Negligible influence of proton pump inhibitors on gastric wall uptake of [۹۹mTc]Tc-MIBI in myocardial perfusion imaging

Introduction: Myocardial perfusion imaging (MPI) faces a challenge in diagnostic accuracy due to gastric wall uptake (GWU). Previous studies have linked GWU to proton pump inhibitors (PPIs) intake, but only a minority of patients on PPIs show activity accumulation. Our study aimed to investigate the influence of PPIs on GWU in MPI by single photon emission computed tomography (SPECT) and assess the necessity or benefits of discontinuing PPIs before the procedure.Methods: The ۳۶۸ patients who underwent a two-day stress/rest [۹۹mTc]Tc-MIBI SPECT/CT MPI were divided into three groups: (i) Control group (n=۱۱۴, without the consumption of any gastroprotective medication), (ii) continued medication(n=۴۸, on PPI treatment) and (iii) discontinued medication (n=۲۰۶, PPI discontinued for one day or more before MPI). Rest SPECT images were analysed for clinically relevant GWU.Results: Based on our study, out of ۱۱۴ patients in group (i),۱۶ individuals (۱۴%), and ۱۰ patients from ۴۸ patients in group (ii) (۲۰.۸%) demonstrated radioactivity accumulation in the gastric wall. In group (iii) despite discontinuing PPIs use, ۲۰.۳% of patients showed GWU. Statistical analysis of these three groups and their subgroups did not show any significant difference in terms of gastric wall uptake of [۹۹mTc]Tc-MIBI in MPI.Conclusion: Concisely, our study found no significant link between PPI use and gastric wall activity in MPI. Further data is needed before adjusting drug guidelines in nuclear medicine centers. Multicenter studies with larger patient cohorts must explore the PPI-GWU relationship, utilizing SPECT/CT scans for precise interference location determination.

Keywords:

Proton pump inhibitors , Gastric wall uptake , [۹۹mTc]Tc-MIBI , Myocardial perfusion imaging , SPECT/CT