Stress and Rest Myocardial Tomoscintigraphies Using Mono- or Double-isotope Protocol With a Semiconductor Camera

Not Applicable

Completed

Interventions: Procedure: Tomoscintigraphy with D.SPECT camera (SPECTRUM Dynamics®, Israel)
Drug: 99mTc-Sestamibi
Drug: Thallium-201

Brief Summary: The purpose is to demonstrate the concordance of diagnostic information obtained with:

1. a conventional examination with 2 distinct recordings on D.SPECT camera after 99mTc-sestamibi injections, the first post-stress and the second at rest, 2 to 3 hours later,

and

2. a double isotope examination with a supplementary recording after injection of a little activity of thallium-201 at rest after the first recording and before the second injection of 99mTc-sestamibi for conventional recording at rest,

in patients showing abnormalities of myocardial perfusion in stress myocardial tomoscintigraphy.

Detailed Description: Myocardial perfusion tomoscintigraphy is very used for diagnosis and characterization of abnormalities of stress and rest myocardial perfusion. This examination can be performed with semiconductor gamma cameras that are more performant than conventional cameras regarding spatial resolution, detection sensitivity and energy resolution.

The amelioration of energy resolution could allow the realization of simultaneous recordings of a dye injected at rest and another injected during stress (double isotope recording), while conventional examination needs 2 different recordings, stress and rest, separated from several hours.

In this study patients undergo a conventional examination with D.SPECT camera with 2 recordings, the first after injection of a little activity of 99mTc-sestamibi at stress (≤ 100 MBq) and the second, 2 hours later, after injection at rest of a 3 time bigger activity of 99mTc-sestamibi (≤ 300 MBq). An activity of thallium-201(≤ 50 MBq) is injected at rest after the first recording of stress. 5 minutes later, a supplementary double isotope recording is realized with D.SPECT camera (99mTc-Sestamibi-stress / thallium201-rest).

The demonstration of the hypothesis of this study could considerably diminish the duration of the examination (from 3 to 4 hours to less than 1 hour).

Recruitment & Eligibility

Inclusion Criteria

> 18, without guardianship, signed informed consent
Without contraindication for myocardial perfusion tomoscintigraphy and stress technique (dipyridamole and/or effort), according to common criteria to French Societies of Cardiology and Nuclear Medicine, as it is requested for all patients needing this routine examination
Not in life-and-death emergency, with a stable clinical state (without cardiac insufficiency or instable coronary, without hypertension not well-stabilized under treatment)
Effective contraceptive method for women of childbearing potential
Weight ≤ 100 kg (> 100 kg patients need higher injected activities in order to obtain adequate image quality)
Perfusion abnormalities on stress images

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Patients	Thallium-201	Patients with abnormalities of myocardial perfusion detected with stress tomoscintigraphy, undergo double isotope myocardial tomoscintigraphy using Thallium-201 and 99mTc-sestamibi and traditional myocardial tomoscintigraphy using 99mTc-sestamibi with a semiconductor camera
Patients	Tomoscintigraphy with D.SPECT camera (SPECTRUM Dynamics®, Israel)	Patients with abnormalities of myocardial perfusion detected with stress tomoscintigraphy, undergo double isotope myocardial tomoscintigraphy using Thallium-201 and 99mTc-sestamibi and traditional myocardial tomoscintigraphy using 99mTc-sestamibi with a semiconductor camera
Patients	99mTc-Sestamibi	Patients with abnormalities of myocardial perfusion detected with stress tomoscintigraphy, undergo double isotope myocardial tomoscintigraphy using Thallium-201 and 99mTc-sestamibi and traditional myocardial tomoscintigraphy using 99mTc-sestamibi with a semiconductor camera

Primary Outcome Measures

Name	Time	Method
Quality of images obtained with double isotope tomoscintigraphy and conventional tomoscintigraphy	day 0	Bad; medium; good; very good
Nature of observed abnormalities obtained with double isotope tomoscintigraphy and conventional tomoscintigraphy	day 0	Without abnormalities or artefacts (normal); with rest reversible abnormalities (ischemia); with rest non reversible abnormalities (infarction)

Secondary Outcome Measures

Name	Time	Method

Locations (2): Service de Médecine Nucléaire - CLCC Jean Perrin
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Clermont Ferrand, France
Service de Médecine Nucléaire - Hôpital de Brabois
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Vandœuvre les Nancy, France