Abstract
To establish test specific normal limits for quantitative analysis of uptake and washout of 201Tl after dipyridamole infusion combined with low level exercise, 20 healthy volunteers were studied with low likelihood of coronary artery disease (CAD) assessed by a stepwise probability analysis based on age, sex, symptoms, resting electrocardiogram, and exercise electrocardiography. Likelihood of CAD in these volunteers was calculated as ≦1%. After dipyridamole infusion combined with low level exercise, one volunteer complained of headache; no other side effects were observed. There were no chest pain complaints. Maximal hemodynamic changes were achieved during the 6th and 7th min of the test. No ST segment depression was recorded. Visual analysis of the 201Tl scintigrams was normal in all volunteers. Mean regional washout at 4 h was 44.37%±2.11%. The regional washout in the 70° LAO view (46.65%±1.10%) was significantly higher than in the anterior and 30° LAO views (43.44%±1.50% and 43.02%±1.45%, respectively). Profiles of uptake and washout of 201Tl were different after dipyridamole infusion combined with low level exercise as compared to maximal exercise. Thus, in quantitative analysis of 201Tl scintigraphy after dipyridamole infusion in conjunction with low level exercise as applied in the present study, it is mandatory to use normal limits of uptake and washout of 201Tl derived from healthy volunteers who underwent the same combined protocol.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Albro PC, Gould KL, Westcott RJ, Hamilton GW, Ritchie JL, Williams DL (1978) Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilatation. III. Clinical trial. Am J Cardiol 42: 751–760
Alfonso S (1970) Inhibition of coronary vasodilating action of dipyridamole and adenosine by aminophylline in the dog. Cric Res 26: 743–752
Anonymus (1977) I.R.C.P.-publication 26: recommendations of the international commission on radiological protection. Pergamon Press
Anonymus (1981) Advies inzake normen voor toediening van radioactieve stoffen aan vrijwilligers. Commissie uit de gezondheidsraad aan de minister voor W.V.C. Staatsuigeverij
Belardinelli L, Fenton RA, West A, Linden J, Althaus JS, Berne RM (1982) Extracellular action of adenosine and the antagonism by aminophylline on the atrioventricular conduction of isolated perfused guinea pig and rat hearts. Circ Res 51: 569–579
Bourdoulas H, Cobb TC, Leighton RF, Wilt SM (1974) Myocardial lactate production in patients with angina-like chest pain and angiographically normal coronary arteries and left ventricle. Am J Cardiol 34: 501–504
Burow RD, Pond M, Schafer AW, Becker L (1979) ‘Circumferential profiles’: a new method for computer analysis of thallium-201 perfusion images. J Nucl Med 20: 771–777
Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Eng J Med 300: 1350–1358
Diamond GA (1986) Reverend Bayes' silent majority. An alternative factor affecting sensitivity and specificity of exercise electrocardiography. Editorial. Am J Cardiol 57: 1175–1181
Goris ML, Daspit SG, McLaughlin P, Kriss JP (1976) Interpolative background subtraction. J Nucl Med 17: 744–747
Gould KL (1978a) Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilatation. I. Physiologic basis and experimental validation. Am J Cardiol 41: 267–278
Gould KL, Westcott RJ, Albro PC, Hamilton GW (1978b) Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilatation. II. Clinical methodology and feasibility. Am J Cardiol 41: 279–287
Gould KL (1978c) Assessment of coronary stenoses with myocardial perfusion imaging during pharmacologic coronary vasodilatation. IV. Limits of detection of stenosis with idealized experimental cross-sectional myocardial imaging. Am J Cardiol 42: 761–768
Kaul S, Boucher CA, Newell JB, Chesler DA, Greenberg JM, Okada RD, Strauss HW, Dinsmore RE, Prohost GM (1986a) Determination of the quantitative thallium imaging variables that optimize detection of coronary artery disease. JACC 7: 527–537
Kaul S, Newell JB, Chesler DA, Prohost GM, Okada RD, Boucher CA (1986b) Quantitative imaging findings in patients with normal coronary angiographic findings and in clinically normal subjects. Am J Cardiol 57: 509–512
Kemp HG, Vokonos PS, Cohn PF, Gorlin R (1976) The anginal syndrome associate with normal coronary arteriograms: report of a six year experience. Am J Med 54: 735–742
Laarman GJ, Niemeyer MG, Verzijlbergen JF, Ascoop CA (1987) Hemodynamic changes and side effects after dipyridamole infusion with and without exercise (abstract). J Nucl Med 28: 579–580
Massie BM, Hollenberg M, Wisneski JA, Go M, Gertz EW, Henderson S (1983) Scintigraphic quantification of myocardial ischemia: a new approach. Circulation 68: 747–755
O'Byrne GT, Maddahi J, Van Train KF, Wong C, Ramsdale D, Friedman JD Berman DS (1986a) Myocardial washout rate of thallium-201: comparison between rest, dipyridamole with and without aminophylline, and exercise states (abstr) J Nucl Med 27: 943
O'Byrne GT, Berman D, Van Train KF, Friedman J, Ramsdale D, Rozanski A, Maddahi J (1986b) Quantitative assessment of dipyridamole thallium-201 planar scintigrams: comparison of dipyridamole-specific to stress normal limits (abstr). JACC 7, No. 2:5a
Rigo P, Bailey IK, Griffith LSC, Pitt B, Burow RD, Wagner HV Jr, Becker LC (1980) Value and limitations of segmental analysis of stress thallium myocardial imaging for localization of coronary artery disease. Circulation 61: 973–981
Rozanski A, Diamond GA, Forrester JS, Morris D, Swan HJC (1983) The declining specificity of exercise radionuclide ventriculography. N Eng J Med 309: 518–522
Rozanski A, Diamond GA, Forrester JS, Berman DS, Morris D, Swan HJC (1984) Alternative reference standards for cardiac normality: implications for diagnostic testing. Ann Intern Med 101: 164–170
Sheffield LT, Holt JH, Reeves TJ (1965) Exercise graded by heart rate in electrocardiographic testing for angina pectoris. Circulation 32: 622–629
Sollevi A, Östergren J, Fagrell B, Hjemdahl P (1984) Theophylline antagonizes cardiovascular response to dipyridamole in man without affecting increases in plasma adenosine. Acta Physiol Scand 121: 165–171
Staniloff HM, Diamond GA, Freeman MR (1982) Simplified application of Bayesian analysis to multiple cardiologic tests. Clin Cardiol 5: 630–636
Vogel RA, Kirch DL, LeFree MT, Rainwater JO, Jensen DP, Steele DP (1979) Thallium-201 myocardial perfusion scintigraphy: results of standard and multi-pinhole tomographic techniques. Am J Cardiol 43: 787–793
Wackers FJTh, Fetterman RC, Mattera JA, Clements JP (1985) Quantitative planar thallium-201 stress scintigraphy: A critical evaluation of the method. Seminars in nuclear medicine 15: 46–66
Watson DD, Campbell NP, Read EK, Gibson RS, Teates CD, Beller GA (1981) Spatial and temporal quantitation of plane thallium myocardial images. J Nucl Med 22: 577–593
Wilson FW, Donald E, Laughlin DE, Ackell PH, Chilian WM, Holida MD, Hartley CJ, Armstrong ML, Marcus ML, White CW (1985) Transluminal, subselective measurement of coronary artery blood flow velocity and vasodilator reserve in man. Circulation 72: 82–92
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Laarman, G.J., Niemeyer, M.G., Bruschke, A.V.G. et al. Quantitative thallium-201 scintigraphy after dipyridamole infusion combined with low level exercise in healthy volunteers. Eur J Nucl Med 15, 239–243 (1989). https://doi.org/10.1007/BF00257540
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00257540