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.

Reverse Redistribution in Tl-201 Stress-Reditribution Myocardial Scintigraphy. Effect of Rest Reinjection

PACE, Leonardo;
1994

Abstract

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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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11386/3104803
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