Skip to main content
SpringerLink
Log in

Dobutamine Tc-99m furifosmin SPECT in detection of coronary artery disease: Evaluation of same day, rest-stress protocol

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

The purpose of this study was to evaluate the feasibility and diagnostic accuracy of same day rest-stress myocardial perfusion SPECT (MP SPECT) protocol by using technetium-99m (Tc-99m) furifosmin in conjunction with dobutamine stress test in subjects in whom coronary artery disease (CAD) had been proven or excluded at coronary angiography (CA).

The study group consisted of 25 patients (8 female and 17 male with a mean age of 53.04±8.56 yrs) unable to perform treadmill exercise or unsuitable for pharmacologic vasodilator stress testing. Ten mCi (370 MBq) of Tc-99m furifosmin was injected intravenously at rest. Sixty min after injection, planar and SPECT images were acquired. One hour later all patients underwent dobutamine stress test. At the peak stress, 20 mCi (740 MBq) of Tc-99m furifosmin was injected. Sixty min after stress dose injection, planar and SPECT images were acquired. Rest-stress planar and SPECT data were evaluated by using visual and quantitative analysis. Heart to adjacent organ (Heart/Lung; H/Lu and Heart/Liver; H/Li) activity ratios were calculated from anterior planar images by using regions of interest (ROI). SPECT data were interpreted by using 20 segment-5 point scoring system from short axis and vertical long axis slices. The results of rest-dobutamine stress Tc-99m furifosmin MP SPECT were compared with CA results.

There were statistically significant differences between H/Lu and H/Li ratios at rest and stress conditions. Heart/adjacent organ activity ratios were similar and significant statistical difference could not be found between CA positive and CA normal patients.

Sensitivity, specificity and accuracy for Tc-99m furifosmin SPECT study were calculated as 90%, 80% and 84% for left anterior descending (LAD), 87%, 94% and 92% for left circumflex (LCx) and 67%, 86% and 80% for right coronary artery (RCA), respectively. Overall sensitivity, specificity and accuracy were calculated as 83%, 87% and 85%, respectively.

According to the results obtained in this study, it may be concluded that same day rest-dobutamine stress Tc-99m furifosmin SPECT protocol is a feasible and accurate technique in the evaluation of CAD, especially in patients unable to perform treadmill exercise or unsuitable for pharmacologic vasodilator stress testing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wackers FJ, Berman DS, Maddahi J, Watson DD, Beller GA, Strauss HW, et al. Technetium-99m hexakis 2-methoxyisobutyl isonitrile: human biodistribution, dosimetry, safety, and preliminary comparison to thallium-201 myocardial perfusion imaging.J Nucl Med 1989; 30 (3): 301–311.

    PubMed  CAS  Google Scholar 

  2. Kelly JD, Forster AM, Higley B, Archer CM, Booker FS, Canning LR, et al. Technetium-99m Tetrofosmin as a new radiopharmaceutical for myocardial perfusion imaging.J Nucl Med 1993; 34 (2): 222–227.

    PubMed  CAS  Google Scholar 

  3. Jain D, Wackers FJ, Mattera J, McMahon M, Sinusas AJ, Zaret BL. Biokinetics of Technetium-99m tetrofosmin: Myocardial imaging agent: Implications for a one-day imaging protocol.J Nucl Med 1993; 34 (8): 1254–1259.

    PubMed  CAS  Google Scholar 

  4. Higley B, Smith FW, Smith T, Gemmel HG, Gupta PD, Gvozdanovic DV, et al. Technetium-99m 1,2-bis[bis(2-ethoxyethyl) phosphino]ethane: Human biodistribution, dosimetry and safety of a new myocardial perfusion imaging agent.J Nucl Med 1993; 34 (1): 30–38.

    PubMed  CAS  Google Scholar 

  5. Gerson MC, Lukes J, Deutsch E, Biniakiewicz D, Rohe RC, Washburn LC, et al. Comparison of Technetium-99m-Q12 and Tl-201 for detection of angiographically documented coronary artery disease in humans.J Nucl Cardiol 1994; 1: (6): 1499–1508.

    Article  Google Scholar 

  6. Gerson MC, Millard RW, Roszell NJ, McGoron AJ, Gabel M, Wasburn LC, et al. Kinetic properties of Tc-99m Q12 in canine myocardium.Circulation 1994; 89 (3): 1291–1300.

    Article  PubMed  CAS  Google Scholar 

  7. Hendel RC, Verani MS, Miller DD, Wackers FJ, McMahon M, Cerqueira MD, et al. Diagnostic utility of tomographic myocardial perfusion imaging with technetium 99m furifosmin (Q12) compared with thallium 201: Results of a phase III multicenter trial.J Nucl Cardiol 1996; 3 (4): 291–300.

    Article  PubMed  CAS  Google Scholar 

  8. Rossetti C, Vanoli G, Paganelli G, Kwiatkowski M, Zito F, Colombo F, et al. Human biodistribution, dosimetry and clinical use of Technetium(III)-99m-Q12.J Nucl Med 1994; 35 (10): 1571–1580.

    PubMed  CAS  Google Scholar 

  9. Biniakiewicz DS, Washburn LC, McGoron AJ, Gerson MC. Synthesis and biodistribution of new Tc-99m Q series complexes with ester functionality. [Abstract No. 59]J Nucl Med 1995; 36 (Supp): 17P.

  10. Schaefer WM, Moka D, Brockmann HA, Schomaecker K, Schicha H. Tl-201, Tc-99m MIBI Tc-99m tetrofosmin and Tc-99m furifosmin: relative retention and clearance kinetics in retrogradely perfused guinea pig hearts.Nucl Med Biol 2002; 29: 243–254.

    Article  PubMed  CAS  Google Scholar 

  11. Matsunari I, Haas F, Nguyen NTB, Reidel G, Wolf I, Senekowitsch-Schmidtke R, et al. Comparison of sestamibi, tetrofosmin, and Q12 retention in porcine myocardium.J Nucl Med 2001; 42 (5): 818–823.

    PubMed  CAS  Google Scholar 

  12. Rodriques M, Chehne F, Kalinowska W, Zielinski C, Sinzinger H. Comparative Tc-99m MIBI, Tc-99m tetrofosmin and Tc-99m furifosmin uptake in human soft tissue sarcoma cell lines.Eur J Nucl Med 2000; 27 (12): 1839–1843.

    Article  PubMed  CAS  Google Scholar 

  13. Lenihan DJ, McGoron AJ, Gabel M, Walsh RA, Gerson MC. Reliability of Tc-99m Q12 and Thallium-201 myocardial activity measurements after triphenyl tetrazolium chloride myocardial staining by perfusion.Invest Radiol 1999; 34 (4): 276–281.

    Article  PubMed  CAS  Google Scholar 

  14. Schomacker K, Majstorov V, Gabruk-Szostak B, Fischer T, Loehr H, Liebenhoff S, et al. Tl-201, Tc-99m MIBI, Tc-99m tetrofosmin and Tc-99m furifosmin (Q12): Distribution in tumor cells and biokinetics in tumor-bearing mice. [Abstract No. 1036].J Nucl Med 1999; 40 (5): 233 p.

  15. McGoron AJ, Gerson MC, Biniakiewicz DS, Roszell NJ, Washburn LC, Millard RW. Extraction and retention of technetium-99m Q12, technetium-99m sestamibi, and thallium-201 in isolated rat heart during coronary acidemia.Eur J Nucl Med 1997; 24 (12): 1479–1486.

    Article  PubMed  CAS  Google Scholar 

  16. Gordon L, Hendrix GH. The use of pharmacological agents in myocardial perfusion imaging: Freeman LM (ed),Nucl Med Annual 1994. New York: Raven Press, Ltd., 1994: 121–140.

    Google Scholar 

  17. Krivokapich J, Huang SC, Schelbert HR. Assessment of the effects of dobutamine on myocardial blood flow and oxidative metabolism in normal human subjects using nitrogen-13 ammonia and carbon-11 acetate.Am J Cardiol 1993; 71: 1351–1356.

    Article  PubMed  CAS  Google Scholar 

  18. Hays JT, Mahmarian JJ, Cochran AJ, Verani MS. Dobutamine thallium-201 tomography for evaluating patients with suspected coronary artery disease unable to undergo exercise or vasodilator pharmacologic stress testing.J Am Coll Cardiol 1993; 21 (7): 1583–1590.

    Article  PubMed  CAS  Google Scholar 

  19. Rosenbaum AF, McGoron AJ, Millard RW, Gabel M, Biniakiewicz D, Walsh RA, et al. Uptake of seven myocardial tracers during increased myocardial blood flow by dobutamine infusion.Invest Radiol 1999; 34 (2): 91–98.

    Article  PubMed  CAS  Google Scholar 

  20. Iskandrian AS, Heo J. Pharmacologic stress testing (Chapter 15). Myocardial Perfusion Imaging (Section IV).Nuclear Cardiology State of the Art and Future Directions. Zaret BL, Beller GA (eds) St. Louis, Missouri; Mosby-Year Book, Inc., 1993: 170–180.

    Google Scholar 

  21. TechnescanTM Q12 Datasheet/Directions for use. Manufacturer’s prescribing information. Mallinckrodt Medical Inc.

  22. Unlu M, Turgut B, Günaydin S, Atavci S, Gökgöz L. Dobutamine Tc-99m tetrofosmin SPECT in the detection of coronary artery disease: Evaluation of a same day reststress protocol. [Abstract No. 606]J Nucl Med 1995: 36 (Suppl): 132P.

  23. Unlu M, Turgut B, Günaydin S, Atavci S, Atasever T, Inanir S, et al. Tc-99m Tetrofosmin imaging in a same day rest-dobutamine stress protocol: Comparison with Tc-99m MIBI. [Abstract]Ann Nucl Med 1996; 10: S78–153.

    Google Scholar 

  24. Montz R, Perez-Castejon MJ, Jurado JA, Martin-Comin J, Esplugues E, Salgado L, et al. A Spanish-Portuguese multicentre clinical trial Technetium-99m tetrofosmin rest/stress myocardial SPET with a same day 2 hour protocol: comparison with coronary angiography.Eur J Nucl Med 1996; 23 (6): 639–647.

    Article  PubMed  CAS  Google Scholar 

  25. Mason JR, Palac RT, Freeman ML, Virupannavar S, Loeb HS, Kaplan E, et al. Thallium scintigraphy during dobutamine infusion: Nonexercise-dependent screening test for coronary disease.Am Heart J 1984; 107 (3): 481–485.

    Article  PubMed  CAS  Google Scholar 

  26. Van Rugge FP, Van der Wall EE, Spanjersberg SJ, De Ross A, Matheijssen NAA, Zwinderman AH, et al. Magnetic resonance imaging during dobutamine stress for detection and localization of coronary artery disease. Quantitative wall motion analysis using a modification of the centerline method.Circulation 1994; 90 (1): 127–138.

    Article  PubMed  Google Scholar 

  27. Günalp B, Dokumaci B, Uyan C, Vardareli E, Isik E, Bayhan H, et al. Value of dobutamine Technetium-99m sestamibi SPECT and echocardiography in the detection of coronary artery disease compared with coronary angiography.J Nucl Med 1993; 34 (6): 889–894.

    PubMed  Google Scholar 

  28. Van Train KF, Areeda J, Garcia EV, Cooke CD, Maddahi J, Kiat H, et al. Quantitative same-day rest-stress Technetium-99m-sestamibi SPECT: Definition and validation of stress normal limits and criteria for abnormality.J Nucl Med 1993; 34 (9): 1494–1502.

    PubMed  Google Scholar 

  29. Bavelaar-Croon CDL, Wahba FFMF, Van Hecke MV, Atsma DE, Stokkel MPM, Pauwels EKJ, et al. Perfusion and functional abnormalities outside the septal region in patients with left bundle branch block assessed with gated SPECT.Q J Nucl Med 2001; 45 (1): 108–114.

    PubMed  CAS  Google Scholar 

  30. Johansen A, Gaster AL, Veje A, Thayssen P, Haghfelt T, Hoilund-Carlsen PF. Interpretive intra-and interobserver reproducibility of rest/stress Tc-99m sestamibi myocardial perfusion SPECT in a consecutive group of male patients with stable angina pectoris before and after percutaneous transluminal angioplasty.Nucl Med Commun 2001; 22: 531–537.

    Article  PubMed  CAS  Google Scholar 

  31. Naruse H, Daher E, Sinusas A, Jain D, Natale D, Mattera J, et al. Quantitative comparison of planar and SPECT normal data files of Thallium-201, Technetium-99m-sestamibi, Technetium-99m-tetrofosmin and Technetium-99m-furifosmin.J Nucl Med 1996; 37 (11): 1783–1788.

    PubMed  CAS  Google Scholar 

  32. Daher E, Sinusas A, Natale D, Botvinick E, Cerqueira M, Gerson M, et al. Tc-99m furifosmin organ clearance and heart/organ ratio: implication for timing of imaging. [Abstract No. 90].J Nucl Med 1995; 36 (Suppl): 24P.

  33. Bangard M, Bender H, Grunwald F, Hummelgen M, Willkomm P, Palmedo H, et al. Myocardial uptake of technetium-99m-furifosmin (Q12) versus technetium-99m-sestamibi (MIBI).Nuclearmedizin 1999; 38 (6): 189–191.

    CAS  Google Scholar 

  34. Marwick T, D’Hondt AM, Baudhuin T, Willemart B, Wijns W, Detry JM, et al. Optimal use of dobutamine stress for the detection and evaluation of coronary artery disease: Combination with echocardiography or scintigraphy, or both?J Am Coll Cardiol 1993; 22 (1): 159–167.

    Article  PubMed  CAS  Google Scholar 

  35. Marwick T, Willemart B, D’Hondt AM, Baudhuin T, Wijns W, Detry JM, et al. Selection of the optimal nonexercise stress for the evaluation of ischemic regional myocardial dysfunction and malperfusion. Comparison of dobutamine and adenosine using echocardiography and Tc99m-MIBI single photon emission computed tomography.Circulation 1993; 87 (2): 345–354.

    Article  PubMed  CAS  Google Scholar 

  36. Watson DD. Methods for detection of myocardial viability and ischemia (Chapter 6). Image Display and analysis (Section II).Nuclear Cardiology State of the Art and Future Directions. Zaret BL, Beller GA (eds), St. Louis, Missouri; Mosby-Year Book, Inc., 1993: 65–76.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Medicine, Department of Nuclear Medicine, Cumhuriyet University, 58140 Campus, Sivas, TÜRKIYE

    Bulent Turgut

  2. Department of Nuclear Medicine, Gazi University School of Medicine, Ankara, Turkey

    Mustafa Unlu, N. Hakan Temiz & Mehmet T. Kitapci

  3. Department of Cardiology, Gazi University School of Medicine, Ankara, Turkey

    Mehmet L. Alkan

Authors
  1. Bulent Turgut
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mustafa Unlu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Hakan Temiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mehmet T. Kitapci
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehmet L. Alkan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bulent Turgut.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turgut, B., Unlu, M., Temiz, N.H. et al. Dobutamine Tc-99m furifosmin SPECT in detection of coronary artery disease: Evaluation of same day, rest-stress protocol. Ann Nucl Med 17, 531–539 (2003). https://doi.org/10.1007/BF03006665

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03006665

Key words

Search

Navigation