Cardiac phase-synchronized myocardial thallium-201 single-photon emission tomography using list mode data acquisition and iterative tomographic reconstruction.
The purpose of this study was to determine whether data acquisition in the list mode and iterative tomographic reconstruction would render feasible cardiac phase-synchronized thallium-201 single-photon emission tomography (SPET) of the myocardium under routine conditions without modifications in tracer dose, acquisition time, or number of steps of the a gamma camera. Seventy non-selected patients underwent 201T1 SPET imaging according to a routine protocol (74 MBq/2 mCi 201T1, 180 degrees rotation of the gamma camera, 32 steps, 30 min). Gamma camera data, ECG, and a time signal were recorded in list mode. The cardiac cycle was divided into eight phases, the end-diastolic phase encompassing the QRS complex, and the end-systolic phase the T wave. Both phase- and non-phase-synchronized tomograms based on the same list mode data were reconstructed iteratively. Phase-synchronized and non-synchronized images were compared. Patients were divided into two groups depending on whether or not coronary artery disease had been definitely diagnosed prior to SPET imaging. The numbers of patients in both groups demonstrating defects visible on the phase-synchronized but not on the non-synchronized images were compared. It was found that both postexercise and redistribution phase tomograms were suited for interpretation. The changes from end-diastolic to end-systolic images allowed a comparative assessment of regional wall motility and tracer uptake. End-diastolic tomograms provided the best definition of defects. Additional defects not apparent on non-synchronized images were visible in 40 patients, six of whom did not show any defect on the non-synchronized images. Of 42 patients in whom coronary artery disease had been definitely diagnosed, 19 had additional defects not visible on the non-synchronized images, in comparison to 21 of 28 in whom coronary artery disease was suspected (P < 0.02; chi 2). It is concluded that cardiac phase-synchronized 201T1 SPET of the myocardium was made feasible by list mode data acquisition and iterative reconstruction. The additional findings on the phase-synchronized tomograms, not visible on the non-synchronized ones, represented genuine defects. Cardiac phase-synchronized 201T1 SPET is advantageous in allowing simultaneous assessment of regional wall motion and tracer uptake, and in visualizing smaller defects.