Role of carbonated water technique to enhance Tc-99m tetrofosmin myocardial perfusion imaging by reducing subdiaphragmat
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ORIGINAL ARTICLE
Role of carbonated water technique to enhance Tc‑99m tetrofosmin myocardial perfusion imaging by reducing subdiaphragmatic artefacts Saba Hussain1 · Fateh Ali Tipoo Sultan2 Received: 15 April 2020 / Accepted: 20 July 2020 © The Japanese Society of Nuclear Medicine 2020
Abstract Objective Myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT) is confounded by the extracardiac artefacts cause by hepatobiliary clearance of the radiotracers. Various techniques have been evaluated to lessen those artefacts. In this study, we endeavoured to determine the effect of carbonated water in reducing such infracardiac artefact so to improve MPI image quality, sensitivity and specificity. Methods A total of 1000 patients were prospectively enrolled and randomised into two equal groups as A and B. Group A were given 250 ml of carbonated beverages and Group B were given 250 ml plain water immediately after radiotracer injection. Images were evaluated qualitatively and quantitatively for the interfering extracardiac artefacts. Results The qualitative analysis favoured carbonated water in reducing the interfering intestinal activity during rest as well as stress (p = 0.005 and p 18 referred for exercise or pharmacological myocardial perfusion imaging to our tertiary care hospital were enrolled in this study. This was a case–control prospective study, conducted between December 2017 and December 2019. This study was approved by the institutional Ethical Review Committee (Reference no. ERC-39/2017). Non-probability consecutive sampling was used. Based on similar study by Thomas DM et al. minimum required sample size was 331 patients for case group as well as for control group, taking case to control ratio of 1 is to 1 to attain 5% level of significance and 95% of power of test [10]. Subjects with hemodynamic instability, bronchial asthma and chronic obstructive lung disease, significant gastrointestinal, hepatobiliary system disease or surgery or uninterpretable SPECT images due to multiple artefacts were excluded from the study. A written informed consent was obtained from all participants before enrolment (Online Resource 1). This study was double blind for patients, data collectors and interpreters.
Fig. 1 SPECT raw data images showing myocardium (green box) to extracardiac (red box) count quantification with significant gut activity (a) and insignificant gut activity (b). [a is the image of patient
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Annals of Nuclear Medicine
Data collection Enrolled patients were randomly divided into two groups. One group (Group A/Cases) was given 250 ml of soda water after stress or during rest, immediately after radiotracer injection. Other group (Group B/Controls) did receive similar amount of plain water. Same day stress/rest protocol was used. Patients were tested with either physical stress using exercise treadmill or pharmacological stress with weightadjusted dipyridamole (0.56 mg/kg infusion during 4 min) injection. To elude the effect of distended stomach, patients were
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