Influences of radionuclides on left ventricular phase analysis of gated myocardial perfusion single-photon emission computed tomography images in ischemic heart disease

Objective Phase analysis is expected to improve the accuracy of myocardial ischemia diagnosis in conjunction with myocardial perfusion and wall motion imaging and quantification. Although previous studies have reported perfusion image disagreements in relation to radionuclides, a few reports have examined the influences of radionuclides on phase analysis. We evaluated the influences of different radionuclides on stress-induced left ventricular mechanical dyssynchrony by phase analysis using electrocardiogram (ECG)-gated myocardial perfusion single photon emission computed tomography (SPECT) (MPS) imaging in patients with ischemic heart disease (IHD). Methods A total of 202 patients with suspected or known IHD were investigated retrospectively. All the patients underwent coronary arteriography and were subsequently classified into the following groups: 43 patients without any coronary lesion (0VD), 71 patients with single-vessel disease (1VD), 59 patients with two-vessel disease (2VD), and 29 patients with three-vessel disease (3VD). Both stress and rest gated-MPS were performed using Tc-99m-methoxyisobutylisonitrile (MIBI)/tetrofosmin (TF) in 118 patients and with (TlCl)-Tl-201 in 84 patients. Phase analysis was performed to obtain the peak phase, phase standard deviation (SD), and bandwidth. Finally, we investigated potential differences between the phase analysis indices and the respective radionuclides used. Results The peak phase did not exhibit any significant differences in the numbers of affected branches in either Tc-99m-MPS or Tl-201-MPS during stress or rest MPS. Furthermore, both the phase SD and bandwidth demonstrated a tendency to increase in patients with increased numbers of affected branches. A significant difference was observed in the stress MPS when Tc-99m-MIBI/TF was used (p < 0.05), but no significant difference was observed in the stress MPS when (TlCl)-Tl-201 was used. Both the phase SD and bandwidth of all patients in Tc-99m-MPS during stress were significantly larger than those at rest (p < 0.05). Conversely, both the phase SD and bandwidth of all patients in Tl-201-MPS at stress was significantly smaller than that at rest (p < 0.05). Conclusion Phase analysis using Tc-99m-MPS was considered to be useful for the detection of stress-induced left ventricular mechanical dyssynchrony, although it is necessary to be careful when using Tl-201-MPS.

Automated summary

Objective phase analysis combined with myocardial perfusion and wall motion imaging is expected to enhance the accuracy of myocardial ischemia diagnosis. Different radionuclides may have varying influences on stress-induced left ventricular mechanical dyssynchrony detection, with Tc-99m-MPS considered more useful compared to Tl-201-MPS.