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Glucose-Loading Thallium-201 Myocardial SPECT

Department of Internal Medicine, Mimihara General Hospital; Sakai; Division of Tracer Kinetics, Biomedical Research Center, Osaka University Medical School, Suita, Osaka, Japan

Correspondence: For correspondence or reprints contact: Hideo Kusuoka, MD, PhD, FACC, Tracer Kinetics, Biomedical Research Center, Osaka University Medical School, Suita Osaka 565, Japan.

ABSTRACT

This study was designed to evaluate the feasibility of assessing myocardial viability using glucose loading followed by ²⁰¹Tl SPECT. Methods: First, the effect of insulin on the kinetics of ²⁰¹Tl uptake was evaluated in isolated perfused rat hearts. Second, glucose-loading ²⁰¹Tl myocardial SPECT was performed in 13 nondiabetic patients with histories of anterior myocardial infarction. Thirty minutes before acquiring rest ²⁰¹Tl SPECT, 20 g of glucose were intravenously injected into the fasting subjects. Thallium perfusion defects were compared to those of conventional rest-redistribution SPECT images obtained within a 2-wk interval. SPECT images were divided into 21 segments, and a defect score in 17 segments was calculated as a sum of the semiquantitative defect scores (0 = normal; 1 = mildly decreased uptake; 2 = severely decreased uptake; 3 = absence of uptake). Results: Thallium-201 uptake in isolated hearts showed a significant increase of 26% after insulin loading. Eleven (24%) of 45 segments showing perfusion defects on the conventional rest SPECT images demonstrated ²⁰¹Tl uptake on glucose-loading SPECT imaging. Defect scores decreased significantly on the glucose-loading SPECT images (9.9 ± 2.2 in early images; mean ± s.e.) compared with the conventional rest-redistribution SPECT images (12.6 ± 6.9 in delayed images, p < 0.05). Conclusion: Glucose-loading SPECT represents a superior method for assessing myocardial viability using ²⁰¹Tl.

Key Words: myocardial SPECT • thallium-201 • hibernating myocardium • glucose loading