Fatih BATİ, Ersoy KEKİLLİ, Ismail KOKSAL, Vedat SUBASİ

The effects of mineral water drinking and extra-abdominal pressure in elimination of attenuation artifacts on myocardial perfusion SPECT

Myocardial perfusion scintigraphy is often used non-invasive diagnostic test for detection of coronary artery disease, myocardial viability, risk assessment and prediction of prognosis. The aim of this study was to evaluate of mineral water drinking and extra-abdominal pressure for elimination of attenuation artifacts on myocardial perfusion SPECT. A total of 27 patients (20 males, 7 females) who have suspicious findings on stress image were included in this study. If patients were reported ischemia or infracted on myocardial perfusion SPECT, they were excluded from the study. Stress SPECT imaging was repeated continuously three times following basal imaging, application of extra-abdominal pressure and after mineral water drinking. SPECT slices were obtained and "Summed Stress Scores" were calculated from three SPECT imaging. Double-blinded two clinicians visually evaluated these slices and have rated based on ease of evaluation as "best image", "Medium" and "Low". Additionally four groups were created from 4 rating areas which had Summed Stress Scores of 3 or above on Polar Map. Mineral water drinking and application of extra-abdominal may be better than basal imaging. Although a method selecting was difficult in theassessment of inferior and inferoseptal wall. Among the three applications for "Summed Stress Scores" were statistically significant differences with Friedman's test in the 1st, 2nd, 3rd and 4th groups (p=0.03, p=0.008, p=0.005 and p=0.0001, respectively). For evaluation of suspicious lesions in the anterior and anteroseptal region, basal imaging did not significantly differ from application of extra-abdominal pressure. Mineral water drinking (and close to the pressure) was found better than basal imaging in Group 2 and 3. In Group 4, there was not significant difference between the application of extra-abdominal pressure and mineral water drinking. On static images, we did not found any significant change for intrathorasic localization and axis of left ventricul among three SPECT. The most remarkable finding among three SPECT was gradually decreasing of hepatic uptake. We though that change in "Summed Stress Score" in both application of extra-abdominal pressure and mineral water drinking may only be due to decreases in hepatic activity associated with time.

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