A MIBI scan or sestamibi scan is now a common method of cardiac imaging. Technetium sestamibi is a lipophilic cation which, when injected intravenously into a patient, distributes in the myocardium proportionally to the myocardial blood flow. Single photon emission computed tomography imaging of the heart is performed using a gamma camera to detect the gamma rays emitted by the technetium-99m as it decays. Two sets of images are acquired. For one set, 99mTc MIBI is injected while the patient is at rest and then the myocardium is imaged. In the second set, the patient is stressed either by exercising on a treadmill or pharmacologically. The drug is injected at peak stress and then imaging is performed. The resulting two sets of images are compared with each other to distinguish ischemic from infarcted areas of the myocardium. This imaging technique has a sensitivity of around 90%. Resting images are useful only for detecting tissue damage, while stress images will also provide evidence of coronary artery disease.
When combined with the drug dipyridamole, a brand name of which is Persantine, a MIBI scan is often referred to as a Persantine MIBI scan.
Parathyroid imaging
In primary hyperparathyroidism, one or more of the four parathyroid glands either develops a benign tumor called an adenoma or undergoes hyperplasia as a result of homeostatic dysregulation. The parathyroid gland takes up 99mTc MIBI following an intravenous injection, and the patient's neck is imaged with a gamma camera to show the location of all glands. A second image is obtained after a washout time, and mitochondria in the oxyphil cells of the abnormal glands retaining the 99mTc are seen with the gamma camera. This imaging method will detect 75 to 90 percent of abnormal parathyroid glands in primary hyperparathyroidism. An endocrine surgeon can then perform a focused parathyroidectomy to remove the abnormal gland.
Following administration, 99mTc MIBI collects in overactive parathyroid glands. During surgery, the surgeon can use a probe sensitive to gamma rays to locate the overactive parathyroid before removing it.
Breast imaging
The drug is also used in the evaluation of breast nodules. Malignant breast tissues concentrate 99mTc MIBI to a much greater extent and more frequently than benign disease. As such, limited characterization of breast anomalies is possible. Scintimammography has a high sensitivity and specificity for breast cancer, both more than 85%. More recently, breast radiologists administer lower doses of 99mTc sestamibi for Molecular Breast Imaging scans which results in a high sensitivity and high specificity for breast cancer detection. It however carries a greater risk of causing cancer, making it not appropriate for general breast cancer screening in patients. The last reference listed refers to a dose, which is given with the Dilon single-head system, which requires a higher dose since only one camera is utilized. A dose, which is used in the other two commercially available MBI systems is essentially equivalent to a mammogram or a tomosynthesis exam. Since even small doses of ionizing radiation are believed to carry some risk of causing cancer, MBI is usually limited to women with dense breast tissue, which often can result in inconclusive mammograms. Researchers continue to devote their time to improving the technology, changing scan parameters, and reducing dose to patients.
