BMIPP compared with PET metabolism.

I-123 15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) was introduced as an approved radiopharmaceutical in Japan in 1993. This article reviews our clinical comparisons between BMIPP and PET metabolism conducted at Kyoto University. BMIPP uptake was suggested to reflect exogenous fatty acid utilization in the myocardium. By the comparison between FDG PET and BMIPP SPECT, reduced uptake of BMIPP relative to thallium was considered metabolically damaged but viable myocardium in ischemic coronary artery disease. In hypertrophic cardiomyopathy, reduction of BMIPP uptake was shown to precede suppression of oxidative or glucose metabolism. Occasionally we encounter subjects with absent myocardial BMIPP uptake. The majority of these subjects showed metabolic switching from normal free fatty acid metabolism to abnormally enhanced glucose metabolism in the fasting state. Thus, BMIPP provides us with the valuable metabolic information which is unattainable using a perfusion tracer.