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
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Figure 1 Tl-201 Stress/Tc-99m Rest Protocol
Schematic depiction of the adenosine (top) and exercise (bottom) thallium-201 (Tl-201) stress/technetium-99m (Tc-99m) rest high-speed SPECT myocardial perfusion imaging studies. At peak stress, patients were injected with Tl-201. After a 5-min post-stress monitoring period, supine and semi-upright (sitting) acquisitions were performed sequentially. Subsequently, Tc-99m sestamibi (mibi) or tetrofosmin (tetro) was injected and a single 4-min sitting rest acquisition was performed. Adeno = adenosine.
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Figure 2 Effective Dose and Organ Weighted Equivalent Doses of High-Speed MPI Protocols
The effective dose was 11.9 mSv for the Tl/Tc study protocol with a similar but slightly lower effective dose of 11.2 mSv for the Tc/Tc study protocol. The effective dose of Tl-201 used in the Tl/Tc study protocol was 9.7 mSv. The individual organ equivalent doses are represented by the horizontal bars for each of the study protocols. MPI = myocardial perfusion imaging; other abbreviations as in Figure 1.
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Figure 3 Adenosine Stress Tl/Tc Protocol: Normal Myocardial Perfusion
Adenosine stress Tl-201/rest Tc-99m tetrofosmin high-speed SPECT myocardial perfusion imaging of a 60-year-old man with a history of hypertension, diabetes, and liver failure being evaluated for liver transplantation. Invasive coronary angiography subsequently revealed normal coronary arteries. Note the absence of significant extracardiac activity on the rest Tc-99m tetrofosmin (Tetro) images despite initiation of imaging 2 min after rest injection. Abbreviations as in Figure 1.
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Figure 4 Exercise Tl/Tc Protocol: Abnormal Myocardial Perfusion
Tl-201/rest Tc-99m sestamibi (MIBI) high-speed myocardial perfusion imaging shows extensive defects in anterior, septal, and apical walls as well as transient ischemic dilation on exercise MPI of a 56-year-old man with atypical chest pain. Invasive coronary angiography revealed occlusion of the mid-left anterior descending artery. Note the absence of significant extracardiac activity on the rest Tc-99m MIBI images despite initiation of imaging 2 min after rest injection. Abbreviations as in Figure 1.
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