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Quantification of the Reversibility of Stress-Induced Thallium-201 Myocardial Perfusion Defects: A Multicenter Trial Using Bull's-eye Polar Maps and Standard Normal Limits

Emory University School of Medicine, Atlanta, Georgia
Ochsner Clinic, New Orleans, Louisiana
Lenox Hill Hospital, New York, New York
St. Luke's Episcopal Hospital, Houston, Texas
Philadelphia Heart Institute, Philadelphia, Pennsylvania
General Electric Medical Systems, Milwaukee, Wisconsin

Correspondence: For reprints contact: Ernest V. Garcia, PhD, Division of Nuclear Medicine, Department of Radiology, Emory University Hospital, 1364 Clifton Rd. NE, Atlanta, GA 30322.

ABSTRACT

A multicenter trial was performed on 140 patients from four centers to determine the accuracy of quantitative analysis of stress/delayed thallium-201 myocardial tomograms using normal limits to assess the relative amount of reversibility of stress-induced defects. The patients were found to have 85 fixed and 124 reversible defects, as determined by visual interpretation. Reversibility bull's-eye polar maps were compared to gender-matched normal limits from 36 normals. Regions were identified as reversible if their normalized difference between stress and 4 hr >1.5 s.d.s from the mean normal limits. Overall agreement between experts at multicenter sites and reversibility maps was 73% for reversible defects and 80% of fixed defects. Sensitivity in detecting reversibility was highest for the left circumflex (88%) and lowest for the right coronary (60%). These results indicate that reversibility polar maps and normal limits offer an objective, accurate technique for determining the reversibility of stress-induced perfusion defects.

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