The Status of Stress Myocardial Perfusion Imaging Using 99mTc Pharmaceuticals in Japan: Results from a Nationwide Survey

Overview

Journal Asia Ocean J Nucl Med Biol

Specialty Nuclear Medicine

Date 2018 Jul 13

PMID 29998141

Citations 1

Authors

Ryuto Otsuka

Yosuke Miyazaki

Narumi Kubo

Mio Kawahara

Jun Takaesu

Kazuki Fukuchi

Affiliations

Soon will be listed here.

Abstract

Objectives: To appropriately use one-day myocardial perfusion imaging (MPI) with Tc radiopharmaceuticals (i.e. to avoid shine-through artifacts), injection doses need to be optimized and dose ratios between the 1 and 2 scans should be maintained at ≥ 3. However, the current state of practice in Japan is unclear. Thus, the aim of this study was to clarify the details of MPI protocols using Tc radiopharmaceuticals in Japan.

Methods: A nationwide survey was conducted in June and July 2016. Questionnaires about stress MPI protocols using Tc radiopharmaceuticals were sent to 641 nuclear medicine facilities.

Results: Responses were received from 246 facilities. One-day protocols were used in 97.1% of the facilities. The most common injection dose ratio was 2.5. Only 18.2% of facilities achieved the recommended injection dose ratio. Stress-only protocols were performed in only 1.7% of facilities; the primary reasons for not performing stress-only protocols were as follows: 1) "The reading-physician cannot interpret the image just after the first scan," and 2) "Preparation of radiopharmaceuticals and scan arrangements turn out to be complicated."

Conclusion: Approximately 80% of nuclear medicine facilities do not follow the recommended injection dose ratio. Stress-only protocols are ideal, but are performed at very few facilities. Both optimization and standardization of stress MPI protocols using Tc radiopharmaceuticals are needed in Japan.

Citing Articles

Current status and perspectives of nuclear cardiology.

Tamaki N, Manabe O Ann Nucl Med. 2023; 38(1):20-30.

PMID: 37891375 DOI: 10.1007/s12149-023-01878-1.

References

Shaw L, Berman D, Maron D, Mancini G, Hayes S, Hartigan P . Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008; 117(10):1283-91. DOI: 10.1161/CIRCULATIONAHA.107.743963. View

Hachamovitch R, Rozanski A, Shaw L, Stone G, Thomson L, Friedman J . Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J. 2011; 32(8):1012-24. DOI: 10.1093/eurheartj/ehq500. View

Van Train K, Garcia E, Maddahi J, Areeda J, Cooke C, Kiat H . Multicenter trial validation for quantitative analysis of same-day rest-stress technetium-99m-sestamibi myocardial tomograms. J Nucl Med. 1994; 35(4):609-18. View

Nakajima K, Okuda K, Momose M, Matsuo S, Kondo C, Sarai M . IQ·SPECT technology and its clinical applications using multicenter normal databases. Ann Nucl Med. 2017; 31(9):649-659. PMC: 5651712. DOI: 10.1007/s12149-017-1210-3. View

Einstein A, Pascual T, Mercuri M, Karthikeyan G, Vitola J, Mahmarian J . Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS). Eur Heart J. 2015; 36(26):1689-96. PMC: 4493324. DOI: 10.1093/eurheartj/ehv117. View

Taillefer R, Laflamme L, Dupras G, Picard M, Phaneuf D, Leveille J . Myocardial perfusion imaging with 99mTc-methoxy-isobutyl-isonitrile (MIBI): comparison of short and long time intervals between rest and stress injections. Preliminary results. Eur J Nucl Med. 1988; 13(10):515-22. DOI: 10.1007/BF00256627. View

Van Train K, Areeda J, Garcia E, Cooke C, Maddahi J, Kiat H . Quantitative same-day rest-stress technetium-99m-sestamibi SPECT: definition and validation of stress normal limits and criteria for abnormality. J Nucl Med. 1993; 34(9):1494-502. View

Otsuka R, Kubo N, Miyazaki Y, Kawahara M, Takaesu J, Fukuchi K . Current status of stress myocardial perfusion imaging pharmaceuticals and radiation exposure in Japan: Results from a nationwide survey. J Nucl Cardiol. 2017; 24(6):1850-1855. DOI: 10.1007/s12350-017-0867-2. View

Dorbala S, Di Carli M, Beanlands R, Merhige M, Williams B, Veledar E . Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry. J Am Coll Cardiol. 2012; 61(2):176-84. PMC: 3549438. DOI: 10.1016/j.jacc.2012.09.043. View

10.

Henzlova M, Duvall W, Einstein A, Travin M, Verberne H . ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol. 2016; 23(3):606-39. DOI: 10.1007/s12350-015-0387-x. View

11.

Pascual T, Mercuri M, El-Haj N, Bom H, Lele V, Al-Mallah M . Nuclear Cardiology Practice in Asia: Analysis of Radiation Exposure and Best Practice for Myocardial Perfusion Imaging　- Results From the IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS). Circ J. 2017; 81(4):501-510. DOI: 10.1253/circj.CJ-16-0677. View

12.

Gupta A, Bajaj N . Reducing radiation exposure from nuclear myocardial perfusion imaging: Time to act is now. J Nucl Cardiol. 2017; 24(6):1856-1859. PMC: 5681434. DOI: 10.1007/s12350-017-0915-y. View

13.

Metz L, Beattie M, Hom R, Redberg R, Grady D, Fleischmann K . The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol. 2007; 49(2):227-37. DOI: 10.1016/j.jacc.2006.08.048. View

14.

Jaarsma C, Leiner T, Bekkers S, Crijns H, Wildberger J, Nagel E . Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: a.... J Am Coll Cardiol. 2012; 59(19):1719-28. DOI: 10.1016/j.jacc.2011.12.040. View

15.

Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J . EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging. 2005; 32(7):855-97. DOI: 10.1007/s00259-005-1779-y. View

16.

Mercuri M, Pascual T, Mahmarian J, Shaw L, Dondi M, Paez D . Estimating the Reduction in the Radiation Burden From Nuclear Cardiology Through Use of Stress-Only Imaging in the United States and Worldwide. JAMA Intern Med. 2016; 176(2):269-73. DOI: 10.1001/jamainternmed.2015.7106. View

17.

Thompson R, OKeefe J, McGhie A, Bybee K, Thompson E, Bateman T . Reduction of SPECT MPI Radiation Dose Using Contemporary Protocols and Technology. JACC Cardiovasc Imaging. 2017; 11(2 Pt 1):282-283. DOI: 10.1016/j.jcmg.2017.03.008. View

18.

Einstein A . Effects of radiation exposure from cardiac imaging: how good are the data?. J Am Coll Cardiol. 2012; 59(6):553-65. PMC: 3272627. DOI: 10.1016/j.jacc.2011.08.079. View

19.

Taillefer R, Gagnon A, Laflamme L, Gregoire J, Leveille J, Phaneuf D . Same day injections of Tc-99m methoxy isobutyl isonitrile (hexamibi) for myocardial tomographic imaging: comparison between rest-stress and stress-rest injection sequences. Eur J Nucl Med. 1989; 15(3):113-7. DOI: 10.1007/BF00254621. View