Comparative feasibility of separate or simultaneous rest thallium- 201/stress technetium-99m-sestamibi dual-isotope myocardial perfusion SPECT

H. Kiat, G. Germano, J. Friedman, K. Van Train, G. Silagan, Ping Wang Fan Ping Wang, J. Maddahi, D. Berman*

*Corresponding author for this work

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Abstract

Separate or simultaneous rest 201Tl/stress 99mTc-sestamibi dual- isotope SPECT are potentially efficient myocardial perfusion imaging protocols which combine the use of a high-resolution 99mTc tracer for stress perfusion assessment and 201Tl, the current single-photon agent of choice, for viability assessment. Methods: To investigate the feasibility of dual-isotope myocardial perfusion SPECT protocols using rest 201Tl and stress sestamibi, 201Tl crosstalk into the 99mTc acquisition window (Group 1, n = 26 patients) and 99mTc crosstalk into 201Tl windows (Group 2, n = 25) were studied. For Group 1, treadmill exercise with sestamibi injection and poststress SPECT ('virgin' sestamibi images) were performed, followed by rest 201Tl injection and SPECT acquisition using dual-isotope windows (contaminated or 'dual' images). For Group 2, the order was reversed: rest 201Tl SPECT (virgin 201Tl images) was performed first, followed by exercise sestamibi injection and dual-isotope SPECT. Results: The contribution of 201Tl scatter to the dual sestamibi images (Group 1) was measured to be 2.9% ± 2.1%, while 99mTc crosstalk contributed 26.7% ± 13.0% to the dual 201Tl images (Group 2). Image quality was considered good to excellent in 92% of the sestamibi (virgin and dual) images and 88% of the virgin 201Tl SPECT, but only in 23% of the dual 201Tl studies. Conclusions: Technetium-99m crosstalk into 201Tl windows is substantial; therefore, simultaneous dual-isotope protocols, which involve assessment of 201Tl images contaminated by 99mTc, are not recommended. On the other hand, because of the small amount of 201Tl crosstalk into the 99mTc window, a separate acquisition dual-isotope approach employing the rest 201Tl (virgin)/stress sestamibi sequence is acceptable.

Original languageEnglish
Pages (from-to)542-548
Number of pages7
JournalJournal of Nuclear Medicine
Volume35
Issue number4
Publication statusPublished - 1994
Externally publishedYes

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Keywords

  • dual-isotope imaging
  • SPECT
  • technetium-99m-sestamibi
  • thallium-201

Cite this

Kiat, H., Germano, G., Friedman, J., Van Train, K., Silagan, G., Fan Ping Wang, P. W., ... Berman, D. (1994). Comparative feasibility of separate or simultaneous rest thallium- 201/stress technetium-99m-sestamibi dual-isotope myocardial perfusion SPECT. Journal of Nuclear Medicine, 35(4), 542-548.