Comparing a High-Dose Dipyridamole SPECT Imaging Protocol with Dobutamine and Exercise Stress Testing Protocols

Abstract

High-dose dipyridamole is safe and easily reversed with intravenous aminophylline. The sensitivity and specificity of dipyridamole and dobutamine stress testing were statistically more accurate than results obtained with treadmill protocols when SPECT is used to image the heart. High-dose dipyridamole resulted in greater changes in heart rate and blood pressure response than seen with standard-dose dipyridamole. Associated side effects can be easily reversed with the administration of intravenous aminophylline without significant complications. The sensitivity, specificity, and accuracy of single photon emission computed tomography using high-dose dipyridamole are 100%, 88.9%, and 97.9%, respectively, for the overall presence or absence of disease when compared with coronary arteriography. This is significantly (P < 0.005) greater than that obtained by treadmill nuclear imaging protocols, independent imaging agent.

Fleming-Harrington Redistribution Wash-in Washout (FHRWW): The Platinum Standard for Nuclear Cardiology

“…The first agent being Thallium-201 (Tl-201) was plagued with limitations including a long half-life (72 hours) resulting in the need to use relatively low doses (6.8-11.1 MBq) of the isotope. Given the limitations (Fleming 1992a(Fleming , 1995 of Compton scatter, tissue attenuation and the emission of mercury x-rays from the isotope, cameras could not acquire adequate counts for imaging until 60 minutes had elapsed. Given the passage of time, much of what Blumgart discussed had been lost to history (Love 1965).…”

“…After our initial work (Fleming 1991a) with these Tc-99m isotopes in 1989, we published several papers (Fleming 1995(Fleming , 1998(Fleming , 1999a(Fleming -b, 1992a(Fleming -b, 2000a(Fleming -b, 2002a under the misinformation that two injections of these compounds were required and like many others we failed to fully understand the work of Blumgart andGorlin. By 1999-2000, Sestamibi was being used for the detection of breast cancer.…”

“…Comparing washout/wash-in results with coronary angiographic assessment of percent diameter stenosis. One hundred twenty patients (ages 25 to 82 years) with suspected coronary artery disease underwent myocardial perfusion imaging after signing informed consent per Institutional protocol following adenosine (n=30), lexiscan (n=61), dobutamine (Fleming 1995, 1999a, Calnon 1997, 1999, Matsunari 2001, n=4 or treadmill (Fleming 1991a(Fleming , 1999a, n=25 stress. Following standardized protocols already published (Fleming 2009a(Fleming -b, 2010a) MPI using both the rest-stress and stress-stress (FHRWW) approach were compared with coronary angiography (Fleming 1992a-b).…”

Mitochondrial Uptake of Sestamibi Distinguishes Between Normal, Inflammatory Breast Changes, Pre-Cancers, and Infiltrating Breast Cancer

“…Anterior images are obtained with the patient in a supine position. Following breast imaging, cardiac imaging is performed as described previously, 20,25 providing information with regard to coronary blood flow, regional wall abnormalities, and left ventricular ejection fraction, which is useful for making further diagnostic decisions, particularly with regard to the use of chemotherapy and radiation therapy.…”

“…The ability to change coronary blood flow using high-dose dipyridamole (HDD) to detect coronary artery disease has been demonstrated. [19][20][21][22][23][24] This approach increases regional blood flow (coronary flow reserve) differences, 25,26 enhancing the detection of coronary artery disease, and as mentioned previously can simultaneously provide useful diagnostic information with regard to adriamycin cardiotoxicity. However, a prospective analysis of the results of combining breast imaging and cardiac imaging using HDD has not yet been made.…”