One-Day Exercise Stress/Rest MYOVIEW Protocol

To obtain the best quality images, one-day studies should be done on a routine basis only in patients who are close to ideal body weight. Either the stress/rest or rest/stress sequence using MYOVIEW is acceptable for one-day studies. The major requirements are that there be a dose ratio of at least 1:3 between the first and second dose and a delay of 2 to 4 hours between studies.1

The timing and sequence of a one-day stress/rest MYOVIEW study is demonstrated. The minimum time between injection at peak stress and starting imaging is 15 minutes for exercise and 45 minutes for pharmacologic stress. In this sequence, the lower MYOVIEW dose is administered when myocardial blood flow is the highest, during stress, and the background activity in the subdiaphragmatic area is low due to a decrease in mesenteric blood flow during exercise. Many cardiologists prefer this protocol, as the timing is similar to that for TI-201 imaging. The diagnostic accuracy for this split dose sequence is excellent and visual and quantitative analysis on the rest study is not adversely affected if appropriate ratios of injected radioactivity and time interval between administration are maintained.2

1. Montz R, Perez-Castejon MJ, Jurado JA, et al. Technetium-99m tetrofosmin rest/stress myocardial SPET with a same-day 2-hour protocol: comparison with coronary angiography. A Spanish-Portuguese multicentre clinical trial. Eur J Nucl Med. 1996;23:639-647
2. Schulz G, Ostwald E, Kaiser HJ, vom Dahl J, Kleinhans E, Buell U. Cardiac stress-rest single-photon emission computed tomography with technetium-99m-labeled tetrofosmin: influence of washout kinetics on regional myocardial uptake values of the rest study with a one-day protocol.
   J Nucl Med. 1997;4:298-301.