Circulation, Vol 77, 316-327, Copyright © 1988 by American Heart Association
EE DePasquale, AC Nody, EG DePuey, EV Garcia, G Pilcher, C Bredlau, G Roubin, A Gober, A Gruentzig and P D'Amato
The purpose of this study was to develop and validate a method for
quantifying the uptake, redistribution, and washout of thallium-201 (201Tl)
obtained with rotational tomography. This method generates maximum count
circumferential profiles of the short-axis slices of the left ventricle,
translates them into polar coordinate profiles, and displays them as a
bullseye plot, which consists of a series of concentric circles with the
apex at the center and the base at the periphery. Normal limits were
established for the distribution of 201Tl in 36 patients with a low (less
than 5%) probability of coronary artery disease (CAD). Forty-five patients
who had undergone coronary angiography were used as a pilot group to define
criteria for the identification and localization of perfusion defects. The
best agreement with the results of angiography was found when abnormal
regions of the bullseye were defined as contiguous defects over 2.5 SDs
below normal. These criteria were applied prospectively to 210 points (179
points with greater than 50% diameter stenosis and 31 with less than 50%).
Visual, quantitative, and combined visual and quantitative analysis were
compared for overall detection of disease and for detection of individual
vessel involvement. The overall sensitivity for detection of disease by
these methods was 97%, 95%, and 95%, respectively. The specificities were
68%, 74%, and 71% respectively. The sensitivity for detection of individual
vessel involvement with the bullseye alone was 78% for the left anterior
descending artery (LAD), 89% for the right coronary artery (RCA), and 65%
for the left circumflex (LCx). For visual analysis, the results were 70%,
88%, and 50%, respectively, while the use of visual and quantitative
analysis combined identified 75% of LAD, 87% of RCA, and 55% of LCx
lesions. We conclude that quantitative analysis of rotational 201Tl
tomographic images is a highly accurate technique for determining the
presence and location of CAD.
ARTICLES
Quantitative rotational thallium-201 tomography for identifying and localizing coronary artery disease
Department of Medicine and Radiology, Emory University School of Medicine, Atlanta.
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