Reduced variability of interpretation and improved image quality with a technetium 99m myocardial perfusion agent: Comparison of thallium 201 and technetium 99m-labeled tetrofosmin

Robert C. Hendel, Michele A. Parker, Frans J.Th Wackers, Pierre Rigo, Avijit Lahiri, Barry L. Zaret

Research output: Contribution to journalArticle

38 Scopus citations


Background: The purpose of this study was to determine the relative image quality and interobserver variability among four readers for201Tl and99mTc-labeled tetrofosmin myocardial perfusion images.99mTc-labeled perfusion agents, with near-optimal physical characteristics for gamma camera imaging, may allow for superior image quality and improved consistency of interpretation. However, most studies to date have demonstrated only similarity in the diagnostic accuracy between technetium agents and thallium. Tetrofosmin is a recently developed99mTc-labeled agent that has shown promising results in early clinical trials. Methods and Results: A multicenter, open-label trial was performed during which treadmill exercise thallium and tetrofosmin scintigraphy was performed within a 2-week period of each other in 216 subjects. Image quality was evaluated subjectively and scans were interpreted in a blinded, independent fashion by four readers. Perfusion abnormalities were graded as consistent with ischemia, infarction, or mixed and were described both globally and regionally. Interobserver variability was assessed by use of the κ statistic, and receiver-operator curves were compared for each observer for the diagnostic accuracy of each agent. More tetrofosmin images were of excellent quality than with thallium (52% vs 28%;p<0.05), and when differences in quality were noted between the agents, tetrofosmin was more often superior (p<0.0001). The interobserver variability was lower with tetrofosmin scintigraphy because generally higher κ values were noted, especially in the lateral wall. Higher receiver-operator curve areas indicative of improved diagnostic accuracy were noted among the four readers for tetrofosmin in 80% of vascular territories. Conclusions: 99mTc-labeled tetrofosmin scintigraphy yields images of improved quality compared with thallium, and there is an overall improvement in the consistency of image analysis associated with the use of tetrofosmin.

Original languageEnglish (US)
Pages (from-to)509-514
Number of pages6
JournalJournal of Nuclear Cardiology
Issue number6
StatePublished - Nov 1 1994



  • coronary artery disease
  • myocardial pertusion imaging
  • radioisotope
  • tetrofosmin
  • thallium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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