Evidence of left ventricular aneurysm by thallium-201 myocardial scintigraphy

Tl-201 myocardial scintigrams from 100 patients were reviewed for evidence of left ventricular aneurysms without prior knowledge of the clinical or angiographic data. Scintigraphic evidence of left ventricular aneurysms was considered present when Tl-201 myocardial activity extended outward from the expected left ventricular contour in a region adjacent to an area of resting scintigraphic hypoperfusion. Scintigraphic findings suggestive of left ventricular aneurysm were detected in four patients, of whom three had angiographic evidence of left ventricular aneurysm. In the fourth patient, a dilated, akinetic left ventricular apex was present but an angiographic diagnosis of left ventricular aneurysm was not made. In three additional patients with angiographic evidence of left ventricular aneurysm, scintigraphic criteria for left ventricular aneurysm were absent. Although ungated Tl-201 myocardial scintigraphy is an insensitive technique for the detection of left ventricular aneurysm, a characteristic scintigraphic pattern should suggest that a left ventricular aneurysm is present.