Gated technetium-99m sestamibi for simultaneous assessment of stress myocardial perfusion, postexercise regional ventricular function and myocardial viability

Abstract

Gated SPECT of stress-injected sestamibi correlates well with echocardiographic assessment of regional function and thus adds information to perfusion SPECT: In patients without previous myocardial infarction, a single-injection stress perfusion/rest function approach using sestamibi-gated SPECT can substitute for conventional stress/rest myocardial perfusion imaging, adding a rest perfusion study only if there are nonreversible defects or consideration of attenuation artifacts. In patients with previous myocardial infarction, the gated SPECT approach does not replace the need for a rest perfusion study.

Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

“…The left ventricle was divided into 16 segments [15]. Regional wall motion was assessed visually by consensus of two blinded experienced observers and scored using a four-point scale (1=normal, 2=hypokine-sis; 3=akinesis; 4=dyskinesis) [16]. Previous data indicated a good reproducibility of these evaluations in our laboratory [17].…”

“…The left ventricular wall motion score index was calculated as the sum of the single segment scores divided by 16. Segment functional recovery after revascularisation was defined on the basis of a decrease by ≥1 grade in wall motion score at follow-up [16]. However, a change from dyskinesia to akinesia was not considered to be significant [19].…”

Evaluation of the Quantitative Gated SPECT (QGS) software program in the presence of large perfusion defects

“…Several groups have compared the quantitative results from the QGS software with similar results from other modalities. Generally in mixed datasets, the concordance with regard to the LVEF is good for contrast ventriculography and ultrasound techniques [6][7][8][9]. Similarly, the concordance with regard to wall thickening is quite good [12].…”

“…In which quantitative assessment of end-diastolic and end-systolic perfusion, wall motion and wall thickening using the 20-segment bull's eye representation of the QGS model [ figure 2], as well as estimates for end-diastolic (EDV) and end-systolic (ESV) ventricular volume and derived stroke volume and LVEF is incorporated. The underlying algorithms have been reviewed in literature [2][3][4][5][6][7][8][9][10][11][12][13]17]. The software algorithm implementation is the same in the different camera systems.…”

“…With regard to the validation of the Cedars-Sinai's Quantitative SPECT (QGS) software, several requirements have already been met. The algorithm and its basic validation have already been described [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. However, one particular issue is still not fully solved: reproducibility of the quantitative assessment of regional functional parameters in the presence of severe major defects or artifacts.…”