This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Berman, D. S. Articles by Friedman, J. D. Search for Related Content PubMed Articles by Berman, D. S. Articles by Friedman, J. D. Related Collections Related Article

Stress Thallium-201/Rest Technetium-99m Sequential Dual Isotope High-Speed Myocardial Perfusion Imaging

Daniel S. Berman, MD^_*,,_*, Xingping Kang, MD^_*, Balaji Tamarappoo, MD^_*, Arik Wolak, MD^_*, Sean W. Hayes, MD^_*,, Ryo Nakazato, MD^_*, Louise E.J. Thomson, MBChB, MSc^_*, Faith Kite, BS^_*, Ishac Cohen, PhD^_*, Piotr J. Slomka, PhD^_*,, Andrew J. Einstein, MD, PhD, John D. Friedman, MD^_*,

^_* Departments of Imaging (Division of Nuclear Medicine), Department of Medicine (Division of Cardiology), and CSMC Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
Department of Medicine, University of California at Los Angeles, School of Medicine, Los Angeles, California
Department of Medicine (Division of Cardiology) and Department of Radiology, Columbia University Medical Center, New York, New York

^_* Reprint requests and correspondence: Dr. Daniel S. Berman, Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room 1258, Los Angeles, California 90048 (Email: bermand{at}cshs.org).

Objectives: Our purpose was to describe a novel, rapid stress thallium-201 (Tl-201)/rest technetium-99m (Tc-99m) agent myocardial perfusion imaging (MPI) protocol (Tl/Tc) with a high-speed MPI scanner and to compare this protocol with a standard rest/stress Tc-99m agent protocol (Tc/Tc) with respect to image quality and radiation dosimetry.

Background: Recent advances in gamma camera technology have provided opportunity for improved SPECT MPI protocols. A rapid Tl/Tc protocol that could improve image information while maintaining a low radiation burden for the patient would be desirable.

Methods: We compared high-speed SPECT MPI studies in 374 consecutive patients undergoing exercise or pharmacologic Tl/Tc protocol to those of 262 patients undergoing rest/stress Tc/Tc protocol.

Results: Tl/Tc imaging was accomplished in <20 min. Overall image quality was good to excellent in 96% and 98% of patients with the Tl/Tc and the Tc/Tc protocols, respectively (p = ns). Beginning rest imaging within 2 min after rest injection with the Tl/Tc protocol did not result in reduced confidence in image interpretation. Early rest Tc images of the Tl/Tc protocol showed less extracardiac activity than was observed on standard rest imaging used in the Tc/Tc protocol (84% vs. 61%), respectively (p < 0.01). The normalcy rate was high in both groups (100% vs. 92%). Radiation burden was similar between the Tl/Tc and Tc/Tc protocols.

Conclusions: A rapid stress Tl-201/rest Tc-99m protocol for use with high-speed SPECT MPI has image quality and radiation dosimetry similar to those observed with a conventional rest/stress Tc-99m protocol. The Tl/Tc protocol offers promise as an efficient and relatively low radiation dose method, in which the superior qualities of Tl-201 for stress imaging and of the Tc-99m agents for rest imaging can be preserved. The findings also suggest that with rapid imaging rest MPI immediately after Tc-99m agent injection may be superior to standard delayed image initiation.

Key Words: dual isotope imaging • high-speed SPECT • myocardial perfusion imaging • coronary artery disease

Abbreviations and Acronyms   CAD = coronary artery disease   CZT = cadmium-zinc-telluride   ICRP = International Commission on Radiological Protection   LVEF = left ventricular ejection fraction   MPI = myocardial perfusion imaging   SPECT = single-photon emission computed tomography   Tc-99m = technetium-99m   TID = transient ischemic dilation   Tl-201 = thallium-201

Related Article

Resurrection of Thallium-201 for Myocardial Perfusion Imaging

H. William Strauss and Dale Bailey
J. Am. Coll. Cardiol. Img. 2009 2: 283-285. [Full Text] [PDF]

This article has been cited by other articles:

				V. Dilsizian Connectivity of Radiotracers to Vasodilators: Is Thallium the Missing Link? J. Am. Coll. Cardiol. Img., October 1, 2009; 2(10): 1209 - 1212. [Full Text] [PDF]

				H. W. Strauss and D. Bailey Resurrection of thallium-201 for myocardial perfusion imaging. J. Am. Coll. Cardiol. Img., March 1, 2009; 2(3): 283 - 285. [Full Text] [PDF]

				V. Dilsizian and J. Narula Seeking Remedy for Molly's Woe Time for a Thallium Pill? J. Am. Coll. Cardiol. Img., March 1, 2009; 2(3): 375 - 377. [Full Text] [PDF]