By Vasken Dilsizian MD, Jagat Narula MD, DM, PhD (auth.)
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Additional info for Atlas of Nuclear Cardiology
Percent collagen replacement is significantly higher in regions with irreversible defects compared with reversible or norma1 201 Tl regions. 6 mm and 80 ± 14%) 201Tl regions. (Adapted from Shirani et al. ) FIGURE 2-11. o ~ ... Q r-- '---. U ~ aJ E . ~ ::J ~ 50 n linicall ETT FIGURE 2-12. Post-revascularization functional outcome of asynergic regions in relation to prerevascularization 201n patterns of normal, reversible, partially reversible, mild to moderate irreversible, and severe irreversible defects using stress-redistributionreinjection 201n protocol.
_---------- ------------------- 100 • R v rsibl dy (unction . c 90 ~ 80 ~ c 70 --" " ~. 001 70 80 RD activity, % of peak 60 90 100 FIGURE 2-26. Quantitation of severity of reduction in myocardial perfusion at rest. Unlike 201Tl studies, there are a growing number of studies in the literature to suggest that 99mTc-sestamibi and tetrofosmin studies underestimate defect reversibility and myocardial viability in patients with chronic coronary artery disease. One approach that may overcome, in part, the limitations of 99mTc-sestamibi and tetrofosmin in assessing myocardial viability is to quantify the severity of regional tracer activity, ie, severity of myocardial perfusion at rest.
_---------- ------------------30 ATLAS OF NUCLEAR CARDIOLOGY . ..... 2-22. Pharmacologic stress. In canine models of A, moderate and B, severe coronary artery occlusion, 201Tl and 99mTc_ sestamibi myocardial perfusion defect size are compared during pharmacologic stimulation and with postmortem staining to define the extent of the hypoperfused region. Bull's-eye displays from four representative experiments of moderate coronary artery stenosis during pharmacologic stimulation for 201Tl and 99mTc-sestamibi and corresponding pathologic polar displays from the same four experiments are shown.