Definition of Thallium Stress Test
This is a scintillation scan (gamma camera or photoscan) involving
the use of thallium-201, a radioisotope.
The radioisotope is administered intravenously and localizes, like
calcium, in the myocardium (heart muscle).
A scintillation camera produces an image of the distribution of
the radioisotope. Areas of inadequate perfusion (blood flow)
appear as "cold spots," thus pinpointing sites of myocardium
(heart muscle) at risk.
Description of Thallium Stress Test
Various nuclear scans have been developed to provide your doctor
with specific types of information. Nuclear scans can show the
size of the heart chambers, how effectively the heart pumps
(ventricular function), how well the coronary arteries supply the
heart with blood (myocardial perfusion), whether there is scarring
of the heart muscle from previous heart attacks, and the status of
the lung circulation.
Additional information can often be obtained from nuclear scanning
by performing it in combination with an exercise stress test. When
performed in combination with exercise or another form of stress,
nuclear scanning tests can provide vital information about the
flow of blood through the coronary arteries.
Radionuclide ventriculography can show this when the heart is
scanned before and during increasing stages of exercise. The
pumping functions of all parts of the ventricle are compared at
each level of exercise. A normal heart will contract more
vigorously during exertion. A heart in which one or more regions
beat poorer than expected during exercise is likely to be
receiving inadequate oxygen-rich blood to keep up with the
muscle's increased need for energy. When the scan shows a region
with poor function, the doctor can conclude that the coronary
artery supplying that portion of the heart muscle is at least
partially blocked.
Another very useful nuclear scanning procedure for evaluating the
coronary blood flow is perfusion scanning. This is usually
performed in conjunction with exercise. Unlike the radionuclide
tracer used in radionuclide ventriculography, the tracer used for
perfusion scanning does not remain in the bloodstream. Rather, it
enters the cells of the myocardium (heart muscle) after it is
carried there through the coronary arteries. During the scanning,
an image is made of the myocardium itself, not of the blood in the
ventricle. If a portion of the myocardium receives less blood than
the rest of the heart, it will receive less tracer and show up on
the scan as a lighter area (perfusion defect).
The number of cases of heart disease detected with thallium scans
is about 20 percent greater than it would be with exercise testing
alone. A common tracer used for perfusion scans is radioactive
thallium; the term "thallium scan" is therefore often used
synonymously with "perfusion scan."
In experienced laboratories, stress perfusion scans are positive
in 75 to 90 percent of patients with anatomically significant
coronary disease and in 20 to 30 percent of those without it
(false positive).
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