Optimization of a simultaneous dual-isotope
I-MIBG myocardial SPECT imaging
protocol with a CZT camera for trigger zone
assessment after myocardial infarction for
routine clinical settings: Are delayed acquisition
and scatter correction necessary?
Emmanuel D’estanque, MD,
Christophe Hedon, MD,
t Lattuca, MD,
lie Bourdon, MD,
Meriem Benkiran, MD,
lie Verd, MD,
Franc¸ois Roubille, MD, PhD,
and Denis Mariano-Goulart, MD, PhD
Nuclear Medicine Department, Montpellier University Hospital, Montpellier Cedex 5, France
Cardiology Department, Montpellier University Hospital, Montpellier, France
U1046 INSERM, UMR9214 CNRS, Montpellier University Hospital, Montpellier, France
Received Dec 4, 2015; accepted Apr 11, 2016
I-MIBG SPECT can assess trigger zones (dysfunctions
in the autonomic nervous system located in areas of viable myocardium) that are substrate for
ventricular arrhythmias after STEMI. This study evaluated the necessity of delayed acquisition
and scatter correction for dual-isotope
I-MIBG SPECT studies with a CZT camera to
identify trigger zones after revascularization in patients with STEMI in routine clinical settings.
Methods. Sixty-nine patients were prospectively enrolled after revascularization to
I-MIBG SPECT using a CZT camera (Discovery NM 530c, GE). The ﬁrst
acquisition was a single thallium study (before MIBG administration); the second and the third
were early and late dual-isotope studies. We compared the scatter-uncorrected and scatter-
corrected (TEW method) thallium studies with the results of magnetic resonance imaging or
transthoracic echography (reference standard) to diagnose myocardial necrosis.
Results. Summed rest scores (SRS) were signiﬁcantly higher in the delayed MIBG studies than
the early MIBG studies. SRS and necrosis surface were signiﬁcantly higher in the delayed thallium
studies with scatter correction than without scatter correction, leading to less trigger zone diagnosis
for the scatter-corrected studies. Compared with the scatter-uncorrected studies, the late thallium
scatter-corrected studies provided the best diagnostic values for myocardial necrosis assessment.
Conclusions. Delayed acquisitions and scatter-corrected dual-isotope
SPECT acquisitions provide an improved evaluation of trigger zones in routine clinical settings
after revascularization for STEMI. (J Nucl Cardiol 2017;24:1361–69.)
Key Words: Trigger zone
Æ MIBG Æ myocardial infarction Æ scatter correction Æ cardiac
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Electronic supplementary material The online version of this
article (doi:10.1007/s12350-016-0524-1) contains supplementary
material, which is available to authorized users.
Reprint requests: Emmanuel D’estanque, MD, Nuclear Medicine
Department, Lapeyronie University Hospital, 371, avenue du Doyen
Gaston Giraud, 34295 Montpellier Cedex 5, France;
Copyright Ó 2016 American Society of Nuclear Cardiology.