Thallium and Cardiolite Scans

Nuclear perfusion testing of the heart

stress test
Thallium Scan. Stockbyte/Getty Images

Several non-invasive tests are useful in the evaluation of coronary artery disease (CAD). Among the most useful are heart scans performed with either thallium or Cardiolyte.

Thallium-201 and technetium-99m sestamibi (Cardiolyte) are two radioactive substances used in tests, called “nuclear perfusion studies,” that look for blockages in the coronary arteries. By injecting thallium or Cardiolyte into the bloodstream, usually during a cardiac stress test, an image of the heart can be made that shows how well blood is flowing to the various parts of the heart muscle.

If a coronary artery is partially or completely blocked because of CAD, the muscle being supplied by the diseased artery will show up on the image as a dark spot - an area of reduced or absent blood flow.

What are Thallium and Sestamibi?

Thallium and Cardiolite are radioactive substances that have been used for many years in cardiac imaging studies. When injected into the bloodstream, these substances attach to certain kinds of cells, including heart muscle cells. A special imaging camera that detects radioactivity can then be used to make an image of the heart muscle that has gathered the thallium or Cardiolyte.

However, thallium and Cardiolyte attach only to the portions of heart muscle that have good blood flow. If one of the coronary arteries is blocked or partially blocked, relatively little radioactivity reaches the muscle supplied by that blocked artery.

How are Nuclear Perfusion Studies Performed?

During a stress test, either thallium or Cardiolite is injected into a vein at the point of maximum exercise.

The radioactive substance then distributes itself throughout the heart muscle, in proportion to the blood flow received by that muscle. Cardiac muscle receiving normal blood flow accumulates a larger amount of thallium/Cardiolite than cardiac muscle that is obstructed by an atherosclerotic plaque

Thallium/Cardiolyte testing can also be used in patients who need stress testing but are unable to exercise. In these cases, adenosine is injected into a vein to simulate exercise

. (Adenosine causes blood flow to redistribute in the heart muscle in a manner similar to exercise — areas with a partial blockage are likely to receive relatively low blood flow for a few minutes after an adenosine injection.)

An image of the heart will then be made by a camera that can "see" the radioactivity emitted by thallium/Cardiolite. From these pictures, any portions of the heart that are not receiving normal blood flow (because of blockage in the coronary arteries) can be identified as “dark spots.”

What are Nuclear Perfusion Studies Good For?

Using thallium or Cardiolite perfusion imaging greatly increases the accuracy of the stress test in diagnosing obstructive CAD. A normal thallium/Cardiolite test is an excellent indication that there are no significant blockages in the coronary arteries. On the other hand, patients with abnormal perfusion scans are highly likely to have significant blockages.

Nuclear perfusion studies are used in three general circumstances. First, they are useful in patients who are suspected to have stable angina due to fixed blockages in the coronary arteries. 

Second, these studies are used in patients who have been treated medically (that is, non-invasively) for unstable anginaor non-ST-segment myocardial infarction (NSTEMI), and who have appeared to stabilize. If their thallium/Cardiolyte tests show no significant residual blockages, it is relatively safe to continue with medical therapy alone. Otherwise they should be considered for angioplasty and stenting, or for bypass surgery.

Third, these studies are used to assess the viability of the heart muscle beyond a severe blockage in a coronary artery. If the heart muscle “lights up” to any extent with thallium/Cardiolyte, then it is still partially viable - and stenting or bypassing the artery can be expected to improve the function of the heart. Otherwise, a revascularization procedure would not be expected to provide much benefit.

What are the Risks of Nuclear Perfusion Scans?

These noninvasive studies are quite safe. Their only drawback is that a small amount of radiation is used. The level of radiation the patient receives is felt to produce only a very small risk of harm, and for appropriately selected patients the potential for benefit far outweighs this small risk.


Anderson J, Adams C, Antman E, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College or Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2007; 50:e1

Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol 2002; 39:1151.

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