The effect of imaging time, radiopharmaceutical, full fat milk and water on interfering extra-cardiac activity in myocardial perfusion single photon emission computed tomography

Peace, Richard; Lloyd, Jim

doi:10.1097/00006231-200501000-00004

Cited by 40 publications

(37 citation statements)

References 14 publications

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“…Myocardial perfusion imaging with 99mTc-labeled agents is used wildly for the diagnosis and risk stratifi cation of CAD [1]. In spite of all the benefi ts of 99mTc-MIBI myocardial perfusion imaging, the radiopharmaceutical has some extra-cardiac uptake, frequently in the stomach, liver, bowel, and spleen [8], which can interfere with accurate interpretation of the MPI [9]. Several techniques have been tried, with mixed results, to reduce the effect of extra-cardiac activity on the interpretation of the images, including delaying the imaging, ingesting water, milk, or food, altering the patient's position, or using various prokinetic medications [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

The association of increased stomach wall radiotracer uptake with prolonged use of Omeprazole capsules on myocardial perfusion imaging (MPI) using 99mTc-sestamibi SPECT

Javadi

Jallalat²,

Semnani³

et al. 2013

Nucl. Med. Rev.

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Myocardial perfusion imaging (MPI) is widely used in routine practice for diagnosis and risk stratification of coronary artery disease (CAD). Intense curvilinear activity in the stomach wall of a patient was seen on MPI raw data. This phenomenon was completely dissimilar to the familiar intraluminal gastric reflux of sestamibi. This observed activity could have resulted in false-positive or false-negative artifacts - and inaccurate diagnosis - of the inferior wall of the left ventricle after MPI processing. On further exploration, the current researchers found that the patient had a history of 10-year Omeprazole capsule consumption. The authors present this infrequent case of intense stomach uptake to stress the related clinical and diagnostic implications with the aim to stimulate acute awareness of possible, unexpected infringements on image quality that could potentially interfere with accurate interpretation of the data.

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Section: Discussionmentioning

confidence: 99%

The association of increased stomach wall radiotracer uptake with prolonged use of Omeprazole capsules on myocardial perfusion imaging (MPI) using 99mTc-sestamibi SPECT

Javadi

Jallalat²,

Semnani³

et al. 2013

Nucl. Med. Rev.

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“…SPECT with 99m Tc-labeled agents is extremely useful for Despite all of the advantages cited for the 99m Tc-labeled myocardial perfusion tracer sestamibi, the tracer suffers from extracardiac localization, most commonly in the stomach, liver, bowel, and spleen (6). Interference from extracardiac radionuclide activity prevents the accurate interpretation of the true myocardial perfusion distribution (7,8).…”

Section: Discussionmentioning

confidence: 99%

“…There have been several methods described within the literature to minimize the effect of extracardiac activity on the interpretation of the images. These techniques include delaying imaging; ingesting water, milk, or food; altering the patient's position; or using various prokinetic medications (6,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In 1 study, researchers compared the efficacy of milk alone versus milk and water simultaneously (12).…”

Section: Discussionmentioning

confidence: 99%

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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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“…13,14 Although recent reports support its feasibility, 11 early post-stress imaging has not yet been fully validated in terms of image quality, preservation of perfusion diagnostic data, and the detection of stunning. Although no accurate worldwide survey data are available, the elapsed time between stress injection and acquisition is variable across different countries and institutions within the same country.…”

Section: Introductionmentioning

confidence: 99%

Detection of post-exercise stunning by early gated SPECT myocardial perfusion imaging: Results from the IAEA multi-center study

Mut

Giubbini

Vítola

et al. 2014

Journal of Nuclear Cardiology

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The effect of imaging time, radiopharmaceutical, full fat milk and water on interfering extra-cardiac activity in myocardial perfusion single photon emission computed tomography

Cited by 40 publications

References 14 publications

The association of increased stomach wall radiotracer uptake with prolonged use of Omeprazole capsules on myocardial perfusion imaging (MPI) using 99mTc-sestamibi SPECT

The association of increased stomach wall radiotracer uptake with prolonged use of Omeprazole capsules on myocardial perfusion imaging (MPI) using 99mTc-sestamibi SPECT

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

Detection of post-exercise stunning by early gated SPECT myocardial perfusion imaging: Results from the IAEA multi-center study

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