Skip to main content
SpringerLink
Log in

A preliminary feasibility study of simultaneous dual-isotope imaging with a solid-state dedicated cardiac camera for evaluating myocardial perfusion and fatty acid metabolism

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Simultaneous dual-isotope SPECT imaging with 201Tl and 123I-β-methyl-p-iodophenylpentadecanoic acid (BMIPP) is used to study the perfusion–metabolism mismatch. It predicts post-ischemic functional recovery by detecting stunned myocardium. On the other hand, 99mTc-MIBI is another radioisotope widely used in myocardial perfusion imaging because of its better image quality and lower radiation exposure than 201Tl. However, since the photopeak energies of 99mTc and 123I are very similar, crosstalk hampers the simultaneous use of these two radioisotopes. To overcome this problem, we conducted simultaneous dual-isotope imaging study using the D-SPECT scanner (Spectrum-Dynamics, Israel) which has a novel detector design and excellent energy resolution. We first conducted a basic experiment using cardiac phantom to simulate the condition of normal perfusion and impaired fatty acid metabolism. Subsequently, we prospectively recruited 30 consecutive patients who underwent successful percutaneous coronary intervention for acute myocardial infarction, and performed 99mTc-MIBI/123I-BMIPP dual-isotope imaging within 5 days after reperfusion. Images were interpreted by two experienced cardiovascular radiologists to identify the infarcted and stunned areas based on the coronary artery territories. As a result, cardiac phantom experiment revealed no significant crosstalk between 99mTc and 123I. In the subsequent clinical study, 99mTc-MIBI/123I-BMIPP dual-isotope imaging in all participant yielded excellent image quality and detected infarcted and stunned areas correctly when compared with coronary angiographic findings. Furthermore, we were able to reduce radiation exposure to significantly approximately one-eighth. In conclusion, we successfully demonstrated the practical application of simultaneous assessment of myocardial perfusion and fatty acid metabolism by 99mTc-MIBI and 123I-BMIPP using a D-SPECT cardiac scanner. Compared with conventional 201TlCl/123I-BMIPP dual-isotope imaging, the use of 99mTc-MIBI instead of 201TlCl improves image quality as well as lowers radiation exposure.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Allman KC (2013) Noninvasive assessment myocardial viability: current status and future directions. J Nucl Cardiol 20(4):618–637

    Article  PubMed  Google Scholar 

  2. Nomura T, Kusaba T, Kodama N, Terada K, Urakabe Y, Nishikawa S, Keira N, Matsubara H, Tatsumi T (2013) Clinical characteristics of silent myocardial ischemia diagnosed with adenosine stress 99mTc-tetrofosmin myocardial scintigraphy in Japanese patients with acute cerebral infarction. Heart Vessels 28(1):27–33

    Article  PubMed  Google Scholar 

  3. Taki J, Matsunari I (2007) Metabolic imaging using SPECT. Eur J Nucl Med Mol Imaging 34(Suppl 1):S34–S48

    Article  PubMed  CAS  Google Scholar 

  4. Tamaki N, Morita K, Kuge Y, Tsukamoto E (2000) The role of fatty acids in cardiac imaging. J Nucl Med 41:1525–1534

    PubMed  CAS  Google Scholar 

  5. Kawai Y, Tsukamoto E, Nozaki Y, Kishino K, Kohya T, Tamaki N (1998) Use of 123I-BMIPP single-photon emission tomography to estimate areas at risk following successful revascularization in patients with acute myocardial infarction. Eur J Nucl Med 25:1390–1395

    Article  PubMed  CAS  Google Scholar 

  6. Kawai Y, Tsukamoto E, Nozaki Y, Morita K, Sakurai M, Tamaki N (2001) Significance of reduced uptake of iodinated fatty acid analogue for the evaluation of patients with acute chest pain. J Am Coll Cardiol 38:1888–1894

    Article  PubMed  CAS  Google Scholar 

  7. Franken PR, Dendale P, De Geeter F, Demoor D, Bossuyt A, Block PJ (1996) Prediction of functional outcome after myocardial infarction using BMIPP and sestamibi scintigraphy. J Nucl Med 37(5):718–722

    PubMed  CAS  Google Scholar 

  8. Hambye AS, Vervaet A, Dobbeleir A, Dendale P, Franken P (2000) Prediction of functional outcome by quantification of sestamibi and BMIPP after acute myocardial infarction. Eur J Nucl Med 27:1494–1500

    Article  PubMed  CAS  Google Scholar 

  9. Hashimoto A, Nakata T, Tsuchihashi K, Tanaka S, Fujimori K, Iimura O (1996) Postischemic functional recovery and BMIPP uptake after primary percutaneous transluminal coronary angioplasty in acute myocardial infarction. Am J Cardiol 77:25–30

    Article  PubMed  CAS  Google Scholar 

  10. Iwado H, Iwado Y, Ohmori K, Mizushige K, Yukiiri K, Takagi Y, Nishiyama Y, Tamaki N, Senda S, Kohno M (2004) Latent abnormal fatty acid metabolism in apparently normal perfusion during stress in patients with restenosis after coronary angioplasty: assessment by exercise stress thallium-201 and iodine-123-labeled 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid-dual myocardial single-photon emission computed tomography. Am J Cardiol 93:685–688

    Article  PubMed  CAS  Google Scholar 

  11. Nakahara T, Hashimoto J, Suzuki T, Fujii H, Kubo A (2001) Completely inverse images in dual-isotope SPECT with Tl-201 and I-123 MIBG in a patient with myocarditis. Ann Nucl Med 15:277–280

    Article  PubMed  CAS  Google Scholar 

  12. Gambhir SS, Berman DS, Ziffer J, Nagler M, Sandler M, Patton JJ (2009) A novel high-sensitivity rapid-acquisition single-photon cardiac imaging camera. J Nucl Med 50(4):635–643

    Article  PubMed  Google Scholar 

  13. Erlandsson K, Kacperski K, van Gramberg D, Hutton BF (2009) Performance evaluation of D-SPECT: a novel SPECT system for nuclear cardiology. Phys Med Biol 54:2635–2649

    Article  PubMed  Google Scholar 

  14. Sharir T, Ben-Haim S, Merzon K, Prochorov V, Dickman D, Ben-Haim S, Berman DS (2008) High-speed myocardial perfusion imaging initial clinical comparison with conventional dual detector anger camera imaging. JACC Cardiovasc Imaging 1(2):156–163

    Article  PubMed  Google Scholar 

  15. Kacperski K, Erlandsson K, Ben-Haim S, Hutton BF (2011) Iterative deconvolution of simultaneous 99mTc and 201Tl projection data measured on a CdZnTe-based cardiac SPECT scanner. Phys Med Biol 56(5):1397–1414

    Article  PubMed  PubMed Central  Google Scholar 

  16. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Katus HA, Lindahl B, Morrow DA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasche P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S (2012) Third universal definition of myocardial infarction. Circulation 126:2020–2035

    Article  PubMed  Google Scholar 

  17. Torizuka K, Yonekura Y, Nishimura T, Tamaki N, Uehara T, Ikekubo K, Hino M (1991) A Phase 1 study of beta-methyl-p-(123I)-iodophenyl-pentadecanoic acid (123I-BMIPP). Kaku Igaku 28(7):681–690

    PubMed  CAS  Google Scholar 

  18. Torizuka K, Yonekura Y, Nishimura T, Tamaki N, Uehara T (1992) Phase 2 study of beta-methyl-p-(123I)-iodophenyl-pentadecanoic acid, a myocardial imaging agent for evaluating myocardial fatty acid metabolism. Kaku Igaku 29(3):305–317

    PubMed  CAS  Google Scholar 

  19. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542

    Article  PubMed  Google Scholar 

  20. Goto K, Takagi A, Arai K, Yamaguchi J, Hagiwara N (2010) Noninvasive assessment of myocardial damage after acute anterior myocardial infarction: myocardial blush grade in conjunction with analysis of coronary flow pattern. Heart Vessels 25(4):299–305

    Article  PubMed  Google Scholar 

  21. Abdelmoneim SS, Martinez MW, Mankad SV, Bernier M, Dhoble A, Pellikka PA, Chandrasekaran K, Oh JK, Mulvagh SL (2014) Resting qualitative and quantitative myocardial contrast echocardiography to predict cardiac events in patients with acute myocardial infarction and percutaneous revascularization. Heart Vessels. doi:10.1007/s00380-013-0460-9

    PubMed  Google Scholar 

  22. Furutani Y, Shiigi T, Nakamura Y, Nakamura H, Harada M, Yamamoto T, Wakeyama T, Nakatsuka M, Ogawa H, Matsuzaki M (1997) Quantification of area at risk in acute myocardial infarction by tomographic imaging. J Nucl Med 38:1875–1882

    PubMed  CAS  Google Scholar 

  23. Matsuki T, Tamaki N, Nakata T, Doi A, Takahashi H, Iwata M, Sakamoto T, Yamauchi K, Shimazaki M, Morita K, Shimamoto K (2004) Prognostic value of fatty acid imaging in patients with angina pectoris without prior myocardial infarction: comparison with stress thallium imaging. Eur J Nucl Med Mol Imaging 31(12):1585–1591

    Article  PubMed  Google Scholar 

  24. Chikamori T, Fujita H, Nanasato M, Toba M, Nishimura T (2005) Prognostic value of I-123 15-(p-iodophenyl)-3-(R, S) methylpentadecanoic acid myocardial imaging in patients with known or suspected coronary artery disease. J. Nucl Cardiol 12:172–178

    Article  PubMed  Google Scholar 

  25. Kobayashi H, Kusakabe K, Momose M, Okawa T, Inoue S, Iguchi N, Hosoda S (1998) Evaluation of myocardial perfusion and fatty acid uptake using a single injection of iodine-123-BMIPP in patients with acute coronary syndromes. J Nucl Med 39:1117–1122

    PubMed  CAS  Google Scholar 

  26. Matsunari I, Saga T, Taki J, Akashi Y, Hirai J, Wakasugi TJ, Aoyama T, Matoba M, Ichiyanagi K, Hisada K (1994) Kinetics of iodine-123-BMIPP in patients with prior myocardial infarction: assessment with dynamic rest and stress images compared with stress thallium-201 SPECT. J Nucl Med 35:1279–1285

    PubMed  CAS  Google Scholar 

  27. Maksud P, Fertil B, Rica C, El Fakhri G, Aurengo A (1998) Artificial neural network as a tool to compensate for scatter and attenuation in radionuclide imaging. J Nucl Med 39:735–745

    PubMed  CAS  Google Scholar 

  28. Hashimoto J, Ogawa K, Bai J, Kubo A, Imai Y (2013) Simultaneous dual-isotope imaging based on an artificial neural network for evaluating myocardial perfusion and fatty acid metabolism. J Nucl Cardiol 20(3):396–405

    Article  PubMed  Google Scholar 

  29. Buechel RR, Herzog BA, Husmann L, Burger IA, Pazhenkottil AP, Treyer V, Valenta I, von Schulthess P, Nkoulou R, Wyss CA, Kaufmann PA (2010) Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: first clinical validation. Eur J Nucl Med Mol Imaging 37:773–778

    Article  PubMed  Google Scholar 

  30. Mouden M, Timmer JR, Ottervanger JP, Reiffers S, Oostdijk AH, Knollema S, Jager PL (2012) Impact of a new ultrafast CZT SPECT camera for myocardial perfusion imaging: fewer equivocal results and lower radiation dose. Eur J Nucl Med Mol Imaging 39:1048–1055

    Article  PubMed  Google Scholar 

  31. Chowdhury FU, Vaidyanathan S, Bould M, Marsh J, Trickett C, Dodds K, Clark TP, Sapsford RJ, Dickinson CJ, Patel CN, Thorley PJ (2014) Rapid-acquisition myocardial perfusion scintigraphy (MPS) on a novel gamma camera using multipinhole collimation and miniaturized cadmium-zinc-telluride (CZT) detectors: prognostic value and diagnostic accuracy in a ‘real-world’ nuclear cardiology service. Eur Heart J Cardiovasc Imaging 15(3):275–283

    Article  PubMed  CAS  Google Scholar 

  32. Shapiro BP, Young PM, Kantor B, Choe YH, McCollough CH, Gerber TC (2010) Radiation dose reduction in CT coronary angiography. Curr Cardiol Rep 12(1):59–67

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors have no conflict of interest. We thank staff at our hospital for assistance in data collection and all patients for their participation in the study.

Author information

Authors and Affiliations

  1. Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-Cho, Fuchu, Tokyo, 183-0003, Japan

    Toshiyuki Ko, Yuko Utanohara, Yasuhiro Suzuki, Makiko Kurihara, Nobuo Iguchi, Jun Umemura, Tetsuya Sumiyoshi & Hitonobu Tomoike

Authors
  1. Toshiyuki Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuko Utanohara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasuhiro Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Makiko Kurihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nobuo Iguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jun Umemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tetsuya Sumiyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hitonobu Tomoike
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nobuo Iguchi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ko, T., Utanohara, Y., Suzuki, Y. et al. A preliminary feasibility study of simultaneous dual-isotope imaging with a solid-state dedicated cardiac camera for evaluating myocardial perfusion and fatty acid metabolism. Heart Vessels 31, 38–45 (2016). https://doi.org/10.1007/s00380-014-0578-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-014-0578-4

Keywords

Search

Navigation