Comparison of persistent thallium perfusion defects by quantitative washout analysis with thallium reinjection in patients with coronary artery disease

Thallium reinjection can improve the detection of severely ischemic viable myocardium in patients with coronary artery disease. However, a disadvantage of this method is that it requires the acquisition of 3 separate sets of images and the administration of an additional dose of the radiotracer. Alternatively, quantitative analysis of the regional myocardial washout of thallium-201 can be easily obtained from the conventional postexercise and redistribution images without additional imaging time or radiation exposure to the patient. To determine whether this method can predict the results of thallium reinjection, this study analyzed thallium-201 images of 31 patients who had persistent perfusion defects in quatitative exercise/delayed redistribution single-photon emission computed tomographic thallium studies and who underwent thallium reinjection. The quantitative mean radioactive counts of each myocardial segment that had a persistent perfusion defect in the initial and delayed redistribution on 4-hour short-axis tomographic slices were measured to derive a delayed/initial ratio, and these values were compared with the results of thallium reinjection. The delayed/initial ratio was 1.06 ± 0.22 in 39 segments that improved, versus 0.58 ± 0.18 in 43 segments without improvement after reinjection (p <0.001). Thirty-eight of the 39 segments that improved had a ratio of ≥0.75, versus only 3 of the 43 segments that showed no improvement (sensitivity, 98%; specificity, 91%). The correlation between the delayed/initial ratio and reinjection results was equally high at any segment location or severity. It is concluded that quantitative regional thallium washout analysis predicts the results of thallium reinjection in segments with persistent thallium defects. Because quantitative analysis can be easily performed without additional cost or radiation exposure, it represents an attractive method that may prove useful in improving the detection of ischemic viable myocardium.