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This study was designed to assess the influence of coronary endothelial function and the serial changes of dual myocardial single photon emission computed tomography (SPECT) imaging in transient left ventricular (LV) apical ballooning.We evaluated 35 consecutive patients (8 men and 27 women; mean age, 71 +/- 13 years) with transient LV apical ballooning. All patients underwent coronary angiography with acetylcholine provocation 1 month after onset. Iodine 123 beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) and thallium 201 dual myocardial SPECT was serially performed on day 1 of admission and 1 month and 6 months later. In 8 of 35 patients (23%), epicardial coronary spasm was induced by acetylcholine infusion. At the peak acetylcholine dose (100 microg), diffuse coronary vasoconstriction developed in 19 of 35 patients (54%). Of 19 patients, 13 had diffuse coronary vasoconstriction with chest pain and ST-segment depression. The total defect score of I-123 BMIPP and Tl-201 SPECT showed marked perfusion-fatty acid metabolic mismatches (13.7 +/- 3.6 vs 8.7 +/- 2.3, P.001) at the LV apex during the acute phase but few mismatched areas (2.1 +/- 1.1 vs 1.5 +/- 1.4, P = not significant) at 6 months.Transient LV apical ballooning might be caused by stress-induced coronary epicardial spasm or endothelial dysfunction, resulting in myocardial stunning.

症例は70歳男性，1カ月前より頭痛を認めていた．頭部CTやMRIでは左側頭部に強い脳浮腫を伴う約2 cm大の均一に造影される出血を伴う病変を認めた．脳血管造影では同部位に濃染像を認めた．Tl-201 SPECTでは同部位にearly phaseとdelayed phaseで高集積を認め悪性脳腫瘍と同様の所見を示した．また，FDG-PETでは全身に異常集積はないが同部位に集積の低下を認めた．これらの所見より腫瘍内出血を伴う悪性脳腫瘍を疑い開頭腫瘍摘出術を行った．腫瘍は黄褐色で弾性硬であり周囲との境界明瞭であった．また，細血管が多数腫瘍内に入り込んでいた．病理所見は海綿状血管腫であり繰り返される出血に伴う炎症性変化と思われるgliosisも認められた．画像所見では悪性脳腫瘍と鑑別が困難であった出血発症の脳内海綿状血管腫の一例を経験した．このような症例に注意し診断，治療に臨む必要があると考えられた．

Resumen —Introduccion El proposito del presente estudio fue describir las variables que se asocian a la isquemia silente en los pacientes a los que se les realiza ergometria con gammagrafia de perfusion miocardica y presentan defectos reversibles de la perfusion. Metodos Se analizan retrospectivamente de forma cuantitativa las gammagrafias con Tl201-SPECT de 522 pacientes que presentaban defectos de perfusion total o parcialmente reversibles durante la prueba de esfuerzo maxima. Se relaciono la aparicion de angina con el tamano del defecto de perfusion y la presencia de diferentes factores de riesgo. Resultados En 412 (73 %) pacientes la isquemia fue silente. En 176 (33 %) pacientes la ergometria fue electricamente positiva. No hubo diferencias en el tamano del defecto de perfusion entre los pacientes con y sin angina (27 ± 12 vs 27 ± 14), pero en los pacientes que presentaron angina durante la ergometria el grado de reversibilidad fue mayor sobre todo en el territorio de la arteria descendente anterior (ADA) (56 ± 40 vs 45 ± 40 p Conclusiones Una elevada proporcion de los pacientes con defectos de la perfusion reversibles en la gammagrafia tuvieron isquemia silente. En los pacientes con angina el grado de reversibilidad en el territorio de la ADA fue mayor. La isquemia silente es mas frecuente en los pacientes con IAM previo.

We aimed to assess whether atropine administration is safe and feasible in patients unable to reach the minimal heart rate (HR) required (80% of age-predicted HR) in myocardial scintigraphic studies after exercise stress testing (EST).We studied 108 patients who underwent myocardial perfusion scintigraphy after EST; 0.5 mg of atropine was administered to those showing signs of fatigue before reaching minimal HR (group A, n = 44). The scintigraphic results for group A were compared with those of patients who spontaneously achieved minimal HR (group B, n = 64). Coronary angiographic results, if available, and clinical follow-up were also compared. In group A, atropine increased HR by 13.7 +/- 7.4 beats/min. The percentage of maximal age-related HR achieved was 83.3% +/- 7.5%; 74% achieved minimal HR. No major adverse effects occurred. When groups A and B were compared, baseline and peak HR, rate pressure product, and maximal metabolic equivalents achieved were higher in group B. There were no differences in number of perfusion studies positive for ischemia (group A, 26/44, and group B, 30/64; P =.2), coronary lesions, or clinical follow-up.Atropine added to EST in patients who cannot achieve their 80% age-related HR is a safe and potentially useful method for myocardial perfusion studies.

Adenosine triphosphate stress thallium-201 single-photon emission computed tomography (ATP SPECT) is useful for diagnosis of coronary artery disease, but its usefulness for evaluating the severity of coronary artery stenosis has not been established.We performed region-of-interest analysis of short-axis images obtained by ATP SPECT in 31 patients with single-vessel disease (50% stenosis of the luminal diameter). We selected the lowest and highest washout rates (WR) among the anterior, lateral, and inferior WRs and calculated the ratio of the lowest WR to the highest WR (WR ratio = 0.925+/-0.027 in 14 control subjects). ATP SPECT showed positive results in 29 (94%) of 31 patients. The severity of coronary artery stenosis was inversely correlated with the WR ratio (r = -0.703, P.0001). The sensitivity and specificity of a WR ratioor = 0.660 for the diagnosis of severe coronary stenosis (or =80% stenosis) were 83% and 80%, respectively.Results suggest that ATP SPECT may be useful for assessment of the severity of coronary artery stenosis in patients with single-vessel disease.

We have shown that the diagnostic accuracy of quantitative single photon emission computed tomography (SPECT) thallium 201 myocardial perfusion imaging is lower in women than in men and that much of the difference can be explained by the smaller size of the left ventricle in women. Therefore attempts at improving the accuracy of myocardial perfusion imaging in women should focus on the problem of lower accuracy in patients with small chamber size. We evaluated two strategies for this: size- and gender-based normal databases and inverse filtering with the Wiener filter.We identified 618 patients undergoing exercise SPECT TI-201 who either had a low pre-test probability of coronary artery disease or had catheterization-documented disease. Their images were analyzed on the basis of gender and chamber size: both gender and size- and gender-based normal databases were created. The studies were analyzed quantitatively, and the accuracy was evaluated by use of the area under the receiver operating characteristic (ROC) curve. Chamber size was significantly lower in women (size index 69+/-22 women vs 96+/-28 men; P.0001). The accuracy of myocardial perfusion imaging was lower in women compared with men (ROC area: 0.92+/-0.01 men vs 0.85+/-0.03 women; P = .03), and there was an even greater difference in accuracy between patients with large versus small chamber size (ROC area: 0.94+/-0.01 large vs 0.81+/-0.03 small; P.001). There was no improvement in the diagnostic accuracy either in women or in patients with small chamber size when a size- and gender-based normal database, Wiener filter, or the Wiener filter with a size- and gender-based normal database was used.The left ventricular chamber size in women is smaller than that in men. There is a significant difference in the accuracy of quantitative SPECT TI-201 between men and women and an even greater difference between patients with large versus small chamber size. Neither size- and gender-based databases nor Wiener filtering significantly improves accuracy in women or in patients with small chamber size.

In this report the usefulness of Tl-201 SPECT and modified retention images in the differentiation of lung cancer and postobstructive collapse was studied. Two-phase Tl-201 SPECT was performed in 20 lung cancer lesions in which postobstructive collapse was suspected on CT. Retention imaging was done afterward. Three types of Tl-201 images were compared with the bolus CT images. Bolus CT differentiated lung cancer from postobstructive collapse in 7 of the 20 lesions (35%). Tl-201 SPECT differentiated the two conditions in 9 of 20 lesions (45%) on early Tl-201 SPECT and in 13 of 20 lesions (65%) on delayed imaging. With modified retention images, differentiation was possible in 13 of 20 lesions (65%). By combining delayed Tl-201 SPECT and modified retention images, lung cancer alone could be demonstrated in 18 of 20 lesions (90%). Combined delayed Tl-201 SPECT and modified retention images were more effective than bolus CT in delineating the extent of lung cancer in the presence of postobstructive collapse.

Thallium-201 single-photon emission computed tomography (Tl-201 SPECT) and F-18 fluorodeoxyglucose positron emission tomography (FDG PET) are accurate and excellent methods for detecting malignant tumors and related metabolic abnormalities. However, there are still some limitations in clinical application. The major limitation of SPECT is poor image resolution. PET is less sensitive for detecting lesions of the urinary system adjacent to the bladder because of bladder radioactivity. Both T1-201 and F-18 FDG PET often provide less information than x-ray computed tomography (CT) about the anatomic landmarks needed to precisely locate lesions. Recent development of multimodality image registration and fusion has been shown to be an excellent tool to resolve these drawbacks. The authors present a rare case of residual cervical carcinoma with bladder invasion, which was detected by fusion imaging of Tl-201 SPECT and FDG PET with CT. This noninvasive image technique may become a valuable alternative to identify bladder invasion in cervical cancer.

Tl-201 single photon emission computed tomography (SPECT) was performed in 88 patients with pulmonary or mediastinal tumors in order to evaluate its usefulness for the detection of disease and for the assessment of the effect of treatment. We also examined mediastinal and hilar lymph node metastasis from lung cancer. Tl-201 SPECT showed abnormal accumulation on delayed images in all lung cancer patients with tumor diameters more than 12 mm. In the 14 operated lung cancer patients, mediastinal and hilar lymph node metastases with diameters of more than 15 mm were imaged, but one with a diameter of 9 mm was missed. The retention index (RI) was 27.52 +/- 31.58 in malignant tumors and -13.67 +/- 8.15 in benign tumors (p0.05). The RI was significantly lower after treatment than before treatment. The interval until tumor recurrence or reactivation tended to be longer in patients who showed a significant decrease in the RI after therapy. These findings suggest the usefulness of the RI as an index of therapeutic efficacy.

To evaluate treatment efficacy, Tl-201 SPECT was performed in three patients with pancreatic cancer. In all of the patients, the degree of Tl-201 uptake by tumor, evaluated from the tumor-liver uptake ratio of Tl-201 activity, correlated well with alterations in serum level of a tumor marker (CA 19-9, DUPAN-2) after treatment. One of the patients showed no tumor shrinkage on CT after treatment; however, Tl-201 SPECT demonstrated reduced uptake in the tumor coupled with a decreased level of CA 19-9. These results suggest that Tl-201 SPECT may become a new tool for assessing the efficacy of treatment in pancreatic cancer.

A 58-year-old man, who had biopsy-proven cardiac sarcoidosis, underwent TI-201 and I-123 MIBG cardiac scintigraphy. Although no perfusion defect was identified by Tl-201, mild heterogeneity of I-123 MIBG uptake was present in the myocardium. The denervated but viable myocardium was demonstrated in the heart with sarcoidosis. Cardiac sympathetic nerve function was impaired in cardiac sarcoidosis, slightly improved with steroid therapy. I-123 MIBG scintigraphy may be useful to assess extent of myocardial involvement and response to therapy.

This study aimed to determine whether Tl-201 single photon emission CT (SPECT) is potentially useful in differentiating false-positive fluorodeoxyglucose positron emission tomography (FDG-PET) findings caused by osteoradionecrosis (ORN) from recurrent head and neck cancer after radiotherapy.Five patients were recruited. Dual-phase FDG-PET and dual-phase Tl-201 SPECT were performed for each patient.All 5 patients proved to have ORN without recurrent cancer. By visual interpretation, the results were 4 positive versus 1 negative for PET, and 4 negative versus 1 positive for Tl-201 SPECT. The Tl-201 SPECT clarified 3 of the 4 false-positive PETs to be ORN. Dual-phase semiquantitative studies showed decreased standardized uptake value (SUV) over time in 3 of the 4 false-positive PETs and decreased lesion/background ratio over time in the false-positive Tl-201 SPECT.The Tl-201 SPECT may help clarify suspected false-positive FDG uptake caused by ORN. Dual-phase FDG-PET and dual-phase Tl-201 SPECT may also have some value.

Objectives: To compare with histopathological findings the findings of prostate cancer imaging by SPECT method using Tl-201 as a tumor seeking agent. Methods: The study comprised 59 patients (age range 51-79 years, mean age 65.3 ± 6.8 years) who were planned to have transrectal ultrasonography (TRUS)-guided biopsies due to suspicion of prostate cancer between April 2011 and September 2011. Early planar, late planar and SPECT images were obtained for all patients. Scintigraphic evaluation was made in relation to uptake presence and patterns in the visual assessment and to Tumor/Background (T/Bg) ratios for both planar and SPECT images in the quantitative assessment. Histopathological findings were compatible with benign etiology in 36 (61%) patients and malign etiology in 23 (39%) patients. Additionally, comparisons were made to evaluate the relationships between uptake patterns,total PSA values and Gleason scores. Results: A statistically significant difference was found between the benign and malignant groups in terms of uptake in planar and SPECT images and T/Bg ratios and PSA values. No statistically significant difference was found between uptake patterns of planar and SPECT images and Gleason scores in the malignant group. Conclusions: SPECT images were superior to planar images in the comparative assessment. Tl-201 SPECT imaging can provide an additional contribution to clinical practice in the diagnosis of prostate cancer and it can be used in selected patients.

A semi-automatical method for apical echocardiographic and myocardial Tl-201 SPECT images registration is proposed. It uses oriented ellipses extracted from the LV myocardial center line in all images of the two modalities in one acquisition direction. These geometrical models allow SPECT-slice selection and 2D-registration, leading to a fused image involving the echographic image and its corresponding SPECT slice. The method was qualitatively evaluated with six patients, showing the potential usefulness of this tool in the study of myocardial ischemia and viability disease. >

The ability of the size of a total myocardial perfusion defect (MPD) to detect extensive coronary artery disease (CAD) is currently suboptimal with exercise thallium 201 single photon emission computed tomography (SPECT). To improve its performance, exercise electrocardiography and indirect scintigraphic markers of extensive CAD were proposed (increased right ventricular Tl-201 uptake, lung-to-heart [L/H] ratio, and left ventricular transient ischemic dilation ratio). We aimed to determine the additive value of these criteria for the detection of extensive CAD. The population included 338 patients who underwent exercise Tl-201 SPECT and coronary angiography. Patients were classified as having extensive CAD (left main, multivessel, or 1-vessel proximal left anterior descending CAD) or limited CAD (1-vessel disease other than proximal left anterior descending CAD or no CAD). First, Tl-201 SPECT provided higher diagnostic value than exercise electrocardiography. Second, age, percent target heart rate achieved, total MPD, and L/H ratio were independent predictors of extensive CAD. Third, visually estimated abnormal right ventricular Tl-201 uptake did not present additional information. Fourth, L/H ratio presented a higher diagnostic accuracy than left ventricular transient ischemic dilation ratio. With exercise Tl-201 SPECT, age, percent target heart rate achieved, total MPD, and L/H ratio were independent predictors of extensive CAD. (J Nucl Cardiol 2002;9: 161–8.)

The authors evaluated the ability of dual SPECT with Tc-99m MIBI and Tl-201 chloride to differentiate malignant and benign solitary pulmonary nodules smaller than 3 cm in diameter. Forty-three patients had solitary pulmonary nodules smaller than 3 cm in diameter based on the findings of chest CT. All patients underwent dual-isotope SPECT with Tc-99m MIBI and Tl-201 chloride. Regions of interest were placed over the tumors (T) and contralateral normal lung tissue (N) on one coronal SPECT view, and T:N ratios and retention indices were calculated. The sensitivities of early and delayed Tc-99m MIBI SPECT and early and delayed Tl-201 chloride SPECT for differentiating malignant and benign lesions were 44%, 48%, 56%, and 52%, respectively. The corresponding specificity rates were 44%, 56%, 25%, and 31%, respectively, and corresponding accuracy rates were 44%, 51%, 44%, and 44%, respectively. There were no statistically significant differences between malignant and benign lesions in the early and delayed T:N ratios for Tc-99m MIBI and Tl-201 chloride and the retention index for Tc-99m MIBI. However, the retention index using Tl-201 chloride in malignant lesions was significantly higher (P < 0.01) than that in benign lesions. Analysis of semiquantitative parameters of the T:N ratio and retention index from Tc-99m MIBI SPECT appears to have little or no value for differentiating malignant from benign solitary pulmonary nodules smaller than 3 cm in diameter. However, the retention index using Tl-201 chloride seems to be a better parameter for differentiating between these malignant and benign lesions.

The aim of the study was to compare the findings of EBCT with those of Tl-201-scintigraphy. 12 patients with CAD were investigated. The 14 fixed Tl-defects were associated with coronary artery stenosis of more than 50% in 5 cases, with atherosclerotic plaques in 2 cases. The 7 non-persisting defects were associated with coronary artery stenosis of more than 50% in 3 cases, with irregularities of the arterial wall in 3 cases, and with atherosclerotic plaques in 2 cases. Contractility and athrophy as seen on EBCT did not correlate with typical findings on scintigraphy. The preliminary data show that EBCT and Tl-scintigraphy do not replace but complement each other.

The aim of the study was to test the clinical value and the impact of attenuation-corrected Tl-201 SPECT (AC), using a moving Gd-153 line source, on the extent and severity of perfusion abnormalities in a clinical setup of patients planned to undergo coronary angiography because of clinically suspected coronary artery disease. 107 patients, planned to undergo coronary angiography, were included in our study. In each patient, AC and NC (non-corrected)-Tl-201 SPECT was performed. AC and NC were evaluated visually as well as by a 31-segment-semiquantitative analysis and correlated with angiographic results. Patients were assigned to two different groups: group A with angina and no previous cardiac infarction or intervention (Specificity NC 68.7 %, AC 83.9 %) and group B with known CAD because of previous myocardial infarction or intervention (Specificity NC 91.3 %, AC 100 %). The extent and the severity of perfusion abnormalities were significantly influenced using AC by demonstrating significantly less abnormal and less severe abnormal segments in the segmental analysis compared to NC, especially for the vascular territory of the LAD and RCA.

Recurrent lung cancer was detected by TI-201 SPECT showing mediastinal and hilar accumulations when the x-ray CT showed recurrence. Recurrence was confirmed by x-ray CT 3 months later. The use of TI-201 SPECT as a complementary modality to other radiological studies for the postoperative assessment of lung cancer should be encouraged.

Gating of resting Tl-201 SPECT to evaluate myocardial viability Is now clinically feasible. Two cases are presented to illustrate the additional information of wall motion and wall thickening obtained from gating. This additional information may improve the classification of viable myocardium and requires further study.

Gated myocardial SPECT may be useful for the simultaneous evaluation of myocardial perfusion and left ventricular function. The authors present a case of unstable angina pectoris with no apparent perfusion abnormality but impaired regional wall motion on gated TI-201 SPECT at rest. Although image quality of gated TI-201 SPECT is inferior to Tc-99m sestamibi SPECT, the results of this case suggest that gated TI-201 SPECT might be useful for the evaluation of viable but dysfunctional myocardium such as in unstable angina pectoris when a perfusion abnormality is obscure at rest. This protocol can be applied to patients in whom exercise is contraindicated in pharmacologic stress studies.

A 75-year-old woman was hospitalized for left hemiplegia. Intratumoral hematoma was considered likely based on the findings of computed tomographic (CT) images, and T1-201 SPECT was performed for further differentiation. Early SPECT images showed tumor-like accumulation in the right basal ganglia. However, the accumulation was washed out on delayed SPECT. Final diagnosis by a follow-up study was subacute hemorrhagic infarction. Although early T1-201 SPECT may show positive results for subacute hemorrhagic infarction, a delayed T1-201 SPECT can show a wash-out pattern that may be specific for this infarction. Early T1-201 SPECT may show tumor-like accumulation for subacute hemorrhagic infarction. This should be kept in mind in the analysis of T1-201 SPECT studies when cerebral infarction is being differentiated from brain tumor.

A case of left breast cancer which was detected incidentally by Tl-201 SPECT performed to evaluate the status of myocardial perfusion, is reported. Both stress and redistribution Tl-201 SPECT clearly delineated the tumor. It was confirmed later as scirrhous carcinoma of the breast.

Background and Objectives:Exercise myocardial perfusion scans in patients with hypertrophic cardiomyo- pathy have shown reversible perfusion abnormalities with unknown clinical significance. We performed this study to characterize dipyridamole Tl-201 SPECT imaging and correlate with clinical findings in patients with hypertrophic cardiomyopathy. Methods:Tl-201 SPECT was performed in 25 patients of hypertrophic cardiomyopathy with asymmetric septal hypertrophy and 20 normal controls after dipyridamole infusion (0.56 mg/kg. Myocardial wall was divided into 8 segments. Tl-201 uptake and relative washout rate were calculated. Results:Tl-201 SPECT showed significantly lower Tl-201 uptake in basal septal (81.3±3.4% vs 78.2±6.4%, p