SPECT THALLIUM ISCHEMIA  IMAGES

            Male 63 y/o, with angina, referred to rule-out  CAD . Note septal and apical diffuse decreased  uptake  at stress (pharmacologic) with reversibility at resting images.  It is a subendocardic pattern, visual extension of 10 % of the left ventricle.

            Sensitivity of Thallium Spect is about 80 % to 90 %, and specificity is 70 % to 80 %. The addition of quantification augments specificity.

            As far as stable chronic coronary artery disease, a recent publication comments on joint US and European guidelines review. It is based on level of evidence and giving a classification of recomendation, as in table below taken from Fihn at al (2).

            See also figures detailing proper indications in this condition (3).

Applying Classification of Recommendations and Level of Evidence

References:

1 Kailasnath P, Sinusas AJ. Comparison of Tl-201 with Tc-99m-labeled myocardial perfusion agents: technical, physiologic, and clinical issues.J Nucl Cardiol. 2001 Jul-Aug;8(4):482-98.

2 Fihn et al. JACC Vol. 60, No. 24, 2012. Stable Ischemic Heart Disease: Full Text December 18, 2012:e44–e164.

3 Jubin Joseph, MRCP,a Alejandro Velasco, MD,b Fadi G. Hage, MD, FASNC,b,c and Eliana Reyes. Guidelines in review: Comparison of ESC and ACC/AHA guidelines for the diagnosis and management of patients with stable coronary artery disease. J Nucl Cardiol 2017.

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