Simultaneous maximal exercise radionuclide angiography and thallium stress perfusion imaging.

Gold-195m is a new ultra-short-lived radionuclide that can be used for cardiac studies. Accurate, reproducible ejection fraction and ventricular wall motion studies can be obtained from first-transit angiography using commercially available imaging and image-processing equipment. The short half-life of gold-195m (30.5 seconds) makes simultaneous dual isotope imaging possible and substantially reduces the radiation exposure from the isotope angiography. The feasibility and possible benefits of performing dual radionuclide studies were evaluated during a single exercise stress test in 24 subjects with known coronary artery disease (CAD) and in 20 normal volunteers. High-quality first-transit angiograms were obtained in all subjects. An 83% sensitivity and 95% specificity for detecting CAD with thallium-201 imaging was noted in this investigation, suggesting that its diagnostic accuracy was not altered by simultaneous dual isotone imaging. When segmental left ventricular (LV) wall motion was compared with thallium-201 perfusion imaging, divergent results were noted in 15 of 44 subjects. An analysis of the ejection fraction (EF) results at rest and stress provided additional information that could be useful in assessing the clinical significance of such differences in segmental wall motion and perfusion. Simultaneous dual isotope imaging appears to be appropriate for situations in which both LV perfusion and function require evaluation. The use of gold-195m allows such information to be obtained from a single exercise test and can thereby reduce the cost and time required for noninvasive evaluations of patients for CAD.