Electrocardiographic-gated dual-isotope simultaneous acquisition SPECT using 18F-FDG and 99mTc-sestamibi to assess myocardial viability and function in a single study

Abstract

Purpose: Dual-isotope simultaneous acquisition single-photon emission computed tomography (DISA SPECT) with 18F-fluorodeoxyglucose (FDG) and (99m)Tc-sestamibi appears attractive for the detection of viable myocardium because it permits simultaneous assessment of glucose utilisation and perfusion. Another potential benefit of this approach is that the measurement of left ventricular (LV) function may be possible by ECG gating. The aim of this study was to test the hypothesis that both myocardial viability and LV function can be assessed by a single ECG-gated 18F-FDG/(99m)Tc-sestamibi DISA SPECT study, based on comparison with 18F-FDG/13N-ammonia positron emission tomography (PET) and magnetic resonance imaging (MRI) as reference techniques.

Methods: Thirty-three patients with prior myocardial infarction underwent ECG-gated 18F-FDG/(99m)Tc-sestamibi DISA SPECT and 18F-FDG/13N-ammonia PET on a single day. Of these, 25 patients also underwent cine-MRI to assess LV function. The LV myocardium was divided into nine regions, and each region was classified as viable or scar using a semiquantitative visual scoring system as well as quantitative analysis. The global and regional LV function measured by gated SPECT was compared with the results of MRI.

Results: There was good agreement in respect of viability (90-96%, kappa 0.74-0.85) between DISA SPECT and PET by either visual or quantitative analysis. Furthermore, although both global and regional LV function measured by gated SPECT agreed with those by MRI, (99m)Tc-sestamibi showed a closer correlation with MRI than did 18F-FDG.

Conclusion: In conclusion, ECG-gated DISA SPECT provides information on myocardial viability, as well as global and regional LV function, similar to that obtained by PET and MRI.