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Value and limitation of stress thallium-201 single photon emission computed tomography: comparison with nitrogen-13 ammonia positron tomography.
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1988
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Computed TomographyHeart FailureEngineeringDiagnosisCoronary Artery DiseasePositron Emission TomographyNeurologyPhoton-counting Computed TomographyTracer InjectionsRadiation OncologyCardiologyCardiac ImagingAtherosclerosisNuclear MedicineRadiologyCardiovascular ImagingMyocardial InfarctionVascular ImageMedical ImagingTomographyRadiographic ImagingCardiovascular DiseaseBiomedical ImagingExercise 201TlSpect Emission ImagingMedicineEmergency MedicineSingle Photon Emission
The study compared the diagnostic value of exercise 201Tl SPECT with exercise 13N ammonia PET for coronary artery disease. Fifty‑one patients received both stress‑delayed 201Tl SPECT and stress‑rest 13N ammonia PET scans. Both modalities showed high, comparable sensitivities (96% vs 98% for abnormal perfusion, 81% vs 88% for >50% stenosis) and 79% segment concordance, but SPECT detected fewer transient defects, potentially underestimating ischemia compared with PET.
The diagnostic value of exercise 201Tl single photon emission computed tomography (SPECT) for assessing coronary artery disease (CAD) was comparatively evaluated with exercise [13N] ammonia positron emission tomography (PET). Fifty-one patients underwent both stress-delayed SPECT imaging using a rotational gamma camera and stress-rest PET imaging using a high resolution PET camera. Of 48 CAD patients, SPECT showed abnormal perfusion in 46 patients (96%), while PET detected perfusion abnormalities in 47 (98%). The sensitivity for detecting disease in individual coronary arteries (greater than 50% stenosis) was also similar for SPECT (81%) and PET (88%). When their interpretations were classified as normal, transient defect, and fixed defect in 765 myocardial segments, SPECT and PET findings were concordant in 606 segments (79%). However, 66 segments showed a fixed defect by SPECT but a transient defect by PET, whereas there were only nine segments showing a transient defect by SPECT and a fixed defect by PET. PET identified transient defects in 34% of the myocardial segments showing a fixed defect by SPECT. We conclude that both stress SPECT and PET showed high and similar sensitivities for detecting CAD and individual stenosed vessels. Since stress-delayed SPECT with single tracer injection detected fewer transient defects, it may underestimate the presence of myocardial ischemia, compared with high resolution PET imaging with two tracer injections.