Tehran University of Medical Sciences
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Davood Beiki

Initial and delayed stress phase imaging in a single-injection double-acquisition SPECT: The potential value of early 99mTc-MIBI redistribution in assessment of myocardial perfusion reversibility in patients with coronary artery disease

Authors: Beiki D, Fallahi B, Mohseni M, Khalaj A, Fard-Esfahani A, Eftekhari M,
Nuklearmedizin, Vol.49, No.1, 2010,Page:19-27

Some studies reported that 99mTc-MIBI may redistribute in ischaemic myocardium and this phenomenon may have potential role for better assessment of viability by delayed 99mTc-MIBI imaging. Some studies also suggested that infusion of low dose dobutamine during delayed imaging may enhance the value of 99mTc-MIBI imaging for evaluation of viability. The aim of this study is to determine whether the observed changes of perfusion defects on delayed images are caused by early radiotracer redistribution or as a result of reversal partial volume effect secondary to inotropic stimulation.


89 patients with angiographically proven coronary artery disease (CAD) were enrolled in this randomized clinical trial study. In all cases, gated-SPECT images were obtained 60 minutes after stress with dipyridamole injection. Subsequently the patients were randomly allocated in two groups and the second imaging was performed at 120th minute during low dose dobutamine (dobutamine group; 45 cases) or placebo infusion (placebo group; 44 cases). Difference between summed stress score of the first (SSS1) and second (SSS2) stress images (DeltaSSS) was considered as a marker of reversibility in single-injection double-acquisition (SIDA) protocol. Also summed difference score (SDS) was recorded as a marker of reversibility in standard stress/rest, double-injection double-acquisition (DIDA) protocol. DeltaSSS of the two studied groups were compared. Also the correlation and agreement between DeltaSSS and SDS were analyzed.


A significant difference was found between SSS1 (median 15, range 0-48) and SSS2 (median 11, range 0-42) in total patients (p < 0.0001). A significant correlation was noted between DeltaSSS and SDS in dobutamine group (r = 0.58, p = 0.002) as well as in placebo group (r = 0.57, p <