Lower limb perfusion scintigraphy with 99mTc-MIBI scintigraphy and determination of endothelin in diabetic and nondiabetic patients

Nevena Manevska; Sinisa Stojanoski; Irfan Ahmeti; Toni Tripunoski; Daniela Pop Gjorceva; Venjamin  Majstorov; Gordana  Pemovska

doi:10.2298/VSP171001115M

Nevena Manevska Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
Sinisa Stojanoski Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
Irfan Ahmeti Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
Toni Tripunoski Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
Daniela Pop Gjorceva Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
Venjamin Majstorov Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia
Gordana Pemovska Ss. Cyril and Methodius University, Institute of Pathophysiology and Nuclear Medicine, Skopje, Northern Macedonia

DOI: https://doi.org/10.2298/VSP171001115M

Keywords: diabetes mellitus, type 2;, periferal arterial disease;, perfusion imaging;, lower extremity;, endothelin-1

Abstract

Background/Aim. Peripheral artery disease (PAD) is a common macrovascular complication in patients with diabetes mellitus (DM) as a result of impairment of homeostatic mechanisms of the endothelium, thus initiating the process of atherosclerosis. The imbalance between endothelium-derived vasodilators and vasoconstrictors plays an important role in the pathogenesis of diabetic microangiopathy, as well as in other vascular complications in diabetes. Perfusion scintigraphy using technetium-99m-methoxyisobutyl isonitrile (^99mTc-MIBI) can be very useful method for evaluation of the lower limbs muscle perfusion. The aim of this study was: to compare the results of dynamic and static studies of lower limbs tissue muscle perfusion scintigraphy with ^99mTc-MIBI (one-day rest-stress protocol) in patients with and without DM and to determine the perfusion reserve for diagnostic evaluation of PAD in patients with DM type 2, as well as to assess the endothelin-1 (ET-1) levels as a vasoconstrictor agent in patients with and without diabetes. Methods. Prospective study was performed in 90 patients, divided into two groups according to the presence of DM – patients with DM type 2 (DP), 60/90 (67%), and patients without DM (NDP), 30/90 (33%). Lower limbs tissue muscle perfusion scintigraphy was done with ^99mTc-MIBI including two studies (“rest” and “stress”). Results. In the DP group significantly lower pick of radioactivity was detected in comparison with the NDP group, in both phases (rest and stress), for both calves. Lower counts from the static phase were registered in the region of both calves. Lower inter-extremity indexes as well as perfusion reserve were found in the DP group. There was a significant difference in concentrations of ET-1 between groups (higher concentrations were found in tzhe DP group). Conclusion. This one-day protocol (rest-stress with ^99mTc-MIBI) of perfusion scintigraphy of lower limbs is considered a useful procedure in PAD assessment in patients with DM type 2, especially the asymptomatic form.

References

Davignon J, Ganz P. Role of endothelial dysfunction in athero-sclerosis. Circulation 2004; 109(23 Suppl 1): III27–32.

Creager MA, Luscher TF, Cosentino F, Beckman JA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I. Circulation 2003; 108(12): 1527–32.

Luscher TF, Creager MA, Beckman JA, Cosentino F. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part II. Circulation 2003; 108(13): 1655–61.

Bohm F, Pernow J. The importance of endothelin-1 for vascular dysfunction in cardiovascular disease. Cardiovasc Res 2007; 76(1): 8–18.

Olin JW, Sealove BA. Peripheral artery disease: current insight into the disease and its diagnosis and management. Mayo Clin Proc 2010; 85(7): 678–92.

Arbab AS, Koizumi K, Toyama K, Arai T, Araki T. Effects of ion channel modulators in the influx and efflux of Tc-99m-MIBI. Ann Nucl Med 1999; 13(1): 27–32.

Piwnica-Worms DP, Kronauge JF, LeFurgey A, Backus M, Hockett D, Ingram P, et al. Mitochondrial localization and characteriza-tion of 99Tc-SESTAMIBI in heart cells by electron probe X-ray microanalysis and 99Tc-NMR spectroscopy. Magn Reson Imaging 1994; 12(4): 641–52.

Piwnica-Worms D, Kronauge JF, Chiu ML. Uptake and Reten-tion of Hexakis (2-Methoxyisobutyl Isonitrile) Technetium(I) in Cultured Chick Myocardial Cells Mitochondrial and Plasma Membrane Potential Dependence. Circulation 1990; 82(5): 1826–38.

Taillefer R. Technetium-99m sestamibi myocardial imaging: same-day stress-rest studies and dipyridamole. Am J Cardiol 1990; 66(13): 80E-84E.

Cosson E, Paycha F, Tellier P, Sachs RN, Ramadan A, Paries J, et al. Lower-Limb Vascularization in Diabetic Patients: Assess-ment by thallium-201 scanning coupled with exercise myocar-dial scintigraphy. Diabetes Care 2001; 24(5): 870–4.

Lin CC, Ding HJ, Chen YW, Huang WT, Kao A. Usefulness of thallium-201 muscle perfusion scan to investigate perfusion reserve in the lower limbs of Type 2 diabetic patients. J Diabe-tes Complications 2004; 18(4): 233–6.

Cizmić M, Pucar D, Zoranović U. Assesment of lower extremities ischemic disease by thallium 201 perfusion scintigraphy in pa-tients with diabetic angiopathy. Vojnosanit Pregl 2011; 68(2): 161–5. (Serbian)

Younes JA, El-Sayed ND, Kamel AI. Prevalence of Subclinical Peripheral Vascular Disease in Obese Egyptian Patients. Indi-an J Nucl Med 2017; 32(4): 271–8.

Soyer H, Uslu I. A patient with peripheral arterial stenosis di-agnosed with lower extremity perfusion scintigraphy. Clin Nucl Med 2007; 32(6): 458–9.

Manevska N, Gjorceva DP, Ahmeti I, Todorovska L, Stojanoski S, Kocovska MZ. Tissue-Muscle Perfusion Scintigraphy of the Lower Limbs in a Patient with Type 2 Diabetes Mellitus and Peripheral Arterial Disease. Mol Imaging Radionucl Ther 2016; 25(1): 42–6.

Tan YZ, Kılıç S, Temiz A, Özdemir S, Kurt T, Cevizci S. Com-parison of Ankle-Brachial Index and Lower Limb Perfusion Reserve in Patients with Behçet’s Disease. Austin J Nucl Med Radiother 2016; 3(1): 1015.

Amin AM, Nawito ZO, Atfy RA, El-Hadidi KT. Tc-99m sesta-mibi lower extremity muscle scan, is it a useful screening tool for assessment of preclinical atherosclerosis in rheumatoid ar-thritis patients? Rheumatol Int 2012; 32(7): 2075–81.

Tooke JE. Possible pathophysiological mechanisms for diabetic angiopathy in type 2 diabetes. J Diabetes Complications 2000; 14(4): 197–200.

Jansson PA. Endothelial dysfunction in insulin resistance and type 2 diabetes. J Intern Med 2007; 262(2): 173–83.

Rask-Madsen C, King GL. Mechanisms of disease: endothelial dysfunction in insulin resistance and diabetes. Nat Clin Pract Endocrinol Metab 2007; 3(1): 46–56.