PT  - JOURNAL ARTICLE
AU  - Kam, Boen L.R.
AU  - Valkema, Roelf
AU  - Poldermans, Don
AU  - Bax, Jeroen J.
AU  - Reijs, Ambroos E.M.
AU  - Rambaldi, Riccardo
AU  - Boersma, Eric
AU  - Rietveld, Trinet
AU  - Roelandt, Jos R.T.C.
AU  - Krenning, Eric P.
TI  - Feasibility and Image Quality of Dual-Isotope SPECT Using <sup>18</sup>F-FDG and <sup>99m</sup>Tc-Tetrofosmin After Acipimox Administration
DP  - 2003 Feb 01
TA  - Journal of Nuclear Medicine
PG  - 140--145
VI  - 44
IP  - 2
4099  - http://jnm.snmjournals.org/content/44/2/140.short
4100  - http://jnm.snmjournals.org/content/44/2/140.full
SO  - J Nucl Med2003 Feb 01; 44
AB  - 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.