Abstract
Aim
Myocardial perfusion scintigraphy (MPS) is an effective tool for early diagnosis of coronary artery disease (CAD) in type II diabetes mellitus (DM). The purpose of this study was to review the comparative findings of Tc-99m MIBI and Tl-201 MPS in defining normal and abnormal myocardial segments, type and extent of the perfusion defects with reference to coronary angiography findings in diabetic patients.
Methods
Thirty patients with type II DM who had abnormal Tc-99m MIBI MPS findings and underwent coronary angiography were included this study (20 male, 10 female; mean age was 64 ± 11 years). Those patients were also investigated with Tl-201 MPS thereafter. All scintigraphic images were evaluated semiquantitatively using a 20-segments myocardial model. The perfusion of myocardial segments, reversibility and severity of defects based on defect score were compared using the MIBI and Tl-201 images in relation to coronary angiography. Diffuse slow-washout of Tl-201 was also noted.
Results
A total of 600 myocardial segments were comparatively analyzed. Diagnostic concordance between both tracers in defining normal and abnormal perfusion on a segmental basis was 88% (κ = 0.71). The percentage of normal, reversible and non-reversible segments in the Tc-99m MIBI and Tl-201 study were 67–61%, 11–20% and 22–19% respectively. While the number of irreversible defects were similar for both tracers, more number of reversible defects were identified by Tl-201 MPS than Tc-99m MIBI (65 vs. 123, p = 0.001). No significant difference between the defect scores of both tracers was found.
Conclusion
MPS using both tracers offered agreement in defining or excluding perfusion abnormalities in a major part of the data. However, Tl-201 MPS yielded better detection rate of myocardial ischemia than Tc-99m MIBI MPS in diabetic patients.
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References
Keen H, Barnes DJ (1997) The diagnosis and classification of diabetes mellitus and impaired glucose tolerance. In: Pickup JC, Williams G (eds) Textbook of diabetes, 2nd edn. Blackwell Science Ltd, USA, pp 2.1–10
Falcone C, Nespoli L, Geroldi D, Gazzaruso C, Buzzi MP, Auquadro C, Tavazzi L, Schvartz PJ (2003) Silent myocardial ischemia in diabetic and nondiabetic patients with coronary artery disease. Int J Cardiol 90:219–227
Wackers FJ, Young LH, Inzucchi SE, Chyun DA, Davey JA, Barrett EJ, Taillefer R, Wittlin SD, Heller GV, Filipchuk N, Engel S, Ratner RE, Iskandrian AE (2004) Detection of ischemia in asymptomatic diabetics investigators. Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care 27(8):1954–1961
Wieneke H, Zander C, Eising EG, Haude M, Bockisch A, Erbel R ( 1999) Noninvasive characterization of cardiac microvascular disease by nuclear medicine using single-photon emission tomography. Herz 24(7):515–521
Slart RH, Bax JJ, van Veldhuisen DJ, van der Wall EE, Dierckx RA, Jager PL (2006) Imaging techniques in nuclear cardiology for the assessment of myocardial viability. Int J Cardiovasc Imaging 22:63–80
Sun SS, Huang JL, Tsai SC, Ho YJ, Kao CH (2001) The higher likelihood of developing cardiomegaly during follow-up in patients with syndrome X and abnormal thallium-201 myocardial perfusion SPECT. Int J Cardiovasc Imaging 17:271–278
Amersham healthcare product information (1995) USA
Burak Z, Akın H, Buket S, Sağcan A, Argon M, Atay Y, Durmaz I, Duman Y (1998) The role of Tc-99m-tetrofosmin myocardial perfusion scintigraphy in the assessment of patients with previous myocardial infarction: a comparative study with Tl-201. Nucl Med Commun 19:127–136
Janand-Delenne B, Savin B, Habib G, Bory M, Vague P, Lassman-Vague P (1999) Silent myocardial ischemia in patients with diabetes. Diabetes Care 22:1396–400
Kang X, Berman DS, Lewin HC, Miranda R, Erel J, Friedman JD, Amanullah AM (1999) Comparative ability of myocardial perfusion single photon emission tomography to detect coronary artery disease in patients with and without diabetes mellitus. Am Heart J 137:949–957
Almeda FQ, Kason TT, Nathan S, Kavinsky CJ (2004) Silent myocardial ischemia: concepts and controversies. Am J Med 116:112–118
Kumar R, Patel CD, Marwah A, Gupta R, Sharma S, Malhotra A (2001) Detection of coronary artery disease by stress thallium scintigraphy in diabetic patients. Nucl Med Commun 22:287–289
Gökçel A, Aydın M, Yalçın F, Yapar AF, Ertorer ME, Özşahin AK, Müderrisoğlu H, Aktaş A, Güvener N, Akbaba M (2003) Silent coronary artery disease in patients with type 2 diabetes mellitus. Acta Diabetol 40:176–180
Antonopoulos A, Anand DV, Lahiri A (2005) Diabetes mellitus: evaluation of patients with known or suspected coronary artery disease and the role played by myocardial perfusion imaging. Nucl Med Commun 26(7):587–591
Kostkiewicz M, Tracz W, Przewlocki T, Kawalec E (2001) Predictive potential of noninvasive methods, inclusive of exercise SPECT Tc99m MIBI imaging, in recognition of high-risk patients with left main coronary artery stenosis. Int J Cardiovasc Imaging 17:347–352
Kahn JK, McGhie I, Akers MS, Sills MN, Faber TL, Kulkarni PV, Willerson JT, Corbett JR (1989) Quantitative rotational tomography with Tl-201 and Tc-99m methoxy-isobutile-isonitrile. Circulation 79:1282–1293
Cramer MJ, Verzijlbergen JF, Van der Wall EE, Niemeyer MG, Zwinderman AH, Ascoop CA, Pauwels EJ (1994) Head-to-head comparison between technetium-99m-sestamibi and thallium-201 tomographic imaging for the detection of coronary artery disease using combined dipyridamole-exercise stress. Coron Atrery Dis 5(9):787–791
Maisey MN, Lowry A, Bischof-Delaloye A, Fridrich R, Inglese E, Khalil MN, van der Schout JB (1990) European multi-centre comparison of thallium-201 and technetium 99m Methoxy isobutiyl isonitrile in ischemic heart disease. Eur J Nucl Med 16(12):896–872
Taillefer R, Lambert R, Dupras G, Gregoire J, Leveille J, Essiambre R, Phaneuf DC (1989) Clinical comparison between thallium-201 and Tc-99m methoxy isobutiyl isonitrile myocardial imaging for detection of coronary artery disease. Eur J Nucl Med 15(12):805
Wackers FJ (1992) Comparison of Tl-201 and technetium-99m methoxy-isobutiyl isonitrile. Am J Cardiol 70(14):30E–34E
Taillefer R, DePuey EG, Udelson JE, Beller GA, Latour Y, Reeves F (1997) Comperative diagnostic accuracy of Tl-201 and Tc-99m MIBI SPECT imaging (perfusion and ECG-gated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol 29:69–77
Glover DK, Ruiz M, Edwards NC, Cunningham M, Simanis JP, Simith WH, Watson DD, Beller GA (1995) Comparison between 201Tl and 99mTc sestamibi uptake during adenosine-induced vasodilatation as a function of coronary stenosis severity. Circulation 91:813–820
Zoneraich S, Silverman G, Zonersich O (1980) Primary myocardial disease, diabetes mellitus, and small vessel disease. Am Heart J 100:754–755
Nitenberg A, Ledoux S, Valensi P, Sachs R, Attali JR, Antony I (2001) Impairment of coronary microvasculary dilatation in response to cold-pressor induced sympathetic stimulation in type 2 diabetic patients with abnormal thallium imaging. Diabetes 50:1180–1185
Yokoyama I, Yonekura K, Ohtake T, Yang V, Shin WS, Yamada N, Ohtoma K, Nagai R (2000) Coronary microangiopathy in type 2 diabetic patients: relation to glycemic control, sex, and microvascular angina rather than to coronary artery disease. J Nucl Med 41:978–985
Hasdai D, Gibbons RJ, Holmes DR, Higano ST, Lerman A (1997) Coronary endothelial dysfunction in humans is associated with myocardial perfusion defects. Circulation 96:3390–3395
Kapur A, Latus KA, Davies G, Dhawan RT, Eastick S, Jarritt PH et al (2002) A comparison of three radionuclide myocardial perfusion tracers in clinical practice: a ROBUST study. Eur J Nucl Med 29:1608–1616
Narita M, Kurihara T, Murano K, Usami M, Honda M (1991) Clinical implications of diffuse slow washout of thallium-201 in exercise stress myocardial SPECT. Kaku Igaku 28:691–699
Yonezawa Y, Hamashige N, Doi Y, Odawara H, Takata J, Yamada M, Akagi N, Maeda T, Yoshida S (1991) Significance of diffuse slow washout in dipyridamole loading thallium-201 myocardial perfusion scintigraphy. Kaku Igaku 28:355–360
Sekiya M, Suzuki J, Watanabe K, Funada J, Takashi O, Akutsu H (2001) Beneficial effect of troglitazone, an insulin-sensitizing antidiabetic agent, on coronary circulation in patients with non-insulin-dependent diabetes mellitus. Jpn Circ J 65:487–490
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The authors would like to thank Dr. Adil Boz for his valuable comments and suggestions through the article.
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Ömür, Ö., Özcan, Z., Argon, M. et al. A comparative evaluation of Tl-201 and Tc-99m sestamibi myocardial perfusion spect imaging in diabetic patients. Int J Cardiovasc Imaging 24, 173–181 (2008). https://doi.org/10.1007/s10554-007-9244-6
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DOI: https://doi.org/10.1007/s10554-007-9244-6