Quantitative myocardial thallium single-photon emission computed tomography in normal women: Demonstration of age-related differences

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Abstract
The aim of this study is the development of a database of normal women for quantitative analysis of exercise and reinjection myocardial single-photon emission computed tomography (SPET). We studied 101 subjects (40 males and 61 females) with less than 5% likelihood of coronary artery disease. All patients underwent stress and rest thallium-201 myocardial SPET. Myocardial stress was induced by bicycle exercise test (n=51), dipyridamole infusion (n=27) or a combined test (n=23). Multivariate ANOVA showed that the type of stress did not influence the percentage of thallium uptake for each region. Significant differences between men and women were found for the percentage of uptake in the inferior and the anterior wall. The most original finding of this study is the correlation between age and thallium uptake in the three regions of the anterior wall, showing an increase in measured thallium uptake with age for women. Consequently, two groups of women, those under and those over 55 years old, were separated, with a significantly lower tracer uptake in the anterior wall in the younger age group. These results may suggest that the commonly described breast tissue attenuation is due not only to breast volume or morphology but also to breast density. This emphasizes the need for two different databases for myocardial SPET quantitative analysis in the female population. Awareness of this fact should allow avoidance of any underestimation of possible anterior wall ischaemia in women aged more than 55 years.