Initial and delayed stress phase imaging in a single-injection double-acquisition SPECT. The potential value of early 99mTc-MIBI redistribution in assessment of myocardial perfusion reversibility in patients with coronary artery disease

Some studies reported that 99mTc-MIBI may redistribute in ischaemic myocardium and this phenomenon may have potential role for better assessment of viability by delayed 99mTc-MIBI imaging. Some studies also suggested that infusion of low dose dobutamine during delayed imaging may enhance the value of 99mTc-MIBI imaging for evaluation of viability. The aim of this study is to determine whether the observed changes of perfusion defects on delayed images are caused by early radiotracer redistribution or as a result of reversal partial volume effect secondary to inotropic stimulation.

PATIENTS, METHODS

89 patients with angiographically proven coronary artery disease (CAD) were enrolled in this randomized clinical trial study. In all cases, gated-SPECT images were obtained 60 minutes after stress with dipyridamole injection. Subsequently the patients were randomly allocated in two groups and the second imaging was performed at 120th minute during low dose dobutamine (dobutamine group; 45 cases) or placebo infusion (placebo group; 44 cases). Difference between summed stress score of the first (SSS1) and second (SSS2) stress images (DeltaSSS) was considered as a marker of reversibility in single-injection double-acquisition (SIDA) protocol. Also summed difference score (SDS) was recorded as a marker of reversibility in standard stress/rest, double-injection double-acquisition (DIDA) protocol. DeltaSSS of the two studied groups were compared. Also the correlation and agreement between DeltaSSS and SDS were analyzed.

RESULTS

A significant difference was found between SSS1 (median 15, range 0-48) and SSS2 (median 11, range 0-42) in total patients (p < 0.0001). A significant correlation was noted between DeltaSSS and SDS in dobutamine group (r = 0.58, p = 0.002) as well as in placebo group (r = 0.57, p < 0.0001). Considering DIDA protocol as a standard reference method, the influence of dobutamine infusion was not shown to be significantly different from the placebo effect on the magnitude of fixed or reversible perfusion defects in SIDA protocol.

CONCLUSION

The changes in the magnitude of the perfusion defects may occur in the first hours of 99mTc-MIBI injection in the stress phase imaging. These changes correlate well and are in agreement with perfusion improvement on the rest images. This phenomenon may be independent of improvement in myocardial function, in more delayed imaging or following inotropic augmentation, and thus is likely due to 99mTc-MIBI redistribution. This may open new technical and clinical aspects and potentials for 99mTc-MIBI imaging.

The radiotracer (99m)Tc-MIBI is not genotoxic for human peripheral blood lymphocytes at diagnostic radioactive dose

The radiotracer technetium-99m methoxyisobutyl isonitrile ((99m)Tc-MIBI) has been widely used for myocardial blood flow imaging. We investigated the genotoxicity of (99m)Tc-MIBI in cultured human lymphocytes at the same concentration used in patients. Radioactivity doses were determined in whole blood at 5 min post-injection of 20 mCi (99m)Tc-MIBI in patients. Subsequently, whole blood of human volunteers was incubated with 1, 2.3, 4 or 8 microCi (99m)Tc-MIBI. After a 30-min incubation, the lymphocytes were stimulated with a mitogen to assay for micronuclei in cytokinesis-blocked binucleated cells. The frequency of micronuclei in samples treated with this radiopharmaceutical up to 2-fold (8 microCi) the concentration of (99m)Tc-MIBI normally found in the blood of patients was not more than in control lymphocyte cultures. We concluded that there is no increased induction of micronuclei in lymphocytes incubated with (99m)Tc-MIBI at the radioactivity doses used for diagnostic purposes.