Serial Myocardial Imaging after a Single Dose of Thallium-201

Document Type : Case report


Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan


Although thallium-201 exercise scintigraphy has been established for the detection of myocardial ischemia and viability, little is known regarding the myocardial thallium-201 kinetics during angioplasty. Herein, we report a 77-year old man with angina pectoris, in whom serial myocardial imaging after a single dose of thallium-201 was helpful in identifying not only the culprit lesion and myocardial viability, but also the dynamic changes in myocardial perfusion during angioplasty. Thallium-201 images after exercise showed a perfusion defect in the inferior wall, with a trivial redistribution 3 hours after the exercise and a marked improvement 24 hours later. Coronary angiography, performed 27 hours after exercise scintigraphy, showed severe stenosis in the right coronary artery. Guidewire crossing of the lesion interrupted the antegrade flow, which was restored after balloon dilation and stent implantation. Thallium-201 images, 2 hours after angioplasty (i.e., 30 hours after exercise), showed a decreased tracer uptake in the inferior wall, which improved the next day (i.e., 48 hours after exercise). Cardiac biomarkers were negative in the clinical course.





  1. Bonow RO, Dilsizian V. Thallium 201 for assessment of myocardial viability. Semin Nucl Med. 1991; 21: 230-41.
  2. Grunwald AM, Watson DD, Holzgrefe HH Jr, Irving JF, Beller GA. Myocardial thallium-201 kinetics in normal and ischemic myocardium. Circulation. 1981; 64:610-8.
  3. Okada RD. Kinetics of thallium-201 in reperfused canine myocardium after coronary artery occlusion. J Am Coll Cardiol 1984; 3: 1245-51.
  4. Liu P, Burns RJ. Easy come, easy go: time to pause and put thallium reverse redistribution in perspective. J Nucl Med. 1993; 34: 1692-4.
  5. Beller GA, Holzgrefe HH, Watson DD. Intrinsic washout rates of thallium-201 in normal and ischemic myocardium after dipyridamole-induced vasodilation. Circulation. 1985; 71:378-86.
  6. Nishiyama H, Adolph RJ, Gabel M, Lukes SJ, Franklin D, Williams CC. Effect of coronary blood flow on thallium-201 uptake and washout. Circulat 1982; 65: 534-42.