Comparative study of single-injection, single-acquisition Tc-99m-MIBI gated SPET and stress-rest perfusion SPET for the evaluation of myocardial viability after bypass surgery in coronary artery disease
Sn. Yoon et al., Comparative study of single-injection, single-acquisition Tc-99m-MIBI gated SPET and stress-rest perfusion SPET for the evaluation of myocardial viability after bypass surgery in coronary artery disease, EUR J NUCL, 27(12), 2000, pp. 1747-1753
Citations number
11
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Medical Research Diagnosis & Treatment
In patients without previous myocardial infarction, the single-injection st
ress perfusion/rest function (SISPRF) approach using stress technetium-99m
methoxyisobutylisonitrile (MIBI) gated single-photon emission tomography (S
PET) can substitute for conventional stress-rest myocardial perfusion imagi
ng for the assessment of myocardial viability. This study compared pre-oper
ative single-injection, single-acquisition Tc-99m-MIBI gated SPET and conve
ntional stress-rest imaging for the prediction of myocardial viability in p
atients who underwent coronary artery bypass surgery (CABG). Rest thallium-
201 SPET followed by stress 99mTc-MIBI gated SPET was performed in 20 patie
nts (nine with previous myocardial infarction (MI) and 11 without previous
MI). The study was performed before and 3 months after CABG, and viability
assessment was validated by wall motion improvement after CABG. A four-poin
t scoring system (0-3 for normal to absent tracer uptake) for 17 segments o
f the left ventricular myocardium was used for the assessment of stress and
rest uptake. Wall motion, wail thickening and perfusion status were analys
ed by semi-quantitative visual assessment. On gated SPET, perfusion defect
reversibility was considered present when a definite perfusion defect was o
bserved and wall motion or thickening was normal or showed only a mild decr
ease. In patients with a previous MI, the left ventricular ejection fractio
n improved significantly after CABG (46% +/- 7% vs 42% +/- 11% before CABG,
P < 0.05). In patients without previous MI, the ejection fraction improved
significantly after CABG (50 <plus/minus> 12% vs 44% +/- 16% before CABG,
P < 0.05), In patients with previous MI, positive predictive values using t
he stress-rest reversibility and SISPRF approaches were 91% and 90%, respec
tively, and corresponding negative predictive values were 25% and 18%. In p
atients without previous MI, positive predictive values using the stress-re
st and SISPRF approaches were 70% and 61%, respectively, and corresponding
negative predictive values were 63% and 14%. It is concluded that SISPRF SP
ET study is of similar value to conventional stress-rest perfusion study in
predicting wall motion improvement in patients with a previous MI, but tha
t it is of limited value in predicting the myocardial viability of patients
without previous MI, owing to a lower predictive value.