Poststress motionlike artifacts caused by the use of a dual-head gamma camera for (201)Tl myocardial SPECT.
When performing (201)Tl myocardial SPECT using a dual-head gamma camera on patients after exercise stress, we have observed in some a sudden increase in the counting rate between the 16th and 17th images. This increase provoked motionlike artifacts, which increased the number of false-positive findings. The aim of our study was to determine possible causes for this leap in activity.


METHODS
We performed myocardial SPECT using a dual-head gamma camera on 110 patients after exercise stress: in 38 patients approximately 5 min after injection (group 1), in 43 patients approximately 14 min after injection (group 2), and in 29 patients twice, at approximately 5 and 20 min after injection (group 3). We also performed dynamic data acquisition for 10 min on 18 patients after exercise stress. We compared activity in the heart region in image series obtained after exercise stress and at rest.


RESULTS
Daily quality control tests eliminated the possibility of any malfunctions of the gamma camera. Careful image analysis showed no visible patient motion. Our results showed that upward creep of the heart could not be a cause of the described phenomenon. After exercise stress, a > or = 5% activity leap in the heart region on the 16th and 17th frames was more frequent in group 1 than in group 2. Two consecutive acquisitions after exercise stress showed that the leap was >5% in 24 patients (83%) and 12 patients (41%) at the first and second acquisitions, respectively (group 3). In all patients, the leap was <5% at rest. Dynamic studies showed that the activity in the heart region steadily decreased in all patients after exercise stress. We suggest that decreasing (201)Tl concentrations in myocardium or blood could be a major reason for the described artifacts.


CONCLUSIONS
We proposed that the pharmacokinetics of (201)Tl-chloride be evaluated within a short time after injection in humans after exercise stress. Now, in our department, we have begun acquisition approximately 12 min after (201)Tl administration, and the above-mentioned phenomenon has not appeared. However, to avoid the artifacts caused by early redistribution of (201)Tl, acquisition must not begin too late.
Blagosklonov
Oleg
O
Department of Nuclear Cardiology, Jean Minjoz University Hospital, Besançon, France. oleg.blagosklonov@univ-fcomte.fr
Sabbah
Ahmad
A
Verdenet
Josette
J
Baud
Michel
M
Cardot
Jean-Claude
JC
D016477:Artifacts; D005080:Exercise Test; D005189:False Positive Reactions; D005260:Female; D015902:Gamma Cameras; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D012189:Retrospective Studies; D013793:Thallium / Q000493:pharmacokinetics; D013794:Thallium Radioisotopes / Q000493:pharmacokinetics; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation*
D013794:Thallium Radioisotopes; C027549:thallium chloride; D013793:Thallium