Evaluation of myocardial viability following acute myocardial infarctic using super(201)Tl SPECT after thallium-glucose-insulin infusion --Comparison with super(18)F-FDG positron emission tomography

Objective and Methods: The aim of this study was to evaluate myocardial viability in patients after acute myocardial infarction (AMI). We compared super(2O1)T1 SPECT after super(2O1)Tl with GIK (10% glucose 250ml, insulin 5 U and KCl 10 mEq) infusion (GIK- super(2O1)T1) with resting super(2O1)T1 and super(99m)Tc-pyrophosphate (PYP) dual SPECT, positron emission computed tomography (PET) using super(18)F-fluorodeoxyglucose ( super(18)F-FDG) in 21 patients with their first AMI, who all underwent successful reperfusion. GIK- super(201)Tl SPECT, super(201)T1 and super(99m)Tc-PYP dual SPECT were done within 10 days after admission and super(18)F-FDG-PET was performed at 3 weeks. GIK- super(201)Tl SPECT was obtained after 30 min of GIK- super(201)T1 infusion. super(18)F-FDG (370 MBq) was injected intravenously after oral glucose (1 g/ kg) loading, and then PET was obtained. PET and SPECT images were divided into 20 segments. Regional tracer uptake was scored using a 4-point scoring system (3 = normal to 0 = defect), and summed to a regional uptake score (RUS). Regional area means the infarcted area in which super(99m)Tc-PYP accumulated. The number of decreased uptake segments (ES) was then determined. The infarcted area was defined as the area of super(99m)Tc-PYP uptake. Results: The ESs for the GIK- super(201)Tl and super(18)F-FDG-PET images were significantly lower than the number of super(99m)Tc-PYP uptake segments. The RUS for GIK- super(2O1)T1 was higher than that for resting- super(201)Tl imaging and similar to those for super(18)F-FDG-PET. Conclusions: In the detection of myocardial viability following AMI, GIK- super(2O1)T1 imaging is useful with findings similar to those of super(18)F-FDG-PET.