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Comparison of single-photon emission computed tomographic (SPECT) myocardial perfusion imaging with thallium-201 and technetium-99m sestamibi in dogs



Comparison of single-photon emission computed tomographic (SPECT) myocardial perfusion imaging with thallium-201 and technetium-99m sestamibi in dogs



Journal of the American College of Cardiology 20(7): 1612-1625



Objectives: The purpose of the present study was to compare single-photon emission computed tomographic (SPECT) myocardial images of technetium-99m (Tc-99m) sestamibi and thallium-201 (T1-201) isotopes in the same dog undergoing partial coronary occlusion during pharmacologic vasodilation. Background: To date, no controlled study has been reported comparing SPECT Tc-99m sestamibi with SPECT T1-201 imaging during stress with anatomic and physiologic standards. Methods: Mongrel dogs were anesthetized with chloralose and instrumented to record left anterior descending coronary blood flow and aortic pressure. Partial coronary occlusion with a hydraulic cuff reduced coronary vascular conductance, which is equal to the coronary blood flow normalized to aortic pressure during peak vasodilation with intravenous adenosine. Each dog received 5 mCi of T1-201, then 30 mCi of Tc-99m sestamibi during partial coronary occlusion at peak vasodilation. Tomographic myocardial imaging was performed in a 180 degree anterior arc scan for 33.5 min, first with T1-201, and later, without moving the dog, for 33.5 min with Tc-99m sestamibi. Postmortem staining defined the region underperfused because of its dependence on the artery that was partially occluded. Results: In seven dogs with moderate reduction in coronary blood flow, coronary vascular conductance decreased with partial coronary occlusion (47 +- 12%) during T1-201 imaging and (47 +- 8%, p = NS) during Tc-99m sestamibi imaging. The underperfused region was 23.9 +- 6.4% of total left ventricular mass. Counts in the defects were 39% higher (0.86 +- 0.08 of normal counts) for Tc-99m sestamibi than for T1-201 (0.64 +- 0.09 of normal counts, p lt 0.001), and the defect on SPECT Tc-99m sestamibi images occupied only a fraction (0.37 +- 0.30) of the area of the defect on the T1-201 images of the same dog. Bull's-eye displays constructed from the pathologic slices showed that the T1-201 defect size was closer to the underperfused region of the left ventricular mass determined pathologically than was the Tc-99m sestamibi defect size. In four additional dogs a severe, near total coronary occlusion was created during T1-201 and Tc-99m sestamibi administration. In these dogs, similar defect contrast (0.55 +- 0.12 vs. 0.62 +- 0.09, p = NS) and areas (0.18 +- 0.07 vs. 0.18 +- 0.11, p = NS) were observed with T1-201 and Tc-99m sestamibi, respectively. Conclusions: Tomographic myocardial imaging with Tc-99m sestamibi during moderately severe partial coronary occlusion underestimated the area of the defect relative to T1-201 or to the pathologic reference standard in dogs. Defect contrast was sharper with tomographic myocardial T1-201 than with tomographic myocardial Tc-99m sestamibi during moderately severe partial coronary occlusion.

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Accession: 008361051

Download citation: RISBibTeXText

PMID: 1452936

DOI: 10.1016/0735-1097(92)90458-y


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