Clinical usefulness of quantitative analysis of right ventricular overloading was evaluated by 201Tl myocardial SPECT in comparison with cardiac catheterization and MRI. Seventy-four MBq of 201TlCl was intravenous injected and 201Tl myocardial SPECT was performed on 40 patients (mean age: 61.0 +/- 11.8) with right ventricular overloading. Regions of interest (ROI) were selected on right and left ventricular walls in a midventricular short axis image of SPECT and uptake of each ROI were counted. The right ventricle (RV)/left ventricle (LV) 201Tl uptake ratio (R/L-Tl) was calculated. Wall thickness of RV and LV were measured on MRI and the RV/LV wall thickness ratio (R/L-WT) was calculated. RV and LV pressure were recorded in cardiac catheterization, and the RV/LV systolic pressure ratio (R/L-P) was calculated. There was significant positive correlation (Y = 0.73X + 0.19, r = 0.71, p < 0.001) between R/L-Tl and R/L-WT. R/L-Tl was positively correlated with R/L-P in patients with pressure overload (Y = 1.14X - 0.049, r = 0.85, p < 0.001) and in patients with volume overload (Y = 0.51X + 0.023, r = 0.88, p < 0.001) and the slope of the regression line in patients with pressure overload was significantly steeper than that in patients with volume overload (p < 0.001). In conclusion, quantitative analysis of right ventricular overload by 201Tl myocardial SPECT is useful to estimate RV/LV wall thickness ratio and pressure ratio.