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Assessment of Myocardial Viability after Thallium-201 Reinjection or Rest-Redistribution Imaging: A Multicenter Study

Departments of Nuclear Medicine, Ospedale Maggiore, Novara, Italy
Faenza Hospital, Faenza, Italy
Firenze University, Firenze, Italy
Niguarda Hospital, Milan, Italy
Montescano Hospital, Italy
La Spezia Hospital, La Spezia, Italy
Roma University, Rome, Italy
Messina University, Messina, Italy
Milano University, Milan, Italy
Department of Cardiology, Bufalini Hospital, Cesena, Italy

Correspondence: For correspondence or reprints contact: Eugenio Inglese, Dept. of Nuclear Medicine, Ospedale Maggiore Novara, Corso Mazzini 18-28100, Novara, Italy.

ABSTRACT

To establish the real nature of ²⁰¹Tl defects in the assessment of myocardial viability (e.g., fixed versus reversible), ²⁰¹Tl reinjection was evaluated in a multicenter trial involving 402 consecutive patients with ischemic heart disease and exercise ²⁰¹Tl defects. Methods: Twelve hospitals, using the same type of gamma camera and computer software, adopted one of the two most widely used reinjection protocols. In 230 patients (Group A), reinjection was performed immediately after stress-redistribution planar imaging; in 172 patients (Group B), reinjection was performed on a separate day and followed by rest-redistribution imaging. The images were interpreted by three blinded observers in a core laboratory on a five-point qualitative scale; the reproducibility in visual scoring was excellent. Results: Groups A and B had a similar prevalence of myocardial segments with abnormal uptake at stress (39%, 40%), as well as with reversible (16%, 17%), partially reversible (21%, 19%) and irreversible (63%, 64%) defects at redistribution. After reinjection, 201TI uptake improved in 27% and 36% of both partially reversible and irreversible defects in Groups A and B. No differences were found when comparing early and delayed reinjection imaging in Group B. Conclusion: This study confirms the validity of ²⁰¹Tl reinjection in a large, unselected population, but the discordance with stress/redistribution is less than has been previously reported for both ²⁰¹Tl reinjection protocols, the prevalence of improved segments after reinjection was higher with the separate day approach.

Key Words: thallium-201 • rest-redistribution imaging • myocardial viability • multicenter trial • planar myocardial imaging

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