Document Detail


Direct imaging of exercise-induced myocardial ischemia with fluorine-18-labeled deoxyglucose and Tc-99m-sestamibi in coronary artery disease.
MedLine Citation:
PMID:  12939208     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 (18FDG). 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 (99mTc-sestamibi) and 18FDG at peak exercise. Rest perfusion imaging was carried out separately. All patients underwent coronary angiography. Exercise 18FDG myocardial images were compared with exercise-rest 99mTc-sestamibi images and coronary angiography. Of 22 patients with > or =50% narrowing of > or =1 coronary arteries, 18 had perfusion abnormalities (sensitivity 82%) whereas 20 had abnormal myocardial 18FDG uptake (sensitivity 91%, P=NS). Perfusion abnormalities were seen in myocardial segments corresponding to 25 vascular territories of a total of 51 vessels with > or =50% luminal narrowing in 22 patients (sensitivity 49%), whereas increased 18FDG uptake was seen in 34 vascular territories (sensitivity 67%, P=0.008). 18FDG images were of high quality and easy to interpret but required simultaneous perfusion images for localizing abnormal myocardial 18FDG uptake. CONCLUSIONS: Exercise-induced myocardial ischemia can be imaged directly with 18FDG. Combined exercise 18FDG-99mTc-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.
Authors:
Zuo-Xiang He; Rong-Fang Shi; Yong-Jian Wu; Yue-Qin Tian; Xiu-Jie Liu; Shi-Wen Wang; Rui Shen; Xue-Wen Qin; Run-Lin Gao; Jagat Narula; Diwakar Jain
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2003-08-25
Journal Detail:
Title:  Circulation     Volume:  108     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-09-09     Completed Date:  2003-10-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1208-13     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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MeSH Terms
Descriptor/Qualifier:
Coronary Angiography
Coronary Artery Disease / complications,  diagnosis*
Coronary Vessels / radionuclide imaging
Diabetes Complications
Diabetes Mellitus / physiopathology
Exercise Test* / adverse effects
Feasibility Studies
Female
Fluorodeoxyglucose F18 / diagnostic use*,  pharmacokinetics
Humans
Male
Middle Aged
Myocardial Ischemia / etiology,  physiopathology,  radionuclide imaging*
Sensitivity and Specificity
Technetium Tc 99m Sestamibi / diagnostic use*,  pharmacokinetics
Chemical
Reg. No./Substance:
109581-73-9/Technetium Tc 99m Sestamibi; 63503-12-8/Fluorodeoxyglucose F18
Comments/Corrections
Comment In:
Circulation. 2004 Mar 30;109(12):e167-70; author reply e167-70   [PMID:  15051653 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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