Image Quality Increases Diagnostic Confidence

MYOVIEW SPECT IMAGES 1
Large Anteroseptal Ischemia

Exercise and rest MYOVIEW SPECT images of a 49-year-old male who presented with increasing anginal chest pain on exertion for the last few months. He also had high BP, high lipids, obesity, and history of smoking. He was on ß-blockers and Ca++ antagonists for hypertension. He exercised for 10:51 minutes on Bruce Protocol, developed chest pain and 2-mm ST segment depression, heart rate (HR) increased from 67 to 105 and BP from 150/80 to 158/90. The SPECT images show a large anteroseptaI ischemia. This is a high-risk study. Cardiac cath showed: LVEDP 20, normal LV function, LAD proximal long 90% lesion, RCA 60%, LCx free from disease. Underwent rotational atherectomy of the LAD, and 2 J&J Palmaz-Schatz stents were placed in the LAD. He had minimal rise in CK and MB postprocedure.

Relevant quality indicators according to the American Society of Nuclear Cardiology2:

  • Accuracy of interpretation
  • Correct differentiation of artifact from perfusion abnormalities
  • Referring physician confidence and patient satisfaction
  • Less necessity for patients with normal scans to undergo angiography
  • Reasonably high ratio of revascularization/angiography from image-directed angiography

Image quality where it counts

  • High target-to-background ratio provides clearer images 3,4
  • Improved image clarity provides confident diagnosis 3,5
  • Demonstrates good sensitivity, specificity, and diagnostic accuracy 5
  • High counts in image available from 15 minutes up to 4 hours after injection 3
  • Earlier imaging and higher quality images possible from 30 to 60 minutes postinjection 3,4

MYOVIEW biokinetics optimizes image quality

  • Rapid clearance from blood, liver, and lungs:
    • Generates high-quality images 3
    • Optimizes heart visualization 3
    • Reduces artifacts from surrounding organs 6,7
In studying patients with known or suspected coronary artery disease, care should be taken to ensure continuous cardiac monitoring and the availability of emergency cardiac treatment. As with all injectable drug products, allergic reactions, and anaphylaxis may occur.
 
Pharmacologic induction of cardiovascular stress may be associated with serious adverse events, such as myocardial infarction, arrhythmia, hypotension, bronchoconstriction, and cerebrovascular events. Caution should be used when pharmacologic stress is selected as an alternative to exercise; it should be used when indicated and in accordance with the pharmacologic stress agent's labeling. The most common adverse reactions reported from post-marketing experience included rash, urticaria, abnormal vision, allergic reactions, and fever.

References: 1. Data on file, Amersham Health. 2. Bateman TM, O'Keefe JH, Williams ME. Design and implementation of a nuclear cardiology testing facility in a private-practice cardiology office setting. J Nucl Cardiol. 1997;4: 156-163. 3. Higley B, Smith FW, Smith T, et al. Technetium-99m-l ,2-bis[bis(2-ethoxyethyl)phosphino]ethane: humanbiodistribution, dosimetry and safety of a new myocardial perfusion imaging agent. J Nucl Med. 1993;34:30-38. 4. Munch G, Neverve J, Matsunari I, Schroter G, Schwaiger M. Myocardialtechnetium- 99m-tetrofosmin and technetium-99m-sestamibi kinetics in normal subjects and patients with coronary artery disease. J Nucl Med. 1997;38:428-432. 5. Jain D. Technetium-99m labeled myocardial perfusion imaging agents. Semin Nucl Med. 1999;29:221-236. 6. Jain D. Nuclear medicine agent brings speed ta cardiac imaging lineup. Adv Radiol Sci Prof May 22, 2000:34-35. 7. Korlyarov EV. Radiopharmaceutical review. Adv Adm Radio/ Radial Onco/. May 1, 2000. Available at: http://www.advanceforar.com/ Accessed: January 3, 2001. 8. MYOVIEW prescribing information.

 


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