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Title: Renal uptake of Tl-201 in hypertensive patients undergoing myocardial perfusion imaging

Abstract

The detection of renovascular disease (RVD) has particular relevance in hypertensive patients (HP) who have symptoms of target organ damage. To evaluate the possibility of RVD in HP undergoing myocardial perfusion scintigraphy for chest pain symptoms, posterior renal images were obtained at 1-3 hours after Tl-201 injection. Analog and computer images were obtained for 5 minutes in 45 HP; 12 patients with no history of hypertension or renal disease served as normal controls. For qualitative analysis, images were coded and read by three observers as to symmetry of renal uptake. Differential renal uptake of Tl-201 (DRU) was quantitated on computer images. In normal controls, uptake was agreed on as symmetric. In HP, 6 patients had marked asymmetry of DRU and 4 had possibly significant asymmetry; 2 had decreased uptake in both kidneys suggesting bilateral RVD or nephrosclerosis. Objective correlation with DRU was obtained in 10 HP who had contrast angiography, confirming 4 cases of unilateral RVD and 2 of bilateral RVD. Thirteen patients also had renography with Tc-99m DTPA; differential renal function by this modality correlated well with DRU of Tl-201 (r = 0.98). Thus, DRU of Tl-201 can be used as a supplement to myocardial scintigraphy to identify HPmore » who require further evaluation and treatment of RVD.« less

Authors:
; ; ; ; ;  [1]
  1. (Univ. of Western Ontario, London (Canada))
Publication Date:
OSTI Identifier:
7137540
Resource Type:
Journal Article
Resource Relation:
Journal Name: Clinical Nuclear Medicine; (USA); Journal Volume: 15:2
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; KIDNEYS; RADIONUCLIDE MIGRATION; MYOCARDIUM; SCINTISCANNING; THALLIUM 201; UPTAKE; UROGENITAL SYSTEM DISEASES; DIAGNOSIS; BLOOD FLOW; DTPA; HYPERTENSION; ISCHEMIA; PATIENTS; AMINO ACIDS; BETA DECAY RADIOISOTOPES; BODY; CARBOXYLIC ACIDS; CARDIOVASCULAR DISEASES; CARDIOVASCULAR SYSTEM; CHELATING AGENTS; COUNTING TECHNIQUES; DAYS LIVING RADIOISOTOPES; DIAGNOSTIC TECHNIQUES; DISEASES; DRUGS; ELECTRON CAPTURE RADIOISOTOPES; ENVIRONMENTAL TRANSPORT; HEART; HEAVY NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; MASS TRANSFER; MUSCLES; NUCLEI; ODD-EVEN NUCLEI; ORGANIC ACIDS; ORGANIC COMPOUNDS; ORGANS; RADIOISOTOPE SCANNING; RADIOISOTOPES; RADIOPROTECTIVE SUBSTANCES; SECONDS LIVING RADIOISOTOPES; SYMPTOMS; THALLIUM ISOTOPES; VASCULAR DISEASES; 550601* - Medicine- Unsealed Radionuclides in Diagnostics

Citation Formats

Hurwitz, G.A., Mattar, A.G., Bhargava, R., Driedger, A.A., Hogendoorn, P., and Wesolowski, C.A. Renal uptake of Tl-201 in hypertensive patients undergoing myocardial perfusion imaging. United States: N. p., 1990. Web. doi:10.1097/00003072-199002000-00005.
Hurwitz, G.A., Mattar, A.G., Bhargava, R., Driedger, A.A., Hogendoorn, P., & Wesolowski, C.A. Renal uptake of Tl-201 in hypertensive patients undergoing myocardial perfusion imaging. United States. doi:10.1097/00003072-199002000-00005.
Hurwitz, G.A., Mattar, A.G., Bhargava, R., Driedger, A.A., Hogendoorn, P., and Wesolowski, C.A. 1990. "Renal uptake of Tl-201 in hypertensive patients undergoing myocardial perfusion imaging". United States. doi:10.1097/00003072-199002000-00005.
@article{osti_7137540,
title = {Renal uptake of Tl-201 in hypertensive patients undergoing myocardial perfusion imaging},
author = {Hurwitz, G.A. and Mattar, A.G. and Bhargava, R. and Driedger, A.A. and Hogendoorn, P. and Wesolowski, C.A.},
abstractNote = {The detection of renovascular disease (RVD) has particular relevance in hypertensive patients (HP) who have symptoms of target organ damage. To evaluate the possibility of RVD in HP undergoing myocardial perfusion scintigraphy for chest pain symptoms, posterior renal images were obtained at 1-3 hours after Tl-201 injection. Analog and computer images were obtained for 5 minutes in 45 HP; 12 patients with no history of hypertension or renal disease served as normal controls. For qualitative analysis, images were coded and read by three observers as to symmetry of renal uptake. Differential renal uptake of Tl-201 (DRU) was quantitated on computer images. In normal controls, uptake was agreed on as symmetric. In HP, 6 patients had marked asymmetry of DRU and 4 had possibly significant asymmetry; 2 had decreased uptake in both kidneys suggesting bilateral RVD or nephrosclerosis. Objective correlation with DRU was obtained in 10 HP who had contrast angiography, confirming 4 cases of unilateral RVD and 2 of bilateral RVD. Thirteen patients also had renography with Tc-99m DTPA; differential renal function by this modality correlated well with DRU of Tl-201 (r = 0.98). Thus, DRU of Tl-201 can be used as a supplement to myocardial scintigraphy to identify HP who require further evaluation and treatment of RVD.},
doi = {10.1097/00003072-199002000-00005},
journal = {Clinical Nuclear Medicine; (USA)},
number = ,
volume = 15:2,
place = {United States},
year = 1990,
month = 2
}
  • In 44 consecutive patients undergoing elective open heart surgery (OHS), serial electrocardiograms (ECG), vectorcardiograms (VCG), serum CPK, cardiac isoenzymes (CPKMB), and myocardial images using Tc-99m pyrophosphate were obtained, before and after the operation, for the detection of acute myocardial infarction (AMI). Twenty-nine patients developed one or more positive tests postoperatively. Two patients had positive myocardial scintiscans; both had other evidence of infarction. Conversely, the appearance of CPKMB, or new ECG and VCG changes, occurred frequently without evidence of infarction, and were not associated with the development of a positive scintiscan. The results show that false-negative results are infrequent in patientsmore » imaged early after OHS, and that cardiac surgical procedures do not cause a high incidence of false-positive scintigrams. Consequently, radionuclide imaging for AMI offers an important adjunct for excluding acute infarction following open heart surgery.« less
  • Thallium-201 imaging may be used to help determine the distribution and amount of myocardium in jeopardy and the success of revascularization after percutaneous transluminal coronary angioplasty. Single photon emission computed tomography is particularly advantageous because of its ability to differentiate vascular territories and thus evaluate patients with multivessel disease. Myocardial infarction resulting from complications such as distal embolization and side-branch occlusion can be detected. Thallium-201 imaging early after angioplasty may show abnormal results caused by transiently insufficient coronary flow reserve. However, studies performed 6 weeks or more after angioplasty accurately detect early restenosis and may identify those individuals likely tomore » become symptomatic and eventually develop restenosis in the future.« less
  • Six patients with angina pectoris had reversible perfusion defects on stress and redistribution thallium imaging. Three patients had a positive electrocardiographic response to exercise. No significant coronary artery lesions were seen on coronary arteriography in any of the six patients. All had mild to moderate hypoxemia at rest and physiologic evidence of chronic obstructive pulmonary disease as defined by the decrease in the ratio of forced expiratory volume at 1 second to forced vital capacity (FEV1/FVC X 100) or decrease in the forced midexpiratory flow rate (FEF25-75), or both. None had clinical findings suggestive of any of the reported causesmore » of positive thallium scans in patients with normal coronary arteriograms. Cellular dysfunction produced by hypoxemia affecting the uptake of thallium seems to be the most likely mechanism of this abnormality.« less
  • Two noninvasive tests to detect and localize coronary stenoses were compared in a fully blinded protocol. /sup 201/Tl myocardial perfusion imaging (MPI) following maximal treadmill exercise and pharmacologic coronary vasodilation with intravenous dipyridamole (DP) was performed in 33 patients. /sup 201/Tl imaging defects in six myocardial perfusion regions were correlated with stenoses in their respective vascular distributions. Disease severity was determined with coronary arteriograms using a computer-assisted method. 198 myocardial regions were evaluated; 101 were supplied by at least one major artery with a greater than or equal to 50% stenosis (luminal diameter narrowing). The sensitivity and specificity for detectingmore » a greater than or equal to 50% stenosis were 85% and 64% (p less than 0.005), respectively, for DP and 84% and 68% (p less than 0.005) for exercise-/sup 201/Tl imaging. A particular combination of anterior and septal imaging defects was useful in detecting left anterior descending artery stenoses proximal to its first septal branch. DP administration was safe in this group of patients; however, 42% experienced transient chest pain. Although the overall sensitivity and specificity of the two methods were not significantly different, DP-MPI appeared more sensitive than exercise-MPI (70% vs 52%, p less than 0.01) in detecting coronary stenoses in the 40% to 60% range. DP-/sup 201/Tl MPI provides a useful alternative test for potential coronary disease patients unable to perform maximal exercise.« less
  • In order to determine whether there are differences in myocardial perfusion at rest among patients with various unstable and stable angina syndromes, serial thallium-201 imaging was performed at rest in 19 patients presenting with rapidly worsening exertional angina (unstable angina, group A), 12 patients with rest angina alone without exertional symptoms (unstable angina, group B), and 34 patients with chronic stable angina. No patient had an episode of angina within 4 hours of study. Nineteen of 19 (100%) patients in group A demonstrated transient defects compared to only 3 of 12 (25%) patients in group B (p less than 0.0001)more » and 4 of 34 (12%) stable angina patients (p less than 0.0001). The majority of zones demonstrating transient defects in group A were associated with hypokinesis of the corresponding left ventriculogram segment without associated ECG evidence of previous infarction. There were no significant differences in the frequency of persistent thallium defects, severity of angiographic coronary artery disease, or frequency of regional wall motion abnormalities of myocardial segments supplied by stenotic coronary arteries among the three groups of patients. Transient defects have been shown to reflect reduction in regional coronary blood flow to viable myocardium. Therefore, we conclude that regional resting hypoperfusion of viable myocardium is far more common in patients with exertional unstable angina symptoms than in patients with rest angina alone or chronic stable angina.« less