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
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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.
KeywordsMyocardial 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.
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