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Identification of Viable Myocardium in Patients with Chronic Coronary Artery Disease: Comparison of Thallium-201 Scintigraphy with Reinjection and Technetium-99m-Methoxyisobutyl Isonitrile

Departments of Nuclear Medicine, Internal Medicine and Cardiology, 2nd Medical School, Università degli Studi di Napoli Federico II, and National Cancer Institute, Napoli, Italy

Correspondence: For reprints contact: Alberto Cuocolo, MD, Via Posillipo 66, 80123 Napoli, Italy.

ABSTRACT

We compared the results of ²⁰¹Tl reinjection and those of ^99mTc-methoxyisobutyl isonitrile (MIBI) in identifying viable myocardium in 20 male patients with angiographically proven coronary artery disease (CAD) and left ventricular dysfunction (ejection fraction 30%±8%). All patients had irreversible defects on standard exercise-redistribution thallium imaging. Thallium was reinjected immediately after the redistribution study, and images were reacquired. The patients also underwent stress and rest ^99mTc-MIBI myocardial scintigraphy (2-day protocol). A total of 300 myocardial regions were analyzed, of which 122 (41%) had irreversible thallium defects on redistribution images before reinjection. Of the 122 myocardial regions with irreversible defects on standard stress-redistribution thallium cardiac imaging, 65 (53%) did not change at reinjection and 57 (47%) demonstrated enhanced uptake of thallium after reinjection. Of the same 122 irreversible defects on stress-redistribution thallium, 100 (82%) appeared as fixed defects and 22 (18%) were reversible on ^99mTc-MIBI myocardial scintigraphy. These data indicate that ²⁰¹Tl cardiac imaging with rest reinjection is superior to ^99mTc-MIBI myocardial scintigraphy in identifying viable myocardium in patients with chronic CAD, suggesting that regions with severe reduction of ^99mTc-MIBI uptake both on stress and rest images may contain viable myocardium.

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