A new noninvasive approach to peripheral vascular disease: thallium-201 leg scans

Siegel, Michael E.; Siemsen, Jan K.

doi:10.2214/ajr.131.5.827

Cited by 37 publications

(17 citation statements)

References 2 publications

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“…This is in good agreement with the results of Tellier (12), who performed the same investigations in a population with proven coronary artery disease and in a group of smokers (19). As reported before (12,13,16,19), the lesions were essentially distal.…”

Section: Ll Scanning Resultssupporting

confidence: 92%

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Lower-Limb Vascularization in Diabetic Patients

et al. 2001

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OBJECTIVE -To investigate, by thallium-201 scanning, circulation in the muscles of the lower limb (LL) in diabetic patients without clinical peripheral vascular disease but with a high cardiovascular risk profile. RESEARCH DESIGN AND METHODS-A total of 80 diabetic patients (76 patients with type 2 diabetes, mean age 57.3 years, duration of diabetes 13.0 Ϯ 7.5 years) with more than one additional cardiovascular risk factor but no claudication were investigated. After stress testing, 1.5 MBq/kg thallium-201 was administered to perform myocardial single-photon emission computed tomography followed by LL scanning. Muscle blood flow was considered abnormal if the asymmetry in thallium-201 uptake between the two buttocks and/or thighs and/or calves was Ͼ10%.RESULTS -Muscle perfusion defects were found in 42% of the patients, mainly in the calves. These defects correlated with retinopathy (P ϭ 0.042) and the HbA 1c level (P ϭ 0.044). In patients with defects in the buttock and/or thigh, the prevalence of nephropathy and retinopathy was higher than in those with isolated defects in the calf (P ϭ 0.032 and 0.023, respectively).CONCLUSIONS -This study suggests that LL scanning coupled with myocardial scintigraphy is a convenient method of investigating peripheral muscle circulation. Proximal perfusion defects in patients without clinical arterial disease are associated with increased prevalence of retinopathy and nephropathy and, therefore, may be due to microvascular disease of LL muscle. Distal defects may indicate silent macrovascular disease of the LL. Diabetes Care 24:870 -874, 2001A fter 38 years of follow-up, the Framingham Heart Study showed that the risk of developing intermittent claudication was increased by associated coronary heart disease and diabetes (1). The prevalence of coronary artery disease and peripheral vascular disease (PVD) is high in the diabetic population (2,3).More than 50% of diabetic patients die from cardiovascular diseases (4), and the morbidity due to PVD is very high (5). Furthermore, claudication is, in turn, a strong predictor of subsequent cardiovascular events (6 -8).In diabetic patients with other risk factors, myocardial scintigraphy is suggestive of silent myocardial ischemia (SMI) in 20 -30% of cases (9). These patients commonly have angiographically normal coronary arteries and endothelial dysfunction, and myocardial microvascular changes are involved (10). Whole-body exercise thallium-201 ( 201 Tl) scintigraphy, performed after stress testing, permits detection of early functional abnormalities of lower-limb (LL) vascularization (11)(12)(13)(14)(15)(16)(17)(18)(19). Furthermore, this test investigates not only macrovascular but also microvascular blood flow (12,19).We performed myocardial 201 Tl scintigraphy after stress testing to detect SMI in a selected population of diabetic patients without claudication and without cardiac symptoms and signs but with a high cardiovascular risk profile. We took this opportunity to perform LL scanning. In particular, we examined the prevalen...

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Section: Ll Scanning Resultssupporting

confidence: 92%

“…To overcome that point, the second method has been used. It consists of measuring the regional 201 Tl uptake in the LL and calculating the right-to-left side intraindividual ratio (11)(12)(13)16,19). The physiological differences related to sex, age, weight, and physical training are then avoided (11).…”

Section: Ll Scanning Methods and Clinical Validationmentioning

confidence: 99%

Lower-Limb Vascularization in Diabetic Patients

et al. 2001

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“…Positron emission tomography (PET) using O-15water and F18-fluorodeoxyglucose (FDG) was tried in the investigation of peripheral ischemia [22,23], but this method is very expensive, and its routine use is therefore limited. However, Tc-99m sestamibi and Thallium-201 (Tl-201) are nonparticular radiopharmaceutical agents that have been used for the investigation of peripheral vascular disease [24] and in SLE patients [17].…”

Section: Discussionmentioning

confidence: 99%

Tc-99m sestamibi lower extremity muscle scan, is it a useful screening tool for assessment of preclinical atherosclerosis in rheumatoid arthritis patients?

et al. 2011

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Increased cardiovascular morbidity and mortality in rheumatoid arthritis (RA) patients cannot be entirely explained by traditional risk factors, suggesting that systemic inflammation characterizing this disease may accelerate atherosclerosis. Technetium 99m-Methoxyisobutyl isonitrile (Tc-99m sestamibi) is a myocardial perfusion imaging agent that has been suggested for evaluation of peripheral vascular disease. We used Tc-99m sestamibi muscle scan to investigate the prevalence of preclinical atherosclerosis in RA patients by perfusion reserve (PR) measurement. This study included 25 RA patients and 25 controls; 13/25 RA (GII) were on glucocorticoids and 12/25 (GI) were not. Database included full history, clinical examination, relevant laboratory tests, and Tc-99m sestamibi muscle scan for lower limbs. The percentage increase in the total counts (Cts) in the exercising calf termed PR was calculated according to the formula: (PR %) = (Cts in exercising calf-Cts in resting calf) ÷ (Cts in resting calf) × 100%. A significant difference was found between the means of PR in RA and controls (30.7±22.6% vs. 48.3±27.2%, P = 0.015). The mean perfusion reserve of GII correlated significantly with the steroids cumulative dose (P = 0.01). A statistically significant negative correlation was elicited between PR and disease duration (P = 0.024), while the negative correlation between PR and Disease Activity Index (DAS28) was not statistically significant (P = 0.065). Tc-99m sestamibi lower-limb muscle scan could be a useful screening tool for detection of preclinical atherosclerosis in lower limbs of RA patients, so early prophylactic measures and therapy modifications could be considered.

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“…Posebno mesto u kvantifikaciji perfuzije na nivou mikrocirkulacije potkolenice zauzima perfuziona scintigrafija donjih ekstremiteta talijumom 201 ( 201 Tl), koji ima biološke osobine kalijuma (K + ), a koji ulazi u ćeliju aktivnim ćelijskim transportom. Na taj način talijum prati eritrocite do tkiva 4 .…”

Section: Uvodunclassified

Assessment of lower extremities ischemic disease by thallium 201 perfusion scintigraphy in patients with diabetic angiopathy

Cizmic

Pucar²,

Zoranovic

2011

VOJNOSANIT PREGL

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Background/Aim. Tibial perfusion in diabetic microangiopathy is considered to be a diagnostic problem. A special place in quantifying muscle microcirculatory perfusion belongs to thallium 201 muscle perfusion scintigraphy (201Tl PS). Thallium, showing the characteristics of potassium (K+), enters a cell by means of active cell transportation and follows erythrocyte up to the tissue. The aim of this study was to determine if 201Tl PS of lower extremities (LE) is a good method for estimating muscle microcirculatory perfusion in diabetic microangiopathy. Methods. The study included 32 patients of an average age 66.1 ± 14.9 years with signs of LE ischemia befalling into III and IV stage of ischemic disease according to the Lariche-Fontain classification. Out of that number there were 27 of the patients with non-insulin-dependent diabetes mellitus (NIDDM), while 5 of the patients were with Burger's disease and Raynand's disorder. Lower extremities PS was performed after 3 min of tibial loading by the use of dorsoplantar foot flexion and intravenous 74 MBq 201Tl as a 10-minute dynamic study. A 10 minute static scintigraphy was carried out of the gluteal region, femurs, tibias and feet per a position and repeated after 3 h at rest in the same projections. The results were interpreted visually and by the semiquantitive method using a program for calculating the number of pulses per pixel in the corresponding region over 1-, 2- and 10-minute dynamic study, thus obtaining numerical data for estimating perfusion. Binding ratio in both legs was estimated visually as low (1), medium (2) and significant (3) difference in both legs. The results were compared with doppler hemodynamic indices (PI and RI). Results. Regardless the group, 201Tl binding intensity rising was significantly 2 min after application, as compared to 1 min, and the obtained level of binding was maintained even after 10 min. In the group Fontain III the majority of the patients showed a medium difference in binding 201Tl (2) in regard to the group Fontain IV with the patients having a low difference (1) between both legs and a significant difference between both legs (3). A statistically significant positive correlation was obtained between the values of RI index regarding distal region of a. tibialis posterior (p < 0.05, r = 0.43), as well as a. tibialis anterior (p = 0.05, r = 0.38). There was no correlation for the PI index. Low collateral net development based on the values for the indices PI and RI showed a less muscle perfusion on 201Tl in regard to medium and well developed collateral net with identical perfusion. Conclusion. The results of lower extremities perfusion scintigraphy are reliable indice of muscle microcilculatory perfusion. There is a statistically significant correlation between the doppler hemodynamic indices and 201Tl perfusion scintigraphy

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A new noninvasive approach to peripheral vascular disease: thallium-201 leg scans

Cited by 37 publications

References 2 publications

Lower-Limb Vascularization in Diabetic Patients

Lower-Limb Vascularization in Diabetic Patients

Tc-99m sestamibi lower extremity muscle scan, is it a useful screening tool for assessment of preclinical atherosclerosis in rheumatoid arthritis patients?

Assessment of lower extremities ischemic disease by thallium 201 perfusion scintigraphy in patients with diabetic angiopathy

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