title: Evaluation of myocardial viability with thallium-201 infusion MPSPECT after oral glucose application in patients with chronic coronary artery disease.
abstract: OBJECTIVE
  The aim of this study was to evaluate the myocardial viability in nondiabetic patients with chronic coronary artery disease (CCAD) or past myocardial infarction (MI), using thallium-201 infusion myocardial perfusion single-photon emission computed tomography (MPSPECT) imaging after oral glucose application (Glu+Tl-infusion).
  
  
  METHODS
  In this study, 33 nondiabetic patients (three female, 30 male, mean age: 55.24+/-11 years, range: 33-77 years) with MI history or known CCAD were included. Rest/redistribution/24 h-late-MPSPECT imaging was performed for all patients. In all patients in whom fixed perfusion defect was observed on any wall of the left ventriculi, after 24 h-late-MPSPECT imaging, 75 g oral glucose was given. Thirty minutes later, 1 mCi thallium-201 in 100 ml of physiological saline solution was applied in a period of 20 min by slow infusion. After infusion at the 10th minute, MPSPECT imaging was performed. Perfusion was evaluated visually for a total of 3432 segments with the 26-segment 5-point scoring technique. Scoring measured perfusion as 0 = no perfusion defect, 1 = mildly reduced, 2 = moderately reduced, 3 = severely reduced, and 4 = absent uptake. Scores '0 and 1' were considered normal and scores '2-4' were considered abnormal.
  
  
  RESULTS
  For serum insulin levels measured after glucose application, a significant increase was determined, according to the period before glucose application (P<0.001). When compared with rest MPSPECT images, segmental perfusion improvement both in redistribution and in the 24 h-late-MPSPECT images were 16.3 and 18.3%, respectively. This ratio was found to be 27.2% for Glu+Tl-infusion images. The ratios of segments in which perfusion was worsening were calculated to be 9.4, 14.5, and 7.3%, respectively, for redistribution, 24 h-late-MPSPECT, and Glu+Tl-infusion images. When this evaluation was made for all three vessel areas, again the highest perfusion improvement and the lowest perfusion worsening were detected for Glu+Tl-infusion images. In addition, when this evaluation was made for the three vessel areas according to the coronary narrowing degree, again the highest perfusion improvement was detected for Glu+Tl-infusion images, in segments in the left anterior descending artery, and right coronary artery areas with >/=90% narrowing. In rest images, in segments with segmental scores of 3 and 4, when the total reversibility ratio was evaluated, this ratio was calculated to be 0.7% for redistribution images and 4.5% for 24 h-late-MPSPECT. The highest total reversibility ratio in these segments was detected with Glu+Tl-infusion images to be 10.3%. When we evaluated the patients with respect to the MI history time, the highest segmental perfusion improvement was detected in patients with 0-3 months of MI history.
  
  
  CONCLUSIONS
  We conclude that in nondiabetic patients who are known to have CCAD or past MI history, Glu+Tl-infusion is an easily applicable method that gives better results for the evaluation of myocardial viability.
authors: Department of Nuclear Medicine, Ministry of Health, Kahramanmaras Hospital, Kahramanmaras, Turkey.
authors: Zekiye
authors: Z
authors: Hasbek
authors: Bulent
authors: B
authors: Turgut
authors: Taner
authors: T
authors: Erselcan
authors: Kenan
authors: K
authors: Yalta
authors: Izzet
authors: I
authors: Tandogan
authors: Gurkan
authors: G
authors: Ozer
authors: Umit
authors: U
authors: Ozdemir
authors: Nergiz Hacer
authors: NH
authors: Turgut
mesh_terms: D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000000981:diagnostic imaging* / Q000209:etiology*; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013793:Thallium / Q000008:administration & dosage; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; C027549:thallium chloride; D013793:Thallium; D005947:Glucose