Comparison of thallium redistribution with rest “reinjection” imaging for the detection of viable myocardium

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Abstract

To determine the incidence of incomplete redistribution on conventional delayed thallium images, 41 patients with persistent perfusion defects on myocardial images recorded 3 to 4 hours after thallium injection during exercise were studied. At the conclusion of their delayed images the patients were reinjected at rest with approximately 1 mCi of thallium-201 and a third set of images was recorded. The images were presented at random in pairs (initial:delayed, initial:reinjection) to 2 experienced observers for qualitative scoring of 9 segments/patient. Of the 360 segments analyzed, concordance between the delayed and reinjected images occurred in 307 (85%). Of 141 segments that demonstrated a persistent perfusion abnormality on 3- to 4-hour delayed images, 44 (31%) were reassigned to a redistribution score after reinjection. In 9 patients, reinjection images provided the only evidence of ischemia from the scintigraphic data. In 13 of 14 vascular territories that demonstrated redistribution after reinjection, intact perfusion (either anterograde or via collaterals) was detected at coronary angiography. These data suggest that rest reinjection imaging may provide a means of detecting viable myocardium in segments that demonstrate a fixed perfusion abnormality on conventional 3- to 4-hour delayed thallium images.

References (30)

  • H Gewirtz et al.

    Transient defects of resting thallium scans in patients with coronary artery disease

    Circulation

    (1979)
  • A Rozanski et al.

    Use of thallium-201 redistribution scintigraphy in the pre-operative differentiation or reversible and nonreversible myocardial asynergy

    Circulation

    (1981)
  • JB Gill et al.

    Prognostic importance of thallium uptake by the lungs during exercise in coronary artery disease

    N Engl J Med

    (1987)
  • KA Brown et al.

    Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain

    JACC

    (1983)
  • RS Gibson et al.

    Prediction of cardiac events after uncomplicated myocardial infarction: a prospective study comparing pre-discharge exercise thallium-201 scintigraphy and coronary angiography

    Circulation

    (1983)
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