title: Sequential dual-isotope SPECT imaging with thallium-201 and technetium-99m-sestamibi.
abstract: This study examined the results of sequential SPECT dual-isotope imaging with 201Tl and 99mTc-sestamibi in 148 patients, 114 of whom also had coronary angiography and 34 had < 5% pretest probability for coronary artery disease (CAD).
  
  
  METHODS
  Stress thallium/rest sestamibi was used in 82 patients and rest thallium/stress sestamibi in 66 patients. Coronary angiography showed that 17 patients had no CAD, 27 patients had one-vessel CAD, 41 patients had two-vessel CAD and 29 patients had three-vessel CAD. The thallium study (3 mCi) was always done before the sestamibi study (20-25 mCi). The stress was either symptom-limited treadmill exercise testing or adenosine infusion at a rate of 140 micrograms/kg/min for 6 min.
  
  
  RESULTS
  The study was completed within 2 hr. The stress and rest images were normal in 11 of 17 patients (65%) with no CAD by angiography and in 33 of 34 patients with a low pretest probability of CAD (normalcy rate = 97%). The images were abnormal in 75 patients with CAD (77%). The perfusion pattern was compared to wall motion in 485 segments (97 patients) assessed by contrast ventriculography. There were no or reversible perfusion defects in 357 of 386 segments (92%) with no wall motion abnormality.
  
  
  CONCLUSIONS
  Sequential dual-isotope imaging is feasible and can be completed in a short period of time and may therefore enhance laboratory throughput and patient convenience.
authors.affiliation: Philadelphia Heart Institute, Presbyterian Medical Center, PA 19104.
authors.forename: J
authors.initials: J
authors.lastname: Heo
authors.forename: I
authors.initials: I
authors.lastname: Wolmer
authors.forename: J
authors.initials: J
authors.lastname: Kegel
authors.forename: A S
authors.initials: AS
authors.lastname: Iskandrian
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013794:Thallium Radioisotopes; D017256:Technetium Tc 99m Sestamibi