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Myocardial Viability Assessment with Technetium-99m-Tetrofosmin and Thallium-201 Reinjection in Coronary Artery Disease

Departments of Radiology and Internal Medicine, Fukui Prefectural Hospital, Fukui, Japan
Department of Nuclear Medicine, Kanazawa University, School of Medicine, Kanazawa, Japan

Correspondence: For correspondence or reprints contact: Ichiro Matsunari, MD, Nuklearmedizinische Klinik und Poliklinik, Der Technischen Universität München, Klinikum Rechts der Isar, Ismaninger Strasse 22, 81675 München, Germany.

ABSTRACT

Exercise-rest ^99mTc-tetrofosmin myocardial perfusion images with a 2-day protocol was compared to exercise-redistribution-reinjection ²⁰¹Tl images to assess the ability of ^99mTc-tetrofosmin to detect viable myocardium. Methods: We studied 25 patients with coronary artery disease and regional or global left ventricular dysfunction. Myocardial SPECT images with ^99mTc-tetrofosmin were obtained 10 min after injection during exercise and 1 and 3 hr after rest injection. Within 1 wk of the ^99mTc-tetrofosmin study, exercise-redistribution-reinjection ²⁰¹Tl SPECT imaging was performed. Results: Visual analysis demonstrated concordance between ²⁰¹Tl and ^99mTc-tefrofosmin imaging for defect reversibility in 126 of 209 segments (60%), with initial defects on both exercise ²⁰¹Tl and ^99mTc-tetrofosmin images. In the remaining discordant 83 segments (40%), 73 (88%) appeared nonreversible on ^99mTc-tetrofosmin imaging but were reversible on ²⁰¹Tl imaging. Conclusion: On the basis of defect reversibility by visual analysis, exercise-rest ^99mTc-tetrofosmin imaging underestimates myocardial viability compared to ²⁰¹Tl reinjection imaging. The identification of viable myocardium with both ^99mTc-tetrofosmin and ²⁰¹Tl can be greatly enhanced to a similar degree if the severity of reduction in activity within nonreversible defects is considered. These two agents may provide comparable information about myocardial viability by quantitative analysis of defect severity.

Key Words: technetium-99m-tetrofosmin • thallium-201 • myocardial viability • coronary artery disease

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