Simple techniques to reduce bowel activity in cardiac SPECT imaging.

Background and aim Scatter from the bowel degrades image quality in 9 9 m Tc sestamibi myocardial perfusion imaging (MPI). Iodinated oral contrast, which has been used to outline bowel in medical imaging, absorbs X-rays as well as gamma rays. The purpose of this study was to test our hypothesis that iodinated oral contrast during MPI would absorb gamma rays emitted form 9 9 m Tc sestamibi in the bowel, thereby reducing scatter and improving cardiac SPECT images. Methods and results Thirty subjects undergoing adenosine stress 9 9 m Tc sestamibi cardiac SPECT were randomized to receive either iodinated oral contrast (IOC), water or no intervention (controls). Subjects had 1 day rest-stress MPI using the adenosine stress protocol. Images were analysed using infra-cardiac counts, image variability, image contrast and the ratios of anterior to inferior and septal to lateral walls. The improvement in image contrast and variability between first and second Images were significant in both the IOC and water groups. The IOC group had a more significant improvement in variability than did the water group. The reduction in infra-cardiac counts was also more significant in the IOC group. Conclusion The use of oral contrast and water improved the image variability and contrast by decreasing the infra-cardiac scatter. The improvement was even more significant in the oral contrast group.