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

Boen L.R. Kam, MD1, Roelf Valkema, MD, PhD1, Don Poldermans, MD, PhD2,3, Jeroen J. Bax, MD, PhD4, Ambroos E.M. Reijs, MSc1, Riccardo Rambaldi, MD, PhD3, Eric Boersma, PhD3, Trinet Rietveld, BSc2, Jos R.T.C. Roelandt, MD, PhD3 and Eric P. Krenning, MD, PhD1,2

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



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  		FIGURE 1. Segmentation of myocardium as used for 2D echocardiography, 18F-FDG, and 99mTc-tetrofosmin DISA SPECT. Conventional echocardiography segments (15) are plotted in polar map with apex centrally and basal segments in outer ring. This format was used to enable optimal comparison between 2D echocardiography and SPECT. Vascular territories are indicative only and may differ between patients (segments 1, 2, 6, 7, and 10–14 represent left anterior descending coronary artery; segments 3, 8, 13, 15, and 16 represent left circumflex coronary artery; and segments 4, 5, 9, and 14 represent right coronary artery).

 


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  		FIGURE 2. Serum FFAs before and after 2 x 250 mg acipimox orally. Decrease is highly significant (P < 0.001; paired t test).

 


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  		FIGURE 3. Image quality scores of baseline 99mTc-tetrofosmin, DISA 99mTc-tetrofosmin, and DISA 18F-FDG images.

 


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  		FIGURE 4. Baseline 99mTc-tetrofosmin, DISA 99mTc-tetrofosmin, and DISA 18F-FDG SPECT images of patient with known 2-vessel disease. (Top row) Baseline 99mTc-tetrofosmin short-axis (SA), horizontal long-axis (HLA), and vertical long-axis (VLA) slices. (Center row) Corresponding DISA 99mTc-tetrofosmin images. (Bottom row) Corresponding 18F-FDG slices. There is large severe defect in perfusion and glucose metabolism in area of apex (matched pattern, scar; vertical arrows). In septum, there is moderate perfusion defect with nearly normal glucose metabolism (mismatch pattern, viable; oblique arrows). Additionally, there is mild perfusion defect in basal posterior area with mismatch (best seen on HLA images, no arrows). DISA perfusion images are less sharp than baseline perfusion images, but diagnostic information is retained.

 




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