{
  "abstract": "Background: Rest/stress [ 99m Tc]technetium sestamibi single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) is a mainstay for evaluating coronary artery disease. However, fixed defects on standard MPI present a well-documented clinical challenge, as they can represent either non-viable scars or viable hibernating myocardium. We aimed to examine the incremental value and rate of diagnostic reclassification provided by performing subsequent dedicated cadmium-zinc-telluride (CZT) [ ²⁰¹ Tl]thallium myocardial SPECT in patients presenting with fixed defects on standard sestamibi MPI.\n\nMethods: In this retrospective study, we analyzed 174 patients—totaling 2,958 myocardial segments—who underwent both protocols. Intermodality correlation was assessed, and the rates of segmental and patient-level reclassification (segments converting from <50% maximum uptake on sestamibi to ≥50% maximum uptake on thallium) were quantified.\n\nResults: While a moderately high correlation was observed between the baseline uptake scores of the two modalities (Spearman's r = 0.817 for rest sestamibi vs. thallium), thallium imaging provided substantial additional information, with 48.0% of segments classified as fixed defects on sestamibi SPECT demonstrating improved uptake on thallium SPECT. At the patient level, 78.9% of individuals who had fixed defects on the initial sestamibi SPECT had at least one segment reclassified. Receiver operating characteristic analysis showed that a rest sestamibi uptake score of <20% predicted a lack of reclassification with 99% specificity, although with low sensitivity (12%).\n\nConclusion: In a selected cohort of patients presenting with fixed defects on standard rest/stress sestamibi SPECT MPI, supplementary imaging with thallium myocardial CZT SPECT provided incremental data, altering the clinical interpretation in nearly 80% of patients. However, in the absence of an independent viability reference standard, this finding represents intertracer diagnostic reclassification rather than proven functional recovery. A rest sestamibi uptake of <20% demonstrated high specificity for non-reclassification; however, this cutoff should be interpreted cautiously as a potential gatekeeping finding when considering downstream testing rather than a rigid rule for omitting further myocardial viability evaluation.",
  "abstract_shown": true,
  "affiliations": [
    "Faculty of Medicine, Khon Kaen University , ,",
    "Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Phattaraphorn Teungsang"
    },
    {
      "affs": [
        0
      ],
      "name": "Methawee Laohamethanee"
    },
    {
      "affs": [
        0
      ],
      "name": "Napat Kitkhuandee"
    },
    {
      "affs": [
        0
      ],
      "name": "Thanapol Kliteneam"
    },
    {
      "affs": [
        1
      ],
      "name": "Daris Theerakulpisut"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4smek8v1mfwff.bib",
  "cited_by": 0,
  "doi": "10.3389/fcvm.2026.1901315",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672228/?tool=EBI",
  "id": "4smek8v1mfwff",
  "issns": [
    "2297-055X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13672228",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2741|Cardiac Imaging and Diagnostics"
    ]
  ],
  "openalex": "W7215084349",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672228/pdf/?tool=EBI",
  "pmcid": "PMC13672228",
  "pmid": null,
  "published": "2026-10-02",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/4smek8v1mfwff.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:18Z",
      "native_id": "PMC:PMC13672228",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13672228"
    },
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "10.3389/fcvm.2026.1901315",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1901315/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2741|Cardiac Imaging and Diagnostics",
      "subfield": "imaging"
    }
  ],
  "title": "Incremental value of dedicated [201Tl] cadmium-zinc-telluride thallium SPECT over rest/stress [99mTc] technetium sestamibi SPECT MPI: a comparative analysis of fixed perfusion defects",
  "title_text": "Incremental value of dedicated [201Tl] cadmium-zinc-telluride thallium SPECT over rest/stress [99mTc] technetium sestamibi SPECT MPI: a comparative analysis of fixed perfusion defects",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/4smek8v1mfwff",
  "venue": "Frontiers in cardiovascular medicine",
  "versions": []
}