{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:56:05Z","timestamp":1790916965682,"version":"4.1.0"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Rest\/stress [\n                      <jats:sup>99m<\/jats:sup>\n                      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) [\n                      <jats:sup>201<\/jats:sup>\n                      Tl]thallium myocardial SPECT in patients presenting with fixed defects on standard sestamibi MPI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, we analyzed 174 patients\u2014totaling 2,958 myocardial segments\u2014who underwent both protocols. Intermodality correlation was assessed, and the rates of segmental and patient-level reclassification (segments converting from &amp;lt;50% maximum uptake on sestamibi to \u226550% maximum uptake on thallium) were quantified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>While a moderately high correlation was observed between the baseline uptake scores of the two modalities (Spearman's r\u2009=\u20090.817 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 &amp;lt;20% predicted a lack of reclassification with 99% specificity, although with low sensitivity (12%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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 &amp;lt;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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1901315","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:40:12Z","timestamp":1790916012000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"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"],"prefix":"10.3389","volume":"13","author":[{"given":"Phattaraphorn","family":"Teungsang","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Khon Kaen University","place":["Khon Kaen, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Methawee","family":"Laohamethanee","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Khon Kaen University","place":["Khon Kaen, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Napat","family":"Kitkhuandee","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Khon Kaen University","place":["Khon Kaen, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanapol","family":"Kliteneam","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Khon Kaen University","place":["Khon Kaen, Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daris","family":"Theerakulpisut","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University","place":["Khon Kaen, 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