Perfusion imaging with thallium-201 to assess stenosis significance

  • Edna H. G. Venneker
  • Berthe L. F. Van Eck-Smit
  • Ernst E. Van Der Wall
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 173)


Since the introduction of coronary angiography in the 1960’s, this invasive technique has become the foremost important diagnostic method in the assessment of patients with coronary artery disease. Despite a relatively high interobserver and intraobserver variability, coronary angiography is still considered the gold standard for the assessment of physiological effects of coronary stenosis. In general practice the assumption exists that there is a close correlation between the angiographic diameter of a coronary artery stenosis and the perfusion of the myocardium. This assumption implies that the decision as to whether to revascularize in order to alleviate ischemia is predominantly based on the percent diameter stenosis found during coronary angiography. However, several studies comparing angiographic findings with postmortem findings have shown that coronary angiography underestimates the severity of the lesion [1]. Overestimation of diameter stenosis may also occur due to for instance spasm of the coronary artery or insufficient filling with contrast medium.


Myocardial Perfusion Coronary Angiography Perfusion Imaging Myocardial Blood Flow Coronary Flow Reserve 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Arnett EN, Isner JM, Redwood DR et al. Coronary artery narrowing in coronary heart disease: Comparison of cineangiographic and necropsy findings. Ann Intern Med 1979; 91: 350–6.PubMedGoogle Scholar
  2. 2.
    Breisblatt WM, Barnes JV, Weiland F, Spaccavento LJ. Incomplete revascularization in multivessel percutaneous transluminal coronary angioplasty: The role for stress thallium-201 imaging. J Am Coll Cardiol 1988; 11: 1183–90.PubMedCrossRefGoogle Scholar
  3. 3.
    Gould KL. Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilation. I. Physiologic basis and experimental validation. Am J Cardiol 1978; 41: 267–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Belgrave E, Lebowitz E. Development of thallium-201 for medical use (Abstr). J Nucl Med 1992; 13: 781.Google Scholar
  5. 5.
    Strauss HW, Harrison K, Langan JK et al. Thallium-201 for myocardial imaging. Relation of thallium-201 to regional myocardial perfusion. Circulation 1975; 51: 641–5.PubMedGoogle Scholar
  6. 6.
    Weich HF, Strauss HW, Pitt B. The extraction of thallium-201 by the myocardium. Circulation 1977; 56: 188–91.PubMedGoogle Scholar
  7. 7.
    Taillefer R. Technetium-99m sestamibi myocardial imaging: Same-day stress-rest studies and dipyridamole. Am J Cardiol 1990; 66: 80E–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Kaul S. Cardiac imaging in conjunction with exercise stress testing in patients with suspected coronary artery disease: A comparison of the techniques. Cardiovasc Imaging 1989; 1: 20–8.Google Scholar
  9. 9.
    Berger BC, Watson DD, Taylor GJ et al. Quantitative thallium-201 exercise scintigraphy for detection of coronary artery disease. J Nucl Med 1981; 22: 585–93.PubMedGoogle Scholar
  10. 10.
    Wackers FJT, Fetterman, RC, Mattera JA et al. Quantitative planar thallium-201 stress scintigraphy: A critical evaluation of the method. Semin Nucl Med 1985; 15: 46–59.PubMedCrossRefGoogle Scholar
  11. 11.
    Fintel DJ, Links JM, Brinker JA et al. Improved diagnostic performance of exercise thallium-201 single photon emission computed tomography over planar imaging in the diagnosis of coronary artery disease: A receiver operating characteristic analysis. J Am Coll Cardiol 1989; 13: 600–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Kiat H, Berman DS, Maddahi J. Comparison of planar and tomographic exercise thallium-201 imaging methods for the evaluation of coronary artery disease. J Am Coll Cardiol 1989; 13: 613–6.PubMedCrossRefGoogle Scholar
  13. 13.
    DePasquale EE, Nody AC, DePuey EG et al. Quantitative rotational thallium-201 tomography for identifying and localizing coronary artery disease. Circulation 1988; 77: 316–27.PubMedCrossRefGoogle Scholar
  14. 14.
    Maddahi J, Van Train K, Prigent F et al. Quantitative single photon emission computed thallium-201 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.PubMedCrossRefGoogle Scholar
  15. 15.
    Van Train KF, Maddahi J, Berman DS et al. Quantitative analysis of tomographic stress thallium-201 myocardial scintigrams: A multicenter trial. J Nucl Med 1990; 31: 1168–79.PubMedGoogle Scholar
  16. 16.
    Mahmarian JJ, Boyce TM, Goldberg RK et al. Quantitative exercise thallium-201 single photon emission computed tomography for the enhanced diagnosis of ischemic heart disease. J Am Coll Cardiol 1990; 15: 318–29.PubMedCrossRefGoogle Scholar
  17. 17.
    Wackers FJ, Berman DS, Maddahi J et al. Technetium-99m hexakis 2-methoxyisobutyl isonitrile: Human biodistribution, dosimetry, safety, and preliminary comparison to thallium-201 for myocardial perfusion imaging. J Nucl Med 1989; 30: 301–11.PubMedGoogle Scholar
  18. 18.
    Kiat H, Maddahi J, Roy LT et al. Comparison of technetium-99m methoxy isobutyl isonitrile and thallium 201 for evaluation of coronary artery disease by planar and tomographic methods. Am Heart J 1989; 117: 1–11.PubMedCrossRefGoogle Scholar
  19. 19.
    Kahn JK, McGhie I, Akers MS et al. Quantitative rotational tomography with 201T1 and 99mTc 2-methoxy-isobutyl-isonitrile. A direct comparison in normal individuals and patients with coronary artery disease. Circulation 1989; 79: 1282–93.PubMedCrossRefGoogle Scholar
  20. 20.
    Folland ED, Vogel RA, Hartigan P et al. Relation between coronary artery stenosis assessed by visual, caliper and computer methods and exercise capacity in patients with single-vessel coronary artery disease. Circulation 1994; 89: 2005–14.PubMedGoogle Scholar
  21. 21.
    James TN. The spectrum of diseases of small coronary arteries and their physiologic consequences. J Am Coll Cardiol 1990; 15: 763–74.PubMedCrossRefGoogle Scholar
  22. 22.
    James TN, Bruschke AVG. Seminar on small coronary artery disease. Introduction. Structure and function of small coronary arteries in health and disease. J Am Coll Cardiol 1990; 15: 511–2.CrossRefGoogle Scholar
  23. 23.
    White CW, Wright CB, Doty DB et al. Does visual interpretation of the coronary arteriogram predict the physiological importance of a coronary stenosis. N Engl J Med 1984; 310: 819–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Wilson RF, Marcus ML, White CW. Prediction of the physiologic significance of coronary arterial lesions by quantitative lesion geometry in patients with limited coronary artery disease. Circulation 1987; 75: 723–32.PubMedCrossRefGoogle Scholar
  25. 25.
    Zijlstra F, Fioretti P, Reiber JHC, Serruys PW. Which cineangiographically assessed anatomic variable correlates best with functional measurements of stenosis severity? A comparison of quantitative analysis of the coronary cineangiogram with measured coronary flow reserve and exercise/redistribution thallium-201 scintigraphy. J Am Coll Cardiol 1988; 12: 686–91.PubMedGoogle Scholar
  26. 26.
    Cowley MJ, Vandermael M, Topoi EJ et al. Is traditionally defined complete revascularization needed for patients with multivessel disease treated by elective coronary angioplasty? Multivessel Angioplasty Prognosis Study (MAPS) Group. J Am Coll Cardiol 1993; 22: 1289–97.PubMedCrossRefGoogle Scholar
  27. 27.
    Lund GK, Nienaber CA, Hamm CW et al. One-session cardiac catherization and balloon dilation (‘prima vista’-PTCA): Results and risks. Dtsch Med Wschr 1994; 119: 169–74.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Edna H. G. Venneker
  • Berthe L. F. Van Eck-Smit
  • Ernst E. Van Der Wall
    • 1
  1. 1.Department of Cardiology C1-P25University Hospital LeidenLeidenThe Netherlands

Personalised recommendations