The effect of pomegranate juice, lemon juice and secanjabin in reducing infra-cardiac activity of 99mTc-MIBI during myocardial perfusion imaging in comparison with fatty food

Document Type : Original Article

Authors

1 Nuclear Medicine and Molecular Imaging Research Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Nuclear Engineering, Faculty of Advanced Sciences and Technologies, University of Isfahan, Isfahan, Iran

3 Department of Persian Medicine, Faculty of Medical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

4 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Introduction: Eating fatty food is a common technique for decreasing extra cardiac activity, but sometimes patients refuse to eat fatty foods due to various reasons during myocardial perfusion imaging. The aim of this study is to introduce an alternative method for patients who are not able to use fatty foods to accelerate the transit of radiotracer from the liver.
Methods: A total of 100 patients were randomized into four groups to take 200 cc of lemon juice, 200 cc of pomegranate juice, 200 cc of secanjabin, and 100 mg of fatty meal, 10 min after injection of 20 mCi 99mTc-MIBI, respectively in groups A, B, C, and D. The study is carried out in both rest and stress imaging at 30 and 50 min post-injection. Using ROI- based analysis, means of activity counts in heart and liver and, then the mean of heart/liver (H/L) ratios were calculated.
Results:According to data analysis of both rest and stress imaging at min 30 and 50, A and D groups had significantly higher H/L ratio than groups B and C. Comparing the images of groups in both rest and stress protocol at minutes 30 and 50, A and D groups had significantly higher H/L ratio at 50 minutes in comparison with 30 minutes.
Conclusion: In patients who refrain from eating fatty foods, drinking of diluted lemon juice may be recommended as a simple technique and the best alternative to decrease extra-cardiac activity and increase the H/L ratio.

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Main Subjects


  1. Paul AK, Nabi HA. Gated myocardial perfusion SPECT: basic principles, technical aspects, and clinical applications. J Nucl Med Technol. 2004 Dec;32(4):179-87; quiz 188-9.
  2. Da Silva AJ, Tang HR, Wong KH, Wu MC, Dae MW, Hasegawa BH. Absolute quantification of regional myocardial uptake of 99mTc-sestamibi with SPECT: experimental validation in a porcine model. J Nucl Med. 2001 May;42(5):772-9.
  3. Fallahi B, Haghighatafshar M, Farhoudi F, Salehi Y, Aghahosseini F. Comparative evaluation of the diagnostic accuracy of 99mTc-sestamibi gated SPECT using five different sets of image acquisitions at stress and rest phases for the diagnosis of coronary artery disease. Am J Nucl Med Mol Imaging. 2014;4(1):10–16.
  4. Higley B, Smith FW, Smith T, Gemmell HG, Das Gupta P, Gvozdanovic DV, Graham D, Hinge D, Davidson J, Lahiri A. Technetium-99m-1,2-bis[bis(2-ethoxyethyl) phosphino]ethane: human biodistribution, dosimetry and safety of a new myocardial perfusion imaging agent. J Nucl Med. 1993 Jan;34(1):30-8.
  5. Wackers FJ, Berman DS, Maddahi J, Watson DD, Beller GA, Strauss HW, Boucher CA, Picard M, Holman BL, Fridrich R. Technetium-99m hexakis 2-methoxyisobutyl isonitrile: human biodistribution, dosimetry, safety, and preliminary comparison to thallium-201 for myocardial perfusion imaging. J Nucl Med. 1989 Mar;30(3):301-11.
  6. Monzen H, Hara M, Hirata M, Nakanishi A, Ogasawara M, Suzuki T, Sato T, Shimoyama H, Tadehara F, Hirose K, Yuki R. Exploring a technique for reducing the influence of scattered rays from surrounding organs to the heart during myocardial perfusion scintigraphy with technetium-99m sestamibi and technetium-99m tetrofosmin. Ann Nucl Med. 2006 Dec;20(10):705-10.
  7. Middleton GW, Williams JH. Interference from duodeno-gastric reflux of 99Tcm radiopharmaceuticals in SPET myocardial perfusion imaging. Nucl Med Commun. 1996 Feb;17(2):114-8.
  8. Ghaedian T, Mortazavi S, Haghighatafshar M. Multiple myeloma and abdominal aortic aneurysm on myocardial perfusion raw images. Clin Nucl Med. 2015 Nov;40(11):e526-7.
  9. Heller EN, DeMan P, Liu YH, Dione DP, Zubal IG, Wackers FJ, Sinusas AJ. Extracardiac activity complicates quantitative cardiac SPECT imaging using a simultaneous transmission-emission approach. J Nucl Med. 1997 Dec;38(12):1882-90.
  10. Germano G, Chua T, Kiat H, Areeda JS, Berman DS. A quantitative phantom analysis of artifacts due to hepatic activity in technetium-99m myocardial perfusion SPECT studies. J Nucl Med. 1994 Feb;35(2):356-9.
  11. Peace RA, Lloyd JJ. The effect of imaging time, radiopharmaceutical, full fat milk and water on interfering extra-cardiac activity in myocardial perfusion single photon emission computed tomography. Nucl Med Commun. 2005 Jan;26(1):17-24.
  12. van Dongen AJ, van Rijk PP. Minimizing liver, bowel, and gastric activity in myocardial perfusion SPECT. J Nucl Med. 2000 Aug;41(8):1315-7.
  13. 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 Apr;25(4):355-9.
  14. Hara M, Monzen H, Futai R, Inagaki K, Shimoyama H, Morikawa M, Tomioka N, Konishi T, Watanabe Y, Yuki R, Kobayashi H, Hirose K. Reduction of infracardiac intestinal activity by a small amount of soda water in technetium-99m tetrofosmin myocardial perfusion scintigraphy with adenosine stress. J Nucl Cardiol. 2008 Mar-Apr;15(2):241-5.
  15. Cherng SC, Chen YH, Lee MS, Yang SP, Huang WS, Cheng CY. Acceleration of hepatobiliary excretion by lemon juice on 99mTc-tetrofosmin cardiac SPECT. Nucl Med Commun. 2006 Nov;27(11):859-64.
  16. Rehm PK, Atkins FB, Ziessman HA, Green SE, Akin EA, Fox LM, Hixson DJ. Frequency of extra-cardiac activity and its effect on 99Tcm-MIBI cardiac SPET interpretation. Nucl Med Commun. 1996 Oct;17(10):851-6.
  17. Weinmann P, Moretti JL. Metoclopramide has no effect on abdominal activity of sestamibi in myocardial SPET. Nucl Med Commun. 1999 Jul;20(7):623-5.
  18. Boz A, Gungor F, Karayalçin B, Yildiz A. The effects of solid food in prevention of intestinal activity in Tc-99m tetrofosmin myocardial perfusion scintigraphy. J Nucl Cardiol. 2003 Mar-Apr;10(2):161-7.
  19. Garcia EV, Cooke CD, Van Train KF, Folks R, Peifer J, DePuey EG, Maddahi J, Alazraki N, Galt J, Ezquerra N Technical aspects of myocardial SPECT imaging with technetium-99m sestamibi. Am J Cardiol. 1990 Oct 16;66(13):23E-31E.
  20. Nuyts J, Dupont P, Van den Maegdenbergh V, Vleugels S, Suetens P, Mortelmans L. A study of the liver-heart artifact in emission tomography. J Nucl Med. 1995 Jan;36(1):133-9.
  21. Purbhoo K, Vangu MD. Efficacy of full-fat milk and diluted lemon juice in reducing infra-cardiac activity of (99m)Tc sestamibi during myocardial perfusion imaging. Cardiovasc J Afr. 2015 Jul-Aug;26(4):171-6.
  22. Malek H, Hedayati R, Yaghoobi N, Bitarafan-Rajabi A, Firoozabadi SH, Rastgou F. The effect of milk, water and lemon juice on various subdiaphragmatic activity-related artifacts in myocardial perfusion imaging. Res Cardiovasc Med. 2015 Sep 14;4(4):e29235.