The prognostic value of ultra low-dose thallium myocardial perfusion protocol using CZT SPECT

  • Veronika Bednárová
  • Vladimír KinclEmail author
  • Milan Kamínek
  • Jiří Vašina
  • Roman Panovský
  • Jan Máchal
Original Paper


The purpose of this study was to assess the prognostic value of ultra-low dose thallium myocardial perfusion imaging. Three hundred and sixty-six patients (245 men) underwent ultra-low dose stress-redistribution imaging on CZT SPECT camera GE Discovery NM 530c. The stress test was performed by bicycle ergometry or regadenoson injection. The activity of 0.5 MBq (0.014 mCi) Tl-201 chloride per kilogram of body weight was administered. The stress images were acquired immediately and redistribution images were taken after 3 h. Patient follow-up was focused on combined end-point (death, myocardial infarction, unstable angina, revascularization and hospitalization for heart failure). Data analysis was performed from hospital database, with a mean period 23 months. Patients with revascularization within 1 month after SPECT was excluded as revascularization for diagnosis. Ischaemia on SPECT was found in 72 patients, 294 patients were without ischaemia. In patients with ischaemia there were 21 (29.2%) subjects with cardiac events, and 23 (7.9%) in patients without ischaemia (HR 4.15, 95% CI 2.30–7.51, p < 0.0001). Ultra-low dose thallium perfusion imaging using CZT camera provides very good prognostic results in assessment of myocardial ischaemia.


Myocardial perfusion Thallium Low-dose CZT SPECT Prognostic value 



This study was supported by the project no. LQ1605 from the National Program of Sustainability II (MEYS CR).

Compliance with ethical standards

Conflict of interest

All authors declare none conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Verberne HJ, Acampa W, Anagnostopoulos C et al (2015) EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 42:1929–1940CrossRefGoogle Scholar
  2. 2.
    Sharir T, Pinskiy M, Pardes A et al (2016) Comparison of the diagnostic accuracies of very low stress-dose with standard-dose myocardial perfusion imaging: automated quantification of one-day, stress-first SPECT using a CZT camera. J Nucl Cardiol 23(1):11–20CrossRefGoogle Scholar
  3. 3.
    van Dijk JD, Borren NM, Mouden M, van Dalen JA, Ottervanger JP, Jager PL (2018) Effect of a patient-specific minimum activity in stress myocardial perfusion imaging using CZT-SPECT: prognostic value, radiation dose, and scan outcome. J Nucl Cardiol 25(1):26–35CrossRefGoogle Scholar
  4. 4.
    Lima RSL, Peclat TR, Souza ACAH, Nakamoto AMK, Neves FM, Souza VF, Glerian LB, De Lorenzo A (2017) Prognostic value of a faster, low-radiation myocardial perfusion SPECT protocol in a CZT camera. Int J Cardiovasc Imaging 33(12):2049–2056CrossRefGoogle Scholar
  5. 5.
    Engbers EM, Timmer JR, Mouden M, Knollema S, Jager PL, Ottervanger JP (2017) Prognostic value of myocardial perfusion imaging with a cadmium-zinc-telluride SPECT camera in patients suspected of having coronary artery disease. J Nucl Med 58(9):1459–1463CrossRefGoogle Scholar
  6. 6.
    Kincl V, Kamínek M, Vašina J, Panovský R, Havel M (2016) Feasibility of ultra low-dose thallium stress-redistribution protocol including prone imaging in obese patients using CZT camera. Int J Cardiovasc Imaging 32(9):1463–1469CrossRefGoogle Scholar
  7. 7.
    Tanaka H, Chikamori T, Tanaka N, Hida S, Igarashi H et al (2014) Diagnostic performance of a novel Cadmium-Zinc-Telluride gamma camera system assessed using fractional flow reserve. Circ J 78:2727–2734CrossRefGoogle Scholar
  8. 8.
    Tsuda N, Shiraishi S, Sakamoto F, Yuki H, Ogasawara K et al (2018) Quantification of myocardial perfusion reserve using dynamic SPECT images of patients with chronic kidney disease. J Cardiol 71:174–180CrossRefGoogle Scholar
  9. 9.
    Barone-Rochette G, Zoreka F, Djaileb L, Piliero N, Calizzano A et al (2018) Diagnostic value of stres thallium-201/rest technetium-99m-sestamibi sequential dual isotope high-speed myocadial perfusion imaging for the dectection of haemodynamically significant coronary artery stenosis. J Nucl Cardiol. Google Scholar
  10. 10.
    Mouden M, Ottervanger JP, Knollema S, Timmer JR, Reiffers S, Oostdijk AH, de Boer MJ, Jager PL (2014) Myocardial perfusion imaging with a cadmium zinc telluride-based gamma camera versus invasive fractional flow reserve. Eur J Nucl Med Mol Imaging 41(5):956–962CrossRefGoogle Scholar
  11. 11.
    Claudin M, Imbert L, Djaballah W, Veran N, Poussier S, Roch V, Perrin M, Verger A, Boutley H, Karcher G, Marie PY (2018) Routine evaluation of left ventricular function using CZT-SPECT, with low injected activities and limited recording times. J Nucl Cardiol 25(1):249–256CrossRefGoogle Scholar
  12. 12.
    Imbert L, Roch V, Merlin C, Djaballah W, Cachin F, Perrin M, Claudin M, Verger A, Boutley H, Karcher G, Marie PY. J Nucl Cardiol. 2017. Google Scholar
  13. 13.
    Songy B, Guernou M, Lussato D, Queneau M, Geronazzo R (2012) Low-dose thallium-201 protocol with a cadmium-zinc-telluride cardiac camera. Nucl Med Commun 33(5):464–469CrossRefGoogle Scholar
  14. 14.
    Hachamovitch R, Berman DS, Shaw LJ et al (1998) Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 97:535–543CrossRefGoogle Scholar
  15. 15.
    Shaw LJ, Iskandrian AE (2004) Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol 11:171–185CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine/CardiologySt. Ann’s University Hospital, Masaryk UniversityBrnoCzech Republic
  2. 2.International Clinical Research CenterSt. Ann’s University HospitalBrnoCzech Republic
  3. 3.Department of Nuclear MedicineUniversity Hospital Olomouc, Palacky UniversityOlomoucCzech Republic
  4. 4.Department of Nuclear MedicineMasaryk Memorial Cancer CenterBrnoCzech Republic
  5. 5.Department of Pathological Physiology, Faculty of MedicineMasaryk UniversityBrnoCzech Republic

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