Skip to main content
SpringerLink
Log in

99mTc-MIBI (RP-30) to define the extent of myocardial Ischemia and evaluate ventricular function

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

Abstract

99mTc-MIBI, a new myocardial perfusion agent, is a technetium labeled isonitrile derivative. We have taken advantage of the physical characteristics of99mTc to combine at rest, post infarction, ventricular function studies with analysis of perfusion. We have studied at rest and at stress, 22 patients with coronary artery disease selected on the basis of an abnormal coronary angiogram or on the basis of a positive exercise ECG stress test for symptomatic angina. We have also studied, at rest only, 20 patients with a previous myocardial infarction. A comparative thallium planar scintigraphy was obtained for all patients. The sensitivity of99mTc-MIBI scintigraphy for detecting individual vessel lesions at stress was 88% as compared with 83% for201TI. Sensitivity was higher in patients with previous myocardial infarction (93% for the 2 isotopes) than in patients without (85% for99mTc-MIBI versus 81% for201TI). Segmental myocardial correspondence between99mTc-MIBI and201Tl was very close (92%). The overall sensitivity for the detection of acute myocardial infarction reached respectively 91% for99mTc MIBI and 87% for201T1. The specificity in the regions corresponding to arteries not involved was excellent for both tracers as we did not observe any false positive result. This is important information but it does not correspond to the specificity to detect coronary artery disease in the overall patient population. The correlation between first pass left ventricular ejection fraction obtained with99mTc-MIBI and equilibrium left ventricular ejection fraction obtained with99mTc red cells was excellent (r = 0.96). It was not as good but was still satisfactory for the right ventricle (r=0.75). By comparison of diastolic and systolic frames., gated tomography provides analysis of regional wall motion and wall thickening. In this preliminary study, we have only limited data collected from a selected population with a high prevalence of coronary artery disease and myocardial infarction. Thus, no definitive conclusion can be drawn on the sensitivity and specificity of these tests when performed in the general population. Further studies analyzing comparatively MIBI scintigrams and angiographic results in a large number appears to be a very promising perfusion agent to document myocardial infarction and myocardial ischemia as well as to provide functional information on global and regional ventricular function.

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

  • Bertrand A, Karcher G, Amor M, Mayer JC, Aug F, Moretti JL, Pernot C, Cherrier F (1987) Qualitative and quantitative comparison of 201-T1 and Tc-99m isonitrile by SPELT in coronary artery disease. Nuklearmedizin 26:120

    Google Scholar 

  • Bodenheimer MM, Banka VS, Fooshee CM, Gillespie JA, Helfant RH (1978) Detection of coronary heart disease using radionuclide determined regional ejection fraction at rest and during handgrip exercise: correlation with coronary arteriography. Circulation 58:640–648

    Google Scholar 

  • Buell U, Stirner H, Kleinhans E, Uebis R (1987) Myocardial kinetics of Te-99m hexakis- (2-methoxy-isobutyl-isonitrile) (RP-30). A comparative study vs T1-201 with SPELT in coronary heart disease. Nuklearmedizin 26:58

    Google Scholar 

  • Campbell S, Holman BL, Kirshenbaum JM, Antman EM, Lister-James J, Davison A, Kozlowski J, English RJ, Jones AG (1986) The scintigraphic evaluation of myocardial infarction and regional ventricular performance using technetium-99m hexakis (t-butylinonitrile) Technetium (1) (TBI): A new myocardial imaging agent. Eur J Nucl Med 12:219–225

    Google Scholar 

  • Deutsch E, Bushong W, Glavan KA, Elder RC, Sodd VJ, Scholz KL, Fortman SL, Lukes SJ (1981 a) Heart imaging with cationic complexes of technetium. Science 214:85–86

    Google Scholar 

  • Deutsch A, Glavan KA, Sodd VJ, Nishiyama H, Ferguson DL, Lukes SJ (1981 b) Cationic Tc-99m complexes as potential myocardial imaging agents. J Nucl Med 22:897–907

    Google Scholar 

  • Grines CL, O'Neill WW, Anselmo EG, Juni JE, Topol EJ (1988) Comparison of left ventricular function and contractile reserve after successful recanalization by thrombolysis versus rescue percutaneous transluminal coronary angioplasty for acute myocardial infarction. Am J Cardiol 62:352–357

    Google Scholar 

  • Grucker D, Florentz P, Chambron J, Schott B, Fincker JL (1988) Myocardial gated tomoscintigraphy with99mTc methoxy-isobutyl-isonitrile (MIBI) in ischemic disease: regional and temporal activity curve analysis. Eur J Nucl Med 14:265

    Google Scholar 

  • Hassan IM, Mohammed MMJ, Badruddosa M, Mahmood AR, Sayed ME, Simo M, Abdel-Dayem HM, Yousef AM (1986) A comparison of two radionuclide ejection-fraction techniques with contrast angiography in ischemic heart disease and valvular heart disease. Eur J Nucl Med 11:474–477

    Google Scholar 

  • Holman BL, Jones AG, Lister-James J, Davison A, Abrams MJ, Kirshenbaum JM, Tumeh SS, English RJ (1984) A new Tc-99mlabeled myocardial imaging agent, hexakis (t-butylisonitrile)technetium (1) /Tc-99m TBI/: Initial experience in the human. J Nucl Med 25:1350–1355

    Google Scholar 

  • Holman BL, Campbell CA, Lister-James J, Jones AG, Davison A, Kloner RA (1986) Effect of reperfusion and hyperemia on the myocardial distribution of technetium-99m t-butylisonitrile. J Nucl Med 27:1172–1177

    Google Scholar 

  • Holman BL, Sporn V, Jones AG, Sia STB, Perez-Balino N, Davison A, Lister-James J, Kronauge JF, Mitta AEA, Camin LL, Campbell S, Williams SJ, Carpenter AT (1987) Myocardial imaging with technetium-99m CPI:Initial experience in the human. J Nucl Med 28:13–18

    Google Scholar 

  • Ingels NB, Daughters GT, Stinson EB, Alderman EL (1980) Evaluation of methods for quantitating left ventricular segmental wall motion in man using myocardial markers as a standard. Circulation 61:966–972

    Google Scholar 

  • Jones AG, Abrams MJ, Davison A, Brodack JW, Toothaker AK, Adelstein J, Kassis AI (1984) Biological studies of a new class of technetium complexes: the hexakis (alkylisonitrile) technetium (I) Cations. Int J Nucl Med Biol 11:225–234

    Google Scholar 

  • Knesewitsch P, Kleinhans E, Buell U (1986) Combined evaluation of first-pass radionuclide angiography and equilibrium radionuclide ventriculography in the diagnosis of coronary artery disease. I. Results at rest. Eur J Nucl Med 12:115–119

    Google Scholar 

  • Liu XJ, Shi RF, Wang YQ, Guo XZ, He ZX, Wang XB (1987) Clinical evaluation of the99mTc-labeled myocardial imaging agent, hexakis (t-butylisonitrile)-technetium. Eur J Nucl Med 13:171–173

    Google Scholar 

  • Maddahi J, Merz R, Van Trin KF, Roy L, Wong C, Berman DS (1987) Quantitative comparison of planar and tomographic Tc99m MIBI (RP-30) and T1-201 myocardial perfusion scintigraphy in patients with coronary disease for perfusion defect intensity and defect reversibility. JACC 9:27A

    Google Scholar 

  • Marcassa C, Marzullo P, Parodi O, Sambuceti G, Neclia D (1988) Quantitative myocardial wall thickening analysis by E.C.G. gated methoxy-isobutyl-isonitrile perfusion scintigraphy. Eur J Nucl Med 14:241

    Google Scholar 

  • Mayer JC, Karcher G, Mathieu E, Maublant J, Itti R, Bourguignon M, Moretti JL, Baconnet B, Bertrand A (1988) Comparative study by two independent observers of the uptake abnormalities of 201-Thallium and Tc99m-MIBI in 81 patients with coronary artery disease. Eur J Nucl Med 14:248

    Google Scholar 

  • McKusick K, Holman BL, Jones AG, Davison A, Rigo P, Sporn V, Vosberg H, Moretti JL (1986) Comparison of 3 Tc-99m isonitriles for detection of ischemic heart disease in humans. J Nucl Med 27:878

    Google Scholar 

  • McKusick K, Beller G, Berman D, Boucher C, Camin L, Delaloye A, Delaloye B, Maddahi J, Manspeaker P, Strauss HW, Wackers F, Watson D (1987) Initial clinical results with 99mTc methoxy isobutyl isonitrile. JACC 9:28A

    Google Scholar 

  • Mousa SA, Williams SJ (1986) Myocardial uptake and retention of Tc-99m-hexakis- aliphatic isonitriles: evidence for specificity. J Nucl Med 27:995

    Google Scholar 

  • Mousa SA, Cooney JM, Williams SJ (1987a) Flow-distribution characteristics of Tc-99m-hexakis-2-methoxy, 2-methylpropyl isonitrile in animal models of myocardial ischemia and reperfusion. JACC 9:137A

    Google Scholar 

  • Mousa SA, Maina M, Brown BA, Williams SJ (1987b)Studies of the mechanism of retention of RP-30 in the heart. Nuklearmedizin 26:55

    Google Scholar 

  • Mousa SA, Cooney JM, Williams SJ (1987c)Assessment of different degrees of coronary artery stenosis in canine models using RP-30. Nuklearmedizin 56:56

    Google Scholar 

  • Nicod P, Gilpin E, Dittrich H, Chappuis F, Ahnve S, Engler R, Henning H, Ross J Jr (1988) Influence on prognosis and morbidity of left ventricular ejection fraction with and without signs of left ventricular failure after acute myocardial infarction. Am J Cardiol 61:1165–1171

    Google Scholar 

  • Okada R, Williams S, Glover D, Crowley K, Garneau J (1987) Myocardial kinetics of technetium-99m-hexakis-2-methoxy-2methylpropyl-isonitrile: a new cardiac imaging agent. JACC 9:26A

    Google Scholar 

  • Perez-Balino N, Sporn V, Holman BL, Sosa-Liprandi A, Masoli O, Mitta A, Camin LL (1986) First pass ejection fraction and myocardial perfusion with single injection of Tc-99m isonitrile. J Nucl Med 27:878, 11

    Google Scholar 

  • Podio V, Castellano G, Spinnler MT, Righetti A, Avataneo G, Leone G, Ciaroni S, Morello P, Turco GL (1988) Myocardial imaging with Tc-99m MIBI: correlation with coronary angiography and stress test. Eur J Nucl Med 14:254

    Google Scholar 

  • Rigo P, Bailey IK, Griffith LC, Pitt B, Wagner HN Jr, Becker LC (1981) Stress Thallium-201 myocardial scintigraphy for the detection of individual coronary areterial lesions in patients with and without previous myocardial infarction. Am J Cardiol 48:209–215

    Google Scholar 

  • Rigo P, Gilis F, Cantineau R (1986) Planar and tomographic evaluation of Tc-99m tertiary butyl isonitrile (Tc-99m TBI) as a myocardial imaging agent. J Nucl Med 27:995

    Google Scholar 

  • Sands H, Delano ML, Gallagher BM (1986) Uptake of hexakis (t-butylisonitrile) technetium (1) and hexakis-(isoprophylisonitrile) Technetium (1) by neonatal rat myocytes and human erythrocytes. J Nucl Med 27:404–408

    Google Scholar 

  • Schelbert HR, Verba JW, Johnson AD, Brock GW, Alazraki NP, Rose FJ (1975) Non-traumatic determination of left ventricular ejection fraction by radionuclide angiocardiography. Circulation 51:902–909

    Google Scholar 

  • Sheehan FH, Stewart DK, Dodge HT, Mitten S, Bolson EL, Brown BG (1983) Variability in the measurement of regional left ventricular wall motion from contrast angiograms. Circulation 68:550–559

    Google Scholar 

  • Sheehan FH, Bolson EL, Dodge HT, Mathey DG, Schofer J, Woo HW (1986) Advantages and applications of the centerline method for characterizing regional ventricular function. Circulation 74:293–395

    Google Scholar 

  • Sheehan FH, Doerr R, Schmidt WG, Bolson EL, Uebis R, Essen R von, Effert S, Dodge HT (1988) Early recovery of left ventricular function after thrombolytic therapy for acute myocardial infarction: an important determinant of survival. JACC 12:289–300

    Google Scholar 

  • Sia STB, Holman BL, McKusick K, Rigo P, Gillis F, Sporn V, Perez-Balino N, Mitta A, Vosberg H, Szabo Z, Schwartzkopff B, Moretti JL, Davison A, Lister-James J, Jones A (1986) The utilization of Tc-99m-TBI as an myocardial perfusion agent in exercise studies: Comparison with T1-201 thallous chloride and examination of its biodistribution in humans. Eur J Nucl Med 12:333–336

    Google Scholar 

  • Smucker ML, Beller GA, Watson DD, Kaul S (1988) Left ventricular dysfunction in excess of the size of infarction: a posible management strategy. Am Heart J 115:749–753

    Google Scholar 

  • Taillefer R, Laflamme L, Dupras G, Picard M, Phaneuf DC, Léveillé J (1988) Myocardial perfusion imaging with 99mTc methoxy-isobutyl-isonitrile (MIBI): Comparison of short and long time intervals between rest and stress injections. Preliminary results. Eur J Nucl Med 13:515–522

    Google Scholar 

  • Tamaki N, Yonekura Y, Yamashita K, Senda M, Saji H, Hashimoto T, Fudo T, Kambara H, Kawai C, Ban T, Konishi J (1988) Relation of left ventricular perfusion and wall motion with metabolic activity in persistent defects on Thallium-201 tomography in healed myocardial infarction. Am J Cardiol 62:202–208

    Google Scholar 

  • Underwood SR, Walton S, Ell PJ, Jarritt PH, Emanuel RW, Swanton RH (1985) Gated blood-pool emission tomography: a new technique for the investigation of cardiac structure and function. Eur J Nucl Med 10:332–337

    Google Scholar 

  • Wackers F, Berman D, Strauss HW, Boucher C, Maddahi J, McKusick K (1987a) Tc99m RP-30 (Cardiolite-TM): a new radio-pharmaceutical for myocardial perfusion imaging: assessment of rest and exercise human biodistribution and safety. Nuklearmedizin 26:56

    Google Scholar 

  • Wackers FJ, Kayden DS, Lange RC, Mattera J (1987b) Rest-exercise orang distribution of RP-30, a new Tc-99m-labeled myocardial perfusion imaging agent. JACC 9:27A

    Google Scholar 

  • Wackers F, Berman D, Beller G, Delaloye B, Boucher C, Maddahi J, Watson D, Delaloye A, Strauss HW, McKusick K (1987c) Rest and exercise myocardial perfusion imaging with Tc-99m RP-30 (Cardiolite-TM): Preliminary clinical comparison with T1-201. Nuklearmedizin 26:57

    Google Scholar 

Download references

Author information

Author notes

  1. Pierre Rigo

    Present address: Nuclear Medicine Department, C.H.U., B.35, B-4000, Sart Tilman (Liège 1), Belgium

Authors and Affiliations

  1. Nuclear Medicine Department, C.H.U., B.35, B-4000, Sart Tilman (Liège 1), Belgium

    Marie-Paule Larock & Robert Cantineau

  2. Division of Cardiology, C.H.U.srB.35, B-4000, Sart Tilman (Liège 1), Belgium

    Victor Legrand & Henri Kulbertus

Authors
  1. Marie-Paule Larock
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert Cantineau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Victor Legrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Henri Kulbertus
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pierre Rigo
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Larock, MP., Cantineau, R., Legrand, V. et al. 99mTc-MIBI (RP-30) to define the extent of myocardial Ischemia and evaluate ventricular function. Eur J Nucl Med 16, 223–230 (1990). https://doi.org/10.1007/BF00842772

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00842772

Key words

Search

Navigation