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Figure 5 is an example of a pharmacological stress study in which intense hepatic tracer uptake interferes with image interpretation. Sometimes bowel loops with tracer activity may be close to or even overlapping the heart. This can substantially degrade the image quality and can render the images uninterpretable. Great caution is required in interpreting images in the presence of marked subdiaphragmatic activity. Attempts should be made to reduce the extracardiac Tc-99m PERFUSION TRACERS 229 Fig 5.
51,52 RELATIONSHIP BETWEEN MYOCARDIAL BLOOD FLOW AND RADIOTRACER UPTAKE The first-pass myocardial extraction fraction and the myocardial blood flow-tracer extraction relationship over a wide range of myocardial perfusion are the two important characteristics of myocardial perfusion tracers. 0) first-pass extraction with a linear relationship between myocardial tracer accumulation and myocardial perfusion over the physiological range of myocardial blood flows. First-pass extraction is studied in experimental animal models by simultaneous injection of known activities of the myocardial perfusion tracer and a nonextractable radiotracer, such as 131Ior 111Inlabeled albumin, in the left atrium with continuous coronary sinus blood sampling.
Address reprint requests to Diwakar Jain, MD, 3 FMP Section of Cardiovascular Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT06520. B. 00/0 Seminars in Nuclear Medicine, Vol XXIX, No 3 (July), 1999: pp 221-236 221 222 DIWAKAR JAIN for marked qualitative differences among different 99mTc cationic perfusion agents. Furthermore, there can be significant interspecies differences in the in vivo binding of various agents to plasma proteins. It is now known that poor quality of (99mTC [DMPE]2CI2) + for myocardial perfusion imaging in human studies is attributable to the fact that this is not a stable in vivo cationic compound.