Thallium-201 peripheral perfusion scans: feasibility of single-dose, single-day, rest and stress study

Me, Siegel; Ca, Stewart

doi:10.2214/ajr.136.6.1179

Cited by 27 publications

(11 citation statements)

References 9 publications

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“…However, while 201 Tl has successfully been used in cardiac perfusion imaging [18] and in skeletal muscle perfusion imaging in PVD patients [19–22], 99m Tc-labeled perfusion tracers have largely replaced the use of 201 Tl. Beside the considerably lower radiation exposure (6 vs. 28 millisievert) 99m Tc-labeled tracers offer more advantages compared to 201 Tl, the most essential being the shorter half-life (6 h for 99m Tc compared to 73 h for 201 Tl), allowing for injection of higher doses, in combination with the higher energy level at which 99m Tc emits gamma rays [140 k electronvolt (keV) compared to 78 keV for 201 Tl], which results in less scatter and attenuation.…”

Section: Perfusion Tracers In Neovascularization Researchmentioning

confidence: 99%

SPECT and PET imaging of angiogenesis and arteriogenesis in pre-clinical models of myocardial ischemia and peripheral vascular disease

Hendrikx

Vöö

Bauwens

et al. 2016

Eur J Nucl Med Mol Imaging

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PurposeThe extent of neovascularization determines the clinical outcome of coronary artery disease and other occlusive cardiovascular disorders. Monitoring of neovascularization is therefore highly important. This review article will elaborately discuss preclinical studies aimed at validating new nuclear angiogenesis and arteriogenesis tracers. Additionally, we will briefly address possible obstacles that should be considered when designing an arteriogenesis radiotracer.MethodsA structured medline search was the base of this review, which gives an overview on different radiopharmaceuticals that have been evaluated in preclinical models.ResultsNeovascularization is a collective term used to indicate different processes such as angiogenesis and arteriogenesis. However, while it is assumed that sensitive detection through nuclear imaging will facilitate translation of successful therapeutic interventions in preclinical models to the bedside, we still lack specific tracers for neovascularization imaging. Most nuclear imaging research to date has focused on angiogenesis, leaving nuclear arteriogenesis imaging largely overlooked.ConclusionAlthough angiogenesis is the process which is best understood, there is no scarcity in theoretical targets for arteriogenesis imaging.

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Section: Perfusion Tracers In Neovascularization Researchmentioning

confidence: 99%

SPECT and PET imaging of angiogenesis and arteriogenesis in pre-clinical models of myocardial ischemia and peripheral vascular disease

Hendrikx

Vöö

Bauwens

et al. 2016

Eur J Nucl Med Mol Imaging

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“…On the other hand, using this protocol, pure stress and rest perfusion data could be obtained on the same day, avoiding another shortcoming of thallium studies, i.e. delayed-stress 20W1 perfusion scintigraphy cannot be used to represent true rest perfusion, as emphasized by Siegel and Stewart [15]. Additionally, the delay period of the 99mTc-sestamibi study was utilized.…”

Section: Discussionmentioning

confidence: 99%

“…No serious side-effects occurred. Simultaneous arterial occlusion was applied to stress the lower extremities as this was convenient in combination with the heart study, and Siegel and co-workers [14,15] (Fig. 1), bilateral high femoral compression was pertbrmed for 5 rain, a specially tight cuff being inflated with a pressure at least 50 mmHg higher than the brachial arterial blood pressure.…”

Section: Methodsmentioning

confidence: 99%

Technetium-99m sestamibi scintigraphy for the assessment of lower extremity ischaemia in peripheral arterial disease

et al. 1994

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Technetium-99m sestamibi was used for functional investigation of the muscle perfusion of lower extremities in 35 patients with peripheral vascular disease. The aim was to test what useful information could be obtained by additional imaging of the legs in patients referred for risk stratification with dipyridamole myocardial scanning. Posterior images were acquired over the thighs and calves after postocclusive reactive hyperaemia and at rest. Inter- and intraextremity ratios and differences between the stress and rest data were used for the assessment of abnormal circulation. Arteriography was performed in every case, and surgical procedures or transluminal angioplasty in 31 patients. To estimate diagnostic accuracy, the results of 99mTc-sestamibi scintigraphy were compared with those of angiography and the functional consequences of revascularization procedures. The sensitivity and specificity of 99mTc-sestamibi scintigraphy were 55% and 25%, respectively, with an overall accuracy of 50%. Apparently methodological error was not responsible for these poor results. Instead, a paradoxically high uptake of the radiopharmaceutical in muscles supplied by significantly stenosed vessels was identified as the main source of both false-negative and false-positive results. The phenomenon resembles the findings of a previous study involving delayed administration of thallium-201 after exercise. In conclusion, 99mTc-sestamibi scintigraphy has not proved sufficiently reliable to help in the management strategy for patients with peripheral vascular disease.

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“…Magnetic resonance (MR) imaging can evaluate lower extremity tissue perfusion and oxygenation in the setting of PAD; however, MR techniques are limited by their insensitivity to measure perfusion at rest and usually require exercise or reactive hyperemia protocols to adequately augment flow 16-18 . Nuclear imaging is capable of detecting abnormalities in lower extremity rest and stress perfusion in the setting of PAD 19,20 . Additionally, nuclear approaches provide improved sensitivity, and when co-registered with high-resolution anatomical imaging, offer optimal localization and quantification of radiotracer uptake 21 .…”

mentioning

confidence: 99%

“…Scintigraphic and single photon emission tomography (SPECT) imaging with the perfusion radiotracer 201 Tl has proven to be an effective technique for identifying lower extremity perfusion in PAD patients 11,19,20,22,23 . Additionally, 201 Tl imaging has proven to be a more sensitive approach than ABI for detecting perfusion abnormalities in asymptomatic patients 11 and may allow for better assessment of microvascular and collateral perfusion than standard techniques such as Doppler ultrasound 13 ; however, quantitative approaches are still lacking.…”

mentioning

confidence: 99%

Multimodality Imaging Approach for Serial Assessment of Regional Changes in Lower Extremity Arteriogenesis and Tissue Perfusion in a Porcine Model of Peripheral Arterial Disease

Stacy

Maxfield

et al. 2014

Circ: Cardiovascular Imaging

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Background A standard quantitative imaging approach to evaluate peripheral arterial disease (PAD) does not exist. Quantitative tools for evaluating arteriogenesis in vivo are not readily available and the feasibility of monitoring serial regional changes in lower extremity perfusion has not been examined. Methods and Results Serial changes in lower extremity arteriogenesis and muscle perfusion were evaluated following femoral artery occlusion in a porcine model using SPECT/CT imaging with post-mortem validation of in vivo findings using gamma counting, post-mortem imaging, and histological analysis. Hybrid thallium-201 (201Tl) SPECT/CT imaging was performed in pigs (n=8) at baseline, immediately post-occlusion, and at 1 and 4 weeks post-occlusion. CT imaging was used to identify muscle regions of interest in the ischemic (I) and non-ischemic (NI) hindlimbs for quantification of regional changes in CT defined arteriogenesis and quantification of 201Tl perfusion. Four weeks post-occlusion, post-mortem tissue 201Tl activity was measured by gamma counting and immunohistochemistry was performed to assess capillary density. Relative 201Tl retention (I/NI) was reduced immediately post-occlusion in distal and proximal muscles and remained lower in calf and gluteus muscles 4 weeks later. Analysis of CT angiography revealed collateralization at 4 weeks within proximal muscles (p<0.05). SPECT perfusion correlated with tissue gamma counting at 4 weeks (p=0.01). Increased capillary density was seen within the ischemic calf at 4 weeks (p=0.004). Conclusions 201Tl SPECT/CT imaging permits serial, regional quantification of arteriogenesis and resting tissue perfusion following limb ischemia. This approach may be effective for detection of disease and monitoring therapy in PAD.

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Thallium-201 peripheral perfusion scans: feasibility of single-dose, single-day, rest and stress study

Cited by 27 publications

References 9 publications

SPECT and PET imaging of angiogenesis and arteriogenesis in pre-clinical models of myocardial ischemia and peripheral vascular disease

SPECT and PET imaging of angiogenesis and arteriogenesis in pre-clinical models of myocardial ischemia and peripheral vascular disease

Technetium-99m sestamibi scintigraphy for the assessment of lower extremity ischaemia in peripheral arterial disease

Multimodality Imaging Approach for Serial Assessment of Regional Changes in Lower Extremity Arteriogenesis and Tissue Perfusion in a Porcine Model of Peripheral Arterial Disease

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