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Biomedical subjects

S Maurea

Publications and source records attributed to S Maurea.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Positron emission tomography (PET) with fludeoxyglucose F 18 in the study of adrenal masses: comparison of benign and malignant lesions].

In this study, 15 patients (4 men and 11 women, mean age: 50 +/- 13 years) with unilateral adrenal masses detected on ultrasound (US), Computed Tomography (CT) and/or Magnetic Resonance (MR) studies were submitted to positron emission tomography (PET) with fluorine-18 deoxyglucose (FDG). Histology demonstrated 3 adenomas, 1 myelolipoma, 1 angiolipoma, 1 neurinoma, 1 cyst, 1 malignant pheochromocytoma, 4 carcinomas and 3 metastases. The patient population was divided into two groups. Group 1 (n = 7) consisted of benign adrenal lesions. Group 2 consisted of malignant adrenal tumors. Lesion measurements were performed on the basis of the results of US, CT and/or MR images. In Group 1, no FDG uptake was observed in adrenal masses. Conversely, in Group 2 adrenal lesions showed abnormally increased FDG uptake, suggesting high glucose tumor metabolism. No significant difference in lesion size was observed between Groups 1 and 2 (5.6 +/- 4.0 vs 6.3 +/- 3.0 cm). Furthermore, in 6 patients of Group 2, total body PET images showed abnormal FDG uptake in extra-adrenal locations, such as chest (n = 2) and abdominal (n = 5) lymph nodes, lungs (n = 6), liver (n = 5), pancreas (n = 1), bone (n = 1) and muscle (n = 1) tissues. In conclusion, the results of this study suggest that PET imaging with FDG can characterize adrenal masses. In particular, abnormally increased FDG uptake in adrenal malignancies allows to differentiate these abnormalities from benign lesions. Furthermore, total body imaging PET can identify extra-adrenal tumor sites in patients with malignant tumors.

Adrenal Gland Neoplasms↗
PubMed1995

Assessment of systolic wall thickening using technetium-99m methoxyisobutylisonitrile in patients with coronary artery disease: relation to thallium-201 scintigraphy with re-injection.

The results of resting planar ECG-gated technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) imaging were compared with those of thallium-201 (Tl) re-injection after exercise-redistribution scintigraphy in 20 patients (19 men, 1 woman, mean age 53 +/- 10 years) with angiographically proven coronary artery disease. Eight normal subjects (seven men, one woman, mean age 50 +/- 8 years) constituted the control group. In these subjects, only resting 99mTc-MIBI imaging was performed. The standardized percent count increase from end-diastole to end-systole was calculated as an index of wall thickening in 13 segments for each study. Regional wall thickening index (WTI) and 99mTc-MIBI uptake were significantly different (P < 0.05) among segments classified as normal, reversible defects, irreversible defects with increased tracer uptake after re-injection (Re+) or irreversible defects with unchanged tracer uptake after re-injection (Re-) on Tl imaging. Furthermore, WTI and 99mTc-MIBI uptake were significantly higher (P < 0.05) in Re- segments with moderate reduction of Tl uptake (> or = 50% of peak activity) than in Re- segments with severe reduction of Tl uptake (< 50% of peak activity). A significant relationship between WTI and the results of Tl scintigraphy was observed (rho = 0.71, P < 0.0001). The percentage of Re- segments with severe reduction of WTI was significantly higher compared to Re+ segments (64% vs 3%, P < 0.01). Furthermore, compared with moderate Re- segments, a significantly higher percentage of severe Re- segments showed a severe reduction of WTI (86% vs 48%, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗
PubMed1995

The diagnosis of nonfunctioning pheochromocytoma. The role of I-123 MIBG imaging.

A patient with an asymptomatic nonsecreting left adrenal pheochromocytoma concentrated I-123 MIBG. Iodine-123 MIBG scintigraphy showed abnormal uptake in the left adrenal bed. The authors conclude that I-123 MIBG imaging may allow the in vivo diagnosis of non-functioning pheochromocytomas when there is no clinical evidence of disease and other laboratory measurements are not helpful for tumor diagnosis.

3-Iodobenzylguanidine↗
PubMed1995

Enhanced detection of viable myocardium by technetium-99m-MIBI imaging after nitrate administration in chronic coronary artery disease.

UNLABELLED: The aim of this study was to assess whether nitrate administration improves the imaging capabilities of 99mTc-MIBI tomography in detecting viable myocardium in coronary artery disease (CAD). METHODS: Thirty-one patients with angiographically proven CAD and chronic LV dysfunction (ejection fraction 39% +/- 9%) underwent two 99mTc-MIBI studies on separate days: one under rest conditions and the other after nitroglycerine (0.005 mg/kg per os) administration. Within 1 wk, all patients also underwent rest-redistribution 201Tl imaging. Eight patients were also studied by echocardiography before and 5 +/- 3 mo after coronary revascularization. RESULTS: On resting 99mTc-MIBI images, 302 segments had normal uptake, 183 segments had moderately reduced uptake and 197 had severely reduced uptake. Of the segments with severely reduced uptake, 54 (27%) had increased uptake after nitroglycerine and were viable on 201Tl images. Of the 143 (73%) segments with severely reduced 99mTc-MIBI uptake and no change after nitroglycerine, 81% were nonviable on 201Tl images. In the eight patients studied before and after revascularization, 87% of segments with reversible 99mTc-MIBI defects and abnormal LV function demonstrated functional recovery after revascularization, whereas 89% of segments with irreversible 99mTc-MIBI defects did not. CONCLUSION: In patients with chronic ischemic LV dysfunction, nitrate administration improved the detection of severely hypoperfused but still viable myocardium on 99mTc-MIBI images.

Coronary Circulation↗
PubMed1995

Myocardial viability index in chronic coronary artery disease: technetium-99m-methoxy isobutyl isonitrile redistribution.

UNLABELLED: The purpose of this study was to evaluate whether an additional redistribution image after a rest 99mTc-MIBI injection enhances detection of viable myocardium and predicts functional recovery after coronary revascularization in patients with chronic coronary artery disease (CAD). METHODS: Thirty-one patients (29 men, mean age 55 +/- 10 yr) with proven CAD and left ventricular (LV) dysfunction (ejection fraction 39% +/- 9%) underwent resting 99mTc-MIBI tomography with initial (1 hr) and delayed (5 hr) images. Within 1 wk of MIBI imaging, all patients underwent rest-distribution 201Tl imaging. Eight patients also underwent two-dimensional echocardiography before and 5 +/- 3 mo after coronary revascularization. RESULTS: On the initial 99mTc-MIBI images, 302 myocardial segments were normal, 183 showed moderate and 197 severe reduction of tracer uptake. Of these 197 segments, 47 (24%) demonstrated increased tracer uptake (> or = 10% versus initial) on delayed images (from 43% +/- 8% to 60% +/- 8%, p < 0.001) and were considered as showing 99mTc-MIBI redistribution. These 47 segments were observed in 20 (65%) patients in whom 201Tl images detected viable myocardium in the same segments. In the eight patients studied before and after revascularization, 83% of segments with 99mTc-MIBI redistribution and abnormal LV function showed functional recovery after revascularization, while 96% of segments without 99mTc-MIBI redistribution did not show functional recovery. CONCLUSION: Resting 99mTc-MIBI redistribution frequently occurs in patients with chronic CAD. Acquisition of 99mTc-MIBI redistribution images enhances detection of viable myocardium and predicts functional recovery after revascularization.

Coronary Disease↗
PubMed1995

[Morpho-functional diagnostic imaging in the assessment of viable myocardium in patients with ischemic heart disease. Correlations between myocardial perfusion and regional function of the left ventricle].

Forty patients (38 men and 2 women, mean age 56 +/- 9 years) with angiographic evidence of coronary artery disease underwent 201Thallium myocardial scintigraphy and two-dimensional echocardiography. 201Thallium uptake and echocardiographic regional ventricular function were studied in corresponding myocardial segments. On exercise-redistribution 201Thallium imaging, 308 segments (51% of the total) had normal Thallium uptake, 48 (8%) exhibited reversible defects and 244 (41%) irreversible defects. Of the latter 244 segments with irreversible defects, 114 (47%) exhibited increased tracer uptake (Re+) and 130 (53%) remained unchanged (Re-) after 201Thallium reinjection at rest. Regional ventricular function was significantly better in the segments with normal Thallium uptake than in the segments with reversible or irreversible defects (p < 0.001). Furthermore, the segments with irreversible defects Re- had impaired regional function compared to the segments with irreversible defects Re+ (p < 0.001). Coronary artery stenosis was significantly more severe in the segments with irreversible defects Re- (93 +/- 16%) than in those with reversible defects (81 +/- 20%) and with irreversible Re+ defects (80 +/- 20%) (both p < 0.001). In conclusion, in coronary artery disease patients, exercise-redistribution 201Thallium cardiac imaging with reinjection at rest can identify severely ischemic but still viable myocardium and may be particularly useful in the prognosis of such patients.

Adult↗
PubMed1995

Impaired left ventricular diastolic filling in patients with acromegaly: assessment with radionuclide angiography.

UNLABELLED: Acromegaly is associated with increased cardiac morbidity and mortality, but it is not clear whether this is the result of a specific disease of heart muscle or of increased incidence of hypertension. METHODS: Twenty-six patients with acromegaly (11 male and 15 female, mean age 45 +/- 13 yr) and 15 and 12 age- and sex-matched normal controls underwent high temporal resolution radionuclide angiography and two-dimensional echocardiography at rest. RESULTS: Normal controls and patients with acromegaly did not differ with respect to heart rate, ejection fraction, time to end systole, peak ejection rate (PER) and time to PER. In contrast, peak filling rate (PFR), normalized to end diastolic volume (EDV), or stroke volume (SV), or expressed as the ratio of PFR-to-PER was reduced (p < 0.01), time to PFR (TPFR) was prolonged (p < 0.01), and echocardiographic left ventricular mass index was higher (p < 0.001) in patients with acromegaly compared to normals. Patients with acromegaly were divided in normotensives (group 1, n = 17) and hypertensives (group 2, n = 9). Although left ventricular mass index was significantly (p < 0.01) higher in group 2 compared to group 1, PFR and time to PFR were not different between the two groups of acromegalic patients. In the entire group of patients with acromegaly significant relationships between left ventricular mass index and EDV/s (r = -0.56, p < 0.01), SV/s (r = -0.73, p < 0.001), and PFR/PER (r = -0.61, p < 0.001) were observed. CONCLUSION: Patients with acromegaly have impaired left ventricular diastolic filling at rest related to greater left ventricular mass index even in the absence of systemic hypertension.

Acromegaly↗
PubMed1995

Technetium-99m-tetrofosmin imaging of differentiated mixed thyroid cancer.

This report describes the accurate localization of metastatic lesions in a patient with differentiated mixed thyroid cancer using 99mTc-tetrofosmin imaging. A 66-yr-old women with a cytological diagnosis of follicular thyroid cancer associated with a large amount of goiter changes was studied by 99mTc-tetrofosmin total-body scintigraphy. No significant tetrofosmin uptake was observed in the thyroid nodules, which mainly showed goiter abnormalities. Abnormal increased tetrofosmin uptake, however, was found in metastatic tumor lesions located in the cervical and dorsal spine as well as in the left lower chest wall and lungs. In conclusion, 99mTc-tetrofosmin, a new radiopharmaceutical proposed for myocardial perfusion imaging, may be useful in patients with thyroid cancer.

Aged↗
PubMed1995

[Scintigraphic characterization of expansive lesions located in the adrenals. Comparison with magnetic resonance imaging].

In this study, 35 patients (11 men and 24 women, mean age 47 +/- 16 years) with unilateral adrenal masses underwent nor-cholesterol (nor-Chol) (n = 11), metaiodobenzylguanidine (MIBG) (n = 15) or nor-Chol and MIBG (n = 9) radionuclide studies. In all patients Magnetic Resonance (MR) adrenal imaging was also performed. In 19 (54%) patients, no laboratory abnormalities of adrenal function were observed. In the other 16 (46%) patients, adrenal hyperfunction was found. In 21 lesions, histology showed 10 pheochromocytomas (Pheos), 6 adenomas, 3 metastases, 1 cyst and 1 nodular focal liver hyperplasia. In the remaining 14 lesions, increased cortisol (n = 4) or aldosterone (n = 2) levels and/or intense nor-Chol uptake (n = 14) were considered suggestive of adenoma. Diagnostic accuracy of both nor-Chol and MIBG radionuclide studies in correctly identifying adenoma or Pheos was 100%. Conversely, qualitative MR signal intensity (SI) analysis on T2-weighted images did not allow to accurately distinguish lesions of different nature. In particular, 10 Pheos, 8 adenomas, 3 mestastasis and 1 cyst clearly showed on T2-weighted images higher SI than the liver; 5 adenomas had a slight higher SI; the remaining lesions (7 adenomas and 1 liver hyperplasia) exhibited low SI. In conclusion, adrenal scintigraphy using nor-Chol or MIBG allows to identify adenomas and Pheos, respectively. Conversely, qualitative MR SI analysis cannot differentiate different adrenal lesion (Pheos, adenoma, metastasis and cyst) and yields heterogeneous results in adenomas.

3-Iodobenzylguanidine↗
PubMed1995

Comparison of labeled MIBG and somatostatin analogs in imaging neuroendocrine tumors.

In 10 patients with histologically proven neuroendocrine tumors (4 carcinoids, 4 pheochromocytomas, 1 medullary thyroid cancer and 1 Merkel tumor) the results of radiolabeled metaiodobenzylguanidine (MIBG) and somatostatin analogs were compared. A total of 24 tumor lesions was detected on standard imaging studies. MIBG scintigraphy correctly localized 12 (50%) of these lesions which were observed in 5 patients (4 with pheochromocytoma and 1 with carcinoid tumor). Scintigraphy using labeled somatostatin analogs correctly localized 21 (87%) lesions which occurred in 8 patients (4 with carcinoid, 2 with pheochromocytoma, 1 with medullary thyroid cancer and 1 with Merkel tumor). Concordant scintigraphic results were obtained in 1 patient with carcinoid and 2 with pheochromocytoma. In conclusion, although this series was limited, our results suggest that MIBG is more accurate than somatostatin analogs in imaging pheochromocytoma. Conversely, somatostatin analogs are more accurate than MIBG in detecting other neuroendocrine tumors such as carcinoids.

3-Iodobenzylguanidine↗
PubMed1994

Clinical significance of reduced regional myocardial glucose uptake in regions with normal blood flow in patients with chronic coronary artery disease.

OBJECTIVES: The objective of this study was to assess the clinical significance of reduced regional fluorine-18 (18F) fluorodeoxyglucose uptake with normal flow in patients with chronic coronary artery disease. BACKGROUND: In patients with ischemic left ventricular dysfunction, 18F-fluorodeoxyglucose uptake may be reduced in some myocardial regions despite normal flow. The significance of this finding is unclear and has not been investigated systematically. METHODS: Twenty-three patients with coronary artery disease and impaired ventricular function (mean ejection fraction [+/- 1 SD] 28 +/- 10%) underwent positron emission tomography with 18F-fluorodeoxyglucose and oxygen-15-labeled water at rest, exercise thallium-201 tomographic imaging with rest reinjection and gated magnetic resonance imaging to measure end-diastolic wall thickness and systolic wall thickening. RESULTS: Of 168 regions with normal flow (> or = 0.7 ml/g per min), 125 (74%) had normal 18F-fluorodeoxyglucose uptake (98 +/- 10%), and the remaining 43 (26%) showed moderately reduced 18F-fluorodeoxyglucose uptake (69 +/- 8%). Systolic wall thickening was absent at rest in 14% of regions with normal 18F-fluorodeoxyglucose uptake compared with 32% of regions with reduced 18F-fluorodeoxyglucose uptake (p < 0.01). Reversible thallium abnormalities were observed in 45 (36%) of 125 regions with normal 18F-fluorodeoxyglucose uptake compared with 27 (63%) of 43 regions with reduced 18F-fluorodeoxyglucose uptake (p < 0.01). This difference was accounted for by a higher proportion of partially reversible defects in regions with reduced 18F-fluorodeoxyglucose uptake compared with regions with normal 18F-fluorodeoxyglucose uptake (42% vs. 18%, respectively, p < 0.01). CONCLUSIONS: Thus, regions with moderately reduced 18F-fluorodeoxyglucose uptake with normal flow occur commonly in patients with ischemic left ventricular dysfunction. The majority of these regions show impaired systolic function at rest and exercise-induced thallium abnormalities that are only partially reversible. These observations suggest that such regions represent an admixture of fibrotic and reversibly ischemic myocardium.

Coronary Circulation↗
PubMed1994

Reverse redistribution in Tl-201 stress-redistribution myocardial scintigraphy. Effect of rest reinjection.

To clarify the clinical significance of Tl-201 reverse redistribution (RR), 33 patients with chronic coronary artery disease (CAD) underwent stress-redistribution Tl-201 cardiac imaging with rest reinjection, coronary arteriography, and 2D-echocardiography. Rest Tc-99m MIBI scintigraphy was also performed in 27 of the 33 patients. A total of 495 segments were analyzed for Tl-201 scintigraphy (405 for Tc-99m MIBI). Each segment was assigned to one of the major coronary artery territories. Two patterns of RR were identified; 1) pattern A (RR-A) showed normal Tl-201 uptake on stress images and lower than normal on redistribution images, and 2) pattern B (RR-B) showed lower than normal Tl-201 uptake on stress images with further decrease on redistribution images. The RR phenomenon was found in 46 (9% of the total) segments; 25 with RR-A and 21 with RR-B. Reverse redistribution pattern A segments had lower Tc-99m MIBI uptake (84 +/- 9% versus 92 +/- 10%, P < 0.0001) and a higher percentage of stenosed coronary arteries (80% versus 49%, P < 0.05) compared to normal segments (n = 204, 41% of the total). No difference in wall motion was observed between RR-A and normal segments. Of the 25 segments with RR-A, 14 showed enhanced Tl-201 uptake after reinjection (Re+) and 11 remained unchanged after reinjection (Re-). Segments that were Re- showed significantly (P < 0.05) lower Tc-99m MIBI uptake (79 +/- 9%) compared to Re+ segments (87 +/- 8%) and normal segments (92 +/- 10%).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗
PubMed1994

[Scintigraphy with iodine-131 metaiodobenzylguanidine in the study of paraganglioma. Comparison between benign and malignant tumors].

In order to evaluate 131I metaiodobenzylguanidine (MIBG) uptake in patients with benign or malignant paragangliomas, 28 patients (14 men and 14 women, mean age 37 +/- 10 years) with benign (no. = 15; group 1) or malignant (no. = 13; group 2) tumors underwent MIBG scintigraphy. A total of 110 lesions (20 benign and 90 malignant) were studied. In all patients histologic disease confirmation was obtained. MIBG uptake was quantified on 48 hours' images (Kodak NMC-1 films) using a photographic densitometer. The optical densities of tumor and adjacent or contralateral normal tissue were used to calculate the MIBG uptake intensity ratio for each lesion. In group 1, all patients exhibited 1 or 2 lesions with abnormal MIBG uptake. In group 2, all patients had 1 to 28 abnormal foci of MIBG uptake. In the patients with 2 or more lesions, the average MIBG uptake intensity ratio was calculated. MIBG uptake intensity ratio was significantly higher in malignant than in benign paragangliomas (5.2 +/- 2.4 vs 2.9 +/- 1.4, p < 0.01). Since MIBG uptake in paragangliomas reflects the intratumoral concentration of catecholamines, higher MIBG uptake in malignant lesions suggests a greater amount of stored catecholamines in these tumors. In conclusion, 131I MIBG scintigraphy may be useful to distinguish benign from malignant paragangliomas.

3-Iodobenzylguanidine↗
PubMed1994

Iodine-131-MIBG imaging to monitor chemotherapy response in advanced neuroblastoma: comparison with laboratory analysis.

UNLABELLED: The rationale of this study was the evaluation of response to chemotherapy in children with advanced neuroblastoma using currently available diagnostic modalities. METHODS: Iodine-131-metaiodobenzylguanidine (MIBG) imaging and 24-hr urinary vanillylmandelic acid (VMA) measurement were evaluated in 14 patients (7 males, 7 females, age range: 2-68 mo) with advanced neuroblastoma both pre- and postchemotherapy (5.6 +/- 2.8 mo) as well as serum ferritin (FER) and neuron-specific enolase (NSE) levels in 9 and 8 patients, respectively. MIBG images were qualitatively compared in each patient. RESULTS: Prechemotherapy, a total of 39 abnormal foci of MIBG uptake was detected. Postchemotherapy, 15 of these showed unchanged MIBG uptake, 7 had decreased uptake and 17 showed no uptake. In addition, four new abnormal foci of uptake were found. Postchemotherapy, a significant reduction of abnormal MIBG uptake (p < 0.01) was observed using a lesion-by-lesion analysis. When biochemical and MIBG postchemotherapy changes were compared, a significant relationship was found only between MIBG and VMA results (r = 0.84, p < 0.01). CONCLUSIONS: In postchemotherapy follow-up of children with advanced neuroblastoma, laboratory evaluation using VMA, FER and NSE measurements reflect only the global functional status of the disease, and are not helpful in defining the response of individual tumor lesions to treatment. Conversely, qualitative analysis using MIBG imaging may allow lesion-by-lesion evaluation of the heterogeneity of neuroblastoma response to chemotherapy. In this setting, changes in MIBG uptake are mirrored by the changes in catecholamine production, as measured by VMA levels.

3-Iodobenzylguanidine↗
PubMed1994

Non-Hodgkin's lymphoma in a patient with follicular thyroid cancer: the role of 99mTc-methoxy isobutyl isonitrile imaging.

In the post-surgical follow-up of a patient with follicular thyroid carcinoma, a palpable mass in the left supraclavicular region was highly indicative of metastatic disease. Technetium-99m methoxy isobutyl isonitrile (99mTc-MIBI) showed an increased but heterogeneous uptake within the lesion. Surprisingly, a different neoplastic disease was histologically demonstrated. Lymph node abnormalities due to non-Hodgkin's lymphoma rather than metastatic thyroid disease were demonstrated. In conclusion, non-Hodgkin's lymphoma may occur in patients with follicular thyroid carcinoma. This new lesion significantly concentrated 99mTc-MIBI. Thus, the results of 99mTc-MIBI imaging have to be carefully evaluated during the follow-up of patients with thyroid cancer.

Adenocarcinoma, Follicular↗
PubMed1994

Enhanced thallium-201 uptake after reinjection: relation to regional ventricular function, myocardial perfusion and coronary anatomy.

The aim of this study was to clarify the significance of enhanced thallium-201 (201Tl) uptake after reinjection following 4-hour redistribution imaging. Thirty-four patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction (ejection fraction 32 +/- 10%) underwent exercise-redistribution (ER) 201Tl scintigraphy with rest injection, resting technetium-99m methoxy isobutyl isonitrile (MIBI) imaging, 2D-echocardiography, and coronary angiography. Wall motion (WM) was graded on echocardiographic images. A total of 510 myocardial segments were quantitatively analyzed. A total of 267 (52%) segments had normal (N) 201Tl uptake, 53 (10%) reversible (RD), and 190 (37%) irreversible (ID) 201Tl defects on ER images. Of these 190 ID, 84 (44%) showed enhanced 201Tl uptake after reinjection (Re+) and 106 (56%) remained unchanged after reinjection (Re-). MIBI uptake was significantly higher in RD compared to Re+ and Re- (both p < 0.01), and in Re+ compared to Re- (p < 0.01). The WM score was significantly lower in RD and Re+ compared to Re- (p < 0.01), while no difference was observed between RD and Re+. The severity of coronary artery stenosis was significantly lower in RD compared to Re+ and Re- (both p < 0.01), but no difference was observed between Re+ and Re-. The occurrence of collaterals was significantly higher (p < 0.01) in Re+ (69%) compared to Re- (38%). In conclusion, in patients with CAD and impaired LV function, enhanced 201Tl uptake after reinjection in myocardial segments with ID on ER images was associated with less severe WM abnormalities, higher MIBI uptake and the presence of collaterals.(ABSTRACT TRUNCATED AT 250 WORDS)

Collateral Circulation↗
PubMed1994

Improved detection of viable myocardium with thallium-201 reinjection in chronic coronary artery disease: comparison with technetium-99m-MIBI imaging.

Exercise-redistribution 201Tl with reinjection at rest and exercise-rest 99mTc-methoxy isobutyl isonitrile (MIBI) cardiac imaging was performed in a patient with multivessel chronic coronary artery disease (CAD) and evaluated before and after coronary revascularization. Thallium reinjection showed reversible defects of the inferior and septal walls and irreversible defect of the infero-apical region. Technetium-99m-MIBI scintigraphy demonstrated irreversible defects of the inferior, septal and infero-apical regions. After coronary artery bypass grafts, both thallium reinjection and 99mTc-MIBI images showed only irreversible defects of the infero-apical region. Functional recovery of the inferior and septal walls was observed on two-dimensional echocardiography. Thallium reinjection identifies severely ischemic but viable myocardium more accurately than 99mTc-MIBI in chronic CAD. Thallium myocardial imaging with reinjection at rest is recommended for evaluating patients with chronic ischemic left ventricular dysfunction to determine if these patients are candidates for revascularization procedures.

Coronary Artery Bypass↗