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European Journal of Nuclear Medicine

, Volume 19, Issue 10, pp 874–881 | Cite as

Presurgical identification of hibernating myocardium by combined use of technetium-99m hexakis 2-methoxyisobutylisonitrile single photon emission tomography and fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography in patients with coronary artery disease

  • G. Lucignani
  • G. Paolini
  • C. Landoni
  • M. Zuccari
  • G. Paganelli
  • L. Galli
  • G. Di Credico
  • G. Vanoli
  • C. Rossetti
  • M. A. Mariani
  • M. C. Gilardi
  • F. Colombo
  • A. Grossi
  • F. Fazio
Original Articles

Abstract

We tested the possibility of identifying areas of hibernating myocardium by the combined assessment of perfusion and metabolism using single photon emission tomography (SPET) with technetium-99m hexakis 2-methoxyisobutylisonitrile (99mTc-MIBI) and positron emission tomography (PET) with fluorine-18 fluoro-2-deoxy-d-glucose (18F-FDG). Segmental wall motion, perfusion and 18F-FDG uptake were scored in 5 segments in 14 patients with coronary artery disease (CAD), for a total number of 70 segments. Each subject underwent the following studies prior to and following coronary arterybypass grafting (CABG): first-pass radionuclide angiography, electrocardiography gated planar perfusion scintigraphy and SPET perfusion scintigraphy with 99mTc-MIBI and, after 16 h fasting, 18F-FDG/PET metabolic scintigraphy. Wall motion impairment was either decreased or completely reversed by CABG in 95% of the asynergic segments which exhibited 18F-FDG uptake, whereas it was unmodified in 80% of the asynergic segments with no 18-FDG uptake. A stepwise multiple logistic analysis was carried out on the asynergic segments to estimate the postoperative probability of wall motion improvement on the basis of the preoperative regional perfusion and metabolic scores. The segments with the highest probability (96%) of functional recovery from preoperative asynergy after revascularization were those with a marked 18F-FDG uptake prior to CABG. High probabilities of functional recovery were also estimated for the segments presenting with moderate and low 18F-FDG uptake (92% and 79%, respectively). A low probability of functional recovery (13 %) was estimated in the segments with no 18F-FDG uptake. Despite the potential limitations due to the semiquantitative analysis of the images, the method appears to provide reliable information for the diagnostic and prognostic evaluation of patients with CAD undergoing CABG and confirms that the identification of hibernating myocardium with 18F-FDG is of paramount importance in the diagnosis of patients undergoing CABG.

Key words

Myocardial perfusion Myocardial metabolism Radionuclide imaging Myocardial viability Coronary artery bypass grafting 

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Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • G. Lucignani
    • 1
  • G. Paolini
    • 2
  • C. Landoni
    • 1
  • M. Zuccari
    • 2
  • G. Paganelli
    • 1
  • L. Galli
    • 3
  • G. Di Credico
    • 2
  • G. Vanoli
    • 1
  • C. Rossetti
    • 1
  • M. A. Mariani
    • 2
  • M. C. Gilardi
    • 1
  • F. Colombo
    • 1
  • A. Grossi
    • 2
  • F. Fazio
    • 1
  1. 1.INB-CNR e Cattedra di Medicina NucleareUniversità di MilanoMilanoItaly
  2. 2.Cattedra di Card iochirurgiaUniversità di MilanoMilanoItaly
  3. 3.Unità di Epidemiologia e Statistica MedicaIstituto ScientificoMilanoItaly

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