Abstract
It has been well documented that it is not uncommon for a thallium-201 perfusion defect to develop or become more evident on delayed exercise thallium scintigraphic imaging, as compared with the initial image immediately following stress. The pathophysiology and clinical significance of the phenomenon are currently unclear. Literature on this subject is reviewed, and it is concluded that reverse redistribution of 201Tl in the post-myocardial infarction patient is indeed a “fact”. In this context it represents a low-risk condition and may imply successful thrombolysis, patent infarct-related coronary artery, improved wall motion at the infarct site and retained myocardial viability in that segment.
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References
Tanasescu D, Berman D, Staniloff H, et al. Apparent worsening of thallium-201 myocardial defects during redistribution —what does it mean? J Nucl Med 1979;20:688.
Hecht HS, Hopkins JM, Rose JG, Blumfield DE, Wong M. Reverse redistribution: worsening of thallium-201 myocardial images from exercise to redistribution. Radiology 1981;140:177–181.
Silberstein EB, DeVries DE Reverse redistribution phenomenon in thallium-201 stress tests: angiographic correlation and clinical significance. J Nucl Med 1985;26:707–710.
Weiss AT, Maddahi J, Lew AS, et al. Reverse redistribution of thallium-201: a sign of non-transmural myocardial infarction with patency of the infarct-related coronary artery. J Am Coll Cardiol 1986;7:61–67.
Brown KA, Benoit L, Clements JP, Wackers FJ. Fat washout of thallium-201 from area myocardial infarction: possible artifact of background subtraction. J Nucl Med 1987;28:945–949.
Lear JL, Raff U, Jain R. Reverse and pseudo redistribution of thallium-201 in healed myocardial infarction and normal and negative thallium-201 washout in ischemia due to background oversubtraction. Am J Cardiol 1988;62:543–550.
Popma KK, Smitherman TC, Walker BS, Simon TR, Dehmer GJ. Reverse redistribution of thallium-201 detected by SPECT imaging after dipyridamole in angina pectoris. Am J Cardiol 1990;1176–1180.
Nii T, Nakashima Y, Nomoto J, Hiroki T, Ohshima F, Arakawa K. Normalisations of reverse redistribution of thallium-201 with procainamide pretreatment in Wolff-Parkinson-White syndrome. Clin Cardiol 1991;14:269–272.
Fukuzawa S, Osawa S, Nobuyoshi M, Inagaki Y. Reverse redistribution on Tl-201 SPECT images after reperfusion therapy for acute myocardial infarction: possible mechanism and prognostic implications. Heart Vessels 1992;7:141–147.
Sakata K, Yoshida H, Ono N, et al. Implications of delayed image on simultaneous thallium-201 single-photon emission computed tomography in patients with acute myocardial infarction. Jpn Circ J 1993;57:27–36.
Yamagishi H, Itagane H, Akioka K, et al. Clinical significance of reverse redistribution on thallium-201 single-photon emission computed tomography in patients with acute myocardial infarction. Jpn Circ J 1992;56:1095–1105.
Langer A, Burns R, Freeman M, et al. Reverse redistribution on exercise thallium scintigraphy: relationship to coronary patency and ventricular function after myocardial infarction. Can J Cardiol 1992;8:709–715.
Van Eck-Smith BLF, van der Wall EE, Kuijper AFM, Swinderman AH, Pauwels EKJ. Immediate thallium-201 reinjection following stress imaging: a time saving approach for detection of myocardial viability. J Nucl Med 1993;34:737–743.
Tatum JL, Rehr RB, DiSciascio G, Romhilt DW Fratkin MI. Thallium 201/technetium-99m-RP-30A disparity in the course of myocardial infarction after attempted reperfusion. J Nucl Med 1988;29:1283–1286.
Okada RD. Kinetics of Tl-201 in reperfused canine myocardium after coronay artery occlusion. J Am Coll Cardiol 1984;3:1245–1251.
Nielsen AP, Morris KG, Murdock R, et al. Linear relationship between the distribution of thallium-201 and blood flow ischemic and non-ischemic myocardium during exercise. Circulation 1980;61:797–801.
Beller GA, Watson DD, Ackell P, et al. Time course of thallium-201 redistribution after transient myocardial ischemia. Circulation 1980;61:791–797.
Gerwitz H, O'Keefe DD, Pohost GM, et al. The effect of ischemia on thallium-201 clearance from the myocardium. Circulation 1978;58:215–219.
Sakata K, Yoshida H, Ono N, et al. Implications of delayed image on simultaneous thallium-201/technetium-99m pyrophosphate dual emission computed tomography early after acute myocardial infarction. Jpn Circ J 1993;57:27–36.
Shah PK, Picher M, Berman DS, et al. Left ventricular ejection fraction determined by radionuclide ventriculography in early stages of first transmural myocardial infarction. Am J Cardiol 1980;45:542–546.
Jain D, Lahiri A, Raval U, Raftery EB. Prognostic implications of a lung uptake of thallium-201 at rest following acute myocardial uptake of unstable angina. Clin Sci 1988;75 Supp1:27P.
Al-Khawaja IM, Lahiri A, Rodrigues EA, et al. Clinical significance of exercise-induced pulmonary uptake of thallium-201 in uncomplicated myocardial infarction. Am J Cardiol Imaging 1988;2:135–141.
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;68:321–336.
Kaul S, Finkelstein DM, Homma S, et al. Superiority of quantitative exercise thallium-201 variables in determining long term prognosis in ambulatory patients with chest pain: a comparison with cardiac catheterization. J Am Coll Cardiol 1988;12:25.
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Correspondence to: A. Labiri
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Dudzic, E.M., Sridhara, B.S. & Lahiri, A. Reverse redistribution: fact or fiction?. Eur J Nucl Med 21, 449–453 (1994). https://doi.org/10.1007/BF00171422
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DOI: https://doi.org/10.1007/BF00171422