WorldWideScience

Sample records for 99tcm-mibi myocardial spect

  1. Development of normal limits for left ventricular ejection fraction measured from gated myocardial perfusion SPECT with 99Tcm-MIBI and 201Tl

    Objective: To develop normal limits for left ventricular ejection fraction (LVEF) measured from gated myocardial perfusion SPECT with 99Tcm-methoxyisobutylisonitrile (MIBI) and 201Tl. Methods: Gated myocardial perfusion SPECT with 99Tcm-MIBI and 20'1Tl was performed on 277 patients with a low Bayesian likelihood (99Tcm-MIBI [normotensive subgroup: n=85; hypertension without left ventricular hypertrophy (LVH) subgroup: n=25] and 201Tl(n=167, normotensive subgroup: n=128; hypertension without LVH subgroup: n=39). The resting LVEF was calculated using an automatic gated myocardial perfusion SPECT processing software. Results: The hypertension without LVH subgroup had significantly higher resting LVEF values compared with normotensive subgroup (P99Tcm-MIBI group and 20'1Tl group. Sex differences were marked: men had significantly lower mean resting LVEF values than women (P0.05). The distributions for resting LVEF values in 99Tcm-MIBI group and 201Tl group were Gaussian (P>0.05). The normal limits were LVEF≥45% in 99Tcm-MIBI (≥45% in men, ≥48% in women) and ≥43% in 201Tl (≥42% in men, ≥47% in women) Conclusion: These normal limits can be evaluated prospectively for their potential clinical value

  2. Evaluation of the therapeutic effect of Tongxinluo for acute myocardial infarction using 99Tcm-MIBI SPECT imaging

    Objective: To investigate the treatment effect of Tongxinluo for revascularization improvement after PCI using 99Tcm-MIBI SPECT imaging for AMI patients. Methods: A total of 38 patients with AMI were randomly divided into a control group (PCI only,18 patients) and Tongxinluo treatment group (20 patients). 99Tcm-MIBI myocardial SPECT was performed 7 d and 180 d after PCI.The left ventricular myocardium was divided into 17 segments. The myocardial 99Tcm-MIBI uptake was scored semi-quantitatively. The number and scores of abnormal perfusion segments were evaluated in all patients. T-test and χ2 test were used to compare the difference between the two groups using SPSS 11.5. Results: The total number of abnormal segments in the treatment group was 59 at 7 d after PCI, among which 37 (62.7%, 37/59) had improved perfusion at 180 d after PCI. In the control group,64 abnormal segments were found at 7 d after PCI; however, the perfusion was improved in only 26 (40.6%, 26/64) segments at 180 d after PCI. By comparing the myocardial perfusion defect scores, there was a significant difference (χ2=5.994, P<0.05) between the control and treatment groups. The total scores of treatment and control groups were 6.2±8.4 and 7.4 ±6.9 (t=0.5, P>0.05), respectively, at 7 d after PCI and 3.4 ±4.6 and 6.8 ±5.9 (t=2.1, P<0.05), respectively, at 180 d after PCI.The changes in scores were 2.9 ± 5.7 and 0.6 ±3.3 (t=1.5, P>0.05) in the treatment and control groups between 7 d and 180 d after PCI. Conclusion: Tongxinluo can reduce the number of persistent perfusion defects after PCI treatment in patients with AMI, and thus has a potential role in preventing revascularization failure. (authors)

  3. Diagnostic value of domestic made adenosine in 99Tcm-MIBI myocardial perfusion SPECT for detecting coronary artery disease

    Objective: To evaluate the accuracy and safety of domestic made adenosine in 99Tcm- methoxyisobutylisonitrile (MIBI) myocardial perfusion SPECT during adenosine stress for the diagnosis of coronary ischemia. Methods: One hundred and two patients [73 men, 29 women, mean age (57 ± 10.4) years] with suspected coronary artery disease underwent adenosine stress and rest myocardial perfusion imaging. Adenosine was infused intravenously at a constant rate of 0.14 mg·kg-1·main-1 for 6 min. At the end of 3 min, 925 MBq of 99Tcm-MIBI was injected. In 70 patients coronary angiography was also performed within one week. Results: Thirty-nine patients had significant coronary artery stenosis and 31 patients had normal result. Adenosine stress myocardial perfusion scintigraphy was abnormal in 32 out of the 39 patients in coronary artery stenosis (sensitivity, 82.05%), and normal in 26 out of the 31 patients with normal angiography (specificity 83.87%). The positive and negative predictive values were 86.49% and 78.79% respectively. The frequency of side-effects was slight and transient with the incidence of 85.29%. Conclusion: The domestic made adenosine in stress myocardial perfusion imaging is safe and sensitive for detecting myocardial ischemia. (authors)

  4. 99Tcm-MIBI and 18F-FDG dual isotope simultaneous acquisition SPECT in determination of myocardial viability

    Objective: Viable myocardium is important to patients with coronary artery disease. The objective of this study was to evaluate the value of dual-isotope simultaneous acquisition SPECT (DISA-SPECT) with 99Tcm-methoxyisobutylisonitrile (MIBI) and 18F-fluorodeoxyglucose (FDG) in detecting viable myocardium (VM). Methods: Twenty-one patients with regional wall motion abnormalities (RWMA) based on routine echocardiography underwent DISA-SPECT, coronary angiography and percutaneous coronary intervention (PCI). Imaging and analysis of the left ventricular myocardial perfusion status were performed according to the 16-segment models proposed by American Society of Echocardiography. The wall motion of every LV segment was observed by echocardiography after 1, 3, 6 months. The images of DISA-SPECT were analyzed semi-quantitatively. The 'gold standard' for true viability was improvement of wall motion of the ventricular segment after PCI. Results: There were 105 viable myocardial segments and 51 non-viable myocardial segments according to the 'gold standard' criterion. The sensitivity, specificity, positive predict value, negative predict value and accuracy of DISA-SPECT in detecting viable myocardium were 93.3% (98/105), 82.4% (42/51), 91.6% (98/107), 85.7% (42/49), 89.7% (140/156), respectively. Conclusion: DISA-SPECT is a valuable technique to detect viable myocardium in patients with coronary artery disease. (authors)

  5. 99Tcm-MIBI myocardial perfusion imaging for evaluation of the myocardial blood supply in patients with metabolic syndrome

    Objective: To evaluate the myocardial blood supply in patients with metabolic syndrome (MS) using 99Tcm-MIBI SPECT MPI. Methods: A total of 342 patients were divided into four groups according to the number of abnormal metabolic indices: no abnormal metabolic index (Group 1), one abnormal index (Group 2), two abnormal indices (Group 3), three or more abnormal indices (Group 4). Each patient underwent two-day protocol of gated stress and rest 99Tcm-MIBI MPI. One hundred and three of the 342 patients were clinically diagnosed as MS and underwent CAG within 1 month after MPI. χ2 test was used to evaluate the difference among the four groups and Kappa test to analyze the correlation between MPI and CAG. Results: Compared with CAG, the diagnostic sensitivity, specificity, positive and negative predictive values by 99Tcm-MIBI SPECT MPI for coronary artery diseases (CAD) in 103 MS patients were 80.5% (33/41), 85.5% (53/62), 78.6% (33/42) and 86.9% (53/61), respectively. The correlation coefficient between MPI and CAG was 0.657 (P2=23.22, P99Tcm-MIBI SPECT MPI can be useful for evaluating myocardial blood supply and the myocardial ischemia rates may correlate positively with the number of abnormal metabolic indices. (authors)

  6. The value of right lateral decubitus position to decrease artificial defect of cardiac anterior wall in 99Tcm-MIBI SPECT myocardial perfusion imaging for women

    Objective: To explore the value of right lateral decubitus position MPI for differentiating myocardial perfusion defect from cardiac anterior wall attenuation artificial defect, caused by breast of woman. Methods: Forty-nine patients(average age (61.5±8.4) years) who had low likelihood of coronary artery disease and had perfusion defect in the anterior wall after exercise stress 99Tcm-MIBI MPI were included. All underwent supine and right lateral decubitus position during resting SPECT images. The myocardial perfusion SPECT images at left ventricle were reconstructed and were measured by Bull's-eye, based on the counts. Results from both supine position imaging and right lateral decubitus position imaging were compared. Paired t test was used to statistically analyse the data by SPSS 13.0. Results: Compared with supine position, the counts of the anterior, inferior, apex and lateral wall in right lateral decubitus position were significantly higher: (71.30±3.53)% vs (66.50±3.85)%, (70.06±4.45)% vs (65.44±4.16)%, (77.90±3.00)% vs (75.81±4.08)%,(79.30±2.26)% vs (72.60±3.87)% (t=6.731, 5.286, 3.555, 10.885, all P<0.01). The counts of septal wall were significantly lower ((66.60±3.98)% vs (70.06±4.51)%, t=-4.625, P<0.01) in right lateral decubitus position than that in supine position. Among the different regions of anterior wall, the counts of the anterior-middle ((76.40 ± 3.80)% vs (68.60 ± 4.76)%) and anterior-apex region ((77.10±3.24)% vs (69.00±3.54)%) were significantly higher (t=9.916, 8.870, both P<0.01) in right lateral decubitus position than those in supine position, but there was insignificance ((56.94±6.06)% vs (58.50±4.98)%, t=-1.493, P>0.05) at anterior-basal region. The artificial defect of different degrees in anterior wall was observed in all patients in supine position, 23 cases (46.9%, 23/49) showed artificial defect in the anterior-middle region and 16 cases (32.7%, 16/49) in the anterior-apex region. All artificial defect

  7. Early myocardial damage assessment in dystrophinopathies using 99Tcm-MIBI gated myocardial perfusion imaging

    Zhang L

    2015-12-01

    Full Text Available Li Zhang,1,* Zhe Liu,2,* Ke-You Hu,3 Qing-Bao Tian,3 Ling-Ge Wei,4 Zhe Zhao,5 Hong-Rui Shen,5 Jing Hu5 1Department of Cardiovascular Disorders, 2Department of Geriatrics, The Third Hospital of Hebei Medical University, 3The Public Health Department, Hebei Medical University, 4Department of Nuclear Medicine, 5Department of Neuromuscular Disorders, The Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China *Li Zhang and Zhe Liu are first coauthors of this paper Background: Early detection of muscular dystrophy (MD-associated cardiomyopathy is important because early medical treatment may slow cardiac remodeling and attenuate symptoms of cardiac dysfunction; however, no sensitive and standard diagnostic method for MD at an earlier stage has been well-recognized. Thus, the aim of this study was to test the early diagnostic value of technetium 99m-methoxyisobutylisonitrile (99Tcm-MIBI gated myocardial perfusion imaging (G-MPI for MD.Methods and results: Ninety-one patients underwent 99Tcm-MIBI G-MPI examinations when they were diagnosed with Duchenne muscular dystrophy (DMD (n=77 or Becker muscular dystrophy (BMD; n=14. 99Tcm-MIBI G-MPI examinations were repeated in 43 DMD patients who received steroid treatments for 2 years as a follow-up examination. Myocardial defects were observed in nearly every segment of the left ventricular wall in both DMD and BMD patients compared with controls, especially in the inferior walls and the apices by using 99Tcm-MIBI G-MPI. Cardiac wall movement impairment significantly correlated with age in the DMD and BMD groups (rs=0.534 [P<0.05] and rs=0.784 [P<0.05], respectively. Intermittent intravenous doses of glucocorticoids and continuation with oral steroid treatments significantly improved myocardial function in DMD patients (P<0.05, but not in BMD patients.Conclusion: 99Tcm-MIBI G-MPI is a sensitive and safe approach for early evaluation of cardiomyopathy in patients with DMD or BMD

  8. Diagnosis of hyperfunctioning ectopic parathyroid glands using 99Tcm-MIBI SPECT scintigraphy combined localizable CT

    Objective: To evaluate the diagnostic value of 99Tcm-methoxyisobutylisonitrile (MIBI) SPECT scintigraphy combined localizable CT in the localization of ectopic parathyroid glands in hyperparathyroidism. Methods: Retrospective data of surgery,pathology and imaging were collected from 28 patients with hyperfunctioning ectopic parathyroid glands. All cases underwent CT studies. Twenty-five patients had 99Tcm-MIBI planar imaging first: SPECT scintigraphy combined localizable CT was performed for the patients with abnormal radionuclide foci immediately. The fusion images obtained after reconstruction showed the exact location of the ectopic foci. Operative histopathologic results were regarded as 'gold standards'. Presuming 4 parathyroid glands as normal findings, findings confirmed by operation and pathology were regarded as positive, otherwise negative. The results of CT and radionuclide imaging were compared by χ2-test of four-foId table. Results: Twenty-eight ectopic parathyroid glands were found in 28 patients, all pathologically confirmed as adenomas. CT found 22 foci, of which 17 were true positive, 5 false positive, 11 false negative, and 79 true negative. 99Tcm-MIBI SPECT scintigraphy combined localizable CT found 23 foci, no false positive, 2 false negative, and 75 true negative. The results showed that the sensitivities were 61% (17/28), 92%(23/25), specificities 94% (79/84), 100% (75/75), accuracies 86% (96/112), 98% (98/100), positive predictive values 77% (17/22), 100% (23/23), and negative predictive values 88% (79190), 97%(75/77), respectively, for CT and radionuclide imaging. 99Tcm-MIBI SPECT scintigraphy combined localizable CT was therefore significantly higher than CT in sensitivity (χ2=6.98, P2=4.61, P2=10.30, P2=5.88, P2=5.36, P99Tcm-MIBI SPECT scintigraphy combined localizable CT is superior to CT alone in the localization of ectopic parathyroid glands in hyperparathyroidism, but false negative can be found in some patients. (authors)

  9. Quantitative analysis of 99Tcm-MIBI myocardial perfusion images before and after intracoronary stenting

    Objective: Assessing the value of 99Tcm-MIBI myocardial perfusion imaging (SPECT) in selection of patients for stenting, and in evaluation of the therapeutic effects of the procedure and its value for following-up of the patients with coronary artery stents. Methods: Rest and dipyridamole stress SPECT were performed in 51 patients with coronary artery diseases and coronary artery stents one week before procedure, one week and half a year (21 cases) after procedure. The location, degree and area of blood flow deficit were quantitatively analyzed. Results: Before the procedure, 50 patients showed blood flow deficit degree >80% (the lower the percentage, the more the blood flow deficit degree), blood flow deficit area 80%, 8 (16%) patients who had been with blood flow deficit area 70% before the procedure, 10 (20%) of them one week after procedure were without any severe blood flow deficit. Their acute myocardial infarctions were significantly improved. Pre-procedure, at rest, the blood flow deficit degree was 38.05%, at one week after procedure became 57.40%, it was improved by 19.35%. The patients with blood flow deficit area of 70.75% at rest before the procedure, showed a deficit area of 55.91% one week after the procedure. Compared to pre-procedure readings, the significant improvement (P 0.05) in blood flow deficit degree and area between rest and dipyridamole stress SPECT before or one week, half a year after procedure. Conclusions: The blood flow deficit degree or area measured by SPECT were improved one week and half a year after procedure. SPECT is valuable in selection of patients for the procedure and in evaluation of the effect of the therapy and it is very useful during follow-up of the patients with intracoronary stents

  10. Assessment of the value of 99Tcm-MIBI stress-rest SPECT imaging for evaluation of the outcomes of percutaneous transluminal coronary angioplasty

    Objective: To assess the value of stress-rest 99Tcm-MIBI (ST-RE) SPECT imaging for evaluation of perfusion improvement, prediction of restenosis (RS) and cardiac event rate in patients after percutaneous transluminal coronary angioplasty (PTCA). Methods: 99Tcm-MIBI ST-RE SPECT imaging was performed on 100 patients [(52 +- 9) years old] (14 +- 15) months after PTCA. On 30 of the 100 patients, ST-RE SPECT imaging were also performed before PTCA, and 30 patients underwent coronary angiography (CAG). The perfusion findings of myocardial segments were qualitatively classified into four patterns: normal (N), reversible defect (RD), partial reversible defect (PRD) and fixed defect (FD). Restenosis was predicted on the basis of RD or PRD. During the follow-up, cardiac death, myocardial infarction (MI), unstable angina and revascularization were considered as cardiac events. Results: 1) Among 100 patients, RD or PRD was observed in 28 patients, indicating myocardial ischemia (IS); FD was observed in 20 patients, indicating MI. The rate of occurrence of ischemic segments had no significant difference between patients with or without MI(P>0.05). 2) Among 30 patients, perfusion imaging was improved in 23 patients, the improved rate was 76.7%. The number of ischemic segments was decreased from 100 (37%) before PTCA to 10 (3.7%) after PTCA (P99Tcm-MIBI SPECT is a useful noninvasive method for evaluating the effect of PTCA and for predicting RS, and it is of high value for predicting cardiac events

  11. Detection of coronary artery disease with exercise 99Tcm-MIBI SPECT in patients with atrial fibrillation

    Objective: To investigate the ability of exercise myocardial perfusion imaging (MPI) for detecting coronary artery disease (CAD) in patients with atrial fibrillation (AF). Methods: Fifty-eight consecutive patients with AF during symptom-limited exercise 99Tcm-methoxyisobutylisonitrile (MIBI) SPECT imaging were retrospectively analyzed. All patients underwent coronary angiography within an interval of 90 d. Results: The overall diagnostic sensitivity, specificity and accuracy of exercise 99Tcm-MIBI SPECT were 60% (9/15), 88% (38/43) and 81% (47/58), respectively. Among patients without valvular disease, the diagnostic sensitivity and specificity were 60% (9/15) and 96% (22/23). The diagnostic accuracy was 80% (16/20) in patients with valvular heart disease. Conclusion: In patients with AF during exercise test, exercise MPI has a moderate sensitivity and an excellent specificity in detection of CAD to those without valvular disease, and has a high diagnostic accuracy in patients with valvular heart disease. (authors)

  12. Detection of myocardial ischemia of hypertrophic cardiomyopathy with gated 99Tcm-MIBI myocardial perfusion imaging

    Objective: To evaluate the value of gated 99Tcm-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging in detection of myocardial ischemia in hypertrophic cardiomyopathy. Methods: Sixty-nine patients with clinically proven hypertrophic cardiomyopathy were divided into 2 groups using coronary angiogram as 'gold standard': positive group (n=19, narrowing ≥ 50%) and negative group (n=50, narrowing99Tcm-MIBI myocardial perfusion imaging was performed and positive in all 69 patients (41 males, 28 females, aged 35-75 years). Comparative analysis between the two groups was carried out using t-test. Results: In the positive group, reversible and irreversible perfusion defects were detected in 9 and 10 patients, respectively. Left ventricular ejection fraction (LVEF) increased to (69.1 ± 2.8)% in 8 patients and decreased to (42.8 ± 2.1)% in 11 patients. In the negative group, reversible and irreversible perfusion defects were found in 37 and 13 patients, respectively. LVEF increased to (70.8 ± 4.0)% in 38 patients and decreased to (48.9 ± 2.7)% in 12 patients. The values of ischemic area, severity and extent of perfusion defect, and LVEF were significantly different between the two groups (t=9.28, 16.51, 2.65; P99Tcm-MIBI myocardial perfusion imaging is valuable in assessing patients with hypertrophic cardiomyopathy. Detection for the presence or absence of coexisting coronary artery disease and myocardial ischemia has an important prognostic indication and management indication for these patients. (authors)

  13. 99Tcm-MIBI gated myocardial perfusion imaging in patients with myocardial bridging diagnosed by CT angiography

    Objective: To explore the clinical value of 99Tcm-MIBI G-MPI in patients diagnosed with myocardial bridging (MB) by CTA. Methods: Forty-five patients with MB and 17 normal controls diagnosed by CTA(64 slices CT) were included. All patients underwent rest 99Tcm-MIBI G-MPI and 17 MB patients and 9 normal controls also underwent stress 99Tcm-MIBI G-MPI. Myocardial ischemia, function and wall motion were assessed. G-MPI results were compared with CTA results by χ2 test, Fisher exact test and t test. Results: In patients with MB, the positive rate of abnormal perfusion by gated stress 99Tcm-MIBI G-MPI was 64.7% (11/17) and 41.2% (7/17) using quantitative analysis and visual evaluation respectively; while the data were 42.2% (19/45) and 22.2% (10/45) by rest G-MPI (P=0.035). The positive rate by rest G-MPI in MB patients was significant different among mural coronary arteries of different depths and different locations. By quantitative analysis of the stress G-MPI, the reversible, fixed, and mixed ischemia patients were 4 (35.3%), 6 (23.5%) and 1 (5.9%) respectively; the reversed, reversible and fixed abnormity of wall motion was found in 4 (23.5%), 4 (23.5%) and 2 (11.8%) patients respectively; the reversed, reversible and fixed wall thickening were found in 6 (35.3%), 5 (29.4%) and 1 (5.9%) patients respectively. There was no significant difference in left ventricular ejection fraction and peak filling rate between MB patients and normal controls in both rest and stress studies (t: from -0.564 to 1.292, all P>0.05). Conclusion: The G-MPI may be useful for the evaluation of myocardial ischemia and myocardial function simultaneously in patients with MB. (authors)

  14. Clinical evaluation of 99Tcm-MIBI myocardial perfusion imaging for the detection of coronary artery disease in patients with metabolic syndrome

    Objective: Metabolic syndrome is a combination of medical disorders that consist of a collection of independent factors at risk of developing coronary artery disease. The purpose of this study was to evaluate the value of 99Tcm-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging for the diagnosis of coronary artery disease in patients with metabolic syndrome. Methods: A total of 251 patients [mean age (59 ± 10) years, 179 men, 72 women] were included in this study. All patients underwent exercise and rest 99Tcm-MIBI myocardial perfusion imaging and coronary angiography. Results: Of the 163 patients with significant coronary artery stenosis, 116 showed abnormal 99Tcm-MIBI myocardial perfusion imaging; and among the 88 patients with normal coronary angiography, 82 showed normal myocardial perfusion imaging. The sensitivity, specificity and accuracy of 99Tcm-MIBI myocardial perfusion imaging for coronary artery disease detection were 71% (116/163), 93% (82/88) and 79% (198/251), respectively. The positive and negative predictive values were 95% (116/122) and 64% (82/129), respectively. Conclusion: 99Tcm-MIBI myocardial perfusion imaging has important clinical value for detecting coronary artery disease in patients with metabolic syndrome. (authors)

  15. Study on evaluating the importance and mechanism of adenosine preconditioning in mediating myocardial protection from ischemic myocardial injury with 99Tcm-MIBI

    Objective: Recently, many investigators are interested in the study on mechanism of adenosine preconditioning in mediating myocardial protection from ischemic myocardial injury. The aim of this paper was to investigate the feasibility of the protective effects and possible mechanism of adenosine pre- conditioning on myocardium injured by ischemic/reperfusion (I/R) with 99Tcm-methoxyisobutylisonitrile (MIBI). Methods: The isolated I/R rabbit heart models were established with Langendorff. Eighteen Krebs-Henseleit(KH) perfused rabbit hearts were randomly assigned to three groups: UR (n=6) group, adenosine preconditioning (AD, n=6) group and ischemic preconditioning (IPC, n=6) group. KH rabbit hearts were pedused with 55.5 MBq 99Tcm-MIBI for 40 min. The changes of myocardial activity were recorded to get the data of uptake and washout. Cardiac function recovery, creatine kinase (CK) and lactate dehydrogenase (LDH) leakage, myocardial infarct size were measured and the transmission electron micro-scope analysis was performed to assess myocardial injury. SPSS 11.5 and Excel were used for data analysis. Results: Based on the myocardial assessment data, the degree of myocardial injury was also less in AD and IPC than in L/R groups. Significantly higher 99Tcm-MIBI myocardium uptake rates and retention fractions were observed in AD and IPC than in UR (t=2.614-7.730, P0.05). The 99Tcm-MIBI activity was positively correlated with coronary artery blood flow (r=0.79, P99Tcm-MIBI was potentially useful to study the protective effects and possible mechanism of adenosine preconditioning on I/R myocardium. (authors)

  16. 99Tcm-MIBI SPECT in estimation of the treatment response to three-dimensional conformal radiotherapy in patients with non-small cell lung cancer

    Objective: To explore whether the degree of 99Tcm-methoxyisobutylisonitrile (MIBI) uptake in non-small cell lung cancer (NSCLC) could be correlated with the treatment response to three-dimensional conformal radiotherapy. Methods: A total of 102 patients with NSCLC were studied with 99Tcm-MIBI SPECT before radiotherapy. The patients were classified by a follow-up CT as responders (complete or partial remission) and non-responders (stable or progressive disease). After intravenous administration of 740 MBq 99Tcm-MIBI, SPECT imaging at 10-30 min (early) and 2-3 h (delayed) were performed. Region of interest (ROI) was placed over the tumors and contralateral normal lung tissue. The uptake ratio of tumor to contralateral normal lung (T/N) was obtained from both early (ER) and delayed (DR) SPECT images. The retention index (RI) was measured as: RI = (DR - ER)/ER x 100%. Statistical analysis was performed by two independent-sample t-test and Mann-Whitney U test using software SPSS 13.0. Results: 99Tcm-MIBI uptake was significantly higher in responders than in non-responders: 2.36 ±0.17 vs 1.82 ±0.14 (ER) and 2.48 ± 0.20 vs 1.94 ± 0.16 (DR), respectively (t = - 13.1, - 12.7, both P99Tcm-MIBI SPECT might be useful to estimate the treatment response to three-dimensional conformal radiotherapy in patients with NSCLC. (authors)

  17. 99Tcm-MIBI adenosine myocardial perfusion imaging in patients with slow coronary flow

    Objective: To investigate the relationship between myocardial ischemia and slow coronary flow phenomenon with 99Tcm-methoxyisobutylisonitrile (MIBI) adenosine myocardial perfusion SPECT imaging. Methods: Forty-four patients were divided to three groups according to the result of coronary angiography (CAG). There were GAG-positive (P-GAG) (n=12), slow coronary flow (CSF) (n =22), and normal coronary flow (NCF) (n = 10). Results: of adenosine myocardial perfusion imaging were compared among these three groups. Semi-quantitative visual scoring method was used to evaluate the myocardial perfusion: 0 = normal,1 = mild decrease, 2 = moderate decrease, 3 = severe decrease, 4 = defect. Statistical analysis was performed using variance analysis, t-test and χ2-test. Results: No significance was observed at age (t =0.27, 0.54 and 0.59), sex (χ2 = 0.92), hypertension, hyperlipemia and diabetes (χ2 = 1.23, all P>0.05) among the three groups. A significantly higher frames of the coronary thrombolysis in myocardial infarction (TIMI) flow was noted in CSF than in NCF groups (33.7±5.5 vs 17.6±3.9, t = 9.58, P0.05). Conclusion: Slow coronary flow phenomenon can be detected by adenosine myocardial perfusion image to offer the evidence of diagnosis and treatment for the chest pain patients with negative coronary angiography results. (authors)

  18. The value of 99Tcm-MIBI rest gated myocardial perfusion imaging in patients with acute myocardial infarction treated by stem cell transplantation

    Objective: Myocardial cell regeneration therapy is one of the most researched topics in modern medical science. The objective of this study was to evaluate the clinical value of 99Tcm-methoxyisobutylisonitrile (MIBI) rest gated myocardial perfusion imaging in patients with acute myocardial infarction (AMI) treated by stem cell transplantation. Methods: Thirty-one patients with AMI were all treated by percutaneous coronary intervention (PCI). And 18 of them subsequently had mesenchymal stem cell (MSC) transplantation therapy. All the patients were examined by 99Tcm-MIBI rest gated myocardial perfusion imaging at the time before and after PCI to evaluate the left ventricular myocardial perfusion and function. The t-test was used to compare data statistically with SPSS 11.0. Results: The number of myocardial segments with perfusion abnormalities decreased in all the AMI patients 1 month after PCI. The number of myocardial segments with perfusion defects decreased 3 to 6 months after PCI in the patients treated by MSC transplantation (2.37 ± 1.09 and 2.21 ± 0.93 ) when compared with the control group without MSC transplantation therapy (3.24 ± 0.93 and 3.21 ± 1.05, t =2.32,2.79, both P 99Tcm-MIBI rest gated myocardial perfusion imaging is an effective functional imaging to evaluate the therapeutic response in patients with AMI treated by MSC transplantation. (authors)

  19. Detection of coronary heart disease with 99Tcm-MIBI myocardial perfusion imaging stressed by intravenous infusion of higenamine hydrochloride

    Objective: To investigate the role of 99Tcm-MIBI MPI stressed by intravenous infusion of higenamine hydrochloride (HG) in detection of coronary heart disease (CHD). Methods: Sixty-two patients with suspected CHD underwent both 99Tcm-MIBI MPI with HG infusion and CAG. CAG was used as the gold standard in diagnosing CHD. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of HG stress studies were evaluated with 99Tcm-MIBI MPI. Results: Using stenosis of the main branch or the first branch with more than 50% stenosis as the diagnostic criteria, 38 patients (61.3%) showed abnormal CAG results, including 24 one-, 9 two-, and 5 three-vessel stenoses. Of the 38 patients (38.7%) with abnormal CAG results, positive results in HG MPI studies were demonstrated in 22 patients. Negative results in HG MPI studies were confirmed in 22 patients among the 24 patients with normal CAG results. For detection of CHD, the diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 99Tcm-MIBI MPI with HG infusion were calculated as 57.9% (22/38), 91.7% (22/24), 71.0% (44/62), 91.7% (22/24) and 57.9% (22/38), respectively. Twenty-two patients (35.5%) had side effects during HG stress studies, but no effects were severe. All patients recovered soon after examination. Conclusion: An HG stress study is feasible and safe, and it is a potential method in detection of CHD with 99Tcm-MIBI MPI. (authors)

  20. A comparison between 99Tcm-tetrofosmin and 99Tcm-MIBI myocardial perfusion imaging in detection of silent myocardial ischemia

    Objective: To compare 99Tcm-tetrofosmin (TF) and 99Tcm-MIBI adenosine stress/resting MPI in detection of silent myocardial ischemia (SMI). Methods: According to the WHO diagnostic criteria for coronary heart disease (CHD), 306 SMI patients were classified to three groups as type Ⅰ (n=122), type Ⅱ (n=112) and type Ⅲ (n=72). The subjects of each type were randomly divided into 2 subgroups; one subgroup underwent adenosine stress/rest MPI with 99Tcm-MIBI and another subgroup with 99Tcm-TF. The clinical diagnosis of CHD was proven with electrocardiogram (46 cases), dynamic electrocardiogram (219 cases) or CAG (41 cases). Comparison factors between the two tracers included image quality and diagnostic efficacy. The image quality was graded into three classes:excellent, good and moderate. χ2 test and analysis of variance were used to analyze data. Results: The sensitivities of detecting myocardial ischemia with 99Tcm-MIBI MPI and 99Tcm-TF MPI in group type Ⅰ were 57.38% (35/61) vs 60.66% (37/61) (χ2=0.136, P>0.05); in group type Ⅱ 69.64% (39/56) vs 64.29% (36/56) (χ2=0.363, P>0.05) and in group type Ⅲ 83.33% (30/36) vs 88.89% (32/36) (χ2=0.465, P>0.05), respectively. There was no significant difference between the sensitivities of the two imaging modalities in all three types of SMI patients.In image quality grading,99Tcm-MIBI and 99Tcm-TF demonstrated excellent images with 41.18% (63/153) vs 48.37% (74/153) (χ2=1.599, P=0.206), good with 45.10% (69/153) vs 34.64% (53/153) (χ2=3.489, P=0.062) and moderate with 13.72% (21/153) vs 16.99%(26/153) (χ2=0.628, P=0.428). There was no unqualified image with either modality.99Tcm-TF displayed quicker radioactivity clearance in liver and lungs. Thereby there was less interference or pitfalls present in the ventricle base or interior wall that may result from higher liver radioactivity retention. The waiting time between the tracer injection and imaging was at least 1 h shorter with 99Tcm-TF compared to 99Tcm-MIBI

  1. The diagnosis accuracy and safety of 99Tcm-MIBI myocardial perfusion imaging-a retrospective multicenter study

    Objective: To evaluate the diagnostic accuracy and safety of 99Tcm-MIBI MPI by retrospectively analyzing data from this multicenter study. Methods: Participating centers included six hospitals: Peking University First Hospital, Beijing Fuwai Hospital of Chinese Academy of Medical Science and Peking Union Medical College, Anzhen Hospital of Capital Medical University, Beijing Hospital of Health Ministry, Beijing Tongren Hospital of Capital Medical University and Peking University People's Hospital. According to the inclusion and exclusion criteria, 500 subjects (335 male, 165 female, mean age (60.1 ±11.1) years) who underwent MPI between April 1998 and April 2006 were enrolled. All subjects were investigated with stress/rest MPI and CAG within 1 month. Stress test was performed with bicycle ergometry or with intravenous dipyridamole, adenosine or ATP. Perfusion defects on MPI were allocated to corresponding coronary arteries. During the stress and imaging period,any discomfort or symptoms were recorded. Coronary stenosis with ≥ 50% luminal narrowing was considered significant in CAG and taken as the gold standard.99Tcm-MIBI MPI results for the number of stenosed vessels, stenotic severity and coronary artery allocation were compared using χ2 test. Results: There were 280 subjects that underwent exercise stress tests and the remaining 220 received pharmacological stress tests (117 adenosine, 32 dipyridamole, 71 ATP). Two hundred and forty-nine patients had significant coronary stenosis and 251 had normal CAG. Out of the 249 patients with positive CAG results, 101 had one-vessel, 66 had two-vessel and 82 had three-vessel disease. Significant stenosis of the LAD was present in 205 patients, 144 had RCA stenosis and 130 had stenosis of the LCX. The sensitivity,specificity, accuracy, positive predictive and negative predictive values of MPI for detection of coronary artery disease were 65.1% (162/249), 81.3% (204/251), 73.2% (366/500), 77.5% (162/209) and 70

  2. Application of SPECT/CT Fusion Imaging in 99Tcm-MIBI Thyroid Scintigraphy%SPECT/CT融合显像在99Tcm-MIBI甲状腺亲肿瘤显像中的应用

    孟庆乐; 杨瑞; 曹艳; 王自正; 李少华; 邵国强

    2014-01-01

    目的:探讨SPECT/CT融合显像在99Tcm-甲氧基异丁基异腈(MIBI)甲状腺亲肿瘤显像中的临床价值。方法103例甲状腺冷结节患者先行99Tcm-MIBI双时相(15 min与2 h)显像,后行SPECT/CT同机断层融合,结果与病理检查结果进行比较。结果99Tcm-MIBI双时相法对甲状腺结节性质良恶性鉴别的灵敏度、特异度和准确性分别为59.1%、49.4%、51.4%,SPECT/CT融合显像诊断的灵敏度、特异度和准确性分别为81.8%、76.5%、77.7%。结论 SPECT/CT融合显像在甲状腺99Tcm-MIBI亲肿瘤显像中可提高诊断准确性,为临床提供可靠信息。%Objective To explore the clinical value of SPECT-CT fusion imaging in 99Tcm-methoxy isobutyl isonitrile (MIBI) thyroid scintigraphy. Methods 103 patients with nonfunctional thyroid nodules were examined by using dual-phase 99Tcm-MIBI thyroid scintigraphy (15min and 2h) and then examined by using SPECT-CT fusion imaging. The results of 103 patients achieved through dual-phase 99Tcm-MIBI thyroid scintigraphy and SPECT-CT fusion imaging were compared with those of pathological examination. Results The sensitivity, speciifcity and accuracy of dual-phase 99Tcm-MIBI thyroid scintigraphy in diagnosing benign and malignant of nonfunctional thyroid nodules were 59.1%, 49.4%and 51.4%, respectively while those of SPECT-CT fusion imaging were 81.8%, 76.5%and 77.7%, respectively. Conclusion The diagnosis accuracy of 99Tcm-MIBI thyroid scintigraphy in nonfunctional thyroid nodules can be improved with the application of SPECT-CT fusion imaging, who can provide reliable information for clinical diagnosis.

  3. Quantification of left ventricular volumes and ejection fraction from gated 99Tcm-MIBI SPECT: a comparison of QGS, ECToolbox and 4D-MSPECT

    Objective: The three commercially available gated SPECT software: quantitative gated SPECT (QGS), emory cardiac toolbox (ECToolbox), and four-dimensional model SPECT (4D-MSPECT) were compared in the calculation of left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV). Methods: Two hundred and twelve patients with suspected or known coronary artery disease were examined using gated 99Tcm-MIBI SPECT. QGS, ECToolbox and 4D-MSPECT were used for the estimation of LVEF, EDV, ESV. One hundred and six of the 212 patients underwent left ventriculography within one month of SPECT. Results: Correlation between the methods were excellent for LVEF, EDV and ESV, the correlation coefficients among the 3 software were 0.89-0.91 for LVEF (P< 0.001), and 0.97-0.98 for EDV and ESV (P<0.001). For LVEF and EDV, significant differences were noticed among the 3 methods (P<0.001). The values of 4D-MSPECT [LVEF:(64.2±12.6)%, EDV: (98.1±39.5) ml] were significantly lower than that of ECToolbox [LVEF: (68.3±12.8)%, EDV: (108.2 ± 39.0) ml]; likewise, the values of QGS [LVEF: (59.2 ± 11.4)%, EDV: (88.8 ± 35.5) ml] were lower than that of 4D-MSPECT. For ESV, there was no significant differences among QGS [(39.0 ± 27.0) ml], ECToolbox[(37.9 ± 31.4) ml] and 4D-MSPECT[(38.7 ± 31.3) ml, P=0.92]. Good correlation existed between results of gated SPECT and left ventriculography for LVEF, EDV and ESV, r=0.70-0.80 for LVEF(P<0.001), 0.57-0.61 for EDV(P<0.001) and 0.87-0.89 for ESV (P<0.001). Conclusion: All 3 programs showed good correlation among one another, and between ventriculography. (authors)

  4. 99Tcm-MIBI evaluation of myeloma

    Full text: Preliminary reports of increased bone marrow uptake of 99Tcm-MIBI in myeloma have demonstrated the potential for assessment of activity of the disease. A series of 27 patients with myeloma in various stages of activity ranging from monoclonal gammopathies of uncertain significance (MGUS) and myeloma in remission or plateau phase to active or relapsed disease were compared with 30 control patients with normal bone marrow. Whole-body images were acquired 10 min following intravenous administration of 900 MBq 99Tcm-MIBI. The whole-body distribution of activity in 30 patients being routinely followed up for thyroid carcinoma, in whom there was no evidence of disease, were used as normal controls against which the myeloma patient scans were compared. Diffuse homogeneous uptake of 99Tcm-MIBI was evident throughout the bone marrow of spine, pelvis or sternum in two-thirds of controls. The 99Tcm-MIBI study was deemed positive in the myeloma patients only if diffuse bone marrow uptake was more intense or extensive than in controls, or if focal abnormalities were observed. Of 20 patients with clinical evidence of active myeloma, the99Tcm-MIBI study was positive in 18, while the 99Tcm-MIBI study was negative in 6 of the 7 patients with MGUS or myeloma in remission or plateau phase. These results support the use of 99Tcm-MIBI as an accurate means of assessment of myeloma disease activity

  5. Clinical value of 99TCm-MIBI SPECT/CT imaging in the identification of benign and malignant thyroid nodules%99TCm-MIBI SPECT/CT亲肿瘤融合显像对甲状腺结节良恶性鉴别的临床价值

    杨文定; 覃卫华

    2012-01-01

    目的 评价SPECT/CT亲肿瘤融合显像对甲状腺结节良恶性鉴别的临床价值.方法 106例甲状腺结节患者静注99TCm-MIBI后行早期(30 min)及延迟(120 min)平面显像,在30 min时进行SPECT/CT融合显像.显像结果与手术病理结果相对照.结果 106例患者中良性病变82例(77.36%),恶性病变24例(22.64%),SPECT/CT融合显像的敏感度为70.83%;特异性为80.49%;诊断准确度为78.30%.结论 SPECT/CT亲肿瘤融合显像对甲状腺结节的良恶性鉴别有重要价值.%Objective To evaluate the clinical value of SPECT/CT imaging to identify benign and malignant thyroid nodules. Methods One hundred and six patients with thyroid nodule received early (30 min) and delayed (120 min) planar imaging as well as SPECT/CT fusion imaging (30 min) after intravenous 99TCm-MIBI. The imaging results were compared the surgical and pathological results. Results Eighty-two patients were found to be benign lesions (77.3%) and 24 were malignant lesions (22.6%). The sensitivity, specificity and the accuracy of SPECT/CT fusion imaging were 70.8%, 80.4%, 78.3%, respectively. Conclusion SPECT/CT fusion imaging has great significance in the identification of benign and malignant thyroid nodule.

  6. Evaluation of Clinical Value of 99 Tcm-MIBI SPECT in Diagnosis of Masses in Maxillofacial Region%99Tcm-MIBI显像在口腔颌面部肿块中的诊断价值

    刘洪伟; 李贵昌

    2012-01-01

    目的:探讨99Tcm-MIBI放射性核素显像在口腔颌面部肿块术前定性诊断的价值.方法:对64例口腔颌面部肿块患者术前行放射性核素显像,显像剂为99Tcm-MIBI,所有病例均行早期和延期显像以判断肿块性质.定性分析行卡方检验,病变侧与颈部肌肉放射性摄取比值(T/N)行t检验,判断结果与病理诊断相比较.结果:99Tcm-MIBI显像对口腔颌面部肿块诊断的灵敏度、特异性和准确性分别为68.00%、89.74%和81.25%,39例颌面部良性肿块阴性35例(89.74%),假阳性4例(10.26%);25例颌面部恶性肿块阳性17例(68.00%),假阴性8例(32.00%);定性分析卡方检验差异有统计学意义.口腔颌面部良恶性肿块T/N,早期相分别为1.53±0.42,1.90±0.38,经t检验两者差别有统计学意义(t=4.352,P<0.01);延期相分别为1.43±0.61,1.99±0.45,经t检验两者差别有统计学意义(t=3.959,P<0.01).结论:99Tcm-MIBI显像可作为鉴别口腔颌面部良恶性肿块的一种检查方法,腮腺区肿块的鉴别优于颌面部其他部位肿块.%Objective: To evaluate the clinical value of 99Tcm -MIBI SPECT on classifying maxillofacial masses as benign or malignant before treatment. Methods: SPECT images of the maxillofacial region were obtained in 64 patients with maxillofacial masses before surgery. We used 99Tcm- MIBI as imaging agent. All the patients were evaluated by early and delay 99Tcm -MIBI imaging. The chi -square test was used to compare date statistically of maxillofacial masses. The results were compared with their pathological diagnoses, clinical examination. Results: The sensitivity, specificity and accuracy of 99Tcm -MIBI SPECT imaging in determining maxillofacial masses were 68. 00% , 89. 74% , 81. 25% respectively. 35 of 39 patients who had benign tumors showed negative imagesC89. 74%), 4 patients showed positive imagesGO. 26%); 17 of 25 patients who had malignant tumors showed positive images (68.00%), 8 patient showed

  7. Clinical value of gated 99Tcm-MIBI SPECT for assessment of left ventricular function in patients with left ventricular aneurysms

    Objective: To validate the accuracy of quantitative gated SPECT (QGS) in assessing EDV, ESV and LVEF in patients with left ventricular aneurysms (LVA), using MRI as a reference. Furthermore, the correlations between the number of segments with severe perfusion defects, size of LVA and the differences of left ventricular volumes and LVEF were explored.Methods Sixty-nine patients (62 males and 7 females; mean age, (56 ± 10) years) with LVA were examined using gated 99Tcm-MIBI SPECT (G-SPECT) (8 frames/cardiac cycle) at rest and MRI (25 frames/cardiac cycle) at (4 ± 3) d. All the data were retrospectively reviewed. EDV, ESV, LVEF and wall thickening (WT) scores were calculated using QGS. The size of LVA was defined by the number of akinetic or dyskinetic segments with WT =3, and the segments with severe perfusion defects (activity ≤ 30%) were analyzed using quantitative perfusion SPECT (QPS) with a 17-segment model. EDV, ESV and LVEF were obtained using the Simpson's rule from MR images. A paired t test, analysis of variance and χ2 test were used to analyze the data obtained from G-SPECT and MRI. Pearson correlation coefficients (r) and Bland-Altman analysis were applied to assess the strength of the agreement,and standard error of estimate (SEE) was calculated. Results: According to the number of segments with severe perfusion defects, patients were divided into Group 1 (≤ 2 segments, n =25), Group 2 (3-4 segments, n=16) and Group 3 (≥ 5 segments, n=28). Correlation was good for all parameters (r =0.83-0.95, all P<0.001) in all groups,except for LVEF in Group 3 (r=0.64, SEE =8%, P<0.001). Compared with MRI, EDV in Group 1 was underestimated by G-SPECT ((174±44) ml vs (161 ±43) ml, t=-2.60, P<0.05), while the other parameters in Groups 1 and 2 had no significant difference (Group 1, t=-1.63, -1.26 for ESV and LVEF; Group 2, t=-0.62, 0.48, -2.07 for EDV, ESV and LVEF, respectively, all P>0.05). In Group 3, EDV ((217 ± 68) ml vs (196±55) ml, t=2.99, P

  8. Diagnostic value of early post-exercise 99Tcm-MIBI ECG-gated myocardial perfusion imaging in severe coronary artery disease

    Objective: To study and compare the diagnostic value in severe coronary artery disease (CAD) of 99Tcm-methoxyisobutylisonitrile (MIBI) electrocardiogram (ECG)-gated early post-exercise myocardial perfusion imaging (G-MPI) with that of non-ECG-gated myocardial perfusion imaging (NG-MPI). Methods: Two hundred and fifteen suspected CAD patients had undergone G-MPI and coronary artery angiography (CAG) within one month were enrolled and distributed into three-vessel and non-three-vessel CAD groups according to CAG results (≥70%); the diagnostic values in severe CAD of G-MPI and NG-MPI were gained and compared to determine which one of the two protocols would be superior in identification of severe three-vessel CAD. Results: When the ≥70% diameter stenosis CAG was the diagnostic standard of severe CAD, the sensitivity of G-MPI and NG-MPI in the diagnosis of severe CAD were 95.3% (143/150) and 90.7% (136/150, χ2=2.509, P=0.113), but when the comparison specifically pinpointed to severe three-vessel CAD, there was significant difference between G-MPI [100%(51/51)] and NG-MPI [92.2% (47/51), χ2=4.163, P=0.041]. Diagnostic specificity of G-MPI was 80.0% and that of NG-MPI was 72.3% (χ2=1.059, P=0.303). Conclusions: The incremental diagnostic sensitivity of G-MPI adding to the NG-MPI in the diagnosis of severe CAD was mainly from the three-vessel subgroup patients. Exercise stress G-MPI has better diagnostic value in severe three-vessel CAD patients than NG-MPI. (authors)

  9. 99Tcm-MIBI双时相显像对继发性甲状旁腺功能亢进症定位诊断的价值%Value of dual-phase 99Tcm-MIBI scintigraphy and SPECT/CT in the localization diagnosis of secondary hyperparathyroidism

    甄力莳; 刘晓健; 张凌; 李红磊; 姚力; 颜珏

    2011-01-01

    Objective To discuss the clinical value of dual-phase 99Tcm-sestamibi (99Tcm-MIBI) scintigraphy and SPECT/CT in secondary hyperparathyroidism, and to investigate the possibility of SPECT/CT for the accurate localization diagnosis of secondary hyperparathyroidism preoperatively.Methods Thirty-one patients underwent parathyroid imaging with double-phase 99Tcm-MIBI before surgery for hyperparathyroidism.Planar imaging was conducted in 22 patients, and planar and SPECT/CT imaging in 9 patients.The diagnosis of hyperparathyroidism was confirmed by surgical and pathological findings.Target/non-target (T/NT) ratio in delay image was compared with the volume of excised parathyroid, the intact parathyroid hormone (iPTH), and the pathology of the surgical sample.Results T/NT ratio was correlated with serum iPTH (r=0.426, P<0.05) and parathyroid volume (r=0.352, P<0.01).Hyperplasia of parathyroid gland was found in all excised samples.Planar images showed hyperparathyroidism in 73 of the 106 excised parathyroid glands, and the accuracy rate is 68.9%.In the 30 excised parathyroid glands, SPECT/CT images detected 23 hyperparathyroidism (accuracy rate 76.7%), and planar imaging found 19 hyperparathyroidism (accuracy rate 63.3%).Conclusions Dual-phase 99Tcm-MIBI scintigraphy can be used to assess function and hyperplasia of parathyroid, being the most effective method for localization diagnosis of secondary hyperparathyroidism.SPECT/CT imaging is more efficient than planar imaging for the detection of parathyroid glands with hyperparathyroidism.SPECT/CT parathyroid imaging combined with CT scan will provide more information about localization of the lesions, especially for those with persistent or recurrent hyperthyroidism after parathyroidectomy.%目的 探讨‰99m锝-甲氧基异丁基异腈(99Tcm-sestamibi,99Tcm-MIBI)双时相法平面显像及SPECT/CT断层显像对继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT甲旁亢)临床应用价值,

  10. Establishment of normal limits for left ventricular ejection fraction and volume measurements from 99Tcm-sestamibi myocardial perfusion gated SPECT

    Objective: Gated SPECT is a reproducible method for assessing left ventricular volume (LVV) and left ventricular ejection fraction (LVEF) from 99Tcm-sestamibi (99Tcm-MIBI) myocardial perfusion imaging studies. LVV and LVEF measurements by this approach correlate well with those obtained from other cardiovascular imaging techniques. Nevertheless, the lack of criteria for abnormal test findings has limited the potential clinical application of this new imaging technique. Methods: Gated myocardial perfusion SPECT with 99Tcm-MIBI (QGSPECT) was performed on 96 individuals with a low Bayesian likelihood (99Tcm-MIBI, 2-dimensional echocardiography was performed on 30 cases within 72 h. Results: The correlation between rest QGSPECT and 2-dimensional echocardiography was r=0.714 for LVEF (p2 in men and ≤60 ml/m2 in women, and ESV index ≤41 ml/m2 in men and ≤25 ml/m2 in women. Conclusion: (1) Quantification of LV function can be accurately evaluated using gated myocardial perfusion SPECT with 99Tcm-MIBI, (2) Using a cohort of low-likelihood subjects, we generated sex-specific normal limits for LVV and LVEF for myocardial perfusion gated SPECT. These normal limits can now be evaluated prospectively for their potential clinical value. (authors)

  11. 99Tcm-MIBI hepatobiliary scintigraphy in peadiatric patients with severe cholestatic infant hepatitis syndrome

    Objective: Because of the limited of 99Tcm-diethyl iminodiacetic acid (99Tcm-EHIDA) hepatobiliary scintigraphy in the diagnosis of severe cholestatic infant hepatitis syndrome, trial use 99Tcm-methoxy isobutyl isonitrile (99Tcm-MIBI) as a new hepatobiliary scintigraphy imaging agent to understand its applied basis and primary evaluate value in diagnosis of severe cholestatic infant hepatitis syndrome. Methods: constructed choledochal atresia animal model and investigated the application basis of 99Tcm-MIBI hepatobiliary scintigraphy. Twenty-seven children patients of severe cholestatic who finally confirmed infant hepatitis syndrome were underwent firstly 99Tcm-EHIDIA hepatobiliary scintigraphy. After 24 h delay imaging next day, 99Tcm-MIBI hepatobiliary scintigraphy was underwent after 1 h. Two imaging agents of value in the diagnosis of severe cholestatic infant hepatitis syndrome were compared. Results: It was proved that 99Tcm-MIBI was surely excreted by hepatobiliary and had no intestinal autocrine phenomenon in animal test. So 99Tcm-MIBI can be used to undergo hepatobiliary scintigraphy. The sensitivity of 99Tcm-MIBI hepatobiliary scintigraphy in the diagnosis of severe cholestatic infant hepatitis syndrome was 100% in our primary clinical study. Its sensitivity was higher than which of 99Tcm-EHIDA hepatobiliary scintigraphy (66.67%) by far. Conclusion: With regard to those children patients who suspected highly severe cholestatic infant hepatitis syndrome in clinical, the sensitivity of 99Tcm-MIBI hepatobiliary scintigraphy is obviously superior to conventional 99Tcm-EHIDA hepatobiliary scintigraphy. (authors)

  12. Correlation between 99Tcm-MIBI uptake and Pgp expression of lung malignant tumors

    The correlation between the uptake of 99Tcm-MIBI and the expression of P-glycoprotein (Pgp) in patients with lung malignant tumor is explored by γ-detecting probe (GDP) intraoperatively. The results show that the Pgp expression of 5 patients with T/NT≤2 is much higher than that of the other 22 patients with T/NT>2. The higher the Pgp expression in lung malignant tumor cells, the lower the uptake of 99Tcm-MIBI is. It indicates that as a major factor of multidrug resistance, Pgp correlates with the uptake of 99Tcm-MIBI negatively in lung malignant tumors. (authors)

  13. 99Tcm-MIBI显像在甲状旁腺功能亢进症中的应用及进展%Application and progress of 99Tcm-MIBI scintigraphy in parathyroidism

    成钊汀; 朱小华

    2015-01-01

    99Tcm-MIBI SPECT exhibited high sensitivity in hyperparathyroidism. Combination of ultrasound or CT can raise the diagnostic and location accuracy, especially in ectopic parathyroid adenoma. With the development of minimally invasive parathyroidectomy, the value of 99Tcm-MIBI SPECT/CT in preoperative location accuracy stands out. Many factors such as size of the gland lesions and biochemical indexes affect the sensitivity and location accuracy of 99Tcm-MIBI scintigraphy. For the negative imaging hyperparathyroidism patients, 11C-methionine PET/CT, 4D-CT and intraoperative radiation navigation is current research hot spot and development orientation.%99Tcm-MIBI SPECT对甲状旁腺功能亢进症的术前诊断有较高的灵敏度,联合超声或CT能提高诊断和定位的准确率,尤其是对异位的甲状旁腺腺瘤。随着微创甲状旁腺切除术的发展,99Tcm-MIBI SPECT/CT在术前准确定位上的价值日益凸显。甲状旁腺病灶的大小、生化指标等因素会影响99Tcm-MIBI显像的灵敏度和定位准确率。对于部分难以准确诊断和定位的甲状旁腺功能亢进症患者,11C-蛋氨酸PET/CT、四维CT、术中放射导航等是目前的研究热点和发展方向。

  14. The clinical value of 99Tcm-MIBI myocardial perfusion imaging in patients with myocardial infarction and yet normal coronary artery angiography%冠状动脉造影正常的心肌梗死患者99Tcm-MIBI心肌灌注显像

    王跃涛; 鹿存芝; 王丽

    2001-01-01

    目的探讨99Tcm-甲氧基异丁基异腈(MIBI)心肌灌注断层显像(MPI)对冠状动脉造影(CAG)正常的心肌梗死(MI)患者的临床应用价值.方法 5例患者中4例为急性MI,1例为异常Q波原因待查,均经CAG证实冠状动脉正常.于CAG后7~10 d行运动-静息99Tcm-MIBI MPI.结果 5例患者中4例MPI异常(均为固定放射性缺损),1例正常.1例异常Q波待诊患者经MPI确诊为MI.4例MPI显示的MI部位较ECG大;1例ECG示透壁性MI者MPI正常.随访期间,1例因心功能不全行室壁瘤切除术.结论 99Tcm-MIBI MPI对CAG正常的MI诊断及梗死部位、程度和预后的判断有较高价值.

  15. Detection of coronary heart disease with 99Tcm-MIBI myocardial perfusion imaging stressed by intravenous infusion of higenamine hydrochloride%盐酸去甲乌药碱负荷99Tcm-MIBI心肌灌注显像在冠心病诊断中的价值

    曹艳; 王自正; 王峰; 张乐乐; 王晓雯; 邵国强; 孟庆乐; 杨瑞

    2012-01-01

    Objective To investigate the role of 99Tcm-MIBI MPI stressed by intravenous infusion of higenamine hydrochloride (HG) in detection of coronary heart disease (CHD).Methods Sixty-two patients with suspected CHD underwent both 99Tcm-MIBI MPI with HG infusion and CAG.CAG was used as the gold standard in diagnosing CHD.The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of HG stress studies were evaluated with 99Tcm-MIBI MPI.Results Using stenosis of the main branch or the first branch with more than 50% stenosis as the diagnostic criteria,38 patients (61.3%) showed abnormal CAG results,including 24 one-,9 two-,and 5 three-vessel stenoses.Of the 38 patients(38.7%) with abnormal CAG results,positive results in HG MPI studies were demonstrated in 22 patients.Negative results in HG MPI studies were confirmed in 22 patients among the 24 patients with normal CAG results.For detection of CHD,the diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 99Tcm-MIBI MPI with HG infusion were calculated as 57.9%(22/38),91.7%(22/24),71.0%(44/62),91.7%(22/24) and 57.9%(22/38),respectively.Twenty-two patients (35.5%) had side effects during HG stress studies,but no effects were severe.All patients recovered soon after examination.Conclusion An HG stress study is feasible and safe,and it is a potential method in detection of CHD with 99Tcm-MIBI MPI.%目的 评估盐酸去甲乌药碱(HG)负荷MPI对冠心病的诊断价值.方法 62例疑诊冠心病患者行HG负荷-静息99Tcm-MIBI MPI和CAG.以CAG结果为“金标准”,计算HG负荷显像诊断冠心病的灵敏度、特异性准确性、阳性预测值和阴性预测值.结果 以冠状动脉(简称冠脉)主支或其一级分支狭窄≥50%作为诊断标准,62例患者中CAG阳性38例(61.3%),阴性24例(38.7%);阳性者中单支病变24例,双支病变9例,三支病变5例.CAG

  16. Leg muscle scintigraphy with 99Tcm-MIBI in the assessment of peripheral vascular (arterial) disease

    A technique for using 99Tcm-methoxyisobutylisonitrile (MIBI) to evaluate leg muscle perfusion in the assessment of peripheral vascular disease (PVD) is described and evaluated. The uptake of MIBI in muscle groups is quantified and normalized to whole body activity. Eleven patients with PVD undergoing angiography and nine controls were studied. There was a significant difference in MIBI uptake in the calf (P99Tcm-MIBI in the assessment of PVD and its advantages over other methods of assessment are discussed. (author)

  17. A study of microscopic dose rate distribution of 99Tcm-MIBI in the liver of mice

    Objective: A microdosimetry model was tried to develop an accurate way to evaluate absorbed dose rates in target cell nuclei from radiopharmaceuticals. Methods: Microscopic frozen section autoradiography was used to determine the subcellular locations of 99Tcm-MIBI relative to the tissue histology in the liver of mice after injection of 99Tcm-MIBI via tail for two hours, and a mathematical model was developed to evaluate the microscopic dose rates in cell nuclei. The Medical Internal Radiation Dose (MIRD) schema was also used to evaluate the dose rates at the same time, and a comparison of the results of the two methods was conducted to determine which method is better to accurately estimate microscopic dose rates. Results: The spatial distribution of 99Tcm-MIBI in the liver of mice at subcellular level was not uniform, and the differences between the microdosimetry model and MIRD schema were significant (P99Tcm-labeled pharmaceuticals at the microscopic level

  18. In vitro nuclear analysis of MDR mediated by pgp and usage of MDR reversing agents with 99Tcm-MIBI

    The value of MDR reversing agents was studied by detecting the uptake of 99Tcm-MIBI in cells to find simple but effective methods for estimating the MDR of tumor cells and the effect of reversing agents. 2 x 106 cells of human myelogeneous leukemia cell line K562 and its resistant subline (K562/D) were incubated with 8 MBq 99Tcm-MIBI, with accumulating with presence of reversal agents cyclosporin A (0.1-0.4 mg/L) and/or verapamil (2.5-10 mg/L) at various time intervals were observed. The results were as follows: 1)Different concentration of verapamil or cyclosporin A significantly increased the 99Tcm-MIBI uptake of K562 resistant subline, while the uptake of K562 cell line expressing nondetectable Pgp was not affected. 2)Combination of low dose verapamil (2.5 mg/L) and cycolsporin A (0.1 mg/L) had similar effect on 99Tcm-MIBI accumulation with higher dose of inhibitor lonely. The results indicated that combination of lower dosages modulators may play same reverse effect with less side effects. (authors)

  19. Comparative study of 99Tcm-HL91 and 99Tcm-MIBI imaging in experimental tumor and inflammation models

    Objective: To evaluate the diagnostic value of 99Tcm-HL91 in experimental tumor and inflammation models comparing with 99Tcm-MIBI. Methods: Three kinds of solid neoplasm bearing mice (Ehrlich carcinoma bearing mice, H22 carcinoma bearing mice and human ovarian COC1 neoplasm bearing nude mice) and two inflammation models (chemical and bacterial inflammation) underwent static whole body planar imaging at 1 and 4 hours after injection of 99Tcm-HL91. Two kinds of neoplasm bearing mice (Ehrlich carcinoma bearing mice, H22 carcinoma bearing mice) and two inflammation models (chemical and bacterial inflammation) underwent static planar imaging after injection of 99Tcm-MIBI, at early phase (10 - 20 minutes) and delayed phase (2 h). All of the mice were sacrificed at 4 h. The tumors, or inflammatory lesions, blood and contralateral normal muscles served as controls were removed, weighted and the radioactivity was measured. ROIs were drawn around tumor, inflammatory lesions and contralateral muscles in planar images, and the radioactivity ratios of target (tumor or inflammatory lesions)-to-blood (T/B), target-to non target (contralateral muscles) i.e. T/NT were calculated. Results: Neoplasms were clearly visible in planar images at 1 and 4 h after injection of 99Tcm-HL91 in all tumor models. At the same time inflammatory lesions could not be seen clearly. Neoplasms were seen in delayed phase in 99Tcm-MIBI group, but it was not easy to distinguish them from inflammation. The T/B ratios and T/NT ratios of 99Tcm-HL91 tumor model groups were significantly higher than that of 99Tcm-MIBI tumor model groups. The T/NT ratios of tumors were significantly higher than that of inflammatory lesions in 99Tcm-HL91 groups. Conclusion: Compared with 99Tcm-MIBI imaging, 99Tcm-HL91 is of much more diagnostic value in detection of certain solid neoplasms, and can distinguish neoplasm from inflammation

  20. Relationship between the cellular uptake of 99Tcm-MIBI and 99Tcm-tetrofosmin with the Pgp expression levels in carcinoma cell lines

    Objective: To study the relationship between the cellular uptake of 99Tcm-MIBI and 99Tcm-tetrofosmin and the Pgp expression levels in four carcinoma cell lines, and the effect of quinidine on the uptake. Methods: 99Tcm-MIBI and 99Tcm-tetrofosmin were used as radioactive tracers to study the uptake kinetics in the carcinoma cell lines Hela, MCF-7, Bca61 and Mcf-7/Adr, and the effect of quinidine on the uptake of 99Tcm-MIBI and 99Tcm-tetrofosmin. The Pgp expression levels in carcinoma cell lines were estimated by using immunocytochemical method. Results: The cellular uptake of both 99Tcm-MIBI and 99Tcm-tetrofosmin was remarkably lower in MCF-7/Adr which gave a strong positive reaction in the Pgp immunocytochemical assay than Hela, MCF-7 and Bca61 did, which gave negative reactions in the immunocytochemical assay. Furthermore, the cellular uptake of 99Tcm-MIBI was higher than that of 99Tcm-tetrofosmin in the three Pgp negative carcinoma cell lines. The uptake of 99Tcm-MIBI and 99Tcm-tetrofosmin exhibited a 3.5 fold and a 4.3 fold increase respectively in the presence of quinidine. Conclusions: The cellular uptake of these two univalent cationic fat-soluble medicines in carcinoma cell lines is negatively correlated with the Pgp expression levels in the cells. Similar to 99Tcm-MIBI, 99Tcm-tetrofosmin seems also to be a good candidate as a noninvasive marker for the diagnosis of multi-drug resistance (MDR) relating to the Pgp levels in tumors. Quinidine can inhibit the drug resistance of MCF-7/Adr in some degree

  1. Relationship between 99Tcm-MIBI imaging and P-gp expression in patients with recurrent differential thyroid carcinoma

    Objective: The aim of this study was to evaluate the relationship between 99Tcm-me- thoxyisobutylisonitrile (MIBI) imaging and P-glycoprotein (P-gp) expression in patient with recurrent differentiated thyroid carcinoma (DTC) after primary definitive thyroidectomy and adjuvant mi ablation after operation. Methods: A total of 173 pathologically confirmed DTC patients were included. All had two- phase 99Tcm-MIBI static imaging preoperatively. Both early (10 min after intravenous injection) and delayed (120 min after intravenous injection) 99Tcm-MIBI tumor/non-tumor (T/NT) ratios and wash-out rates were calculated. Imaging results were analyzed by three experienced nuclear medicine physicians. At the time of follow-up (three years after diagnosis), nine (5.20%) had local tumor recurrence. Nine non-recurrent disease patients were randomized selected as controls. The postoperative carcinoma tissue specimens were obtained to detect P-gp expression through immunohistochemical staining and RT-PCR technique. T test and Spearman correlation were done with SPSS 10.0. Results: In recurrent group, the early and late T/NT ratios and wash-out rates were 1.18 ± 0.28, 1.16 ± 0.24, and (17.00 ± 2.91)%. In non-recurrent group, the early and late T/NT ratios and wash-out rates were 1.54 ± 0.26, 1.65 ± 0.26, and (7.00 ± 3.21)%. Statistically higher P-gp positive cell number and P-gp gene expression were noted in recurrent than in non- recurrentgroups [(43.00 ± 8.21)% vs (26.00 ± 6.91)%, t=4.753, P99Tcm-MIBI wash-out rate among DTC patients (r=0.84, P99Tcm-MIBI wash-out rate among DTC patients and was significantly higher in recurrent than in non-recurrent groups, which might be due to higher P-gp positive cell number in recurrent than in non-recurrent groups. (authors)

  2. The impact of exercise myocardial perfusion SPECT imaging on the selection of patients for coronary angiography

    Objective: Exercise 99Tcm-MIBI myocardial perfusion SPECT is accurate for the diagnosis of coronary artery disease (CAD). This study assessed the impact of exercise myocardial perfusion imaging on the selection of patients for coronary angiography. Methods: 2188 consecutive patients who underwent exercise myocardial perfusion SPECT in authors' department in 1999 were retrospectively analyzed. Among them, 1807 were men, 381 women (average age: 53.5 +- 7.2 years). Overall, exercise myocardial SPECT was normal in 1731 patients, abnormal in 359 cases, and equivocal in 98 patients. There were 141 patients who underwent CAG within 60 days after myocardial SPECT. Results: Overall, 12% of the patients with abnormal SPECT imaging underwent coronary angiography, but only 5% of the patients with a normal SPECT imaging did (P < 0.001). Among these 141 patients who underwent coronary angiography, significant coronary stenosis was present in 91% of the patients who had had an abnormal SPECT imaging, but only 8% of those who had had a normal SPECT imaging (P < 0.001). In those patients who underwent coronary angiography, revascularization rate was 25% for the patients with abnormal SPECT imaging, but only 1% for the patients with a normal SPECT imaging. Conclusion: The results of exercise myocardial perfusion SPECT have a significant impact on the selection of patients for coronary angiography and revascularization

  3. The relationship between ventricular arrhythmia and abnormal myocardial perfusion and nitroglycerin administration

    Objective: To investigate the clinical significance of abnormal myocardial perfusion on the 99Tcm-MIBI scan and the relationship between perfusion defects and ventricular arrhythmia in patients with hypertension. Methods: 88 patients with hypertension underwent stress-rest 99Tcm-MIBI myocardial perfusion SPECT. Then, of the scan-abnormal cases, 57 underwent nitroglycerin intervention. 24-hour ambulatory electrocardiographic monitoring was performed on all patients and coronary angiography on 31 patients. Results: Abnormal perfusion was found on rest 99Tcm-MIBI scintigraphy in 64.8% cases. 59 of 98 (60.2%) perfusion-defective segments showed complete or partial filling after nitroglycerin administration. Multiple logistic regression analysis revealed that ventricular arrhythmia correlated with the occurrence of left ventricular hypertrophy (LVH), and showed a linear correlation between ventricular arrhythmia and perfusion defect degrees. Conclusions: Myocardial perfusion SPECT and administration of nitroglycerin can assess coronary flow and show perfusion abnormalities caused by microvascular diseases in hypertension or LVH. Hypertension complicated by CAD and LVH plays an important role in the occurrence of various ventricular arrhythmia

  4. Experimental study of hypoxic preconditioning on 99Tcm-MIBI and 201Tl kinetics in cultured neonatal rat cardio-myocytes

    Objective: To study the effect of hypoxic preconditioning (HPC) on 99Tcm-MIBI and 201Tl kinetics in cultured neonatal rat cardio-myocytes. Methods: The protection of HPC was assayed on the model of hypoxia/reoxygenation (H/R) of cultured neonatal rat cardio-myocytes and the Trypan blue exclusion method was used to assess cell viability. Normal, hypoxic preconditioning and hypoxia/reoxygenation cardio-myocytes groups were studied. By measuring the diffused and released radioactivity of myocytes in different time intervals, the effect of HPC on 99Tcm-MIBI and 201Tl uptake and clearance kinetics in the myocytes was observed in various conditions. Results: Compared with H/R, the number of viable cells after HPC [(75.31 +- 3.45)% vs (55.50 +- 3.13)%, P 99Tcm-MIBI and 201Tl to a plateau level with a half-time of 12.8 min and 6.5 min, respectively. HPC caused a significant increase in uptake of 99Tcm-MIBI [normal control, (4852 +- 491) counts·min-1·mg-1 protein to HPC group, (6103 +- 170) counts·min-1·mg-1 protein; P 201Tl uptake [normal control, (3190 +- 183) counts·min-1·mg-1 protein to HPC group, (2120 +- 202) counts·min-1·mg-1 protein; P 99Tcm-MIBI and 201Tl were both retarded. Conclusions: These results suggested that the neonatal rat cardio-myocytes after HPC offered more capacity to tolerate the H/R damage and HPC could influence the 99Tcm-MIBI and 201Tl uptake and clearance

  5. Hydrochloric Acid Higenamine Load 99Tcm-MIBI Myocardial Perfusion Imaging in the Diagnosis of Coronary Artery Disease%盐酸去甲乌药碱负荷99Tcm-MIBI心肌灌注显像在冠心病诊断中的价值

    孙艳; 侯平

    2015-01-01

    Objective To analyze higenamine hydrochloride (HG)-MIBI load 99Tcm labeled myocardial perfusion imaging (MPI) screening method for diagnosing coronary artery disease.Methods The hospital 100 cases of suspected CAD patients underwent HG load MPI and coronary angiography (CAG) examination, results of coronary angiography as a standard to calculate the load MPI HG coronary artery disease sensitivity, specificity and accuracy The positive predictive value and negative predictive value.Results Coronary heart disease by HG load MPI inspection for 76.18% sensitivity, 75.00% of accuracy, 93.75% specificity, less adverse reactions.Conclusion The diagnosis of coronary artery disease HG load MPI clinical effect has certain advantages, clinical mild side effects.%目的:分析去甲乌药碱盐酸盐(HG)负载99Tcm标记-MIBI心肌灌注显像(MPI)的检查方法用于冠心病的诊断价值。方法我院100例可疑冠心病患者均进行HG负荷MPI和冠状动脉造影(CAG)检查,以冠状动脉造影的结果为标准来计算HG负荷MPI对冠状动脉疾病的敏感度,特异性,准确性,阳性预测值和阴性预测值。结果冠状动脉心脏疾病经HG负荷MPI检查为76.18%的敏感度,75.00%的准确性,93.75%的特异性,不良反应较小。结论采用HG负荷MPI诊断冠心病的临床效果具有一定优势,临床副作用轻微。

  6. The study of relationship between breast cancer 99Tcm-MIBI imaging with the expression of P-glycoprotein and multidrug resistance-associated protein

    Objective: To evaluate the relationship between the uptake, washout of 99Tcm-methoxy-isobutylisonitrile (MIBI) and P-glycoprotein (P-gp) or multidrug resistance-related protein (MRP) expression in 36 breast cancer patients. Methods: 36 patients with untreated breast cancer were studied prospectively a week before surgical operation, all were injected intravenously with 740 MBq 99Tcm-MIBI in the arm contralateral to the lesion. Anterior planar images were acquired at 10 and 180 min after injection and the tumor-to-normal breast ratios (T/N) and washout rates (WR) were calculated. Immunohistochemical analyses of P-gp and MRP expression were used to evaluate the removed tumor tissues after operation and categorized into four groups. The differences of the early T/N ratios, the late T/N ratios and the WR among them were compared. Results: The early T/N ratios in group A and B were higher than that in group D. There was statistic difference between group A and D (P=0.001 ), and also in group B and D (P=0.045). The late T/N ratios had no statistic differences among them (F=0.499, P=0.686). The WR of group A, B, C were higher than that in group D and there were significant differences between them (P99Tcm-MIBI from the lesions and expression of P-gp or MRP in untreated breast cancer patients. 99Tcm-MIBI imaging with washout analysis might be a useful method for evaluating P-gp or MRP overexpression and their function in breast cancer. (authors)

  7. Value of dual-phase 99Tcm-MIBI scintigraphy in the localization and diagnosis of secondary hyperparathyroidism%99Tcm-MIBI双时相显像定位诊断继发性甲状旁腺功能亢进症的价值

    周洁; 洪智慧; 石怡珍; 杨仪; 唐军; 刘增礼

    2014-01-01

    Objective To explore the clinical value of dual-phase 99Tcm-MIBI scintigraphy in the localization and diagnosis of secondary hyperparathyroidism (SHPT).Methods A total of 20 patients (8 males,12 females; average age 49.6 years) with uremic SHPT who underwent parathyroidectomy from 2010 to 2013 were retrospectively analyzed.All patients underwent 99Tcm-MIBI SPECT/CT and 19 underwent color Doppler ultrasonography (CDUS).Post-excisional histopathology was considered as the gold standard.The diagnostic efficacies of 99Tcm-MIBI and CDUS for SHPT were calculated.The correlation between T/NT ratio in delayed imaging and the volume of excised parathyroid and the intact PTH (iPTH) were analyzed.x2 test,Pearson or Spearson correlation analysis were used to analyze the data.Results The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 99Tcm-MIBI SPECT/CT and CDUS in the diagnosis of SHPT were 66.67% (44/66),100%(14/14),100% (44/44),38.89%(14/ 36),72.50% (58/80) and 78.19%(43/55),52.38%(11/21),81.13%(43/53),47.83(11/23),71.05% (54/76),respectively.There were significant differences in specificity and positive predictive value (x2 =9.33,9.26,both P<0.05),but no significant differences in the sensitivity,negative predictive value and accuracy (x2 =1.97,0.04,0.46,all P>0.05).T/NT ratio correlated with serum iPTH and parathyroid volume (r=0.638,rs =0.571,both P<0.05).Conclusions The specificity of 99Tcm-MIBI SPECT/CT is superior to CDUS in the diagnosis of SHPT.Dual-phase 99Tcm-MIBI SPECT/CT could locate the hyperfunctional parathyroid gland and provide the basis for surgical treatment.%目的 探讨99Tcm-MIBI双时相显像在定位诊断继发性甲状旁腺功能亢进症(SHPT)中的临床价值.方法 回顾性分析2010年至2013年间20例(男8例,女12例,平均年龄49.6岁)行甲状旁腺切除术的肾性SHPT患者影像学资料,以术后病理结果为“金标准”,计算99Tcm-MIBI双时相SPECT/CT显

  8. Comparative study of gated myocardial perfusion imaging using 99Tcm-tetrofosmin and 99Tcm-sestamibi

    Objective: To compare the results of 99Tcm-tetrofosmin (TF) and 99Tcm-MIBI G-MPI in evaluating left ventricular myocardial perfusion and other functional parameters. Methods: TF and MIBI were both labeled by 99Tcm and the radiochemical purities were tested. During December 2011 to May 2012, 112 patients who had examinations of CAG and echocardiograph in one week after G-MPI were divided into 99Tcm-TF group (47 patients) and 99Tcm-MIBI group (65 patients) by simple random sampling. Patients who suffered from severe arrhythmia, clinically suspicious of myocarditis or cardiomyopathy were excluded. The research was approved by the ethics committee, and all patients signed informed consents. One-day 99Tcm-TF G-MPI and two-day 99Tcm-MIBI G-MPI were performed. The left ventricular functional parameters were acquired automatically by Cedars quantitative gated SPECT (QGS) software, including LVEF, EDV, ESV, peak filling rate (PFR), peak ejection rate (PER) and phase standard difference (SD). The data were analyzed using χ2 test, two-sample t test, paired t test and linear correlation analysis by SPSS 17.0. Results: The radiochemical purities of 99Tcm-TF and 99Tcm-MIBI were (97.5±0.4) % and (99.1±0.2) % respectively. The coincidence rates of 99Tcm-TF and 99Tcm-MIBI G-MPI with CAG were 88.9% (40/45) and 90.5% (57/63), respectively. There was no significant difference between G-MPI results of the two agents (χ2=0.389, P>0.05). There was also no significant difference between left ventricular functional parameters of the two agents (LVEF:(62.60±13.56)% vs (60.52±7.08)%, t=0.940; EDV: (103.3±17.29) ml vs (98.52±19.37) ml, t=1.348; ESV: (41.73±12.69) ml vs (46.05±10.81) ml, t=0.851; PER: (2.73±0.67)EDV/s vs (2.61±1.04) EDV/s, t=0.725; PFR: (2.13±0.80) EDV/s vs (2.07±1.09) EDV/s, t=0.339; phase SD: (5.58±4.16)° vs (5.97±4.64)°, t=0.450; all P>0.05). There was no significant difference between left ventricular functional parameters by G-MPI and UCG (LVEF:(61.39

  9. The clinical application value of myocardial perfusion imaging in evaluating coronary artery myocardial bridge patients with symptoms

    Objective: Myocardial bridge is a common inborn coronary artery anomaly, myocardial bridge may be associated with myocardial ischemia. Only a few patients with coronary artery myocardial bridge were evaluated with nuclear medicine techniques. The aim of this study was to investigate the role of nuclear cardiology with myocardial perfusion technique in symptomatic myocardial bridge patients. Methods Nineteen myocardial bridge patients with the symptoms of chest pain and chest distress were analyzed retrospectively. 99Tcm-methoxyisobutylisonitrile (MIBI) myocardial perfusion images (both exercise and rest) were performed in all. Imaging results were compared with the results of movement electrocardiogram (ECG) and coronary arteriography. The t test or χ2 test was used to statistically analyze the data with Stata 7.0 software. Results: Of the 19 patients, 18 patients had myocardial bridge locating at the left anterior descending artery, 1 patient at the left anterior descending and left circumflex artery, the mean angiographic systolic occlusion within the myocardial bridge was (65.4 ± 22.1)%. Of these 19 patients, Exercise-rest 99Tcm-MIBI myocardial perfusion imaging defined positive myocardial ischemia in 10 and negative in 9 patients. Of the 10 patients with 99Tcm-MIBI myocardial perfusion imaging defined myocardial ischemia, 8 had reversible radioactive defect of partial anterior wall and (or) apex, 1 had reversible defect of post lateral wall and post septal wall, and 1 had reversible defect of inferior wall. The positive predictive value of myocardial perfusion imaging was 52.6% (10/19), which was higher than movement ECG [21.1% (4/19), χ2= 4.07, P 99Tcm-MIBI myocardial periusion imaging defined myocardial ischemia. Six cases with Grade II stenosis, two were 99Tcm-MIBI myocardial perfusion imaging defined myocardial ischemia. Eight cases with Grade III stenosis, seven were 99Tcm-MIBI myocardial perfusion imaging defined myocardial ischemia. The mean angio

  10. Comparison of low-dose dobutamine stress echocardiography and single photon emission computed tomography and delayed contrast MRI in the diagnosis of myocardial viability: Meta-analysis

    Objective: To assess the diagnostic value of different imaging methods including low- dose dobutamine stress echocardiography, SPECT and contrast enhancement MRI with Meta-analysis in the diagnosis of myocardial viability. Methods: Articles published from 1998 to 2008 were searched in Cochrane library, Medline, Embase database, OVID database and CNKI for relevant English and Chinese articles. According to the criteria for diagnostic research published by Cochrane Method Group on screening and diagnostic tests, each article was critically screened and appraised, including the absolute numbers of true-positive, false-negative, tree-negative, and false-positive. Statistical analysis was performed employing Meta-test. Heterogeneity was tested, pooled weighted sensitivity and specificity and the corresponding 95% CI were calculated. Characteristic (SROC) curve was performed and the area under the curve was calculated. Finally, sensitivity analysis was performed. Results: Twenty-one of 438 retrieved articles were included, in which there were ten articles about Low-dose dobutamine stress echocardiography, and six articles about 99Tcm-MIBL/99Tcm-Tetrofosmin SPECT, and six articles about contrast enhancement MRI, and one of both 99Tcm-MIBL/99Tcm-tetrofosmin SPECT and contrast enhancement MRI. All groups had heterogeneity, and a random effects regression was developed. The pooled weighted sensitivity and specificity and area under SROC curve for low-dose dobutamine stress echocardiography to diagnose myocardial viability was 0.73(0.62-0.82)/0.82 (0.77-0.86) and 87.07% respectively. They were 0.82 (0.59-0.94)/ 0.77 (0.64-0.86) and 86.97% for 99Tcm-MIBI/99Tcm-Tetrofosmin SPECT respectively, while they were 0.94 (0.86-0.97)/0.75 (0.66-0.83) and 91.41% for contrast enhancement MRI respectively. Conclusion: As noninvasive testing technologies, low-dose dobutamine stress echocardiography and 99Tcm-MIBI/99Tcm-tetrofosmin SPECT and delayed contrast enhanced MRI allow the

  11. Detection of myocardial infarction with dual energy CT myocardial iodine maps and perfusion myocardial single photon emission computed tomography scintigraphy: an experimental study in canine

    Objective: To investigate the feasibility and accuracy of dual energy CT myocardial iodine maps in detecting acute myocardial infarction in canine model. Methods: Myocardial ischemia model was made by ligaturing left anterior descending coronary arteries (LAD) after thoracotomy in six dogs, while another 3 dogs undergoing thoracotomy not ligaturing LAD as control group. Before and three hours after operation, dual-source CT (DSCT) was performed, followed by resting 99Tcm-MIBI single photon emission computed tomography myocardial perfusion imaging. Then, dogs were sacrificed, and the hearts were removed, triphenyketrazolium chloride staining and conventional HE staining were performed. CT number of non-ischemic and ischemic regions were measured and analyzed. The wall of the left ventricle in the short axis was divided into 17 segments, the segments of myocardial perfusion defect in DSCT myocardial iodine maps, SPECT, and pathology were determined. Student t test was used to analyze the difference of CT number between infarcted and non-infarcted myocardium. Kappa test was used for the accuracy of DSCT myocardial iodine maps and SPECT in detecting myocardial ischemia according to the pathological results. Results: No abnormal regions were detected using DSCT myocardial iodine maps in preoperative control and infarction group. After thoracotomy, partial sparse or defective perfusion was consistently noted in six dogs' apical anterior and partition wall in both DSCT myocardial iodine maps and SPECT. In the infarcted group, the attenuation of infarction region (34.75±16.66) HU was significantly decreased compared with preoperative measurements (123.18±15.38 ) HU (t=10.526, P<0.01); decreased perfusion in the infarcted region was also noted in the DSCT myocardial iodine maps and SPECT. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DSCT myocardial iodine maps and SPECT were 85.0% (34/40), 84.1% (95/113), 65.4% (34

  12. Radionuclide assessment of left ventricular perfusion and function after percutaneous translumial septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

    Objective: The purpose of this study was to evaluate the clinical value of 99Tcm-MIBI myocardial perfusion imaging (MPI) and equilibrium radionuclide angiography (ERNA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent percutaneous translumial septal myocardial ablation (PTSMA). Methods: Eight patients (5 men, 3 women) with symptomatic HOCM underwent rest 99Tcm-MIBI MPI and ERNA before and after PTSMA. The septal-to-lateral counts ratio and the extent of septal perfusion defect of the left ventricle were calculated from MPI. The left ventricular ejection fraction (EF), peak filling rate (PFR) and septal regional EF were measured from ERNA. Results: 99Tcm-MIBI MPI showed increased septa199Tcm-MIBI uptake before PTSMA in all patients, but septal perfusion defects after PTSMA in 7 patients. The count-activity ratio of the septal-to-lateral wall decreased from 1.15±0.11 to 0.76±0.14 (p0.05 ]. Conclusion: MPI and ERNA are useful for the assessment of myocardial pefusion and change of left ventricular function after PTSMA in patients with HOCM. (authors)

  13. Effect of subcutaneous injection of insulin on 18F-FDG myocardial imaging in diabetics

    Objective: To evaluate the effect of subcutaneous injection of insulin on 18F-fluorodeoxyglucose (FDG) myocardial imaging in patients with diabetes mellitus. Methods: Fifty-seven patients with coronary artery disease complicated with diabetes mellitus [mean age (60 +- 8) years] underwent 18F-FDG PET and dual isotope simultaneous acquisition SPECT with 99Tcm-MIBI/18F-FDG. Thirty minutes before FDG injection, blood glucose was measured with an automatic glucose analyzer and insulin was subcutaneously used, the dose was adjusted according to the level of blood glucose. Results: Regression analysis showed that the insulin was positively associated with blood glucose. The linear regression analysis showed that the correlation between dose of insulin (y) and blood glucose (x) was good, r 0.8172; the linear regression equation was y = -5.4 + 1.2x. 52 of 57 images were of good quality with 91% success rate. Conclusion: Subcutaneous injection of insulin is an effective and simple method for obtaining cardiac FDG images of good quality in patients with diabetes mellitus

  14. Classification decision tree algorithm assisting in diagnosing solitary pulmonary nodule by SPECT/CT fusion imaging

    Qiang Yongqian; Guo Youmin; Jin Chenwang; Liu Min; Yang Aimin; Wang Qiuping; Niu Gang

    2008-01-01

    Objective To develop a classification tree algorithm to improve diagnostic performances of 99mTc-MIBI SPECT/CT fusion imaging in differentiating solitary pulmonary nodules (SPNs). Methods Forty-four SPNs, including 30 malignant cases and 14 benign ones that were eventually pathologically identified, were included in this prospective study. All patients received 99Tcm-MIBI SPECT/CT scanning at an early stage and a delayed stage before operation. Thirty predictor variables, including 11 clinical variables, 4 variables of emission and 15 variables of transmission information from SPECT/CT scanning, were analyzed independently by the classification tree algorithm and radiological residents. Diagnostic rules were demonstrated in tree-topology, and diagnostic performances were compared with Area under Curve (AUC) of Receiver Operating Characteristic Curve (ROC). Results A classification decision tree with lowest relative cost of 0.340 was developed for 99Tcm-MIBI SPECT/CT scanning in which the value of Target/Normal region of 99Tcm-MIBI uptake in the delayed stage and in the early stage, age, cough and specula sign were five most important contributors. The sensitivity and specificity were 93.33% and 78. 57e, respectively, a little higher than those of the expert. The sensitivity and specificity by residents of Grade one were 76.67% and 28.57%, respectively, and AUC of CART and expert was 0.886±0.055 and 0.829±0.062, respectively, and the corresponding AUC of residents was 0.566±0.092. Comparisons of AUCs suggest that performance of CART was similar to that of expert (P=0.204), but greater than that of residents (P<0.001). Conclusion Our data mining technique using classification decision tree has a much higher accuracy than residents. It suggests that the application of this algorithm will significantly improve the diagnostic performance of residents.

  15. SPECT imaging for breast cancer staging

    Accurate staging in breast cancer, including tumour sizing and the assessment of nodal and distant metastases, is required in order to plan surgery and post-operative therapy. Medical imaging techniques have made an important contribution to the diagnosis of carcinoma of the breast and the evaluation of local, regional and distant metastases. The study is aimed at establishing certain aspects of the diagnostic importance and priority of single photon emission computed tomography (SPECT) imaging in breast cancer. SPECT was carried out just after planar scintigraphy and then after intravenous injection of different radiopharmaceuticals in 45 women with histologically confirmed post-operation breast cancer. In 21 patients under loco-regional control of the disease before and/or after surgery, planar mammoscintigraphy and SPECT were conducted after intravenous injection of 99Tcm-MIBI (methoxyisobutyl isonitrile) or 99Tcm-anti-CEA (carcinoembryonic antigen) monoclonal antibody (MoAb). Bone SPECT was carried out in 24 patients when whole body scintigraphy was unable to determine the exact localization of bone metastatic lesions in the skull, thorax and pelvis. The results suggest that SPECT with 99Tcm-MIBI and 99Tcm-anti-CEA MoAb has high sensitivity and improves the results of conventional planar scintigraphy for breast cancer detection. Breast SPECT is a preferable method for tumour and lymph node imaging because of the excellent separation of the deep breast structures from the myocardium in the left breast and of the right breast from the liver, thus improving the resolution of small, deep seated lesions. SPECT improves breast cancer staging, and determines the tumour, nodule and metastasis categories, which are important for the treatment strategy and prognosis of the disease. (author). 10 refs, 3 figs, 2 tabs

  16. Myocardial perfusion SPECT imaging in patients with myocardial bridging

    Objective: Stress myocardial perfusion SPECT imaging was used to assess myocardial ischemia in patients with myocardial bridging. Methods: Ninety-six patients with myocardial bridging of the left anterior descending artery documented by coronary angiography were included in this study. All under- went exercise or pharmacological stress myocardial perfusion SPECT assessing myocardial ischemia. None had prior myocardial infarction. One year follow-up by telephone interview was performed in all patients. Results The mean stenotic severity of systolic phase on angiography was (65 ± 19)%. In the SPECT study, 20 of 96 (20.8%) patients showed abnormal perfusion. This percentage was significantly higher than that of stress electrocardiogram (ECG). The higher positive rate of SPECT perfusion images was showed in the group of patients with severe systolic narrowing (≥75%) than that with mild-to-moderate systolic narrowing (50% vs 6.3%, P<0.001). The prevalence of abnormal image was significantly higher in ELDERLY PEOPLE; patients with STT change on rest ECG than in those with normal rest ECG (54.2% vs 9.7%, P<0.001). During follow-up, one patient with abnormal SPECT perfusion image sustained angina and accepted percutaneous coronary intervention, and no cardiac event occurred in patients with normal images. Conclusions: Stress myocardial perfusion SPECT imaging can be used effectively for assessing myocardial ischemia and has potential prognostic value for patients with myocardial bridging. (authors)

  17. SPECT Myocardial Blood Flow Quantitation Concludes Equivocal Myocardial Perfusion SPECT Studies to Increase Diagnostic Benefits.

    Chen, Lung-Ching; Lin, Chih-Yuan; Chen, Ing-Jou; Ku, Chi-Tai; Chen, Yen-Kung; Hsu, Bailing

    2016-01-01

    Recently, myocardial blood flow quantitation with dynamic SPECT/CT has been reported to enhance the detection of coronary artery disease in human. This advance has created important clinical applications to coronary artery disease diagnosis and management for areas where myocardial perfusion PET tracers are not available. We present 2 clinical cases that undergone a combined test of 1-day rest/dipyridamole-stress dynamic SPECT and ECG-gated myocardial perfusion SPECT scans using an integrated imaging protocol and demonstrate that flow parameters are capable to conclude equivocal myocardial perfusion SPECT studies, therefore increasing diagnostic benefits to add value in making clinical decisions. PMID:26053731

  18. The effects of delayed percutaneous transluminal coronary angioplasty plus intracoronary stents on myocardial perfusion in patients with acute myocardial infarction

    Objective: To assess the myocardial perfusion in patients with acute myocardial infarction (AMI) after delayed percutaneous transluminal coronary angioplasty (PTCA) and intracoronary stent implanting. Methods: Fifty-six patients with AMI were divided into delayed PTCA + stent group (treatment group, n=30) and control group (n=26). The treatment group were received delayed PTCA and coronary artery stents 15-30 d after AMI. The first 99Tcm-MIBI was performed 1-3 d before PTCA + stent (treatment group) and 15-30 d after AMI (control group), and followed by the second (1 month later), and the third (6 months later) 99Tcm-MIBI. Results: One month and six months after the treatment procedure (PTCA + stent), the blood flow deficit degree of myocardial infarction area in treatment group was much improved comparing with that before the procedure (treatment group, P0.05). Conclusions: There is residual myocardial viability in the AMI regions and PTCA + stent implantation keeps more jeopardize myocardium viable. Active therapy after AMI can significantly improve myocardial perfusion

  19. New imaging techniques in myocardial perfusion SPECT

    Gated myocardial SPECT and attenuation correction gave birth to new insights into the pathophysiology of ischemic myocardial perfusion and function in clinical routine practice. Gated myocardial Tc-99m-compound SPECT improved diagnostic accuracy of coronary artery disease and enabled us to observe motion and thickening of myocardial walls as well as myocardial perfusion at the same time. Quantitative and qualitative assessment of myocardial performance and perfusion let us to understand the myocardial physiology in ischemia and infarction. In every patient who underwent gated perfusion SPECT, we will find ejection fraction, left ventricular volumes and regional wall motion. There are hopes to use gated Tl-201 SPECT for the same purpose and to use gated SPECT for evaluation of wall motion and thickening at stress or immediate post-stress. Attenuation correction could improve diagnostic accuracy mainly by increasing normalcy ratio or performance of non-expert physicians Both gated methods and attenuation correction improved specificity of non-expert physicians in diagnosing patients with moderate pretest likelihood. New imaging techniques will fill the desire of cardiologists to examine function and perfusion, and possibly metabolism in their clinical routine practice

  20. Experimental study of the molecular mechanisms of myocardial ischemic memory with 18F-FDG PET/CT imaging

    This study was aimed to explore whether the changes of mRNA and the existence and duration of ischemic 18F-FDG uptake correlate with the extent of myocardial ischemia in ischemia-reperfusion canine model. The 20-minute (n= 4) and 40-minute (n=4) coronary artery occlusion followed by 24 h of open-artery reperfusion in canine model were per- formed. All dogs underwent fasting (>12 h) dynamic 18F-FDG PET/CT and 99Tcm-MIBI SPECT imaging at baseline, 1 h and 24 h after reperfusion. When all imaging were completed, myocardial samples from the ischemic and nonischemic region were obtained, and the mRNA expression of glucose transporter-l (GLUT-1), glucose transporter-4 (GLUT-4), and heart-fatty acid binding protein (H-FABP) were estimated by Real Time PCR. There was no difference in the ratio of hypoperfused region/nomoperfused region of 18F-FDG up- take between the 20-minute group and 40-minute group at baseline. When examined at 1 h, increased 18F-FDG uptake was observed in the 40-minute group. When estimated at 24 h, only the 40-minute group showed slightly higher 18F-FDG uptake than baseline, whereas no such difference was demonstrated in the 20-minute group. Similar mRNA expression of GLUT-1, GLUT-4 and H-FABP were demonstrated in the nonischemic regions between the 2 groups, whereas increased expressions of GLUT-1 and GLUT-4, and decreased H-FABP mRNA were demonstrated in the ischemic regions. The changes of mRNA expression were more obvious in the 40 minute group than in the 20-minute group. The results showed that the existence and persistent period of ischemic 18F-FDG uptake (ischemic memory) was correlated with the extent of myocardial ischemia. (authors)

  1. Left ventricular synchrony assessed by phase analysis of gated myocardial perfusion SPECT imaging in healthy subjects

    Objective: To investigate the value of Cedars-Sinai quantitative gated SPECT (QGS) phase analysis for left ventricular synchrony assessment in healthy subjects. Methods: Seventy-four healthy subjects (41 males, 33 females,average age: (60±13) years) underwent both rest and exercise 99Tcm-MIBI G-MPI. QGS software was used to analyze the reconstructed rest gated SPECT images automatically, and then the parameters of left ventricular synchrony including phase bandwidth (BW) and phase standard deviation (SD) were obtained. The influences of gender and age (age<60 years, n=36; age ≥ 60 years, n=38) on left ventricular systolic synchronicity were analyzed. The phase angle for original segmental contraction was measured to determine the onset of the ventricular contraction using 17-segment model. Forty healthy subjects were selected by simple random sampling method to evaluate the intra-observer and interobserver repeatability of QGS phase analysis software. Two-sample t test and linear correlation analysis were used to analyze the data. Results: The BW and SD of left ventricular in healthy subjects were (37.22 ±11.71)°, (11.84±5.39)° respectively. Comparisons between male and female for BW and SD yielded no statistical significance (BW: (36.00±9.70)°, (38.73±13.84)°; SD: (11.88±5.56)°, (11.79±5.26)°; t=0.96 and-0.07, both P>0.05); whereas the older subjects (age≥60 years) had larger BW than the others (age<60 years ; (39.95± 12.65)°, (34.33± 10.00)°; t=-2.11, P<0.05) and no statistical significance was shown for SD between the two age groups ((11.18±4.31)°, (12.54±6.33)°; t=1.08, P>0.05). Of the 74 subjects, the mechanical activation started from the ventricular base to apex in 54 subjects (73%), and from apex to base in only 20 subjects (27%). High repeatability of phase analysis was observed for both intra-observer and inter-observer (r=0.867-0.906, all P<0.001). Conclusions: Good left ventricular segmental synchrony is shown in healthy

  2. Detection of coronary artery damage at sub-acute phase of Kawasaki disease with myocardial perfusion imaging and two-dimensional echocardiography

    Objective: To compare the diagnostic values of rest 99Tcm-MIBI MPI and two-dimensional echocardiography (2-DE) for the detection of coronary artery damage at sub-acute phase of Kawasaki disease (KD). Methods: Twenty-four children (14 males and 10 females, mean age: (2.50±2.19) years) with KD at sub-acute phase were studied between August 1999 and March 2012. All patients underwent rest 99Tcm-MIBI MPI and 2-DE. χ2 and Wilcoxon rank sum tests with SPSS 13.0 were used for data analysis. Results: The positive rate of MPI was 66.67% (16/24), significantly higher than that of 2-DE (37.50%,9/24; χ2=4.00, P<0.05). There was no significant difference between the duration for definite diagnosis by MPI and 2-DE ((13.79±2.86) vs (15.89±5.60) d; Z=-0.746, P>0.05). Eight of 24 patients (33.33%) had positive results for both MPI and 2-DE, and 7 patients (29.17%) had negative findings for both methods. Eight patients (8/24, 33.33%) were positive on MPI but negative on 2-DE, and 1 patient (1/24, 4.17%) was positive on 2-DE but negative on MPI. The areas of myocardial ischemia detected by MPI in 4 patients were consistent with the findings by 2-DE. Conclusions: Rest 99Tcm-MIBI MPI is a valuable noninvasive method to evaluate the coronary circulation and myocardial ischemia in KD patients at sub-acute phase. In combination with MPI, 2-DE might provide more comprehensive information for the evaluation of KD. (authors)

  3. Evaluation of cardiac morphing to improve the quality of myocardial perfusion imaging

    Objective: To explore the value of cardiac morphing in reducing cardiac motion artifacts and improving the quality of MPI. Methods: In this retrospective study, 20 healthy volunteers underwent MPI with cardiac morphing at initial consultation during March 2011 to August 2011. Coronary artery disease (CAD) was excluded in 8 patients according to their age, clinical features, ECG and CTCA. CAD was excluded by CAG in 12 patients. The number of sparse segments and the percentage of average count at the myocardial wall were obtained by 99Tcm-MIBI MPI. Cardiac morphing was performed with the workstation of GE Discovery D670 SPECT. Two experienced nuclear medicine physicians, who were blinded to each other, measured the percentage of average count in the polar bulls-eye map. The difference was compared by paired t-test. Results: A total of 10 sparse segments were identified without a morphing mode, while 4 sparse segments were identified using a morphing mode. The artifacts were reduced in apex and anterior walls using the morphing mode. The percentages of average count in the apex and anterior walls were (78.05 ± 0.83)% and (74.50 ± 2.35)%, respectively, without a morphing mode and (84.05 ± 1.32)% and (81.10 ± 1.45)%, respectively, with a morphing mode. Their differences were statistically significant (apex: t=11.854; anterior wall: t=9.413, both P<0.05). There was no significant difference between these modes in the anterolateral, posterolateral, anterior and posterior walls, as well as inferior and posterior septa (t=1.876, 1.330, 1.690, 2.014, 0.167, 1.868, all P>0.05). Conclusion: Cardiac morphing can effectively reduce cardiac motion artifacts and improve the image quality of MPI. (authors)

  4. Myocardial perfusion SPECT in Australia: processing parameters

    Despite clear guidelines provided by the SNM and the ASNC for acquisition parameters in myocardial perfusion SPECT, there is no universally accepted consensus on processing protocols for myocardial perfusion SPECT. This study is the second part of a self administered, anonymous questionnaire of current procedures employed for myocardial perfusion SPECT across Australia. The sampling frame comprised 136 Nuclear Medicine departments across Australia including all departments accredited by the ANZSNM. QGS is the quantitative software of choice in 58.9% (53/90) of departments (95% CI: 48.6% to 68.5%). Private clinics are 2.4 times more likely (RR) to use ECTb than other department types. Filtered backprojection is the reconstruction algorithm of choice in 71.7% (71/99) of departments (95% CI: 62.2% to 79.6%) while iterative reconstruction is employed in 16.2% (16/99) of departments (95% CI: 10.2% to 24.7%). Reconstruction is performed using 180 Deg of data in 83.8% (83/99) of departments (95% CI: 75.3% to 89.8%) while 360 Deg of data is reconstructed in 5.1% (5/99) of departments (95% CI: 2.2% to 11.3%). Pre filtering is employed in the reconstruction process in 58.0% (51/88) of departments (95% CI: 47.5% to 67.7%) while a post filter is employed in 39.8% (35/88) of departments (95% CI: 30.2% to 50.2%). There is evidence to suggest that there is widespread use of processing parameters that are either discordant where there are recommendations in the literature or counter-intuitive in the absence of documented guidelines. There is a requirement for investigation of the actual impact of these variations on the diagnostic utility of myocardial perfusion SPECT and a need for development of working guidelines for optimisation of processing protocols. Copyright (2005) The Australian and New Zealand Society of Nuclear Medicine

  5. Canine study on myocardial ischemic memory with 18F-FDG PET/CT imaging

    Objective: To explore whether the existence and duration of ischemia measured by dynamic 18F-FDG PET/CT imaging correlated with the extent of myocardial ischemia in a canine model of myocardial ischemia-reperfusion. Methods: Canine coronary artery occlusion was carried out for 20 min (n=4) and for 40 min (n=4) followed by 24 h of open-artery reperfusion. All dogs underwent dynamic 18F-FDG PET/CT and 99Tcm-MIBI SPECT imaging at baseline and 1 h and 24 h after reperfusion.Quantitative analysis of myocardial 18F-FDG uptake was performed using Carimas Core software,and the extraction ratio of 18F-FDG (K) was calculated by the ratio of 18F-FDG uptake rate in the ischemic area (kischemia) and normoperfused region (knormoperfused). Echocardiographic data were also acquired between each PET/CT imaging study to detect the wall motion in the ischemic and normoperfused myocardium. Paired t test and non-parametric statistical tests, measured by SPSS 19.0, were used to analyze the data. Results: Coronary occlusion produced sustained, abnormal wall motion in the ischemic region for more than 1 h. Similar K values were demonstrated between the 20 min and 40 min groups at baseline (1.02 ±0.06 and 1.03 ±0.05, Z=-0.29, P>0.05). At 1 h after reperfusion, the reperfusion regions showed normal perfusion but with increased 18F-FDG uptake, which was higher in the 40 min ischemic group than in the 20 min ischemic group (2.31 ±0.13 and 1.87 ±0.09, Z=-2.31, P<0.05). At 24 h after reperfusion, however, only the 40 min ischemic group showed slightly higher 18F-FDG uptake than baseline (1.15 ± 0.02 and 1.03 ±0.05, t=4.32, P<0.05), whereas no significant difference was found in the 20 min ischemic group (1.05 ± 0.04 and 1.02 ± 0.06, t=0.87, P>0.05). Histological examination of the ischemic myocardium from both groups revealed neatly arranged cells without interstitial edema, hemorrhage nor inflammatory response. Conclusions: Myocardial 'ischemic memory' was correlated with the

  6. Usefulness of myocardial perfusion SPECT after percutaneous coronary intervention (PCI)

    Lee, Jong Jin; Lee, Dong Soo [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2005-02-15

    As the indication of percutaneous coronary intervention (PCI) has expanded to the more difficult and complicated cases, frequent restenosis is still expected after PCI. According to AHA/ACC guideline of the present time, routine use of myocardial perfusion single photon emission tomography (SPECT) is not recommended after coronary intervention, but symptom itself or exercise EKG is not enough for the detection of restensis or for the prediction of event-free survival. In high risk and/or symptomatic subjects, direct coronary angiography is required. Myocardial perfusion SPECT could detect restenosis in 79% of the patients if performed 2 to 9 months after PCI. Reversible perfusion decrease in the myocardial perfusion SPECT is known to be the major prognostic indicator of major adverse cardiac event in PCI patients and also the prognosis is benign in the patients without reversible perfusion decrease. Though the cumulated specificity is 79% in the literature and optimal timing of myocardial perfusion SPECT is in controversy, SPECT is recommended even in asymptomatic patients at 3 to 9 months after PCI. Considering the evidences recently reported in the literature, myocardial perfusion SPECT is useful for risk stratification and detection of coronary artery restenosis requiring re-intervention in the asymptomatic patients after PCI.

  7. Metastatic thyroid cancer appearing as increased lung uptake on myocardial 99Tcm-sestamibi scintigraphy

    Full text: A 61-year-old female presented to the Nuclear Medicine Department with shortness of breath and central chest pain for the previous 2 months, for investigation of reversible myocardial ischaemia. The patient was administered 259 MBq of 99Tcm-sestamibi (MIBI) at rest, and SPET images of myocardial perfusion were acquired using a Siemens Multispect3 gamma camera, at 45 min post-administration. The patient then underwent 3 min of exercise on a bicycle, achieving a peak workload of 25 W and a peak heart rate of 161 beats-min-1 The exercise was terminated due to the patient's usual shortness of breath. The ECG was normal at rest and peak stress. The patient was injected with 777 MBq of 99Tcm-MIBI 2 min prior to peak exercise. SPET images were again acquired at 45 min post-administration. Gated images could not be performed. Reconstructed images showed no scintigraphic evidence of reversible myocardial ischaemia, but there was a fixed anterior wall defect. Review of the raw planar images demonstrated markedly increased lung uptake in a heterogeneous distribution. Further questioning confirmed a history of follicular thyroid cancer with pulmonary metastases, which were confirmed on current chest X-ray, in a distribution identical to the scintigraphic images. The fixed anterior defect may be a reconstruction artefact, rather than a prior infarct. In conclusion, we have demonstrated an unusual cause for increased lung uptake on routine myocardial perfusion imaging with 99Tcm-MIBI; thyroid cancer should be included in the differential diagnosis of such an appearance

  8. Evaluation of infantile ventricular tachycardia by 201Tl myocardial SPECT

    201Tl myocardial SPECT findings in infantile ventricular tachycardia (VT) were examined. The subjects were 4 cases of infantile VT subjected exercise-loading 201Tl scintigraphy in 1990. These cases (3 males and 1 female) were aged 11-14 years, being persistent and non-persistent type VT (2 cases each). Echocardiography revealed no abnormal findings in these 4 cases. Exercise-loading was performed by means of sitting ergometer. ECG revealed sinus arrhythmia except for one case which throughout its course of treatment, had already been presenting ventricular extrasystole from before the excercise-loading. Myocardial SPECT revealed persistent defects (antero-septal wall defects in three cases). The above suggests that 201Tl myocardial SPECT enables us to search for etiology of VT, prognosis and the like. (author)

  9. Myocardial Perfusion Spect Imaging in Dextrocardia: A Case Report

    Semra Özdemir

    2013-08-01

    Full Text Available The myocardial perfusion scintigraphy acquisition and analysis present some technical differences in the rare dextrocardia cases. Here we report a case of a 38 year-old woman with dextrocardia who had been applied myocardial perfusion scintigraphy. Presented case showed that the thoracic and abdominal organs had a mirror image with situs inversus totalis type dextrocardia. The incidence of coronary heart disease and life span of people with situs inversus totalis are the same as the normal population. So we may apply myocardial perfusion scintigraphy to this patient group. The current case is presented in order to remind the special applications of myocardial perfusion SPECT imaging in patients with dextrocardia.

  10. Comparative study on the localization of myocardial ischemia by myocardial perfusion SPECT and exercise electrocardiography

    Objective: To investigate the correspondence between the myocardial perfusion SPECT and exercise electrocardiography (ECG) in localization of myocardial ischemia. Methods: Three hundred and two patients with abnormal findings in the myocardial perfusion SPECT and ECG were selected and Chi-square test was performed to analyze the relationship between ECG and SPECT in determining the ischemic myocardial segment. Results: Compared with patients with ST depression, most patients with ST elevation had significantly more angina symptoms in history occurring during exercise test, and lower exercise tolerability (P<0.05). Some weak correspondence (K=0.36, P<0.01) was shown between the localization of ST depression and defect territory of myocardial perfusion, while a complete correspondence (K=1.00, P<0.01) between ST elevation and SPECT in determining the abnormal myocardial segment was observed. In patients with anterior ST depression, perfusion defects occurred more frequently in left anterior descending coronary artery (LAD) territory (66.9%) than in right coronary artery (RCA) territory (33.1%). ST segment depression related poorly with the results of myocardial perfusion in determining the defects. Conclusion: The exercise-induced ST elevation is more correspondent to the defects of myocardial perfusion in the localization of myocardial ischemia compared with ST depression

  11. Automatic extraction of left ventricle in SPECT myocardial perfusion imaging

    An automatic method of extracting left ventricle from SPECT myocardial perfusion data was introduced. This method was based on the least square analysis of the positions of all short-axis slices pixels from the half sphere-cylinder myocardial model, and used a iterative reconstruction technique to automatically cut off the non-left ventricular tissue from the perfusion images. Thereby, this technique provided the bases for further quantitative analysis

  12. Associative analysis of 300 cases of 99Tcm-MIBI nuclide myocardial perfusion imaging and coronary artery angiography%99Tcm-MIBI核素心肌灌注显像与冠脉造影的相关性分析(附300例报告)

    刘明江; 蔡力; 唐英蓉; 蒋瑾; 宋文忠

    2003-01-01

    目的探讨99Tcm-MIBI核素心肌灌注显像(ECT)对冠心病(CAD)的临床诊断价值.方法300例住院患者,其中男234例,女66例.年龄30~85(57.5±16.5)岁.同时进行ECT和冠脉造影(CAG)检查,将结果进行对比分析.结果①ECT、CAG阳性100例(33.33%),ECT阳性而CAG阴性30例(10%),ECT阴性而CAG阳性52例(17.33%),ECT、CAG阴性101例(33.67%);②ECT对CAG阳性CAD诊断的敏感性为65.79%,特异性77.1%,阳性预测值为76.92%,阴性预测值为66.01%,准确性指数为71.02%.结论ECT是一种无创、方便、费用低的检查方法,对冠心病的诊断、指导治疗和判断预后有重要的意义.

  13. Comparison of 1- and 2-day protocols for myocardial SPECT

    El-Ali, H H; Palmer, John; Carlsson, Marcus; Edenbrandt, Lars; Ljungberg, Michael; El Ali, Henrik H.

    2005-01-01

    Myocardial perfusion single-photon emission computed tomography (SPECT) is carried out by combining a rest and a stress study that are performed either on one day or two separate days. A problem when performing the two studies on 1 day is that the residual activity from the first study contribute...

  14. Myocardial SPECT in children with sickle cell disease

    Aim: While cerebral and bones strokes are well documented in children with sickle cell disease (SCD), impairment of myocardial perfusion is an unknown complication. Conventional techniques such as exercise testing and echocardiography have a low sensitivity and specificity to detect myocardial ischemia in patients with SCD. The aim of this prospective study was to assess myocardial perfusion with 201Tl SPECT in children with SCD. Materials and Methods: Twenty-two patients, aged 12 ± 4 years, were included. Myocardial perfusion was assessed by 201Tl SPECT after stress and 3 hours later after reinjection on a single head gammacamera equipped with a LEAP collimator (64x64 matrix size format, 30 projections over 1800, 30 seconds per step). Left ventricular ejection fraction (LVEF) was assessed by equilibrium radionuclide angiography at rest on the same day. Results: Myocardial perfusion was impaired in 13/22 patients: 8 had reversible defects and 5 had fixed defects. The left ventricular cavity was dilated in 13/22 patients. The mean LVEF was 63 ± 9%. There was no relationship between myocardial perfusion and left ventricular dilation or function. Conclusion: Myocardial perfusion is frequently impaired in children with SCD. Treatment with hydroxyurea should be considered in SCD patients with perfusion defects

  15. Usefulness of hyperventilation myocardial SPECT for diagnosing vasospastic angina pectoris

    We evaluated the usefulness of hyperventilation myocardial scintigraphy (HV-SPECT) for diagnosing vasospastic angina pectoris. The subjects consisted of 11 patients with rest angina and 13 with rest and exertional angina in whom coronary spasm was demonstrated by coronary angiography, and 6 with exertional angina in whom a significant stenotic lesion was observed by coronary angiography. Hyperventilation was performed at a rate of 40/min for 5 minutes in all the patients. Ischemia was considered to be present when defect and redistribution were observed by SPECT. HV-SPECT revealed positive findings in 8 patients with rest angina (73%) and 9 with exertional and rest angina (69%) but only in 1 with exertional angina (17%). Ischemic ST changes on monitor ECG were observed in 13 of the 30 patients (43%); ST was enhanced in 4 patients and depressed in 9 patients. In the patients with rest angina, HV-SPECT induced ischemic findings more frequently than exercise SPECT (73% vs 55%). HV-SPECT seems to be useful as a non-invasive method for diagnosing angina pectoris resulting from coronary spasm. (author)

  16. Myocardial Perfusion SPECT Imaging in Patients after Percutaneous Coronary Intervention

    Georgoulias, Panagiotis; Valotassiou, Varvara; Tsougos, Ioannis; Demakopoulos, Nikolaos

    2010-01-01

    Coronary artery disease (CAD) is the most prevalent form of cardiovascular disease affecting about 13 million Americans, while more than one million percutaneous transluminal intervention (PCI) procedures are performed annually in the USA. The relative high occurrence of restenosis, despite stent implementation, seems to be the primary limitation of PCI. Over the last decades, single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), has proven an invaluable tool ...

  17. Role of myocardial perfusion SPECT in asymptomatic diabetic patients

    Purpose: It is important that early diagnosis and treatment of coronary artery disease in diabetic patients, but there are few reports on the prevalence of stress-induced myocardial perfusion abnormalities and the rates of cardiac event in patients with type 2 diabetes. We evaluated the scan findings on gated myocardial perfusion SPECT in asymptomatic diabetic patients. Methods: We performed pharmacological stress test and gated perfusion SPECT in 69 diabetic patients without cardiovascular symptom (mean age: 65 year, male 31 and female 38). Patients underwent two-day imaging protocol and stress study was performed injection of Tc-99m MIBI during adenosine infusion. We followed up these patients by reviewing medical records. Results: Fifty-two of 69 patients (74.5%) showed normal scan findings and 17 patients (24.6%) showed reversible or fixed perfusion defects. Three of 52 patients with normal scan findings showed decreased LV ejection fraction and decreased wall motion. Twenty-three patients with normal scan findings were possible to follow up for more than 1yr (mean time: 18.3±3.3 mo.) and they all had no cardiac event. Three patients with reversible perfusion defects were performed coronary angioplasty. Conclusion: Myocardial perfusion SPECT is a noninvasive method and maybe useful in early diagnosis and predicting prognosis in diabetic patients

  18. Comparison of myocardial blood flows using 99mTc-MIBI myocardial SPECT and 15O-water PET

    Myocardial SPECT is widely used in the diagnosis and evaluation of coronary artery disease (CAD). However. due to the results expressed as relative values, myocardial SPECT has limitation in multi-vessel disease and diffuse CAD. Water PET is used in estimating the coronary blood flow non-invasively. In this study, we investigated the coronary blood flow relationship between myocardial SPECT and water PET. 99mTc-MIBI myocardial SPECT and 15O-water PET were done in 15 patients with suspected CAD (M:F=10:5, Mean age 61±8yrs) under conditions of rest and adenosine stress, respectively. SPECT scan was performed using low energy high resolution collimator dual head SPECT camera (Vertex EPIC, Philips-ADAC Labs, Milpitas, USA) and images were analyzed using automated software (AutoQUANT, ADAC Labs., CA, U.S.A.). PET scan was performed using ECAT EXACT camera (CTI, Knoxville, TN/ Siemens Medical System, Inc., Hoffman Estates, IL, USA). Left myocardium was extracted using ensemble independent component analysis, and the 9 ROIs were drawn (apex, 4 mid walls and 4 basal walls). Fourteen segments of myocardial SPECT excluding basal segments were matched with 9 PET segments. No correlation was found between myocardial SPECT and water PET in both rest and stress, in the analysis of a total of 135 segments. However, in the analysis of segments with myocardial blood flow under or equal to 1 ml/g/min in the stress water PET (n=22), there were statistically significant correlation between myocardial SPECT and water PET in both rest (Pearson correlation=0.58. p<0.01) and stress (Pearson correlation=0.58. p<0.01), respectively. In segments with decreased myocardial blood flow in the stress water PET, there were statistically significant correlation between myocardial SPECT and water PET, in both rest and stress

  19. Myocardial viability assessed by Tl-201 SPECT. Redistribution versus reinjection

    The purpose of this study was to verify if a third series of images acquired by reinjection thallium-201, 24 h after conventional myocardial perfusion with the radioisotope, improves the identification of myocardial viability segments. The methods: we studied 30 patients, mean age 57.7 ±9.4 years, with old myocardial infarction using thallium (Tl)-201 SPECT, and we obtained three series of images (stress, redistribution after 4 h and reinjection after 24 h. Cardiac images were divided in 5 segments (apical, lateral, anterior, septal and inferior) and each one received a value by a score system according to the Tl-201 myocardial uptake (0=normal uptake; 1=mild hypoperfusion; 2=moderate hypoperfusion; 3=severe hypoperfusion or no myocardial uptake). We considered viable myocardium when the uptake of Tl-201 in the segment related to te myocardial infarction increases at least 1 point in two different axis of Tl-201 SPECT. The results: seven (23,3%) patients demonstrated increase of Tl-201 uptake only at reinjection images, showing a high efficacy of the method. Nine (30%) patients showed persistent hypoperfusion at all series of images suggesting only fibrosis in the are related to the infarction. Fourteen (46,7%) patients showed increase of Tl-201 concentration at redistribution images; among these patients, six showed improvement of myocardial uptake at reinjection. This condition was interpreted as regional chronic ischemic process: hibernating myocardium. The conclusion was that Tl-201 hypoperfusion at redistribution images without significant changes in relation to the stress images do not represent fibrosis at all. The reinjection technic was better than conventional redistribution in the detection of viable myocardium. This data allows a better therapeutic orientation. (author)

  20. Value of myocardial perfusion SPECT in pediatric population

    Isotopic myocardial perfusion studies are less frequently used in children than in adults and their indications are also different. Our goal was to analyze retrospectively the experience with stress perfusion myocardial SPECT in pediatric population. Method: Since 1998 to 2001, ten studies were performed to 5 girls and 3 boys. Their mean age was 7±3 years ranging from 1-11. Three of them presented abnormal coronary arteries pre and post surgical intervention with or without coil; three had Kawasaki disease with coronary aneurysms and the other two, congenital cardiopathies (Cantrell pentalogy and great vessel transposition,both with posterior left ventricular hypokinesia post surgery). Stress was obtained using dipyridamole infusion (0.56 mg/kg) in 6 cases and treadmill exercise using Bruce protocol in 4. All those tests were well tolerated. Sestamibi Tc99m was selected in 80% of the cases and Tl 201 in the rest. Only 2 small children required anesthesia during SPECT acquisition. Results: Stress EKG did not demonstrated ischemia in any case. Coronary angiography was performed only in 50% of the patients, it was concordant with SPECT features in all, two of those patients presented transient perfusion defects (one Kawasaki and one abnormal coronary artery with a fistulae).The repaired pentalogy presented ischemia and septal infarction; in that patient echocardiographic hipokinesia was concordant with fixed hypoperfusion. One case with abnormal coronary plus mitral regurgitation (without isotopic ischemia) was submitted to embolization posteriorly, obtaining motion improvement. Clinical outcome was concordant with the presence or absence of isotopic ischemia in the rest of the patients. Conclusion: SPECT myocardial perfusion was helpful in the therapeutic approach and in prediction of outcome in children

  1. Evaluation of left ventricular volumes and ejection fraction by gated myocardial perfusion SPECT versus cardiac MRI

    It is stated that cardiac MRI imaging can provide accurate estimation of left ventricular (LV) volumes and ejection fraction (EF). The purpose of this study was to evaluate the accuracy of gated myocardial perfusion single photon emission computed tomography (SPECT) for assessment of LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF, using cardiac MRI as the reference methods/(methodology). Gated myocardial perfusion SPECT images were analyzed with two different quantification software, quantitative gated SPECT (QGS) and 4D-MSPECT. Thirty-four consecutive patients were studied. Myocardial perfusion SPECT and cardiac MRI had excellent intra/interobserver reproducibility. Correlation between the results of gated myocardial perfusion SPECT and cardiac MRI were high for EDV and EF. However, ESV and EDV were significantly underestimated by gated myocardial perfusion SPECT compared to cardiac MRI. Moreover, gated myocardial perfusion SPECT overestimated EF for small heart. One reason for the difference in volumes and EF is the delineation of the endocardial border. Cardiac MRI has higher spatial resolution. We should understand the differences of volumes and EF as determined by gated myocardial perfusion SPECT and cardiac MRI. (author)

  2. Relation between 99Tcm-MIBI uptake and biological factors in 23 cases of parathyroid adenoma

    Purpose: The aim of this study was to correlate the semiquantitative analysis of 99Tcm-methoxyisobutyl isonitrile (MIBI) double phases scan with serum biochemical values (iPTH, Ca, P, Mg) and tumor volume of parathyroid adenoma. Methods: Early (15 min) and delayed (120 min) anterior plannar images of MIBI scans were reviewed in 23 patients who eventually underwent parathyroid adenoma ectomies. All the clinical records were reviewed retrospectively. The ratio of parathyroid-to-thyroid (P/T) was determined by average counts of the diseased parathyroid gland and normal thyroid gland. 23 patients were divide to 2 groups according to whether The late phase P/T (P/T2) was bigger than early phase P/T (P/T1), the patients were divided into 2 groups: Group A (P/T2≥P/T1), Group B (P/T2< P/T1). Result: There was a positive correlation between P/T1 and preoperative serum iPTH (-0.42, P<0.05). And there was a adverse correlation between P/T1 and preoperative serum phosphorus values (I=-0.42, P<0.05). However, there was no significant correlation between P/T2 and serum biochemical values. Additionally, no significant correlation between MIBI uptake ratios and increased gland volume was found. Group B had a significant high value in the preoperative Ca (t=-3.68, P<0.01) and variation of perioperative Ca (t=-3.08, P<0.01). Conclusion: The results of our study show that the serum iPTH levels and phosphorus value may have an effect on MIBI uptake, and should be considered prior to MIBI imaging. (authors)

  3. Effect of wall thickness of left ventricle on {sup 201}Tl myocardial SPECT images. Myocardial phantom study

    Koto, Masanobu; Kawase, Osami [Kobe Univ. (Japan). Hospital; Namura, Hiroyuki; Yamasaki, Katsuhito; Kono, Michio

    1996-07-01

    {sup 201}Tl myocardial SPECT is known for better sensitivity, specificity, and accuracy than planar images in detecting coronary artery disease and diagnosing myocardial viability. SPECT images arc also superior to planar images in diagnostic sensitivity and anatomical orientation. However, as limitation of the spatial resolution of the machine, we often encounter poor SPECT plower image quality in patients with decreased wall thickness. To test the accuracy of SPECT images in patients with marked thinning of the left ventricular wall, as occurs in dilated cardiomyopathy, we performed a experimental study using myocardial phantom with 7 mm wall thickness. Tomographic image of the phantom images were rather heterogeneous, though no artificial defect was located Dilated cardiomyopathy is thought to be characterized by patchy defects in the left ventricle. Careful attention should be given to elucidating myocardial perfusion in patients with a thin left ventricle wall, as there are technical limitations in addition to clinical features. (author)

  4. Evaluation of myocardial damage in Duchenne's muscular dystrophy with thallium-201 myocardial SPECT

    Myocardial damage and cardiopulmonary functions in patients with Duchenne's muscular dystrophy (DMD) were assessed using thallium-201 myocardial single-photon emission computed tomography (SPECT) and technetium-99m multigated radionuclide angiography. Twenty-five patients with DMD were divided into 4 groups according to percent of perfusion defect (%PD) calculated by the bull's-eye method and age. PD was detected in 24 (96.0%) of 25 patients with DMD, and it spread from the left ventricular lateral wall to the anterior wall and/or interventricular septum. PD was detected even in a 6-year-old DMD boy. Patients in Group I (%PD≥10% and age<15 years old) were shown to have a higher risk of left-sided heart failure without respiratory failure. Patients in Group II (%PD≥10 and age≥15) showed decreased pulmonary function and worsened arterial blood gas values as compared with Group IV (%PD<10 and age≥15). There was no significant difference in cardiac function among the 4 groups. It is postulated that myocardial damage in Group II patients is dependent primarily on a deficiency of dystrophin and on chronic respiratory failure, and that some of them are at risk of cardiopulmonary failure. It is concluded that myocardial SPECT is useful for the early diagnosis of myocardial damage and evaluation of cardiopulmonary function in DMD patients. (author)

  5. Assessment of myocardial fatty acid metabolism in patients with vasospastic angina using {sup 123}I-BMIPP myocardial SPECT

    Ito, Kazuki; Sugihara, Hiroki; Terada, Kouji [Kyoto Prefectural Univ. of Medicine (Japan)] [and others

    1995-10-01

    Myocardial perfusion and fatty acid metabolism may be unpaired in the patients of vasospastic angina (VSA), because abnormal regional wall motion of left ventricle has been shown in some cases of VSA without apparent history of myocardial infarction. To study the clinical utility of {sup 123}I-BMIPP scintigraphy in diagnosis of myocardial ischemia in VSA, both {sup 123}I-BMIPP (rest) and {sup 201}Tl (exercise) SPECT were performed in the 20 patients of VSA diagnosed by coronary angiography. Defect scores were calculated visually from the 17 segments of myocardial images and were compared with patient`s anginal history, period from last attack, numbers of attack, left ventricular (LV) ejection fraction and severity of regional LV wall motion abnormality. {sup 123}I-BMIPP SPECT images showed decreased tracer uptake in 14 cases of 20 (70%) VSA patients. Exercise {sup 201}Tl SPECT images showed decreased tracer uptake in 3 cases of 20 (15%) of patients. Severity of regional LV wall motion abnormality was correlated with defect score of BMIPP. Though total defect score of BMIPP did not correlate with patient`s anginal history, number of symptoms and LV ejection fraction, correlated inversely with period from last attack. It was suggested that {sup 123}I-BMIPP myocardial SPECT images in VSA patients showed `memories` of myocardial ischemic damages induced by vasospasm. In summary, {sup 123}I-BMIPP myocardial SPECT images could be a useful test for diagnosis and evaluation of VSA. (author).

  6. Determination of optimum filter in inferolateral view of myocardial SPECT

    Background: In myocardial perfusion SPECT imaging, images are degraded by photon attenuation, distance-dependent collimator, detector response and photon scattering. As filters greatly affect quality of nuclear medicine images, in this study determination of optimum filter for inferolateral view is our prime objective. Materials and Methods: .A phantom simulating heart left ventricle was built. About 1mCi of 99mTc, was injected into the phantom. Images were taken from this phantom. Parzen, Hamming, Hanning, Butter worth and Gaussian filters were exerted on the images obtained from the phantom.. By defining some criteria such as contrast, signal to noise ratio, and defect size delectability, the best filter was determined for our ADAC spect system at our nuclear medicine center. In this study, 27 patients who previously had undergone coronary angiography were chosen to be included. All of these patients revealed significant stenosis in the left circumflex artery. Myocardial SPECT images of these patients had inferolateral defect. The images of these patients were processed with 12 filters including the optimum filters obtained from phantom study and some other non-optimum filters. A nuclear medicine physician quantified the results by assigmng mark from 0 to 4. to every image. 0 mark for images that didn't show the defect properly and 4 for the best one. The data from patient study were analyzed with non-related, non -parametric Friedman test. Results: Nyquist frequency of 0.325 and 0.5 were obtained as the optimum cut-off frequencies for hamming and Hanning filters respectively. Order 11 and cut-off frequency of 0.45 and order 20. with cut-off frequency of 0.5 were found to be optimum for Butter worth and Gaussian filters. In patient studies it was found that, Butter worth filter with cut-off frequency of 0.45 and order of 11 produced the best quality images. Conclusion: In this study. Butter worth filter with cut-off frequency of 0.45 and order of 11 was the

  7. Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography

    Feger, S.; Rief, M.; Zimmermann, E.; Richter, F.; Roehle, R. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Dewey, M. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Institut fuer Radiologie, Berlin (Germany); Schoenenberger, E. [Medizinische Hochschule Hannover, Department of Medicine, Hannover (Germany)

    2015-07-15

    To evaluate patient acceptance of noninvasive imaging tests for detection of coronary artery disease (CAD), including single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), stress perfusion magnetic resonance imaging (MRI), coronary CT angiography (CTA) in combination with CT myocardial stress perfusion (CTP), and conventional coronary angiography (CCA). Intraindividual comparison of perception of 48 patients from the CORE320 multicentre multinational study who underwent rest and stress SPECT-MPI with a technetium-based tracer, combined CTA and CTP (both with contrast agent, CTP with adenosine), MRI, and CCA. The analysis was performed by using a validated questionnaire. Patients had significantly more concern prior to CCA than before CTA/CTP (p < 0.001). CTA/CTP was also rated as more comfortable than SPECT-MPI (p = 0.001). Overall satisfaction with CT was superior to that of MRI (p = 0.007). More patients preferred CT (46 %; p < 0.001) as a future diagnostic test. Regarding combined CTA/CTP, CTP was characterised by higher pain levels and an increased frequency of angina pectoris during the examination (p < 0.001). Subgroup analysis showed a higher degree of pain during SPECT-MPI with adenosine stress compared to physical exercise (p = 0.016). All noninvasive cardiac imaging tests are well accepted by patients, with CT being the preferred examination. (orig.)

  8. Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography

    To evaluate patient acceptance of noninvasive imaging tests for detection of coronary artery disease (CAD), including single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), stress perfusion magnetic resonance imaging (MRI), coronary CT angiography (CTA) in combination with CT myocardial stress perfusion (CTP), and conventional coronary angiography (CCA). Intraindividual comparison of perception of 48 patients from the CORE320 multicentre multinational study who underwent rest and stress SPECT-MPI with a technetium-based tracer, combined CTA and CTP (both with contrast agent, CTP with adenosine), MRI, and CCA. The analysis was performed by using a validated questionnaire. Patients had significantly more concern prior to CCA than before CTA/CTP (p < 0.001). CTA/CTP was also rated as more comfortable than SPECT-MPI (p = 0.001). Overall satisfaction with CT was superior to that of MRI (p = 0.007). More patients preferred CT (46 %; p < 0.001) as a future diagnostic test. Regarding combined CTA/CTP, CTP was characterised by higher pain levels and an increased frequency of angina pectoris during the examination (p < 0.001). Subgroup analysis showed a higher degree of pain during SPECT-MPI with adenosine stress compared to physical exercise (p = 0.016). All noninvasive cardiac imaging tests are well accepted by patients, with CT being the preferred examination. (orig.)

  9. ATP-loading 201Tl myocardial SPECT for the detection of ischemic heart disease

    To evaluate the usefulness for the detection of ischemic heart disease, ATP myocrdial SPECT was performed in 35 patients (mean; 59±9.4 years) with angina pectoris or old myocardial infarction. Coronary angiography (CAG) was performed in all patients. The ultra-short half-life of ATP required a continuous infusion for its use. ATP was infused intravenously at a rate of 0.16 mg/kg/min for 5 min, with 201Tl injection taking place at 3 min. Myocardial SPECT imaging was begun 5 min and 4 hr later after the end of ATP infusion. ATP caused a significant decrease in arterial blood pressure (p201Tl myocardial SPECT for the detection of coronary artery disease (CAD) was evaluated using CAG as a golden standard. The sensitivity and specificity for CAD detection were 82% and 90%, respectively. ATP myocardial SPECT is a promising new test for the detection of ischemic heart disease. (author)

  10. Sequential change of cardiomyopathy of Duchenne muscular dystrophy by 201Tl myocardial SPECT

    201Tl myocardial SPECT were performed to evaluate of cardiomyopathy in Duchenne type of progressive muscular dystrophy (DMD). Follow up SPECT images of the same patients were also obtained about 1 year after the first scan. Cases subjected to study were 10 DMD. At the first study the hypoperfusion area of the left ventricular muscle were observed in 6 cases (60%) out of 10. At the second study the hypoperfusion areas became wider and lower in 4 out of 6 cases (66.7%). The new hypoperfusion area which was not demonstrated at the first study was observed at the second study in one case of these cases. These results suggested that the positive rate of cardiomyopathy in DMD by 201Tl myocardial SPECT was high, and 201Tl myocardial SPECT is a useful examination to detect the change of myocardial damage in DMD. (author)

  11. Determination of optimum filter in myocardial SPECT: A phantom study

    Background: In myocardial perfusion SPECT images are degraded by photon attenuation, the distance-dependent collimator, detector response and photons scatter. Filters greatly affect quality of nuclear medicine images. Materials and Methods: A phantom simulating heart left ventricle was built. About 1mCi of 99mTc was injected into the phantom. Images was taken from this phantom. Some filters including Parzen, Hamming, Hanning, Butter worth and Gaussian were exerted on the phantom images. By defining some criteria such as contrast, signal to noise ratio, and defect size detectability, the best filter can be determined. Results: 0.325 Nyquist frequency and 0.5 nq was obtained as the optimum cut off frequencies respectively for hamming and handing filters. Order 11, cut off 0.45 Nq and order 20 cut off 0.5 Nq obtained optimum respectively for Butter worth and Gaussian filters. Conclusion: The optimum member of every filter's family was obtained

  12. 99mTc-MIBI SPECT in estimation of adalat influence on myocardial perfusion in CAD patients

    Calcium antagonists (CA) adalat effect on myocardial perfusion in CAD patients are studied using 99mTc-MIBI SPECT. 99mTc-MIBI SPECT provides useful information for evaluation of CA effect on myocardial perfusion and revealing of steel syndrome as a result of CA treatment. The IPD is one of the most sensitive signs of improvement in myocardial perfusion after treatment

  13. ECG-gated thallium-201 myocardial SPECT in patients with old myocardial infarction compared with ECG-gated blood pool SPECT

    We evaluated one of the merits of ECG-gated thallium-201 single photon emission computed tomography (g-Tl SPECT), i.e., the ability to appreciate left ventricular (LV) wall motion. LV wall motion assessed by g-Tl SPECT and by ECG-gated Blood Pool SPECT (g-BP SPECT) was classified into three grades and compared segment by segment. Tl-201 uptake by g-Tl SPECT was also classified into three grades and compared with those of wall motion in g-BP SPECT. Fifty patients with prior myocardial infarction were injected intravenously at rest with 111 to 185 MBq (3 to 5 mCi) of Tl-201. The left ventricular regions were divided into anterior, septal, inferior and lateral segments (50 patients x 4 segments = 200 segments in total). The grades of wall motion and Tl-201 uptake detected by g-Tl SPECT correlated well with those of wall motion in g-BP SPECT (94.5% and 85%, respectively). With g-Tl SPECT it was possible to evaluate left ventricular wall motion, providing clear perfusion images. (author)

  14. Risk assessment after coronary angioplasty with SPECT myocardial perfusion studies

    The chest pain can be use for stratifying the risk of the patients after coronary angioplasty. Nevertheless this strategy has shown to have a low accuracy in the detection of restenosis and myocardial ischemia. Aims: To establish the usefulness of the SPECT studies in the risk stratification after the coronary angioplasty. Evaluate the incidence of silent ischemia or symptomatic, and its impact on the prognosis. Method: There were included 107 patients (p) submitted to a gated SPECT between the year of the coronary angioplasty. The analysis of the images was performed according to different scores (SSS, SRS, SDS). These data was correlated with the symptoms of the patients. We define group 1 (G1) as the asymptomatic without ischemia (n 59p), group 2 (G2) as silent ischemia (n = 28p) and group 3 (G3) as symptomatic with ischemia (n = 20p). A clinical follow-up was done in search of events (target vessel revascularization, unstable angina, AMI and death). Results: Significant differences were not observed in the clinical variables between the different groups. The SSS was lower in the G1 compare with G2 and G3 (p 0.0001) and was similar between the last two, p = NS (SSS: G1: 2.2 ± 4.9; G2: 7.6 ± 5.9; G3: 9.5 ± 6.8). The SDS was greater in G3 vs. G1 and G2, p = 0.0001, and greater in G2 vs. G1, p = 0.0001 (SDS: G1: 0; G2: 4.8 ± 3.5; G3: 7.2 ± 6.5). No differences where observed in the SRS between the three groups. In the follow-up the total percentage of events was lesser when compare the G1 with the G2 and G3 (G1: 3.3%; G2 and G3: 18.7%; p 0.02). The percentage of annual events of the G3 symptomatic with ischemia (11.03%) and G2 silent ischemia (4.04%) did not present differences (p 0.7). When the events of the G2 (4.04%) were compared with the G1 (1.24%) we observed a trend to major frequency of events in the G2 (p = 0.6). Conclusions: The presence of myocardial ischemia after coronary angioplasty is a determinant of the prognosis. Nevertheless, the extension

  15. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision

    Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/ publications/guidelines/201507EANMFINAL myocardialperfusionguideline.pdf. (orig.)

  16. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision

    Verberne, Hein J.; Eck-Smit, Berthe L.F. van; Wit, Tim C. de [University of Amsterdam, Department of Nuclear Medicine, F2-238, Academic Medical Center, Amsterdam (Netherlands); Acampa, Wanda [National Council of Research, Institute of Biostructures and Bioimaging, Naples (Italy); Anagnostopoulos, Constantinos [Academy of Athens, Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Athens (Greece); Ballinger, Jim [Guy' s Hospital - Guy' s and St Thomas' Trust Foundation, Department of Nuclear Medicine, London (United Kingdom); Bengel, Frank [Hannover Medical School, Department of Nuclear Medicine, Hannover (Germany); Bondt, Pieter De [OLV Hospital, Department of Nuclear Medicine, Aalst (Belgium); Buechel, Ronny R.; Kaufmann, Philip A. [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Flotats, Albert [Universitat Autonoma de Barcelona, Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain); Hacker, Marcus [Medical University of Vienna, Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Hindorf, Cecilia [Skaane University Hospital, Department of Radiation Physics, Lund (Sweden); Lindner, Oliver [University Hospital of the Ruhr-University Bochum, Heart and Diabetes Center North Rhine-Westphalia, Institute for Radiology, Nuclear Medicine and Molecular Imaging, Bad Oeynhausen (Germany); Ljungberg, Michael [Lund University, Department of Medical Radiation Physics, Lund (Sweden); Lonsdale, Markus [Bispebjerg Hospital, Department of Clinical Physiology and Nuclear Medicine, Copenhagen (Denmark); Manrique, Alain [Caen University Hospital, Department of Nuclear Medicine, Service Commun Investigations chez l' Homme, GIP Cyceron, Caen (France); Minarik, David [Skaane University Hospital, Radiation Physics, Malmoe (Sweden); Scholte, Arthur J.H.A. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Slart, Riemer H.J.A. [University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen (Netherlands); Traegaardh, Elin [Skaane University Hospital and Lund University, Clinical Physiology and Nuclear Medicine, Malmoe (Sweden); Hesse, Birger [University Hospital of Copenhagen, Department of Clinical Physiology and Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark)

    2015-11-15

    Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/ publications/guidelines/2015{sub 0}7{sub E}ANM{sub F}INAL myocardial{sub p}erfusion{sub g}uideline.pdf. (orig.)

  17. 18F-FDG PET/CT显像对心肌“缺血记忆”的分子机制研究%Experimental Study of the Molecular Mechnisms of Myocardial Ischemic Memory With 18F-FDG PET/CT Imaging

    谢博洽; 杨敏福; 叶珏; 杨子鹤; 窦克非; 韩春雷; 田毅

    2012-01-01

    This study was aimed to explore whether the changes of mRNA and the existence and duration of ischemic 18F-FDG uptake correlate with the extent of myocardial ischemia inischemia-reperfusion canine model. The 20-minute (77= 4) and 40-minute (n= 4) coronary artery occlusion followed by 24 h of open-artery reperfusion in canine model were performed. All dogs underwent fasting (>12 h) dynamic 18F-FDG PET/CT and 99Tcm-MIBI SPECT imaging at baseline, 1 h and 24 h after reperfusion. When all imaging were completed, myocardial samples from the ischemic and nonischemic region were obtained, and the mRNA expression of glucose transporter-1 (GLUT-1), glucose transporter-4 (GLUT-4), and heart-fatty acid binding protein (H-FABP) were estimated by Real Time PCR. There was no difference in the ratio of hypoperfused region/nomoperfused region of 18F-FDG uptake between the 20-minute group and 40-minute group at baseline. When examined at 1 h, increased 18F-FDG uptake was observed in the 40-minute group. When estimated at 24 h, only the 40-minute group showed slightly higher 18F-FDG uptake than baseline, whereas no such difference was demonstrated in the 20-minute group. Similar mRNA expression of GLUT-1, GLUT-4 and H-FABP were demonstrated in the nonischemic regions between the 2 groups, whereas increased expressions of GLUT-1 and GLUT-4, and decreased H-FABP mRNA were demonstrated in the ischemic regions. The changes of mRNA expression were more obvious in the 40 minute group than in the 20-minute group. The results showed that the existence and persistent period of ischemic 18F-FDG uptake (ischemic memory) was correlated with the extent of myocardial ischemia.%建立了不同程度的犬急性心肌缺血-再灌注模型.利用18F-FDG PET/CT动态心肌显像和实时定量PCR方法探讨了缺血心肌葡萄糖代谢改变(缺血记忆)和缺血程度的关系.将8只杂种犬随机分为球囊封堵20 min组(4只)和40 min组(4只),在空腹状态下(禁食>12 h

  18. Usefulness of gated SPECT myocardial imaging in evaluation of patients with inferior myocardial infarction

    Gated single photon emission computed tomography (gated SPECT) myocardial imaging gives useful information about the extent and severity of perfusion abnormalities (PA) and global left ventricular (LV) function in patients with coronary artery disease. The aim of this study was to evaluate by gated SPECT myocardial imaging differences in perfusion scores and LV function between stress and rest in patients with mild left ventricular dysfunction and/or normal function and previous inferior myocardial infarction (IMI) and to detect myocardial stunning. The study included 77 patients (age 53±8.21) with mild left ventricular dysfunction and previous IMI divided into two groups. Group 1 consisted of 34 patients with IMI and additional ischemia on perfusion scan and group 2 with 43 patients with previous IMI without ischemia on perfusion scan. All patients underwent a 2-day stress-rest gated SPECT myocardial imaging protocol with 99m technetium-methoxyisobutylisonitrile (99mTc-MIBI). There was a more significant post-stress to rest decrease in ejection fraction (EFps) in patients with IMI and additional ischemia (group 1) than in patients with IMI (group 2) (-1.5±2.5 vs. 1.5±2.3, p<0.001). In group 1, there was a significant increase in post-stress end-systolic volume (ESVps) in comparison to ESVr (70.4±29.8 vs. 66.2±26.2 ml, p=0.044). However, the decrease in EF post-stress to rest did not reach the level of significance (51.7±10.8 vs. 53.2±10.2%, p=0.147). The extent and severity of perfusion abnormalities were higher on stress (SSS) than on rest images (SRS) (13.9±8.6 vs. 8.3±7.8, p<0.001). There was no difference in global LV parameters or perfusion abnormalities in patients in group 2 between stress and rest except for a significant increase in the post-stress EF to rest value (57.9±11.9 vs. 56.2±10.5%, p=0.018). Severe decrease of post-stress EF to rest was found in 12 (16%) patients indicating stunning. In patients with mild left ventricular dysfunction

  19. The usefulness of myocardial SPECT for the preoperative cardiac risk evaluation in noncardiac surgery

    We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. 118 patients ( M: F=66: 52, 62.7±10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest Tl-201/ stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heat failure and unstable angina) were surveyed through perioperative periods (14.6±5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery

  20. Feasibility of one-eighth time gated myocardial perfusion SPECT functional imaging using IQ-SPECT

    Caobelli, Federico; Thackeray, James T.; Bengel, Frank M. [Medizinische Hochschule Hannover, Klinik fuer Nuklearmedizin, Hannover (Germany); Soffientini, Alberto; Pizzocaro, Claudio; Guerra, Ugo Paolo [Fondazione Poliambulanza, Department of Nuclear Medicine, Brescia (Italy)

    2015-11-15

    IQ-SPECT, an add-on to general purpose cameras based on multifocal collimation, can reduce myocardial perfusion imaging (MPI) acquisition times to one-fourth that of standard procedures (to 12 s/view). In a phantom study, a reduction of the acquisition time to one-eighth of the standard time (to 6 s/view) was demonstrated as feasible. It remains unclear whether such a reduction could be extended to clinical practice. Fifty patients with suspected or diagnosed CAD underwent a 2-day stress-rest {sup 99m}Tc-sestamibi MPI protocol. Two consecutive SPECT acquisitions (6 and 12 s/view) were performed. Electrocardiogram-gated images were reconstructed with and without attenuation correction (AC). Polar maps were generated and visually scored by two blinded observers for image quality and perfusion in 17 segments. Global and regional summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS) were determined. Left ventricular volumes and ejection fraction were calculated based on automated contour detection. Image quality was scored higher with the 12 s/view acquisition, both with and without AC. Summed scores were statistically comparable between the 6 s/view and the 12 s/view acquisition, both globally and in individual coronary territories (e.g. in images with AC, SSS were 6.6 ± 8.3 and 6.2 ± 8.2 with 6 s and 12 s/view, respectively, p = 0.10; SRS were 3.9 ± 5.6 and 3.5 ± 5.3, respectively, p = 0.19; and SDS were 2.8 ± 5.7 and 2.6 ± 5.7, respectively, p = 0.59). Both acquisitions allowed MPI-based diagnosis of CAD in 25 of the 50 patients (with AC). Calculated end-diastolic volume (EDV) and end-systolic volume (ESV) were modestly higher with the 6 s/view acquisition than with the 12 s/view acquisition (EDV +4.8 ml at rest and +3.7 ml after stress, p = 0.003; ESV +4.1 ml at rest and +2.6 ml after stress, p = 0.01), whereas the ejection fraction did not differ (-1.2 % at rest, p = 0.20, and -0.9 % after stress, p = 0.27). Image quality and

  1. Feasibility of one-eighth time gated myocardial perfusion SPECT functional imaging using IQ-SPECT

    IQ-SPECT, an add-on to general purpose cameras based on multifocal collimation, can reduce myocardial perfusion imaging (MPI) acquisition times to one-fourth that of standard procedures (to 12 s/view). In a phantom study, a reduction of the acquisition time to one-eighth of the standard time (to 6 s/view) was demonstrated as feasible. It remains unclear whether such a reduction could be extended to clinical practice. Fifty patients with suspected or diagnosed CAD underwent a 2-day stress-rest 99mTc-sestamibi MPI protocol. Two consecutive SPECT acquisitions (6 and 12 s/view) were performed. Electrocardiogram-gated images were reconstructed with and without attenuation correction (AC). Polar maps were generated and visually scored by two blinded observers for image quality and perfusion in 17 segments. Global and regional summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS) were determined. Left ventricular volumes and ejection fraction were calculated based on automated contour detection. Image quality was scored higher with the 12 s/view acquisition, both with and without AC. Summed scores were statistically comparable between the 6 s/view and the 12 s/view acquisition, both globally and in individual coronary territories (e.g. in images with AC, SSS were 6.6 ± 8.3 and 6.2 ± 8.2 with 6 s and 12 s/view, respectively, p = 0.10; SRS were 3.9 ± 5.6 and 3.5 ± 5.3, respectively, p = 0.19; and SDS were 2.8 ± 5.7 and 2.6 ± 5.7, respectively, p = 0.59). Both acquisitions allowed MPI-based diagnosis of CAD in 25 of the 50 patients (with AC). Calculated end-diastolic volume (EDV) and end-systolic volume (ESV) were modestly higher with the 6 s/view acquisition than with the 12 s/view acquisition (EDV +4.8 ml at rest and +3.7 ml after stress, p = 0.003; ESV +4.1 ml at rest and +2.6 ml after stress, p = 0.01), whereas the ejection fraction did not differ (-1.2 % at rest, p = 0.20, and -0.9 % after stress, p = 0.27). Image quality and LV

  2. Clinical application of {sup 99m}Tc-tetrofosmin myocardial SPECT. A multicenter trial

    Nishimura, Tsunehiko [Osaka Univ. (Japan). Faculty of Medicine; Nobuyoshi, Masakiyo

    1995-09-01

    We performed a multicenter trial of {sup 99m}Tc-tetrofosmin myocardial SPECT for the assessment of acute thrombolysis, pre and post elective PTCA and myocardial viability in comparison with {sup 201}Tl myocardial SPECT. The participants consisted of 212 patients at 44 institutions and the study lasted for 10 months. In assessing acute thrombolysis, the perfusion defect from the acute to subacute phase was reduced by 25% and that from the subacute to chronic phase by 10%. The mean perfusion defect score at subacute and chronic phase was well correlated with regional wall motion. The mean defect score during the subacute phase could predict future wall motion abnormalities. In assessing pre and post PTCA, {sup 99m}Tc-tetrofosmin stress/rest myocardial SPECT could identify the changes of perfusion as in the case with successful PTCA and/or restenosis. In assessing the myocardial viability, {sup 99m}Tc-tetrofosmin rest myocardial SPECT was superior to {sup 201}Tl redistribution, and equal to {sup 201}Tl reinjection method. In summary, we concluded that {sup 99m}Tc-tetrofosmin is a powerful tool, with which to diagnose and manage patients with coronary artery diseases. (author).

  3. Estimate of myocardial salvage in late presentation acute myocardial infarction by comparing functional and perfusion abnormalities in predischarge gated SPECT

    We hypothesized that, because of persistent stunning, the extent of post-treatment functional abnormalities detected using gated single-photon emission computed tomography (SPECT) could be representative of the initial risk area in acute myocardial infarction (AMI) treated by reperfusion therapy. In 48 AMI patients, we acquired two 99mTc-sestamibi gated SPECT studies (at admission with tracer injection before treatment and at discharge 5 to 10 days later). We assessed the myocardial salvage defined by the admission minus predischarge summed rest score, and we compared it with the value obtained by subtracting the extent of perfusion defect from the extent of wall motion or wall thickening abnormalities in predischarge gated SPECT. Myocardial salvage was expressed as salvage index (salvaged myocardium divided by initial risk area). There was a good correlation between summed rest score salvage index and wall motion (Spearman's ρ = 0.754, p 99mTc-sestamibi gated SPECT allows assessing myocardial salvage using only post-treatment data. The salvage index derived using wall thickening as surrogate of admission perfusion defect correlates well with the salvage index measured by comparing pre- and post-treatment perfusion defects. (orig.)

  4. Functional imaging in the assessment of myocardial infarction: MR imaging vs. MDCT vs. SPECT

    Mahnken, Andreas H. [Department of Diagnostic Radiology, RWTH Aachen University (Germany); Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University (Germany)], E-mail: mahnken@rad.rwth-aachen.de; Bruners, Philipp [Department of Diagnostic Radiology, RWTH Aachen University (Germany); Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University (Germany); Stanzel, Sven [Institute of Medical Statistics, RWTH Aachen University (Germany); Koos, Ralf [Medical Clinic I, RWTH Aachen University (Germany); Muehlenbruch, Georg; Guenther, Rolf W. [Department of Diagnostic Radiology, RWTH Aachen University (Germany); Reinartz, Patrick [Department of Nuclear Medicine, RWTH Aachen University (Germany); Radios Center of Diagnostic Radiology and Nuclear Medicine, Duesseldorf (Germany)

    2009-09-15

    Purpose: To intraindividually compare magnetic resonance (MR) imaging, ECG-gated multi-detector spiral computed tomography (MDCT) and gated single photon emission computed tomography (SPECT) for the evaluation of global and regional myocardial function and the identification of myocardial perfusion abnormalities. Materials and methods: Nine patients (8 men; 55.1 {+-} 8.9 years) with a history of myocardial infarction (MI) were included in this retrospective study. All patients had undergone segmented k-space steady state free precession MR imaging, {sup 99m}Tc-MIBI gated myocardial perfusion SPECT and contrast enhanced ECG-gated 16-MDCT. Ventricular volumes and ejection fraction (EF) were calculated. Left ventricular (LV) wall motion at rest was analyzed. For SPECT and arterial phase MDCT perfusion abnormalities were assessed. Data was compared with Lin's concordance-correlation coefficient ({rho}{sub c}), Bland-Altman plots and kappa statistics. Results: For EF, there was an excellent concordance and correlation ({rho}{sub c} = 0.99) between SPECT (EF = 41.7 {+-} 10.4%), MDCT (EF = 42.2 {+-} 11.1%), and MR imaging (EF = 41.9 {+-} 11.4%). Considering MR imaging as standard of reference, MDCT ({kappa} = 0.86) is superior to SPECT ({kappa} = 0.51) for the assessment of the regional wall motion at rest. There was a good agreement between SPECT and MDCT regarding the detection of perfusion abnormalities ({kappa} = 0.62). Conclusion: MDCT, MR imaging, and SPECT allow for the reliable assessment of global and regional left ventricular function in patients with a history of MI. MDCT also allows to some extent for the detection of perfusion abnormalities. With its potential to assess both, the coronary arteries as well as the myocardium, MDCT a promising modality for the comprehensive diagnostic work-up in patients with suspected myocardial ischemia.

  5. Detection of myocardial ischemia with myocardial perfusion SPECT in patients with diabetes mellitus

    Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Anh, B. C.; Lee, J.; Lee, K. B [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2004-07-01

    Diabetes mellitus(DM) is a critical disease associated with higher rates of cardiovascular morbidity and mortality. Atherosclerosis accounts for 65-80% of all deaths in diabetic patients and patients with DM are known to show high prevalence of coronary artery diseases(CAD). We evaluated the incidence of scintigraphic evidence of CAD in diabetic patients and results were compared with cardiovascular symptoms and clinical factors. 169 patients with DM(mean age 629years, 68 males) were referred for evaluation of CAD between Jan 2002 and Dec 2003. 101(60%) patients were with chest pain and 68(40%) were asymptomatic. Patients underwent exercise(n=6) or adenosine stress(n=163) SPECT myocardial perfusion imaging(MPI). Exclusion criteria included history of documented myocardial infarction, prior revascularization, clinically significant valvular heart disease, left-bundle branch block on rest ECG. We evaluated symptoms associated with cardiac problem and other clinical and laboratory data to reveal correlation with presence of CAD. MPI were assessed visually and semi-quantitatively with C-Equal program. Myocardial ischemia was detected in 52(31%) patients. Among them, 41 had 1-vessel and 9 had 2-vessel disease. In 52 patients with ischemia, 28(54%) were male and 24(46%) were female. 20/68(29%) asymptomatic and 32/101(32%) symptomatic patients had ischemia. Higher prevalence of neuropathy, hypertension, higher blood glucose level, HbA1c and CRP was noted in patients with myocardial ischemia. Serum levels of cholesterol and LDL was not significantly different between patients with ischemia and with normal MPI findings. Abnormal MPI findings were not related with gender and age. These results show a high prevalence of abnormal MPI results in diabetic patients regardless of symptoms. Screening stress MPI in diabetic patients should be indicated irrespective of symptoms, especially in patients with neuropathy, hypertension, higher level of blood glucose, or increased CRP.

  6. N-13 ammonia myocardial positron computed tomography, (1). Comparative study with thallium-201 SPECT

    Tamaki, Nagara; Senda, Michio; Yonekura, Yoshiharu

    1985-02-01

    Myocardial positron computed tomography (PCT) was obtained in 11 cases and the images were compared with thallium-201 single-photon emission computed tomography (SPECT). The myocardial PCT was performed at rest after 10-20 mCi of N-13 labeled ammonia injection using whole-body multislice PCT device (Positologica III). The PCT clearly delineated 2.5-3.0 mm hot spots while the SPECT barely showed 5.0 mm hot spots of Derenzo phantom. The myocardial images looked better in PCT because of the better spatial resolution and count statistics. The myocardium looked thinner and the papillary muscle was visualized by PCT. The PCT also showed the right ventricle in each case. Furthermore, PCT detected increased lung uptake of ammonia in 2 of the 8 cases with myocardial infarction, suggesting presence of pulmonary congestion. Perfusion defect was clearly seen by PCT as well as SPECT. However, the cardiac short-axis and long-axis sections which were easily obtained by SPECT were useful for the localization of the lesion. We conclude that both PCT and SPECT were valuable for the assessment of coronary artery disease. (author).

  7. Nuclear myocardial perfusion imaging using thallium-201 with a novel multifocal collimator SPECT/CT: IQ-SPECT versus conventional protocols in normal subjects

    Matsuo, Shinro; Nakajima, Kenichi; Onoguchi, Masahisa; Wakabayashi, Hiroshi; Okuda, Koichi; Kinuya, Seigo

    2015-01-01

    Objective A novel multifocal collimator, IQ-SPECT (Siemens) consists of SMARTZOOM, cardio-centric and 3D iterative SPECT reconstruction and makes it possible to perform MPI scans in a short time. The aims are to delineate the normal uptake in thallium-201 (201Tl) SPECT in each acquisition method and to compare the distribution between new and conventional protocol, especially in patients with normal imaging. Methods Forty patients (eight women, mean age of 75 years) who underwent myocardial p...

  8. Clinical usefulness of 123I-MIBG myocardial SPECT in patients with adriamycin-induced cardiomyopathy

    In 29 patients who had been administrated adriamycin (ADR) for the treatment of hematopoietic malignancies, myocardial SPECT was performed 20 minutes and 4 hours after an intravenous dose of 123I-metaiodobenzylguanidine (MIBG). Findings of the myocardial SPECT were compared with the total dose of ADR, ejection fraction (EF) and left ventricular wall motion, as assessed by ultrasound echocardiography. The mean total dose of ADR was 329.3 mg/m2 (range, 150-550 mg/m2). Although the cardiac function was normal, the washout rate (WR) of MIBG was high in 75% of the patients whose MIBG myocardial SPECT showed abnormality on ADR, suggesting the presence of adrenergic nerve disorder. The total dose of ADR was significantly correlated with WR of MIBG (p<0.001). Consequently WR of MIBG may be an index which reflects adrenergic nerve disorder in the myocardium earlier than EF. It was suggested that adrenergic nerve disorder was involved in pathogenesis of myocardial complications associated with ADR administration. In summary, MIBG myocardial SPECT could be a useful test for determining a dosage regimen of ADR therapy of individual patients. (author)

  9. Validation of a short-scan-time imaging protocol for thallium-201 myocardial SPECT with a multifocal collimator

    IQ-SPECT (Siemens AG, Munich, Germany) is a highly sensitive single-photon-emission computed tomography (SPECT) myocardial perfusion imaging (MPI) system that uses a multifocal collimator. We searched for a suitable protocol for short-time imaging by IQ-SPECT in thallium-201 (Tl-201) MPI by evaluating phantom images and also by comparing human IQ-SPECT images with conventional SPECT images as reference standards. We assessed the image quality using the normalized mean square error (NMSE) and drew up count profiles in Tl-201 SPECT images acquired with IQ-SPECT in a phantom study. We also performed Tl-201 stress myocardial SPECT/CT in 21 patients and compared delayed images acquired by using IQ-SPECT with 36 or 17 views per head with images obtained by using conventional SPECT. The NMSE of SPECT images from IQ-SPECT with 36 views was approximately one-fifth of that with 17 views. The myocardial count profile of images with 17 views was lower than those of images with 36 or 104 views in some regions. Defect scores were significantly lower, and image quality scores higher, in images from conventional SPECT than in those from IQ-SPECT with 17 views. Defect scores and image quality scores were equivalent in images from conventional SPECT and those from IQ-SPECT with 36 views. Agreement with the results of conventional SPECT in terms of coronary artery territory-based defect judgment was the best in IQ-SPECT with 36 views with computed tomography-derived attenuation correction (CTAC): the kappa values for IQ-SPECT with 36 views were 0.76 (without CTAC) and 0.83 (with CTAC), and those for IQ-SPECT with 17 views were 0.62 (without CTAC) and 0.59 (with CTAC). The difference in quantitative tracer uptake between conventional SPECT images and IQ-SPECT images was significantly greater for IQ-SPECT images with 17 views than for those with 36 views. Scanning with 36 views per head with CTAC may be appropriate for Tl-201 MPI using IQ-SPECT, because it provides images equivalent to

  10. Development of gated myocardial SPECT analysis software and evaluation of lift ventricular function

    A new software (Cardiac SPECT analyzer: CSA) was developed for quantification of volumes and ejection fraction of gated myocardial SPECT. Volumes and ejection fraction by CSA were validated by comparing with those quantified by Quantitative Gated SPECT (QGS) software. Gated myocardial SPECT was performed in 40 patients with ejection fraction from 15% to 85%. In 26 patients, gated myocardial SPECT was acquired again with the patients in situ. A cylinder model was used to eliminate noise semi-automatically and profile data was extracted using Gaussian fitting after smoothing. The boundary points of endo- and epicardium was found using an iterative learning algorithm. Enddiastolic (EDV) and endsystolic volumes (ESV) and ejection fraction (EF) were calculated. These values were compared with those calculated by QGS and the same gated SPECT data was repeatedly quantified by CSA and variation of the values on sequential measurements of the same patients on the repeated acquisition. From the 40 patient data, EF, EDV and ESV by CSA were correlated with those by QGS with the correlation coefficients of 0.97, 0.92, 0.96. Two standard deviation (SD) of EF on Bland Altman plot was 10.1%. Repeated measurements of EF, EDV, and ESV by CSA were correlated with each other with the coefficients of 0.96, 0.99 for EF, EDV and ESV respectively. On repeated acquisition, reproducibility was also excellent with correlation coefficients of 0.89, 0.97, 0.98, and coefficient of variation of 8.2%, 5.4mL, 8.5mL and 2SD of 10.6%, 21.2mL, and 16.4mL on Bland Altman plot for EF, EDV and ESV. We developed the software of CSA for quantified of volumes and ejection fraction of gated myocardial SPECT. Volumes and ejection fraction quantified using the software was found valid for its correctness and precision

  11. Reproducibility of gated myocardial perfusion SPECT for the assessment of myocardial function: comparison with thallium-201 and technetium-99m-MIBI

    We compared the reproducibility of 291Tl and 99mTc-sestamibi (MIBI) gated SPECT (g-SPECT) for the assessement of myocardial function. G-SPECT acquisition for the assessment of myocardial function was repeated in the same position in 34 patients who received 201Tl and in 31 who received 99mTc-MIBI . The quantification of enddiastolic volume (EDV), endsystolic volume (ESV) and ejection fraction (EF) on 201Tl and 99mTc-MIBI g-SPECT were processed independently using Cedars quantitative g-SPECT software. The reporducibility of the assessment of myocardial function on 201Tl g-SPECT was compared to that of 99mTc-MIBI g-SPECT. Correlation between the two measurements for volumes and EF was excellent by the repeated g-SPECT studies of 291Tl(r=0.928 to 0.986; p99mTc-MIBI (r=0.979 to 0.997; p99mTc-MIBI g-SPECT(EDV: 14.1 ml, ESV; 9.4 ml and EF: 5.5%) than by repeated 201Tl g-SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI g-SPECT (EDV: 2.1 ml. ESV 2.7 ml and EF:2.3%) than by repeated 2'01TI g-SPECT (EDV: 3.2 ml, ESV: 3.5 ml and EF: 5.2%). 99mTc-MIBI provides more reproducible volumes and EF and 201Tl on repeated acquisition s-SPECT. 99mTc-MIBI g-SPECT is the preferable method for the clinical monitoring of myocardial function

  12. GATED SPECT TO EVALUATE LEFT VENTRICULAR MYOCARDIAL PERFUSION, FUNCTION AND DYSSYNCHRONY FOR RESYNCHRONIZATION THERAPY

    E.N. Ostroumov

    2009-05-01

    Full Text Available The study included 15 consecutive patients with heart failure and substantial LV dyssynchrony undergoing CRT. Clinical and phase analysis of gated myocardial perfusion SPECT assessed at baseline, after 2–3 days and after 3–4 months of CRT. The results demonstrated inversely relationship between the response to CRT and the nonviable myocardium. Evaluation of myocardial viability is necessary to considered in the selection process for CRT.

  13. Significance of 99mTc-MIBI myocardial SPECT imaging in diagnosis of syndrome X

    To assess the value of myocardial imaging in the diagnosis of syndrome X, the study was performed with 99mTc-MIBI myocardial SPECT imaging in 64 patients. The patients were divided into three groups: group 1 had 21 patients diagnosed as syndrome X, group 2 had 17 patients with chest pain and normal coronary arteries without ST segment depression during exercise, group 3 had 26 patients with the angina pectoris and coronary stenoses≥50%. The myocardial SPECT imaging of the three groups was compared qualitatively and semi-quantitatively. Myocardial imaging identified 11 cases of myocardial ischemia from 21 patients with syndrome X. The ischemic score of myocardial imaging was 1.1 +- 0.3 for syndrome X and 1.8 +- 0.7 for patients with coronary heart disease (CHD) angina pectoris (t = 3.1746, P<0.01). Myocardial imaging may partly show myocardial ischemia in patients with syndrome X. The extent of ischemia in patients with syndrome X was significantly less than that in patients with CHD angina pectoris

  14. Clinical meaning of 123I-MIBG myocardial SPECT in patients with dilated cardiomyopathy

    Metaiodobenzylguanidine(MIBG)-myocardial SPECT was performed on patients with dilated cardiomyopathy (DCM) undergoing treatment with β blocker (Nipradilol). The findings of MIBG-myocardial SPECT were compared with the changes in cardiac function obtained by echocardiograms. The patients enrolled in the study were seven males who has been diagnosed as definitely suffering from DCM according to diagnostic guidelines provided by the Ministry of Health and Welfare, Japan. The patients were aged 57.5±10.2 years. Following intravenous administration of 111 MBq (3 mCi) of MIBG, myocardial SPECT was taken 20 minutes, and 4 hours later. The washout rate of the left ventricular wall was higher in the unchanged group (40.7±1.2%) than in the improved group (30.3±6.1%). Both the early and delayed images showed higher extent and severity scores for the unchanged group than for the improved group. A correlation of left ventricular ejection fraction (LVEF) with the washout rates was demonstrated (r=-0.819, p<0.05). A correlation was also observed between the variations in LVEF before and after β blocker therapy with the washout rates (r=-0.969, p<0.01), MIBG-myocardial SPECT suggested possibility of the evaluation of severity and prognosis in the patients with DCM. (author)

  15. Myocardial Infarction Area Quantification using High-Resolution SPECT Images in Rats

    Oliveira, Luciano Fonseca Lemos de [Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Mejia, Jorge [Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP (Brazil); Carvalho, Eduardo Elias Vieira de; Lataro, Renata Maria; Frassetto, Sarita Nasbine [Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Fazan, Rubens Jr.; Salgado, Hélio Cesar [Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil); Galvis-Alonso, Orfa Yineth [Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP (Brazil); Simões, Marcus Vinícius, E-mail: msimoes@fmrp.usp.br [Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP (Brazil)

    2013-07-15

    Imaging techniques enable in vivo sequential assessment of the morphology and function of animal organs in experimental models. We developed a device for high-resolution single photon emission computed tomography (SPECT) imaging based on an adapted pinhole collimator. To determine the accuracy of this system for quantification of myocardial infarct area in rats. Thirteen male Wistar rats (250 g) underwent experimental myocardial infarction by occlusion of the left coronary artery. After 4 weeks, SPECT images were acquired 1.5 hours after intravenous injection of 555 MBq of 99mTc-Sestamibi. The tomographic reconstruction was performed by using specially developed software based on the Maximum Likelihood algorithm. The analysis of the data included the correlation between the area of perfusion defects detected by scintigraphy and extent of myocardial fibrosis assessed by histology. The images showed a high target organ/background ratio with adequate visualization of the left ventricular walls and cavity. All animals presenting infarction areas were correctly identified by the perfusion images. There was no difference of the infarct area as measured by SPECT (21.1 ± 21.2%) and by histology (21.7 ± 22.0%; p=0.45). There was a strong correlation between individual values of the area of infarction measured by these two methods. The developed system presented adequate spatial resolution and high accuracy for the detection and quantification of myocardial infarction areas, consisting in a low cost and versatile option for high-resolution SPECT imaging of small rodents.

  16. Clinical value of rapid clearance in resting sestamibi cardiac SPECT in patients with acute myocardial infarction

    Resting 99mTc sestamibi (MIBI) SPECT and exercise-reinjection thallium-201 (Tl) SPECT were performed in fourteen patients with acute myocardial infarction (AMI). MIBI SPECT were obtained 90 min (MIBI-90) and 300 min (MIBI-300) after injection of 370 MBq of MIBI at rest. MIBI-90 and MIBI-300 were compared with exercise Tl imaging (Tl-EX) and Tl reinjection imaging (REINJ). Each SPECT image was divided into 22 segments and myocardial uptake was scored visually. Abnormal perfusion defects were observed in 94 myocardial regions. Worsening of the score was observed in 79 segments (84%) on MIBI-300 compared with MIBI-90. Total MIBI-300 uptake score per person was significantly greater than that at MIBI-90 (14.8±8.6 vs. 7.7±7.9, p=0.001). The concordance rate of defect score between MIBI-90 and REINJ was significantly higher than that between MIBI-300 and REINJ (55% vs. 17%, p=0.001). In nine patients without recanalization of an infarct-related artery, perfusion defects were seen in 74 segments. The concordance rate of defect scores between MIBI-300 and T1-EX was significantly higher than that between MIBI-90 and Tl-EX (45% vs. 16%, p=0.001). In conclusion, rapid clearance of MIBI was observed frequently in patients with AMI. MIBI-90 and MIBI-300 may reflect myocardial viability and areas at risk for AMI, respectively. (author)

  17. Delayed imaging and additional methods to reduce subdiaphragmatic activity in myocardial perfusion SPECT imaging

    Wosnitzer, Brian; Ata, Pashmina; DePuey, Ernest Gordon

    2015-01-01

    Compton scatter from radiotracer in structures close to the heart may partially or completely mask myocardial perfusion defects on SPECT imaging. Previous reports have discussed benefits of additional delayed imaging. We present a case in which additional delayed stress imaging reduced Compton scatter and unveiled clinically significant, stress-induced ischemia.

  18. Dynamic model of the left ventricle for use in simulation of myocardial perfusion SPECT and gated SPECT

    Simulation is a useful tool in cardiac SPECT to assess quantification algorithms. However, simple equation-based models are limited in their ability to simulate realistic heart motion and perfusion. We present a numerical dynamic model of the left ventricle, which allows us to simulate normal and anomalous cardiac cycles, as well as perfusion defects. Bicubic splines were fitted to a number of control points to represent endocardial and epicardial surfaces of the left ventricle. A transformation from each point on the surface to a template of activity was made to represent the myocardial perfusion. Geometry-based and patient-based simulations were performed to illustrate this model. Geometry-based simulations modeled (1) a normal patient, (2) a well-perfused patient with abnormal regional function, (3) an ischaemic patient with abnormal regional function, and (4) a patient study including tracer kinetics. Patient-based simulation consisted of a left ventricle including a realistic shape and motion obtained from a magnetic resonance study. We conclude that this model has the potential to study the influence of several physical parameters and the left ventricle contraction in myocardial perfusion SPECT and gated-SPECT studies

  19. Dipyridamole 201Tl myocardial SPECT imaging in patients with dilated cardiomyopathy

    Objective: To explore the characteristics of dipyridamole 201Tl myocardial perfusion imaging (MPI) SPECT in patients with dilated cardiomyopathy. Methods: Thirty patients with dilated cardiomyopathy underwent pharmacological stress 201Tl MPI SPECT after intravenous infusion of dipyridamole (0.56 mg/kg) for 4 min. The early and delayed SPECT images were acquired respectively at 10 and 240 min after 201Tl injection. The images were analyzed and reported by two or three experienced nuclear medicine physicians. Results: All patients were found to have abnormal perfusion patterns at delay imaging, however 90.00% (27/30) were also abnormal at early images. Six patients had reverse redistribution. Conclusion: Dipyridamole 201Tl MPI SPECT imaging may be of some value for the assessment of patients with dilated cardiomyopathy. (authors)

  20. Incidence and impact of patient motion in myocardial perfusion SPECT imaging

    Full text: Myocardial perfusion imaging has played an important role in the evaluation and management of patients with Coronary artery disease (CAD) for over 20 years. Despite advances in 99mTc based radiopharmaceuticals and multiple detector gantries, patient motion m myocardial perfusion SPECT acquisitions is still problematic and may produce artefacts which mimic the appearances of CAD. While there have been a number of significant contributions to the investigation of motion induced artefacts in myocardial perfusion imaging, the vast majority of these investigations have utilised 201Tl as the radiopharmaceutical and a single detector gantry. This study would assess if patient motion during 99mTc based myocardial perfusion SPECT studies is a significant source of potential false positive findings for CAD. A prospective cross sectional study of 800 myocardial perfusion SPECT studies using 99mTc Myoview at three Nuclear Medicine sites was used to determine the incidence, type and location of visually detectable motion. An experimental study was used to evaluate the effect of patient motions (identified by the clinical study) on the integrity of myocardial perfusion SPECT data using 522 motion simulations generated from a technically and diagnostically normal dataset. Among the 800 individual studies analysed, 36 per cent contained visually detectable motion 31.5 per cent of rest studies demonstrated visually detectable motion compared to 40.5 per cent for stress (p=0.004) The most common type of motion detected was 'multiple bounce' which represented 47.6 per cent of motion. Left anterior oblique (LAO) and anterior were the most common specific locations in the raw data where patient motion was detected with 21.3 per cent and 17.2 per cent of motion respectively 21.7 per cent of simulated motion demonstrated motion induced artefacts. Abrupt motion resulted in artefacts for 52.6 per cent of studies while bounce motion resulted in artefacts in 6.8 per cent of

  1. Comparison between stress myocardial perfusion SPECT recorded with cadmium-zinc-telluride and Anger cameras in various study protocols

    The results of stress myocardial perfusion SPECT could be enhanced by new cadmium-zinc-telluride (CZT) cameras, although differences compared to the results with conventional Anger cameras remain poorly known for most study protocols. This study was aimed at comparing the results of CZT and Anger SPECT according to various study protocols while taking into account the influence of obesity. The study population, which was from three different institutions equipped with identical CZT cameras, comprised 276 patients referred for study using protocols involving 201Tl (n = 120) or 99mTc-sestamibi injected at low dose at stress (99mTc-Low; stress/rest 1-day protocol; n = 110) or at high dose at stress (99mTc-High; rest/stress 1-day or 2-day protocol; n = 46). Each Anger SPECT scan was followed by a high-speed CZT SPECT scan (2 to 4 min). Agreement rates between CZT and Anger SPECT were good irrespective of the study protocol (for abnormal SPECT, 201Tl 92 %, 99mTc-Low 86 %, 99mTc-High 98 %), although quality scores were much higher for CZT SPECT with all study protocols. Overall correlations were high for the extent of myocardial infarction (r = 0.80) and a little lower for ischaemic areas (r = 0.72), the latter being larger on Anger SPECT (p 201Tl or 99mTc-Low group and in whom stress myocardial counts were particularly low with Anger SPECT (228 ± 101 kcounts) and dramatically enhanced with CZT SPECT (+279 ± 251 %). Concordance between the results of CZT and Anger SPECT is good regardless of study protocol and especially when excluding obese patients who have low-count Anger SPECT and for whom myocardial counts are dramatically enhanced on CZT SPECT. (orig.)

  2. Comparison between stress myocardial perfusion SPECT recorded with cadmium-zinc-telluride and Anger cameras in various study protocols

    Verger, Antoine; Karcher, Gilles [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); INSERM U947, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Djaballah, Wassila [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); INSERM U947, Nancy (France); Fourquet, Nicolas [Clinique Pasteur, Toulouse (France); Rouzet, Francois; Le Guludec, Dominique [AP-HP, Hopital Bichat, Department of Nuclear Medicine, Paris (France); INSERM U 773 Inserm and Denis Diderot University, Paris (France); Koehl, Gregoire; Roch, Veronique [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Imbert, Laetitia [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Centre Alexis Vautrin, Department of Radiotherapy, Vandoeuvre (France); Poussier, Sylvain [INSERM U947, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Fay, Renaud [INSERM, Centre d' Investigation Clinique CIC-P 9501, Nancy (France); Marie, Pierre-Yves [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); INSERM U961, Nancy (France); Hopital de Brabois, CHU-Nancy, Medecine Nucleaire, Vandoeuvre-les-Nancy (France)

    2013-03-15

    The results of stress myocardial perfusion SPECT could be enhanced by new cadmium-zinc-telluride (CZT) cameras, although differences compared to the results with conventional Anger cameras remain poorly known for most study protocols. This study was aimed at comparing the results of CZT and Anger SPECT according to various study protocols while taking into account the influence of obesity. The study population, which was from three different institutions equipped with identical CZT cameras, comprised 276 patients referred for study using protocols involving {sup 201}Tl (n = 120) or {sup 99m}Tc-sestamibi injected at low dose at stress ({sup 99m}Tc-Low; stress/rest 1-day protocol; n = 110) or at high dose at stress ({sup 99m}Tc-High; rest/stress 1-day or 2-day protocol; n = 46). Each Anger SPECT scan was followed by a high-speed CZT SPECT scan (2 to 4 min). Agreement rates between CZT and Anger SPECT were good irrespective of the study protocol (for abnormal SPECT, {sup 201}Tl 92 %, {sup 99m}Tc-Low 86 %, {sup 99m}Tc-High 98 %), although quality scores were much higher for CZT SPECT with all study protocols. Overall correlations were high for the extent of myocardial infarction (r = 0.80) and a little lower for ischaemic areas (r = 0.72), the latter being larger on Anger SPECT (p < 0.001). This larger extent was mainly observed in 50 obese patients who were in the {sup 201}Tl or {sup 99m}Tc-Low group and in whom stress myocardial counts were particularly low with Anger SPECT (228 {+-} 101 kcounts) and dramatically enhanced with CZT SPECT (+279 {+-} 251 %). Concordance between the results of CZT and Anger SPECT is good regardless of study protocol and especially when excluding obese patients who have low-count Anger SPECT and for whom myocardial counts are dramatically enhanced on CZT SPECT. (orig.)

  3. 201Tl myocardial SPECT and β-endorphin levels in patients with suspected silent ischemia

    Today silent myocardial ischemia (SMI) is a well-recognized phenomenon. Treadmill exercise according to the Bruce protocol, 201Tl myocardial SPECT and coronary angiography were performed in a total of 106 patients with suspected SMI. In group I (high probability of ischemia; n=46), reversible defects detected by SPECT correlated well with significant stenoses and irreversible defects with subtotal stenoses or complete occlusions. SPECT sensitivity in the detection of ischemia was 91%, its specificity 96%. In group II (low probability of ischemia; n=60), SPECT sensitivity was as high as in group I (94%) but due to a high number of false-positive results (e.g. cardiomyopathy) specificity was only 75%. However, SPECT was superior to exercise ECG (sensitivity 70%; specificity 56%) in the detection of SMI. In addition, β-endorphin levels were determined in 180 healthy subjects, 37 patients with symptomatic CAD and in 34 patients with SMI before and during maximum exercise. Exercise values in patients with SMI were significantly higher than in healthy subjects or in patients with symptomatic CAD. (orig./MG)

  4. Value of dipyridamole stress 201Tl myocardial SPECT in detecting dysfunction of coronary microcirculation

    Objective: To evaluate the value of dipyridamole stress 201Tl myocardial SPECT in detecting dysfunction of coronary microcirculation. Methods: Forty-eight patients diagnosed with cardiac syndrome X underwent dipyridamole stress 201Tl myocardial SPECT. Dipyridamole (0.56 mg/kg) was intravenously injected over 4 min followed by 201Tl (111 MBq) injection at 2 min after dipyridamole administration. Image was acquired at 10 min and 240 min post-injection and co-analyzed by over two experienced doctors in nuclear medicine after three-dimensional reconstruction. The patients with 'reverse redistribution' underwent repeated dipyridamole stress 201Tl SPECT after medical therapy for 2 weeks. The clinical symptoms and results of the treadmill exercise test pre-and post-therapy were compared. Results: Forty two patients (42/48, 87.50%) showed segmental defects: 'reverse redistribution' on delayed (240 min)201Tl images. After medical treatment, 36 cases of the 42 'reverse redistribution' patients had improvement in both clinical symptoms and treadmill exercise test. Post-treatment 201Tl imaging showed improvement in 45/49 (91.84%) defect segments. Six of the 42 patients had no improvement in clinical symptoms and/or treadmill exercise test. Post-treatment 201Tl imaging showed no improvement in all the 7 defect segments on the first scan. Conclusion: Dipyridamole stress 201Tl myocardial SPECT may be valuable in evaluation of impaired coronary microcirculation associated with cardiac syndrome X. (authors)

  5. Noninvasive quantification of myocardial perfusion heterogeneity by Markovian analysis in SPECT nuclear imaging

    Cardiovascular diseases are the leading cause of mortality worldwide, and third of these deaths are caused by coronary artery disease and rupture of vulnerable atherosclerotic plaques. The heterogeneous alteration of the coronary microcirculation is an early phenomenon associated with many cardiovascular risk factors that can strongly predict the subsequent development of coronary artery disease, and lead to the appearance of myocardial perfusion heterogeneity. Nuclear medicine allows the study of myocardial perfusion in clinical routine through scintigraphic scans performed after injection of a radioactive tracer of coronary blood flow. Analysis of scintigraphic perfusion images currently allows the detection of myocardial ischemia, but the ability of the technique to measure the perfusion heterogeneity in apparently normally perfused areas is unknown. The first part of this thesis focuses on a retrospective clinical study to determine the feasibility of myocardial perfusion heterogeneity quantification measured by Thallium-201 single photon emission computed tomography (SPECT) in diabetic patients compared with healthy subjects. The clinical study has demonstrated the ability of routine thallium-201 SPECT imaging to quantify greater myocardial perfusion heterogeneity in diabetic patients compared with normal subjects. The second part of this thesis tests the hypothesis that the myocardial perfusion heterogeneity could be quantified in small animal SPECT imaging by Thallium-201 and/or Technetium-99m-MIBI in an experimental study using two animal models of diabetes, and is correlated with histological changes. The lack of difference in myocardial perfusion heterogeneity between control and diabetic animals suggests that animal models are poorly suited, or that the technology currently available does not seem satisfactory to obtain similar results as the clinical study. (author)

  6. Evaluation of myocardial perfusion and function by gated SPECT in patients with Behcet's disease

    Behcet's disease (BD) is a systemic multi-system vasculitis that can have a wide range of effects on the cardiovascular system. The objective of this study was to determine the existence of myocardial perfusion defects caused by coronary microvascular dysfunction in BD and to evaluate coronary arterial distribution and left ventricular systolic function by gated single-photon emission computed tomography (SPECT). The study population consisted of 23 (15 men and 8 women) patients with BD and 20 healthy controls (12 men and 8 women). Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) gated SPECT studies were performed at stress and rest in a 2-day protocol. Stress and rest left ventricular ejection fraction (LVEF) were calculated. Using non-gated SPECT images myocardial perfusion scores [summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), and fix defect score (FDS)] and perfusion defect extent as percentage (stress, rest ischemic, and fix %LV) were determined. Using gated SPECT images, wall motion score indices (stress wall motion score indices and rest wall motion score indices) were calculated. Coronary angiography (CAG) was applied to patients with abnormal myocardial perfusion scintigraphy (MPS). The mean ages of the BD and control groups were 39.3±10.6 years and 36.2±8.3 years, respectively. No statistically significant differences were observed between the two groups regarding clinical features and cardiologic findings. Abnormal MPS was found in 13 (56.5%) of the BD patients; 3 patients had non-transmural infarcts and 10 patients reversible perfusion defects. Reversible perfusion defects were also found in two controls (10.0%). When the two groups were compared regarding the gated SPECT findings, differences were determined in the following parameters; SSS, SRS, SDS, FDS, stress and rest LVEF, stress and rest %LV, and stress and rest wall motion score index (WMSI). In the BD group, when gated SPECT results were compared

  7. Abnormal perfusion on myocardial perfusion SPECT in patients with Wolff-Parkinson-White syndrome

    Kang, Do Young; Cha, Kwang Soo; Han, Seung Ho; Park, Tae Ho; Kim, Moo Hyun; Kim, Young Dae [Donga University College of Medicine, Busan (Korea, Republic of)

    2005-02-15

    Abnormal myocardial perfusion may be caused by ventricular preexcitation, but its location, extent, severity and correlation with accessory pathway (AP) are not established. We evaluated perfusion patterns on myocardial perfusion SPECT and location of AP in patients with WPW (Wolff-Parkison-White) syndrome. Adenosine Tc-99m MIBI or Tl-201 myocardial perfusion SPECT was performed in 11 patients with WPW syndrome. Perfusion defects (PD) were compared to AP location based on ECT with Fitzpatrick's algorithm of electrophysiologic study and radiofrequency catheter ablation. Patients had atypical chest discomfort or no symptom. Risk of coronary artery disease (CAD) was below 0.1 in 11 patients using the nomogram to estimate the probability of CAD. Coronary angiography was performed in 4 patients(mid-LAD 50% in one, normal in others). In 4 patients, AP localization was done by electrophysiologic study and radiofrequency catheter ablation (RFCA). Small to large extent (11.0 {+-} 8.5%, range:3 {approx} 35%) and mild to moderate severity (-71 {+-} 42.7%, range:-217 {approx} -39%) of reversible (n=9) or fixed (n=1) perfusion defects were noted. One patients with right free wall (right lateral) AP showed normal. PD locations were variable following the location of AP. One patient with left lateral wall AP was followed 6 weeks after RFCA and showed significantly decreased PD on SPECT with successful ablation. Myocardial perfusion defect showed variable extent, severity and location in patients with WPW syndrome. Abnormal perfusion defect showed in most of all patients, but if did not seem to be correlated specifically with location of accessory pathway and coronary artery disease. Therefore myocardial perfusion SPECT should be interpreted carefully in patients with WPW syndrome.

  8. Abnormal perfusion on myocardial perfusion SPECT in patients with Wolff-Parkinson-White syndrome

    Abnormal myocardial perfusion may be caused by ventricular preexcitation, but its location, extent, severity and correlation with accessory pathway (AP) are not established. We evaluated perfusion patterns on myocardial perfusion SPECT and location of AP in patients with WPW (Wolff-Parkison-White) syndrome. Adenosine Tc-99m MIBI or Tl-201 myocardial perfusion SPECT was performed in 11 patients with WPW syndrome. Perfusion defects (PD) were compared to AP location based on ECT with Fitzpatrick's algorithm of electrophysiologic study and radiofrequency catheter ablation. Patients had atypical chest discomfort or no symptom. Risk of coronary artery disease (CAD) was below 0.1 in 11 patients using the nomogram to estimate the probability of CAD. Coronary angiography was performed in 4 patients(mid-LAD 50% in one, normal in others). In 4 patients, AP localization was done by electrophysiologic study and radiofrequency catheter ablation (RFCA). Small to large extent (11.0 ± 8.5%, range:3 ∼ 35%) and mild to moderate severity (-71 ± 42.7%, range:-217 ∼ -39%) of reversible (n=9) or fixed (n=1) perfusion defects were noted. One patients with right free wall (right lateral) AP showed normal. PD locations were variable following the location of AP. One patient with left lateral wall AP was followed 6 weeks after RFCA and showed significantly decreased PD on SPECT with successful ablation. Myocardial perfusion defect showed variable extent, severity and location in patients with WPW syndrome. Abnormal perfusion defect showed in most of all patients, but if did not seem to be correlated specifically with location of accessory pathway and coronary artery disease. Therefore myocardial perfusion SPECT should be interpreted carefully in patients with WPW syndrome

  9. Comparison of myocardial function between post-menopausal and pre-menopausal women: evaluation by gated myocardial SPECT

    In addition to inhibiting coronary atherosclerosis, estrogen is expected to have protective effects on cardiac myocytes. We investigated the difference in myocardial functional parameters evaluated by gated myocardial SPECT after adenosine-stress between post-menopausal and pre-menopausal healthy women. This study included 22 healthy post-menopausal women (mean age: 53.0 yr) and 20 pre-menopausal women (mean age: 43.0 yr) who performed Tc-99m tetrofosmin gated myocardial SPECT after adenosine-stress. Measured hemodynamic parameters, EDV, ESV, stroke volume, EF, cardiac output and cardiac index were compared between the two groups. For comparison, similar-aged two male groups with matched numbers were also studied. There was no significant difference in hemodynamic parameters. EDV, ESV, stroke volume, EF, or cardiac output between the post-menopausal and pre-menopausal women. However, post-menopausal women have a smaller cardiac index (mean: 1.95 L/min/m2 vs 2.20 L/min/m2; p=0.045) and adenosine-induced HR increase (mean : 80.5/min vs 89.7/min ; p=0.03), compared to the pre-menopausal women. On the contrary, the two male groups of the same age range and numbers with the women groups showed no significant difference in any myocardial parameters. These results suggest that menopause may be correlated with reduced increase in cardiac index and HR increase after adenosine-stress

  10. Comparison of myocardial function between post-menopausal and pre-menopausal women: evaluation by gated myocardial SPECT

    Hwang, K. H.; Choa, Won Sick; Yoon, Min Ki [Gachon Medical School, Gil Hospital, Incheon (Korea, Republic of)

    2005-07-01

    In addition to inhibiting coronary atherosclerosis, estrogen is expected to have protective effects on cardiac myocytes. We investigated the difference in myocardial functional parameters evaluated by gated myocardial SPECT after adenosine-stress between post-menopausal and pre-menopausal healthy women. This study included 22 healthy post-menopausal women (mean age: 53.0 yr) and 20 pre-menopausal women (mean age: 43.0 yr) who performed Tc-99m tetrofosmin gated myocardial SPECT after adenosine-stress. Measured hemodynamic parameters, EDV, ESV, stroke volume, EF, cardiac output and cardiac index were compared between the two groups. For comparison, similar-aged two male groups with matched numbers were also studied. There was no significant difference in hemodynamic parameters. EDV, ESV, stroke volume, EF, or cardiac output between the post-menopausal and pre-menopausal women. However, post-menopausal women have a smaller cardiac index (mean: 1.95 L/min/m2 vs 2.20 L/min/m2; p=0.045) and adenosine-induced HR increase (mean : 80.5/min vs 89.7/min ; p=0.03), compared to the pre-menopausal women. On the contrary, the two male groups of the same age range and numbers with the women groups showed no significant difference in any myocardial parameters. These results suggest that menopause may be correlated with reduced increase in cardiac index and HR increase after adenosine-stress.

  11. Assessment of regional quantitative analysis by ECG-gated myocardial SPECT after coronary artery bypass surgery

    Higuchi, Takahiro; Taki, Junichi; Nakajima, Kenichi; Tsuji, Sirou; Yoneyama, Tatsuya; Kinuya, Seigo; Tonami, Norihisa; Kawasuji, Michio [Kanazawa Univ. (Japan). School of Medicine

    1999-12-01

    ECG-gated myocardial SPECT (G-SPECT) was performed before and after coronary artery bypass surgery (CABG) to investigate how this operation would affect the assessment of regional quantitative analyses. Nineteen patients with coronary artery disease underwent G-SPECT before and 1 month after uncomplicated CABG. {sup 99m}Tc-MIBI 740 MBq was injected at rest, then G-SPECT was performed 60 min later. Regional ejection fraction (rEF), wall motion (WM), systolic was thickening (WT) and % tracer uptake were evaluated by quantitative gated SPECT program (QGS). Parameters were obtained quantitatively in 16 segments based on the functional bull's eye map. Percent tracer uptake increased in septum from 75{+-}11% to 78{+-}11% (p<0.001), while WT did not change (40{+-}19% to 41{+-}20%) after CABG. However, in septum rEF decreased from 17{+-}13% to 6{+-}9% (p<0.001) and WM decreased in septum from 1.6{+-}1.1 mm to 0.6{+-}0.9 mm (p<0.001). Significant reduction of rEF and WM despite of no deterioration of WT and % tracer uptake suggested that rEF and WM were affected by pseudoparadoxical asynergy after uncomplicated CABG. For the evaluation of regional function after CABG by G-SPECT, WT might be the preferred parameter. (author)

  12. Assessment of regional quantitative analysis by ECG-gated myocardial SPECT after coronary artery bypass surgery

    ECG-gated myocardial SPECT (G-SPECT) was performed before and after coronary artery bypass surgery (CABG) to investigate how this operation would affect the assessment of regional quantitative analyses. Nineteen patients with coronary artery disease underwent G-SPECT before and 1 month after uncomplicated CABG. 99mTc-MIBI 740 MBq was injected at rest, then G-SPECT was performed 60 min later. Regional ejection fraction (rEF), wall motion (WM), systolic was thickening (WT) and % tracer uptake were evaluated by quantitative gated SPECT program (QGS). Parameters were obtained quantitatively in 16 segments based on the functional bull's eye map. Percent tracer uptake increased in septum from 75±11% to 78±11% (p<0.001), while WT did not change (40±19% to 41±20%) after CABG. However, in septum rEF decreased from 17±13% to 6±9% (p<0.001) and WM decreased in septum from 1.6±1.1 mm to 0.6±0.9 mm (p<0.001). Significant reduction of rEF and WM despite of no deterioration of WT and % tracer uptake suggested that rEF and WM were affected by pseudoparadoxical asynergy after uncomplicated CABG. For the evaluation of regional function after CABG by G-SPECT, WT might be the preferred parameter. (author)

  13. Reproducibility of gated myocardial perfusion SPECT for the assessment of myocardial function: comparison with thallium-201 and technetium-99m-MIBI

    We compared the reproducibility of 201TI and 99mTc-sestamibi (MIBI) gated SPECT measurement of myocardial function using the Germano algorithm. Gated SPECT acquisition was repeated in the same prosition in 30 patients who received 201TI and in 26 who received 99m Tc-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on 201TI and 99mTc-MIBI gated SPECT was processed independently using Cedars quantitative gated SPECT software. The reproducibility of the assessment of myocardial function on 201TI gated SPECT was compared with that of 99mTc-MIBI gated SPECT. Correlation between the two measurements for volumes and EF was excellent by the repeated gated SPECT studies of 201TI (r=0.928 to 0.986; p99mTc-MIBI (r=0.979 to 0.997; p99mTc-MIBI gated SPECT (EDV: 14.1 ml, ESV: 9.4 ml and EF: 5.5 %) than by repeated 201TI gated SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: , 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI gated SPECT (EDV: 2.1 ml, ESV: 2.7 ml and EF: 2.3%) than by more reproducible volumes and EF than 201TI on repeated acquisition gated SPECT. 99mTc-MIBI gated SPECT is the preferable method for the clinical monitoring of myocardial function

  14. Clinical meaning of myocardial washout in Tc-MIBI and Tc-PPN (tetrofosmin) myocardial SPECT in normal volunteers

    Background: There are few reports about the washout in Tc-MIBI and Tc-PPN rest myocardial SPECT. Purpose: To evaluate the differences of Tc-MIBI and Tc-PPN washout in gender and to compare the contraction fraction (CF) and washout, we obtained early and delayed images of Tc-multigated (MUGA) myocardial SPECT in normal volunteers and calculated ejection fraction (EF), CF and washout rate. Methods: Tc-MIBI and Tc-PPN MUGA myocardial SPECT was performed in normal volunteers (20-23 years old ,9 female and 10 male). Myocardial washout rate of Tc-MIBI and Tc-PPN was calculated from early and delayed images. EF was calculated from the early images by using QGS software. On the other hand, three-dimensional (3D) images were reconstructed from early images of Tc-MIBI and Tc-PPN using Application Visualization System Medical Viewer (AVS-MV), then threshold was set at 50%. The myocardial volume with a radioisotope count in end-diastole (ED:counts /ml) and end systole (ES:counts /ml) were calculated from the 3D image. Contraction fraction using AVS-MV(AVS-CF) was calculated by following formula. AVS-CF (ED-ES)/ED. Results: The MIBI washout rate was 22.0% in female, and 17.6% in male. The PPN washout rate was 29.5% in female, and 23.4% in male. The MIBI and PPN washout rates in female showed higher than male. QGS-EF and AVS-CF in female were higher than those in male {female and male: (QGS-EF of MIBI : 63.6% and 54.5%), (QGS-EF of PPN : 62.6% and 55.2%), (AVS-CF of MIBI : 48.3% and 36.2%), (AVS-CF of PPN : 48.0% and 39.2%)}.There was a good correlation between EF and AVS-CF of MIBI in all volunteers (r2=0.806, p<0.001). But there were no significant correlations between washout rate and EF of MIBI. There was a good correlation between washout rate and AVS-CF of PPN in all volunteers (r2=0.527, p<0.02). But there were no significant correlations between washout rate and PPN (r2=0.393, N.S.). Conclusion: Our results indicated that myocardial washout rates in female were higher

  15. Myocardial perfusion SPECT for assessment of left ventricular function and volume- comparison with echocardiography

    Objective: The purpose of this study was to evaluate left ventricular volume and function by gated SPECT and comparison of the results with echocardiography. Methods: 65 Consecutive patients (49 male, 16 female; mean age 61+11 years) who underwent both gated 99mTc-MIBI myocardial perfusion SPECT and echocardiography within a 15 days period were included in the study. Exclusion criteria were any change in clinical status between acquisition of the gated SPECT and echocardiography studies, acute myocardial infarction occurring less than 7 days before study, and surgical procedures occurring within 30 days of the study. The clinical diagnosis of each patient was not considered, as this was not relevant to the purpose of the study. The diagnoses were as follows: coronary artery disease (n=46), hypertensive heart disease (n=8), old myocardial infarction (n=5), myocarditis (n=2), and routine medical examination(n=4). A dose of 740 MBq of 99Tcm-sestamibi was administered in resting condition. Gated SPECT images were obtained with ADAC Vertex MCD-AC SPECT system. The raw projection images were reconstructed with filtered back-projection (ramp filter), without attenuation correction. The data, including left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), end-systolic volume (ESV) were obtained using AUTOQUANT software (ADAC corporation). The echocardiography study used its standard techniques. Two nuclear medicine physicians processed the raw images respectively to evaluate internal reproducibility of gated SPECT. In order to compare the results of gated SPECT with echocardiography on different left ventricular volumes, all patients were divided into two groups (EDV90 ml, n=34) based by EDV measurements in echocardiography. Results: The correlation coefficient of LVEF, EDV, ESV between SPECT and echocardiography were 0.77, 0.86 and 0.90 respectively. P0.07). The reproducibility of gated SPECT was excellent. There were no significant differences in LVEF(59

  16. Interobserver Reproducibility of Segmental Scoring of 99mTc-MIBI Myocardial SPECT

    The accuracy of dipyridamole stress/rest 99mTc-MIBI myocardial imaging for detection of ischemia depends on reproducible image interpretation. To evaluate the reproducibility of visual assessment, agreement in interpretation among two independent observers, blinded to clinical data, was evaluated in SPECT images of 131 patients (94 males, 38 females, mean age 58 ±7 yr) with suspected coronary artery disease who underwent both dipyridamole stress/rest 99mTc-MIBI myocardial SPECT and coronary angiography, The left ventricle was divided into twenty-nine segments in stress and rest SPECT images and each segment was visually graded according to a five point scale (segmental score: O=normal, 1 =equivocal, 2=mild decrease, 3=severe decrease and 4=absent uptake). Overall concordance of segmental scoring between the two observers was 80%. The Pear- sons correlation coefficient (r) of the segmental scores for stress and rest images were 0.67 and 0.65, respectively, while the difference in score between the two images showed a correlation of 0.45 (all p<0.001). Agreement between two observers in final SPECT diagnosis as absence or presence of disease was 93%. The degree of agreement in segmental scoring showed no difference between patients with or without agreement as to the presence of disease. Therefore it appeared that cases with inconcordant diagnosis between the 2 observers were mainly due to a difference in individual threshold for interpretating the significance of a particular decreased uptake area rather than to a difference in perceiving the degree of the hypoactivity. Thus, establishment of individual optimum thresholds in visual interpretation of myocardial SPECT may be helpful to improve reproducibility and accuracy of scan diagnosis.

  17. Bull's-eye map of myocardial perfusion MR imaging. Comparison with SPECT

    When diagnosing heart disease, chest roentgenograms, ultrasonography, single-photon emission computed tomography (SPECT), and coronary arteriography are usually performed. Magnetic resonance (MR) imaging is not widely used for evaluating heart disease. Recent technological progress has allowed high quality images of the heart to be reliably obtained. A routine MR study taking about 30-40 minutes can provide a large amount of diagnostic information, such as cardiac structure, function, perfusion, and myocardial viability. The analysis software that can offer Bull's-eye maps from myocardial perfusion images has recently become commercially available. In this study, the characteristics of Bull's-eye mapping of MR imaging is compared with that of Bull's-eye mapping of SPECT using the same heart phantom. The difference in the image quality of the Bull's-eye maps was evaluated among the receiver coils of MR imaging. On Bull's-eye maps from both MR imaging and SPECT, decreased signal intensity was noted in the posterolateral wall. The degree of decrease in the signal of the MR imaging was more prominent than of SPECT. The decrease was severe for the general-purpose receive-only flexible (GPFLEX) coil, moderate for the cardiac and TORSO coil, and slight for the body coil. In the selection of a coil, it is necessary to take into consideration the trade-off between the distribution of signal intensity and the signal-to-noise ratio (SNR). (author)

  18. Evaluation of coronary artery disease by exercise Tc-99m sestamibi myocardial SPECT

    Aim: The role and utility of exercise Tc-99m sestamibi myocardial SPECT in the detection and assessment of coronary artery disease. Material and Methods: 29 patients (24 males and 5 females, with a mean age of 54 years) with suspected coronary artery disease were studied. All patients had a coronary angiography prior to the radionuclide study. Eighteen patients had previous history of myocardial infarction. All underwent exercise Tc-99m sestamibi myocardial SPECT by same day stress and rest Tc-99m sestamibi protocol. Eight mCi of Tc99m MIBI was injected intravenously at peak exercise and 25mCi for rest. Imaging in all patients was done using Dual Headed SPECT Gamma Camera (Millennium VG), 64 x 64 matrix, 3o/view, and 20s/frame, 180 deg. rotation RAO to LPO. Segmental myocardial uptake defects were compared with diseased vessels as shown in angiography. Results: The overall sensitivities of exercise Tc-99m sestamibi myocardial SPECT for the detection of 50-70% and > 70% stenoses were 88% and 91,3% respectively. The specificity for lesion between 50-70% was 100%, and it was 83.3% for lesion with >70% stenosis. The sensitivity rates for the diagnosis of stenosis in left anterior descending coronary artery, left circumflex, and right coronary artery based on defect in at least one of the segments corresponding to one of the diseased vessels were 75.3%; 80% and 76.5% for lesion showing 50-70% stenoses, and 80%, 85.7% and 86.7% for lesions with >70% stenoses respectively. The corresponding specificity rates for detection of 50-70% stenoses were 60%, 71.4% and 91.7% respectively, and for detection of >70% stenoses were 55.6%; 73.3% and 92.9% respectively. Conclusion: Exercise Tc-99m estamibi myocardial SPECT is useful in the evaluation of significant coronary artery disease, in predicting prognosis and in the evaluation of patients with suspected coronary artery disease. (This study was conducted as a part of International Atomic Energy Agency's fellowship program in

  19. The accuracy of myocardial perfusion SPECT imaging in the evaluation of coronary artery disease in women and men

    The purpose of this study is to compare sensitivity, specificity and accuracy of myocardial perfusion SPECT for the detection of coronary artery disease (CAD) in women and men. 588 patients (455 males and 133 females, 273 after a previous myocardial infarction) underwent stress myocardial perfusion SPECT. The accuracy of myocardial perfusion SPECT was proved by coronary angiography (stenosis >50% was considered as a CAD). The sensitivity of SPECT was slightly higher, but statistically not significant, in men than in women (94% versus 91%, p > 0.05). The specificity was higher in women than in men (93% versus 82%), but this difference was not statistically significant either (p > 0.05). The accuracy of SPECT was the same for both sexes (92%). In angiographically verified group of patients the selection bias was obvious - patients with CAD dominated (74%) and the fraction of patients with CAD in men's group (83%) was significantly higher than in women's group (50%), p < 0.05. No significant difference was revealed in the accuracy of myocardial perfusion SPECT in men and women. Our results are in accordance with the prevailing opinion in literature that discovered differences in sensitivity, specificity and diagnostic accuracy are usually not statistically significant or that they can be explained by the selection bias of patients in angiographically verified groups (significantly higher fraction of patients with CAD in men's group). (author)

  20. Diagnosis of silent myocardial ischemia in type 2 diabetic patients by electrocardiogram, ergometry and Gated-SPECT

    31 asymptomatic type 2 diabetic patients were studied by lab tests, electrocardiogram, ergometry, Gated-SPECT and coronariography to determine the relation between the atherosclerotic risk factors and the silent myocardial ischemia. Patients were classified into two groups: positive SPECT and negative SPECT. Association tests were made for each variable and ROC curves were constructed to identify risk markers. In 35.5% of the patients silent myocardial ischemia was detected with a good angiographic correlation. A significant association was evidenced between positive SPECT and the atherosclerotic risk factors, namely, low values of HDLc, family pathological history of ischemic heart disease and peripheral vascular disease. The logistic regression models showed that low values of HDLc together with family pathological history of ischemic heart disease may be strong predictors of silent myocardial ischemia in asymptomatic type 2 diabetic patients

  1. Gender difference of accuracy in detecting coronary artery disease by myocardial perfusion SPECT

    Myocardial SPECT is an effective test for detecting coronary artery disease in the general population. But the diagnostic accuracy between sexes is not defined. The purpose of this study is to compare the diagnostic accuracy between males and females. One hundred and seventy seven male and 98 female patients who underwent myocardial SPECT within 1 month of coronary angiography were studied. Myocardial SPECTs were considered abnormal if fixed or reversible perfusion defects were detected. Stenosis severity of ≥ 50% luminal diameter reduction of any artery defined coronary artery disease (CAD). Overall sensitivity for detection of CAD was 98% in men and 97% in women (p=not significant). However, specificities, accuracies, and positive predictive values (PPV) in men and women were 49% vs 31% (p<0.05), 81% vs 57% (p<0.01), 78% vs 48% (p<0.01), respectively. Diagnostic accuracies for detection of right coronary artery disease were not different in both sexes, however, accuracies for detection of left anterior descending artery disease and left circumflex artery disease were significantly lower in female (p<0.05). A significant difference of diagnostic accuracy between sexes, especially n LAD and LCx disease, was noted. Artifacts from breast attenuation might be a cause for the lower diagnostic accuracy in female

  2. The usefulness of treatment evaluation of severe heart failure by ECG-gated myocardial SPECT

    Our purpose of study was to investigate the usefulness of treatment evaluation of severe heart failure by Electrocardiogram (ECG)-gated myocardial single photon emission computed tomography (SPECT). We evaluated the cardiac function in the case of severe heart failure by gated SPECT and compared it with the cardiac function obtained by left ventriculography (LVG), echocardiography, cardiac MRI, and B-type natriuretic peptide (BNP) values. We investigated the correlation of ejection fraction (EF), time lag of wall motion between the septal and lateral walls of the left ventricle for cardiac resynchronization therapy (CRT) and wall thickening (WT). We classified the left ventricular (LV) into basal, middle and apical areas for comparison of WT. We investigated the effect of a perfusion defect score in these comparisons. The gated SPECT results were correlated with comparative subjects in EF. The results were correlated with MRI on the middle area of the LV in the comparison of WT. We thought it was possible that there was an effect from a perfusion defect score in a time lag comparison of wall motion. Treatment evaluation of severe heart failure by gated SPECT is useful, because it is able to obtain three-dimensional cardiac function analysis, and it offers objectivity and reproducible quantitative evaluation. At the same time, perfusion SPECT is helpful for CRT and LV-plasty. (author)

  3. Evaluation of cardiomyopathy in Duchenne muscular dystrophy by Tl-201 myocardial SPECT

    Clinical evaluation of Tl-201 myocardial SPECT in patients with cardiomyopathy of Duchenne type progressive muscular dystrophy (DMD) was reported. Cases subjected to study were 14 DMD and 8 normal. Using a rotating gamma camera system (ZLC7500 and Scintipac 70A), SPECT data were collected for 16 minutes (32 angles x 30 sec/angle, 1800). The hypoperfusion areas of the left ventricular muscle were observed in 10 patients (71 %), which was in posterior wall (71 %), inferior wall (57 %), lateral and anterior wall (43 %) in the order of frequency. The hypoperfusion area became wider with age and stage, exept for some patients. It was suggested that myocardial degeneration in DMD started in posterior wall and then spread in other areas. For the purpose of quantitative evaluation of myocardial damage, Tl-201 myocardial uptake ratio (MUR) and left ventricular muscle volume (LVMV) were calculated using the results obtained by phantom studies. MUR and LVMV were higher in DMD than those of normal individuals (3.6 +- 1.0 %: 2.7 +- 0.3 %, p < 0.05, 190.2 +- 67.5 ml: 157.8 +- 21.5 ml, n.s., respectively). (author)

  4. Normal value of functional parameters in gated myocardial perfusion SPECT in patients with low risk of coronary artery disease: emory cardiac tool box program

    Kang, D. Y.; Kim, M. H.; Kim, Y. D.; Kim, D. K. [Donga University College of Medicine, Busan (Korea, Republic of)

    2002-07-01

    Absolute value of the functional data of gated myocardial perfusion SPECT is necessary to determine that individual patient is normal or not. Tc-99m MIBI gated myocardial perfusion SPECT was performed using emory cardiac tool box program. All patients (M:F=15:36, age 64{+-}10 yrs) showed normal myocardial perfusion. The patients with following characteristics were excluded; previous angina or MI, ECG change with Q wave or ST-T change, diabetes mellitus, hypercholesterolemia, typical chest pain and hypertension. In all patients, myocardial mass is 117{+-}23 g in stress gated SPECT, 106{+-}22 g in stress ungated SPECT and 102{+-}21 g in rest ungated SPECT. EDV is 90{+-}28 ml, ESV 26{+-}20 ml, SV 66{+-}21 ml, EF 73{+-}10 % and TID 1.06{+-}0.14. Myocardial mass in rest ungated SPECT is significantly different between men and women (p=0.025). Myocardial mass is significantly different between stress gated SPECT and stress ungated SPECT (p=0.000), and between stress ungated SPECT and rest ungated SPECT (p=0.003). We provide normal value of functional parameters to determine the abnormality of individual patients in patients with low risk of coronary artery disease.

  5. Normal value of functional parameters in gated myocardial perfusion SPECT in patients with low risk of coronary artery disease: emory cardiac tool box program

    Absolute value of the functional data of gated myocardial perfusion SPECT is necessary to determine that individual patient is normal or not. Tc-99m MIBI gated myocardial perfusion SPECT was performed using emory cardiac tool box program. All patients (M:F=15:36, age 64±10 yrs) showed normal myocardial perfusion. The patients with following characteristics were excluded; previous angina or MI, ECG change with Q wave or ST-T change, diabetes mellitus, hypercholesterolemia, typical chest pain and hypertension. In all patients, myocardial mass is 117±23 g in stress gated SPECT, 106±22 g in stress ungated SPECT and 102±21 g in rest ungated SPECT. EDV is 90±28 ml, ESV 26±20 ml, SV 66±21 ml, EF 73±10 % and TID 1.06±0.14. Myocardial mass in rest ungated SPECT is significantly different between men and women (p=0.025). Myocardial mass is significantly different between stress gated SPECT and stress ungated SPECT (p=0.000), and between stress ungated SPECT and rest ungated SPECT (p=0.003). We provide normal value of functional parameters to determine the abnormality of individual patients in patients with low risk of coronary artery disease

  6. 123I-MIBG SPECT shows myocardial denervation after transmyocardial laser revascularisation

    Transmyocardial laser revascularization (TMLR) is an invasive therapy used to treat patients with severe refractory angina pectoris in whom standard treatment is insufficient or not possible. Randomized trials have reported a clear clinical benefit (relief of angina and improvement of Quality of Life (QOL)) of TMLR compared to maximal medical treatment. The post-TMLR clinical improvement has been suggested to be associated with myocardial sympathetic denervation. The aim of the present study was to investigate if TMLR induces myocardial sympathetic denervation. TMLR was performed in 8 patients with refractory angina pectoris. Pre- and post-TMLR myocardial perfusion scintigraphy (99mTc-Tetrofosmin SPECT) and sympathetic innervation (123I-MIBG SPECT) were semi-quantitatively assessed using an 18 segment model and a 5 point scoring system. Pre- and post-TMLR summed perfusion, denervation and difference scores were calculated. In all patients post-TMLR 123I-MIBG SPECT showed decreased uptake: summed denervation score pre-TMLR was 13.4±3.9 vs. 23.9±4.3 post-TMLR (P=0.00002). In 80% of segments the decreased uptake could be related to the TMLR treated area. Pre- and post TMLR myocardial perfusion scintigraphy did not show significant differences. In all patients angina reduced by ≥ 2 classes (NYHA classification) at 3 to 12 months follow up, and QOL significantly improved. Our results indicate that TMLR-induced improvement of angina and QOL can be explained by destruction of nociceptors or cardiac neural pathways, changing the perception of anginal pain

  7. Evaluation of myocardial disorders in patients with dilated cardiomyopathy and left ventricular eccentric hypertrophy; By sup 201 Tl myocardial SPECT

    Yamazaki, Junichi; Ohsawa, Hidefumi; Uchi, Takashi (Toho Univ., Tokyo (Japan). School of Medicine) (and others)

    1992-03-01

    {sup 201}Tl myocardial SPECT was performed in cases of dilated cardiomyopathy and valvular heart disease with left ventricular eccentric hypertrophy, and the two groups were compared from the standpoint of the mechanism of onset of myocardial disorders. Significant coefficients of correlation were seen between the Tl score and LVDd (r=0.792, r=0.785) and Tl score and LVEF (r=-0.634, r=-0.555) in both dilated cardiomyopathy and valvular heart disease. In cases of valvular heart disease, significant correlation coefficients (r=-0.756, r=-0.720) between LVDd and r-WR (relative-washout rate), and Tl score and r-WR were observed, but no such correlation was seen in dilated cardiomyopathy. In valvular heart disease, a decrease in myocardial perfusion associated with enlargement of the left ventricle appeared, while in dilated cardiomyopathy, there was a marked decrease in LVEF in proportion to the thallium defect. Therefore, it was assumed that left ventricular wall disorders occur due to myocardial metabolic disorders and coronary microcirculation disorders. (author).

  8. Interrelation of ST-segment depression during bicycle ergometry and extent of myocardial ischaemia by myocardial perfusion SPECT

    The aim of this study was to compare ST-segment depression (STD) during bicycle ergometry and extent of myocardial ischaemia assessed by myocardial perfusion SPECT (MPS) in a large patient cohort. Consecutive patients (n = 955) referred for MPS with bicycle ergometry and interpretable stress ECG were evaluated with respect to ECG and MPS findings of ischaemia. The maximal STD was recorded and exercise ECG was considered ischaemic if STD was horizontal or downsloping (≥1 mm). MPS was interpreted using a 20-segment model with a scale of 0 to 4. A summed stress (SSS), summed rest (SRS) and summed difference score (SDS = SSS-SRS, e.g. extent of ischaemia) were derived. Ischaemia was defined as an SDS ≥ 2. An exercise-induced STD was present in 215 patients (22%) and myocardial ischaemia on MPS was present in 366 patients (38%). The extent of ST-segment depression and the number of ECG leads with significant STD were each strongly and significantly associated with increasing severity of ischaemia and the number of coronary territories involved (p < 0.01 for all correlations). These data demonstrate a strong correlation between the extent of STD, number of ischaemic leads and severity of myocardial ischaemia as assessed by MPS during bicycle ergometry. (orig.)

  9. Non invasive evaluation of the coronary atherosclerosis illness in patients with silent ischemia: utility of the SPECT of myocardial perfusion. Electric, angiographic and image correlation

    The objective of the work was to determine the utility of the SPECT (Single Photon Emission Computerized Tomography) of myocardial perfusion for the ischemia detection in asymptomatic patients with Coronary Atherosclerosis Illness. It was concluded that the SPECT of myocardial perfusion has a high sensitivity (97%) for the silent ischemia diagnosis

  10. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT

    Verberne, Hein J; Acampa, Wanda; Anagnostopoulos, Constantinos;

    2015-01-01

    Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated ...

  11. Reference Range of Functional Data of Gated Myocardial Perfusion SPECT by Quantitative Gated SPECT of Cedars-Sinai and 4D-MSPECT of Michigan University

    Kang, Do Young; Kim, Moo Hyun; Kim, Young Dae [College of Medicine, Univ. of Donga, Pusan (Korea, Republic of)

    2003-07-01

    Various programs have been developed for gating of myocardial perfusion SPECT. Among the those program, the most popular program is the Quantitative Gated SPECT (QGS)? developed by Cedars-Sinai hospital and most recently released program is 4D-MSPECT? developed by university of Michigan. It is important to know the reference range of the functional data of gated myocardial perfusion SPECT because it is necessary to determine abnormality of individual patient and echocardiographic data is different from those of gated SPECT. Tc-99m MIBI gated myocardial perfusion SPECT image was reconstructed by dual head gamma camera (Siemens, BCAM, esoft) as routine procedure and analyzed using QGS? and 4D-MSPECT? program. All patients (M: F=9: 18, Age 69{+-}9 yrs) showed normal myocardial perfusion. The patients with following characteristics were excluded: previous angina or MI history, ECG change with Q wave or ST-T change, diabetes melitius, hypercholesterolemia, typical chest pain, hypertension and cardiomyopathy. Pre-test likelihood of all patients was low. (1) In stress gated SPECT by QGS?, EDV was 73{+-}25 ml, ESV 25{+-}14 ml, EF 67{+-}11 % and area of first frame of gating 106.4{+-}21cm{sup 2}. In rest gated SPECT, EDV was 76{+-}26 ml, ESV 27{+-}15 ml, EF 66{+-}12 and area of first frame of gating 108{+-}20cm{sup 2}. (2) In stress gated SPECT by 4D-MSPECT?, EDV was 76{+-}28 ml, ESV 23{+-}16 ml, EF 72{+-}11 %, mass 115{+-}24 g and ungated volume 42{+-}15 ml. In rest gated SPECT, EDV was 75{+-}27 ml, ESV 23{+-}12 ml, EF 71{+-}9%, mass 113{+-}25g and ungate dvolume 42{+-}15 ml, (3) s-EDV, s-EF, r-ESV and r-EF were significantly different between QGS? and 4D-MSPECT? (each p=0.016, p<0.001. p=0.003 and p=0.001). We determined the normal reference range of functional parameters by QGS? and 4D-MSPECT? program to diagnose individually the abnormality of patients. And the reference ranges have to adopted to be patients by each specific gating program.

  12. Reference Range of Functional Data of Gated Myocardial Perfusion SPECT by Quantitative Gated SPECT of Cedars-Sinai and 4D-MSPECT of Michigan University

    Various programs have been developed for gating of myocardial perfusion SPECT. Among the those program, the most popular program is the Quantitative Gated SPECT (QGS)? developed by Cedars-Sinai hospital and most recently released program is 4D-MSPECT? developed by university of Michigan. It is important to know the reference range of the functional data of gated myocardial perfusion SPECT because it is necessary to determine abnormality of individual patient and echocardiographic data is different from those of gated SPECT. Tc-99m MIBI gated myocardial perfusion SPECT image was reconstructed by dual head gamma camera (Siemens, BCAM, esoft) as routine procedure and analyzed using QGS? and 4D-MSPECT? program. All patients (M: F=9: 18, Age 69±9 yrs) showed normal myocardial perfusion. The patients with following characteristics were excluded: previous angina or MI history, ECG change with Q wave or ST-T change, diabetes melitius, hypercholesterolemia, typical chest pain, hypertension and cardiomyopathy. Pre-test likelihood of all patients was low. (1) In stress gated SPECT by QGS?, EDV was 73±25 ml, ESV 25±14 ml, EF 67±11 % and area of first frame of gating 106.4±21cm2. In rest gated SPECT, EDV was 76±26 ml, ESV 27±15 ml, EF 66±12 and area of first frame of gating 108±20cm2. (2) In stress gated SPECT by 4D-MSPECT?, EDV was 76±28 ml, ESV 23±16 ml, EF 72±11 %, mass 115±24 g and ungated volume 42±15 ml. In rest gated SPECT, EDV was 75±27 ml, ESV 23±12 ml, EF 71±9%, mass 113±25g and ungate dvolume 42±15 ml, (3) s-EDV, s-EF, r-ESV and r-EF were significantly different between QGS? and 4D-MSPECT? (each p=0.016, p<0.001. p=0.003 and p=0.001). We determined the normal reference range of functional parameters by QGS? and 4D-MSPECT? program to diagnose individually the abnormality of patients. And the reference ranges have to adopted to be patients by each specific gating program

  13. Myocardial perfusion imaging using SPECT/CT and PET/CT

    With technical progress coronary CT angiography is increasingly accepted as a noninvasive alternative in morphological imaging. However, image quality and interpretation are still influenced by various factors like blooming artifacts, misregistration and the experience of the interpreter. The combination with stress-rest myocardial perfusion SPECT or PET as a hybrid scanner or two standalone scanners enables comprehensive noninvasive anatomical and functional imaging of the heart as well as three dimensional image fusion. Hybrid-imaging is feasible with today's commercially available software packages but still requires time demanding manual intervention and experienced interpretation. PET investigations, either in replacement of SPECT for perfusion measurements, or in addition with new biomarkers will provide even more impact to hybrid imaging in future. (orig.)

  14. Prognostic value of normal stress-only myocardial perfusion imaging: a comparison between conventional and CZT-based SPECT

    Yokota, Shu; Ottervanger, Jan Paul; Timmer, Jorik R. [Isala Hospital, Department of Cardiology, Zwolle (Netherlands); Mouden, Mohamed; Engbers, Elsemiek [Isala Hospital, Department of Cardiology, Zwolle (Netherlands); Isala Hospital, Department of Nuclear Medicine, Zwolle (Netherlands); Knollema, Siert; Jager, Pieter L. [Isala Hospital, Department of Nuclear Medicine, Zwolle (Netherlands)

    2016-02-15

    Single photon emission computed tomography (SPECT) myocardial perfusion imaging has proven to have prognostic importance in patients with suspected stable coronary artery disease (CAD). The recently introduced ultrafast cadmium zinc telluride (CZT)-based gamma cameras have been associated with less equivocal findings and more normal interpretations, allowing stress-only imaging to be performed more often. However, it is yet unclear whether normal stress-only CZT SPECT has comparable prognostic value as normally interpreted stress-only conventional SPECT. The study population consisted of 1,650 consecutive patients without known CAD with normal stress-only myocardial perfusion results with either conventional (n = 362) or CZT SPECT (n = 1,288). The incidence of major adverse cardiac events (MACE, all-cause death, non-fatal myocardial infarction and/or coronary revascularization) was compared between the conventional SPECT and CZT SPECT groups. Multivariable analyses using the Cox model were used to adjust for differences in baseline variables. Patients scanned with CZT were less often male (33 vs 39 %), had less often hypercholesterolaemia (41 vs 50 %) and had more often a family history of CAD (57 vs 49 %). At a median follow-up time of 37 months (interquartile range 28-45 months) MACE occurred in 68 patients. The incidence of MACE was 1.5 %/year in the CZT group, compared to 2.0 %/year in the conventional group (p = 0.08). After multivariate analyses, there was a trend to a lower incidence of MACE in the CZT SPECT group (hazard ratio 0.61, 95 % confidence interval 0.35-1.04, p = 0.07). The prognostic value of normal stress-only CZT SPECT is at least comparable and may be even better than that of normal conventional stress SPECT. (orig.)

  15. Prognostic value of normal stress-only myocardial perfusion imaging: a comparison between conventional and CZT-based SPECT

    Single photon emission computed tomography (SPECT) myocardial perfusion imaging has proven to have prognostic importance in patients with suspected stable coronary artery disease (CAD). The recently introduced ultrafast cadmium zinc telluride (CZT)-based gamma cameras have been associated with less equivocal findings and more normal interpretations, allowing stress-only imaging to be performed more often. However, it is yet unclear whether normal stress-only CZT SPECT has comparable prognostic value as normally interpreted stress-only conventional SPECT. The study population consisted of 1,650 consecutive patients without known CAD with normal stress-only myocardial perfusion results with either conventional (n = 362) or CZT SPECT (n = 1,288). The incidence of major adverse cardiac events (MACE, all-cause death, non-fatal myocardial infarction and/or coronary revascularization) was compared between the conventional SPECT and CZT SPECT groups. Multivariable analyses using the Cox model were used to adjust for differences in baseline variables. Patients scanned with CZT were less often male (33 vs 39 %), had less often hypercholesterolaemia (41 vs 50 %) and had more often a family history of CAD (57 vs 49 %). At a median follow-up time of 37 months (interquartile range 28-45 months) MACE occurred in 68 patients. The incidence of MACE was 1.5 %/year in the CZT group, compared to 2.0 %/year in the conventional group (p = 0.08). After multivariate analyses, there was a trend to a lower incidence of MACE in the CZT SPECT group (hazard ratio 0.61, 95 % confidence interval 0.35-1.04, p = 0.07). The prognostic value of normal stress-only CZT SPECT is at least comparable and may be even better than that of normal conventional stress SPECT. (orig.)

  16. Tests of scanning model observers for myocardial SPECT imaging

    Gifford, H. C.; Pretorius, P. H.; Brankov, J. G.

    2009-02-01

    Many researchers have tested and applied human-model observers as part of their evaluations of reconstruction methods for SPECT perfusion imaging. However, these model observers have generally been limited to signal-known- exactly (SKE) detection tasks. Our objective is to formulate and test scanning model observers that emulate humans in detection-localization tasks involving perfusion defects. Herein, we compare several models based on the channelized nonprewhitening (CNPW) observer. Simulated Tc-99m images of the heart with and without defects were created using a mathematical anthropomorphic phantom. Reconstructions were performed with an iterative algorithm and postsmoothed with a 3D Gaussian filter. Human and model-observer studies were conducted to assess the optimal number of iterations and the smoothing level of the filter. The human-observer study was a multiple-alternative forced-choice (MAFC) study with five defects. The CNPW observer performed the MAFC study, but also performed an SKE-but-variable (SKEV) study and a localization ROC (LROC) study. A separate LROC study applied an observer based on models of human search in mammograms. The amount of prior knowledge about the possible defects differed for these four model-observer studies. The trend was towards improved agreement with the human observers as prior knowledge decreased.

  17. Usefulness of I-123 MIBG myocardial SPECT in patients with dilated cardiomyopathy for predicting cardiac events

    We evaluated cardiac sympathetic nerve activity in patients with dilated cardiomyopathy (DCMP) using I-123 metaiodobenzylguanidine (MIBG) myocardial SPECT, and tried to find variables to predict disease progression (DP). MIBG SPECT was performed in 17 patients (M:F = 11:6, age 63.9±11.1 years) with DCMP (idiopathic = 14, ischemic = 2 and other = 1). At 15 min and 4 hs after IV injection of I-123 MIBG (5 mCi), planar and SPECT images were acquired. Using planar images, heart to mediastinum (H/M) ratios, and washout rate (WR) 100 x [ (H-M)15min (H-M)4hr]/(H-M) 15min were calculated with ROIs drawn for heart contour and mediastinum (7x7 pixels). Using SPECT images, total uptake score (TUS) was defined as sum of 17 myocardial segments using 3-point scale. Using M-mode echocardiography, LV ejection fraction (LVEF) was calculated as follows: (LVDd2-LVDs2)/LVDd2. The decline of EF more than 5%, or hospitalization due to dyspnea aggravation was defined as DP. All the patients were observed for 339±106 days. During follow up periods, no mortality cases were observed but 2 cases suffered from EF decline, 2 hospitalization and 1 both EF decline and hospitalization. However Cox proportion hazard regression analysis did not identify significant parameter for DP among H/M ratio, WR, TUS, and deltaTUS. Patients could be divided into 2 groups based on WR, the known prognostic marker. The high WR patients (more than 50%, n=9) had significantly lower H/M ratio (1.55±0.27 versus 2.01±0.32 p<0.01) and significantly lower TUS4hr (12.1±13.9 versus 32.7±11.4, p<0.01) than low WR patients (less than 50%, n=8). WR and TUS4hr showed negative correlation (rho=-0.705, p<0.01). MIBG SPECT was applied to DCMP patients for evaluation of DP. Longer follow up period of more than 1 year seems to be essential for prognosis evaluation. In addition to WR, TUS obtained at 4 hour MIBG SPECT may be used as a useful marker of DCMP

  18. Cost-effectiveness of exercise 201Tl myocardial SPECT in patients with chest pain assessed by decision-tree analysis

    To evaluate the potential cost-effectiveness of exercise 201Tl myocardial SPECT in outpatients with angina-like chest pain, we developed a decision-tree model which comprises three 1000-patients groups, i.e., a coronary arteriography (CAG) group, a follow-up group, and a SPECT group, and total cost and cardiac events, including cardiac deaths, were calculated. Variables used for the decision-tree analysis were obtained from references and the data available at out hospital. The sensitivity and specificity of 201Tl SPECT for diagnosing angina pectoris, and its prevalence were assumed to be 95%, 85%, and 33%, respectively. The mean costs were 84.9 x 104 yen/patient in the CAG group, 30.2 x 104 yen/patient in the follow-up group, and 71.0 x 104 yen/patient in the SPECT group. The numbers of cardiac events and cardiac deaths were 56 and 15, respectively in the CAG group, 264 and 81 in the follow-up group, and 65 and 17 in the SPECT group. SPECT increases cardiac events and cardiac deaths by 0.9% and 0.2%, but it reduces the number of CAG studies by 50.3%, and saves 13.8 x 104 yen/patient, as compared to the CAG group. In conclusion, the exercise 201Tl myocardial SPECT strategy for patients with chest pain has the potential to reduce health care costs in Japan. (author)

  19. Impact of injection dose, post-reconstruction filtering, and collimator choice on image quality of myocardial perfusion SPECT using cadmium-zinc telluride detectors in the rat

    Mizutani, Asuka; Matsunari, Ichiro; Kobayashi, Masato; Nishi, Kodai; Fujita, Wataru; Miyazaki, Yoshiharu; Nekolla, Stephan G; Kawai, Keiichi

    2015-01-01

    Background The aims of this study were (1) to evaluate the impact of injection dose, post-reconstruction filtering, and collimator choice on image quality of myocardial perfusion single-photon emission computed tomography (SPECT) using cadmium-zinc telluride (CZT) detectors and (2) to determine how these factors affect measured infarct size in the in vivo rat. Methods Twenty-four healthy and eight myocardial infarct (MI) rats underwent myocardial perfusion SPECT imaging after injection of var...

  20. Prognostic value of gated SPECT myocardial perfusion imaging in patients with coronary artery disease

    213 patients with known or suspected CAD whom underwent gated SPECT myocardial perfusion imaging (MPI) in Department of Nuclear Medicine, 108 Central Military Hospital. Mean follow-up time was 14.6 ± 6.6 months. Patients with reversible defect and mixed defect had higher rate of cardiac events (43.4%) and revascularization (34.9%) than those with fixed defect (18.4% and 10.2%), respectively (p < 0.01; OR 3.4 - 4.7). The severity of myocardial perfusion defects was significantly correlated to wall motion, left ventricular function and cardiac events as well. Patients with WMS ≥ 2 and EF less than 40% had higher risk and heart failure, cardiac death rate than those with WMS <2 and EF < 40% (p < 0.05). Conclusions: In patients with known or suspected CAD, the characteristics of MPI are of high value in CAD prognosis. (author)

  1. The value of serial 99mTc-MIBI myocardial SPECT imaging in animal models of acute myocardial ischemia and reperfusion

    The purpose is to evaluate acute ischemia and reperfusion in canine models by serial 99mTc-MIBI myocardial SPECT studies. In 24 dogs, myocardial ischemia was induced by dilated balloon inserted in LAD or LCX, followed by reperfusion at 1h (Group I), 4h (Group II) later, and permanent ischemia by copper coil (Group III). The first and second imaging was taken after ischemia and after reperfusion. The 3rd, 4th and 5th SPECT were at 7, 14 and 28 days later. Defect fraction (DF), and ischemic fraction (IF) was obtained from the Bull's-eye images. The first DFs in all 3 groups correlated well with the myocardium at risk (IF) measured by pathological study. DF in group I decreased consistently since the second SPECT, in Group II DF had some decrease, while in Group III no decrease of DF was measured. The SF in all animals showed the same trend. The last DF was correlated with the real size of infarct foci (NF) determined by TTC staining by pathological study. 99mTc-MIBI SPECT was sensitive and accurate in revealing myocardial damage after acute ischemia and its response to reperfusion. The first (before), second (right after), and the last SPECT (4 weeks after reperfusion) were the most informative and clinically useful

  2. Impact of a new ultrafast CZT SPECT camera for myocardial perfusion imaging: fewer equivocal results and lower radiation dose

    Mouden, Mohamed [Isala Klinieken, Department of Cardiology, Zwolle (Netherlands); Isala Klinieken, Department of Nuclear Medicine, Zwolle (Netherlands); Timmer, Jorik R.; Ottervanger, Jan Paul [Isala Klinieken, Department of Cardiology, Zwolle (Netherlands); Reiffers, Stoffer; Oostdijk, Ad H.J.; Knollema, Siert; Jager, Pieter L. [Isala Klinieken, Department of Nuclear Medicine, Zwolle (Netherlands)

    2012-06-15

    The new ultrafast cardiac single photon emission computed tomography (SPECT) cameras with cadmium-zinc-telluride (CZT)-based detectors are faster and produce higher quality images as compared to conventional SPECT cameras. We assessed the need for additional imaging, total imaging time, tracer dose and 1-year outcome between patients scanned with the CZT camera and a conventional SPECT camera. A total of 456 consecutive stable patients without known coronary artery disease underwent myocardial perfusion imaging on a hybrid SPECT/CT (64-slice) scanner using either conventional (n = 225) or CZT SPECT (n = 231). All patients started with low-dose stress imaging, combined with coronary calcium scoring. Rest imaging was only done when initial stress SPECT testing was equivocal or abnormal. Coronary CT angiography was subsequently performed in cases of ischaemic or equivocal SPECT findings. Furthermore, 1-year clinical follow-up was obtained with regard to coronary revascularization, nonfatal myocardial infarction or death. Baseline characteristics were comparable between the two groups. With the CZT camera, the need for rest imaging (35 vs 56%, p < 0.001) and additional coronary CT angiography (20 vs 28%, p = 0.025) was significantly lower as compared with the conventional camera. This resulted in a lower mean total administered isotope dose per patient (658 {+-} 390 vs 840 {+-} 421 MBq, p < 0.001) and shorter imaging time (6.39 {+-} 1.91 vs 20.40 {+-} 7.46 min, p < 0.001) with the CZT camera. After 1 year, clinical outcome was comparable between the two groups. As compared to images on a conventional SPECT camera, stress myocardial perfusion images acquired on a CZT camera are more frequently interpreted as normal with identical clinical outcome after 1-year follow-up. This lowers the need for additional testing, results in lower mean radiation dose and shortens imaging time. (orig.)

  3. Impact of a new ultrafast CZT SPECT camera for myocardial perfusion imaging: fewer equivocal results and lower radiation dose

    The new ultrafast cardiac single photon emission computed tomography (SPECT) cameras with cadmium-zinc-telluride (CZT)-based detectors are faster and produce higher quality images as compared to conventional SPECT cameras. We assessed the need for additional imaging, total imaging time, tracer dose and 1-year outcome between patients scanned with the CZT camera and a conventional SPECT camera. A total of 456 consecutive stable patients without known coronary artery disease underwent myocardial perfusion imaging on a hybrid SPECT/CT (64-slice) scanner using either conventional (n = 225) or CZT SPECT (n = 231). All patients started with low-dose stress imaging, combined with coronary calcium scoring. Rest imaging was only done when initial stress SPECT testing was equivocal or abnormal. Coronary CT angiography was subsequently performed in cases of ischaemic or equivocal SPECT findings. Furthermore, 1-year clinical follow-up was obtained with regard to coronary revascularization, nonfatal myocardial infarction or death. Baseline characteristics were comparable between the two groups. With the CZT camera, the need for rest imaging (35 vs 56%, p < 0.001) and additional coronary CT angiography (20 vs 28%, p = 0.025) was significantly lower as compared with the conventional camera. This resulted in a lower mean total administered isotope dose per patient (658 ± 390 vs 840 ± 421 MBq, p < 0.001) and shorter imaging time (6.39 ± 1.91 vs 20.40 ± 7.46 min, p < 0.001) with the CZT camera. After 1 year, clinical outcome was comparable between the two groups. As compared to images on a conventional SPECT camera, stress myocardial perfusion images acquired on a CZT camera are more frequently interpreted as normal with identical clinical outcome after 1-year follow-up. This lowers the need for additional testing, results in lower mean radiation dose and shortens imaging time. (orig.)

  4. Diagnosis of acute myocardial infarction using dual SPECT (99mTc PYP and 201Tl Cl) method

    We investigated the usefulness of the dual SPECT method with the Tc-99m and Tl-201 in comparison with the conventional Tc-99m planar method. Myocardial scintigraphy was performed in 57 patients with acute myocardial infarction; 30 were assessed by the conventional planar method and 27 by the dual SPECT method. The accumulation ratio of Tc-99m (%Tc) by the dual SPECT method was calculated from the coronal image and was compared with the serum values of total CPK, peak CPK, total CPK-MB, and peak CPK-MB obtained from serial sampling and the LVEF obtained by a left ventriculography a month later. The sensitivity for diagnosis of myocardial infarction was 73.3% by the planar method and 88.9% by the dual SPECT method. The infarct sites were identified in 61.5% of the antero-septal lesion, in 35.7% of the infero-posterior lesion and in 66.7% of the lateral lesion using the planar method, while using the dual SPECT method were 100% identification for both antero-septal and lateral lesions, and 75% for the infero-posterior lesion. The highest correlation, with a rate of 0.854, was between the %Tc and the total CPK. The %Tc also showed a positive correlation with peak CPK (r=0.798), with total CPK-MB (r=0.792) and with peak CPK-MB (r=0.751) (p<0.01). The LVEF had a tendency to decrease as %Tc exceeded 30%. The dual SPECT method was superior to the conventional planar method in detecting, in identifying the site and in evaluating the size of myocardial infarction. It also showed a high correlation between the %Tc and the LVEF at chronic stage of myocardial infarction. (author)

  5. Parameters for discriminating multiple-vessel coronary artery lesion in exercise 201Tl myocardial SPECT

    This study was performed to select parameters most suitable for discriminating multiple-vessel lesion in exercise 201Tl SPECT. Exercise 201Tl SPECT and coronary contrasting were carried out in 110 patients. At 1 min before the end (appearance of heart pain, severe arrhythmia, hypotension or fatigue) of exercise with a bicycle ergometer, 4 mCi of 201Tl was intravenously injected and myocardial SPECT was done with gamma camera from 32 directions for 20 sec at 5 min and 4 hr after the exercise. Images were analyzed by scaring the uptake of 201Tl for left ventricle. Parameters were Initial score of Tl uptake, Score difference of Tl uptake, Lung/heart, Initial width, Width difference, Diffuse slow washout, Cavity/myocardium, Lung/myocardium and Lung/cavity. Parameters versus Number of diseased vessels were analyzed by chi square method or ANOVA and the parameters for the present purpose were selected by stepwise discriminant analysis. Lung/heart and Initial score were found most suitable. (K.H.)

  6. Effect of respiratory motion on quantitative myocardial gated SPECT. A simulation study

    Respiratory motion is a potential cause of artefact and downgrading the quality of electrocardiogram (ECG)-gated single photon emission computed tomography (SPECT) images that may result in clinical misinterpretation. We studied qualitatively the effects of respiratory motion on gated SPECT myocardial perfusion and function using Monte Carlo simulated data. NURBS-based Cardiac Torso (NCAT) phantom was used to model a human torso. The cardiac and respiratory cycles of torso were 1 and 5 s, respectively. Eight realizations of the phantom, having diaphragmatic motion amplitudes of 0-7 cm were generated. SimSET Monte Carol simulator was used to image the phantom and generate gated studies of 16 frames per cardiac cycle. Our results demonstrated the underestimation of left ventricle end-diastolic, end-systolic, stroke volumes and ejection fraction and overestimation of wall motion and wall thickening (p<0.01). In addition, the mean percentage of count in the basal-inferior, mid-inferior, apical-inferior, basal-septal and mid-septal segments were significantly lower due to respiratory motion when compared with control (p<0.01). The changes in uptake were not significant in the apex, antroapical, apicoseptal, apicolateral, mid-anterior, basal-anterior, mid-lateral and basal-lateral segments. Respiratory motion has significant effect on the calculation of the left ventricular functional and regional myocardial perfusion in the GSPECT. The amount of deterioration and quality distortion of the images depends on the amplitude of the diaphragmatic motion. (author)

  7. Assessment of 201Tl myocardial SPECT reinjected at 24 hours after stress imaging

    To improve the quality of 24 hours delayed images (24 DL) of stress thallium-201 myocardial SPECT, reinjection was performed at 24 hours later (24 RI), and the results were compared with those of 24 DL. A total of 45 patients were studied, including 18 patients in 24 DL, 27 patients in 24 RI. All of them showed persistent defect or incomplete redistribution on the routine stress and 3 hours delayed SPECT scans. In 24 RI, 37 MBq of thallium-201 was reinjected at 24 hours later. Myocardial count of 24 DL was about 1/4 of stress image, while 24 RI was about 1/2. Quality of 24 RI image was nearly equal to 3 hours delayed image. Of regions without redistribution on 3 hours delayed image, 5 (36%) regions showed new redistribution at 24 RI. Of regions incomplete redistribution, 6 (25%) regions showed further redistribution. Compared with 24 DL, the frequency of redistribution tended to be higher in this protocol than that of the 24 DL (11%, 17% respectively). In conclusion, the reinjection on 24 hours delayed imaging was considered to be useful to evaluate viability of myocardium in patients with CAD. (author)

  8. Cost-effectiveness of myocardial perfusion SPECT for diagnosis of coronary artery disease in Korea: comparison with exercise ECG and coronary angiography

    Cost-effectiveness of myocardial SPECT for the diagnosis of coronary artery disease was investigated considering the present and amended costs of myocardial SPECT and exercise ECG in Korea. Four diagnostic tactics such as 1) coronary angiography (CAG) after exercise ECG, 2) CAG after myocardial SPECT, 3) direct CAG, and 4) CAG after myocardial SPECT following exercise ECG were chosen. Costs were calculated using the present costs of various tests and effects represented by Quality Adjusted Life Year (QALY) were estimated. Difference of QALY (ΔQALY) was calculated by subtracting QALY of diagnosed/treated cases from QALY of undiagnosed cases. Cost/ΔQALY was calculated and compared between four different tactics according to pre-test probability. When pre-test probability was equal to or larger than 0.6, direct CAG was the most cost-effective. When pre-test probability was between 0.2 and 0.6, CAG after myocardial SPECT following exercise ECG was the most cost-effective. CAG after myocardial SPECT was the second most cost-effective. Cost-effectiveness was similar when the costs of exercise ECG were doubled or quadrupled. CAG after exercise ECG was always the least cost-effective. Myocardial SPECT with or without preceding exercise ECG was the most cost-effective method to diagnose coronary artery disease in the present or expected amended cost system

  9. Quantitative evaluation of right ventricular overload in cor pulmonale using 201Tl myocardial SPECT

    To determine quantitatively the discriminant and characteristics of cor pulmonale, 201Tl myocardial perfusion SPECT was performed in 16 patients with chronic obstructive pulmonary disease (COPD) and 7 with restrictive pulmonary disease (RPD). One section of the short-axis SPECT image in which the right ventricle was most clearly visualized was selected. Tl-score was defined as the ratio of the sum of counts in the region of interest (ROI) at the anterior, mid, and posterior regions of the right ventricular free wall to the sum of counts in ROI at the posterior, lateral, and anterior walls of the left ventricle, and the anterior and posterior regions of the interventricular septum. In the group of COPD patients, Tl-score was positively correlated with mean pulmonary arterial pressure (mPAP), total pulmonary vascular resistance (TPR), and arterial carbon dioxide tension (PaCO2), while it was inversely correlated with arterial oxygen tension (PaO2). However, there was no significant correlation between Tl-score and mPAP, TPR, PaCO2, and PaO2 in the group of RPD patients. In assessing pulmonary hypertension as defined by mPAP over 20 mmHg, a Tl-score greater than 0.25 was useful with a sensitivity of 69% and a specificity of 90%. The occurrence of cor pulmonale is a major factor in determining the prognosis of COPD patients. It was concluded that 201Tl myocardial SPECT is useful for evaluating right ventricular overload quantitatively, as well as for assessing core pulmonale, especially in COPD patients, since the ratio of Tl counts in the right and left ventricles was significantly correlated with right cardiopulmonary hemodynamic parameters. (N.K.)

  10. Quantitation of myocardial blood flow and myocardial flow reserve with {sup 99m}Tc-sestamibi dynamic SPECT/CT to enhance detection of coronary artery disease

    Hsu, Bailing [University of Missouri-Columbia, Nuclear Science and Engineering Institute, Columbia, MO (United States); Chen, Fu-Chung; Chen, Chien-Cheng [Show Chwan Memorial Hospital, Section of Cardiology, Department of Internal Medicine, Changhua (China); Wu, Tao-Cheng [Taipei Veterans General Hospital, Section of Cardiology, Department of Internal Medicine, Taipei (China); Huang, Wen-Sheng [Changhua Christian Hospital, Department of Medical Research and Department of Nuclear Medicine, Changhua (China); Hou, Po-Nien [Chang Bing Show Chwan Memorial Hospital, Department of Nuclear Medicine, Lukong Town, Changhua Shien (China); Hung, Guang-Uei [Chang Bing Show Chwan Memorial Hospital, Department of Nuclear Medicine, Lukong Town, Changhua Shien (China); Central Taiwan University of Science and Technology, Department of Medical Imaging and Radiological Science, Taichung (China); China Medical University, Department of Biomedical Imaging and Radiological Science, Taichung (China)

    2014-12-15

    Conventional dual-head single photon emission computed tomography (SPECT)/CT systems capable of fast dynamic SPECT (DySPECT) imaging have a potential for flow quantitation. This study introduced a new method to quantify myocardial blood flow (MBF) and myocardial flow reserve (MFR) with DySPECT scan and evaluated the diagnostic performance of detecting coronary artery disease (CAD) compared with perfusion using invasive coronary angiography (CAG) as the reference standard. This study included 21 patients with suspected or known CAD who had received DySPECT, ECG-gated SPECT (GSPECT), and CAG (13 with ≥50 % stenosis in any vessel; non-CAD group: 8 with patent arteries or <50 % stenosis). DySPECT and GSPECT scans were performed on a widely used dual-head SPECT/CT scanner. The DySPECT imaging protocol utilized 12-min multiple back-and-forth gantry rotations during injections of {sup 99m}Tc-sestamibi (MIBI) tracer at rest or dipyridamole-stress stages. DySPECT images were reconstructed with full physical corrections and converted to the physical unit of becquerels per milliliter. Stress MBF (SMBF), rest MBF (RMBF), and MFR were quantified by a one-tissue compartment flow model using time-activity curves derived from DySPECT images. Perfusion images were processed for GSPECT scan and interpreted to obtain summed stress score (SSS) and summed difference score (SDS). Receiver-operating characteristic (ROC) analyses were conducted to evaluate the diagnostic performance of flow and perfusion. Using the criteria of ≥50 % stenosis as positive CAD, areas under the ROC curve (AUCs) of flow assessment were overall significantly greater than those of perfusion. For patient-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.91 ± 0.07, 0.86 ± 0.09, 0.64 ± 0.12, and 0.59 ± 0.13. For vessel-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.81 ± 0.05, 0.76 ± 0.06, 0.62 ± 0.07, and 0.56 ± 0.08, respectively. The preliminary data suggest that MBF quantitation with a

  11. Tl-201 myocardial SPECT in patients with Duchenne's muscular dystrophy: A long-term follow-up

    Tl-201 SPECT was used to evaluate myocardial involvement in 13 patients with Duchenne's muscular dystrophy. Serial studies of 9 patients were done at two-year intervals. The hypoperfused areas of the left ventricle became more prominent with age and severity

  12. Development of a New Cardiac and Torso Phantom for Verifying the Accuracy of Myocardial Perfusion SPECT

    Corrections of attenuation, scatter and resolution are important in order to improve the accuracy of single photon emission computed tomography (SPECT) image reconstruction. Especially, the heart movement by respiration and beating cause the errors in the corrections. Myocardial phantom is used to verify the correction methods, but there are many different parts in the current phantoms in actual human body. Therefore the results using a phantom are often considered apart from the clinical data. We developed a new phantom that implements the human body structure around the thorax more faithfully. The new phantom has the small mediastinum which can simulate the structure in which the lung adjoins anterior, lateral and apex of myocardium. The container was made of acrylic and water-equivalent material was used for mediastinum. In addition, solidified polyurethane foam in epoxy resin was used for lung. Five different sizes of myocardium were developed for the quantitative gated SPECT (QGS). The septa of all different cardiac phantoms were designed so that they can be located at the same position. The proposed phantom was attached with liver and gallbladder, the adjustment was respectively possible for the height of them. The volumes of five cardiac ventricles were 150.0, 137.3, 83.1, 42.7 and 38.6 ml respectively. The SPECT were performed for the new phantom, and the differences between the images were examined after the correction methods were applied. The three-dimensional tomography of myocardium was well reconstructed, and the subjective evaluations were done to show the difference among the various corrections. We developed the new cardiac and torso phantom, and the difference of various corrections was shown on SPECT images and QGS results.

  13. New reconstruction algorithm allows shortened acquisition time for myocardial perfusion SPECT

    Shortening scan time and/or reducing radiation dose at maintained image quality are the main issues of the current research in radionuclide myocardial perfusion imaging (MPI). We aimed to validate a new iterative reconstruction (IR) algorithm for SPECT MPI allowing shortened acquisition time (HALF time) while maintaining image quality vs. standard full time acquisition (FULL time). In this study, 50 patients, referred for evaluation of known or suspected coronary artery disease by SPECT MPI using 99mTc-Tetrofosmin, underwent 1-day adenosine stress 300 MBq/rest 900 MBq protocol with standard (stress 15 min/rest 15 min FULL time) immediately followed by short emission scan (stress 9 min/rest 7 min HALF time) on a Ventri SPECT camera (GE Healthcare). FULL time scans were processed with IR, short scans were additionally processed with a recently developed software algorithm for HALF time emission scans. All reconstructions were subsequently analyzed using commercially available software (QPS/QGS, Cedars Medical Sinai) with/without X-ray based attenuation correction (AC). Uptake values (percent of maximum) were compared by regression and Bland-Altman (BA) analysis in a 20-segment model. HALF scans yielded a 96% readout and 100% clinical diagnosis concordance compared to FULL. Correlation for uptake in each segment (n = 1,000) was r = 0.87at stress (p < 0.001) and r = 0.89 at rest (p < 0.001) with respective BA limits of agreement of -11% to 10% and -12% to 11%. After AC similar correlation (r = 0.82, rest; r = 0.80, stress, both p < 0.001) and BA limits were found (-12% to 10%; -13% to 12%). With the new IR algorithm, SPECT MPI can be acquired at half of the scan time without compromising image quality, resulting in an excellent agreement with FULL time scans regarding to uptake and clinical conclusion. (orig.)

  14. Impact of attenuation correction and gated acquisition in SPECT myocardial perfusion imaging: results of the multicentre SPAG (SPECT Attenuation Correction vs Gated) study

    In clinical myocardial single photon emission computed tomography (SPECT), attenuation artefacts may cause a loss of specificity in the identification of diseased vessels that can be corrected by means of gated SPECT (GSPECT) acquisition or CT attenuation correction (AC). The purpose of this multicentre study was to assess the impact of GSPECT and AC on the diagnostic performance of myocardial scintigraphy, according to patient's sex, body mass index (BMI) and site of coronary artery disease (CAD). We studied a group of 104 patients who underwent coronary angiography within 1 month before or after the SPECT study. Patients with a BMI > 27 were considered ''overweight''. Attenuation-corrected and standard GSPECT early images were randomly interpreted by three readers blinded to the clinical data. In the whole group, GSPECT and AC showed a diagnostic accuracy of 86.5% (sensitivity 82%, specificity 93%) and 77% (sensitivity 75.4%, specificity 81.4%), respectively (p < 0.05). In women, when anterior ischaemia was matched with CAD, AC failed to show any increase in specificity (AC 63.6% vs GSPECT 63.6%) with evident loss of sensitivity (AC 72.7% vs GSPECT 90.9%). AC significantly improved SPECT specificity in the identification of right CAD in overweight men (AC 100% vs GSPECT 66.7%, p <0.05). AC improved specificity in the evaluation of right CAD in overweight men. In the other evaluable subgroups specificity was not significantly affected while sensitivity was frequently reduced. (orig.)

  15. Assessment of myocardial perfusion and function in victims of scorpion envenomation using gated-SPECT

    Figueiredo, Alexandre Baldini de; Cupo, Palmira; Pintya, Antonio O.; Caligaris, Fabio; Marin-Neto, Jose A; Hering, Sylvia E.; Simoes, Marcus Vinicius, E-mail: simoesmv@yahoo.co [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    2010-04-15

    Background: cardiogenic shock and acute pulmonary edema are the major causes of death of patients with scorpion envenomation, whose pathophysiological mechanism remains controversial. Objective: to investigate the correlation between myocardial perfusion abnormalities and left ventricular contractile function in victims of scorpion envenomation. Methods: fifteen patients underwent ECG-gated myocardial perfusion scintigraphy (gated SPECT) within 72 hours of, and 15 days after scorpion envenomation. Images were analyzed by means of a semi-quantitative visual perfusion score (0 = normal, 4 = absent) and motion score (0 = normal, 4 akinesia), using the 17-segment model. Summed perfusion (SPS) and summed motion (SMS) scores were calculated for each patient. Ejection fraction (LVEF) was calculated by a commercially available software. Results: at baseline, 12 out of the 15 patients presented abnormal myocardial perfusion and contractility. Mean values of SPS, SMS and LVEF were 12.5 +- 7.3, 17.0 +- 12.8, and 44.6 +- 16.0%, respectively. A positive correlation between SPS and SMS (r = 0.68; p = 0.005) and negative correlation between SPS and LVEF (r -0.75; p = 0.0021) were found. The follow-up studies showed recovery of global contractility (LVEF of 68.9 +- 9.5, p = 0.0002), segmental contractility (SMS of 2.6 +- 3.1, p = 0.0009) and perfusion (SPS of 3.7 +- 3.3, p = 0.0003). Improvement of LVEF correlated positively with improvement of SPS (r = 0.72; p = 0.0035). Conclusions: myocardial perfusion abnormalities are common in scorpion envenomation and correlate topographically with the contractile dysfunction. Recovery of contractility correlates with reversibility of perfusion defects. These findings suggest the participation of myocardial perfusion abnormalities in the pathophysiology of this form of acute ventricular failure. (author)

  16. Assessment of myocardial perfusion and function in victims of scorpion envenomation using gated-SPECT

    Background: cardiogenic shock and acute pulmonary edema are the major causes of death of patients with scorpion envenomation, whose pathophysiological mechanism remains controversial. Objective: to investigate the correlation between myocardial perfusion abnormalities and left ventricular contractile function in victims of scorpion envenomation. Methods: fifteen patients underwent ECG-gated myocardial perfusion scintigraphy (gated SPECT) within 72 hours of, and 15 days after scorpion envenomation. Images were analyzed by means of a semi-quantitative visual perfusion score (0 = normal, 4 = absent) and motion score (0 = normal, 4 akinesia), using the 17-segment model. Summed perfusion (SPS) and summed motion (SMS) scores were calculated for each patient. Ejection fraction (LVEF) was calculated by a commercially available software. Results: at baseline, 12 out of the 15 patients presented abnormal myocardial perfusion and contractility. Mean values of SPS, SMS and LVEF were 12.5 ± 7.3, 17.0 ± 12.8, and 44.6 ± 16.0%, respectively. A positive correlation between SPS and SMS (r = 0.68; p = 0.005) and negative correlation between SPS and LVEF (r -0.75; p = 0.0021) were found. The follow-up studies showed recovery of global contractility (LVEF of 68.9 ± 9.5, p = 0.0002), segmental contractility (SMS of 2.6 ± 3.1, p = 0.0009) and perfusion (SPS of 3.7 ± 3.3, p = 0.0003). Improvement of LVEF correlated positively with improvement of SPS (r = 0.72; p = 0.0035). Conclusions: myocardial perfusion abnormalities are common in scorpion envenomation and correlate topographically with the contractile dysfunction. Recovery of contractility correlates with reversibility of perfusion defects. These findings suggest the participation of myocardial perfusion abnormalities in the pathophysiology of this form of acute ventricular failure. (author)

  17. Evaluation of mechanical dyssynchrony and myocardial perfusion using phase analysis of gated SPECT imaging in patients with left ventricular dysfunction

    Trimble, Mark A.; Borges-Neto, Salvador; Honeycutt, Emily F.; Shaw, Linda K.; Pagnanelli, Robert; Chen, Ji; Iskandrian, Ami E.; Garcia, Ernest V.; Velazquez, Eric J.

    2010-01-01

    Background Using phase analysis of gated single photon emission computed tomography (SPECT) imaging, we examined the relation between myocardial perfusion, degree of electrical dyssynchrony, and degree of SPECT-derived mechanical dyssynchrony in patients with left ventricular (LV) dysfunction. Methods and Results We retrospectively examined 125 patients with LV dysfunction and ejection fraction of 35% or lower. Fourier analysis converts regional myocardial counts into a continuous thickening function, allowing resolution of phase of onset of myocardial thickening. The SD of LV phase distribution (phase SD) and histogram bandwidth describe LV phase dispersion as a measure of dyssynchrony. Heart failure (HF) patients with perfusion abnormalities ities have higher degrees of dyssynchrony measured by median phase SD (45.5° vs 27.7°, P 43°) was 43.2%. Conclusions HF patients with perfusion abnormalities or prolonged QRS durations QRS durations have higher degrees of mechanical dyssynchrony. Gated SPECT myocardial perfusion imaging can quantify myocardial function, perfusion, and dyssynchrony and may help in evaluating patients for cardiac resynchronization therapy. PMID:18761269

  18. Prognostic value of normal exercise 99mTc-MIBI myocardial perfusion SPECT: comparison with exercise electrocardiography and coronary angiography

    Myocardial perfusion scintigraphy is a useful technique to diagnose and to predict prognosis in patients with suspected or known coronary artery disease. The purpose of the present study is to evaluate the prognostic value of normal exercise 99mTc-MIBI myocardial perfusion single photon emission computed tomography (SPECT) and to analyze results with regard to those of exercise electrocardiography or coronary angiography. We evaluated 301 patients (mean age 52±10 years, 166 males and 135 females) with normal exercise 99mTc-MIBI myocardial perfusion SPECT performed for suspected coronary artery disease. Subjects were evaluated for cardiac events and followed for 8-55 months (mean 19±10 months) after imaging. During the follow-up period, there was no cardiac death but only one non-fatal myocardial infarction (event rate 0.21% per year). In addition, only one patient underwent coronary revascularization. There was no significant difference in cardiac event rate between patinets with positive (n=3D27) and negative (n=3D235) exercise electrocardiography (p:NS). There was no cardiac event in 17 patients who underwent coronary angiography (4 patients with >50% luminal narrowing, 2 patients with vasospasm and 11 patients with no significant lesion). Patients with normal exercise 99mTc-MIBI myocardial perfusion SPECT has a very low risk for cardiac events regardless of exercise electrocardiographic and coronary angiographic findings.=20

  19. The interpolated projection data estimation method improves the image quality of myocardial perfusion SPECT with a short acquisition time

    The interpolated projection data estimation processing (IPDE) method increases the amount of projection data by interpolation of the projection data. We examined the usefulness of the IPDE method for 201Tl myocardial perfusion imaging (MPI) single photon emission computed tomography (SPECT) with a short acquisition time. Forty patients with suspected ischemic heart disease underwent stress 201Tl-MPI SPECT. Both stress and delayed images were acquired with 4 cycles of 360 deg continuous rotation with a 90-direction setting for 14 min. The projection data used for reconstruction were all cycle data (Tl-90-14 min), 2 cycles of data (Tl-90-7 min), and 2 cycles of data processed using the IPDE method (Tl-180IPDE-7 min). This study compared the detection of the perfusion defect by the uptake score and the image quality of 201Tl-MPI SPECT using the normalized mean square error (NMSE). The uptake score of Tl-180IPDE-7 min was significantly more concordant with Tl-90-14 min in comparison to the Tl-90-7 min (p201Tl-MPI SPECT than for the stress 201Tl-MPI SPECT (p201Tl-MPI SPECT for a short acquisition time. Furthermore, the IPDE method is a simple software program that does not require any expensive equipment or use advanced algorithms. These results suggest that the IPDE method may be useful as an adjunctive method for shortening the acquisition time of 201Tl-MPI SPECT. (author)

  20. Myocardial viability assessed by Tl-201 SPECT. Redistribution versus reinjection; Estudo da viabilidade miocardica atraves do SPECT-talio-201. Redistribuicao convencional versus reinjecao

    Chalela, William Azem; Pimentel, Flavio Ferrarini de Oliveira; Uchida, Augusto Hiroshi; Bottega, Augusto; Ramires, Jose Antonio Franchine; Izaki, Marisa; Moraes, Aguinaldo Pereira; Soares Junior, Jose; Giorgi, Maria C. Pinto; Moffa, Paulo Jorge; Bellotti, Giovanni; Giovanni Guido Cerri; Meneghetti, Jose Claudio [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina. Instituto do Coracao

    1994-07-01

    The purpose of this study was to verify if a third series of images acquired by reinjection thallium-201, 24 h after conventional myocardial perfusion with the radioisotope, improves the identification of myocardial viability segments. The methods: we studied 30 patients, mean age 57.7 {+-}9.4 years, with old myocardial infarction using thallium (Tl)-201 SPECT, and we obtained three series of images (stress, redistribution after 4 h and reinjection after 24 h). Cardiac images were divided in 5 segments (apical, lateral, anterior, septal and inferior) and each one received a value by a score system according to the Tl-201 myocardial uptake (0=normal uptake; 1=mild hypoperfusion; 2=moderate hypoperfusion; 3=severe hypoperfusion or no myocardial uptake). We considered viable myocardium when the uptake of Tl-201 in the segment related to the myocardial infarction increases at least 1 point in two different axis of Tl-201 SPECT. The results: seven (23,3%) patients demonstrated increase of Tl-201 uptake only at reinjection images, showing a high efficacy of the method. Nine (30%) patients showed persistent hypoperfusion at all series of images suggesting only fibrosis in the are related to the infarction. Fourteen (46,7%) patients showed increase of Tl-201 concentration at redistribution images; among these patients, six showed improvement of myocardial uptake at reinjection. This condition was interpreted as regional chronic ischemic process: hibernating myocardium. The conclusion was that Tl-201 hypoperfusion at redistribution images without significant changes in relation to the stress images do not represent fibrosis at all. The reinjection technic was better than conventional redistribution in the detection of viable myocardium. This data allows a better therapeutic orientation. (author)

  1. Measurement of left ventricular chamber and myocardial volume in hypertrophic cardiomyopathy patients by ECG-gated myocardial perfusion SPECT. Application of a newly developed edge-detection algorithm

    Quantitative gated SPECT (QGS) software has been reported to demonstrate inaccurate edge detection in the left ventricular chamber in hypertrophic cardiomyopathy patients. In this study we developed a method to calculate left ventricular volume (LVV) and left myocardial volume (LMV) from gated SPECT data using a newly developed edge-detection algorithm, and we compared it with the QGS method of calculating LVV and LMV in a phantom study. Our method gave more accurate measurements LVV and LMV whereas the QGS method underestimated LMV. Compared with QGS LVV and LMV, our method yielded better results in the phantom study. (author)

  2. Transplantation of progenitor cells after reperfused acute myocardial infarction: evaluation of perfusion and myocardial viability with FDG-PET and thallium SPECT

    Doebert, Natascha; Berner, Uwe; Menzel, Christian; Hamscho, Nadja; Gruenwald, Frank [Department of Nuclear Medicine, University of Frankfurt (Germany); Britten, Martina; Assmus, Birgit; Lehmann, Ralf; Schaechinger, Volker; Zeiher, Andreas M. [Department of Cardiology, University of Frankfurt (Germany); Dimmeler, Stefanie [Department of Molecular Cardiology, University of Frankfurt (Germany)

    2004-08-01

    Clinical outcome after myocardial infarction depends on the extent of irreversibly damaged myocardium. Implantation of bone marrow-/circulating blood-derived progenitor cells has been shown to improve contractile cardiac function after myocardial infarction in both experimental and initial clinical studies. In the present study, first observations of the effect of local intracoronary progenitor cell infusion on the regeneration of infarcted cardiac tissue after acute myocardial infarction was evaluated by means of {sup 18}F-fluorodeoxyglucose positron emission tomography (PET) and {sup 201}Tl single-photon emission computed tomography (SPECT). Twenty-six patients underwent intracoronary infusion of bone marrow-derived (BMCs) (15 patients) or circulating blood-derived endothelial progenitor cells (EPCs) (11 patients) 4{+-}2 days after acute myocardial infarction. Based on a left ventricular segmentation model (17 segments), mean signal intensities as a parameter of viability and perfusion in the infarct zone and non-infarct areas were calculated quantitatively by PET and SPECT at baseline and at 4 months of follow-up. Transplantation of progenitor cells was associated with a significant increase in the mean signal intensity (MSI) in the infarct zone from 54.5% (25th and 75th percentiles: 47.7%, 60.0%) to 58.0% (52.7%, 66.7%) on PET (P=0.013) and from 58.0% (49.5%, 63.0%) to 61.5% (52.5%, 70.2%) on SPECT (P=0.005). Global left ventricular ejection fraction (LVEF) increased from 53.5% (42.6%, 60.0%) to 58.0% (53.0%, 65.8%) (P<0.001). In the five patients without an increase in MSI on PET, LVEF changed from 60.0% (50.0%, 64.0%) to 72.0% (64.0%, 75.5%) at follow-up. PET and SPECT did not show any significant changes in MSI in the non-infarct areas [from 73% (68.5%, 76.2%) to 73% (69.7%, 78.0%) for PET and from 72.0% (66.5%, 77.6%) to 73.0% (67.5%, 78.2%) for SPECT]. There were no significant differences in myocardial viability and perfusion between BMC and EPC infusion

  3. Assessment of myocardial perfusion and cardiac sympathetic nerve dysfunction in patients with sick sinus syndrome. Evaluation of coronary hemodynamics and 201TlCl/123I-MIBG myocardial SPECT

    To clarify the coronary hemodynamics, myocardial perfusion and cardiac sympathetic nerve function in patients with sick sinus syndrome (SSS), we performed left coronary digital subtraction angiography (DSA) in 41 patients, exercise 201TlCl-myocardial scintigraphy (planar and SPECT) in 69 patients, and 201TlCl/123I-MIBG myocardial dual SPECT in 13 patients without significant organic coronary stenosis. Coronary artery spasm was documented on coronary angiography in 25/43 (58%) patients with SSS by ergonovine provocation test. Compared with normals, patients with SSS demonstrated prolongation of left coronary circulation time (CCT) on own heart beats and right atrial pacing. We suspected that prolonged CCT may be induced by increased peripheral coronary vascular resistance and impaired coronary micro-circulation in patients with SSS. Forty-two patients (60.9%) developed exercise-induced 201Tl-myocardial perfusion defect on SPECT images. On myocardial dual SPECT images, 11/13 (85%) patients showed localized myocardial low uptake in 123I-MIBG-SPECT images. In eight patients with normal findings on 201Tl-SPECT, six patients showed abnormality on 123I-MIBG-SPECT. We suspected that coronary vasospasm, impaired coronary micro-circulation and cardiac sympathetic nerve dysfunction are taken a part of pathophysiology in SSS (decreased β-adrenergic receptor of peripheral coronary arteries?). (author)

  4. 18F-FDG SPECT myocardial imaging of right ventricle in patients with idiopathic pulmonary hypertension

    Objective: To investigate the value of 18F-FDG SPECT myocardial imaging in evaluating haemodynamic change, treatment outcome and prognosis for idiopathic pulmonary arterial hypertension (IPAH). Methods: All 24 patients with IPAH underwent 18F-FDG SPECT myocardial imaging. Right ventricle/left ventricle (RV/LV)-FDG uptake was calculated by ROI method drawing over the central areas of left and right ventricular free walls. All patients underwent right heart catheterization within 3 days after imaging studies. Mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) were recorded. After six month pharmaceutical treatment, 15 IPAH patients were re-examined with 18F-FDG SPECT myocardial imaging followed by repeated right heart catheterization within 3 days. Plasma N-terminal pro-brain naturetic peptide (NT-proBNP) and endothelin-1 (ET-1) were measured in 17 patients using electrochemiluminescent immunoassay and enzyme immunoassay respectively. All patients were followed up for 12 months at least. Correlations between RV/LV-FDG uptake and mPAP and PVR were determined by simple linear regression analysis. Change of RV/LV-FDG before and after treatment was calculated using Student's t-test. Survival in groups with RV/LV FDG uptake ≥ 1.15 and RV/LV-FDG uptake<1.15 were compared using Log-rank test. Results: Significant correlations were found between RV/LV-FDG uptake and mPAP (r=0.562, P<0.01), and between RV/LV-FDG uptake and PVR (r=0.574, P<0.01). There were no significant correlation between RV/LV-FDG uptake and NT-proBNP (r=0.181, P>0.05), but a significant correlation between RV/LV-FDG and ET-1 was observed (r=0.669, P<0.01). The RV/LV-FDG uptake in patients with positive treatment outcome (n=6) decreased from 1.38 ± 0.52 to 0.92 ±0.26 (t=4.018, P<0.05) after 6 months treatment. In contrast, no significant change of RV/LV-FDG uptake was seen in those patients (n=9) with negative treatment outcome (t=1.861, P>0.05). The mean follow-up time

  5. Thallium gated SPECT myocardial imaging: Detection of post stress transient ischemic stunning

    Introduction: Stunned myocardium refers to the state of persistent regional dysfunction after a transient period of ischemia that has been followed by reperfusion. The exact duration of this myocardial dysfunction varies. It is known that gated SPECT using Tc99m-tracers show post-ischemic stunning. However, earlier post-stress images (within 6 minutes) using Tl-201 rather than later images (30-60 minutes) using the Tc99m based tracers are expected to yield better assessment of this phenomenon. Materials and methods: Twenty-five patients (23 Males, 2 Females), mean age 57 ±10 years (36-75 years) with no previous history of myocardial infarction and with angiographically proven coronary artery disease were taken up for the study (7 SVD, 2 DVD, 13 TVD). Twenty-one patients underwent treadmill exercise and 4 underwent dobutamine stress. Stress gated images were acquired immediately post injection of 111MBq of Tl-201, and rest redistribution gated images were acquired 3-4 hours later. Myocardial perfusion and wall motion were assessed visually, while wall thickening and perfusion defect and reversibility were assessed quantitatively using an automated polar plot display, in 20 myocardial segments. Results: The stress images in 25 patient (25x20=500 segments) showed 225 segments with stress induced ischemia. Of these, 214 segments were dysfunctional. Wall motion abnormalities (WMA) was detected in 81 segments, wall-thickening abnormality (WTA) in 44 segments While 89 had both WMA and WTA. Rest redistribution images showed 89 persistently dysfunctional and 125 improved segments. Of the 89 dysfunctional segments, 41 had WMA, 28 had WTA and 20 had both WMA and WTA. These 89 segments wherein persistence of dysfunction was noted in spite of normal or improved perfusion were identified as stunned segments. However this study also showed up 125 additional segments, which were dysfunctional in stress images and were normal in rest images. Conclusion: Gated SPECT Tl-201 imaging

  6. Optimisation of protocol for low dose CT-derived attenuation correction in myocardial perfusion SPECT imaging

    In clinical routine, attenuation correction (AC) using X-ray CT is a relatively new method for reducing attenuation artefacts. We evaluated the quality of attenuation maps generated with very low tube current to minimise exposure due to transmission scanning. SPECT/CT acquisitions were performed with a Millenium VG3 gamma camera with the Hawkeye CT device (GE Medical Systems). In phantom studies, determination of linear absorption coefficients (μ) for air, water and Teflon was carried out. The attenuation maps in both stress and resting studies from 62 patients (21 females and 41 males, age 63.7 ± 11.0 years, BMI 30.0 ± 5.7 kg/m2) were compared. All patients underwent exercise or pharmacologic stress testing and a resting study for comparison using Tc-99m MIBI or Tc-99m Tetrofosmin. AC in stress studies was performed using 2.5 mA tube current (set as default), whereas 1.0 mA was used in resting studies. In both phantom and patient studies, differences of linear absorption coefficients were not significant (p > 0.05). Effective dose decreased from 0.90 mSv down to 0.36 mSv, respectively. Our results indicate that reliable attenuation maps (μ-maps) of the thorax can be obtained even with the use of very low tube current. In our study, radiation exposure in CT-based AC for myocardial perfusion SPECT was substantially lowered (60% reduction). This is of particular importance in high-risk patients who may have to undergo follow-up scans and in research studies on volunteers. The procedure introduced is relatively simple and can be transferred to other SPECT/CT devices, which allow adjustment of tube current. (orig.)

  7. Optimisation of protocol for low dose CT-derived attenuation correction in myocardial perfusion SPECT imaging

    Preuss, Rainer [Ruhr-University Bochum, Institute of Radiology, Nuclear Medicine, and Molecular Imaging; Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen (Germany); Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany); Weise, Reiner; Lindner, Oliver; Fricke, Eva; Fricke, Harald; Burchert, Wolfgang [Ruhr-University Bochum, Institute of Radiology, Nuclear Medicine, and Molecular Imaging; Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen (Germany)

    2008-06-15

    In clinical routine, attenuation correction (AC) using X-ray CT is a relatively new method for reducing attenuation artefacts. We evaluated the quality of attenuation maps generated with very low tube current to minimise exposure due to transmission scanning. SPECT/CT acquisitions were performed with a Millenium VG3 gamma camera with the Hawkeye CT device (GE Medical Systems). In phantom studies, determination of linear absorption coefficients ({mu}) for air, water and Teflon was carried out. The attenuation maps in both stress and resting studies from 62 patients (21 females and 41 males, age 63.7 {+-} 11.0 years, BMI 30.0 {+-} 5.7 kg/m{sup 2}) were compared. All patients underwent exercise or pharmacologic stress testing and a resting study for comparison using Tc-99m MIBI or Tc-99m Tetrofosmin. AC in stress studies was performed using 2.5 mA tube current (set as default), whereas 1.0 mA was used in resting studies. In both phantom and patient studies, differences of linear absorption coefficients were not significant (p > 0.05). Effective dose decreased from 0.90 mSv down to 0.36 mSv, respectively. Our results indicate that reliable attenuation maps ({mu}-maps) of the thorax can be obtained even with the use of very low tube current. In our study, radiation exposure in CT-based AC for myocardial perfusion SPECT was substantially lowered (60% reduction). This is of particular importance in high-risk patients who may have to undergo follow-up scans and in research studies on volunteers. The procedure introduced is relatively simple and can be transferred to other SPECT/CT devices, which allow adjustment of tube current. (orig.)

  8. The accuracy and reverse effects of thallium myocardial SPECT using adenosine triphosphate loading in the diagnosis of coronary artery disease. Comparison with other loading methods semiquantitatively

    The adverse effects and diagnostic accuracy of thallium-201 myocardial SPECT after intravenous infusion of adenosine triphosphate (ATP) were studied and compared with SPECT examinations with other type of loading. The subjects of the study were 147 patients with or without coronary artery disease, who underwent some type of loading SPECT and coronary arteriography (CAG) within 30 days. Myocardial ischemia was evaluated qualitatively in SPECT and was compared with CAG for the diagnostic accuracy of coronary artery disease. The degree of myocardial uptake defect was also calculated semiquantitatively using visual scoring method and compared with coronary artery severity score. The adverse effects occurred in 46.7% of ATP loading SPECT which was more frequent that DIP loading SPECT, but all of them were transient and mild. As for the diagnostic ability the ATP loading SPECT was as effective as other type of loading in qualitative interpretation, and the perfusion defect scores showed a good correlation with coronary artery stenosis grade. The myocardial SPECT using ATP is safe and useful for the diagnosis of coronary artery disease especially in patients who cannot exercise. (author)

  9. Evaluation of the therapeutic effect of hyperbaric oxygenation and erythropoietin in the treatment of chronic heart failure using myocardial perfusion scintigraphy G-SPECT

    Baškot Branislav; Živković Miodrag; Tepić Sandra; Obradović Slobodan

    2009-01-01

    Background. The most important predictors of longterm survival in patients with cardiac ischemic disease are left ventricular ejection fraction, left ventricular volumes, infarction size, presence and extent of residual myocardial ischemia. One of the most important recent developments in single photon emission computed tomography (SPECT) myocardial perfusion imaging is the ability to acquire these studies in conjunction with electrocardiogram (ECG) gating (G-SPECT). The ability to asses radi...

  10. Chocolate intake may reduce liver count in 99m-Tc-tetrofosmin myocardial SPECT

    The accumulation of 99m-Tc-Tetrofosmin (TF) in the liver and intestine may often interfere the image quality of myocardial TF SPECT. Although milk intake before acquisition is recommended to reduce its accumulation by enhancing biliary excretion of TF, some patients cannot accept milk. To elucidate the efficacy of chocolate intake as a substitute for milk, we investigated 72 patients with coronary heart disease who underwent TF SPECT (stress imaging; n=36, rest imaging; n=36). Following injection of TF, the patients were randomly treated either with milk (n=24), or chocolate (n=24). The images were acquired before treatment, at 15 min, at 30 min, and 45 min after treatment. The ratio of liver to heart count (LHR) was calculated and was compared between the two groups. LHR in the stress imaging was not significantly different between the milk-treated and chocolate-treated groups: 1.86 vs 1.87 before treatment, 1.39 vs 1.39 at 30 min, and 1.02 vs 1.03 at 45 min. LHR in the rest imaging was also the same between the two groups: 1.43 vs 1.42 before treatment, 1.22 vs 1.21 at 15 min, and 0.95 vs. 0.95 at 30 min. Chocolate intake may be equally effective to milk intake in reducing the liver accumulation of TF. (author)

  11. SPECT myocardial perfusion versus fractional flow reserve for evaluation of functional ischemia: A meta analysis

    Purpose: The present meta-analysis illustrates the accuracy of myocardial perfusion SPECT (MPS) to diagnose functional stenotic coronary artery disease (CAD) with fractional flow reserve (FFR) as standard reference. Methods: All investigators screened and selected studies that compared MPS with FFR in symptomatic patients with suspected CAD. Patients and study characteristics were independently extracted by two investigators; differences were resolved by consensus. Results: 13 articles, including 1,017 patients, 699 vessels were included in the study. No significant publication bias was detected (P = 0.65). At the patient level, the summary sensitivity and specificity were 77% (95% confidence interval [CI], 70–83%) and 77% (95%CI, 67–84%) for MPS. Vessel-level pooled sensitivity was 66% (95%CI, 57–74%) and specificity was 81% (95%CI, 70–89%). The overall diagnostic performance of MPS was moderate. [The area under the summary receiver operating characteristic (sROC) curve was 0.83]. No study influenced the pooled results larger than 0.03. Conclusions: The accuracy between FFR and MPS SPECT was moderate

  12. Gated myocardial perfusion SPECT assists in identifying artifacts in patients with LBBB

    Full text: Purpose: To evaluate the incremental value of gating of SPECT acquisition for enhancing accuracy and to standardize the protocol for reporting MPS in LBBB patients Methods: Resting gated SPECT MPS was performed in 10 normal and 50 subjects with LBBB (with low probability of CAD). ROIs were drawn on the lateral wall and septum on gated study and time bin with peak myocardial thickening were noted. Quantitative and visual analyses were done on non-gated (NG), end diastolic (ED), end systolic (ES) images. Results: Peak myocardial thickening occur earlier than the time bin representing systole. Contraction of all other walls in LBBB group and in control was in phase with systole. On NG images of LBBB group, SLR was lower than in controls further worsening was observed in ES which markedly improved in ED to approach the value in controls. MT at ES for septum was markedly lower in LBBB group than in controls. Lateral wall in LBBB group demonstrated values of MT similar to those in controls. In control subjects, frames showing peak lateral and peak septal wall counts were the same as their respective ES frame. However time bin showing peak septal wall counts were different from ES frame in LBBB subjects, peak SLR is significantly higher than that observed in ES frame, higher than that in NG study but still lower than that of controls. MT at ES, equal to peak MT for lateral wall and IVS. Significantly higher value of septal MT at peak level than end systole was observed. Visual analysis showed septal hypoperfusion in 38 (76%) patients on NG images and in 46 (92%) patients on ES images, whereas only 2 (4%) patients showed abnormalities on ED images. Conclusion: In LBBB patients without coronary artery disease, reduced septal thickening is the major contributing factor for production of these septal perfusion artifacts. Conducting gated MPS in LBBB patients, and reporting perfusion status on end diastolic frames can eliminate these artifacts. (author)

  13. Radioimmunoassay of myosin heavy beta chains in human serum for the evaluation of the size of myocardial infarction: correlation with myocardial Tl-201 SPECT and cardiac angioscintigraphy

    To determine the relationship between serum levels of myosin heavy beta chains assessed by an IRMA technique and other radionuclide and enzymatic parameters in the evaluation of the size of myocardial infarction, we studied 22 patients with acute myocardial infarction. Blood samples taken daily between 1st to 13th day of evolution allow the determination of peak and integral of myosine release that showed a good correlation (p<0.01) with myocardial underperfusion score in T1-201 SPECT, left ventricular ejection fractions at 1st day and at the pre-discharge study, just as CPK peak. This new assay is an interesting mean to evaluate the size of myocardial infarction

  14. Assessment of the efficiency of ECG-Gated99mTc-MIBI SPECT for the evaluation of myocardial viability

    In the field of nuclear cardiology, various methods have been employed to evaluate myocardial viability. It is more challenging when one wants to evaluate viability in the hibernating myocardium. Electrocardiographic (ECG)-gated Tc-MIBI SPECT has the unique capability of evaluating both perfusion and ventricular function (wall motion and thickness), simultaneously. We studied forty patients with coronary artery disease who had positive previous history of myocardial infraction. They all underwent ECG-gated99mTc-MIBI SPECT before and 2-3 months after coronary artery bypass rafting (CAB G). Global ejection fraction, segmental myocardial perfusion and ventricular wall motion were compared before and after operation. Assessment of perfusion, alone, in some myocardial segments such as apical, mid and basal segments of septum-demonstrated no statistical meaningful difference. There was no significant changes in septal wall motion. The pre and post operative mean ventricular ejection (E F) were 51.35% and 51%, respectively. (p=0/85). Regarding the severity of perfusion defeat as the only criterion for viability, a number of the myocardial segments were preoperatively evaluated as non-viable, that was not in agreement with the post-operative results, (in other words the myocardial viability was underestimated). Based on dual criteria (perfusion and wall motion) all the myocardial walls were viable on both pre and post operative scintigrams. We concluded that severity of myocardial perfusion defect was not a perfectly accurate rit erion for myocardial viability. Also ejection fraction was not appropriate for the evaluation of ventricular functional improvement after CAB G

  15. Evaluating image denoising methods in myocardial perfusion single photon emission computed tomography (SPECT) imaging

    The statistical nature of single photon emission computed tomography (SPECT) imaging, due to the Poisson noise effect, results in the degradation of image quality, especially in the case of lesions of low signal-to-noise ratio (SNR). A variety of well-established single-scale denoising methods applied on projection raw images have been incorporated in SPECT imaging applications, while multi-scale denoising methods with promising performance have been proposed. In this paper, a comparative evaluation study is performed between a multi-scale platelet denoising method and the well-established Butterworth filter applied as a pre- and post-processing step on images reconstructed without and/or with attenuation correction. Quantitative evaluation was carried out employing (i) a cardiac phantom containing two different size cold defects, utilized in two experiments conducted to simulate conditions without and with photon attenuation from myocardial surrounding tissue and (ii) a pilot-verified clinical dataset of 15 patients with ischemic defects. Image noise, defect contrast, SNR and defect contrast-to-noise ratio (CNR) metrics were computed for both phantom and patient defects. In addition, an observer preference study was carried out for the clinical dataset, based on rankings from two nuclear medicine clinicians. Without photon attenuation conditions, denoising by platelet and Butterworth post-processing methods outperformed Butterworth pre-processing for large size defects, while for small size defects, as well as with photon attenuation conditions, all methods have demonstrated similar denoising performance. Under both attenuation conditions, the platelet method showed improved performance with respect to defect contrast, SNR and defect CNR in the case of images reconstructed without attenuation correction, however not statistically significant (p > 0.05). Quantitative as well as preference results obtained from clinical data showed similar performance of the

  16. Assessment of myocardial damage and metabolic disorder in the left ventricle in patients with mitral stenosis using 201Tl and 123I-BMIPP myocardial SPECT

    This study was designed to evaluate the myocardial damage and metabolic disorder of the left ventricle in patients with mitral stenosis. We studied 15 patients with mitral stenosis. Their grade of chronic heart failure using New York Heart Association classification were class I: 5 patients, class II: 5, class III: 3, class IV: 2, respectively. The severely stenotic group (valve area 2) included 6 patients, mildly stenostic group (1.5 cm2≤ valve area 2) included 9. A 111 MBq of 123I-BMIPP was intravenously injected at rest, SPECT images were obtained at 15 min and 3 hours after injection. A 111 MBq of 201Tl was intravenously injected at rest, and SPECT images were obtained at 15 min after injection. Washout rate (WR) of 123I-BMIPP from the whole left ventricle was obtained using polar maps. The concentration of norepinephrine (NE: pg/ml) in the blood at rest was measured. The mean values of pulmonary artery pressure was measured in ten patients using Swan-Ganz catheter. 123I-BMIPP myocardial SPECT and measurement of NE were reexamined in 5 patients after mitral valvuloplasty. NE values were 476±72 and 793±286 in classes I+II and III+IV, respectively. NE values was increased in the severe heart failure group (p201Tl and 123I-BMIPP myocardial SPECT. Three patients showed slightly reduced uptake on both 201Tl and 123I-BMIPP myocardial SPECT. WR was 27.2±4.8% and 44.3±6.7% in class I+II and class III+IV, respectively. WR was increased in severe heart failure group (p<0.05). WR was 27.8±6.0% and 41.3±9.4% in the mildly and severely stenotic group, respectively. WR was increased in the severely stenotic group (p<0.05). NE was correlated with WR (p<0.001). In patients with mitral valvuloplasty, WR was 44.3±6.7% and 31.4±4.7% before and after mitral valvuloplasty, respectively. NE values were 857±266 and 574±165, respectively. Both WR and NE were decreased after mitral valvuloplasty (p<0.01). In patients with mitral stenosis, WR was increased in the severe

  17. Utility of the combination of DAT SPECT and MIBG myocardial scintigraphy in differentiating dementia with Lewy bodies from Alzheimer's disease

    Shimizu, Soichiro; Hirao, Kentaro; Kanetaka, Hidekazu; Namioka, Nayuta; Hatanaka, Hirokuni; Hirose, Daisuke; Fukasawa, Raita; Umahara, Takahiko; Sakurai, Hirohumi; Hanyu, Haruo [Tokyo Medical University, Department of Geriatric Medicine, Shinjuku-ku, Tokyo (Japan)

    2016-01-15

    {sup 123}I-2β-Carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ({sup 123}I-FP-CIT) dopamine transporter single photon emission computed tomography (DAT SPECT) and {sup 123}I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy can be used to assist in the diagnosis of patients with dementia with Lewy bodies (DLB). We compared the diagnostic value of these two methods in differentiating DLB from Alzheimer's disease (AD). Furthermore, we evaluated whether a combination of DAT SPECT and MIBG myocardial scintigraphy would provide a more useful means of differentiating between DLB and AD. Patients with AD (n = 57) and patients with DLB (n = 76) who underwent both DAT SPECT and MIBG myocardial scintigraphy were enrolled. The sensitivity, specificity, and accuracy of both methods as well as their combination for differentiating DLB from AD were calculated. Moreover, we examined whether symptoms of the patients with DLB were associated with the patterns of the abnormalities displayed on DAT SPECT and MIBG myocardial scintigraphy. The sensitivity and specificity of differentiating DLB from AD were 72.4 and 94.4 % by the heart to mediastinum ratio of MIBG uptake, 88.2 and 88.9 % by the specific binding ratio on DAT SPECT, and 96.1 and 90.7 % by their combination, respectively. The combined use of DAT SPECT and MIBG myocardial scintigraphy enabled more accurate differentiation between DLB and AD compared with either DAT SPECT or MIBG myocardial scintigraphy alone. There was a significantly higher frequency of parkinsonism in the abnormal DAT SPECT group than the normal DAT SPECT group. On the other hand, there was a higher frequency of the appearance of rapid eye movement (REM) sleep behavior disorder in the abnormal MIBG uptake group than the normal MIBG uptake group. These results suggested that using a combination of these scintigraphic methods is a useful and practical approach to differentiate DLB from AD. (orig.)

  18. Quantitation of myocardial blood flow and myocardial flow reserve with 99mTc-sestamibi dynamic SPECT/CT to enhance detection of coronary artery disease

    Conventional dual-head single photon emission computed tomography (SPECT)/CT systems capable of fast dynamic SPECT (DySPECT) imaging have a potential for flow quantitation. This study introduced a new method to quantify myocardial blood flow (MBF) and myocardial flow reserve (MFR) with DySPECT scan and evaluated the diagnostic performance of detecting coronary artery disease (CAD) compared with perfusion using invasive coronary angiography (CAG) as the reference standard. This study included 21 patients with suspected or known CAD who had received DySPECT, ECG-gated SPECT (GSPECT), and CAG (13 with ≥50 % stenosis in any vessel; non-CAD group: 8 with patent arteries or 99mTc-sestamibi (MIBI) tracer at rest or dipyridamole-stress stages. DySPECT images were reconstructed with full physical corrections and converted to the physical unit of becquerels per milliliter. Stress MBF (SMBF), rest MBF (RMBF), and MFR were quantified by a one-tissue compartment flow model using time-activity curves derived from DySPECT images. Perfusion images were processed for GSPECT scan and interpreted to obtain summed stress score (SSS) and summed difference score (SDS). Receiver-operating characteristic (ROC) analyses were conducted to evaluate the diagnostic performance of flow and perfusion. Using the criteria of ≥50 % stenosis as positive CAD, areas under the ROC curve (AUCs) of flow assessment were overall significantly greater than those of perfusion. For patient-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.91 ± 0.07, 0.86 ± 0.09, 0.64 ± 0.12, and 0.59 ± 0.13. For vessel-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.81 ± 0.05, 0.76 ± 0.06, 0.62 ± 0.07, and 0.56 ± 0.08, respectively. The preliminary data suggest that MBF quantitation with a conventional SPECT/CT system and the flow quantitation method is a clinically effective approach to enhance CAD detection. (orig.)

  19. Myocardial Perfusion SPECT Imaging in Dextrocardia with Situs Inversus: A Case Report.

    Ayeni, Olusegun Akinwale; Malan, Nico; Hammond, Emmanuel Niiboye; Vangu, Mboyo-Di-Tamba Heben

    2016-01-01

    Dextrocardia is a cardiac positional anomaly in which the heart is located in the right hemithorax with its base-to-apex axis directed to the right and caudad. Situs inversus is an autosomal recessive disorder that causes organs in the chest and abdomen to be positioned in a mirror image from their normal position. Dextrocardia may occur in isolation or as part of situs inversus. Similarly, situs inversus may occur with or without dextrocardia. Situs inversus accompanied with dextrocardia (situs inversus totalis) is a rare congenital abnormality occurring in 0.01% of live births. Herein, we present the case of a 35-year-old man with previously diagnosed situs inversus totalis with mirror-image dextrocardia, referred to our facility for diagnosis of coronary artery disease (CAD). The incidence and presentation of CAD in patients with dextrocardia are similar to the normal population. However, considerable attention should be paid to the acquisition of myocardial perfusion scintigraphy and data processing/analysis in this group of patients. The present case highlights the distinctive applications and potential pitfalls of myocardial perfusion single-photon emission computed tomography (SPECT) imaging in patients with dextrocardia. PMID:27408900

  20. [Preliminary evaluation of the effect of an attenuation correction method in myocardial perfusion SPECT].

    Cortés-Blanco, A; Fujii, C; Goris, M L

    1999-12-01

    We propose a method to assess an attenuation correction method in myocardial perfusion SPECT. Three types of images are obtained: one resulting from a classic acquisition and filtered back-projection (classic), and those resulting from acquisition with a transmission source and an iterative reconstruction, with (music) or without (hybrid) the attenuation correction factored in to compare the three types of images and classify them as normal or abnormal, a three dimensional inter-patient quantitative comparison method was used. Differences were computed as fractions of the myocardial volume in which density differences are significant by population standards. In 7 cases the cumulative difference between prone and supine in hybrid images was 124 and 45 in music images. In 10 cases the cumulative difference between classic vs music images was 279, and between classic and hybrid 86. The AC changed 4/12 cases from abnormal to normal. The attenuation correction effect was concentrated on the septal and inferior walls, but neither exclusively nor evenly among patients. The attenuation correction effectively minimizes attenuation effects by a factor of 2.7, due to a correction of at least 69%. The correction has a small but substantial effect on the results. PMID:10611567

  1. The effect of image translation table on diagnostic efficacy of myocardial perfusion SPECT studies

    Background: The aim of this study was to determine which of the most popular colour scales used in the Xeleris processing system (GE) should preferably be used during a clinical interpretation of myocardial perfusion images, and to find out whether a colour scale saturation level affects the diagnostic efficacy of the study. Material And Methods: From among 100 patients in whom a myocardial perfusion scintigraphy had been performed, a subgroup of people referred for coronary angiography, with neither prior history nor ECG signs of a myocardial infarction has been selected retrospectively. This group consisted of 41 patients (14 females) in the age group 46 to 76 years. All patients underwent two-day myocardial perfusion SPECT imaging using 99mTc-MIBI as a radiopharmaceutical. Reconstructed slices were interpreted in 3 colour scales: white-red-yellow-green-blue-black with computer-assigned thresholds (French 100%), the same French scale but without a white colour (image maximum set manually to a border value between red and white - French w.w.), and a white-yellow-violet-pink-blue-black scale (GEcolor), by consensus of two experienced nuclear medicine specialists. A semiquantitative method for evaluation of perfusion images was applied, based on myocardium segmentation. Perfusion in each segment was scored using a five-point system. Study interpretation (normal/abnormal perfusion) was based on summed stress scores (SSS), being equal/above or below a given threshold value. The choice of optimal SSS threshold value was based on sensitivity and specificity of the study in detection of perfusion defects resulting from critical stenoses of main coronary arteries. Results: SSS values differed among colour scales (p < 0.00001). The lowest values were obtained for a French 100% scale (mean value = 5.0, SD = 8.0), the highest for French w.w. (mean values = 8.1, SD = 8.7), and for GE colour scale - mean value - 5.6, SD - 7.9. A French 100% scale gave high sensitivity (88

  2. Identification of myocardial stunning by means of gated perfusion SPECT in patients undergoing ischaemic stress myocardial tests

    Myocardial stunning or post-ischaemic dysfunction is defined as a contractile alteration that follows an ischaemic insult, persisting for some time after restoration of adequate blood flow. Interest in myocardial stunning has been growing after the recognition that it represents a common phenomenon in patients with coronary artery disease (CAD). We investigated the difference in left ventricular ejection fraction (LVEF) measured by gated SPECT (GSPECT) in the post-stress and rest periods, and compared the results with the perfusion patterns found in the conventional non-gated tomograms in order to evaluate post-stress myocardial stunning. One hundred and seventy one consecutive patients were studied with post stress and rest GSPECT using a two-day protocol. Stress tests consisted of dynamic exercise (74%) or pharmacologic intervention with dipyridamole (26%). Studies were started 45 to 60 min after the injection of 920 MBq of Tc-99m sestamibi. Quantitation of GSPECT was performed with the method previously described by Germano et al. and changes in LVEF from rest to post-stress (D) were measured. According to the perfusion patterns found when interpreting the conventional tomograms, patients were divided into 4 groups: Group-I = no perfusion defects (n =67); Group-II = fixed perfusion defects (n = 20); Group-III = reversible defects (n = 44); Group-IV = partially reversible perfusion defects (n = 40). LVEF as measured by GSPECT decreased slightly but significantly in the post-stress period when an ischemic insult was present (groups I and II), while it remained unchanged with a mild tendency to increase when ischemia was absent (groups III and IV). Values of 'D' were +0.04 ± 0.15, +0.06 ± 0.13, -0.05 ± 0.10 and -0.07 ± 0.18 for groups I, II, III and IV respectively. Not only exercise stress but also dipyridamole caused a transient decrease in LVEF, confirming that this drug is not a mere producer of flow heterogeneity. It was concluded that both post-stress and

  3. Comparison of multi-slice CT (MSCT) and TI-201 myocardial SPECT in detection of coronary artery disease: relation to coronary arteriography

    To evaluate the diagnostic potentials of MSCT and TI-201 SPECT in the assessment of coronary artery disease. Twenty-four patients (15 men, 9 women, 42-79 years) with clinically suspected coronary artery disease were studied by TI-201 myocardial SPECT and MSCT. MSCT data were obtained with 12 x 0.75 mm, 420ms rotation, multi-slice CT scanner (SOMATOM Sensation, Siemens) using non-ionic contrast, 80ml, 4ml/sec. Multiplanar reconstruction techniques were used for evaluation of coronary arteries. TI-201 myocardial SPECT were performed at stress with adenosine and at rest. Data from MSCT and TI-201 SPECT were compared territory by territory (divided into two segments; LAD and RCA/LCx) and related to coronary arteriography, in which more than 60% stenoses are regarded as significant. MSCT and TI-201 SPECT showed agreement in 37 out of 48 segments (77.1%). Out of 11 disagreed segments (22.9), TI-201 SPECT was superior in 6 segments and MSCT was superior in 5 segments. Sensitivities and specificities of MSCT and TI-201 SPECT by coronary arteriography are 81.8%, 69.2% and 86.3%, 76.9%, respectively. Agreed 4 segments between MSCT and TI-201 SPECT exhibited results that differ from the results of coronary arteriography. Myocardial bridge in two cases were detected as significant stenoses by MSCT but showed normal perfusion in TI-201 SPECT. Agreement between MSCT and TI-201 SPECT in the assessment of coronary artery disease was good but TI-201 SPECT has higher sensitivity and specificity for the detection of jeopardized myocardium than MSCT. MSCT and TI-201 SPECT provide complementary information in the assessment of coronary artery disease and could help reduce probable mistake in the interpretation of hemo dynamically insignificant lesion in coronary arteriography

  4. Serial assessment of left ventricular function in various patient groups with Tl-201 gated myocardial perfusion SPECT

    The present study was performed to assess stress-related left ventricular (LV) function variations in various patient groups and to determine if they were affected by sex or the type of stress experienced. We used thallium (Tl)-201 gated myocardial perfusion single-photon emission computed tomography (SPECT) for the analysis. A total of 270 patients were examined by electrocardiography-gated myocardial perfusion SPECT imaging to assess LV function. After injection of Tl-201 at a dose of 111 MBq at peak stress, SPECT scans were acquired at 10 min (after stress) and 3 h (rest) after injection on a three-headed camera. In the normal perfusion group, the mean LV ejection fraction (LVEF) was significantly higher, and both the end-diastolic volume index (EDVI) and end-systolic volume index (ESVI) were significantly lower in women than in men (P<0.05). Poststress stunning occurred in 29 of 98 patients (30.0%) in the ischemia group and in 42 of 90 patients (46.7%) in the fixed group. There was a significant difference in poststress stunning between bicycle ergometer stress and dipyridamole stress (P<0.05). In patients with normal perfusion, LVEF, EDVI, and ESVI determined by gated Tl-201 SPECT should be corrected for sex. In addition, the influence of the type of stress should be considered when assessing stress-related LV function variations. (author)

  5. SPECT myocardial perfusion imaging. Long-term prognostic value in diabetic patients with and without coronary artery disease

    Aim: To determine the long-term prognostic value of SPECT myocardial perfusion imaging (MPI) for the occurrence of cardiovascular events in diabetic patients. Patients, methods: SPECT MPI of 210 consecutive Caucasian diabetic patients were analysed using Kaplan-Meier event-free survival curve and independent predictors were determined by Cox multivariate analyses. Results: Follow-up was complete in 200 (95%) patients with a median period of 3.0 years (0.8-5.0). The population was composed of 114 (57%) men, age 65 ± 10 years, 181 (90.5%) type 2 diabetes mellitus, 50 (25%) with a history of coronary artery disease (CAD) and 98 (49%) presenting chest pain prior to MPI. The prevalence of abnormal MPI was 58%. Patients with a normal MPI had neither cardiac death, nor myocardial infarction, independently of a history of coronary artery disease or chest pain. Among the independent predictors of cardiac death and myocardial infarction, the strongest was abnormal MPI (p 5-fold increase in cardiovascular events. This emphasizes the value of SPECT MPI in predicting and risk-stratifying cardiovascular events in diabetic patients. (orig.)

  6. The effect of viable myocardium on left ventricular function after elective revascularization in patients with myocardial infarction by dual-isotope simultaneous acquisition myocardial perfusion-metabolic imaging

    Objective: To evaluate the effect of myocardial viability on left ventricular function after elective revascularization in patients with myocardial infarction by 99Tcm-MIBI and 18F-FDG dual-isotope simultaneous acquisition (DISA) myocardial perfusion-metabolic imaging. Methods: Ninety-one patients clinically confirmed of myocardial infarction underwent DISA imaging. Based on the results of echocardiography, the patients were divided into heart failure group (group A) and normal cardiac function group (group B). After PCI, left ventricular function was measured by echocardiography in 1, 3 and 6 months. The t-test and χ2-test were used to compare the difference between the two groups using SPSS 13.0. Results: The average number of diseased segments by myocardial perfusion imaging was 9.8±3.5 and 5.4±2.6 in groups A and B, respectively (t=6.87, P2=40.61, P<0.001). The summed perfusion score (SPS), summed metabolism score (SMS) and summed difference score (SDS=SMS-SPS) were 28.43±11.86 vs 21.36±9.54, 20.17±8.52 vs 15.19±5.74 and 0.39±3.17 vs -12.72±4.55, respectively in groups A and B (t=3.15, P<0.01; t=3.32, P<0.01; t=15.59, P<0.01). The mean change of LVEF (ΔLVEF) and the mean change of left ventricular end-diastole dimension (ΔLVEDd) of the patients with more than 4 viable myocardial segments in group A were significantly more than those in group B((12.81±2.62)% vs (5.90±1.91)%, t=16.33, P<0.001; (-13.13±4.20) mm vs (-7.75±2.31) mm, t=6.86, P<0.001). However, the ΔLVEF and ΔLVEDd of the patients with less than 4 viable myocardial segments in group A were significantly less than those in group B (t=3.25, P<0.01; t=4.92, P<0.001). Conclusion: The amount of viable myocardium in infarct myocardium is an important factor for left ventricular function recovery after elective revascularization. (authors)

  7. Characteristic findings of exercise ECG test, perfusion SPECT and coronary angiography in patients with exercise induced myocardial stunning

    Transient wall motion abnormality and contractile dysfunction of the left ventricle (LV) can be observed in patients with coronary artery disease due to post-stress myocardial stunning. To understand clinical characteristics of stress induced LV dysfunction, we have compared the findings of exercise stress test, myocardial perfusion SPECT and coronary angiography between subjects with and without post-stress LV dysfunction. Among subjects who underwent exercise stress test, myocardial perfusion SPECT and coronary angiography within a month of interval, we enrolled 36 patients with post-stress LV ejection fraction (LVEF) was ≥5% lower than rest (stunning group) and 16 patients with difference of post-stress and rest LVEF was lesser than 1% (non-stunning group) for this study. Treadmill exercise stress gated myocardial perfusion SPECT was performed with dual head SPECT camera using 740 MBq Tc-99m MIBI and coronary angiography was also performed by conventional Judkins method. Stunning group had a significantly higher incidence of hypercholesterolemia than non-stunning group(45.5 vs 7.1%, p=0.01). Stunning group also had higher incidence of diabetes mellitus and lower incidence of hypertension, but these were not statistically significant. Stunning group had larger and more severe perfusion defect in stress perfusion myocardial SPECT than non-stunning group(extent 18.2 vs 9.2%, p=0.029; severity 13.5 vs 6.9, p=0.040). Stunning group also had higher degree of reversibility of perfusion defect, higher incidence of positive exercise stress test and higher incidence of having severe stenosis(80∼99%) in coronary angiography than non-stunning group, but these were not statistically significant. In stunning group, all of 4 patients without perfusion defect had significant coronary artery stenosis and had received revascularization treatment. Patients with post-stress LV dysfunction had larger and more severe perfusion defect and severe coronary artery stenosis than

  8. Characteristic findings of exercise ECG test, perfusion SPECT and coronary angiography in patients with exercise induced myocardial stunning

    Ahn, Byeong Cheol; Seo, Ji Hyoung; Bae, Jin Ho; Jeong, Shin Young; Park, Hun Sik; Lee, Jae Tae; Chae, Shung Chull; Lee, Kyu Bo [School of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    2004-06-01

    Transient wall motion abnormality and contractile dysfunction of the left ventricle (LV) can be observed in patients with coronary artery disease due to post-stress myocardial stunning. To understand clinical characteristics of stress induced LV dysfunction, we have compared the findings of exercise stress test, myocardial perfusion SPECT and coronary angiography between subjects with and without post-stress LV dysfunction. Among subjects who underwent exercise stress test, myocardial perfusion SPECT and coronary angiography within a month of interval, we enrolled 36 patients with post-stress LV ejection fraction (LVEF) was {>=}5% lower than rest (stunning group) and 16 patients with difference of post-stress and rest LVEF was lesser than 1% (non-stunning group) for this study. Treadmill exercise stress gated myocardial perfusion SPECT was performed with dual head SPECT camera using 740 MBq Tc-99m MIBI and coronary angiography was also performed by conventional Judkins method. Stunning group had a significantly higher incidence of hypercholesterolemia than non-stunning group(45.5 vs 7.1%, p=0.01). Stunning group also had higher incidence of diabetes mellitus and lower incidence of hypertension, but these were not statistically significant. Stunning group had larger and more severe perfusion defect in stress perfusion myocardial SPECT than non-stunning group(extent 18.2 vs 9.2%, p=0.029; severity 13.5 vs 6.9, p=0.040). Stunning group also had higher degree of reversibility of perfusion defect, higher incidence of positive exercise stress test and higher incidence of having severe stenosis(80{approx}99%) in coronary angiography than non-stunning group, but these were not statistically significant. In stunning group, all of 4 patients without perfusion defect had significant coronary artery stenosis and had received revascularization treatment. Patients with post-stress LV dysfunction had larger and more severe perfusion defect and severe coronary artery stenosis than

  9. Quantitative analysis of SPECT imaging parameters in patients with resting perfusion defects on myocardial perfusion scintigraphy

    Functional status/contractile behaviour of hibernating myocardium was analyzed objectively by analyzing the available quantitative parameters obtained on gated SPECT myocardial perfusion imaging (MPI) using Emory cardiac toolbox (ECTB) software. Materials and Methods: In this retrospective study, 70 patients with perfusion defects on 99Tc-Sestamibi MPI (12 females, 58 males) who also underwent 18F-FDG Cardiac PET study for assessment of hibernating myocardium were included for analysis. Patients were divided in three categories based on summed rest score (SRS) obtained from ECTB software, depicting the extent of perfusion defects. In a study population matched for extent of perfusion defects, quantitative parameters obtained from ECTB software such as left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (EDV), left ventricular end systolic volume (ESV) and left ventricular stroke volume (SV) were compared between patients showing evidence of hibernating myocardium and patients showing no evidence of hibernating myocardium. Student 't' test was applied on the given observations and a P-value <0.05 was considered as a significant difference between the means in two categories. Results: There was no significant difference in LVEF, EDV, ESV and SV measurements between those who demonstrate hibernating myocardium and those who show no evidence of hibernating myocardium across all the categories of patients. Few trends were evident in the present study in LVEF, EDV and ESV measurements i.e., fall in mean LVEF with increasing SRS and rise in mean EDV and ESV with increasing SRS. Conclusions: The findings were consistent with the nature of hibernating myocardium i.e., non-contractile and dysfunctional. The fall in the LVEF was suggestive of deteriorating myocardial function with increasing extent of perfusion defects. The increasing left ventricular EDV and ESV with increasing extent of perfusion defects was suggestive of rising incidence of

  10. Prevalence and predictors of mechanical dyssynchrony as defined by phase analysis in patients with left ventricular dysfunction undergoing gated SPECT myocardial perfusion imaging

    Samad, Zainab; Atchley, Allen E.; Trimble, Mark A.; Sun, Jie-Lena; Shaw, Linda K.; Pagnanelli, Robert; Chen, Ji; Garcia, Ernest V.; Iskandrian, Ami E.; Velazquez, Eric J.; Borges-Neto, Salvador

    2011-01-01

    Background A novel method to quantify dyssynchrony using phase analysis of single-photon emission computed tomography (SPECT) myocardial perfusion imaging has been developed. We sought to determine the prevalence of SPECT-derived mechanical dyssynchrony, and we report clinical variables which predict mechanical dyssynchrony in patients with left ventricular dysfunction. Methods We used a count-based Fourier analysis method to convert the regional myocardial counts from discrete frames per cardiac cycle into a continuous thickening function which allows resolution of the phase of the onset of myocardial contraction. The standard deviation of left ventricular phases (Phase SD) describes the regional phase dispersion as a measure of dyssynchrony. Significant dyssynchrony was defined as Phase SD ≥ 43°. 260 patients with left ventricular ejection fraction ≤35% were examined. Results The prevalence of mechanical dyssynchrony in the entire cohort of patients studied was 52%. Univariate predictors of Phase SD were age (P = .03), black race (P = .0005), QRS duration, EF, EDV, summed stress score (SSS), and summed rest score (SRS) (all P = <.0001). Black race, male gender, QRS EF, and SRS were independent predictors of SPECT-based mechanical dyssynchrony. Conclusions Significant SPECT-based mechanical dyssynchrony is relatively common among patients with left ventricular dysfunction. In a population of patients with predominantly ischemic heart disease referred for SPECT, a reduced EF, increasing QRS duration, severity and extent of myocardial scar on SPECT imaging are independent predictors of mechanical dyssynchrony and may serve to identify patients for dyssynchrony screening. PMID:21082299

  11. 82Rb PET myocardial perfusion imaging is superior to 99mTc-labelled agent SPECT in patients with known or suspected coronary artery disease

    We compared the quality, interpretive confidence and interreader agreement between SPECT and PET myocardial perfusion imaging (MPI) in the same group of patients. The study group comprised 27 patients (age 55 ± 8.5 years, 12 men) with known or suspected coronary artery disease (CAD) who had undergone gated rest/stress MPI with 99mTc-labelled agent SPECT (with and without attenuation correction, AC), and subsequent clinical confirmation with 82Rb PET. Three experienced readers blinded to the clinical information interpreted all MPI studies. Interreader agreement was significantly superior for PET studies than for SPECT studies. Following consensus interpretation, the quality of 22 % of the non-AC SPECT studies, 33 % of the AC SPECT studies and 63 % of the PET studies was assessed as excellent or good (p = 0.016). Interpretations were definitely normal or abnormal in 7 % of non-AC SPECT studies, 30 % of AC SPECT studies and 85 % of PET studies (p = 0.046). In 13 patients who had received either invasive coronary angiography or CT angiography with no significant CAD, the true-positive rate for significant CAD was higher for PET, and the true-negative rate was equal for PET and AC SPECT, and lower for non-AC SPECT. 82Rb PET MPI, used as a confirmatory test after SPECT, offers improved image quality, interpretive confidence and interreader agreement. (orig.)

  12. Diagnosis of coronary artery disease using myocardial perfusion SPECT in patients with diabetes mellitus: analysis of risk factors

    Seo, Ji Hyoung; Kang, Seong Min; Bae, Jin Ho; Jeong, Shin Young; Lee, Sang Woo; Yoo, Jeong Soo; Ahn, Byeong Cheol; Lee, Jae Tae [Kyungpook National University, Daegu, (Korea, Republic of)

    2006-06-15

    Diabetes mellitus is a critical disease with higher rates of cardiovascular morbidity and mortality due to myocardial ischemia and infarction. There is growing interest in how to determine high-risk patients who are candidates for screening testing. This study was performed to evaluate the incidence of coronary artery disease (CAD) in diabetic patients detected by Tc-99m MIBI myocardial perfusion SPECT (MPS) and to assess risk factors of CAD and cardiac hard events. 203 diabetic patients (64 male, mean age 64.1 {+-} 9.0 years) who underwent MPS were included between Jan 2000 and July 2004. Cardiac death and nonfatal myocardial infarction (MI) were considered as hard events, and coronary angioplasty and bypass surgery >60 days after testing were considered as soft events. The mean follow-up period was 36 {+-} 18 months. Patients underwent exercise (n=6) or adenosine stress (n=197) myocardial perfusion SPECT. Perfusion defects on MPS were detected in 28.6% (58/203) of the patients. There was no cardiac death but 11 hard events were observed. The annual cardiac hard event rate was 1.1%. In univariate analysis of clinical factors, typical anginal pain, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were significantly associated with the occurrence of hard events. Anginal pain, peripheral vascular disease, and resting ECG abnormality remained independent predictors of nonfatal MIs with multivariate analysis. Abnormal SPECT results were significantly associated with high prevalence of hard events but not independent predictors on uni- and multivariate analyses. patients who were male, had longer diabetes duration (especially over 20 years), peripheral vascular disease, peripheral polyneuropathy, or resting ECG abnormality had higher incidence of CAD. Among clinical factors in diabetic patients, typical angina, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were strong predictors of hard events.

  13. Diagnosis of coronary artery disease using myocardial perfusion SPECT in patients with diabetes mellitus: analysis of risk factors

    Diabetes mellitus is a critical disease with higher rates of cardiovascular morbidity and mortality due to myocardial ischemia and infarction. There is growing interest in how to determine high-risk patients who are candidates for screening testing. This study was performed to evaluate the incidence of coronary artery disease (CAD) in diabetic patients detected by Tc-99m MIBI myocardial perfusion SPECT (MPS) and to assess risk factors of CAD and cardiac hard events. 203 diabetic patients (64 male, mean age 64.1 ± 9.0 years) who underwent MPS were included between Jan 2000 and July 2004. Cardiac death and nonfatal myocardial infarction (MI) were considered as hard events, and coronary angioplasty and bypass surgery >60 days after testing were considered as soft events. The mean follow-up period was 36 ± 18 months. Patients underwent exercise (n=6) or adenosine stress (n=197) myocardial perfusion SPECT. Perfusion defects on MPS were detected in 28.6% (58/203) of the patients. There was no cardiac death but 11 hard events were observed. The annual cardiac hard event rate was 1.1%. In univariate analysis of clinical factors, typical anginal pain, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were significantly associated with the occurrence of hard events. Anginal pain, peripheral vascular disease, and resting ECG abnormality remained independent predictors of nonfatal MIs with multivariate analysis. Abnormal SPECT results were significantly associated with high prevalence of hard events but not independent predictors on uni- and multivariate analyses. patients who were male, had longer diabetes duration (especially over 20 years), peripheral vascular disease, peripheral polyneuropathy, or resting ECG abnormality had higher incidence of CAD. Among clinical factors in diabetic patients, typical angina, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were strong predictors of hard events

  14. Transient ischemic dilation ratio (TID) correlates with HbA1c in patients with diabetes type 2 with proven myocardial ischemia according to exercise myocardial SPECT

    Abnormal values of the transient ischemic dilation ratio (TID) according to an exercise myocardial single photon emission computed tomography (SPECT) are linked to severe coronary artery disease. The authors investigated the relationship between TID and the levels of vascular cell adhesion molecule (VCAM), intercellular adhesion molecule (ICAM), E-selectin, microalbuminuria, intimamedia thickness and HbA1c of diabetic subjects. We observed 38 subjects with diabetes type 2 (10 women, 28 men), of average age 56.08±8.24 years, with no past history of cardiovascular disease. All subjects were examined using an exercise myocardial SPECT. Transient ischemic dilation, summed stress score (SSS), summed rest score (SRS) and stress total severity score (STSS) were determined to quantify myocardial ischemia. The average IMT value was 1.05±0.31 mm. The TID value was 1.02±0.154, VCAM 795.24±163.25 mg/l, ICAM 516.55±164.07, E-selectin 63.82±38.89, HbA1c 7.09±1.68%, microalbuminuria 68.01±55.21 mg/l. When ascertaining the relation of TID to the other factors we used Pearson's correlation at the level of significance p1c (p=0.035); the other factors did not show any significant correlation. Diabetes and its long term unsatisfactory compensation can be one of the factors which affect left ventricular transient ischemic dilation. (author)

  15. Comparison of automatic quantification software for the measurement of ventricular volume and ejection fraction in gated myocardial perfusion SPECT

    Full text: Introduction: Gated myocardial perfusion SPECT has been used to calculate left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV) and has correlated well with conventional methods. However, the comparative accuracy of and correlations across various types of gated SPECT software are not well understood. Materials and methods: Twelve patients participated in a radionuclide gated blood-pool (GBP) study in addition to undergoing 99mTc-sestamibi gated SPECT. Three different software algorithms, Quantitative Gated SPECT (QGS) from Cedars-Sinai, MultiDim from Stanford University Medical School and GQUANT from Alfa Nuclear were used to compute LVEF and LVEDV. These software algorithms operate in 3-dimensional space, two dependent on surface detection and the other on statistical parameters. The LVEF as calculated from gated SPECT myocardial perfusion images were compared with LVEF calculated from the GBP studies in the same patients to assess accuracy of the three software algorithms. Results: The software success-rate was 92% (11/12 pts) for MultiDim and 100% for the QGS and GQUANT. Agreement between LVEF measured with MultiDim and QGS, MultiDim and GQUANT and QGS and GQUANT were excellent (LVEF-MuItidim 0.80 LVEF QGS +5.02, r = 0.93, LVEF GQUANT = 1.10 LVEF MuItidim -1.33, r 0.90 and LVEF GQUANT = 1.02 LVEF QGS -1.40, r = 0.96). The correlation coefficient for LVEF between gated SPECT and the GBP study was 0.95, 0.95 and 0.97, for MultiDim, GQUANT and QGS, respectively. Conclusion: All 3 software programs showed good correlation between LVEF for gated SPECT and the GBP study. Good agreement for LVEF was observed also between the three software algorithms. However, because each method has unique characteristics that depend on its specific algorithm and thus behaves differently in the various patients, the methods should not be used interchangeably. (author)

  16. Is the cardiac function improvement after PTCA predictable by the quantitative indices from exercise stress 201Tl myocardial SPECT, in patients with old myocardial infarction?

    We examined whether the improvement of left ventricular function after percutaneous transluminal coronary angioplasty (PTCA) in patients with one diseased vessel can be predicted by the quantitative indices from exercise stress 201Tl single photon emission computed tomography (SPECT) and radionuclide angiography (RNA) before PTCA. Exercise stress 201Tl myocardial SPECT and RNA were performed before and after PTCA in 28 patients with old myocardial infarction (OMI). The patients were divided into two groups according to the results of coronary angiogram performed at 3 to 6 months after PTCA; patency was confirmed in 22 patients (Group P) and restenosis was observed in the remaining 6 patients (Group S). In Group P, the count ratios defined as 201Tl uptake in the PTCA region divided by the uptake in the normal region were significantly improved at 1 week and 3 to 6 months after PTCA in the initial image. 201Tl washout rates in the normal regions were significantly increased at 1 week after PTCA in Group S, and these rates in the PTCA regions were significantly increased at 1 week after PTCA in Group P. Left ventricular ejection fractions (LVEF) obtained from RNA were significantly improved 1 week and 3 to 6 months after PTCA in Group P. The changes of LVEF between pre-PTCA and 3 to 6 months after PTCA (ΔLVEF) were significantly correlated with the count ratios of both initial and delayed SPECT images in Group P (r=0.652; p<0.01, r=0.645; p<0.01 respectively). From the multiple regression analysis using stepwise methods, the count ratio in delayed image and the LVEF before PTCA were selected as independent predictive variables for ΔLVEF (multiple correlation coefficient=0.776). Thus, the improvement of LVEF after PTCA may be predictable by the count ratio in the delayed SPECT image and LVEF before PTCA when the treated vessel is persistently patent. (author)

  17. Prognostic Value of Normal Perfusion but Impaired Left Ventricular Function in the Diabetic Heart on Quantitative Gated Myocardial Perfusion SPECT

    This study aimed at identifying the predictive parameters on quantitative gated myocardial perfusion single-photon emission computed tomography (QG-SPECT) in diabetic patients with normal perfusion but impaired function. Methods Among the 533 consecutive diabetic patients, 379 patients with normal perfusion on rest Tl-201/dipyridamole-stress Tc-99m sestamibi Gated SPECT were enrolled. Patients were grouped into those with normal post-stress left ventricular function (Group I) and those with impaired function (EF <50 or impaired regional wall motion, Group II). We investigated cardiac events and cause of death by chart review and telephone interview. Survival analysis and Cox proportional hazard model analysis were performed. Between the Group I and II, cardiac events as well as chest pain symptoms, smoking, diabetic complications were significantly different (P<0.05). On survival analysis, event free survival rate in Group II was significantly lower than in Group I (P=0.016). In univariate Cox proportional hazard analysis on overall cardiac event, Group (II over I), diabetic nephropathy, summed motion score (SMS), summed systolic thickening score (STS), numbers of abnormal segmental wall motion and systolic thickening predicted more cardiac events (P<0.05). Multivariate analysis showed that STS was the only independent predictor cardiac event. The functional parameter, especially summed systolic thickening score on QG-SPECT had prognostic values, despite normal perfusion, in predicting cardiac events in diabetic patients, and QG-SPECT provides clinically useful risk stratification in diabetic patients with normal perfusion

  18. Effect of maintenance oral theophylline on dipyridamole-thallium-201 myocardial imaging using SPECT and dipyridamole-induced hemodynamic changes

    To evaluate the effect of maintenance oral theophylline therapy on the diagnostic efficacy of dipyridamole-thallium-201 single photon emission computed tomography (SPECT) imaging for coronary artery disease, dipyridamole-thallium-201 SPECT imaging was performed in eight men with documented coronary artery disease before initiation of theophylline treatment and repeated while these patients were receiving therapeutic doses of oral theophylline. Before theophylline treatment, intravenous dipyridamole caused a significant increase in heart rate, decrease in blood pressure, angina in seven of eight patients, and ST segment depression in four of eight patients. While they were being treated with theophylline, none of the patients had angina or ST segment depression, and there were no hemodynamic changes with intravenous dipyridamole. Before theophylline treatment, dipyridamole-thallium-201 SPECT imaging showed reversible perfusion defects in myocardial segments supplied by stenotic coronary arteries. With theophylline treatment, dipyridamole-thallium-201 SPECT showed total absence of reversible perfusion defects. Treatment with theophylline markedly reduced the diagnostic accuracy of dipyridamole-thallium-201 imaging for coronary artery disease

  19. Prognostic Value of Normal Perfusion but Impaired Left Ventricular Function in the Diabetic Heart on Quantitative Gated Myocardial Perfusion SPECT

    Jeong, Hwanjeong; Choi, Sehun; Han, Yeonhee [Research Institute of Chonbuk National Univ. Medical School and Hospitial, Jeonju (Korea, Republic of); Lee, Dong Soo; Lee, Hoyoung; Chung, Junekey [Seoul National Univ., Seoul (Korea, Republic of)

    2013-09-15

    This study aimed at identifying the predictive parameters on quantitative gated myocardial perfusion single-photon emission computed tomography (QG-SPECT) in diabetic patients with normal perfusion but impaired function. Methods Among the 533 consecutive diabetic patients, 379 patients with normal perfusion on rest Tl-201/dipyridamole-stress Tc-{sup 99m} sestamibi Gated SPECT were enrolled. Patients were grouped into those with normal post-stress left ventricular function (Group I) and those with impaired function (EF <50 or impaired regional wall motion, Group II). We investigated cardiac events and cause of death by chart review and telephone interview. Survival analysis and Cox proportional hazard model analysis were performed. Between the Group I and II, cardiac events as well as chest pain symptoms, smoking, diabetic complications were significantly different (P<0.05). On survival analysis, event free survival rate in Group II was significantly lower than in Group I (P=0.016). In univariate Cox proportional hazard analysis on overall cardiac event, Group (II over I), diabetic nephropathy, summed motion score (SMS), summed systolic thickening score (STS), numbers of abnormal segmental wall motion and systolic thickening predicted more cardiac events (P<0.05). Multivariate analysis showed that STS was the only independent predictor cardiac event. The functional parameter, especially summed systolic thickening score on QG-SPECT had prognostic values, despite normal perfusion, in predicting cardiac events in diabetic patients, and QG-SPECT provides clinically useful risk stratification in diabetic patients with normal perfusion.

  20. Stress-redistribution-reinjection Tl-201 gated SPECT in patients with myocardial infarct: relationship with myocardial ischemia and ventricular volume, infarction area size and Tl-201 pulmonary capitation

    Gated perfusion myocardial SPECT provides a number of quantitative data which are useful in diagnostic, stratification and prognosis of coronary patients.The aim of this study was to correlate each other some of these quantitative data and to evaluate its relationship with myocardial ischemia in patients with myocardial infarct. Materials and methods. Forty nine stress-redistribution-reinjection Tl-201 gated SPECT studies referred because of myocardial infarction asking for viability were revised, calculating and recording for both stress and reinjection (Ri) studies the following data: left ventricular (L V) ejection fraction (E F), stroke L V volume (S V) and end-diastolic L V volume (EDV). Lung/myocardial ratio of Tl-201 in stress (L/M) and residual non-infarcted myocardium surface (RNS) in reinjection images (perfusion > -2.5 S D of control data base) were calculated. These data were correlated one each other, and using some of them the 'myocardial preservation' index (M PI) was calculated. The parameters considered in the equation were taken from Ri image, except for L/M.Studies were classified according to original reports as with or without residual peri-infarct ischemia, comparing quantitative parameters between both groups of patients. Results. There was significant correlation among all the quantitative parameters studied. Only RNS showed a slightly association with presence of ischemia, having the patients with RNS = 50% higher frequency of defect reversibility (p:0.025). By other hand, the patients with ischemia had M PI values significantly higher (p<0.05) than those without ischemia (median: 5.98, range:0.63-8.16 vs median: 2.24, range:0.83-6.63, respectively). The best M PI cut-off value to separate patients with and without myocardial ischemia was 3.2, allowing to distinguish two groups with different frequency of myocardial ischemia (p:0.008), yielding a positive predictive value of 87.5% (sensitivity: 63.6%, specificity: 81.3%). Conclusion. 1

  1. 冠状动脉成像与核素心肌显像评价功能相关性冠状动脉病变的对比研究%Comparison of coronary angiography with myocardial perfusion imaging in assessment of functionally relevant coronary artery lesion

    彭泽华; 黄际远; 蒲红; 白林; 陈加源; 李刚; 黄劲

    2010-01-01

    Objective To evaluate the accuracy of dual-source CT coronary angiography (DSCTCA) for the depiction of functionally relevant coronary artery lesion ( FRCAL) , by using myocardial perfusion imaging (MPI) with single photon emission computed tomography(SPECT). Methods DSCTCA,99Tcm-MIBI SPECT myocardial perfusion imaging (MPI) and conventional coronary angiography (CCA) were performed in 59 patients with clinical suspected CAD . Coronary artery diameter narrowing of 50% or greater at DSCTCA was defined as stenosis and was compared with MPI findings. CCA was served as a reference standard for DSCTCA. Results (1) Agreement between DSCTCA and CCA was good (kapaa = 0.93 for patient-based analysis, Kappa = 0. 88 for vessel-based analysis) . (2) DSCTCA revealed stenoses in 86 segments corresponding to 60 arteries in 34 patients. (3) MPI revealed 19 reversible,21 partially reversible, and 5 fixed defects in 25 patients. (4) About 65.0% (39/60) of all the narrowed coronary arteries were determined to be FRCAL Sensitivity, specificity, accuracy, positive predictive values and negative predictive values, respectively, of DSCTCA in the detection of all MPI defects were 92.0%, 67.6%, 78.0%, 67. 6% and 92. 0% on a per-patient basis and 86. 7% , 89. 0% , 88. 6% , 65. 0% and 96. 6% on a perartery basis. (5) ROC analysis showed that predictive value of DSCTCA in FRCAL was similar with those of CCA (AUCs = 0. 80, 0. 82). Conclusions DSCTCA can evaluate FRCAL indirectly. When DSCTCA results are negative,it can help ruled out patients with FRCAL The positive DSCTCA results should combin MPI in predictor of myocardial ischemia.%目的 以单光子发射计算机断层(SPECT)心肌灌注显像(MPI)为参考标准,采用双源CT冠状动脉成像(DSCTCA)评价功能相关性冠状动脉病变(FRCAL)的准确性.方法 59例临床疑诊冠心病的患者,行DSCTCA、99Tcm-甲氧异丁基异腈(MIBI)SPECT心肌灌注显像及冠状动脉造影(CCA)检查,

  2. Simultaneous Tc-99m/I-123 Dual Radionuclide Myocardial Perfusion/Innervation Imaging Using Siemens IQ-SPECT with SMARTZOOM Collimator

    Du, Yong; Bhattacharya, Manojeet; Frey, Eric C.

    2014-01-01

    Simultaneous dual-radionuclide myocardial perfusion/innervation SPECT imaging can provide important information about mismatch between scar tissue and denervated regions. The Siemens IQ-SPECT system developed for cardiac imaging uses a multifocal SMARTZOOM collimator to achieve a four-fold sensitivity for the cardiac region compared to a typical parallel-hole low-energy high-resolution collimator but without the data truncation that can result with conventional converging-beam collimators. Th...

  3. Non invasive evaluation of the coronary atherosclerosis illness in patients with silent ischemia: utility of the SPECT of myocardial perfusion. Electric, angiographic and image correlation; Valoracion no invasiva de la enfermedad ateroesclerosa coronaria en pacientes con isquemia silente: utilidad del SPECT de perfusion miocardica. Correlacion electrica, angiografica y de imagen

    Puente B, A.; Roffe G, F.; Aceves C, J.; Gomez A, E. [Hospital Centro Medico Nacional 20 de Noviembre, ISSSTE, Mexico D.F. (Mexico)

    2005-07-01

    The objective of the work was to determine the utility of the SPECT (Single Photon Emission Computerized Tomography) of myocardial perfusion for the ischemia detection in asymptomatic patients with Coronary Atherosclerosis Illness. It was concluded that the SPECT of myocardial perfusion has a high sensitivity (97%) for the silent ischemia diagnosis.

  4. An Optimized Metz Restoration Filtering In Routine Use For Thallium-201 Myocardial Perfusion SPECT

    for SPECT studies. A significant improvement in myocardial SPECT perfusion images quality was observed in images filtered with this optimized Metz filter, compared with unprocessed images and those filtered by the smoothing filters (Butter worth and Handing). For quantitative analysis, this filter appears to offer improved accuracy. In addition, this filter was shown to be used in clinical routine and to be adapted to the visual preferences of the individual reader. It could also serves as a useful teaching tool on the effects of filtering. (Authors)

  5. The relationship between stress-induced myocardial ischemia and coronary artery atherosclerosis measured by hybrid SPECT/CT camera

    The coronary artery calcium (CAC) score and myocardial perfusion imaging can now be detected simultaneously using a hybrid single photon emission computed tomography (SPECT)/CT camera. However, there has been little evaluation on the relationship between stress-induced ischemia and coronary artery calcification in a Japanese population. The aim of this study was to investigate the relationship between these parameters and to elucidate the diagnostic value of the CAC score as an adjunct to myocardial perfusion imaging (MPI) for the assessment of coronary artery disease (CAD) in an intermediate-risk population. We retrospectively analyzed 105 patients (63% men, mean age 71 years) with CAD or suspected CAD who underwent MPI using SPECT/CT. CAC scanning was performed using a SPECT/CT camera. There was a significant difference in the CAC score between patients with ischemia (n=42) and those without ischemia (n=63) (1353±1524 vs. 332±554, p1000; 3.0±2.0). Higher age is related roughly with higher CAC score with no statistical significance (r2=0.1) (80 years old; 1258±1546, ns). The location of calcification was not related to the ischemic area. In a population with a predominately intermediate likelihood of CAD, a calcium score of zero has a possibility of excluding inducible ischemia on MPI. In part, ischemic MPI is associated with a high likelihood of subclinical atherosclerosis as detected by CAC. Hybrid SPECT/CT might be useful for diagnostic assessment and coronary artery with known or suspected CAD. (author)

  6. SPECT myocardial perfusion imaging. Long-term prognostic value in diabetic patients with and without coronary artery disease

    Koehli, M. [Dept. of Endocrinology, Diabetology and Metabolism, Univ. Hospital Lausanne (Switzerland); Dept. of Nuclear Medicine, Univ. Hospital Lausanne (Switzerland); Monbaron, D.; Gaillard, R.C.; Ruiz, J. [Dept. of Endocrinology, Diabetology and Metabolism, Univ. Hospital Lausanne (Switzerland); Prior, J.O.; Bischof Delaloye, A. [Dept. of Nuclear Medicine, Univ. Hospital Lausanne (Switzerland); Calcagni, M.L. [Dept. of Nuclear Medicine, Univ. Hospital Lausanne (Switzerland); Dept. of Cardiology, Univ. Hospital Lausanne (Switzerland); Fivaz-Arbane, M.; Stauffer, J.C. [Inst. of Nuclear Medicine, Univ. Cattolica del Sacro Cuore, Roma (Italy)

    2006-07-01

    Aim: To determine the long-term prognostic value of SPECT myocardial perfusion imaging (MPI) for the occurrence of cardiovascular events in diabetic patients. Patients, methods: SPECT MPI of 210 consecutive Caucasian diabetic patients were analysed using Kaplan-Meier event-free survival curve and independent predictors were determined by Cox multivariate analyses. Results: Follow-up was complete in 200 (95%) patients with a median period of 3.0 years (0.8-5.0). The population was composed of 114 (57%) men, age 65 {+-} 10 years, 181 (90.5%) type 2 diabetes mellitus, 50 (25%) with a history of coronary artery disease (CAD) and 98 (49%) presenting chest pain prior to MPI. The prevalence of abnormal MPI was 58%. Patients with a normal MPI had neither cardiac death, nor myocardial infarction, independently of a history of coronary artery disease or chest pain. Among the independent predictors of cardiac death and myocardial infarction, the strongest was abnormal MPI (p < 0.0001), followed by history of CAD (Hazard Ratio (HR) = 15.9; p = 0.0001), diabetic retinopathy (HR = 10.0; p = 0.001) and inability to exercise (HR = 7.7; p = 0.02). Patients with normal MPI had a low revascularisation rate of 2.4% during the follow-up period. Compared to normal MPI, cardiovascular events increased 5.2 fold for reversible defects, 8.5 fold for fixed defects and 20.1 fold for the association of both defects. Conclusion: Diabetic patients with normal MPI had on excellent prognosis independently of history of CAD. On the opposite, an abnormal MPI led to a > 5-fold increase in cardiovascular events. This emphasizes the value of SPECT MPI in predicting and risk-stratifying cardiovascular events in diabetic patients. (orig.)

  7. Efficacy of the direct myocardial revascularization performed on the beating heart or performed with the use of extra corporal circulation - comparison by means of myocardial perfusion SPECT

    Introduction. In the recent years, new techniques of direct myocardial revascularization: OPCAB - off pump coronary artery bypass and MIDCAB - minimal invasive coronary artery bypass were developed. Aim of this study was to compare the efficacy of these methods with that of CABG performed with the use of extracorporal circulation. Material and methods. 20 patients operated on the beating heart (group 1; 16 men and 4 women; aged 40 to 65 years; mean 53,0 ±8,6 years) and 36 patients operated in the extracorporal circulation (group 2; 33 men and 3 women; aged 34 to 69 years, mean 52,5 ±8,6 years). In all the patients myocardial SPECT using 99mTc-MIBI at rest and after stimulation with dipyridamole (0,56 mg/kg) was performed twice: before and 4-7 months after revascularization. Myocardial perfusion was evaluated in 9 segments using following scale: from 1 (normal) to 5 points (no uptake). The average score in all nine segments constituted a perfusion index (PI). The differences of PI before and after operation, both at rest and after dipyridamole were compared. Results. In none of the patients of group 1 a perioperational ischemia was found by ECG or enzymatic (CK-MB) measurements. In a part of group 2 signs of transient ischemia were found. Global evaluation of perfusion in SPECT is presented. PI were similar in both groups, both at rest and after dipyridamole. Conclusion: Efficacy of the direct myocardial revascularization performed on the beating heart is similar to that of the CABG operations performed with the use of extracorporal circulation. The OPCAB and MIDCAM operations are less traumatizing

  8. Prognosis of patients with positive exercise test and normal myocardial perfusion SPECT

    Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Ahn, B. C.; Lee, J.; Lee, K. B [College of Medicine, Kyungpook National University, Daegu (Korea, Republic of)

    2004-07-01

    Exercise SPECT myocardial perfusion imaging(Ex-MPI) is regarded as a predictive technique particularly in patients with coronary artery disease(CAD) capable of performing exercise testing. In clinical practice, we encounter equivocal situations of discordant findings between exercise ECG and MPI. We evaluated the prognosis of subjects with positive ECG and normal MPI findings, and predictive factors for cardiac events. 2571 Ex-MPI studies were reviewed over a period of 3 years. Subjects were followed for more than 2 years(24-56 months, mean 35{+-}10months) for cardiac events after study. The cardiac events were defined as hard events(cardiac death and nonfatal myocardial infarction(MI)) and soft events(aggravation of CAD necessitating revascularization, congestive heart failure necessitating hospital admission). We evaluated age, sex, typical angina pain, rest ECG, hypertension, diabetes mellitus(DM), serum levels of cholesterol and LDL, smoking history, history of cerebrovascular disease(CVD) and peripheral artery disease(PAD), and rest left ventricular ejection fraction(LVEF) as clinical variables. Of 83 subjects with positive ECG and normal MPS findings, 6 were considered as false negative results confirmed with coronary angiography. There were 77 patients (mean age 52{+-}10 years, 39 males) with positive ECG and normal MPI results. During the follow-up period, of 77 there were 3 cardiac events (annual rate 1.9%), no cardiac death, 2 nonfatal MIs (annual rate 1.3%) and 1 soft event (annual rate 0.6%). 2/39 males(5.1%), and 1/38 females(2.6%) had cardiac events. All cardiac events were observed within 2 years. 1-year cardiac event rate was 0.6% and 2-year cardiac event rate was 1.9%. Among clinical factors, male sex, typical chest pain and smoking history at the time of MPI were predictive of cardiac events. Patients with positive ECG and negative EX-MPI results have low risk for cardiac events. Nevertheless, the cardiac events cannot be excluded totally in some

  9. Clinical implications of diffuse slow washout of thallium-201 in exercise stress myocardial SPECT

    Clinical implications of diffuse slow washout of thallium-201 (DSWO) in exercise-redistribution myocardial SPECT were studied. Thallium-201 washout rate was calculated by Bull's-eye method. DSWO was defined as having abnormal thallium-201 washout rate (<30% per 3 hours) in more than two thirds of each coronary artery (CA) area. Of 974 patients whose exercise heart rate exceeded 120/min, 51 (5.2%) showed DSWO and coronary angiography was performed in 43. Twenty-three patients (53%) showed triple vessel disease (3VD), 8 (19%) showed single or double vessel disease (1VD/2VD) and 12 (28%) showed normal CA. Patients with normal CA consisted of 6 patients with hypertrophic cardiomyopathy (HCM), 5 with hypertension (HT) and one with electrocardiographic abnormality only. The cause of DSWO were assessed from the history of effort angina (EA) and congestive heart failure (CHF), delayed fill-in of the perfusion defect and the ratio of lung to heart thallium-201 activity (L/M) at exercise as an indicator of the left ventricular (LV) function. High prevalence of EA (74%), high incidence of scintigraphic delayed fill-in (83%) and normal L/M suggested diffuse LV ischemia as the cause of DSWO in 3VD. On the other hand in patients with 1VD/2VD, LV dysfunction at exercise was considered as the cause of DSWO because of low prevalence of EA (13%) and scintigraphic delayed fill-in (13%)(p<0.01, p<0.005 each vs 3VD), and high L/M (p<0.001 vs 3VD) and high prevalence of CHF (38%, NS). In patients with HCM LV ischemia at small vessel levels was assumed as the cause of DSWO from the high incidence of EA (83%) and delayed fill-in (50%), low L/M and normal CA. In cases of HTLV dysfunction and/or LV ischemia at the small vessel levels were considered as the cause of DSWO. Thus, it was concluded that DSWO is a noteworthy finding in exercise stress myocardial imaging. (author)

  10. Prognosis of patients with positive exercise test and normal myocardial perfusion SPECT

    Exercise SPECT myocardial perfusion imaging(Ex-MPI) is regarded as a predictive technique particularly in patients with coronary artery disease(CAD) capable of performing exercise testing. In clinical practice, we encounter equivocal situations of discordant findings between exercise ECG and MPI. We evaluated the prognosis of subjects with positive ECG and normal MPI findings, and predictive factors for cardiac events. 2571 Ex-MPI studies were reviewed over a period of 3 years. Subjects were followed for more than 2 years(24-56 months, mean 35±10months) for cardiac events after study. The cardiac events were defined as hard events(cardiac death and nonfatal myocardial infarction(MI)) and soft events(aggravation of CAD necessitating revascularization, congestive heart failure necessitating hospital admission). We evaluated age, sex, typical angina pain, rest ECG, hypertension, diabetes mellitus(DM), serum levels of cholesterol and LDL, smoking history, history of cerebrovascular disease(CVD) and peripheral artery disease(PAD), and rest left ventricular ejection fraction(LVEF) as clinical variables. Of 83 subjects with positive ECG and normal MPS findings, 6 were considered as false negative results confirmed with coronary angiography. There were 77 patients (mean age 52±10 years, 39 males) with positive ECG and normal MPI results. During the follow-up period, of 77 there were 3 cardiac events (annual rate 1.9%), no cardiac death, 2 nonfatal MIs (annual rate 1.3%) and 1 soft event (annual rate 0.6%). 2/39 males(5.1%), and 1/38 females(2.6%) had cardiac events. All cardiac events were observed within 2 years. 1-year cardiac event rate was 0.6% and 2-year cardiac event rate was 1.9%. Among clinical factors, male sex, typical chest pain and smoking history at the time of MPI were predictive of cardiac events. Patients with positive ECG and negative EX-MPI results have low risk for cardiac events. Nevertheless, the cardiac events cannot be excluded totally in some

  11. Design of a digital phantom population for myocardial perfusion SPECT imaging research

    Digital phantoms and Monte Carlo (MC) simulations have become important tools for optimizing and evaluating instrumentation, acquisition and processing methods for myocardial perfusion SPECT (MPS). In this work, we designed a new adult digital phantom population and generated corresponding Tc-99m and Tl-201 projections for use in MPS research. The population is based on the three-dimensional XCAT phantom with organ parameters sampled from the Emory PET Torso Model Database. Phantoms included three variations each in body size, heart size, and subcutaneous adipose tissue level, for a total of 27 phantoms of each gender. The SimSET MC code and angular response functions were used to model interactions in the body and the collimator-detector system, respectively. We divided each phantom into seven organs, each simulated separately, allowing use of post-simulation summing to efficiently model uptake variations. Also, we adapted and used a criterion based on the relative Poisson effective count level to determine the required number of simulated photons for each simulated organ. This technique provided a quantitative estimate of the true noise in the simulated projection data, including residual MC simulation noise. Projections were generated in 1 keV wide energy windows from 48–184 keV assuming perfect energy resolution to permit study of the effects of window width, energy resolution, and crosstalk in the context of dual isotope MPS. We have developed a comprehensive method for efficiently simulating realistic projections for a realistic population of phantoms in the context of MPS imaging. The new phantom population and realistic database of simulated projections will be useful in performing mathematical and human observer studies to evaluate various acquisition and processing methods such as optimizing the energy window width, investigating the effect of energy resolution on image quality and evaluating compensation methods for degrading factors such as

  12. Applying the J-optimal channelized quadratic observer to SPECT myocardial perfusion defect detection

    Kupinski, Meredith K.; Clarkson, Eric; Ghaly, Michael; Frey, Eric C.

    2016-03-01

    To evaluate performance on a perfusion defect detection task from 540 image pairs of myocardial perfusion SPECT image data we apply the J-optimal channelized quadratic observer (J-CQO). We compare AUC values of the linear Hotelling observer and J-CQO when the defect location is fixed and when it occurs in one of two locations. As expected, when the location is fixed a single channels maximizes AUC; location variability requires multiple channels to maximize the AUC. The AUC is estimated from both the projection data and reconstructed images. J-CQO is quadratic since it uses the first- and second- order statistics of the image data from both classes. The linear data reduction by the channels is described by an L x M channel matrix and in prior work we introduced an iterative gradient-based method for calculating the channel matrix. The dimensionality reduction from M measurements to L channels yields better estimates of these sample statistics from smaller sample sizes, and since the channelized covariance matrix is L x L instead of M x M, the matrix inverse is easier to compute. The novelty of our approach is the use of Jeffrey's divergence (J) as the figure of merit (FOM) for optimizing the channel matrix. We previously showed that the J-optimal channels are also the optimum channels for the AUC and the Bhattacharyya distance when the channel outputs are Gaussian distributed with equal means. This work evaluates the use of J as a surrogate FOM (SFOM) for AUC when these statistical conditions are not satisfied.

  13. Design of a digital phantom population for myocardial perfusion SPECT imaging research

    Ghaly, Michael; Du, Yong; Fung, George S. K.; Tsui, Benjamin M. W.; Links, Jonathan M.; Frey, Eric

    2014-06-01

    Digital phantoms and Monte Carlo (MC) simulations have become important tools for optimizing and evaluating instrumentation, acquisition and processing methods for myocardial perfusion SPECT (MPS). In this work, we designed a new adult digital phantom population and generated corresponding Tc-99m and Tl-201 projections for use in MPS research. The population is based on the three-dimensional XCAT phantom with organ parameters sampled from the Emory PET Torso Model Database. Phantoms included three variations each in body size, heart size, and subcutaneous adipose tissue level, for a total of 27 phantoms of each gender. The SimSET MC code and angular response functions were used to model interactions in the body and the collimator-detector system, respectively. We divided each phantom into seven organs, each simulated separately, allowing use of post-simulation summing to efficiently model uptake variations. Also, we adapted and used a criterion based on the relative Poisson effective count level to determine the required number of simulated photons for each simulated organ. This technique provided a quantitative estimate of the true noise in the simulated projection data, including residual MC simulation noise. Projections were generated in 1 keV wide energy windows from 48-184 keV assuming perfect energy resolution to permit study of the effects of window width, energy resolution, and crosstalk in the context of dual isotope MPS. We have developed a comprehensive method for efficiently simulating realistic projections for a realistic population of phantoms in the context of MPS imaging. The new phantom population and realistic database of simulated projections will be useful in performing mathematical and human observer studies to evaluate various acquisition and processing methods such as optimizing the energy window width, investigating the effect of energy resolution on image quality and evaluating compensation methods for degrading factors such as crosstalk in

  14. Effect of different image reconstruction algorithms on phase analysis of gated myocardial perfusion SPECT studies

    Objective: To evaluate the effect of various iterative reconstruction methods on phase analysis of gated myocardial perfusion imaging (MPI). Methods: Thirty consecutive patients scanned by the Philips CardioMD system were recruited into this study. The gated SPECT (GSPECT) data were reconstructed with filtered backprojection (FBP), maximum likelihood expectation maximization (MLEM), three-dimensional (3D) resolution recovery MLEM (AST), attenuation corrected (AC) MLEM, AC and 3D Monte Carlo scatter corrected (ACSC) MLEM methods. Parameters of left ventricular (LV) dyssynchrony (phase standard deviation and histogram bandwidth) were measured using the software SyncTool. Paired t-test was used to compare the differences of the LV dyssynchrony indices between FBP and MLEM, AC MLEM, ACSC MLEM, AST respectively. Results: The phase standard deviations of stress GSPECT MPI for FBP, MLEM, AC MLEM, ACSC MLEM, and AST were 11.6 degree, 10.9 degree, 11.2 degree, 11.6 degree, 11.4 degree respectively;while the histogram bandwidths were 35.7 degree, 34.3 degree, 35.1 degree, 36.9 degree, 35.1 degree respectively. The phase standard deviations of rest GSPECT MPI for FBP, MLEM, AC MLEM, ACSC MLEM and AST were 15.2 degree, 14.5 degree, 15.4 degree, 15.4 degree, 14.8 degree respectively; while the histogram bandwidths were 47.3 degree, 46.4 degree, 46.4 degree, 47.9 degree, 46.1 degree respectively. No statistical significance was observed between the FBP and various iterative reconstruction methods for both the stress and rest GSPECT MPI study (t:-1.179 to 1.554, P>0.05 for all). Conclusion: The standard FBP reconstruction method is accurate enough for the measurement of LV dyssynchrony indices using the widely used clinical software SyncTool. (authors)

  15. ROC evaluation of SPECT myocardial lesion detectability with and without single iteration non-uniform Chang attenuation compensation using an anthropomorphic female phantom

    The purpose of this work was to evaluate lesion detectability with and without nonuniform attenuation compensation (AC) in myocardial perfusion SPECT imaging in women using an anthropomorphic phantom and receiver operating characteristics (ROC) methodology. Breast attenuation causes artifacts in reconstructed images and may increase the difficulty of diagnosis of myocardial perfusion imaging in women. The null hypothesis tested using the ROC study was that nonuniform AC does not change the lesion detectability in myocardial perfusion SPECT imaging in women. The authors used a filtered backprojection (FBP) reconstruction algorithm and Chang's single iteration method for AC. In conclusion, with the proposed myocardial defect model nuclear medicine physicians demonstrated no significant difference for the detection of the anterior wall defect; however, a greater accuracy for the detection of the inferior wall defect was observed without nonuniform AC than with it. Medical physicists did not demonstrate any statistically significant difference in defect detection accuracy with or without nonuniform AC in the female phantom

  16. Evaluation of exercise-induced myocardial stunning by means of immediate post-exercise Tc-99m sestamibi gated SPECT

    Aim: Repeated episodes of myocardial stunning may lead to chronic ventricular dysfunction. We attempted to assess the parameters related to post-exercise stunning in patients undergoing gated SPECT. Methods: Six hundred patients undergoing a one-day stress/rest 99mTc-sestamibi gated SPECT were studied. Stress imaging was acquired within 15 minutes after injection. Summed perfusion scores (S.S.S., S.R.S. and S.D.S.) were calculated using Q.P.S., and L.V. function assessed using Q.G.S.. Stunning was defined as the association of ischemia (S.S.S. = 4 and SDS > 0) and a minimum of 5% decrease in post-stress E.F.. Results: Ischemia was found in 225 (37.5%) patients. Among these, 67 (30%) showed myocardial stunning. Patients with stunning had a lower rest E.S.V. (47 ± 24 ml vs 65 ± 52 ml, p < 0.0003) and E.D.V. (108± 35 ml vs 122 ± 66 ml, p 0.03), an increased rest L.V.E.F. (58 ± 10% vs 52 ± 13%, p < 0.0001) and a decreased post-stress L.V.E.F. (49 ± 10% vs 53 ± 13%, p < 0.02) compared to patients with no stunning. The number of myocardial segments showing reversible perfusion defects was increased in patients with stunning (2.7 ± 2.6 vs 1.7 ± 2.1, p < 0.02). On logistic regression, an extent of ischemia greater than two segments and a rest E.F. greater than 45% were independent predictors of the occurrence of myocardial stunning in patients with ischemia. Conclusions: In patients with ischemia, exercise-induced stunning was associated with an increased extent of ischemia but also preserved rest ventricular function. (authors)

  17. Microvascular obstruction on delayed enhancement cardiac magnetic resonance imaging after acute myocardial infarction, compared with myocardial {sup 201}Tl and {sup 123}I-BMIPP dual SPECT findings

    Mori, Hiroaki [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Department of Cardiology, Kainan Hospital, Yatomi (Japan); Isobe, Satoshi, E-mail: sisobe@med.nagoya-u.ac.jp [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Sakai, Shinichi [Department of Cardiology, Kainan Hospital, Yatomi (Japan); Yamada, Takashi [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Watanabe, Naoki; Miura, Manabu [Department of Cardiology, Kainan Hospital, Yatomi (Japan); Uchida, Yasuhiro; Kanashiro, Masaaki; Ichimiya, Satoshi [Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi (Japan); Okumura, Takahiro; Murohara, Toyoaki [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan)

    2015-08-15

    Highlights: • The percentage infarct size (%IS) was significantly greater in the microvascular obstruction (MO) group than in the non-MO group. • The percentage mismatch score (%MMS) on dual scintigraphy significantly correlated with the %IS and the percentage MO. • The %MMS was significantly greater in the non-MO group than in the MO group, and was an independent predictor for MO. - Abstract: Background: The hypo-enhanced regions within the hyper-enhanced infarct areas detected by cardiac magnetic resonance (CMR) imaging reflect microvascular obstruction (MO) after acute myocardial infarction (AMI). The combined myocardial thallium-201 ({sup 201}Tl)/iodine-123-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid ({sup 123}I-BMIPP) dual single-photon emission computed tomography (SPECT) is a useful tool for detecting myocardial reversibility after AMI. We evaluated whether MO could be an early predictor of irreversible myocardial damage in comparison with {sup 201}Tl and {sup 123}I-BMIPP dual SPECT findings in AMI patients. Methods: Sixty-two patients with initial AMI who successfully underwent coronary revascularization were enrolled. MO was defined by CMR imaging. Patients were divided into 2 groups as follows: MO group (n = 32) and non-MO group (n = 30). Scintigraphic defect scores were calculated using a 17-segment model with a 5-point scoring system. The mismatch score (MMS) was calculated as follows: the total sum of (Σ) {sup 123}I-BMIPP defect score minus Σ{sup 201}Tl defect score. The percentage mismatch score (%MMS) was calculated as follows: MMS/(Σ{sup 123}I-BMIPP score) × 100 (%). Results: The percentage infarct size (%IS) was significantly greater in the MO group than in the non-MO group (32.2 ± 13.8% vs. 18.3 ± 12.1%, p < 0.001). The %MMS significantly correlated with the %IS and the percentage MO (r = −0.26, p = 0.03; r = −0.45, p < 0.001, respectively). The %MMS was significantly greater in the non-MO group than in the MO group (45.4

  18. Disappearance of myocardial perfusion defects on prone SPECT imaging: Comparison with cardiac magnetic resonance imaging in patients without established coronary artery disease

    Hedén Bo

    2009-08-01

    Full Text Available Abstract Background It is of great clinical importance to exclude myocardial infarction in patients with suspected coronary artery disease who do not have stress-induced ischemia. The diagnostic use of myocardial perfusion single-photon emission computed tomography (SPECT in this situation is sometimes complicated by attenuation artifacts that mimic myocardial infarction. Imaging in the prone position has been suggested as a method to overcome this problem. Methods In this study, 52 patients without known prior infarction and no stress-induced ischemia on SPECT imaging were examined in both supine and prone position. The results were compared with cardiac magnetic resonance imaging (CMR with delayed-enhancement technique to confirm or exclude myocardial infarction. Results There were 63 defects in supine-position images, 37 of which disappeared in the prone position. None of the 37 defects were associated with myocardial infarction by CMR, indicating that all of them represented attenuation artifacts. Of the remaining 26 defects that did not disappear on prone imaging, myocardial infarction was confirmed by CMR in 2; the remaining 24 had no sign of ischemic infarction but 2 had other kinds of myocardial injuries. In 3 patients, SPECT failed to detect small scars identified by CMR. Conclusion Perfusion defects in the supine position that disappeared in the prone position were caused by attenuation, not myocardial infarction. Hence, imaging in the prone position can help to rule out ischemic heart disease for some patients admitted for SPECT with suspected but not documented ischemic heart disease. This would indicate a better prognosis and prevent unnecessary further investigations and treatment.

  19. Validation of a new cardiac image fusion software for three-dimensional integration of myocardial perfusion SPECT and stand-alone 64-slice CT angiography

    Combining the functional information of SPECT myocardial perfusion imaging (SPECT-MPI) and the morphological information of coronary CT angiography (CTA) may allow easier evaluation of the spatial relationship between coronary stenoses and perfusion defects. The aim of the present study was the validation of a novel software solution for three-dimensional (3D) image fusion of SPECT-MPI and CTA. SPECT-MPI with adenosine stress/rest 99mTc-tetrofosmin was fused with 64-slice CTA in 15 consecutive patients with a single perfusion defect and a single significant coronary artery stenosis (≥50% diameter stenosis). 3D fused SPECT/CT images were analysed by two independent observers with regard to superposition of the stenosed vessel onto the myocardial perfusion defect. Interobserver variability was assessed by recording the X, Y, Z coordinates for the origin of the stenosed coronary artery and the centre of the perfusion defect and measuring the distance between the two landmarks. SPECT-MPI revealed a fixed defect in seven patients, a reversible defect in five patients and a mixed defect in three patients and CTA documented a significant stenosis in the respective subtending coronary artery. 3D fused SPECT/CT images showed a match of coronary lesion and perfusion defect in each patient and the fusion process took less than 15 min. Interobserver variability was excellent for landmark detection (r = 1.00 and r = 0.99, p < 0.0001) and very good for the 3D distance between the two landmarks (r = 0.94, p < 0.001). 3D SPECT/CT image fusion is feasible, reproducible and allows correct superposition of SPECT segments onto cardiac CT anatomy. (orig.)

  20. Reference values of functional parameters in gated myocardial perfusion SPECT: comparison with QGS and 4DM program

    The objectives of this study were-First, to determine the normal range of left ventricular end diastolic volume (EDV), end systolic volume (ESV) and ejection fraction (EF) from gated myocardial perfusion SPECT for Quantitative Gated SPECT (QGS) and 4D-MSPECT (4DM), respectively. Second, to evaluate the relationships between values produced by both software packages. Tc-99m MIBI gated myocardial perfusion SPECT were performed for 77 patients (mean age: 49.6 ± 13.7y, n=37(M), 40(F)) with a low likelihood (0.05). In 4DM, the mean EDV, ESV and EF for all patients were 89.1 ± 26.4ml, 29.1 ± 12.8ml and 68.5 ± 6.7% at stress test. Most cases in 4DM, there was no significant difference statistically between stress and rest test (ρ >0.05). But statistically significant difference was found in EF (68.5 ± 6.7% at stress vs 70.9 ± 8.0% at rest, ρ <0.05). Correlation coefficients between the methods for EDV, ESV and EF were comparatively high (0.95, 0.93, 0.71 at stress test and 0.95, 0.90, 0.69 at rest test, respectively). However, Bland-Altman plots showed a large range of the limit value of agreement for EDV, ESV and EF between both methods (-30ml ∼ 10ml, -12ml ∼ 8ml, -14% ∼ 11% at stress test and -32ml ∼ 5ml, -13ml ∼ 13ml, -18% ∼ 12% at rest test). We found the normal ranges of EDV, ESV and EF for patients with a low likelihood of CAD in both methods. We expect these values will be a good reference to interpret gated myocardial perfusion SPECT. Although good correlation was observed between both methods, they should not be used interchangeably. Therefore, when both programs are used at the same site, it will be important to apply normal limits specific to each method

  1. Comparison of diagnostic value of coronary artery disease between ATP-stress and exercise-stress thallium myocardial SPECT images

    A study was made between adenosine triphosphate disodium (ATP)-stress thallium myocardial scintigrams and exercise-stress scintigrams to compare their respective extents and degree of defects. The subjects of the study were 33 ischemic heart disease patients, who received ATP stress and treadmill exercise stress with a mean interval of 25 days. ATP was infused for 5 minutes with an infusion rate of 0.16 or 0.18 mg per kg of body weight per minute. Thallium was injected three minutes after infusion. The percent-defect index (percentage of the extent and degree of the defects for all 33 patients), was calculated with visual scoring using a five-zone myocardial division method and semi-quantitative four-grade representation method for both the ATP and exercise SPECT images. The extent of the defects in ATP- and exercise-stress images was 51.5% and 44.2%, and that in redistribution images was 36.4% and 33.9%, respectively. The degree of defects in ATP- and exercise-stress images was 35.8% and 32.3%, while that in redistribution images was 20.8% and 17.2%, respectively (p=NS in all cases). In conclusion, the image quality of thallium SPECT with ATP stress was equivalent that of exercise stress, indicating identical diagnostic values for coronary lesions. (author)

  2. Semiquantitative SPECT myocardial perfusion with dipyridamole in patients unable to exercise. Event rate during 4 years of follow up

    The increasingly numbers of patients (P) that can't reach an adequate level of exercise in order to evaluate CAD, lead us to use pharmacological and technical tools available for this subgroup of P. Aim: evaluate the prognostic significance of myocardial perfusion SPECT imaging with pharmacological stress in P without LBBB, unable to exercise. Material and Methods: 209 P were included. Mean age: 65 years old (39-88), male 66%. Clinical: Pre test likelihood 8: 28%; SDS 0 and SRS 0: 31.7%; SDS 0 + SRS >=1: 21%; SDS >=1: 47.3%. III) Follow up: 13 patients were early re-vascularized induced by SPECT study results, 10 patients get lost and 186 were follow up by a mean 1086 days. Cumulative events rate: 1st year SCE 9.7%, HCE 1.6%; 2nd year SCE 14%, HCE 4.3%; 3rd year SCE 17.7%, HCE 5.4%; 4th year SCE 21%, HCE 5,4%. Scintigraphic indices and events rate relationship are presented. Conclusion: There was a relationship between scintigraphic indices and hard cardiac events. The semiquantitative myocardial perfusion with dipyridamole stress was a safe test and useful to discriminate groups of P with different risk of events

  3. Comparative value of brain perfusion SPECT and [123I]MIBG myocardial scintigraphy in distinguishing between dementia with Lewy bodies and Alzheimer's disease

    Both decreased occipital perfusion on brain single-photon emission computed tomography (SPECT) and reduction in cardiac 123I-metaiodobenzylguanidine (MIBG) uptake are characteristic features of dementia with Lewy bodies (DLB), and potentially support the clinical diagnosis of DLB. The aim of this study was to compare the diagnostic value of these two methods for differentiation of DLB from Alzheimer's disease (AD). The study population comprised 19 patients with probable DLB and 39 patients with probable AD who underwent both SPECT with N-isopropyl-p-[123I]iodoamphetamine and MIBG myocardial scintigraphy. Objective and quantitative measurement of perfusion in the medial occipital lobe, including the cuneus and lingual gyrus, was performed by the use of three-dimensional stereotactic surface projections. Medial occipital perfusion was significantly decreased in the DLB group compared with the AD group. The mean heart/mediastinum ratios of MIBG uptake were significantly lower in the DLB group than in the AD group. Although SPECT failed to demonstrate significant hypoperfusion in the medial occipital lobe in five patients with DLB, marked reduction of MIBG uptake was found in all patients with DLB. Receiver operating characteristic analysis revealed that MIBG myocardial scintigraphy enabled more accurate discrimination between DLB and AD than was possible with perfusion SPECT. MIBG myocardial scintigraphy may improve the sensitivity in the detection of DLB. In particular, this method may provide a powerful differential diagnostic tool when it is difficult to distinguish cases of DLB from AD using brain perfusion SPECT. (orig.)

  4. Impact of right-ventricular apical pacing on the optimal left-ventricular lead positions measured by phase analysis of SPECT myocardial perfusion imaging

    Hung, Guang-Uei [Chang Bing Show Chwan Memorial Hospital, Changhua (China); China Medical University, Department of Biomedical Imaging and Radiological Science, Taichung (China); Huang, Jin-Long [Taichung Veterans General Hospital, Cardiovascular Center, Taichung (China); School of Medicine, National Yang-Ming University, Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, Taipei (China); Chung-Shan Medical University, Department of Medicine, School of Medicine, Taichung (China); Lin, Wan-Yu; Tsai, Shih-Chung [Taichung Veterans General Hospital, Department of Nuclear Medicine, Taichung (China); Wang, Kuo-Yang [Taichung Veterans General Hospital, Cardiovascular Center, Taichung (China); Chung-Shan Medical University, Department of Medicine, School of Medicine, Taichung (China); Chen, Shih-Ann [School of Medicine, National Yang-Ming University, Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, Taipei (China); Taipei Veterans General Hospital, Division of Cardiology, Department of Medicine, Taipei (China); Lloyd, Michael S.; Chen, Ji [Emory University, Department of Radiology and Imaging Sciences, Atlanta, GA (United States)

    2014-06-15

    The use of SPECT phase analysis to optimize left-ventricular (LV) lead positions for cardiac resynchronization therapy (CRT) was performed at baseline, but CRT works as simultaneous right ventricular (RV) and LV pacing. The aim of this study was to assess the impact of RV apical (RVA) pacing on optimal LV lead positions measured by SPECT phase analysis. This study prospectively enrolled 46 patients. Two SPECT myocardial perfusion scans were acquired under sinus rhythm with complete left bundle branch block and RVA pacing, respectively, following a single injection of {sup 99m}Tc-sestamibi. LV dyssynchrony parameters and optimal LV lead positions were measured by the phase analysis technique and then compared between the two scans. The LV dyssynchrony parameters were significantly larger with RVA pacing than with sinus rhythm (p ∝0.01). In 39 of the 46 patients, the optimal LV lead positions were the same between RVA pacing and sinus rhythm (kappa = 0.861). In 6 of the remaining 7 patients, the optimal LV lead positions were along the same radial direction, but RVA pacing shifted the optimal LV lead positions toward the base. The optimal LV lead positions measured by SPECT phase analysis were consistent, no matter whether the SPECT images were acquired under sinus rhythm or RVA pacing. In some patients, RVA pacing shifted the optimal LV lead positions toward the base. This study supports the use of baseline SPECT myocardial perfusion imaging to optimize LV lead positions to increase CRT efficacy. (orig.)

  5. Clinical application of stress/rest myocardial perfusion imaging in the patients with 50%-75% coronary stenosis

    Objective: To evaluate the clinical application of stress/rest Mpi in the patients with 50%-75% coronary artery stenosis. Methods: The criteria for patient selection were that the patients should have at least one main coronary artery with stenosis more than 50%, and the maximal stenosis should be less than 75% according to Cage. The stress/rest Mpi was performed in 2 weeks before or after CAG. A total of 244 patients (178 males, 66 females) with mean age (57 ± 10) years were included in this study. Symptom restriction stress test was used and stress MPI was performed 1-1.5 h after 99Tcm-MIBI (925 MBq) injection at the exercise peak. Rest MPI was performed within 48-72 h after stress MPI.Myocardial ischemia was diagnosed when there was a reduced uptake or even a defect in 2 different tomographic sections or in the same part of a myocardium in the continuous 2 slices. When there was an irreversible reduced uptake or defect, myocardial infarction was given as the final diagnosis. No reduced uptake or defect in all slices was shown as normal. The impact of MPI images on the selection for optimal clinical therapy plans was also discussed. χ2 test was used for statistical analysis. Results: A total of 340 coronary arteries with stenosis 50%-75% were found by CAG. According to stress/rest MPI results, 207 patients (84.8%)presented normal, 33 had myocardial ischemia, 3 had myocardial infarction, and 1 had both myocardial infarction and ischemia. In abnormal MPI images, there were 61 ischemic segments and 9 infarct segments,which were associated with 43 stenotic arteries (23 LAD, 10 LCX, and 10 RCA). Patients were divided into 2 groups according to the results of MPI: Group 1 with normal MPI (207/244, 84.8%) and Group 2 with abnormal MPI (37/244, 15.2%). In Group 1, 9 patients underwent coronary artery revascularization (PTCA or CABG), and the others had medical treatment. Eight patients had PTCA and 29 patients had medical treatment in Group 2. There was a statistically

  6. The Association between Left Verticle Diastolic Dysfunction and Endothelial Dysfunction and the Result of Stress Myocardial SPECT in Asymptomatic Patients with Type 2 Diabetes

    Charvát, J.; Michalová, K.; Chlumský, J.; Valenta, Zdeněk; Kvapil, M.

    2005-01-01

    Roč. 33, - (2005), s. 473-482. ISSN 0300-0605 Institutional research plan: CEZ:AV0Z10300504 Keywords : coronary heart disease * type 2 diabetes mellitus * left ventricular diastolic dysfunction * left ventricular hyperthropy * stress myocardial SPECT Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery Impact factor: 0.653, year: 2005

  7. Use of coronary calcium score scans from stand-alone multislice computed tomography for attenuation correction of myocardial perfusion SPECT

    To evaluate the use of CT attenuation maps, generated from coronary calcium scoring (CCS) scans at in- and expiration with a 64-slice CT scanner, for attenuation correction (AC) of myocardial perfusion SPECT images. Thirty-two consecutive patients underwent99mTc-tetrofosmin gated adenosine stress/rest SPECT scan on an Infinia Hawkeye SPECT-CT device (GE Medical Systems) followed by CCS and CT angiography on a 64-slice CT. AC of the iteratively reconstructed images was performed with AC maps obtained: (a) from the ''Hawkeye'' low-resolution X-ray CT facility attached to the Infinia camera (IRAC); (b) from the CCS scan acquired on a 64-slice CT scanner during maximal inspiration (ACINSP) and (c) during normal expiration (ACEXP). Automatically determined uptake values of stress scans (QPS, Cedars Medical Sinai) from ACINSP and ACEXP were compared with IRAC. Agatston score (AS) values using ACINSPversus ACEXP were also compared. ACINSP and ACEXP resulted in identical findings versus IRAC by visual analysis. A good correlation for uptake values between IRAC and ACINSP was found (apex, r=0.92; anterior, r=0.85; septal, r=0.91; lateral, r=0.86; inferior, r=0.90; all pEXP (apex, r=0.97; anterior, r=0.91; septal, r=0.94; lateral, r=0.92; inferior, r=0.97; all pEXP proved superior to ACINSP, suggesting that in hybrid scans CCS may be performed during normal expiration to allow its additional use for AC of SPECT MPI. (orig.)

  8. Effects of scatter correction on the assessment of myocardial perfusion and left ventricular function by gated Tc-99m myocardial SPECT

    The purpose of this study was to evaluate the effect of scatter correction on the assessment of myocardial perfusion and left ventricular function by gated Tc-99m myocardial SPECT. Subjects were 11 normal volunteers, 20 patients with non-cardiac chest pain and 13 patients with coronary artery diseases. We classified above 3 groups into normal and diseased groups. Scatter correction was done using dual-energy-window scatter correction method (DEW-SC). We compared acquired counts, image contrast, corrected maximum relative counts, indices of left ventricular function, extent and severity of perfusion defects calculated by 'CEqual program' between scatter non-corrected and corrected images. Scatter corrected studies was lower in counts by 18 ± 3% than uncorrected studies, but image contrast were improved in all cases. Scatter correction using DEW-SC took 3 minutes to complete, and 512 kB memory to store. There were no significant difference among indices of left ventricular function between scatter non-corrected and corrected images. Although extents of perfusion defects were not significantly different, severity was severer in scatter corrected images. Scatter correction using DEW-SC is simple to do, 3nd improve image contrast without changing other indices of myocardial perfusion and function

  9. A quantitative assessment of heart phantom motion and its effect on myocardial perfusion SPECT images

    In order to study the image characteristics of motion artifacts and to determine the relations of motion artifacts with varied motion types, and the imaging timings, frames, distances and directions during SPECT acquisition, a myocardial phantom filled with pertechnetate solution was used to simulate the patient motion. In non-returning pattern, the simulation motion was timed at the 0 degree, -45 degree and -90 degree positions during the rotation of the detector over a 180 degree arc from +45 degree right anterior oblique to -135 degree left posterior oblique. Simulation motion was performed by moving the phantom +-5 mm, +-10 mm and +- 20 mm along X- (from left to right), Y- (from head to caudal) and Z-axis (from back to ventral) respectively. In returning pattern the acquired 30 projections were divided into three equal parts. The simulation motion was timed at the middle 1-7 projections of each part and performed by moving the phantom +-5, +-10, +-15, +-20, +-25, +-30 and +-50 mm along X-, Y- and Z-axis respectively. Each image was compared with normal image and assessed by three experienced observers without knowledge of the phantom motion. Logistic regression analysis was used to determine the relationship of motion artifacts with the affecting factors. No significant artifacts can be found when the phantom was moved slightly, no matter which motion pattern, direction and timing were taken. The characteristics of motion artifacts showed a radioactive marker dot in inferior wall firstly when the phantom was moved along X-axis. Septal and lateral wall became 'hot' symmetrically when the phantom was moved along Y-axis. And nodular hot could be found in anterior wall when the phantom was moved along Z-axis. At last the 'lumpy' and 'defect' areas existed alternately and formed a triangle respectively. The presence of motion artifacts was related to motion directions, distance and affected frames, but was independent of motion timing. The characteristics of motion

  10. Optimization and comparison of simultaneous and separate acquisition protocols for dual isotope myocardial perfusion SPECT

    Dual-isotope simultaneous-acquisition (DISA) rest-stress myocardial perfusion SPECT (MPS) protocols offer a number of advantages over separate acquisition. However, crosstalk contamination due to scatter in the patient and interactions in the collimator degrade image quality. Compensation can reduce the effects of crosstalk, but does not entirely eliminate image degradations. Optimizing acquisition parameters could further reduce the impact of crosstalk. In this paper we investigate the optimization of the rest Tl-201 energy window width and relative injected activities using the ideal observer (IO), a realistic digital phantom population and Monte Carlo (MC) simulated Tc-99m and Tl-201 projections as a means to improve image quality. We compared performance on a perfusion defect detection task for Tl-201 acquisition energy window widths varying from 4 to 40 keV centered at 72 keV for a camera with a 9% energy resolution. We also investigated 7 different relative injected activities, defined as the ratio of Tc-99m and Tl-201 activities, while keeping the total effective dose constant at 13.5 mSv. For each energy window and relative injected activity, we computed the IO test statistics using a Markov chain Monte Carlo (MCMC) method for an ensemble of 1,620 triplets of fixed and reversible defect-present, and defect-absent noisy images modeling realistic background variations. The volume under the 3-class receiver operating characteristic (ROC) surface (VUS) was estimated and served as the figure of merit. For simultaneous acquisition, the IO suggested that relative Tc-to-Tl injected activity ratios of 2.6–5 and acquisition energy window widths of 16–22% were optimal. For separate acquisition, we observed a broad range of optimal relative injected activities from 2.6 to 12.1 and acquisition energy window of widths 16–22%. A negative correlation between Tl-201 injected activity and the width of the Tl-201 energy window was observed in these ranges. The

  11. Factors affecting the myocardial activity acquired during exercise SPECT with a high-sensitivity cardiac CZT camera as compared with conventional Anger camera

    Injected doses are difficult to optimize for exercise SPECT since they depend on the myocardial fraction of injected activity (MFI) that is detected by the camera. The aim of this study was to analyse the factors affecting MFI determined using a cardiac CZT camera as compared with those determined using conventional Anger cameras. Factors affecting MFI were determined and compared in patients who had consecutive exercise SPECT acquisitions with 201Tl (84 patients) or 99mTc-sestamibi (87 patients) with an Anger or a CZT camera. A predictive model was validated in a group of patients routinely referred for 201Tl (78 patients) or 99mTc-sestamibi (80 patients) exercise CZT SPECT. The predictive model involved: (1) camera type, adjusted mean MFI being ninefold higher for CZT than for Anger SPECT, (2) tracer type, adjusted mean MFI being twofold higher for 201Tl than for 99mTc-sestamibi, and (3) logarithm of body weight. The CZT SPECT model led to a +1 ± 26 % error in the prediction of the actual MFI from the validation group. The mean MFI values estimated for CZT SPECT were more than twofold higher in patients with a body weight of 60 kg than in patients with a body weight of 120 kg (15.9 and 6.8 ppm for 99mTc-sestamibi and 30.5 and 13.1ppm for 201Tl, respectively), and for a 14-min acquisition of up to one million myocardial counts, the corresponding injected activities were only 80 and 186 MBq for 99mTc-sestamibi and 39 and 91 MBq for 201Tl, respectively. Myocardial activities acquired during exercise CZT SPECT are strongly influenced by body weight and tracer type, and are dramatically higher than those obtained using an Anger camera, allowing very low-dose protocols to be planned, especially for 99mTc-sestamibi and in non-obese subjects. (orig.)

  12. Frequency and severity of myocardial perfusion abnormalities using Tc-99m MIBI SPECT in cardiac syndrome X

    Cardiac syndrome X is defined by a typical angina pectoris with normal or near normal (stenosis <40%) coronary angiogram with or without electrocardiogram (ECG) change or atypical angina pectoris with normal or near normal coronary angiogram plus a positive none-invasive test (exercise tolerance test or myocardial perfusion scan) with or without ECG change. Studies with myocardial perfusion imaging on this syndrome have indicated some abnormal perfusion scan. We evaluated the role of myocardial perfusion imaging (MPI) and also the severity and extent of perfusion abnormality using Tc-99m MIBI Single Photon Emission Computed Tomography (SPECT) in these patients. The study group consisted of 36 patients with cardiac syndrome X. The semiquantitative perfusion analysis was performed using exercise Tc-99m MIBI SPECT. The MPI results were analyzed by the number, location and severity of perfusion defects. Abnormal perfusion defects were detected in 13 (36.10%) cases, while the remaining 23 (63.90%) had normal cardiac imaging. Five of 13 (38.4%) abnormal studies showed multiple perfusion defects. The defects were localized in the apex in 3, apical segments in 4, midventricular segments in 12 and basal segments in 6 cases. Fourteen (56%) of all abnormal segments revealed mild, 7(28%) moderate and 4 (16%) severe reduction of tracer uptake. No fixed defects were identified. The vessel territories were approximately the same in all subjects. The Exercise treadmill test (ETT) was positive in 25(69%) and negative in 11(30%) patients. There was no consistent pattern as related to the extent of MPI defects or exercise test results. Our study suggests that multiple perfusion abnormalities with different levels of severity are common in cardiac syndrome X, with more than 30 % of these patients having at least one abnormal perfusion segment. Our findings suggest that in these patients microvascular angina is probably more common than is generally believed

  13. Prognostic value of myocardial perfusion SPECT imaging in elderly patients without history of coronary artery disease and low prevalence of them

    Elderly patients without history of coronary artery disease are difficult to characterized because the clinical symptoms are often atypical, occult or absent. On the other hand, these patients frequently cannot achieve adequate level of exercise during stress testing and this limitation can compromise the diagnostic and prognostic ability of the test. Generally the prognostic value of myocardial perfusion SPECT is well established for a general population but not for elderly patients. Aim: This study assessed the prognostic value of Tc99m-sestamibi SPECT in a group of patients older than 65 years with low prevalence of coronary artery disease. Material and Methods: Population: 161 consecutive patients older than 65 years without history of coronary artery disease and low prevalence of them were studied with Tc99m-sestamibi SPECT perfusion imaging. Mean age 71 years old (65-87), male 55%, mean pretest likelihood 11%. Risk factors: diabetes 17%, high blood pressure 74%, high cholesterol 45%, smokers 88%. Stress test: bicycle exercise 39% and dipyridamole 61%. Myocardial perfusion SPECT: semiquantitative analysis to evaluate perfusion defects with a 14-segments model and 4-point scoring system for uptake reduction. Scintigraphic indices: SSS (sum of the stress scores), SRS (sum of the rest scores) and SDS (SSS-SRS). Follow up: cardiac events: hard (acute myocardial infarction and cardiac death) and soft (need for PTCA/CABG and angina). Results: Mean follow up: 508 days. Events rate: hard 0.6% (1 acute myocardial infarction), soft 5.6%. Univariate analysis identified sex (p=0.017) and SDS (p=0.009) as cardiac events predictors. Complete or reduced (independent variables which predicted events) logistic regression analysis correctly predicted the absence of events but did not predict the presence of events. Conclusion: In this elderly population with a low clinical risk where the stress test is a suboptimal method of study for coronary artery disease, semiquantitative

  14. Noninvasive quantification of myocardial perfusion heterogeneity by Markovian analysis in SPECT nuclear imaging; Quantification non invasive de l'heterogeneite de la perfusion du myocarde par analyse markovienne en imageries nucleaire SPECT

    Pons, G.

    2011-04-28

    Cardiovascular diseases are the leading cause of mortality worldwide, and third of these deaths are caused by coronary artery disease and rupture of vulnerable atherosclerotic plaques. The heterogeneous alteration of the coronary microcirculation is an early phenomenon associated with many cardiovascular risk factors that can strongly predict the subsequent development of coronary artery disease, and lead to the appearance of myocardial perfusion heterogeneity. Nuclear medicine allows the study of myocardial perfusion in clinical routine through scintigraphic scans performed after injection of a radioactive tracer of coronary blood flow. Analysis of scintigraphic perfusion images currently allows the detection of myocardial ischemia, but the ability of the technique to measure the perfusion heterogeneity in apparently normally perfused areas is unknown. The first part of this thesis focuses on a retrospective clinical study to determine the feasibility of myocardial perfusion heterogeneity quantification measured by Thallium-201 single photon emission computed tomography (SPECT) in diabetic patients compared with healthy subjects. The clinical study has demonstrated the ability of routine thallium-201 SPECT imaging to quantify greater myocardial perfusion heterogeneity in diabetic patients compared with normal subjects. The second part of this thesis tests the hypothesis that the myocardial perfusion heterogeneity could be quantified in small animal SPECT imaging by Thallium-201 and/or Technetium-99m-MIBI in an experimental study using two animal models of diabetes, and is correlated with histological changes. The lack of difference in myocardial perfusion heterogeneity between control and diabetic animals suggests that animal models are poorly suited, or that the technology currently available does not seem satisfactory to obtain similar results as the clinical study. (author)

  15. Tl-201 Gated-SPECT: Post-exercise regional myocardial dysfunction in normoperfused territories as an indicator of TVD

    Introduction: The identification of multivessel coronary artery disease has implications in management of patients with coronary artery disease (CAD). Non-gated Thallium-201 SPECT has a suboptimal sensitivity in the detection of individual coronary stenoses in patients with multi-vessel disease. The present study assesses the incremental value of regional post-stress myocardial dysfunction obtained with Thallium-201 gated SPECT studies (Tl-201gSPECT), in the detection of individual coronary stenoses in patients with triple-vessel coronary artery disease (TVD). Materials and Methods: Patients in group I, n= 25 (24 males, 1 female), aged 36 to 75 years (avg-56 + 9.3 yrs), with previously diagnosed or subsequently proven angiographic evidence of TVD, underwent same day exercise stress and redistribution myocardial Tl-201 gSPECT studies. An additional 15 patients (13 males, 2 females), aged 41 to 75 (avg. 58 + 9), who were angiographically normal (n=3) or had SVD (n=7) or DVD (n=5) were also recruited under the same protocol (group II). All patients underwent symptom limited treadmill exercise with the same protocol. The mean double product in group I was 22,985 + 4280 and the reasons for termination of exercise were THR in 14, dyspnoea in 7, fatigue in 2, ischemic ST segment changes in 1 and angina in 1. In group II, the mean double product was 24000 + 4326 and the reasons for termination of exercise were THR in 11, fatigue in 2, and chest pain in 1. The anterior and inferior myocardial walls were each divided into 3 segments, the septum and lateral wall into 6 and apex into 2. Segmental perfusion (SP), walls thickening (WT) and wall motion (WM) were then assessed. SP was scored from 0=normal to 4= absent. Emory Cardiac Toolbox software generated polar maps were used to score WT. WM was assessed qualitatively using scores of 0=normal to 4= dyskinesia. Where the endocardial border was not visualized, computer generated endocardial outlines were used to assess the wall

  16. Role of stress myocardial perfusion SPECT scan in detection and management of coronary artery disease: Nairobi experience

    Aim: Stress myocardial perfusion scans have acquired a significant role in the detection and management of Coronary Artery Disease. However, this mode of investigation has only recently been available in Nairobi, and this is the first such study from East Africa. We undertook a comparison of our results with that in the literature, to see whether they conformed to it. Materials and Methods: We performed a review of our initial 82 evaluable studies. The scans were performed with 99mTc-Tetrofosmin, using the single day stress-rest protocol with SPECT acquisitions. We carried out a correlation of our scan findings with angiographic data (where available), and clinical follow-up. The clinical end points where furnished by the referring physicians. We focused on myocardial infarction, need for re-vascularisation, and death. The mean clinical follow-up was 21.8 months (range of 12 months to 39 months). Results: Eighty (98%) of the studies revealed concordance with angiographic findings and/or were predictive of clinical outcome. Two studies were discordant, and will be discussed. The results are comparable with those in the literature. Conclusion: It is concluded that stress myocardial perfusion studies, done at our Centre, had a good predictive value, with regards to the presence and severity of disease, and correlated with the clinical outcome data

  17. Optimization of iterative reconstruction parameters with attenuation correction, scatter correction and resolution recovery in myocardial perfusion SPECT/CT

    The aim of this study was to characterize the optimal reconstruction parameters for ordered-subset expectation maximization (OSEM) with attenuation correction, scatter correction, and depth-dependent resolution recovery (OSEMACSCRR). We assessed the optimal parameters for OSEMACSCRR in an anthropomorphic torso phantom study, and evaluated the validity of the reconstruction parameters in the groups of normal volunteers and patients with abnormal perfusion. Images of the anthropomorphic torso phantom, 9 normal volunteers and 7 patients undergoing myocardial perfusion single photon emission computed tomography (SPECT) were acquired with a SPECT/CT scanner. SPECT data comprised a 64 x 64 matrix with an acquisition pixel size of 6.6 mm. A normalized mean square error (NMSE) of the phantom image was calculated to determine both optimal OSEM update and a full width at half maximum (FWHM) of Gaussian filter. We validated the myocardial count, contrast and noise characteristic for clinical subjects derived from OSEMACSCRR processing. OSEM with depth-dependent resolution recovery (OSEMRR) and filtered back projection (FBP) were simultaneously performed to compare OSEMACSCRR. The combination of OSEMACSCRR with 90-120 OSEM updates and Gaussian filter with 13.2-14.85 mm FWHM yielded low NMSE value in the phantom study. When we used OSEMACSCRR with 120 updates and Gaussian filter with 13.2 mm FWHM in the normal volunteers, myocardial contrast showed significantly higher value than that derived from 120 updates and 14.85 mm FWHM. OSEMACSCRR with the combination of 90-120 OSEM updates and 14.85 mm FWHM produced lowest % root mean square (RMS) noise. Regarding the defect contrast of patients with abnormal perfusion, OSEMACSCRR with the combination of 90-120 OSEM updates and 13.2 mm FWHM produced significantly higher value than that derived from 90-120 OSEM updates and 14.85 mm FWHM. OSEMACSCRR was superior to FBP for the % RMS noise (8.52±1.08 vs. 9.55±1.71, P=0.02) and defect

  18. Assessment of Takotsubo (ampulla) cardiomyopathy using 99mTc-tetrofosmin myocardial SPECT. Comparison with acute coronary syndrome

    We assessed Takotsubo (ampulla) cardiomyopathy compared with acute coronary syndrome (ACS) using two-dimensional echocardiography and 99mTc-tetrofosmin myocardial SPECT. We examined 10 patients with Takotsubo cardiomyopathy and 16 with ACS at the time of emergency admission (acute phase), at three to nine days after the attack (subacute phase) and at one month after the attack (chronic phase). The left ventricle was divided into nine regions on echocardiograms and SPECT images, and the degree of abnormalities in each region was scored in five grades from normal (0) to severely abnormal (4). Coronary angiography revealed total or subtotal occlusion in patients with ACS but no stenotic legions in those with Takotsubo cardiomyopathy. The amount of ST segment elevation (mm) was 7.9±3.4 in patients with Takotsubo cardiomyopathy and 7.3±3.7 in those with ACS (N.S.). Abnormal wall motion scores on echocardiograms were 13.8±4.4, 4.4±3.8 and 1.8±2.3 during the acute, subacute and chronic phases in patients with Takotsubo cardiomyopathy, and 13.9±4.0, 11.7±3.7, 7.6±4.2, respectively in patients with ACS. The value of MB fraction of creatine phosphokinase (IU/l) was 34±23 in patients with Takotsubo cardiomyopathy and 326±98 in those with ACS (p99mTc-tetrofosmin myocardial SPECT were 11.4±3.2, 3.2±3.3 and 0.7±1.1 during the acute, subacute and chronic phases respectively, in patients with Takotsubo cardiomyopathy, and 15.8±4.1, 13.5±4.4, 8.2±4.4, respectively, in those with ACS. The numbers of myocardial segments that did not uptake 99mTc-tetrofosmin during the acute phase were 0.5±0.8 and 3.6±2.8 in patients with Takotsubo cardiomyopathy and ACS, respectively. Impaired coronary microcirculation might be a causative mechanism of Takotsubo cardiomyopathy. (author)

  19. The safety of anginine in patients undergoing myocardial perfusion scintigraphy (MPS)- a nurses' perspective

    Full text: Anginine-augmented MPS improves detection rate of myocardial viability and reversible ischaemia. However, anginine can cause significant hypotension. The aims of this study were to determine i) safety of anginine in patients with an intermediate to high risk of myocardial ischaemia undergoing MPS; ii) frequency and degree of fall in systolic blood pressure (SBP); iii) BP monitoring requirements; and iv) type of patient(s) prone to side effects. 63 patients (33M, 30F, mean age-67.2y) were included. Each was cannulated, drank two glasses of water, and lay supine prior to administration of anginine (1 x puff sublingually). 99Tcm-MIBI was administered 3-5 minutes later. BP measurements were obtained every five minutes for 20 minutes. SBP fell in 46/63 patients (range 5 - 40mmHg, mean 1 6mmHg, in 14 fall >20mmHg), and rose in 14/63. Maximal fall occurred 5-15 minutes post-administration of anginine (14 at 5min, 15 at 10min, 17 at 15min), returning toward baseline by 20 minutes in all patients. Seven patients developed a headache and two light-headedness; in all SBP fell >10mmHg. The quality of the scans was unaffected. There were 22(35%) abnormal studies - 14 reversible defects, two fixed defects, six cardiomyopathy (mean SBP tall 8.1mmHg, 8.6mmHg with normal study). LVEF was obtained in 33 patients; SBP fell in 24 (mean LVEF 57.8%), and rose in nine (mean LVEF 56.8%). The frequency and extent of hypotension in relation to age, sex, LVEF, or scan findings was not statistically significant. Anginine is sate to administer to patients undergoing MPS. Careful monitoring of the BP is recommended during the initial 20 minutes post-administration. No particular patient type was identified at higher risk. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  20. Functional evaluation of myocardial viability by 99mTc tetrofosmin gated SPECT. A quantitative comparison with 18F fluorodeoxyglucose positron emission CT (18F FDG PET)

    To validate functional analysis of gated SPECT in detecting myocardial viability, seventeen patients (male 15, female 2, mean age 58) with angiographically proven chronic ischemic heart disease (RCA 6, LAD 10, LCX 1) and eight normal volunteers (all male) were studied. All patients underwent 18F FDG PET and 99mTc tetrofosmin (TF) gated SPECT within a week. After being displayed in a polar map, myocardial perfusion was regionally determined by the mean count in 9 segments at end diastole (ED) and end systole (ES) in gated SPECT. Systolic function was determined by the count increase ratio from ED to ES (WTI: ES-ED/ED). Glucose metabolism was assessed by 18F FDG PET in the segments correspondent to those defined for SPECT. TF %uptake of <60% was defined as hypoperfusion, and FDG %uptake of <50% was defined as reduced glucose metabolism. The myocardial segments were classified into 3 categories: ''normal'' perfusion (n=85), ''mismatch'' (reduced perfusion with reserved FDG uptake, n=25) and ''matched'' reduced perfusion and metabolic reduction (n=26). Mean WTI in ''mismatch'' segment was 0.38±0.21, and was significantly greater than that in ''matched reduced'' segments, 0.15±0.20 (p<0.001). It was also greater than that in normal'' segments, 0.27±0.16. Regression analysis showed that association between WTI and FDG %uptake was significant (r=0.57, p<0.0005) for the ischemic segments (''mismatch''+''matched'', n=51), but the association was weak for the entire segments although it was statistically significant (r=0.26, p=0.02, n=136). For the segments determined as infarct by perfusion image, systolic functional analysis by gated SPECT is helpful in differentiation of a viable myocardial region or artifact from a scar. Nevertheless, further clinical and technical assessment is required for ECG gating to eliminate overestimation of viability and to warrant clinical use. (author)

  1. Clinical course of cor pulmonale investigated after an interval of one year by thallium-201 myocardial SPECT scintigraphy

    Cor pulmonale was evaluated in 13 patients with chronic lung disease by thallium-201 myocardial SPECT scintigraphy together with pulmonary function tests and right heart catheterization. One year later, we performed this scintigraphy again to investigate the clinical course of the cor pulmonale. In 6 of 13 patients with respiratory failure (Pao2 less than 60 Torr), a remarkable progression in cor pulmonale was noted after one year, despite outpatient oxygen therapy. If the patients were admitted because of acute exacerbation of respiratory failure, the cor pulmonale was found to have worsened. In contrast, patients with acute exacerbation due to respiratory infection or causes other than respiratory failure, showed little change in cor pulmonale. Although patients with a marked progression of cor pulmonale tended to have poor pulmonary function data and elevated pulmonary arterial pressure, the clinical course of cor pulmonale could not be predicted from the initial pulmonary function tests or right heart catheterization. (author)

  2. Usefulness of 99mTc-MIBI stress myocardial SPECT Bull's-eye quantification incoronary artery disease

    99mTc-methoxy-isobutyl isonitrile (MIBI) myocardial SPECT quantification performed using a Bull's-eye polar map, was evaluated and compared with visual analysis in 120 patients with proven or suspected CAD. The study series comprised 106 men and 14 women, age 37-75 years, 68 of whom had had a prior myocardial infarction. Coronary angiography was taken as the gold standard. Forty age-matched subjecs, with less than a 5% chance of having CAD, were enrolled to establish the normal database for males and females. ROC analysis was used to calculate the optimal thresholds for the definition of the disease extension in each vascular territory of the Bull's-eye polar map. Bull's-eye analysis agreed with visual analysis in 296/360 vessels. Two and three-vessel disease were most frequently observed using the Bull's-eye approach. However, a greater number of false positive (FP) cases were found with Bull's-eye than with visual analysis (28 versus 3 cases): FP cases were detected principally (21/28) in patients with previous myocardial infarction. It is interesting to note that this phenomenon, commonly observed in the LCX or RCA territory, was almost always correctly interpreted as a FP case by visual analysis. In conclusion, it is found the sensitivity and specificity for CAD diagnosis with the Bull's-eye approach to be similar to that of visual analysis, but the former method seems to be somewhat more sensitive for the localization of LAD and LCX disease. However, particular attention should be paid to patients with previous myocardial infarction, as FP cases are not infrequently observed with quantitative analysis, especially in the LCX and RCA territories

  3. Evaluation of the therapeutic effect of hyperbaric oxygenation and erythropoietin in the treatment of chronic heart failure using myocardial perfusion scintigraphy G-SPECT

    Baškot Branislav

    2009-01-01

    Full Text Available Background. The most important predictors of longterm survival in patients with cardiac ischemic disease are left ventricular ejection fraction, left ventricular volumes, infarction size, presence and extent of residual myocardial ischemia. One of the most important recent developments in single photon emission computed tomography (SPECT myocardial perfusion imaging is the ability to acquire these studies in conjunction with electrocardiogram (ECG gating (G-SPECT. The ability to asses radionuclide myocardial perfusion and function with ECG G-SPECT imaging has revolutionized this field of nuclear cardiology. Study with G-SPECT development algorithms permits to quantify measures of left ventricular (LV volume, ejection fraction (LVEF and even regional myocardial wall motion and thickening. The American Society of Nuclear Cardiology (ASNC in its position paper from March 1999 recommends the routine incorporation of G-SPECT during cardiac perfusion scintigraphy. Case report. We presented a 70-year-old male with ischemic heart disease (dilatative, cardiomyopathy and absolute arrhythmia. He was few times hospitally treated by medicamentous therapy with no evidence of improvement. After hospital treatment, we included hyperbaric oxygenation (HBO and erythropoietin injections. Hyperbaric oxygenation was carried out in a monoplace hyperbaric chamber, BLK S-303, by a graduated protocol for patients with severe heart insufficiency, totally 15 treatments. Recombinant erythropoietin beta (RecormonR F. Hoffmann-La Roche was applied deeply subcutaneously, every second day from 2 000 IU to totally 16 000 IU. Before the therapy G-SPECT study was performed with 99m technetium-MIBI, and we obtained the functional parameters and perfusion of the left ventricle to follow-up the therapy effects. The study was performed by an ADAC-VERTEX PLUS-EPIC two-head gamma camera with dedicated quantitatively algorithm Auto-QUANT. The results of LVEF were 15%, with severity

  4. Clinical relevance of dipyridamole stress Tc-99m-sestamibi myocardial SPECT for the early stage of acute myocardial infarction after reperfusion treatment

    This study aimed to evaluate coronary flow in acute myocardial infarction (MI) by stress myocardial perfusion imaging (MPI), and to compare that with metabolic status and perfusion at rest. Twenty-three patients with acute MI who received successful angioplasty within 12 hours were studied. All patients underwent dipyridamole stress or rest technetium (Tc)-99m-sestamibi and 123I-BMIPP SPECT imaging in the acute phase (mean 3.8 and 7.3 days respectively). For each images, segmental accumulations were semi-quantitatively graded by 4-point scoring system (0=normal, 1=mild reduction, 2=severe reduction, 3=defect) for 14 segments to yield the total defect score (TDS). TDS in stress MPI was significantly bigger than that in rest MPI, although it was not significantly different from that in BMIPP. In the segments with infarction, dipyridamole stress MPI revealed to have greater defect than rest Tc in acute phase. This may indicate that the myocardium salvaged by reperfusion has disorder in coronary flow as well as metabolic disorder. (author)

  5. A comparative study of primary coronary stenting with intravenous thrombolysis for acute myocardial infarction using 99mTc-MIBI SPECT imaging

    To evaluate and compare the therapeutic effectiveness of primary coronary stenting with that of intravenous thrombolysis for acute myocardial infarction (AMI) using 99mTc-MIBI myocardial SPECT imaging. A total of 42 patients with AMI was undergoing primary coronary stenting (stenting group, 23 patients) or intravenous thrombolysis therapy (thrombolysis groups 19 patients). 99mTc-MIBI myocardium SPECT imaging was performed before and 1 week after stenting or thrombolysis therapy. The left ventricular myocardium of each patient was divided into 20 segments. The semiquantitative score of myocardial 99mTc-MIBI uptake was expressed with a five-point scoring system. The scores of scanning before stenting or intravenous thrombolysis was SBS. The scores of scarring after stenting or intravenous thrombolysis was SAS. Deducting SAS from SBS was SDS. Make a comparison between the SAS. stenting group and fhrombolysis group: SBS was 41.3±9.8 and 39.4±7.9 (t=1.2, P>0.05); SAS was 17.8±6.4 and 27.3±6.7 (t=5.8, P99mTc-MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the stenting and intravenous thrombolysis in treatment of AMI. At the same time;, the results indicate that primary coronary stenting seems to be more effective than intravenous thrombolysis

  6. Safety and feasibility of thallium-201 myocardial SPECT with intravenous infusion of disodium adenosine triphosphate (ATP) in the diagnosis of coronary artery disease

    ATP (adenosine triphosphate) is a potent coronary vasodilator with a rapid onset of action and a very short half-life. Myocardial perfusion scintigraphy with intravenous ATP has not yet bee sufficiently proven in the diagnosis, follow-up, and risk stratification of coronary artery disease. The purpose of this study was to evaluate the safety, feasibility and diagnostic accuracy of pharmacologic stress thallium-102 myocardial SPECT using an intravenous ATP infusion in patients with suspected coronary artery disease. Thallium-201 myocardial SPECT in 319 patients with suspected coronary artery disease were performed after the infusion of ATP (0.08 mg/min for 6 min). The adverse effects were carefully monitored. Coronary angiography was also performed within 3 weeks. Although 76.5% of he patients had some adverse effects, they were transient, mild, and well tolerated. In all patients, the ATP infusion protocol was completed and only 2 patients required aminophylline. The adverse effects were dyspnea in 63%, headache in 31%, flushing in 21%, chest pain in 14% and abdominal discomfort in 5% of the patients. The sensitivity and specificity were 80% and 90% respectively. Thallium-201 myocardial SPECT after 6 min-infusion of ATP at a rate of 0.08 mg/kg/min is safe and has a diagnostic value in detecting coronary artery disease

  7. Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease

    George, Richard T; Mehra, Vishal C; Chen, Marcus Y;

    2014-01-01

    . MATERIALS AND METHODS: This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise or...... pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (Az...

  8. Aid in the detection of myocardial perfusion abnormality utilizing SPECT atlas and images registration: preliminary results

    Padua, Rodrigo Donizete Santana de [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Div. de Cardiologia]. E-mail: rodrigo_dsp@hcrp.fmrp.usp.br; Oliveira, Lucas Ferrari de [Universidade Federal de Pelotas (UFPel), RS (Brazil). Inst. de Fisica e Matematica. Dept. de Tecnologia da Informacao; Marques, Paulo Mazzoncini de Azevedo [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Centro de Ciencias das Imagens e Fisica Medica; Groote, Jean-Jacques Georges Soares de [Instituto de Ensino Superior COC, Ribeirao Preto, SP (Brazil). Lab. of Artifical Intelligence and Applications; Castro, Adelson Antonio de [Universidade de Sao Paulo (USP), Ribeirao Preto, SP, (Brazil). Faculdade de Medicina; Ana, Lauro Wichert [Universidade de Sao Paulo (USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Centro de Ciencias das Imagens e Fisica Medica; Simoes, Marcus Vinicius [Universidade de Sao Paulo (USP), Ribeirao Preto, SP, (Brazil). Faculdade de Medicina. Divisao de Cardiologia

    2008-11-15

    To develop an atlas of myocardial perfusion scintigraphy and evaluating its applicability in computer-aided detection of myocardial perfusion defects in patients with ischemic heart disease. The atlas was created with rest-stress myocardial perfusion scintigraphic images of 20 patients of both genders with low probability of coronary artery disease and considered as normal by two experienced observers. Techniques of image registration and mathematical operations on images were utilized for obtaining template images depicting mean myocardial uptake and standard deviation for each gender and physiological condition. Myocardial perfusion scintigraphy images of one male and one female patient were aligned with the corresponding atlas template image, and voxels with myocardial uptake rates two standard deviations below the mean voxel value of the respective region in the atlas template image were highlighted on the tomographic sections and confirmed as perfusion defects by both observe. The present study demonstrated the creation of an atlas of myocardial perfusion scintigraphy with promising results of this tool as an aid in the detection of myocardial perfusion defects. However, further prospective validation with a more representative sample is recommended. (author)

  9. Aid in the detection of myocardial perfusion abnormality utilizing SPECT atlas and images registration: preliminary results

    To develop an atlas of myocardial perfusion scintigraphy and evaluating its applicability in computer-aided detection of myocardial perfusion defects in patients with ischemic heart disease. The atlas was created with rest-stress myocardial perfusion scintigraphic images of 20 patients of both genders with low probability of coronary artery disease and considered as normal by two experienced observers. Techniques of image registration and mathematical operations on images were utilized for obtaining template images depicting mean myocardial uptake and standard deviation for each gender and physiological condition. Myocardial perfusion scintigraphy images of one male and one female patient were aligned with the corresponding atlas template image, and voxels with myocardial uptake rates two standard deviations below the mean voxel value of the respective region in the atlas template image were highlighted on the tomographic sections and confirmed as perfusion defects by both observe. The present study demonstrated the creation of an atlas of myocardial perfusion scintigraphy with promising results of this tool as an aid in the detection of myocardial perfusion defects. However, further prospective validation with a more representative sample is recommended. (author)

  10. Examination concerning dissociation of left ventricular volume calculation value based on difference of analytical algorithm and perfusion tracer in gated myocardial SPECT

    According to improvement of SPECT system, ECG-gated SPECT with 201TlCl have been applied to the left ventricular volumetry. In this study 24 patients without ischemia demonstrated by stress (99mTc-TF) and rest (201TlCl) dual-isotope ECG-gated myocardial SPECT were enrolled. To evaluate left ventricular volumetry using 201Tl ECG-gated SPECT data, the left ventricular end diastolic volumes (EDV) were compared between Quantitative Gated SPECT (QGS) and Emory Cardiac Toolbox (ECT) as well as between dual-isotopes based on the same ECG-gated data. The EDV values with 99mTc data (EDVTc) using QGS were well correlated with those using ECT (r=0.96, pTc (r=0.98, p201Tl (EDVTl) (r=0.93, pTl compared with EDVTc. In contrast, EDVTl were significantly higher than EDVTc in ECT performance. The QGS errors subtracting EDVTl from EDVTc were more evident according to the left ventricular volume increase. On the other hand, ECT error showed no tendency associated with the left ventricular volume. From these results, a careful strategy for selection of tracers and softwares should be necessary to assessment of quantitative values derived from ECG-gated SPECT data because of interaction with softwares, tracers, and subjects. (author)

  11. Normal limits of left ventricular volumes and ejection fraction measured by gated myocardial perfusion SPECT: comparison of Tc-99m MIBI and Tl-201

    We evaluated radioisotope and sex-specific differences of normal limits for left ventricle volumes (LWs) and ejection fraction (EF) using myocardial perfusion gated SPECT (g-SPECT). Rest Tl-201/post-stress Tc-99m MIBI g-SPECT measurements with acquisitions of 8-frame were evaluated for 70 patients (mean age 55 ± 14, 56% female) who either had 50%) (n=58). LVEF, LWs were automatically determined by quantitative gated SPECT using QGS program. Similar results were obtained for mean LVEF between Tc-99m MIBI (62% ± 7%) and Tl-201 (63% ± 8%) g-SPECT measurements. In contrast, Tl-201 g-SPECT had significantly lower LWs values (EDV; 74 ± 23 mL, ESV; 28 ± 14 mL) than Tc-99m MIBI g-SPECT (EDV; 82 ± 25 mL, ESV; 32 ± 15 mL) (p<0.05). Women had significantly lower EDV (Tc-99m MIBI; 71 ± 18 mL, Tl-201; 65 ± 17 mL), and ESV values (Tc-99m MIBI; 27 ± 10 mL, Tl-201; 23 ± 8 mL) compared with EDV (Tc-99m MIBI; 96 ± 27 mL, Tl-201; 85 ± 24 mL), and ESV values (Tc-99m MIBI; 40 ± 17 mL, Tl-201; 36 ± 16 mL) of men (p<0.05). Women had significantly higher LV EF values (65% ± 7%) than men (60% ± 8%) by Tl-201 gated SPECT (p<0.05). These data suggest significant differeuces in normal limits for LWs and EF, according to genders and radiopharmaceutical. Therefore, the evaluation of cardiac function in patients should consider radioisotope and sex-matched normal values

  12. Evaluation of the graft flow reserve after coronary artery bypass grafting by stress {sup 201}Tl myocardial SPECT. Comparison between arterial grafts and venous grafts

    Ichikawa, Akihiro; Taki, Junichi; Nakajima, Kenichi; Kawasuji, Michio; Tonami, Norihisa [Kanazawa Univ. (Japan). School of Medicine

    1997-01-01

    We performed stress {sup 201}Tl myocardial SPECT to evaluate ischemia and perfusion reserve after coronary artery bypass grafting (CABG). A total of 103 patients was performed stress {sup 201}Tl myocardial SPECT one month after CABG. Each patient`s myocardium was divided into 9 segments and visually evaluated using five grade scoring system (0=defect, 1=severe decrease, 2=moderate decrease, 3=mild decrease, 4=normal uptake). Eleven of 133 (8.27%) segments covered by patent venous grafts showed reversible {sup 201}Tl defect, however, 36 of 117 (30.8%) segments which covered by patent arterial grafts showed reversible {sup 201}Tl defect. This finding was observed more significantly in arterial grafts than in venous grafts (p<0.001). These finding suggests that arterial grafts have lower flow capacity than venous grafts at peak exercise. (author)

  13. Evaluation of the graft flow reserve after coronary artery bypass grafting by stress 201Tl myocardial SPECT. Comparison between arterial grafts and venous grafts

    We performed stress 201Tl myocardial SPECT to evaluate ischemia and perfusion reserve after coronary artery bypass grafting (CABG). A total of 103 patients was performed stress 201Tl myocardial SPECT one month after CABG. Each patient's myocardium was divided into 9 segments and visually evaluated using five grade scoring system (0=defect, 1=severe decrease, 2=moderate decrease, 3=mild decrease, 4=normal uptake). Eleven of 133 (8.27%) segments covered by patent venous grafts showed reversible 201Tl defect, however, 36 of 117 (30.8%) segments which covered by patent arterial grafts showed reversible 201Tl defect. This finding was observed more significantly in arterial grafts than in venous grafts (p<0.001). These finding suggests that arterial grafts have lower flow capacity than venous grafts at peak exercise. (author)

  14. Dual myocardial single photon emission computed tomography (SPECT) using thallium-201 and I-123-β-methyl-i-pentadecanoic acid in patients with Duchenne's progressive muscular dystrophy

    Dual single photon emission computed tomography (SPECT) was performed in 31 patients with Duchenne's progressive muscular dystrophy (DMD) using 123I-β-methyl pentadecanoic acid (BMIPP) for myocardial fatty acid metabolism and 201thallium (Tl)-chloride for myocardial perfusion. The left ventricle was divided into 9 segments, and accumulation of the radiotracers was assessed visually for each segment to calculate defect score for each tracer. There was some degree of decrease in myocardial accumulation of both tracers in all DMD patients. Reduced accumulation was most common at the apex (BMIPP: 67%, Tl: 63%), followed by the posterior wall, lateral wall, and anterior wall. On the other hand, reduced accumulation was less common at the septum. BMIPP showed a higher accumulation than Tl in all segments but the septum. When BMIPP defect score was larger than Tl defect score, BMIPP defect score tended to increase during 4 years follow-up (p Tl defect score revealed a slight fibrosis or normal myocardium. It can be concluded that the dual SPECT myocardial scintigraphy using BMIPP and Tl provides accurate information about disease progression of the heart in patients with DMD by detecting abnormalities of the myocardial metabolism of each substance, thereby enabling the assessment of left ventricular function. (author)

  15. Correlation of risk area and reverse redistribution of 99mTc-steamboat's SPECT in acute myocardial infarction following direct P TCA

    Redistribution of 99mTc-steamboat's is negligible in usual circumstances, but recent reports demonstrated reverse redistribution is detectable in acute myocardial patients. Correlation of risk area, observed in 99mTc-steamboat's ''frizzed' SPECT image at onset, and delayed images at 5-25 days after onset (post-P TCA image) is evaluated in 19 acute myocardial infarction patients treated with direct P TCA. Reverse redistribution was observed in 85% of reperfused area. Linear relationship of %uptake in each SPECT segment between onset and post-PTCA images (taken at 0.5, 4, and 6 hours after injection) is evaluated and the relationship improves over time course. The correlation coefficient between onset and 6 hours-delayed image is 0.88, and the visual concordance shows 77% of score matching. Delayed 99mTc-sestamibi SPECT image on reperfused AMI seems to represent risk area with some underestimation. It may be useful to estimate both risk and salvaged areas on early and delayed SPECT with a single 99mTc-sestamibi injection. (author)

  16. A trial for the quantification of regional myocardial blood flow with continuous infusion of Tc-99m MIBI and dynamic SPECT

    We propose a new method to quantify regional myocardial blood flow (rMBF) by continuous infusion of Tc-99m MIBI and dynamic SPECT. Five patients with old myocardial infarction were studied. During continuous infusion of MIBI (approximately 740 MBq) with a syringe pump in 10 min, dynamic SPECT scan was performed every minute and lasted 20 min after the start of infusion to identify myocardial uptake of MIBI. Input function was obtained from the radioactivity in the left ventricle (LV) in dynamic SPECT images. Spillover fraction between LV and myocardium (M) was corrected with phantom data. The influx constant (Ku) was calculated by Patlak plot graphical analysis, and compared with rMBF measured by PET (F) with N-13 ammonia based on Patlak plot analysis with correction for the extraction fraction. To correct the limited first-pass extraction of MIBI, linearization correction by means of the permeability-surface area (PS) product value was also applied. Spillover fractions of MIBI were 0.169±0.056 from LV to M, and 0.042±0.021 from M to LV. Ku was well correlated with F (Ku=0.057+0.220F, r=0.83, pMIBI=-0.131+0.858F, r=0.94, p<0.01). The proposed method has the potential to be a clinically feasible tool for quantitative measurement of rMBF. (author)

  17. Simultaneous Tc-99m/I-123 dual-radionuclide myocardial perfusion/innervation imaging using Siemens IQ-SPECT with SMARTZOOM collimator

    Du, Yong; Bhattacharya, Manojeet; Frey, Eric C.

    2014-06-01

    Simultaneous dual-radionuclide myocardial perfusion/innervation SPECT imaging can provide important information about the mismatch between scar tissue and denervated regions. The Siemens IQ-SPECT system developed for cardiac imaging uses a multifocal SMARTZOOM collimator to achieve a four-fold sensitivity for the cardiac region, compared to a typical parallel-hole low-energy high-resolution collimator, but without the data truncation that can result with conventional converging-beam collimators. The increased sensitivity allows shorter image acquisition times or reduced patient dose, making IQ-SPECT ideal for simultaneous dual-radionuclide SPECT, where reduced administrated activity is desirable in order to reduce patient radiation exposure. However, crosstalk is a major factor affecting the image quality in dual-radionuclide imaging. In this work we developed a model-based method that can estimate and compensate for the crosstalk in IQ-SPECT data. The crosstalk model takes into account interactions in the object and collimator-detector system. Scatter in the object was modeled using the effective source scatter estimation technique (ESSE), previously developed to model scatter with parallel-hole collimators. The geometric collimator-detector response was analytically modeled in the IQ-SPECT projector. The estimated crosstalk was then compensated for in an iterative reconstruction process. The new method was validated with data from both Monte Carlo simulations and physical phantom experiments. The results showed that the estimated crosstalk was in good agreement with simulated and measured results. After model-based compensation the images from simultaneous dual-radionuclide acquisitions were similar in quality to those from single-radionuclide acquisitions that did not have crosstalk contamination. The proposed model-based method can be used to improve simultaneous dual-radionuclide images acquired using IQ-SPECT. This work also demonstrates that ESSE scatter

  18. Simultaneous Tc-99m/I-123 dual-radionuclide myocardial perfusion/innervation imaging using Siemens IQ-SPECT with SMARTZOOM collimator

    Simultaneous dual-radionuclide myocardial perfusion/innervation SPECT imaging can provide important information about the mismatch between scar tissue and denervated regions. The Siemens IQ-SPECT system developed for cardiac imaging uses a multifocal SMARTZOOM collimator to achieve a four-fold sensitivity for the cardiac region, compared to a typical parallel-hole low-energy high-resolution collimator, but without the data truncation that can result with conventional converging-beam collimators. The increased sensitivity allows shorter image acquisition times or reduced patient dose, making IQ-SPECT ideal for simultaneous dual-radionuclide SPECT, where reduced administrated activity is desirable in order to reduce patient radiation exposure. However, crosstalk is a major factor affecting the image quality in dual-radionuclide imaging. In this work we developed a model-based method that can estimate and compensate for the crosstalk in IQ-SPECT data. The crosstalk model takes into account interactions in the object and collimator-detector system. Scatter in the object was modeled using the effective source scatter estimation technique (ESSE), previously developed to model scatter with parallel-hole collimators. The geometric collimator-detector response was analytically modeled in the IQ-SPECT projector. The estimated crosstalk was then compensated for in an iterative reconstruction process. The new method was validated with data from both Monte Carlo simulations and physical phantom experiments. The results showed that the estimated crosstalk was in good agreement with simulated and measured results. After model-based compensation the images from simultaneous dual-radionuclide acquisitions were similar in quality to those from single-radionuclide acquisitions that did not have crosstalk contamination. The proposed model-based method can be used to improve simultaneous dual-radionuclide images acquired using IQ-SPECT. This work also demonstrates that ESSE scatter

  19. Factors affecting the myocardial activity acquired during exercise SPECT with a high-sensitivity cardiac CZT camera as compared with conventional Anger camera

    Verger, Antoine; Karcher, Gilles [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); INSERM U947 and Universite de Lorraine, Nancy (France); Nancyclotep experimental imaging platform, Nancy (France); Imbert, Laetitia [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep experimental imaging platform, Nancy (France); Centre Alexis Vautrin, Department of Radiotherapy, Vandoeuvre (France); Yagdigul, Yalcine; Roch, Veronique [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep experimental imaging platform, Nancy (France); Fay, Renaud [INSERM, Centre d' Investigation Clinique CIC-P 9501, Nancy (France); Djaballah, Wassila [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); INSERM U947 and Universite de Lorraine, Nancy (France); Rouzet, Francois; Le Guludec, Dominique [AP-HP, Hopital Bichat, Department of Nuclear Medicine, Paris (France); INSERM U 773 and Denis Diderot University, Paris (France); Fourquet, Nicolas [Clinique Pasteur, Toulouse (France); Poussier, Sylvain [INSERM U947 and Universite de Lorraine, Nancy (France); Nancyclotep experimental imaging platform, Nancy (France); Marie, Pierre-Yves [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep experimental imaging platform, Nancy (France); INSERM U1116 and Universite de Lorraine, Nancy (France); CHU-Nancy, Allee du Morvan, Medecine Nucleaire, Hopital de Brabois, Vandoeuvre-les-Nancy (France)

    2014-03-15

    Injected doses are difficult to optimize for exercise SPECT since they depend on the myocardial fraction of injected activity (MFI) that is detected by the camera. The aim of this study was to analyse the factors affecting MFI determined using a cardiac CZT camera as compared with those determined using conventional Anger cameras. Factors affecting MFI were determined and compared in patients who had consecutive exercise SPECT acquisitions with {sup 201}Tl (84 patients) or {sup 99m}Tc-sestamibi (87 patients) with an Anger or a CZT camera. A predictive model was validated in a group of patients routinely referred for {sup 201}Tl (78 patients) or {sup 99m}Tc-sestamibi (80 patients) exercise CZT SPECT. The predictive model involved: (1) camera type, adjusted mean MFI being ninefold higher for CZT than for Anger SPECT, (2) tracer type, adjusted mean MFI being twofold higher for {sup 201}Tl than for {sup 99m}Tc-sestamibi, and (3) logarithm of body weight. The CZT SPECT model led to a +1 ± 26 % error in the prediction of the actual MFI from the validation group. The mean MFI values estimated for CZT SPECT were more than twofold higher in patients with a body weight of 60 kg than in patients with a body weight of 120 kg (15.9 and 6.8 ppm for {sup 99m}Tc-sestamibi and 30.5 and 13.1ppm for {sup 201}Tl, respectively), and for a 14-min acquisition of up to one million myocardial counts, the corresponding injected activities were only 80 and 186 MBq for {sup 99m}Tc-sestamibi and 39 and 91 MBq for {sup 201}Tl, respectively. Myocardial activities acquired during exercise CZT SPECT are strongly influenced by body weight and tracer type, and are dramatically higher than those obtained using an Anger camera, allowing very low-dose protocols to be planned, especially for {sup 99m}Tc-sestamibi and in non-obese subjects. (orig.)

  20. Quantitative comparison of dobutamine and exercise stress 99mTc-MIBI myocardial SPECT in diagnosis of coronary artery disease

    Aim: To compare the value of dobutamine and exercise stress 99mTc-MIBI myocardial imaging in diagnosis of coronary heart disease (CHD). Material and Methods: The subjects included twenty-one patients, in whom 18 were suspected with CHD and 3 were clinically diagnosed with myocardial infarction. The final diagnosis in all patients was confirmed by coronary angiography. Both dobutamine stress (DOB-ST) and bicycle exercise stress (EX-ST) 99mTc-MIBI myocardial perfusion SPECT were undertaken in every patient. The two stress imaging in one patient were performed within three days. Results: Twenty-four vessels in fourteen patients were diagnosed with coronary artery disease. There were no significant difference between DOB-ST and EX-ST in overall sensitivity (92.8% vs 92.8%), specificity (71.4 vs 85.7%), positive predictive value (86.7% vs 92.9%) and negative predictive value (83.3 vs 85.7%). There were also no significant difference in the sensitivity and specificity for detecting single or multiple vessel disease and for detecting specified vessel lesions (LDA, RCA, LCX). However, in 69 segments which related to the diseased vessels DOB-ST revealed 47 ischemic segments and EX-ST found 30 ischemic segments (P<0.05). The ischemic size which was expressed by the percentage of black-out area in polar map were bigger in DOB-ST image than that in EX-ST image (22.8±11.4% vs 17.5±12.3%, P<0.01) and, average radioactivity uptake ratio of ischemic region in DOB-ST image was lower than that in EX-ST image (43.2±13.8% vs 57.4±14.6%, P<0.01). Conclusion: DOB-ST demonstrated similar diagnostic efficacy to EX-ST in detecting coronary artery disease, thus it may be a feasible intervention for myocardial perfusion imaging. Whether DOB-ST is more sensitive to detect mild ischemia than EX-ST remains to be further investigated

  1. Is chronic ST segment elevation a marker of myocardial non viability in patients with Q wave anteroseptal MI? Correlation with myocardial perfusion SPECT

    Persistence of ST segment elevation for more than 2-4 weeks in patients with acute antero septal transmural myocardial infarction (ASMI) is considered to be a specific marker of left ventricular aneurysm. Objective: We attempted to assess the face value of this statement by correlating the findings of 99mTc Sestamibi Myocardial perfusion SPECT (MPSPECT), one of the most specific modalities of myocardial viability assessment with resting 12 lead ECG. METHOD: 240 ASMI patients (192:48 Male: Female pts, age range 36-71 yrs Mean 51±8 yrs) referred for risk stratification to our department between Jan 02 -Jan 04 were retrospectively analysed. The baseline demographic details and LV systolic function parameters were more or less the same for all these patients. The mean LV EF at rest was 40±6 %. All these patients fulfilled the following inclusion criteri 1) Patients with Q Wave ASMt more than 1 month old, 2) ECG at rest showing sinus rhythm, QRS 1.5 mm. Patients with atrial arrhythmias and bundle branch block were excluded. All these patients underwent same day rest stress gated 99mTc MIBI/ tetrofosmin MPSPECT on a dual head variable angle gamma camera. Patients performed either conventional treadmill stress or taken up for pharmacological stress. LAD territory myocardial segments (i.e. apex, anterior, septal) were evaluated for the presence of reversible ischaemia / viable myocardium. Images were visually interpreted and using a 16 segment myocardial model quantification was also performed. Presence of reversible perfusion defects, uptake of MIBI at rest more than 40 % and myocardial systolic wall thickening (count increase by at least 10% during systole) were considered as markers of viability. Results' Patients were categorized into two groups. ST elevation positive i.e. patients with rest ST elevation > 1.5 mm (137 pts 57%) and ST elevation negative (103 pts 37%) by the rest ECG criteria. In ST positive group, 47/137 pts (34%) showed viability (mean viable

  2. Is chronic st segment elevation a marker of myocardial non viability in patients with Q wave anteroseptal mi? - correlation with myocardial perfusion SPECT

    Persistence of ST segment elevation for more than 2-4 weeks in patients with acute antero septal transmural myocardial infarction (ASMI) is considered to be a specific marker of left ventricular aneurysm. Objective: We attempted to assess the face value of this statement by correlating the findings of 99m-Tc Sestamibi Myocardial perfusion SPECT (MPSPECT), one of the most specific modalities of myocardial viability assessment with resting 12 lead ECG. Method: 240 ASMI patients (192:48 Male: Female pts, age range 36-71 yrs Mean 51±8 yrs) referred for risk stratification to our department between Jan 02 -Jan 04 were retrospectively analysed. The baseline demographic details and LV systolic function parameters were more or less the same for all these patients. The mean LV EF at rest was 40±6 %. All these patients fulfilled the following inclusion criteria: 1) Patients with Q Wave ASMI more than l month old, 2) ECG at rest showing sinus rhythm, QRS 1.5 mm. Patients with atrial arrhythmias and bundle branch block were excluded. All these patients underwent same day rest stress gated 99mTc MIBI/ tetrofosmin MPSPECT on a dual head variable angle gamma camera. Patients performed either conventional treadmill stress or taken up for pharmacological stress. LAD territory myocardial segments (i.e. apex, anterior, septal) were evaluated for the presence of reversible ischaemia/viable myocardium. Images were visually interpreted and using a 16 segment myocardial model quantification was also performed. Presence of reversible perfusion defects, uptake of MIBI at rest more than 40% and myocardial systolic wall thickening (count increase by at least 10% during systole) were considered as markers of viability. Results: Patients were categorized into two groups. ST elevation positive i.e. patients with rest ST elevation > 1.5 mm (137 pts 57%) and ST elevation negative (103 pts 37%) by the rest ECG criteria. In ST positive group, 47/137 pts (34%) showed viability (mean viable

  3. Development of 4D mathematical observer models for the task-based evaluation of gated myocardial perfusion SPECT

    Lee, Taek-Soo; Frey, Eric C.; Tsui, Benjamin M. W.

    2015-04-01

    This paper presents two 4D mathematical observer models for the detection of motion defects in 4D gated medical images. Their performance was compared with results from human observers in detecting a regional motion abnormality in simulated 4D gated myocardial perfusion (MP) SPECT images. The first 4D mathematical observer model extends the conventional channelized Hotelling observer (CHO) based on a set of 2D spatial channels and the second is a proposed model that uses a set of 4D space-time channels. Simulated projection data were generated using the 4D NURBS-based cardiac-torso (NCAT) phantom with 16 gates/cardiac cycle. The activity distribution modelled uptake of 99mTc MIBI with normal perfusion and a regional wall motion defect. An analytical projector was used in the simulation and the filtered backprojection (FBP) algorithm was used in image reconstruction followed by spatial and temporal low-pass filtering with various cut-off frequencies. Then, we extracted 2D image slices from each time frame and reorganized them into a set of cine images. For the first model, we applied 2D spatial channels to the cine images and generated a set of feature vectors that were stacked for the images from different slices of the heart. The process was repeated for each of the 1,024 noise realizations, and CHO and receiver operating characteristics (ROC) analysis methodologies were applied to the ensemble of the feature vectors to compute areas under the ROC curves (AUCs). For the second model, a set of 4D space-time channels was developed and applied to the sets of cine images to produce space-time feature vectors to which the CHO methodology was applied. The AUC values of the second model showed better agreement (Spearman’s rank correlation (SRC) coefficient = 0.8) to human observer results than those from the first model (SRC coefficient = 0.4). The agreement with human observers indicates the proposed 4D mathematical observer model provides a good predictor of the

  4. Early detection of radiation-induced heart disease using 99mTc-MIBI SPECT gated myocardial perfusion imaging in patients with oesophageal cancer during radiotherapy

    Background and purpose: The primary aim of this prospective study was to investigate the value of 99mTc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) in the detection of radiation-induced heart disease (RIHD) as early as during radiotherapy (RT) for oesophageal cancer (EC). The second aim was to analyse the correlation between cardiac toxicity and the dose–volume factors. Materials and methods: The 99mTc-MIBI SPECT GMPI was performed both pre-RT and during RT (40 Gray). The results of the SPECT were quantitatively analysed with QGS/QPS software and read by two experienced nuclear medicine physicians. The correlation between the changes in the SPECT parameters and the RT dosimetric data was analysed. Results: Eighteen patients with locally advanced EC were enrolled in the study. Compared with the baseline, the imaging during RT showed not only significant decreases in the wall motion (WM) (1/20 segments), wall thickening (WT) (2/20 segments), end-diastolic perfusion (EDP) (5/20 segments) and end-systolic perfusion (ESP) (8/20 segments) (p < 0.05) but also a significant increase in the heart rate (74.63 ± 7.79 vs 81.49 ± 9.90, p = 0.036). New myocardial perfusion defects were observed in 8 of the 18 patients. The V37–V40 was significantly higher (p < 0.05) in the patients with the new perfusion defects during RT than in the patients who did not exhibit these defects. Conclusions: Radiotherapy for EC induces cardiac damage from an early stage. 99mTc-MIBI SPECT GMPI can detect the occurrence of cardiac impairment during RT. The WM, WT, EDP and ESP may be valuable as early indicators of RIHD. The percentage of the heart volume that receives a high dose is an important factor that is correlated with RIHD

  5. Reduced coronary flow reserve in patients with primary hyperparathyroidism: a study by G-SPECT myocardial perfusion imaging

    The mechanisms underlying increased cardiovascular risk in primary hyperparathyroidism (pHPT) have not been fully defined. Recently, this issue has become the subject of renewed interest due to the increasing evidence that the endothelium and vascular wall are targets for parathyroid hormone (PTH). The aim of this study was to measure regional coronary flow reserve (CFR) to determine whether the vascular damage induced by pHPT extends to affect the coronary microvascular function. A total of 22 pHPT patients without a history of coronary artery disease and 7 age-matched control subjects were recruited. Dipyridamole myocardial blood flow (MBF) was assessed using 99mTc-sestamibi by measuring first-transit counts in the pulmonary artery and myocardial count rate from G-SPECT images. Baseline MBF was estimated 2 h later according to the same procedure. Regional CFR was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular model. Three pHPT patients showed reversible perfusion defects and were excluded from the analysis. In the remaining 19, CFR was significantly lower with respect to the control subjects (1.88 ± 0.64 vs. 3.36 ± 0.66, respectively; p < 0.01). Moreover, patients studied for more than 28 months from pHPT diagnosis showed lower CFR values than the others (1.42 ± 0.18 vs. 2.25 ± 0.64, respectively; p < 0.01). Consequently, the time from diagnosis to the nuclear study showed a reasonable correlation with the degree of CFR impairment (Spearman's rho -0.667, p < 0.02). pHPT is associated with a significant dysfunction of the coronary microcirculation. This disorder might contribute to the high cardiovascular risk of conditions characterized by chronic elevations in serum PTH levels. (orig.)

  6. Reduced coronary flow reserve in patients with primary hyperparathyroidism: a study by G-SPECT myocardial perfusion imaging

    Marini, Cecilia [CNR Institute of Bioimages and Molecular Physiology Milan, Genoa (Italy); Giusti, Massimo; Vera, Lara; Minuto, Francesco [University of Genoa, Department of Endocrinological and Metabolic Sciences, Genoa (Italy); Armonino, Riccardo; Ghigliotti, Giorgio; Bezante, Gian Paolo; Morbelli, Silvia; Pomposelli, Elena; Massollo, Michela; Gandolfo, Patrizia; Sambuceti, Gianmario [University of Genoa, Department of Internal Medicine, Genoa (Italy)

    2010-12-15

    The mechanisms underlying increased cardiovascular risk in primary hyperparathyroidism (pHPT) have not been fully defined. Recently, this issue has become the subject of renewed interest due to the increasing evidence that the endothelium and vascular wall are targets for parathyroid hormone (PTH). The aim of this study was to measure regional coronary flow reserve (CFR) to determine whether the vascular damage induced by pHPT extends to affect the coronary microvascular function. A total of 22 pHPT patients without a history of coronary artery disease and 7 age-matched control subjects were recruited. Dipyridamole myocardial blood flow (MBF) was assessed using {sup 99m}Tc-sestamibi by measuring first-transit counts in the pulmonary artery and myocardial count rate from G-SPECT images. Baseline MBF was estimated 2 h later according to the same procedure. Regional CFR was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular model. Three pHPT patients showed reversible perfusion defects and were excluded from the analysis. In the remaining 19, CFR was significantly lower with respect to the control subjects (1.88 {+-} 0.64 vs. 3.36 {+-} 0.66, respectively; p < 0.01). Moreover, patients studied for more than 28 months from pHPT diagnosis showed lower CFR values than the others (1.42 {+-} 0.18 vs. 2.25 {+-} 0.64, respectively; p < 0.01). Consequently, the time from diagnosis to the nuclear study showed a reasonable correlation with the degree of CFR impairment (Spearman's rho -0.667, p < 0.02). pHPT is associated with a significant dysfunction of the coronary microcirculation. This disorder might contribute to the high cardiovascular risk of conditions characterized by chronic elevations in serum PTH levels. (orig.)

  7. New software for raw data mask processing increases diagnostic ability of myocardial SPECT imaging

    Increased activity of myocardial perfusion tracer technetium-99m in liver and hepatobiliary system causes streak artifacts, which may affect clinical diagnosis. We developed a mask-processing tool for raw data generated using technetium-99m as a myocardial perfusion tracer. Here, we describe improvements in image quality under the influence of artifacts caused by high accumulation in other organs. A heart phantom (RH-2) containing 15 MBq of pertechnetate was defined as model A. Model B was designed in the same phantom containing ten times of cardiac radioactivity overlapping with other organs. Variance in the vertical profile count in the lower part of the myocardial inferior wall and in the myocardial circumferential profile curve were investigated in a phantom and clinical cases using our raw data masking (RDM) software. The profile variances at lower parts of myocardial inferior walls were 965.43 in model A, 1390.11 in model B and 815.85 in B-RDM. The mean ±SD of myocardial circumferential profile curves were 83.91±7.39 in model A, 69.61±11.45 in model B and 82.68±9.71 in model B-RDM. For 11 clinical images with streak artifacts, the average of the variance significantly differed between with and without RDM (3.95 vs. 21.05; P<0.05). For 50 clinical images with hepatic accumulation artifacts, the average of the variance on vertical profiles on images with and without RDM significantly differed (5.99 vs. 15.59; P<0.01). Furthermore, when a segment with <60% uptake in polar maps was defined as abnormal, the average extent score of 1 h (Tc-1h), 5 min of RDM (Tc-0h-RDM) and 5 min of non-RDM (Tc-0h-non-RDM) were 2.25±3.12, 2.35±3.16, and 1.37±2.41, respectively. Differences were significant between Tc-1h and Tc-0h-non-RDM (P<0.005) but not between Tc-1h and Tc-0h-RDM. Batch processing was enabled in all frames by shifting the myocardium to the center of rotation using this software. The waiting time between infusion and image acquisition should be decreased

  8. Impact of endothelial dysfunction on left ventricular remodeling after successful primary coronary angioplasty for acute myocardial infarction. Analysis by quantitative ECG-gated SPECT

    We hypothesized that endothelial cell integrity in the risk area would influence left ventricular remodeling after acute myocardial infarction. Twenty patients (61±8 y.o.) with acute myocardial infarction underwent 99mTc-tetrofosmin imaging in the sub-acute phase and three months after successful primary angioplasty due to myocardial infarction. All patients were administered angiotensin-converting enzyme inhibitor after revascularization. Cardiac scintigraphies with quantitative gated SPECT were performed at the sub-acute stage and again 3 months after revascularization to evaluate left ventricular (LV) remodeling. The left ventricular ejection fraction (EF) and end-systolic and end-diastolic volume (ESV, EDV) were determined using a quantitative gated SPECT (QGS) program. Three months after myocardial infarction, all patients underwent cardiac catheterization examination with coronary endothelial function testing. Bradykinin (BK) (0.2, 0.6, 2.0 μg/min) was administered via the left coronary artery in a stepwise manner. Coronary blood flow was evaluated by Doppler flow velocity measurement. Patients were divided into two groups by BK-response: a preserved endothelial function group (n=10) and endothelial dysfunction group (n=10). At baseline, both global function and LV systolic and diastolic volumes were similar in both groups. However, LV ejection fraction was significantly improved in the preserved-endothelial function group, compared with that in the endothelial dysfunction group (42±10% to 48±9%, versus 41±4% to 42±13%, p<0.05). LV volumes progressively increased in the endothelial dysfunction group compared to the preserved-endothelial function group (123±45 ml to 128±43 ml, versus 111±47 ml to 109±49 ml, p<0.05). In re-perfused acute myocardial infarction, endothelial function within the risk area plays an important role with left ventricular remodeling after myocardial infarction. (author)

  9. Prognostic risk stratification of myocardial ischaemia evaluated by gated myocardial perfusion SPECT in patients with chronic kidney disease

    Hatta, Tsuguru [Ohmihachiman Community Medical Center, Division of Nephrology, Department of Medicine, Shiga (Japan); Nishimura, Shigeyuki [Saitama Medical School Hospital, Division of Cardiology, Saitama (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science, Kyoto (Japan)

    2009-11-15

    The aim of this study was to identify useful predictors of cardiac events in patients with chronic kidney disease (CKD). Among 4,031 patients identified from the Japanese Assessment of Cardiac Events and Survival Study (J-ACCESS) database with suspected or known ischaemic heart disease, we selected 820 with an estimated glomerular filtration rate (eGFR) of < 60 ml/min per 1.73 m{sup 2}. A total of 75 cardiac events developed among these 820 patients. The incidence of cardiac events was higher in the group with a lower eGFR. Multivariate Cox analysis indicated that age, diabetes mellitus, end-systolic volume, summed stress score (SSS) and eGFR were predictors of cardiac events. Event rates of patients with SSS {>=} 9 were significantly higher in groups with lower eGFR values (< 40 and 40-49 ml/min). The SSS value ({>=} 9) is a reliable predictor of cardiac events and myocardial single photon emission computed tomography has incremental value for predicting cardiac events and survival in CKD. (orig.)

  10. Association of the positive results of myocardial perfusion SPECT in the presence of hypertension in patients 40 years or more

    To know the association of arterial hypertension (AH) with positive results on myocardial perfusion SPECT (MPSPECT), in order to optimize the use of this technique. Material and Method: We analyzed 227 MPSPECT studies, two-day protocol, average age of patients = 57.92 years, 119 (52.4%) males. According to the presence of AH the population was divided in H (hypertensives) n=155 and NH (non-hypertensives) n=72. Both groups did not differ in age average (57.34 vs.59.17, p=0.094), but they did in body mass index (H=28.98 vs. NH=26.63, p<0.001), however not outstandingly (difference of means = 2.35), being both groups classified as overweighted. Therefore, the only additional risk was the presence of AH. Results: One-hundred and eighty three (80.6%) SPECTMP studies were positive. In the intergroup comparison no significant difference was observed in the incidence of positive results (81.90% vs. 77.80%, p=0.461), which persisted when the groups were subdivided into symptomatic and asymptomatic. Conclusion: No association between AH and the result of MPSPECT was observed, therefore symptomatic patients with this triad of atherosclerotic risk factors (AH, overweight and age =40 years), should be explored with MPSPECT while asymptomatic patients should undergo exercise testing. Non-hypertensive patients should be first evaluated with exercise teststing independently of the presence of symptomatology

  11. The importance of the gated-spect in myocardial perfusion studies on the prognostic evaluation of patients with left bundle branch block disease

    Aim: To evaluate the outcome of patients with left bundle branch block disease (LBBB) relating it to the perfusion and functional findings after Gated-Spect Myocardial Perfusion studies. Materials and Methods: Results of Gated-Spect Myocardial Perfusion studies, performed between March of 1998 and April 2002, were correlated to the clinical outcome of 41 patients with LBBB. The evaluative data were obtained by interview directly with the patients, or their relatives or referral physician. Myocardial perfusion studies were conducted following the one-day protocol, after injection of 296- 370 MBq Sestamibi [Tc-99m] (Cardiolite) for rest studies, and 1110 MBq for stress studies. The images were acquired using a two-head tomographic gamma camera (Varicam - Elscint, Haifa), with low energy and high-resolution collimators, disposed in 'L' mode. The projection data were obtained in 64x64 matrix, for a 180 degrees circular orbit, from right anterior to left posterior oblique, with 3 degree per step. Each step took 30-35 seconds during rest studies and 25-30 seconds during stress studies. Regular EKG signals were registered to obtain Gated-Spect studies. Results: Twenty patients presented normal LVEFs (≥ 50%) and twenty and one, abnormal results. All the twenty patients with normal perfusional studies presented unremarkable outcomes after 1 of the 2 years of the study. The LVEF in this group of patients ranged from 27% to 87%. Twenty-and-one showed abnormalities on their perfusional studies. Of these, eighteen who had LVEFs greater than 30%, had not hard cardiac events (cardiac death or MIs) during the same interval. Conclusion: These preliminary data show that patients with LBBB and a normal myocardial perfusion study have low risk of coronary event, independent of the fraction of ejection. The patients with abnormal perfusional study and significant reduced LVEF (less than 30 %) present higher risk of cardiac event

  12. Radiation-induced heart disease due to intrathonacic tumor radiotherapy of a single dose to the rabbits' heart

    Objective: To observe the changes of radiation-induced heart disease (RIHD) in the rabbits irradiated in clinical related dose, and to evaluate the apoptosis and hypoxia in the irradiated heart by the new scintigraphic agents of 99Tcm-HL91 and 99Tcm-Annexin V of heart SPECT. Methods: Tenty-four New Zealand white rabbits 4-month old and 2-3 kg by weight were divided into two groups. Group 1 (clinical related dose group): 16 irradiated by a single close from 0 to 18 Gy. Group 2 (high dose group): 8 irradiated dose from 22 to 80 Gy. The serum cTnI/CKMB, ECG, and heart SPECT(using 99Tcm-MIBI, 99Tcm-HL91 and 99Tcm-Annexin V as agents) were detected before and after irradiation. The animals were followed for 5 months. Then biopsy of rabbit heart was performed and pathologic examination was made by H.E. stain. Results: In the 16 rabbits of clinical related dose group, none died of RIHD. Whereas 2 rabbits died of RIHD in the high dose group. One died of myocardial infarction and the other of congestive heart failure. According to the Stewart introduced heart lesion grading system, of the clinical close ann, there were moderate in 1 rabbit, minimal in 14; and of the high dose ann, it was severe in 2, marked in 1, moderate in 5. The parallel relation was observed between the ECG results and the pathological changes (χ2=0.08, P=0.771). Serum value of cTnI, was elevated at the 12th hour after irradiation reaching the peak and maintained for 4 months. However, it came down in the 5th month. The difference of serum cTnI value before and after radiation was statistically significant. Myocardial perfusion scintigraphy tested by heart SPECT (99Tcm-MIBI) showed defects was present in all irradiated rabbits. The relationship between the defects and radiation dose or between the defects and the real RIHD was uncertain. The SPECT images displayed that 99Tcm-HL91 and 99mTc-Annexin V did not accumulate in the irradiated heart. Conclusions: No serious damage is found in rabbits heart

  13. Comparison of Gated SPECT Myocardial Perfusion Imaging with Echocardiography for the Measurement of Left Ventricular Volumes and Ejection Fraction in Patients With Severe Heart Failure

    Shojaeifard, Maryam; Ghaedian, Tahereh; Yaghoobi, Nahid; Malek, Hadi; Firoozabadi, Hasan; Bitarafan-Rajabi, Ahmad; Haghjoo, Majid; Amin, Ahmad; Azizian, Nasrin; Rastgou, Feridoon

    2015-01-01

    Background: Gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is known as a feasible tool for the measurement of left ventricular ejection fraction (EF) and volumes, which are of great importance in the management and follow-up of patients with coronary artery diseases. However, considering the technical shortcomings of SPECT in the presence of perfusion defect, the accuracy of this method in heart failure patients is still controversial. Objectives: The aim of the present study was to compare the results from gated SPECT MPI with those from echocardiography in heart failure patients to compare echocardiographically-derived left ventricular dimension and function data to those from gated SPECT MPI in heart failure patients. Patients and Methods: Forty-one patients with severely reduced left ventricular systolic function (EF ≤ 35%) who were referred for gated SPECT MPI were prospectively enrolled. Quantification of EF, end-diastolic volume (EDV), and end-systolic volume (ESV) was performed by using quantitative gated spect (QGS) (QGS, version 0.4, May 2009) and emory cardiac toolbox (ECTb) (ECTb, revision 1.0, copyright 2007) software packages. EF, EDV, and ESV were also measured with two-dimensional echocardiography within 3 days after MPI. Results: A good correlation was found between echocardiographically-derived EF, EDV, and ESV and the values derived using QGS (r = 0.67, r = 0.78, and r = 0.80 for EF, EDV, and ESV, respectively; P < 0.001) and ECTb (r = 0.68, 0.79, and r = 0.80 for EF, EDV, and ESV, respectively; P < 0.001). However, Bland-Altman plots indicated significantly different mean values for EF, 11.4 and 20.9 using QGS and ECTb, respectively, as compared with echocardiography. ECTb-derived EDV was also significantly higher than the EDV measured with echocardiography and QGS. The highest correlation between echocardiography and gated SPECT MPI was found for mean values of ESV different. Conclusions: Gated

  14. Asymmetrically thickened posterior wall is associated with decline of ejection fraction after stress on adenosine stress/rest thallium-201 gated myocardial SPECT

    Kim, Bom Sahn; Lee, Won Woo; Lee, Dong Soo; Chung, June Key; Lee, Myung Chul; Kim, Sang Eun [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    2004-07-01

    LV parameters (LVEF. ESVI and EDVI) on adenosine stress/rest thallium-201 gated myocardial SPECT (gSPECT) are various from stress to rest. We investigated the reason why they were various in patients without coronary artery disease. Seventy-one patients(M:F=32:39, age 58.1{+-}9.7yrs), who underwent gSPECT and coronary angiography (CAG) due to chest pain or preoperative evaluation were included. CAG results were normal or insignificant. Exclusion criteria were atrial fibrillation, thyroid disease, primary cardiomyopathy, myocardial bridge, LBBB, MI, and valvular heart disease. Patients were calssified into 3 groups by EF difference ({delta}EF=rest-stress EF) on gSPECT : group1 ({delta}EF{>=}10), group2 (0 {<=}{delta}EF<10), and group3 ({delta}EF<0). LV parameters on gSPECT and thicknesses of IVS (interventricular septum) and LVPW (left ventricular posterior wall) on echocardiography were compared among the 3 groups. Myocardial perfusion status were normal or mild reversible/persistent perfusion defect in 76.1% (54/71). LVEFs at stress were not different among all 3 groups : 59.3{+-}8.54% in group 1 (61.3{+-}10.22% in group 2 and 64.8{+-}7.58% in group 3 (p>0.05). But LVEF at rest was smaller in group 3 (58.7{+-}8.38%) than the other groups (72.5{+-}8.77% in group1 and 66.7{+-}10.6% in group2) (p<0.01). EDVIs and ESVI at stress were larger than those at rest in all groups (p<0.05) except ESVI in group 3 (16.2{+-}6.21ml at stress and 17.5{+-}6.41ml at rest, p<0.01), and that was attributed to EF<0 in group 3. In echocardiographical analysis, group 3 had significantly increased wall thickness of LVPW (10.7{+-}1.2mm versus 9.4{+-}1.6mm, p=0.01) and decreased wall thickness ratio of IVS/LVPW (0.963{+-}0.102 versus 1.048{+-}0.104, p=0.035) than group 1. In patients without coronary artery disease, LVEF, EDVI and ESVI on gSPECT were various and decline of LVEF from stress to rest was caused by unnormalized ESVI . Asymmetrically thickened LVPW may play a crucial role and

  15. Diagnostic Value of Myocardial Perfusion SPECT with Dipyridamole in a Female Population

    Background: Exercise stress scintigraphy is a safe procedure widely used for the diagnosis of ischemic heart disease. Pharmacologic stress testing is an important alternative. The delayed presentation of ischemic heart disease in women, together with a lower diagnostic accuracy of exercise stress testing in this population, has generated interest in the potential benefits provided by myocardial perfusion imaging tests. Objective: To determine the diagnostic value of myocardial perfusion images with 99mTc-tetrofosmin in a one day protocol after a pharmacologic stress with dipyridamole in a female population, and the relation with the coronary territories using coronary angiography as a reference technique. Material and Methods: In total, 149 clinical charts of women with suspected ischemic heart disease undergoing myocardial perfusion imaging tests and coronary angiography were retrospectively analyzed. Results: Sensitivity and specificity were 94% (93.47%-94.53%) and 82% (80.94%-83.06%), respectively. Values of sensitivity and specificity according to coronary territories were 71.62% (70.88%-72.36%) and 76% (75.27%-76.73%) for the left anterior descending (LAD) artery, 69.09% (68.11%-70.07%) and 76.84% (76.26%-77.42%) for the left circumflex (LCx) coronary artery, and 87.23% (86.11%-88.36%) and 74.51% (73.97%-75.05%) for the right coronary artery (RCA), respectively. Conclusion: Myocardial perfusion scintigraphy with 99mTc-tetrofosmin and dipyridamole using a one day stress-rest protocol has high sensitivity and specificity for the diagnosis of ischemic heart disease in women. (authors)

  16. assessment of the clinical role of simultaneous 99mTc-MIBI and 201Tl dual-isotopic myocardial perfusion SPECT imaging in the patients wit hypertension

    Objective: To study the clinical role of Simultaneous rest technetium-99m sestamibi (99mTc-MIBI) and stress thallium-201 (201Tl) Dual-isotopic myocardial perfusion SPECT imaging in the patients with hypertension. Methods: 116 patients with high blood pressure underwent simultaneous dual-isotopic myocardial perfusion SPECT imaging with 99mTc-MIBI and 201Tl. 99mTc-MIBI was injected at rest, 15 min later dobutamine was instilled into vein begin with 5 mg/kg/min, before and after instilling the base ECG, blood pressure, heart rate was recorded. when the maximal dose of Dobutamine was achieved, thallium-201 was injected, the dual-isotopic simultaneously SPECT imagine was performed. The stress and rest imagine was obtained. After tomographic reconstruction, the images were interpreted by two experienced observers without previous knowledge of results of other studies. Coronary angiography was performed in two weeks. All of 116 patients were found normal. Results: (1) All of 116 patients with high blood pressure were divided as three group by the course of disease: A group (20 year), 15. The heart/lung ratios of A, B, C group were 2.651±0.246, 2.546±0.231, 2.490±0.36 (mean±SD)respectively, no significant difference was noted among three group. Normal heart/lung ratios is 2.50±0.28 among of control group of 20. (2) The overall sensitivity for the dual-isotopic simultaneously myocardial SPECT imagine of high blood pressure was 46.55%(54/116). (3) Anterior, lateral, inferior, apex, interventricular septal segment were regarded as a whole segment, 111 segments display abnormal 201Tl uptake. 63, 30, 18 segments were in A, B, C group respectively, and no significant difference was noted among three group. 4 85 segments reveal reduced stressing 201Tl uptake and no typical redistribution was observed in the delay 201Tl imagines. 20, 24, 14, 12, 15 segments were in anterior, lateral, inferior, apex, interventricular septal segment respectively. 26 segments display inverse 201

  17. Critical myocardial perfusion in hypertrophic cardiomyopathy demonstrated with thallium-201 SPECT with a quantitative bullseye map

    PURPOSE: A particular problem in hypertrophic cardiomyopathy (HCM) is the need to distinguish between true and apparent ischemia in otherwise normal areas of muscle when these are compared with adjacent hypertrophic muscle. The authors of this paper studied patients with proved HCM to define patterns of perfusion. T1-201 single photon emission CT (SPECT) was performed in 83 HCM patients immediately after stress (dipyridamole, 0.5 mg/kg) and 3 hours later for the redistribution image. The data were analyzed by a normalized quantitative analysis using a local bulls-eye technique. In all patients, the pattern of tracer distribution was different from expected uptake in a normal population. By virtue of the increased microcirculation to hypertrophied muscle, adjacent normal muscle appeared relatively ischemic

  18. [The Optimal Reconstruction Parameters by Scatter and Attenuation Corrections Using Multi-focus Collimator System in Thallium-201 Myocardial Perfusion SPECT Study].

    Shibutani, Takayuki; Onoguchi, Masahisa; Funayama, Risa; Nakajima, Kenichi; Matsuo, Shinro; Yoneyama, Hiroto; Konishi, Takahiro; Kinuya, Seigo

    2015-11-01

    The aim of this study was to reveal the optimal reconstruction parameters of ordered subset conjugates gradient minimizer (OSCGM) by no correction (NC), attenuation correction (AC), and AC+scatter correction (ACSC) using IQ-single photon emission computed tomography (SPECT) system in thallium-201 myocardial perfusion SPECT. Myocardial phantom acquired two patterns, with or without defect. Myocardial images were performed 5-point scale visual score and quantitative evaluations using contrast, uptake, and uniformity about the subset and update (subset×iteration) of OSCGM and the full width at half maximum (FWHM) of Gaussian filter by three corrections. We decided on optimal reconstruction parameters of OSCGM by three corrections. The number of subsets to create suitable images were 3 or 5 for NC and AC, 2 or 3 for ACSC. The updates to create suitable images were 30 or 40 for NC, 40 or 60 for AC, and 30 for ACSC. Furthermore, the FWHM of Gaussian filters were 9.6 mm or 12 mm for NC and ACSC, 7.2 mm or 9.6 mm for AC. In conclusion, the following optimal reconstruction parameters of OSCGM were decided; NC: subset 5, iteration 8 and FWHM 9.6 mm, AC: subset 5, iteration 8 and FWHM 7.2 mm, ACSC: subset 3, iteration 10 and FWHM 9.6 mm. PMID:26596202

  19. Evaluation of clinical usefulness of myocardial perfusion imaging with tetrofosmin in patients with ischemic heart disease. Comparison with [sup 201]Tl SPECT

    Yoshida, Tsuyoshi; Sasaki, Masayuki; Ichiya, Yuichi (Kyushu Univ., Fukuoka (Japan). Faculty of Medicine) (and others)

    1994-09-01

    We evaluated the clinical usefulness of [sup 99m]Tc-1, 2-bis[bis(2-ethoxyethyl)phosphino]ethane (tetrofosmin) and compared it with [sup 201]Tl. The subjects consisted of 12 patients including 8 patients with old myocardial infarction (OMI), 2 with effort angina, one with stable angina and one with myocarditis. The tetrofosmin SPECT images were obtained during exercise and at rest. The quality of tetrofosmin SPECT images was equal or slightly superior to that of [sup 201]Tl. And the sensitivity, specificity and accuracy of tetrofosmin for the detection of coronary stenosis and/or obstruction were equal to that of [sup 201]Tl. We conclude that tetrofosmin is useful in the diagnosis of ischemic heart disease. (author).

  20. Therapeutic effects of coenzyme Q10 on dilated cardiomyopathy. Assessment by 123I-BMIPP myocardial single photon emission computed tomography (SPECT). A multicenter trial in Osaka University Medical School Group

    To evaluate therapeutic effects of Coenzyme Q10 (CoQ10), 15 patients with dilated cardiomyopathy were investigated by 123I-BMIPP myocardial single photon emission computed tomography (SPECT). The BMIPP defect score was determined semiquantitatively by using representative short and long axial SPECT images. Mean BMIPP defect score with CoQ10 treatment was significantly low, 7.7±6.1 compared to 12.7±7.4 without CoQ10 treatment. On the other hand, in 8 patients of dilated cardiomyopathy, % fractional shortening using echocardiography was not different before and after CoQ10 treatment. In conclusion, 123I-BMIPP myocardial SPECT was proved to be sensitive to evaluate the therapeutic effects of CoQ10, which improve myocardial mitochondrial function, in the cases of dilated cardiomyopathy. (author)

  1. Quantification of myocardial perfusion SPECT for the assessment of coronary artery disease: should we apply scatter correction?

    Compared to other non invasive testings for CAD diagnosis, myocardial perfusion imaging (MPI) is considered as a very sensitive method which accuracy is however often dimmed by a certain lack of specificity, especially in patients with a small heart. With gated SPECT MPI, use of end-diastolic instead of summed images has been presented as an interesting approach for increasing specificity. Since scatter correction is reported to improve image contrast, it might potentially constitute another way to ameliorate MPI accuracy. We aimed at comparing the value of both approaches, either separate or combined, for CAD diagnosis. Methods. Hundred patients addressed for gated 99m-Tc sestamibi SPECT MPI were prospectively included (Group A). Thirty-five had an end-systolic volume <30ml by QGS-analysis (Group B). All had a coronary angiogram within 3 months of the MPI. Four polar maps (non-corrected and scatter-corrected summed, and non-corrected and scatter-corrected end-diastolic) were created to quantify the extent (EXT) and severity (TDS) of the perfusion defects if any. ROC-curve analysis was applied to define the optimal thresholds of EXT and TDS separating non-CAD from CAD-patients, using a 50%-stenosis on coronary angiogram as cutoff for disease positivity. Results. Significant CAD was present in 86 patients (25 in Group B). In Group A, assessment of EXT and TDS of perfusion defects on scatter-corrected summed images demonstrated the highest accuracy (76% for EXT; sens: 77%; spec: 71%, and 74% for TDS, sens: 73%, spec: 79%). Accuracy of EXT and TDS calculated from the other data sets was slightly but not significantly lower, especially because of a lower sensitivity. As a comparison, visual analysis was 90% accurate for the diagnosis of CAD (sens: 94%, spec: 64%). In group B, overall results were worse mainly due to a decreased sensitivity, with accuracies ranging between 51 and 63%. Again scatter-corrected summed data were the most accurate (EXT: 60%, TDS: 63%, visual

  2. Attenuation corrected stress myocardial SPECT: possibility of reduction in number of rest investigation

    Attenuation-corrected (AC) imaging frequently shows normal stress myocardial perfusion while non-corrected (NC) imaging shows hypoperfusion. The aim of the work was to assess whether it is necessary to continue with resting examination in this situation. 121 consecutive patients had positive finding at AC and/or NC sestamibi stress myocardial imaging using E.CAM Profile system and resting examination was carried out. AC stress imaging was normal while NC imaging showed hypoperfusion in 29 cases. In one case this finding was reversed. In this group of 30 patients with AC/NC stress discrepancies, resting examination has not revealed any additional information in 28 cases. In 2 cases NC imaging, in contrast to AC, showed stress ischaemia. In one of these 2 cases coronarography was carried out with negative result. In the other case patient refused coronarography. The resting examination did not bring any benefits in 29-30 cases out of 30 (96.7 to 100.0%) patients with AC/NC stress discrepancies. If the results of this study are considered accordingly, in our group approximately one fourth of the resting examinations (29 to 30 out of 121) could be saved. (author)

  3. The development of iodine-123-labeled-methyl-branched fatty acids for myocardial SPECT imaging

    Iodine-123-labeled fatty acids represent unique metabolic probes for correlation of energy substrate metabolism with regional myocardial viability. Interest in the use of these agents results from differences which are often observed in various types of heart disease between regional myocardial fatty acid uptake patterns and flow tracer distribution. Although the physiological basis is not completely understood, differences between regional fatty acid and flow tracer distribution may reflect alterations in important parameters of metabolism which can be useful for patient management or therapeutic strategy decision making. The iodine-123-labeled 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) fatty acid analogue was developed at the Oak Ridge National Laboratory and was recently introduced as ''Cardiodine trademark'' in 1993 by Nihon Medi-Physics for commercial distribution in Japan. Iodine-123-BMPP is also being used in clinical studies on an institutional approval basis at several institutions in Europe and the US. This paper describes the development of the concept of fatty acid ''metabolic trapping'' of methyl-branched fatty acids and their use for single photon emission computerized tomographic cardiac imaging

  4. Prognostic value of Tc-99m tetrofosmin myocardial perfusion gated SPECT in patients with diabetes mellitus and suspected coronary artery disease

    Santos, Marcia Maria Sales dos; Pantoja, Mauricio da Rocha; Cwajg, Eduardo [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil); CINTILAB, Rio de Janeiro, RJ (Brazil); E-mail: mmsales@oi.com.br

    2008-01-15

    Background: The cardiovascular disease is the main cause of death among diabetic patients, which makes it crucial to identify the individuals at higher risk of cardiovascular events. Objective: To evaluate the prognostic value of scintigraphy with gated single photon emission computed tomography (SPECT) in patients with diabetes mellitus (DM) and suspected coronary artery disease. Methods: Retrospective study with 232 diabetic patients submitted to scintigraphy with gated SPECT. Perfusion Gated SPECT (scores and number of altered segments) as well as ventricular function parameters (ejection fraction, left ventricle volume and contractility) were evaluated. Cardiac death, acute ischemic coronary syndrome, revascularization procedures or encephalic vascular accident were considered future cardiovascular events. The uni- and multivariate analyses were carried out by the multiple logistic regression model (p< 0.05). Results: At the univariate analysis, age (p=0.02), chest angina (p=0.01), insulin therapy (p=0.02), myocardial perfusion abnormalities (p<0.0001), the number of segments involved (p=0.0001), the perfusion scores (p=0.0001), the ejection fraction (p=0.004), the final systolic volume (p=0.03) and the finding of segmental alteration at the LV contractility (p<0.0001) were associated with future events at the univariate analysis. At the multivariate analysis, the male sex (p=0.007), age (p=0.03), angina (p=0.001), insulin therapy (p=0.007) and the SDS {>=} 3 (p=0.0001), and the number of altered segments {>=} 3 (p=0.0001) were predictors of cardiovascular events. Conclusion: The myocardial scintigraphy with gated SPECT adds independent information to the stratification of the risk of future cardiovascular events in patients with DM and suspected coronary artery disease. (author)

  5. Potential diagnostic value of regional myocardial adrenergic imaging using {sup 123}I-MIBG SPECT to identify patients with Lewy body diseases

    Lebasnier, Adrien; Peyronnet, Damien; Bouvard, Gerard [University Hospital Center of Caen, Department of Nuclear Medicine, Caen (France); Lamotte, Guillaume; Defer, Gilles [University Hospital Center of Caen, Department of Neurology, Caen (France); Manrique, Alain [University Hospital Center of Caen, Department of Nuclear Medicine, Caen (France); Cyceron PET Centre, Caen (France); Normandie Universite, Caen (France); Agostini, Denis [University Hospital Center of Caen, Department of Nuclear Medicine, Caen (France); Normandie Universite, Caen (France)

    2015-01-28

    The aim of this study was to determine the potential diagnostic value of regional myocardial adrenergic {sup 123}I-metaiodobenzylguanidine (MIBG) single photon emission computed tomography (SPECT) imaging to identify patients with Lewy body diseases (LBD+). Sixty-four consecutive patients who underwent cardiac {sup 123}I-MIBG SPECT to differentiate LBD+, including Parkinson's disease (PD) and dementia with Lewy bodies (DLB), from patients without LBD (LBD-) were retrospectively reviewed. A neurologist expert in memory disorders determined the final clinical diagnosis by using international clinical diagnostic criteria. Planar [heart to mediastinum ratio (HMR)] and {sup 123}I-MIBG SPECT[innervation defect score (IDS)] using the 17-segment left ventricular model (five-point scale) were obtained 4 h after the injection of {sup 123}I-MIBG on a low-energy high-resolution (LEHR) collimator. Receiver-operating characteristic (ROC) analysis was performed to determine the optimal HMR and IDS cut-off values to discriminate LBD+ from LBD-. Of the 64 patients, 45 (70 %) were diagnosed LBD+ (DLB, n = 27; PD, n = 18) and 19 were diagnosed LBD- (5 other dementias, 14 other parkinsonisms). The HMR and IDS of LBD+ were significantly different from those of LBD- (1.30 ± 0.21 vs 1.65 ± 0.26, p < 0.001; 39 ± 28 vs 8 ± 16, p = 0.001). The optimal HMR and IDS cut-off values to discriminate LBD+ (n = 45) from LBD- (n = 19) were 1.47 and 6/68, providing a sensitivity and specificity of 82.2 and 84.2 % and 86.7 and 73.7 %, respectively. Regional myocardial adrenergic {sup 123}I-MIBG imaging SPECT has a potential diagnostic value to identify LBD+. (orig.)

  6. Feasibility and diagnostic accuracy of Ecg-gated SPECT myocardial perfusion imaging by a two-hour protocol: The Myofast study

    Aim of the study: To assess the feasibility of early stress and rest myocardial perfusion and function study using a fast 99mTc-tetrofosmin gated-SPECT protocol in patients with known coronary artery disease. Materials and methods: Forty-three patients (pts) (37 M, 6 F, mean age 63.8 ± 9.8 years) underwent a 99mTc-Tetrofosmin gated-SPECT (Axis Picker-Philips) myocardial study and a coronary angiography (C.A.) within 3 months. Images were acquired (LEHR, eight bins, 40 sec per image) after injection of 99mTc-tetrofosmin (200 to 380 MBq) early (15 min) post-stress (36 dipyridamole, two dobutamine and five ergo-metric stress), and at rest after 99mTc-tetrofosmin reinjection (600 to 1150 MBq), in a total time not exceeding 2 hours. Processing was performed with Q.G.S. software using the 17-segment model. Pathological study was defined as a summed difference score (SDS) greater than or equal to 4 4, a fixed defect with summed rest score greater than or equal to 4 and/or L.V. dysfunction defined as myocardial stunning (variation between stress and rest L.V.E.F. greater than or equal to 4 5%), stress L.V.E.F. less than or equal to 45% or rest L.V.E.F. less than or equal to 40%. Results were compared with C.A., and stenosis greater than or equal to 4 50% was considered as significant. Results: For 100% the quality of SPECT imaging was good or excellent. For six patients gating was impossible because of arrhythmia. The overall sensitivity, specificity and accuracy were 95%, 50%, and 91%, respectively. The concordance between gated SPECT and C.A. was moderate (kappa = 0.45, S.E. = 0.15). Interestingly, early-gated acquisition permitted to underline left ventricular dysfunction in 11 cases (30%), of whom eight had poly vascular disease. Stunning was detected in six of 37 cases (16%), of whom six had poly vascular disease. Conclusion: A one-day two-hour 99mTc-tetrofosmin gated-SPECT protocol to assess left ventricular perfusion and function is feasible and accurate. Early

  7. Influence of extracardiac activity and perfusion abnormalities on the results of myocardial gated SPECT with commercial software

    Isotopic myocardial perfusion single photon emission computed tomography (SPECT) studies, gated with electrocardiogram signal, are currently used to assess coronary artery disease (CAD) patients. The excellent sensitivity of the technique for detecting ischemia or necrotic areas depends on different clinical and technical parameters, mainly, from strict quality control of the acquisition and processing. Extracardiac activity of the radiotracer (commonly in intestinal loops or liver) overlapping or adjacent to myocardium can affect the interpretation. Available software for gamma cameras includes automatic myocardial edging programs that allow manual intervention. Our interest was to assess the impact of the manual or automatic method in common clinical conditions observed using current myocardial perfusion protocols. The main hypotheses were: a) adjacent extracardiac activity affects significantly automatic edging, furthermore if perfusion abnormalities co-exist, b) interoperator reproducibility of the semiautomatic processing is also affected by these events. Methods. From 350 myocardial SPECT perfusion tests performed in the last semester, we selected 100, (47 females, age: 63±14 years), 50 with and 50 without extracardiac activity. Each sub-group included 25 cases with perfusion abnormalities and 25 without them. Patients that moved during the test, miscorrected by motion-correction software were excluded. 99mTc-Sestamibi was used in 77 cases (gated in both phases) and 201Thallium (gated only at rest) in 23 patients. Dipyridamol stress protocol was used in 82 cases, exercise stress in 13, and 1 case with viability protocol. A Dual Head Siemens ECAM 180 was used and an acquisition protocol was included: orbit 180 deg., collimators in 45 deg., gated: 8 frames. The post stress acquisition was performed within the hour post-injection. All cases were processed automatically and by four independent operators (physicians with different level of training in nuclear

  8. No evidence of myocardial restoration following transplantation of mononuclear bone marrow cells in coronary bypass grafting surgery patients based upon cardiac SPECT and 18F-PET

    Ünal Nermin

    2006-07-01

    Full Text Available Abstract Background We tested the hypothesis, that intramyocardial injection of mononuclear bone marrow cells combined with coronary artery bypass grafting (CABG surgery improves tissue viability or function in infarct regions with non-viable myocardium as assessed by nuclear imaging techniques. Methods Thus far, 7 patients (60 ± 10 [SD] years undergoing elective CABG surgery after a myocardial infarction were included in this study. Prior to sternotomy, bone marrow was harvested by sternal puncture. Mononuclear bone marrow cells were isolated by gradient centrifugation and resuspended in 2 ml volume of Hank's buffered salt solution. At the end of CABG surgery 10 injections of 0.2 ml each were applied to the core area and borderzones of the infarct. Global and regional perfusion and viability were evaluated by ECG-gated 99mTc-tetrofosmin myocardial single-photon emission computed tomograph (SPECT imaging and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET in all study patients Results Non-viable segments indicating transmural defects were identified in 5 patients. Two patients were found to have non-transmural defects before surgery. Concomitant surgical revascularisation and bone marrow cell injection was performed in all patients without major complications. The median total injected mononuclear cell number was 7.0 × 107 (range: 0.8–20.4. At 3 months 99mTc-tetrofosmin SPECT and 18F-FDG-PET scanning showed in 5 patients (transmural defect n = 4; non-transmural defect n = 1 no change in myocardial viability and in two patients (transmural defect n = 1, non-transmural defect n = 1 enhanced myocardial viability by 75%. Overall, global and regional LV ejection fraction was not significantly increased after surgery compared with the preoperative value. Conclusion In CABG surgery patients with non-viable segments the concurrent use of intramyocardial cell transfer did not show any clear improvement in tissue viability or function by

  9. Duke treadmill score (DTS) and gated single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) in chest pain patient initial experience

    Background: Risk stratification of the patient with suspected or known coronary artery disease(CAD)by means of non-invasive testing are highly relevant in clinical cardiology for the selection of patient who require further diagnostic or therapeutic investigation. Aim: To predict severity of myocardial ischaemia by exercise tolerance test (ETT) determined duke treadmill score (DTS) and myocardial perfusion study. Material and methods: A total of 108 (92-men) patients presenting with Canadian cardiovascular society (CCS) class Mil severity of chest pain, mean age 49.88+8.44 yrs, were studied during October 2002-march 2003. All patient underwent ETT and SPECT-MPI scan using Tc-99m-tetrofosmin in one-day stress and rest protocol. Coronary angiogram (CAG) was done within six months of the perfusion study. After performing ETT, patients were categorized by DTS, myocardial perfusion studies were also stratified according to severity of perfusion defect. The angiographic findings (significant>50% stenosis) and perfusion defects in MPI were compared with the severity of DTS. Result: In high DTS group 91.66% patients had perfusion defect, whereas in intermediate and low risk group it was 60% and 40.90% respectively. In high DTS group 91.66% of patient had angiographically proven CAD, 58.33% of them had triple vessel disease (TVD) while in intermediate and low risk group angiographically proven CAD were 65% and 22.27% of whom TVD only in 15% and 0% respectively. Conclusion: The results of ETT using DTS score satisfactorily correlate with SPECT-MPI scanning in high DTS subsets of patients .So it is suggested that patient of high risk DTS could undergo CAG for further evaluation without radio-nuclide perfusion study. Intermediate and low risk needs myocardial perfusion imaging study to guide for further evaluation. (authors)

  10. Prediction of Revascularization after Myocardial Perfusion SPECT by Machine Learning in a Large Population

    Arsanjani, Reza; Dey, Damini; Khachatryan, Tigran; Shalev, Aryeh; Hayes, Sean W.; Fish, Mathews; Nakanishi, Rine; Germano, Guido; Berman, Daniel S.; Slomka, Piotr

    2016-01-01

    Objective We aimed to investigate if early revascularization in patients with suspected coronary artery disease (CAD) can be effectively predicted by integrating clinical data and quantitative image features derived from perfusion SPECT (MPS) by machine learning (ML) approach. Methods 713 rest 201Thallium/stress 99mTechnetium MPS studies with correlating invasive angiography (372 revascularization events (275 PCI / 97 CABG) within 90 days after MPS (91% within 30 days) were considered. Transient ischemic dilation (TID), stress combined supine/prone total perfusion deficit (TPD), quantitative rest and stress TPD, exercise ejection fraction, and end-systolic volume along with clinical parameters including patient gender, history of hypertension and diabetes mellitus, ST-depression on baseline ECG, ECG and clinical response during stress, and post-ECG probability by boosted ensemble ML algorithm (LogitBoost) to predict revascularization events. These features were selected using an automated feature selection algorithm from all available clinical and quantitative data (33 parameters). 10-fold cross-validation was utilized to train and test the prediction model. The prediction of revascularization by ML algorithm was compared to standalone measures of perfusion and visual analysis by two experienced readers utilizing all imaging, quantitative, and clinical data. Results The sensitivity of machine learning (73.6±4.3%) for prediction of revascularization was similar to one reader (73.9±4.6%) and standalone measures of perfusion (75.5±4.5%). The specificity of machine learning (74.7±4.2%) was also better than both expert readers (67.2±4.9% and 66.0±5.0%, P machine learning (0.81±0.02) was similar to reader 1 (0.81±0.02) but superior to reader 2 (0.72±0.02, P < 0.01) and standalone measure of perfusion (0.77±0.02, P < 0.01). Conclusion ML approach is comparable or better than experienced reader in prediction of the early revascularization after MPS and is

  11. A quantitative assessment of heart phantom motion and its effect on myocardial perfusion SPECT images

    2002-01-01

    In order to study the image characteristics of motion artifacts and todetermine the relations of motion artifacts with varied motion types, and the inag-ing timings, frames, distances and directions during SPECT acquisition, a myocardialphantom filled with pertechnetate solution was used to simulate the patient motion.In nonreturning pattern, the simulation motion was timed at the 0°, -45° and -90°positions during the rotation of the detector over a 180° arc from +45° right antcrioroblique to -135° left posterior oblique. Simulation motion was performed by movingthe phantom +5mm, ±-10mm and +20mm along X- (from left to right), Y- (fromhead to caudal) and Z-axis (from back to ventral) respectively. In returning patternthe acquired 30 projections were divided into three equal parts. The simulation motionwas timed at the middle 1-7 projections of each part and performed by moving thephantom +5, ±10, ±15, ±20, ±25, ±30 and ±50 mm along X-, Y- and Z-axis respec-tively. Each image was compared with normal image and assessed by three experiencedobservers without knowledge of the phantom motion. Logistic regression analysis wasused to determine the relationship of motion artifacts with the affecting factors. Nosignificant artifacts can be found when the phantom was moved slightly, no matterwhich motion pattern, direction and timing were taken. The characteristics of motionartifacts showed a radioactive marker dot in inferior wall firstly when the phantomwas moved along X-axis. Septal and lateral wall became "hot" symmetrically whenthe phantom was moved along Y-axis. And nodular hot could be found in anteriorwall when the phantom was moved along Z-axis. At last the "lumpy" and "defect"areas existed alternately and formed a triangle respectively. The presence of motionartifacts was related to motion directions, distance and affected frames, but was in-dependent of motion timing. The characteristics of motion artifacts could be foundwhen the phantom was moved

  12. Asymmetrically thickened posterior wall is associated with decline of ejection fraction after stress on adenosine stress/rest thallium-201 gated myocardial SPECT

    LV parameters (LVEF. ESVI and EDVI) on adenosine stress/rest thallium-201 gated myocardial SPECT (gSPECT) are various from stress to rest. We investigated the reason why they were various in patients without coronary artery disease. Seventy-one patients(M:F=32:39, age 58.1±9.7yrs), who underwent gSPECT and coronary angiography (CAG) due to chest pain or preoperative evaluation were included. CAG results were normal or insignificant. Exclusion criteria were atrial fibrillation, thyroid disease, primary cardiomyopathy, myocardial bridge, LBBB, MI, and valvular heart disease. Patients were calssified into 3 groups by EF difference (ΔEF=rest-stress EF) on gSPECT : group1 (ΔEF≥10), group2 (0 ≤ΔEF0.05). But LVEF at rest was smaller in group 3 (58.7±8.38%) than the other groups (72.5±8.77% in group1 and 66.7±10.6% in group2) (p<0.01). EDVIs and ESVI at stress were larger than those at rest in all groups (p<0.05) except ESVI in group 3 (16.2±6.21ml at stress and 17.5±6.41ml at rest, p<0.01), and that was attributed to EF<0 in group 3. In echocardiographical analysis, group 3 had significantly increased wall thickness of LVPW (10.7±1.2mm versus 9.4±1.6mm, p=0.01) and decreased wall thickness ratio of IVS/LVPW (0.963±0.102 versus 1.048±0.104, p=0.035) than group 1. In patients without coronary artery disease, LVEF, EDVI and ESVI on gSPECT were various and decline of LVEF from stress to rest was caused by unnormalized ESVI . Asymmetrically thickened LVPW may play a crucial role and further investigation is warranted

  13. Collimator optimization in myocardial perfusion SPECT using the ideal observer and realistic background variability for lesion detection and joint detection and localization tasks

    Ghaly, Michael; Du, Yong; Links, Jonathan M.; Frey, Eric C.

    2016-03-01

    In SPECT imaging, collimators are a major factor limiting image quality and largely determine the noise and resolution of SPECT images. In this paper, we seek the collimator with the optimal tradeoff between image noise and resolution with respect to performance on two tasks related to myocardial perfusion SPECT: perfusion defect detection and joint detection and localization. We used the Ideal Observer (IO) operating on realistic background-known-statistically (BKS) and signal-known-exactly (SKE) data. The areas under the receiver operating characteristic (ROC) and localization ROC (LROC) curves (AUCd, AUCd+l), respectively, were used as the figures of merit for both tasks. We used a previously developed population of 54 phantoms based on the eXtended Cardiac Torso Phantom (XCAT) that included variations in gender, body size, heart size and subcutaneous adipose tissue level. For each phantom, organ uptakes were varied randomly based on distributions observed in patient data. We simulated perfusion defects at six different locations with extents and severities of 10% and 25%, respectively, which represented challenging but clinically relevant defects. The extent and severity are, respectively, the perfusion defect’s fraction of the myocardial volume and reduction of uptake relative to the normal myocardium. Projection data were generated using an analytical projector that modeled attenuation, scatter, and collimator-detector response effects, a 9% energy resolution at 140 keV, and a 4 mm full-width at half maximum (FWHM) intrinsic spatial resolution. We investigated a family of eight parallel-hole collimators that spanned a large range of sensitivity-resolution tradeoffs. For each collimator and defect location, the IO test statistics were computed using a Markov Chain Monte Carlo (MCMC) method for an ensemble of 540 pairs of defect-present and -absent images that included the aforementioned anatomical and uptake variability. Sets of test statistics were

  14. Creation of an ensemble of simulated cardiac cases and a human observer study: tools for the development of numerical observers for SPECT myocardial perfusion imaging

    O'Connor, J. Michael; Pretorius, P. Hendrik; Gifford, Howard C.; Licho, Robert; Joffe, Samuel; McGuiness, Matthew; Mehurg, Shannon; Zacharias, Michael; Brankov, Jovan G.

    2012-02-01

    Our previous Single Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging (MPI) research explored the utility of numerical observers. We recently created two hundred and eighty simulated SPECT cardiac cases using Dynamic MCAT (DMCAT) and SIMIND Monte Carlo tools. All simulated cases were then processed with two reconstruction methods: iterative ordered subset expectation maximization (OSEM) and filtered back-projection (FBP). Observer study sets were assembled for both OSEM and FBP methods. Five physicians performed an observer study on one hundred and seventy-nine images from the simulated cases. The observer task was to indicate detection of any myocardial perfusion defect using the American Society of Nuclear Cardiology (ASNC) 17-segment cardiac model and the ASNC five-scale rating guidelines. Human observer Receiver Operating Characteristic (ROC) studies established the guidelines for the subsequent evaluation of numerical model observer (NO) performance. Several NOs were formulated and their performance was compared with the human observer performance. One type of NO was based on evaluation of a cardiac polar map that had been pre-processed using a gradient-magnitude watershed segmentation algorithm. The second type of NO was also based on analysis of a cardiac polar map but with use of a priori calculated average image derived from an ensemble of normal cases.

  15. Retrospective analysis of quantitative parameters obtained on myocardial perfusion SPECT imaging (ECTB software) in heart failure patients and their comparison with 2D-echocardiography results

    The objectives of the study are to study the quantitative parameters obtained on Gated MPI SPECT on ECTB software in patients of fixed defects on myocardial perfusion imaging and their comparison between individuals showing evidence of hibernating myocardium and patients without any evidence of hibernating myocardium and to do the comparative analysis of quantitative parameters such as LVEF, EDV, ESV and SV obtained in the aforementioned patients on Gated MPI SPECT (ECTB) and 2D ECHOCARDIOGRAPHY. It is concluded that the present findings are consistent with the nature of hibernating myocardium i.e. non-contractile and dysfunctional myocardium. The noticeable difference in the EDV and ESV in category 'SRS 0-10' is indicative of evidence of early diastolic dysfunction in this group of patients. The trends in the LVEF, EDV and ESV are suggestive of deteriorating myocardial function with increasing extent of ischemia. The increase in left ventricular EDV and ESV with increasing ischemia is suggestive of increasing incidence of gross morphological LV cavity dilatation or 'Dilated ischemic cardiomyopathy (DCMP)' in these patients. The quantitative parameters obtained on ECTB software on MPI study shows good correlation with 2D Echocardiography results

  16. Comparison of myocardial fatty acid metabolism with left ventricular function and perfusion in cardiomyopathies. By 123I-BMIPP SPECT and 99mTc-tetrofosmin electrocardiographically gated SPECT

    The objective of this study was to investigate myocardial fatty acid metabolism and its relationship with left ventricular (LV) function and perfusion in hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). Thirty-nine patients with cardiomyopathies (58±14 y), comprising 15 DCM and 24 HCM, and 9 age-matched healthy controls were studied with 123I-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) and 99mTc-tetrofosmin (TF) electrocardiographically gated SPECT. As parameters of myocardial fatty acid metabolism, the heart-to-mediastinum ratio (H/M) and global washout of BMIPP were calculated from early and delayed planar images, while regional BMIPP uptake and washout were calculated from SPECT. In TF study, the H/M (H/M-TF) and LV ejection fraction (LVEF) were calculated as global parameters of perfusion and function, while regional TF uptake and wall thickening index were calculated as regional parameters of perfusion and function using the Quantitative Gated SPECT software. The differences in the parameters and the correlations between the parameters from the 2 studies were investigated by one-way ANOVA and multiple linear regression analysis. BMIPP uptake was decreased (p0.05), but showed a significant correlation with H/M-TF (p0.05) but had a significant correlation with regional perfusion (p<0.0001) in DCM. In HCM, regional BMIPP parameters showed significant multiple linear correlations with both regional function (p<0.005) and perfusion (p<0.0001). According to the partial correlation coefficients, delayed regional BMIPP uptake was the most significant factor for predicting regional function in HCM, while early regional BMIPP uptake was the only or the most significant factor for predicting regional perfusion in DCM and HCM, respectively. In DCM, BMIPP uptake and washout could not reflect LV function. In HCM, regional delayed BMIPP uptake might be useful for evaluating regional function. In DCM and HCM, early BMIPP uptake might be

  17. Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction

    Berti, Valentina; Sciagra, Roberto; Pupi, Alberto [University of Florence, Nuclear Medicine Unit, Department of Clinical Physiopathology, Florence (Italy); Acampa, Wanda; Ricci, Francesca; Gallicchio, Rosj; Cuocolo, Alberto [University Federico II and Institute of Biostructures and Bioimages of the National Council of Research, Department of Biomorphological and Functional Sciences, Naples (Italy); Cerisano, Giampaolo [Careggi Hospital, Division of Cardiology, Florence (Italy); Vigorito, Carlo [University Federico II, Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Cardiac Rehabilitation Unit, Naples (Italy)

    2011-06-15

    After acute myocardial infarction (AMI), left ventricular (LV) remodelling may occur despite successful reperfusion. This study aimed to investigate by gated single photon emission computed tomography (SPECT) the long-term evolution of myocardial perfusion and LV function after AMI and to identify the predictors of LV remodelling. Sixty-eight AMI patients successfully treated by primary percutaneous coronary intervention underwent {sup 99m}Tc-sestamibi gated SPECT at 1 month (baseline) and over 6-month follow-up after the acute event. LV remodelling was defined as 20% increase in LV end-diastolic volume at follow-up. At baseline, patients with remodelling (n = 14) showed larger (infarct size 29.3 {+-} 7.8%) and more transmural (infarct severity 0.28 {+-} 0.10) infarctions, and reduced LV ejection fraction (35.4 {+-} 5.6%), but similar LV volume indexes, compared to patients without remodelling (n = 54) (infarct size 20.8 {+-} 14.4%, p < 0.05, infarct severity 0.40 {+-} 0.11, p < 0.001, ejection fraction 44.5 {+-} 9.2, p < 0.001). At stepwise multivariate regression analysis, infarct severity showed the best predictive value for predicting LV remodelling (F = 5.54, p < 0.05). Using the thresholds identified by receiver-operating characteristic curve analysis, infarct size and severity detected patients with remodelling with 75% accuracy and 95% negative predictive value. Infarct resorption (defined as the defect size difference between follow-up and baseline) was comparable between patients with (-4.4 {+-} 8.4%) and without remodelling (-6.8 {+-} 9.4%) (p = NS). Perfusion parameters assessed by gated SPECT in the subacute phase after successfully treated AMI correlate with changes in functional parameters at long-term follow-up. Infarct severity is more effective than infarct size, but both are helpful for predicting LV remodelling. (orig.)

  18. Cold pressor test myocardial perfusion SPECT as a predictor of the development of ischemia at exercise in the follow up of asymptomatic patients with moderate cardiovascular risk

    Introduction: Previous studies have published the correlation between myocardial perfusion SPECT (MP) during cold pressor test (CPT) and intracoronary acetylcholine and its usefulness as independent marker of endothelial dysfunction (ED). Objective: To analyze the incidence of positivization of MP exercise studies in the follow up of asymptomatic patients with moderate cardiovascular risk (CV) and ED detected by PF. Material and Methods: Of 301 patients of the PARADIGMA Registry (normal exercise MP SPECT and clinical probability < 20% of events at 10 years [moderate risk by Framingham index]) 55 had positive PF (+) (18.3%). Prospectively and consecutively, 15 asymptomatic patients with PF (+), and a control group (CG) of 15 patients with negative PF, with paired sex, age and coronary risk factors (CRF), that accomplished a 12 ± 2 months follow up, and that underwent a new exercise and resting MP SPECT were analyzed. An MP extension score was used in a model of 17 segments. The CRF and the incidence of ischemia during follow up exercise MP of each group were assessed. Results: Age: PF (-) 57.3 ± 8.9 versus TF (+) 52.5 ± 7.5 (p = 0,09). Positivized the exercise MP: PF group (+) 5/15: 33.3% and 0 in the CG (p=0.04). No statistically significant differences between CRF in both groups. Conclusions: An abnormal MP SPECT during PF in asymptomatic patients with moderate CV risk differentiated those patients who positivized exercise MP studies at one year follow up and there were no abnormal studies in the control group. (author)

  19. Reversible wall motion abnormality on adenosine stress/rest thallium-201 gated myocardial SPECT is an independent predictor of coronary artery disease

    As early as 10 minutes after adenosine stress, immediate post-stress wall motion (ipsWM) can be evaluated on adenosine stress/rest TI-201 gated SPECT (gSPECT). To widen application of TI-201 in gated SPECT, we investigated image quality, LV parameters (EF, EDV, and ESV) reproducibility, and diagnostic competency of gSPECT regarding ipsWM evaluation Myocardial perfusion and wall motion were evaluated by 5-point scoring system in 20-segment model. Image quality was assessed using weighted Kappa (Kw) for inter-and intra-observer agreements of wall motion scores (n=49). Reproducibility was examined through repeated acquisition (n=31). Diagnostic competency was evaluated versus coronary angiography (CAG) and multivariate logistic regression analysis was performed to identify significant predictors of coronary artery disease (CAD) among stress abnormal perfusion (SSSp), stress abnormal wall motion (SSSwm), and reversible abnormal wall motion (SDSwm) (n=60). Kw for ipsWM was significantly better than that for rest regarding inter- (0.717 vs 0.489) and intra-observer agreements (0.792 vs 0.688) (p<0.05). 2SD for ipsWM was smaller than that for rest at EF (8.6% vs 10.7%) and ESV (6.0ml vs 8.4ml). Sensitivities of SSSp, SSSwm, and SDSwm were 63.3% (19/30), 63.3% (19/30), and 43.3% (13/30) and specificities 83.3% (25/30), 83.3% (25/30), and 86.7% (26/30), respectively. By multivariate analysis, SSSp (p=0.013) and SDSwm (p=0.039) remained significant predictors. Additionally, SSSwm or SDSwm could find undetected CAD in 54.5% (6/11) of patients with normal perfusion. TI-201 can be successfully applied to gated SPECT for ipsWM evaluation. Moreover, reversible wall motion abnormality on gSPECT is an independent predictor of significant CAD

  20. Electrocardiographic-gated dual-isotope simultaneous acquisition SPECT using 18F-FDG and 99mTc-sestamibi to assess myocardial viability and function in a single study

    Dual-isotope simultaneous acquisition single-photon emission computed tomography (DISA SPECT) with 18F-fluorodeoxyglucose (FDG) and 99mTc-sestamibi appears attractive for the detection of viable myocardium because it permits simultaneous assessment of glucose utilisation and perfusion. Another potential benefit of this approach is that the measurement of left ventricular (LV) function may be possible by ECG gating. The aim of this study was to test the hypothesis that both myocardial viability and LV function can be assessed by a single ECG-gated 18F-FDG/99mTc-sestamibi DISA SPECT study, based on comparison with 18F-FDG/13N-ammonia positron emission tomography (PET) and magnetic resonance imaging (MRI) as reference techniques. Thirty-three patients with prior myocardial infarction underwent ECG-gated 18F-FDG/99mTc-sestamibi DISA SPECT and 18F-FDG/13N-ammonia PET on a single day. Of these, 25 patients also underwent cine-MRI to assess LV function. The LV myocardium was divided into nine regions, and each region was classified as viable or scar using a semiquantitative visual scoring system as well as quantitative analysis. The global and regional LV function measured by gated SPECT was compared with the results of MRI. There was good agreement in respect of viability (90-96%, κ0.74-0.85) between DISA SPECT and PET by either visual or quantitative analysis. Furthermore, although both global and regional LV function measured by gated SPECT agreed with those by MRI, 99mTc-sestamibi showed a closer correlation with MRI than did 18F-FDG. In conclusion, ECG-gated DISA SPECT provides information on myocardial viability, as well as global and regional LV function, similar to that obtained by PET and MRI. (orig.)

  1. Usefulness of thallium-201 myocardial SPECT using dipyridamole infusion combined with low level exercise for the detection of the ischemic heart disease

    To evaluate the usefulness of thallium-201 myocardial SPECT using dipyridamole infusion combined with low level exercise (Dp-method) for the detection of the ischemic heart disease, we performed both Dp-method and maximum physical exercise SPECT (Ex-method) in the same patients, and compared the results obtained by the two methods. In the visual evaluation, the detectability of each stenotic coronary territory by Dp-method tended to be higher than that by Ex-method (accuracy 71% vs 67%). The severity of the defect and the degree of the redistribution were higher by Dp-method than those by Ex-method. The washout rate (WR) analysis in 14 angina pectoris patients showed the detectability (accuracy) by Dp-method to be significantly higher than that by Ex-method (86% vs 64%; p<0.05). In comparison of mean WR values in normal subjects (10 cases for Dp-method and other 8 cases for Ex-method), mean WR by Dp-method was as high as that by Ex-method and the deviation of WR value among subjects was very small. This was probably due to the effect of the low level exercise. These results suggested that Dp-method was more excellent than Ex-method in the evaluation of the ischemic heart disease, and was a useful method of the daily routine work. The incidence of chest symptom and the electrocardiographic ST-depression was as high by Dp-method as that by Ex-method. The filling defects in Dp-method were thought to be induced not only by the difference in the relative increase of the myocardial perfusion, but also by the myocardial ischemia. (author)

  2. The development and initial evaluation of a realistic simulated SPECT dataset with simultaneous respiratory and cardiac motion for gated myocardial perfusion SPECT

    Lee, Taek-Soo; Tsui, Benjamin M. W.

    2015-02-01

    We developed a realistic simulation dataset for simultaneous respiratory and cardiac (R&C) gated SPECT/CT using the 4D NURBS-based Cardiac-Torso (NCAT) Phantom and Monte Carlo simulation methods, and evaluated it for a sample application study. The 4D NCAT phantom included realistic respiratory motion and beating heart motion based on respiratory gated CT and cardiac tagged MRI data of normal human subjects. To model the respiratory motion, a set of 24 separate 3D NCAT phantoms excluding the heart was generated over a respiratory cycle. The beating heart motion was modeled separately with 48 frames per cardiac cycle for each of the 24 respiratory phases. The resultant set of 24  ×  48 3D NCAT phantoms provides a realistic model of a normal human subject at different phases of combined R&C motions. An almost noise-free SPECT projection dataset for each of the 1152 3D NCAT phantoms was generated using Monte Carlo simulation techniques and the radioactivity uptake distribution of 99mTc sestamibi in different organs. By grouping and summing the separate projection datasets, separate or simultaneous R&C gated acquired data with different gating schemes could be simulated. In the initial evaluation, we combined the projection datasets into ungated, 6 respiratory-gates only, 8 cardiac-gates only, and combined 6 respiratory-gates & 8 cardiac-gates projection datasets. Each dataset was reconstructed using 3D OS-EM without and with attenuation correction using the averaged and respiratory-gated attenuation maps, and the resulting reconstructed images were compared. These results were used to demonstrate the effects of R&C motions and the reduction of image artifact due to R&C motions by gating and attenuation corrections. We concluded that the realistic 4D NCAT phantom and Monte Carlo simulated SPECT projection datasets with R&C motions are powerful tools in the study of the effects of R&C motions, as well as in the development of R&C gating schemes and motion

  3. The development and initial evaluation of a realistic simulated SPECT dataset with simultaneous respiratory and cardiac motion for gated myocardial perfusion SPECT

    We developed a realistic simulation dataset for simultaneous respiratory and cardiac (R and C) gated SPECT/CT using the 4D NURBS-based Cardiac-Torso (NCAT) Phantom and Monte Carlo simulation methods, and evaluated it for a sample application study. The 4D NCAT phantom included realistic respiratory motion and beating heart motion based on respiratory gated CT and cardiac tagged MRI data of normal human subjects. To model the respiratory motion, a set of 24 separate 3D NCAT phantoms excluding the heart was generated over a respiratory cycle. The beating heart motion was modeled separately with 48 frames per cardiac cycle for each of the 24 respiratory phases. The resultant set of 24  ×  48 3D NCAT phantoms provides a realistic model of a normal human subject at different phases of combined R and C motions. An almost noise-free SPECT projection dataset for each of the 1152 3D NCAT phantoms was generated using Monte Carlo simulation techniques and the radioactivity uptake distribution of 99mTc sestamibi in different organs. By grouping and summing the separate projection datasets, separate or simultaneous R and C gated acquired data with different gating schemes could be simulated. In the initial evaluation, we combined the projection datasets into ungated, 6 respiratory-gates only, 8 cardiac-gates only, and combined 6 respiratory-gates and 8 cardiac-gates projection datasets. Each dataset was reconstructed using 3D OS-EM without and with attenuation correction using the averaged and respiratory-gated attenuation maps, and the resulting reconstructed images were compared. These results were used to demonstrate the effects of R and C motions and the reduction of image artifact due to R and C motions by gating and attenuation corrections. We concluded that the realistic 4D NCAT phantom and Monte Carlo simulated SPECT projection datasets with R and C motions are powerful tools in the study of the effects of R and C motions, as well as in the development of R and C

  4. Effect of patient positioning on left ventricular volumes and function during gated Tc-99m Sestamibi myocardial perfusion SPECT: Comparison between the results obtained in prone and supine positions

    State-of-the-art SPECT myocardial perfusion imaging involves the acquisition of SPECT images in electrocardiography (ECG)-gated mode for simultaneous assessment of myocardial perfusion and left ventricular function with reference to left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), left ventricular stroke volume (SV) and ejection fraction (LVEF). Myocardial perfusion imaging has traditionally been performed with the patient in the supine position. However imaging patients in the prone position has markedly improved the specificity in evaluating inferior wall abnormalities by identifying and reducing artifacts. The main aim of this study was to investigate the effect of prone positioning of the patient on left ventricular volumes and function indices acquired on Gated SPECT. We studied 60 patients (40 men and 20 women) aged 36-75 years (mean age 52.1±8.8 years), all of whom underwent Tc-99m Sestamibi gated myocardial perfusion SPECT at rest in both prone and supine positions. All acquisitions were analyzed visually and semi-quantitatively using QGS software for EDV, ESV, SV and LVEF. LVEF did not differ significantly between supine and prone acquisitions, whereas EDV, ESV and SV were significantly lower for prone acquisitions (EDV: 78.05 ±32.89 ml, ESV: 36.22±28.04 ml, SV: 41.83±11.78 ml) than for supine acquisitions (EDV: 86.37±37.70 ml, ESV: 41.40±33.28 ml, SV: 44.97±11.38 ml). Heart rate was significantly higher on prone position (71.87±9.56) than supine position (67.30±9.54) (P<0.001). Our study showed that heart rate as well as EDV, ESV and SV are significantly different between prone and supine positions. Therefore comparison of prone gated SPECT data with reference values that usually were obtained on supine position is unsuitable. (author)

  5. No evidence of myocardial restoration following transplantation of mononuclear bone marrow cells in coronary bypass grafting surgery patients based upon cardiac SPECT and 18F-PET

    Tossios, Paschalis; Müller-Ehmsen, Jochen; Schmidt, Matthias; Scheid, Christof; Ünal, Nermin; Moka, Detlef; Schwinger, Robert HG; Mehlhorn, Uwe

    2006-01-01

    Background We tested the hypothesis, that intramyocardial injection of mononuclear bone marrow cells combined with coronary artery bypass grafting (CABG) surgery improves tissue viability or function in infarct regions with non-viable myocardium as assessed by nuclear imaging techniques. Methods Thus far, 7 patients (60 ± 10 [SD] years) undergoing elective CABG surgery after a myocardial infarction were included in this study. Prior to sternotomy, bone marrow was harvested by sternal puncture. Mononuclear bone marrow cells were isolated by gradient centrifugation and resuspended in 2 ml volume of Hank's buffered salt solution. At the end of CABG surgery 10 injections of 0.2 ml each were applied to the core area and borderzones of the infarct. Global and regional perfusion and viability were evaluated by ECG-gated 99mTc-tetrofosmin myocardial single-photon emission computed tomograph (SPECT) imaging and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in all study patients < 6 days before and 3 months after the intervention. Results Non-viable segments indicating transmural defects were identified in 5 patients. Two patients were found to have non-transmural defects before surgery. Concomitant surgical revascularisation and bone marrow cell injection was performed in all patients without major complications. The median total injected mononuclear cell number was 7.0 × 107 (range: 0.8–20.4). At 3 months 99mTc-tetrofosmin SPECT and 18F-FDG-PET scanning showed in 5 patients (transmural defect n = 4; non-transmural defect n = 1) no change in myocardial viability and in two patients (transmural defect n = 1, non-transmural defect n = 1) enhanced myocardial viability by 75%. Overall, global and regional LV ejection fraction was not significantly increased after surgery compared with the preoperative value. Conclusion In CABG surgery patients with non-viable segments the concurrent use of intramyocardial cell transfer did not show any clear improvement in

  6. No evidence of myocardial restoration following transplantation of mononuclear bone marrow cells in coronary bypass grafting surgery patients based upon cardiac SPECT and 18F-PET

    We tested the hypothesis, that intramyocardial injection of mononuclear bone marrow cells combined with coronary artery bypass grafting (CABG) surgery improves tissue viability or function in infarct regions with non-viable myocardium as assessed by nuclear imaging techniques. Thus far, 7 patients (60 ± 10 [SD] years) undergoing elective CABG surgery after a myocardial infarction were included in this study. Prior to sternotomy, bone marrow was harvested by sternal puncture. Mononuclear bone marrow cells were isolated by gradient centrifugation and resuspended in 2 ml volume of Hank's buffered salt solution. At the end of CABG surgery 10 injections of 0.2 ml each were applied to the core area and borderzones of the infarct. Global and regional perfusion and viability were evaluated by ECG-gated 99mTc-tetrofosmin myocardial single-photon emission computed tomograph (SPECT) imaging and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in all study patients < 6 days before and 3 months after the intervention. Non-viable segments indicating transmural defects were identified in 5 patients. Two patients were found to have non-transmural defects before surgery. Concomitant surgical revascularisation and bone marrow cell injection was performed in all patients without major complications. The median total injected mononuclear cell number was 7.0 × 107 (range: 0.8–20.4). At 3 months 99mTc-tetrofosmin SPECT and 18F-FDG-PET scanning showed in 5 patients (transmural defect n = 4; non-transmural defect n = 1) no change in myocardial viability and in two patients (transmural defect n = 1, non-transmural defect n = 1) enhanced myocardial viability by 75%. Overall, global and regional LV ejection fraction was not significantly increased after surgery compared with the preoperative value. In CABG surgery patients with non-viable segments the concurrent use of intramyocardial cell transfer did not show any clear improvement in tissue viability or function by

  7. Long-term prognostic value of early poststress {sup 99m}Tc-tetrofosmin lung uptake during exercise (SPECT) myocardial perfusion imaging

    Georgoulias, Panagiotis; Valotassiou, Varvara; Tzavara, Chara [University Hospital of Larissa, Department of Nuclear Medicine, Larissa (Greece); Tsougos, Ioannis [University Hospital of Larissa, Department of Medical Physics, Larissa (Greece); Xaplanteris, Petros [NIMTS Hospital, Department of Cardiology, Athens (Greece); Demakopoulos, Nikolaos [NIMTS Hospital, Department of Nuclear Medicine, Athens (Greece)

    2010-04-15

    The aim of this study was to determine the long-term prognostic value of early poststress lung/heart ratio (LHR) of {sup 99m}Tc-tetrofosmin radioactivity. We studied 276 patients (aged 62.2{+-}8.9 years, 168 men) with stress/rest {sup 99m}Tc-tetrofosmin myocardial gated-SPECT and coronary angiography. To evaluate myocardial ischaemia, we calculated the summed stress score, summed rest score and summed difference score indices. For the eLHR calculation, an anterior image was acquired, 4-6 min after radiotracer injection at stress (eLHR was defined as mean counts per pixel in the lung region of interest divided by the mean counts per pixel in the myocardial region of interest). Cardiovascular death and nonfatal myocardial infarction were considered as hard cardiac events, and late revascularization procedures as soft cardiac events. The Cox proportional hazards model in a stepwise method was used to determine the independent predictors for hard and soft cardiac events. During the follow-up period hard cardiac events occurred in 28 patients (10.1%) and soft cardiac events in 32 patients (11.6%). Implying multiple Cox regression analysis, eLHR was found to be a significant independent predictor for both soft and hard cardiac events. The hazard ratio (for a 0.1 unit increase) was 4.41 (95% CI 1.52-12.73, p=0.006) for soft cardiac events and 4.22 (95% CI 2.07-8.62, p<0.001) for hard cardiac events. The other significant prognostic factors were use of {beta}-blockers, the summed stress score and the use of nitrates for soft events, and exercise duration and the summed stress score for hard cardiac events. Early poststress {sup 99m}Tc-tetrofosmin LHR has an independent and powerful value in predicting hard and soft cardiac events. (orig.)

  8. Nuclear myocardial perfusion imaging with a novel cadmium-zinc-telluride detector SPECT/CT device: first validation versus invasive coronary angiography

    We evaluated the diagnostic accuracy of attenuation corrected nuclear myocardial perfusion imaging (MPI) with a novel hybrid single photon emission computed tomography (SPECT)/CT device consisting of an ultrafast dedicated cardiac gamma camera with cadmium-zinc-telluride (CZT) solid-state semiconductor detectors integrated onto a multislice CT scanner to detect coronary artery disease (CAD). Invasive coronary angiography served as the standard of reference. The study population included 66 patients (79% men; mean age 63 ± 11 years) who underwent 1-day 99mTc-tetrofosmin pharmacological stress/rest examination and angiography within 3 months. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) as well as accuracy of the CT X-ray based attenuation corrected CZT MPI for detection of CAD (≥50% luminal narrowing) was calculated on a per-patient basis. The prevalence of angiographic CAD in the study population was 82%. Sensitivity, specificity, PPV, NPV and accuracy were 87, 67, 92, 53 and 83%, respectively. In this first report on CZT SPECT/CT MPI comparison versus angiography we confirm a high accuracy for detection of angiographically documented CAD. (orig.)

  9. Gated myocardial perfusion SPECT underestimates left ventricular volumes and shows high variability compared to cardiac magnetic resonance imaging -- a comparison of four different commercial automated software packages

    Arheden Håkan

    2010-05-01

    Full Text Available Abstract Background We sought to compare quantification of left ventricular volumes and ejection fraction by different gated myocardial perfusion SPECT (MPS programs with each other and to magnetic resonance (MR imaging. Methods N = 100 patients with known or suspected coronary artery disease were examined at rest with 99 mTc-tetrofosmin gated MPS and cardiac MR imaging. Left ventricular end-diastolic volume (EDV, end-systolic volume (ESV, stroke volume (SV and ejection fraction (EF were obtained by analysing gated MPS data with four different programs: Quantitative Gated SPECT (QGS, GE MyoMetrix, Emory Cardiac Toolbox (ECTb and Exini heart. Results All programs showed a mean bias compared to MR imaging of approximately -30% for EDV (-22 to -34%, p Conclusions Gated MPS, systematically underestimates left ventricular volumes by approximately 30% and shows a high variability, especially for ESV. For EF, accuracy was better, with a mean bias between -15 and 6% of EF. It may be of value to take this into consideration when determining absolute values of LV volumes and EF in a clinical setting.

  10. Nuclear myocardial perfusion imaging with a novel cadmium-zinc-telluride detector SPECT/CT device: first validation versus invasive coronary angiography

    Fiechter, Michael; Kaufmann, Philipp A. [University Hospital Zurich, Department of Radiology, Cardiac Imaging, Zurich (Switzerland); University of Zurich, Zurich Center for Integrative Human Physiology (ZIHP), Zurich (Switzerland); Ghadri, Jelena R.; Kuest, Silke M.; Pazhenkottil, Aju P.; Wolfrum, Mathias; Nkoulou, Rene N.; Goetti, Robert; Gaemperli, Oliver [University Hospital Zurich, Department of Radiology, Cardiac Imaging, Zurich (Switzerland)

    2011-11-15

    We evaluated the diagnostic accuracy of attenuation corrected nuclear myocardial perfusion imaging (MPI) with a novel hybrid single photon emission computed tomography (SPECT)/CT device consisting of an ultrafast dedicated cardiac gamma camera with cadmium-zinc-telluride (CZT) solid-state semiconductor detectors integrated onto a multislice CT scanner to detect coronary artery disease (CAD). Invasive coronary angiography served as the standard of reference. The study population included 66 patients (79% men; mean age 63 {+-} 11 years) who underwent 1-day {sup 99m}Tc-tetrofosmin pharmacological stress/rest examination and angiography within 3 months. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) as well as accuracy of the CT X-ray based attenuation corrected CZT MPI for detection of CAD ({>=}50% luminal narrowing) was calculated on a per-patient basis. The prevalence of angiographic CAD in the study population was 82%. Sensitivity, specificity, PPV, NPV and accuracy were 87, 67, 92, 53 and 83%, respectively. In this first report on CZT SPECT/CT MPI comparison versus angiography we confirm a high accuracy for detection of angiographically documented CAD. (orig.)

  11. Myocardial mass and functional parameters of left ventricle (LV) measured with gated SPECT: comparison between stress and rest imaging in patients with no perfusion defect

    LV mass (LVM) and other functional parameters were thought to be prognostic factors in patients with heart disease and can be measured by gated myocardial perfusion SPECT. The purpose of this study was to evaluate the difference in LVM and functional parameters measured by gated myocardial perfusion SPECT between stress and rest images. The relationship between LVM and functional parameters was also evaluated. LVM, EDV (end diastolic volume), ESV (end systolic volume) and EF (ejection fraction) of LV were measured with AutoQuant program (Vertex puls, ADAC) in patients showing no perfusion defect in LV wall. There were 101 subjects (male/female, 50/51) with mean age of 55 (32∼76) year-old and 77 subject underwent exercise stress, 24 adenosine stress. There were no significant differences in LVM, EDV, ESV, EF, whereas excellent correlations between stress and rest images (LV mass r=0.936, EDV r=0.942, excellent correlations between stress ad rest images (LV mass r=0.936, EDV r=0.942, ESV r=0.918, EF r=0.801), LVM was positive correlated with EDV and ESV but negatively correlated with EF (Kendall's correlation test, r=0.683 p<0.01, r=0.648 p<0.01 r=-0.391 0<0.01, respectively). LVM, EDV, ESV and EF measured by AutoQuant program are not different between stress and rest images in patients with no perfusion defect. LVM was positively correlated with EDV and ESV and negatively correlated with EF

  12. Assessment of myocardial viability using Tl-201 SPECT at rest to predict the reversibility of left ventricular wall motion abnormalities; Vitalitaetsdiagnostik mit der {sup 210}Tl-SPECT in Ruhe zur Vorhersage der Reversibilitaet linksventrikulaerer Wandbewegungsstoerungen

    Schulz, G.; Koch, K.C. [Universitaetsklinikum der RWTH Aachen (Germany). Klinik fuer Nuklearmedizin, Medizinische Klinik; Vom Dahl, J. [Universitaetsklinikum der RWTH Aachen (Germany). Klinik fuer Nuklearmedizin, Medizinische Klinik; Kleinhans, E.; Kaiser, H.J.; Verhasselt, S.; Messmer, B.J. [Universitaetsklinikum der RWTH Aachen (Germany). Klinik fuer Thorax-, Herz- und Gefaesschirurgie; Hanrath, P. [Universitaetsklinikum der RWTH Aachen (Germany). Klinik fuer Nuklearmedizin, Medizinische Klinik; Buell, U.

    1996-12-01

    19 patients with advanced coronary artery disease and regional wall motion abnormalities were examined at rest with Tl-201 SPECT (acquisition 15 minutes and 3 hours post injection), successfully revascularized, proven by a second coronary angiography three month after revascularisation. Wall motion was again evaluated by cineventriculography. Results: The preoperative a- or dyskinetic segments were best separated by the minimal relative Tl-201 uptake in the defect 3 hrs p.i. in (i) postinterventionally improved wall motion (Tl-201 uptake 67{+-}14%, viable) and in (ii) without recovery (Tl-201 uptake 46{+-}12%, p<0.001, non viable). A threshold at a Tl-201 uptake of more than 50% yielded a positive predictive value of 0.73 and a negative predictive value of 0.86. If the segments with wall motion abnormalities (hypokinetic included) were evaluated as one group, no such threshold was obtained: All segments which occured a Tl-201 uptake of more than 80% showed a functional recovery, wall motion did not improve in any segment with a Tl-201 uptake of less than 40%. In the present study a considerable influence of the defect localisation with regard to the posterior wall was not observed. The values of Tl-201 redistribution under resting condition were not useful to predict functional recovery. Conclusion: Tl-201 SPECT in rest predicts preoperatively the reversibility in regions with severe wall motion abnormalities only and indicates myocardial viability in these cases. Thus, the method is basicly useful to determine myocardial viability. In hypokinetic segments, however, a wide range of TL-201 uptake values exists without definite evidence to functional recovery. (orig./MG) [Deutsch] Eingeschlossen wurden 19 Patienten mit angiographisch gesicherter koronarer Herzkrankheit und regionalen Wandbewegungsstoerungen, die praeoperativ einer {sup 201}Tl-SPECT (Acquisition 15 min und 3 h p.i.) unterzogen, erfolgreich revaskularisiert und drei Monate nach Revaskularisation

  13. Noninvasive stress testing of myocardial ischemia: comparison of GRE-MRI perfusion and wall motion analysis to 99mTc-MIBI-SPECT, relation to coronary angiography

    In the evaluation of ischemic heart disease only MR imaging seems to have the potential to assess myocardial perfusion, function, and coronary morphology on a single instrument. The aim of this study was to assess the feasibility of a stress test with dipyridamole (0.56 mg/kg) to analyze myocardial perfusion by Gd first-pass enhancement in ultrafast gradient-recalled-echo MRI (perf-MRI), and wall motion by cine gradient-recalled-echo MRI (Cine-MRI) in one imaging session. Twelve patients underwent complete rest and stress studies; satisfactory MR images were acquired in 10 patients. By 99mTc-MIBI-SPECT sensitivities to detect ischemic segments were 66.7 % with Perf-MRI, 80.0 % with WM-MRI and 86.7 % for Perf-WM-MRI (Perf-MRI vs Perf-WM-MRI; p = 0.03). Scar was equally detected with a sensitivity of 91.6 % with either MRI technique. Thus, Perf-Cine-MRI provides complementary information for the management of ischemic heart disease and has a higher sensitivity than Perf-MRI alone. (orig.). With 3 figs., 2 tabs

  14. Myocardial perfusion SPECT in a case of retropulmonary looping of left coronary artery in a baby after arterial switch surgery

    Pediatric myocardial perfusion imaging (MPI) is not a routine investigation in an Indian setting due to under referrals and logistic problems. However, MPI is a frequently performed and established modality of investigation in adults for the identification of myocardial ischemia and viability. We report myocardial perfusion scintigraphy in a case of retropulmonary looping of left coronary artery in a baby after arterial switch surgery. Adenosine stress MPI revealed a large infarct involving anterior segment with moderate reversible ischemia of the lateral left ventricular segment. Coronary angiogram later confirmed left main coronary artery ostial occlusion with retrograde collateral supply from dilated right coronary artery

  15. Task-based evaluation of a 4D MAP-RBI-EM image reconstruction method for gated myocardial perfusion SPECT using a human observer study

    Lee, Taek-Soo; Higuchi, Takahiro; Lautamäki, Riikka; Bengel, Frank M.; Tsui, Benjamin M. W.

    2015-09-01

    We evaluated the performance of a new 4D image reconstruction method for improved 4D gated myocardial perfusion (MP) SPECT using a task-based human observer study. We used a realistic 4D NURBS-based Cardiac-Torso (NCAT) phantom that models cardiac beating motion. Half of the population was normal; the other half had a regional hypokinetic wall motion abnormality. Noise-free and noisy projection data with 16 gates/cardiac cycle were generated using an analytical projector that included the effects of attenuation, collimator-detector response, and scatter (ADS), and were reconstructed using the 3D FBP without and 3D OS-EM with ADS corrections followed by different cut-off frequencies of a 4D linear post-filter. A 4D iterative maximum a posteriori rescaled-block (MAP-RBI)-EM image reconstruction method with ADS corrections was also used to reconstruct the projection data using various values of the weighting factor for its prior. The trade-offs between bias and noise were represented by the normalized mean squared error (NMSE) and averaged normalized standard deviation (NSDav), respectively. They were used to select reasonable ranges of the reconstructed images for use in a human observer study. The observers were trained with the simulated cine images and were instructed to rate their confidence on the absence or presence of a motion defect on a continuous scale. We then applied receiver operating characteristic (ROC) analysis and used the area under the ROC curve (AUC) index. The results showed that significant differences in detection performance among the different NMSE-NSDav combinations were found and the optimal trade-off from optimized reconstruction parameters corresponded to a maximum AUC value. The 4D MAP-RBI-EM with ADS correction, which had the best trade-off among the tested reconstruction methods, also had the highest AUC value, resulting in significantly better human observer detection performance when detecting regional myocardial wall motion

  16. Task-based evaluation of a 4D MAP-RBI-EM image reconstruction method for gated myocardial perfusion SPECT using a human observer study

    We evaluated the performance of a new 4D image reconstruction method for improved 4D gated myocardial perfusion (MP) SPECT using a task-based human observer study. We used a realistic 4D NURBS-based Cardiac-Torso (NCAT) phantom that models cardiac beating motion. Half of the population was normal; the other half had a regional hypokinetic wall motion abnormality. Noise-free and noisy projection data with 16 gates/cardiac cycle were generated using an analytical projector that included the effects of attenuation, collimator-detector response, and scatter (ADS), and were reconstructed using the 3D FBP without and 3D OS-EM with ADS corrections followed by different cut-off frequencies of a 4D linear post-filter. A 4D iterative maximum a posteriori rescaled-block (MAP-RBI)-EM image reconstruction method with ADS corrections was also used to reconstruct the projection data using various values of the weighting factor for its prior. The trade-offs between bias and noise were represented by the normalized mean squared error (NMSE) and averaged normalized standard deviation (NSDav), respectively. They were used to select reasonable ranges of the reconstructed images for use in a human observer study. The observers were trained with the simulated cine images and were instructed to rate their confidence on the absence or presence of a motion defect on a continuous scale. We then applied receiver operating characteristic (ROC) analysis and used the area under the ROC curve (AUC) index. The results showed that significant differences in detection performance among the different NMSE-NSDav combinations were found and the optimal trade-off from optimized reconstruction parameters corresponded to a maximum AUC value. The 4D MAP-RBI-EM with ADS correction, which had the best trade-off among the tested reconstruction methods, also had the highest AUC value, resulting in significantly better human observer detection performance when detecting regional myocardial wall motion

  17. Detection of myocardial stunning with gated SPECT and its relationship with location, extension and severity of perfusion defects induced by exercise or pharmacologic stress

    Aim: To investigate the relationship between transient ventricular dysfunction detected by gated SPECT with the location, extension and severity of ischemic areas in patients with reversible perfusion defects. Material and Methods: We retrospectively studied 83 patients (61±11 yrs., 61 men, 27 with previous MI) submitted for coronary artery disease (CAD) evaluation with 99mTc-MIBI gated SPECT using a 2-day protocol whose perfusion imaging pattern had been reported positive for myocardial ischemia. Stress test was exercise in 54 cases, dipyridamole in 28 and dobutamine in 1. Previous work from our group demonstrated up to 12% change in LVEF from rest to post-stress in a population with low likelihood of CAD and a normal perfusion pattern. Thus, according to % variation of left ventricular ejection fraction (LVEF) from rest to post-stress we further divided the population into 2 subgroups, (A) with less than 12% change in LVEF (n=56) and (B) with more than 12% negative variation (n=27). For evaluation of perfusion, a simplified 7-segment division of the myocardium was used and a combined ischemic score was obtained by multiplying the number of segments with reversible defects by the 1-4 assigned severity score. Results: There was no significant difference between the two groups regarding age, gender, stress result (clinical or ECG), number of fixed perfusion defects or rest LVEF. Dipyridamole test was more frequent among patients of group B. Post-stress LVEF was 49±14% for group A and 41±15% for group B, p=0.0125. Combined ischemic score was 6.82±6.5 vs. 11.96±12 respectively, p=0.014. In patients of group A, defects corresponding to the right coronary territory were more frequent, while the left descending artery territory was more commonly affected in group B patients, however this was not statistically significant. Left circumflex territory was equally affected in both groups. Conclusion: Transient ventricular dysfunction after a stress test can be

  18. Prognostic value of myocardial perfusion single photon emission computed tomography for major adverse cardiac cerebrovascular and renal events in patients with chronic kidney disease: results from first year of follow-up of the Gunma-CKD SPECT multicenter study

    Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. We examined whether stress myocardial perfusion single photon emission computed tomography (SPECT) provides reliable prognostic markers for these patients. In this multicenter, prospective cohort trial from the Gunma-CKD SPECT study protocol, patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml per 1.73 m2] undergoing stress 99mTc-tetrofosmin SPECT for suspected or possible ischemic heart disease were initially followed for 1 year, with the following study endpoints: primary, the occurrence of cardiac deaths (CDs), and secondary, major adverse cardiac, cerebrovascular, and renal events (MACCREs). The summed stress score (SSS), summed rest score, and summed difference score (SDS) were estimated with the standard 17-segment, 5-point scoring model. Left ventricular end-diastolic volume, end-systolic volume (ESV), and ejection fraction were measured using electrocardiogram-gated SPECT. During the first year of follow-up, 69 of 299 patients experienced MACCREs (CD, n = 7; non-fatal myocardial infarction, n = 3; hospitalization for heart failure, n = 13; cerebrovascular accident, n = 1; need for revascularization, n = 38; and renal failure, i.e., hemodialysis initiation, n = 7). ESV and SSS were associated with CDs (p < 0.05), and eGFR and SDS were associated with MACCREs (p < 0.05), in multivariate logistic analysis. Patients with high ESV and high SSS had a significantly higher CD rate during the first year than the other CKD patient subgroups (p < 0.05). Patients with low eGFR and high SDS had a significantly higher MACCRE rate than the other subgroups (p < 0.05). Myocardial perfusion SPECT can provide reliable prognostic markers for patients with CKD. (orig.)

  19. Prognostic value of myocardial perfusion single photon emission computed tomography for major adverse cardiac cerebrovascular and renal events in patients with chronic kidney disease: results from first year of follow-up of the Gunma-CKD SPECT multicenter study

    Kasama, Shu [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Toyama, Takuji [Department of Cardiovascular Medicine, Gunma Prefectural Cardiovascular Center, Maebashi (Japan); Sato, Makito [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Tatebayashi Kosei Hospital, Department of Internal Medicine, Gunma (Japan); Sano, Hirokazu [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Isesaki Municipal Hospital, Department of Cardiovascular Medicine, Isesaki (Japan); Ueda, Tetsuya [Fujioka General Hospital, Division of Cardiology, Fujioka (Japan); Sasaki, Toyoshi [Takasaki General Medical Center, Division of Cardiology, Takasaki (Japan); Nakahara, Takehiro; Kurabayashi, Masahiko [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Higuchi, Tetsuya; Tsushima, Yoshito [Gunma University Graduate School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Maebashi (Japan)

    2016-02-15

    Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. We examined whether stress myocardial perfusion single photon emission computed tomography (SPECT) provides reliable prognostic markers for these patients. In this multicenter, prospective cohort trial from the Gunma-CKD SPECT study protocol, patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml per 1.73 m{sup 2}] undergoing stress {sup 99m}Tc-tetrofosmin SPECT for suspected or possible ischemic heart disease were initially followed for 1 year, with the following study endpoints: primary, the occurrence of cardiac deaths (CDs), and secondary, major adverse cardiac, cerebrovascular, and renal events (MACCREs). The summed stress score (SSS), summed rest score, and summed difference score (SDS) were estimated with the standard 17-segment, 5-point scoring model. Left ventricular end-diastolic volume, end-systolic volume (ESV), and ejection fraction were measured using electrocardiogram-gated SPECT. During the first year of follow-up, 69 of 299 patients experienced MACCREs (CD, n = 7; non-fatal myocardial infarction, n = 3; hospitalization for heart failure, n = 13; cerebrovascular accident, n = 1; need for revascularization, n = 38; and renal failure, i.e., hemodialysis initiation, n = 7). ESV and SSS were associated with CDs (p < 0.05), and eGFR and SDS were associated with MACCREs (p < 0.05), in multivariate logistic analysis. Patients with high ESV and high SSS had a significantly higher CD rate during the first year than the other CKD patient subgroups (p < 0.05). Patients with low eGFR and high SDS had a significantly higher MACCRE rate than the other subgroups (p < 0.05). Myocardial perfusion SPECT can provide reliable prognostic markers for patients with CKD. (orig.)

  20. Serial change of 123I-BMIPP SPECT imaging during recovery from stunned myocardium after acute myocardial infarction. Correlation with 201Tl and two-dimensional echocardiography

    Using 123I-β-methyl iodophenyl pentadecanoic acid (123I-BMIPP), we investigated changes in myocardial fatty acid metabolism at recovery from stunned myocardium after acute myocardial infarction (AMI), correlation with recovery of regional wall motion and thallium-201 (201Tl) distribution in particular. The subjects were 15 patients who underwent successful reperfusion therapy after the first onset of AMI. None of the patients had multi-vessel disease or ischemic episode during their clinical course. Patients underwent 123I-BMIPP scintigraphy, 201Tl scintigraphy and two-dimensional echocardiography during the acute and chronic phases. Then, we compared regional wall motion with distribution of 123I-BMIPP and 201Tl. Regional wall motion and SPECT were evaluated by the established 16 segment model. In patients, showing serial improvement in regional wall motion, there was 80.0% (8/10) showed normal 201Tl distribution during the acute phase or normalized during the chronic phase. However, distribution of 123I-BMIPP normalized only in 10.0% (1/10) of this group. In examination of each segment that showed serial improvement in regional wall motion, 92.3% (24/26) of these segments showed normal distribution of 201Tl during the acute phase or normalized distribution during chronic phase, despite distribution of 123I-BMIPP improved in only 3.8% (1/26) of these segments. These indicate that, in the process of recovery from myocardial stunning after AMI, abnormal distribution of 123I-BMIPP continued longer than abnormal distribution of 201Tl. (author)

  1. Use of {sup 99m}Tc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

    Leoncini, Mario; Bellandi, Francesco; Maioli, Mauro; Toso, Anna; Dabizzi, Roberto Piero [Misericordia e Dolce Hospital, Division of Cardiology, Prato (Italy); Sciagra, Roberto; Pupi, Alberto [University of Florence, Department of Clinical Physiopathology, Nuclear Medicine Unit, Florence (Italy); Sestini, Stelvio; Coppola, Angela; Mennuti, Alberto [Misericordia e Dolce Hospital, Nuclear Medicine Unit, Prato (Italy)

    2004-10-01

    Preserved thrombolysis in myocardial infarction (TIMI) flow before percutaneous coronary intervention (PCI) in acute myocardial infarction is related to improved outcome. Gated single-photon emission computed tomography (SPECT) allows the simultaneous assessment of left ventricular perfusion and function. We evaluated the initial risk area and subsequent evolution of perfusion and function according to TIMI flow before successful primary PCI. In 36 patients, treated with abciximab, primary PCI and stenting, {sup 99m}Tc-sestamibi was injected before PCI and gated SPECT acquired thereafter. Gated SPECT was repeated 7 and 30 days later. Perfusion defect, wall motion score index, left ventricular ejection fraction and volumes were examined. Before PCI, 14 patients (group A) showed TIMI flow 2-3 and 22 (group B) TIMI flow 0-1, but no differences in clinical variables, initial risk area, wall motion score, ejection fraction or volumes. Perfusion defect was smaller in group A at 7 (9%{+-}11% vs 19%{+-}14%, p<0.02) and 30 days (7%{+-}7% vs 16%{+-}12%, p<0.02) and the salvage index was higher at 30 days (77%{+-}22% vs 55%{+-}28%, p<0.02). Wall motion score was lower in group A at 30 days (p<0.05). Ejection fraction significantly improved in both groups at 7 and 30 days. End-diastolic volume showed a trend towards a reduction in group A, whilst it was significantly increased in group B. Conversely, end-systolic volume was significantly decreased in group A but remained unchanged in group B. In the setting of optimal myocardial reperfusion for myocardial infarction, preserved TIMI flow before PCI does not limit the initial risk area but it does improve myocardial salvage and functional recovery. (orig.)

  2. Effects of CT-based attenuation correction of rat microSPECT images on relative myocardial perfusion and quantitative tracer uptake

    Purpose: Our goal in this work was to investigate the impact of CT-based attenuation correction on measurements of rat myocardial perfusion with 99mTc and 201Tl single photon emission computed tomography (SPECT). Methods: Eight male Sprague-Dawley rats were injected with 99mTc-tetrofosmin and scanned in a small animal pinhole SPECT/CT scanner. Scans were repeated weekly over a period of 5 weeks. Eight additional rats were injected with 201Tl and also scanned following a similar protocol. The images were reconstructed with and without attenuation correction, and the relative perfusion was analyzed with the commercial cardiac analysis software. The absolute uptake of 99mTc in the heart was also quantified with and without attenuation correction. Results: For 99mTc imaging, relative segmental perfusion changed by up to +2.1%/−1.8% as a result of attenuation correction. Relative changes of +3.6%/−1.0% were observed for the 201Tl images. Interscan and inter-rat reproducibilities of relative segmental perfusion were 2.7% and 3.9%, respectively, for the uncorrected 99mTc scans, and 3.6% and 4.3%, respectively, for the 201Tl scans, and were not significantly affected by attenuation correction for either tracer. Attenuation correction also significantly increased the measured absolute uptake of tetrofosmin and significantly altered the relationship between the rat weight and tracer uptake. Conclusions: Our results show that attenuation correction has a small but statistically significant impact on the relative perfusion measurements in some segments of the heart and does not adversely affect reproducibility. Attenuation correction had a small but statistically significant impact on measured absolute tracer uptake

  3. Assessment of left ventricular function by gated myocardial perfusion and gated blood-pool SPECT. Can we use the same reference database?

    The purpose of this study was to compare left ventricular (LV) volume and ejection fraction (LVEF) measurements obtained with electrocardiographic gated single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (GS-MPI) with those obtained with gated SPECT cardiac blood-pool imaging (GS-pool). Fifteen patients underwent GS-MPI with technetium-99m tetrofosmin and GS-pool with technetium-99m-erythrocyte, within a mean interval of 8±3 days. Eight patients had suspected dilated cardiomyopathy and seven patients had angiographically significant coronary artery disease. End-diastolic volume (EDV), end-systolic volume (ESV) and LVEF measurements were estimated from GS-MPI images by means of Cedars-Sinai automatic quantitative program and from GS-pool images by the threshold technique. Mean differences between GS-MPI and GS-pool in EDV, ESV and LVEF measurements were -2.8±10.5 ml [95% confidence interval (CI): -8.6±3.0 ml], 2.6±7.3 ml (CI: -1.4-6.6 ml) and -2.3±5.1% (CI: -5.1-0.6%), respectively. No significant difference in the mean differences from 0 was found for EDV, ESV or LVEF measurements. Bland-Altman plots revealed no trend over the measured LV volumes and LVEF. For all parameters, regression lines approximated lines of identity. The excellent agreement between GS-MPI and GS-pool measurements suggests that, for estimation of LV volumes and LVEF, these two techniques may be used interchangeably and measurements by one method can serve as a reference for the other. (author)

  4. Crosstalk analysis of simultaneously acquired dual-isotope 201tl myocardial perfusion SPECT and 99Tcm-RBC equilibrium ventricle imaging

    Objective: To analysis the crosstalk between the 20'1Tl and 99Tcm while the myocardial SPECT imaging with 201Tl and the equilibrium ventricle imaging with 99Tcm-RBC are simultaneously acquired, and to search after a method to reduce the down scatter of 99Tcm in the 201Tl window. Methods: Myocardial perfusion images were acquired using a cardiac phantom, which can present various levels of ischemia. The pulse height analysis was performed before the SPECT acquisition. The down scatter ratio of different 201Tl doses was calculated on each project with variable acquisition energy window. After the raw data were reconstructed with Butterworth filter, the defect-to-myocardium count ratios from different 201Tl acquisition window and variable defect levels were compared. Results: During the dual-isotope acquisition with 201Tl and 99Tcm the main crosstalk was the down scatter of 99Tcm in 201Tl window, which was considerably reduced while using higher dosage of 201Tl. The down scatter was also inhibited by applying more specific energy window of 201Tl. The defect-to-myocardium ratio analysis showed that only the data acquired under 15% energy window were affected on the contrast of the defects in short axis slice. The window of 201Tl and the extent of the ischemia influenced the defect-to-myocardium ratios of mimic ischemia segments differently. The completely defect group appeared insensible to the change of acquisition window. Between the defect-to-myocardium ratio of 33% filled group and the 66% filled group considerable difference was demonstrated while the acquisition window of 20% was used. Conclusions: The down scatter of 99Tcm is the major factor which influences the simultaneous dual-isotope acquisition. The stain can be reduced either using more specific 201Tl energy acquisition window or applying higher dosage of 201Tl. But due to the long half-life of 201Tl, the authors can not increase the dosage discretionarily. As the more specific window of 201Tl can avoid

  5. A comparative study between TL-201 SPECT myocardial perfusion scintigraphy and dobutamine stress echocardiography in the detection of coronary artery disease at the Philippine Heart Center

    Although thallium-201 SPECT myocardial perfusion scintigraphy (MPS) has shown considerable accuracy for the detection of coronary artery disease (CAD), dobutamine stress echocardiography (DSE), a relatively new method for the detection of CAD had been recently utilized at the Philippine Heart Center. To assess its diagnostic worth versus that of thallium-201 spect myocardial scintigraphy (MPS), we studied 18 patients who underwent both procedures. Coronary angiography (CA) was used as the gold standard. MPS was performed with maximal treadmill exercise or with dipyridamole (0.568 mg/kg over 4 minutes) and Tl-201 was injected at peak stress. DSE was performed by infusing dobutamine at an increment of 5 μg/kg/min up to a maximum of 40. Atropine (0.01%) was added when 85% of maximum predicted heart rate is not achieved. Significant stenosis (>70%) was found in 16 out of 18 patients by CA. The sensitivity for the presence of CAD was 88% (14/16) and 69% (11/16) for MPS and DSE respectively. Specificity was 100% (2/2) for both. PPV was 100% for both while NPV was 50% and 29% for MPS and DSE respectively. Diagnostic accuracies were 89% and 72% for MPS and DSE respectively (P>0.05). Sensitivity for detecting left anterior descending artery (LAD) lesion was 71% 64% for MPS and DSE respectively; specificity was 75% and 100% respectively. For the left circumplex artery (LCX) lesion, both MPS and DSE had a sensitivity of 62% and specificity of 60%. Likewise for the right coronary artery (RCA) lesion, both had a sensitivity of 66% and specificity of 50%. Diagnostic accuracies were equal for both tests at 72% for LAD; 61% for LCX; and 61% for RCA. Kappa tests for association shows ρ values of >0.05 for overall and individual CAD detection suggesting no significant difference between MPS and DSE. Although there is a trend showing better detection of CAD with MPS, this particular study shows that both tests are comparable with regards to detection of the presence of CAD and of

  6. Automatic detection of coronary artery disease in myocardial perfusion SPECT using image registration and voxel to voxel statistical comparisons.

    Peace, R A; Staff, R T; Gemmell, H G; McKiddie, F I; Metcalfe, M J

    2002-08-01

    The purpose of this study was to compare the performance of automatic detection of coronary artery disease (CAD) with that of expert observers. A male and female normal image template was constructed from normal stress technetium-99m single photon emission computed tomography (SPECT) studies. Mean and standard deviation images for each sex were created by registering normal studies to a standard shape and position. The test group consisted of 104 patients who had been routinely referred for SPECT and angiography. The gold standard for CAD was defined by angiography. The test group studies were registered to the respective templates and the Z-score was calculated for each voxel. Voxels with a Z-score greater than 5 indicated the presence of CAD. The performance of this method and that of three observers were compared by continuous receiver operating characteristic (CROC) analysis. The overall sensitivity and specificity for automatic detection were 73% and 92%, respectively. The area (Az) under the CROC curve (+/-1 SE) for automatic detection of CAD was 0.88+/-0.06. There was no statistically significant difference between the performances of the three observers in terms of Az and that of automatic detection (P> or =0.25, univariate Z-score test). The use of this automated statistical mapping approach shows a performance comparable with experienced observers, but avoids inter-observer and intra-observer variability. PMID:12124485

  7. Diagnosis of myocardial involvement in patients with systemic myopathies with 15-(p-[I-123]iodophenyl) pentadecanoic acid (IPPA) SPECT

    Involvement of the myocardium in non-infectious myopathies presents in most cases as systolic dysfunction or a disturbed cardiac rhythm. We are interested in exploring how often cardiac involvement can be evaluated with various diagnostic techniques in patients with proven myopathy. We investigated 41 patients with myopathies of various etiology, including mitochondrial and congenital myopathies, Curshmann-Steinert disease, muscular dystrophy, and others. Myopathy was proven by muscular biopsy usually from the bicep. Fatty acid imaging was performed with 15-(p-[I-123]iodophenyl)pentadecanoic acid (IP-PA) and sequential SPECT-scintigraphy with a 180 deg. rotation starting at the 45 deg. RAO position. 190 MBq were injected at the maximal stage of a submaximal exercise. Filtered backprojection and reorientation of the slices were achieved by standard techniques. The quantitative comparison of the oblique slices (bulls-eye technique) of the SPECT-studies revealed turnover-rates as a qualitative measure of β-oxidation. Serum levels of lactate (L), pyruvate (P), glucose (G) and triglycerides (TG) were measured at rest and stress. Ventricular function was investigated by radionuclide ventriculography (MUGA) at rest and under stress with Tc-99m labeled red blood cells. In addition, ECG, 24 hour-ECG, and echocardiography were also performed with standard techniques

  8. Dual myocardial single photon emission computed tomography (SPECT) using thallium-201 and I-123-{beta}-methyl-i-pentadecanoic acid in patients with Duchenne's progressive muscular dystrophy

    Shimoyama, Katsuya [Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine

    1999-10-01

    Dual single photon emission computed tomography (SPECT) was performed in 31 patients with Duchenne's progressive muscular dystrophy (DMD) using {sup 123}I-{beta}-methyl pentadecanoic acid (BMIPP) for myocardial fatty acid metabolism and {sup 201}thallium (Tl)-chloride for myocardial perfusion. The left ventricle was divided into 9 segments, and accumulation of the radiotracers was assessed visually for each segment to calculate defect score for each tracer. There was some degree of decrease in myocardial accumulation of both tracers in all DMD patients. Reduced accumulation was most common at the apex (BMIPP: 67%, Tl: 63%), followed by the posterior wall, lateral wall, and anterior wall. On the other hand, reduced accumulation was less common at the septum. BMIPP showed a higher accumulation than Tl in all segments but the septum. When BMIPP defect score was larger than Tl defect score, BMIPP defect score tended to increase during 4 years follow-up (p<0.042). However, when Tl defect score was larger than BMIPP defect score, an increase in Tl defect score was slight. A significant negative correlation was found between the sum of the BMIPP and Tl defect scores and the left ventricular ejection fraction (LVEF) (r=0.66, p<0.0001). According to the histo-pathological study of two autopsied hearts, severe myocardial fibrosis was seen in segments with fixed perfusion defect. In addition, the mismatched segments of BMIPP defect score > Tl defect score revealed a slight fibrosis or normal myocardium. It can be concluded that the dual SPECT myocardial scintigraphy using BMIPP and Tl provides accurate information about disease progression of the heart in patients with DMD by detecting abnormalities of the myocardial metabolism of each substance, thereby enabling the assessment of left ventricular function. (author)

  9. SPECT imaging of myocardial infarction using {sup 99m}Tc-labeled C2A domain of synaptotagmin I in a porcine ischemia-reperfusion model

    Fang Wei [Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing 100037 (China); Wang Feng [Nuclear Medicine Department, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing 210006 (China); Ji Shundong [Jiangsu Institute of Hematology, 1st Hospital of Suzhou University, Suzhou 215006 (China); Zhu Xiaoguang [Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, WI 53226 (United States); Meier, Heidi T. [Clinical Veterinarian and Radiology Research, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, WI 53295 (United States); Hellman, Robert S. [Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, WI 53226 (United States); Brindle, Kevin M. [MRC Laboratory of Molecular Biology, Cambridge CB2 2QH (United Kingdom); Davletov, Bazbek [Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA (United Kingdom); Zhao Ming [Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, WI 53226 (United States)], E-mail: mzhao@mcw.edu

    2007-11-15

    Introduction: The C2A domain of synaptotagmin I recognizes necrotic and apoptotic cells by binding to exposed anionic phospholipids. The goal is to explore the potential imaging utility of {sup 99m}Tc-labeled C2A in the detection of acute cardiac cell death in a porcine model that resembles human cardiovascular physiology. Methods: Ischemia (20-25 min) was induced in pigs (M/F, 20-25 kg) using balloon angioplasty. {sup 99m}Tc-C2A-GST (n=7) or {sup 99m}Tc-BSA (n=2) was injected intravenously 1-2 h after reperfusion. Noninfarct animals were injected with {sup 99m}Tc-C2A-GST (n=4). SPECT images were acquired at 3 and 6 h postinjection. Cardiac tissues were analyzed to confirm the presence of cell death. Results: Focal uptake was detected in five out of seven subjects at 3 h and in all infarct subjects at 6 h postinjection but not in infarct animals injected with {sup 99m}Tc-BSA or in noninfarct animals with {sup 99m}Tc-C2A-GST. Gamma counting of infarct versus normal myocardium yielded a 10.2{+-}5.7-fold elevation in absolute radioactivity, with histologically confirmed infarction. Conclusions: We present data on imaging myocardial cell death in the acute phase of infarction in pigs. C2A holds promise and warrants further development as an infarct-avid molecular probe.

  10. Late gadolinium uptake demonstrated with magnetic resonance in patients where automated PERFIT analysis of myocardial SPECT suggests irreversible perfusion defect

    Myocardial perfusion single photon emission computed tomography (MPS) is frequently used as the reference method for the determination of myocardial infarct size. PERFIT® is a software utilizing a three-dimensional gender specific, averaged heart model for the automatic evaluation of myocardial perfusion. The purpose of this study was to compare the perfusion defect size on MPS, assessed with PERFIT, with the hyperenhanced volume assessed by late gadolinium enhancement magnetic resonance imaging (LGE) and to relate their effect on the wall motion score index (WMSI) assessed with cine magnetic resonance imaging (cine-MRI) and echocardiography (echo). LGE was performed in 40 patients where clinical MPS showed an irreversible uptake reduction suggesting a myocardial scar. Infarct volume, extent and major coronary supply were compared between MPS and LGE as well as the relationship between infarct size from both methods and WMSI. MPS showed a slightly larger infarct volume than LGE (MPS 29.6 ± 23.2 ml, LGE 22.1 ± 16.9 ml, p = 0.01), while no significant difference was found in infarct extent (MPS 11.7 ± 9.4%, LGE 13.0 ± 9.6%). The correlation coefficients between methods in respect to infarct size and infarct extent were 0.71 and 0.63 respectively. WMSI determined with cine-MRI correlated moderately with infarct volume and infarct extent (cine-MRI vs MPS volume r = 0.71, extent r = 0.71, cine-MRI vs LGE volume r = 0.62, extent r = 0.60). Similar results were achieved when wall motion was determined with echo. Both MPS and LGE showed the same major coronary supply to the infarct area in a majority of patients, Kappa = 0.84. MPS and LGE agree moderately in the determination of infarct size in both absolute and relative terms, although infarct volume is slightly larger with MPS. The correlation between WMSI and infarct size is moderate

  11. Assessment of automatic quantification of myocardial perfusion and left ventricular function derived from ECG gated myocardial SPECT with {sup 99m}Tc-tetrofosmin in ischemic heart disease

    Abe, Mitsunori; Habara, Hirokazu; Tatsuno, Hironari; Fukuda, Hiroshi; Hamada, Noriko; Kazatani, Yukio [Ehime Prefectural Central Hospital (Japan)

    1999-09-01

    Non-invasive assessment of ischemic heart disease (IHD) requires information of both myocardial perfusion and left ventricular (LV) function. Recently, automatic quantification of ECG-gated myocardial scintigraphy with {sup 99m}Tc-tetrofosmin (QGS) can provide both of them. QGS, coronary angiograms (CAG) and left venticulograms (LVG) were performed in 83 patients with severe IHD in same period. Significant stenosis of coronary artery in CAG were assessed by QGS. The sensitivity, specificity and accuracy of significant stenosis by QGS was excellent (85%, 93% and 88%). The LV end-distolic and end-systolic volumes (EDV and ESV), LV ejection fraction (EF) and regional LV wall motion determined by QGS were compared to LVG. There was a good correlation between the values obtained from QGS and LVG (EDV: r=0.86, ESV: r=0.94, EF: r=0.84, p<0.0001), but QGS tended to underestimate EDV and EF. High complete agreement of regional LV wall motion was gained with 427 (74.0%) out of total 581 segments. In conclusion, QGS data was considered to be useful for assessment of determine significant stenosis and LV function in severe IHD. (author)

  12. Effect of caffeine on SPECT myocardial perfusion imaging during regadenoson pharmacologic stress: a prospective, randomized, multicenter study

    Tejani, Furqan H.; Thompson, Randall C.; Kristy, Rita; Bukofzer, Stan

    2014-01-01

    A multicenter, double-blind, randomized study was conducted to assess the effect of caffeine on regadenoson stress myocardial perfusion imaging (MPI). Subjects with a high likelihood of coronary artery disease underwent a rest single-photon emission computed tomography MPI on day 1 (MPI-1) and a stress MPI with regadenoson on day 3 (MPI-2). Individuals with ≥1 segment with a reversible defect received double-blind caffeine tablets (200 or 400 mg) or placebo 90 min before a repeat regadenoson ...

  13. Assessment of cardiac function using myocardial perfusion imaging technique on SPECT with 99mTc sestamibi

    Gani, M. R. A.; Nazir, F.; Pawiro, S. A.; Soejoko, D. S.

    2016-03-01

    Suspicion on coronary heart disease can be confirmed by observing the function of left ventricle cardiac muscle with Myocardial Perfusion Imaging techniques. The function perfusion itself is indicated by the uptake of radiopharmaceutical tracer. The 31 patients were studied undergoing the MPI examination on Gatot Soebroto Hospital using 99mTc-sestamibi radiopharmaceutical with stress and rest conditions. Stress was stimulated by physical exercise or pharmacological agent. After two hours, the patient did rest condition on the same day. The difference of uptake percentage between stress and rest conditions will be used to determine the malfunction of perfusion due to ischemic or infarct. Degradation of cardiac function was determined based on the image-based assessment of five segments of left ventricle cardiac. As a result, 8 (25.8%) patients had normal myocardial perfusion and 11 (35.5%) patients suspected for having partial ischemia. Total ischemia occurred to 8 (25.8%) patients with reversible and irreversible ischemia and the remaining 4 (12.9%) patients for partial infarct with characteristic the percentage of perfusion ≤50%. It is concluded that MPI technique of image-based assessment on uptake percentage difference between stress and rest conditions can be employed to predict abnormal perfusion as complementary information to diagnose the cardiac function.

  14. Myocardial metabolism of 123I-BMIPP under low-dose dobutamine infusion: implications for clinical SPECT imaging of ischemic heart disease

    123I-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (123I-BMIPP) is a fatty acid analog for single-photon emission computed tomography (SPECT) imaging that is mainly stored in the triglyceride pool. Low-dose dobutamine infusion has been reported to improve BMIPP uptake in the stunned myocardium, but the mechanism underlying this effect remains unclear. The purpose of this study was therefore to investigate the myocardial metabolism of 123I-BMIPP in the stunned myocardium under low-dose dobutamine infusion, and to elucidate the mechanism by which dobutamine improves BMIPP uptake. Using open-chest dogs, stunned myocardium was induced by occlusion of the left anterior descending artery (LAD) for 30 min, with subsequent reperfusion (ischemia group, n=6). After direct injection of BMIPP into the LAD, myocardial extraction and retention were examined and metabolites evaluated (using high-performance liquid chromatography) during dobutamine infusion. The results in the ischemia group were compared with findings obtained in a control group under dobutamine infusion (n=6). Dobutamine infusion significantly increased both the rapid extraction (within 30 s) of BMIPP into the myocardium (control vs ischemia group: 48±19% vs 66±14%, p<0.05) and its subsequent retention (73±13% vs 85±8%, p<0.05). The metabolites from the myocardium consisted of back diffusion of nonmetabolized BMIPP, the alpha-oxidation metabolite, intermediate metabolites, and the full-oxidation metabolite. Among these metabolites, the full-oxidation metabolite decreased significantly (from 34.0±20.0% to 15.8±9.3%, p<0.05) in the stunned regions, though back diffusion of nonmetabolized BMIPP increased (from 51.3±21.9% to 71.3±10.1%, p<0.05). These results indicate that increased uptake of BMIPP in stunned myocardium is mainly due to decreased beta-oxidation in tissue and increased shunt retention of BMIPP in the triglyceride pool, and thereby provide further insight into the pathophysiology of stunned

  15. Comparison of myocardial perfusion SPECT with 64-slice multi-slice computed tomography angiography in cardiac screening of asymptomatic diabetic patients

    Lim, Il Han; Lee, Won Woo; Chang, Hyuck Jae; Choi, Sang II; Kim, Sang Eun [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    2007-07-01

    Asymptomatic diabetic patients may suffer silent ischemia. However, the question that what is the optimal screening tool for detection of cardiac disease in asymptomatic diabetic patients has not been addressed. We prospectively recruited diabetic patients who had not complained chest pain, and obtained myocardial perfusion SPECT (MPS) and cardiac CT angiography (CTA). We compared perfusion status on MPS with findings on CTA. A total of 110 diabetic patients (Age range 41-84, mean age 61.6{+-}7.74; gender, M: F 66:44) without cardiac symptom underwent both MPS and CTA. The MPS protocol was one-day single isotope study, adenosine stress Tc-99m MIBI/rest Tc-99m MIBI. CTA was conducted using 64-slice multi-slice CT (Brillance64, Philips Medical Systems). Perfusion status on MPS was assessed by summed-stress score (SSS) using 20-segment model, and SSS of {>=}4 was considered abnormal. Coronary stenosis of more than 50% luminal narrowing in CTA was considered significant, and coronary artery calcium scoring (CACS) was graded as: < or =10, 11-100, 101-400, or >400. MPS found abnormal perfusion in 11.8% (13/110) and CTA significant coronary stenosis in 20.9% (23/110). Five patients showed both abnormal perfusion and significant coronary stenosis. CACS (n=103 patients) were measured as; < or =10 in 45.6%, 11-100 in 28.1%, 101-400 in 19.4%, and >400 in 6.8%. The patient proportion of abnormal MPS in each CACS group were; 10.6% with < or = 10, 17.2% with 11-100, 5% with 101-400, and 0% with >400. The patient proportion of significant coronary stenosis on CTA in each CACS group were; 2.13% with < or =10, 27.6% with 11-100, 35% with 101-400, and 57.1% with >400. In asymptomatic diabetic patients, coronary stenosis by CTA showed correlation with coronary artery calcium scoring, but myocardial perfusion status by MPS did not. Long-term evaluation is essential for determination of prognostic significance of MPS and cardiac CTA.

  16. Effect of the reverse redistribution pattern on the left ventricular ejection fraction in the Tc- 99m MIBI SPECT myocardial perfusion scintigraphy

    Bekir Taşdemir

    2015-09-01

    Full Text Available Objective: The causes and prognostic significance of the reverse redistribution pattern (RRP is not clear yet. In this study, we aimed to evaluate the RRP effect on the left ventricular ejection fraction (EF. Methods: Imaging of the patients whose technetium-99m sestamibi myocardial perfusion scintigraphy was carried out and reported as normal were retrospectively examined. One-day protocol and/or pharmacologic stress testing applied patients were excluded. 21 patients with RRP met the inclusion criteria. All of these patients were included in the study as RRP group. Randomly selected 21 patients with non-RRP were included in the study as control group. Transient ischemic dilation (TID scores and EF values were automatically calculated with the Quantitative Gated SPECT (QGS program. Results: While a statistically significant difference was not found between the RRP and control groups in terms of age, sex, hypertension, family history, hyperlipidemia, and diabetes (p>0.05, there was a statistically significant difference in terms of smoking (p=0.019. TID scores in the RRP group were significantly lower compared to the control group (p<0.001. In addition, a statistically significant decrease was determined in the EF values in the rest images compared to the stress images in the RRP group (p=0.002. Furthermore, this decrease was significantly higher than in the control group (p= 0.034. Conclusion: The results related to the TID scores and EF values are suggesting the existence of an ischemic cause in the background of the RRP. Additionally, the relationship found between smoking and RRP may be associated with the tachycardia and / or coronary spasm-inducing effect of smoking. J Clin Exp Invest 2015; 6 (3: 286-290

  17. Detection of myocardial viability by means of Single Proton Emission Computed Tomography (Perfused SPECT) dual 201 Tl (rest of 15 minutes, 24 late hours and 24 hours reinjection) and gated-SPECT 99m Tc-SESTAMIBI in effort or stimulation of the coronary reserves

    The objective of this work was to determine if the images of SPECT 201 TI in rest of 15 minutes, 24 late hours and Gated-SPECT 99m Tc-SESTAMIBI in effort or stimulation of coronary reservation correlate with the study of 24 hours post reinjection of 201TI to determine the presence of having knitted viable myocardium. Material and methods: 29 patients were studied with coronary arterial illness (EAC) to who are carried out SPECT 201 TI in rest with images of 15 minutes, 24 late hours and 24 hours reinjection, by means of the administration of 201TI to dose of 130 MBq and reinjection with 37 MBq. and Gated-SPECT 99mTc-SESTAMIBI in effort or stimulation of coronary reservation, later to the administration of 1110 MBq. Results: 29 patients were included according to inclusion approaches and exclusion, of those which 22 (75.86%) they correspond at the masculine sex and 7 (24.13%) to the feminine one, with an average of 62.1 year-old age, 2320 segments myocardial were analysed so much it is phase post-effort as rest; they were diagnosed a total of 264 segments with heart attack, of which viability myocardium was observed in 174 segments. The statistical tests are analysis of frequencies. The non parametric test of Wilcoxon and Mann-Whitney. Conclusions: the viability myocardial at the 24 late hours and 24 hours reinjection was similar; significant difference exists between the study of 15 minutes and 24 hours reinjection, ischemic illness was also demonstrated in territories different to the heart attack area in the studies of 15 minutes, late 24 hours and 24 hours reinjection. (Author)

  18. Single Photon Emission Computed Tomography (SPECT)

    ... Tools & Resources Stroke More Single Photon Emission Computed Tomography (SPECT) Updated:Sep 11,2015 What is a ... Heart Attack Myocardial Perfusion Imaging (MPI) Positron Emission Tomography (PET) Radionuclide Ventriculography, Radionuclide Angiography, MUGA Scan Heart ...

  19. The benefits of prone SPECT myocardial perfusion imaging in reducing both artifact defects and patient radiation exposure

    Background: Prone imaging has been demonstrated to minimize diaphragmatic and breast tissue attenuation. Objectives: To determine the role of prone imaging on the reduction of unnecessary rest perfusion studies and coronary angiographies performed, thus decreasing investigation time and radiation exposure. Methods: We examined 139 patients, 120 with an inferior wall and 19 with an anterior wall perfusion defect that might represented attenuation artifact. Post-stress images were acquired in both the supine and prone position. Coronary angiography was used as the 'gold standard' for evaluating coronary artery patency. The study was terminated and rest imaging was obviated in the presence of complete improvement of the defect in the prone position. Quantitative interpretation was performed. Results were compared with clinical data and coronary angiographic findings. Results: Prone acquisition correctly revealed defect improvement in 89 patients (89/120) with inferior wall and 12 patients (12/19) with anterior wall attenuation artifact. Quantitative analysis demonstrated statistically significant difference in the mean summed stress scores (SSS) of supine and mean SSS of prone studies in patients with disappearing inferior wall defect in the prone position and patent right coronary artery (true negative results). The mean difference between SSS in supine and in prone position was higher with disappearing than with remaining defects. Conclusion: Technetium-99m (Tc-99m) tetrofosmin myocardial perfusion imaging with the patient in the prone position overcomes soft tissue attenuation; moreover it provides an inexpensive, accurate approach to limit the number of unnecessary rest perfusion studies and coronary angiographies performed. (author)

  20. Increased accuracy of single photon emission computed tomography (SPECT myocardial perfusion scintigraphy using iterative reconstruction of images

    Stević Miloš

    2016-01-01

    Full Text Available Background/Aim. Filtered back projection (FBP is a common way of processing myocardial perfusion imaging (MPI studies. There are artifacts in FBP which can cause falsepositive results. Iterative reconstruction (IR is developed to reduce false positive findings in MPI studies. The aim of this study was to evaluate the difference in the number of false positive findings in MPI studies, between FBP and IR processing. Methods. We examined 107 patients with angina pectoris with MPI and coronary angiography (CAG, 77 man and 30 woman, aged 32−82. MPI studies were processed with FBP and with IR. Positive finding at MPI was visualization of the perfusion defect. Positive finding at CAG was stenosis of coronary artery. Perfusion defect at MPI without coronary artery stenosis at CAG was considered like false positive. The results were statistically analyzed with bivariate correlation, and with one sample t-test. Results. There were 20.6% normal, and 79.4% pathologic findings at FBP, 30.8% normal and 69.2% pathologic with IR and 37.4% normal and 62.6% pathologic at CAG. FBP produced 19 false-positive findings, at IR 11 false positive findings. The correlation between FBP and CAG was 0.658 (p < 0.01 and between IR and CAG 0.784 (p < 0.01. The number of false positive findings at MPI with IR was significantly lower than at FBP (p < 0.01. Conclusion. Our study shows that IR processing MPI scintigraphy has less number of false positive findings, therefore it is our choice for processing MPI studies.

  1. The Benefits of Prone SPECT Myocardial Perfusion Imaging in Reducing Both Artifact Defects and Patient Radiation Exposure

    Maria Stathaki

    2015-10-01

    Full Text Available AbstractBackground:Prone imaging has been demonstrated to minimize diaphragmatic and breast tissue attenuation.Objectives:To determine the role of prone imaging on the reduction of unnecessary rest perfusion studies and coronary angiographies performed, thus decreasing investigation time and radiation exposure.Methods:We examined 139 patients, 120 with an inferior wall and 19 with an anterior wall perfusion defect that might represented attenuation artifact. Post-stress images were acquired in both the supine and prone position. Coronary angiography was used as the “gold standard” for evaluating coronary artery patency. The study was terminated and rest imaging was obviated in the presence of complete improvement of the defect in the prone position. Quantitative interpretation was performed. Results were compared with clinical data and coronary angiographic findings.Results:Prone acquisition correctly revealed defect improvement in 89 patients (89/120 with inferior wall and 12 patients (12/19 with anterior wall attenuation artifact. Quantitative analysis demonstrated statistically significant difference in the mean summed stress scores (SSS of supine and mean SSS of prone studies in patients with disappearing inferior wall defect in the prone position and patent right coronary artery (true negative results. The mean difference between SSS in supine and in prone position was higher with disappearing than with remaining defects.Conclusion:Technetium-99m (Tc-99m tetrofosmin myocardial perfusion imaging with the patient in the prone position overcomes soft tissue attenuation; moreover it provides an inexpensive, accurate approach to limit the number of unnecessary rest perfusion studies and coronary angiographies performed.

  2. Comparison of 123I-MIBG myocardial scintigraphy, brain perfusion SPECT, and voxel-based MRI morphometry for distinguishing between dementia with Lewy bodies and Alzheimer's disease

    This study aimed to compare the diagnostic value of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, N-isopropyl-p[123I]iodoamphetamine (IMP) brain perfusion single-photon emission computed tomography (SPECT), and brain magnetic resonance imaging (MRI) voxel-based morphometry (VBM) for the differentiation of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). Thirty-five and 34 patients with probable DLB and probable AD, respectively, were enrolled. All patients underwent 123I-MIBG myocardial scintigraphy, 123I-IMP brain perfusion SPECT, and brain MRI. For 123I-MIBG imaging, we calculated early and delayed heart-to-mediastinum (H/M) uptake ratios. Three-dimensional stereotactic surface projections (3D-SSP) were used to analyze the results of 123I-IMP SPECT. VBM with statistical parametric mapping 8 plus diffeomorphic anatomical registration using exponentiated Lie algebra (DARTEL) was used to analyze the brain MRI data. The area under the receiver operating characteristic curves (AUC) for discriminating DLB and AD was highest (0.882) for the delayed H/M ratio on 123I-MIBG scintigraphy. AUC for z-score measurement in the occipital lobe was 0.818 and that for the extent of gray matter (GM) atrophy in the whole brain was 0.788. AUC for the combination of 3D-SSP and VBM analysis was 0.836. The respective sensitivities and specificities for distinguishing DLB from AD were 97.1 and 100% for the delayed H/M ratio using 123I-MIBG scintigraphy; 88.6 and 73.5% for the occipital lobe z-score using 3D-SSP analysis; 85.7 and 64.7% for the extent of whole brain GM atrophy using voxel-based MRI morphometry; and 91.4 and 76.5% for the combination of 3D-SSP analysis and VBM. 123I-MIBG myocardial scintigraphy was superior to brain perfusion SPECT and brain MRI using an advanced statistical technique to differentiate DLB and AD. (author)

  3. Accuracy of gated cine-images for differentiating fixed defects from attenuation artifacts in Tc-99m tetrofosmin myocardial SPECT: comparison with visual grading, projection views and ejection fractions

    The differentiation of attenuation artifacts from true lesions is important in the interpretation of myocardial perfusion imaging. We investigated the degree of increased accuracy which gated cine-images provide over conventional methods of visual grading, reviewing projection views and left ventricular ejection fraction (LVEF) measurements in this regard. Eighty three patients (M: 65, F: 18; mean age, 58.2 ± 9.0) with equivocal fixed defects in stress-rest myocardial SPECT using Tc-99m tetrofosmin were included. Two independent observers graded confidence levels for true lesion over attenuation artifacts with a 5 point scaling system after sequentially reviewing tomographic images, projection images and gated cine-images. LVEF was measured by gated SPECT. The fixed defects were proved to be true lesions in 23 cases while 42 cases were due to attenuation artifact, and 18 cases with the undetermined final diagnosis were excluded. There were no significant differences in age, body weight and LVEF between the two groups. Receiver operator characteristics (ROC) curve analysis showed that LVEF measurements did not improve diagnostic accuracy while gated-cine images provided additional accuracy over visual (p=0.126 for observer A; p=0.0002 for observer B) or visual plus projection view assessment (p=0.278 for observer A; p=0.019 in observer B). Moreover, although there was significant inter-observer variance for accuracy with visual assessment alone (p=0.005), the gated cine-images provided the highest accuracy and lowest inter-observer variance (p=0.821). In conclusion, gated SPECT improves the accuracy of differentiating attenuation artifacts from true lesions compared to conventional mehod. It also enahnces the objectively of assessment by reducing inter-observer variability

  4. Prognostic value of 18F-FDG positron emission tomography in patients with coronary artery disease and left ventricular dysfunction

    Objective: To evaluate the prognostic value of 18F-FDG positron emission tomography (PET) in patients (pts) with coronary artery disease (CAD)and left ventricular dysfunction and to clarify whether revascularization (RVS) will decrease the cardiac events in pts with myocardial perfusion-metabolism mismatch(MM). Methods: 107 consecutive pts (mean age 57 +- 9 yr.) with CAD and left ventricular dysfunction [left ventricular ejection fraction (LVEF)=(38 +- 9)%] who underwent 18F-FDG PET imaging and 99Tcm-MIBI SPECT imaging were followed up for (24 +- 5) months. Myocardial segments were classified as myocardial perfusion-metabolism mismatch (MM) and match (M). LVEF and left ventricular end diastolic diameter (LVEDD) were measured with echocardiography (Echo). Results: Fifty-nine pts underwent RVS and 48 pts underwent medical therapy. Three months (POS1) and 6 months (POS2) after RVS, Echo was performed on forty-six pts and 23 pts, respectively. Cardiac death, myocardial infarction, unstable angina pectoris and late RVS (>3 mon) were considered as cardiac events. Among 64 patients with 2 or more MM segments, 35 pts received RVS (MM1) and 29 pts received medical therapy (MM2). Among 43 pts with less than 2 MM segments, 24 pts underwent RVS (M1) and 19 pts underwent medical therapy (M2). After RVS, LVEF in MM1 was increased from (38 +- 8)% to (48 +- 10)% (P0.05). The cardiac event rate of 51.7% (15/29) in MM2 was significantly higher than that of 2.9% (1/35) in MM1 (x2 = 20.14, P2 = 7.02, P24.52, P<0.05). Conclusions: The results suggest that the presence of MM in pts with CAD and left ventricular dysfunction is associated with poor prognosis on medical therapy, and these pts may need aggressive RVS to prevent a future cardiac event and to improve left ventricular function

  5. Stress-first protocol for myocardial perfusion SPECT imaging with semiconductor cameras: high diagnostic performances with significant reduction in patient radiation doses

    Effective doses of 14 mSv or higher are currently being attained in patients having stress and rest myocardial perfusion imaging (MPI) single photon emission computed tomography (SPECT) performed on the same day with conventional protocols. This study aimed to assess the actual reduction in effective doses as well as diagnostic performances for MPI routinely planned with: (1) high-sensitivity cadmium zinc telluride (CZT) cameras, (2) very low injected activities and (3) a stress-first protocol where the normality of stress images may lead to avoiding rest imaging. During a 1-year period, 2,845 patients had MPI on a CZT camera, a single-day stress-first protocol and low injected activities (120 MBq of 99mTc-sestamibi at stress for 75 kg body weight and threefold higher at rest). The ability to detect > 50 % coronary stenosis was assessed in a subgroup of 149 patients who also had coronary angiography, while the normalcy rate was assessed in a subgroup of 128 patients with a low pretest likelihood of coronary artery disease (<10 %). Overall, 33 % of patients had abnormal MPI of which 34 % were women and 34 % were obese. The mean effective doses and the percentage of exams involving only stress images were: (1) 3.53 ± 2.10 mSv and 37 % in the overall population, (2) 4.83 ± 1.56 mSv and 5 % in the subgroup with angiography and (3) 1.96 ± 1.52 mSv and 71 % in the low-probability subgroup. Sensitivity and global accuracy for identifying the 106 patients with coronary stenosis were 88 and 80 %, respectively, while the normalcy rate was 97 %. When planned with a low-dose stress-first protocol on a CZT camera, MPI provides high diagnostic performances and a dramatic reduction in patient radiation doses. This reduction is even greater in low-risk subgroups with high rates of normal stress images, thus allowing the mean radiation dose to be balanced against cardiac risk in targeted populations. (orig.)

  6. Stress-first protocol for myocardial perfusion SPECT imaging with semiconductor cameras: high diagnostic performances with significant reduction in patient radiation doses

    Perrin, Mathieu; Claudin, Marine; Veran, Nicolas; Morel, Olivier; Besseau, Cyril; Boutley, Henri [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); Djaballah, Wassila; Poussier, Sylvain; Verger, Antoine [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); INSERM U947 et Universite de Lorraine, Nancy (France); Moulin, Frederic [CHU-Nancy, Department of Cardiology, Nancy (France); Imbert, Laetitia; Karcher, Gilles [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); UMR 7039 CRAN et Universite de Lorraine, Nancy (France); Marie, Pierre-Yves [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Nancyclotep Experimental Imaging Platform, Nancy (France); INSERM U1116 et Universite de Lorraine, Nancy (France)

    2015-02-25

    Effective doses of 14 mSv or higher are currently being attained in patients having stress and rest myocardial perfusion imaging (MPI) single photon emission computed tomography (SPECT) performed on the same day with conventional protocols. This study aimed to assess the actual reduction in effective doses as well as diagnostic performances for MPI routinely planned with: (1) high-sensitivity cadmium zinc telluride (CZT) cameras, (2) very low injected activities and (3) a stress-first protocol where the normality of stress images may lead to avoiding rest imaging. During a 1-year period, 2,845 patients had MPI on a CZT camera, a single-day stress-first protocol and low injected activities (120 MBq of {sup 99m}Tc-sestamibi at stress for 75 kg body weight and threefold higher at rest). The ability to detect > 50 % coronary stenosis was assessed in a subgroup of 149 patients who also had coronary angiography, while the normalcy rate was assessed in a subgroup of 128 patients with a low pretest likelihood of coronary artery disease (<10 %). Overall, 33 % of patients had abnormal MPI of which 34 % were women and 34 % were obese. The mean effective doses and the percentage of exams involving only stress images were: (1) 3.53 ± 2.10 mSv and 37 % in the overall population, (2) 4.83 ± 1.56 mSv and 5 % in the subgroup with angiography and (3) 1.96 ± 1.52 mSv and 71 % in the low-probability subgroup. Sensitivity and global accuracy for identifying the 106 patients with coronary stenosis were 88 and 80 %, respectively, while the normalcy rate was 97 %. When planned with a low-dose stress-first protocol on a CZT camera, MPI provides high diagnostic performances and a dramatic reduction in patient radiation doses. This reduction is even greater in low-risk subgroups with high rates of normal stress images, thus allowing the mean radiation dose to be balanced against cardiac risk in targeted populations. (orig.)

  7. Detection of myocardial viability by means of Single Proton Emission Computed Tomography (Perfused SPECT) dual {sup 201} Tl (rest of 15 minutes, 24 late hours and 24 hours reinjection) and gated-SPECT {sup 99m} Tc-SESTAMIBI in effort or stimulation of the coronary reserves; Deteccion de viabilidad miocardica mediante tomografia por emision de foton unico (SPECT perfusorio) dual {sup 201} Talio (Reposo de 15 minutos, 24 horas tardio y 24 horas reinyeccion) y gated-SPECT {sup 99m} Tc-SESTAMIBI en esfuerzo o estimulo de reserva coronaria

    Mendoza V, R

    2004-07-01

    The objective of this work was to determine if the images of SPECT {sup 201} TI in rest of 15 minutes, 24 late hours and Gated-SPECT {sup 99m} Tc-SESTAMIBI in effort or stimulation of coronary reservation correlate with the study of 24 hours post reinjection of {sup 201}TI to determine the presence of having knitted viable myocardium. Material and methods: 29 patients were studied with coronary arterial illness (EAC) to who are carried out SPECT {sup 201} TI in rest with images of 15 minutes, 24 late hours and 24 hours reinjection, by means of the administration of {sup 201}TI to dose of 130 MBq and reinjection with 37 MBq. and Gated-SPECT {sup 99m}Tc-SESTAMIBI in effort or stimulation of coronary reservation, later to the administration of 1110 MBq. Results: 29 patients were included according to inclusion approaches and exclusion, of those which 22 (75.86%) they correspond at the masculine sex and 7 (24.13%) to the feminine one, with an average of 62.1 year-old age, 2320 segments myocardial were analysed so much it is phase post-effort as rest; they were diagnosed a total of 264 segments with heart attack, of which viability myocardium was observed in 174 segments. The statistical tests are analysis of frequencies. The non parametric test of Wilcoxon and Mann-Whitney. Conclusions: the viability myocardial at the 24 late hours and 24 hours reinjection was similar; significant difference exists between the study of 15 minutes and 24 hours reinjection, ischemic illness was also demonstrated in territories different to the heart attack area in the studies of 15 minutes, late 24 hours and 24 hours reinjection. (Author)

  8. The effect of radionuclide imaging on clinical diagnosis and treatment of CAD

    Objective: To evaluate the effect of radionuclide imaging on the diagnosis and treatment of coronary heart disease (CAD) comparing with other methods. Methods: 2282 cases were included in this study. Among them, 1950 underwent 99Tcm-MIBI myocardial imaging and 872 cases underwent blood pool radionuclide ventriculography. Results: The total sensitivity in detecting CAD was 90.4% and specificity was 86.3%; some of the incorrect diagnoses were corrected with the two modalities. In 40 cases, radionuclide imaging provided important clues for prognostication. Conclusion: The radionuclide cardiography is noninvasive and very helpful for the diagnosis of CAD in detail and for evaluation of therapeutic efficiency, prognostication of the disease

  9. Brain SPECT

    Brain SPECT investigations have gained broad acceptance since the introduction of the lipophilic tracer Tc-99m-HMPAO. Depending on equipment and objectives in different departments, the examinations can be divided into three groups: 1. Under normal conditions and standardised patient preparation the 'rest' SPECT can be performed in every department with a tomographic camera. In cerebrovascular disease there is a demand for determination of either the perfusion reserve in reversible ischemia or prognostic values in completed stroke. In cases of dementia, SPECT may yield useful results according to differential diagnosis. Central cerebral system involvement in immunologic disease may be estimated with higher sensitivity than in conventional brain imaging procedures. In psychiatric diseases there is only a relative indication for brain SPECT, since results during recent years have been contradictory and may be derived only in interventional manner. In brain tumor diagnostics SPECT with Tl-201 possibly permits grading. In inflammatory disease, especially in viral encephalitis, SPECT may be used to obtain early diagnosis. Normal pressure hydrocephalus can be distinguished from other forms of dementia and, consequently, the necessity for shunting surgery can be recognised. 2. In departments equipped for emergency cases an 'acute' SPECT can be performed in illnesses with rapid changing symptoms such as different forms of migraine, transient global amnesia, epileptic seizures (so-called 'ictal SPECT') or urgent forms like trauma. 3. In cooperation with several departments brain SPECT can be practised as an interventional procedure in clinical and in scientific studies. (orig./MG)

  10. Application of radionuclide techniques in evaluation of dilated cardiomyopathy and ischemic cardiomyopathy

    Objective: To assess the clinical significance of radionuclide techniques in differentiating dilated cardiomyopathy (DCM) from ischemic cardiomyopathy (CAD-CM). Methods: 28 patients (pts) with DCM and 55 pts with CAD-CM were studied. All pts underwent 99Tcm-MIBI myocardial perfusion SPECT and 18F-FDG myocardial metabolic PET. 73 pts had 99Tcm-RBC radionuclide ventriculography and 68 pts had coronary angiography. Results: 23 pts (82%) with DCM showed perfusion abnormalities with mild and not segmental distribution. 52 pts (95%) with CAD-CM showed perfusion abnormalities that distributed along the coronary vessel territories. Perfusion defects were found in 4 pts (14%) with DCM and 45 pts (82%) with CAD-CM (P<0.01). The average perfusion score was 4.5 +- 2.6 in DCM and 9.5 +- 2.9 in CAD-CM, the area of perfusion diminished uptake was significantly smaller in DCM than in CAD-CM (P < 0.001). 2 pts with DCM and 18 pts with CAD-CM had metabolic defect. The patterns of perfusion/metabolic imaging showed mismatch in most pts with CAD-CM but match in pts with DCM. The LVEF in pts with DCM and CAD-CM was decreased but no significant difference between DCM and CAD-CM was observed. The RVEF in pts with DCM was significantly lower than that in pts with CAD-CM (32.4% +- 13.9% vs 40.9% +- 15.4%, P < 0.05). Conclusions: The radionuclide techniques showed to be helpful for distinguishing DCM from CAD-CM. The discriminate analysis revealed that segmental perfusion abnormality and RVEF were the most important factors for differentiation of DCM from CAD-CM

  11. Acute myocardial infarction:myocardial salvage assessment

    NSENGIYUMVA Pierre; CHEN Li-juan; MA Gen-shan

    2015-01-01

    Primary coronary revascularization by means of percutaneous coronary intervention ( PCI) is a highly ef-fective treatment of acute myocardial infarction re-establishing coronary perfusion and stopping the ongoing necrosis in the dependent myocardium .Single-photon emission computed tomography ( SPECT) is the most widely used mo-dality assessing myocardial salvage as the difference between the acute perfusion defect before intervention and the remaining scar size measured in a second scan several days after the event .SPECT allows quantification of area at risk( AAR) and final infarct size ( FIS) by tracer injection prior to revascularization and after 1 month, respective-ly.SPECT provides the most validated measure of myocardial salvage and has been utilized in multiple randomized clinical trials.However, SPECT is logistically challenging , expensive, and includes radiation exposure .More re-cently, a large number of studies have suggested that cardiac magnetic resonance ( CMR) can determine salvage in a single examination by combining measures of myocardial oedema in the AAR exposed to ischaemia reperfusion with FIS quantification by late gadolinium enhancement .

  12. Surveillance study for creating the national clinical database relating to ECG-gated myocardial perfusion SPECT of asymptomatic ischemic heart disease in patients with type-2 diabetes mellitus. J-ACCESS 2 study design

    Diabetes mellitus is an independent risk factor for acute myocardial infarction. Thus, a surveillance study was conducted as part of studies to create a national database related to electrocardiogram (ECG)-gated myocardial perfusion single-photon emission computed tomography (SPECT) of ischemic heart disease. Single-photon emission computed tomography was conducted in patients with type 2 diabetes mellitus and their prognoses will be followed for 3 years, stratified by patients' clinical background and SPECT findings. A total of 513 patients from 50 institutions were enrolled in this study, 297 of whom were men (age 66.2±0.4 years, mean±standard error of the mean (SEM)) and 261 women (age 67.8±0.5 years). They have a history of retinopathy (25.3%), neuropathy (19.9%), cerebrovascular disorder, chronic obstructive pulmonary disease, and photocoagulation. Major risk factors for present disease were hypertension (82.3%) and hyperlipidemia (79.7%). In 244 patients (129 men and 115 women), body mass index (BMI) was 25 or more. Fifty-two of them (10.1%) underwent coronary angiography; of these, 26 (50.0%) had no coronary artery lesions with 75% or more stenosis, and only 1 (1.9%) had a left main trunk with 50% or more stenosis. An overwhelming majority of patients (94.3%) underwent SPECT imaging by a 1-day stress-followed-by-rest procedure. Stress procedure was exercise in most (70.8%) patients, followed by dipyridamole infusion in 14.6%, adenosine infusion in 6.6%, and adenosine triphosphate infusion in 5.7%. Endpoint of stress examination was most often fatigue in lower limbs (40.7%), followed by completion of pharmacological stress protocol (28.7%), and achievement of target heart rate (26.3%). The largest number of patients (198, 38.6%) received 99mTc-tetrofosmin at an initial dosage of 200-300 MBq (mean 331±3 MBq) followed by a second dosage of 700-800 MBq (mean 748±8 MBq). Among them, 491 (95.7%) received some kind of therapeutic drug: hypoglycemic drugs were

  13. Accelerated Monte Carlo simulation for scatter correction in SPECT

    Jong, Hugo Wilhelmus Antonius Maria de

    2002-01-01

    Single Photon Emission Tomography (SPECT) is often used in the clinical practice to image the distribution of photon-emitting pharmaceuticals in the patient. From this distribution, functional information can be obtained (e.g. perfusion and metabolic processes). To assess the viability of myocardial tissue using SPECT, one perfusion measurement is acquired with the patient in rest and one measurement after exercise. In dual-isotope SPECT, Tl-201 can be used for the rest acquisition and Tc-99m...

  14. Detection of apical hypertrophic cardiomyopathy by cardiovascular MRI

    Objective: To investigate the clinical value of cardiovascular magnetic resonance imaging (cMRI) in identifying apical hypertrophic cardiomyopathy. Methods: Sixty-five patients with typical apical hypertrophic cardiomyopathy (T-AHCM), 51 patients with pre-apical hypertrophic cardiomyopathy (P-AHCM)and 26 normal controls were confirmed by cMRI. All cases underwent electrocardiogram and echocardiography, of which 16 and 34 cases were studied by radionuclide 99Tcm-MIBI SPECT myocardial scanning and coronary angiography plus left ventriculography, respectively. Results: cMRI confirmed all patients with apical hypertrophic cardiomyopathy, but echocardiography missed 96 cases. Two chamber and four chamber views of cine-cMRI were considered as the best position to show detailed structure of cardiac apex. Forty-seven cases showed spade-like configuration of left ventricular cavity in T-AHCM group, but only 15 patients in P-AHCM group presented the same character. T-AHCM group showed higher apical thickness and ratio of the apical wall thickness to that at basal level than P-AHCM group(18.6±2.7) mm vs (13.6±1.0) mm, 2.2±0.5 vs 1.6±0.3, P<0.05), and the ratios of both T-AHCM group and P-AHCM group were significantly higher than that of control group (9.5±1.7) mm, 1.1±0.1, P<0.05). Hypertrophic wall thickening was lesser in T-AHCM group than in P-AHCM group, while the values of both T-AHCM group and P-AHCM group were significantly lesser than that of control one. Conclusion: MRI is the best diagnostic modality for AHCM, which is highly accurate and better than echocardiography, especially for the diagnosis of mild hypertrophy in the early stage. (authors)

  15. Screening for silent myocardial ischemia caseof diabetics : interest of myocardial perfusion scintigraphy

    Silent myocardial ischemia is a major cause of morbidity and mortality in diabetic patients. Its diagnosis by noninvasive means such as myocardial SPECT would improve the management of these patients. The purpose of this study is to assess the frequency of silent myocardial ischemia in asymptomatic diabetics and their evolution. As a result, the myocardial SPECT is a reliable tool for screening for silent myocardial ischemia in diabetic patients. Its prognostic value allows to stratify the cardiac risk and guide therapeutic management. Its integration into a screening strategy in Tunisia seems limited by its low availability and cost. The latter could be reduced by better patient selection.

  16. An investigation of the trade-off between the count level and image quality in myocardial perfusion SPECT using simulated images: the effects of statistical noise and object variability on defect detectability.

    He, Xin; Links, Jonathan M; Frey, Eric C

    2010-09-01

    Quantum noise as well as anatomic and uptake variability in patient populations limits observer performance on a defect detection task in myocardial perfusion SPECT (MPS). The goal of this study was to investigate the relative importance of these two effects by varying acquisition time, which determines the count level, and assessing the change in performance on a myocardial perfusion (MP) defect detection task using both mathematical and human observers. We generated ten sets of projections of a simulated patient population with count levels ranging from 1/128 to around 15 times a typical clinical count level to simulate different levels of quantum noise. For the simulated population we modeled variations in patient, heart and defect size, heart orientation and shape, defect location, organ uptake ratio, etc. The projection data were reconstructed using the OS-EM algorithm with no compensation or with attenuation, detector response and scatter compensation (ADS). The images were then post-filtered and reoriented to generate short-axis slices. A channelized Hotelling observer (CHO) was applied to the short-axis images, and the area under the receiver operating characteristics (ROC) curve (AUC) was computed. For each noise level and reconstruction method, we optimized the number of iterations and cutoff frequencies of the Butterworth filter to maximize the AUC. Using the images obtained with the optimal iteration and cutoff frequency and ADS compensation, we performed human observer studies for four count levels to validate the CHO results. Both CHO and human observer studies demonstrated that observer performance was dependent on the relative magnitude of the quantum noise and the patient variation. When the count level was high, the patient variation dominated, and the AUC increased very slowly with changes in the count level for the same level of anatomic variability. When the count level was low, however, quantum noise dominated, and changes in the count level

  17. An investigation of the trade-off between the count level and image quality in myocardial perfusion SPECT using simulated images: the effects of statistical noise and object variability on defect detectability

    Quantum noise as well as anatomic and uptake variability in patient populations limits observer performance on a defect detection task in myocardial perfusion SPECT (MPS). The goal of this study was to investigate the relative importance of these two effects by varying acquisition time, which determines the count level, and assessing the change in performance on a myocardial perfusion (MP) defect detection task using both mathematical and human observers. We generated ten sets of projections of a simulated patient population with count levels ranging from 1/128 to around 15 times a typical clinical count level to simulate different levels of quantum noise. For the simulated population we modeled variations in patient, heart and defect size, heart orientation and shape, defect location, organ uptake ratio, etc. The projection data were reconstructed using the OS-EM algorithm with no compensation or with attenuation, detector response and scatter compensation (ADS). The images were then post-filtered and reoriented to generate short-axis slices. A channelized Hotelling observer (CHO) was applied to the short-axis images, and the area under the receiver operating characteristics (ROC) curve (AUC) was computed. For each noise level and reconstruction method, we optimized the number of iterations and cutoff frequencies of the Butterworth filter to maximize the AUC. Using the images obtained with the optimal iteration and cutoff frequency and ADS compensation, we performed human observer studies for four count levels to validate the CHO results. Both CHO and human observer studies demonstrated that observer performance was dependent on the relative magnitude of the quantum noise and the patient variation. When the count level was high, the patient variation dominated, and the AUC increased very slowly with changes in the count level for the same level of anatomic variability. When the count level was low, however, quantum noise dominated, and changes in the count level

  18. An investigation of the trade-off between the count level and image quality in myocardial perfusion SPECT using simulated images: the effects of statistical noise and object variability on defect detectability

    He, Xin; Links, Jonathan M.; Frey, Eric C.

    2010-09-01

    Quantum noise as well as anatomic and uptake variability in patient populations limits observer performance on a defect detection task in myocardial perfusion SPECT (MPS). The goal of this study was to investigate the relative importance of these two effects by varying acquisition time, which determines the count level, and assessing the change in performance on a myocardial perfusion (MP) defect detection task using both mathematical and human observers. We generated ten sets of projections of a simulated patient population with count levels ranging from 1/128 to around 15 times a typical clinical count level to simulate different levels of quantum noise. For the simulated population we modeled variations in patient, heart and defect size, heart orientation and shape, defect location, organ uptake ratio, etc. The projection data were reconstructed using the OS-EM algorithm with no compensation or with attenuation, detector response and scatter compensation (ADS). The images were then post-filtered and reoriented to generate short-axis slices. A channelized Hotelling observer (CHO) was applied to the short-axis images, and the area under the receiver operating characteristics (ROC) curve (AUC) was computed. For each noise level and reconstruction method, we optimized the number of iterations and cutoff frequencies of the Butterworth filter to maximize the AUC. Using the images obtained with the optimal iteration and cutoff frequency and ADS compensation, we performed human observer studies for four count levels to validate the CHO results. Both CHO and human observer studies demonstrated that observer performance was dependent on the relative magnitude of the quantum noise and the patient variation. When the count level was high, the patient variation dominated, and the AUC increased very slowly with changes in the count level for the same level of anatomic variability. When the count level was low, however, quantum noise dominated, and changes in the count level

  19. Optimal protocol for 99mTc-tetrofosmin myocardial SPECT imaging with exercise or dipyridamole stress test and the characteristics of Bullseye normal file

    To determine optimal protocol for 99mTc-tetrofosmin SPECT imaging, 30 normal volunteers underwent treadmill or dipyridamole stress test with 770 MBq of tetrofosmin injection. Anterior planar images were acquired every 10-15 minutes for calculating heart/liver ratio. SPECT images were also obtained every 30 minutes for generating Bullseye normal files. In analysis of spatial tracer distribution among normal files, myocardium in Bullseye plot was divided in 9 areas, where mean values of % tracer uptake were calculated and compared by analysis of variance (ANOVA). In those 9 areas, mean values of SD (SD mean) were also compared for predicting artificial blackout in the Bullseye plot among 3 standard normal files: dipyridamole-201Tl, dipyridamole-tetrofosmin (60 min post-injection), and treadmill-tetrofosmin (30 min post-injection). In planar image analysis, high initial uptake in the liver and its acceptable clearance were noted in dipyridamole stress test. Adequate heart/liver ratio was accomplished immediately after treadmill, but 40 minutes later after dipyridamole stress test. ANOVA analysis showed no statistical difference in the spatial % tracer uptake among normal files, irrespective of time after acquisition, data collection time, or difference of tracer. However, SD means in inferior and lateral area of treadmill-tetrofosmin file were significantly small compared to that of dipyridamole-201Tl normal file (p<0.02 by ANOVA). Thus, we conclude that optimal timing for tetrofosmin SPECT imaging is immediately after treadmill, but at least 40 minutes after dipyridamole stress test. In addition, we should also keep in mind that unexpected blackout may appear in inferior and lateral area, when applying our normal files for reference. (author)

  20. Non-invasive assessment of coronary microvascular function in patients with syndrome X using exercise and rest myocardial SPECT with 99mTc-tetrofosmin

    The purpose of this study was to evaluate impaired coronary microvascular function in Syndrome X (Sx) by measuring % uptake increase in myocardial counts. Global and regional myocardial uptake was determined with 99mTc-tetrofosmin and a 4-hour exercise (370 MBq iv) and rest (740 MBq iv) protocol, in 11 patients with anginal syndrome and normal coronary arteriograms (Sx) and in 10 control subjects (C). The parameter of % uptake increase (ΔMTU) was calculated as the ratio of exercise counts to rest myocardial counts with correction of myocardial uptake for dose administered and physical decay between the exercise study and the rest study. Global ΔMTU was significantly lower in Sx than C (12.9±5.4% vs 22.3±10.8%, p<0.05). Regional ΔMTU in each of 4 left ventricular regions (anterior, septal, inferior, posterolateral) was significantly lower in Sx than in C (p<0.05), except for the inferior region. However, there were no significant differences between ΔMTU in the 4 left ventricular regions in the same group. None of the patients with Sx exhibited an ischemic pattern in the ST-segment/heart rate loop. ΔMTU was useful as a non-invasive means of evaluating impaired coronary microvascular function in Sx. (author)

  1. Association of the positive results of the myocardial perfusion SPECT with 99mTc-MIBI, with the presence of Dyslipidemia in patient with 40 years or more age

    Know the association of the Dyslipidemia (DLP) with the positive results of the Myocardial Perfusion SPECT (MPSPECT), for the optimization of the use of this. MATERIAL AND METHOD: Analyze 152 MPSPECT, different day, age average: 58.32 years, 86(56.6%), were masculine. Alone differed by the presence of DLP, according to were divided in DLP, n=37(24.3%) and NDLP (Not-Dyslipidemia), n=115(75.7%), didn't present significant differences in the age average (59.59/57.90 p=0.284), body mass index (24.85/25.03, p=0.739), neither of the frequency of mature, therefore the additional risk alone contributes the DLP. RESULTS: 102(67.1%) MPSPECT were positive, in the comparison among groups was not observed significant difference in the incidence of positive results (67.60/67.00, p=0.945), which stayed when the groups were subdivided in symptomatic and asymptomatic CONCLUSION: The Dyslipidemia doesn't contribute significant risk of ischemic cardiopathy in patient in age of risk, therefore there is not significant association with positive results of the SPECTPM, in patient in age of risk. (author)

  2. No evidence of myocardial restoration following transplantation of mononuclear bone marrow cells in coronary bypass grafting surgery patients based upon cardiac SPECT and 18F-PET

    Ünal Nermin; Scheid Christof; Schmidt Matthias; Müller-Ehmsen Jochen; Tossios Paschalis; Moka Detlef; Schwinger Robert HG; Mehlhorn Uwe

    2006-01-01

    Abstract Background We tested the hypothesis, that intramyocardial injection of mononuclear bone marrow cells combined with coronary artery bypass grafting (CABG) surgery improves tissue viability or function in infarct regions with non-viable myocardium as assessed by nuclear imaging techniques. Methods Thus far, 7 patients (60 ± 10 [SD] years) undergoing elective CABG surgery after a myocardial infarction were included in this study. Prior to sternotomy, bone marrow was harvested by sternal...

  3. Targeted multi-pinhole SPECT

    Small-animal single photon emission computed tomography (SPECT) with focused multi-pinhole collimation geometries allows scanning modes in which large amounts of photons can be collected from specific volumes of interest. Here we present new tools that improve targeted imaging of specific organs and tumours, and validate the effects of improved targeting of the pinhole focus. A SPECT system with 75 pinholes and stationary detectors was used (U-SPECT-II). An XYZ stage automatically translates the animal bed with a specific sequence in order to scan a selected volume of interest. Prior to stepping the animal through the collimator, integrated webcams acquire images of the animal. Using sliders, the user designates the desired volume to be scanned (e.g. a xenograft or specific organ) on these optical images. Optionally projections of an atlas are overlaid semiautomatically to locate specific organs. In order to assess the effects of more targeted imaging, scans of a resolution phantom and a mouse myocardial phantom, as well as in vivo mouse cardiac and tumour scans, were acquired with increased levels of targeting. Differences were evaluated in terms of count yield, hot rod visibility and contrast-to-noise ratio. By restricting focused SPECT scans to a 1.13-ml resolution phantom, count yield was increased by a factor 3.6, and visibility of small structures was significantly enhanced. At equal noise levels, the small-lesion contrast measured in the myocardial phantom was increased by 42%. Noise in in vivo images of a tumour and the mouse heart was significantly reduced. Targeted pinhole SPECT improves images and can be used to shorten scan times. Scan planning with optical cameras provides an effective tool to exploit this principle without the necessity for additional X-ray CT imaging. (orig.)

  4. Incremental prognostic value of cardiac function assessed by ECG-gated myocardial perfusion SPECT for the prediction of future acute coronary syndrome

    The prognostic value of electrocardiogram (ECG)-gated rest 201T1/stress 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography for the prediction of acute coronary syndrome (ACS: myocardial infarction (MI) and unstable angina (UA)) and the implications of ejection fraction (EF) has not yet been defined in Japanese. The 1,895 patients were followed up for the occurrence ACS. The mean follow-up interval was 26.9±15.5 months. The 142 patients with revascularization within 60 days were censored. Summed stress score (SSS) and summed difference score (SDS) were calculated. The 19 MI and 29 UA occurred (1.1% and 1.6%, respectively). Univariate Cox analysis showed that hypertension (Wald 5.09, p<0.05), poststress EF (Wald 10.9, p<0.01), SSS (Wald 12.4, p<0.001) and SDS (Wald 18.7, p<0.001) were significant predictors of ACS. Multivariate Cox analysis showed that hypertension (Wald 4.27, p<0.05) and SDS (Wald 8.59, p<0.01) were independent predictors. When multiple clinical risk factors (number of coronary risk factors ≥2), significant ischemia (SDS≥4) and low EF (EF<45%) were applied to multivariate Cox analysis, the combination of significant ischemia and low EF showed the highest predictive value (Wald 11.9; p<0.001) for future ACS. Poststress EF added incremental prognostic value for the prediction of ACS. (author)

  5. Quantitative cardiac SPECT

    This thesis studied automated statistical mapping in myocardial perfusion SPECT to detect coronary artery disease (CAD). Registering myocardial studies to a 3D template allows an analysis on a voxel by voxel basis. Normal mean and standard deviation templates were created for each sex by registering 25 male and 25 female studies to a standard shape and position. A test group of 104 patients undergoing dipyridamole technetium-99m tetrofosmin SPECT and angiography were used to assess the automated method. Patients were divided into those with angiographic evidence of CAD (n=56) and those without (n=48). The test studies were registered to the templates and count normalized by minimizing the sum of absolute differences. A Z-score map of the statistical differences between registered study and template were calculated for all voxels within the myocardium. The contrast (Z-score) and extent (number of voxels in a cluster exceeding the contrast threshold) thresholds for detection of CAD were optimized using receiver operating characteristic (ROC) analysis. The optimal thresholds resulted in a sensitivity of 73% and a specificity of 92% for automatic detection of CAD. The area under the fitted ROC curve (±1 SE) was 0.86±0.08 for a Z-score contrast threshold of 5. The performance of this method and that of three experienced observers was compared by continuous ROC analysis. There was no statistically significant difference between the performances of the three observers and that of automatic detection in terms of the area under the ROC curves (p≥0.25). The use of this automated statistical mapping approach shows a performance comparable with experienced observers, but avoids observer variability

  6. The benefits of prone SPECT myocardial perfusion imaging in reducing both artifact defects and patient radiation exposure; Beneficio da aquisicao de imagem na posicao Prona em perfusao miocardica com SPECT para reducao de artefatos e exposicao do paciente a radiacao

    Stathaki, Maria; Koukouraki, Sophia; Papadaki, Emmanouela; Tsaroucha, Angeliki; Karkavitsas, Nikolaos, E-mail: mariast_cha@yahoo.gr [Department of Nuclear Medicine, University Hospital of Heraklion, Crete (Greece)

    2015-10-15

    Background: Prone imaging has been demonstrated to minimize diaphragmatic and breast tissue attenuation. Objectives: To determine the role of prone imaging on the reduction of unnecessary rest perfusion studies and coronary angiographies performed, thus decreasing investigation time and radiation exposure. Methods: We examined 139 patients, 120 with an inferior wall and 19 with an anterior wall perfusion defect that might represented attenuation artifact. Post-stress images were acquired in both the supine and prone position. Coronary angiography was used as the 'gold standard' for evaluating coronary artery patency. The study was terminated and rest imaging was obviated in the presence of complete improvement of the defect in the prone position. Quantitative interpretation was performed. Results were compared with clinical data and coronary angiographic findings. Results: Prone acquisition correctly revealed defect improvement in 89 patients (89/120) with inferior wall and 12 patients (12/19) with anterior wall attenuation artifact. Quantitative analysis demonstrated statistically significant difference in the mean summed stress scores (SSS) of supine and mean SSS of prone studies in patients with disappearing inferior wall defect in the prone position and patent right coronary artery (true negative results). The mean difference between SSS in supine and in prone position was higher with disappearing than with remaining defects. Conclusion: Technetium-99m (Tc-99m) tetrofosmin myocardial perfusion imaging with the patient in the prone position overcomes soft tissue attenuation; moreover it provides an inexpensive, accurate approach to limit the number of unnecessary rest perfusion studies and coronary angiographies performed. (author)

  7. Feasibility and diagnostic accuracy of Ecg-gated SPECT myocardial perfusion imaging by a two-hour protocol: The Myofast study;Faisabilite et precision diagnostique d'un protocole de scintigraphie myocardique synchronisee a l'ECG en deux heures: l'etude Myofast

    Dunet, V.; Costo, S.; Sabatier, R.; Grollier, G.; Bouvard, G.; Agostini, D. [CHU Cote-de-Nacre, Service de medecine nucleaire, 14 - Caen (France)

    2010-04-15

    Aim of the study: To assess the feasibility of early stress and rest myocardial perfusion and function study using a fast {sup 99m}Tc-tetrofosmin gated-SPECT protocol in patients with known coronary artery disease. Materials and methods: Forty-three patients (pts) (37 M, 6 F, mean age 63.8 +- 9.8 years) underwent a {sup 99m}Tc-Tetrofosmin gated-SPECT (Axis Picker-Philips) myocardial study and a coronary angiography (C.A.) within 3 months. Images were acquired (LEHR, eight bins, 40 sec per image) after injection of {sup 99m}Tc-tetrofosmin (200 to 380 MBq) early (15 min) post-stress (36 dipyridamole, two dobutamine and five ergo-metric stress), and at rest after {sup 99m}Tc-tetrofosmin reinjection (600 to 1150 MBq), in a total time not exceeding 2 hours. Processing was performed with Q.G.S. software using the 17-segment model. Pathological study was defined as a summed difference score (SDS) greater than or equal to 4 4, a fixed defect with summed rest score greater than or equal to 4 and/or L.V. dysfunction defined as myocardial stunning (variation between stress and rest L.V.E.F. greater than or equal to 4 5%), stress L.V.E.F. less than or equal to 45% or rest L.V.E.F. less than or equal to 40%. Results were compared with C.A., and stenosis greater than or equal to 4 50% was considered as significant. Results: For 100% the quality of SPECT imaging was good or excellent. For six patients gating was impossible because of arrhythmia. The overall sensitivity, specificity and accuracy were 95%, 50%, and 91%, respectively. The concordance between gated SPECT and C.A. was moderate (kappa = 0.45, S.E. = 0.15). Interestingly, early-gated acquisition permitted to underline left ventricular dysfunction in 11 cases (30%), of whom eight had poly vascular disease. Stunning was detected in six of 37 cases (16%), of whom six had poly vascular disease. Conclusion: A one-day two-hour {sup 99m}Tc-tetrofosmin gated-SPECT protocol to assess left ventricular perfusion and function is

  8. The association of increased stomach wall radiotracer uptake with prolonged use of omeprazole capsules on myocardial perfusion imaging (MPI) using 99mTc-sestamibi SPECT.

    Javadi, Hamid; Jallalat, Sara; Semnani, Shahriar; Mogharrabi, Mehdi; Nabipour, Iraj; Tabib, Seyed Masoud; Abbaszadeh, Moloud; Assadi, Majid

    2013-01-01

    Myocardial perfusion imaging (MPI) is widely used in routine practice for diagnosis and risk stratification of coronary artery disease (CAD). Intense curvilinear activity in the stomach wall of a patient was seen on MPI raw data. This phenomenon was completely dissimilar to the familiar intraluminal gastric reflux of sestamibi. This observed activity could have resulted in false-positive or false-negative artifacts - and inaccurate diagnosis - of the inferior wall of the left ventricle after MPI processing. On further exploration, the current researchers found that the patient had a history of 10-year Omeprazole capsule consumption. The authors present this infrequent case of intense stomach uptake to stress the related clinical and diagnostic implications with the aim to stimulate acute awareness of possible, unexpected infringements on image quality that could potentially interfere with accurate interpretation of the data. PMID:24068640

  9. [Comparison Study of Left Ventricular Function Assessment by 18F-FDG PET, Gated SPECT and 2D-Echocardiography in Patients with Myocardial Infarction].

    Li, Fanglan; Huang, Rui; Ou, Xiaohong; Li, Lin

    2015-10-01

    The aim of this study is to analyze the concordance between EDV, ESV and LVEF values derived from 18F-FDG PET, GSPECT and ECHO in patients with myocardial infarction. Sixty-four patients with coronary artery disease (CAD) and myocardial infarction were enrolled in the study. Each patient underwent at least two of the above mentioned studies within 2 weeks. LVEF, EDV and ESV values were analyzed with dedicated software. Statistical evaluation of correlation and agreement was carried out EDV was overestimated by 18F-FDG PET compared with GSPECT [(137.98 ± 61.71) mL and (125.35 ± 59.34) mL]; ESV was overestimated by 18F-FDG PET (85.89 ± 55.21) mL and GSPECT (82.39 ± 55.56) mL compared with ECHO (68.22 ± 41.37) mL; EF was overestimated by 18F-FDG PET (41.96% ± 15.08%) and ECHO (52.18% ± 13.87%) compared with GSPECT (39.75% ± 15.64%), and EF was also overestimated by 18F-FDG PET compared with GSPECT. The results of linear regression analysis showed good correlation between EDV, ESV and LVEF values derived from 18F-FDG PET, GSPECT and ECHO (r = 0.643-0.873, P = 0.000). Bland-Altman analysis indicated that 18F-FDG PET correlated well with ECHO in the Left ventricular function parameters. While GSPECT correlated well with 18F-FDG PET in ESV, GSPECT had good correlation with Echo in respect of EDV and EF; whereas GSPECT had poor correlation with PET/ECHO in the remaining left ventricular function parameters. Therefore, the clinical physicians should decide whether they would use the method according to the patients' situation and diagnostic requirements. PMID:26964317

  10. Very high coronary artery calcium score with normal myocardial perfusion SPECT imaging is associated with a moderate incidence of severe coronary artery disease

    Yuoness, Salem A.; Goha, Ahmed M.; Romsa, Jonathan G.; Akincioglu, Cigdem; Warrington, James C.; Datta, Sudip; Gambhir, Sanjay; Urbain, Jean-Luc C.; Vezina, William C. [London Health Sciences Centre, Department of Nuclear Medicine, London, ON (Canada); Massel, David R. [London Health Sciences Centre, Division of Cardiology, London, ON (Canada); Martell, Rafael [Private Practice, London, ON (Canada)

    2015-09-15

    Myocardial perfusion imaging (MPI) has limitations in the presence of balanced multivessel disease (MVD) and left main (LM) coronary artery disease, occasionally resulting in false-normal results despite the high cardiovascular risk associated with this condition. The purpose of this study was to assess the incidence of severe coronary artery disease (CAD) in the presence of a very high Agatston coronary artery calcium (CAC) score (>1,000) in stable symptomatic patients without known CAD but with normal MPI results. A total of 2,659 prospectively acquired consecutive patients were referred for MPI and evaluation of CAC score by CT. Of this patient population, 8 % (222/2,659) had ischemia without myocardial infarction (MI) on MPI and 11 % (298/2,659) had abnormal MPI (MI and/or ischemia). On presentation 1 % of the patients (26/2,659) were symptomatic, had a CAC score >1,000 and normal MPI results. The definition of normal MPI was strict and included a normal hemodynamic response without ischemic ECG changes and normal imaging, particularly absence of transient ischemic dilation. All of these 26 patients with a CAC score >1,000 and normal MPI findings underwent cardiac catheterization. Of these 26 patients, 58 % (15/26) had severe disease (≥70 % stenosis) leading to revascularization. Of this group, 47 % (7/15) underwent percutaneous intervention, and 53 % (8/15) underwent coronary artery bypass grafting. All of these 15 patients had either MVD (14/15) or LM coronary artery disease (1/15), and represented 0.6 % (15/2,659) of all referred patients (95 % CI 0.3 - 0.9 %). The majority, 90 % (8/9), had severe CAD with typical chest pain. A very high CAC score (>1,000) with normal MPI in a small subset of symptomatically stable patients was associated with a moderate incidence of severe CAD (95 % CI 37 - 77 %). Larger studies and/or a meta-analysis of small studies are needed to more precisely estimate the incidence of CAD in this population. This study also supports

  11. Very high coronary artery calcium score with normal myocardial perfusion SPECT imaging is associated with a moderate incidence of severe coronary artery disease

    Myocardial perfusion imaging (MPI) has limitations in the presence of balanced multivessel disease (MVD) and left main (LM) coronary artery disease, occasionally resulting in false-normal results despite the high cardiovascular risk associated with this condition. The purpose of this study was to assess the incidence of severe coronary artery disease (CAD) in the presence of a very high Agatston coronary artery calcium (CAC) score (>1,000) in stable symptomatic patients without known CAD but with normal MPI results. A total of 2,659 prospectively acquired consecutive patients were referred for MPI and evaluation of CAC score by CT. Of this patient population, 8 % (222/2,659) had ischemia without myocardial infarction (MI) on MPI and 11 % (298/2,659) had abnormal MPI (MI and/or ischemia). On presentation 1 % of the patients (26/2,659) were symptomatic, had a CAC score >1,000 and normal MPI results. The definition of normal MPI was strict and included a normal hemodynamic response without ischemic ECG changes and normal imaging, particularly absence of transient ischemic dilation. All of these 26 patients with a CAC score >1,000 and normal MPI findings underwent cardiac catheterization. Of these 26 patients, 58 % (15/26) had severe disease (≥70 % stenosis) leading to revascularization. Of this group, 47 % (7/15) underwent percutaneous intervention, and 53 % (8/15) underwent coronary artery bypass grafting. All of these 15 patients had either MVD (14/15) or LM coronary artery disease (1/15), and represented 0.6 % (15/2,659) of all referred patients (95 % CI 0.3 - 0.9 %). The majority, 90 % (8/9), had severe CAD with typical chest pain. A very high CAC score (>1,000) with normal MPI in a small subset of symptomatically stable patients was associated with a moderate incidence of severe CAD (95 % CI 37 - 77 %). Larger studies and/or a meta-analysis of small studies are needed to more precisely estimate the incidence of CAD in this population. This study also supports

  12. Molecular imaging in myocardial fibrosis

    With the development of life science and medical technology, myocardial fibrosis is being increasingly recognized as a new therapeutic target for heart diseases. However, traditional methods for detection of myocardial fibrosis, such as myocardial biopsy and laboratory assay of serum metabolites or enzymes, are not satisfactory in meeting the clinical demands because of their intrinsic limitations. Molecular imaging may non-invasively and quantitatively evaluate the presence/absence, degree and turnover of myocardial fibrosis in vivo with good specificity, thus being useful for clinical assessment and intervention. Currently, the commonly used molecular imaging modalities for evaluation of myocardial fibrosis include SPECT, PET and MRI. It is hopeful that the molecular probe for targeted ultrasound technology may also be developed in the near future. This review highlights the current status and future trends of molecular imaging in myocardial fibrosis. (authors)

  13. Avaliação da perfusão e função miocárdicas em vítimas de escorpionismo utilizando o Gated-SPECT Evaluación de la perfusión y función miocárdicas en víctimas de escorpionismo utilizando el Gated-SPECT Assessment of myocardial perfusion and function in victims of scorpion envenomation using Gated-SPECT

    Alexandre Baldini de Figueiredo

    2010-04-01

    are the major causes of death of patients with scorpion envenomation, whose pathophysiological mechanism remains controversial. OBJECTIVE: To investigate the correlation between myocardial perfusion abnormalities and left ventricular contractile function in victims of scorpion envenomation. METHODS: Fifteen patients underwent ECG-gated myocardial perfusion scintigraphy (gated SPECT within 72 hours of, and 15 days after scorpion envenomation. Images were analyzed by means of a semi-quantitative visual perfusion score (0 = normal, 4 = absent and motion score (0 = normal, 4 = akinesia, using the 17-segment model. Summed perfusion (SPS and summed motion (SMS scores were calculated for each patient. Ejection fraction (LVEF was calculated by a commercially available software. RESULTS: At baseline, 12 out of the 15 patients presented abnormal myocardial perfusion and contractility. Mean values of SPS, SMS and LVEF were 12.5 ± 7.3, 17.0 ± 12.8, and 44.6 ± 16.0%, respectively. A positive correlation between SPS and SMS (r = 0.68; p = 0.005 and negative correlation between SPS and LVEF (r = -0.75; p = 0.0021 were found. The follow-up studies showed recovery of global contractility (LVEF of 68.9 ± 9.5, p = 0.0002, segmental contractility (SMS of 2.6 ± 3.1, p = 0.0009 and perfusion (SPS of 3.7 ± 3.3, p = 0.0003. Improvement of LVEF correlated positively with improvement of SPS (r = 0.72; p = 0.0035. CONCLUSIONS: Myocardial perfusion abnormalities are common in scorpion envenomation and correlate topographically with the contractile dysfunction. Recovery of contractility correlates with reversibility of perfusion defects. These findings suggest the participation of myocardial perfusion abnormalities in the pathophysiology of this form of acute ventricular failure. (Arq Bras Cardiol 2010;94(4: 418-425

  14. Cell tracking and therapy evaluation of bone marrow monocytes and stromal cells using SPECT and CMR in a canine model of myocardial infarction

    Merrifield Peter

    2009-04-01

    Full Text Available Abstract Background The clinical application of stem cell therapy for myocardial infarction will require the development of methods to monitor treatment and pre-clinical assessment in a large animal model, to determine its effectiveness and the optimum cell population, route of delivery, timing, and flow milieu. Objectives To establish a model for a in vivo tracking to monitor cell engraftment after autologous transplantation and b concurrent measurement of infarct evolution and remodeling. Methods We evaluated 22 dogs (8 sham controls, 7 treated with autologous bone marrow monocytes, and 7 with stromal cells using both imaging of 111Indium-tropolone labeled cells and late gadolinium enhancement CMR for up to12 weeks after a 3 hour coronary occlusion. Hearts were also examined using immunohistochemistry for capillary density and presence of PKH26 labeled cells. Results In vivo Indium imaging demonstrated an effective biological clearance half-life from the injection site of ~5 days. CMR demonstrated a pattern of progressive infarct shrinkage over 12 weeks, ranging from 67–88% of baseline values with monocytes producing a significant treatment effect. Relative infarct shrinkage was similar through to 6 weeks in all groups, following which the treatment effect was manifest. There was a trend towards an increase in capillary density with cell treatment. Conclusion This multi-modality approach will allow determination of the success and persistence of engraftment, and a correlation of this with infarct size shrinkage, regional function, and left ventricular remodeling. There were overall no major treatment effects with this particular model of transplantation immediately post-infarct.

  15. Optimising the number of thermoluminescent dosimeters required for the measurement of effective dose for computed tomography attenuation correction data in SPECT/CT myocardial perfusion imaging

    Background: The use of thermoluminescent dosimeters (TLDs) is regarded as time consuming and laborious. As part of our dosimetry research it was necessary to optimise the use of our resources, both physical and time. Experimental work was carried out to develop a method that allowed for a reduction in the number of TLDs needed for accurate effective dose measurement. For this work specific reference to computed tomography attenuation correction (CTAC) for myocardial perfusion imaging (MPI) acquisitions is made although it is proposed that the developed method could be applied to dose assessments using TLDs. Research to measure and compare the effective dose from CTAC for MPI was to be carried out using an ATOM 701 dosimetry phantom, Harshaw 3500 manual TLD reader and TLD-100s. Method: To establish the areas of the phantom where dose measurements should be carried out, a batch calibrated TLD-100 dosimeters were placed along the centre of the phantom. A simulated CTAC for MPI was performed. After reading the distribution of the dose was recorded and areas where dose levels were below the sensitivity threshold dose of 50 μGy were noted. To test the effect of excluding dose measurement for some areas on the final calculation of effective dose and the time taken to acquire the data a repeat acquisition was performed with the full complement of TLDs placed in the phantom in organ locations recommended by the manufacturer. The time taken for loading, unloading and reading was recorded. Effective dose and organ doses were calculated. The calculation was repeated with TLDs outside the established range excluded and the potential time saved calculated. Results: Excluding TLDs from areas where doses were below the 50 μGy threshold resulted in 82 fewer TLDs being used (268–186) leading to a time saving of around 2 h per batch. The results of the experiment showed that effective dose measurements were 1.75% lower with the reduced chipset and organ dose measurements were not

  16. 99Tcm-MIBI显像诊断异位甲状旁腺腺瘤合并结节性甲状腺肿1例%Ectopic parathyroid adenoma nodular goiter diagnosed with 99Tcm-MIBI scintigraphy: a case report

    李前伟

    2003-01-01

    @@ 患者,女,19岁,因反复发作性游走性大关节疼痛2年,加重伴乏力1月于2001年6月13日收入我院内分泌科.查体:皮肤紧张,甲状腺右叶外侧可扪及2 cm×1.5 cm结节,随吞咽上下移动,质中,无压痛,双膝关节内侧轻压痛,下肢肌力Ⅳ级,余无异常.

  17. Initial and delayed stress phase imaging in a single-injection double-acquisition SPECT. The potential value of early 99mTc-MIBI redistribution in assessment of myocardial perfusion reversibility in patients with coronary artery disease

    Some studies reported that 99mTc-MIBI may redistribute in ischaemic myocardium and this phenomenon may have potential role for better assessment of viability by delayed 99mTc-MIBI imaging. Some studies also suggested that infusion of low dose dobutamine during delayed imaging may enhance the value of 99mTc-MIBI imaging for evaluation of viability. The aim of this study is to determine whether the observed changes of perfusion defects on delayed images are caused by early radiotracer redistribution or as a result of reversal partial volume effect secondary to inotropic stimulation. Patients, methods: 89 patients with angiographically proven coronary artery disease (CAD) were enrolled in this randomized clinical trial study. In all cases, gated-SPECT images were obtained 60 minutes after stress with dipyridamole injection. Subsequently the patients were randomly allocated in two groups and the second imaging was performed at 120th minute during low dose dobutamine (dobutamine group; 45 cases) or placebo infusion (placebo group; 44 cases). Difference between summed stress score of the first (SSS1) and second (SSS2) stress images (ΔSSS) was considered as a marker of reversibility in single-injection double-acquisition (SIDA) protocol. Also summed difference score (SDS) was recorded as a marker of reversibility in standard stress/rest, double-injection double-acquisition (DIDA) protocol. ΔSSS of the two studied groups were compared. Also the correlation and agreement between ΔSSS and SDS were analyzed. Results: A significant difference was found between SSS1 (median 15, range 0-48) and SSS2 (median 11, range 0-42) in total patients (p 99mTc-MIBI injection in the stress phase imaging. These changes correlate well and are in agreement with perfusion improvement on the rest images. This phenomenon may be independent of improvement in myocardial function, in more delayed imaging or following inotropic augmentation, and thus is likely due to 99mTc-MIBI redistribution

  18. Tc-99m MIBI Gated SPECT in detection of left ventricular stunning vs. Coronary angiography

    Assessment of myocardial perfusion and myocardial contractility is of diagnostic and prognostic factor in patient with severe coronary heart diseases. It is associated with transient cardioplegic of variable duration (post-ischemic LV dysfunction or LV stunning). After recovery of perfusion defect there is abnormal wall motion, and decrease in EF by 5 units. Gated SPECT image enables analysis of wall motion, wall thickening, and ejection fraction measurement with a combined assessment of myocardial perfusion and ventricular function during single injection of radiopharmaceutical. It aims to:- 1-Estimate the prevalence of stunning in different patients with CAD. 2-Evaluate the best time of post stress acquisition of gated SPECT for detection of stunning. Patients and methods: The study includes 173 patients, which was categorized according to severity of the disease into 4 groups. Group I: control, 4 of them has hypertension .Group II: myocardial ischemia alone. Group IIa: mild and moderate myocardial ischemia. Group IIb: sever myocardial ischemia. Group III: myocardial infarction. Group IV: myocardial infarction and myocardial ischemia. The results revealed that: 1- Early imaging (10 min.) post stress gated SPECT is highly recommended to detect stunning especially in high risk patient. 2- Gated SPECT setting at stress and rest is very necessary for detection of stunning and in prognostic stratification. 3- Wall motion assessment is more important than EF assessment to detect stunning

  19. Myocardial perfusion defects and the left ventricular ejection fraction disclosed by scintigraphy in patients with primary hyperparathyroidism

    Ogard, Christina Gerlach; Søndergaard, Susanne Bonnichsen; Jakobsen, Henrik;

    2005-01-01

    Patients with primary hyperparathyroidism (PHPT) have increased risk of cardiovascular disease. For patients undergoing preoperative parathyroid imaging with 99mTc-sestamibi single photon emission computed tomography (SPECT), we combined cervical SPECT and gated cardiac SPECT to achieve information...... about the localization of parathyroid adenomas, myocardial perfusion, and the left ventricular ejection fraction (LVEF) at rest. A series of 22 patients with PHPT and no history of myocardial infarction or angina pectoris were recruited consecutively. At 60 minutes after injection of 700 MBq 99m......Tc-sestamibi, SPECT of the neck and gated myocardial perfusion SPECT were performed at the same time. All of the patients who underwent parathyroidectomy had the parathyroid adenoma localized as predicted from the SPECT. Five patients (23%) had myocardial perfusion defects extending more than 15% (range 15-25%), and...

  20. Initial and delayed stress phase imaging in a single-injection double-acquisition SPECT. The potential value of early {sup 99m}Tc-MIBI redistribution in assessment of myocardial perfusion reversibility in patients with coronary artery disease

    Beiki, D. [Research Inst. for Nuclear Medicine, Tehran Univ. of Medical Sciences, Tehran (Iran); Dept. of Nuclear Pharmacy, Tehran Univ. of Medical Sciences, Tehran (Iran); Fallahi, B.; Fard-Esfahani, A.; Eftekhari, M. [Research Inst. for Nuclear Medicine, Tehran Univ. of Medical Sciences, Tehran (Iran); Mohseni, Z.; Khalaj, A. [Dept. of Nuclear Pharmacy, Tehran Univ. of Medical Sciences, Tehran (Iran)

    2010-07-01

    Some studies reported that {sup 99m}Tc-MIBI may redistribute in ischaemic myocardium and this phenomenon may have potential role for better assessment of viability by delayed {sup 99m}Tc-MIBI imaging. Some studies also suggested that infusion of low dose dobutamine during delayed imaging may enhance the value of {sup 99m}Tc-MIBI imaging for evaluation of viability. The aim of this study is to determine whether the observed changes of perfusion defects on delayed images are caused by early radiotracer redistribution or as a result of reversal partial volume effect secondary to inotropic stimulation. Patients, methods: 89 patients with angiographically proven coronary artery disease (CAD) were enrolled in this randomized clinical trial study. In all cases, gated-SPECT images were obtained 60 minutes after stress with dipyridamole injection. Subsequently the patients were randomly allocated in two groups and the second imaging was performed at 120{sup th} minute during low dose dobutamine (dobutamine group; 45 cases) or placebo infusion (placebo group; 44 cases). Difference between summed stress score of the first (SSS{sub 1}) and second (SSS{sub 2}) stress images ({delta}SSS) was considered as a marker of reversibility in single-injection double-acquisition (SIDA) protocol. Also summed difference score (SDS) was recorded as a marker of reversibility in standard stress/rest, double-injection double-acquisition (DIDA) protocol. {delta}SSS of the two studied groups were compared. Also the correlation and agreement between {delta}SSS and SDS were analyzed. Results: A significant difference was found between SSS{sub 1} (median 15, range 0-48) and SSS{sub 2} (median 11, range 0-42) in total patients (p < 0.0001). A significant correlation was noted between {delta}SSS and SDS in dobutamine group (r = 0.58, p = 0.002) as well as in placebo group (r = 0.57, p < 0.0001). Considering DIDA protocol as a standard reference method, the influence of dobutamine infusion was not

  1. Comparison of the four formulas of software ECToolbox for the assessment of left ventricular ejection fraction with the equilibrium radionuclide ventriculography

    Objective: To compare the correlation and consistency of left ventricular ejection fraction (LVEF) obtained by electrocardiography gated myocardial perfusion SPECT (G-MPS) using the four formulas (R0-R3) in Emory cardiac toolbox (ECToolbox) software and by equilibrium radionuclide ventriculography (ERNV), and determine the optimal diagnostic thresholds of the four formulas. Methods: Sixty-three patients,including 23 patients with a history of myocardial infarction and 40 patients with suspected coronary heart disease, underwent both 99Tcm-MIBI rest G-MPS and 99Tcm labeled red blood cell ERNV within a week. The LVEF values calculated by R0, R1, R2 and R3 formulas of ECToolbox were compared with those obtained by ERNV. Using LVEF≥50% obtained by ERNV as the gold standard, the optimal diagnostic thresholds of the four formulas (R0-R3) were assessed by receiver operating characteristic (ROC) curve. Results: The mean LVEF of ERNV was 55.41%±17.49%. The mean LVEF values of the four formulas were 63.75%±16.63%, 55.87%±15.99%, 69.22%±18.83% and 56.32%±14.47%, respectively. On correlation analysis, a strong positive correlation was observed between LVEF values derived by ERNV and those derived by the four formulas (all r>0.95, all P<0.01). The differences of LVEF were statistically significant between ERNV and the two formulas R0 and R2 (t =15.775 and 21.525, both P<0.01), while between ERNV and the two formulas R1 and R3 (t=0.848 and 1.448, both P>0.05). Normal cutoff values for LVEF on R0, R1, R2, R3 were 56.5%, 51.5%, 64.5% and 52.5% respectively, using a 50% or more cutoff value on ERNV. Conclusions: A strong correlation was observed among the four formulas of ECToolbox software programs when compared with ERNV. However, there are subtle differences in the objective values of LVEF generated by individual calculation methods, which must be taken into account for clinical studies. (authors)

  2. Brain SPECT. SPECT in der Gehirndiagnostik

    Feistel, H. (Erlangen-Nuernberg Univ., Erlangen (Germany). Nuklearmedizinische Klinik mit Poliklinik)

    1991-12-01

    Brain SPECT investigations have gained broad acceptance since the introduction of the lipophilic tracer Tc-99m-HMPAO. Depending on equipment and objectives in different departments, the examinations can be divided into three groups: 1. Under normal conditions and standardised patient preparation the 'rest' SPECT can be performed in every department with a tomographic camera. In cerebrovascular disease there is a demand for determination of either the perfusion reserve in reversible ischemia or prognostic values in completed stroke. In cases of dementia, SPECT may yield useful results according to differential diagnosis. Central cerebral system involvement in immunologic disease may be estimated with higher sensitivity than in conventional brain imaging procedures. In psychiatric diseases there is only a relative indication for brain SPECT, since results during recent years have been contradictory and may be derived only in interventional manner. In brain tumor diagnostics SPECT with Tl-201 possibly permits grading. In inflammatory disease, especially in viral encephalitis, SPECT may be used to obtain early diagnosis. Normal pressure hydrocephalus can be distinguished from other forms of dementia and, consequently, the necessity for shunting surgery can be recognised. 2. In departments equipped for emergency cases an 'acute' SPECT can be performed in illnesses with rapid changing symptoms such as different forms of migraine, transient global amnesia, epileptic seizures (so-called 'ictal SPECT') or urgent forms like trauma. 3. In cooperation with several departments brain SPECT can be practised as an interventional procedure in clinical and in scientific studies. (orig./MG).

  3. SPECT in psychiatry. SPECT in der Psychiatrie

    Barocka, A. (Psychiatrische Klinik und Poliklinik, Erlangen (Germany)); Feistel, H. (Nuklearmedizinische Klinik, Erlangen (Germany)); Ebert, D. (Psychiatrische Klinik und Poliklinik, Erlangen (Germany)); Lungershausen, E. (Psychiatrische Klinik und Poliklinik, Erlangen (Germany))

    1993-08-13

    This review presents Single Photon Emission Computed Tomography (SPECT) as a powerful tool for clinical use and research in psychiatry. Its focus is on regional cerebral blood flow, measured with technetium labelled HMPAO. In addition, first results with brain receptor imaging, concerning dopamin-D[sub 2] and benzodiazepine receptors, are covered. Due to major improvements in image quality, and impressive number of results has been accumulated in the past three years. The authors caution against using SPECT results as markers for disease entities. A finding like 'hypofrontality' is considered typical of a variety of mental disorders. Clearly both, more experience with SPECT and contributions from psychopathology, are needed. (orig.)

  4. Brain SPECT using dipyridamole for evaluation of vascular reserve

    Baseline and stress brain SPECT studies using CO2 inhalation, acetazolamide (DiamoxR) and adenosine administrations have been used in the evaluation of cerebral vascular reserve. Recently dipyridamole (PersantineR) which is one of the pharmacologic myocardial perfusion SPECT agents as a potent vasodilator is suggested as another cerebral vasodilator. IV DiamoxR is not available in Korea. Therefore, the purpose of our study was to evaluate dipyridamole in stress brain SPECT in patients with Moya Moya disease. Eight patients with angiographically proven Moya Moya disease were studied. Their ages ranged from 7 to 62 year old. There were 4 males and 4 females. Each patient had a baseline and persantine brain SPECT studies with 1 to 3 days' interval. Dipyridamole was given intravenously at a dose of 0.56 mg/kg over 4 minutes while watching vital signs such as blood pressure, heart rate, and electrocardiogram. Three minutes after the completion of the infusion, 99mTc-ECD (0.2 mCi/Ib body weight) was injected. Brain SPECT was performed 30 minutes later using a tripple head gamma camera equipped with LEHR collimators. A total of 128 projections with an acquisition time of 30 second per projection was obtained and reconstructed by filtered back projections without attenuation correction. The difference between the baseline and persantine studies was analysed by visual and semiquantitavely. During the infusion of persantine, heart rate, blood pressure and side effects such as headache, chest discomfort were similar to the persantine myocardial SPECT studies. Five of eight patients showed a significant decrease in rCBF on persantine brain SPECT in comparison to the baseline study. The remaining three revealed no significant change in rCBF. Our study suggests that the dipyridamole stress brain SPECT is feasible and useful in assessing cerebral blood flow reserve. However we need to evaluate more number of patients in the future

  5. Detection of myocardial perfusion defect with 320-row volume CT myocardial perfusion imaging

    Objective: To evaluate the feasibility of 320-row volume CT myocardial perfusion imaging (CT-MPI) in detecting myocardial perfusion defect. Methods: Fourteen patients with positive single-positron emission computed tomography myocardial perfusion imaging (SPECT-MPI) findings underwent both rest and adenosine stress 320-row volume CT-MPI. Rest and stress CT perfusion images were analyzed by employing dedicated software in 320-row CT workstation. Both SPECT-MPI and CT-MPI were evaluated for fixed and reversible perfusion defects using a 16-segment model (apex was excluded). The sensitivity, specificity of 320-row volume CT-MPI in detecting myocardial perfusion defect were evaluated by taking SPECT-MPI as a reference standard. Results: Both rest and stress 320-row volume CT-MPI were successfully performed in all patients. Thirty nine segments with fixed or reversible perfusion defects in all patients were depicted by SPECT-MPI, while 34 perfusion defects in 12 patients were identified by CT-MPI. The sensitivity, specificity of 320-row volume CT-MPI for detection of perfusion defects were 87.2%(34/39), 91.4% (169/185), respectively. Conclusion: 320-row volume CT-MPI has high sensitivity and specificity for detection of myocardial perfusion defects. (authors)

  6. Diferenças relacionadas ao sexo nos volumes ventriculares e na fração de ejeção do ventrículo esquerdo estimados por cintilografia de perfusão miocárdica: comparação entre os programas Quantitative Gated SPECT (QGS e Segami Gender differences in ventricular volumes and left ventricle ejection fraction estimated by myocardial perfusion imaging: comparison of Quantitative Gated SPECT (QGS and Segami software programs

    Alice Tatsuko Yamada

    2007-03-01

    Full Text Available OBJETIVO: Analisar as diferenças relacionadas ao sexo nas medidas obtidas pelos programas Segami e Quantitative Gated SPECT (QGS. MÉTODOS: Cento e oitenta e um indivíduos assintomáticos sem evidência de cardiopatia foram submetidos a estudos de perfusão miocárdica. O volume diastólico final (VDF, volume sistólico final (VSF e a fração de ejeção do ventrículo esquerdo (FEVE foram quantificados pelos programas QGS and Segami para avaliar a influência do sexo, idade, peso, altura, freqüência cardíaca, pressão arterial sistólica, pressão arterial diastólica, índice de massa corporal e área de superfície corporal. RESULTADOS: As médias obtidas com o método QGS foram VDF (mulheres = 68 ml; homens = 95 ml; p OBJECTIVES: To test for gender differences in the measurements obtained by Segami and Quantitative Gated SPECT (QGS software programs. METHODS: 181 asymptomatic individuals without heart disease were submitted to myocardial perfusion imaging. End-diastolic volumes (EDV, end-systolic volumes (ESV and left ventricular ejection fraction (LVEF were measured by QGS and Segami software programs to evaluate the influence of gender, age, weight, height, heart rate, systolic blood pressure, diastolic blood pressure, body mass index and body surface area. RESULTS: The means in the QGS method were: EDV (women= 68 ml; men= 95 ml; p<0.001, LVEF (women= 66.24%; men= 58, 7% and Segami: EDV (women= 137 ml; men= 174 ml, LVEF (women= 62.67%; men= 58, 52%. There were significant differences between men and women in the EDV (p<0.001, ESV (p<0.001 and LVEF (p=0.001 that persisted after adjusting for body surface area. CONCLUSION: Ventricular volumes were significantly lower and LVEF was significantly higher in women, estimated by QGS or Segami software programs.

  7. Design and assessment of cardiac SPECT systems

    Lee, Chih-Jie

    Single-photon emission computed tomography (SPECT) is a modality widely used to detect myocardial ischemia and myocardial infarction. Objectively assessing and comparing different SPECT systems is important so that the best detectability of cardiac defects can be achieved. Whitaker, Clarkson, and Barrett's study on the scanning linear observer (SLO) shows that the SLO can be used to estimate the location and size of signals. One major advantage of the SLO is that it can be used with projection data rather than reconstruction data. Thus, this observer model assesses overall hardware performance independent by any reconstruction algorithm. In addition, we will show that the run time of image-quality studies is significantly reduced. Several systems derived from the GE CZT-based dedicated cardiac SPECT camera Discovery 530c design, which is officially named the Alcyone Technology: Discovery NM 530c, were assessed using the performance of the SLO for the task of detecting cardiac defects and estimating the properties of the defects. Clinically, hearts can be virtually segmented into three coronary artery territories: left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA). One of the most important functions of a cardiac SPECT system is to produce images from which a radiologist can correctly predict in which territory the defect exists. A good estimation of the defect extent from the images is also very helpful for determining the seriousness of the myocardial ischemia. In this dissertation, both locations and extent of defects were estimated by the SLO, and system performance was assessed using localization receiver operating characteristic (LROC) / estimation receiver operating characteristic (EROC) curves. Area under LROC curve (AULC) / area under EROC curve (AUEC) and true positive fraction (TPF) at specific false positive fraction (FPF) can be treated as the gures of merit (FOMs). As the results will show, a

  8. Evaluation of the diagnosis for hypertrophic cardiomyopathy (HCM) with SPECT

    A heart phantom-7070 was used to measure the wall thickness of cardiac chambers. Two methods were employed: (1) profile curve measurement, (2) calculation of the thickness of cardiac walls. 9 normal cases and 13 patients with hypertrophic cardiomyopathy were studied using 99mTc-CDI SPECT. 4 patterns were obtained: (1) Local hypertrophy of ventricular septum; (2) The predominant hypertrophy localized in left ventricular lateral wall; (3) Markedly hypertrophied septum and also involving left ventricular walls, especially the apical region; (4) Markedly hypertrophied papillary muscles with perfusion defects in the left wall and septum. These results suggest that myocardial SPECT is a promising and noninvasive method for the diagnosis of HCM

  9. Usefulness of {sup 99m}Tc-tetrofosmin myocardial scintigraphy before and after coronary intervention

    Adachi, Itaru; Hou, Nobuyoshi; Komori, Tsuyoshi; Tabuchi, Koujiro; Matsui, Ritsuo; Sueyoshi, Kouzou; Narabayashi, Isamu; Matsuda, Shigeki; Tamoto, Shigemi [Osaka Medical Coll., Takatsuki (Japan)

    1997-06-01

    Dipyridamole-loading {sup 99m}Tc-tetrofosmin myocardial scintigraphy was performed for patients with coronary artery disease who underwent percutaneous transluminal coronary angiography (PTCA) in order to examine whether SPECT imaging prior to treatment is useful for the determination of prognosis after coronary intervention. Thirty-six patients including 9 with angina pectoris (AP), 22 with old myocardial infarction (OMI) and 5 OMI with AP were underwent dipyridamole-loading {sup 99m}Tc-tetrofosmin myocardial SPECT before and after coronary intervention. The length of follow-up was 185{+-}107 days after PTCA. Improvement of myocardial uptake was observed on myocardial SPECT in all cases with AP. Improvement of the myocardial uptake was observed 50% (4/8) of patients with OMI who had no myocardial viability. It was suggested that the improvement of myocardial uptake after PTCA was due to incomplete fill-in in cases with AP and that presence of fill-in was important for level of fill-in in patients with AP. The improvement of myocardial uptake in the scar tissue in patients with OMI contributed to the hibernating myocardium. We concluded that correct detection of hibernating myocardium was difficult despite the superior imaging capacity of {sup 99m}Tc-tetrofosmin myocardial SPECT. (author)

  10. Usefulness of {sup 123}I-MIBG and {sup 123}I-BMIPP myocardial scintigraphy for detecting coronary artery disease and for evaluating left ventricular function

    Toyama, Takuji; Suzuki, Yasushi; Tsukagoshi, Joichi [Gunma Univ., Maebashi (Japan). School of Medicine] [and others

    1995-02-01

    We evaluated the diagnostic value of {sup 123}I-metaiodobenzylguanidine (MIBG) and {sup 123}I-labeled beta-methyliodophenyl pentadecanoic acid (BMIPP) myocardial SPECTs for evaluating coronary artery disease and left ventricular function, in comparison with the diagnostic value of {sup 201}Tl (Tl) SPECT. For forty-nine patients with coronary artery disease, resting MIBG and BMIPP SPECTs were performed to detect coronary artery stenosis, compared with the diagnostic value of exercise Tl. Left ventricular ejection fraction and regional wall motion were compared with the total US (TUS) and regional US (RUS) of resting MIBG and BMIPP SPECTs, and in turn, compared with resting Tl SPECT. The sensitivity of resting BMIPP SPECT for detecting coronary artery stenosis was lower, and the specificity of resting MIBG SPECT was lower than the other two methods. The accuracy of resting MIBG SPECT for evaluating coronary lesions was nearly the same as the accuracy of exercise Tl, but higher than that of BMIPP SPECT. Left ventricular ejection fraction was well correlated with TUS of resting MIBG SPECT (r=0.80), resting BMIPP SPECT (r=0.77), and resting Tl SPECT (r=0.68). Regional wall motion was most correlated with RUS of resting BMIPP SPECT, compared with that of resting Tl and MIBG SPECTs. These data suggest that resting MIBG SPECT is useful for detecting coronary artery disease and that resting BMIPP SPECT is valuable in evaluating regional left ventricular function. (author).

  11. A comparison of 99mTc-MIBI myocardial perfusion imaging and electron beam CT in detection of CAD in patients without myocardial infarction

    Our previous researches have demonstrated that 99mTc-MIBI myocardial tomography (SPECT) has higher specificity in detection of coronary artery disease (CAD) than that of coronary artery calcification (CAC) assessed by cardial electron beam CT(EBCT). However, these researches involved patients with myocardial infarction, which may be in favor of obtaining high accuracy for detection of CAD by SPECT.The purpose of this study was to compare SPECT with EBCT in detection of CAD in patents without myocardial infarction history. Seventy-three patients (55 male, 18 female, 52.6 ± 10.6 yrs old) without myocardial infarction underwent stress-rest SPECT, cardiac EBCT and coronary angiography (CAG) within one month. CAC as CT value ≥ 130 HU within the boundary of coronary artery on EBCT, and ≥50% coronary narrowing was considered as diagnostic standard of CAD. There were 35 patients and 38 patients with and without ≥ 50% coronary stenosis, respectively. Ninety-six percent (23/24) patients with abnormal SPECT and CAC detected by EBCT had coronary arteries with ≥ 50% stenosis, and 90.5% (19/21) patients with normal SPECT and EBCT had normal CAG or 45 yrs old the specificity f SPECt (94.3%) was significantly

  12. SPECT in psychiatry

    This review presents Single Photon Emission Computed Tomography (SPECT) as a powerful tool for clinical use and research in psychiatry. Its focus is on regional cerebral blood flow, measured with technetium labelled HMPAO. In addition, first results with brain receptor imaging, concerning dopamin-D2 and benzodiazepine receptors, are covered. Due to major improvements in image quality, and impressive number of results has been accumulated in the past three years. The authors caution against using SPECT results as markers for disease entities. A finding like 'hypofrontality' is considered typical of a variety of mental disorders. Clearly both, more experience with SPECT and contributions from psychopathology, are needed. (orig.)

  13. First clinical experiences with parametric SPECT of the gated cardiac blood pool

    SPECT of the gated cardiac blood pool as well as conventional 300LAO equilibrium radionuclide ventriculography was performed in a total of 12 patients (4 healthy subjects and 8 patients with CAD or cardiomyopathy). Seven out of 8 patients with myocardial pathology showed abnormalities of the anterior wall motion. In all of the respective cases SPECT and laevocardiography yielded concordant results while conventional radionuclide ventriculography was limited to the detection of septal and posterior wall motion abnormalities. Thus, SPECT of the cardiac blood pool is an anternative to ''first pass'' techniques which are limited to only few heart beats. (orig.)

  14. ECG-gated radionuclide ventriculography using SPECT technique; EKG-getriggerte Radionuklidventrikulographie in SPECT-Technik

    Eilles, C. [Regensburg Univ. (Germany). Abt. fuer Nuklearmedizin

    1999-03-01

    The calculation of absolute left ventricular volumes and quantitative investigator-independent analysis of wall motion abnormalities can be performed very accurately with ECG-gated radionuclide ventriculography using SPECT technique. To verify the technique, GASPECT analysis was done in comparison to cine angiography, MRI and thermodilution. The extent of wall motion abnormalities correlates well with global left ventricular function and myocardial infarct size. The GASPECT technique is suitable of scientific evaluation of small changes in left ventricular function. In contrast to ECG-gated SPECT using perfusion agents, the accuracy of the measurement is not hampered by perfusion disturbances or myocardial scars. Despite the advantages of GASPECT, the technique requires too much effort in clinical routine work. Echocardiography is a much easier way to estimate left ventricular function and the extent of wall motion as well. (orig.) [Deutsch] Die EKG-getriggerte Radionuklidventrikulographie in SPECT-Technik (GASPECT) erlaubt die Bestimmung absoluter linksventrikulaerer Volumina wie auch die untersucherunabhaengige quantitative Analyse von Wandbewegungsstoerungen mit grosser Genauigkeit. Die Validierung der Methode in der Bestimmung absoluter Volumina erfolgte im Vergleich zur Cineangiokardiographie, der MRT und der Thermodilution. Das Ausmass von Wandbewegungsstoerungen korreliert eng mit der globalen linksventrikulaeren Funktion und den gemessenen Infarktgroessen. Die GASPECT erscheint somit besonders fuer wissenschaftliche Fragestellungen relevant, bei denen auch geringe Veraenderungen nachzuweisen sind. Im Gegensatz zur EKG-getriggerten SPECT mit Perfusionsmarkern wird die Genauigkeit der Bestimmungen nicht durch massive Perfusionsstoerungen oder Myokardnarben beeintraechtigt. Trotz dieser Vorteile der GASPECT erscheint das Verfahren fuer die kardiologische Routine als zu aufwendig, da Abschaetzungen der linksventrikulaeren Funktion wie auch des Ausmasses von

  15. Evaluation of SPECT quantification of radiopharmaceutical distribution in canine myocardium

    This study evaluates the quantitative accuracy of SPECT for in vivo distributions of 99mTc radiopharmaceuticals using fanbeam (FB) and parallel-beam (PB) collimators and compares uniform and nouniform attenuation correction methods in terms of quantitative accuracy. SPECT quantification of canine myocardial radioactivity was performed followed by well counter measurements of extracted myocardial tissue samples. Transmission scans using a line source and an FB collimator were performed to generate nonuniform attenuation maps of the canine thorax. Emission scans with two energy windows were acquired. Images were reconstructed using a filtered backprojection algorithm, with a dual-window scatter subtraction combined with either no attenuation compensation or single iteration Chang attenuation compensation based on a uniform attenuation map μ=0.152 cm-1 or the nonuniform transmission map. The measured mean counts from the SPECT images were converted using the well counter. The experimental results demonstrate that, compared with well counter values, the in vivo distributions of 99mTc were most accurately determined in FB and PB SPECT reconstructions with nonuniform attenuation compensation, under-estimated without attenuation compensation and overestimated with uniform attenuation compensation. 37 refs., 9 figs., 10 tabs

  16. Myocardial scintigraphy in the diagnosis of myocardial contusion

    To assess the clinical value of a new fatty acid imaging tracer, 123I-β-methyl iodophenyl pentadecanoic acid (BMIPP), I-BMIPP and thallium-201 (Tl) dual imaging was performed at rest in fifteen patients with mild blunt chest trauma (mean AIS thoracic 1.4±0.51, mean ISS 6.47±3.50, mean RTS 7.69±0.43). All patients were prospectively evaluated on the basis of serial electrocardiograms (ECG) and cardiac enzyme studies (total CPK). Tl and BMIPP dual scintigrams were performed within 10 days following admission. SPECT images were divided into seven segments, and the segmental images were visually scored according to tracer uptake on a 3 (severely decreased tracer uptake) to 0 (normal) scale. Nine patients had scintigraphic defects and were considered to have a myocardial contusion. ECG findings, AIS, ISS, and CPK levels failed to distinguish between scintigraphically positive patients and scintigraphically negative patients. Five of the 14 hypoperfused segments on BMIPP imaging, showed normal Tl uptake, one showed lower BMIPP uptake than Tl, and the remaining eight showed similar distribution of both tracers. The mismatch between tracer uptake on BMIPP images and Tl images was thought to reflect impaired myocardial fatty acid metabolism. Thus, mild blunt chest trauma results in a higher frequency of traumatic myocardial injury than previously recognized, and BMIPP is a promising radio-pharmaceutical for evaluating impaired myocardial fatty acid metabolism in patients with myocardial contusion. (author)

  17. Myocardial ischemia in Kawasaki disease

    The detection of myocardial ischemia is essential for evaluation of patients with Kawasaki disease, especially who have had coronary artery lesions. To evaluate the clinical efficacy of Tl-201 single photon emission computed tomography (SPECT) after dipyridamole infusion (maximum dose 0.70 mg/kg) for detecting myocardial ischemia, 44 patients with Kawasaki disease aged 7.7±4.8 years at the study and 10 age matched controls were observed. In the Kawasaki disease group, significant coronary artery stenosis was observed in 14, coronary aneurysm without stenosis in 18, the regression of the coronary aneurysms in 2 and without coronary lesions in 10 patients. In 24 of 44 patients, treadmill exercise stress test was also performed at the same period. Myocardial ischemic changes were observed in 11 patients, all combined with significant coronary artery stenosis. The sensitivity of SPECT for detection of overall coronary stenosis was 79%, coronary that of treadmill exercise test was only 33% (p<0.001). Furthermore, among the patients having significant coronary stenosis, the severity score was significantly elevated in patients who had electrocardiographic abnormal Q wave compared to those without abnormal Q wave (51.0±38.8 versus 20.0±12.1, p<0.05). These data suggest that the pharmacological stress scintigraphy using dipyridamole injection provides not only the accurate detection but quantitative evaluation of myocardial ischemia in these patients. This noninvasive technique may become one of the most useful index for detection and follow-up of myocardial ischemia in Kawasaki disease. (author)

  18. Myocardial imaging with radioiodinated beta-methyl-branched fatty acid in cardiomyopathy

    The purpose of our experimental and clinical studies was to examine whether myocardial distribution of beta-methyl iodophenyl pentadecanoic acid (BMIPP) is different from that of thallium in cardiomyopathic hamsters and how single photon emission computed tomography (SPECT) delineate the different between thallium and BMIPP distributions in patients with cardiomyopathy. Quantitative dual tracer autoradiography demonstrated an uncoupling of myocardial thallium and [I-125]BMIPP distributions as well as a regional heterogeneity of [I-125]BMIPP distribution in cardiomyopathic hamsters. In patients with septal or apical hypertrophy and normal contractility, SPECT showed reduced [I-123]BMIPP uptake in the thickened myocardium with normal or high thallium uptake. In patients with hypertrophy and systolic dysfunction as well as those with dilated cardiomyopathy, SPECT with thallium and [I-123]BMIPP showed similar heterogeneous distributions. In conclusion, SPECT with [I-123]BMIPP may provide unique features different from thallium imaging and may delineate regional abnormalities of myocardial fatty acid metabolism in cardiomyopathy. (author)

  19. Function's evaluation, perfusion and metabolism by positron emission tomography associated with multislice tomography (PET/CT) in patient with previous diagnosis to myocardial necrosis

    A 64-years-old male patient with previous diagnosis of myocardial necrosis as assessed by myocardial perfusion gated single photon emission computed tomography (gSPECT) with 3-vessel-disease, left ventricular dysfunction and symptomatic by epigastric pain. The patient was referred for myocardial viability assessment by positron emission tomography (PET) to define clinical management decision. (authors)

  20. Radiotracers for SPECT imaging. Current scenario and future prospects

    Adak, S.; Vijaya Raj, K.K.; Mandal, S. [GE Healthcare Medical Diagnostics, John F. Welch Technology Center, Bangalore (India).; Bhalla, R.; Pickett, R.; Luthra, S.K. [GE Healthcare Medical Diagnostics, The Grove Centre, Amersham (United Kingdom)

    2012-07-01

    Single photon emission computed tomography (SPECT) has been the cornerstone of nuclear medicine and today it is widely used to detect molecular changes in cardiovascular, neurological and oncological diseases. While SPECT has been available since the 1980s, advances in instrumentation hardware, software and the availability of new radiotracers that are creating a revival in SPECT imaging are reviewed in this paper. The biggest change in the last decade has been the fusion of CT with SPECT, which has improved attenuation correction and image quality. Advances in collimator design, replacement of sodium iodide crystals in the detectors with cadmium zinc telluride (CZT) detectors as well as advances in software and reconstruction algorithms have all helped to retain SPECT as a much needed and used technology. Today, a wide spectrum of radiotracers is available for use in cardiovascular, neurology and oncology applications. The development of several radiotracers for neurological disorders is briefly described in this review, including [{sup 123}I]FP-CIT (DaTSCAN trademark) available for Parkinson's disease. In cardiology, while technetium-99m labeled tetrofosmin and technetium-99m labeled sestamibi have been well known for myocardial perfusion imaging, we describe a recently completed multicenter clinical study on the use of [{sup 123}I]mIBG (AdreView trademark) for imaging in chronic heart failure patients. For oncology, while bone scanning has been prevalent, newer radiotracers that target cancer mechanisms are being developed. Technetium-99m labeled RGD peptides have been reported in the literature that can be used for imaging angiogenesis, while technetium-99m labeled duramycin has been used to image apoptosis. While PET/CT is considered to be the more advanced technology particularly for oncology applications, SPECT continues to be the modality of choice and the workhorse in many hospitals and nuclear medicine centers. The cost of SPECT instruments also

  1. Radiotracers for SPECT imaging. Current scenario and future prospects

    Single photon emission computed tomography (SPECT) has been the cornerstone of nuclear medicine and today it is widely used to detect molecular changes in cardiovascular, neurological and oncological diseases. While SPECT has been available since the 1980s, advances in instrumentation hardware, software and the availability of new radiotracers that are creating a revival in SPECT imaging are reviewed in this paper. The biggest change in the last decade has been the fusion of CT with SPECT, which has improved attenuation correction and image quality. Advances in collimator design, replacement of sodium iodide crystals in the detectors with cadmium zinc telluride (CZT) detectors as well as advances in software and reconstruction algorithms have all helped to retain SPECT as a much needed and used technology. Today, a wide spectrum of radiotracers is available for use in cardiovascular, neurology and oncology applications. The development of several radiotracers for neurological disorders is briefly described in this review, including [123I]FP-CIT (DaTSCAN trademark) available for Parkinson's disease. In cardiology, while technetium-99m labeled tetrofosmin and technetium-99m labeled sestamibi have been well known for myocardial perfusion imaging, we describe a recently completed multicenter clinical study on the use of [123I]mIBG (AdreView trademark) for imaging in chronic heart failure patients. For oncology, while bone scanning has been prevalent, newer radiotracers that target cancer mechanisms are being developed. Technetium-99m labeled RGD peptides have been reported in the literature that can be used for imaging angiogenesis, while technetium-99m labeled duramycin has been used to image apoptosis. While PET/CT is considered to be the more advanced technology particularly for oncology applications, SPECT continues to be the modality of choice and the workhorse in many hospitals and nuclear medicine centers. The cost of SPECT instruments also makes them more

  2. Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography

    Vavere, Andrea L; Simon, Gregory G; George, Richard T;

    2013-01-01

    diagnostic performance of combined 320-row CTA and myocardial CT perfusion imaging (CTP) in comparison with the combination of invasive coronary angiography and single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). The trial is being performed at 16 medical centers located in 8...... disease compared with (1) the combination of conventional coronary angiography and SPECT-MPI and (2) conventional coronary angiography alone. If successful, the technology could revolutionize the management of patients with symptomatic CAD....

  3. Brain SPECT in childhood

    The modalities and the indications of perfusion and neurotransmission SPECT in childhood are presented. The perfusion as well as neurotransmission tracers have not yet authorization for use in children; they have to be used by prescription of magistral preparation or in research protocols. The radioprotection rules have to be strictly respected. The most frequent indication of perfusion SPECT is pharmacologically resistant epilepsy; the ictal SPECT before surgery allows the localization of the epileptogenic focus. Other indications are relevant in the prognosis of neonatal anoxia and encephalitis. In psychiatric disorders, especially in autism, the interest is the physiopathological approach of the brain dysfunctions. The neurotransmission SPECT is emerging as a consequence of the development of new radiotracer, as the dopaminergic system ligands. The decrease of the dopamine D2 receptors in the striatum can be imaged and quantified in the neonate. The lesions of dopamine system seem to be a consequence of the neonatal hypoxia-ischemia and it is predictive of motor sequelae. Brain SPECT should become a routine examination in child neurologic and psychiatric disorders. (authors)

  4. Avaliação da perfusão e função miocárdicas em vítimas de escorpionismo utilizando o Gated-SPECT Evaluación de la perfusión y función miocárdicas en víctimas de escorpionismo utilizando el Gated-SPECT Assessment of myocardial perfusion and function in victims of scorpion envenomation using Gated-SPECT

    Alexandre Baldini de Figueiredo; Palmira Cupo; Antônio O Pintya; Fábio Caligaris; Marin-Neto, José A.; Sylvia E. Hering; Marcus Vinicius Simões

    2010-01-01

    FUNDAMENTO: O choque cardiogênico e o edema agudo de pulmão são as principais causas de óbito em pacientes com escorpionismo, cujo mecanismo fisiopatológico ainda é controverso. OBJETIVOS: Investigar a correlação entre os distúrbios da perfusão miocárdica e a função contrátil do ventrículo esquerdo, em vítimas de escorpionismo. MÉTODOS: Quinze pacientes submeteram-se à cintilografia de perfusão miocárdica sincronizada com ECG (Gated SPECT), dentro de 72 horas e 15 dias após o acidente escorpi...

  5. SPECT in psychiatry

    In the last fifteen years different attempts have been undertaken to understand the biological basis of major psychiatric disorders. One important tool to determine patterns of brain dysfunction is single emission computed tomography (SPECT). Whereas SPECT investigations are already a valuable diagnostic instrument for the diagnosis of dementia of the Alzheimer Type (DAT) there have not been consistent findings that can be referred to as specific for any other particular psychiatric diagnostic entity. Nevertheless, SPECT studies have been able to demonstrate evidence of brain dysfunction in patients with schizophrenia, depression, anxiety disorders, and substance abuse in which other methods showed no clear abnormality of brain function. Our manuscript reviews the data which are currently available in the literature and stresses the need for further studies, especially for prediction and monitoring psychiatric treatment modalities. (orig.)

  6. Evaluation of the ischemic myocardium in acute coronary syndromes using 123I-MIBG and 201TlCl SPECT imaging

    Images from myocardial I-123-meta-iodobenzylguanidine (MIBG) single photon emission computed tomography (SPECT) and Tl-201 SPECT were reviewed in 20 patients with acute coronary syndromes, including 6 with unstable angina and 7 with non-transmural myocardial infarction. Myocardial SPECT imaging was undertaken 90 min after iv injection of I-123 MIBG, followed by myocardial perfusion SPECT imaging 15 min after iv injection of 201TlCl. One week later, coronary arteriography was performed. Of 7 patients with non-transmural myocardial infarction, 3 were not recognized as having hypoperfusion or defect on Tl-201 images, but were found to have defects in culprit vessels on I-123 MIBG images. In 3 of 6 patients with unstable angina, I-123 MIBG imaging clearly visualized defects in culprit vessels, although there were no abnormal findings in serum creatinine kinase or Tl-201 myocardial imaging. Thus I-123 MIBG myocardial imaging was found to visualize ischemic zones, not detected by the other imaging methods, especially in non-transmural myocardial infarction and unstable angina. (N.K.)

  7. Myocardial perfusion studies in coronary diseases

    For detecting in precocious form a coronary disease is necessary to apply a diagnostic techniques. The main considerations to be indicated in the present work are: physiological considerations, myocardial perfusion studies with radiotracers such as Talio 201, 99mTc, MIBI, 99mTc-Teboroxima, 99mTc-Fosfinas, instrumentation for obtain good images,proceedings protocols, studies interpretation, standards, SPECT, anomalies standards, coronary diseases

  8. Usefulness of brain SPECT

    Brain SPECT was not effectively exploited until I-123 isopropyl amphetamine (IAMP), indicator able to penetrate the blood brain barrier, became available. Although the experience of research teams working with IAMP is quite restricted due to the high cost of the indicator, some applications now appear to be worth the cost and in some cases provide data which cannot be obtained with routine techniques, especially in cerebrovascular patients, in epilepsy and some cases of tumor. Brain SPECT appears as an atraumatic test which is useful to establish a functional evaluation of the cerebral parenchyma, and which is a complement to arteriography, X-ray scan and regional cerebral blood flow measurement

  9. Role of myocardial perfusion single photon emission computed tomography in pediatric cardiology practice

    Sundaram P

    2009-01-01

    Full Text Available Diagnostic and prognostic power of myocardial perfusion imaging in patients with coronary artery disease has been demonstrated with planar imaging which was further improvised with addition of gated SPECT and newer Technetium labeled myocardial perfusion tracers like SestaMIBI, Tetrofosmin. Myocardial perfusion abnormalities at rest and after stress are considered to be the best predictors of cardiac event-free survival in adults with ischemic heart disease. This article highlights various myocardial perfusion imaging (MPIradiopharmaceuticals, exercise procedures, pharmacological stress protocols, indications for MPI and myocardial perfusion patterns in children with some of the common congenital and acquired heart diseases.

  10. Role of myocardial perfusion single photon emission computed tomography in pediatric cardiology practice

    Diagnostic and prognostic power of myocardial perfusion imaging in patients with coronary artery disease has been demonstrated with planar imaging which was further improvised with addition of gated SPECT and newer Technetium labeled myocardial perfusion tracers like SestaMIBI, Tetrofosmin. Myocardial perfusion abnormalities at rest and after stress are considered to be the best predictors of cardiac event–free survival in adults with ischemic heart disease. This article highlights various myocardial perfusion imaging (MPI) radiopharmaceuticals, exercise procedures, pharmacological stress protocols, indications for MPI and myocardial perfusion patterns in children with some of the common congenital and acquired heart diseases

  11. Performance of a semiconductor SPECT system. Comparison with a conventional anger-type SPECT instrument

    The performance of a new single photon emission computed tomography (SPECT) scanner with a cadmium-zinc-telluride (CZT) solid-state semiconductor detector (Discovery NM 530c; D530c) was evaluated and compared to a conventional Anger-type SPECT with a dual-detector camera (Infinia). Three different phantom studies were performed. Full width at half maximum (FWHM) was measured using line sources placed at different locations in a cylindrical phantom. Uniformity was measured using cylindrical phantoms with 3 different diameters (80, 120, and 160 mm). Spatial resolution was evaluated using hot-rod phantoms of various diameters (5, 9, 13, 16, and 20 mm). Three different myocardial phantom studies were also performed, acquiring projection data with and without defects, and evaluating the interference of liver and gallbladder radioactivity. In a clinical study, the D530c employed list-mode raw data acquisition with electrocardiogram (ECG)-gated acquisition over a 10-min period. From the 10-min projection data, 1-, 3-, 5-, 7- and 10-min SPECT images were reconstructed. The FWHM of the D503c was 1.73-3.48 mm (without water) and 3.88-6.64 mm (with water), whereas the FWHM of the Infinia was 8.17-12.63 mm (without water) and 15.48-16.28 mm (with water). Non-uniformity was larger for the D530c than for the Infinia. Truncation artifacts were also observed with the D530c in a Φ160 mm phantom. The contrast ratio, as defined by myocardial defect/non-defect ratio, was better for the D530c than for the Infinia, and the influence from liver and gallbladder radioactivities was less. Quantitative gated SPECT (QGS) software demonstrated significant differences between data captured over a 10-min period, relative to those acquired over periods of <5 min; there was no difference between ejection fractions calculated using data capture for periods ≥5 min (p<0.05). The D530c is superior to the Infinia, with regard to both spatial resolution and sensitivity. In this study, these

  12. Myocardial Bridge

    ... Myocarditis Obstructive Sleep Apnea Pericarditis Peripheral Vascular Disease Rheumatic ... Related terms: myocardium, coronary arteries, myocardial ischemia Your heart is made of muscle, called the myocardium. The ...

  13. Myocardial Bridging.

    Yuan, Shi-Min

    2016-02-01

    Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features of the bridges vary significantly. Alterations of the endothelial morphology and the vasoactive agents impact on the progression of atherosclerosis of myocardial bridging. Patients may present with chest pain, myocardial infarction, arrhythmia and even sudden death. Patients who respond poorly to the medical treatment with β-blockers warrant a surgical intervention. Myotomy is a preferred surgical procedure for the symptomatic patients. Coronary stent deployment has been in limited use due to the unsatisfactory long-term results. PMID:27074276

  14. Myocardial Bridging

    Shi-Min Yuan

    2016-02-01

    Full Text Available Abstract Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features of the bridges vary significantly. Alterations of the endothelial morphology and the vasoactive agents impact on the progression of atherosclerosis of myocardial bridging. Patients may present with chest pain, myocardial infarction, arrhythmia and even sudden death. Patients who respond poorly to the medical treatment with β-blockers warrant a surgical intervention. Myotomy is a preferred surgical procedure for the symptomatic patients. Coronary stent deployment has been in limited use due to the unsatisfactory long-term results.

  15. Gated single photon emission computer tomography for the detection of silent myocardial ischemia

    Background: Asymptomatic patients with severe coronary atherosclerosis may have a normal resting electrocardiogram and stress test. Aim: To assess the yield of Gated Single Photon Emission Computer Tomography (SPECT) for the screening of silent myocardial ischemia in type 2 diabetic patients. Material and methods: Electrocardiogram, stress test and gated-SPECT were performed on 102 type 2 diabetic patients aged 60 ± 8 years without cardiovascular symptoms. All subjects were also subjected to a coronary angiography, whose results were used as gold standard. Results: Gated-SPECT showed myocardial ischemia on 26.5% of studied patients. The sensibility, specificity, accuracy, positive predictive value and negative predictive value were 92.3%, 96%, 95%, 88.8%, 97.3%, respectively. In four and six patients ischemia was detected on resting electrocardiogram and stress test, respectively. Eighty percent of patients with doubtful resting electrocardiogram results and 70% with a doubtful stress test had a silent myocardial ischemia detected by gated-SPECT. There was a good agreement between the results of gated-SPECT and coronary angiography (k =0.873). Conclusions: Gated-SPECT was an useful tool for the screening of silent myocardial ischemia

  16. Correlation between uptake of 99TcM-MIBI and multidrug resistant proteins of breast cancer

    Objectives: To assess the correlation between 99Tcm-MIBI uptake and the expression level of multidrug resistant proteins of breast cancer. Methods: Thirty patients with infiltrating ductal carcinoma were enrolled in this study. 99Tcm-MIBI scintigraphy were performed at 15 min and 90 min after injecting the tracer. The uptake of 99Tcm-MIBI were evaluated as tumor over background ratio with region of interest technique. Such indexes as early uptake ratio (EUR), delay uptake ratio (DUR) and retention index (RI) were calculated respectively. P-gp (P-glycoprotein) and MRP (multidrug resistant-associated protein) expression in surgically resected tumors were investigated by immunohistochemistry. Immunohistochemistry HPIAS-1000 image analysis system was used to determined the level of P-gp and MRP expression. The difference of P-gp and MRP level in the group with RI ≥ 0 and the group with RI99Tcm-MIBI on delayed scans in breast cancer. The uptake of 99Tcm-MIBI may be not related to the levels of MRP expression. Thus 99Tcm-MIBI scintigraphy may predict the MDR development which associated with P-gp expression in breast carcinoma. (authors)

  17. Evaluation of left ventricular ejection fraction using quantitative gated SPECT (QGS)

    Electrocardiographic ally gated myocardial perfusion SPECT (G SPECT) is a state-of the art technique for the combined evaluation of myocardial perfusion and left ventricular function within a single study. It is currently one of the most commonly performed cardiology procedures in a nuclear medicine department. Automation of the image processing and quantification has made this techniques highly reproducible, practical and user friendly in the clinical setting . In patients with coronary artery disease, gating enhances the diagnostic and prognostic capability of myocardial perfusion imaging provides incremental information over the the perfusion data, and has shown potentials for myocardial viability assessment and sequential follow-up after therapy. Evaluation of the left ventricular (L V) function is important in clinical cardiology. Quantifying the degree and extent of the L V functional abnormalities permits a systematic assessment of the disease process on the myocardial performance. The aim of this thesis is to evaluate left ventricular ejection fraction (LVEF) in patients with no evidence of ischemic response during the stress test. This investigation was carried out in view of the few reports concerning the findings ventricular function with gated SPECT in these situations in the normal population, which is relevant when considering the possibility of myocardial stunning. Method: We prospectively studied 30 selected patients, in difference age and gender. A one-day protocol was used, with injection 555 MBq - 1.11 MBq (15 - 30 mCi) of 99 mTc-M1 B1 at stress and rest. Gated perfusion SPECT was acquired 30 to 60 minutes after radiotracer injection in both condition and processed using QGSPECT software. Difference between stress and rest LVEF was calculated. Result and conclusion: rest LVEF was higher in the stress (exercise) group, A trend line was done in both groups and r-value was (0.9) and p=0.04 in acceptance value. Standard deviation of LVEF also was

  18. ST segment elevation after myocardial infarction: Viability or ventricular dysfunction? Comparison with myocardial scintigraphy