Twenty-four-hour Tl-201 delayed scan underestimates myocardial viability in patients with acute myocardial infarction after percutaneous transluminal coronary angioplasty
Myocardial viability in area at risk of acute myocardial infarction (AMI) after reperfusion therapy may be underestimated by the 24-hour images due to reverse redistribution (r-RD).
Subjects were 37 AMI patients in whom Tc-99m pyrophosphate (PYP)/Tl-201 dualisotope SPECT was positive. The 24-hour delayed scan was performed with only a Tl window. One month later, follow up rest Tl SPECT was performed to evaluate myocardial viability. In early (at PYP/Tl-201 dual-isotope SPECT), 24-hour, and one month follow up Tl studies, Tl uptake in the area of AMI was scored into four grades: 3 as normal to 0 as severely reduced. The scores were evaluated.
Among the 37 AMI lesions, there were 16 r-RD, 3 RD, 16 fixed defect (FD) and 2 normal (positive PYP and normal Tl). Mean Tl scores were early; 1.4±1.1, 24-hr; 0.9±0.9 and one month; 1.3±1.1. The 24-hour Tl score was lower than the early and one month Tl scores (p<0.01).
Reverse redistribution is frequently observed in an area at risk where PYP SPECT was positive. Nuclear medicine physicians should be aware of the existence of frequent r-RD in Tl scan to avoid the underestimation of myocardial viability in the acute phase after PTCA.
Key wordsthallium-201 myocardium viability reverse redistribution
Unable to display preview. Download preview PDF.
- 7.Umamoto I, Sugihara H, Harada Y, Sawada, T, Matsumuro, A, Matsubara K, et al. The clinical significance of reverse redistribution of Tl-201 SPECT at rest in the 1st month after the onset of acute myocardial infarction.KAKU IGAKU (Jpn J Nucl Med) 1991; 28: 749–757.Google Scholar