Evaluation of the efficacy of full fat milk and diluted lemon juice versus no intervention to reduce interfering infra-cardiac activity of Tc-99M Sestamibi during myocardial perfusion imaging.
Date
2013
Authors
Purbhoo, Khushica
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Abstract
The use of Single Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging (MPI), with Technetium – 99m (Tc-99m) Sestamibi in conjunction with either exercise, pharmacologic stress or both is an established tool for both the diagnosis and prognostication of patients with ischemic heart disease. For perfusion imaging with SPECT, Tc-99m labeled radiopharmaceuticals (Sestamibi or Tetrofosmin) are commonly used. The major metabolic pathway for clearance of Sestamibi is the hepatobiliary system which creates difficulty in both visual and quantitative interpretation of myocardial perfusion, particularly of the inferior and infero-septal walls after reconstruction.
Diluted lemon juice, an acid-rich drink is an alimentary cholekinetic that facilitates Sestamibi transit through the liver. Whole milk stimulates liver clearance as well as increases peristaltic movement. The aim of the study was to determine which protocol would be the best to reduce interfering infra-cardiac activity and therefore result in an improvement in image quality. We had three groups, comparing the use of full fat milk, diluted lemon juice and a control group that had no intervention.
All patients referred to our institution for MPI from November 2009 to May 2012 were enrolled in the study. A total of six hundred and thirty (630) patients who fulfilled the inclusion criteria were randomized without stratification into three groups. Group 0 (G0) were given diluted lemon juice, 246 patients; full fat milk to group 1 (G1), 313 patients and group 2 (G2); 71 patients, had no intervention. The latter was the control group. Raw data of both the stress and rest images were visually and quantitatively assessed by two Nuclear Medicine physicians for the presence of infra-cardiac activity. The physicians were blinded to the intervention received and the data were reviewed simultaneously.
The administration of milk or lemon juice resulted in a significant decrease in the intensity of infra-cardiac activity compared to the control group. This improvement was even more significant in the milk group for patients done during rest myocardial perfusion imaging.
Description
A Research Report submitted to the Faculty of Health Sciences,
University of the Witwatersrand, in fulfillment of the requirements for
the degree of
Master of Medicine
In the branch of Nuclear Medicine
Johannesburg
September 2013