Comparison of Tc-99m sestamibi and TI-201 gated perfusion SPECT

doi:10.1016/S1071-3581(99)90040-5

Journal of Nuclear Cardiology

Volume 6, Issue 3, May–June 1999, Pages 278-285

https://doi.org/10.1016/S1071-3581(99)90040-5 Get rights and content

Abstract

Background. To determine the interpretability of gated thallium-201 perfusion SPECT compared with that performed by use of technetium-99m sestamibi (MIBI), 33 patients with prior myocardial infarction were studied. Patients received 22 to 30 mCi (814 to 1110 MBq) MIBI at peak stress, and a 15-minute gated SPECT acquisition was begun 30 to 40 minutes thereafter. On a subsequent day gated TI-201 SPECT was acquired for 15 minutes, 4 hours after a resting 3.5 mCi (130 MBq) injection. SPECT was performed over a 180-degree arc by use of a 90-degree angled 2-detector camera.

Results. Gated studies were interpreted independently by 4 experienced physicians. Study quality was graded (0 = uninterpretable to 4 = excellent). Wall motion (0 = normal to 2 = akinetic/dyskinetic) and wall thickening (0 = normal to 2 = absent) were graded for each of 10 segments viewed in orthogonal planes. Left ventricular ejection fraction (LVEF) was calculated by use of software thus far validated only for MIBI. The average count density of mid-ventricular end-diastolic short axis tomograms with sestamibi was 3.47 times greater than with thallium. Mean study quality was 3.4 for MIBI and 1.8 for thallium (P < 10^p−6). No gated MIBI SPECTs, but 2 gated thallium studies (6%) were judged uninterpretable. Among interpretable scans, interobserver agreement (Kendall statistic) in assessing wall motion was 0.73 for MIBI and 0.66 for thallium (P = .01). For assessing wall thickening, the Kendall statistic was 0.73 for MIBI and 0.69 for thallium (P = .05). Correlation (r) of LVEFs was 0.91, SEE = 6.4.

Conclusions. We conclude that gated thallium SPECT is inferior to MIBI because of much poorer image quality and somewhat poorer interobserver agreement among experienced physicians. However, LVEF can be determined reliably from gated thallium SPECT.

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The objective of this study was to assess the incremental value of myocardial wall motion and thickening compared with perfusion alone obtained from gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in diagnosing myocardial viability in patients with ischemic heart failure.
Eighty-three consecutive patients with ischemic heart failure who underwent both ^99mTc-MIBI gated SPECT MPI and ¹⁸F-FDG positron emission tomography (PET) myocardial metabolic imaging were retrospectively enrolled. SPECT/PET myocardial viability was defined as the reference standard. Segmental myocardial perfusion, wall motion, and thickening were measured by an automated algorithm from gated SPECT MPI. Univariate and stepwise multivariate analysis were conducted to establish an optimal multivariate model for predicting hibernating myocardium and scar.
Among the 1411 segments evaluated, 774 segments had normal perfusion and 637 segments had decreased perfusion. The latter were classified by ¹⁸F-FDG PET into 338 hibernating segments and 299 scarred segments. The multivariate regression analysis showed that the model that combined myocardial perfusion uptake with wall motion and thickening scores had the optimal predictive efficiency to distinguish hibernating myocardium from scar in the segments with decreased perfusion. The model had the largest C-statistic (0.753 vs 0.666, P < 0.0001), and the global chi-square was increased from 53.281 to 111.234 when compared with perfusion alone (P < 0.001).
Assessment of myocardial wall motion and thickening in addition to conventional perfusion uptake in the segments with decreased perfusion enables better differentiation of hibernating myocardium from scar in patients with ischemic heart failure. Considering wide availability and high cost-effectiveness, regional myocardial function integrated with perfusion on gated SPECT MPI has great promise to become a clinical tool in the assessment of myocardial viability.
Thallium-201 gated single-photon emission tomography for assessing left ventricular volumes and function in patients with aortic valve stenosis: Comparison with echocardiography as the reference standard
2014, IJC Heart and Vasculature
Citation Excerpt :
In the current study, we demonstrated the following: 1) patients with AS had a larger LVM index and a larger EDV compared to control subjects; 2) there were good correlations in EDV and ESV between echocardiography and QGS even in patients with AS and 3) there was a good correlation in EF between the 2 methods even in patients with AS, but Bland–Altman plot for EF showed a negative proportional error. Compared to technetium-99m (Tc-99m)-labeled agents, Tl-201 is considered to possess poor image quality due to its lower photon energy [13]. However, recent development of myocardial collimeters and its better physiological properties have resulted in a renewed interest in the use of Tl-201 for gated SPECT.
Aortic valve stenosis (AS) is characterized by chronic left ventricular pressure overload, leading to left ventricular hypertrophy (LVH). We assessed correlations in left ventricular volumes and function between echocardiography and quantitative gated SPECT (QGS) in patients with AS.
The study population consisted of 28 patients with AS defined as a peak velocity of > 3.0 m/s and 28 age- and sex-matched control subjects. Patients with AS had a peak pressure gradient of 73.4 ± 24.5 mm Hg and a larger LVM index compared to control subjects (115.5 ± 29.2 g/m² vs 78.3 ± 12.1 g/m², p < 0.01). There were good correlations in end-diastolic volume and end-systolic volume between echocardiography and QGS in patients with AS as well as control subjects. Bland–Altman plot for end-systolic volume showed a significant negative slope of − 0.51 in patients with AS. There was a good correlation in ejection fraction between the 2 methods in patients with AS as well as control subjects. However, Bland–Altman plots showed significant negative slopes of − 0.40 in patients with AS and − 0.74 in control subjects.
Our data suggested that QGS was a useful method for assessing left ventricular volumes and function even in patients with AS. Cardiologists should recognize its specific characteristics.
Assessment of global and regional left ventricular contractile function in patients with known or suspected coronary artery disease: Comparison between myocardial perfusion scintigraphy and gated blood pool SPECT data
2014, Medecine Nucleaire
L’analyse de la contraction ventriculaire gauche a une importance majeure dans le diagnostic et la prise en charge des patients atteints de cardiopathies. Le but de notre étude a été de comparer les paramètres étudiant la cinétique globale et segmentaire du ventricule gauche fournis par la tomoventriculographie isotopique et par la scintigraphie de perfusion myocardique.
Deux groupes ont été constitués, le premier comprenant 23 scintigraphies de perfusion à la ^99mTc-Tetrofosmine et le second 50 scintigraphies de perfusion au chlorure de ²⁰¹Thallium, dont les données ont été comparées à celles de tomoventriculographies isotopiques réalisées de façon rapprochée.
Nous avons obtenu de bonnes corrélations (r = 0,81 à 0,94) en ce qui concerne les paramètres fonctionnels globaux (fraction d’éjection et volumes télédiastolique et télésystolique) dans les deux groupes. D’assez bonnes corrélations existaient également à l’échelle segmentaire (r = 0,49 à 0,62), entre la fraction d’éjection segmentaire obtenue en tomoventriculographie et l’épaississement pariétal (« Thickening ») ou le déplacement de la surface endocardique en systole (« Motion ») calculés en scintigraphie de perfusion. Ces corrélations étaient significativement plus faibles dans le groupe bilanté par scintigraphie au chlorure de ²⁰¹Thallium, et ce d’autant plus pour les segments hypokinétiques.
Bien que ces deux explorations scintigraphiques utilisent des approches très différentes, la tomoventriculographie isotopique et la scintigraphie de perfusion myocardique permettent une étude de la contraction ventriculaire gauche à l’échelle globale et segmentaire, avec des données bien corrélées mais restant néanmoins non interchangeables.
The analysis of the left ventricular contractile function plays a major role in the diagnosis and management of patients with cardiopathies. The aim of our study was to compare gated blood pool SPECT and myocardial perfusion scintigraphy for the assessment of the left ventricular wall contractility at the global and the segmental scales.
The data of 23 ^99mTc-Tetrofosmin perfusion scintigraphies, and 50 ²⁰¹Thallium perfusion scintigraphies were compared to those of gated blood pool SPECT performed at close interval.
The correlations were good (r = 0.81 to 0.94) concerning the global parameters (left ventricular ejection fraction, end-diastolic and end-systolic volumes) in the two groups. Quite good correlations were also found at the segmental scale (r = 0.49 to 0.62), between the segmental ejection fraction calculated in gated blood pool SPECT and the wall thickening or the wall motion estimated in perfusion scintigraphy. These correlations were significantly lower in the “²⁰¹Thallium perfusion scintigraphy” group than in the “^99mTc-Tetrofosmin perfusion scintigraphy” group, especially for hypokinetic segments.
Although they use very different approaches, GBPS and MPS give data about global and segmental left ventricular wall contraction that are well correlated, but not strictly interchangeable.
Use of multidetector computed tomography for evaluation of global and regional left ventricular function
2009, Journal of Cardiovascular Computed Tomography
Citation Excerpt :
Despite the validation of electrocardiographic (ECG)–gated single-photon emission computed tomography (SPECT) and its automated software analysis packages against other imaging methods,23–26 the accuracy of SPECT can be hampered when severe perfusion defects or attenuation artifacts are present, as well as in patients with small or large hearts.27 Moreover, higher variability in measurements were observed with Tl-201 compared with Tc-99m radioisotopes28,29 and between any pair of software algorithms.30 The ability of cardiac magnetic resonance imaging (MRI) to combine adequate tissue-blood pool contrast with excellent spatial and temporal resolution in one study, free from geometric assumptions and exposure of the patient to ionizing radiation, was instrumental to its high degree of accuracy and reproducibility in numerous reports.31–33
Left ventricular (LV) function was shown to play a paramount role in the evaluation, management, and prognosis of patients with cardiac pathology. With the advent of multidetector computed tomography (MDCT), a novel tool for cardiac function assessment became available. This comes at no additional cost to the patient undergoing coronary CT angiography in terms of radiation exposure or contrast material delivery. The accuracy of LV function assessment by retrospective electrocardiographic gating intimately depends on the level of spatial and temporal resolution achievable during scanning. With the aid of today's fast-advancing technology, MDCT is now capable of acquiring data with isotropic submillimeter voxels that allow true 3-dimensional threshold-based chamber segmentation for accurate volumetric analysis. The challenge, however, continues to involve optimizing temporal resolution through various reconstruction techniques and technologic innovations. MDCT-determined global LV function variables were shown to strongly correlate with those of standard imaging methods. Regional function assessment has now become feasible with today's latest scanners. Its accuracy, however, still awaits a major breakthrough in temporal resolution to approach or possibly surpass that of echocardiography or magnetic resonance imaging.
Myocardial perfusion and function single photon emission computed tomography
2006, Journal of Nuclear Cardiology
Nuclear Cardiology: Present and Future
2006, Current Problems in Cardiology
Nuclear cardiology has made significant advances since the first reports of planar scintigraphy for the evaluation of left ventricular perfusion and function. While the current “state of the art” of gated myocardial perfusion single-photon emission computed tomographic (SPECT) imaging offers invaluable diagnostic and prognostic information for the evaluation of patients with suspected or known coronary artery disease (CAD), advances in the cellular and molecular biology of the cardiovascular system have helped to usher in a new modality in nuclear cardiology, namely, molecular imaging. In this review, we will discuss the current state of the art in nuclear cardiology, which includes SPECT and positron emission tomographic evaluation of myocardial perfusion, evaluation of left ventricular function by gated myocardial perfusion SPECT and gated blood pool SPECT, and the evaluation of myocardial viability with PET and SPECT methods. In addition, we will discuss the future of nuclear cardiology and the role that molecular imaging will play in the early detection of CAD at the level of the vulnerable plaque, the evaluation of cardiac remodeling, and monitoring of important new therapies including gene therapy and stem cell therapy.

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Original articleComparison of Tc-99m sestamibi and TI-201 gated perfusion SPECT

Abstract

J Am Coll Cardiol

J Am Coll Cardiol

Assessment of systolic thickening with thallium-201 ECG-gated single-photon emission computed tomography: a parameter for local left ventricular function

J Nucl Med

ECG-gated thallium-201 myocardial SPECT in patients with old myocardial infarction compared with ECG-gated blood pool SPECT

Ann Nuklearmedizin

Original article
Comparison of Tc-99m sestamibi and TI-201 gated perfusion SPECT