Usefulness of Dual 67Ga and 99mTc-Sestamibi Single-Photon-Emission CT Scanning in the Diagnosis of Cardiac Sarcoidosis

doi:10.1378/chest.126.4.1372

Chest

Volume 126, Issue 4, October 2004, Pages 1372-1376

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Cardiac sarcoidosis is potentially fatal and hence requires a precise diagnosis. We performed dual ⁶⁷Ga (Ga)-^99mTc-sestamibi (Tc) single-photon emission CT (SPECT) scans by superimposing a Ga-SPECT image on the myocardial outline traced with Tc. The usefulness of this imaging technique in the diagnosis of cardiac sarcoidosis was studied. The subjects in this study were 14 patients with sarcoidosis (mean [± SD] age, 52 ± 16 years; 5 men and 9 women). An IV dose of Tc (74 MBq per 2 mL) was injected into patients 72 h after an IV dose of Ga (111 MBq per 3 mL) was injected. The dual SPECT scan was performed 30 min after the Tc dose was administered. The energy used for collection was 93 keV for Ga and 140 keV for Tc. The myocardial outline was successfully traced in all subjects, allowing us to check for myocardial Ga uptake and to identify its location. Abnormal Ga uptake in the myocardium was observed in 9 of the 14 subjects. In seven of these nine subjects, the location of the abnormal myocardial Ga uptake was identical to the location of reduced Tc uptake. Abnormal Ga uptake disappeared in all cases following steroid therapy. Of the five subjects who were free of abnormal Ga uptake, two showed reduced Tc uptake, and these two subjects had been receiving steroid therapy. These results suggest that dual SPECT scanning using Ga and Tc represents a very useful diagnostic imaging technique since it improves the diagnostic capability of Ga-SPECT to allow the highly specific diagnosis of cardiac sarcoidosis.

Section snippets

Preliminary Experiment

A cylindrical source (diameter, 24 mm) containing Ga (67 MBq per 2 mL) and Tc (67 MBq per 2 mL) was placed on the collimator plane to collect information on the two nuclides simultaneously. An acryl plate with a thickness of 0, 3, or 6 cm was interposed between the collimator and the source. To calculate the scatter ratio, the scatter levels for Ga (collected with an energy of 93 keV) and Tc (collected with an energy of 140 keV) were measured. The influence of the scatter from each nuclide on

Preliminary Experiment

The degree of Tc scatter, which affects Ga images, remained unchanged, and the scatter ratio was constant (ie, 4.7 to 4.8%) for acryl plate thicknesses of 0 to 6 cm. However, the degree of Ga scatter, which affects Tc images, increased with the thickness of the acryl plate (from 6.2 to 8.5% for thicknesses of 0 to 6 cm, respectively). In the experiment using a heart phantom, clear Ga SPECT images were obtained by dual (ie, Ga plus Tc) SPECT scanning when the Tc/Ga concentration ratio was in the

Discussion

The influence of scattered rays from Ga on Tc images was found to increase with the thickness of the acryl plate. However, since the aim of the present study was to improve the accuracy of detection and localization of lesions by Ga SPECT scanning, but not Tc-SPECT scanning, the influence of scattered rays of Ga on Tc images may cause minimal problems. Furthermore, since no significant influence of Tc scattered rays on Ga images was observed even when the thickness of the acryl plate was

Conclusion

Dual (ie, Ga + Tc) SPECT scanning provides a very useful means of improving the capability of Ga SPECT scanning (which is highly specific to sarcoidosis) in the diagnosis of cardiac sarcoidosis. This imaging technique is expected to provide information that is valuable for the early diagnosis of cardiac lesions associated with sarcoidosis and the determination of the indication of steroid therapy.

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Selected ReportsUsefulness of Dual 67Ga and 99mTc-Sestamibi Single-Photon-Emission CT Scanning in the Diagnosis of Cardiac Sarcoidosis

Section snippets

Preliminary Experiment

Preliminary Experiment

Discussion

Conclusion

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Selected Reports
Usefulness of Dual ⁶⁷Ga and ^99mTc-Sestamibi Single-Photon-Emission CT Scanning in the Diagnosis of Cardiac Sarcoidosis