually and quantitatively using myocardium-to-blood-pool (M/B) ratios as a measure of target-to-background ratio. The image quality and diagnostic value of DISA ^99mTc-tetrofosmin SPECT was compared with standard ^99mTc-tetrofosmin SPECT at baseline. Results: After acipimox administration, the plasma levels of free fatty acids were extremely low (68 ± 89 nmol/L). No severe side effects were observed, only paroxysmal flushing. The ¹⁸F-FDG image quality was good in 46 patients (92%) and moderate but still interpretable in the other 4 patients (8%). The clinical information of the baseline ^99mTc-tetrofosmin SPECT was retained in the DISA ^99mTc-tetrofosmin SPECT images because we did observe no substantial fill-in of perfusion defects by high ¹⁸F-FDG uptake in the same segment. Conclusion: Cardiac ¹⁸F-FDG SPECT after acipimox is safe and resulted consistently in good image quality; this simple approach may be the method of choice for routine cardiac metabolic imaging.

Key Words: ¹⁸F-FDG • ^99mTc-tetrofosmin • SPECT • myocardial viability • image quality

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