The Effect of Milk, Water and Lemon Juice on Various Subdiaphragmatic Activity-Related Artifacts in Myocardial Perfusion Imaging

BACKGROUND Subdiaphragmatic activity can produce subdiaphragmatic-related artifacts, which can degrade the quality of myocardial perfusion imaging (MPI). OBJECTIVES We examined the impact of drinking milk, water, and lemon juice on different subdiaphragmatic-related artifacts by using (99m)Tc-sestamibi myocardial single-photon emission computed tomography (SPECT) in order to determine a feasible method for improving the image quality. PATIENTS AND METHODS A total of 179 patients (age 58 ± 9.6 years) were enrolled in this study. The patients were randomly divided into five groups. Ten minutes after injection of 740 MBq 99mTc-sestamibi in both pharmacologic stress and rest phases, the individuals in group 1 were given water and milk (125 mL of each); those in group 2 were given lemon juice (250 mL); group 3 was given milk (250 mL); and group 4 was given water (250 mL), whereas no intervention was performed in group 5. The study was double-blind for both subjects and data collectors. MPI was performed for all patients and image quality was controlled by 2 experienced nuclear physicians. Interfering activity was determined visually on reconstructed images and categorized as extracardiac normalization artifact, overlapping of activity, scattering of activity, and ramp filter artifact. RESULTS There were significant differences in terms of interfering activity among the five groups; group 3 (milk) had significantly lower interfering activity than other groups had, as defined by overlapping of activity (on both stress and rest images), ramp filter artifact (stress images), and scatter artifact (rest images) (P < 0.05). Furthermore, there was a significant difference in the incidence of good-quality images, with no interfering activity in group 3 in the resting state compared with the other groups in the study (P < 0.05). CONCLUSIONS Drinking 250 mL of milk in either the stress phase or the rest phase of imaging diminishes interfering subdiaphragmatic-related artifacts, particularly overlapping of activity in MPI SPECT, resulting in better-quality images.