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

Document Type : Original Article

Authors

1 Division of Health Science, Osaka University Graduate School of Medicine

2 Osaka University

Abstract

Objective(s): To appropriately use one-day myocardial perfusion imaging (MPI) with 99mTc radiopharmaceuticals (i.e. to avoid shine-through artifacts), injection doses need to be optimized and dose ratios between the 1st and 2nd 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 99mTc radiopharmaceuticals in Japan.
Methods: A nationwide survey was conducted in June and July 2016. Questionnaires about stress MPI protocols using 99mTc 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 99mTc radiopharmaceuticals are needed in Japan.

Keywords

Main Subjects


  1. Jaarsma C, Leiner T, Bekkers SC, Crijns HJ, Wildberger JE, Nagel E, et al. 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 meta-analysis. J Am Coll Cardiol. 2012;59(19):1719-28.
  2. Metz LD, Beattie M, Hom R, Redberg RF, Grady D, Fleischmann KE. The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol. 2007;49(2):227-37.
  3. Dorbala S, Di Carli MF, Beanlands RS, Merhige ME, Williams BA, Veledar E, et al. Prognostic value of stress myocardial perfusion positron emission tomography: results from a multicenter observational registry. J Am Coll Cardiol. 2013;61(2):176-84.
  4. Hachamovitch R, Rozanski A, Shaw LJ, Stone GW, Thomson LE, Friedman JD, et al. 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.
  5. Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, et al. 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.
  6. Einstein A. Effects of radiation exposure from cardiac imaging: how good are the data? J Am Coll Cardiol. 2012;59(6):553-65.
  7. Einstein A, Pascual TN, Mercuri M, Karthikeyan G, Vitola JV, Mahmarian JJ, et al. Current worldwide nuclear cardiology practices and radiation exposure: result from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS). Eur Heart J. 2015;36(26):1689-96.
  8. 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):1850-5.
  9. Pascual TN, Mercuri M, El-Haj N, Bom HH, Lele V, Al-Mallah MH, et al. 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):501-10.

10. Gupta A, Bajaj NS. Reducing radiation exposure from nuclear myocardial perfusion imaging: time to act is now. J Nucl Cardiol. 2017;24(6):1856-9.

11. Mercuri M, Pascual TN, Mahmarian JJ, Shaw LJ, Dondi M, Paez D, et al. 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.

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

13. Taillefer R, Gagnon A, Laflamme L, Grégoire J, Léveillé J, Phaneuf DC. 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.

14. Van Train KF, Areeda J, Garcia EV, Cooke CD, Maddahi J, Kiat H, et al. 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.

15. Hesse B, Tägil K, Cuocolo A, Anagnostopoulos C, Bardiés M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging. 2005;32(7):855-97.

16. Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol. 2016;23(3):606-39.

17. Taillefer R, Laflamme L, Dupras G, Picard M, Phaneuf DC, Léveillé 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.

18. Thompson RC, O’Keefe JH, McGhie AI, Bybee KA, Thompson EC, Bateman TM. Reduction of SPECT MPI radiation dose using contemporary protocols and technology. JACC Cardiovasc Imaging. 2017;11(2 Pt 1):282-3.

19. Nakajima K, Okuda K, Momose M, Matsuo S, Kondo C, Sarai M, et al. IQ·SPECT technology and its clinical applications using multicenter normal databases. Ann Nucl Med. 2017;31(9):649-59.