Phenytoin Could Potentially Increase Hepatic Clearance of 99mTc-Sestamibi in Myocardial Perfusion Imaging

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Myocardial perfusion imaging (MPI) is one of the most commonly used nuclear medicine imaging modalities for coronary artery disease evaluation and risk stratification. The authors present incidental image findings in a patient who underwent MPI twice because of development of seizures just before the first SPECT-MPI acquisition. The projection images for first MPI done without medication (phenytoin) showed the retention of hepatic tracer activity. After a few days from restarting of phenytoin, the repeat MPI showed complete hepatic clearance of tracer. This case highlights the possible pharmacokinetic interaction between phenytoin intake and 99mTc-sestamibi, resulting in faster hepatic clearance of the radiotracer.

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