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PubMed1978

Thallium-205 and proton nuclear magnetic resonance investigation of the complexation of thallium by the ionophores monensin and nigericin.

A thallium-205 and proton nuclear magnetic resonance study of the ionophores monensin and nigericin is reported. Evidence is presented for the simultaneous existence of two forms of monensin free acid in chloroform solution, one containing a water molecule in the central cavity and one with a water molecule on the periphery, linking the ends of the monensin molecule by hydrogen bonding. There appear to be three structurally different monensin complexes of thallium, two in the salt form and one in the acid form. In free nigericin acid, both terminal hydroxyl moieties hydrogen bond to the terminal carboxylic acid oxygens; in the Na+ salt, the binding of one of the carboxylate oxygens to the metal ion allows but one of the terminal OH's to hydrogen bond strongly. Thallium-205 chemical shifts and spin-lattice relaxation times in the title complexes are discussed and compared to those in ionophores studied previously.

Anti-Bacterial Agents↗
PubMed2003

Myocardial thallium defects in apical hypertrophic cardiomyopathy are associated with a benign prognosis. Thallium defects in apical hypertrophy.

BACKGROUND: We investigated whether myocardial thallium-201 defects in patients with apical hypertrophic cardiomyopathy are associated with an unfavorable clinical outcome, and additionally compared the presence of defects to echocardiography and angiography findings. METHODS: Dipyridamole thallium-201 single photon emission tomography was performed in 26 apical hypertrophic cardiomyopathy patients, aged 41-78 (22 men, 6 women). Patients with or without perfusion defects were compared for echocardiographic measurements of wall thickness, chamber dimensions, and fractional shortening. Twelve patients underwent coronary angiography. The occurrence of cardiac events was evaluated during clinical follow-up for a mean period of 4.3 +/- 1.9 years (range: 1.0-7.0 year). RESULTS: Thirteen patients (50%) showed perfusion defects, which were predominantly reversible (fixed in 1) and mostly apical (9 of 13). Patients with and without defects did not differ in symptoms, EKG findings, echocardiographic morphology or fractional shortening (41 +/- 4 vs. 41 +/- 7%). Coronary angiography was normal in all patients in whom it was performed (nine with and three without defects). During follow-up, there were no deaths or myocardial infarction. Of the defect positive group, one case developed paroxysmal supraventricular tachycardia, and another had a cerebrovascular accident. Of the defect negative group, one case developed sick sinus syndrome, while another had a hospital admission for anginal pain. CONCLUSIONS: While reversible thallium defects in the absence of coronary artery disease occur frequently in patients with apical hypertrophic cardiomyopathy, the prognosis remains benign despite the presence of ischemia and there is no evidence for an association with adverse patient outcome.

Adult↗
PubMed1998

Revised hydrolysis constants for thallium(I) and thallium(III) and the environmental implications.

The hydrolysis constants for Tl(I) and Tl(III) have been determined by combining potentiometric measurement with the PKAS computer program. The log hydrolysis constants (Khi) for Tl(I)(OH)i-1i + H2O<==>Tl(I) (OH)i1-i + H+ have been determined to be -11.7, and those for Tl(III)(OH)i-1(4-i) + H2O<==>Tl(III)(OH)i3-i + H+ are -2.69, -6.36, -7.42, and -8.78, respectively. The corresponding stepwise association constant for monovalent thallium is 10(2.3) for Tl(OH)aq, and those for trivalent thallium are 10(11.31) for Tl(OH)2+, 10(7.64) for Tl(OH)2+, 10(6.58) for Tl(OH)3aq, and 10(5.22) for Tl(OH)4-. The solubility product (Ksp) for solid Tl(OH)3,Solid has been redetermined to be 10(-45.2), implying that it is one of the least soluble among metal hydroxides. Revised fields of predominance of Tl(I) and Tl(III) hydroxides in aquatic environment are described, and the importance of Tl(III)/Tl(I) redox couple in the cycling of thallium is discussed.

Air Pollutants, Occupational↗
PubMedDate not supplied

Experimental studies on thallium toxicity in rats. II--The influence of several antidotal treatments on the tissue distribution and elimination of thallium, after subacute intoxication.

The influence of several antidotal treatments--e.g. Prussian Blue + Furosemide, Furosemide, activated Charcoal, Potassium Chloride and Potassium Iodide--on the tissue distribution and elimination of thallium after subacute intoxication is studied. From these experiments, the fate of electrolytes (Na+, K+, Cl-) may be evaluated. It was established that the efficacy of an antidotal treatment in thallium intoxication may be judged not only by the determination of its ability to interfere in the reabsorption and redistribution of thallium. Prussian Blue was the only antidotal that did not cause such a dangerous redistribution.

Animals↗
PubMed1986

Quantitation of extent, depth, and severity of planar thallium defects in patients undergoing exercise thallium-201 scintigraphy.

Previous quantitation of exercise-redistribution planar 201TI scintigraphy has shown high sensitivity and specificity in the detection of coronary artery disease and improved detection of individual coronary stenoses over visual analysis. By using similar methodology based on the circumferential profile method, we studied 133 patients to quantitatively assess the extent, depth, and severity of thallium defects compared with consensus visual analysis. These quantitative measurements are objective, requiring only three operator interactions. In comparing quantitative and visual results, a close correlation was found for measurement of extent of thallium defect (r = 0.73) and severity of defect (r = 0.79). In detecting patients with the high-risk scintigraphic pattern of a severe stress thallium defect, a quantitative depth score of greater than or equal to 36 had an 81% sensitivity and an 82% specificity. Thus, this nearly automatic, computerized quantitative method allows objective determination of extent, severity, and depth of planar 201TI defects.

Aged↗
PubMed1995

Reverse redistribution on planar thallium scintigraphy: relationship to resting thallium uptake and long-term outcome.

Reverse redistribution (RR) of thallium-201 has been associated with both acute and healed myocardial infarction, and with recent thrombolysis. The physiologic basis for RR in coronary artery disease (CAD) is unclear but may be related to an admixture of viable and scarred myocardium within the RR segment. We performed thallium reinjection imaging at rest to better characterize RR defects in patients with chronic CAD. We found enhanced uptake of 201Tl in 52% of RR segments after reinjection, consistent with significant regional viability that was not evident on redistribution images. We then used a logistic multiple regression analysis to determine whether RR alone or in combination with other scintigraphic findings could predict patient outcome. The results showed that severe RR was an independent predictor of patient outcome. We conclude that RR may have prognostic significance in chronic CAD.

Aged↗
PubMed1984

[Thallium in wine--trace element vinogram of thallium].

The ultra trace element Thallium is regularly found in very low quantities in wine, in red wines with 0.2 micrograms T1/1 about twice as much as in white wines. Certain hints the origin and behaviour of such low T1-contents can be derived from additional investigations (soil, location, fertilizer, influence of wine making). A correlation between T1 and K is known, but above that it can be shown, that similarly to Rb certain parts of the grape (grape, flesh, peel) are richer in T1 and that thereby the higher content of T1 in red wines can be explained. Slightly higher T1-levels are found in wines which grow next to cement plants or on abandoned mines. The Anodic Stripping Voltammetry in EDTA-containing base solution has proved effective for the determination of very low levels in the investigated samples. Wine and similar samples are decomposed with H2SO4-H2O2. After extraction as T1(III) bromide Thallium is measured by anodic-stripping-voltammetry. The preceding separation of T1 from soil samples or the like is achieved by evaporation analysis.

Electrochemistry↗
PubMed1999

Thallium-201 right lung/heart ratio during exercise in patients with coronary artery disease: relation to thallium-201 myocardial single-photon emission tomography, rest and exercise left ventricular function and coronary angiography.

The aim of this study was to correlate lung thallium-201 uptake on exercise with 201Tl single-photon emission tomography (SPET) myocardial perfusion imaging, rest and exercise equilibrium radionuclide angiographic and coronary angiographic findings in patients with coronary artery disease (CAD) using a simple, reproducible lung/heart (L/H) ratio that would be easy to use in clinical practice. L/H ratio was defined on the anterior planar image obtained during exercise 201Tl SPET acquisition as the mean counts per pixel in an entire right lung field region of interest divided by the mean counts per pixel in the hottest myocardial wall region of interest. We studied 103 patients. Fifty-nine patients (group I) with <5% likelihood of CAD were used as a reference group. In 44 CAD patients (group II), L/H ratio was compared with 201Tl SPET, radionuclide angiographic and coronary angiographic variables. The group I L/H ratio of 0.35+/-0.05 (mean +/-1 SD) was significantly lower (P<0.001) than the group II L/H ratio of 0. 45+/-0.10. An L/H ratio >0.45 (mean + 2 SD in group I) was considered abnormal. In group II, L/H ratio showed a significant correlation with stress and rest 201Tl perfusion defect size (r = 0. 39 and r = 0.42, P<0.01, respectively), but not with extent of ischaemic myocardium. The mean L/H ratio was 0.41+/-0.10 in patients with one-vessel disease (n = 15), 0.46+/-0.08 in those with two-vessel disease (n = 17) and 0.47+/-0.12 in those with three-vessel disease (n = 12), but no significant difference was found between the three subgroups. L/H ratio showed a significant inverse relation with rest and exercise left ventricular ejection fraction (r = -0.37 and r = -0.50, P<0.05 and P<0.001, respectively). Using stepwise multiple regression analysis, exercise left ventricular ejection fraction and previous history of hypertension were the sole two variables independently predictive of the L/H ratio. In conclusion, although lung thallium uptake is usually found to correlate with extent and severity of CAD, increased L/H ratio should primarily be considered as a marker of exercise-induced left ventricular systolic and perhaps diastolic dysfunction, probably independent of the underlying cardiac disease.

Case-Control Studies↗
PubMed1986

Myocardial thallium-201 kinetics during coronary occlusion and reperfusion: influence of method of reflow and timing of thallium-201 administration.

Thallium-201 (201Tl) uptake and redistribution kinetics were examined in an open-chest canine preparation of occlusion and reperfusion. Seven dogs (group I) underwent 3 hr of sustained occlusion and received 1.5 mCi of 201Tl after 40 min of occlusion of the left anterior descending coronary artery (LAD). Group II (n = 18) underwent 60 min of LAD occlusion followed by sudden and total release of the ligature. Group IIa (n = 8) received intravenous 201Tl during occlusion of the LAD, whereas group IIb (n = 10) received intravenous 201Tl at the time of peak reflow. Group III dogs (n = 26) also underwent 60 min of LAD occlusion that was followed by gradual reflow through a residual critical stenosis. Animals in this group also received 201Tl either before (IIIa; n = 16) or after reflow was established (IIIb; n = 10). In group I, the relative 201Tl gradient (nonischemic minus ischemic activity) decreased from 88 +/- 8% (mean +/- SEM) to 59 +/- 6% during 3 hr of coronary occlusion (p = .034). After rapid and total reperfusion (group IIa), this gradient decreased from 71 +/- 6% during occlusion to 26 +/- 5% after reflow (p less than .001). After slow reperfusion through a residual stenosis (group IIIa), the gradient decreased from 81 +/- 5% to 31 +/- 5% (p less than .001) (p = .56 compared with group IIa). In rapidly reperfused dogs receiving intravenous thallium during peak reflow (IIb), initial 201Tl activity in the ischemic zone was 155 +/- 20% of initial normal activity and fell to 93 +/- 13% of normal after 2 hr of reperfusion. Similarly, in dogs reperfused slowly through a critical stenosis (IIIb), which received 201Tl during reflow, 201Tl activity soon after reflow was 94 +/- 4% of initial normal and decreased to 80 +/- 6% at 2 hr of reperfusion (p = .10). Histochemical evidence of necrosis was present in the biopsy region in 80% of the 20 dogs subjected to triphenyl tetrazolium chloride (TTC) staining. Microsphere-determined transmural blood flow was similar in all groups during LAD occlusion and final flows after 2 hr were comparable in all subgroups undergoing reflow. Ischemic zone flow (% normal) was significantly higher at the time of 201Tl administration in groups IIb (192 +/- 25%) and IIIb (110 +/- 5%), which received 201Tl during reflow, than in groups IIa (31 +/- 9%) and IIIa (22 +/- 5%), which received 201Tl during occlusion.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMedDate not supplied

Thallium-201: what do we gain from new clinical protocols and acquisition procedures? The Italian Study on Thallium Reinjection/SIRT).

Nine medical centers, equipped with the same gamma camera and computer software, participated in this multicenter study on thallium-201 reinjection imaging. Preliminary findings for the first 143 patients with ischemic heart disease and perfusion defects at stress imaging are reported. Eighty-eight patients were reinjected at rest after conventional stress-redistribution imaging. Another 55 patients were reinjected at rest on a separate day. After segmental comparison of conventional redistribution versus stress imaging, differences > 1 in the segmental scores on a reduced 3 point scale identified 58 patients with irreversible or mainly irreversible defects (dominant scar pattern) and 85 patients with reversible or mainly reversible defects (dominant ischemic pattern). When reinjection was compared to stress images, 24 patients out of 58 with a dominant scar pattern at the conventional analysis were then assigned to the group with a dominant ischemic pattern. No clinical variables or exercise stress data were found to be significantly different in this patient subgroup. Only 4 out of 85 patients with a dominant ischemic pattern were reassigned to a dominant scar pattern after reinjection scoring. These preliminary results of the SIRT study confirm the consistent problem of scar overestimation by conventional stress-redistribution imaging and the clinical value of the thallium-201 reinjection procedure for differentiating viable from necrotic myocardium.

Cell Survival↗
PubMed1992

Significance of increased lung thallium uptake during adenosine thallium-201 scintigraphy.

To determine the relationship of lung 201Tl activity during adenosine scintigraphy to the presence and extent of coronary artery disease, we investigated 132 subjects comprising 4 groups: 36 normal volunteers, 19 patients with angiographically normal coronaries, 29 patients with single-vessel (greater than 50% luminal stenosis) and 48 patients with multivessel coronary artery disease. Lung activity was quantified relative to maximal myocardial activity in both an early anterior planar image (pretomography) and the unprocessed tomographic image in the anterior projection. A good correlation was found for the lung-to-heart ratio assessed by planar and tomographic imaging (r = 0.83, p less than 0.0001), but the ratio was higher with planar imaging. The lung-to-heart ratio in the planar images was significantly higher in patients with multivessel disease compared to those with single-vessel disease (p less than 0.05) or volunteers and subjects with normal coronary arteries combined (p less than 0.001). A lung-to-heart ratio of greater than 0.45 in the planar images (upper 95% confidence limit for the normal subjects) was found in 6 (21%) single-vessel disease and 17 (35%) multivessel disease patients. Patients with elevated lung thallium activity during adenosine infusion had more hypoperfused myocardial segments (p = 0.007), more segments with redistribution (p = 0.04) and larger initial perfusion defect size (p = 0.04) than those with normal lung activity. Thus, evaluation of lung activity during adenosine thallium scintigraphy provides supplementary information regarding the severity of coronary artery disease and extent of myocardial hypoperfusion.

Adenosine↗
PubMed1992

Attenuation correction of thallium SPECT using differential attenuation of thallium photons.

The greatest limitation of 201Tl for the diagnosis of coronary artery disease remains the high soft-tissue attenuation of its low energy photons. However, thallium also emits a smaller number of higher energy photons. Since photons of higher energy undergo less attenuation, it was postulated that the amount of attenuation could be ascertained from the ratio of the low-to-high energy photon counts. A planar phantom was used to derive a regression equation relating attenuation to the count ratio of the low and high energy peaks. A three-dimensional heart phantom was constructed and SPECT images were obtained in air and water. Application of the attenuation correction algorithm to the SPECT images of the phantom in water produced images quantitatively similar to that obtained in air. We conclude that by using differential photon attenuation, correction of 201Tl SPECT using a single order post-processing technique is feasible. This technique may allow for more accurate analysis of thallium myocardial perfusion scintigraphy.

Heart↗
PubMed1991

[Minimal redistribution of thallium-201 representing reversible ischemia after coronary bypass surgery: value of quantitative analysis of exercise thallium-201 SPECT].

We previously reported the value of minimal redistribution (MR) of thallium-201 in analyzing quantitative polar map analysis (QNT) which correlated well with metabolic activity on FDG-PET. To determine whether ischemic areas that have redistribution are truly reversible, we performed stress and 3-hr delayed thallium-201 SPECT imaging and radionuclide ventriculography (RNV) in 41 patients with coronary artery disease before and after coronary bypass surgery (CABG). Redistribution (RD) was categorized into 4 grades: complete RD (CR), incomplete RD (IR), MR and persistent defect (PD). MR was defined as the segment that showed > or = 2SD improvement in more than 1/3 of the area on QNT, but RD was not evident by visual analysis. 1. QNT identified MR in 30 of 56 segments (54%) where PD is noted by visual inspection. 2. The MR segments showed severer wall motion abnormality (wall motion score: 1.83 +/- 1.12) than did the IR or CR segments (0.99 +/- 1.04) (p < 0.01), but the wall motion was well preserved, compared to the PD segments (2.54 +/- 0.90) (p < 0.01). 3. The grade of RD was compared with improvement in regional perfusion and wall motion on RNV after CABG. Improvement in perfusion was observed in 62 of 77 IR or CR segments (81%) and in 17 of 30 MR segments (57%), but in only 3 of 26 PD segments (12%) (p < 0.01). 4. Similarly, improvement in wall motion was observed in 45 of 57 IR or CR segments (79%) and in 22 of 27 MR segments (81%), but in only 5 of 25 PD segments (20%) (p < 0.01). Thus, the MR segments should be considered reversible after CABG. We conclude that QNT of RD should be performed to detect RD which is slight, yet suggestive of viability.

Aged↗
PubMed1995

[A study on thallium-201 SPECT in brain metastases of lung cancer: with special reference to tumor size and tumor to normal brain thallium uptake ratio].

Thallium-201 brain SPECT was performed on 20 patients with brain metastases of lung cancer using a three-head rotating gamma camera and the effect of tumor size on tumor detectability and tumor to normal brain thallium uptake ratio (T/N ratio) was studied. Among 71 metastatic lesions, only 9 (22.5%) of 40 lesions of 13 mm diameter or below and 31 (100%) of 31 lesions of 14 mm diameter or above could be detected in this study. There was a significant correlation between T/N ratio and tumor size (r = 0.75, p < 0.001). The greater the metastatic lesion, the higher the T/N ratio. Even among the tumors in a single patient with multiple brain metastases, there was a significant linear correlation between tumor size and T/N ratio (r = 0.96, p < 0.01). In this patient, T/N ratio varied by the tumor size and these differences in T/N ratios were thought to be based on the partial volume effect. However, T/N.d which was a parameter corrected by tumor diameter (d) showed a constant value regardless of tumor size. The present results showed that T/N ratio, which was usually believed to quantitate the malignancy grade of brain tumor, was affected by tumor size and that more accurate parameter could be obtained by the correction of T/N ratio by tumor size.

Adenocarcinoma↗
PubMed1994

[Detection of viability by percent thallium uptake with conventional thallium scintigraphy].

Thallium myocardial scintigraphy (TMS) is used for diagnosis of viability in infarcted myocardium before coronary revascularization. Underestimation of viability by TMS has been reported by many investigators. To evaluate viability precisely, thallium re-injection method or 24 hour delayed imaging is performed. However these techniques are not convenient and are difficult to perform in clinical practice. Percent Tl-uptake method was developed for predicting myocardial viability. To evaluate usefulness of this method, TMS was performed before and after PTCA in 23 patients with myocardial infarction. Left ventricle was divided into 3 layers, then each layer was divided into 4 segments (12 segments in total). Forth three segments showed recovery of perfusion on TMS after PTCA. Viability in infarcted myocardium is predicted by 1) redistribution (RD), 2) %Tl-uptake > or = 45% on the image immediately after exercise (TE), and 3) %Tl-uptake > or = 45% on delayed image (TD). Sensitivity was RD: 60%, TE: 90% and TD: 95% (p < 0.001 vs. RD). Specificity was RD: 74%, TE: 68%, and TD: 60% (NS). Predictive accuracy (PA) was RD: 69%, TE: 77%, TD: 73% (NS). Compared with RD, %Tl-uptake, either TE or TD, increased sensitivity with slightly improved PA, but decreased specificity slightly. Therefore %Tl-uptake would be a sensitive and useful predictor to find patients who are most likely to benefit from re-vascularization.

Adult↗
PubMed1993

[Evaluation of the cardiac and pulmonary uptake of Thallium 201 in subject with suspected ischemic heart disease examined by single-photon emission tomography with Thallium 201, at rest and after exertion].

Counts in selected lung and heart ROI were taken in 10 thallium-201 stress SPECT. They were tested for diseased or welfare status of the patient. Eighteen parameters from scintigraphies and from stress test for each patient were placed in a file and tested for correlation in a minicomputer. Lung/heart ratio was found to be not indicative of disease while it is a sign of thallium distribution in the body. Numerical evaluation of scintigraphies was however found to be a sign of disease.

Adult↗
PubMed1999

Thallium-201 SPECT of adjacent intracranial tumours: a contrast in thallium kinetics.

We report a case of adjacent intracranial tumours: malignant fibrous histiocytoma (MFH) and meningioma. Thallium-201 single-photon emission computed tomography demonstrated different thallium kinetics between the tumours (slow washout from the MFH and rapid clearance in the meningioma) and could be said to have been useful for preoperative histological estimation.

Aged↗
PubMed2001

Detection of myocardial viability using rest-redistribution thallium-201 imaging in a stress 99Tcm-tetrofosmin/rest thallium-201 dual-isotope protocol.

This study investigated the utility of optional thallium-201 (201Tl) imaging for detecting myocardial viability in the stress 99Tcm-tetrofosmin/rest 201Tl dual-isotope protocol. Seventy-nine patients with old myocardial infarction and 25 patients with acute myocardial infarction underwent acquisition of three consecutive 201Tl images (early, intermediate and delayed) using the dual-isotope protocol. A polar map was created and defect scores (extent and severity) were determined by comparison with normal control data. Fluorodeoxyglucose positron emission tomography was also performed in 16 patients with old myocardial infarction. In patients with old infarction, the severity score decreased significantly from the early to the intermediate images, and decreased further on the delayed images. In patients with acute infarction, the score increased from the early to the intermediate images, but not on the delayed images. Regional uptake on the delayed images showed a better correlation with the fluorodeoxyglucose images than that on the early images. Redistribution on the delayed images was exclusively observed in the myocardial segments with less uptake than that estimated by fluorodeoxyglucose. In conclusion, addition of delayed 201Tl imaging to the dual-isotope protocol could improve the sensitivity for detecting myocardial viability.

Aged↗