An evaluation of the role of thallium-201 myocardial imaging in the investigation of ischaemic heart disease

McKillop, James Hugh (1979) An evaluation of the role of thallium-201 myocardial imaging in the investigation of ischaemic heart disease. PhD thesis, University of Glasgow.

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Ischaemic heart disease due to coronary artery atherosclerosis is a major cause of death and morbidity in all Western countries with the West of Scotland having a particularly grim record in this respect. A definitive diagnosis of coronary artery disease during life can only be made on the basis of selective coronary arteriography. This technique, however, is difficult and associated with a small, but definite, mortality and morbidity. A noninvasive or minimally invasive investigation which could identify those patients in whom coronary arteriography is really indicated would, therefore, be of great value. The standard noninvasive methods presently available, such as electrocardiography or ultrasound, all have shortcomings. Because of advances in instrumentation and the introduction of new radiopharmaceuticals, it has become possible in recent years to apply various radioisotope techniques to the study of cardiological problems. The potassium analogue thallium-201 became readily available for gamma camera imaging of the myocardium in 1975 and this thesis is concerned with an evaluation of its clinical role in the noninvasive diagnosis of coronary artery disease. Chapter I is a review of the literature published on the application of nuclear medicine techniques (other than thallium-201 myocardial imaging) to the study of cardiac disease, especially coronary artery disease. Chapter II begins with a consideration of the whole body distribution and toxicology of thallium, then considers thallium-201 as a scintillation camera imaging agent. Chapter III describes a study comparing thallium-201 myocardial imaging, electrocardiography and selective coronary arteriography in a group of patients with chest pain. Chapter IV is concerned with a comparison of visual analysis and semiquantitative analysis of the same group of myocardial images and presents some evidence that the accuracy of interpretation of myocardial images is increased when a semiquantitative method is used. Chapter V examines the clinical value of rest thallium-201 myocardial imaging performed 3 to 6 days after admission in 50 patients with suspected acute myocardial infarction. Chapter VI describes a study to determine whether stress thallium-201 myocardial imaging can indicate which of these patients have coronary artery disease. It is concluded that the radionuclide technique does not aid the selection for coronary arteriography in this group of patients. In Chapter VII, a comparison is made of post-operative stress thallium-201 myocardial imaging and selective coronary arteriography in a group of patients who had undergone coronary artery bypass graft surgery. Myocardial imaging successfully predicted the status of most bypass grafts and could also be used to detect disease of ungrafted vessels. It is concluded that myocardial imaging may be of value in the post-operative follow up of these patients, especially in those who continue to have chest pain. The final Chapter in the thesis considers the clinical value of thallium-201 myocardial imaging for the noninvasive detection of ischaemic heart disease and discusses the problems associated with the technique. The conclusions drawn are based both on my own work and on that published in the literature by other groups. (Abstract shortened by ProQuest.).

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Additional Information: Advisers: E M McGirr; A C Kennedy
Keywords: Medical imaging, Nuclear physics and radiation, Biophysics
Date of Award: 1979
Depositing User: Enlighten Team
Unique ID: glathesis:1979-72710
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 11 Jun 2019 11:06
Last Modified: 11 Jun 2019 11:06

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