By Vasken Dilsizian MD, Jagat Narula MD, DM, PhD (auth.)
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Extra resources for Atlas of Nuclear Cardiology
Experimental studies with 99mTc-sestamibi have shown that myocardial uptake and clearance of 99mTc-sestamibi are related to the mitochondrial transmembrane potential and do not differ from ischemic to nonischemic regions. In addition, experimental studies of myocardial infarction, with and without reperfusion, have fueled optimism in the use of MISI ~ 4- 24 h 30 min B FIGURE Stress Time, h 99mTc-sestamibi clinically for myocardial viability assessment. In the clinical setting, however, with the exception of a few studies, both 99mTc-sestamibi and tetrofosmin appear to underestimate myocardial viability.
Although standard stress-3- to 4-hour redistribution 20lTl scintigraphy may underestimate the presence of ischemic but viable myocardium in . Blood lOI TI 2 Post-stress myocardial uptake redistribution Time, h , " 3-h 1 , " t I II • ,, , ,, ' , , '. 1 Blood (2U1 TI I Post- Ires myocardial uptake A (irrever ible d f o II :~ ..... ormal ..... 1 h mic :~~ t) C :~ - ..... \ Time, h t 3-h redi tribution increases) during the period between stress and redistribution imaging, then a stress-induced defect in a region with viable myocytes that can accumulate 20lTl on the redistribution phase will appear reversible.
In addition, a significant inverse correlation between the magnitude of 20lTI activity after reinjection and regional volume fraction of interstitial fibrosis has been demonstrated in comparative clinicopathologic studies . It is possible that the initial myocardial uptake of 20lTI (~ostinjection) reflects regional blood flow while redistribution of OlTI in a given defect depends not only on the severity of the initial defect but also on the presence of viable myocytes, the concentration of the tracer in the blood, and the rate of decline of 20lTIleveis in the blood.