Abstract
Background: Septal perfusion defects are common on my‐ocardial perfusion single‐photon emission computed tomography (SPECT) slices in patients with left bundle‐branch block (LBBB) in the absence of coronary artery disease.
Hypothesis: The use of gated myocardial perfusion SPECT imaging in such patients should be clinically validated. The aims of this study were, therefore, to validate clinically the use of gated myocardial SPECT imaging to avoid false positive septal perfusion defects in patients with LBBB and to compare nongated and gated SPECT imaging techniques in the same patients in the same imaging session.
Methods: We performed stress‐rest myocardial perfusion SPECT and resting gated SPECT using Technetium‐99m MIBI in 25 patients with LBBB and in 6 control subjects. Stress‐rest SPECT images and end‐diastolic and end‐systolic gated SPECT slices were assessed visually and quantitatively (septum/lateral wall count ratio). Coronary angiography was performed in 15 patients with LBBB and in all 6 control subjects.
Results: Stress‐rest (nongated) SPECT slices and end‐diastolic and end‐systolic gated SPECT images were normal in all control subjects. Stress‐rest (nongated) SPECT imaging revealed septal perfusion defect in 20 (11 reversible, 9 irreversible) patients with LBBB, whereas the figures were 15 and 5 for end‐systolic and end‐diastolic gated SPECT images, respectively. Coronary angiography results were normal in all control subjects and in 15 patients with LBBB. Quantitative analysis of gated SPECT images revealed no statistically significant difference between patients with LBBB and control subjects in end‐diastolic mean septum/lateral wall count values (0.86 ± 0.19 in LBBB vs. 0.98 ± 0.15 in normal subjects, p > 0.05), but the difference was statistically significant for end‐systolic, stress, and rest values (p < 0.001 for all).
Conclusion: Gated SPECT imaging, particularly end‐diastolic images, revealed fewer false positive results and thus can be used to avoid false positive septal perfusion defects commonly seen in stress‐rest (nongated) myocardial perfusion SPECT in patients with LBBB.
Keywords: SPECT, myocardium, gated SPECT, Tc‐99m MIBI, left bundle‐branch block
Full Text
The Full Text of this article is available as a PDF (69.0 KB).
References
- 1. Sugihara M, Tamaki N, Nozawa M, Ohmura T, Inamoto Y, Taniguchi Y, Aoki E, Mitsunami E, Kinoshita M: Septal perfusion and wall thickening in patients with left bundle branch block assessed by Tc‐99m‐sestamibi gated tomography. J Nucl Med 1997; 38: 545–547 [PubMed] [Google Scholar]
- 2. Knapp WH, Bentrup A, Schmidt U, Ohlmeier H: Myocardial scintigraphy with thallium‐201 and technetium‐99m‐hexakis‐methoxyisobutylisonitrile in left bundle branch block: A study in patients with and without coronary artery disease. Eur J Nucl Med 1993; 20: 219–224 [DOI] [PubMed] [Google Scholar]
- 3. Braat SH, Brugada P, Bar FW, Gorgels AP, Wellens HJ: Tl‐201 exercise scintigraphy and left bundle branch block. Am J Cardiol 1985; 55: 224–226 [DOI] [PubMed] [Google Scholar]
- 4. Huerta EM, Rodriguez PL, Castro Beiras JM, Illera JP, Asin Cardiel E: Tl‐201 exercise scintigraphy having complete left bundle branch block. Int J Cardiol 1987; 16: 43–46 [DOI] [PubMed] [Google Scholar]
- 5. La Canna G, Giubbini R, Cicogna R, Curnis A, Guerra UP, Arosio G, Visioli O: Study of myocardial perfusion by means of scintigraphy with thallium‐201 in left bundle branch block induced by exertion. G Ital Cardiol 1987; 17: 498–504 [PubMed] [Google Scholar]
- 6. Matzer L, Kiat H, Friedman JD, Van Train K, Maddahi J, Berman DS: A new approach to assessment of tomography Tl‐201 scintigraphy in patients with left bundle branch block. Am J Cardiol 1991; 17: 1309–1317 [DOI] [PubMed] [Google Scholar]
- 7. Knapp WH, Schmidt U, Bentrup A, Notohamiprodjo G, Gleichmann U: Results of myocardial scintigraphy in patients with left bundle‐branch block using Tl‐201 and Tc‐99m‐MIBI. Kardiologie 1991; 80: 732–737 [PubMed] [Google Scholar]
- 8. Lebtahi NE, Stauffer JC, Delaloye AB: Left bundle branch block and coronary artery disease: Accuracy of dipyridamole thallium‐201 single‐photon emission computed tomography in patients with exercise anteroseptal perfusion defects. J Nucl Cardiol 1997; 4: 266–273 [DOI] [PubMed] [Google Scholar]
- 9. Krishnan R, Lu J, Zhu YY, Dae MW, Botvinick EH: Myocardial perfusion scintigraphy in left bundle branch block: A perspective on the issue from image analysis in a clinical context. Am Heart J 1993; 126: 578–586 [DOI] [PubMed] [Google Scholar]
- 10. Larcos G, Gibbons RJ, Brown ML: Diagnostic accuracy of exercise thallium‐201 single‐photon emission computed tomography in patients with left bundle branch block. Am J Cardiol 1991; 15: 756–760 [DOI] [PubMed] [Google Scholar]
- 11. DePuey EG, Krawezynska EG, Robbins WL: Thallium‐201 SPECT in coronary artery disease patients with left bundle branch block. J Nucl Med 1988; 29: 1479–1485 [PubMed] [Google Scholar]
- 12. Altehoefer C, Dahl JV, Kleinhans E, Uebis R, Hanrath P, Buell U: Tc‐99m methoxyisobutylisonitrile stress/rest SPECT in patients with constant left bundle branch block. Nucl Med Commun 1993; 14: 30–35 [DOI] [PubMed] [Google Scholar]
- 13. Tighe DA, Hutchinson HG, Park CH, Chung EK, Fischman DL, Raichlen JS: False‐positive reversible perfusion defect during dobutamine‐thallium imaging in left bundle branch block. J Nucl Med 1994; 35: 1989–1991 [PubMed] [Google Scholar]
- 14. Hambye AS, Dobbeleir A, Redveaux M, Vandevivere J, Heuvel P: Determination of systolic thickening index with gated Tc‐99m sestamibi SPECT. Clin Nucl Med 1997; 22: 172–175 [DOI] [PubMed] [Google Scholar]
- 15. Chua T, Kiat H, Germano G, Maurer G, Van Train K, Friedman J, Berman T: Gated Tc‐99m sestamibi for simultaneous assessment of stress myocardial perfusion, postexercise regional ventricular function and myocardial viability: Correlation with echocardiography and rest thallium‐201 scintigraphy. J Am Coll Cardiol 1994; 23: 1107–1114 [DOI] [PubMed] [Google Scholar]
- 16. Tao KA, Hon‐Der CY: Evaluation of global and regional left ventricular function using Tc‐99m sestamibi ECG‐gated single‐photon emission tomography. Eur J Nucl Med 1998; 25: 515–521 [DOI] [PubMed] [Google Scholar]
- 17. Mannting F, Mannting MM: Gated SPECT with Tc‐99m sestamibi for assessment of myocardial perfusion abnormalities. J Nucl Med 1993; 34: 601–608 [PubMed] [Google Scholar]
- 18. Taillefer R, Laflamme L, Dupras G, Picard M, Pheneuf DC, Leveille J: Myocardial perfusion imaging with 99m‐Tc‐methoxy‐isobutyl‐isonitrile (MIBI): Comparison of short and long time intervals between rest and stress injections. Preliminary results. Eur J Nucl Med 1988; 13: 515–522 [DOI] [PubMed] [Google Scholar]
- 19. Wackers FJ, Berman DS, Maddahi J, Watson DD, Beller GA, Strauss HW, Boucher CA, Picard M, Holman BL, Fridrich R: Technetium‐99m hexakis 2‐methoxyisobutyl isonitrile: Human biodistribution, dosimetry, safety, and preliminary comparison to thallium‐201 for myocardial perfusion imaging. J Nucl Med 1989; 30: 301–311 [PubMed] [Google Scholar]
- 20. Taillefer R, Lette J, Phaneuf DC, Leveille J, Lemire F, Essiambre R: Thallium‐201 myocardial imaging during pharmacologic coronary vasodilation: Comparison of oral and intravenous administration of dipyridamole. J Am Coll Cardiol 1986; 8: 76–83 [DOI] [PubMed] [Google Scholar]
- 21. Gould KL, Sorenson SG, Albro P, Caldwell JH, Chaudhuri T, Hamilton GW: Thallium‐201 myocardial imaging during coronary vasodilation induced by oral dipyridamole. J Nucl Med 1986; 27: 31–36 [PubMed] [Google Scholar]
- 22. Eisener RL, Schmarkey LS, Martin SE, Carey D, Worthy MA, Chu TH, Horowitz SF, Patterson RE: Defects on SPECT perfusion images can occur due to abnormal segmental contraction. J Nucl Med 1994; 35: 227–234 [PubMed] [Google Scholar]
- 23. Taillefer R, Depuey EG, Udelson JE, Beller GA, Latour Y, Reeves F: Comparative diagnostic accuracy of Tl‐201 and Tc‐99m sestamibi SPECT imaging (perfusion and ECG‐gated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol 1997; 29: 69–77 [DOI] [PubMed] [Google Scholar]
- 24. Larcos C, Brown F: Role of dipyridamole Tl‐201 imaging in left bundle branch block. Am J Cardiol 1991; 68: 509–512 [DOI] [PubMed] [Google Scholar]
- 25. Burns R, Galligan L, Wright L: Improved specificity of myocardial Tl‐201 SPECT in patients with left bundle branch block. Am J Cardiol 1991; 68: 504–508 [DOI] [PubMed] [Google Scholar]
- 26. Nigam A, Humen DP: Prognostic value of myocardial perfusion imaging with exercise and/or dipyridamole hyperemia in patients with LBBB. J Nucl Med 1998; 39: 579–581 [PubMed] [Google Scholar]
- 27. Konno M, Morita K, Adachi I, Ito Y, Kohya T, Kitabatake A, Tsukamoto E, Tamaki N: Quantitative analysis of regional wall motion and thickening by quantitative gated SPECT: Comparison with visual analysis. Clin Nucl Med 2001; 26: 202–207 [DOI] [PubMed] [Google Scholar]