The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
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Reproducibility of Adenosine Tc-99m sestaMIBI SPECT for the Diagnosis of Coronary Artery Disease

관동맥질환의 진단을 위한 아데노신 Tc-99m sestaMIBI SPECT의 재현성

  • Lee, Duk-Young (Department of Nuclear Medicine, Kyungpook National University School of Medicine) ;
  • Bae, Jin-Ho (Department of Nuclear Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Sang-Woo (Department of Nuclear Medicine, Kyungpook National University School of Medicine) ;
  • Chun, Kyung-Ah (Department of Nuclear Medicine, Kyungpook National University School of Medicine) ;
  • Yoo, Jeong-Soo (Department of Nuclear Medicine, Kyungpook National University School of Medicine) ;
  • Ahn, Byeong-Cheol (Department of Nuclear Medicine, Kyungpook National University School of Medicine) ;
  • Ha, Jeoung-Hee (Department of Pharmacology, Kyungpook National University School of Medicine) ;
  • Chae, Shung-Chull (Department of Cardiology, Kyungpook National University School of Medicine) ;
  • Lee, Kyu-Bo (Department of Nuclear Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Jae-Tae (Department of Nuclear Medicine, Kyungpook National University School of Medicine)
  • 이덕영 (경북대학교 의과대학 핵의학교실) ;
  • 배진호 (경북대학교 의과대학 핵의학교실) ;
  • 이상우 (경북대학교 의과대학 핵의학교실) ;
  • 천경아 (경북대학교 의과대학 핵의학교실) ;
  • 유정수 (경북대학교 의과대학 핵의학교실) ;
  • 안병철 (경북대학교 의과대학 핵의학교실) ;
  • 하정희 (경북대학교 의과대학 약리학교실) ;
  • 채성철 (경북대학교 의과대학 순환기내과) ;
  • 이규보 (경북대학교 의과대학 핵의학교실) ;
  • 이재태 (경북대학교 의과대학 핵의학교실)
  • Published : 2005.12.31
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Abstract

Purpose: Adenosine myocardial perfusion SPECT has proven to be useful in the detection of coronary artery disease, in the follow up the success of various therapeutic regimens and in assessing the prognosis of coronary artery disease. The purpose of this study is to define the reproducibility of myocardial perfusion SPECT using adenosine stress testing between two consecutive Tc-99m sestaMIBI (MIBI) SPECT studies in the same subjects. Methods: Thirty patients suspected of coronary artery disease in stable condition underwent sequential Tc-99m MIBI SPECT studies using intravenous adenosine. Gamma camera, acquisition and processing protocols used for the two tests were identical and no invasive procedures were performed between two tests. Mean interval between two tests were 4.1 days (range: 2-11 days). The left ventricular wall was divided into na segments and the degree of myocardial tracer uptake was graded with four-point scoring system by visual analysis. Images were interpretated by two independent nuclear medicine physicians and consensus was taken for final decision, if segmental score was not agreeable. Results: Hemodynamic responses to adenosine were not different between two consecutive studies. There were no serious side effects to stop infusion of adenosine and side effects profile was not different. When myocardial uptake was divided into normal and abnormal uptake, 481 of 540 segments were concordant (agreement rate 89%, Kappa index 0.74). With four-grade storing system, exact agreement was 81.3% (439 of 540 segments, tau b=0.73). One and two-grade differences were observed in 97 segments (18%) and 4 segments (0.7%) respectively, but three-grade difference was not observed in any segment. Extent and severity scores were not different between two studios. The extent and severity scores of the perfusion defect revealed excellent positive correlation between two test (r value for percentage extent and severity score is 0.982 and 0.965, p<0.001) Conclusion: Hemodynamic responses and side effects profile were not different between two consecutive adenosine stress tests in the same subjects. Adenosine Tc-99m sestaMIBI SPECT is highly reproducible, and could be used to assess temporal changes in myocardial perfusion in individual patients.

목적: 아데노신 부하 Tc-99m MIBI SPECT는 관동맥질환의 진단, 예후 평가, 치료 방침의 설정, 치료 효과 판정 및 경과 관찰에 유용성이 있다고 알려져 있다. 치료 효과 판정 및 치료 방침 설정을 위해서는 검사 방법의 재현성이 높아야 한다. 본 연구는 아데노신 부하 Tc-99m MIBI SPECT의 재현 성능을 평가하기 위하여 동일인에서 2회 연속적으로 시행한 아데노신 부하 Tc-99m MIBI SPECT에서 약물주사에 따른 혈역학적 변화와 부작용의 빈도, 영상에 나타난 심근분절의 방사능섭취 정도의 차이를 알아 보고자 하였다. 대상 및 방법: 관동맥질환이 의심되거나 관동맥질환으로 진단된 후 추적검사를 위하여 아데노신 부하 Tc-99m MIBT SPECT를 시행한 30명의 환자를 대상으로 2-11 일(평균: 4.1 일)의 간격으로 검사를 반복하였다. 관류영상의 육안적 판독은 좌심실의 단층 영상을 18분절로 구분하여, 섭취 정도에 따라 4등급으로 분류하였고, 관류 정도의 평가는 2명의 핵의학 전공의사가 각각 평가한 후 일치하지 않은 경우에는 두 판독자 간에 토의로 합의된 소견으로 비교하였다. 결과: 아데노신 주사에 따른 수축기혈압, 이완기 혈압 및 맥박 수의 변화는 두 검사 사이에 유의한 차이가 없었고, 두 번의 검사를 시행하는 동안 검사를 중지하거나 부작용 치료를 위한 처치를 받아야 만큼 중독한 부작용의 발생은 없었다. 관류점수상 540분절 중 439분절에서 완전하게 일치하였고(일치도 81.3%, tau B index 0.73%), 1점 차이(97분절, 18%), 2점 차이(4분절, 0.7%)있었으나 3점 이상의 차이가 있은 경우는 없었다. 두 검사에서 측정된 관류결손의 범위와 중증도점수 사이에는 각각 $\gamma$-값 0.982와0.965의 높은 양의 상관성을 나타내었다(p<0.001, respectively). 결론: 연속적으로 2회 시행한 아데노신 부하 Tc-99m MIBI SPECT는 부하에 따른 혈역학적 변화 및 부작용의 발생이 유사하였고, 심근분절의 관류상태의 시각적 평가 및 관류결손의 정량적 판정에서 매우 높은 재현성을 보여주었다. 그러므로 아데노신 Tc-99m MIBI SPECT는 관동맥질환이 의심되거나 관동맥질환으로 진단된 환자에서 약물치료나 중재적 시술 또는 외과적 수술 치료 후 심근관류상태의 경시적 변화를 평가하는데 유용하게 이용될 수 있을 것이라 판단된다.

Keywords

References

  1. Sigal SL, Soufer R, Fetterman RC, Mattera JA, Wackers FJ. Reproducibility of quantitative planar thallium-201 scintigraphy:quantitative criteria for reversibility of myocardial perfusion defects. J Nucl Med 1991;32:759-65
  2. Alazraki NP, Krawezynska EG, DePuey EG, Ziffer JA, Vansant JP, Pettigrew RI, et al. Reproducibility of thallium-201 exercise SPECT studies. J Nucl Med 1994;35:1237-44
  3. Paeng JC, Lee DS, Cheon GJ, Lee MM, Chung JK, Lee MC. Reproducibility of an automatic quantitation of regional myocardial wall motion and systolic wall thickening on gated Tc-99m-sestamibi myocardial SPECT. J Nucl Med 2001;42:695-700
  4. Hyun IY, Kwan J, Park KS, Lee WH. Reproducibility of Tl-201 and Tc-99m sestamibi gated myocardial perfusion SPECT measurement of myocardial function. J Nucl Cardiol 2001;8:182-7 https://doi.org/10.1067/mnc.2001.112753
  5. Kim KM, Lee DS, Kim YK, Cheon GJ, Kim SK, Chung JK et al. Reproducibility of non-invasive measurement for left ventricular contractility using gated myocardial SPECT. Korean J Nucl Med 2001;35:152-60
  6. Danias PG, Ahlberg AW, Train MI, Mahr NC, Abreu JE, Marini D, et al. Visual assessment of left ventricular perfusion and function with electrocardiography-gated SPECT has high intra-observer and inter-observer reproducibility among experienced nuclear cardiologists and cardiology trainees. J Nucl Cardiolo 2002;9:263-70 https://doi.org/10.1067/mnc.2002.121233
  7. Wilson RF, Wyche K, Christensen BV, Zimmer S, Laxson DD. Effect of adenosine on human coronary artery circulation. Circulation 1990;82:1595-606 https://doi.org/10.1161/01.CIR.82.5.1595
  8. Glover DK, Ruiz M, Edwards NC, Cunningham M, Simanis JP, Smith WH, et al. Comparison between $^{201}Tl\;and\;^{99m}Tc$ -sestamibi uptake during adenosine induced vasodilation as a function of coronary stenosis severity. Circulation 1995;91:813-20 https://doi.org/10.1161/01.CIR.91.3.813
  9. Glover DK, Ruiz M, Yang JY, Smith WH, Watson DD, Beller GA. Myocardial technetium-99m tetrofosmin uptake during adenosine induced vasodilation with either a critical or mild coronary stenosis:comparison to thallium-201 and regional myocardial blood flow. Circulation 1997;96:332-8
  10. Meleca MJ, McGovern AJ, Gerson MC, Millard RW, Gabel M, Biniakiewicz et al. Flow versus uptake comparison of thallium-201 with technetium-99m perfusion tracers in a canine model of myocardial ischemis. J Nucl Med 1997;38:1847-56
  11. Zaret BL. Second annual Mario S. Verani, MD, Memorial Lecture:Nuclear Cardiology, the next 10 years. J Nucl Cardiol 2004;11:393-407 https://doi.org/10.1016/j.nuclcard.2004.05.001
  12. Mendoza DD, Cerquiera. MD. In retroSPECT: The prognostic value of nuclear cardiology-past, present, and future. J Nucl Cardiol 2004;11:237-8 https://doi.org/10.1016/j.nuclcard.2004.03.010
  13. Cerqueira MD, Verani MS, Schwaiger M, Heo J, Iskandrian AS. Safety profile of adenosine stress perfusion imaging: results from the Adenoscan Multicenter Trial registry. J Am Coll Cardiol 1994;23:384-9 https://doi.org/10.1016/0735-1097(94)90424-3
  14. Jain D, Joska T, Lee FA, Burg M, Lampert R, Zaret BL. Day-to day reproducibility of mental stress-induced abnormal left ventricular function response in patients with coronary artery disease and its relationship to autonomic activation. J Nucl Cardiol 2001;8:347-55 https://doi.org/10.1067/mnc.2001.113517
  15. Kaufmann PA, Gnecchi-Ruscone T, Yap JT, Rimoldi O, Camici PG. Assessment of the reproducibility of baseline and hyperemic myocardial blood flow measurements with O-15-labeled water and PET. J Nucl Med 1999;40:1848-56
  16. Flammmang D, Chassing A, Donal E, Hamani D, Erickson M, McCarville S. Reproducibility of the adenosine-5'-triphosphate test in vasovagal syndrome. J Cardiovascular Electrophysiol 1998;9:1161-6 https://doi.org/10.1111/j.1540-8167.1998.tb00087.x
  17. Heller GV. Tracer selection with different stress modalities based on tracer kinetics. J Nucl Cardiol 1996;3:S15-S21 https://doi.org/10.1016/S1071-3581(96)90203-2
  18. Levine MG, Ahlberg AW, Mann A, White MP, McGill CC, de Leon CM, et al. Comparison of exercise, adenosine, and dobutamine stress with the use of Tc-99m tetrofosmin tomographic iamging. J Nucl Cardiol 1999;6:389-96 https://doi.org/10.1016/S1071-3581(99)90004-1
  19. Lee J, Chae SC, Lee K, Heo J, Iskandrian AS. Biokinetics of thallium-201 in normal subjects : comparison between adenosine, dipyridamole, dobutamine and exercise. J Nucl Med 1994;35:535-41
  20. Santos-Ocampo CD, Herman SD, Travin MI, Garber CE, Ahlberg AW, Messinger DE, et al. Comparison of exercise, dipyridamole, adn adenosine by use of technetium-99m setsmibi tomographic imaging. J Nucl Cardiol 1994;1:57-64 https://doi.org/10.1007/BF02940012
  21. Kapur A, Latus KA, Davies G, Dhawan RT, Eastick S, Jaritt PH, et al. A comparison of three radionuclide myocardial perfusion tracers in clinical practice: the ROBUST study. Eur J Nucl Med 2002;29:1608-16 https://doi.org/10.1007/s00259-002-0998-8
  22. Brambilla M, Inglese E, Cannizzaro G, Dondi M, Sara R, Arrigo F et al. A multicenter trial on interobserver and intraobserver reproducibility of segmental scoring of thallium-201 planar myocardial imaging before and after reinjection. Italian Group of Nuclear Cardiology. J Nucl Med 1994;35:601-8
  23. Hendel RC, Parker MA, Wackers FJ, Lahiri A, Zaret BL. Reduced variability of interpretation and improved image quality with a technetium 99m myocardial perfusion agent: comparison of thallium 201 and technetium 99m-labeled tetrofosmin. J Nucl Cardiol 1994;1:509-14 https://doi.org/10.1007/BF02939973
  24. Johansen A, Gaster AL, Veje A, Thayssen P, Haghfelt T, Hoilund-Carlsen PF. Interpretative intra- and interobserver reproducibility of rest/stress 99mTc-sestamibi myocardial perfusion SPECT in a consecutive group of male patients with stable angina pectoris before and after percutaneous transluminal angioplasty. Nucl Med Commun 2001;22:531-7 https://doi.org/10.1097/00006231-200105000-00011
  25. Berman DS, Kiat H, Friedman JS, Wang FP, van Train K, Matzer L, et al. Separate acquisition rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion single-photon emission computed tomography: a clinical validation study. J Am Coll Cardiol 1993;22:1455-64 https://doi.org/10.1016/0735-1097(93)90557-H
  26. Suleiman K, Desai D, Raval U, Senior R, Lahiri A. The effect of training on the interpretation of Tc-99m sestmibi myocradial perfusion SPECT inpatients with suspected coronary artery disease. Nucl Med Commun 1997;18:922-6 https://doi.org/10.1097/00006231-199710000-00005
  27. Golub RJ, McClellan JR, Herman SD, Travin MI, Kline GM, Aitken PW, Baron JI, Ahlberg AW, Heller GV. Effectiveness of nuclear cardiology training guidelines: a comparison of trainees with experienced readers. J Nucl Cardiol 1996;3:114-8 https://doi.org/10.1016/S1071-3581(96)90003-3
  28. Nagamachi S, Czernin J, Kim AS, Sun KT, Phelps ME, Schlbert HR. Reproducibility of measurement of regional resting and hyperemic myocardial blood flow assessed with PET. J Nucl Med 1996;37:1626-31
  29. Wyss CA, Koepfli PK, Mikolajczyk K, Burger C, von Schulthess GK, Kaufmann PA. Bicycle exercise stress in PET for assessment of coronary flow reserve: repeatability and comparison with adenosine stress. J Nucl Med 2003;44:146-54
  30. Yeo JS, Lee DS, Lee KH, Kim JH, Sohn KS, Cho SW, et al. Interobserver reproducibility of segmental scoring of Tc-99m-MIBI myocardial SPECT. Korean J Nucl Med 1994;28:317-25
  31. Golub RJ, Ahlberg AW, McClellan JR, Herman SD, Travin MI, Mather JF, et al. Interpretative reproducibility of stress Tc-99m sestamibi tomographic myocardial perfusion imaging. J Nucl Cardiol 1999;6:257-69 https://doi.org/10.1016/S1071-3581(99)90037-5