MIBI-SPECT

K. Yutani, E. Shiba, H. Kusuoka, M. Tatsumi, T. Uehara, T. Taguchi, S.l. Takai, T. Nishimura, Comparison of FDG-PET with MIBI-SPECT in the detection of breast cancer and axillary lymph node metastasis, J. Comput. Assist. Tomogr. 24(2) (2000) 274-280. 

In a retrospective study including 46 patients with locally advanced or metastatic breast cancer, Takamura et al. evaluated the significance of [ Tc]MIBI uptake in early and delayed images in predicting tumor response to chemotherapy with epirubicin and cyclophosphamide or docetaxel [87]. Before starting chemotherapy, the patients underwent a [ Tc]MIBI SPECT study. The parameters extracted from SPECT images were the tumor-to-nor-mal tissue ratios (T/N) of [ Tc]MIBI uptake at 10 min (early phase) and at 180 min (delayed phase) and the retention index (RI) was calculated as follows RI = (T/N(d))/(T/N(e)). After chemotherapy, tumor response was determined by clinical examination. 

Fig. 5 Representative p Tc]MIBI SPECT scintimammograms obtained at 10 min (early phase) and 180 min (delayed phase) after i.v. injection of [ Tc]MIBI responder (A and B) and non-responder (C and D) patients (reprinted with permission of Wiley-Liss, Inc., a subsidiary of John Wiley Sons, Inc., Ref. [87])...

Zhou et al. in a study including 34 patients with histologically confirmed lung cancer underwent [ Tc]MIBI SPECT followed by surgery [93]. The early and delayed SPECT images were acquired at 15 and 180 min, respectively, after injection of [ Tc]MIBI. Sample tumors were analyzed by immunohistochemistry and RT-PCR for expression of Pgp and MRPl. The delayed uptake (at 180 min) and the efflux rate of [ Tc]MIBI (between 15 and 180 min) correlates significantly with the expression levels of Pgp. Such correlations were not observed in relation to the early tumor uptake, which suggests that early uptake is more affected by blood flow. 

Akgun A, Cok G, Karapolat I, Goksel T and Burak Z. Tc-99m MIBI SPECT in prediction of prognosis in patients with small cell lung cancer. Ann Nucl Med 2006 20 269-275. 

Dual isotope SPECT protocols obtain resting images with t1 and stress images with MIBI followed by 24 h xi late redistribution imaging [39, 40]. These protocols have demonstrated good prediction of contractile function recovery after revascularization comparable to simpler single tracer protocols [41]. 

The value of SPECT viability imaging with is well established clinically with overall 70-75% accuracy for predicting recovery of LV function compared to PET [28, 29, 61, 89]. For MIBI, predictive accuracy decreases to 64% compared to PET [106, 107]. Some of these discrepancies are explained by frequent inferior wall attenuation artifacts encountered with SPECT [4, 108]. The randomized trial CHRISTMAS (Carvedilol Hibernating Reversible Ischemia) demonstrated that SPECT MIBI predicted LV functional recovery in patients receiving carvedilol [109] with LVEF improving by 3.8%, more in those patients with... 

Figure 13.4 (See color insert) SPECT study of myocardial infarction. Notice that the increase in uptake of [ Tc]BTAP annexin V corresponds to the perfusion deficit identified in the [ Tc]MIBI scan. This data is reproduced with permission from Ref. (16).

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