Cardiovascular Journal of Africa: Vol 26 No 4 (July/August 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 4, July/August 2015 176 AFRICA
to reduce interfering infra-cardiac activity. We did not look at
the effect of time in addition to the interventions carried out.
Also, even though the acquisition of prone images was part of
our protocol, we did not analyse the raw data, therefore in the
absence of prone analyses, the overall effect on a stress study
with regard to the interventions carried out is not known.
Conclusion
When using 99mTc sestamibi, the infra-cardiac activity causes
significant artifacts after reconstruction and may lead to errors
in visual and quantitative assessment of myocardial perfusion,
especially in the inferior and infero-septal walls. Our study
demonstrated that the administration of milk or lemon juice
resulted in a significant decrease in the intensity of infra-cardiac
activity compared to a control group. There was a trend towards
greater improvement in the group that received milk for the
resting part of the study compared to the group that received
lemon juice. However, we are not sure of the impact of the
amount of either milk or lemon juice, as well as the timing of
their administration on the study outcomes. Therefore, further
studies are needed to determine the ideal amount and timing
of administration of these interventions. Also, further studies
should be done with regard to prone acquisition with these
interventions.
We thank the staff at the Nuclear Medicine Department at Chris Hani
Baragwanath Academic and Charlotte Maxeke Johannesburg Academic
Hospitals for the practical implementation of this study. Special thanks
go to Professor Elena Libhaber for her assistance with the statistics. The
work was supported in part by a grant received from the University of the
Witwatersrand, South Africa.
References
1. Mbewu A. The burden of cardiovascular disease in sub-Saharan Africa.
SA Heart J 2009; 6(1): 4–10.
2. Better N, Karthikeyan G, Vitola J, Fatima A, Peix A, Novak MD, et
al. Performance of rest myocardial perfusion imaging in the manage-
ment of acute chest pain in the emergency room in developing nations
(PREMIER trial). J Nucl Cardiol 2012; 19(6): 1146–1153.
3. De Greef J, Govender R, Vermaak W, Perumal N, Libhaber E, Vangu
M-Di-T. Does dipyridamole-induced ischaemia affect NT-pro BNP
secretion? Cardiovasc J Afr 2007; 18(6): 371–374.
4. Wackers FJT. Myocardial perfusion imaging. In: Sandler MP, Coleman
RE, Patton JA, Wackers FJT, Gottschalk A, eds. Diagnostic Nuclear
Medicine, 4th edn. Connecticut: Lippincott, Williams & Wilkins, 2002:
273–319.
5. Pennell DJ, Rahman SL. Cardiac stress. In: Ell PJ, Gambhir SS, eds.
Nuclear Medicine in Clinical Diagnosis and Treatment, 3rd edn. London
and Stanford: Churchill Livingstone, 2004: 1093–1104.
6. Better N, Hicks RJ. Infarct-avid imaging and myocardial perfusion
scintigraphy techniques using single-photon radiotracers. In: Ell PJ,
Gambhir SS, eds. Nuclear Medicine in Clinical Diagnosis and Treatment,
3rd edn. London and Stanford: Churchill Livingstone, 2004: 1047–1070.
7. Burrell S, MacDonald A. Artifacts and pitfalls in myocardial perfusion
imaging. J Nucl Med Technol 2006; 34: 193–211.
8. Hofman M, Mckay J, Nandurkar D. Efficacy of milk versus water to
reduce interfering infra-cardiac activity in Tc-99m sestamibi myocardial
perfusion scintigraphy. Nucl Med Commun 2006; 27(11): 837–842.
9. Van Dongen AJ, van Rijk PP. Minimizing liver, bowel and gastric activ-
ity in myocardial perfusion SPECT. J Nucl Med 2000; 41(8): 1315–1317.
10. Lowenstein BA, Pezzuti R, Cohen MC. The use of prone imaging
on acute resting gated myocardial perfusion imaging with Tc-99m
Sestamibi. J Nucl Cardiol 2003; 10(2): 211–212.
11. Peace R, Lloyd J. The effect of imaging time, radiopharmaceutical, full
fat milk and water on interfering extra-cardiac activity in myocardial
perfusion single photon emission tomography. Nucl Med Commun 2005;
26(1): 17–24.
12. Cherng S-C, Chen YH, Lee MS, Yang SP, Huang WS, Cheng CY.
Acceleration of hepatobiliary excretion by lemon juice on Tc-99m
Tetrofosmin Cardiac SPECT. Nucl Med Commun 2006; 27(11): 859–864.
13. Vorster M, Satekge MM, Rheeder P. Erythromycin as an alternative to
reduce interfering extra-cardiac activity in myocardial perfusion imag-
ing. Cardiovasc J Afr 2010; 21(3): 142–147.
14. Malhotra G, Upadhye TS, Nabar A, Asopa RV, Nayak UN, Rajan
MGR. Can carbonated lime drink prior to myocardial perfusion imag-
ing with Tc-99m MIBI reduce the extra-cardiac activity that degrades
the image quality and leads to fallacy in interpretation? Clin Nucl Med
2012; 35: 160–164.
15. Iqbal SM, Khalil ME, Lone BA, Gorski R, Blum S, Heller EN. Simple
techniques to reduce bowel activity in cardiac SPECT imaging. Nucl
Med Commun 2004; 25(4): 355–360.
16. Adil B, Akin YZ, Firat G, Binnur K, Metin E. The volume effect of
the stomach on intestinal activity on same-day exercise-rest Tc-99m
Tetrofosmin myocardial imaging. Clin Nucl Med 2001; 26: 622–625.
17. Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J, et
al. EANM/ESC procedural guidelines for myocardial perfusion imaging
in Nuclear Cardiology. Eur J Nucl Med 2005; 32(7): 855–897.
18. Statsoft Inc. STATISCA: data analysis software system, version 8.0.
Tilsa, OK, USA: statsoft Inc; ;2008.