[en] 99mTc-MIBI, a new myocardial perfusion agent, is a technetium labeled isonitrile derivative. We have taken advantage of the physical characteristics of 99mTc to combine at rest, post infarction, ventricular function studies with analysis of perfusion. We have studied at rest and at stress, 22 patients with coronary artery disease selected on the basis of an abnormal coronary angiogram or on the basis of a positive exercise ECG stress test for symptomatic angina. We have also studied, at rest only, 20 patients with a previous myocardial infarction. A comparative thallium planar scintigraphy was obtained for all patients. The sensitivity of 99mTc-MIBI scintigraphy for detecting individual vessel lesions at stress was 88% as compared with 83% for 201Tl. Sensitivity was higher in patients with previous myocardial infarction (93% for the 2 isotopes) than in patients without (85% for 99mTc-MIBI versus 81% for 201Tl). Segmental myocardial correspondence between 99mTc-MIBI and 201Tl was very close (92%). The overall sensitivity for the detection of acute myocardial infarction reached respectively 91% for 99mTc MIBI and 87% for 201Tl. The specificity in the regions corresponding to arteries not involved was excellent for both tracers as we did not observe any false positive result. This is important information but it does not correspond to the specificity to detect coronary artery disease in the overall patient population. The correlation between first pass left ventricular ejection fraction obtained with 99mTc-MIBI and equilibrium left ventricular ejection fraction obtained with 99mTc red cells was excellent (r = 0.96). It was not as good but was still satisfactory for the right ventricle (r = 0.75).(ABSTRACT TRUNCATED AT 250 WORDS)
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Larock, M. P.
Cantineau, R.
Legrand, Victor ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie
Kulbertus, Henri ; Université de Liège - ULiège > Services généraux (Faculté de médecine) > Relations académiques et scientifiques (Médecine)
Rigo, Pierre ; Université de Liège - ULiège > Département des sciences de la motricité > Pathologie générale et médecine nucléaire
Language :
English
Title :
99mtc-Mibi (Rp-30) to Define the Extent of Myocardial Ischemia and Evaluate Ventricular Function
Bertrand A., Karcher G., Amor M., Mayer J.C., Aug F., Moretti J.L., Pernot C., Cherrier F. (1987) Qualitative and quantitative comparison of 201-T1 and Tc-99m isonitrile by SPELT in coronary artery disease. Nuklearmedizin 26:120.
Bodenheimer M.M., Banka V.S., Fooshee C.M., Gillespie J.A., Helfant R.H. (1978) Detection of coronary heart disease using radionuclide determined regional ejection fraction at rest and during handgrip exercise: correlation with coronary arteriography. Circulation 58:640-648.
Buell U., Stirner H., Kleinhans E., Uebis R. (1987) Myocardial kinetics of Te-99m hexakis- (2-methoxy-isobutyl-isonitrile) (RP-30). A comparative study vs T1-201 with SPELT in coronary heart disease. Nuklearmedizin 26:58.
Campbell S., Holman B.L., Kirshenbaum J.M., Antman E.M., Lister-James J., Davison A., Kozlowski J., English R.J., Jones A.G. (1986) The scintigraphic evaluation of myocardial infarction and regional ventricular performance using technetium-99m hexakis (t-butylinonitrile) Technetium (1) (TBI): A new myocardial imaging agent. Eur J Nucl Med 12:219-225.
Deutsch E., Bushong W., Glavan K.A., Elder R.C., Sodd V.J., Scholz K.L., Fortman S.L., Lukes S.J. (1981) Heart imaging with cationic complexes of technetium. Science 214:85-86.
Deutsch A., Glavan K.A., Sodd V.J., Nishiyama H., Ferguson D.L., Lukes S.J. (1981) Cationic Tc-99m complexes as potential myocardial imaging agents. J Nucl Med 22:897-907.
Grines C.L., O'Neill W.W., Anselmo E.G., Juni J.E., Topol E.J. (1988) Comparison of left ventricular function and contractile reserve after successful recanalization by thrombolysis versus rescue percutaneous transluminal coronary angioplasty for acute myocardial infarction. Am J Cardiol 62:352-357.
Grucker D., Florentz P., Chambron J., Schott B., Fincker J.L. (1988) Myocardial gated tomoscintigraphy with99mTc methoxy-isobutyl-isonitrile (MIBI) in ischemic disease: regional and temporal activity curve analysis. Eur J Nucl Med 14:265.
Hassan I.M., Mohammed M.M.J., Badruddosa M., Mahmood A.R., Sayed M.E., Simo M., Abdel-Dayem H.M., Yousef A.M. (1986) A comparison of two radionuclide ejection-fraction techniques with contrast angiography in ischemic heart disease and valvular heart disease. Eur J Nucl Med 11:474-477.
Holman B.L., Jones A.G., Lister-James J., Davison A., Abra M.J., Kirshenbaum J.M., Tumeh S.S., English R.J. (1984) A new Tc-99mlabeled myocardial imaging agent, hexakis (t-butylisonitrile)technetium (1) /Tc-99m TBI/: Initial experience in the human. J Nucl Med 25:1350-1355.
Holman B.L., Campbell C.A., Lister-James J., Jones A.G., Davison A., Kloner R.A. (1986) Effect of reperfusion and hyperemia on the myocardial distribution of technetium-99m t-butylisonitrile. J Nucl Med 27:1172-1177.
Holman B.L., Sporn V., Jones A.G., Sia S.T.B., Perez-Balino N., Davison A., Lister-James J., Kronauge J.F., Mitta A.E.A., Camin L.L., Campbell S., Willia S.J., Carpenter A.T. (1987) Myocardial imaging with technetium-99m CPI:Initial experience in the human. J Nucl Med 28:13-18.
Ingels N.B., Daughters G.T., Stinson E.B., Alderman E.L. (1980) Evaluation of methods for quantitating left ventricular segmental wall motion in man using myocardial markers as a standard. Circulation 61:966-972.
Jones A.G., Abra M.J., Davison A., Brodack J.W., Toothaker A.K., Adelstein J., Kassis A.I. (1984) Biological studies of a new class of technetium complexes: the hexakis (alkylisonitrile) technetium (I) Cations. Int J Nucl Med Biol 11:225-234.
Knesewitsch P., Kleinhans E., Buell U. (1986) Combined evaluation of first-pass radionuclide angiography and equilibrium radionuclide ventriculography in the diagnosis of coronary artery disease. I. Results at rest. Eur J Nucl Med 12:115-119.
Liu X.J., Shi R.F., Wang Y.Q., Guo X.Z., He Z.X., Wang X.B. (1987) Clinical evaluation of the99mTc-labeled myocardial imaging agent, hexakis (t-butylisonitrile)-technetium. Eur J Nucl Med 13:171-173.
Maddahi J., Merz R., Van Trin K.F., Roy L., Wong C., Berman D.S. (1987) Quantitative comparison of planar and tomographic Tc99m MIBI (RP-30) and T1-201 myocardial perfusion scintigraphy in patients with coronary disease for perfusion defect intensity and defect reversibility. JACC 9:27A.
Marcassa C., Marzullo P., Parodi O., Sambuceti G., Neclia D. (1988) Quantitative myocardial wall thickening analysis by E.C.G. gated methoxy-isobutyl-isonitrile perfusion scintigraphy. Eur J Nucl Med 14:241.
Mayer J.C., Karcher G., Mathieu E., Maublant J., Itti R., Bourguignon M., Moretti J.L., Baconnet B., Bertrand A. (1988) Comparative study by two independent observers of the uptake abnormalities of 201-Thallium and Tc99m-MIBI in 81 patients with coronary artery disease. Eur J Nucl Med 14:248.
McKusick K., Holman B.L., Jones A.G., Davison A., Rigo P., Sporn V., Vosberg H., Moretti J.L. (1986) Comparison of 3 Tc-99m isonitriles for detection of ischemic heart disease in humans. J Nucl Med 27:878.
McKusick K., Beller G., Berman D., Boucher C., Camin L., Delaloye A., Delaloye B., Maddahi J., Manspeaker P., Strauss H.W., Wackers F., Watson D. (1987) Initial clinical results with 99mTc methoxy isobutyl isonitrile. JACC 9:28A.
Mousa S.A., Willia S.J. (1986) Myocardial uptake and retention of Tc-99m-hexakis- aliphatic isonitriles: evidence for specificity. J Nucl Med 27:995.
Mousa S.A., Cooney J.M., Willia S.J. (1987) Flow-distribution characteristics of Tc-99m-hexakis-2-methoxy, 2-methylpropyl isonitrile in animal models of myocardial ischemia and reperfusion. JACC 9:137A.
Mousa S.A., Maina M., Brown B.A., Willia S.J. (1987) Studies of the mechanism of retention of RP-30 in the heart. Nuklearmedizin 26:55.
Mousa S.A., Cooney J.M., Willia S.J. (1987) Assessment of different degrees of coronary artery stenosis in canine models using RP-30. Nuklearmedizin 56:56.
Nicod P., Gilpin E., Dittrich H., Chappuis F., Ahnve S., Engler R., Henning H., Ross J. (1988) Influence on prognosis and morbidity of left ventricular ejection fraction with and without signs of left ventricular failure after acute myocardial infarction. Am J Cardiol 61:1165-1171.
Okada R., Willia S., Glover D., Crowley K., Garneau J. (1987) Myocardial kinetics of technetium-99m-hexakis-2-methoxy-2methylpropyl-isonitrile: a new cardiac imaging agent. JACC 9:26A.
Perez-Balino N., Sporn V., Holman B.L., Sosa-Liprandi A., Masoli O., Mitta A., Camin L.L. (1986) First pass ejection fraction and myocardial perfusion with single injection of Tc-99m isonitrile. J Nucl Med 27:878.
Podio V., Castellano G., Spinnler M.T., Righetti A., Avataneo G., Leone G., Ciaroni S., Morello P., Turco G.L. (1988) Myocardial imaging with Tc-99m MIBI: correlation with coronary angiography and stress test. Eur J Nucl Med 14:254.
Rigo P., Bailey I.K., Griffith L.C., Pitt B., Wagner H.N., Becker L.C. (1981) Stress Thallium-201 myocardial scintigraphy for the detection of individual coronary areterial lesions in patients with and without previous myocardial infarction. Am J Cardiol 48:209-215.
Rigo P., Gilis F., Cantineau R. (1986) Planar and tomographic evaluation of Tc-99m tertiary butyl isonitrile (Tc-99m TBI) as a myocardial imaging agent. J Nucl Med 27:995.
Sands H., Delano M.L., Gallagher B.M. (1986) Uptake of hexakis (t-butylisonitrile) technetium (1) and hexakis-(isoprophylisonitrile) Technetium (1) by neonatal rat myocytes and human erythrocytes. J Nucl Med 27:404-408.
Schelbert H.R., Verba J.W., Johnson A.D., Brock G.W., Alazraki N.P., Rose F.J. (1975) Non-traumatic determination of left ventricular ejection fraction by radionuclide angiocardiography. Circulation 51:902-909.
Sheehan F.H., Stewart D.K., Dodge H.T., Mitten S., Bolson E.L., Brown B.G. (1983) Variability in the measurement of regional left ventricular wall motion from contrast angiograms. Circulation 68:550-559.
Sheehan F.H., Bolson E.L., Dodge H.T., Mathey D.G., Schofer J., Woo H.W. (1986) Advantages and applications of the centerline method for characterizing regional ventricular function. Circulation 74:293-395.
Sheehan F.H., Doerr R., Schmidt W.G., Bolson E.L., Uebis R., von Essen R., Effert S., Dodge H.T. (1988) Early recovery of left ventricular function after thrombolytic therapy for acute myocardial infarction: an important determinant of survival. JACC 12:289-300.
Sia S.T.B., Holman B.L., McKusick K., Rigo P., Gillis F., Sporn V., Perez-Balino N., Mitta A., Vosberg H., Szabo Z., Schwartzkopff B., Moretti J.L., Davison A., Lister-James J., Jones A. (1986) The utilization of Tc-99m-TBI as an myocardial perfusion agent in exercise studies: Comparison with T1-201 thallous chloride and examination of its biodistribution in humans. Eur J Nucl Med 12:333-336.
Smucker M.L., Beller G.A., Watson D.D., Kaul S. (1988) Left ventricular dysfunction in excess of the size of infarction: a posible management strategy. Am Heart J 115:749-753.
Taillefer R., Laflamme L., Dupras G., Picard M., Phaneuf D.C., Léveillé J. (1988) Myocardial perfusion imaging with 99mTc methoxy-isobutyl-isonitrile (MIBI): Comparison of short and long time intervals between rest and stress injections. Preliminary results. Eur J Nucl Med 13:515-522.
Tamaki N., Yonekura Y., Yamashita K., Senda M., Saji H., Hashimoto T., Fudo T., Kambara H., Kawai C., Ban T., Konishi J. (1988) Relation of left ventricular perfusion and wall motion with metabolic activity in persistent defects on Thallium-201 tomography in healed myocardial infarction. Am J Cardiol 62:202-208.
Underwood S.R., Walton S., Ell P.J., Jarritt P.H., Emanuel R.W., Swanton R.H. (1985) Gated blood-pool emission tomography: a new technique for the investigation of cardiac structure and function. Eur J Nucl Med 10:332-337.
Wackers F., Berman D., Strauss H.W., Boucher C., Maddahi J., McKusick K. (1987) Tc99m RP-30 (Cardiolite-TM): a new radio-pharmaceutical for myocardial perfusion imaging: assessment of rest and exercise human biodistribution and safety. Nuklearmedizin 26:56.
Wackers F.J., Kayden D.S., Lange R.C., Mattera J. (1987) Rest-exercise orang distribution of RP-30, a new Tc-99m-labeled myocardial perfusion imaging agent. JACC 9:27A.
Wackers F., Berman D., Beller G., Delaloye B., Boucher C., Maddahi J., Watson D., Delaloye A., Strauss H.W., McKusick K. (1987) Rest and exercise myocardial perfusion imaging with Tc-99m RP-30 (Cardiolite-TM): Preliminary clinical comparison with T1-201. Nuklearmedizin 26:57.