title: Myocardial scintigraphy with iodine-123 phenylpentadecanoic acid and thallium-201 in patients with coronary artery disease: a comparative dual-isotope study.
abstract: To characterise the clinical usefulness of serial myocardial scintigraphy with iodine-123 phenylpentadecanoic acid (IPPA) in comparison with thallium-201, dual-isotope investigations were performed in 41 patients with angiographically documented coronary artery disease. Both tracers were administered simultaneously during symptom-limited ergometry. Planar scintigrams were acquired immediately after stress, and delayed imaging was performed after 1 h for IPPA and 4 h for 201Tl. Scintigrams were evaluated both qualitatively and quantitatively using a newly developed algorithm for automated image superposition. Initial myocardial uptake of both tracers was closely correlated (r = 0.75, p < 0.001). Both tracers also revealed a similar sensitivity for the identification of individual coronary artery stenoses > or = 75% (IP-PA: 70.0%, 201Tl: 66.3%, P = NS) with identical specificity (69.8%). The number of persistent defects, however, was significantly higher with IPPA (P = 0.021), suggesting that visual analysis of serial IPPA scintigrams may overestimate the presence of myocardial scar tissue. On the other hand, previous Q wave myocardial infarction was associated with a decreased regional IPPA clearance (29% +/- 11% vs 44% +/- 11% in normal myocardium, P < 0.05). The data indicate that serial myocardial scintigraphy with IPPA is essentially as sensitive as scintigraphy with 201Tl for the detection of stress-induced perfusion abnormalities. Quantitative analysis of myocardial IPPA kinetics, however, is required for the evaluation of tissue viability.
authors.affiliation: Department of Cardiology, Ruprecht-Karls University, Heidelberg, Federal Republic of Germany.
authors.forename: R
authors.initials: R
authors.lastname: Zimmermann
authors.forename: B
authors.initials: B
authors.lastname: Rauch
authors.forename: M
authors.initials: M
authors.lastname: Kapp
authors.forename: B
authors.initials: B
authors.lastname: Bubeck
authors.forename: F J
authors.initials: FJ
authors.lastname: Neumann
authors.forename: F
authors.initials: F
authors.lastname: Seitz
authors.forename: P
authors.initials: P
authors.lastname: Stokstad
authors.forename: G
authors.initials: G
authors.lastname: Mall
authors.forename: H
authors.initials: H
authors.lastname: Tillmanns
authors.forename: W
authors.initials: W
authors.lastname: Kübler
mesh_terms: D000465:Algorithms; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D013997:Time Factors
chemical_list: D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D013794:Thallium Radioisotopes; C025391:omega-(4-iodophenyl)pentadecanoic acid