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Journal of Nuclear Cardiology

, Volume 1, Issue 1, pp 17–28 | Cite as

Comparison of reinjection thallium 201 and resting technetium 99m sestamibi tomographic images for the quantification of infarct size after acute myocardial infarction

  • Timothy F. Christian
  • Michael K. O’Connor
  • Mona R. Hopfenspirger
  • Raymond J. Gibbons
Original Articles

Abstract

Background

Both thallium 201 and technetium 99m sestamibi have been used to quantitate infarct size at rest. Exercise201Tl scintigraphy has been shown to have powerful prognostic information after myocardial infarction. A single study using these agents that could provide data on infarct size and prognosis would be of value. The purpose of this study was to compare estimates of infarct size by use of201Tl and99mTc sestamibi and to correlate these measurements with left ventricular ejection fraction in patients after acute myocardial infarction.

Methods and Results

The study group consisted of 20 patients who underwent low-level201Tl stress studies with reinjection and99mTc sestamibi resting studies within 4 days. Acute reperfusion was attempted in 18 of 20 patients. For99mTc sestamibi tomographic imaging, infarct size was quantitated with 60% of maximal counts per slice for five short-axis slices as described in multiple previous studies. The postreinjection delayed201Tl images acquired 4 hours after stress were quantitated according to the same threshold method.201Tl patient images were also quantitated with a commercially available polar map program and compared with sex-matched control subjects. Ejection fraction was determined for each patient by radionuclide ventriculography 6 weeks later. Ejection fraction was well preserved for the group: mean 0.53±0.10. Infarct size with99mTc sestamibi was 12%±13% of the left ventricle, which was significantly smaller than either method with201Tl: threshold method, 29%±18% of left ventricle; polar map method, 25%±17% of left ventricle (both201Tl estimates,p<0.0001 vs99mTc sestamibi;201Tl, 70% threshold vs201Tl polar map,p=0.04). There was a significant correlation between infarct size with99mTc sestamibi and that with201Tl (r=0.72 to 0.73;p<0.001). Infarct size with99mTc sestamibi, however, provided the closest correlation with ejection fraction (r=0.81;p<0.001), with the two201Tl quantitative methods providing very similar correlations (r=0.69;p<0.001).

Conclusions

Infarct size with reinjection201Tl imaging correlates significantly with resting infarct size with99mTc sestamibi, although it provides significantly larger estimates. Although both approaches can be combined with a same-day exercise protocol, the closer correlation of infarct size with ejection fraction at 6 weeks suggests that resting infarct size with99mTc sestamibi may be slightly more accurate.

Key Words

radionuclide imaging myocardial infarction radioistopes 

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References

  1. 1.
    The TIMI Study Group. Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction. N Engl J Med 1989;320:618–27.Google Scholar
  2. 2.
    White WD, Norris RM, Brown MA, Brandt PWT, Whitlock RML, Wild CJ. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 1987;76:44–51.PubMedGoogle Scholar
  3. 3.
    Palmeri ST, Harrison DG, Cobb FR, et al. A QRS scoring system for assessing left ventricular function after myocardial infarction. N Engl J Med 1982;306:4–9.PubMedGoogle Scholar
  4. 4.
    Sobel BE, Bresnahan DF, Shell NE, Yoder RD. Estimation of infarct size in man and its relation to prognosis. Circulation 1972;46:640–8.PubMedGoogle Scholar
  5. 5.
    Ellis SG, Henschke CI, Sandor T, Wynne J, Braunwald E, Kloner RA. Time course of functional and biochemical recovery of myocardium salvaged by reperfusion. J Am Coll Cardiol 1983;1:1047–55.PubMedGoogle Scholar
  6. 6.
    Sheehan FH, Mathey DG, Schofer J, Krebber HJ, Dodge HT. Effect of interventions in salvaging left ventricular function in acute myocardial infarction: a study of intracoronary streptokinase. Am J Cardiol 1983;52:431–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Christian TF, Behrenbeck T, Pellikka PA, Huber KC, Chesebro JH, Gibbons RJ. Mismatch of left ventricular function and infarct size demonstrated by technetium-99m isonitrile imaging after reperfusion therapy for acute myocardial infarction: identification of myocardial stunning and hyperkinesia. J Am Coll Cardiol 1990;16:1632–8.PubMedGoogle Scholar
  8. 8.
    Mori T, Minamiji K,Horoyuki K, Ogawa K, Yoshida Y. Rest injected thallium-201 imaging for assessing viability of severe asynergic regions. J Nucl Med 1991;32:1718–24.PubMedGoogle Scholar
  9. 9.
    Perrone Filardi P, Dilsizian V, Maurea S, et al. Rest-redistribution thallium scintigraphy for identifying viable myocardium: relation to regional function and metabolic activity [Abstract]. Circulation 1991;84:1888.Google Scholar
  10. 10.
    Bonow RO, Dilsizian V, Cuocolo A, Bacharach SL. Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction: comparison of thallium scintigraphy with reinjection and PET imaging with18F-fluorodeoxyglucose. Circulation 1991;83:26–37.PubMedGoogle Scholar
  11. 11.
    Dilsizian V, Rocco TP, Freedman NMT, Leon MB, Bonow RO. Enhanced detection of ischemic but viable myocardium by the reinjection of thallium after stress-redistribution imaging. N Engl J Med 1990;323:141–6.PubMedGoogle Scholar
  12. 12.
    Gibson RS, Watson DD, Craddock GB, et al. Prediction of cardiac events after uncomplicated myocardial infarction: a prospective study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography. Circulation 1983;68:321–36.PubMedGoogle Scholar
  13. 13.
    Verani MS, Jeroudi MO, Mahmarian JJ, et al. Quantification of myocardial infarction during coronary occlusion and myocardial salvage after reperfusion using cardiac imaging with technetium-99m-hexakis-2-methoxy isobutyl isonitrile. J Am Coll Cardiol 1988;12:1573–81.PubMedGoogle Scholar
  14. 14.
    Sinusas AJ, Trautman KA, Bergin JD, et al. Quantification of “area at risk” during coronary occlusion and degree of myocardial salvage after reperfusion with technetium-99m-methoxyisobutyl-isonitrile. Circulation 1990;82:1424–37.PubMedGoogle Scholar
  15. 15.
    Gibbons RJ, Verani MS, Behrenbeck T, et al. Feasibility of tomographic Tc-99m-hexakis-2-methoxy-2-methylpropyl-isonitrile imaging for the assessment of myocardial area at risk and the effect of acute treatment in myocardial infarction. Circulation 1989;80:1277–86.PubMedGoogle Scholar
  16. 16.
    Christian TF, Behrenbeck T, Gersh BJ, Gibbons RJ. Relation of left ventricular volume and function over one year following acute myocardial infarction to infarct size determined by Tc99m sestamibi. Am J Cardiol 1991;68:21–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Behrenbeck T, Pellikka PA, Huber KC, Bresnahan JF, Gersh BJ, Gibbons RJ. Primary angioplasty in myocardial infarction: assessment of improved myocardial perfusion with technetium-99m isonitrile. J Am Coll Cardiol 1991;17:365–72.PubMedGoogle Scholar
  18. 18.
    Christian TF, Schwartz RS, Gibbons RJ. Determinants of infarct size in reperfusion therapy for acute myocardial infarction. Circulation 1992;86:81–90.PubMedGoogle Scholar
  19. 19.
    Taillefer R, La Flamme L, Dupras G, Picard M, Phareuf C, Leville J. Myocardial perfusion imaging with Tc-99m (MIBI): comparison of short and long term intervals between rest and stress injections: preliminary results. Eur J Nucl Med 1988;13:515–22.PubMedCrossRefGoogle Scholar
  20. 20.
    The TIMI Study Group. The Thrombolysis in Myocardial Infarction Trial. N Engl J Med 1985;312:932–6.Google Scholar
  21. 21.
    Kennedy JW, Martin GV, Davis KB, et al. The Western Washington Intravenous Streptokinase in Acute Myocardial Infarction Randomized Trial. Circulation 1988;77:345–52.PubMedGoogle Scholar
  22. 22.
    O’Connor MK, Hammel TC, Gibbons RJ. In vitro validation of a simple tomographic technique for estimation of percent myocardium “at risk” following administration of Tc-99m-isonitrile. Eur J Nucl Med 1990;17:69–76.PubMedCrossRefGoogle Scholar
  23. 23.
    Christian TF, Gibbons RJ, Gersh BJ. Effect of infarct location on myocardial salvage assessed by technetium-99m isonitrile. J Am Coll Cardiol 1991;17:1303–8.PubMedGoogle Scholar
  24. 24.
    Maddahi J, Van Train K, Prigent F, et al. Quantitative single photon emission computed tomography for detection and localization of coronary artery disease: optimization and prospective validation of a new technique. J Am Coll Cardiol 1989;14:1689–99.PubMedGoogle Scholar
  25. 25.
    Callahan RJ, Frolich HW, McKusick KA, Leppo J, Strauss HW. A modified method for the in vivo labelling of red blood cells with Tc-99m: concise communication. J Nucl Med 1981;23:315–8.Google Scholar
  26. 26.
    Gibbons RJ, Clements IP, Zinsmeister AR, Brown ML. Exercise response of the systolic pressure to end-systolic volume ratio in patients with coronary artery disease. J Am Coll Cardiol 1987;10:33–9.PubMedGoogle Scholar
  27. 27.
    The Multicenter Postinfarction Research Group. Risk stratification and survival after myocardial infarction. N Engl J Med 1983;309:331–6.Google Scholar
  28. 28.
    Tamaki S, Nakajima H, Murakami T, et al. Estimation of infarct size by myocardial emission computed tomography with thallium-201 and its relation to creatine kinase-MB release after myocardial infarction in man. Circulation 1982;66:994–1001.PubMedGoogle Scholar
  29. 29.
    Ritchie JL, Cerquiera M, Maynard C, Davis K, Kennedy JW. Ventricular function and infarct size: the Western Washington Intravenous Streptokinase in Myocardial Infarction Randomized Trial. J Am Coll Cardiol 1988;11:689–97.PubMedGoogle Scholar
  30. 30.
    Simoons ML, Wijns W, Balakumaran K, et al. The effect of intracoronary thrombolysis with streptokinase on myocardial thallium distribution and left ventricular function assessed by blood-pool scintigraphy. Eur Heart J 1982;3:433–40.PubMedGoogle Scholar
  31. 31.
    Brown KA. Prognostic value of thallium-201 myocardial perfusion imaging: a diagnostic tool comes of age. Circulation 1991;83:363–81.PubMedGoogle Scholar
  32. 32.
    Sinusas AJ, Watson DD, Cannon JR Jr, Beller GA. Effect of ischemia and post-ischemic dysfunction on myocardial uptake of technetium 99m labeled methoxyisobutyl isonitrile and thallium-201. J Am Coll Cardiol 1989;14:1785–93.PubMedCrossRefGoogle Scholar
  33. 33.
    Melin JA, Becker LC, Bulkley BH. Differences in thallium-201 uptake in reperfused and nonreperfused myocardial infarction. Circ Res 1983;53:414–9.PubMedGoogle Scholar
  34. 34.
    Okada RD, Pohost GM. The use of preintervention and postintervention thallium imaging for assessing the early and late effects of experimental coronary arterial reperfusion in dogs. Circulation 1984;69:1153–60.PubMedGoogle Scholar
  35. 35.
    Prigent F, Maddahi J, Garcia EV, Saitoh Y, VanTrain K, Berman D. Quantification of myocardial infarct size by thallium-201 single photon emission computerized tomography: experimental validation in the dog. Circulation 1986;74:852–61.PubMedGoogle Scholar
  36. 36.
    Caldwell JH, Williams DL, Harp GD, Stratton JR, Ritchie JL. Quantitation of size of relative myocardial perfusion defect by single-photon emission computed tomography. Circulation 1984;70:1048–56.PubMedGoogle Scholar
  37. 37.
    Mahmarian JJ, Pratt EM, Borges-Neto S, Cushion WR, Roberts R, Verani MS. Quantification of infarct size by thallium-201 single-photon emission computed tomography during acute myocardial infarction in humans: comparison with enzymatic estimates. Circulation 1988;78:831–9.PubMedGoogle Scholar
  38. 38.
    De Coster PM, Melin JA, Detry JR, Brasseur LA, Bickers C, Col J. Coronary artery reperfusion in acute myocardial infarction: assessment by pre- and post-intervention thallium-201 myocardial perfusion imaging. Am J Cardiol 1985;55:889–95.PubMedCrossRefGoogle Scholar
  39. 39.
    DeCoster PM, Wijns W, Cauwe F, Robert A, Beckers C, Melin JA. Area-at-risk determination by technetium-99m-hexakis-2-methoxyisobutyl-isonitrile in experimental reperfused myocardial infarction. Circulation 1990;82:2151–62.Google Scholar
  40. 40.
    Medrano R, Weilbaecher D, Young JB, et al. Assessment of myocardial viability with technetium-99m-sestamibi in patients undergoing cardiac transplantation: a scintigraphic-pathologic study [Abstract]. Circulation 1992;86I:108.Google Scholar
  41. 41.
    Beanlands RSB, Dawood F, Wen WH, et al. Are the kinetics of technetium-99m-methoxyisobutyl-isonitrile affected by cell metabolism and viability? Circulation 1990;82:1802–14.PubMedGoogle Scholar
  42. 42.
    Okada RD, Glover D, Gaffney T, Williams S. Myocardial kinetics of technetium-99m-hexakis-2-methoxy-2-methylpropyl-isonitrile. Circulation 1988;77:491–8.PubMedGoogle Scholar
  43. 43.
    Ritchie JL, Albro PC, Caldwell JH, Trobaugh GB, Hamilton GW. Thallium-201 myocardial imaging: a comparison of the redistribution and rest images. J Nucl Med 1979;20:477–83.PubMedGoogle Scholar
  44. 44.
    Narahara KA, Villanueva-Meyer J, Thompson CJ, Brizendine M, Mena I. Comparison of thallium-201 and technetium-99m-hexakis-2-methoxyisobutyl-insonitrile single photon emission computed tomography for estimating the extent of myocardial ischemia and infarction in coronary artery disease. Am J Cardiol 1990;66:1438–44.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 1994

Authors and Affiliations

  • Timothy F. Christian
    • 1
  • Michael K. O’Connor
    • 1
  • Mona R. Hopfenspirger
    • 1
  • Raymond J. Gibbons
    • 1
  1. 1.From the Divisions of Cardiovascular Diseases and Internal MedicineMayo Clinic and Mayo FoundationRochester

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