Author + information
- Received June 2, 2008
- Revision received December 19, 2008
- Accepted December 22, 2008
- Published online March 1, 2009.
- 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‡ and
- John D. Friedman, MD⁎,†
- ↵⁎Reprint requests and correspondence:
Dr. Daniel S. Berman, Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room 1258, Los Angeles, California 90048
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.
Drs. Berman and Friedman are on the medical advisory board of Spectrum Dynamics, and Dr. Berman has equity interest in Spectrum Dynamics. Dr. Berman also received research funding from Spectrum Dynamics, but this funding was not used for the present study.
- Received June 2, 2008.
- Revision received December 19, 2008.
- Accepted December 22, 2008.
- American College of Cardiology Foundation