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REVERSE REDISTRIBUTION IN TL-201 STRESS-REDISTRIBUTION MYOCARDIAL SCINTIGRAPHY - EFFECT OF REST REINJECTION (93 visite)
Clin Nucl Med (ISSN: 0363-9762, 1536-0229, 1536-0229electronic), 1994 Nov; 19(11): 956-961.
Tipo di articolo: Journal Article,
Impact factor: 0.34
Impact factor a 5 anni: 2.157
Parole chiave: Technetium 99m, Thallium 201, Angiocardiography, Article, Clinical Article, Coronary Artery, Coronary Artery Circumflex Branch, Diagnostic Imaging, Diagnostic Value, Heart Scintiscanning, Heart Stress, Human, Left Anterior Descending Coronary Artery, Scintiangiocardiography, Two Dimensional Echocardiography, Comparative Study, Coronary Angiography, Coronary Disease, Exercise Test, Female, Heart Catheterization, Middle Age, Technetium Tc 99m Sestamibi, Thallium Radioisotopes, Time Factors,
To clarify the clinical significance of TI-201 reverse redistribution (RR), 33 patients with chronic coronary artery disease (CAD) underwent stress-redistribution TI-201 cardiac imaging with rest reinjection, coronary arteriography, and 2D-echocardiography. Rest Tc-99m MIBI scintigraphy was also performed in 27 of the 33 patients. A total of 495 segments were analyzed for TI-201 scintigraphy (405 for Tc-99m MIBI). Each segment was assigned to one of the major coronary artery territories. Two patterns of RR were identified; 1) pattern A (RR-A) showed normal TI-201 uptake on stress images and lower than normal on redistribution images, and 2) pattern B (RR-B) showed lower than normal TI-201 uptake on stress images with further decrease on redistribution images. The RR phenomenon was found in 46 (9% of the total) segments; 25 with RR-A and 21 with RR-B. Reverse redistribution pattern A segments had lower Tc-99m MIBI uptake (84 +/- 9% versus 92 +/- 10%, P < 0.0001) and a higher percentage of stenosed coronary arteries (80% versus 49%, P < 0.05) compared to normal segments (n = 204, 41% of the total). No difference in wall motion was observed between RR-A and normal segments. Of the 25 segments with RR-A, 14 showed enhanced TI-201 uptake after reinjection (Re+) and 11 remained unchanged after reinjection (Re-). Segments that were Re- showed significantly (P < 0.05) lower Tc-99m MIBI uptake (79 +/- 9%) compared to Re+ segments (87 +/- 8%) and normal segments (92 +/- 10%). No difference in wall motion was observed between Re+ and Re- segments. Normal and Re+ segments did not differ significantly in any of the variables considered. Reverse redistribution-pattern B segments did not significantly differ from those with reversible or irreversible TI-201 defects. These data suggests that in patients with chronic CAD segments with normal TI-201 uptake on stress images and decreased TI-201 uptake on redistribution images should not be considered normal segments. Thallium-201 reinjection at rest appears to be able to further stratify these segments, identifying those with enhanced TI-201 uptake after reinjection that show myocardial perfusion and coronary anatomy similar to normal segments.
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