99Tcm-methoxyisobutylisonitrile stress/rest SPECT in patients with constant complete left bundle branch block

Numerous studies have revealed frequent false positive septal findings of 201Tl stress imaging in patients with left bundle branch block (LBBB) even with angiographically excluded significant coronary artery disease (CAD). To scrutinize this phenomenon for stress/rest 99Tcm-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) was used to review 22 patients with constant LBBB. The findings were reversible septal defect in one patient, partially reversible septal defect in one patient and irreversible septal defects in eight patients. In four patients 99Tcm-MIBI scans were entirely normal. Thus, 12/22 (55%) patients revealed normal septal 99Tcm-MIBI uptake. Both patients with a stress-induced septal defect revealed a significant left anterior descending artery stenosis on coronary angiography. These preliminary results suggest, that 99Tcm-MIBI might be more specific and accurate than 201Tl in the evaluation of CAD in patients with LBBB because of apparently rare or absent false positive septal findings.