Abstract
Thallium-201 ( 201TI) is a well-established radionuclide used in myocardial perfusion imaging for assessing the presence and prognostic significance of coronary artery disease. Recently, technetium-99m hexakis-2-methoxyisobutyl isonitrile ( 99mTc-sestamibi) has become available for the same diagnostic and prognostic procedures. This discussion compares the imaging characteristics and clinical applications of 201TI with those of 99mTc-sestamibi. There is a strong diagnostic concordance between the 2 agents in symptomatic patients. Various comparative clinical trials have shown in numerous patients that both agents have a similar diagnostic yield in both planar and single-photon emission computed tomography (SPECT) imaging. Because of better image quality of the 99mTc agent, there is a trend toward better specificity and normalcy rate, in comparison to 201TI. However, when using reinjection imaging protocols, 201TI retains a unique place as an imaging agent to identify viable myocardium.
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