In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 108, No. 10 ( 2003-09-09), p. 1208-1213
Abstract:
Background— Scintigraphic myocardial perfusion imaging is the most widely used noninvasive modality for the detection of coronary artery disease (CAD). A technique for direct imaging of exercise-induced myocardial ischemia is highly desirable and preferable over perfusion imaging but is presently unavailable. We evaluated the feasibility and diagnostic accuracy of direct imaging of exercise-induced myocardial ischemia with fluorine-18-2-deoxyglucose ( 18 FDG). Methods and Results— Twenty-six patients with known or suspected CAD and no prior myocardial infarction underwent simultaneous myocardial perfusion and ischemia imaging after the intravenous injection of Tc-99m-sestamibi ( 99m Tc-sestamibi) and 18 FDG at peak exercise. Rest perfusion imaging was carried out separately. All patients underwent coronary angiography. Exercise 18 FDG myocardial images were compared with exercise-rest 99m Tc-sestamibi images and coronary angiography. Of 22 patients with ≥50% narrowing of ≥1 coronary arteries, 18 had perfusion abnormalities (sensitivity 82%) whereas 20 had abnormal myocardial 18 FDG uptake (sensitivity 91%, P =NS). Perfusion abnormalities were seen in myocardial segments corresponding to 25 vascular territories of a total of 51 vessels with ≥50% luminal narrowing in 22 patients (sensitivity 49%), whereas increased 18 FDG uptake was seen in 34 vascular territories (sensitivity 67%, P =0.008). 18 FDG images were of high quality and easy to interpret but required simultaneous perfusion images for localizing abnormal myocardial 18 FDG uptake. Conclusions— Exercise-induced myocardial ischemia can be imaged directly with 18 FDG. Combined exercise 18 FDG- 99m Tc-sestamibi imaging provides a better assessment of exercise-induced myocardial ischemia compared with exercise-rest perfusion imaging. Direct ischemia imaging eliminates some of the limitations of presently used myocardial perfusion imaging. Large-scale clinical studies are warranted.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/01.CIR.0000088784.25089.D9
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2003
detail.hit.zdb_id:
1466401-X
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