Thallium-201 washout in coronary artery disease using SPECT ? a comparison with coronary angiography

Abstract

In this study, tomographic 201Tl washout analysis and coronary angiography were compared in 100 subjects. Seventeen subjects with healthy coronary arteries were used as reference material, on the basis of which the reference ranges for both the total washout of the heart muscle and the regional washout were determined. With angiography as the standard, this material yielded the following sensitivity values for total myocardial washout: 80% for three vessel proximal disease (n = 30), 64% for peripheral three vessel disease (n = 14), 66% for two vessel disease (n = 29) and 71% for single vessel disease (n = 17). Specificity in the reference group was 94%. Sensitivity values for regional washout were 83%, 93%, 59% and 71%, respectively. Stress ECG gave about 10% lower sensitivities. As far as sensitivity is concerned, however, visual assessment of tomographic images proved to be the best single method. In three patients, washout analysis was necessary to reveal evenly distributed ischemia and in seven cases it was essential in order to confirm an uncertain diagnosis; in other words, washout analysis had diagnostic value in 10 of the 100 patients.

Coronary Angiography and Thallium-201 Single Photon Emission Computed Tomography in Multiple Vessel Coronary Artery Disease

“…This could be explained in 10 patients by ischemia produced by a more severe obstruction in another artery, either a stenosis in RCA or a branch stenosis in LAD or LCX. With quantitative evaluation higher values for sensitivity and specificity have been obtained for 201TI SPECT (5,8,10,11,15,17,19,20,24).…”

Polar Presentation of Coronary Angiography and Thallium-201 Single Photon Emission Computed Tomography

“…This study and many others (2,6,7,11,18,26,28) have demonstrated that 201Tl SPECT is a sensitive method for the detection of coronary disease. SPECT does not, however, always indicate the total extent of the disease.…”

“…The code system was adapted from the American Heart Association (AHA) reporting system (I). An arterial lesion was considered significant if the diameter was reduced by 50 per cent or more (6,7,12,18,25,29). Left main stem stenoses were reported as stenotic lesions of the same degree in both LAD and LCX.…”

“…The introduction of single photon emission computed tomography (SPECT) for myocardial isotope imaging (19), has improved the accuracy of localization of ischemic regions and myocardial infarctions in the left ventricle (2,6,11,15,18,23,24,27). In many isotope studies of the myocardium, a stereotyped distribution of coronary arteries is assumed (4,7,11,12,26), in the absence of specific knowledge of coronary artery anatomy in the particular patient.…”

Quantitative Evaluation of Myocardial Stress/Rest 201TISPECT: Results of a ROI-Based Method in 108 Patients with CHD

“…Tomographic wash-out analysis added 10% of sensitivitv to visual analysis of 2 0 1 T1 SPECT (13). It is less sensitive than evaluating perfusion defects (8).…”