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Characterization of the Reinjection Thallium Image

Pierluigi Pieri^*, Kenneth A. McKusick, Alan J. Fischman, Nathaniel Alpert, Constantinos Bougas and H. William Strauss

Division of Nuclear Medicine, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
Department of Radiology, Harvard Medical School, Boston, Massachusetts

Correspondence: For correspondence or reprints contact: Kenneth A. Mckusick, MD, Division of Nuclear Methane, Massachusetts General Hospital, 55 Fruit St., Boston MA, 02114.

ABSTRACT

The ²⁰¹Tl image after reinjection was characterized by analysis of stress and reinjection data acquired in 204 consecutive patients undergoing planar ²⁰¹Tl cardiac stress tests. In an additional 63 patients, redistribution data were also acquired to determine the effect of washout on the final reinjection image. Maximum count densities for the myocardium, lung and liver were measured, and the ratios between the stress and redistribution and the stress and reinjection sets of data were calculated. In patients with <5% probability of coronary artery disease (CAD)("normal" group), the reinjection image was typified by less myocardial activity (initial/reinjection = 1.22), slightly less lung activity (initial/reinjection = 1.05) and greater hepatic activity compared to the initial postexercise image. In male patients with >5% probability of CAD, peak myocardial activity after reinjection was affected by the following variables: the interval between stress and reinjection, the amount of the initial dose and the ²⁰¹Tl scan results (normal ²⁰¹Tl study: initial/reinjection = 1.16; abnormal = 1.06; p < 0.009). Myocardial activity after reinjection was linearly related to myocardial activity after redistribution (r = 0.82). There was no significant influence by those variables in the 76 women who were studied. In conclusion, myocardial ²⁰¹Tl was decreased after reinjection in normal patients. The results indicate that there is an increased likelihood of underlying CAD in male patients undergoing exercise stress tests when ²⁰¹Tl myocardial activity on reinjection is greater than on the initial image.

FOOTNOTES

^* Current address: Division of Cardiology, M. Bufalini Hospital, Cesena, Italy.

Current address: 35 Ethanikis Aminis, Papagou, Greece.

Current address: Pharmeceutical Research Institute, Bristol Myers Squibb, Princeton, NJ.