Evaluation of myocardial ischemia using a rest metabolism/stress perfusion protocol with fluorine-18 deoxyglucose/technetium-99m MIBI and dual-isotope simultaneous-acquisition single-photon emission computed tomography

J Am Coll Cardiol. 1995 Oct;26(4):870-8. doi: 10.1016/0735-1097(95)00295-6.


Objectives: This study sought to develop a dual-isotope single-acquisition single-photon emission computed tomographic (SPECT) protocol using a multihead SPECT camera equipped with an ultra-high energy collimator to evaluate rest metabolism/stress perfusion simultaneously with fluorine-18 (F-18) deoxyglucose/technetium-99m (Tc-99m) 2-hexakis-2-methoxy-2-methylpropyl isonitrile (MIBI).

Background: The most accurate and logistic method of identifying injured but viable myocardium remains a diagnostic challenge.

Methods: Sixty-five patients were given 25 to 50 g of glucose and, after approximately 60 min, an injection of 370 MBq (10 mCi) of F-18 fluorodeoxyglucose. After a 35-min distribution phase, patients underwent exercise or pharmacologic stress followed by administration of 925 MBq (25 mCi) of Tc-99m MIBI. Five patients underwent F-18 fluorodeoxyglucose position emission tomography before dual-isotope SPECT:

Results: With a window of 20% for both photopeaks and a technetium-99m/fluorine-18 concentration of 3.2:1, the "spillover" from fluorine-18 into the technetium-99m window is < 6% of the total counts in the window in patients with a normal distribution of both radiopharmaceuticals. Phantom images clearly demonstrated cardiac defects measuring 2 x 1 and 2 x 0.5 cm. There was no significant difference in the images of the five patients who underwent both positron emission tomography and SPECT: Fifty-seven patients (mean [+/- SD] age 55 +/- 15 years, range 25 to 83; 38 men, 19 women) had satisfactory images and were included in the study. Twenty-one patients had normal study results; 15 had mismatched defects; 14 had matched defects; and 7 had both matched and mismatched defects. Twenty-three patients (mean age 54 +/- 6 years, range 30 to 83; 14 men, 9 women) underwent coronary angiography within 3 months of dual-isotope SPECT: There were seven normal studies, eight with mismatched defects, one with a matched defect and seven with matched and mismatched defects. When stenosis > 70% was used as the criterion for a diagnosis of coronary artery disease, dual-isotope SPECT had a sensitivity of 100%, specificity of 88%, positive predictive value of 93%, negative predictive value of 100% and an accuracy of 96%.

Conclusions: Dual-isotope SPECT may provide an alternative, accurate, cost-effective method to nitrogen-13 ammonia/F-18 fluorodeoxyglucose positron emission tomography or thallium-201 reinjection for identifying injured or dysfunctional but viable myocardium.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Coronary Angiography
  • Coronary Disease / diagnostic imaging
  • Coronary Disease / epidemiology
  • Deoxyglucose / analogs & derivatives*
  • Dipyridamole
  • Exercise Test
  • Female
  • Fluorine Radioisotopes*
  • Fluorodeoxyglucose F18
  • Heart / diagnostic imaging*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnostic imaging*
  • Myocardial Ischemia / epidemiology
  • Myocardium / metabolism
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Technetium Tc 99m Sestamibi*
  • Tomography, Emission-Computed, Single-Photon / methods*
  • Vasodilator Agents


  • Fluorine Radioisotopes
  • Vasodilator Agents
  • Fluorodeoxyglucose F18
  • Dipyridamole
  • Technetium Tc 99m Sestamibi
  • Deoxyglucose