The use of Technetium-99m-Sestamibi in the evaluation of equivocal breast artefact in Thallium 201 myocardial perfusion studies

Full text: 900 female patients (age 36-75, mean 56) were referred for Thallium 201 (201TI) over a two year period to assess for coronary artery disease (CAD). 17 patients, with significant anterior will abnormality, were restudied with 99mTc-Sestamibi with gating due to the clinicians low suspicion for significant CAD. Patients underwent a stress rest reinjection protocol study using 201TI and subsequently had a stress planar/SPECT and rest gates 99mTc- Sestamibi study. All images were obtained using GE Optima camera with Hires collimators. 99mTc-Sestamibi data was analysed using CEQUAL reconstruction protocol. Eight patients had normal 99mTc-Sestamibi planar/SPECT studies while a further eight had persisting, although smaller, anterior wall defects which demonstrated normal wall motion on gated SPECT images. One patient had a reversible anterior wall defect confirming the presence of significant ischaemia. Myocardial perfusion imaging with 99mTc-Sestamibi alone enabled 9/17 (53%) patients to have a more definitive evaluation of the anterior wall abnormality. The addition of gated SPECT wall motion analysis enabled the remaining eight patients to be fully evaluated. Conclusion: In women with a low clinical suspicion of coronary artery disease 99mTc-Sestamibi perfusion imaging with gated SPECT provides a more definitive method of excluding coronary artery disease