Skip to main content
SpringerLink
Log in

Stomach interference in 82Rb-PET myocardial perfusion imaging

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

82Rubidium(82Rb)-positron-emission-tomography (PET) is prone to some of the same imaging artifacts as single-photon-emission-computed-tomography myocardial perfusion imaging (MPI) including interference from excessive subdiaphragmatic activity. Our aim was to determine associations between clinical parameters and MPI interference including any potential correlation between interference severity and stomach volume.

Methods and results

Two hundred men and women fasted two hours prior to standard clinical 82Rb myocardial perfusion rest/stress PET. Images were analyzed for radiotracer interference between left ventricle myocardium and extracardiac activity. Furthermore, volume of the stomach was measured. Interference, predominantly caused by 82Rb activity in the stomach, was less severe in stress PET compared to rest (absent in 46% vs 31% of patients during stress and rest, P < 0.05). In addition, a large stomach volume was associated with more severe interference in rest (P < 0.05) while a high body mass index was associated with less interference.

Conclusion

Among clinical parameters associated with patient size, BMI was the strongest predictor of MPI interference. Furthermore, a large stomach volume was associated with more severe MPI interference, suggesting that sufficient fasting prior to imminent 82Rb PET may be important to reduce interference from adjacent radiotracer activity and consequently improve interpretation of MPI results, especially in small patients.

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

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

Abbreviations

IHD:

Ischemic heart disease

MBq:

Megabecquerel

MPI:

Myocardial perfusion imaging

PET:

Positron-emission-tomography

82Rb:

82Rubidium

SPECT:

Single-photon emission computed tomography

References

  1. Juneau D, Erthal F, Ohira H, et al. Clinical PET myocardial perfusion imaging and flow quantification. Cardiol Clin 2016;34:69-85.

    Article  Google Scholar 

  2. Lortie M, Beanlands RS, Yoshinaga K, et al. Quantification of myocardial blood flow with 82Rb dynamic PET imaging. Eur J Nucl Med Mol Imaging 2007;34:1765-74.

    Article  Google Scholar 

  3. Chatal JF, Rouzet F, Haddad F, et al. Story of Rubidium-82 and Advantages for myocardial perfusion PET imaging. Front Med (Lausanne) 2015;2:65.

    Google Scholar 

  4. Di Carli MF, Dorbala S, Meserve J, et al. Clinical myocardial perfusion PET/CT. J Nucl Med 2007;48:783-93.

    Article  Google Scholar 

  5. Hunter CR, Hill J, Ziadi MC, et al. Biodistribution and radiation dosimetry of (82)Rb at rest and during peak pharmacological stress in patients referred for myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2015;42:1032-42.

    Article  CAS  Google Scholar 

  6. Senthamizhchelvan S, Bravo PE, Lodge MA, et al. Radiation dosimetry of 82Rb in humans under pharmacologic stress. J Nucl Med 2011;52:485-91.

    Article  Google Scholar 

  7. Burrell S, MacDonald A. Artifacts and pitfalls in myocardial perfusion imaging. J Nucl Med Technol 2006;34:193-211 quiz 12–4.

    PubMed  Google Scholar 

  8. Rehm PK, Atkins FB, Ziessman HA, et al. Frequency of extra-cardiac activity and its effect on 99Tcm-MIBI cardiac SPET interpretation. Nucl Med Commun 1996;17:851-6.

    Article  CAS  Google Scholar 

  9. van Dongen AJ, van Rijk PP. Minimizing liver, bowel, and gastric activity in myocardial perfusion SPECT. J Nucl Med 2000;41:1315-7.

    PubMed  Google Scholar 

  10. Vermeltfoort IA, van Dijk AB, de Jong JA, et al. A randomized study of the effect of carbonated water prior to myocardial SPECT. Ann Nucl Med 2014;28:669-73.

    Article  CAS  Google Scholar 

  11. Esteves FP, Nye JA, Khan A, et al. Prompt-gamma compensation in Rb-82 myocardial perfusion 3D PET/CT. J Nucl Cardiol 2010;17:247-53.

    Article  Google Scholar 

  12. Orton EJ, Al Harbi I, Klein R, et al. Detection and severity classification of extracardiac interference in (8)(2)Rb PET myocardial perfusion imaging. Med Phys 2014;41:102501.

    Article  Google Scholar 

  13. Iqbal SM, Khalil ME, Lone BA, et al. Simple techniques to reduce bowel activity in cardiac SPECT imaging. Nucl Med Commun 2004;25:355-9.

    Article  Google Scholar 

  14. Boz A, Gungor F, Karayalcin B, et al. The effects of solid food in prevention of intestinal activity in Tc-99m tetrofosmin myocardial perfusion scintigraphy. J Nucl Cardiol 2003;10:161-7.

    Article  Google Scholar 

  15. Weinmann P, Moretti JL. Metoclopramide has no effect on abdominal activity of sestamibi in myocardial SPET. Nucl Med Commun 1999;20:623-5.

    Article  CAS  Google Scholar 

  16. Hurwitz GA, Clark EM, Slomka PJ, et al. Investigation of measures to reduce interfering abdominal activity on rest myocardial images with Tc-99m sestamibi. Clin Nucl Med 1993;18:735-41.

    Article  CAS  Google Scholar 

  17. Stowers SA, Umfrid R. Supine-prone SPECT myocardial perfusion imaging: The poor man’s attenuation compensation. J Nucl Cardiol 2003;10:338.

    Article  Google Scholar 

  18. Segall GM, Davis MJ. Prone versus supine thallium myocardial SPECT: A method to decrease artifactual inferior wall defects. J Nucl Med 1989;30:548-55.

    CAS  PubMed  Google Scholar 

  19. Thomas GS, Prill NV, Majmundar H, et al. Treadmill exercise during adenosine infusion is safe, results in fewer adverse reactions, and improves myocardial perfusion image quality. J Nucl Cardiol 2000;7:439-46.

    Article  CAS  Google Scholar 

  20. Vitola JV, Brambatti JC, Caligaris F, et al. Exercise supplementation to dipyridamole prevents hypotension, improves electrocardiogram sensitivity, and increases heart-to-liver activity ratio on Tc-99m sestamibi imaging. J Nucl Cardiol 2001;8:652-9.

    Article  CAS  Google Scholar 

  21. Kjeldsen K. Myocardial Na, K-ATPase: Clinical aspects. Exp Clin Cardiol 2003;8(3):131-3.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Disclosure

All the authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Thomas Rasmussen MD, PhD, Andreas Kjær MD, PhD, DMSc & Philip Hasbak MD, DMSc

Authors
  1. Thomas Rasmussen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andreas Kjær MD, PhD, DMSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philip Hasbak MD, DMSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Rasmussen MD, PhD.

Additional information

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 246 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rasmussen, T., Kjær, A. & Hasbak, P. Stomach interference in 82Rb-PET myocardial perfusion imaging. J. Nucl. Cardiol. 26, 1934–1942 (2019). https://doi.org/10.1007/s12350-018-1359-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-018-1359-8

Keywords

Search

Navigation