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Image Interpretation

  • Dudley J. Pennell
  • S. Richard Underwood
  • Durval C. Costa
  • Peter J. Ell

Abstract

An essential prelude to image interpretation is to review the planar images which form the raw data of the tomograms. Although the planar images have few counts and only coarse detail can be seen, it is at this stage that potential artefacts are most easily detected. A cine display of the planar images gives the impression of the patient rotating and allows both clinical and technical details to be assessed. Excessive lung uptake, the prognostic importance of which is discussed later in this chapter, can easily be judged. Motion of the patient during the acquisition can be seen and upward creep may also be apparent (case 76).1,2 The phenomenon of upward creep is sometimes seen in stress images following vigorous exercise. As the cardiovascular system returns to the resting state there are changes in heart rate, respiratory rate and redistribution of blood through the body. The mean position of the diaphragm rises and this pushes the heart up. This can lead to an apparent defect which will not be present in the redistribution images, thus simulating a reversible perfusion defect. If there is any doubt whether upward creep has occurred, then the planar images can be summed to show the outline of the heart moving cranially through the acquisition. Another artefact that is easily detected by reviewing the planar images is attenuation from the breast (case 3) or from metallic objects (case 77).

Keywords

Single Photon Emission Compute Tomographic Myocardial Perfusion Inferior Wall Reversible Defect Reversible Perfusion Defect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Friedman J, Van Train K, Maddahi J et al. “Upward creep” of the heart: a frequent source of false-positive reversible defects during thallium-201 stress-redistribution SPECT. J Nucl Med 1989;30:1718–22.PubMedGoogle Scholar
  2. 2.
    Mester J, Welle R, Claussen M et al. Upward creep of the heart in exercise thallium 201 single photon emission tomography: clinical relevance and a simple correction method. Eur J Nucl Med 1991 (in press).Google Scholar
  3. 3.
    DePuey EG, Garcia EV. Optimal specificity of thallium-201 SPECT through recognition of imaging artefacts. J Nucl Med 1989;30:441–9.PubMedGoogle Scholar
  4. 4.
    Weiss AT, Berman DS, Lew AS et al. Transient ischaemic dilatation of the left ventricle on stress thallium-201 scintigraphy: a marker of severe and extensive coronary artery disease. J Am Coll Cardiol 1987;9:752–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Cloninger KG, DePuey EG, Garcia EV et al. Incomplete redistribution in delayed thalljum-201 single photon emission computed tomographic (SPECT) images: an overestimation of myocardial scarring. J Am Coll Cardiol 1988;12:955–63.PubMedCrossRefGoogle Scholar
  6. 6.
    Ziessman HA, Keyes JW, Fox LM, Green CE, Fox SM. Delayed redistribution in thallium 201 SPECT myocardial perfusion studies. Chest 1989;96:1031–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Yang LD, Berman DS, Kiat H et al. The frequency of late reversibility in SPECT thallium-201 stress—redistribution studies. J Am Coll Cardiol 1990;15:334–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Botvinick EH. Late reversibility: a viability issue. J Am Coll Cardiol 1990;15:341–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Ohtani H, Tamaki N, Yonekura Y et al. Value of thallium-201 reinjection after delayed SPECT imaging for predicting reversible ischemia after coronary artery bypass grafting. Am J Cardiol 1990;66:394–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Dilsizian V, Rocco TP, Freedman NMT, Leon MB, Bonow RO. Enhanced detection of ischaemic but viable myocardium by the reinjection of thallium after stress—redistribution imaging. N Engl J Med 1990;323:141–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Rocco TP, Dilsizian V, McKusick KA, Fischman AJ, Boucher CA, Strauss HW. Comparison of thallium redistribution with rest “reinjection” imaging for the detection of viable myocardium. Am J Cardiol 1990;66:158–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Tamaki N, Ohtani H, Yonekura Y et al. Significance of fill-in after thallium-201 reinjection following delayed imaging: comparison with regional wall motion and angiographic findings. J Nucl Med 1990;31:1617–23.PubMedGoogle Scholar
  13. 13.
    Brunken RC, Kottou S, Nienaber CA et al. PET detection of viable tissue in myocardial segments with persistent defects at Tl-201 SPECT. Radiology 1989;172:65–73.PubMedGoogle Scholar
  14. 14.
    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 with 18F-fluorodeoxyglucose. Circulation 1991;83:26–37.PubMedGoogle Scholar
  15. 15.
    Weiss AT, Maddahi J, Lew AS et al. Reverse redistribution of thallium-201: a sign of nontransmural myocardial infarction with patency of the infarct-related coronary artery. J Am Coll Cardiol 1986;7:61–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Ricci DR, Orlick AE, Doherty PW, Cipriano PR, Harrison DC. Reduction of coronary blood flow during coronary artery spasm occurring spontaneously and after provocation by ergonovine maleate. Circulation 1978;57:392–5.PubMedGoogle Scholar
  17. 17.
    Bennett JM, Blomerus P. Thallium-201 scintigraphy perfusion defect with dipyridamole in a patient with a myocardial bridge. Clin Cardiol 1988;11:268–70.PubMedCrossRefGoogle Scholar
  18. 18.
    Meller J, Goldsmith SJ, Rudin A et al. Spectrum of exercise thallium-201 myocardial perfusion imaging in patients with chest pain and normal coronary angiograms. Am J Cardiol 1979;43:717–23.PubMedCrossRefGoogle Scholar
  19. 19.
    Berger BC, Abramowitz R, Park CH et al. Abnormal thallium-201 scans in patients with chest pain and angiographically normal coronary arteries. Am J Cardiol 1983;52:365–70.PubMedCrossRefGoogle Scholar
  20. 20.
    O’Gara PT, Bonow RO, Maron BJ et al. Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium-201 emission computed tomography. Circulation 1987;76:1214–23.PubMedCrossRefGoogle Scholar
  21. 21.
    von Dohlen TW, Prisant LM, Frank MJ. Significance of positive or negative thallium-201 scintigraphy in hypertrophic cardiomyopathy. Am J Cardiol 1989;64:498–503.CrossRefGoogle Scholar
  22. 22.
    Bulkley BH, Rouleau JR, Whitaker JQ, Strauss HW, Pitt B. The use of thallium-201 for myocardial perfusion imaging in sarcoid heart disease. Chest 1977;72:27–32.PubMedCrossRefGoogle Scholar
  23. 23.
    Follansbee WP, Curtiss EI, Medsger TA et al. Physiologic abnormalities of cardiac function in progressive systemic sclerosis with diffuse scleroderma. N Engl J Med 1984;310:142–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Braat SH, Brugada P, Bar FW, Gorgels APN, Wellens HJJ. Thallium-201 exercise scintigraphy and left bundle branch block. Am J Cardiol 1985;55:224–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Hirzel HO, Senn M, Nuesch K et al. Thallium-201 scintigraphy in complete left bundle branch block. Am J Cardiol 1984;53:764–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Jazmati B, Sadaniantz A, Emaus SP, Heller GV. Exercise thallium-201 imaging in complete left bundle branch block and the prevalence of septal perfusion defects. Am J Cardiol 1991;67:46–9.PubMedCrossRefGoogle Scholar
  27. 27.
    DePuey EG, Garcia EV, Ezquerra NF. Three-dimensional techniques and artificial intelligence in thallium-201 cardiac imaging. AJR 1989;152:1161–8.PubMedGoogle Scholar
  28. 28.
    Gill JB, Ruddy TD, Newell JB et al. Prognostic importance of thallium uptake by the lungs during exercise in coronary artery disease. N Engl J Med 1987;317:1485–9.CrossRefGoogle Scholar
  29. 29.
    Mannting F. Pulmonary thallium uptake: correlation with systolic and diastolic left ventricular function at rest and during exercise. Am Heart J 1990;119:1137–46.,Google Scholar
  30. 30.
    Kurata C, Tawarahara K, Taguchi T, Sakata K, Yamazaki N, Naitoh Y. Lung thallium-201 uptake during exercise emission computed tomography. J Nucl Med 1991;32:417–23.PubMedGoogle Scholar
  31. 31.
    Mannting F. A new method for quantification of pulmonary thallium uptake in myocardial SPECT studies. Eur J Nucl Med 1990;16:213–22.PubMedCrossRefGoogle Scholar
  32. 32.
    Burow RD, Pond M, Schafer AW, Becker L. Circumferential profiles: a new method for computer analysis of thallium-201 myocardial perfusion images. J Nucl Med 1979;20:771–7.PubMedGoogle Scholar
  33. 33.
    Garcia EV, Van Train K, Maddahi J et al. Quantitation of rotational thallium-201 myocardial perfusion tomography. J Nucl Med 1985;26:17–26.PubMedGoogle Scholar
  34. 34.
    DePasquale EE, Nody AC, DePuey EG et al. Quantitative rotational thallium-201 tomography for identifying and localising coronary artery disease. Circulation 1988;77:316–27.PubMedCrossRefGoogle Scholar
  35. 35.
    Mahmarian JJ, Boyce TM, Goldberg RK, Cocanougher MK, Roberts R, Verani MS. Quantitative exercise thallium-201 single photon emission computed tomography for the enhanced diagnosis of ischaemic heart disease. J Am Coll Cardiol 1990;15:318–29.PubMedCrossRefGoogle Scholar
  36. 36.
    DePasquale EE, Nody AC, DePuey EG et al. Quantitative rotational thallium-201 tomography for identifying and localising coronary artery disease. Circulation 1988;77:316–27.PubMedCrossRefGoogle Scholar
  37. 37.
    Hör G. Myocardial scintigraphy - 25 years after start. Eur J Nucl Med 1988;13:619–36.PubMedCrossRefGoogle Scholar
  38. 38.
    Leppo J. Thallium washout analysis: fact or fiction? J Nucl Med 1987;28:1058–60.PubMedGoogle Scholar
  39. 39.
    Maddahi J, Garcia EV, Berman DS, Waxman A, Swan HJC, Forrester J. Improved noninvasive assessment of coronary artery disease by quantitative analysis of regional stress myocardial distribution and washout of thallium-201. Circulation 1981;64:924–35.PubMedCrossRefGoogle Scholar
  40. 40.
    Francisco DA, Collins SM, Go RT, Ehrhardt JC, Van Kirk OC, Marcus ML. Tomographic thallium-201 myocardial perfusion scintigrams after maximal coronary artery vasodilation with intravenous dipyridamole. Circulation 1982;66:370–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Tamaki NY, Yonekura T, Imkai T et al. Segmental analysis of stress thallium myocardial emission tomography for localisation of coronary artery disease. Eur J Nucl Med 1984;9: 99–105.PubMedCrossRefGoogle Scholar
  42. 42.
    Niemeyer MG, Laarman GJ, Lelbach S et al. Quantitative thallium-201 myocardial exercise scintigraphy in normal subjects and patients with normal coronary arteries. Eur J Radiol 1990;10:19–27.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1992

Authors and Affiliations

  • Dudley J. Pennell
    • 1
  • S. Richard Underwood
    • 2
  • Durval C. Costa
    • 1
  • Peter J. Ell
    • 1
  1. 1.Institute of Nuclear MedicineUniversity College and Middlesex School of MedicineLondonUK
  2. 2.Royal Brompton National Heart and Lung InstituteLondonUK

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