Dual Radionuclide Study of Acute Myocardial Infarction

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Abstract
Imaging with 201Tl and 99mTc-pyrophosphate in 80 patients with documented acute myocardial infarction (55 transmural, 25 nontransmural infarction) was evaluated. Color-coded isocount display of 201Tl images was essential for interpretation in 16 patients. Combined 201Tl and 99mTc-pyrophosphate imaging for infarct detection was 100% sensitive; however, either was falsely negative in 12 of 80 patients. False-negative individual 201Tl or 99mTc-pyrophosphate infarct images were most common in patients with small infarcts or left ventricular hypertrophy. 201Tl images correctly localized the site of acute transmural infarction in all 51 patients with a positive image; 99mTc-pyrophosphate localized the infarction site in 49 of 53 with an abnormal image. Comparison of the size of the imaged infarct region revealed size discordance in 25 of 49 patients, with 99mTc-pyrophosphate larger in 21 of 49 and 201Tl larger in only 4 of 49. Thus dual radionuclide imaging provides definition of the presence and location of acute myocardial infarction.