Myoview - Clinical Practice

 

 

A comparison of three radionuclide myocardial perfusion tracers in clinical practice: the ROBUST* study.

A. Kapur, K.A. Latus, G. Davies, R.T. Dhawan, S. Eastick, P.H. Jarritt, G. Roussakis, M.C. Young, C. Anagnostopoulos, J. Bomanji, D.C. Costa, D.J. Pennell, E.M. Prvulovich, P.J. Ell, and S.R. Underwood

*ROBUST is an acronym for the Royal Brompton and UCL Study of Thallium and Technetium.

Comparison of Thallium-201 and Technetium-99m Myocardial Perfusion Tracers

Objective

Compare the technical and clinical performance of thallium-201 (Tl), methoxyisobutylisonitrile (MIBI), and tetrofosmin (Tf) in routine clinical practice.

Methodology

  • 2,560 randomized patients received Tl-201, MIBI, or Tf
  • 1-day stress/rest protocol was used for MIBI and Tf
  • Tracer uptake was scored using a 17-segment model, quality and artifact scores were assigned
  • Ratios of heart, liver, subdiaphragm, and lung were studied

Results

  • Mean quality scores
    • Scores for exercise testing did not differ significantly among all three tracers
    • Both technetium-99m tracers scored significantly higher than Tl-201 in rest scores
  • Attenuation artifacts
    • Both technetium tracers had a higher percentage of studies with no artifact than did Tl-201
  • Low-count artifacts
    • No difference between tracers with stress
    • At rest, no difference between MIBI and Tf
  • Ratios
    • Heart/Subdiaphragm: MIBI and Tf were equal
    • Heart/Liver: MIBI and Tf were equal
    • Heart/Lung: MIBI and Tf were equal
  • Sensitivity and specificity for detection of CAD
    • No significant difference between tracers
  • Overall image quality score
    • No difference between MIBI and Tf, each had similar high accuracy for the detection of coronary stenosis

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Discussion Points

  • Image quality: superior with technetium tracers
  • Organ uptake: MIBI and Tf are equal
  • Comparison with coronary anatomy (subset of patients)
    • Evaluating the ability of perfusion imaging to detect coronary obstruction
    • High sensitivity and specificity were found overall (91% and 87%, respectively) for each tracer, with no difference between tracers

Outcome

All three tracers perform well in clinical terms, with high sensitivity and specificity for angiographic stenosis and no differences in accuracy between tracers.

References: 1. Kapur A, Latus KA, Davies G, et al. A comparison of three radionuclide myocardial perfusion tracers in clinical practice: the ROBUST study. Eur J Nucl Med. 2002:29;1608-1616. 2. MYOVIEW Prescribing Information.

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