Abstract.
Simultaneous dual-isotope (rest thallium-201/stress technetium-99m sestamibi) myocardial single-photon emission tomography (SPET) would be an ideal procedure; however, 99mTc cross-talk on the 201Tl window hampers its routine use. Photon energy recovery (PER) is a spectral deconvolution technique validated for scatter and cross-talk removal in phantom studies and a limited series of patients. In this study we aimed to validate the technique in 295 patients within a context of clinical routine practice. Conventional separate rest 201Tl myocardial SPET data sets were visually compared with simultaneous dual-isotope data sets corrected by PER. Conventional separate rest 201Tl data sets were identical to dual PER-corrected 201Tl data sets in 173 (58.6%) patients. As dual PER 201Tl data sets are corrected for 99mTc cross-talk but also for 201Tl scatter, they were compared with separate rest 201Tl data sets corrected by PER in the 122 discordant patients. No difference was found in 77 (26.1%) patients. In 26 (8.8%) patients, the difference consisted in the presence of a defect on dual PER 201Tl data sets only, mirroring an ischaemic defect on 99mTc-sestamibi data sets. This difference can be attributed to the influence of stress on the kinetics of 201Tl injected at rest. In the remaining 19 (6.4%) patients, the difference between separate and simultaneous PER-corrected data sets was scored as mild in 11 and moderate in eight patients and seemed to be related to multiple methodological factors. It is concluded that PER correctly removes 99mTc cross-talk. With the addition of an appropriate attenuation correction, the PER technique may allow the routine use of simultaneous dual-isotope myocardial scintigraphy in the near future.
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Weinmann, P., Faraggi, M., Moretti, J. et al. Clinical validation of simultaneous dual-isotope myocardial scintigraphy. Eur J Nucl Med 30, 25–31 (2003). https://doi.org/10.1007/s00259-002-0995-y
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DOI: https://doi.org/10.1007/s00259-002-0995-y