Simple techniques to reduce bowel activity in cardiac SPECT imaging

Iqbal, S. A.; Khalil, Mohammed; Lone, Bashir A.; Gorski, Robert; Blum, Steve; Heller, E.

doi:10.1097/00006231-200404000-00007

Cited by 28 publications

(13 citation statements)

References 4 publications

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“…Thus, the decrease in the MYO:EXC ratio in the delayed stress studies when the combined intervention was given may have been impacted by this natural biologic process. Overall, the MYO:EXC ratio was higher than the recommended target to non-target ratio of 2:1 and was also higher than results from previous studies [3,5,6,12,15,16,20,25]. It is suspected that the differences in imaging times between the studies played a role in the discrepancies of the ratio between studies.…”

Section: Discussioncontrasting

confidence: 58%

A randomized-controlled study of a modified technique to reduce extracardiac activity in myocardial perfusion imaging

Bresser

Sathekge

Makanjee

et al. 2017

Nuclear Medicine Communications

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Section: Discussioncontrasting

confidence: 58%

A randomized-controlled study of a modified technique to reduce extracardiac activity in myocardial perfusion imaging

Bresser

Sathekge

Makanjee

et al. 2017

Nuclear Medicine Communications

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“…Alternatively, several techniques have been studied to improve myocardial SPECT quality, including the intake of water [1], milk [2], iodinated oral contrast [3] or lemon juice [4], all of which reducing interfering abdominal activity, either by increasing the stomach volume or by accelerating the transit time of the tracer in the liver.…”

Section: Introductionmentioning

confidence: 99%

A randomized study of the effect of carbonated water prior to myocardial SPECT

et al. 2014

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Objective In myocardial perfusion single-photon emission computed tomography (SPECT), abdominal activity often interferes with the evaluation of perfusion in the inferior wall, especially after pharmacological stress. In this randomized study, we examined the effect of carbonated water intake versus still water intake on the quality of images obtained during myocardial perfusion images (MPI) studies. Methods A total of 467 MIBI studies were randomized into a carbonated water group and a water group. The presence of intestinal activity adjacent to the inferior wall was evaluated by two observers. Furthermore, a semiquantitative analysis was performed in the adenosine subgroup, using a count ratio of the inferior myocardial wall and adjacent abdominal activity. Results The need for repeated SPECT in the adenosine studies was 5.3 % in the carbonated water group versus 19.4 % in the still water group (p = 0.019). The inferior wall-to-abdomen count ratio was significantly higher in the carbonated water group compared to the still water group (2.11 ± 1.00 vs. 1.72 ± 0.73, p \ 0.001). The effect of carbonated water during rest and after exercise was not significant. Conclusions This randomized study showed that carbonated water significantly reduced the interference of extra-cardiac activity in adenosine SPECT MPI.

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“…Interference from extracardiac radionuclide activity prevents the accurate interpretation of the true myocardial perfusion distribution (7,8). Compton scatter from the bowel degrades image quality in 99m Tc-sestamibi myocardial perfusion imaging, artifactually increasing count density in the inferior myocardial wall (9). In contrast, subdiaphragmatic activity is in the x-plane of the heart; the ramp filter artifact may decrease the count density of the inferior wall (10).…”

Section: Discussionmentioning

confidence: 99%

“…When SPECT is performed without attenuation correction, a glass of whole milk may suffice. Another study described the use of oral contrast and water to improve image variability and contrast by decreasing the infracardiac scatter (9). Another study demonstrated the advantages of a full stomach to reduce scatter artifact in the inferior wall, arising because of intestinal activity (15).…”

Section: Discussionmentioning

confidence: 99%

Effect of Proton Pump Inhibitors and H2 Antagonists on the Stomach Wall in 99mTc-Sestamibi Cardiac Imaging

Goel¹,

Bommireddipalli²,

DePuey³

2009

Journal of Nuclear Medicine Technology

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On the basis of previously unpublished observations, we hypothesized that prolonged use of proton pump inhibitors (PPIs) causes an increase in 99m Tc-sestamibi uptake in the stomach wall, manifested as curvilinear activity surrounding the photopenic fundus of the stomach cavity. We prospectively evaluated the frequency of stomach wall uptake in patients undergoing myocardial perfusion SPECT who were taking PPIs or H 2 antagonists. Methods: Patients (n 5 138) who were scheduled for single-day rest/stress 99m Tc-sestamibi SPECT were randomly selected. Poststress SPECT was performed 30 min after treadmill exercise or 45 min after dipyridamole infusion. The rest scan was obtained 45 min after tracer injection. All patients drank 473 mL of water 5-10 min after both the rest and the stress radiotracer injections. Patients were questioned regarding their use of PPIs and H 2 antagonists. The significant use of either was defined as more than 2 wk of continuous therapy before cardiac SPECT. Masked observers assessed poststress planar projection images in endless-loop cinematic format for the following 3 patterns: stomach cavity uptake, attributable to duodenogastric reflux of tracer; stomach wall uptake; and no stomach uptake. A 2-tailed x 2 test with Yates correction was used to calculate statistically significant associations among variables. Results: Only patients with observed patterns of stomach wall uptake (n 5 30) and no stomach wall uptake (n 5 91) were included. Patients with stomach cavity uptake (n 5 17) were excluded because the assessment of the adjacent stomach wall uptake was not possible. Of the patients included (n 5 121), 30 were men and 91 were women. Sixty-seven patients were older than 60 y; 26 patients were taking PPIs. Of the 95 patients not taking PPIs, 14 were taking H 2 antagonists. No patients were taking both medications. Stomach wall uptake was strongly associated with prolonged use of PPIs (x 2 5 51.9, P , 0.0001). No statistically significant association was noted among age, sex, or use of H 2 antagonists (P 5 NS). Conclusion: Prolonged PPI therapy, but not H 2 antagonist therapy, contributes to a significant increase in stomach wall activity, potentially resulting in Compton scatter or ramp filter artifacts affecting the inferior wall of the left ventricle. Stomach wall activity, unlike the stomach cavity activity, cannot be prevented by the ingestion of water before imaging. Therefore, it is important to elicit a history of prolonged PPI use to better anticipate the possibility of increased stomach wall activity, which can confound the image quality and interpretation.

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Simple techniques to reduce bowel activity in cardiac SPECT imaging

Abstract: The use of oral contrast and water improved the image variability and contrast by decreasing the infra-cardiac scatter. The improvement was even more significant in the oral contrast group.

Cited by 28 publications

References 4 publications

A randomized-controlled study of a modified technique to reduce extracardiac activity in myocardial perfusion imaging

A randomized-controlled study of a modified technique to reduce extracardiac activity in myocardial perfusion imaging

A randomized study of the effect of carbonated water prior to myocardial SPECT

Effect of Proton Pump Inhibitors and H2 Antagonists on the Stomach Wall in 99mTc-Sestamibi Cardiac Imaging

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