Hartford Hospital, Heart and Vascular Institute, 80 Seymour Street, Hartford, CT, 06102, USA.
Cardiovascular Imaging Technologies, Kansas City, MO, USA.
J Nucl Cardiol. 2021 Aug;28(4):1381-1394. doi: 10.1007/s12350-020-02093-5. Epub 2020 Mar 31.
Based on superior image quality, more accurate gated images, and lower radiation exposure to patients, Technetium-99m (Tc-99m) based tracers are preferred over Thallium-201 for SPECT myocardial perfusion imaging. The two Tc-99m tracers, sestamibi and tetrofosmin, have many similar characteristics but there are differences in blood and liver clearance rates, as well as the recommended time after injection for imaging to achieve optimal image quality. Because published peer-reviewed studies examining optimal times between injection and imaging are limited, it can be difficult to identify evidence-based opportunities to optimize imaging protocols. Using systematic literature review methods, this study was designed to identify and consolidate the available evidence on the use of sestamibi compared to tetrofosmin for variable injection to imaging times in regard to test efficiency, including test length and re-scan rates, and image quality, including overall quality and cardiac to extra-cardiac ratios. The composite of this data shows that earlier imaging with tetrofosmin is equivalent to later imaging with sestamibi when assessing subjective image quality or when quantifying heart-to-extra-cardiac ratios. Image quality and heart-to-extra-cardiac ratios comparing early versus later imaging with tetrofosmin were comparable if not equivalent to each other. The equivalency of the imaging quality occurs with 15 minutes (on average) earlier imaging compared to sestamibi and 30 minutes compared to standard time tetrofosmin. The subjective findings of equivalent image quality are also shown with objective measurements of heart-to-extra-cardiac ratios. In this review, the significantly shorter injection-to-acquisition times with tetrofosmin compared to sestamibi resulted in better efficiency and less waiting times for patients; in addition, significantly higher re-scan rates with sestamibi compared to tetrofosmin due to hepatic activity contributed to better throughput with tetrofosmin.
基于卓越的图像质量、更准确的门控图像以及更低的患者辐射暴露，锝-99m（Tc-99m）基示踪剂在单光子发射计算机断层扫描（SPECT）心肌灌注成像中优于铊-201。两种 Tc-99m 示踪剂，即甲氧基异丁基异腈（ sestamibi）和四氟硼酸甲氧基异丁基异腈（tetrofosmin），具有许多相似的特征，但在血液和肝脏清除率方面存在差异，以及推荐的注射后成像时间以获得最佳图像质量。由于发表的同行评议研究检查注射后和成像之间的最佳时间有限，因此确定优化成像方案的基于证据的机会可能具有挑战性。本研究采用系统文献回顾方法，旨在确定和整合有关 sestamibi 与 tetrofosmin 之间在可变注射到成像时间方面的使用的现有证据，以评估测试效率，包括测试长度和重新扫描率，以及图像质量，包括整体质量和心脏与心脏外比值。这些数据的综合结果表明，在评估主观图像质量或量化心脏与心脏外比值时，与 sestamibi 相比，早期使用 tetrofosmin 进行成像与后期使用 sestamibi 进行成像等效。如果不是等效，则早期与晚期使用 tetrofosmin 进行成像的图像质量和心脏与心脏外比值相当。与 sestamibi 相比，平均提前 15 分钟（平均）进行成像与 tetrofosmin 相比具有等同的成像质量，与标准时间的 tetrofosmin 相比提前 30 分钟。心脏与心脏外比值的客观测量也显示出等效的图像质量。在本综述中，与 sestamibi 相比，tetrofosmin 的注射到采集时间明显缩短，从而提高了效率并减少了患者的等待时间；此外，由于肝脏活动导致 sestamibi 比 tetrofosmin 具有更高的重新扫描率，因此 tetrofosmin 的吞吐量更好。
