Time to completed redistribution of thallium-201 in exercise myocardial scintigraphy: Relationship to the degree of coronary artery stenosis

doi:10.1016/0002-8703(83)90642-7

American Heart Journal

Volume 106, Issue 5, Part 1, November 1983, Pages 989-995

https://doi.org/10.1016/0002-8703(83)90642-7 Get rights and content

Abstract

The relationship between the severity of coronary artery stenosis and the time to completed redistribution of thallium 201 (Tl-201) defects following maximal exercise was investigated in 59 patients undergoing stress-redistribution Tl-201 scintigraphy, coronary angiography, and contrast ventriculography. Multiple view Tl-201 scintigrams were obtained, beginning 6 minutes (immediately post stress), less than 1 hour (early), 3 to 5 hours (average), and 18 to 24 hours (late) following intravenous Tl-201 injection at peak exercise. Angiographic lesions were grouped into five levels of severity by percent stenosis. In the 107 defects which were seen on the immediate post stress images, early redistribution was noted in 15 (14%) and late redistribution was found in 23 (21%). In addition, there was a correlation (r = 0.56) between the time to completed redistribution and the severity of the coronary artery stenosis (p = 0.001). In comparison to defects with early and average redistribution, the segments contralateral to those with defects showing late redistribution more often had a critical stenosis supplying that segment. The frequency of myocardial infarction on ECG and the number of segments with akinetic and dyskinetic wall motion were less in defects undergoing late rather than no redistribution. Thus the time to completed Tl-201 redistribution following stress appears to be related to the severity of stenosis in the coronary artery supplying the defect. Also, late redistribution is associated with the presence and early redistribution with the absence of a significant stenosis in the coronary artery to the contralateral segment.

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This observation led to the development of imaging protocols with late-redistribution imaging, or reinjection imaging and separate day imaging after a resting injection of thallium-201. Late-redistribution imaging, which involves redistribution imaging 18–24 hours after tracer injection, shows increased relative tracer content in a significant number of perfusion defects that are fixed by imaging at 4 hours [26–28]. Redistribution between immediate and late resting images was reported in 1979 with several studies demonstrating that reduced thallium-201 uptake in the immediate rest images does not necessarily represent myocardial scar [29].
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^☆: Supported in part by SCOR Grant No. 17651 from the National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Md.; and by a research grant from the American Heart Association, Greater Los Angeles Affiliate, Inc.

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Time to completed redistribution of thallium-201 in exercise myocardial scintigraphy: Relationship to the degree of coronary artery stenosis☆

Abstract

Am J Cardiol

Semin Nucl Med

Am J Cardiol

Chest

Thallium-201 for myocardial imaging. Relation of thallium-201 to regional myocardial perfusion

Circulation

Segmental analysis of Tl-201 stress myocardial scintigraphy

J Nucl Med

Myocardial imaging with thallium-201 at rest and during exercise. Comparison with coronary arteriography and resting and stress electrocardiography

Circulation

Value and limitations of segmental analysis of stress thallium myocardial imaging for localization of coronary artery disease

Circulation

Differentiation of transiently ischemic from infarcted myocardium by serial imaging after a single dose of thallium-201

Circulation

Comparison of single-dose and double-dose thallium-201 myocardial perfusion scintigraphy for the detection of coronary artery disease and prior myocardial infarction

Circulation

Thallium-201 myocardial scintigraphy in patients with triple vessel disease and ischemic exercise tests

Circulation

Thallium-201 myocardial imaging: A comparison of the redistribution and rest images

J Nucl Med

Disparity between rest and delayed exercise scans in patients with multivessel coronary artery disease: Differentiation of infarction from ischemia (abstr)

Circulation

Effect of stenosed and occluded coronary arteries on immediate and late myocardial uptake of thallium-201

Br Heart J

Rate of redistribution in Tl-201 exercise myocardial scintigraphy: Inverse relationship to degree of coronary artery stenosis (abstr)

Circulation