title: Identification of viable myocardium in patients with chronic coronary artery disease: comparison of thallium-201 scintigraphy with reinjection and technetium-99m-methoxyisobutyl isonitrile.
abstract: We compared the results of 201Tl reinjection and those of 99mTc-methoxyisobutyl isonitrile (MIBI) in identifying viable myocardium in 20 male patients with angiographically proven coronary artery disease (CAD) and left ventricular dysfunction (ejection fraction 30% +/- 8%). All patients had irreversible defects on standard exercise-redistribution thallium imaging. Thallium was reinjected immediately after the redistribution study, and images were reacquired. The patients also underwent stress and rest 99mTc-MIBI myocardial scintigraphy (2-day protocol). A total of 300 myocardial regions were analyzed, of which 122 (41%) had irreversible thallium defects on redistribution images before reinjection. Of the 122 myocardial regions with irreversible defects on standard stress-redistribution thallium cardiac imaging, 65 (53%) did not change at reinjection and 57 (47%) demonstrated enhanced uptake of thallium after reinjection. Of the same 122 irreversible defects on stress-redistribution thallium, 100 (82%) appeared as fixed defects and 22 (18%) were reversible on 99mTc-MIBI myocardial scintigraphy. These data indicate that 201Tl cardiac imaging with rest reinjection is superior to 99mTc-MIBI myocardial scintigraphy in identifying viable myocardium in patients with chronic CAD, suggesting that regions with severe reduction of 99mTc-MIBI uptake both on stress and rest images may contain viable myocardium.
authors.affiliation: Department of Nuclear Medicine, 2nd Medical School, Università degli Studi di Napoli Federico II, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cuocolo
authors.forename: L
authors.initials: L
authors.lastname: Pace
authors.forename: B
authors.initials: B
authors.lastname: Ricciardelli
authors.forename: M
authors.initials: M
authors.lastname: Chiariello
authors.forename: B
authors.initials: B
authors.lastname: Trimarco
authors.forename: M
authors.initials: M
authors.lastname: Salvatore
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009570:Nitriles; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes / Q000008:administration & dosage
chemical_list: D009570:Nitriles; D015609:Organotechnetium Compounds; D013794:Thallium Radioisotopes; D017256:Technetium Tc 99m Sestamibi