Medical Radiology and Radiation Safety. 2026. Vol. 71. № 1
DOI:10.33266/1024-6177-2026-71-1-57-66
W.Yu. Ussov1, S.M. Minin1, Zh.Zh. Anashbaev1, E.A. Samoilova1, S.I. Sazonova2,
A.V. Grishkov1, K.N. Sorokina3, A.P. Borisenko1, Yu.B. Lishmanov4,
A.M. Chernyavsky1
Assessment of Adenosin Blood Flow Reactivity of the Primary Tumor and Metastases of Non-Small Cell Lung Cancer using Single-Photon Emission Computed Tomography of the Chest with 99mTc-MIBI
1 E.N. Meshalkin National Research Medical Center, Novosibirsk, Russia
2 Scientific Research Institute of Cardiology, Tomsk, Russia
3 National Research Novosibirsk State University, Novosibirsk, Russia
4 National Research Tomsk Polytechnic University, Tomsk, Russia
Contact person: Wladimir Yuryevich Ussov, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. , This email address is being protected from spambots. You need JavaScript enabled to view it.
Abstract
Background: Functional pharmacological methods of influencing the tumor blood flow in lung cancer, in combination with SPECT/CT of the chest organs with 99mTc-MIBI, are completely insufficiently used today. An answer has not been received to an almost very important question: which SPECT/CT study gives the best image of lungcancer (LC) – at rest, or with a pharmacological loading test, primarily with the most widely used drug, ATP?
Purpose: Was to evaluate whether conducting a pharmacological test with ATP improves the imaging picture of lung cancer in SPECT/CT with 99mTc-MIBI. We also analyzed the relationship between the level of blood flow in the primary node of the LC and the presence of distant metastases in these individuals.
Material and methods: The examinations were conducted with the patients’ written consent. The present study included 11 patients who were initially referred for functional SPECT/CT of myocardial blood flow with 99mTc-MIBI to confirm the diagnosis of coronary artery disease. They all had lung cancer – peripheral in six and central in five. The patients were divided into two groups: group 1 (n = 5) included patients with stage T1–2N0–1M0, and group 2 (n = 6) included patients with stage T2–3N2–3M0–1 RL.
SPECT/CT with 99mTc-MIBI was performed twice in all patients – initially with a pharmacological loading functional test with intravenous ATP injection, at a dosage 0,16 mg/kgBW/min for 5 min, and then at rest, into a 64×64 matrix with a 180° rotation of each detector of a two-detector gamma camera, 32–64 projections, and a rotation radius of 35–40 cm, with a set of less than 50,000 scintillations per each. Up to 50 transverse tomographic sections of the heart and chest were reconstructed, taking into account the tissue absorption of 0.12 cm‒1. Visual analysis was performed for the pre
sence of nodular pathological neoplasms in the lungs with a pathological accumulation of 99mTc-MIBI and calculation of the values of myocardial and tumor blood flow, as TBF = SUVTc-MIBI × (MV / Bodyweight) × 100, where SUVTc-MIBI is the standardized value of radiopharmaceutical uptake, MV – the minute volume of cardiac output, in ml/min, and 100 is the conversion factor for representing the result in the usual units of ml/min/100 g of tissue.
Results: In group 1(T1–2N0–1M0) The resting tumor blood flow was 24 ± 7 ml/min/100 g of tissue, and in the case of an ATP test it was 26 ± 7 ml/min/100 g of tissue. In group 2 (T2–3N2–3M0–1, n=6), 32 ± 8 and 33 ± 7 ml/min/100 g of tissue, respectively. The best visualization of lymph nodes in SPECT/CT with 99mTc-MIBI was also achieved at rest. In patients without distant metastases (i.e. M0, these are all patients from group 1 and one from group 2, six in total) the average TBF in the tumor in all was < 28 ml/min/100 g, whereas in the presence of distant metastases (M1), the average TBF in the primary node of the RL was ≥ 27 ml/min/100 g. The increase in TBF – obviously as a manifestation of more intense tumor neoangiogenesis was accompanied by a significantly higher probability of the formation of distant RL metastases.
Conclusion: It is most optimal and informative to study the blood flow of lung cancer by SPECT/CT with 99mTc-MIBI at rest, rather than with a pharmacological test with ATP. Its greatest information content at rest regarding the visualization of affected and accumulating 99mTc-MIBI lymph nodes allows this method to be used most widely and safely in patients with suspected or verified lung cancer.
Keywords: SPECT/CT, 99mTc-MIBI, coronary heart disease, lung cancer, adenosine test, cardiooncology
For citation: Ussov WYu, Minin SM, Anashbaev ZhZh, Samoilova EA, Sazonova SI, Grishkov AV, Sorokina KN, Borisenko AP, Lishmanov YuB, Chernyavsky AM. Assessment of Adenosin Blood Flow Reactivity of the Primary Tumor and Metastases of Non-Small Cell Lung Cancer using Single-Photon Emission Computed Tomography of the Chest with 99mTc-MIBI. Medical Radiology and Radiation Safety. 2026;71(1):57–66. (In Russian). DOI:10.33266/1024-6177-2026-71-1-57-66
References
1. Merabishvili V.M., Yurkova Yu.P., Levchenko Ye.V., Shcherbakov A.M., Krotov N.F. The State of Oncological Care in Russia: Lung Cancer, Patient Survival (Population-Based Study at the Federal District Level). Voprosy Onkologii = Problems in Oncology. 2021;67;4:492-500 (In Russ.). Doi: 10.37469/0507-3758-2021-67-4-492-500. EDN AMQMYT.
2. Mao Y, Yang D, He J, Krasna MJ. Epidemiology of Lung Cancer. Surg Oncol Clin N Am. 2016 Jul;25;3:439-45. Doi: 10.1016/j.soc.2016.02.001. PMID: 27261907.
3. Novikova S.V., Vazhenin A.V., Tyukov Yu.A. Lung Cancer: Epidemiology, Diagnostics and Prevention. Nepreryvnoye Meditsinskoye Obrazovaniye i Nauka = Continuous Medical Education and Science. 2024;19;4:22–27 (In Russ.). EDN EGSBRV.
4. Minin S.M., Vasil’tseva O.Ya., Bukhovets I.L., Anashbayev Zh.Zh., Lishmanov Yu.B., Ivanovskaya Ye.A., Usov V.Yu., Chernyavskiy A.M. Pharmacological Test with Nitroglycerin in Combination with Perfusion Single-Photon Emission Computed Tomography with 99mTc-Technetrile in Assessing the Viability of Ischemic Myocardium in Patients after Acute Myocardial Infarction. Regionarnaya Gemodinamika i Mikrotsirkulyatsiya = Regional Blood Circulation and Microcirculation. 2024;23;1:50–63 (In Russ.). Doi: 10.24884/1682-6655-2024-23-1-50-6.
5. Minin S.M., Anashbayev ZH.ZH., Samoylova Ye.A., Zheravin A.A., Usov V.YU., Krasil’nikov S.Ye., Chernyavskiy A.M. SPECT/CT with 99mTc-Technetrile in Staging, Planning of External Beam Radiation Therapy and Subsequent Observation of Lung Cancer: a Clinical Case and a Targeted Literature Review. Meditsinskaya Radiologiya i Radiatsionnaya Bezopasnost’ = Medical Radiology and Radiation Safety. 1996;41;6:11-15
(In Russ.). EDN MOVAXT.
6. Arsen’yev A.I., Barchuk A.A., Kostitsyn K.A., Nefedova A.V., Barchuk A.S., Chernaya A.V., Levchenko Ye.V., Tarkov S.A., Nefedov A.O., Gagua K.Ye. Panel Study of the Effectiveness of Low-Dose Computed Tomography and Transthoracic Core Biopsy in the Early Diagnosis of Lung Cancer. Vestnik Khirurgii im. I.I.Grekova = Grekov’s Bulletin of Surgery. 2018;177;1:60-64 (In Russ.). Doi: 10.24884/0042-4625-2018-177-1-60-64. EDN YWEIEK.
7. Stukanov S.L., Usov V.Yu., Kolomiyets S.A., Ryannel’ Yu.Ye., Velichko S.A., Zyryanov B.N. Single-Photon Emission Computed Tomography with 99mTc-Technetrile in Lung Cancer. Meditsinskaya Radiologiya i Radiatsionnaya Bezopasnost’ = Medical Radiology and Radiation Safety. 1996;41;6:11-15 (In Russ.). EDN MOVAXT.
8. Zyryanov B.N., Siyanov V.S., Velichko S.A., Makarkin N.A. Rak Logkogo. Novyye Podkhody v Diagnostike i Lechenii = Lung Cancer. New Approaches to Diagnostics and Treatment. Tomsk, Nauchno-Isledovatel’skiy Institut Onkologii. Natsional’nyy Issledovatel’skiy Tomskiy Gosudarstvennyy Universitet Publ., 1997. 346 p. (In Russ.). ISBN 978-5-93856-283-7. EDN VFDVIL.
9. Ansheles A.A., Sergiyenko V.B. Yadernaya Kardiologiya = Nuclear Cardiology. Moscow, Natsional’nyy Meditsinskiy Issledovatel’skiy Tsentr Kardiologii Publ., 2021. 516 p. (In Russ.). ISBN 978-5-93856-283-7. EDN VFDVIL
10. Krivonogov N.G., Minin S.M., Krylov A.L., Lishmanov Yu.B. Quantitative Determination of Radionuclides in the Assessment of Myocardial Blood Flow. Byulleten’ Sibirskoy Meditsiny = Bulletin of Siberian Medicine. 2013;12;3:111–116 (In Russ.). EDN QZDKUF.
11. Usov V.Yu., Sukhov V.Yu., Babikov V.Yu., Borodin O.Yu., Vorozhtsova I.N., Lishmanov Yu.B., Udut V.V., Krivonogov N.G. Quantitative Spectral Measurement of Tissue Blood flow in the Myocardium by the Absolute Accumulation of the Radiopharmaceutical 99mTc-Technetril. Translyatsionnaya Meditsina = Translational Medicine. 2022;9;1:29–38 (In Russ.). Doi: 10.18705/2311-4495-2022-9-1-29-38.
12. Losev O.Ye., Borodulin V.B., Rusetskaya N.Yu., Bobyleva Ye.V., Borodulin Yu.V. Molecular Mechanisms of Lung Cancer. Patologicheskaya Fiziologiya i Eksperimental’naya Terapiya = Pathological Physiology and Experimental Therapy. 2021;65;1:124–132 (In Russ.). Doi: 10.25557/0031-2991.2021.01.124-132.
13. Korablev R.V., Vasil’yev A.G. Neoangiogenesis and Tumor Growth. Rossiyskiye Biomeditsinskiye Issledovaniya = Russian Biomedical Research. 2017;2;4:3-10 (In Russ.). EDN XSCZAT.
14. Kostyuchenko V.V. History of the Development of Stereotactic Radiation. Meditsinskaya Fizika = Medical Physics. 2015;4;68:85-97 (In Russ.). EDN VECGGF.
15. Kanayev S.V., Novikov S.N., Beynusov D.S., Levchenko Ye.V., Girshovich M.M., Zhukova L.A., Krzhivitskiy P.I. The Role of Single-Photon Emission Computed Tomography and X-Ray Computed Tomography in the Diagnosis of Metastatic Lesions of the Lymph Nodes in Patients with Non-Small Cell Lung Cancer. Radiatsionnaya Onkologiya i Yadernaya Meditsina = Nuclear and Radiation Safety Journal. 2013;1;2:47-52 (In Russ.). EDN TGOTZV.
16. Demeshko P.D., Sakovich R.A., Baranovskiy A.A., Sinayka V.V., Minaylo I.I., Merzlyakova A.K., Petkevich M.N. PET/CT in Planning Radiation Therapy for Non-Small Cell Lung Cancer. Onkologicheskiy Zhurnal = Oncological Journal. 2017;11;1:97–102 (In Russ.). EDN ZHNPRH.
17. Vorob’yeva V.O., Nudnov N.V., Miller S.V., Rodionov Ye.V., Usov V.Yu. Magnetic Resonance Imaging of the Lungs with Paramagnetic Contrast Enhancement in the Dynamic Control of Lung Cancer Treatment in a Radiophobic Patient: a Clinical Observation. Luchevaya Diagnostika i Luchevaya Terapiya = Diagnostic Radiology and Radiotherapy. 2022;13;3:97–107 (In Russ.). Doi: http://dx.doi.org/10.22328/2079-5343-2022-13-3-97-107.
18. Tyurin I.Ye. Radiation Diagnostics in the Russian Federation. Onkologicheskiy Zhurnal = Oncological Journal. 2018;1;4:43-51 (In Russ.). EDN QZSWYK.
19. Sorokina K.N., Tulupov A.A., Tolstikova T.G., Usov V.Yu. Modern Approaches to the Development of Contrast Agents for MRI Diagnostics. Byulleten’ Sibirskoy Meditsiny = Bulletin of Siberian Medicine. 2011;10;6:79-85 (In Russ.). EDN ONZEDZ.
20. Usov V.YU., Ryannel’ YU.Ye., Mikhaylovich YA.M., Slonimskaya Ye.M., Velichko S.A. Mammascintigraphy: Basics, Protocols, and Clinical Application. Meditsinskaya Radiologiya i Radiatsionnaya Bezopasnost’ = Medical Radiology and Radiation Safety. 1999;44;3:72-82 (In Russ.). EDN MPDAQN.
21. Khafizov M.M., Baykov D.E., Akhmadeyeva L.R. Radioisotope Visualization of Mediastinal Forms of B-cell Lymphoma and Differential Diagnosis of Pathologically Altered Areas of Adjacent Lung Parenchyma Using PET/CT with 18F-FDG and SPECT/CT with 99mTc-MIBI. Effektivnaya Farmakoterapiya = Effective Pharmacotherapy. 2023;19;48:30-33 (In Russ.). Doi: 10.33978/2307-3586-2023-19-48-30-33. EDN DYMBLN.
22. Minin S.M., Anashbayev Zh.Zh., Novikova N.V., Samoylova Ye.A., Sazonova S.I., Salin N.V., Korobeynikov S.M., Usov V.Yu., Chernyavskiy A.M. Possibilities of Using Single-Photon Emission Computed Tomography (SPECT-CT) with 99mTc-Technetrile in Screening of Chest Tumors (Lung Cancer, Breast Cancer) in Patients with Cardiovascular Pathology. Meditsinskaya Radiologiya i Radiatsionnaya Bezopasnost’ = Medical Radiology and Radiation Safety. 2025;70;6:45-54 (In Russ.). Doi: 10.33266/1024-6177-2023-68-5-96-104.
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Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Article received: 20.11.2025. Accepted for publication: 25.12.2025.