Abstract
Introduction: Stress myocardial perfusion scintigraphy has been one of the sensitive modalities to diagnose inducible ischemia. Theoretically one of the major pitfalls quoted is the lack of sensitivity in triple vessel disease due to balanced hypoperfusion. The aim of this investigation is to evaluate the efficacy of Gated Stress Myocardial Perfusion (MPI) SPECT in known patient of Triple Vessel Disease (TVD).
Materials and Methods: 34 patients of known TVD were subjected to single day Gated stress MPI using Tc99m sestamibi.
Results: Out of 34 patients perfusion abnormalities were detected in 31 patients (91.2%). Twenty-three of them (67.6%) had the defect in the territory of LAD, 11 (32%) in LCX and 25 (73.5%) in RCA. Transient Ischemic Dilatation (TID) was found in 24 patients (70 %) associated with perfusion defect. One out of three patients with normal perfusion showed TID .False Negative rate for hemodynamically significant coronary artery stenosis if only perfusion defects are evaluated is 2.94%. Management decision changed in 11 patients out of 34 patients (32.3%). With increase in the percentage of coronary stenosis there is increase in probability of occurance of perusion defects on myocardial perfusion scan.
Conclusion: This study showed that combined assessment of perfusion patterns and gated SPECT help in risk stratification, TID can help in TVD with balance ischemia, However it is commonly associated with perfusion defects.
Keywords: Gated SPECT, Triple Vessel Disease, Transient Ischemic Dilatation.
References
- Maddahi J, Rodrigues E, Kiat H, Van Train KF, Berman DS: Detection and evaluation of coronary artery disease by thallium-201 myocardial perfusion scintigraphy. In: DePuey EG, Berman DS, Garcia EV (eds). Cardiac SPECT Imaging. New York: Raven Press, 1995, pp 103-20
- Kapur A, Latus K, Davies G et al 2002, Eur J Nucl Med 29: 1608-1616
- DePasquale EE, Nody AC, De Puey EG, et al. Quantitative rotational thallium-201 tomography for identifying and localizing coronary artery disease. Circulation 1988;77:316-327.
- Maddahi J, Van Train K, Prigent F, et al. Quantitative single photon emission computed thallium-201 tomography for detection and localization of coronary artery disease, optimization and prospective validation of a new technique. J Am Coll Cardiol 1989;14:1689-1699.
- Iskandrian AS, Heo J, Kong B, Lyons E. Effect of exercise level on the ability of thallium-201 tomographic imaging in detecting coronary artery disease: analysis of 461 patients. J Am Coll Cardiol 1989;14:1477-1486.
- Mahmarian JJ, Boyce TM, Goldberg RK, et al. Quantitative exercise thallium-201 single photon emission computed tomography for the enhanced diagnosis of ischemic heart disease. J Am Coll Cardiol 1990;15:318- 329.
- Van Train KF, Maddahi J, Berman DS, et al. Quantitative analysis of tomographic stress thallium-201 myocardial scintigrams: a multicenter trial. J Nucl Med 1990;31:1168-1179.
- Ladenheim ML, Pollock BH, Rozanski A, et al. Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease. J Am CollCardiol 1986;7:464-471. Ann Nucl Med Sci2002;15:175-182 Vol. 15 No. 4 December 2002 180 Scintigraphic findings in TVD
- Iskandrian AS, Heo J, Decoskey D, Askenase A, Segal BL. Use of exercise thallium-201 imaging for risk stratification of elderly patients with coronary artery disease. Am J Cardiol 1988;61:269-272.
- Brown KA, Rowen M. Prognostic value of a normal exercise myocardial perfusion imaging study in patients with angiographically significant coronary artery disease. Am J Cardiol 1993;71:865-867.
- Abdel Fattah A, Kamal AM, Pancholy S, et al. Prognostic implications of normal exercise tomographic thallium images in patients with angiographic evidence of significant coronary artery disease. Am J Cardiol 1994;74:769-771.
- Pavin D, Delonca J, Siegenthaler M, Doat M, Rutishauser W, Righetti A. Long-term (10 years) prognostic value of a normal thallium-201 myocardial exercise scintigraphy in patients with coronary artery disease documented byangiography. Eur Heart J 1997;18:69-77.
- Tamaki N, Yonekura Y, Mukai T, et al. Stress thallium- 201 transaxial emission computed tomography: quantitative versus qualitative analysis for evaluation of coronary artery disease. J Am CollCardiol 1984;4:1213-1221.
- Fintel DJ, Links JM, Brinker JA, et al. Improved diagnostic performance of exercise thallium-201 single photon emission computed tomography over planar imaging in the diagnosis of coronary artery disease: a receiver operating characteristic analysis. J Am CollCardiol 1989;13:600-612.
- Weiss AT, Berman DS, Lew AS, et al. Transient ischemic dilation of the left ventricle on stress thallium-201 scintigraphy: a marker of severe and extensive coronary artery disease. J Am Coll Cardiol 1987;9:752-759.
- Gibson RS, Watson DD, Carabello BA, Holt ND, Beller GA. Clinical implications of increased lung uptake of thallium-201 during exercise scintigraphy 2 weeks after myocardial infarction. Am J Cardiol 1982;49:1586-1593.
- Bingham JB, McKusick KA, Strauss HW, Boucher CA, Pohost GM. Influence of coronary artery disease on pulmonary uptake of thallium-201. Am J Cardiol 1980;46:821-826.
- Kushner FG, Okada RD, Kirshenbaum HD, Boucher CA, Strauss HW, Pohost GM. Lung thallium-201 uptake after stress testing in patients with coronary artery disease. Circulation 1981;63:341-347.
- Levy R, Rozanski A, Berman DS, et al. Analysis of the degree of pulmonary thallium washout after exercise in patients with coronary artery disease. J Am Coll Cardiol 1983;2:719-728.
- Maddahi J, Berman DS. Reverse redistribution of thallium- 201. J Nucl Med 1995;36:1019-1021.
- Chouraqui P, Rodrigues EA, Berman DS, Maddahi J. Significance of dipyridamole-induced transient dilation of the left ventricle during thallium-201 scintigraphy in suspected coronary artery disease. Am J Cardiol 1990;66:689-694.
- Mazzanti M, Germano G, Kiat H, et al. Identification of severe and extensive coronary artery disease by automatic measurement of transient ischemic dilation of the left ventricle in dual-isotope myocardial perfusion SPECT. J Am Coll Cardiol 1996;27:1612-1620.
- Kaul S, Finkelstein DM, Homma S, Leavitt M, Okada RD, Boucher CA. Superiority of quantitative exercise thallium-201 variables in determining long-term prognosis in ambulatory patients with chest pain: a comparison with cardiac catheterization. J Am Coll Cardiol 1988;12:25-34.
- Hansen CL, Sangrigoli R, Nkadi E, Kramer M. Comparison of pulmonary uptake with transient cavity dilation after exercise thallium-201 perfusion imaging. JAmCollCardiol 1999;33:1323-1327.
- Nuclear Medicine Communications: May 2003 - Volume 24 - Issue 5 - pp 543-549.
- Halligan WT, Morris PB, Schoepf UJ, et al. Transient Ischemic Dilation of the Left Ventricle on SPECT: Correlation With Findings at Coronary CT Angiography. J Nucl Med. 2014;55:917-922.
Corresponding Author
Dr Tejonath G
Nuclear Medicine Department, Basavatarakam Indoamerican Cancer Hospital, Banjara Hills, No. 10, Hyderabad – 500034, India
DOI: https://dx.doi.org/10.18535/jmscr/v9i2.15
