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Exercise gated planar myocardial perfusion imaging using technetium-99m sestamibi for the diagnosis of coronary artery disease: an alternative to exercise tomographic imaging

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Abstract

Single-photon emission tomography (SPET) using technetium-99m labelled myocardial tracers (e.g.99mTc-sestamibi) has become one of the most popular myocardial imaging methods for the diagnosis of coronary artery disease (CAD). This prospective study was designed to evaluate the diagnostic performance of99mTc-sestamibi exercise gated planar myocardial imaging by comparison with both visual and quantitative analyses of SPET. The study was conducted in 115 consecutive patients with known or suspected CAD, including 54 patients with a previous myocardial infarction (MI), referred for exercise testing prior to coronary angiography. Multi-gated planar imaging and SPET were performed after bicycle exercise. The end-diastolic (ED) and SPET images were visually scored (SVi). Myocardial uptake was quantitated on SPET slices using maximum count circumferential profiles (SQu) and defect extent was measured by comparison with gender-matched data sets obtained from 27 controls (<5% likelihood of CAD). CAD was defined as coronary artery stenosis >50% and/or regional wall motion abnormality. The cut-off criteria for positivity of the three procedures were determined from receiver operating characteristic (ROC) curves derived from the data of patients without previous MI. The area under the ROC curves was similar for ED, SVi and SQu. This was confirmed by the analysis of sensitivity performed using the ROC curve-derived cut-off criteria, in patients with or without previous MI. SVi was more sensitive than ED in identifying the diseased vessel(s) (ED: 41% vs SVi: 80%;P<0.0005) but ED was more specific in this respect (ED: 79% vs SVi: 61%;P<0.0005). We conclude that visual analysis of ED images obtained from gated99mTc-sestamibi stress planar imaging is a valuable alternative to SPET imaging for the diagnosis of CAD. SPET is, however, more accurate for the evaluation of the disease extent and localization and therefore remains the method of choice for the assessment of myocardial perfusion.

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Authors and Affiliations

  1. Centre of Nuclear Medicine, University of Louvain Medical School, Brussels and Mont-Godinne, Belgium

    François Jamar, Rifat Topcuoglu, Francisca Cauwe, Patrick De Coster, Véronique Roelants & Christian Beckers

  2. Division of Cardiology, University of Louvain Medical School, Louvain, Belgium

    William Wijns

  3. Centre de Médecine Nucléaire, UCL 54.30, Avenue Hippocrate, 54, B-1200, Brussels, Belgium

    Jacques A. Melin

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  1. François Jamar
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Jamar, F., Topcuoglu, R., Cauwe, F. et al. Exercise gated planar myocardial perfusion imaging using technetium-99m sestamibi for the diagnosis of coronary artery disease: an alternative to exercise tomographic imaging. Eur J Nucl Med 22, 40–48 (1995). https://doi.org/10.1007/BF00997246

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  • DOI: https://doi.org/10.1007/BF00997246

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