De Boer J, Slart R H J A, Blanksma P K, Willemsen A T M, Jager P L, Paans A M J, Vaalburg W, Piers D A
Department of Nuclear Medicine, University Hospital Groningen, The Netherlands.
Nucl Med Commun. 2003 Mar;24(3):251-7. doi: 10.1097/00006231-200303000-00004.
Dual isotope simultaneous acquisition single photon emission computed tomography (DISA SPECT) offers the advantage of obtaining information on myocardial perfusion using Tc-sestamibi ( Tc-MIBI) and metabolism using F-fluorodeoxyglucose ( F-FDG) in a single study. The prerequisite is that the Tc-MIBI images are not degraded by scattered 511 keV photons or poor count statistics due to the lower efficiency of the extra high energy (EHE) collimator. Therefore, we compared the registered Tc-MIBI uptake and image quality of DISA and single isotope acquisition. Furthermore, we investigated whether DISA yields additional information for the assessment of myocardial viability in comparison with rest-stress Tc-MIBI. Nineteen patients with known coronary artery disease and irreversible perfusion defects on previous rest-stress MIBI test studies were investigated. After oral glucose loading and simultaneous injection of 600 MBq of Tc-MIBI and 185 MBq of F-FDG at rest, DISA was performed using energy windows of 140 (+/-15%), 170 (+/-20%) and 511 keV (+/-15%). Planar 140 keV images were corrected for scatter by subtraction using the 170 keV window. The single and dual isotope Tc-MIBI images were both displayed in a polar map with 128 segments normalized to maximum counts. F-FDG and Tc-MIBI images were visually scored for a perfusion-metabolism mismatch pattern using nine regions per heart. There was an excellent correlation (r =0.93, P<0.0001) between the Tc-MIBI uptake detected in the single and dual isotope acquisition. The average difference between the dual and single isotope Tc-MIBI uptake was -1.2% (not significantly different from zero) and the coefficient of variation of the difference was 8.7%. Of the 79 regions with irreversible perfusion defects on previous rest-stress Tc-MIBI, six regions in five patients showed a perfusion-metabolism mismatch pattern. We conclude that DISA does not affect the quality of the Tc-MIBI images. Furthermore, F-FDG- Tc-MIBI DISA may show viability in a small but significant (7.6%, P<0.0034) number of regions with irreversible perfusion defects on rest-stress Tc-MIBI.
双同位素同时采集单光子发射计算机断层扫描（DISA SPECT）具有在一项研究中使用锝- sestamibi（Tc-MIBI）获取心肌灌注信息以及使用氟-氟脱氧葡萄糖（F-FDG）获取代谢信息的优势。前提是由于超高能（EHE）准直器效率较低，Tc-MIBI图像不会因散射的511 keV光子或计数统计不佳而退化。因此，我们比较了DISA和单同位素采集的配准Tc-MIBI摄取和图像质量。此外，我们研究了与静息-负荷Tc-MIBI相比，DISA是否能为评估心肌存活性提供额外信息。对19例已知冠心病且在先前静息-负荷MIBI试验研究中有不可逆灌注缺损的患者进行了研究。口服葡萄糖负荷后，在静息状态下同时注射600 MBq的Tc-MIBI和185 MBq的F-FDG，使用140（±15%）、170（±20%）和511 keV（±15%）的能量窗进行DISA。使用170 keV窗通过减法对平面140 keV图像进行散射校正。单同位素和双同位素Tc-MIBI图像均以极坐标图显示，128个节段归一化为最大计数。使用每个心脏九个区域对F-FDG和Tc-MIBI图像进行视觉评分，以评估灌注-代谢不匹配模式。单同位素和双同位素采集中检测到的Tc-MIBI摄取之间存在极好的相关性（r = 0.93，P < 0.0001）。双同位素和单同位素Tc-MIBI摄取的平均差异为-1.2%（与零无显著差异），差异的变异系数为8.7%。在先前静息-负荷Tc-MIBI上有不可逆灌注缺损的79个区域中，五例患者的六个区域显示出灌注-代谢不匹配模式。我们得出结论，DISA不会影响Tc-MIBI图像的质量。此外，F-FDG-Tc-MIBI DISA可能在静息-负荷Tc-MIBI上有不可逆灌注缺损的一小部分但数量可观（7.6%，P < 0.0034）的区域显示出心肌存活性。
