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      Exercise Thallium-201 Myocardial Scintigraphy: Advantages and Limitations

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          Exercise thallium-201 (<sup>201</sup>Tl) myocardial scans were obtained in 102 patients undergoing diagnostic coronary arteriography, of whom 59 showed more than 70% narrowing of one or more of the coronary arteries, 8 showed 50–70% narrowing of one vessel, and 35 had normal coronary arteriograms. Among the 59 patients with coronary artery disease, the exercise ECG was positive in 33 (55%) and the exercise <sup>201</sup>Tl was abnormal in 45 (76%). 52 of these 59 patients (91%) had either an abnormal exercise <sup>201</sup>Tl or a positive exercise ECG or both (p < 0.001 compared to exercise ECG). The exercise ECG was inconclusive in 17 patients and among those, the exercise <sup>201</sup>Tl correctly identified 13 cases (76%). Of 29 patients with a normal left ventriculogram, 17 (58%) showed abnormal exercise <sup>201</sup>Tl, 28 of 30 patients (93%) with abnormal left ventriculograms showed an abnormal myocardial scan (p < 0.05). 23 of 25 patients (92%) with collateral circulation had abnormal exercise <sup>201</sup>Tl compared with 22 of 34 patients (64%) without collateral circulation (p < 0.05). Among 35 patients with normal coronary arteriogram, 5 (15%) had abnormal exercise <sup>201</sup>Tl; 4 of them also had positive exercise ECGs, and 2 showed prolapse of the mitral valve angiographically. 14 patients in this group had inconclusive exercise ECGs; and the exercise <sup>201</sup>Tl correctly identified 13 of them (92%). We conclude that (1) exercise <sup>201</sup>Tl improves the diagnostic value of exercise ECG; (2) the left ventriculogram and collateral circulation show a significant correlation with the incidence of abnormal exercise <sup>201</sup>Tl; (3) false-negative exercise <sup>201</sup> Tl is observed predominantly in patients with disease limited to the secondary branches of the left coronary system, and (4) false-positive exercise <sup>201</sup>Tl can be encountered in patients with prolapse of the mitral valve and with normal coronary arteriograms.

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          Author and article information

          S. Karger AG
          31 October 2008
          : 65
          : 3
          : 136-152
          Likoff Cardiovascular Institute, and Nuclear Medicine Division, Hahnemann Medical College and Hospital, Philadelphia, Pa
          170804 Cardiology 1980;65:136–152
          © 1980 S. Karger AG, Basel

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          Pages: 17
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