Impact of mediastinal, liver and lung 123I- metaiodobenzylguanidine (123I-MIBG) washout on calculated 123I-MIBG myocardial washout

Abstract

Purpose: In planar 123I-metaiodobenzylguanidine ( 123I-MIBG) myocardial imaging mediastinum (M) activity is often used as a background correction in calculating "washout" (WO). However, the most likely sources for counts that might produce errors in estimating myocardial (Myo) activity are lung (Lu) and liver (Li), which typically have higher counts/pixel (cpp) than M. The present study investigated the relationship between changes in Lu, Li and Myo activity between early and late planar 123I-MIBG images, with comparison to M as the best estimator of non-specific background activity. Methods: Studies on 98 subjects with both early (e) and late (l) planar 123I-MIBG images were analysed. There were 68 subjects with chronic heart failure (CHF), 14 with hypertension (HTN) but no known heart disease and 16 controls (C). For each image, regions of interest (ROIs) were drawn: an irregular whole Myo, Lu, upper M and Li. For each ROI, WO was calculated as [(cpp(e)-cpp(l:decay corrected))/cpp(e)]×100%. Results: Multivariable forward stepwise regression analysis showed that overall a significant proportion of the variation in Myo WO could be explained by a model containing M WO and Lu WO (37%, p∈