Quantitative thallium-201 single-photon emission computed tomography during maximal pharmacologic coronary vasodilation with adenosine for assessing coronary artery disease

Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.

The diagnostic value of maximal pharmacologic coronary vasodilation with intravenously administered adenosine in conjunction with thallium-201 single-photon emission computed tomography (SPECT) for detection of coronary artery disease was investigated in 101 consecutive patients who had concomitant coronary arteriography. Tomographic images were assessed visually and from computer-quantified polar maps of the thallium-201 distribution. Significant coronary artery disease, defined as greater than 50% luminal diameter stenosis, was present in 70 patients. The sensitivity for detecting patients with coronary artery disease using quantitative analysis was 87% in the total group, 82% in patients without myocardial infarction and 96% in those with prior myocardial infarction; the specificity was 90%. The sensitivity for diagnosing coronary artery disease in patients without infarction with single-, double-and triple-vessel disease was 76%, 86% and 90%, respectively. All individual stenoses were identified in 68% of patients with double-vessel disease and in 65% of those with triple-vessel disease. The extent of the perfusion defects, as quantified by polar maps, was directly related to the extent of coronary artery disease. In conclusion, quantitative thallium-201 SPECT during adenosine infusion has high sensitivity and specificity for diagnosing the presence of coronary artery disease, localizing the anatomic site of coronary stenosis and identifying the majority of affected vascular regions in patients with multivessel involvement.

This article has been cited by other articles:

				J. R. Arnold, T. D. Karamitsos, T. J. Pegg, J. M. Francis, R. Olszewski, N. Searle, R. Senior, S. Neubauer, H. Becher, and J. B. Selvanayagam Adenosine Stress Myocardial Contrast Echocardiography for the Detection of Coronary Artery Disease: A Comparison With Coronary Angiography and Cardiac Magnetic Resonance J. Am. Coll. Cardiol. Img., September 1, 2010; 3(9): 934 - 943. [Abstract] [Full Text] [PDF]

				S.-Y. Chung, K.-Y. Lee, E. J. Chun, W.-W. Lee, E. K. Park, H.-J. Chang, and S. I. Choi Comparison of Stress Perfusion MRI and SPECT for Detection of Myocardial Ischemia in Patients With Angiographically Proven Three-Vessel Coronary Artery Disease Am. J. Roentgenol., August 1, 2010; 195(2): 356 - 362. [Abstract] [Full Text] [PDF]

				T. Kurita, H. Sakuma, K. Onishi, M. Ishida, K. Kitagawa, T. Yamanaka, T. Tanigawa, T. Kitamura, K. Takeda, and M. Ito Regional myocardial perfusion reserve determined using myocardial perfusion magnetic resonance imaging showed a direct correlation with coronary flow velocity reserve by Doppler flow wire Eur. Heart J., February 2, 2009; 30(4): 444 - 452. [Abstract] [Full Text] [PDF]

				M. Nagao, H. Matsuoka, H. Kawakami, H. Higashino, T. Mochizuki, K. Murase, and M. Uemura Quantification of Myocardial Perfusion by Contrast-Enhanced 64-MDCT: Characterization of Ischemic Myocardium Am. J. Roentgenol., July 1, 2008; 191(1): 19 - 25. [Abstract] [Full Text] [PDF]

				M. D. Cerqueira, P. Nguyen, P. Staehr, S. R. Underwood, A. E. Iskandrian, and on behalf of the ADVANCE-MPI Trial Investigators Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging integrated ADVANCE-MPI trial results. J. Am. Coll. Cardiol. Img., May 1, 2008; 1(3): 307 - 316. [Abstract] [Full Text] [PDF]

				I. Madar, H. T. Ravert, Y. Du, J. Hilton, L. Volokh, R. F. Dannals, J. J. Frost, and J. M. Hare Characterization of Uptake of the New PET Imaging Compound 18F-Fluorobenzyl Triphenyl Phosphonium in Dog Myocardium J. Nucl. Med., August 1, 2006; 47(8): 1359 - 1366. [Abstract] [Full Text] [PDF]

				H. Sakuma, N. Suzawa, Y. Ichikawa, K. Makino, T. Hirano, K. Kitagawa, and K. Takeda Diagnostic Accuracy of Stress First-Pass Contrast-Enhanced Myocardial Perfusion MRI Compared with Stress Myocardial Perfusion Scintigraphy Am. J. Roentgenol., July 1, 2005; 185(1): 95 - 102. [Abstract] [Full Text] [PDF]

				C Y Loong and C Anagnostopoulos Diagnosis of coronary artery disease by radionuclide myocardial perfusion imaging Heart, August 1, 2004; 90(suppl_5): v2 - v9. [Full Text] [PDF]

				N. Ishida, H. Sakuma, M. Motoyasu, T. Okinaka, N. Isaka, T. Nakano, and K. Takeda Noninfarcted Myocardium: Correlation between Dynamic First-Pass Contrast-enhanced Myocardial MR Imaging and Quantitative Coronary Angiography Radiology, October 1, 2003; 229(1): 209 - 216. [Abstract] [Full Text] [PDF]

				Z.-X. He, T. D. Hedrick, C. M. Pratt, M. S. Verani, V. Aquino, R. Roberts, and J. J. Mahmarian Severity of Coronary Artery Calcification by Electron Beam Computed Tomography Predicts Silent Myocardial Ischemia Circulation, January 25, 2000; 101(3): 244 - 251. [Abstract] [Full Text] [PDF]

				K. W. Mahaffey, J. A. Puma, N. A. Barbagelata, M. F. DiCarli, M. A. Leesar, K. F. Browne, P. R. Eisenberg, R. Bolli, A. C. Casas, V. Molina-Viamonte, et al. Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: Results of a multicenter, randomized, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) Trial J. Am. Coll. Cardiol., November 15, 1999; 34(6): 1711 - 1720. [Abstract] [Full Text] [PDF]

				R. J. Gibbons, K. Chatterjee, J. Daley, J. S. Douglas, S. D. Fihn, J. M. Gardin, M. A. Grunwald, D. Levy, B. W. Lytle, R. A. O'Rourke, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2092 - 2197. [Full Text] [PDF]

				A. M. Garber and N. A. Solomon Cost-Effectiveness of Alternative Test Strategies for the Diagnosis of Coronary Artery Disease Ann Intern Med, May 4, 1999; 130(9): 719 - 728. [Abstract] [Full Text] [PDF]