On the clinical value of thallium-201 washout analysis in the detection of multiple jeopardized myocardial regions

Ascoop, C. A. P. L.; Klein, Bart; Niemeyer, Menco G.; Oudheusden, Dave van; Rijneke, Rob D.; Tellingen, C. van

doi:10.1016/0167-5273(86)90035-5

Cited by 10 publications

(11 citation statements)

References 17 publications

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“…A positive study was indicated by (1) a junctional depression of at least 0.1 mV followed by a horizontal or downsloping ST segment for at least 80 ms with a normal ST segment at rest (type B, C, or D exercise ST responses) [12] or (2) a slow upsloping ST segment with ST depression of at least 0.2 mV 80 ms after the end of the QRS complex, with a normal ST segment at rest (type F exercise ST response) [12,13].…”

Section: Exercise Electrocardiographymentioning

confidence: 99%

“…The visual differences between the post-exercise and delayed images were classified in the same manner (grade 1 = no reversible defect, grade 2 = possible reversible defect, grade 3 = defi nite reversible defect). The overall scintigram was considered abnor mal when the total score was proven to be higher than 18 during the post-exercise phase [13]. The optimal criterion for the classification of reversible defects was achieved when a score of 17 or less was considered negative [13].…”

Section: Patient Populationmentioning

confidence: 99%

“…Our method to obtain the exercise 201T1 scintigrams has pre viously been described [13]. A dose of 74 MBq (2 mCi) of 201T1 was injected through an indwelling intravenous cannula at maximal exercise which was continued for 1 min after injection.…”

Section: Tl Imagingmentioning

confidence: 99%

“…The following patients were not included: (1) patients who underwent exercise testing after coronary bypass surgery of percutaneous transluminal coronary angioplasty; (2) patients who failed to perform adequate exercise; -exercise was considered inadequate if the patient achieved less than 85% of the age-predicted maximal heart rate in the absence of angina or isch aemic ST depression; (3) patients with valvular, congenital, or car- The visual assessment was performed by means of a semiquan titative method [15]. Each image was divided into five roughly equal segments for a total of 15 segments numbered 1-15 [13]. The 201T1 scintigrams of the initial uptake and the delayed interval or redistri bution phase were inspected on a computer gray scale without smoothing or background subtraction.…”

Section: Patient Populationmentioning

confidence: 99%

“…There was a minimum of 300,000 counts per image obtained. All images were stored by the computer on magnetic disc in a 128 X 128 X 8-bit matrix (MDS-A2) [6,13],…”

Section: Tl Imagingmentioning

confidence: 99%

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Value of Visual and Quantitative Analysis of Thallium-201 Imaging in Patients with Diagnostic and Non-Diagnostic Exercise Electrocardiograms

Niemeyer¹,

Wall²,

Verzijlbergen³

et al. 1991

Am J Noninvas Cardiol

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Myocardial 201T1 imaging in conjunction with exercise stress testing has become an accepted technique for evaluating patients with known or suspected coronary artery disease. Especially in patients with an abnormal baseline repolarization on the electrocardiogram at rest, 20IT1 imaging has proven value. The aim of our study was (1) to evaluate the role of visual assessment and quantitative analysis of myocardial stress perfusion scintigraphy in 203 consecutive patients presenting for evaluation of possible coronary artery disease and (2) to evaluate the advantage of 201T1 myocardial imaging for the detection of coronary artery disease over exercise electrocardiography in patients with a normal electrocardiogram at rest and in patients with an abnormality of repolarization on the electrocardiogram at rest. Significant coronary artery disease (≥50% luminal stenosis) was present in 162 patients. The patients were divided into two groups: 121 patients with diagnostic exercise electrocardiograms (group 1) and 82 patients with non-diagnostic exercise electrocardiograms (group 2). The sensitivity of exercise electrocardiography in group 1 patients was not significantly different from that of visual analysis of myocardial perfusion scintigraphy (76 vs. 68%), but the sensitivity of the exercise electrocardiography was significantly higher than that of quantitative analysis of myocardial perfusion scintigraphy (76 vs. 63%; p = 0.0318). The sensitivity of visual analysis was not significantly different from that of quantitative analysis. The difference between the specificity of exercise electrocardiography and visual and quantitative analysis of myocardial perfusion scintigraphy was not significant (80 and 77% vs. 90%). The sensitivity of visual and quantitative analysis of myocardial perfusion scintigraphy in group 2 patients (both 90%) was significantly higher than that of visual and quantitative analysis of myocardial perfusion scintigraphy in group 1 patients (68 and 63%, respectively; p < 0.001). The specificity of visual and quantitative analysis of myocardial perfusion scintigraphy was not significantly different in group 1 patients (77 and 90%) when compared with the specificity of group 2 patients (both 82%). It is concluded that (1) visual and quantitative analysis of myocardial perfusion scintigraphy in detecting coronary artery disease offers no advantage for this purpose in patients with diagnostic exercise electrocardiograms when compared with exercise electrocardiography alone; (2) comparison of thallium scintigraphy (both visual analysis and quantitative analysis) in patients with diagnostic and non-diagnostic exercise electrocardiograms showed that sensitivity, specificity, and accuracy were higher in the group with the non-diagnostic exercise electrocardiograms; (3) the main advantage of exercise imaging with 201T1 is in patients with non-diagnostic exercise electrocardiograms.

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Section: Exercise Electrocardiographymentioning

confidence: 99%

Section: Patient Populationmentioning

confidence: 99%

Section: Tl Imagingmentioning

confidence: 99%

Section: Patient Populationmentioning

confidence: 99%

“…There was a minimum of 300,000 counts per image obtained. All images were stored by the computer on magnetic disc in a 128 X 128 X 8-bit matrix (MDS-A2) [6,13],…”

Section: Tl Imagingmentioning

confidence: 99%

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Value of Visual and Quantitative Analysis of Thallium-201 Imaging in Patients with Diagnostic and Non-Diagnostic Exercise Electrocardiograms

Niemeyer¹,

Wall²,

Verzijlbergen³

et al. 1991

Am J Noninvas Cardiol

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Comparison of technetium-99m sestamibi left ventricular wall motion and perfusion studies with thallium-201 perfusion imaging: in search of the combination of variables with the highest accuracy in predicting coronary artery disease

Verzijlbergen

Zwinderman²,

Ascoop

et al. 1996

Eur J Nucl Med

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Measurements of myocardial perfusion and ventricular function are expected to provide additional information in the detection of coronary artery disease (CAD). The purpose of this study was threefold: (1) to determine to what extent technetium-99m sestamibi wall motion yields different information compared with 99mTc-sestamibi and thallium-201 perfusion; (2) to test which information unique to either study is of value in diagnosing CAD; and (3) to assess the combination of variables with the highest diagnostic accuracy. Perfusion and wall motion scores (at rest and during exercise) obtained from visual and quantitative planar 201Tl and 99mTc-sestamibi scintigraphy of 60 patients with suspected CAD were compared with the angiographic results by means of a polytomous logistic regression model and the diagnostic values were compared with one another. All univariate variables were significantly related to the probability of CAD and its extent. Comparative studies revealed a large degree of correlation between 201Tl stress and redistribution variables. The rest 99mTc-sestamibi and wall motion studies contained partially different information. Stepwise logistic regression analysis showed the strongest diagnostic power for the combination of 201Tl visual analysis of the stress images with quantitative redistribution images (sensitivity 93%, specificity 71%). The diagnostic power was similar for all combinations of visual and quantitative analyses of the exercise and redistribution images. The strongest diagnostic power of the 99mTc-sestamibi variables was the score of the diastolic stress image (sensitivity 91%, specificity 79%). Comparable sensitivity and specificity estimates were found when both optimal models were compared. Wall motion studies did not have additional diagnostic power. Although 99mTc-sestamibi wall motion studies, both at rest and during exercise, provide information in addition to the 99mTc-sestamibi or 201Tl myocardial perfusion variables, the information does not enhance the diagnostic power with regard to the prediction of CAD.

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Is quantitative analysis superior to visual analysis of planar thallium 201 myocardial exercise scintigraphy in the evaluation of coronary artery disease?

et al. 1990

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Abstract. Quantitative analysis of myocardial exercise scintigraphy has been previously reported to be superior to visual image interpretation for detection of the presence and extent of coronary artery disease. Computer analysis of perfusion defects and washout rate of thallium 201 was performed on scintigrams from a group of 131 consecutive patients (prospective group), using criteria defined from a previous group of 72 patients (initial group), and compared with visual interpretation of scintigrams for detection and evaluation of coronary artery disease. The sensitivity of the quantitative technique with regard to overall detection of coronary artery disease was not significantly different from the visual method (69% and 74%, respectively), whereas the specificity was higher (86% and 68%). Quantitative analysis did not increase the sensitivity of thallium imaging over the visual method in the left anterior descending artery (46% vs 65%) and the right coronary artery (51% vs 72%) but did increase sensitivity in the left circumflex artery (75% vs 47%). Whereas in the initial group quantitative analysis resulted in a better identification of multivessel disease (sensitivity 81% vs 57%), in the prospective group sensitivity decreased (54% vs 67%) without significant loss of specificity. The initial group had a 40 % incidence of three-vessel disease and the prospective group, 22% (P<0.05). One-vessel disease was higher in the prospective group (32% vs 11%, P< 0.05). Thus, assessing the quantitative technique in a larger prospective patient population, there was no improvement of Offprint requests to." E.K.J. Pauwels detection of the presence and extent of coronary artery disease when compared with visual interpretation.

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On the clinical value of thallium-201 washout analysis in the detection of multiple jeopardized myocardial regions

Cited by 10 publications

References 17 publications

Value of Visual and Quantitative Analysis of Thallium-201 Imaging in Patients with Diagnostic and Non-Diagnostic Exercise Electrocardiograms

Value of Visual and Quantitative Analysis of Thallium-201 Imaging in Patients with Diagnostic and Non-Diagnostic Exercise Electrocardiograms

Comparison of technetium-99m sestamibi left ventricular wall motion and perfusion studies with thallium-201 perfusion imaging: in search of the combination of variables with the highest accuracy in predicting coronary artery disease

Is quantitative analysis superior to visual analysis of planar thallium 201 myocardial exercise scintigraphy in the evaluation of coronary artery disease?

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