Journal of Nuclear Cardiology

, Volume 25, Issue 6, pp 2016–2023 | Cite as

Low-dose dual-isotope procedure planed for myocardial perfusion CZT-SPECT and assessed through a head-to-head comparison with a conventional single-isotope protocol

  • Laetitia ImbertEmail author
  • Véronique Roch
  • Charles Merlin
  • Wassila Djaballah
  • Florent Cachin
  • Mathieu Perrin
  • Marine Claudin
  • Antoine Verger
  • Henri Boutley
  • Gilles Karcher
  • Pierre-Yves Marie
Original Article


Purpose of the report

This study aimed at assessing an original low-dose dual-isotope procedure in which the abnormal stress Tc-99m Sestamibi SPECT is followed by rest Tl-201 SPECT, along with a head-to-head comparison with a single-isotope procedure.

Methods and results

One hundred two patients, referred for a low-dose stress-SPECT with Sestamibi (123 ± 20 MBq) on a CZT camera and for whom a rest Sestamibi SPECT was warranted, had an additional Tl-201 rest-SPECT (52 ± 5 MBq) between stress and rest Sestamibi SPECT recordings. Tl-201 images were processed for spill-over and scatter corrections, and uptake differences with stress Sestamibi SPECT were analyzed: (1) for rest acquisitions from Tl-201 (dual-isotope procedure) and from Sestamibi (single-isotope procedure) and (2) in segments for which a diagnosis of ischemia, infarct, or normal perfusion was achieved. Mean effective dose was 8.3 mSv for dual-isotope but would decrease to 5.7 mSv for an expected rate of 37% of patients for whom rest-SPECT is not warranted. After a further background correction of Tl-201 images, the rest–stress difference in myocardial uptake was equivalent between dual- and single-procedures for identifying ischemic segments (respective areas-under-curves: 0.83 ± 0.03 and 0.81 ± 0.03).


This original dual-isotope procedure provides acceptable radiation doses and consistent results, as compared with conventional single-isotope.


Myocardial perfusion imaging CZT camera dual-isotope protocol Sestamibi thallium-201 



Agence nationale de sécurité du médicament et des produits de santé




Comité de protection des personnes




International commission on radiological protection


Myocardial perfusion imaging


Quantitative perfusion software


Receiver operating characteristics


Region of interest


Single photon emission computed tomography



The authors thank Pierre Pothier, for critical review of the manuscript, and the Nancyclotep experimental imaging platform, for organizational support.


The authors declare that they have no conflict of interest.

Supplementary material

12350_2017_914_MOESM1_ESM.pptx (586 kb)
Supplementary material 1 (PPTX 586 kb)


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Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Laetitia Imbert
    • 1
    • 2
    • 3
    • 4
    Email author
  • Véronique Roch
    • 1
    • 2
  • Charles Merlin
    • 5
    • 6
  • Wassila Djaballah
    • 1
    • 2
  • Florent Cachin
    • 5
    • 6
  • Mathieu Perrin
    • 1
    • 2
  • Marine Claudin
    • 1
    • 2
  • Antoine Verger
    • 1
    • 2
    • 3
  • Henri Boutley
    • 2
    • 7
  • Gilles Karcher
    • 1
    • 2
    • 7
  • Pierre-Yves Marie
    • 1
    • 2
    • 8
  1. 1.CHRU-Nancy, Université de Lorraine, Department of Nuclear MedicineNancyFrance
  2. 2.Nancyclotep Experimental Imaging PlatformNancyFrance
  3. 3.INSERM, Université de Lorraine, UMR 947, IADINancyFrance
  4. 4.Department of RadiotherapyLorraine Cancerology InstituteVandoeuvreFrance
  5. 5.Department of Nuclear Medicine, Jean Perrin CentreUniversité d’AuvergneClermont-FerrandFrance
  6. 6.INSERM, Université d’Auvergne, UMR 990, IMTVClermont-FerrandFrance
  7. 7.University of LorraineFaculty of MedicineNancyFrance
  8. 8.INSERM, Université de Lorraine, UMR 1116, DCACNancyFrance

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