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Improved Detection of Viable Myocardium with Thallium-201 Reinjection in Chronic Coronary Artery Disease: Comparison with Technetium-99m-MIBI Imaging

Departments of Nuclear Medicine, University Federico II, and National Cancer Institute, Napoli, Italy

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

ABSTRACT

Exercise-redistribution ²⁰¹Tl with reinjection at rest and exercise-rest ^99mTc-methoxy isobutyl isonitrile (MIBI) cardiac imaging was performed in a patient with multivessel chronic coronary artery disease (CAD) and evaluated before and after coronary revascularization. Thallium reinjection showed reversible defects of the inferior and septal walls and irreversible defect of the infero-apical region. Technetium-99m-MIBI scintigraphy demonstrated irreversible defects of the inferior, septal and infero-apical regions. After coronary artery bypass grafts, both thallium reinjection and ^99mTc-MIBI images showed only irreversible defects of the infero-apical region. Functional recovery of the inferior and septal walls was observed on two-dimensional echocardiography. Thallium reinjection identifies severely ischemic but viable myocardium more accurately than ^99mTc-MIBI in chronic CAD. Thallium myocardial imaging with reinjection at rest is recommended for evaluating patients with chronic ischemic left ventricular dysfunction to determine if these patients are candidates for revascularization procedures.

Key Words: chronic coronary artery disease • thallium-201 • technetium-99m-MIBI

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