^99mTc tetrofosmin myocardial perfusion scintigraphy in CAD

Summary

Aim: Early stress imaging (15 min after injection of the radiopharmaceutical) in ^99mTc tetrofosmin myocardial perfusion scintigraphy (MPS) has been shown feasible in comparison to standard imaging after 45 minutes, but the effects on image quality and diagnostic accuracy ask for further evaluation. Patients, methods: 97 patients (61 men, 36 women, age 69 ± 11 years) underwent both early (EA) and standard (SA) acquisition (after 14 ± 4 min and 43 ± 6 min, respectively) using ^99mTc tetrofosmin gated SPECT with iterative reconstruction. sub- diaphragmatic tracer activity and image quality was scored in a 4-point scale by blinded observers. Semiquantitative myo- cardial perfusion analysis was performed on a 17-segment model using standard cardiac quantification SPECT software (4 DM- SPECT). Stenoses of indeterminate haemody- namic significance were validated by measurement of fractional flow reserve (FFR). Results: Extra-cardiac tracer activity was more commonly found in EA (43%) than in SA (38%), but without any diagnostic impact in > 95% of the patients. The mean summed stress score was significantly higher for early than standard imaging (6.4 ± 6.3 vs.5.6 ± 6.1, p = 0.009). The amount of ischaemic area was not significantly different (EA: 9.1 ±6.7 % vs. SA: 7.8 ± 6.9 %). The mean stress ejection fraction was 52 ± 11% (EA) compared to 55 ± 11 % (SA) (p = ns). FFR was inversely related to SDS at early (r = -0.704, p < 0.05) and standard (r=-0.678, p < 0.05) acquisition. All patients with a FFR < 0.8 (considered as hemodynamically significant stenoses) revealed a positive scan. Conclusion: Stress ^99mTc tetrofosmin MPS with early acquisition is feasible and at least equally accurate when iterative reconstruction is applied.

Zusammenfassung

Hintergrund: Die Machbarkeit und Untersuchungsqualität der frühzeitigen Bildaquisition (15 Minuten nach Injektion des Radiopharma- kons) wird bei der Myokardszintigrafie (MS) mit ^99mTc-Tetrofosmin im Vergleich zu der konventionellen Bildakquisition nach 45 Minuten kontrovers beurteilt. Patienten, Methode: 97 Patienten (61 Männer, 36 Frauen; Alter 69 ± 11 Jahre) unterzogen sich der ^99mTc-Te- trofosmin-MS nach pharmakologischer Belastung mit Adenosin (konventionelle Doppelkopfkamera, gated SPECT-Technik, iterative Rekonstruktion) mit Früh- (FA) und Standardaufnahmen (SA) nach 14 ± 4 min bzw. 43 ± 6 min. subdiaphragmatische Akkumulation des Radiopharmakons, Bildqualität und Myokardperfusion (17-Segment-Modell, 4 DM-SPECT Software) wurden semiquantitativ beurteilt. Die Validierung erfolgte bei Stenosen unklarer Signifikanz durch die Bestimmung der fraktionalen Flussreserve (FFR). Ergebnisse: Extrakardiale Artefakte wurden häufiger bei FA (43%) als bei SA (38%) erfasst, waren jedoch in > 95% der Patienten ohne Auswirkungen auf die Beurteilbarkeit. Der mittlere Stress Score war bei FA signifikant höher als bei SA (6,4 ± 6,3 vs. 5,6 ± 6,1, p = 0,009), während das mittlere Ischämieausmaß nicht unterschiedlich war (9,1 ± 6,7 vs. 7,8 ± 6,9%). Die Post-Stress-Auswurffrak- tion war bei FA (52 ± 11%) und SA (55 ± 11%) nicht unterschiedlich. Die FFR korrelierte negativ mit dem Ischämie Score bei FA (r = −0,704, p < 0,05) und SA (r = −0,678, p < 0,05). In allen Patienten mit einer FFR < 0,8 (Schwellenwert für die hämodynamische Wirksamkeit einer Stenose) konnte ein Ischämienachweis erbracht werden. Schlussfolgerung: Die ^99mTc-Tetrofosmin-Stress-MS mit früher Bildakquisition ist unter Verwendung eines iterativen Rekonstruktionsalgorhyth- mus machbar und besitzt eine zumindest gleichwertige diagnostische Aussagekraft.

Keywords

Myocardial perfusion scintigraphy - ^99mTc tetrofosmin - early acquisition - fractional flow reserve - coronary artery disease

Schlüsselwörter

Myokardperfusionsszintigraphie - 99mTc-Tetrofosmin - Frühaufnahmen - fraktionale Fluss reserve - koronare Herzerkrankung

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