thallium-201 and Coronary-Artery-Disease

The assessment of myocardial viability continues to be a pressing and sometimes challenging clinical question. Among other imaging modalities proven to be useful in the assessment of myocardial viability, single-photon emission computed tomography (SPECT) instrumentation and expertise continue to be the most widely available to the practicing physicians. Understanding the utility of SPECT myocardial perfusion imaging in this domain is an enduring need.. A wealth of basic science and clinical data established the value of a variety of Tl-201 and Tc-99m SPECT protocols in the assessment of myocardial viability. The diagnostic performance for Tl-201 and Tc-99m imaging protocols for identifying viable myocardium is very good and is comparable for both agents. Quantitative assessment of radiotracer uptake can predict, in an objective manner, the probability of recovery of myocardial function following revascularization.. SPECT myocardial perfusion imaging with Tl-201 and Tc-99m tracers can provide an objective and quantifiable assessment of myocardial viability, which can help predict the likelihood of myocardial function recovery following coronary revascularization. Effective application of this imaging technique can guide clinical decision-making for coronary revascularization.

Topics: Coronary Artery Disease; Heart; Humans; Myocardial Perfusion Imaging; Myocardial Revascularization; Myocardium; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Tissue Survival; Tomography, Emission-Computed, Single-Photon

Myocardial perfusion imaging (MPI) is a well-established diagnostic tool to evaluate coronary artery disease (CAD) and also an effective prognostic tool for patients with CAD. However, few studies investigated the prognostic value of attenuation correction (AC) in MPI, and the results were controversial.. To investigate the prognostic value of computed tomography (CT)-based AC thallium-201 (Tl-201) MPI.. A total of 108 consecutive patients who underwent Tl-201 MPI and received coronary angiography within 90 days were included. Medical records were reviewed and missing information was completed after telephone contact. The prognostic value was evaluated by Kaplan-Meier analysis, univariable and multivariable Cox proportional hazards model.. After a mean follow-up of 7.72 ± 3.72 years, 27 patients had died, 41 had been readmitted for cardiovascular (CV)-related events and 44 had reached the composite of death plus CV-related re-admission. Kaplan-Meier curves for all-cause mortality for SSS with a cutoff value of 13 for AC and 16 for non-AC (NAC) images showed a significant difference between the two curves for both AC and NAC images (p = 0.011 for AC and p = 0.021 for NAC). In the multivariable model, SSS and SRS showed similar independent predictive values in predicting all-cause mortality and composite of all-cause mortality plus CV-related re-admission, in both AC and NAC images. Subgroup analysis implicated that AC MPI possibly provided better risk stratification in obese patients.. CT-based AC and NAC MPI showed similar value and were the only significant predictors for the composite of mortality and CV events.

Topics: Aged; Coronary Artery Disease; Female; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Prognosis; Survival Rate; Thallium Radioisotopes; Tomography, X-Ray Computed

Type 2 diabetes mellitus (T2DM) increases coronary artery disease (CAD) risk. In this study, we used T2DM clinical variables to predict abnormality in thallium-201 myocardial perfusion scans (Th-201 scans). These clinical variables were summed stress score (SSS), summed rest score, and summed difference score (SDS), with data obtained from 368 male and 428 female participants with T2DM. Multiple linear regression results were as follows. In male participants, body mass index (BMI) and creatinine (Cr) were associated with SSS (β = 0.224, p < 0.001; β = 0.140, p = 0.022, respectively), and only BMI was associated with SDS (β = 0.174, p = 0.004). In female participants, BMI and high-density lipoprotein cholesterol level were associated with SSS (β = 0.240, p < 0.001; β =  - 0.120, p = 0.048, respectively), and only BMI was correlated with SDS (β = 0.123, p = 0.031). Our multivariate logistic regression indicated that in male and female participants, BMI was the only independent indicator of high SSS (SSS ≥ 9). In this study, we demonstrated that male patients have a higher SSS and SDS than female patients do in Th-201 scans for T2DM in a Chinese population. For male and female patients, BMI was the strongest predictor of abnormality in Th-201 scans. Our results can help clinicians identify patients with T2DM at high risk of CAD.

Topics: Adult; Aged; Aged, 80 and over; Coronary Artery Disease; Coronary Circulation; Diabetes Mellitus, Type 2; Female; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Prognosis; Retrospective Studies; Thallium Radioisotopes

Previous studies have demonstrated left ventricular mechanical dyssynchrony (LVMD) in patients with severe coronary artery disease (CAD) with ≥ 70% stenosis. The aim of this study was to evaluate the clinical usefulness of stress/rest LVMD in the diagnosis of CAD with ≥ 50% stenosis using dipyridamole thallium-201 (Tl-201) myocardial perfusion imaging (MPI) with a cadmium-zinc-telluride camera.. A total of 476 patients without known CAD who underwent dipyridamole Tl-201 MPI and coronary angiography within 6 months were retrospectively reviewed. LVMD parameters including phase standard deviation and phase histogram bandwidth, phase skewness and phase kurtosis, as well as myocardial perfusion and myocardial stunning were assessed in post-stress and rest MPI. Relationships between the presence of CAD on coronary angiography and single photon emission computerized tomography (SPECT) parameters were evaluated. The presence of perfusion abnormalities was the best diagnostic tool in detecting CAD. Although less left ventricular synchrony was observed post-stress in the CAD group compared to the non-CAD group, no significant dyssynchrony was noted.. The addition of phase analysis to help diagnose CAD in Tl-201-gated SPECT with dipyridamole stress may have limited value in patients with CAD with ≥ 50% stenosis.

Topics: Aged; Cadmium; Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; Coronary Angiography; Coronary Artery Disease; Dipyridamole; Female; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Myocardial Stunning; Tellurium; Thallium Radioisotopes; Vasodilator Agents; Ventricular Function; Zinc

Topics: Cadmium; Coronary Artery Disease; Dipyridamole; Humans; Myocardial Perfusion Imaging; Tellurium; Thallium Radioisotopes; Zinc

The benefits of attenuation correction (AC) in technetium-99m myocardial perfusion imaging (MPI) have been well established. However, the value of thallium (Tl-201) AC and routine computed tomography AC (CTAC) were less well established. The aims of this study were to evaluate the diagnostic performance of thallium (Tl-201) MPI with additional CTAC and to determine which participants would benefit most.. A total of 108 consecutive patients who underwent Tl-201 MPI and received coronary angiography within 3 months were enrolled. Diagnostic performance was determined by sensitivity, specificity, and receiver operating characteristic curve analysis. Subgroup analyses were performed using gender and obesity. CTAC improved the area under the curve (0.84 vs. 0.77, P = 0.037 at patient level), primarily due to a significant improvement in specificity (0.78 vs. 0.57, P = 0.013) and no significant difference in sensitivity (0.79 vs. 0.82, P = 0.75). In subgroup analysis, CTAC was most helpful in obese subjects, men, and especially right coronary artery lesions.. CTAC significantly improved diagnostic performance primarily by increasing the specificity, and the improvements were significantly greater in obese patients and male patients. These findings suggest that CTAC should be applied to Tl-201 MPI as routine clinical practice.

Topics: Aged; Area Under Curve; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Myocardial Perfusion Imaging; Obesity; Reference Standards; Reproducibility of Results; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Sex Factors; Single Photon Emission Computed Tomography Computed Tomography; Thallium Radioisotopes

To evaluate the value of preoperative dipyridamole thallium-201 scintigraphy for reducing cardiovascular complication in secondary hyperparathyroidism (SHPTH) patients.. Thallium scintigraphy was arranged for all dialysis patients who underwent parathyroidectomy from Jan 2011 to July 2015. Management of defects on thallium scintigraphy included cardiac catheterization and ultrasonography. Analysis includes 30-day mortality, morbidity and the predicting factors for thallium scintigraphy defect.. Of 249 patients with SHPTH, 19 (7.6%) had defects on thallium scintigraphy, 15 (88%) of whom had coronary artery disease on angiography. History of acute coronary syndrome (ACS, p < 0.001), diabetes mellitus (DM, p = 0.03), male sex (p = 0.03), and higher body mass index (BMI, p = 0.001) were significant predictors of positive thallium scintigraphy results. History of ACS was the most significant predictor after adjustment in the multivariate logistic analysis (odds ratio, 22.56; 95% confidence interval, 7.02-72.53). All the patients survived the 30-day postoperative period, with minimal cardiovascular morbidity.. Preoperative dipyridamole thallium-201 scintigraphy is useful for SHPTH patients to minimized surgical mortality and morbidity.

Topics: Adult; Aged; Coronary Artery Disease; Dipyridamole; Female; Follow-Up Studies; Humans; Hyperparathyroidism, Secondary; Male; Middle Aged; Parathyroidectomy; Postoperative Complications; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Thallium Radioisotopes; Treatment Outcome

We aimed to determine the optimal thallium 201 chloride (thallium-201) dose using a novel ultrafast cardiac gamma camera with cadmium-zinc-telluride (CZT) solid-state semiconductor detectors (D-SPECT).. The optimal thallium-201 dose for obtaining left ventricular (LV) myocardial counts was determined from a phantom study. Consecutive 292 patients underwent stress myocardial perfusion imaging with a thallium-201 injection. Stress test comprised exercise or pharmacological (adenosine) provocation. We calculated an optimal thallium-201 dose that resulted in better LV myocardial counts during 6 minutes of acquisition time. We corrected the respective values according to the patient's age, sex, body mass index (BMI), and type of stress test. The lowest thallium-201 dose for obtaining acceptable imaging was 1.2 million counts. Radiopharmaceutical doses showed a positive correlation with the patient's age (P < .001), sex (P = .012), BMI (P < .001), and type of stress test (P < .001). Multivariate analysis revealed that the patient's BMI and the type of stress test were statistically significant factors for determining the correct radiopharmaceutical dose (P < .001 for both).. For clinical use of the CZT SPECT system, the optimal individual thallium-201 doses can be determined based on the patient's BMI and type of stress test.

Topics: Aged; Aged, 80 and over; Cadmium; Coronary Artery Disease; Exercise Test; Female; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Phantoms, Imaging; Radiopharmaceuticals; Tellurium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left; Zinc

Myocardial perfusion single-photon emission computed tomography (SPECT) is often performed even in patients with suspected coronary artery disease complicated by anemia. We assessed the effects of hemoglobin level on myocardial washout rate of Thallium-201 (Tl-201) in patients with normal myocardial perfusion assessed by SPECT. The study population consisted of 231 patients with summed stress score of zero on SPECT. The mean myocardial washout rate of Tl-201 in the left ventricle was calculated from the stress and the redistribution Bull's eye map. Hematological test was performed within 2 weeks before gated SPECT. There were 135 male and 96 female patients with a mean age of 72.6 ± 9.0 years. The mean hemoglobin was 12.9 ± 1.9 mg/dl; the median was 13.2 mg/dl and the range was 8.0-16.5 mg/dl. There was a significant inverse correlation between hemoglobin level and myocardial washout rate of Tl-201 (r = -0.45, p < 0.001). Univariate linear regression analysis showed that age, female, body mass index, serum creatinine, hemoglobin, end-diastolic volume, and ejection fraction were associated with myocardial washout rate of Tl-201. Multivariate analysis showed that only hemoglobin was the independent predictor of myocardial washout rate of Tl-201 (β = -0.35, p < 0.001). Our data suggested that anemia was a major determinant of increased myocardial washout rate of Tl-201 in patients with normal myocardial perfusion on SPECT.

Topics: Aged; Biomarkers; Coronary Artery Disease; Coronary Circulation; Female; Hemoglobins; Humans; Male; Myocardium; Retrospective Studies; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

The myocardial perfusion single photon emission computed tomography synchronized with the electrocardiogram (gated SPECT) has been widely used for the assessment of left ventricular (LV) systolic and diastolic functions using Quantitative gated SPECT. The aim of this study was to compare the effects of 8-frame and 16-frame thallium-201 (Tl-201) gated SPECT for determining LV systolic and diastolic parameters. The study population included 42 patients with suspected coronary artery disease who underwent gated SPECT by clinical indication. LV systolic and diastolic parameters were assessed on 8-frame and 16-frame gated SPECT. There were good correlations in end-diastolic volume (r = 0.99, p < 0.001), end-systolic volume (ESV) (r = 0.97, p < 0.001) and ejection fraction (EF) (r = 0.95, p < 0.001) between 8-frame and 16-frame gated SPECT. Bland-Altman plot showed a significant negative slope of -0.08 in EDV indicating a larger difference for larger EDV. Eight-frame gated SPECT overestimated ESV by 2.3 ml, and underestimated EF by -4.2% than 16-frame gated SPECT. There were good correlations in peak filling rate (PFR) (r = 0.87, p < 0.001), one third mean filling rate (r = 0.87, p < 0.001) and time to PFR (r = 0.61, p < 0.001) between 8-frame and 16-frame gated SPECT. Eight-frame gated SPECT underestimated PFR by -0.22 than 16-frame gated SPECT. Eight-frame gated SPECT estimated as much MFR/3 and TPFR as 16-frame gated SPECT. According to the data, the study suggested that 8-frame Tl-201 gated SPECT could underestimate systolic and/or diastolic parameter when compared with 16-frame gated SPECT.

Topics: Aged; Aged, 80 and over; Coronary Artery Disease; Female; Heart Ventricles; Humans; Japan; Male; Myocardial Contraction; Myocardial Perfusion Imaging; Stroke Volume; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left