Prediction of Functional Improvement of Ischemic Myocardium With ^<123>I-BMIPP SPECT and ^<99m>Tc-Tetrofosmin SPECT Imaging : A Study of Patients With Large Acute Myocardial Infarction and Receiving Revascularization Therapy

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Background ^<18>F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) is assumed to be the most useful method of evaluating the viability of the myocardium, but its use is limited by the need for a cyclotron. In the present study, the ability of a combination of ^<99m>Tc-tetrofosmin (TF) and ^<123>I-β-methyliodophenyl pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT), a combination of ^<18>F-FDG PET and ^<123>I-BMIPP SPECT, and a combination of ^<18>F-FDG PET and ^<99m>Tc-TF SPECT were compared to predict functional improvement of ischemic myocardium after a large acute myocardial infarction (AMI). Methods and Results Ten patients with large AMI were studied by ^<99m>Tc-TF SPECT, ^<123>I-BMIPP SPECT and ^<18>F-FDG PET within 3 weeks. Six months later, ^<99m>Tc-TF imaging was performed. All patients underwent successful revascularization, and had no restenosis. Regional tracer uptake was scored using a 4-point scale in 20 segments of the SPECT and PET images. When the defect score of ^<123>I-BMIPP SPECT exceeded the defect score of ^<99m>Tc-TF SPECT or ^<18>F-FDG PET by 1 point or more, and when the defect score of ^<99m>Tc-TF SPECT exceeded the defect score of ^<18>F-FDG PET by 1 point or more, the segment was considered to show mismatching. When the defect score was the same in 2 tracers, the segment was considered to show matching. ^<99m>Tc-TF imaging at 3 weeks and 6 months used quantitative gated SPECT (QGS) to score wall motion using a 6-point scale (-1=dyskinesis, 0=akinesis, 1=severe hypokinesis, 2=moderate hypokinesis, 3=mild hypokinesis, and 4=normokinesis). The sensitivity of the combination of ^<123>I-BMIPP and ^<99m>Tc-TF imaging in predicting functional improvement was 61%, that of ^<18>F-FDG PET and ^<123>I-BMIPP SPECT was 94%, and that of ^<18>F-FDG PET and ^<99m>Tc-TF SPECT was 76%. The specificity of the combination of ^<123>I-BMIPP and ^<99m>Tc-TF imaging in predicting functional improvement was 83%, that of ^<18>F-FDG PET and ^<123>I-BMIPP SPECT was 40%, and that of ^<18>F-FDG PET and ^<99m>Tc-TF SPECT was 49%. The accuracy of the combination of ^<123>I-BMIPP and ^<99m>Tc-TF imaging in predicting functional improvement was 70%, that of ^<18>F-FDG PET and ^<123>I-BMIPP SPECT was 71%, and that of ^<18>F-FDG PET and ^<99m>Tc-TF SPECT was 63%. Conclusion The combination of ^<123>I-BMIPP and ^<99m>Tc-TF imaging is a practical modality for predicting the functional improvement of ischemic myocardium after a large AMI.
社団法人日本循環器学会の論文
2005-02-20

Prediction of Functional Improvement of Ischemic Myocardium With ^<123>I-BMIPP SPECT and ^<99m>Tc-Tetrofosmin SPECT Imaging : A Study of Patients With Large Acute Myocardial Infarction and Receiving Revascularization Therapy

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