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Sample records for ecg-gated myocardial perfusion

  1. Clinical evaluation of the Tl-201 ECG-gated myocardial SPECT

    International Nuclear Information System (INIS)

    Mochizuki, Teruhito

    1989-01-01

    In order to evaluate the clinical usefulness of the Tl-201 ECG-gated myocardial single photon emission computed tomography (SPECT), we compared the wall motion and the grade of the Tl-201 uptake of the ECG-gated myocardial SPECT with the wall motion of the ECG-gated blood pool SPECT. Materials were 87 patients of 50 old myocardial infarctions (OMIs), 19 hypertrophic cardiomyopathies (HCMs), 2 dilated cardiomyopathies (DCMs) and 16 others. After intravenous injection of 111-185 MBq (3-5 mCi) of Tl-201 at rest, the projection data were acquired using a rotating gamma-camera through 180deg, from RAO 45deg in 24 directions, each of which consisted of 80-100 beats. For the reconstruction of ED, ES and non-gated images, R-R interval was divided into about 20 (18-22) fractions. In 348 regions of interest (anterior, septal, lateral and inferior wall) in 87 cases, wall motion and the Tl-201 uptake were evaluated to three grades (normal, hypokinesis and akinesis; normal, low and defect, respectively), which were compared with the wall motion of the ECG-gated blood pool SPECT. The wall motion and the grade of the Tl-201 uptake of the ECG-gated myocardial SPECT correlated well with the wall motion of the ECG-gated blood pool SPECT (96.6% and 87.9%, respectively). In conclusion, the ECG-gated myocardial SPECT can provide clear perfusion images and is a very useful diagnostic strategy to evaluate the regional wall motion and perfusion simultaneously. (author)

  2. Myocardial enhancement pattern in patients with acute myocardial infarction on two-phase contrast-enhanced Ecg-gated multidetector-row computed tomography

    International Nuclear Information System (INIS)

    Ko, S.M.; Seo, J.B.; Hong, M.K.; Do, K.H.; Lee, S.H.; Lee, J.S.; Song, J.W.; Park, S.J.; Park, S.W.; Lim, T.H.

    2006-01-01

    Aim: To evaluate the myocardial enhancement pattern of the left ventricle on two-phase contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) images in patients with acute myocardial infarction (AMI). METHODS: Two-phase contrast-enhanced ECG-gated MDCT examinations were performed in 16 patients with AMI. The presence, location and pattern of myocardial enhancement were evaluated. MDCT findings were compared with the catheter angiographic results. RESULTS: Subendocardial (n=9) or transmural (n=6) area of early perfusion defects of the myocardium was detected in 15 of 16 patients (94%) on early-phase CT images. Variable delayed myocardial enhancement patterns on late-phase CT images were observed in 12 patients (75%): (1) subendocardial residual perfusion defect and subepicardial late enhancement (n=6); (2) transmural late enhancement (n=1); (3) isolated subendocardial late enhancement (n=1); and (4) isolated subendocardial residual perfusion defect (n=2). On catheter angiography, 14 of 15 corresponding coronary arteries showed significant stenosis. CONCLUSION: Variable abnormal myocardial enhancement pattern was seen on two-phase, contrast-enhanced ECG-gated MDCT in patients with AMI. Assessment of myocardial attenuation on CT angiography gives additional information of the location and extent of infarction

  3. Calculation of left ventricular volume and ejection fraction from ECG-gated myocardial SPECT. Automatic detection of endocardial borders by threshold method

    International Nuclear Information System (INIS)

    Fukushi, Shoji; Teraoka, Satomi.

    1997-01-01

    A new method which calculate end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (LVEF) of the left ventricle from myocardial short axis images of ECG-gated SPECT using 99m Tc myocardial perfusion tracer has been designed. Eight frames per cardiac cycle ECG-gated 180 degrees SPECT was performed. Threshold method was used to detect myocardial borders automatically. The optimal threshold was 45% by myocardial SPECT phantom. To determine if EDV, ESV and LVEF can also be calculated by this method, 12 patients were correlated ventriculography (LVG) for 10 days each. The correlation coefficient with LVG was 0.918 (EDV), 0.935 (ESV) and 0.900 (LVEF). This method is excellent at objectivity and reproductivity because of the automatic detection of myocardial borders. It also provides useful information on heart function in addition to myocardial perfusion. (author)

  4. Prognostic significance of stress myocardial ECG-gated perfusion imaging in asymptomatic patients with diabetic chronic kidney disease on initiation of haemodialysis

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    Momose, Mitsuru; Kondo, Chisato; Kobayashi, Hideki; Kusakabe, Kiyoko [Tokyo Women' s Medical University, School of Medicine, Department of Radiology, Shinjuku-ku, Tokyo (Japan); Babazono, Tetsuya [Tokyo Women' s Medical University, School of Medicine, Diabetes Centre, Shinjuku-ku, Tokyo (Japan); Nakajima, Takatomo [Tokyo Women' s Medical University, School of Medicine, Department of Cardiology, Shinjuku-ku, Tokyo (Japan)

    2009-08-15

    Diabetic patients with chronic kidney disease (CKD) frequently develop cardiac events within several years of the initiation of haemodialysis. The present study assesses the prognostic significance of stress myocardial ECG-gated perfusion imaging (MPI) in patients with diabetic CKD requiring haemodialysis. Fifty-five asymptomatic patients with diabetic stage V CKD and no history of heart disease scheduled to start haemodialysis were enrolled in this study (56{+-}11 years old; 49 with type 2 diabetes mellitus). All patients underwent {sup 201}Tl stress ECG-gated MPI 1 month before or after the initiation of haemodialysis to assess myocardial involvement. We evaluated SPECT images using 17-segment defect scores graded on a 5-point scale, summed stress score (SSS) and summed difference scores (SDS). The patients were followed up for at least 2 years (42{+-}15 months) to determine coronary intervention (CI) and heart failure (HF) as soft events and acute myocardial infarction (AMI) and all causes of deaths as hard events. The frequencies of myocardial ischaemia, resting perfusion defects, low ejection fraction and left ventricular (LV) dilatation were 24,20,29 and 49%, respectively. Ten events (18%) developed during the follow-up period including four CI, one HF, one AMI and four sudden deaths. Multivariate Cox analysis selected SDS (p=0.0011) and haemoglobin A{sub 1c} (HbA{sub 1c}) (p=0.0076) as independent prognostic indicators for all events. Myocardial ischaemia, in addition to glycaemic control, is a strong prognostic marker for asymptomatic patients with diabetic CKD who are scheduled to start haemodialysis. Stress MPI is highly recommended for the management and therapeutic stratification of such patients. (orig.)

  5. Pulse wave as an alternate signal for data synchronization during gated myocardial perfusion SPECT imaging.

    Science.gov (United States)

    Lang, Otto; Trojanova, Helena; Balon, Helena R; Kunikova, Ivana; Bilwachs, Milos; Penicka, Martin; Kaminek, Milan; Myslivecek, Miroslav

    2011-09-01

    Proper identification of the cardiac cycle is essential for gated SPECT myocardial perfusion imaging. We have developed an alternate method of ECG for gating, that is, using the peripheral pulse wave (PW) as the triggering signal for gated SPECT acquisition. The aim of this study is to compare the use of this method of gating with the standard ECG trigger. We tested the PW triggering by comparing it with the ECG trigger. We evaluated 33 patients (25 males, 8 females), average age of 61 years (39-80) referred for stress myocardial perfusion imaging. Data from all patients were acquired twice and were processed by CEqual and QGS software. We compared the left ventricular ejection fraction (LVEF), end-diastolic and end-systolic volumes (EDV, ESV). Paired t test and Pearson correlation coefficient were used for comparison. The mean LVEF, EDV, and ESV calculated with the ECG trigger were 0.52, 120, and 64, respectively, those with the pulse-wave trigger were 0.48, 126, and 71, respectively. Mean paired difference for LVEF was -0.034 (P<0.001), for EDV 5.9 (P=0.012), and for ESV 7.9 (P<0.001). Pearson correlation coefficient for LVEF was 0.955, for EDV 0.987, and for ESV 0.991 (P<0.001 for all correlations). Triggering of gated-data acquisition by the PW is feasible. Quantitative parameters of cardiac function correlate highly with those obtained from the ECG trigger and the absolute differences are not clinically significant across a wide range of values.

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

    International Nuclear Information System (INIS)

    Li Dianfu; Huang Jun; Feng Jianlin; Cheng Xu; Li Xinli; Cao Kejiang

    2005-01-01

    Objective: To study and compare the diagnostic value in severe coronary artery disease (CAD) of 99 Tc m -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, χ 2 =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), χ 2 =4.163, P=0.041]. Diagnostic specificity of G-MPI was 80.0% and that of NG-MPI was 72.3% (χ 2 =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)

  7. ECG-gated myocardial imaging with 201Tl

    International Nuclear Information System (INIS)

    Baehre, M.

    1980-01-01

    ECG-gated myocardial scintigraphy by means of 201 TI was performed in 11 patients. Good scintigrams could be gained by using long imaging times, but there was no additional information when compared with static images. Disadvantages were long imaging time, higher technical expenditure, and the smaller number of projections. Furthermore, there is no possibility of performing myocardial imaging under stress. (orig.) [de

  8. Assessment of the effect of revascularization early after CABG using ECG-gated perfusion single-photon emission tomography

    International Nuclear Information System (INIS)

    Kubo, Shigeto; Tadamura, Eiji; Kudoh, Takashi; Inubushi, Masayuki; Konishi, Junji; Ikeda, Tadashi; Koshiji, Takaaki; Nishimura, Kazunobu; Komeda, Masashi; Tamaki, Nagara

    2001-01-01

    When an arterial graft is used, reversible perfusion defects on single-photon emission tomography (SPET) perfusion images are occasionally observed early after coronary artery bypass graft surgery (CABG), owing to the restricted flow capacity. The purpose of this study was to determine whether the functional information obtained with electrocardiography (ECG)-gated perfusion SPET could be helpful in evaluating the effect of revascularization early after CABG. Twenty-three patients (18 men and 5 women, mean age 65±9 years) underwent stress/re-injection thallium-201 ECG-gated SPET before and 4 weeks after CABG (13 with exercise and 10 with dipyridamole). Patency of all grafts was confirmed by coronary angiography 1 month after CABG. Cardiac functional data including the left ventricular ejection fraction (LVEF) and the transient ischaemic dilatation (TID) ratio were analysed using a commercially available automated program. The conventional stress and re-injection tomograms were interpreted by means of a five-point scoring system in a nine-segment model. Stress-induced reversible 201 Tl perfusion defects were present in 64% of the myocardial segments bypassed by patent arterial grafts, in contrast to 42% of the myocardial segments bypassed by patent venous grafts (χ 2 =7.8, P=0.005). Of the 23 patients, 12 showed improvement in summed ischaemic scores (group 1), while 11 had no change or deterioration (group 2), although all grafts were patent on postoperative catheterization. The TID ratio improved in both group 1 and group 2 before and after CABG (1.14±0.13 vs 0.99±0.07, P=0.001 and 1.09±0.07 vs 0.94±0.05, P=0.002, respectively). However, LVEF did not significantly improve in group 1 or group 2 after CABG (42.5%±9.9% vs 47.5%±11.8%, and 52.1%±7.5% vs 53.1%±5.9%, respectively). Perfusion imaging or LVEF assessment is of limited value early after CABG. The TID ratio obtained with ECG-gated perfusion SPET may be a useful marker to evaluate the effect of

  9. Assessment of left ventricular function by electrocardiogram-gated myocardial single photon emission computed tomography using quantitative gated single photon emission computed tomography software

    International Nuclear Information System (INIS)

    Morita, Koichi; Adachi, Itaru; Konno, Masanori

    1999-01-01

    Electrocardiogram (ECG)-gated myocardial single photon emission computed tomography (SPECT) can assess left ventricular (LV) perfusion and function easily using quantitative gated SPECT (QGS) software. ECG-gated SPECT was performed in 44 patients with coronary artery disease under post-stress and resting conditions to assess the values of LV functional parameters, by comparison to LV ejection fraction derived from gated blood pool scan and myocardial characteristics. A good correlation was obtained between ejection fraction using QGS and that using cardiac blood pool scan (r=0.812). Some patients with myocardial ischemia had lower ejection fraction under post-stress compared to resting conditions, indicating post-stress LV dysfunction. LV wall motion and wall thickening were significantly impaired in ischemic and infarcted myocardium, and the degree of abnormality in the infarcted areas was greater than in the ischemia area. LV functional parameters derived using QGS were useful to assess post-stress LV dysfunction and myocardial viability. In conclusion, ECG-gated myocardial SPECT permits simultaneous quantitative assessment of myocardial perfusion and function. (author)

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

    Science.gov (United States)

    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.

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

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    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.

  12. 'Motion frozen' quantification and display of myocardial perfusion gated SPECT

    International Nuclear Information System (INIS)

    Slomka, P.J.; Hurwitz, G.A.; Baddredine, M.; Baranowski, J.; Aladl, U.E.

    2002-01-01

    Aim: Gated SPECT imaging incorporates both functional and perfusion information of the left ventricle (LV). However perfusion data is confounded by the effect of ventricular motion. Most existing quantification paradigms simply add all gated frames and then proceed to extract the perfusion information from static images, discarding the effects of cardiac motion. In an attempt to improve the reliability and accuracy of cardiac SPECT quantification we propose to eliminate the LV motion prior to the perfusion quantification via automated image warping algorithm. Methods: A pilot series of 14 male and 11 female gated stress SPECT images acquired with 8 time bins have been co-registered to the coordinates of the 3D normal templates. Subsequently the LV endo and epi-cardial 3D points (300-500) were identified on end-systolic (ES) and end-diastolic (ED) frames, defining the ES-ED motion vectors. The nonlinear image warping algorithm (thin-plate-spline) was then applied to warp end-systolic frame was onto the end-diastolic frames using the corresponding ES-ED motion vectors. The remaining 6 intermediate frames were also transformed to the ED coordinates using fractions of the motion vectors. Such warped images were then summed to provide the LV perfusion image in the ED phase but with counts from the full cycle. Results: The identification of the ED/ES corresponding points was successful in all cases. The corrected displacement between ED and ES images was up to 25 mm. The summed images had the appearance of the ED frames but have been much less noisy since all the counts have been used. The spatial resolution of such images appeared higher than that of summed gated images, especially in the female scans. These 'motion frozen' images could be displayed and quantified as regular non-gated tomograms including polar map paradigm. Conclusions: This image processing technique may improve the effective image resolution of summed gated myocardial perfusion images used for

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

    International Nuclear Information System (INIS)

    Ohkoshi, Nobuyuki; Watanabe, Shingo; Matsumoto, Tooru

    2011-01-01

    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)

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

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    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.

  15. Measurement of left ventricular ejection fraction from gated technetium-99m sestamibi myocardial images

    International Nuclear Information System (INIS)

    Boonyaprapa, S.; Ekmahachai, M.; Thanachaikun, N.; Jaiprasert, W.; Sukthomya, V.; Poramatikul, N.

    1995-01-01

    Sixty patients underwent SPET imaging with MIBI. Immediately after SPET acquisition ECG-gated 99m Tc-MIBI perfusion images were acquired using 24 planar images per R-R interval. A new method for measurement of LVEF from the ECG-gated 99m Tc-MIBI perfusion images was developed. To validate the method, LVEF derived from MIBI perfusion images was compared with that from conventional radionuclide ventriculography in all 60 patients. Forty patients had evidence of myocardial infarction and 20 had normal perfusion on MIBI imaging. There was no statistically significant difference between LVEF computed from 99m Tc-MIBI perfusion images and that from radionuclide ventriculography (r=0.7062, P 99m Tc-MIBI perfusion images can be obtained at the same time as assessment of myocardial perfusion and in the same orientation and metabolism of the myocardium, thereby permitting more accurate and realistic prognosis and diagnosis in patients with coronary artery disease. (orig.)

  16. Myocardial perfusion SPECT imaging in patients with myocardial bridging

    International Nuclear Information System (INIS)

    Fang Wei; Qiu Hong; Yang Weixian; Wang Feng; He Zuoxiang

    2008-01-01

    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. Gated single-photon emission tomography imaging protocol to evaluate myocardial stunning after exercise

    International Nuclear Information System (INIS)

    Hashimoto, Jun; Kubo, Atsushi; Iwasaki, Ryuichiro; Iwanaga, Shiro; Mitamura, Hideo; Ogawa, Satoshi; Kosuda, Shigeru

    1999-01-01

    This study was designed to apply ECG-gating to stress myocardial perfusion single-photon emission tomography (SPET) for the evaluation of myocardial stunning after exercise. Technetium-99m sestamibi was selected as the perfusion agent and a rest/exercise 1-day protocol was employed. Fourteen patients without coronary stenosis and 33 patients with coronary stenosis were enrolled in the study. We carried out three data acquisitions with ECG-gating: a 15-min data acquisition starting 30 min after the rest injection (AC1), a 5-min acquisition starting 5 min after the stress injection (AC2) and a 15-min acquisition starting 20 min after the stress injection (AC3). Calculation of left ventricular ejection fraction (LVEF) values was performed by means of automatic determination of the endocardial surface for all gating intervals in the cardiac cycle. Measured global EF values in 14 patients without coronary stenosis were 52.3%±7.6% (AC1), 60.6%±8.9% (AC2) and 55.6%±5.6% (AC3), and those in 11 patients with severe ischaemia were 53.6%±8.0% (AC1), 45.6%±12.1% (AC2) and 49.7%±10.7%. The magnitude of the depression of post-stress LVEF relative to the rest LVEF correlated with the severity of ischaemia (r=0.594, P=0.002), and segments manifesting post-stress functional depression were associated with ischaemic segments showing reversible perfusion defects. Stress myocardial perfusion SPET with ECG-gating is a feasible method for the evaluation of myocardial stunning as well as exercise-induced ischaemia. (orig.)

  18. Automated quantitative coronary computed tomography correlates of myocardial ischaemia on gated myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Graaf, Michiel A. de; Boogers, Mark J.; Veltman, Caroline E.; El-Naggar, Heba M.; Bax, Jeroen J.; Delgado, Victoria; Broersen, Alexander; Kitslaar, Pieter H.; Dijkstra, Jouke; Kroft, Lucia J.; Younis, Imad Al; Reiber, Johan H.; Scholte, Arthur J.

    2013-01-01

    Automated software tools have permitted more comprehensive, robust and reproducible quantification of coronary stenosis, plaque burden and plaque location of coronary computed tomography angiography (CTA) data. The association between these quantitative CTA (QCT) parameters and the presence of myocardial ischaemia has not been explored. The aim of the present investigation was to evaluate the association between QCT parameters of coronary artery lesions and the presence of myocardial ischaemia on gated myocardial perfusion single-photon emission CT (SPECT). Included in the study were 40 patients (mean age 58.2 ± 10.9 years, 27 men) with known or suspected coronary artery disease (CAD) who had undergone multidetector row CTA and gated myocardial perfusion SPECT within 6 months. From the CTA datasets, vessel-based and lesion-based visual analyses were performed. Consecutively, lesion-based QCT was performed to assess plaque length, plaque burden, percentage lumen area stenosis and remodelling index. Subsequently, the presence of myocardial ischaemia was assessed using the summed difference score (SDS ≥2) on gated myocardial perfusion SPECT. Myocardial ischaemia was seen in 25 patients (62.5 %) in 37 vascular territories. Quantitatively assessed significant stenosis and quantitatively assessed lesion length were independently associated with myocardial ischaemia (OR 7.72, 95 % CI 2.41-24.7, p 2 = 20.7) and lesion length (χ 2 = 26.0) to the clinical variables and the visual assessment (χ 2 = 5.9) had incremental value in the association with myocardial ischaemia. Coronary lesion length and quantitatively assessed significant stenosis were independently associated with myocardial ischaemia. Both quantitative parameters have incremental value over baseline variables and visually assessed significant stenosis. Potentially, QCT can refine assessment of CAD, which may be of potential use for identification of patients with myocardial ischaemia. (orig.)

  19. Determinants of the response of left ventricular ejection fraction to vasodilator stress in electrocardiographically gated {sup 82}rubidium myocardial perfusion PET

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    Brown, Tracy L.Y.; Merrill, Jennifer; Bengel, Frank M. [Johns Hopkins University, Department of Radiology and Radiological Sciences, Division of Nuclear Medicine, Baltimore, MD (United States); Volokh, Lana [GE Healthcare, Haifa (Israel)

    2008-02-15

    Myocardial perfusion imaging with {sup 82}Rb PET allows for ECG-gated studies to be obtained early after radiotracer injection, capturing ventricular function close to peak pharmacologic action of dipyridamole. This is different from gated SPECT and may potentially provide additional diagnostic information. We sought to identify potential correlates of the PET-derived ejection fraction response to vasodilator stress. One hundred ten consecutive patients undergoing {sup 82}Rb PET myocardial perfusion imaging during evaluation for coronary artery disease were included. Using a GE Discovery STRx PET-CT scanner, ECG-gated images (eight bins) were obtained at rest and 4 min after dipyridamole infusion, 90 s after infusion of 1,480-2,220 MBq of {sup 82}Rb. Summed rest, stress, and difference scores (SRS, SSS, and SDS) were determined using a five-point scoring system and 20-segment model. Ejection fraction was calculated using automated QGS software. Significant reversibility (SDS {>=} 4) was found in 23 patients (21%). Mean LVEF in all patients was 47 {+-} 13% at rest and 53 {+-} 13% during dipyridamole. LVEF increased in 89 patients, and decreased in 17 patients during vasodilation. The change in LVEF was inversely correlated with SDS (r = -0.26; p = 0.007). Additionally, it was inversely correlated with resting LVEF (r = -0.20; p = 0.03) and SSS (r = -0.25; p = 0.009). No significant correlations were observed with SRS, heart rate, blood pressure, age, hypertension, hypercholesterolemia, or pretest likelihood of disease. At multivariate regression analysis, SDS was an independent predictor of the change in LVEF. Gated {sup 82}Rb PET during pharmacologic stress allows for assessment of the functional response to vasodilation. The magnitude of LVEF increase is determined by stress perfusion/reversible perfusion defects. Functional response to hyperemia may thus be incorporated in future evaluations of diagnostic and prognostic algorithms based on {sup 82}Rb PET. (orig.)

  20. Automated quantitative coronary computed tomography correlates of myocardial ischaemia on gated myocardial perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Graaf, Michiel A. de; Boogers, Mark J.; Veltman, Caroline E. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); The Interuniversity Cardiology Institute of The Netherlands, Utrecht (Netherlands); El-Naggar, Heba M.; Bax, Jeroen J.; Delgado, Victoria [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Broersen, Alexander; Kitslaar, Pieter H.; Dijkstra, Jouke [Leiden University Medical Center, Department of Radiology, Division of Image Processing, Leiden (Netherlands); Kroft, Lucia J. [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Younis, Imad Al [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands); Reiber, Johan H. [Leiden University Medical Center, Department of Radiology, Division of Image Processing, Leiden (Netherlands); Medis medical imaging systems B.V., Leiden (Netherlands); Scholte, Arthur J. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands)

    2013-08-15

    Automated software tools have permitted more comprehensive, robust and reproducible quantification of coronary stenosis, plaque burden and plaque location of coronary computed tomography angiography (CTA) data. The association between these quantitative CTA (QCT) parameters and the presence of myocardial ischaemia has not been explored. The aim of the present investigation was to evaluate the association between QCT parameters of coronary artery lesions and the presence of myocardial ischaemia on gated myocardial perfusion single-photon emission CT (SPECT). Included in the study were 40 patients (mean age 58.2 {+-} 10.9 years, 27 men) with known or suspected coronary artery disease (CAD) who had undergone multidetector row CTA and gated myocardial perfusion SPECT within 6 months. From the CTA datasets, vessel-based and lesion-based visual analyses were performed. Consecutively, lesion-based QCT was performed to assess plaque length, plaque burden, percentage lumen area stenosis and remodelling index. Subsequently, the presence of myocardial ischaemia was assessed using the summed difference score (SDS {>=}2) on gated myocardial perfusion SPECT. Myocardial ischaemia was seen in 25 patients (62.5 %) in 37 vascular territories. Quantitatively assessed significant stenosis and quantitatively assessed lesion length were independently associated with myocardial ischaemia (OR 7.72, 95 % CI 2.41-24.7, p < 0.001, and OR 1.07, 95 % CI 1.00-1.45, p = 0.032, respectively) after correcting for clinical variables and visually assessed significant stenosis. The addition of quantitatively assessed significant stenosis ({chi} {sup 2} = 20.7) and lesion length ({chi} {sup 2} = 26.0) to the clinical variables and the visual assessment ({chi} {sup 2} = 5.9) had incremental value in the association with myocardial ischaemia. Coronary lesion length and quantitatively assessed significant stenosis were independently associated with myocardial ischaemia. Both quantitative parameters have

  1. 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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  2. Localization and quantification of acute myocardial infarction by myocardial perfusion tomographic imaging

    International Nuclear Information System (INIS)

    Lin Xiufang; Min Changgeng; Lin Zhihu; Ke Ruoyi

    1994-01-01

    The authors reported the result of the quantification and localization of 30 clinically confirmed acute myocardial infarction patients in comparison with that of ECG. A left ventricle model was used to correct the area calculated by the method of Bull's eye. The result indicated that the infarction area calculated by the corrected Bull's eye method correlated closely with that determined by the ECG QRS scoring method (r = 0.706, P<0.01). Myocardial infarctions of all 30 patients were detected by both ECG and myocardial perfusion tomographic imaging. The accuracy of localization of myocardial infarction by myocardial perfusion imaging was similar to that of ECG in the anterior wall, anterior septum, anterior lateral and inferior wall, but superior to that of ECG in the apex, posterior lateral, posterior septum, and posterior wall

  3. Resting electrocardiogram and stress myocardial perfusion imaging in the determination of left ventricular systolic function: an assessment enhancing the performance of gated SPET.

    Science.gov (United States)

    Moralidis, Efstratios; Spyridonidis, Tryfon; Arsos, Georgios; Skeberis, Vassilios; Anagnostopoulos, Constantinos; Gavrielidis, Stavros

    2010-01-01

    This study aimed to determine systolic dysfunction and estimate resting left ventricular ejection fraction (LVEF) from information collected during routine evaluation of patients with suspected or known coronary heart disease. This approach was then compared to gated single photon emission tomography (SPET). Patients having undergone stress (201)Tl myocardial perfusion imaging followed by equilibrium radionuclide angiography (ERNA) were separated into derivation (n=954) and validation (n=309) groups. Logistic regression analysis was used to develop scoring systems, containing clinical, electrocardiographic (ECG) and scintigraphic data, for the discrimination of an ERNA-LVEFstatistic (mean+/-2SD) provided values of 0.001+/-0.176, 0.071+/-0.196 and 0.040+/-0.152, respectively. The average LVEF was a better discriminator of systolic dysfunction than gated SPET-LVEF in receiver operating characteristic (ROC) analysis and identified more patients (89%) with a stress myocardial perfusion imaging variables. This model provides reliable LVEF estimations, comparable to those from (201)Tl gated SPET, and can enhance the clinical performance of the latter.

  4. An evaluation of the ECG gated cardiac CT on old myocardial infarction

    International Nuclear Information System (INIS)

    Tanegashima, Kazuhiro; Tejima, Yasuaki; Nakasone, Noriyo; Hyodo, Haruo

    1984-01-01

    In order to examine the accuracy of ECG gated cardiac CT (G-CCT), G-CCT findings were compared with ECG and cardiac echographic findings in 25 cases of old myocardial infarction. From the detection rate according to the infarct area, abnormal findings in the anterior wall and the septum obtained from G-CCT were in good accordance with those from ECG. Although all of the G-CCT findings did not agree with those of cardiac echography in cases in which abnormal findings were seen in multiple areas, the detection rate of cardiac abnormal findings as a whole by G-CCT was the same as that by cardiac echography. (Namekawa K.)

  5. Ecg changes after dipyridamole infusion in patients undergoing myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Taherpour, M.; Zakavi, R.; Ariana, K.

    2002-01-01

    Dipyridamole is used as the main pharmacological stress agent in patient referred for myocardial perfusion imaging. This vasodilator agent makes difference between normal and abnormal coronary perfusion. Some authors believe that post-Dipyridamole Ecg changes have low sensitivity and relatively high specificity for ischemic detection. This study tries to evaluate this issue. All patients who referred to nuclear medicine department for Myocardial Perfusion Imaging and were not suitable for treadmill E T T, and had no L BBB pattern in basal Ecg were included in the study. Basal and post Dipyridamole Ecg were interpreted with a cardiologist after infusion of 142 u g/kg/min of Dipyridamole and all changes as well as basal Ecg abnormalities were recorded. Also Q Tc were calculated in all Ecg records: M P Is were interpreted by a nuclear medicine specialist and summed stress and rest scores were determined. Two hundred patients including 89 female (44.5%) and 111 male (55.5%) with a mean age of 55.2 years and age range of 30-85 years were studied. Mean basal and post Dipyridamole heart rates were 72.2/min and 84.8/min and mean basal and post Dipyridamole Qt Cs were 419.6 msec and 435.7 msec respectively. New Ecg changes were noted in 22.5% of cases and consisted of 1% T-wave flattening, 1% T-wave inversion, 16.5% St depression and 4% Pseudo normalization. Horizontal pattern was the main type of St segment depression (83.%) among new S T changes. Mean St depression severity was 0.8 mm with a range of 0.5-2 mm. New St depression was noted in lateral leads (Excluding high lateral) in 62.5% of new S T changes. M P I was interpreted normal in 4% of cases and showed some degrees of ischemia in 42% of the cases. The mean post Dipyridamole heart rate increment, was 11.2/ min patients with abnormal scintigraphy (infarct and/or ischemia) compared to 14.5/ min in normal cases. (P=0.009). Also Qt c increment in patients with ischemia was significantly more than patients with simple

  6. Cardiac events in patients with positive exercise ECG and normal myocardial perfusion scan - a retrospective study

    International Nuclear Information System (INIS)

    Marshman, K.; Thomson, L.E.J.; Rowe, C.C.; Burns, A.J.; Woon, F.S.

    2002-01-01

    Full text: The low risk of future cardiac events following a normal myocardial perfusion study with normal stress ECG has been well documented. However, there is little literature regarding the prognosis in patients with a positive stress ECG (PosETT) and normal myocardial perfusion scan (MPS). A search of our database over an eighteen month period identified 21 patients who fitted study criteria. A PosETT was defined as stress induced horizontal or downsloping ST depression > 1mm in one or more leads with a normal baseline 12 lead ECG. Patients were divided into two subgroups depending on the severity of ST depression. A mildly PosETT was defined as ST depression of 1-1.5mm (n=10) and strongly PosETT was defined as ST depression of >2mm in at least one lead with depression in other leads (n=l 1). A normal MPS was defined as absence of reversible perfusion defects on SPECT imaging. Technetium 99m Tetrofosmin was the imaging agent used in 18/21 patients. All 21 patients exercised using the Bruce protocol for 3-12 minutes, and 9 experienced chest pain 12 months after the MPS, referring physicians were contacted. Cardiac events were defined as cardiac death, myocardial infarction, unstable angina, cardiac failure, revascularisation or a coronary angiogram demonstrating >70% stenosis. To date, follow up is complete in 11 patients with one confirmed case of single vessel revascularisation 3 months post MPS. Full follow up data will be presented. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  7. Evaluation of multi-gated myocardial perfusion imaging in various heart diseases

    International Nuclear Information System (INIS)

    Nishimura, Tsunehiko; Uehara, Toshitake; Kozuka, Takahiro

    1980-01-01

    Multi-gated myocardial perfusion imaging were studied in a hundred cases of various heart diseases. In normal cases, ED ES images showed thinning and thickening of wall motion respectively to compare with static images. In the myocardial infarction cases, the dynamic changes of wall motion was decreased at infarcted areas in all cases. In congestive cardiomyopathy, the change of wall motion is smaller than normal cases in all cases, while in hypertrophic cardiomyopathy, the change is not so hyperdynamic to compare with normal cases and by multi-gated images, asymmetric hypertrophy was clearly detected in HCM than static images. In conclusion, these methods were useful to detect the myocardial contraction stage in various heart diseases. (author)

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

    International Nuclear Information System (INIS)

    Jia Peng; Guo Wanhua; Du Minghua; Gao Ling

    2010-01-01

    Objective: To evaluate the value of gated 99 Tc m -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, narrowing 99 Tc m -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; P 99 Tc m -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)

  9. Gated spect myocardial perfusion scintigraphy for identifying septal perfusion artifacts in left bundle branch block

    International Nuclear Information System (INIS)

    Afzal, M.S.; Imran, M.B.; Akhtar, M.S.; Muhammand, K.; Nadeem, A.; Aslam, N.; Khurshid, S.J.; Farooq, U.I.; Sohaib, M.

    2006-01-01

    To determine the role of gated Single Photon Emission Computed Tomography (SPECT) for accurate assessment of myocardial perfusion scintigraphy (MPS) of patients with left bundle branch block (LBBB). MPS data of patients with LBBB was analyzed. Resting gated SPECT MPS was performed after an injection of 740 MBq 99mTc-MIBI in 10 normal and 25 subjects with LBBB (with low probability of coronary artery disease). Visual and quantitative analyses were done on non-gated (NG), end diastolic (ED), end systolic (ES) images. Calculations included septal to lateral wall ratio (SLR), myocardial thickening (MT=% increase in counts during systole) at end systolic phase and myocardial thickening at peak level (% peak MT). Septal hypoperfusion was noted in 19 (76%) patients on NG images and in only 1 (4%) patient on gated SPECT ED images. On NG images of LBBB group, SLR was lower than in controls (0.68 +- 0.07 vs. 0.87 +- 0.05, p<0.001). SLR of LBBB patients approached to that of control group in gated SPECT ED data (0.86 +- 0.06 vs 0.88 +- 0.06, p=ns). Myocardial thickening at ES for septum was markedly lower in LBBB group than in controls (21.83% +- 10.86 vs. 66.32% +- 20.15, p<0.001). (author)

  10. Clinical indications for Thallium-201 myocardial perfusion scanning

    International Nuclear Information System (INIS)

    Dunn, R.J.; Kelly, D.T.

    1982-01-01

    Thallium-201 myocardial perfusion scanning can assess regional myocardial perfusion non-invasively. As it is both time-consuming and expensive its use should be restricted to specific diagnostic problems. The clinical indications in known or suspected coronary artery disease are reviewed. In suspected coronary artery disease thallium scanning is most useful in patients with chest pain when the exercise ECG is uninterpretable, in men with probable angina but a negative exercise ECG, or conversely a positive exercise ECG without typical angina, and in women with probable angina and either a positive or a negative exercise ECG. In known coronary artery disease, thallium scanning may help determine the functional significance of a coronary obstruction found at angiography and may determine the site of myocardial ischaemia when multiple obstructions are present

  11. Low dose prospective ECG-gated delayed enhanced dual-source computed tomography in reperfused acute myocardial infarction comparison with cardiac magnetic resonance

    International Nuclear Information System (INIS)

    Wang Rui; Zhang Zhaoqi; Xu Lei; Ma Qin; He Yi; Lu Dongxu; Yu Wei; Fan Zhanming

    2011-01-01

    Purpose: To determine whether prospective electrocardiogram (ECG)-gated delayed contrast-enhanced dual-source computed tomography (DCE-DSCT) can accurately delineate the extension of myocardial infarction (MI) compared with delayed enhanced cardiac MR (DE-MR). Material and methods: Eleven patients were examined using dual-source CT and cardiac MR in 2 weeks after a first reperfused MI. DCE-DSCT scan protocol was performed with prospective ECG-gating sequential scan model 7 min after contrast administration. In a 17-model, infarcted myocardium detected by DE-MR was categorized as transmural and subendocardial extension. Segment of infarcted location and graded transmurality were compared between DCE-MDCT and DE-MR. Results: In all eleven patients, diagnostic quality was obtained for depicting delayed enhanced myocardium. Agreement between DCE-DSCT and MR was good on myocardial segment based comparison (kappa = 0.85, p < 0.001), and on transmural and subendocardial infarction type comparison (kappa = 0.82, p < 0.001, kappa = 0.52, p < 0.001, respectively). CT value was higher on infarcted region than that of normal region (100.02 ± 9.57 HU vs. 72.63 ± 7.32 HU, p < 0.001). Radiation dose of prospectively ECG-gating protocol were 0.99 ± 0.08 mSv (0.82-1.19 mSv). Conclusions: Prospective ECG-gated DCE-DSCT can accurately assess the extension and the patterns of myocardial infarction with low radiation dose.

  12. Low dose prospective ECG-gated delayed enhanced dual-source computed tomography in reperfused acute myocardial infarction comparison with cardiac magnetic resonance

    Energy Technology Data Exchange (ETDEWEB)

    Wang Rui, E-mail: rui_wang1979@yahoo.cn [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Zhang Zhaoqi, E-mail: zhaoqi5000@vip.sohu.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Xu Lei, E-mail: leixu2001@hotmail.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Ma Qin, E-mail: tel1367@gmail.com [Department of Emergency, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); He Yi, E-mail: heyi139@sina.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Lu Dongxu, E-mail: larry.hi@163.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Yu Wei, E-mail: yuwei02@gmail.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Fan Zhanming, E-mail: fanzm120@tom.com [Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China)

    2011-11-15

    Purpose: To determine whether prospective electrocardiogram (ECG)-gated delayed contrast-enhanced dual-source computed tomography (DCE-DSCT) can accurately delineate the extension of myocardial infarction (MI) compared with delayed enhanced cardiac MR (DE-MR). Material and methods: Eleven patients were examined using dual-source CT and cardiac MR in 2 weeks after a first reperfused MI. DCE-DSCT scan protocol was performed with prospective ECG-gating sequential scan model 7 min after contrast administration. In a 17-model, infarcted myocardium detected by DE-MR was categorized as transmural and subendocardial extension. Segment of infarcted location and graded transmurality were compared between DCE-MDCT and DE-MR. Results: In all eleven patients, diagnostic quality was obtained for depicting delayed enhanced myocardium. Agreement between DCE-DSCT and MR was good on myocardial segment based comparison (kappa = 0.85, p < 0.001), and on transmural and subendocardial infarction type comparison (kappa = 0.82, p < 0.001, kappa = 0.52, p < 0.001, respectively). CT value was higher on infarcted region than that of normal region (100.02 {+-} 9.57 HU vs. 72.63 {+-} 7.32 HU, p < 0.001). Radiation dose of prospectively ECG-gating protocol were 0.99 {+-} 0.08 mSv (0.82-1.19 mSv). Conclusions: Prospective ECG-gated DCE-DSCT can accurately assess the extension and the patterns of myocardial infarction with low radiation dose.

  13. Evaluation of ECG-gated [(11)C]acetate PET for measuring left ventricular volumes, mass, and myocardial external efficiency.

    Science.gov (United States)

    Hansson, Nils Henrik; Tolbod, Lars; Harms, Johannes; Wiggers, Henrik; Kim, Won Yong; Hansen, Esben; Zaremba, Tomas; Frøkiær, Jørgen; Jakobsen, Steen; Sørensen, Jens

    2016-08-01

    Noninvasive estimation of myocardial external efficiency (MEE) requires measurements of left ventricular (LV) oxygen consumption with [(11)C]acetate PET in addition to LV stroke volume and mass with cardiovascular magnetic resonance (CMR). Measuring LV geometry directly from ECG-gated [(11)C]acetate PET might enable MEE evaluation from a single PET scan. Therefore, we sought to establish the accuracy of measuring LV volumes, mass, and MEE directly from ECG-gated [(11)C]acetate PET. Thirty-five subjects with aortic valve stenosis underwent ECG-gated [(11)C]acetate PET and CMR. List mode PET data were rebinned into 16-bin ECG-gated uptake images before measuring LV volumes and mass using commercial software and compared to CMR. Dynamic datasets were used for calculation of mean LV oxygen consumption and MEE. LV mass, volumes, and ejection fraction measured by CMR and PET correlated strongly (r = 0.86-0.92, P PET (P PET-based MEE, corrected for bias, correlated fairly with PET/CMR-based MEE (r = 0.60, P PET-based MEE bias was strongly associated with LV wall thickness. Although analysis-related improvements in accuracy are recommended, LV geometry estimated from ECG-gated [(11)C]acetate PET correlate excellently with CMR and can indeed be used to evaluate MEE.

  14. Prognostic value of gated 201Tl myocardial perfusion SPECT imaging in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Li Zicheng; Chen Xiaoming; Xu Hao

    2006-01-01

    Objective: To study the prognostic value of gated 201 Tl myocardial perfusion SPECT imaging in patients with coronary artery disease and assessment of therapy strategy for the individual patient. Methods: Eighty-four patients underwent rest and exercise stress 201 Tl gated myocardial perfusion SPECT imaging and were followed up for (32.92 ± 16.77) months. Images were studied using 17 segments and 1 to 4 scoring. Global summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS=SSS-SRS) were also calculated. Post-stress and rest ejection fraction (EF) were automatically measured. Results: Nine cardiac events occurred (3.90% per year). SSS, SDS, SRS and EF were the independent predictors of cardiac events (P 201 Tl myocardial perfusion SPECT imaging can provide prognostic assessment for the patients with coronary artery disease and guide in selection of therapeutic strategy. Among all of the indices SSS is the best predictors of cardiac events. (authors)

  15. Comparison between fragmented QRS and Q waves in myocardial scar detection using myocardial perfusion single photon emission computed tomography.

    Science.gov (United States)

    Dabbagh Kakhki, Vahid Reza; Ayati, Narjess; Zakavi, Seyed Rasoul; Sadeghi, Ramin; Tayyebi, Mohammad; Shariati, Farzaneh

    2015-01-01

    Accurate diagnosis of myocardial infarction (MI) is of paramount importance in patient management, which necessitates the development of efficient and accurate diagnostic methods. Q wave is not present in all patients with MI, and its prevalence is declining. Recently, fragmented QRS (fQRS) complex has been introduced as a marker of prior MI. To investigate diagnostic value of fQRS compared to Q wave. We included 500 consecutive patients with known or suspected coronary artery disease who underwent two days of gated myocardial perfusion imaging using dipyridamole pharmacologic stress. Electrocardiogram (ECG) was evaluated to detect fQRS as well as Q-wave. Finally, subjects were compared in terms of ventricular perfusion and function indices. A total of 207 men and 269 women with mean age of 57.06 ± 12 years were studied. ECG analysis showed that 14.3% of the patients had both fQRS and Q waves, 30.7% had fQRS, and 3.8% had Q waves. Fixed myocardial perfusion defect was noted in 22.3% of patients according to MPIs. Sensitivity, specificity, and positive and negative predictive values for myocardial scar detection were 78%, 65%, 39%, and 91%, respectively, for fQRS and 61%, 94%, 76%, and 89%, respectively, for Q wave. Although fQRS had lower specificity compared to Q wave in the detection of myocardial scar, due to higher sensitivity and negative predictive value can be an invaluable diagnostic index. There is also an incremental value for fQRS in association with Q-wave in myocardial scar assessment.

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

    International Nuclear Information System (INIS)

    Wang Yuetao; Fu Ning; Ding Xuemei; Lu Cunzhi; Zhu Feng; Wang Guanmin; Huang Yijie; Wang Linguang

    2008-01-01

    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. 99 Tc m -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 χ 2 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 99 Tc m -MIBI myocardial perfusion imaging defined positive myocardial ischemia in 10 and negative in 9 patients. Of the 10 patients with 99 Tc m -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), χ 2 = 4.07, P 99 Tc m -MIBI myocardial periusion imaging defined myocardial ischemia. Six cases with Grade II stenosis, two were 99 Tc m -MIBI myocardial perfusion imaging defined myocardial ischemia. Eight cases with Grade III stenosis, seven were 99 Tc m -MIBI myocardial perfusion imaging defined myocardial

  17. Functional assessment of the right ventricle with gated myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Wadhwa, S.S.; Abbati, D.; Carolan, M.

    2002-01-01

    Full text: Evaluation of right ventricular function can provide valuable information in a variety of cardiac and non-cardiac conditions. Functional assessment of the right ventricle is difficult owing to its anatomy and geometry. We describe a method of assessing right ventricular function using gated myocardial perfusion SPECT. In 20 patients right and left ventricular ejection fractions (RVEF, LVEF) were determined using gated blood pool (GBPS) and gated myocardial perfusion SPECT (GSPECT). To avoid contamination with right atrial activity the two frame method was adopted for gated blood pool data when measuring RVEF. In 9 patients with normal right ventricles, an index of wall thickening for the right ventricle was derived from the peak systolic and diastolic counts in the free wall. There was good linear correlation between the two methods adopted for calculation of LVEF and RVEF. Bland - Airman analysis demonstrated good agreement between the two methods with no specific bias. The mean LVEF was 47.9 +/-12% (GBPS) and 47.3 +/- 12.4 (GSPECT). The mean RVEF was 43.2 +/- 9.6% (GBPS) and 44.2 +/- 8.5% (GSPECT). In both cases the values were significantly different. The mean wall motion index was 35%. There was no correlation between the wall thickness index and ejection fraction however the index was greater in patients with normal right ventricle than in those with reduced RVER Gated SPECT offers an alternative to GBPS for the functional assessment of the right ventricle. Utilising GSPECT will allow the simultaneous assessment of both the right and left ventricles. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  18. Quantification of left ventricular regional functions using ECG-gated myocardial perfusion SPECT. Validation of left ventricular systolic functions

    International Nuclear Information System (INIS)

    Yamamoto, Akira; Takahashi, Naoto; Iwahara, Shin-ichiro; Munakata, Kazuo; Hosoya, Tetsuo

    2006-01-01

    We have developed a program to quantify regional left ventricular (LV) function and wall motion synchrony using electrocardiogram (ECG)-gated myocardial perfusion SPECT (MPS). This preliminary study was undertaken to validate the use of this program for estimating regional LV systolic function. Patients were subjected to MPS by 99m Tc-sestamibi at rest. The study included 20 patients who were confirmed to have a low probability of coronary artery disease (LPG; low probability group), 19 heart disease patients who were examined by MPS and equilibrium radionuclide angiography (ERNA) (ERG; ERNA group), and 24 patients who were examined by MPS and 2-dimensional echocardiography (2DE) (2DEG; 2DE group). The values of the ejection fraction (EF) and peak ejection rate (PER) were estimated. The global functions evaluated by this program were compared with those obtained by ERNA in the ERG. For regional assessment, the reference values of the functional indices were obtained for 17 LV segments in LPG. The Z score, (reference average value of the segment-patient's value of the segment)/reference standard deviation of the segment, was used for the evaluation of regional functions; a score equal to or greater than 2 was defined as abnormal. Semiquantitative visual interpretation of 2DE was used as the standard to assess wall motion. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these criteria and the relationship between 2DE grading and Z scoring were validated in 2DEG. The values of the global EF and PER evaluated by this program correlated with those determined by ERNA (r=0.76 and 0.58, respectively; p -10 ). The potential of this program to quantify the regional systolic function was validated. (author)

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

    Directory of Open Access Journals (Sweden)

    E.N. Ostroumov

    2009-01-01

    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.

  20. Diagnostic value of rest and stress gated 82Rb PET myocardial perfusion imaging using quantitative software

    International Nuclear Information System (INIS)

    Shi Hongcheng; Gu Yusen; Liu Wenguan; Zhu Weimin; Halkar, R.K.; Santana, C.A.; Feng Yusheng

    2008-01-01

    Objective: Gated myocardial perfusion imaging (MPI) is regularly performed using SPECT. More recently, gated 82 Rb MPI has been used to assess left ventricular myocardial perfusion and function with new generation PET scanners. The objective of this study was to evaluate the value of rest and stress gated 82 Rb PET myocardial perfusion imaging and to determine whether the quantitative technique in- creased the confidence level of the interpreters. Methods: Thirty-two patients underwent rest and adenosine stress gated 82 Pb PET MPI. Emory Cardiac Toolbox quantitative software was used for processing and inter-predation. Left ventricular ejection fraction (LVEF), end-diastolic, end-systolic and transient ischemia dilation ratio were automatically generated. Three interpreters (nuclear medicine doctors) independently reviewed the studies. Visual scoring (1-5 scales: excellent, good, unsure, poor, uninterpretable) was used to assess the overall quality of the gated images and the added confidence level of interpretation. Visual assessment of the LVEF was compared to the automatically generated LVEF. Comparison between the visual assessment and software generated was graded on a 1- 5 scales (helpful, probably helpful, unsure, probably not helpful, definitely not helpful). The analysed items were divided into two groups (favorable group and negative group). The percentage and 95% confidence intervals of each group were calculated. Results: A total of 192 gated studies were evaluated (64 gated x 3 interpreters ). The overall quality of the gated images was good [excellent 40.1% (77/192), good 43.2% (83/192), unsure 3.1% (6/192), poor 13.6% (26/192), uninterpretable 0]. The 95% confidence intervals of good and excellent quality range from 78.1% to 88.6%. The interpreter's agreed with the automated LVEF on 85.4% of the gated images [agree 76.6% (147/192), probably agree 8.8% (17/192), unsure 3.1% (6/192), probably disagree 8.8% (17/192), disagree 2.6% (5/192)]. And its 95

  1. Evaluation of left ventricular ejection fraction from radial long-axis tomography. A new reconstruction algorithm for ECG-gated technetium-99m Sestamibi SPECT

    International Nuclear Information System (INIS)

    Tsujimura, Eiichiro; Kusuoka, Hideo; Uehara, Toshiisa

    1997-01-01

    Radial long-axis tomography can provide views similar to contrast left ventriculography (LVG) including the basal and apical areas of the left ventricle, not possible in routine short-axis tomography. We applied this method to ECG-gated Tc-99m Sestamibi (MIBI) myocardial SPECT images to estimate the left ventricular ejection fraction (LVEF). ECG-gated Tc-99m MIBI SPECT was performed with a temporal resolution of 10 frames per R-R interval. LVEF was calculated on the basis of left ventricular volume estimates at end diastole (ED) and end systole (ES) with using an ellipsoid body model. To validate this method, LVEF's derived from ECG-gated Tc-99m MIBI SPECT were compared with those from LVG in 11 patients with coronary artery disease. There was a close linear correlation between LVEF values calculated from Tc-99m MIBI SPECT and those from LVG (r=0.89, p<0.001), although the gated SPECT underestimated LVEF compared to LVG. The technique showed excellent reproducibility (intra-observer variability, r=0.96, p<0.001; inter-observer variability, r=0.71, p<0.005). The radial long-axis tomography technique gives a good estimate of LVEF, in agreement with estimates based on LVG. ECG-gated Tc-99m MIBI SPECT can, therefore, be applicable to assess myocardial perfusion and ventricular function at the same time. (author)

  2. Evaluation of left ventricular ejection fraction from radial long-axis tomography. A new reconstruction algorithm for ECG-gated technetium-99m Sestamibi SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Tsujimura, Eiichiro; Kusuoka, Hideo; Uehara, Toshiisa [Osaka Univ. (Japan). Faculty of Medicine] [and others

    1997-08-01

    Radial long-axis tomography can provide views similar to contrast left ventriculography (LVG) including the basal and apical areas of the left ventricle, not possible in routine short-axis tomography. We applied this method to ECG-gated Tc-99m Sestamibi (MIBI) myocardial SPECT images to estimate the left ventricular ejection fraction (LVEF). ECG-gated Tc-99m MIBI SPECT was performed with a temporal resolution of 10 frames per R-R interval. LVEF was calculated on the basis of left ventricular volume estimates at end diastole (ED) and end systole (ES) with using an ellipsoid body model. To validate this method, LVEF`s derived from ECG-gated Tc-99m MIBI SPECT were compared with those from LVG in 11 patients with coronary artery disease. There was a close linear correlation between LVEF values calculated from Tc-99m MIBI SPECT and those from LVG (r=0.89, p<0.001), although the gated SPECT underestimated LVEF compared to LVG. The technique showed excellent reproducibility (intra-observer variability, r=0.96, p<0.001; inter-observer variability, r=0.71, p<0.005). The radial long-axis tomography technique gives a good estimate of LVEF, in agreement with estimates based on LVG. ECG-gated Tc-99m MIBI SPECT can, therefore, be applicable to assess myocardial perfusion and ventricular function at the same time. (author)

  3. Analysis of the cardiac motion in myocardial infarction by the ECG-synchronized CT

    International Nuclear Information System (INIS)

    Watanabe, Shigeru; Shimizu, Masahiko; Yoshida, Hideo; Morooka, Nobuhiro; Shukuya, Masaki

    1981-01-01

    The cardiac motion in patients with myocardial infarction was analyzed by the ECG-synchronized computed tomography (CT). For ECG synchronization, the ECG gating method and the data sorting method were used. By the ECG gating method, the gated cardiac images during 0.1 msec intervals at end-diastolic and the end-systolic phases were obtained. By the data sorting method, phasic CT images were reconstructed retrospectively by selecting appropriate data from a series of consecutive scans taken with simultaneous continuous ECG recordings. Six normal subjects and eight patients with myocardial infarction were studied by the ECG gating method, and 14 normal subjects and 25 patients with myocardial infarction were studied by the data sorting method. The end-diastolic and the end-systolic pictures at mid left ventricular level were superimposed and the cardiac borders were traced for the analysis (Fig. 4). Then the cardiac cross-sectional areas at each cardiac phase (40 msec) were calculated, and a cardiac area curve was obtained by plotting them consecutively. The cross-sectional images were divided into right anterior, right posterior, left anterior and left posterior segments. Cardiac area curves of the each segment were also obtained for further analysis. From these curves, the changing ratio of cardiac areas (maximum area - minimum area/maximum area) and the maximum area velocity in systole and diastole were calculated. On the images and the cardiac area curves in myocardial infarction patients, abnormal myocardial movements such as partial akinesis, hypokinesis or paradoxical movement were apparent asd the area of abnormal motions corresponded well with the location of infarction determined by ECG, RI scanning and angiography. A decrease of the changing ratio and the velocity in the infarction area were shown (Fig. 6, 7) and the functional disturbances were suggested during not only systole but diastole also. (author)

  4. Simultaneous determination of left ventricular perfusion and function

    International Nuclear Information System (INIS)

    Gremillet, E.; Champailler, A.; Esquerre, J.P.; Ouhayoun, E.; Coca, F.; Furber, A.; Le Jeune, J.J.

    1997-01-01

    Myocardial perfusion scintigraphy is a very useful tool for the diagnosis and prognosis of coronary artery disease. The evaluation of left ventricular function during stress testing in also very useful to determine the prognosis of coronary artery disease. This chapter highlights three different imaging methods to assess left ventricular function and myocardial perfusion/ The first one consists of sequential dual isotope myocardial SPECT with ECG-gating. The second concerns magnetic resonance imaging and the third explores first pass exercise ventriculography and myocardial perfusion scintigraphy simultaneously evaluated by means of 99m Tc-sestamibi. (authors)

  5. Prediction of functional recovery after revascularization using quantitative gated myocardial perfusion SPECT: a multi-center cohort study in Japan

    International Nuclear Information System (INIS)

    Nakajima, Kenichi; Tamaki, Nagara; Kuwabara, Yoichi; Kawano, Masaya; Matsunari, Ichiro; Taki, Junichi; Nishimura, Shigeyuki; Yamashina, Akira; Ishida, Yoshio; Tomoike, Hitonobu

    2008-01-01

    Prediction of left ventricular functional recovery is important after myocardial infarction. The impact of quantitative perfusion and motion analyses with gated single-photon emission computed tomography (SPECT) on predictive ability has not been clearly defined in multi-center studies. A total of 252 patients with recent myocardial infarction (n = 74) and old myocardial infarction (n = 175) were registered from 25 institutions. All patients underwent resting gated SPECT using 99m Tc-hexakis-2-methoxy-isobutyl isonitrile (MIBI) and repeated the study after revascularization after an average follow-up period of 132 ± 81 days. Visual and quantitative assessment of perfusion and wall motion were performed in 5,040 segments. Non-gated segmental percent uptake and end-systolic (ES) percent uptake were good predictors of wall motion recovery and significantly differed between improved and non-improved groups (66 ± 17% and 55 ± 18%, p 99m Tc-MIBI uptake provided a useful predictor of wall motion improvement. Application of quantitative approach with non-gated and ES percent uptake enhanced predictive accuracy over visual analysis particularly in a multi-center study. (orig.)

  6. LV dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging in patients with Wolff-Parkinson-White syndrome.

    Science.gov (United States)

    Chen, Chun; Li, Dianfu; Miao, Changqing; Feng, Jianlin; Zhou, Yanli; Cao, Kejiang; Lloyd, Michael S; Chen, Ji

    2012-07-01

    The purpose of this study was to evaluate left ventricular (LV) mechanical dyssynchrony in patients with Wolff-Parkinson-White (WPW) syndrome pre- and post-radiofrequency catheter ablation (RFA) using phase analysis of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Forty-five WPW patients were enrolled and had gated SPECT MPI pre- and 2-3 days post-RFA. Electrophysiological study (EPS) was used to locate accessory pathways (APs) and categorize the patients according to the AP locations (septal, left and right free wall). Electrocardiography (ECG) was performed pre- and post-RFA to confirm successful elimination of the APs. Phase analysis of gated SPECT MPI was used to assess LV dyssynchrony pre- and post-RFA. Among the 45 patients, 3 had gating errors, and thus 42 had SPECT phase analysis. Twenty-two patients (52.4%) had baseline LV dyssynchrony. Baseline LV dyssynchrony was more prominent in the patients with septal APs than in the patients with left or right APs (p syndrome. Septal APs result in the greatest degree of LV mechanical dyssynchrony and afford the most benefit after RFA. This study supports further investigation in the relationship between electrical and mechanical activation using EPS and phase analysis of gated SPECT MPI.

  7. Gated-SPECT myocardial scintigraphy in left bundle branch block: A study in patients with and without coronary artery disease

    International Nuclear Information System (INIS)

    Falcao, A.M.; Moffa, P.J.; Chalela, W.A.; Soares, J.; Oliveira, C.G.; Kreling, J.C.; Ferreira, B.A.; Uchida, A.H.; Meneghetti, J.C.

    2002-01-01

    Introduction: Myocardial perfusion scintigraphy (MPS) is a non-invasive method helpful for evaluating coronary heart disease. In left bundle branch block (LBBB), the myocardial scintigraphy frequently reveals septal abnormalities in the absence of coronary artery disease (CAD) and gives rise to 'false-positive' results in patients (pts) with suspected CAD. The purpose of this study was to assess the diagnostic role of ECG-gated SPECT in pts with complete LBBB, with and without known CAD. Methods. This study included 46 pts, 29 women (63%), with mean age 63.8 ± 11.6yr, divided into two groups: Group 1 (n=21 pts) with LBBB and CAD angiographically confirmed and Group 2 (n=25 pts) with LBBB and normal coronangiography. All pts underwent MPS at rest and two stress tests - dipyridamole (DIP) and treadmill exercise test (ET) with Bruce protocol. Myocardial perfusion, wall motility and wall thickening were analyzed qualitatively by consensus of two observers in anterior, septal, inferior, lateral and apical myocardial segments. Scores were attributed to: perfusion as normal, reversible or fixed defects; motility as normal, hypokinesia, akinesia or dyskinesia and thickening if present or absent. The left ventricle ejection fraction (LVEF) was automatically calculated from the ECG-gated SPECT. Results: The comparative analysis between groups 1 and 2 for both stresses (DIP and ET) for the parameters analyzed in the myocardial segments are presented: LVEF at rest, ET and DIP show statistically significant differences between groups 1 and 2 (p<0.0001). Conclusion: In the anterior and septal segments, only septal thickening was capable of differentiating between LBBB with and without CAD, independent of the kind of stress. In the other segments there was no influence of disturbance conduction for the perfusion analysis

  8. Prognostic study of risk stratification among Japanese patients with ischemic heart disease using gated myocardial perfusion SPECT: J-ACCESS study

    International Nuclear Information System (INIS)

    Nishimura, Tsunehiko; Nakajima, Kenichi; Kusuoka, Hideo; Yamashina, Akira; Nishimura, Shigeyuki

    2008-01-01

    Although the prognostic value of myocardial perfusion imaging using gated single photon emission computed tomography (SPECT) for predicting major cardiac events has been evaluated, little is known about the relevance of this procedure to the Japanese population. A total of 4,031 consecutive Japanese patients with suspected or confirmed ischemic heart diseases were registered at 117 hospitals in the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT investigation. Gated stress/rest myocardial perfusion SPECT was performed and the patients were followed up for 3 years. Segmental perfusion scores and quantitative gated SPECT results were calculated. Major cardiac events were defined as cardiac death, nonfatal myocardial infarction, and severe heart failure. During the 3-year follow-up, cardiac death (n = 57) and nonfatal myocardial infarction (n = 39) occurred in 96 patients (2.4%/3 years) when hard events were the endpoints. When severe heart failure was included as an endpoint, major cardiac events that developed in 175 patients (4.3%/3 years) comprised cardiac death (n = 45), nonfatal myocardial infarction (n = 37), and severe heart failure (n = 93). Normal and severely abnormal summed stress score values were associated with low (2.31%/3 years) and high (9.21%/3 years) rates of major cardiac events, respectively. Rates of major cardiac events were significantly higher in patients with ejection fraction (EF) <45% than in those with EF 45% or higher (16.55 vs 2.94%/3 years; P < 0.001). The incidence of major cardiac events within 3 years was also significantly higher among patients with high end-systolic volumes. The major event rates were similar among nondiabetic patients with and diabetic patients without prior myocardial infarction at 5.06% and 5.73%/3 years, respectively. Cardiac event rates were significantly lower in the Japanese than in the USA and European populations. However, large myocardial perfusion defects and

  9. Noninvasive detection of regional myocardial perfusion abnormality with /sup 201/Tl and /sup 81/Rb

    Energy Technology Data Exchange (ETDEWEB)

    Narita, M; Usami, M; Kurihara, T; Kawararadani, H; Kanao, K

    1977-05-01

    Myocardial scintigrams were performed at rest and during exercise using /sup 201/Tl and /sup 81/Rb. Patients underwent graded ergometer exercise stress tests. In normals, myocardial images were horse-shoe or O-shaped and concentration of radionuclide was relatively uniform throughout the myocardium. In 13 patients with old myocardial infarctions, and abnormal Q waves, regional myocardial perfusion defects (cold area) were detected. Their locations correlated with sites of the abnormal Q waves. Two patients had no abnormal Q waves at the examination, but their scintigrams showed cold areas, the locations of which coincided with coronary angiographic findings. Exercise stress ECG and stress scintigrams were performed. Myocardial perfusion defects, which developed from exercise stress, were detected in 9 of 10 positive exercise ECG patients, 2 of 4 equivocal exercise ECG patients, and 2 of 10 negative exercise ECG patients. These 2 patients (exercise ECG (-), stress scintigram (+)) had typical angina. Findings of exercise stress scintigrams coincided better with clinical findings than did those of exercise ECG. These scintigraphic methods appear to be excellent for detection of noninvasive coronary heart disease noninvasively.

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

    International Nuclear Information System (INIS)

    Wei Lingge; Kadoya, Masumi; Momose, Mitsuhiro; Kurozumi, Masahiro; Matsushita, Tsuyoshi; Yamada, Akira

    2007-01-01

    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)

  11. Assessment of left ventricular function by 201Tl FCG-gated myocardial SPECT

    International Nuclear Information System (INIS)

    Toba, Masahiro; Ishida, Yoshio; Fukuchi, Kazuki; Fukushima, Kazuhito; Katafuchi, Tetsurou; Hayashida, Kohei; Oka, Hisashi; Takamiya, Makoto

    1999-01-01

    We applied the QGS program for LV function analysis (described by Germano, 1995) to a 201 Tl SPECT study at rest, and estimated its accuracy. We performed 201 Tl ECG-gated myocardial SPECT in 25 patients with ischemic heart disease under an acquisition time used in the routine 99m Tc ECG-gated SPECT study. The quality of the gated images was visually assessed with a 4-point grading system. LVEDV, LVESV, LVEF determined by the QGS program were compared with those by Simpson's method on biplane LVG in 25 patients. Regional wall motion scores in 7 myocardial segments were assessed on the three-dimensional display created by the QGS program and the cine display of biplane LVG with a 5-point grading system. Wall motion scores obtained by the QGS program were compared with those by LVG. Although 72.0% of 201 Tl ECG-gated SPECT images were fair or poor in image quality, there were good correlations between the values obtained by the QGS program and LVG (LVEDV: r=0.82, LVESV: r=0.88, LVEF: r=0.89). In addition, wall motion scores by the QGS program were correspondent to those by LVG in 77.1% of all 175 myocardial segments. We conclude that the QGS program provides high accuracy in evaluating left ventricular function even from 201 Tl ECG-gated myocardial SPECT data. (author)

  12. Mouse myocardial first-pass perfusion MR imaging

    NARCIS (Netherlands)

    Coolen, Bram F.; Moonen, Rik P. M.; Paulis, Leonie E. M.; Geelen, Tessa; Nicolay, Klaas; Strijkers, Gustav J.

    2010-01-01

    A first-pass myocardial perfusion sequence for mouse cardiac MRI is presented. A segmented ECG-triggered acquisition combined with parallel imaging acceleration was used to capture the first pass of a Gd-DTPA bolus through the mouse heart with a temporal resolution of 300-400 msec. The method was

  13. LV dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging in patients with Wolff-Parkinson-White syndrome

    International Nuclear Information System (INIS)

    Chen, Chun; Li, Dianfu; Miao, Changqing; Zhou, Yanli; Cao, Kejiang; Feng, Jianlin; Lloyd, Michael S.; Chen, Ji

    2012-01-01

    The purpose of this study was to evaluate left ventricular (LV) mechanical dyssynchrony in patients with Wolff-Parkinson-White (WPW) syndrome pre- and post-radiofrequency catheter ablation (RFA) using phase analysis of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Forty-five WPW patients were enrolled and had gated SPECT MPI pre- and 2-3 days post-RFA. Electrophysiological study (EPS) was used to locate accessory pathways (APs) and categorize the patients according to the AP locations (septal, left and right free wall). Electrocardiography (ECG) was performed pre- and post-RFA to confirm successful elimination of the APs. Phase analysis of gated SPECT MPI was used to assess LV dyssynchrony pre- and post-RFA. Among the 45 patients, 3 had gating errors, and thus 42 had SPECT phase analysis. Twenty-two patients (52.4 %) had baseline LV dyssynchrony. Baseline LV dyssynchrony was more prominent in the patients with septal APs than in the patients with left or right APs (p < 0.05). RFA improved LV synchrony in the entire cohort and in the patients with septal APs (p < 0.01). Phase analysis of gated SPECT MPI demonstrated that LV mechanical dyssynchrony can be present in patients with WPW syndrome. Septal APs result in the greatest degree of LV mechanical dyssynchrony and afford the most benefit after RFA. This study supports further investigation in the relationship between electrical and mechanical activation using EPS and phase analysis of gated SPECT MPI. (orig.)

  14. LV dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging in patients with Wolff-Parkinson-White syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Chun; Li, Dianfu; Miao, Changqing; Zhou, Yanli; Cao, Kejiang [First Affiliated Hospital of Nanjing Medical University, Department of Cardiology, Nanjing, Jiangsu (China); Feng, Jianlin [First Affiliated Hospital of Nanjing Medical University, Department of Nuclear Medicine, Nanjing, Jiangsu (China); Lloyd, Michael S. [Emory University School of Medicine, Division of Cardiology, Atlanta, GA (United States); Chen, Ji [Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA (United States)

    2012-07-15

    The purpose of this study was to evaluate left ventricular (LV) mechanical dyssynchrony in patients with Wolff-Parkinson-White (WPW) syndrome pre- and post-radiofrequency catheter ablation (RFA) using phase analysis of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Forty-five WPW patients were enrolled and had gated SPECT MPI pre- and 2-3 days post-RFA. Electrophysiological study (EPS) was used to locate accessory pathways (APs) and categorize the patients according to the AP locations (septal, left and right free wall). Electrocardiography (ECG) was performed pre- and post-RFA to confirm successful elimination of the APs. Phase analysis of gated SPECT MPI was used to assess LV dyssynchrony pre- and post-RFA. Among the 45 patients, 3 had gating errors, and thus 42 had SPECT phase analysis. Twenty-two patients (52.4 %) had baseline LV dyssynchrony. Baseline LV dyssynchrony was more prominent in the patients with septal APs than in the patients with left or right APs (p < 0.05). RFA improved LV synchrony in the entire cohort and in the patients with septal APs (p < 0.01). Phase analysis of gated SPECT MPI demonstrated that LV mechanical dyssynchrony can be present in patients with WPW syndrome. Septal APs result in the greatest degree of LV mechanical dyssynchrony and afford the most benefit after RFA. This study supports further investigation in the relationship between electrical and mechanical activation using EPS and phase analysis of gated SPECT MPI. (orig.)

  15. Usefulness of combination post-stress dysfunction and perfusion imaging in technetium-99m-tetrofosmin myocardial scintigraphy

    International Nuclear Information System (INIS)

    Yamazaki, Yoko; Imai, Kamon; Konaka, Ryohei; Nakajima, Takatomo; Goto, Sayaka; Horie, Toshinobu; Saito, Satoshi; Ozawa, Yukio; Kanmatsuse, Katsuo

    2001-01-01

    Myocardial perfusion imaging has lower sensitivity for the diagnosis of coronary artery disease in patients with three-vessel disease. The presence of post-stress dysfunction of the left ventricle, evaluated by electrocardiography (ECG) gated single photon emission computed tomography (SPECT) with a quantitative gated SPECT program, was investigated in patients with coronary artery disease, and also whether combining post-stress dysfunction and myocardial perfusion imaging improved the diagnosis of coronary artery disease. ECG gated technetium-99m-tetrofosmin SPECT was performed using a one day, stress and rest, protocol in 139 patients. SPECT and coronary angiography were performed within 1 month. The coronary artery disease group consisted of 89 patients: 43 with one-vessel disease (1VD), 28 with two-vessel disease (2VD), and 18 with three-vessel disease (3VD). The group with zero-vessel disease (0VD) consisted of 50 patients. According to post-stress and rest ejection fraction (EF) and end-systolic volume (ESV), post-stress dysfunction is defined as follows: rest EF - post-stress EF≥5% and post-stress ESV - rest ESV≥5ml. In the coronary artery disease group, post-stress ESV was larger than rest ESV (37.8±26.4, 34.0±24.2 ml, p<0.001), and post-stress EF was lower than rest EF (61.5±11.1%, 64.2±10.8%, p<0.001). In the 0VD group, ESV and EF were the same for post-stress and rest (25.7±20.8, 26.2±21.6 ml, NS; 70.4±9.5%, 70.0±9.6%, NS). Post-stress dysfunction was 6.0% in the 0VD group and 30.3% in the coronary artery disease group (p<0.001). Furthermore, post-stress dysfunction in the 2VD (35.7%) and 3VD (38.9%) groups was higher than that in the 0VD group (p<0.01, p<0.01). Sensitivity of coronary artery disease diagnosis by myocardial perfusion imaging was 75%. The combination of post-stress dysfunction and myocardial perfusion imaging improved sensitivity from 75% to 82% (p<0.05), but reduced the specificity from 92% to 86% (p=0.08). Post

  16. Visualization of neonatal coronary arteries on multidetector row CT: ECG-gated versus non-ECG-gated technique

    International Nuclear Information System (INIS)

    Tsai, I.C.; Lee, Tain; Chen, Min-Chi; Fu, Yun-Ching; Jan, Sheng-Lin; Wang, Chung-Chi; Chang, Yen

    2007-01-01

    Multidetector CT (MDCT) seems to be a promising tool for detection of neonatal coronary arteries, but whether the ECG-gated or non-ECG-gated technique should be used has not been established. To compare the detection rate and image quality of neonatal coronary arteries on MDCT using ECG-gated and non-ECG-gated techniques. Twelve neonates with complex congenital heart disease were included. The CT scan was acquired using an ECG-gated technique, and the most quiescent phase of the RR interval was selected to represent the ECG-gated images. The raw data were then reconstructed without the ECG signal to obtain non-ECG-gated images. The detection rate and image quality of nine coronary artery segments in the two sets of images were then compared. A two-tailed paired t test was used with P values <0.05 considered as statistically significant. In all coronary segments the ECG-gated technique had a better detection rate and produced images of better quality. The difference between the two techniques ranged from 25% in the left main coronary artery to 100% in the distal right coronary artery. For neonates referred for MDCT, if evaluation of coronary artery anatomy is important for the clinical management or surgical planning, the ECG-gated technique should be used because it can reliably detect the coronary arteries. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  18. Mouse myocardial first-pass perfusion MR imaging

    NARCIS (Netherlands)

    Coolen, B.F.; Moonen, R.P.M.; Paulis, L.E.M.; Geelen, T.; Nicolay, K.; Strijkers, G.J.

    2010-01-01

    A first-pass myocardial perfusion sequence for mouse cardiac MRI is presented. A segmented ECG-triggered acquisition combined with parallel imaging acceleration was used to capture the first pass of a Gd-DTPA bolus through the mouse heart with a temporal resolution of 300–400 msec. The method was

  19. Impaired coronary flow reserve is the most important marker of viable myocardium in the myocardial segment-based analysis of dual-isotope gated myocardial perfusion single-photon emission computed tomography

    International Nuclear Information System (INIS)

    Lee, Won Woo; So, Young; Kim, Ki Bong; Lee, Dong Soo

    2014-01-01

    The aim of this study was to investigate the most robust predictor of myocardial viability among stress/rest reversibility (coronary flow reserve [CFR] impairment), 201 Tl perfusion status at rest, 201 Tl 24 hours redistribution and systolic wall thickening of 99m Tc-methoxyisobutylisonitrile using a dual isotope gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with coronary artery disease (CAD) who were re-vascularized with a coronary artery bypass graft (CABG) surgery. A total of 39 patients with CAD was enrolled (34 men and 5 women), aged between 36 and 72 years (mean 58 ± 8 standard in years) who underwent both pre- and 3 months post-CABG myocardial SPECT. We analyzed 17 myocardial segments per patient. Perfusion status and wall motion were semi-quantitatively evaluated using a 4-point grading system. Viable myocardium was defined as dysfunctional myocardium which showed wall motion improvement after CABG. The left ventricular ejection fraction (LVEF) significantly increased from 37.8 ± 9.0% to 45.5 ± 12.3% (p 201 Tl rest perfusion status (p = 0.024) were significant predictors of wall motion improvement. However, in multiple logistic regression analysis, stress/rest reversibility alone was a significant predictor for post-CABG wall motion improvement (p < 0.001). Stress/rest reversibility (impaired CFR) during dual-isotope gated myocardial perfusion SPECT was the single most important predictor of wall motion improvement after CABG.

  20. An integrated bioimpedance—ECG gating technique for respiratory and cardiac motion compensation in cardiac PET

    International Nuclear Information System (INIS)

    Koivumäki, Tuomas; Nekolla, Stephan G; Fürst, Sebastian; Loher, Simone; Schwaiger, Markus; Vauhkonen, Marko; Hakulinen, Mikko A

    2014-01-01

    Respiratory motion may degrade image quality in cardiac PET imaging. Since cardiac PET studies often involve cardiac gating by ECG, a separate respiratory monitoring system is required increasing the logistic complexity of the examination, in case respiratory gating is also needed. Thus, we investigated the simultaneous acquisition of both respiratory and cardiac gating signals using II limb lead mimicking electrode configuration during cardiac PET scans of 11 patients. In addition to conventional static and ECG-gated images, bioimpedance technique was utilized to generate respiratory- and dual-gated images. The ability of the bioimpedance technique to monitor intrathoracic respiratory motion was assessed estimating cardiac displacement between end-inspiration and -expiration. The relevance of dual gating was evaluated in left ventricular volume and myocardial wall thickness measurements. An average 7.6  ±  3.3 mm respiratory motion was observed in the study population. Dual gating showed a small but significant increase (4 ml, p = 0.042) in left ventricular myocardial volume compared to plain cardiac gating. In addition, a thinner myocardial wall was observed in dual-gated images (9.3  ±  1.3 mm) compared to cardiac-gated images (11.3  ±  1.3 mm, p = 0.003). This study shows the feasibility of bioimpedance measurements for dual gating in a clinical setting. The method enables simultaneous acquisition of respiratory and cardiac gating signals using a single device with standard ECG electrodes. (paper)

  1. Exercise-induced thallium-201 myocardial perfusion defects in angina pectoris without significant coronary artery stenosis

    International Nuclear Information System (INIS)

    Nakazato, Masayasu; Maruoka, Yuji; Sunagawa, Osahiko; Kinjo, Kunihiko; Tomori, Masayuki; Fukiyama, Koshiro

    1990-01-01

    We performed exercise thallium-201 myocardial scintigraphy in 32 patients with angina pectoris to study the incidence of perfusion defects, who had no significant organic stenosis on coronary angiography. None of them had myocardial infarction or cardiomyopathy. Thallium-201 myocardial scintigraphy and 12-lead ECG recording were performed during supine bicycle ergometer exercise. Perfusion defects in thallium-201 scintigrams in SPECT images were assessed during visual analysis by two observers. In the coronary angiograms obtained during intravenous infusion of nitroglycerin, the luminal diameter of 75% stenosis or less in the AHA classification was regarded as an insignificant organic stenosis. Myocardial perfusion defects in the thallium-201 scintigrams were detected in eight (25%) of the 32 patients. Six of these eight patients had variant angina documented during spontaneous attacks with ST elevations in standard 12-lead ECGs. Perfusion defects were demonstrated at the inferior or infero-posterior regions in six patients, one of whom had concomitant anteroseptal defect. The defects were not always accompanied by chest pain. All but one patient demonstrating inferior or inferoposterior defects showed ST depression in leads II, III and aV F on their ECGs, corresponding to inferior wall ischemia. The exception was a case with right bundle branch block. Thus, 25% of the patients with angina pectoris, who had no evidence of significant organic stenosis on their coronary angiograms, exhibited exercise-induced perfusion defects in their thallium-201 scintigrams. Coronary spasms might have caused myocardial ischemia in these patients. (author)

  2. [Influence of the professional experience of the clinical cardiologist on the adequacy of the clinical indications of myocardial perfusion gated-SPECT].

    Science.gov (United States)

    Dominguez-Rodriguez, Alberto; Avanzas, Pablo; Abreu-Gonzalez, Pedro; Sanchez Grande-Flecha, Alejandro; García-Baute, María Del Carmen; Gómez, María Ángeles

    2017-11-30

    During cardiology training, the cardiology fellow has to be trained in all things related to the indication, interpretation, and performing of nuclear cardiology studies using single photon emission computed tomography (SPECT). The aim of the present study was to analyse the relationship between the adequacy of indications of myocardial perfusion gated-SPECT and the years of experience since the completion of cardiology training. A descriptive, retrospective analysis was performed on a single-centre register, in which the indications (adequate or inadequate use) were recorded according to myocardial perfusion gated-SPECT guidelines, prescribed by cardiologists of a university hospital. A total of 950 gated-SPECT tests were analysed according to the appropriate or inadequate indication. The sample of study was distributed in quartiles (years) since the cardiologist finished the residency. Cardiologists with less than 10 years of clinical experience reported a higher proportion of gated-SPECT tests compared to the more experienced cardiologists (87.6 vs. 9.3%, P<.001). After adjusting for age, gender, and cardiovascular risk factors, the multivariate analysis showed that, for each year of experience after completion of cardiology training, the probability of adequately indicating the test (OR: 1.33, 95% CI: 1.29-1.38, P<.001) was statistically significant. The professional experience of the clinical cardiologist is the most important factor to perform an appropriate indication of gated-SPECT myocardial perfusion. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

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

    International Nuclear Information System (INIS)

    Mut, F.; Beretta, M.; Vidal, I.; Rener, A.; Alonso, O.

    2002-01-01

    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

  4. Role of myocardial perfusion single photon emission computed tomography in pediatric cardiology practice

    Directory of Open Access Journals (Sweden)

    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.

  5. Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients

    Energy Technology Data Exchange (ETDEWEB)

    Oki, Glaucia Celeste Rossatto [Clinica Diagnoson and Hospital Aristides Maltez, Salvador, BA (Brazil). Servicos de Medicina Nuclear; Pavin, Elizabeth Joao; Parisi, Maria Candida R. [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Internal Medicine. Service of Endocrinology; Coelho, Otavio Rizzi; Almeida, Raitany C. [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Internal Medicine. Service of Cardiology; Etchebehere, Elba Cristina Sa de Camargo; Ramos, Celso Dario, E-mail: cdramos@unicamp.br [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Radiology. Service of Nuclear Medicine; Camargo, Edwaldo Eduardo [Hospital Sirio-Libanes, Campinas, SP (Brazil). Service of Nuclear Medicine

    2013-01-15

    Objective: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. Materials and Methods: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with {sup 99m}Tc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. Results: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). Conclusion: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia. (author)

  6. Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients

    International Nuclear Information System (INIS)

    Oki, Glaucia Celeste Rossatto; Pavin, Elizabeth Joao; Parisi, Maria Candida R.; Coelho, Otavio Rizzi; Almeida, Raitany C.; Etchebehere, Elba Cristina Sa de Camargo; Ramos, Celso Dario; Camargo, Edwaldo Eduardo

    2013-01-01

    Objective: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. Materials and Methods: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with 99m Tc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. Results: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). Conclusion: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia. (author)

  7. Effects of perfusion detect on the measurement of left ventricular mass, ventricular volume and post-stress left ventricular ejection fraction in gated myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Ahn, Byeong Cheol; Bae, Sun Keun; Lee, Sang Woo; Jeong, Sin Young; Lee, Jae Tae; Lee, Kyu Bo

    2002-01-01

    The presence of perfusion defect may influence the left ventricular mass (LVM) measurement by quantitative gated myocardial perfusion SPECT (QGS), and ischemic myocardium, usually showing perfusion defect may produce post-stress LV dysfunction. This study was aimed to evaluated the effects of extent and reversibility of perfusion defect on the automatic measurement of LVM by QGS and to investigate the effect of reversibility of perfusion defect on post-stress LV dysfunction. Forty-six patients (male/female=34:12, mean age=64 years) with perfusion defect on myocardial perfusion SPECT underwent rest and post-stress QGS. Forty patients (87%) showed reversible defect. End-diastolic volume (EDV), end-systolic volume (ESV), LV ejection fraction (EF), and LV myocardial volume were obtained from QGS by autoquant program, and LVM was calculated by multiplying the LV myocardial volume by the specific gravity of myocardium. LVMs measured at rest and post-stress QGS showed good correlation, and higher correlation was founded in the subjects with fixed perfusion defect and with small defect (smaller than 20%). There were no significant differences in EDVs, ESVs and EFs between obtained by rest and post-stress QGS in patients with fixed myocardial defect. Whereas, EF obtained by post-stress QGS was lower than that by rest QGS in patients with reversible defect and 10 (25%) of them showed decreases in EF more than 5% in post-stress QGS, as compared to that of rest QGS. Excellent correlations of EDVs, ESVs, EFs between rest and post-stress QGS were noted. Patients with fixed defect had higher correlation between defect can affect LVM measurement by QGS and patients with reversible defect shows post-stress LV dysfunction more frequently than patients with fixed perfusion defect

  8. The application of phase analysis of gated myocardial perfusion imaging to assess left ventricular mechanical dyssynchrony in cardiovascular disease

    International Nuclear Information System (INIS)

    Wang Jianfeng; Wang Yuetao

    2013-01-01

    Left ventricular mechanical dyssynchrony is closely related to the severity of cardiovascular disease, it is essential to assess left ventricular mechanical dyssynchrony accurately for early prediction of adverse cardiac events and prognosis assessment of the cardiac resynchronization therapy. As a new technology to assess left ventricular mechanical dyssynchrony, the phase analysis of gated myocardial perfusion imaging (GMPI) can get both quantitative indicators of regional myocardial perfusion, evaluation of regional myocardial viability and scar tissue, as well as quantitative analysis of left ventricular function and left ventricular mechanical synchrony, it has broad application prospects in cardiovascular disease to assess left ventricular mechanical dyssynchrony and prognosis assessment. This review mainly described the applications of GMPI phase analysis in the cardiovascular disease. (authors)

  9. Role of myocardial perfusion SPECT in asymptomatic diabetic patients

    International Nuclear Information System (INIS)

    Cho, I.; Chun, K.; Won, K.; Lee, H.; Park, J.; Shin, D.; Kim, Y.; Shim, B.; Lee, J.

    2002-01-01

    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

  10. Diagnosis of severe and extensive coronary artery disease using gated myocardial perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Ihn Ho; Lee, Hyoung Woo; Won, Kyu Chang; Park, Jong Sun; Sin, Dog Gu; Kim, Young Jo; Shim, Bong Sub [College of Medicine, Yeungnam Univ., Taegu (Korea, Republic of)

    1999-07-01

    Left ventricular volumes and ejection fractions constitute important informations in the diagnosis and prognosis of cardiac disease. Aim of the study is to verify if the assessment of left ventricular function and perfusion together by gated myocardial perfusion SPECT is useful for diagnosing severe and extensive CAD. We examined 27 consecutive patients (17 males and 10 females, mean age : 60.1 years) who underwent two day rest/stress Tc-99m MIBI gated SPECT. Stress was done with adenosine. Post-stress gated SPECT was done at 1 hour after an injection of Tc-99m MIBI (740 MBq). All patients underwent coronary angiography after gated SPECT within 1 month. We divided them three groups with single vessel disease, double vessel disease and triple vessel disease or severe proximal left coronary artery stenosis. Extent of Defect (ED), Reversibility of Extent (RE), Severity of Defect (SD) and Severity of Reversibility (SR) were calculated by CEqual program. Post-stress LVEF, Rest LVEF, End-diastolic volume(EDV), End-systolic volume(ESV), Transient Ischemic Dilation (TID) of left ventricle (Post-stress EDV/Rest EDV) were calculated using gated SPECT quantification program. Left ventricle is divided with 18 segments and wall motion was scored (normal=0, mild hypokinesia =1, severe hypokinesia =2, akinesia =3 and dyskinesia =4), and then post-stress summed wall motion score was calculated. Post-stress summed wall motion score and post-stress LVEF were significant differences between three groups ( P <0.01). Extent of defect, Extent of reversibility, Severity of defect and severity of reversibility in Polar map were significant differences between three groups ( P <0.01). Post-stress Transient left ventricular dilatation and test LVEF were not significant differences between three groups ( P > 0.05). The gated SPECT pattern (low post-stress LVEF and post-stress summed wall motion score) add important diagnostic information over ungated perfusion data (high ED, ER and SR and

  11. Prognostic value of normal exercise myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Lin Jinghui; Zhu Mei; Wu Shuyan

    1996-01-01

    To assess the prognostic implications, patients with a normal exercise myocardial imaging were followed up. 54 patients underwent exercise myocardial perfusion imaging and exercise ECG test. The images of all of them were normal. Coronary arteriography was performed in 50 patients. Among them 4 patients had single vessel lesion. Follow-up period of all the patients was >1 year (12∼90 Mo.). Likelihood of coronary artery disease (CAD, CAD LK) was estimated before and after test by Bayesian analysis. Mean of the pretest CAD LK was 19% and after test decreased to 13%. The difference between the CAD LK pre- and after test was significant (U = 6.0198, P<0.01). During the follow-up period cardiac event (CE) occurred in only one patient. The CE rate was 0.2% per year. No CE occurred in the 4 patients with CAD and in the 55 patients with positive exercise ECG. The data confirm that a normal stress myocardial imaging predicts an excellent prognosis even in patients with CAD or a high pretest CAD LK or a positive exercise ECG

  12. A clinical study of gated simultaneous rest 201Tl/stress 99Tcm-sestamibi dual isotope myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Tang Anwu; Qiao Shuixian; Luo Yaowu; Liang Xiaolin

    2002-01-01

    Objective: To investigate a modified gated radionuclide myocardial tomography in methodology for raising the sensitivity and efficiency of detecting myocardial ischemia. Methods: One hundred and three patients were involved and divided into two groups: coronary artery disease (CAD) patient 37, non-CAD patient 66. 201 Tl 111 MBq was injected intravenously 5 min before stress, the patient exercised with ergometer following the modified Bruce protocol, and was injected 99 Tc m -sestamibi at the peak of stress. 45 min later, the simultaneous dual energy peak gated acquisition was then performed. Stress ( 99 Tc m -sestamibi) and rest ( 201 Tl) images were reconstructed. Results: Positive findings were seen in 35/37 (94.6%) in CAD group and 7/66 (10.6%) in non-CAD, respectively; LVEF, EDV and ESV of two groups were (52.33+-16.26)%, (70.45+-28.12) mL, (33.35 +- 18.86) mL and (61.76 +- 9.38)%, (60.45 +- 18.18) mL, (23.30 +- 11.09) mL, respectively. Conclusion: The simultaneous stress ( 99 Tc m -sestamibi) and rest ( 201 Tl) gated myocardial imaging is an efficient and practical protocol for the study of myocardial perfusion and the diagnosis of ischemia

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    Matsunari, Ichiro; Matsudaira, Masamichi; Hisada, Kinichi; Kanayama, Sugako; Yoneyama, Tatsuya; Nakajima, Kenichi; Taki, Junichi; Tonami, Norihisa; Nekolla, Stephan G.

    2005-01-01

    Dual-isotope simultaneous acquisition single-photon emission computed tomography (DISA SPECT) with 18 F-fluorodeoxyglucose (FDG) and 99m Tc-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 18 F-FDG/ 99m Tc-sestamibi DISA SPECT study, based on comparison with 18 F-FDG/ 13 N-ammonia positron emission tomography (PET) and magnetic resonance imaging (MRI) as reference techniques. Thirty-three patients with prior myocardial infarction underwent ECG-gated 18 F-FDG/ 99m Tc-sestamibi DISA SPECT and 18 F-FDG/ 13 N-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, 99m Tc-sestamibi showed a closer correlation with MRI than did 18 F-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.)

  15. Retrospectively ECG-gated multi-detector row CT of the chest: does ECG-gating improve three-dimensional visualization of the bronchial tree?

    International Nuclear Information System (INIS)

    Schertler, T.; Wildermuth, S.; Willmann, J.K.; Crook, D.W.; Marincek, B.; Boehm, T.

    2004-01-01

    Purpose: To determine the impact of retrospectively ECG-gated multi-detector row CT (MDCT) on three-dimensional (3D) visualization of the bronchial tree and virtual bronchoscopy (VB) as compared to non-ECG-gated data acquisition. Materials and Methods: Contrast-enhanced retrospectively ECG-gated and non-ECG-gated MDCT of the chest was performed in 25 consecutive patients referred for assessment of coronary artery bypass grafts and pathology of the ascending aorta. ECG-gated MDCT data were reconstructed in diastole using an absolute reverse delay of -400 msec in all patients. In 10 patients additional reconstructions at -200 msec, -300 msec, and -500 msec prior to the R-wave were performed. Shaded surface display (SSD) and virtual bronchoscopy (VB) for visualization of the bronchial segments was performed with ECG-gated and non-ECG-gated MDCT data. The visualization of the bronchial tree underwent blinded scoring. Effective radiation dose and signal-to-noise ratio (SNR) for both techniques were compared. Results: There was no significant difference in visualizing single bronchial segments using ECG-gated compared to non-ECG-gated MDCT data. However, the total sum of scores for all bronchial segments visualized with non-ECG-gated MDCT was significantly higher compared to ECG-gated MDCT (P [de

  16. Myocardial perfusion scintigraphy with thallium-201 - principle and method

    International Nuclear Information System (INIS)

    Dressler, J.

    1981-01-01

    Since from the cardiological and cardio-surgical aspects non-invasive methods practicable in the diagnostics of regional myocardial blood perfusion are claiming priority, the myocardial perfusion scintigraphy with thallium 201 has gained more and more importance in the diagnostics of coronary heart diseases. Although radiothallium because of its nucleo-physical characteristics is not regarded as ideal radiopharmaceutical, it is at present, because of its potassium-analogue biokinetics the best radiopharmaceutical to represent the regional coronary perfusion distribution, the vitality and configuration of the heart muscle non-invasively. With careful clinical indication and under consideration of the physico-technical limitations, the informative value provided by the serial scintigraphy with thallium 201 is greater than that provided by the excercise ECG. Various possibilities for solving the problem of quantitative analysis of the myocardial scintigrams have been given. Up to the present day a standardised evaluation procedure corresponding to that of the visual scintigram interpretation has not yet found general acceptance. (orig.) [de

  17. Multi detector computed tomography (MDCT) of the aortic root; ECG-gated verses non-ECG-gated examinations

    International Nuclear Information System (INIS)

    Kristiansen, Joanna; Guenther, Anne; Aalokken, Trond Mogens; Andersen, Rune

    2011-01-01

    Purpose: Motion artifacts may degrade a conventional CT examination of the ascending aorta and hinder accurate diagnosis. We quantitatively compared retrospectively electrocardiographic (ECG) -gated multi detector computed tomography (MDCT) with non-ECG-gated MDCT in order to demonstrate whether or not one of the methods should be preferred. Method: The study included seventeen patients with surgically reconstructed aortic root and reimplanted coronary arteries. All patients had undergone both non-gated MDCT and retrospectively ECG-gated MDCT employing a stringently modulated tube current with single phase image reconstruction. The incidence of motion artifacts in the left main coronary artery (LM), proximal right coronary artery (RCA), and aortic root and ascending aorta were rated using a four point scale. The effective dose for each scan was calculated and normalized to a 15 cm scan length. Statistical analysis of motion artifacts and radiation dose was performed using Wilcoxon matched pairs signed rank sum test. Results: A significant reduction in motion artifacts was found in all three vessels in images from the retrospectively ECG-gated scans (LM: P = 0.005, RCA: P = 0.015, aorta: P = 0.003). The mean normalized effective radiation dose was 3.69 mSv (±1.03) for the non-ECG-gated scans and 16.37 mSv (±2.53) for the ECG-gated scans. Conclusion: Retrospective ECG-gating with single phase reconstruction significantly reduces the incidence of motion artifacts in the aortic root and the proximal portion of the coronary arteries but at the expense of a fourfold increase in radiation dose.

  18. ECG gated magnetic resonance imaging in cardiovascular disease

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Im, Chung Kie; Han, Man Chung; Kim, Chu Wan

    1985-01-01

    Using KAIS 0.15 Tesla resistive magnetic imaging system, ECG gated magnetic resonance (MR) image of various cardiovascular disease was obtained in 10 patients. The findings of MR image of the cardiovascular disease were analysed and the results were as follows: 1. In 6 cases of acquired and congenital cardiac diseases, there were 2 cases of myocardial infarction, 1 case of mitral stenosis and 3 cases of corrected transportation of great vessels. The others were 3 cases of aortic disease and 1 case of pericardial effusion with lymphoma. 2. Myocardial thinning and left ventricular aneurysm were detected in MR images of myocardial infarction. The left atrium was well delineated and enlarged in the case of mitral stenosis. And segmental analysis was possible in the cases of corrected transposition since all cardiac structures were well delineated anatomically. 3. In aortic diseases, the findings of MR image were enlarged lumen, compressed cardiac chambers in ascending aortic aneurysm, intimal flap, enhanced false lumen in dissecting aneurysm and irregular narrowing of aorta with arterial obstruction in Takayasu's arteritis. 4. Pericardial effusion revealed a conspicuous contrast with neighboring mediastinal fat and cardiac wall due to it low signal encircling cardiac wall. 5. ECG gated MR image is an accurate non-invasive imaging modality for the diagnosis of cardiovascular disease and better results of its clinical application are expected in the future with further development in the imaging system and more clinical experiences

  19. Assessment of maximal myocardial perfusion by ECG-triggered digital subtraction angiography

    Energy Technology Data Exchange (ETDEWEB)

    Pijls, N.H.J.; Uijen, G.J.H.; Werf, T. van der (Katholieke Univ. Nijmegen (Netherlands). Cardiology Dept.)

    1991-01-01

    Early studies about calculation of coronary blood flow by analysis of contrast agent passage on the coronary arteriogram were reported more than 2 decades ago by Rutishauser et al. and Smith et al. Thereafter is was shown that visualization of contrast passage through the myocardium could be enhanced by ECG-triggered digital subtraction imaging and it was suggested that myocardial flow could be calculated by studying the temporal changes in contrast intensity in a myocardial region of interest (ROI) as a function of time: the time density curve (TDC). (orig./GDG).

  20. Assessment of myocardial washout of Tc-99m-sestamibi in patients with chronic heart failure. Comparison with normal control

    Energy Technology Data Exchange (ETDEWEB)

    Kumita, Shin-ichiro; Seino, Yoshihiko; Cho, Keiichi; Nakajo, Hidenobu; Toba, Masahiro; Fukushima, Yoshimitsu; Takano, Teruo; Kumazaki, Tatsuo [Nippon Medical School, Tokyo (Japan); Okamoto, Noriake [Bristol-Myers Squibb K.K., Tokyo (Japan)

    2002-06-01

    In contrast to {sup 201}TlCl, {sup 99m}Tc-sestamibi shows very slow myocardial clearance after its initial myocardial uptake. In the present study, myocardial washout of {sup 99m}Tc-sestamibi was calculated in patients with non-ischemic chronic heart failure (CHF) and compared with biventricular parameters obtained from first-pass and ECG-gated myocardial perfusion SPECT data. After administration of {sup 99m}Tc-sestamibi, 25 patients with CHF and 8 normal controls (NC) were examined by ECG-gated myocardial perfusion SPECT and planar data acquisition in the early and delayed (interval of 3 hours) phase. Left ventricular ejection fraction (LVEF, %), peak filling rate (PFR, sec{sup -1}), end-diastolic volume (LVEDV, ml) and end-systolic volume (LVESV, ml) were automatically calculated from the ECG-gated SPECT data. Myocardial washout rates over 3 hours were calculated from the early and delayed planar images. Myocardial washout rates in the CHF group (39.6{+-}5.2%) were significantly higher than those in the NC group (31.2{+-}5.5%, p<0.01). The myocardial washout rates for the 33 subjects showed significant correlations with LVEF (r=-0.61, p<0.001), PFR (r=-0.47, p<0.01), LVEDV (r=0.45, p<0.01) and LVESV (r=0.48, p<0.01). The myocardial washout rate of {sup 99m}Tc-sestamibi is considered to be a novel marker for the diagnosis of myocardial damage in patients with chronic heart failure. (author)

  1. Quantitative analysis of Tl-201 myocardial perfusion image with special reference to circumferential profile method

    Energy Technology Data Exchange (ETDEWEB)

    Miyanaga, Hajime [Kyoto Prefectural Univ. of Medicine (Japan)

    1982-08-01

    A quantitative analysis of thallium-201 myocardial perfusion image (MPI) was attempted by using circumferential profile method (CPM) and the first purpose of this study is to assess the clinical utility of this method for the detection of myocardial ischemia. In patients with coronary artery disease, CPM analysis to exercise T1-MPI showed high sensitivity (9/12, 75%) and specificity (9/9, 100%), whereas exercise ECG showed high sensitivity (9/12, 75%), but relatively low specificity (7/9, 78%). In patients with myocardial infarction, CPM also showed high sensitivity (34/38, 89%) for the detection of myocardial necrosis, compared with visual interpretation (31/38, 81%) and with ECG (31/38, 81%). Defect score was correlated well with the number of abnormal Q waves. In exercise study, CPM was also sensitive to the change of perfusion defect in T1-MPI produced by exercise. So the results indicate that CPM is a good method not only quantitatively but also objectively to analyze T1-MPI. Although ECG is the most commonly used diagnostic tool for ischemic heart disease, several exercise induced ischemic changes in ECG have been still on discussion as criteria. So the second purpose of this study is to evaluate these ischemic ECG changes by exercise T1-MPI analized quantitatively. ST depression (ischemic 1 mm and junctional 2 mm or more), ST elevation (1 mm or more), and coronary T wave reversion in exercise ECG were though to be ischemic changes.

  2. The value of gated myocardial perfusion imaging for the evaluation of early treatment effectiveness of ischemic heart disease using Ad-HGF myocardial injection

    International Nuclear Information System (INIS)

    Feng Jianlin; Cheng Xu; Li Jianhua; Xu Zhaoqiang; Li Dianfu; Yuan Biao; Zhang Yourong; Cao Kejiang; Huang Jun

    2008-01-01

    Objective: Hepatocyte growth factor (HGF) has multipotent actions mediated by c- Mesenchymal epithelial transition factor (Met) receptor. Preclinical studies in animal models of myocardial ischemia demonstrated that treatment with HGF could benefit myocardial perfusion, cardiac remodeling, angiogenesis and myocardial function. This study used gated 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging (G-MPI) to assess the early treatment effectiveness of adenovirus HGF (Ad-HGF) directly administered in ischemic heart disease (IHD) patients. Methods: Eighteen patients with IHD were divided into 3 groups receiving low dose [5 x 10 8 plaque forming unit (PFU)/site], medium (1.5 x 10 9 PFU/site) and high dose (5 x l0 9 PFU/site) of Ad-HGF. And the Ad-HGF was injected at 10 sites in each patient. Rest G-MPI was performed before and after treatment for myocardial perfusion and left ventricular function measurement. Stata 7.0 was used to analyse the data. Results: (1) After Ad-HGF, myocardial perfusion was improved in 3/6, 5/6 and 6/6 patients in low, medium and high dosage groups. The dosage of AD-HGF was closely correlated with the improvement of myocardial perfusion (χ 2 =4.34, P<0.05). (2) Left ventricular ejection fraction (LVEF) was significantly increased [(50.1 ± 6.4)% vs (58.7 ± 5.6)%, t=6.1, P<0.01], end-diastolic volume [EDV, (137.7 ± 33.2) ml vs (123.7 ± 32.7) ml] and end-systolic volume [ESV, (70.2 ± 22.4) ml vs (51.9 ± 14.9) ml] were significantly reduced. (3) The LVEFs were increased in all groups, and the LVEF improvement in the high dosage group [(8.6 ± 5.9)%] was significantly greater than the other two groups [(4.3 ± l.2)%, (6.8 ± 5.7)%]. The difference of post-treatment improvement on LVEF between the low and medium dosage groups was not significant. The dosage of Ad-HGF was closely correlated with the improvement of LVEF (r=0.67, P< 0.01). Conclusion: G-MPI is a reliable method for evaluating the early effectiveness of

  3. The clinical application of SPECT myocardial perfusion imaging with 99mTc-MIBI

    International Nuclear Information System (INIS)

    Dong Weiyu

    1992-01-01

    This paper reported 182 SPECT myocardial perfusion images with China made 99m Tc-MIBI and were compared with ECG and UCG. The sensitivity of SPECT in ischemic were 91.2% and was higher than ECG (74.9%)and UCG (61.8%) (P < 0.01). And its specificity, accuracy and positive predictive rate were 78.3%, 90% and 97% respectively. Besides 9 cases have reverse distribution after exercise and rest images. In some ICD patients had shown their SPECT images, the perfusion defects in exercise as well as in rest image

  4. Thallium-201 myocardial perfusion scintigraphy to evaluate patients with chest pain (preliminary study)

    International Nuclear Information System (INIS)

    Mahfouz, M.; Elhaddad, S.; Elghoneimy, I.; Elmesidy, S.; Haggag, F.; Sbdou, S.; Dayem, K.A.; Ezzeldiy, H.

    1985-01-01

    201 Tl perfusion scintigraphy for the diagnosis of coronary artery disease was carried out in 25 patients of mean age years, presenting with chest pain. Scintiscan were obtained at rest and after exercise and were compared with ECG studies at rest and after exercise. In all patients with previous myocardial infarctions, perfusion defects were present at rest, two of these patients showed abnormal stress scintigraphy consistent with a new ischemic response which was not detected by the stress ECG. In 3 out of the 8 patients with normal ECG, in 2 out of the 4 patients with response suggesting ischemia and in 4 out of the 7 patients with definite ECG proof of ischemia infarction was detected by 201 Tl. In all the previous, resting and exercise ECG failed to show evidence of infarction.1 fig.,2 tab

  5. Diagnostic and prognostic role of myocardial perfusion scintigraphy in kidney transplant candidates: narrative review

    Directory of Open Access Journals (Sweden)

    Alberto Bestetti

    2016-10-01

    Full Text Available PurposeCardiac screening in adult kidney transplant candidates with myocardial perfusion scintigraphy (MPS can reveal findings associated with increased risk for coronary heart disease events, but the exact value of this screening test is still undetermined.MethodsNarrative review based on the available literature and guidelines on the yield, benefits, and harms of MPS screening in kidney transplant candidates.ResultsAlthough coronary angiography carries low risk in general population, it is not without risk particularly in patients with complex comorbid disease and the use of intravenous contrast media may precipitate a need for hospitalization and death. We could avoid invasive coronary angiography in patients with chronic kidney disease, although with high coronary calcium score, but good left ventricle function and normal perfusion, evaluated by Gated single-photon emission computed tomographic (SPECT MPS. In fact, although Gated SPECT MPS has not a high sensitivity, it provides some variables that are closely related to sudden death: post-stress and rest-ejection fraction and left ventricular volumes, left ventricle muscle mass, extent of ischemia and scar.ConclusionsGated SPECT MPS is a valid noninvasive cardiac screening test. It can be used as alternative to stress echocardiography in kidney transplant candidates with high cardiovascular risk and a positive or inconclusive exercise tolerance ECG test.Patients with abnormal perfusion and cardiac dysfunction should undergo invasive coronary artery imaging and endovascular treatment, while angiography could be avoided in patients with normal MPI, having good long-term prognosis.

  6. A quantitative analysis of Tl-201 myocardial perfusion image with special reference to circumferential profile method

    International Nuclear Information System (INIS)

    Miyanaga, Hajime

    1982-01-01

    A quantitative analysis of thallium-201 myocardial perfusion image (MPI) was attempted by using circumferential profile method (CPM) and the first purpose of this study is to assess the clinical utility of this method for the detection of myocardial ischemia. In patients with coronary artery disease, CPM analysis to exercise T1-MPI showed high sensitivity (9/12, 75%) and specificity (9/9, 100%), whereas exercise ECG showed high sensitivity (9/12, 75%), but relatively low specificity (7/9, 78%). In patients with myocardial infarction, CPM also showed high sensitivity (34/38, 89%) for the detection of myocardial necrosis, compared with visual interpretation (31/38, 81%) and with ECG (31/38, 81%). Defect score was correlated well with the number of abnormal Q waves. In exercise study, CPM was also sensitive to the change of perfusion defect in T1-MPI produced by exercise. So the results indicate that CPM is a good method not only quantitatively but also objectively to analyze T1-MPI. Although ECG is the most commonly used diagnostic tool for ischemic heart disease, several exercise induced ischemic changes in ECG have been still on discussion as criteria. So the second purpose of this study is to evaluate these ischemic ECG changes by exercise T1-MPI analized quantitatively. ST depression (ischemic 1 mm and junctional 2 mm or more), ST elevation (1 mm or more), and coronary T wave reversion in exercise ECG were though to be ischemic changes. (J.P.N.)

  7. ECG-manifest and ECG-silent dipyridamole technetium-99m sestamibi SPET perfusion defects in patients with ischaemic heart disease

    International Nuclear Information System (INIS)

    Galli, M.; Marcassa, C.; Bosimini, E.; Zoccarato, O.; Comazzi, F.; Giannuzzi, P.

    1997-01-01

    To investigate the relationship between ECG changes and perfusion abnormalities, body surface maps were recorded during dipyridamole infusion in 55 subjects (11 normals and 44 patients with ischaemic heart disease) undergoing dipyridamole technetium-99m sestamibi single-photon emission tomography (SPET). All had a normal resting ECG. The extent and severity of the sestamibi defect were quantified. New negative areas in the isointegral maps and rest-dipyridamole map differences >2 SD from normal limits were considered abnormal. After dipyridamole in normals, neither perfusion defects nor ≥1 mm ST segment depression on 12-lead ECG nor new negative areas in isointegral maps occurred. In patients, dipyridamole induced new perfusion defects in 35 (80%) but ST segment depression in only 18 (41%, P<0.001). Of the 35 patients with perfusion defects, 17 (49%, group 1) showed ST segment depression, while the other 18 (51%, group 2) did not. Abnormal body surface maps were found in 100% of group 1 and 88% of group 2 patients (NS). In group 1, the provoked hypoperfusion was of greater extent (P=0.007) and severity (P=0.01) and the onset of map abnormalities was significantly earlier (P<0.001) than in group 2; time to map abnormalities was also significantly shorter than time to ST segment depression (P=0.01). In the 35 patients with complete scintigraphic, body map and angiographic data, the severity of reversible perfusion defect proved to be the strongest correlate of ST segment depression upon logistic regression analysis. Thus, sestamibi SPET abnormalities after dipyridamole are almost always associated with electrical changes on body surface maps, suggesting myocardial ischaemia as their cause. The much less common 12-lead ECG changes are slower to appear and reflect a more severe hypoperfusion. (orig./MG). With 5 figs., 4 tabs

  8. Comparison of 16-frame and 8-frame gated SPET imaging for determination of left ventricular volumes and ejection fraction

    International Nuclear Information System (INIS)

    Navare, Sachin M.; Liu, Yi-Hwa; Wackers, Frans J.T.

    2003-01-01

    Electrocardiographic (ECG) gated single-photon emission tomography (SPET) allows for simultaneous assessment of myocardial perfusion and left ventricular (LV) function. Presently 8-frame per cardiac cycle ECG gating of SPET images is standard. The aim of this study was to compare the effect of 8-frame and 16-frame gated SPET on measurements of LV volumes and to evaluate the effects of the presence of myocardial perfusion defects and of radiotracer dose administered on the calculation of LV volumes. A total of 86 patients underwent technetium-99m SPET myocardial perfusion imaging using 16-frame per cardiac cycle acquisition. Eight-frame gated SPET images were generated by summation of contiguous frames. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were calculated from the 16-frame and 8-frame data sets. The patients were divided into groups according to the administered dose of the radiotracer and the size of the perfusion defect. Results. Sixteen frame per cardiac cycle acquisition resulted in significantly larger EDV (122±72 ml vs 115±68 ml, P<0.0001), smaller ESV (64±58.6 ml vs 67.6±59.5 ml, P<0.0001), and higher LVEF (55.3%±18% vs 49%±17.4%, P<0.0001) as compared to 8-frame SPET imaging. This effect was seen regardless of whether a high or a low dose was administered and whether or not significant perfusion defects were present. This study shows that EDV, ESV and LVEF determined by 16-frame gated SPET are significantly different from those determined by 8-frame gated SPET. The radiotracer dose and perfusion defects do not affect estimation of LV parameters by 16-frame gated SPET. (orig.)

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

    International Nuclear Information System (INIS)

    Muzzarelli, Stefano; Pfisterer, Matthias Emil; Zellweger, Michael Johannes; Mueller-Brand, Jan

    2009-01-01

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    Muzzarelli, Stefano; Pfisterer, Matthias Emil; Zellweger, Michael Johannes [University Hospital Basel, Cardiology Department, Basel (Switzerland); Mueller-Brand, Jan [University Hospital Basel, Nuclear Medicine Department, Basel (Switzerland)

    2009-11-15

    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.)

  11. Normal LVEF measurements are significantly higher in females asassessed by post-stress resting Tc-99m sestamibi gated myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Kim, Jong Ho; Shin, Eak Kyun

    1999-01-01

    Volume-LVEF relationship is one of the most important factors of automatic EF quantification algorithm from gated myocardial perfusion SPECT(gMPS) (Germano et al. JNM, 1995). Gender difference whereby normal LVEF measurements are higher in females assessed by gMPS (Yao et al. JNM 1997). To validate true physiologic value of LVEF vs sampling or measured error, various parameters were evaluated statistically in both gender and age matched 200 subjects (mean age= 58.41±15.01) with normal LVEF more than 50%, and a low likelihood of coronary artery disease. Correlation between LVEDVi(ml/m2) and LVEF was highly significant (r=-0.62, p<0.0001) with similar correlations noted in both male (r=-0.45, p<0.0001) and female (r=-0.67, p<0.0001) subgroups. By multivariate analysis, LV volume and stroke volume was the most significant factor influencing LVEF in male and female, respectively. In conclusion, there is a significant negative correlation between LV volume and LVEF as measured by Tc-99m gated SPECT. Higher normal LVEF value should be applied to females as assessed by post-stress resting Tc-99m Sestamibi gated myocardial perfusion SPECT

  12. Quantitative evaluation of renal dynamic scan with 99mTc-MAG3 assessment of interoposterior myocardial infarction using ECG gated SPECT with 99mTc-MIBI

    International Nuclear Information System (INIS)

    Cho, Keiichi; Kumita, Shinichiro; Mizumura, Sunao

    1997-01-01

    Simultaneous assessment of regional myocardial perfusion and local contraction ability of interoposterior myocardial infarction was examined by ECG gated SPECT. In thirteen cases of acute interoposterior myocardial infarction, the above-mentioned data were obtained by 180deg data acquisition method using L-shaped 2 detecting element type gamma camera. Mean and standard deviation of %Uptake and wall thickening (WT) in inferior wall were as follows: Infarction case; 57±9.2%/23±11.3%, normal case; 71±8.2%/61±10.2%. The significant depression (p<0.01/p<0.001) of both data were found in the infarction case. The both data in posterior wall were as follows: Infarction case; 55±10.7%/16±8.9%, normal case; 64±9.7%/41±15.0%. The significant depression (p<0.05/p<0.001) were also found in the infarction case. In both inferior wall and posterior wall, the AUC of ROC curve of WT was greater than that of %Uptake, and diagnostic ability of this method was favorable. The best sensitivity/specificity rate and the threshold were as follows: %Uptake of inferior wall 77/65, -0.5SD, WT of inferior wall 100/100, -2SD, %Uptake of posterior wall 62/82, -1SD, WT of posterior wall 85/88, -4SD. Accordingly, in diagnosis of interoposterior myocardial infarction, assessment of focus cardiac function, for example WT, is necessary as well as %Uptake. (K.H.)

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

    International Nuclear Information System (INIS)

    Lee, Dong Soo; Kang, Keon Wook; Cheon, Gi Jeong; Jang, Myung Jin; Lee, Myoung Mook; Chung, June Key; Lee, Myung Chul

    2000-01-01

    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

  14. Rapid gated Thallium-201 perfusion SPECT - clinically feasible?

    International Nuclear Information System (INIS)

    Wadhwa, S.S.; Mansberg, R.; Fernandes, V.B.; Wilkinson, D.; Abatti, D.

    1998-01-01

    Full text: Standard dose energy window optimised Thallium-201 (Tl-201) SPECT has about half the counts of a standard dose from Technetium-99m Sestamibi (Tc99m-Mibi) gated perfusion SPECT. This study investigates the clinical feasibility of rapid energy window optimised Tl-201 gated perfusion SPECT (gated-TI) and compares quantitative left ventricular ejection fraction (LVEF) and visually assessed image quality for wall motion and thickening to analogous values obtained from Tc99m-Mibi gated perfusion SPECT (gated - mibi). Methods: We studied 60 patients with a rest gated Tl-201 SPECT (100 MBq, 77KeV peak, 34% window, 20 sec/projection) followed by a post stress gated Sestamibi SPECT (1GBq, 140KeV, 20% window, 20 sec/projection) separate dual isotope protocol. LVEF quantitation was performed using commercially available software (SPECTEF, General Electric). Visual grading of image quality for wall thickening and motion was performed using a three-point scale (excellent, good and poor). Results: LVEF for gated Tl-201 SPECT was 59.6 ± 12.0% (Mean ± SD). LVEF for gated Sestamibi SPECT was 60.4 ±11.4% (Mean ± SD). These were not significantly different (P=0.27, T-Test). There was good correlation (r=0.9) between gated-TI and gated-mibi LVEF values. The quality of gated-Tl images was ranked as excellent, good and poor in 12, 50 and 38% of the patients respectively. Image quality was better in gated-mibi SPECT, with ratings of 12, 62 and 26% respectively. Conclusion: Rapid gated Thallium-201 acquisition with energy window optimisation can be effectively performed on majority of patients and offers the opportunity to assess not only myocardial perfusion and function, as with Technetium based agents, but also viability using a single day one isotope protocol

  15. 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

    Energy Technology Data Exchange (ETDEWEB)

    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

  16. Myocardial perfusion abnormality and chest pain in patients with hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa

    1991-01-01

    To investigate the role of myocardial ischemia in the development of chest pain in patients with hypertrophic cardiomyopathy (HCM), exercise stress (Ex) redistribution myocardial single photon emission CT's (SPECT's) with thallium-201 (Tl) were obtained in 27 patients with HCM. In all patients, coronary arteries were normal arteriographically. Patients were classified into NYHA Class I, II and III according to the frequency and severity of the chest pain during daily life. In these 3 groups, age, sex and intraventricular septal thickness measured by echocardiography were not different. Types of myocardial perfusion obtained by myocardial SPECT's were divided into 5: (1) normal perfusion, (2) no perfusion defect with abnormal myocardial Tl washout rate (WOR) during 3 hours (<30%) [Def(-)/WORabn], (3) reversible perfusion defect (RD), (4) fixed defect with abnormal WOR (FD/WORabn), and (5) fixed defect with normal WOR (FD/WORnl). In 14 patients of Class I, 9 patients (64%) showed normal perfusion but the rest showed perfusion abnormality (def(-)/WORabn in 3 and RD in 2). In Class II and III, all patients showed perfusion abnormalities of RD, FD/WORabn or FD/WORnl. As the functional class progressed from Class II to III, the ratio of fixed defect (both WORnl and WORabn) to RD increased, but it was not statistically significant. In 2 patients in whom Ex SPECT's were repeated because of the progression of the chest pain, the severity of the perfusion abnormality also progressed. Perfusion abnormalities were observed most frequently in anterior (35%), then inferior/posterior (20%) and septal wall (18%). The frequency of Ex induced ECG abnormalities (ST-depression or T wave changes) increased as the NYHA Class progressed (Class III vs I p<0.05). These findings suggested the following: chest pain in patients with HCM relates to the myocardial ischemia which may originate in the myocardial small arteries, and when the lesions progress myocardial necrosis may ensue. (author)

  17. ECG-gating in non-cardiac digital subtraction angiography

    International Nuclear Information System (INIS)

    Gattoni, F.; Baldini, V.; Cairo, F.

    1987-01-01

    This paper reports the results of the ECG-gating in non-cardiac digital subtraction angiography (DSA). One hundred and fifteen patients underwent DSA (126 examinations); ECG-gating was applied in 66/126 examinations: images recorded at 70% of R wave were subtracted. Artifacts produced by vascular movements were evaluated in all patients: only 40 examinations, carried out whithout ECG-gating, showed vascular artifacts. The major advantage of the ECG-gated DSA is the more efficent subtraction because of the better images superimposition: therefore, ECG-gating can be clinically helpful. On the contrary, it could be a problem in arrhytmic or bradycardic patients. ECG-gating is helpful in DSA imaging of the thoracic and abdominal aorta and of the cervical and renal arteries. In the examinations of peripheral vessels of the limbs it is not so efficent as in the trunk or in the neck

  18. Visualization of hypertrophied papillary muscle mimicking left ventricular mass on gated blood pool and T1-201 myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Bunko, H.; Nakajima, K.; Tonami, N.; Asanoi, H.; Hisada, K.

    1981-01-01

    A sixty-year old man with acute myocardial infarction was incidentally found to have a hypertrophied anterolateral papillary muscle (ALPPM) of the left ventricle on gated blood pool (GBP) and T1-201 myocardial perfusion images. Hypertrophy of the ALPPM was visualized as a movable defect in the lateral basal area on GBP imaging throughout the cardiac cycle and on the TI-201 study as a radionuclide accumulating structure, consistent with the defect in the GBP. A combination of these findings may suggest the presence of a hypertrophied papillary muscle of the left ventricle

  19. Low-dose dobutamine stress gated SPET for identification of viable myocardium: comparison with stress-rest perfusion SPET and PET

    International Nuclear Information System (INIS)

    Yoshinaga, Keiichiro; Tamaki, Nagara; Katoh, Chietsugu; Kuge, Yuji; Noriyasu, Kazuyuki; Yamada, Satoshi; Ito, Yoshinori; Kohya, Tetsuro; Kitabatake, Akira; Kawai, Yuko

    2002-01-01

    The detection of viable myocardium is important for the prediction of functional recovery after revascularisation. However, a fixed perfusion defect often includes viable myocardium, and perfusion imaging then underestimates myocardial viability. We previously reported that low-dose dobutamine stress gated single-photon emission tomography (SPET) provides similar findings to dobutamine stress echocardiography in the assessment of myocardial viability. The present study investigated whether low-dose dobutamine stress gated SPET is of additional value as compared with stress-rest technetium-99m tetrofosmin SPET for the detection of myocardial viability. Standard stress-rest perfusion SPET, low-dose dobutamine stress gated SPET and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) were studied in 23 patients (mean age 67±7.6 years) with previous myocardial infarction. Twenty-one of them were successfully studied with each technique. FDG PET viability (FDG uptake ≥50%) was employed as the gold standard. One-day stress-rest 99m Tc-tetrofosmin myocardial SPET was performed. After the resting study, gated SPET was acquired following infusion of 7.5 μg kg -1 min -1 of dobutamine. Left ventricular wall motion in 16 segments was assessed by cine mode display using a four-point scale. Myocardial viability was considered present when there was improvement by one point. Of a total of 336 segments analysed, 53 had persistent defects on stress-rest perfusion SPET. FDG viability was seen in 16 of 17 dobutamine-responsive segments, but in only 11 of 36 dobutamine non-responsive segments (P<0.01). Thus, in the segments with persistent defects, viability findings on low-dose dobutamine stress gated SPET were concordant with those on FDG PET in 77% of segments (kappa value =0.55). For the detection of FDG-viable myocardium, the combination of stress-rest perfusion SPET and low-dose dobutamine stress gated SPET achieved a better sensitivity than stress

  20. Assessment of myocardial perfusion using a new scanning agent

    Energy Technology Data Exchange (ETDEWEB)

    Khalil, M.N

    1987-01-01

    This work assessed a new compound: Tc-99m tertiary butyl isonitrile (T-BIN) in scanning the normal myocardium in dogs. Experimentally induced myocardial infarcts (M.I.) were detected. The compound cleared significantly from the blood within 15 minutes and from the lungs within an hour after intravenous administration. Liver uptake was high and remained so. Cardiac uptake occurred quickly and continued for 6 hours. Comparable results were obtained in normal humans and patients. Myocardial scanning was best after 60 minutes at rest or 30 minutes after exercise. Liver uptake sometimes obscured the detection of inferior M.I. but this problem was reduced using a 45/sup 0/ left anterior oblique view with a 20/sup 0/ cranial tilt. At rest 9/10 patients with M.I. showed defects corresponding to the infarct sites. In 20 patients with angina pectoris 16 had perfusion defects on exercise. In 15/16 patients reversible ischaemia was demonstrated. The reperfusion scans were best obtained at 4 hours post exercise. Both Tl-201 and T-BIN detected equally the infarcts (3/3) but in patients with angina 8/10 with T-BIN and 6/10 with Tl-201 showed defects. ECG gating of the T-BIN scans was also studied.

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

    International Nuclear Information System (INIS)

    Santos, Marcia Maria Sales dos; Pantoja, Mauricio da Rocha; Cwajg, Eduardo

    2008-01-01

    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)

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

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

    International Nuclear Information System (INIS)

    Van Staden, J.A.; Herbst, C.P.; Du Raan, H.; Lotter, M.G.; Otto, A.C.

    2004-01-01

    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 99m Tc-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)

  4. Assessment of left ventricular function using 201Tl electrocardiogram-gated myocardial single photon emission computed tomography

    International Nuclear Information System (INIS)

    Nishikubo, Naotsugu; Tamai, Hiroyuki

    2013-01-01

    Advances in computed tomography (CT) technology make it possible to obtain left ventricular wall motion using 3D reconstruction. In this study, we compared the images obtained from CT and 201 Tl electrocardiogram (ECG) gated single photon emission computed tomography (SPECT). In 20 patients with ischemic heart disease, we performed 201 Tl ECG gated SPECT (GE Healthcare Millennium VG) and ECG gated CT (Philips Medical Systems Brilliance iCT) to evaluate of left ventricular wall motion during the resting phase. In SPECT, left ventricular images were reconstructed using quantitative gated SPECT (QGS) software. In CT, the images were reconstructed using Virtual Place (AZE Software). The left ventricle was classified into five regions (anterior, lateral, inferior, septal, and apical). The amplitude of the wall motion was classified into five grades according to AHA classification. The values of the wall motion were separately checked by two radiographers. Assessment of left ventricular function myocardial wall movement using the three-dimensional movie display with ECG gated myocardial SPECT data was in agreement with the evaluation by cardiac CT inspection, and corresponded with wall motion in 88 of all 100 segments. SPECT analysis has the same quantity as that of obtained from CT for evaluation of left ventricular wall motion. (author)

  5. Future cardiac events in patients with ischemic ECG changes during adenosine infusion as a myocardial stress agent and normal cardiac scan.

    Science.gov (United States)

    Amer, Hamid; Niaz, Khalid; Hatazawa, Jun; Gasmelseed, Ahmed; Samiri, Hussain Al; Al Othman, Maram; Hammad, Mai Al

    2017-11-01

    We sought to determine the prognostic importance of adenosine-induced ischemic ECG changes in patients with normal single-photon emission computed tomography myocardial perfusion images (MPI). We carried out a retrospective analysis of 765 patients undergoing adenosine MPI between January 2013 and January 2015. Patients with baseline ECG abnormalities and/or abnormal scan were excluded. Overall, 67 (8.7%) patients had ischemic ECG changes during adenosine infusion in the form of ST depression of 1 mm or more. Of these, 29 [43% (3.8% of all patients)] had normal MPI (positive ECG group). An age-matched and sex-matched group of 108 patients with normal MPI without ECG changes served as control participants (negative ECG group). During a mean follow-up duration of 33.3±6.1 months, patients in the positive ECG group did not have significantly more adverse cardiac events than those in the negative ECG group. One (0.9%) patient in the negative ECG group had a nonfatal myocardial infarction (0.7% annual event rate after a negative MPI). Also in this group, two (1.8%) patients admitted with a diagnosis of CAD where they have been ruled out by angiography. A fourth case in this, in the negative ECG group, was admitted because of heart failure that proved to be secondary to a pulmonary cause and not CAD. A case only in the positive ECG group was admitted as a CAD that was ruled out by coronary angiography. Patients with normal myocardial perfusion scintigraphy in whom ST-segment depression develops during adenosine stress test appear to have no increased risk for future cardiac events compared with similar patients without ECG evidence of ischemia.

  6. Evaluation of left ventricular function using electrocardiographically gated myocardial SPECT with (123)I-labeled fatty acid analog.

    Science.gov (United States)

    Nanasato, M; Ando, A; Isobe, S; Nonokawa, M; Hirayama, H; Tsuboi, N; Ito, T; Hirai, M; Yokota, M; Saito, H

    2001-12-01

    Electrocardiographically (ECG) gated myocardial SPECT with (99m)Tc-tetrofosmin has been used widely to assess left ventricular (LV) function. However, the accuracy of variables using ECG gated myocardial SPECT with beta-methyl-p-(123)I-iodophenylpentadecanoic acid (BMIPP) has not been well defined. Thirty-six patients (29 men, 7 women; mean age, 61.6 +/- 15.6 y) with ischemic heart disease underwent ECG gated myocardial SPECT with (123)I-BMIPP and with (99m)Tc-tetrofosmin and left ventriculography (LVG) within 1 wk. LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), and LV end-systolic volume (LVESV) were determined on gated SPECT using commercially available software for automatic data analysis. These volume-related items on LVG were calculated with an area-length method and were estimated by 2 independent observers to evaluate interobserver validity. The regional wall motion with these methods was assessed visually. LVEF was 41.1% +/- 12.5% on gated SPECT with (123)I-BMIPP, 44.5% +/- 13.1% on gated SPECT with (99m)Tc-tetrofosmin, and 46.0% +/- 12.7% on LVG. Global LV function and regional wall motion between both gated SPECT procedures had excellent correlation (LVEF, r = 0.943; LVEDV, r = 0.934; LVESV, r = 0.952; regional wall motion, kappa = 0.92). However, the correlations of global LV function and regional wall motion between each gated SPECT and LVG were significantly lower. Gated SPECT with (123)I-BMIPP showed the same interobserver validity as gated SPECT with (99m)Tc-tetrofosmin. Gated SPECT with (123)I-BMIPP provides high accuracy with regard to LV function and is sufficiently applicable for use in clinical SPECT. This technique can simultaneously reveal myocardial fatty acid metabolism and LV function, which may be useful to evaluate various cardiac diseases.

  7. Tl-201 myocardial perfusion scanning in patients with right bundle branch block coronary artery disease

    International Nuclear Information System (INIS)

    Shirani, J.; Malpani, A.R.; Blend, M.J.; Bekerman, C.

    1990-01-01

    This paper evaluates the specificity of stress T1-201 myocardial perfusion studies (T1-201 MPS) for coronary artery disease (CAD) in patients with right bundle branch block (RBBB). Twenty-four patients with RBBB and atypical chest pain with ECG findings limited to RBBB, adequate stress test (ie, >85% of maximal heart rate for age), and no clinical, hemodynamic, or ECG evidence of ischemia during exercise underwent T1-201 MPS. These perfusion patterns were compared with an equal number of age- and gender-matched controls with a normal ECG who met all other criteria mentioned above. Patients with RBBB showed a significantly higher frequency of reversible inferoposterior T1-201 defects (62.5% vs 20.8%)

  8. Incremental value of regional wall motion analysis immediately after exercise for the detection of single-vessel coronary artery disease. Study by separate acquisition, dual-isotope ECG-gated single-photon emission computed tomography

    International Nuclear Information System (INIS)

    Yoda, Shunichi; Sato, Yuichi; Matsumoto, Naoya; Tani, Shigemasa; Takayama, Tadateru; Uchiyama, Takahisa; Saito, Satoshi

    2005-01-01

    Although the detection of wall motion abnormalities gives incremental value to myocardial perfusion single-photon emission computed tomography (SPECT) in the diagnosis of extensive coronary artery disease (CAD) and high-grade single-vessel CAD, whether or not it is useful in the diagnosis of mild, single-vessel CAD has not been studied previously. Separate acquisition, dual isotope electrocardiogram (ECG)-gated SPECT was performed in 97 patients with a low likelihood of CAD (Group 1) and 46 patients with single-vessel CAD (Group 2). Mild CAD was defined by stenosis of 50-75% (Group 2a, n=22) and moderate to severe CAD was defined by stenosis ≥76% (Group 2b, n=24). Myocardial perfusion and wall motion were graded by a 5 point-scale, 20-segment model. The sensitivity of myocardial perfusion alone was 50% for Group 2a, 83% for Group 2b and 67% for Group 2 as a whole. The overall specificity was 90%. When the wall motion analysis was combined, the sensitivity was increased to 82% in Group 2a and 92% in Group 2b. The ability to detect a wall motion abnormality immediately after exercise gives incremental diagnostic value to myocardial perfusion SPECT in the identification of mild, single-vessel CAD. (author)

  9. Limited diagnostic accuracy of gated myocardial perfusion SPECT for wall motion analysis in patients with asymmetric septal hypertrophy

    International Nuclear Information System (INIS)

    Seo, J.H.; Ahn, B.C.; Bae, J.H.; Jeong, S.Y.; Lee, J.; Lee, K.B.

    2004-01-01

    Objective: Although gated SPECT(G-SPECT) using Tc-99m MIBI is well-known diagnostic modality in the evaluation of myocardial perfusion and wall motion analysis, there were limited reports for subjects with asymmetric septal hypertrophy (ASH). This study was performed to evaluate the clinical usefulness of G-SPECT for assessments of myocardial perfusion and wall motion analysis in patients with ASH on 2D-echocardiography(Echo). Methods: Thirty patients (male 18, 59 12 years) with ASH on Echo (septal wall thickness 13 mm and 1.3 times as thick as that of posterior wall) underwent Tc-99m MIBI G-SPECT. Two studies were performed within one month. No patient had experienced any significant cardiac event, nor had changed medical and surgical therapy during the studies. Functional parameters of the left ventricle were acquired with QGS software(AutoQUANTTM). Three experts performed visual interpretation for the presence of septal thickening and perfusion abnormalities on G-SPECT and two experienced cardiologists measured dimension, thickness and wall motion of the left ventricle on Echo. Results: Mean septum thickness measured by Echo was 1.90 0.50 cm, and the septum/posterior wall thickness ratio was 1.85 0.51. On visual SPECT analysis, 14 patients (46.7%) were interpreted as with thickened septum and 17 patients (57%) as with abnormal perfusion. All 3 patients who underwent coronary angiography showed significant luminal stenosis and also had perfusion abnormalities on SPECT. On Echo, only one patient showed septal hypokinesia, who showed anteroseptal infarction on SPECT, and the others showed normal septal wall motion. But 13 patients (54%) among 24 patients showed septal hypokinesia on G-SPECT. Patients with thickened septum on SPECT had thicker septum (2.3 vs 1.6 cm) and higher septum/posterior wall thickness ratio (2.2 vs 1.6) on Echo, compared with patients without septal thickening on SPECT. Conclusions: Although G-SPECT could proffer diagnostic accuracy for

  10. Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours

    DEFF Research Database (Denmark)

    Fakhri, Yama; Busk, Martin; Schoos, Mikkel Malby

    2016-01-01

    -presenters). The Anderson-Wilkin's score (AW-score) estimates the acuteness of myocardial ischemia from the electrocardiogram (ECG) in STEMI patients. We hypothesized that the AW-score is superior to symptom duration in identifying substantial salvage potential in late-presenters. METHODS: The AW-score (range 1......-4) was obtained from the pre-pPCI ECG in 55 late-presenters and symptoms 12-72 hours. Myocardial perfusion imaging was performed to assess area at risk before pPCI and after 30days to assess myocardial salvage index (MSI). We correlated both the AW-score and pain-to-balloon with MSI and determined the salvage...

  11. Alterations in electrocardiogram of adenosine test for 99Tcm-MIBI myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Xie Boqia; Tian Yueqin; Zheng Lihui

    2011-01-01

    Objective: To analyze alterations in electrocardiogram (ECG) of adenosine test in 99 Tc m -MIBI myocardial perfusion imaging(MPI)SPECT study. Methods: A total of 641 patients were included in the study. The patients each underwent 99 Tc m -MIBI MPI with adenosine test. The ECGs were taken before, during, and after adenosine infusion. Results: In all, abnormal ECGs were found in 205(32.0%) patients. During adenosine infusion, 20.6%(132/641) of patients suffered from arrhythmia, 29.5%(39/132) had atrial premature beats, 34.1% (45/132) had premature ventricular beats, and 6.1% (8/132) had sinoatrial block. In addition, 5.3% (7/132) had first-, 24.2% (32/132) had second-, and 0.8% (1/132) had third-degree atrioventricular block (AVB). After adenosine infusion, 4.4%( 28/641) of patients suffered from arrhythmia, 57.1% (16/28) had atrial premature beats, 39.3% (11/28) had premature ventricular beats, and 3.6% (1/28) had sinoatrial block. The perfusion images showed ischemia in 36 patients and infarction in 8 patients. Adenosine infusion was terminated in 39 patients (6.1%) because of poorly tolerated side effects. However, no death or acute myocardial infarction occurred in the study. Conclusions: Adenosine pharmacologic test for 99 Tc m -MIBI MPI may result in relatively high incidence of arrhythmia in ECG monitoring. (authors)

  12. Feasibility of epicardial adipose tissue quantification in non-ECG-gated low-radiation-dose CT: comparison with prospectively ECG-gated cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Simon-Yarza, Isabel; Viteri-Ramirez, Guillermo; Saiz-Mendiguren, Ramon; Slon-Roblero, Pedro J.; Paramo, Maria [Dept. of Radiology, Clinica Univ. de Navarra, Pamplona (Spain); Bastarrika, Gorka [Dept. of Radiology, Clinica Univ. de Navarra, Pamplona (Spain); Cardiac Imaging Unit, Clinica Univ. de Navarra, Pamplona (Spain)], e-mail: bastarrika@unav.es

    2012-06-15

    Background: Epicardial adipose tissue (EAT) is an important indicator of cardiovascular risk. This parameter is generally assessed on ECG-gated computed tomography (CT) images. Purpose: To evaluate feasibility and reliability of EAT quantification on non-gated thoracic low-radiation-dose CT examinations with respect to prospectively ECG-gated cardiac CT acquisition. Material and Methods: Sixty consecutive asymptomatic smokers (47 men; mean age 64 {+-} 9.8 years) underwent low-dose CT of the chest and prospectively ECG-gated cardiac CT acquisitions (64-slice dual-source CT). The two examinations were reconstructed with the same range, field of view, slice thickness, and convolution algorithm. Two independent observers blindly quantified EAT volume using commercially available software. Data were compared with paired sample Student t-test, concordance correlation coefficients (CCC), and Bland-Altman plots. Results: No statistically significant difference was observed for EAT volume quantification with low-dose-CT (141.7 {+-} 58.3 mL) with respect to ECG-gated CT (142.7 {+-} 57.9 mL). Estimation of CCC showed almost perfect concordance between the two techniques for EAT-volume assessment (CCC, 0.99; mean difference, 0.98 {+-} 5.1 mL). Inter-observer agreement for EAT volume estimation was CCC: 0.96 for low-dose-CT examinations and 0.95 for ECG-gated CT. Conclusion: Non-gated low-dose CT allows quantifying EAT with almost the same concordance and reliability as using dedicated prospectively ECG-gated cardiac CT acquisition protocols.

  13. Feasibility of epicardial adipose tissue quantification in non-ECG-gated low-radiation-dose CT: comparison with prospectively ECG-gated cardiac CT

    International Nuclear Information System (INIS)

    Simon-Yarza, Isabel; Viteri-Ramirez, Guillermo; Saiz-Mendiguren, Ramon; Slon-Roblero, Pedro J.; Paramo, Maria; Bastarrika, Gorka

    2012-01-01

    Background: Epicardial adipose tissue (EAT) is an important indicator of cardiovascular risk. This parameter is generally assessed on ECG-gated computed tomography (CT) images. Purpose: To evaluate feasibility and reliability of EAT quantification on non-gated thoracic low-radiation-dose CT examinations with respect to prospectively ECG-gated cardiac CT acquisition. Material and Methods: Sixty consecutive asymptomatic smokers (47 men; mean age 64 ± 9.8 years) underwent low-dose CT of the chest and prospectively ECG-gated cardiac CT acquisitions (64-slice dual-source CT). The two examinations were reconstructed with the same range, field of view, slice thickness, and convolution algorithm. Two independent observers blindly quantified EAT volume using commercially available software. Data were compared with paired sample Student t-test, concordance correlation coefficients (CCC), and Bland-Altman plots. Results: No statistically significant difference was observed for EAT volume quantification with low-dose-CT (141.7 ± 58.3 mL) with respect to ECG-gated CT (142.7 ± 57.9 mL). Estimation of CCC showed almost perfect concordance between the two techniques for EAT-volume assessment (CCC, 0.99; mean difference, 0.98 ± 5.1 mL). Inter-observer agreement for EAT volume estimation was CCC: 0.96 for low-dose-CT examinations and 0.95 for ECG-gated CT. Conclusion: Non-gated low-dose CT allows quantifying EAT with almost the same concordance and reliability as using dedicated prospectively ECG-gated cardiac CT acquisition protocols

  14. Myocardial perfusion imaging with thalium 201 during and after exercise in patients with coronary heart

    Energy Technology Data Exchange (ETDEWEB)

    Bravo, P B; Villacorta, E V; Monzon, O P; Torres, Jr, J F; Guzman, S V

    1977-07-01

    A unique, non-invasive technique for the evaluation of the regional myocardial perfusion of patients with coronary heart disease has been developed. This entails the use of radionuclide, like thallium (Tl-201), which concentrates in the normal myocardium, leaving areas of ischemia or scarring or ''cold'' perfusion defects. Myocardial perfusion imaging in conjunction with graded exercise testing significantly increases the positivity of the stress test alone among patients with classic angina from 80% to 95%. It gives invaluable information as to the site and extent of the lesion and its reversibility. Among the patients with ECG Q waves indicative of previous infarction, image defects were detected in 93.7%; reversible ischemia co-existing with the infarction was also demonstrated.

  15. Role of myocardial perfusion imaging in acute coronary syndrome

    International Nuclear Information System (INIS)

    Aleem, M.

    2007-01-01

    Full text: In the cardiac emergency department, a number of patients present with acute chest pain. In case of non diagnostic ECG and enzymes, accurately categorizing the patient in high and low probability is difficult. Aim of study was to evaluate the role of resting myocardial perfusion imaging (MPI) in patients with acute coronary syndrome (ACS) and then to compare the results with subsequent stress imaging. Material and Methods. A total of 34 patients were selected for the study, which were divided into three groups on the basis of respective probabilities of having ACS. This probability was decided on the basis of nature of chest pain, ECG findings, enzymes levels, and age and sex. Arbitrary score was given to patient's condition. This score ranged from 1 to 14. Patients with score between 1-6 were assigned low probability, from 7-10 were assigned intermediate probability and patients having score greater than 11 were placed in high probability groups. Patients in the low and intermediate probability groups were injected with Tc 99 m- MIBI within 6 hours of onset of chest pain and were undergone resting myocardial perfusion imaging (MPI) 3 to five hours after injection.. Imaging in high probability group was performed at discharge. Four weeks after the acute event all the patients underwent stress myocardial perfusion imaging. Results: All patients (100%) with low probability of ACS (n=10) showed negative resting scans. On stress MPI two patients (20%) showed new defects. Patient with high probability of ACS (n=12), all were positive 100% on resting MPI. On stress MPI, three showed (25%) no change from rest MPI, while nine patients (75%) showed augmentation of defects and four out of these nine patients (33%) also showed new perfusion defects. Patients with intermediate probability of ACS (n=12), three showed positive rest MPI (25%). On stress MPI out of these three cases, one showed (8%) no change from rest MPI and two showed (17%) augmentation of defect

  16. Left ventricular functional parameters by gated SPECT myocardial perfusion imaging in a Latin American country.

    Science.gov (United States)

    Kapitan, Miguel; Beltran, Alvaro; Beretta, Mario; Mut, Fernando

    2018-04-01

    There is paucity of data on left ventricular (LV) functional parameters using gated SPECT myocardial perfusion imaging (MPI) from the Latin American region. This study provides detailed information in low-risk patients both at rest and during exercise. We studied 90 patients (50 men) with a very low likelihood of coronary artery disease. Gated-SPECT MPI was performed with Tc-99m MIBI using a 2-day protocol, with 16 frames/R-R cycle. The LV ejection fraction and volumes were not different between the rest and post-stress images. LVEF was 68 ± 7% post-stress and 70 ± 7% at rest in women, and 62 ± 7% and 63 ± 7%, respectively, in men (P = .19, .26). LV volumes were larger in men than women (P stress. Transient ischemic dilatation was similar, with upper limits of 1.20 and 1.19 in women and men, respectively (P = NS). These data could prove helpful for the interpretation of gated SPECT MPI data in Latin America using identical protocol as used in this study.

  17. Myocardial perfusion scintigraphy in Germany in 2009: utilization and state of the practice

    Energy Technology Data Exchange (ETDEWEB)

    Lindner, Oliver; Burchert, Wolfgang [University Hospital of the Ruhr University Bochum, Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen (Germany); Bengel, Frank M. [Hanover University School of Medicine, Department of Nuclear Medicine, Hannover (Germany); Zimmermann, Rainer [Klinikum Pforzheim GmbH, Cardiology Department, Pforzheim (Germany); Dahl, Juergen vom [Kliniken Maria Hilf GmbH, Cardiology Department, Moenchengladbach (Germany); Schaefers, Michael [Westfaelische Wilhelms Universitaet Muenster, European Institute of Molecular Imaging, Muenster (Germany)

    2011-08-15

    Since 2006, the working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine, in cooperation with the working group Nuclear Cardiology of the German Cardiac Society, has been surveying the utilization and technical realization of myocardial perfusion scintigraphy (MPS) in Germany. This paper presents the results of the reporting year 2009. A total of 291 centres participated in the inquiry, including 179 private practices (PP), 86 hospitals (HO) and 26 university hospitals (UH). MPS of 98,103 patients were reported. The MPS numbers per million population (pmp) were estimated at 2,360; 76% of the MPS were performed in PP, 17% in HO and 7% in UH. The ratio of MPS to coronary angiography to revascularization was 0.5 to 2.3 to 1. Data from 134 centres which participated in the surveys from 2005 to 2009 showed a decrease in MPS utilization of 2.2%. Nearly half of the MPS were requested by ambulatory care cardiologists. Of all MPS studies, 89% were conducted with {sup 99m}Tc perfusion tracers. Ergometry was the preferred stress test (69%). Adenosine was used in 16%, adenosine + exercise in 7%, dipyridamole in 3%, dipyridamole + exercise in 5% and dobutamine in <1%. Gated single proton emission computed tomography (SPECT) acquisition was performed in 56% of all rest MPS and in 56% of all stress MPS. Both rest and stress MPS were ECG gated in 41%. Only 33% of the centres always performed a quantification of the perfusion studies, whereas 51% did not apply any quantification; 4% of the MPS studies were corrected for attenuation, and 17 centres used transmission sources of 12 CT-based systems. A scan activity of 2,380 MPS pmp is in the upper third of the European range. The ratios to coronary angiography and to revascularization suggest that angiography dominates diagnosis and management of coronary artery disease (CAD). The clinical and technical realizations reveal that the predominant goals of further trainings to optimize MPS are in the field

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

    International Nuclear Information System (INIS)

    Saghari, Mohsen; Assadi, Majid; Eftekhari, Mohammad; Yaghoubi, Mohammad; Fard-Esfahani, Armaghan; Malekzadeh, Jan-Mohammad; Sichani, Babak Fallhi; Beiki, Davood; Takavar, Abbas

    2006-01-01

    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

  19. Cardiac function and myocardial perfusion immediately following maximal treadmill exercise inside the MRI room

    Directory of Open Access Journals (Sweden)

    Ballinger Michelle R

    2008-01-01

    Full Text Available Abstract Treadmill exercise stress testing is an essential tool in the prevention, detection, and treatment of a broad spectrum of cardiovascular disease. After maximal exercise, cardiac images at peak stress are typically acquired using nuclear scintigraphy or echocardiography, both of which have inherent limitations. Although CMR offers superior image quality, the lack of MRI-compatible exercise and monitoring equipment has prevented the realization of treadmill exercise CMR. It is critical to commence imaging as quickly as possible after exercise to capture exercise-induced cardiac wall motion abnormalities. We modified a commercial treadmill such that it could be safely positioned inside the MRI room to minimize the distance between the treadmill and the scan table. We optimized the treadmill exercise CMR protocol in 20 healthy volunteers and successfully imaged cardiac function and myocardial perfusion at peak stress, followed by viability imaging at rest. Imaging commenced an average of 30 seconds after maximal exercise. Real-time cine of seven slices with no breath-hold and no ECG-gating was completed within 45 seconds of exercise, immediately followed by stress perfusion imaging of three short-axis slices which showed an average time to peak enhancement within 57 seconds of exercise. We observed a 3.1-fold increase in cardiac output and a myocardial perfusion reserve index of 1.9, which agree with reported values for healthy subjects at peak stress. This study successfully demonstrates in-room treadmill exercise CMR in healthy volunteers, but confirmation of feasibility in patients with heart disease is still needed.

  20. Gated myocardial SPECT using spatial and temporal filtering

    International Nuclear Information System (INIS)

    Hatton, R.L.; Hutton, B.F.; Kyme, A.Z.; Larcos, G.

    2002-01-01

    Full text: Standard protocols for examining myocardial perfusion and motion defects involve the use of gated SPECT images, and a composite of the gated frames. This study examines the usefulness of extracting one or a combination of frames from the gated image to assess perfusion, and whether the addition of a temporal filter to the gated image improves signal to noise. Choice of the most appropriate frame was also considered. Sixteen and eight frame gated SPECT studies were simulated using the dynamic NURBS-based cardiac torso (NCAT) phantom. Variously sized perfusion defects were included in the inferior wall to assess contrast to normal tissue. Scatter and attenuation were not included. Butterworth spatial cutoff frequencies were varied to establish the most appropriate combination of temporal/spatial filters to reduce noise and retain contrast in the images. The 16 frame data produced higher ejection fraction across all spatial filter cutoffs, and generally was unaffected by temporal filtering. Temporal filtering reduced the noise in a uniform liver region in the gated images to within 25% of the composite image noise. The lesion extent and contrast were greater in the end-diastolic frames compared to end-systolic and mid-cycle frames. In conclusion, by using a temporally filtered end-diastolic image from the gated sequence, a favourable balance between noise and contrast can be achieved. Work is progress to confirm these findings in the clinical situation. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

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

    International Nuclear Information System (INIS)

    Seo, Ji Hyoung; Kang, Seong Min; Bae, Jin Ho; Jeong, Shin Young; Lee, Sang Woo; Yoo, Jeong Soo; Ahn, Byeong Cheol; Lee, Jae Tae

    2006-01-01

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  3. MYOCARDIAL PERFUSION ASSESSMENT IN FORECASTING EFFECT OF CORONARY ANGIOPLASTY IN PATIENTS WITH ISCHEMIC CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. B. Mironkov

    2015-01-01

    Full Text Available Aim. To define influence of the left ventricle (LV perfusion defects on the clinical status dynamics after coronary angioplasty in patients with the expressed myocardium dysfunction of ischemic etiology. Materials and methods. Examined 86 patients (81 men and 5 women aged from 46 to 73 years before and in 2–3 days after percutaneous coronary intervention with diagnosis: CAD, CHF with NYHA class III–IV, echocardiography parameters of LV: ejection fraction less than 40%, end-diastolic volume is more than 200 ml. Perfusion defects of myocardium estimated with use of ECG-gated single photon emission computed tomography. Predictors were defined: perfusion defects on LV apex (in score, perfusion defects in the area of LAD, LCx and RCA (%, the LV global perfusion defects (in score and %. Results. In 42% of cases 6-minute walk test increased to 3 times; The NYHA class decreased by 2 classes (group 1. In 28 cases 6-minute walk test increased to 2 times and the NYHA class decreased on 1 class. In 22 patients 6-minute walk test increased less than 50% of reference values and there was no dynamics NYHA class (50 patients of the group 2. Initial extent of LV global perfusion defects in group 1 – 41,2 ± 4,0%, in group 2 – 58,3 ± 2,4% (р = 0,0004. Similar values are received for perfusion indicators in the area of LAD and the LV apex. Prevalence of myocardial perfusion defects at rest reflects prevalence of a cardiosclerosis in a cardiac muscle. Conclusion. Degree of LV myocardial perfusion defects in patients with the expressed heart failure of ischemic etiology is the key indicator influencing clinical efficiency of coronary angioplasty. Critical size for definition of the favorable forecast of revascularization are 60% and more perfusion defects testifying that in a cardiac muscle the focal cardiosclerosis prevails over the functioning myocardium. 

  4. Patterns of disturbed myocardial perfusion in patients with coronary artery disease. Regional myocardial perfusion in angina pectoris

    International Nuclear Information System (INIS)

    Selwyn, A.P.; Forse, G.; Fox, K.; Jonathan, A.; Steiner, R.

    1981-01-01

    Fifty patients who presented with angina pectoris were studied to examine the disturbances of regional myocardial perfusion during stress. Each patient underwent 16-point precordial mapping of the ECG during an exercise test, and coronary and left ventricular angiography. Regional myocardial perfusion was assessed using an atrial pacing test and a short-lived radionuclide, krypton-81m. Eleven patients had negative exercise tests and uniform increases in myocardial activity of krypton-81m of 98 +/- 18.0% during pacing. Ten patients performed 30,000-43,000 J in positive exercise tests. These patients showed abnormal coronary anatomy and increases in myocardial activity of krypton-81m to remote and jeopardized myocardium at the onset of pacing. However, further pacing produced a decrease in activity in the affected segment of 68.0 +/- 9.0% accompanied by ST-segment depression and angina. Twelve patients achieved 26,000-32,000 J in positive exercise tests and had significant coronary artery disease. Atrial pacing produced increased activity of krypton-81m to remote myocardium. The jeopardized segment at first showed no change and then a decrease in regional activity of krypton-81m (89.0 +/- 17%) accompanied by ST-segment depression and chest pain. Seventeen patients achieved only 7000-22,000 J in positive exercise tests. These patients showed abnormal coronary anatomy and developed decreases in regional activity of krypton-81m to the affected segment of myocardium starting at the onset of atrial pacing and decreasing by 88 +/- 0 7.0% below control. We conclude that different patterns of disturbed myocardial distribution of krypton-81m are present during stress-induced ischemia in patients with coronary artery disease. There was a close temporal relationship between these disturbances and ST-segment depression

  5. Significance of abnormal myocardial perfusion scintigraphy in young adult patients with SLE

    International Nuclear Information System (INIS)

    Zakavi, S.R.; Kakhki, V.R.D.; Sadeghi, R.; Jokar, M.H.; Khazaei, G.

    2009-01-01

    Detection of subclinical coronary artery disease (CAD) is a potential challenge in patients with systemic lupus erythematosus (SLE) and it is suggested that myocardial perfusion single photon emission computerized tomography (SPECT) is more sensitive than exercise test in this setting. However, the significance of perfusion abnormalities in SLE patients is not well known. In this study, we evaluated the prognostic significance of myocardial perfusion defects in patients with SLE. Patients with proven diagnosis of SLE admitted to the hospital due to noncardiac problems with no history of CAD were studied. All patients underwent 99m Tc-methoxyisobutylisonitrile (MIBI) myocardial perfusion scan using dipyridamole as pharmacological stress. All patients were followed up by reviewing patients file in lupus clinic and any minor or major cardiac events were recorded. Eighteen female and two male patients with mean age of 28.2±12.05 years were included. Six patients had mild reversible perfusion defects with mean summed difference score of 2.5±1.0. Pattern of reverse redistribution (reverse fill-in) was noted in three patients. Eleven patients had normal myocardial perfusion. Hypokinesia was noted in three patients on gated images. One patient with abnormal perfusion died 21 days after imaging due to on-cardiac cause. Nineteen patients were followed for a mean time of 39.2±16.0 months. No major or minor cardiac events were noted during follow-up. Three patients (one with abnormal perfusion) had at least one readmission during follow-up period. Our study showed that myocardial perfusion abnormalities are fairly frequent in SLE patients but the defects are generally mild and do not advocate an adverse prognosis. (author)

  6. Comparison of Hemodynamic Effects and Negative Predictive Value of Normal Adenosine Gated Myocardial Perfusion Scan With or Without Caffeine Abstinence

    International Nuclear Information System (INIS)

    Zaman, Maseeh uz; Fatima, Nosheen; Zaman, Areeba; Zaman, Unaiza; Tahseen, Rabia

    2016-01-01

    For vasodilator stress, myocardial perfusion imaging (MPI) with at least 12-h caffeine abstinence is recommended, as it attenuates cardiovascular hyperemic response of adenosine and dipyridamole. However, many published conflicting results have shown no significant effect upon perfusion abnormalities in MPI performed without caffeine abstinence. The aim of this study was to compare the hemodynamic changes and negative predictive value (NPV) of normal MPIs with adenosine stress performed with or without caffeine abstinence. This was a prospective study that accrued 50 patients from May 2013 till September 2013 and followed till November 2014. These patients had a normal adenosine-gated MPI (GMPI) with technetium-99m methoxy isobutyl isonitrile ( 99m Tc-MIBI) after 12-h caffeine abstinence (no-caffeine). Next day, all patients had a repeat adenosine stress within 60 min after ingestion of a cup of coffee (about 80 mg of caffeine) followed by no MPI in 30 patients due to concern about radiation dose (prior-caffeine adenosine—no MPI; group A). Twenty patients opted for a repeat MPI (prior-caffeine adenosine—MPI; group B). Adenosine-induced hemodynamic response and NPV of the normal MPI with no-caffeine and prior-caffeine protocols were compared. The mean age of the study cohort was 57 ± 9 years with a male-to-female ratio of 76:24% and mean body mass index (BMI) of 26.915 ± 4.121 kg/m 2 . Prevalence of hypertension, diabetes, dyslipidemia, and positive family history were 76%, 20%, 22%, and 17%, respectively. Comparison of group A with group B revealed no significant difference in demographic parameters, hemodynamic or electrocardiography (ECG) parameters, or left ventricular (LV) function parameters during adenosine intervention with prior-caffeine and no-caffeine protocols. During the follow-up, no fatal myocardial infarction (MI) was reported but 6 nonfatal MIs were reported based upon the history of short hospitalization for chest pain but without biochemical

  7. Comparative study of adenosine and exercise 201Tl myocardial perfusion tomographic imaging for detection of coronary heart disease

    International Nuclear Information System (INIS)

    Wang Xiong

    1997-01-01

    To compare diagnostic accuracy of adenosine and exercise 201 Tl myocardial perfusion tomographic imaging for detection of coronary heart disease (CHD) in patients with a normal rest ECG and no history of myocardial infarction, 81 patients with CHD and 10 normal control subjects underwent adenosine myocardial perfusion imaging, exercise nuclide myocardial perfusion imaging was performed in 117 patients with CHD and 16 normal control subjects, two groups also had coronary arteriography. Both exercise and adenosine testing parameters were analysed. It is shown: 1) The sensitivity and specificity for detection of CHD were 79% vs 80% for adenosine group and 81% vs 81% for exercise myocardial perfusion imaging group respectively. There was no significant difference in comparison with two matched groups (χ 2 = 1.13, χ 2 = 0.18, χ 2 = 0.12, P>0.05). 2) Side effects induced by adenosine accounted for 89% of patients, all symptoms were mild and disappeared quickly after the termination of the study except in 2 cases withdrawal of infusion needed because of severe angina pectoris. Adenosine myocardial perfusion imaging is a safe and sensitive method for detection of CHD. The diagnostic value of adenosine test is similar to that of exercise myocardial perfusion imaging and particularly useful in evaluating patients unable to perform exercise test or achieve adequate level of exercise

  8. Clinical evaluation of myocardial perfusion imaging with 99mTc-CPI

    International Nuclear Information System (INIS)

    Liu Xiujie

    1988-01-01

    10 normal subjects and 55 cases of patients with heart diseases were studied with 99m Tc-CPI myocardial perfusion imaging. The 99m Tc-CPI myocarbial imaging is superior to 99m Tc-TBI, because the uptake of 99m Tc-CPI in both lung and liver is lower. The imaging quality of 99m Tc-CPI is nearly as good as that of 201 Tl. 16 patients had both 99m Tc-CPI myocardial imaging and coronary artery angiography. The sensitivity of 99m Tc-CPI myocardial imaging for detecting coronary artery disease (CAD) was 92%, whereas the sensitivity of ECG was 84.6%. 99m Tc-CPI myocardial tomography was obtained in 17 patients using Toshiba 90B SPECT system. The imaging quality of myocardial tomography using 99m Tc-CPI is very good and superior to planar imaging for detecting myocardial infarction

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

    International Nuclear Information System (INIS)

    Padma, S.; Zachariah, M.; Haridas, K.K.

    2004-01-01

    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 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 99m Tc 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

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

    International Nuclear Information System (INIS)

    Padma, S; Zachariah, M.; Haridas, K K

    2004-01-01

    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 99m Tc 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

  11. Diagnosis of accessory conduction pathway using ECG-gated emission CT analysis

    International Nuclear Information System (INIS)

    Misaki, Takuro; Mukai, Keiichi; Tsubota, Makoto; Iwa, Takashi; Nakajima, Ken-ichi; Hisada, Kin-ichi

    1987-01-01

    Pinpointing the location of accessory conduction pathway (ACP) is of great importance in the surgical treatment for Wolff-Parkinson-White (WPW) syndrome. For this purpose, this study explored the usefulness of ECG-gated emission computed tomography (Gated-ECT) in 30 patients who preoperatively underwent Gated-ECT. The site of earliest contraction at level of atrioventicular valves, obtained on tomographic phase analysis, was compared with the site of earliest activation, obtained on epicardial mapping during surgery. The concordance rate of the two methods was 94 % (28/30). Among them, one patient was found to have the association of corrected transposition of great arteries on Gated-ECT. Gated-ECT was, however, of limited value in differentiating right posterior ACP from right postseptal ACP. The discordance between the sites of earliest contraction and activation, which was observed in the two others, was likely due to decreased wall motion resulting from myocardial disturbance. Gated-ECT may have a diagnostic potential for the location of ACP, especially in view of providing images that corresponded to the surgical anatomy. (Namekawa, K.)

  12. 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

    Directory of Open Access Journals (Sweden)

    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

  13. Automatic extraction of left ventricular mass and volumes using parametric images from non-ECG-gated 15O-water PET/CT

    DEFF Research Database (Denmark)

    Nordström, J; Harms, Hans; Lubberink, Mark

    of the present study was to investigate the feasibility of measuring LV geometry using dynamic 15O-water PET/CT without ECG-gating. Methods: Parametric images of MBF, perfusable tissue fraction (PTF) and LV blood pool were generated automatically using kinetic modelling. Segmentation of the LV wall using PTF......Introduction: 15O-water positron emission tomography (PET) is considered the gold standard for non-invasive quantification of myocardial blood flow (MBF). It has been shown to identify patients with significant coronary artery disease (CAD) with high accuracy. Hypertrophy with or without dilatation...... combined to measure stroke volume (SV=EDV-ESV) and ejection fraction (EF=SV/EDV). Accuracy was determined by comparing PET to cardiac magnetic resonance (CMR) in 30 asymptomatic patients with high grade LV regurgitation (group A). Precision was determined as inter-observer variation in group...

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

    International Nuclear Information System (INIS)

    Zhao, Chunlei; Shuke, Noriyuki; Okizaki, Atsutaka

    2003-01-01

    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 123 I-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) and 99m Tc-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 (p 0.05), but showed a significant correlation with H/M-TF (p 0.05) 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

  15. Pretest clinical diagnosis of coronary artery disease and stress myocardial perfusion scintigram

    International Nuclear Information System (INIS)

    Kasalicky, J.; Kovac, I.; Lanska, V.

    2001-01-01

    To assess the probability of perfusion defects at exercise stress myocardial perfusion SPECT scintigraphy from pretest clinical diagnosis (medical personal history, previous ergometric investigation). To determine the value of clinical factors for probability of scintigraphic defects with respect to avoiding unnecessary investigation in subjects with low probability of abnormal scintigrams. 2143 subjects (1235 men, 908 women) were investigated by SPECT perfusion scintigraphy at stepwise increasing exercise stress. They were divided into three groups with regard to their medical history and exercise test at scintigraphy: subjects without any signs of coronary artery disease (CAD), patients with high likelihood of CAD (i.e., typical anginal pain, in particular at stress, positive stress ECG changes, angiographically documented important CAD) and patients after myocardial infarction (MI). Important risk factors (hypertension, diabetes, age and sex), as well as the role of revascularisation procedures, were taken into account for multiple logistic regression in order to express their importance for the odds of scintigraphic defect visualisation. Perfusion scintigraphic defects (PSD) were found in 5.2% of subjects without signs of CAD, in contrast to patients with manifest CAD (68.8% with PSD) and in those after MI (90.2% with PSD). There were other important factors corroborating the likelihood of PSD (in decreasing order of importance): diabetes, male, ECG changes at stress, increasing age. Successful revascularisation improved scintigraphic images. The examination of CAD symptom-free subjects, in particular with atypical chest discomfort, is useless. SMPS in patients after documented MI is to be carried out for other intended purposes, not for CAD diagnosis only. SMPS is highly recommended in patients with CAD symptoms and high CAD probability in order to decide further treatment and prognosis. (author)

  16. Prediction of functional recovery after primary PCI using the estimate of myocardial salvage in gated SPECT early after acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Calabretta, Raffaella; Castello, Angelo; Linguanti, Flavia; Tutino, Francesca; Ciaccio, Alfonso; Sciagra, Roberto [University of Florence, Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ' ' Mario Serio' ' , Florence (Italy); Giglioli, Cristina [Careggi University Hospital, Cardiothoracovascular Department, Florence (Italy)

    2018-04-15

    Primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) aims to achieve myocardial salvage (MS). Because the reference method for measuring MS requires myocardial perfusion imaging (MPI) after tracer injection before PCI, alternative approaches have been proposed, but none has gained wide acceptance. Gated SPECT MPI can assess infarct size (IS), but can also show myocardial stunning. Thus, we compared functional and perfusion abnormalities early after AMI to estimate MS, and to predict left ventricular ejection fraction (LVEF) recovery at follow-up. We studied 120 patients with AMI. Gated SPECT MPI was performed early (before hospital discharge) and at 6 months after AMI to measure IS, MS and functional outcome. MS was defined as the difference between the number of segments with abnormal thickening (i.e. the stunned area or area at risk) and the number of segments with abnormal perfusion (i.e. the final IS), expressed as a percentage of the total number of segments in the AHA model. LVEF was calculated using quantitative gated SPECT. The area at risk was 40 ± 25%, IS was 17.3 ± 16% and MS was 22 ± 19%. Early LVEF was 46.6 ± 11.6% and late LVEF was 51.4 ± 11.6%, with 54 patients showing at least an increase in LVEF of more than 5 units. ROC analysis showed that MS was able to predict LVEF recovery with an area under the curve (AUC) of 0.79 (p < 0.0001), and using a cut off >23% detected LVEF recovery with 74% sensitivity and 71% specificity. Conversely, IS was associated with an AUC 0.53 (not significant). MS assessed by a single early gated SPECT MPI study can accurately predict LVEF evolution after primary PCI for AMI. (orig.)

  17. Comparison with myocardial perfusion MRI and myocardial perfusion SPECT in the diagnostic performance of coronary artery disease. A meta-analysis

    International Nuclear Information System (INIS)

    Iwata, Kunihiro; Kubota, Makoto; Ogasawara, Katsuhiko

    2008-01-01

    We compared the diagnostic abilities of stress myocardial perfusion MRI (myocardial perfusion MRI) and myocardial perfusion single photon emission computed tomography (SPECT), using a meta-analysis method. We investigated the diagnostic abilities of MRI and SPECT in similar subject groups in reports written in English or Japanese. The reports to be used for analysis were selected according to a ''screening standard,'' which was established in advance. After consolidating the data from the selected reports, we compared the integrated odds ratio, the point estimation values of sensibility/specificity, and the summary receiver operating characteristic (ROC) curve. For the analysis, six reports were selected (subjects: 153, coronary-artery target sites: 447). Meta-analysis revealed that the diagnostic ability of myocardial perfusion MRI was superior to that of myocardial perfusion SPECT regarding each of the parameters. This is considered to be supportive evidence of the usefulness of myocardial perfusion MRI. (author)

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

    Directory of Open Access Journals (Sweden)

    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

  19. Optimization of Ecg Gating in Quantitative Femoral Angiography

    International Nuclear Information System (INIS)

    Nilsson, S.; Berglund, I.; Erikson, U.; Johansson, J.; Walldius, G.

    2003-01-01

    Purpose: To determine which phase of the heart cycle would yield the highest reproducibility in measuring atherosclerosis-related variables such as arterial lumen volume and edge roughness. Material and Methods: 35 patients with hypercholesterolemia underwent select ive femoral angiography, repeated four times at 10-min intervals. The angiographies were performed with Ecg-gated exposures. In angiographies 1 and 2 the delay from R-wave maximum to each exposure was 0.1 s, in angiographies 3 and 4 the delay was 0.1, 0.3, 0.5 or 0.7 s or the exposures were performed 1/s without Ecg gating. Arterial lumen volume and edge roughness were measured in a 20-cm segment of the superficial femoral artery using a computer-based densitometric method. Measurement reproducibility was determined by comparing angiographies 1-2 and angiographies 3-4. Results: When measuring arterial lumen volume and edge roughness of a 20-cm segment of the femoral artery, reproducibility was not dependent on Ecg gating. In measuring single arterial diameters and cross-sectional areas, the reproducibility was better when exposures were made 0.1 s after the R-wave maximum than when using other settings of the Ecg gating device or without Ecg gating. Conclusion: The influence of pulsatile flow upon quantitative measurement in femoral angiograms seems to be the smallest possible in early systole, as can be demonstrated when measuring single diameters and cross-sectional areas. In variables based on integration over longer segments, measurement reproducibility seems to be independent of phase

  20. Optimization of Ecg Gating in Quantitative Femoral Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Nilsson, S.; Berglund, I.; Erikson, U. [Univ. Hospital, Uppsala (Sweden). Dept. of Oncology, Radiology and Clinical Immunology; Johansson, J.; Walldius, G. [Karolinska Hospital, Stockholm (Sweden). King Gustav V Research Inst.

    2003-09-01

    Purpose: To determine which phase of the heart cycle would yield the highest reproducibility in measuring atherosclerosis-related variables such as arterial lumen volume and edge roughness. Material and Methods: 35 patients with hypercholesterolemia underwent select ive femoral angiography, repeated four times at 10-min intervals. The angiographies were performed with Ecg-gated exposures. In angiographies 1 and 2 the delay from R-wave maximum to each exposure was 0.1 s, in angiographies 3 and 4 the delay was 0.1, 0.3, 0.5 or 0.7 s or the exposures were performed 1/s without Ecg gating. Arterial lumen volume and edge roughness were measured in a 20-cm segment of the superficial femoral artery using a computer-based densitometric method. Measurement reproducibility was determined by comparing angiographies 1-2 and angiographies 3-4. Results: When measuring arterial lumen volume and edge roughness of a 20-cm segment of the femoral artery, reproducibility was not dependent on Ecg gating. In measuring single arterial diameters and cross-sectional areas, the reproducibility was better when exposures were made 0.1 s after the R-wave maximum than when using other settings of the Ecg gating device or without Ecg gating. Conclusion: The influence of pulsatile flow upon quantitative measurement in femoral angiograms seems to be the smallest possible in early systole, as can be demonstrated when measuring single diameters and cross-sectional areas. In variables based on integration over longer segments, measurement reproducibility seems to be independent of phase.

  1. Performance of Thallium-201 Electrocardiography-gated Myocardial Perfusion Single Photon Emission Computed Tomography to Assess Left Ventricular Function

    Directory of Open Access Journals (Sweden)

    Guang-Uei Hung

    2005-05-01

    Full Text Available This study evaluated the performance of gated single photon emission computed tomography (SPECT with thallium-201 (201Tl in assessing left ventricular ejection fraction (LVEF, end-diastolic volume (EDV, and end-systolic volume (ESV in Taiwanese by determining repeatability and correlation with two-dimensional (2D echocardiography. A total of 18 patients underwent two sequential gated SPECT acquisitions within 30 minutes in the resting state to assess repeatability. Another 28 patients who underwent gated SPECT and 2D echocardiography within 7 days were included for comparison. The two sequential measurements were well correlated with respect to LVEF, EDV, and ESV (r = 0.97, 0.95, and 0.97, respectively, all p < 0.0001. Bland-Altman analysis revealed that two standard deviations of the absolute difference between the two sequential measurements for LVEF, EDV, and ESV were 6.4%, 16.8 mL, and 8.6 mL, respectively. For LVEF, EDV, and ESV, correlations between redistribution 201Tl-gated SPECT and echocardiography were also excellent (all r = 0.83, p < 0.0001. LVEF was similar with 201Tl-gated SPECT and echocardiography, but EDV and ESV were significantly higher with echocardiography (p < 0.05. Our study revealed that 201Tl-gated SPECT has high repeatability and excellent correlation with echocardiography for the assessment of LVEF and volumes in Taiwanese. These results support the clinical application of gated SPECT in routine 201Tl myocardial perfusion imaging in Taiwanese.

  2. The effect of relaxing music on heart rate and heart rate variability during ECG GATED-myocardial perfusion scintigraphy.

    Science.gov (United States)

    Tan, Yusuf Ziya; Ozdemir, Semra; Temiz, Ahmet; Celik, Fatmanur

    2015-05-01

    The positive changes in human behavior caused by relaxing music demonstrate the psychological effect of music on human body. A meta-analytical study has shown that relaxing music affects blood pressure and heart rate in coronary heart patients and cancer patients. The aim of our study is to research whether there is a significant effect on heart rate and heart rate variability due to listening to relaxing music during ECG GATED MPS imaging under gamma camera. The music group (n = 50 patients) could choose from 15 different musical types including folk music (no lyric). The other 50 patients were placed in a "no music group" and did not get headphones or any music. There was a statistically significant reduction in the heart rate of patients in the music group compared to those in the control group. Relaxing music provides great benefits to both patient and clinician. There is close relationship between relaxing music and health procedure, can use every area of the health noninvasiv, safe, cheap and is a method don't have side effect. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Step-and-shoot prospectively ECG-gated vs. retrospectively ECG-gated with tube current modulation coronary CT angiography using 128-slice MDCT patients with chest pain: diagnostic performance and radiation dose

    International Nuclear Information System (INIS)

    Kim, Jeong Su; Choo, Ki Seok; Jeong, Dong Wook

    2011-01-01

    Background With increasing awareness for radiation exposure, the study of diagnostic accuracy of coronary CT angiography (CCTA) with low radiation dose techniques is mandatory to both radiologist and clinician. Purpose To compare diagnostic performance and effective radiation dose between step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with tube current modulation (TCM) CCTA using 128-slice multidetector computed tomography (MDCT). Material and Methods We retrospectively evaluated 60 patients who underwent CCTA with either of two different low-dose techniques using 128-slice MDCT (23 patients for step-and shoot-prospectively ECG-gated and 37 patients for retrospectively ECG-gated with TCM CCTA) followed by conventional coronary angiography. All coronary arteries and all segments thereof, except anatomical variants or small size (< 1.5 mm) ones, were included in analysis. Results In per-segment analysis, sensitivity, specificity, positive predictive value, and negative predictive value were 91/96%, 95/94%, 75/73%, and 98/99% for step-and-shoot prospectively ECG-gated and retrospectively ECG gated with TCM CCTA, respectively, relative to conventional coronary angiography. Effective radiation dose were 1.75 ± 0.83 mSv, 4.91 ± 1.71 mSv in the step-and-shoot prospectively ECG-gated and retrospectively ECG-gated with TCM CCTA groups, respectively. Conclusion The two low-radiation dose CCTA techniques using 128-slice MDCT yields comparable diagnostic performance for coronary artery disease in symptomatic patients with low heart rates

  4. Simultaneous ECG-gated PET imaging of multiple mice

    International Nuclear Information System (INIS)

    Seidel, Jurgen; Bernardo, Marcelino L.; Wong, Karen J.; Xu, Biying; Williams, Mark R.; Kuo, Frank; Jagoda, Elaine M.; Basuli, Falguni; Li, Changhui; Griffiths, Gary L.

    2014-01-01

    Introduction: We describe and illustrate a method for creating ECG-gated PET images of the heart for each of several mice imaged at the same time. The method is intended to increase “throughput” in PET research studies of cardiac dynamics or to obtain information derived from such studies, e.g. tracer concentration in end-diastolic left ventricular blood. Methods: An imaging bed with provisions for warming, anesthetic delivery, etc., was fabricated by 3D printing to allow simultaneous PET imaging of two side-by-side mice. After electrode attachment, tracer injection and placement of the animals in the scanner field of view, ECG signals from each animal were continuously analyzed and independent trigger markers generated whenever an R-wave was detected in each signal. PET image data were acquired in “list” mode and these trigger markers were inserted into this list along with the image data. Since each mouse is in a different spatial location in the FOV, sorting of these data using trigger markers first from one animal and then the other yields two independent and correctly formed ECG-gated image sequences that reflect the dynamical properties of the heart during an “average” cardiac cycle. Results: The described method yields two independent ECG-gated image sequences that exhibit the expected properties in each animal, e.g. variation of the ventricular cavity volumes from maximum to minimum and back during the cardiac cycle in the processed animal with little or no variation in these volumes during the cardiac cycle in the unprocessed animal. Conclusion: ECG-gated image sequences for each of several animals can be created from a single list mode data collection using the described method. In principle, this method can be extended to more than two mice (or other animals) and to other forms of physiological gating, e.g. respiratory gating, when several subjects are imaged at the same time

  5. Utility of Electrocardiography (ECG)-Gated Computed Tomography (CT) for Preoperative Evaluations of Thymic Epithelial Tumors.

    Science.gov (United States)

    Ozawa, Yoshiyuki; Hara, Masaki; Nakagawa, Motoo; Shibamoto, Yuta

    2016-01-01

    Preoperative evaluation of invasion to the adjacent organs is important for the thymic epithelial tumors on CT. The purpose of our study was to evaluate the utility of electrocardiography (ECG)-gated CT for assessing thymic epithelial tumors with regard to the motion artifacts produced and the preoperative diagnostic accuracy of the technique. Forty thymic epithelial tumors (36 thymomas and 4 thymic carcinomas) were examined with ECG-gated contrast-enhanced CT using a dual source scanner. The scan delay after the contrast media injection was 30 s for the non-ECG-gated CT and 100 s for the ECG-gated CT. Two radiologists blindly evaluated both the non-ECG-gated and ECG-gated CT images for motion artifacts and determined whether the tumors had invaded adjacent structures (mediastinal fat, superior vena cava, brachiocephalic veins, aorta, pulmonary artery, pericardium, or lungs) on each image. Motion artifacts were evaluated using a 3-grade scale. Surgical and pathological findings were used as a reference standard for tumor invasion. Motion artifacts were significantly reduced for all structures by ECG gating ( p =0.0089 for the lungs and p ECG-gated CT and ECG-gated CT demonstrated 79% and 95% accuracy, respectively, during assessments of pericardial invasion ( p =0.03). ECG-gated CT reduced the severity of motion artifacts and might be useful for preoperative assessment whether thymic epithelial tumors have invaded adjacent structures.

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

    International Nuclear Information System (INIS)

    Matsuo, Shinro; Nakae, Ichiro; Matsumoto, Tetsuya; Horie, Minoru

    2006-01-01

    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 99m Tc-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)

  7. Myocardial perfusion scintigraphy - possibilities of diagnosing CAD

    International Nuclear Information System (INIS)

    Tsonevska, A.

    1998-01-01

    A reviewing the diagnostic methods used in the intricate process of evaluating CAD patients in a attempt to establish the role played by radionuclide methods in the diagnostic strategy is done. The perfusion cardiotropic radiopharmaceuticals used and the various methods of evaluating myocardial are discussed. Although 210 Tl-chloride is the most widely used myocardial perfusion agent, recently 99m Tc-MIBI is proposed as an alternative because of its advantages. Myocardial perfusion assessment is done by various techniques depending on the specific aim, each of them having its proper advantages and shortcomings. The inference is reached that regardless of the routine practical implementation of myocardial perfusion scintigraphy and comprehensive studies along this line in course, there are problems still not well enough clarified awaiting solution

  8. Analysis of the diagnostic value of the Gated-SPECT study of myocardial perfusion in the diagnosis of coronary disease in users seen at the Hospital Rafael Angel Calderon Guardia

    International Nuclear Information System (INIS)

    Calvo Montero, Karla; Coto Rodriguez, Maria Fernanda

    2011-01-01

    An analysis of the diagnostic value of the Gated-SPECT study of myocardial perfusion with Sestamibi marked with 99m Tc for the diagnosis of Coronary Disease was performed at the Hospital Rafael Angel Calderon Guardia. 13 patients with nuclear study and coronary angiography performed, were selected for the investigation. An estimate of the sensitivity, specificity and predictive values of the myocardial perfusion study was performed for the detection of the disease. Then, these values were related to socio-demographic and clinical characteristics of the patients submitted to the diagnosis. The need to use appropriate criteria to request this type of study was evidenced when determining that most of the patients presented risk factors compared to 26% of patients who did not present any factor [es

  9. Measurement of ventricular function by ECG gating during atrial fibrillation

    International Nuclear Information System (INIS)

    Bacharach, S.L.; Green, M.V.; Bonow, R.O.; Findley, S.L.; Ostrow, H.G.; Johnston, G.S.

    1981-01-01

    The assumptions necessary to perform ECG-gated cardiac studies are seemingly not valid for patients in atrial fibrillation (AF). To evaluate the effect of AF on equilibrium gated scintigraphy, beat-by-beat measurements of left-ventricular function were made on seven subjects in AF (mean heart rate 64 bpm), using a high-efficiency nonimaging detector. The parameters evaluated were ejection fraction (EF), time to end-systole (TES), peak rates of ejection and filling (PER,PFR), and their times of occurrence (TPER, TPFR). By averaging together single-beat values of EF, PER, etc., it was possible to determine the true mean values of these parameters. The single-beam mean values were compared with the corresponding parameters calculated from one ECG-gated time-activity curve (TAC) obtained by superimposing all the single-beat TACs irrespective of their length. For this population with slow heart rates, we find that the values for EF, etc., produced from ECG-gated time-activity curves, are very similar to those obtained from the single-beat data. Thus use of ECG gating at low heart rates may allow reliable estimation of average cardiac function even in subjects with AF

  10. Prognostic value of abnormal exercise myocardial perfusion imaging and its types in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Zhu Mei; Pan Zhongyun; Lin JInghui; Zhang Chunli; Nie Tao; Wang Yanfu

    1998-01-01

    Purpose: To evaluate the prognostic value of abnormal exercise myocardial perfusion imaging and its types in patients with coronary artery disease (CAD). Methods: 69 patients with CAD underwent exercise myocardial perfusing imaging and exercise ECG test. The images of all of them were abnormal. 45 patients were angiographically proved CAD. Follow-up period ranged from 6∼110 months and even longer than 12 months for patients with no cardiac events (CE). Results: CE occurred in 15 patients during the follow-up period. The CE incidence was 8.7% per year. Cox regression analysis revealed that there was a good correlation between the number of myocardial segments with reversible defects and future CE. Comparing the results of 13 patients with small extent irreversible defects with the data obtained from normal subjects reported previously, there was no significant difference between two no-CE rates (x 2 = 0.09, P>0.05). Conclusions: Normal myocardial images and irreversible defects involving rather small areas predicted an excellent prognosis. The better predictor of future CE is the quantity of myocardial segments with reversible defect

  11. ECG gated NMR-CT for cardiovascular diseases

    International Nuclear Information System (INIS)

    Nishikawa, J.; Machida, K.; Iio, M.; Yoshimoto, N.; Sugimoto, T.; Kawaguchi, H.; Mano, H.

    1984-01-01

    The authors applied NMR-CT to cardiac study with ECG gated technique to evaluate the left ventricular (LV) function and compared it with cardiovascular nuclear medicine study (NM). The NMR-CT machine has resistive air-core magnet with 0.15 Tesla. The saturation recovery image or inversion recovery image were obtained as 256 x 256 matrix and 15 mm in thickness. The study population was ten patients who were evaluated both by NMR image and by NM performed within one week interval. The heart muscle was able to be visualized without any contrast material nor radioisotopes in inversion recovery images, whereas saturation recovery images failed to separate heart muscle from blood pool. The wall motions of LV in both methods were well correlated except for inferior wall. The values of ejection fraction in NMR image were moderately low, but two modalities showed satisfactory correlation (r=0.85). The region of myocardial infarction was revealed as wall thinning and/or wall motion abnormality. It is still preliminary to draw a conclusion, however, it can be said that in the evaluation of LV function, method by NMR might be of equal value to those of NM. It can be certain that eventually gated NMR-CT will become more effective method for various aspects of cardiovascular evaluation

  12. Meta-Analysis of Stress Myocardial Perfusion Imaging

    Science.gov (United States)

    2017-06-06

    Coronary Disease; Echocardiography; Fractional Flow Reserve, Myocardial; Hemodynamics; Humans; Magnetic Resonance Imaging; Myocardial Perfusion Imaging; Perfusion; Predictive Value of Tests; Single Photon Emission Computed Tomography; Positron Emission Tomography; Multidetector Computed Tomography; Echocardiography, Stress; Coronary Angiography

  13. Myocardial perfusion imaging with dual energy CT

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Kwang Nam [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of); De Cecco, Carlo N. [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Caruso, Damiano [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiological Sciences, Oncology and Pathology, University of Rome “Sapienza”, Rome (Italy); Tesche, Christian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich (Germany); Spandorfer, Adam; Varga-Szemes, Akos [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States)

    2016-10-15

    Highlights: • Stress dual-energy sCTMPI offers the possibility to directly detect the presence of myocardial perfusion defects. • Stress dual-energy sCTMPI allows differentiating between reversible and fixed myocardial perfusion defects. • The combination of coronary CT angiography and dual-energy sCTMPI can improve the ability of CT to detect hemodynamically relevant coronary artery disease. - Abstract: Dual-energy CT (DECT) enables simultaneous use of two different tube voltages, thus different x-ray absorption characteristics are acquired in the same anatomic location with two different X-ray spectra. The various DECT techniques allow material decomposition and mapping of the iodine distribution within the myocardium. Static dual-energy myocardial perfusion imaging (sCTMPI) using pharmacological stress agents demonstrate myocardial ischemia by single snapshot images of myocardial iodine distribution. sCTMPI gives incremental values to coronary artery stenosis detected on coronary CT angiography (CCTA) by showing consequent reversible or fixed myocardial perfusion defects. The comprehensive acquisition of CCTA and sCTMPI offers extensive morphological and functional evaluation of coronary artery disease. Recent studies have revealed that dual-energy sCTMPI shows promising diagnostic accuracy for the detection of hemodynamically significant coronary artery disease compared to single-photon emission computed tomography, invasive coronary angiography, and cardiac MRI. The aim of this review is to present currently available DECT techniques for static myocardial perfusion imaging and recent clinical applications and ongoing investigations.

  14. Dynamic CT myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Caruso, Damiano; Eid, Marwen; Schoepf, U. Joseph; Jin, Kwang Nam; Varga-Szemes, Akos; Tesche, Christian; Mangold, Stefanie

    2016-01-01

    Highlights: • CT myocardial perfusion provides functional assessment of the myocardium. • CCTA is limited in determining the hemodynamic significance of coronary stenosis. • CT-MPI can accurately detect hemodynamically significant coronary artery stenosis. - Abstract: Non-invasive cardiac imaging has rapidly evolved during the last decade due to advancements in CT based technologies. Coronary CT angiography has been shown to reliably assess coronary anatomy and detect high risk coronary artery disease. However, this technique is limited to anatomical assessment, thus non-invasive techniques for functional assessment of the heart are necessary. CT myocardial perfusion is a new CT based technique that provides functional assessment of the myocardium and allows for a comprehensive assessment of coronary artery disease with a single modality when combined with CTA. This review aims to discuss dynamic CT myocardial perfusion as a new technique in the assessment of CAD.

  15. Dynamic CT myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Caruso, Damiano [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiological Sciences, Oncological and Pathological Sciences, University of Rome “Sapienza”, Latina (Italy); Eid, Marwen [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC (United States); Jin, Kwang Nam [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul (Korea, Republic of); Varga-Szemes, Akos [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Tesche, Christian [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich (Germany); Mangold, Stefanie [Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen (Germany); and others

    2016-10-15

    Highlights: • CT myocardial perfusion provides functional assessment of the myocardium. • CCTA is limited in determining the hemodynamic significance of coronary stenosis. • CT-MPI can accurately detect hemodynamically significant coronary artery stenosis. - Abstract: Non-invasive cardiac imaging has rapidly evolved during the last decade due to advancements in CT based technologies. Coronary CT angiography has been shown to reliably assess coronary anatomy and detect high risk coronary artery disease. However, this technique is limited to anatomical assessment, thus non-invasive techniques for functional assessment of the heart are necessary. CT myocardial perfusion is a new CT based technique that provides functional assessment of the myocardium and allows for a comprehensive assessment of coronary artery disease with a single modality when combined with CTA. This review aims to discuss dynamic CT myocardial perfusion as a new technique in the assessment of CAD.

  16. Role of adenosine 99MTc sestamibi myocardial perfusion spect in evaluation of symptomatic hypertensives with recent onset left bundle branch block

    International Nuclear Information System (INIS)

    Padma, S.; Sundaram, P.S.; Zachariah, M.; Hariads, K.K.

    2004-01-01

    Objectives: Adenosine pharmacological stress Myocardial Perfusion Imaging (AMPI) is the preferred imaging modality for IHD evaluation in pts with Left Bundle Branch Block (LBBB). Good prognosis has been reported in recent onset LBBB pts with normal MPI. Our aim was to evaluate the utility and analyze the predictive value of SestaMIBI AMPI in symptomatic recent onset LBBB hypertensives for coronary artery disease evaluation. Methods: 29 hypertensive pts, age range 36-72yrs, mean 54+ 6 yrs, M:F- 21:8 with recent onset complete LBBB, under evaluation for typical/atypical angina who had AMPI between Nov 02-Nov 03, were retrospectively analyzed. LBBB was diagnosed ECG wise if there is prolonged QRS complex i.e. 0.125sec or more in sinus/supraventricular rhythm, a QS or rS complex in lead 1, and an R-wave peak time of 0.06sec in leads 1, V5 or V6 with no Q wave in same lead. Pts with prior Myocardial Infarct / revasularisation, pacemaker induced LBBB were excluded. Single day 6 min. Adenosine infusion Stress-rest 99m Tc MIBI gated MPI was performed with a dual head variable angle Gamma Camera at 76-degree angle. Coronary Angiogram (CAG) correlation was available in 24 pts. Results: Myocardial perfusion SPECT images were assessed visually and by a 20-segment model. Location, extent and severity of the LV perfusion defects were evaluated. 6/29 pts (20.7%) had normal stress-rest perfusion in all LV segments.12 (41.4%) had isolated septal fixed defect with normal perfusion in rest of the segments.3 pts (10.3%)showed isolated reversible septal defects while 8(27.6%) had reversible septal defects with reversible defects in other LV segments also. Pts with fixed septal perfusion defect showed moderate to good septal wall thickening in gated SPECT images. While all pts with multiple reversible perfusion defects had angiographically proven coronary artery disease (i.e. 3pts had LAD lesion, 2 had Triple vessel and 3 showed double vessel lesions), 1 out of 3 pts with isolated

  17. Applicability of myocardial perfusion scintigraphy in the evaluation of cardiac synchronization

    Energy Technology Data Exchange (ETDEWEB)

    Reis, Christiane Cigagna Wiefels; Nascimento, Erivelton Alessandro do; Dias, Fernanda Baptista Ribeiro; Ribeiro, Mario Luiz; Wanderley, Annelise Passos Bispo; Batista, Layanara Albino; Nunes, Thais Helena Peixoto; Mesquita, Claudio Tinoco, E-mail: chriswreis@gmail.com [Universidade Federal Fluminense (UFF), Niterói, RJ (Brazil). Hospital Universitário Antônio Pedro

    2017-07-15

    To systematically assess the literature on the applicability of myocardial perfusion scintigraphy with phase analysis in the investigation of cardiac dyssynchrony and in the selection of patients for cardiac resynchronization therapy (CRT), manuscripts published on the PubMed database over the past five years have been reviewed. The following MeSH terms were used: heart failure, left ventricular, dyssynchrony, gated-SPECT, phase analysis and resynchronization therapy. Altogether, 99 manuscripts were included for discussion. Speckle-tracking echocardiography is still widely used in the evaluation of dyssynchrony, but the advent of myocardial perfusion scintigraphy with the phase analysis technique has been gaining ground, as besides being operator independent, it can evaluate myocardial viability in the same test. Its use became more widespread in patients with left bundle branch block, with recommendation of CRT. Phase analysis also allows evaluating, in a highly reproducible way, the last ventricular segment to contract, hence allowing the best positioning of the CRT electrode. Knowing that the presence, location and extent of fibrosis in the left ventricle, associated with dyssynchrony are determinants of response to resynchronization therapy, GATED- SPECT can provide this information in a single test and in a reproducible and accurate way. Phase histogram offers several parameters that provide greater sensitivity and specificity to the method. It seems that the technique is able to add value both in the selection and in the evaluation of response of patients eligible to CRT. Further studies are being conducted to demonstrate its clinical applicability. (author)

  18. Thallium-201 myocardial perfusion imaging at rest and during exercise. Comparative sensitivity to electrocardiography in coronary artery disease

    International Nuclear Information System (INIS)

    Bailey, I.K.; Griffith, L.S.C.; Rouleau, J.; Strauss, H.W.; Pitt, B.

    1977-01-01

    The sensitivity of myocardial perfusion imaging (MPI) using thallium-201 injected both at rest and during peak exercise was compared to simultaneously recorded 12 lead electrocardiography (ECG) for the detection of transient ischemia in 20 normal subjects and 63 patients with coronary artery disease (CAD). No significant perfusion defects or ECG changes were seen on either the rest or exercise studies in any of the normal subjects. Fifty-six percent of patients with CAD developed new perfusion defects with exercise compared to 38 percent who developed ischemic ST-segment depression (P < 0.02). However, when chest pain and/or ST depression were considered indices of ischemia, the sensitivity of exercise testing and thallium-201 MPI was similar. The increased sensitivity of MPI compared to ST-segment depression on the ECG was due to patients with baseline ECG abnormalities and those who failed to achieve 85 percent of predicted maximum heart rate with exercise. Analysis of the exercise results according to the extent of coronary artery disease revealed a progressive increase in both positive ECGs and MPI with the number of vessels involved. In patients with single vessel disease the MPI was more sensitive than the ECG (P < 0.02). The combination of the rest and exercise ECG, MPI and chest pain during exercise failed to identify 11 percent of patients with CAD. Exercise thallium-201 MPI is a useful adjunct to conventional exercise testing particularly when evaluating patients with abnormal resting ECGs, those who develop ventricular conduction defects or arrhythmias during exercise, and those who fail to achieve their predicted heart rate because of fatigue or breathlessness

  19. Assessment of ischemic heart disease by dipyridamole stress electrocardiographic gated myocardial single photon emission computed tomography with technetium-99m tetrofosmin

    International Nuclear Information System (INIS)

    Kanna, Masahiko; Mitani, Isao; Nakamaru, Masashi; Shibuya, Ken; Takeda, Kazuyoshi; Asahina, Shigeru; Kitamura, Yutaka; Higuma, Kikuhiko; Ishii, Masao

    1998-01-01

    Simultaneous assessment of stress perfusion and rest function is possible with gated single photon emission computed tomography (SPECT) using stress injected technetium-99m ( 99m Tc) tetrofosmin (TF). The feasibility of dipyridamole stress electrocardiographic gated myocardial SPECT (GSPECT) with TF was examined as an alternative to conventional stress/rest imaging. Fifty-one patients underwent stress GSPECT. 740 MBq of TF was administered 3 min after dipyridamole infusion. GSPECT acquisition was performed one hour after the injection. Additional rest SPECT was performed on another day only in patients with abnormal perfusion on stress images. Perfusion and thickening were analyzed visually on 17 segments of the left ventricle. Percentage of wall thickening (%WT) was also calculated in 17 segments of the polar map. Thirty-two of 51 patients (63%) had normal stress perfusion and normal rest thickening. Nineteen of 51 patients (37%) had abnormal perfusion on stress images. Among 157 abnormal perfusion segments of the 19 patients, 139 segments (89%) had thickening and the rest (11%) had no thickening. %WT was higher in the reversible segments with or without thickening. There was better agreement for the identification of normal segments and the presence of reversibility between stress GSPECT and the conventional stress/rest study in patients without previous myocardial infarction than in those with previous myocardial infarction (89% vs 79%). These results suggest that stress GSPECT may substitute for conventional stress/rest perfusion study in patients without previous myocardial infarction, allowing shorter examination time and lower cost. However, stress GSPECT does not replace the need for rest perfusion study in patients with previous myocardial infarction, because of underestimation of viability, but %WT may eliminate this underestimation. (author)

  20. Prevalence of silent myocardial ischaemia during exercise stress testing. Its relation to effort tolerance and myocardial perfusion abnormalities.

    Science.gov (United States)

    Fragasso, G; Sciammarella, M G; Rossetti, E E; Xuereb, R G; Xuereb, M; Bonetti, F; Carandente, O M; Margonato, A; Chierchia, S L

    1992-07-01

    The number of underperfused myocardial segments, the extent of coronary artery disease and the severity of impairment of coronary flow reserve were compared in 147 consecutive patients exhibiting painful or painless ischaemic ST segment depression on exercise testing. Of 147 patients, only 61 (41%) experienced angina (group 1) whilst 86 (59%) did not (group 2). In the two groups coronary disease was comparable for both extent and distribution, and neither the location of transient perfusion defects nor their relation to areas of old myocardial necrosis appeared to influence the presence or absence of chest pain. However, exercise duration, exercise time and rate-pressure product at the beginning of ischaemia were lower in group 1. Furthermore, a greater proportion of asymptomatic patients had only one ischaemic segment on 99mTc-MIBI perfusion scintigraphy. We conclude that: (1) in patients with effort angina and coronary disease, the incidence of electrocardiographic silent ischaemic events induced by exercise is similar to that observed in studies based on continuous ECG monitoring. (2) Exertional angina is more frequently associated with greater ischaemic areas and with more severe degrees of impairment of residual coronary flow reserve. (3) The presence of an old myocardial infarction does not appear to influence the incidence of ischaemic cardiac pain.

  1. Assessment of prognostic value of semiquantitative parameters on gated single photon emission computed tomography myocardial perfusion scintigraphy in a large middle eastern population

    International Nuclear Information System (INIS)

    Chavoshi, Maryam; Fard-Esfahani, Armaghan; Fallahi, Babak; Emami-Ardekani, Alireza; Beiki, Davood; Hassanzadeh-Rad, Arman; Eftekhari, Mohammad

    2005-01-01

    Coronary artery disease is the leading cause of mortality worldwide. The goal of this study is to determine the prognostic value of semiquantitative parameters of electrocardiogram-gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in a large Middle Eastern (Iranian) population. This study was a prospective study including all patients referred to our center for myocardial perfusion scan. The patients were followed annually up to 24 months and their survival information was collected. From 1148 patients, 473 (41.2%) men and 675 (58.8%) women, 40.6% had normal MPI, 13.3% near normal and 46.1% abnormal MPI. After follow-up of 929 patients, 97.4% of patients were alive, and 2.6% succumbed to cardiac deaths. Abnormal ejection fraction was related with cardiac events (P = 0.001), but neither transient ischemic dilation (TID) (P = 0.09) nor lung/heart ratio (P = 0.92) showed such relationship. Association between summed difference score (SDS) and soft cardiac events (P < 0.001) was significant. Summed motion score (SMS) and summed thickening score (STS) showed a significant relation with hard cardiac events, including myocardial infarction and cardiac death (P < 0.001 and P = 0.001, respectively). Totally, risk of all cardiac events was significantly higher in abnormal MPI group than normal group (P < 0.001, 0.02, and 0.025, respectively). No significant relationship was found between TID and total cardiac events (P = 0.478). Semiquantitative variables derived from gated SPECT MPI have independent prognostic value. Rate of total cardiac events is higher in patients with higher summed stress score and SDS. Total and hard cardiac events are higher in upper scores of functional parameters (SMS and STS). Total cardiac events are higher in patients with lower left ventricular ejection fraction

  2. The clinical value of 99Tcm-N-NOET exercise and delayed myocardial perfusion imaging in patients with hypertension

    International Nuclear Information System (INIS)

    Wei Hua; Li Sijin; Liu Jianzhong; Wu Zhifang; Liu Haiyan; Hu Guang; Wang Jin; Li Qing

    2010-01-01

    Objective: To investigate clinical significance of the 99 Tc m -bis (N-ethoxy-N-ethyl-dithiocar-bamato) nitridotechnetium ( 99 Tc m -N-NOET) exercise and delayed myocardial perfusion imaging (MPI) in hypertensive patients. Methods: Sixty patients with hypertension and 19 normal subjects were carried out 99 Tc m -N-NOET exercise and delayed MPI, and analyzed the results of MPI, exercise electrocardiography (ECG), cardiac function parameters end-diastolic volume (EDV), end-systolic volume (ESV), left ventricular ejection fraction (LVEF), triangle open LVEF (LVEF exercis-LVEF delay) and coronary angiography (CAG). Results: 1) Sixty patients with hypertension, 22 cases (36.7%) of exercise ECG were abnormal, 16 cases (26.7%) were the chest tightness in exercise, 13 cases (21.7%) were blood pressure excessive reaction in exercise; control group, 2 cases (10.5%) of exercise ECG were abnormal, 1 case (5.3%, 1/19) was chest tightness in exercise, no person was blood pressure response in excessive. 2) The positive rate of myocardial perfusion in hypertensive group was significantly higher than the control group (31.75%vs. 5.30%, P 0.05), triangle open LVEF 2 =4.501, P 2 =0.25, P>0.05). The sensitivity, specificity and accuracy of 99 Tc m -N-NOET MPI were 72.7%, 87.5% and 78.9%. Conclusions: 1) 99 Tc m -N-NOET exercise and delayde MPI can diagnose whether hypertension patients with myocardial ischemia or not. 2) triangle open LVEF of hypertensive patients reduced, triangle open LVEF is lower in hypertensive patients of MPI-positive. (authors)

  3. Evaluation of myocardial perfusion reserve in patients with CAD using Contrast-Enhanced MRI: A comparison between semiquantitative and quantitative methods

    International Nuclear Information System (INIS)

    Schmitt, M.; Mohrs, O.K.; Petersen, S.E.; Kreitner, K.F.

    2002-01-01

    Objective: Comparison between two semiquantitative methods and a quantitative evaluation of myocardial blood flow (MBF) for assessment of myocardial perfusion reserve (MPR) in patients with CAD. Material and Methods: 9 patients with coronary stenoses>50% were examined with an ECG-gated Saturation Recovery Turbo FLASH sequence by using Gd-DTPA as contrast agent (CA). The entive measurements were performed both during rest and hyperemia induced by adenosine. The up-slopes of the signal-time S(t) curves in the myocardium and left ventricular (LV) cavity were evaluated by a linear fit. MPR was calculated from the original up-slopes of the myocardial S(t) curves and from the up-slopes, which were normalized to the up-slopes of the LV S(t) curves, respectively. For quantification of MBF values, the mathematical model MMID 4 was used and MPR was evaluated from the MBF values. Results: With all tested methods, MPR was reduced in myocardial regions subtended by arteries with stenoses≥70% compared with remote regions. With MMID 4 and the normalized up-slope method, differences between severe ischemic and remote regions were statistically significant. Conclusion: The up-slope method with normalization and quantification with MMID 4 are more sensitive methods to differentiate between remote and ischemic myocardium than the up-slope method without normalization. (orig.) [de

  4. Assessment of hypertrophic cardiomyopathy by ECG gated cardiac computed tomography

    International Nuclear Information System (INIS)

    Takeuchi, Kazuhide; Tanaka, Chujiro; Oku, Hisao

    1981-01-01

    The applicability of ECG gated cardiac computed tomography (CT) in 12 patients with hypertrophic cardiomyopathy was examined. Six of the 12 patients had hypertrophic obstructive cardiomyopathy, including one patient with mid-ventricular obstruction. Three of the 12 patients had hypertrophic non-obstructive cardiomyopathy, and three had apical hypertrophic cardiomyopathy. The diagnosis of hypertrophic cardiomyopathy was confirmed by the angiocardiogram in all patients. Cardiac CT was performed after intravenous administration of contrast media usually given as a bolus injection. The gantry was set with positive 20 0 tilt angle. In all patients with hypertrophic obstructive cardiomyopathy except for mid-ventricular obstruction, the hypertrophied interventricular septum in the basal and mid portions was observed, and the left ventricular cavity was narrowed in systole. In a patient with mid-ventricular obstruction, the marked hypertrophied interventricular septum and antero-lateral papillary muscle were observed. In diastole, the left ventricular cavity was narrow and divided into two parts. The apical cavity was completely disappeared in systole. In all patients with hypertrophic non-obstructive cardiomyopathy, the diffuse hypertrophied interventricular septum was observed in diastole. In systole, the apical portion of the left ventricular cavity was markedly narrow and antero-lateral papillary muscle was hypertrophic. In all patients with apical hypertrophic cardiomyopathy, the marked apical hypertrophy of the left ventricular wall was observed in diastole. It is concluded that ECG gated cardiac CT could estimate myocardial wall motion and thickness and differentiate the types of hypertrophic cardiomyopathy each other. (author)

  5. 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

    International Nuclear Information System (INIS)

    Kusuoka, Hideo; Yamasaki, Yoshimitsu; Izumi, Tohru; Kashiwagi, Atsunori; Kawamori, Ryuzo; Shimamoto, Kazuaki; Yamada, Nobuhiro; Nishimura, Tsunehiko

    2008-01-01

    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 99m Tc-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

  6. The value of regional wall motion abnormalities on gated mycardiac perfusion imaging in perfusion imaging in predicting angiographic stenoses of coronary artery

    International Nuclear Information System (INIS)

    Yao Lixin; Liu Binbin

    2007-01-01

    Objective: To determine the possible level of angiographic stenoses of coronary artery at which reversible regional wall motion abnormalities (RWMA) are present on 99m Tc-sestamibi ( 99m Tc-MIBI)-gated myocardial perfusion imaging (MPI). Methods: ninty patients undergoing coronary angiography MPI within two weeks were recruited. A five grades and nine segments marking system was introduced to assess the RWMA and thickening of left ventricles. Results: The sensitivity of reversible RWMA for detecting ≥75% angiographic stenoses was 64%,with a specificity of 95% and positive predictive value of 97%. The presence of reversible RWMA was able to stratify patients with severe angiographic stenoses of 75% or more from those less than 75% with high positive predictive value. A good correlation was noted between the presence of reversible RWMA and the coronary artery jeopardy score. Multivariate analysis showed that the post-stress RWMA and reversible RWMA scores and positive dipyridamole-stress exercise electrocardiogram(ECG) were significant predictors of angiographic severity. Conclusions: Reversible RWMA, as shown by dipyridamole stress 99m Tc-MIBI MPI, is a significant predictor of angiographic disease with very high specificity and adds incremental value to MPI for the assessment of angiographic severity. (authors)

  7. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results

    Energy Technology Data Exchange (ETDEWEB)

    Weininger, Markus [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC (United States); Ramachandra, Ashok [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Fink, Christian [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Rowe, Garrett W.; Costello, Philip [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Henzler, Thomas [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany)

    2012-12-15

    Purpose: Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain. Methods and materials: Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel “shuttle” mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT. Results: In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments. Conclusion: Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.

  8. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results

    International Nuclear Information System (INIS)

    Weininger, Markus; Schoepf, U. Joseph; Ramachandra, Ashok; Fink, Christian; Rowe, Garrett W.; Costello, Philip; Henzler, Thomas

    2012-01-01

    Purpose: Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain. Methods and materials: Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel “shuttle” mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT. Results: In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments. Conclusion: Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.

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

    International Nuclear Information System (INIS)

    Kang, Do Young; Cha, Kwang Soo; Han, Seung Ho; Park, Tae Ho; Kim, Moo Hyun; Kim, Young Dae

    2005-01-01

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Science.gov (United States)

    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

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

    International Nuclear Information System (INIS)

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

    2015-01-01

    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 99m Tc 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

  13. ECG-gated multislice spiral CT for diagnosis of acute pulmonary embolism

    International Nuclear Information System (INIS)

    Marten, K.; Engelke, C.; Funke, M.; Obenauer, S.; Baum, F.; Grabbe, E.

    2003-01-01

    AIM: The purpose of this study was to determine the feasibility of echocardiogram (ECG)-gated multi-slice CT angiography (MCTA) in patients with clinical suspicion of acute venous thromboembolism (VTE), to investigate the effect of ECG-gating on cardiac motion artefacts, and to determine the diagnostic reader agreement of ECG-gated MCTA in comparison with conventional MCTA. MATERIALS AND METHODS: Forty-eight consecutive patients were prospectively enrolled and randomly underwent ECG-gated (n=25, group 1) or non-ECG-gated (n=23, group 2) eight-slice pulmonary MCTA. Image data were evaluated by three independent chest radiologists with respect to the presence or absence of emboli at different arterial levels (main, lobar, segmental, and subsegmental arteries), and with regard to cardiac motion artefacts. Statistical tests used to calculate inter-observer agreement were weighted κ statistics, extended κ statistics and confidence indices indicating three-reader agreement accuracy. RESULTS: Twenty-seven patients (56.3%) were diagnosed to have pulmonary embolism (13 from group 1, 14 from group 2). Cardiac motion artefacts were significantly more frequent in group 2 (70% in group 2 versus 13% in group 1, p=0.0001). The overall diagnostic agreement was excellent with both MCTA techniques (three-reader confidence index for all vascular territories: 0.76 and 0.84 for groups 1 and 2, respectively (extended κ=0.69 and 0.78, respectively); three-reader confidence index for diagnosis of VTE: 0.94 and 0.85 for groups 1 and 2, respectively (extended κ=0.91 and 0.73, respectively), weighted κ=0.81-0.83 and 0.92-0.95 for groups 1 and 2, respectively, and did not differ significantly between the two groups. In addition there was no significant difference of inter-observer agreement in either group at any assessed pulmonary arterial level. CONCLUSION: ECG-gated pulmonary MCTA is feasible in patients with clinical suspicion of VTE. However, ECG-gated image acquisition did not

  14. Quantitative aspects of myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Vogel, R.A.

    1980-01-01

    Myocardial perfusion measurements have traditionally been performed in a quantitative fashion using application of the Sapirstein, Fick, Kety-Schmidt, or compartmental analysis principles. Although global myocardial blood flow measurements have not proven clinically useful, regional determinations have substantially advanced our understanding of and ability to detect myocardial ischemia. With the introduction of thallium-201, such studies have become widely available, although these have generally undergone qualitative evaluation. Using computer-digitized data, several methods for the quantification of myocardial perfusion images have been introduced. These include orthogonal and polar coordinate systems and anatomically oriented region of interest segmentation. Statistical ranges of normal and time-activity analyses have been applied to these data, resulting in objective and reproducible means of data evaluation

  15. Function's evaluation, perfusion and metabolism by positron emission tomography associated with multislice tomography (PET/CT) in patient with previous diagnosis to myocardial necrosis

    International Nuclear Information System (INIS)

    Campisi, Roxana; Aramayo, Natalia; Osorio, Amilcar

    2010-01-01

    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) [es

  16. Evaluation of myocardial involvement in Duchenne's progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Kawai, Naoki; Sotobata, Iwao; Okada, Mitsuhiro

    1985-01-01

    Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. A qualitative analysis was performed from five projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in the LV posterolateral or posterior wall (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle involvements or thoracic deformities assessed by transmission computed tomography. Extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. Progression of the myocardial scintigraphic abnormalities were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies over 2 to 3 years. It was concluded that thallium myocardial perfusion imaging is a useful clinical technique to assess myocardial involvement in Duchenne's progressive muscular dystrophy. (author)

  17. Impairment of myocardial perfusion in children with sickle cell disease

    International Nuclear Information System (INIS)

    Maunoury, C.; Acar, P.; Montalembert, M. de

    2003-01-01

    While brain, bone and spleen strokes are well documented in children with sickle cell disease (SCD), impairment of myocardial perfusion is an unknown complication. Non invasive techniques such as exercise testing and echocardiography have a low sensitivity to detect myocardial ischemia in patients with SCD. We have prospectively assessed myocardial perfusion with Tl-201 SPECT in 23 patients with SCD (10 female, 13 male, mean age 12 ± 5 years). Myocardial SPECT was performed after stress and 3 hours later after reinjection on a single head gamma camera equipped with a LEAP collimator (64 x 64 matrix size format, 30 projections over 180 deg C, 30 seconds per step). Left ventricular ejection fraction (LVEF) was assessed by equilibrium radionuclide angiography at rest on the same day. Myocardial perfusion was impaired in 14/23 patients: 9 reversible defects and 5 fixed defects. The left ventricular cavity was dilated in 14/23 patients. The mean LVEF was 63 ± 9%. There was no relationship between myocardial perfusion and left ventricular dilation or function. The frequent impairment of myocardial perfusion in children with SCD could lead to suggest a treatment with hydroxyurea, an improvement of perfusion can be noted with hydroxyurea. (author)

  18. Myocardial perfusion in type 2 diabetes with left ventricular hypertrophy

    DEFF Research Database (Denmark)

    Hesse, Birger; Meyer, Christian; Nielsen, Flemming S

    2004-01-01

    The purpose of this study was to assess whether acute angiotensin-converting enzyme (ACE) inhibition would improve myocardial perfusion and perfusion reserve in a subpopulation of normotensive patients with diabetes and left ventricular hypertrophy (LVH), both independent risk factors of coronary...... disease. Using positron emission tomography (PET), we investigated the response of regional myocardial perfusion to acute ACE inhibition with i.v. infusion of perindoprilat (vs saline infusion as control, minimum interval 3 days) in 12 diabetic patients with LVH. Myocardial perfusion was quantified...... with controls, maximal perfusion was reduced in patients (1.8+/-0.6 vs 2.5+/-1.0 ml min(-1) g(-1); P2.7+/-1.0 vs 3.6+/-1.3; P=0.059). During perindoprilat infusion, myocardial perfusion reserve in patients increased to 3.9+/-0.9 ( P

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

    Energy Technology Data Exchange (ETDEWEB)

    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

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

    International Nuclear Information System (INIS)

    Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Ahn, B. C.; Lee, J.; Lee, K. B

    2004-01-01

    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

  1. Dosimetry in myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Toledo, Janine M.; Trindade, Bruno; Ribeiro, Tarcisio P.C. [Universidade Federal de Minas Gerais (DEN/UFMG), Belo Horizonte (Brazil). Dept. de Engenharia Nuclear. Programa de Pos-Graduacao em Ciencias e Tecnicas Nucleares

    2011-07-01

    This paper conducts a dosimetric investigation on the myocardial perfusion image protocol, together with a literature reviewing, motivated by the significant statistic increasing on mortality, morbidity and disability associated with cardiovascular disease, surpassing infectious diseases. Nuclear Cardiology plays a role n the diagnostic functional evaluation of the heart and in the prognostic of patients with suspected or known cardiac ischemia. In the context of unstable myocardial ischemic syndrome, myocardial perfusion scintigraphy is a non-invasive procedure performed by administering a radiopharmaceutical targeted to the heart. As tool for this study are that the images obtained by thoracic angiotomography and abdominal aorta as a anatomic and functional information for model reproduction in SISCODES - System of Codes for Absorbed Dose Calculations based on Stochastic Methods. Data were manipulated in order to create a voxel computational model of the heart to be running in MCNP - Monte Carlo Neutron Particle Code. . It was assumed a homogeneous distribution of Tl-201 in cardiac muscle. Simulations of the transport of particles through the voxel and the interaction with the heart tissue were performed. As a result, the isodose curves in the heart model are displayed as well as the dose versus volume histogram of the heart muscle. We conclude that the present computational tools can generate doses distributed in myocardial perfusion. (author)

  2. Dosimetry in myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Toledo, Janine M.; Trindade, Bruno; Ribeiro, Tarcisio P.C.

    2011-01-01

    This paper conducts a dosimetric investigation on the myocardial perfusion image protocol, together with a literature reviewing, motivated by the significant statistic increasing on mortality, morbidity and disability associated with cardiovascular disease, surpassing infectious diseases. Nuclear Cardiology plays a role n the diagnostic functional evaluation of the heart and in the prognostic of patients with suspected or known cardiac ischemia. In the context of unstable myocardial ischemic syndrome, myocardial perfusion scintigraphy is a non-invasive procedure performed by administering a radiopharmaceutical targeted to the heart. As tool for this study are that the images obtained by thoracic angiotomography and abdominal aorta as a anatomic and functional information for model reproduction in SISCODES - System of Codes for Absorbed Dose Calculations based on Stochastic Methods. Data were manipulated in order to create a voxel computational model of the heart to be running in MCNP - Monte Carlo Neutron Particle Code. . It was assumed a homogeneous distribution of Tl-201 in cardiac muscle. Simulations of the transport of particles through the voxel and the interaction with the heart tissue were performed. As a result, the isodose curves in the heart model are displayed as well as the dose versus volume histogram of the heart muscle. We conclude that the present computational tools can generate doses distributed in myocardial perfusion. (author)

  3. Persistence of normal cardiac function and myocardial perfusion in irradiated long-term survivors of Hodgkin's disease

    International Nuclear Information System (INIS)

    Constine, L.S.; Schwartz, R.G.; Savage, D.E.; King, V.; Muhs, A.; Rubin, P.

    1996-01-01

    Purpose: The risk of myocardial infarction and cardiac dysfunction following mantle irradiation (RT) for Hodgkin's disease is controversial. The relative risk of fatal myocardial infarction is 2.8 in our Hodgkin's patients, similar to other reports. Sensitive evaluations of cardiac function and myocardial perfusion might be expected to reveal pre-clinical abnormalities of potential significance. We hypothesized the presence of pre-clinical cardiac toxicity and progressive deterioration of left ventricular performance and myocardial ischemia over time in long-term survivors of Hodgkin's disease. The data reported herein extend our previous study in patient number (n=50) and follow-up duration (mean 16.5 years). Materials and Methods: Equilibrium radionuclide angiocardiography (ERNA) was used to quantify left ventricular (LV) systolic and diastolic function with LV ejection fraction (LVEF) and peak filling rate (PFR), respectively. Quantitative myocardial perfusion scintigraphy (MPS) and ECG stress testing with exercise or dipyridamole were used to assess myocardial perfusion and electrical function. Patients at least 1.0 year after RT were eligible if ≤ 50 years old at RT and without known Hodgkin's or cardiac disease. Fifty patients, ages 10-46 years (mean 26.0) at RT, were tested 1.1 to 29.1 years (mean 9.1) after RT. Seventeen patients were tested 2 - 3 times separated by 0.5 - 6.5 years (mean 3.3). The mean central cardiac RT dose was 35.1 Gy (range 18.5 - 47.5) in daily 1.5-2.0 Gy fractions. Twelve patients were additionally irradiated to the left ventricle (LVRT), usually through partial transmission left lung shields (range 14.3-21.3 Gy). Results: No patient had symptomatic cardiac disease at the time of evaluation. The mean LVEF (first test, n = 50) was 60 ± 6% (range 42-73%) [normal ≥ 50%], and PFR (first test, n=44) was 3.43 ± 0.83 end diastolic volume per second (range 1.5-5.2 EDV/sec) [normal ≥ 2.54 EDV/sec] with 2 and 7 patients below normal

  4. 201Th chloride scintiscanning in myocardial infarction - correlation with ECG findings - diagnostic potential

    International Nuclear Information System (INIS)

    Kostka, I.

    1980-01-01

    The author intended to find out in how far myocardial scintiscanning with 201 Th chloride is a necessary auxiliary investigation in diagnosing acute myocardial infarction and whether there are correlations between ECG, increase of enzyme levels, and pressure measured in the lesser circulatory system. The scintiscans were evaluated by a new method: Defect sizes were determined using a transparent template and recorded in angular degrees. Also the reduced activity was considered. Especially posterior myocardial infarctions can be localized more easily and clearly by means of myocardial scintiscanning at rest, and also infarction sizes can be judged more easily. For a diagnosis of small myocardial infarctions or in patients with a block in their ECG picture, scintiscanning is a necessary part of the diagnostic spectrum. The findings of myocardial scintiscanning correspond well with those of other methods. As for the pressure increase in the lesser circulatory system, it is well correlated with the defect size shown by the scintiscan. 201 Th scintiscanning offers a good diagnostic possibility in those myocardial infarctions where ECG findings are ambiguous. (orig./MG) [de

  5. Normal myocardial perfusion scan portends a benign prognosis independent from the pretest probability of coronary artery disease. Sub-analysis of the J-ACCESS study

    International Nuclear Information System (INIS)

    Imamura, Yosihiro; Fukuyama, Takaya; Nishimura, Sigeyuki; Nishimura, Tsunehiko

    2009-01-01

    We assessed the usefulness of gated stress/rest 99mTc-tetrofosmin myocardial perfusion single photon emission computed tomography (SPECT) to predict ischemic cardiac events in Japanese patients with various estimated pretest probabilities of coronary artery disease (CAD). Of the 4031 consecutively registered patients for a J-ACCESS (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT) study, 1904 patients without prior cardiac events were selected. Gated stress/rest myocardial perfusion SPECT was performed and segmental perfusion scores and quantitative gated SPECT results were derived. The pretest probability for having CAD was estimated using the American College of Cardiology/American Heart Association/American College of Physicians- American Society of Internal Medicine guideline data for the management of patients with chronic stable angina, which includes age, gender, and type of chest discomfort. The patients were followed up for three years. During the three-year follow-up period, 96 developed ischemic cardiac events: 17 cardiac deaths, 8 nonfatal myocardial infarction, and 71 clinically driven revascularization. The summed stress score (SSS) was the most powerful independent predictor of all ischemic cardiac events (hazard ratio 1.077, confidence interval (CI) 1.045-1.110). Abnormal SSS (>3) was associated with a significantly higher cardiac event rate in patients with an intermediate to high pretest probability of CAD. Normal SSS (≤3) was associated with a low event rate in patients with any pretest probability of CAD. Myocardial perfusion SPECT is useful for further risk-stratification of patients with suspected CAD. The abnormal scan result (SSS>3) is discriminative for subsequent cardiac events only in the groups with an intermediate to high pretest probability of CAD. The salient result is that normal scan results portend a benign prognosis independent from the pretest probability of CAD. (author)

  6. Regional myocardial perfusion of cardioplegic solutions

    International Nuclear Information System (INIS)

    Eugene, J.; Lyons, K.P.; Ott, R.A.; Gelezunas, V.L.; Chang, C.W.; Kowall, M.G.; Haiduc, N.J.

    1987-01-01

    We compared the regional myocardial perfusion of blood cardioplegic solution (BCP) and crystalloid cardioplegic solution (CCP) in 14 mongrel dogs. Cardiopulmonary bypass was established at 28 degrees C, and a hydraulic occluder was placed around the proximal left anterior descending (LAD) coronary artery. In group 1 (N = 7) collateral coronary arteries were ligated; in group 2 (N = 7) collateral coronary arteries were left in situ. After the aorta was clamped, BCP and CCP were alternately perfused at 200 ml/min. The occluder was inflated to produce moderate, severe, and critical LAD stenosis, and regional perfusion was measured by xenon-133 washout with the Silicon Avalanche Radiation Detector. BCP infusion produced a consistently higher aortic pressure, but CCP flow was better than BCP flow under all conditions, particularly without coronary collaterals. Regional myocardial perfusion of CCP is superior to BCP

  7. Improved exercise myocardial perfusion during lidoflazine therapy

    International Nuclear Information System (INIS)

    Shapiro, W.; Narahara, K.A.; Park, J.

    1983-01-01

    Lidoflazine is a synthetic drug with calcium-channel blocking effects. In a study of 6 patients with severe classic angina pectoris, single-blind administration of lidoflazine was associated with improved myocardial perfusion during exercise as determined by thallium-201 stress scintigraphy. These studies demonstrate that lidoflazine therapy is associated with relief of angina, an increased physical work capacity, and improved regional myocardial perfusion during exercise

  8. ECG-gated computed tomography: a new role for patients with suspected aortic prosthetic valve endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Fagman, Erika; Flinck, Agneta; Lamm, Carl [Sahlgrenska University Hospital, Department of Radiology, Gothenburg (Sweden); Perrotta, Sossio [Sahlgrenska University Hospital, Department of Cardiovascular Surgery and Anaesthesia, Gothenburg (Sweden); Bech-Hanssen, Odd [Sahlgrenska University Hospital, Department of Clinical Physiology, Gothenburg (Sweden); Sahlgrenska University Hospital, Department of Cardiology, Gothenburg (Sweden); Olaison, Lars [Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg (Sweden); Svensson, Gunnar [Sahlgrenska University Hospital, Department of Cardiovascular Surgery and Anaesthesia, Gothenburg (Sweden); The Sahlgrenska Academy at the University of Gothenburg, Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg (Sweden)

    2012-11-15

    The aim of this prospective study was to investigate the agreement in findings between ECG-gated CT and transoesophageal echocardiography (TEE) in patients with aortic prosthetic valve endocarditis (PVE). Twenty-seven consecutive patients with PVE underwent 64-slice ECG-gated CT and TEE and the results were compared. Imaging was compared with surgical findings (surgery was performed in 16 patients). TEE suggested the presence of PVE in all patients [thickened aortic wall (n = 17), vegetation (n = 13), abscess (n = 16), valvular dehiscence (n = 10)]. ECG-gated CT was positive in 25 patients (93 %) [thickened aortic wall (n = 19), vegetation (n = 7), abscess (n = 18), valvular dehiscence (n = 7)]. The strength of agreement [kappa (95 % CI)] between ECG-gated CT and TEE was very good for thickened wall [0.83 (0.62-1.0)], good for abscess [0.68 (0.40-0.97)] and dehiscence [0.75 (0.48-1.0)], and moderate for vegetation [0.55 (0.26-0.88)]. The agreement was good between surgical findings (abscess, vegetation and dehiscence) and imaging for ECG-gated CT [0.66 (0.49-0.87)] and TEE [0.79 (0.62-0.96)] and very good for the combination of ECG-gated CT and TEE [0.88 (0.74-1.0)]. Our results indicate that ECG-gated CT has comparable diagnostic performance to TEE and may be a valuable complement in the preoperative evaluation of patients with aortic PVE. (orig.)

  9. ECG-gated computed tomography: a new role for patients with suspected aortic prosthetic valve endocarditis

    International Nuclear Information System (INIS)

    Fagman, Erika; Flinck, Agneta; Lamm, Carl; Perrotta, Sossio; Bech-Hanssen, Odd; Olaison, Lars; Svensson, Gunnar

    2012-01-01

    The aim of this prospective study was to investigate the agreement in findings between ECG-gated CT and transoesophageal echocardiography (TEE) in patients with aortic prosthetic valve endocarditis (PVE). Twenty-seven consecutive patients with PVE underwent 64-slice ECG-gated CT and TEE and the results were compared. Imaging was compared with surgical findings (surgery was performed in 16 patients). TEE suggested the presence of PVE in all patients [thickened aortic wall (n = 17), vegetation (n = 13), abscess (n = 16), valvular dehiscence (n = 10)]. ECG-gated CT was positive in 25 patients (93 %) [thickened aortic wall (n = 19), vegetation (n = 7), abscess (n = 18), valvular dehiscence (n = 7)]. The strength of agreement [kappa (95 % CI)] between ECG-gated CT and TEE was very good for thickened wall [0.83 (0.62-1.0)], good for abscess [0.68 (0.40-0.97)] and dehiscence [0.75 (0.48-1.0)], and moderate for vegetation [0.55 (0.26-0.88)]. The agreement was good between surgical findings (abscess, vegetation and dehiscence) and imaging for ECG-gated CT [0.66 (0.49-0.87)] and TEE [0.79 (0.62-0.96)] and very good for the combination of ECG-gated CT and TEE [0.88 (0.74-1.0)]. Our results indicate that ECG-gated CT has comparable diagnostic performance to TEE and may be a valuable complement in the preoperative evaluation of patients with aortic PVE. (orig.)

  10. Myocardial perfusion in silent myocardial ischemia

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa

    1989-01-01

    To investigate myocardial perfusion in silent myocardial ischemia, we performed exercise stress myocardial tomography with thallium-201 (Tl) in 85 patients with coronary artery disease (CAD). Exercise stress myocardial tomography was obtained both immediately after exercise and three hours later. Patients were classified into two groups according to the presence (Symptomatic Group, n=36) or absence (Silent Group, n=49) of chest pain during exercise stress. Clinical features (age, gender and history of myocardial infarction) and arteriographically determined severity of CAD were the same in both groups. The extent of myocardial ischemia (% Ischemia) estimated by exercise stress myocardial tomography was the same in each group (30±10 % in Silent Group, 28±12 % in Symptomatic Group, NS). The severity of exercise-induced myocardial ischemia was expressed as a minimal value of myocardial Tl washout rate (minimal WOR) of each patient. Although exercise heart rate was identical in both groups, minimal WOR in Silent Group was significantly higher than that of Symptomatic Group (4±10% vs -16±14%, p<0.001). The study in patients who exhibited both silent and symptomatic ischemia showed the same results. These findings suggest that the severity of ischemia is a fundamental factor in determining the presence or absence of pain during exercise induced ischemia. (author)

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

    International Nuclear Information System (INIS)

    Cheng Xu; Huang Gang

    2004-01-01

    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 99m Tc-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 99 Tc m -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 (EDV 90 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. P 0.07). The reproducibility of gated SPECT was excellent. There were no significant differences in

  12. Automatic Detection of Myocardial Boundaries in MR Cardio Perfusion Images

    NARCIS (Netherlands)

    Spreeuwers, Luuk; Breeuwer, Marcel

    2001-01-01

    Cardiovascular diseases often result in reduced blood perfusion of the myocardium (MC). Recent advances in MR allow fast recordingof contrast enhanced myocardial perfusion scans. For perfusion analysis the myocardial boundaries must be traced. Currently this is done manually. In this paper a method

  13. IDENTIFIKASI SINYAL ECG IRAMA MYOCARDIAL ISCHEMIA DENGAN PENDEKATAN FUZZY LOGIC

    Directory of Open Access Journals (Sweden)

    Azhar A N

    2009-07-01

    Full Text Available The heart is one of vital organs in human body. Incidence of heart disease can be fatal for the patient. Myocardial ischemia, the disease that is often suffered by the human, is a disease due to clogged heart arteries blood vessels. One of the ways to detect this disease is by reading the graph output of electrocardiogram (ECG signal. ECG signal represents the condition and activity of the heart. Specialized knowledge, accuration and expertise are required to read ECG graph. To help expert or doctor, expert system based on artificial intelligent, such as Fuzzy Logic approach, can be applied to improve diagnostic accuracy and thoroughness. Fuzzy logic can be applied because of it flexibility to understand the linguistic variables used in identifying myocardial ischemia disease.

  14. Comparison between retrospective gating and ECG triggering in magnetic resonance velocity mapping

    DEFF Research Database (Denmark)

    Søndergaard, L; Ståhlberg, F; Thomsen, C

    1993-01-01

    ECG-triggered cinematographic studies of the cardiovascular system are hampered by several technical restrictions such as the inability to image end-diastole, ghosting, varying signal intensity, and phase contributions from eddy currents. Retrospective gating may solve these problems, but involves...... of flow pulses. However, by reducing the time window retrospectively gated flow measurements were in good agreement with those that are ECG triggered. When fulfilling the demand of a narrow time window for interpolation, retrospective gating offers several advantages in MR velocity mapping....

  15. Myocardial perfusion imaging in hyperthrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Moorin, B.

    1998-01-01

    Full text: Patients with Hyperthrophic Cardiomyopathy (HCM) frequently suffer from syncope and cardiac arrest which may lead to sudden death. This is most often caused by ventricular arrhythmia's in adults, however in young patients the mechanisms are thought to be different. Ischaemia may play a significant role even in young asymptomatic HCM patients. The mechanisms of ischaemic development in HCM differ from those in the 'normal' myocardium (Due to intramural small vessel abnormalities and abnormal myocellular architecture). In HCM the coronary microcirculation is most often affected and massive hypertrophy means more energy is required to promote contraction thus increasing oxygen demand and compounding the effects of any ischaemic changes. A case of a 12 year old HCM patient is presented who has symptoms of syncope associated with exercise whose mother died suddenly of cardiac arrest developed from HCM. A myocardial perfusion rest/stress study was undertaken to detect any underlying myocardial ischaemia. Myocardial perfusion scintigraphy demonstrates any reduction in the microcirculation in addition to that present in the macrocirculation, unlike angiography which will only detect the latter. In this case the scan clearly showed evidence of ischaemia in the lateral wall and this may be an explanation for her episodes of syncope. We suggest an algorithm or the routine work-up of young patients with HCM which makes aggressive use of myocardial perfusion imaging to detect ischaemic changes. This may identify patients who are at higher risk and will assist with treatment decisions. We feel myocardial perfusion scintigraphy is a sensitive non-invasive accurate method of detecting microcirculatory ischaemia and is thus invaluable in HCM patients

  16. Myocardial perfusion imaging for detection of silent myocardial ischemia

    International Nuclear Information System (INIS)

    Beller, G.A.

    1988-01-01

    Despite the widespread use of the exercise stress test in diagnosing asymptomatic myocardial ischemia, exercise radionuclide imaging remains useful for detecting silent ischemia in numerous patient populations, including those who are totally asymptomatic, those who have chronic stable angina, those who have recovered from an episode of unstable angina or an uncomplicated myocardial infarction, and those who have undergone angioplasty or received thrombolytic therapy. Studies show that thallium scintigraphy is more sensitive than exercise electrocardiography in detecting ischemia, i.e., in part, because perfusion defects occur more frequently than ST depression and before angina in the ischemic cascade. Thallium-201 scintigraphy can be performed to differentiate a true- from a false-positive exercise electrocardiographic test in patients with exercise-induced ST depression and no angina. The development of technetium-labeled isonitriles may improve the accuracy of myocardial perfusion imaging. 11 references

  17. Stress-induced myocardial ischemia is associated with early post-stress left ventricular mechanical dyssynchrony as assessed by phase analysis of {sup 201}Tl gated SPECT myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Chien-Cheng; Shen, Thau-Yun [Show Chwan Memorial Hospital, Department of Cardiology, Changhua (China); Chang, Ming-Che [Changhua Christian Hospital, Department of Nuclear Medicine, Changhua (China); Hung, Guang-Uei [Chang Bing Show Chwan Memorial Hospital, Department of Nuclear Medicine, Changhua (China); China Medical University, Department of Biomedical Imaging and Radiological Science, Taichung (China); Chen, Wan-Chen [Chang Bing Show Chwan Memorial Hospital, Department of Nuclear Medicine, Changhua (China); Kao, Chia-Hung [China Medical University, Department of Biomedical Imaging and Radiological Science, Taichung (China); Chen, Ji [Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA (United States)

    2012-12-15

    In {sup 201}Tl SPECT myocardial perfusion imaging (MPI) data are acquired shortly after the stress injection to assess early post-stress left ventricle (LV) function. The purpose of this study was to use {sup 201}Tl SPECT MPI to investigate whether stress-induced myocardial ischemia is associated with LV mechanical dyssynchrony. Enrolled in the study were 75 patients who were referred for dipyridamole stress and rest {sup 201}Tl gated SPECT MPI. The early post-stress scan was started 5 min after injection, and followed by the rest scan 4 h later. The patients were divided into three groups: ischemia group (N = 25, summed stress score, SSS, {>=}5, summed rest score, SRS, <5), infarct group (N = 16, SSS {>=}5, SRS {>=}5) and normal group (N = 34, SSS <5, SRS <5). LV dyssynchrony parameters were calculated by phase analysis, and compared between the stress and rest images. In the ischemia group, LV dyssynchrony was significantly larger during stress than during rest. On the contrary, LV dyssynchrony during stress was significantly smaller than during rest in the normal and infarct groups. LV dyssynchrony during rest was significantly larger in the infarct group than in the normal and ischemia groups. There were no significant differences in LV dyssynchrony during rest between the normal and ischemia groups. Stress-induced myocardial ischemia caused dyssynchronous contraction in the ischemic region, leading to a deterioration in LV synchrony. Normal myocardium had more synchronous contraction during stress. The different dyssynchrony pattern between ischemic and normal myocardium early post-stress may aid the diagnosis of coronary artery disease using {sup 201}Tl gated SPECT MPI. (orig.)

  18. Clinical application of ECG-gated 256-slice CT angiography for diagnosis of congenital heart disease

    International Nuclear Information System (INIS)

    Tian Xinhua; Liu Jianhua; Gong Tingting; Geng Lili; Sun Yong

    2011-01-01

    Objective: To investigate the clinical application of ECG-gated 256-slice CT angiography for diagnosis of congenital heart disease, and to evaluate the relationship of the image quality and radiation dose between prospective ECG-gated and retrospective ECG-gated cardiac CT angiography (CTA). Methods: Sixty patients who doubt congenital heart disease underwent cardiac CTA, and they were randomly divided into two groups. Thirty patients in group A underwent prospective ECG-gated cardiac CTA, and thirty patients in group B underwent retrospective ECG-gated cardiac CTA. Then the homogeneous enhancement of vascular structures, stair-step artifact, overall image quality and radiation dose were evaluated. Results: The homogeneous enhancement of vascular structures were 2.8±0.3 and 2.7±0.6, respectively, in two groups; and there was no statistical significance (P>0.05). The stair-step artifact were 3.0±0.9 and 3.1±0.9, respectively, in two groups; and there was also no statistical significance (P>0.05). The overall image quality were 3.0±0.8 and 3.1±0.9, respectively, in two group; and there was statistical significance (P>0.05). However, the effective dose were (5.24±0.52) mSv and (16.68±1.49) mSv, respectively, in two groups; and there was statistical significance (P<0.001). Conclusion: Compared with retrospective ECG-gated cardiac CTA, prospective ECG-gated cardiac CTA can reduce radiation dose about 68.6% , while maintaining the image quality which could be made diagnosis. (authors)

  19. Postoperative Functional Outcome After Off-Pump Versus On-Pump Coronary Artery Bypass Grafting Using Gated Myocardial SPECT: A Comparison by Propensity Score Analysis

    International Nuclear Information System (INIS)

    Lee, Jong Jin; Paeng, Jin Chul; Lee, Dong Soo; Kim, Ki Bong; Chung, June Key; Lee, Myung Chul; Kang, Won Jun

    2010-01-01

    We evaluated the short-term and mid-term differences in perfusion and function after off-pump and on-pump coronary artery bypass grafting (CABG) using gated myocardial single photon emission computed tomography. A total of 70 patients with coronary artery disease who underwent CABG were included based on the propensity score matching results from 165 patients. Thirty-five patients underwent off-pump and 35 patients on-pump CABG. Rest 201 TI/dipyridamole stress 99m Tc-methoxyisobutylisonitrile gated single photon emission computed thermographs were performed preoperatively and postoperatively at short-term (103±23 days after surgery) and mid-term follow-up (502±111 days after surgery). Changes in left ventricular ejection fraction, end systolic volume, stress and rest segmental perfusion, and segmental wall thickening were compared between the two groups. The segments with preoperative rest 201 T1 uptake under 60% of maximum uptake were included in the segmental analysis. Left ventricular ejection fraction (P=0.001) and end systolic volume (P=0.008) showed significant improvement in both groups. There were no significant short-term and mid-term differences between the two groups in terms of left ventricular ejection fraction (P=0.309) and end systolic volume (P=0.938). Likewise, segmental rest (P=0.178) and stress perfusion (P=0.071), and systolic wall thickening (P=0.241) showed significant improvement in both groups with similar time courses. Off-pump CABG resulted in significant improvements in left ventricular ejection fraction, end systolic volume, and regional myocardial perfusion and function that are comparable to on-pump CABG at short-term and mid-term. Gated myocardial SPECT successfully revealed that off-pump CABG is as good as on-pump CABG from the viewpoint of myocardial perfusion and function.

  20. Clinical value and severity of myocardial perfusion defects in asymptomatic diabetic patients with negative or weakly positive exercise treadmill test

    International Nuclear Information System (INIS)

    Zakavi, Seyed Rasoul; Taherpour, Mehdi; Moossavi, Zohreh; Sadeghi, Ramin; Kakhki, Vahidreza Dabbagh; Rokni, Haleh

    2013-01-01

    Although coronary artery disease (CAD) is the leading cause of death in type 2 diabetic patients, it is frequently asymptomatic. Myocardial perfusion imaging (MPI) is reported to show ischemia in a significant number of asymptomatic diabetic patients. We studied the prevalence and severity of myocardial perfusion defects in asymptomatic diabetic patients and its clinical impact. One hundred thirty consecutive asymptomatic patients, aged 35-65 years with type 2 diabetes mellitus and with no history of CAD and no cardiac symptoms were recruited in the study. Echocardiography, electrocardiography (ECG), routine laboratory tests and exercise treadmill test (ETT) were performed and patients with weakly positive or negative ETT underwent Dipyridamole MPI. Patients with positive ETT were referred to coronary angiography. Patients were followed for at least 17 months (mean 21.7 months) and any cardiac event was recorded. We studied 81 female and 49 male patients with mean age of 51.8 years. Negative, weakly positive and positive ETT result was noted in 74.3%, 15% and 10.7% respectively. 75% of patients with positive ETT had coronary artery disease in angiography. Gated myocardial perfusion SPECT was done in 106 patients. MPI showed reversible defect in 26.9% of the patients with a mean summed stress score of 3.3±1.8. Follow up completed in 112 patients and only one patient with abnormal MPI underwent coronary angiography followed by PTCA. No cardiac death, MI, UA or hospital admission occurred among our patients during follow up (17-26 months). Mean stress end diastolic volume (EDV) was significantly higher in patients with reversible defect compared to patients without reversible defect based on MPI findings (62.0±31.6 Vs 48.5±18.4 ml, P=0.04). Blood glucose and HbA1c were significantly higher in patients with ischemia compared to patients without ischemia (P<0.05). Meanwhile the ratio of TG to HDL was 6.06±3.2 in ischemic patients compared to 4.8±2.3 in normal

  1. Measurement of myocardial perfusion using magnetic resonance

    DEFF Research Database (Denmark)

    Fritz-Hansen, T.; Jensen, L.T.; Larsson, H.B.

    2008-01-01

    Cardiac magnetic resonance imaging (MRI) has evolved rapidly. Recent developments have made non-invasive quantitative myocardial perfusion measurements possible. MRI is particularly attractive due to its high spatial resolution and because it does not involve ionising radiation. This paper reviews...... myocardial perfusion imaging with MR contrast agents: methods, validation and experiences from clinical studies. Unresolved issues still restrict the use of these techniques to research although clinical applications are within reach Udgivelsesdato: 2008/12/8...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  3. Quantification of left ventricular function by gated myocardial perfusion SPECT using multidimTM

    International Nuclear Information System (INIS)

    Huang Jin; Song Wenzhong; Chen Mingxi

    2004-01-01

    Objective: To evaluate the accuracy of left ventricular function by gated SPECT using the software Multidim TM . Methods: Rest gated SPECT was performed on 42 cases involved 26 normal subjects and 16 patients with myocardial infarct (MI). All cases underwent rest equilibrium radionuclide angiocardiography (ERNA) within 1 w. Results: (1)End diastolic volume (EDV), end systolic volume (ESV) and left ventricular ejection fraction(LVEF)were calculated using the software MultidimtMand ERNA. The correlation coefficient between the two Methods was 0.90,0.89,0.92 respectively(P TM , but the EDV and ESV value measured by this software maybe high with small heart. (authors)

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

    Energy Technology Data Exchange (ETDEWEB)

    Paul, A.K.; Hasegawa, Shinji; Yoshioka, Jun; Yamaguchi, Hitoshi; Tsujimura, Eiichiro; Nishimura, Tsunehiko [Osaka Univ., Suita (Japan). Graduate School of Medicine

    2000-04-01

    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)

  5. DIAGNOSTIC VALUE of Tc-99m TETROFOSMİN GATED SPECT IN MYOCARDIAL VIABILITY INVESTIGATION AFTER ADMINISTRATION TRIMETAZIDINE and NITRATE IN THE PATIENTS WITH MYOCARDIAL INFARCTION

    OpenAIRE

    TURHAL, Özgül; TUTUŞ, Ahmet; KULA, Mustafa

    2018-01-01

    ABSTRACT Aim: With the aim of investigating of the myocardial viability on the patients with MI, the results obtained from Tc-99m-tetrofosmin gated SPECT following the nitrate infusion and acute TMZ were compared.Method: For this study, 30 patients who had MI and were be planned of revascularization process were taken. The patients were applied Tc-99m-tetrofosmin gated SPECT basally and following nitrate infusion and acute TMZ separately each day. The data from perfusion were quantitatively e...

  6. 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

    Science.gov (United States)

    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 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 SPECT MPI has a good correlation with echocardiography for the measurement of left ventricular EF, EDV, and ESV in patients with severe heart failure. However, the absolute values of these functional parameters from echocardiography and gated

  7. The myocardial perfusion imaging of bone marrow mesenchymal stem cell transplantation treated acute myocardial infarction in pig

    International Nuclear Information System (INIS)

    He Miao; Hou Xiancun; Li Yaomei; Zhou Peng; Qi Chunmei; Wu Weihuan; Li Li

    2006-01-01

    Objective: To evaluate the clinical value of bone marrow mesenchymal stem cell transplantation on acute myocardial infarction in pig with myocardial perfusion imaging. Methods: Acute myocardial infarction models were established by 21 minitype Chinese pigs and were divided into two groups. After 10 days, experimental group (n=11) was transplanted with bone marrow mesenchymal stem cell at the infarct areas, and the control group (n=10) with incubation solution. Before and eight weeks after transplantation, both groups were examined by 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging and with semi-quantitative analysis. Besides, echocardiogram and immunohistochemistry were also performed. Results: There was significant difference of total myocardial perfusion abnormal segments (46 vs 26), infarct areas [(34±12)% vs (21±10)%] and myocardial ischemia score [(20.0±4.3) vs (12.1±3.6)] between two groups (P<0.05). Also, there were accordant results with echocardiogram and immunohistochemistry findings. Conclusions: Bone marrow mesenchymal stem cell transplantation may improve blood perfusion and viability of the ischemic areas: Myocardial perfusion imaging can accurately observe the survival of bone marrow mesenchymal stem cell transplanted at the infarct areas. (authors)

  8. Effect of beta-blockade on low-dose dobutamine-induced changes in left ventricular function in healthy volunteers: assessment by gated SPET myocardial perfusion scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Everaert, H.; Vanhove, C.; Franken, P.R. [Division of Nuclear Medicine, University Hospital, Free University of Brussels (AZ VUB), Brussels (Belgium)

    2000-04-01

    Viability studies are often performed in patients receiving beta-blocking agents. However, the intake of beta-blocking agents could influence the identification of viable myocardium when low-dose dobutamine is used to demonstrate inotropic reserve. The aim of this study was to quantify the effect of beta-blockade on global and regional left ventricular function in healthy volunteers using low-dose dobutamine gated single-photon emission tomographic (SPET) myocardial perfusion scintigraphy. Ten subjects were studied once ''on'' and once ''off'' beta-blocker therapy (metoprolol succinate, 100 mg day{sup -1}). On each occasion four consecutive gated SPET acquisitions (of 7 min duration) were recorded after injection of 925 MBq technetium-99m tetrofosmin on a triple-headed camera equipped with focussing (Cardiofocal) collimators. Acquisitions were made at rest (baseline 1 and 2) and 5 min after the beginning of the infusion of 5 and 10 {mu}g kg{sup -1} min{sup -1} dobutamine. Wall thickening (WT) was quantified using a method based on circumferential profile analysis. Left ventricular ejection fraction (LVEF) was obtained using the Cedars-Sinai algorithm. Blood pressure (BP) and heart rate (HR) were recorded at the end of each acquisition. At baseline LVEF, WT and systolic BP values under beta-blockade were not significantly different from those obtained in the non-beta-blocked state. The mean HR and diastolic BP at baseline were lower under beta-blockade. Dobutamine administration (at 5 and 10 {mu}g kg{sup -1} min{sup -1}) induced a significant increase in WT, LVEF and systolic BP in all subjects both on and off beta-blockade. The increases in WT, LVEF and systolic BP in the beta-blocked state were less pronounced but not significantly different. HR increased significantly at 10 {mu}g kg{sup -1} min{sup -1} dobutamine without beta-blocker administration, while no increase in HR was observed in the beta-blocked state. Beta

  9. Evaluation of myocardial involvement in Duchenne progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Kawai, Naoki; Yamamoto, Shuhei; Okada, Mitsuhiro

    1983-01-01

    Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. The qualitative analysis was performed in anterior, 3 left anterior oblique and left lateral projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in LV posterolateral or posterior walls (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle changes or thoracic deformities assessed by transmission computed tomography. Slightly increased thallium-201 activity in RV free wall and lungs was shown in nine and one patient, respectively. The extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. The myocardial scintigraphic changes were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies in 2 to 3 years. It was concluded that the thallium myocardial perfusion imaging was a useful clinical technique to evaluate the cardiomyopathy in Duchenne progressive muscular dystrophy. (author)

  10. Evaluation of myocardial involvement in Duchenne progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kawai, Naoki; Yamamoto, Shuhei; Okada, Mitsuhiro (Nagoya Univ. (Japan). Faculty of Medicine)

    1983-12-01

    Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. The qualitative analysis was performed in anterior, 3 left anterior oblique and left lateral projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in LV posterolateral or posterior walls (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle changes or thoracic deformities assessed by transmission computed tomography. Slightly increased thallium-201 activity in RV free wall and lungs was shown in nine and one patient, respectively. The extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. The myocardial scintigraphic changes were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies in 2 to 3 years. It was concluded that the thallium myocardial perfusion imaging was a useful clinical technique to evaluate the cardiomyopathy in Duchenne progressive muscular dystrophy.

  11. Quantitative Myocardial Perfusion Imaging Versus Visual Analysis in Diagnosing Myocardial Ischemia: A CE-MARC Substudy.

    Science.gov (United States)

    Biglands, John D; Ibraheem, Montasir; Magee, Derek R; Radjenovic, Aleksandra; Plein, Sven; Greenwood, John P

    2018-05-01

    This study sought to compare the diagnostic accuracy of visual and quantitative analyses of myocardial perfusion cardiovascular magnetic resonance against a reference standard of quantitative coronary angiography. Visual analysis of perfusion cardiovascular magnetic resonance studies for assessing myocardial perfusion has been shown to have high diagnostic accuracy for coronary artery disease. However, only a few small studies have assessed the diagnostic accuracy of quantitative myocardial perfusion. This retrospective study included 128 patients randomly selected from the CE-MARC (Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease) study population such that the distribution of risk factors and disease status was proportionate to the full population. Visual analysis results of cardiovascular magnetic resonance perfusion images, by consensus of 2 expert readers, were taken from the original study reports. Quantitative myocardial blood flow estimates were obtained using Fermi-constrained deconvolution. The reference standard for myocardial ischemia was a quantitative coronary x-ray angiogram stenosis severity of ≥70% diameter in any coronary artery of >2 mm diameter, or ≥50% in the left main stem. Diagnostic performance was calculated using receiver-operating characteristic curve analysis. The area under the curve for visual analysis was 0.88 (95% confidence interval: 0.81 to 0.95) with a sensitivity of 81.0% (95% confidence interval: 69.1% to 92.8%) and specificity of 86.0% (95% confidence interval: 78.7% to 93.4%). For quantitative stress myocardial blood flow the area under the curve was 0.89 (95% confidence interval: 0.83 to 0.96) with a sensitivity of 87.5% (95% confidence interval: 77.3% to 97.7%) and specificity of 84.5% (95% confidence interval: 76.8% to 92.3%). There was no statistically significant difference between the diagnostic performance of quantitative and visual analyses (p = 0.72). Incorporating rest myocardial

  12. Ventricular short-axis measurements in patients with pulmonary embolism: Effect of ECG-gating on variability, accuracy, and risk prediction

    International Nuclear Information System (INIS)

    Scheffel, Hans; Stolzmann, Paul; Leschka, Sebastian; Desbiolles, Lotus; Seifert, Burkhardt; Marincek, Borut; Alkadhi, Hatem

    2012-01-01

    Objective: To assess prospectively the intra- and interobserver variability, accuracy, and prognostic value of right and left ventricular short-axis diameter (RVd and LVd) measurements for risk stratification in patients with pulmonary embolism (PE) using ECG-gated compared to non-gated CT. Materials and methods: Sixty consecutive patients (33 women; mean age 58.7 ± 10.3 years) with suspicion of PE underwent both non-gated and ECG-gated chest CT. RVd and LVd on four-chamber views and intra- and interobserver agreements were calculated for both protocols. RVd/LVd ratios were calculated and were related to 30-days adverse clinical events using receiver operating characteristics with area-under-the-curve (AUC) analyses. Results: Both inter- and intraobserver variability showed narrower limits of agreement for all measurements with ECG-gated as compared to non-gated CT. Diameter measurements were significantly lower using non-ECG-gated CT as compared to ECG-gated CT for RVd and LVd (both p < .05). The AUC for the RVd/LVd ratio from ECG-gated CT was significantly larger than that from non-gated CT (0.956, 95% CI: 0.768–0.999 versus 0.675, 95% CI: 0.439–0.860; p = .048). Conclusion: RVd and LVd measurements from ECG-gated chest CT show less intra- and interobserver variability and more accurately reflect ventricular function. In our patient cohort ECG-gated chest CT allows better prediction of short-term outcome of patients with acute PE that needs to be validated in a larger outcome study

  13. Cintilografia de perfusão miocárdica sob baixa dose de dobutamina na identificação do miocárdio viável Low-dose dobutamine myocardial perfusion scintigraphy in the identification of viable myocardium

    Directory of Open Access Journals (Sweden)

    Renata Freire de Moraes

    2010-10-01

    Full Text Available OBJETIVO: Verificar se a cintilografia de perfusão miocárdica duoisotópica(99mTc-sestamibi/tálio-201, método de alta sensibilidade para identificação do músculo viável, tem sua especificidade aumentada com a inclusão de informações sobre reserva contrátil miocárdica obtidas simultaneamente através de gated SPECT na vigência de baixas doses de dobutamina de forma semelhante ao ecocardiograma. MATERIAIS E MÉTODOS: Estudaram-se 260 segmentos miocárdicos de 13 pacientes com infarto do miocárdio, encaminhados para pesquisa de viabilidade antes do procedimento de revascularização. Avaliaram-se a integridade celular e a reserva contrátil pela cintilografia de perfusão miocárdica duoisotópica com imagens de repouso e redistribuição do tálio-201 e de estresse (99mTc-sestamibi gated SPECT, em condições basais e na vigência de baixas doses de dobutamina. A melhora do desempenho contrátil em controle cintilográfico pós-revascularização (99mTc-sestamibi gated SPECT confirmava a presença de viabilidade. Para análise dos resultados quantificaram-se os parâmetros funcionais dos segmentos miocárdicos nas diferentes etapas do estudo, estratificando-os quanto à viabilidade para posterior comparação funcional pós-revascularização. RESULTADOS: No tratamento estatístico a análise do espessamento sistólico se destacou como parâmetro de avaliação da reserva contrátil miocárdica pelo método, mostrando tendência a incremento na especificidade (84%, demonstrando valores superiores aos da literatura. CONCLUSÃO: O método tende a apresentar contribuições efetivas na busca do miocárdio viável.OBJECTIVE: To evaluate the increase in specificity of dual isotope myocardial perfusion gated SPECT (99mTc-sestamibi/thallium-201, a highly sensitive method to detect viable myocardium, with addition of data on contractile reserve simultaneously acquired by low-dose dobutamine gated SPECT, similarly to echocardiography

  14. Myocardial perfusion modeling using MRI

    DEFF Research Database (Denmark)

    Larsson, H B; Fritz-Hansen, T; Rostrup, Egill

    1996-01-01

    In the present study, it is shown that it is possible to quantify myocardial perfusion using magnetic resonance imaging in combination with gadolinium diethylenetriaminopentaacetic acid (Gd-DTPA). Previously, a simple model and method for measuring myocardial perfusion using an inversion recovery...... turbo-FLASH (fast low-angle shot) sequence and Gd-DTPA has been presented. Here, an extension of the model is presented taking into account fast and slow water exchange between the compartments, enabling the calculation of the unidirectional influx constant (Ki) for Gd-DTPA, the distribution volume...... of Gd-DTPA (lambda), the vascular blood volume (Vb), and the time delay through the coronary arteries (delta T). The model was evaluated by computer simulation and used on experimental results from seven healthy subjects. The results in the healthy volunteers for a region of interest placed...

  15. Semi-quantitative myocardial perfusion measured by computed tomography in patients with refractory angina

    DEFF Research Database (Denmark)

    Qayyum, Abbas Ali; Kühl, Jørgen Tobias; Kjaer, Andreas

    2017-01-01

    INTRODUCTION: Computed tomography (CT) is a novel method for assessment of myocardial perfusion and has not yet been compared to rubidium-82 positron emission tomography (PET). We aimed to compare CT measured semi-quantitative myocardial perfusion with absolute quantified myocardial perfusion usi...

  16. Myocardial perfusion after prolonged submaximal exercise in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Flotats, A.; Mena, E.; Camacho, V.; Tembl, A.; Hernandez, M.A.; Estorch, M.; Carrio, I.; Serra-Grima, R.

    2002-01-01

    Aim: Exercise training in patients with coronary artery disease (CAD) has established benefits. We assessed myocardial perfusion after submaximal but prolonged exercise in patients with CAD, who were enrolled in supervised exercise rehabilitation programs. Material and Methods: Nine patients with CAD enrolled in supervised exercise rehabilitation programs (7 men, 2 women; mean age 54±9 years), 7 with prior AMI and 2 with re-vascularized (CABG) multiple vessel disease, were encouraged to walk/run actively around the perimeter of our Hospital during the annual social sporting event organised in our Institution. Patients were studied by means of perfusion Tc-99m tetrofosmin SPECT imaging after prolonged exercise and at rest (gated SPECT), for two consecutive years. All patients remained symptom free during this interval period. Quantitative analysis was performed dividing polar map images in 13 segments. Tracer activity 9% in the resting image. The analysis was focused on those segments showing perfusion defects. Results: No symptoms other than fatigue were registered during prolonged exercise (range 1-2 hr). There were no significant differences in distance covered (7,462±3,031 m vs. 8,456±2,998 m), heart rate (92±11 bpm vs. 85±13 bpm) and rate-pressure product at the end of exercise (10,804±2,467 vs. 10,403±2,955) or gated SPECT calculated LVEF (44%±19 vs. 46%±20) between the two consecutive annual sporting events. Tracer activity in segments with perfusion defects did not significantly differ between both events. Overall agreement between both examinations regarding patient classification as having scar/ischemia was 77% (kappa=0.49). There was one patient who showed partial reversibility in three segments, consistent with mild anteroapical ischemia, only in the first examination. On the other hand, another patient showed reversibility in one segment (medium septum), only in the second examination, when he covered a distance 1.3 times superior. Conclusions

  17. High fat diet-induced glucose intolerance impairs myocardial function, but not myocardial perfusion during hyperaemia: a pilot study

    Directory of Open Access Journals (Sweden)

    van den Brom Charissa E

    2012-06-01

    Full Text Available Abstract Background Glucose intolerance is a major health problem and is associated with increased risk of progression to type 2 diabetes mellitus and cardiovascular disease. However, whether glucose intolerance is related to impaired myocardial perfusion is not known. The purpose of the present study was to study the effect of diet-induced glucose intolerance on myocardial function and perfusion during baseline and pharmacological induced hyperaemia. Methods Male Wistar rats were randomly exposed to a high fat diet (HFD or control diet (CD (n = 8 per group. After 4 weeks, rats underwent an oral glucose tolerance test. Subsequently, rats underwent (contrast echocardiography to determine myocardial function and perfusion during baseline and dipyridamole-induced hyperaemia (20 mg/kg for 10 min. Results Four weeks of HFD feeding resulted in glucose intolerance compared to CD-feeding. Contractile function as represented by fractional shortening was not altered in HFD-fed rats compared to CD-fed rats under baseline conditions. However, dipyridamole increased fractional shortening in CD-fed rats, but not in HFD-fed rats. Basal myocardial perfusion, as measured by estimate of perfusion, was similar in CD- and HFD-fed rats, whereas dipyridamole increased estimate of perfusion in CD-fed rats, but not in HFD-fed rats. However, flow reserve was not different between CD- and HFD-fed rats. Conclusions Diet-induced glucose intolerance is associated with impaired myocardial function during conditions of hyperaemia, but myocardial perfusion is maintained. These findings may result in new insights into the effect of glucose intolerance on myocardial function and perfusion during hyperaemia.

  18. Hybrid ECG-gated versus non-gated 512-slice CT angiography of the aorta and coronary artery: image quality and effect of a motion correction algorithm.

    Science.gov (United States)

    Lee, Ji Won; Kim, Chang Won; Lee, Geewon; Lee, Han Cheol; Kim, Sang-Pil; Choi, Bum Sung; Jeong, Yeon Joo

    2018-02-01

    Background Using the hybrid electrocardiogram (ECG)-gated computed tomography (CT) technique, assessment of entire aorta, coronary arteries, and aortic valve can be possible using single-bolus contrast administration within a single acquisition. Purpose To compare the image quality of hybrid ECG-gated and non-gated CT angiography of the aorta and evaluate the effect of a motion correction algorithm (MCA) on coronary artery image quality in a hybrid ECG-gated aorta CT group. Material and Methods In total, 104 patients (76 men; mean age = 65.8 years) prospectively randomized into two groups (Group 1 = hybrid ECG-gated CT; Group 2 = non-gated CT) underwent wide-detector array aorta CT. Image quality, assessed using a four-point scale, was compared between the groups. Coronary artery image quality was compared between the conventional reconstruction and motion correction reconstruction subgroups in Group 1. Results Group 1 showed significant advantages over Group 2 in aortic wall, cardiac chamber, aortic valve, coronary ostia, and main coronary arteries image quality (all P ECG-gated CT significantly improved the heart and aortic wall image quality and the MCA can further improve the image quality and interpretability of coronary arteries.

  19. Self-gated fat-suppressed cardiac cine MRI.

    Science.gov (United States)

    Ingle, R Reeve; Santos, Juan M; Overall, William R; McConnell, Michael V; Hu, Bob S; Nishimura, Dwight G

    2015-05-01

    To develop a self-gated alternating repetition time balanced steady-state free precession (ATR-SSFP) pulse sequence for fat-suppressed cardiac cine imaging. Cardiac gating is computed retrospectively using acquired magnetic resonance self-gating data, enabling cine imaging without the need for electrocardiogram (ECG) gating. Modification of the slice-select rephasing gradients of an ATR-SSFP sequence enables the acquisition of a one-dimensional self-gating readout during the unused short repetition time (TR). Self-gating readouts are acquired during every TR of segmented, breath-held cardiac scans. A template-matching algorithm is designed to compute cardiac trigger points from the self-gating signals, and these trigger points are used for retrospective cine reconstruction. The proposed approach is compared with ECG-gated ATR-SSFP and balanced steady-state free precession in 10 volunteers and five patients. The difference of ECG and self-gating trigger times has a variability of 13 ± 11 ms (mean ± SD). Qualitative reviewer scoring and ranking indicate no statistically significant differences (P > 0.05) between self-gated and ECG-gated ATR-SSFP images. Quantitative blood-myocardial border sharpness is not significantly different among self-gated ATR-SSFP ( 0.61±0.15 mm -1), ECG-gated ATR-SSFP ( 0.61±0.15 mm -1), or conventional ECG-gated balanced steady-state free precession cine MRI ( 0.59±0.15 mm -1). The proposed self-gated ATR-SSFP sequence enables fat-suppressed cardiac cine imaging at 1.5 T without the need for ECG gating and without decreasing the imaging efficiency of ATR-SSFP. © 2014 Wiley Periodicals, Inc.

  20. Evaluation of regional wall motion in myocardial infarction using animation ECG gated cardiac computed tomography

    International Nuclear Information System (INIS)

    Shimizu, Takahiko; Hyodo, Haruo; Hayashi, Terumi; Yamamoto, Hideo; Yagi, Shigeru

    1984-01-01

    Regional wall motion of the left ventricle was evaluated in 21 patients with myocardial infarction using an animation system of gated cardiac computed tomographic (CT) images (animation gated CCT). The results obtained were compared with data by two-dimensional echocardiography (2-DE). 1. Evaluation of the asynergic area by animation gated CCT and 2-DE: Animation gated CCT detected the following specific regions with asynergy established by 2-DE; 10/10 cases (100%) at the anterior wall of the left ventricle, 14/14 cases (100%) at the interventricular septum, and 9/11 cases (81.8%) at the infero-posterior wall. In addition, one false positive case and one negative case were observed at the lateral wall and the apex, respectively. Of 37 instances with asynergic areas established by 2-DE, 21 cases or 89.2% were detected by animation gated CCT; the sensitivity was 91.9%. 2. Evaluation of severity of asynergy by animation gated CCT and 2-DE: The degree of asynergy evaluated by both methods was compared with each other, and the agreement was as follows: 10/10 cases (100%) at the left-ventricular anterior wall, 13/13 cases (100%) at the interventricular septum, and 7/9 cases (77.8%) at the infero-posterior wall. 3. Evaluation of the asynergic area by nonanimation gated CCT and 2-DE: Nonanimation gated CCT detected asynergic areas ascertained by 2-DE at the following areas; 8/10 cases (80%) at the left-ventricular anterior wall, 12/14 cases (85.7%) at the interventricular septum, and 4/11 cases (36.4%) at the infero-posterior wall. The difference between animation and nonanimation gated CCT was statistically significant (p<0.05). The severity of asynergy could not be evaluated by nonanimation gated CCT. (J.P.N.)

  1. Comparative analysis of the diagnostic and prognostic value of exercise ECG and thallium-201 scintigraphic markers of myocardial ischemia in asymptomatic and symptomatic patients

    International Nuclear Information System (INIS)

    Gibson, R.S.

    1989-01-01

    A considerable amount of data now exists that indicates that exercise ECG--due to its suboptimal sensitivity and specificity--has limited diagnostic and prognostic value in asymptomatic subjects, patients with chest pain of unclear etiology or those with chronic stable angina pectoris, and in patients recovering from acute myocardial infarction. Because of this and the well-recognized advantages of thallium-201 scintigraphy, there appears to be a strong rationale for recommending exercise perfusion imaging, rather than exercise ECG alone, as the preferred method for detecting CAD and staging its severity. This recommendation seems justified given the fact that (1) thallium-201 scintigraphy is far more sensitive and specific in detecting myocardial ischemia than exercise testing; (2) unlike stress ECG, thallium-201 scintigraphy can localize ischemia to a specific area of areas subtended by a specific coronary artery; and (3) thallium-201 scintigraphy has been shown to be more reliable to risk stratification of individual patients than exercise testing alone. The more optimal prognostic efficiency of thallium-201 scintigraphy is due, in part, to the fact that the error rate in falsely classifying patients as low-risk is substantially and significantly smaller with thallium-201 scintigraphy than with stress ECG. 52 references

  2. Myocardial perfusion scintigraphy 2007 in Germany. Results of the query and current status

    Energy Technology Data Exchange (ETDEWEB)

    Lindner, O. [Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany); Burchert, W. [Inst. fuer Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Bad Oeynhausen (Germany); Arbeitsgemeinschaft Kardiovaskulaere Nuklearmedizin der Deutschen Gesellschaft fuer Nuklearmedizin (Germany); Bengel, F.M. [Cardiovascular Nuclear Medicine, Johns Hopkins Medical Institutions, Baltimore (United States); Arbeitsgruppe Nuklearkardiologische Diagnostik der Deutschen Gesellschaft fuer Kardiologie (Germany); Zimmermann, R. [Arbeitsgruppe Nuklearkardiologische Diagnostik der Deutschen Gesellschaft fuer Kardiologie (Germany); Medizinische Klinik, Klinikum Pforzheim GmbH, Pforzheim (Germany); Dahl, J. vom [Klinik fuer Kardiologie, Kliniken Maria Hilf GmbH, Moenchengladbach (Germany); Schaefer, W. [Klinik fuer Nuklearmedizin, Universitaetsklinikum Aachen (Germany); Schober, O. [Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Muenster UKM (Germany); Schaefers, M. [Arbeitsgemeinschaft Kardiovaskulaere Nuklearmedizin der Deutschen Gesellschaft fuer Nuklearmedizin (Germany); Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Muenster UKM (Germany)

    2009-07-01

    Aim: This third survey of the working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine in cooperation with the working group Nuclear Cardiology of the German Cardiac Society was to deliver information on the procedures and in particular on the development of myocardial perfusion scintigraphy (MPS) from 2005 to 2007. Method: 370 questionnaires (222 private practices (PP), 117 hospitals (HO), 31 university hospitals (UH)) were evaluated. Results: MPS of 114,374 patients were reported, 83% were investigated with {sup 99m}Tc-perfusion tracers. 76% [2006=74%] were performed in PP, 15% [2006=17%] in HO and 9% [2006=9%] in UH. Diabetics represented 21% of all MPS patients in 2007. Data of 215 institutions which participated all from 2005 to 2007 showed an increase in MPS of 2.3% (PP +6.8%, HO -4.5%, UH -18.2%). The type of stress was pharmacological in 27% [2006 = 27%]; 67% adenosine (of these 25% with exercise), 31% dipyridamole (of these 55% with exercise), and 2% dobutamine. Gated SPECT was performed in 47% [2006 = 42%] of all rest and in 44% [2006 = 39%] of all stress MPS. 61% [2006 = 83%] of all institutions did not apply perfusion scores. 20% [2006 = 24%] of the institutions reported changes in the use of MPS by competing methods. Conclusion: There is a small increase of MPS between 2005 and 2007 despite competing methods. Gated SPECT has experienced more acceptance, but is still underrepresented. As compared to the European average and general standards of MPS a considerable backlog accounts to pharmacological stress tests, gated SPECT and perfusion scores. (orig.)

  3. Myocardial perfusion scintigraphy 2007 in Germany. Results of the query and current status

    International Nuclear Information System (INIS)

    Lindner, O.; Burchert, W.; Bengel, F.M.; Zimmermann, R.; Dahl, J. vom; Schaefer, W.; Schober, O.; Schaefers, M.

    2009-01-01

    Aim: This third survey of the working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine in cooperation with the working group Nuclear Cardiology of the German Cardiac Society was to deliver information on the procedures and in particular on the development of myocardial perfusion scintigraphy (MPS) from 2005 to 2007. Method: 370 questionnaires (222 private practices (PP), 117 hospitals (HO), 31 university hospitals (UH)) were evaluated. Results: MPS of 114,374 patients were reported, 83% were investigated with 99m Tc-perfusion tracers. 76% [2006=74%] were performed in PP, 15% [2006=17%] in HO and 9% [2006=9%] in UH. Diabetics represented 21% of all MPS patients in 2007. Data of 215 institutions which participated all from 2005 to 2007 showed an increase in MPS of 2.3% (PP +6.8%, HO -4.5%, UH -18.2%). The type of stress was pharmacological in 27% [2006 = 27%]; 67% adenosine (of these 25% with exercise), 31% dipyridamole (of these 55% with exercise), and 2% dobutamine. Gated SPECT was performed in 47% [2006 = 42%] of all rest and in 44% [2006 = 39%] of all stress MPS. 61% [2006 = 83%] of all institutions did not apply perfusion scores. 20% [2006 = 24%] of the institutions reported changes in the use of MPS by competing methods. Conclusion: There is a small increase of MPS between 2005 and 2007 despite competing methods. Gated SPECT has experienced more acceptance, but is still underrepresented. As compared to the European average and general standards of MPS a considerable backlog accounts to pharmacological stress tests, gated SPECT and perfusion scores. (orig.)

  4. Variation in heart rate influences the assessment of transient ischemic dilation in myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Leslie, William D; Levin, Daniel P; Demeter, Sandor J

    2007-01-01

    Transient arrhythmias can affect transient ischemic dilation (TID) ratios. This study was initiated to evaluate the frequency and effect of normal heart rate change on TID measures in routine clinical practice. Consecutive patients undergoing stress/rest sestamibi gated myocardial perfusion scintigraphy were studied (N = 407). Heart rate at the time of stress and rest imaging were recorded. TID ratios were analyzed in relation to absolute change in heart rate (stress minus rest) for subjects with normal perfusion and systolic function (Group 1, N = 169) and those with abnormalities in perfusion and/or function (Group 2, N = 238). In Group 1, mean TID ratio was inversely correlated with the change in heart rate (r = -0.47, P < 0.0001). For every increase of 10 BPM in heart rate change, the TID ratio decreased by approximately 0.06 (95% confidence interval 0.04–0.07). In Group 2, multiple linear regression demonstrated that the change in heart rate (beta = -0.25, P < 0.0001) and the summed difference score (beta = 0.36, P < 0.0001) were independent predictors of the TID ratio. Normal variation in heart rate between the stress and rest components of myocardial perfusion scans is common and can influence TID ratios in patients with normal and abnormal cardiac scans

  5. Nifedipine and thallium-201 myocardial perfusion in progressive systemic sclerosis

    International Nuclear Information System (INIS)

    Kahan, A.; Devaux, J.Y.; Amor, B.

    1986-01-01

    Heart disease in patients with progressive systemic sclerosis may be due in part to myocardial ischemia caused by a disturbance of the coronary microcirculation. To determine whether abnormalities of myocardial perfusion in this disorder are potentially reversible, we evaluated the effect of the coronary vasodilator nifedipine on myocardial perfusion assessed by thallium-201 scanning in 20 patients. Thallium-201 single-photon-emission computerized tomography was performed under control conditions and 90 minutes after 20 mg of oral nifedipine. The mean (+/- SD) number of left ventricular segments with perfusion defects decreased from 5.3 +/- 2.0 to 3.3 +/- 2.2 after nifedipine (P = 0.0003). Perfusion abnormalities were quantified by a perfusion score (0 to 2.0) assigned to each left ventricular segment and by a global perfusion score (0 to 18) for the entire left ventricle. The mean perfusion score in segments with resting defects increased from 0.97 +/- 0.24 to 1.26 +/- 0.44 after nifedipine (P less than 0.00001). The mean global perfusion score increased from 11.2 +/- 1.7 to 12.8 +/- 2.4 after nifedipine (P = 0.003). The global perfusion score increased by at least 2.0 in 10 patients and decreased by at least 2.0 in only 1. These observations reveal short-term improvement in thallium-201 myocardial perfusion with nifedipine in patients with progressive systemic sclerosis. The results are consistent with a potentially reversible abnormality of coronary vasomotion in this disorder, but the long-term therapeutic effects of nifedipine remain to be determined

  6. Impairment of myocardial perfusion in children with sickle cell disease; Alteration de la perfusion myocardique chez l'enfant drepanocytaire

    Energy Technology Data Exchange (ETDEWEB)

    Maunoury, C. [Hopital Necker-Enfants-Malades, Service de Medecine Nucleaire, 75 - Paris (France); Acar, P. [Centre Hospitalier Universitaire, Hopital des Enfants, Service de Cardiologie Pediatrique, 31 - Toulouse (France); Montalembert, M. de [Hopital Necker-Enfants-Malades, Service de Pediatrie Generale, 75 - Paris (France)

    2003-10-01

    While brain, bone and spleen strokes are well documented in children with sickle cell disease (SCD), impairment of myocardial perfusion is an unknown complication. Non invasive techniques such as exercise testing and echocardiography have a low sensitivity to detect myocardial ischemia in patients with SCD. We have prospectively assessed myocardial perfusion with Tl-201 SPECT in 23 patients with SCD (10 female, 13 male, mean age 12 {+-} 5 years). Myocardial SPECT was performed after stress and 3 hours later after reinjection on a single head gamma camera equipped with a LEAP collimator (64 x 64 matrix size format, 30 projections over 180 deg C, 30 seconds per step). Left ventricular ejection fraction (LVEF) was assessed by equilibrium radionuclide angiography at rest on the same day. Myocardial perfusion was impaired in 14/23 patients: 9 reversible defects and 5 fixed defects. The left ventricular cavity was dilated in 14/23 patients. The mean LVEF was 63 {+-} 9%. There was no relationship between myocardial perfusion and left ventricular dilation or function. The frequent impairment of myocardial perfusion in children with SCD could lead to suggest a treatment with hydroxyurea, an improvement of perfusion can be noted with hydroxyurea. (author)

  7. The diagnosis of silent myocardial ischemia. Motion-Frozen (or morphing) myocardial perfusion imaging.

    Science.gov (United States)

    Chang, Cheng; Ye, Bo; Xie, Wenhui; Zhang, Daoliang; Lei, Bei; Ye, Xiaodan

    2016-01-01

    Silent myocardial ischemia is typically defined as objective evidence of myocardial ischemia in patients without subjective ischemia symptoms. Currently, coronary artery angiography is the gold standard for diagnosis of asymptomatic coronary artery disease (CAD). Computed tomography coronary angiography (CTCA) can visually demonstrate the morphology, trend and extent of coronary stenosis and is commonly used in clinical screening of CAD. Myocardial perfusion imaging can be used not only to identify whether anatomical stenosis causes myocardial dysfunction, but to also assess the risk stratification and prognosis of myocardial disease (MD). Myocardial perfusion imaging using morphing combined with CTCA can simultaneously show the relationship between CAD and myocardial ischemia from an anatomical and functional aspect. This allows earlier diagnosis of asymptomatic CAD myocardial ischemia, accurate identification of the culprit vessels, and could prevent unnecessary interventional therapy. The 1-day dobutamine stress/resting met-hod is also one of the methods used. The combination of CTCA and the morphing technique can provide anatomical and functional information on coronary arteries at the same time, significantly improving the diagnostic sensitivity, specificity, and accuracy of MD.

  8. Predictive value of myocardial perfusion scintigraphy after stress in patients without previous myocardial infarction

    International Nuclear Information System (INIS)

    Tuner, D.A.; Battle, W.E.; Deshmukh, H.; Colandrea, M.A.; Snyder, G.J.; Fordham, E.W.; Messer, J.V.

    1978-01-01

    Seventy-five patients who had chest pain but no history or ECG evidence of myocardial infarction (MI) underwent myocardial-stress perfusion scintigraphy (MSPS) with thallium-201, treadmill-stress testing (TST), and coronary cineangiography (CA). The sensitivities of MSPS and TST for coronary stenosis greater than or equal to 75 percent were 68 percent and 71 percent, respectively; their specificities were 97 percent and 79 percent, respectively (0.1 greater than p greater than 0.05). When the character of a patient's chest pain is considered, Bayesian analysis leads to the following conclusions: MSPS can be useful in pre-CA screening of patients with chest pain but no MI if their pain is thought to be of uncertain or nonischemic origin; the sensitivity of Tl-201 MSPS is not sufficient for pre-CA screening of patients without MI who have typical or atypical angina pectoris; the sensitivity of MSPS would have to be approximately 95 percent in order for the test to be useful in pre-CA screening of patients who have atypical angina pectoris; MSPS may be superior to TST in these applications; and it is not clear that there is any advantage in combining MSPS and TST into a single screening test rather than using MSPS alone

  9. Assessment of the myocardial perfusion pattern in patients with multivessel coronary artery disease

    International Nuclear Information System (INIS)

    Iskandrian, A.S.; Hakki, A.H.; Segal, B.L.; Kane, S.A.; Amenta, A.

    1983-01-01

    A total of 42 symptomatic patients with coronary artery disease involving two or three vessels were studied using exercise thallium-201 myocardial scintigraphy. Qualitative analysis of the images predicted multivessel disease in 75% of the patients with two-vessel disease and in 82% of the patients with three-vessel disease. Quantitative analysis of the size of the perfusion defect indicated that approximately 40% of the left ventricular perimeter showed abnormal perfusion pattern during stress in these patients, and there was no significant difference in the size of the defect in patients with two-vessel disease or three-vessel disease (41 +/- 17% vs 42 +/- 14%, respectively, mean +/- SD). The exercise heart rate, exercise ECG response, and severity of narrowing did not correlate with the size of the perfusion defect. Patients with anterior infarction had larger defects in the distribution of the left anterior descending artery than those without infarction. Collaterals offered partial protection during exercise only when they were not jeopardized. This study confirms the value of qualitative analysis of exercise thallium-201 imaging in predicting multivessel disease, and describes a simple method of assessing the extent of perfusion abnormalities during stress in patients with multivessel disease. The results may be important in patient management and prognosis

  10. Myocardial Perfusion and Function Are Distinctly Altered by Sevoflurane Anesthesia in Diet-Induced Prediabetic Rats.

    Science.gov (United States)

    van den Brom, Charissa E; Boly, Chantal A; Bulte, Carolien S E; van den Akker, Rob F P; Kwekkeboom, Rick F J; Loer, Stephan A; Boer, Christa; Bouwman, R Arthur

    2016-01-01

    Preservation of myocardial perfusion during surgery is particularly important in patients with increased risk for perioperative complications, such as diabetes. Volatile anesthetics, like sevoflurane, have cardiodepressive effects and may aggravate cardiovascular complications. We investigated the effect of sevoflurane on myocardial perfusion and function in prediabetic rats. Rats were fed a western diet (WD; n = 18) or control diet (CD; n = 18) for 8 weeks and underwent (contrast) echocardiography to determine perfusion and function during baseline and sevoflurane exposure. Myocardial perfusion was estimated based on the product of microvascular filling velocity and blood volume. WD-feeding resulted in a prediabetic phenotype characterized by obesity, hyperinsulinemia, hyperlipidemia, glucose intolerance, and hyperglycemia. At baseline, WD-feeding impaired myocardial perfusion and systolic function compared to CD-feeding. Exposure of healthy rats to sevoflurane increased the microvascular filling velocity without altering myocardial perfusion but impaired systolic function. In prediabetic rats, sevoflurane did also not affect myocardial perfusion; however, it further impaired systolic function. Diet-induced prediabetes is associated with impaired myocardial perfusion and function in rats. While sevoflurane further impaired systolic function, it did not affect myocardial perfusion in prediabetic rats. Our findings suggest that sevoflurane anesthesia leads to uncoupling of myocardial perfusion and function, irrespective of the metabolic state.

  11. Myocardial perfusion imaging by digital subtraction angiography

    International Nuclear Information System (INIS)

    Kadowaki, Hiroyuki; Ishikawa, Kinji; Ogai, Toshihiro; Katori, Ryo

    1986-01-01

    Several methods of digital subtraction angiography (DSA) were compared to determine which could better visualize regional myocardial perfusion using coronary angiography in seven patients with myocardial infarction, two with angina pectoris and five with normal coronary arteries. Satisfactory DSA was judged to be achieved if the shape of the heart on the mask film was identical to that on the live film and if both films were exactly superimposed. To obtain an identical mask film in the shape of each live film, both films were selected from the following three phases of the cardiac cycle; 1) at the R wave of the electrocardiogram, 2) 100 msec before the R wave, and 3) 200 msec before the R wave. The last two were superior for obtaining mask and live films which were similar in shape, because the cardiac motion in these phases was relatively small. Using these mask and live films, DSA was performed either with the continuous image mode (CI mode) or the time interval difference mode (TID mode). The overall perfusion of contrast medium through the artery to the vein was adequately visualized using the CI mode. Passage of contrast medium through the artery, capillary and vein was visualized at each phase using TID mode. Subtracted images were displayed and photographed, and the density of the contrast medium was adequate to display contour lines as in a relief map. Using this DSA, it was found that regional perfusion of the contrast medium was not always uniform in normal subjects, depending on the typography of the coronary artery. In all patients with anterior myocardial infarction, low perfusion was observed at the infarcted portion compared to the non-infarcted myocardium. In patients with inferior myocardial infarction, this low perfusion area was not observed because right coronary angiography was not subjected to DSA in this study. (J.P.N.)

  12. Can preoperative myocardial perfusion scintigraphy predict changes in left ventricular perfusion and function after coronary artery bypass graft surgery?

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Johansen, Allan

    2012-01-01

    OBJECTIVESWe wanted to evaluate whether preoperative myocardial perfusion scintigraphy (MPS) could predict changes in cardiac symptoms and postoperative myocardial perfusion and left ventricular function after coronary artery bypass grafting (CABG).METHODSNinety-two patients with stable angina...... in 26%. Left ventricular ejection fraction (LVEF), which was normal before operation in 45%, improved in 40% of all patients. The increase in LVEF was not related to the preoperative pattern of perfusion defects. Of 30 patients with normalized perfusion after CABG, 29 (97%) had reversible defects...... that reversible or partly reversible perfusion defects at a preoperative MPS have a high chance of normalized myocardial perfusion assessed by MPS 6 months after operation. Normal perfusion is obtained almost exclusively in territories with reversible ischaemia. Symptoms improved in nearly all patients and LVEF...

  13. Clinical evaluation of the 99mTc-labelled myocardial imaging agent, hexakis (t-butylisonitrile)-technetium

    International Nuclear Information System (INIS)

    Liu Xiujie; Shi Rongfang; Wang Yanquen; Guo Xiuzhen; He Zuoxiang; Wang Xuebin; Liu Boli; Chinese Academy of Medical Sciences, Beijing. Div. of Nuclear Cardiology; Chinese Academy of Medical Sciences, Beijing. Cardiovascular Inst.; Beijing Normal Univ.

    1987-01-01

    99m Tc-TBI myocardial perfusion imaging has been studied in 7 normal subjects and 24 patients with coronary artery disease. Scintigraphic data revealed that 99m Tc-TBI myocardial perfusion imaging is more sensitive than ECG in detecting myocardial infarction. In comparing 99m Tc-TBI imaging with contrast angiography, its' sensitivity for the diagnosis of coronary artery disease was 91.7%. (orig.)

  14. Correlation of resting ECG, stress ECG and thallium scan in the evaluation of coronary artery disease

    International Nuclear Information System (INIS)

    Khan, A.; Amin, W.; Khan, M.Z.A.; Ahmed, A.; Kiani, M.R.

    1987-01-01

    This study includes 70 cases who underwent myocardial perfusion studies with thallium 201 during the year 1984-85. They were studied clinically, had their resting ECGs, stress ECGs and coronary angiograms. Majority of these patients were males, their ages ranged between 34-70 years. The patients population included with typical/atypical chest pain, some with resting ECG abnormalities, after coronary angiography and a few after coronary artery bypass graft surgery. The result of all the modalities were compared with the conventional gold standard for ischaemic heart disease, i.e. coronary angiogram. It is concluded that the sensitivity of resting ECG in the diagnosis of ischaemic heart disease is very low. The exercise test alone was found conclusive in about 74% of patients while sensitivity of thallium scan was 66% in this particular group of patients. (author)

  15. Reversible cold-induced abnormalities in myocardial perfusion and function in systemic sclerosis

    International Nuclear Information System (INIS)

    Alexander, E.L.; Firestein, G.S.; Weiss, J.L.; Heuser, R.R.; Leitl, G.; Wagner, H.N. Jr.; Brinker, J.A.; Ciuffo, A.A.; Becker, L.C.

    1986-01-01

    The effects of peripheral cold exposure on myocardial perfusion and function were studied in 13 patients with scleroderma without clinically evident myocardial disease. Ten patients had at least one transient, cold-induced, myocardial perfusion defect visualized by thallium-201 scintigraphy, and 12 had reversible, cold-induced, segmental left ventricular hypokinesis by two-dimensional echocardiography. The 10 patients with transient perfusion defects all had anatomically corresponding ventricular wall motion abnormalities. No one in either of two control groups (9 normal volunteers and 7 patients with chest pain and normal coronary arteriograms) had cold-induced abnormalities. This study is the first to show the simultaneous occurrence of cold-induced abnormalities in myocardial perfusion and function in patients with scleroderma. The results suggest that cold exposure in such patients may elicit transient reflex coronary vasoconstriction resulting in reversible myocardial ischemia and dysfunction. Chronic recurrent episodes of coronary spasm may lead to focal myocardial fibrosis

  16. Myocardial ischemia and angina pectoris

    International Nuclear Information System (INIS)

    Selwyn, A.P.; Fox, K.M.; Jonathan, A.; Lavender, P.; Watson, I.

    1981-01-01

    Ambulatory monitoring of ST segment changes was performed in 60 patients presenting with angina, positive ECG stress tests and coronary artery disease, 85% of ischemic ECG events were asymptomatic, 37% occurred with no increase in heart rate and 15% of episodes either lasted 20 minutes or more or fluctuated in severity. A controlled pilot study in ten patients showed depression. Radionuclide studies in 50 patients with angina and coronary artery disease have shown that stress (i.e., atrial pacing) produced different patterns of disturbed regional myocardial perfusion related to the patient's exercise capacity and eventually leading to a decrease in regional myocardial perfusion during the ischemic episode. ST segment depression appeared only after the decrease in regional myocardial perfusion. These findings combined with past research suggest that patients with angina and coronary artery disease can suffer frequent asymptomatic disturbances of the regional myocardial perfusion. The frequency of these episodes and the time course for the recovery of the metabolic consequences mean that segments of ventricular myocardium may be constantly abnormal. The relative importance of changes in coronary tone and malfunction of platelets in the diseased coronary tree needs to be examined in clinical research. Pilot studies of antiplatelet agents have shown a significant beneficial effect on episodes of ischemia occurring at night and those occurring without any increase in heart rate. The techniques and observations in these patients with coronary artery disease all suggest that acute transient regional myocardial ischemia is caused by a variety of mechnisms. Further research using objective methods is required to discover the causes of ischemia and to rationalize treatment. (orig./MG) [de

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

    International Nuclear Information System (INIS)

    Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Anh, B. C.; Lee, J.; Lee, K. B

    2004-01-01

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  19. Hypertension impairs myocardial blood perfusion reserve in subjects without regional myocardial ischemia

    International Nuclear Information System (INIS)

    Nakajima, Hiroshi; Onishi, Katsuya; Kurita, Tairo

    2010-01-01

    Quantitative analysis of myocardial perfusion MRI can provide noninvasive assessments of myocardial perfusion reserve (MPR), which is associated with endothelial function. Endothelial function is influenced by various factors, including hypertension, diabetes, dyslipidemia, renal dysfunction and anemia. The purpose of this study was to evaluate which risk factor is the strongest effector of MPR in subjects without regional myocardial ischemia. We studied 110 patients (66 years ±10, male 68%, hypertension 76%, diabetes mellitus (DM) 40% and dyslipidemia 65%) without regional myocardial ischemia. Adenosine triphosphate (ATP) stress and rest first-pass perfusion magnetic resonance (MR) images were acquired with a 1.5-T MR system, and MPR was calculated as the ratio of stress to rest myocardial blood flow (MBF). Average rest MBF in 110 patients was 1.07±0.62 ml min -1 g -1 , whereas stress MBF was 3.15±1.93 ml min -1 g -1 and the MPR was 3.33±1.82. Rest MBF correlated significantly with hematocrit, whereas stress MBF showed a strong correlation with estimated glomerular filtration rate (e-GFR). MPR was associated with hypertension, age, e-GFR, hematocrit and left ventricular mass index (LVMI). In multiple regression analysis, hypertension (P=0.003, β=-0.274) showed the strongest correlation with MPR among other risk factors, such as diabetes (P=ns), dyslipidemia (P=ns), e-GFR (P=ns), LVMI (P=0.007, β=-0.248) and hematocrit (P=ns) after adjusting age and gender. Hypertension is the most important effector of MPR in subjects without myocardial ischemia. (author)

  20. Hypertension impairs myocardial blood perfusion reserve in subjects without regional myocardial ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Nakajima, Hiroshi; Onishi, Katsuya; Kurita, Tairo [Mie Univ., Graduate School of Medicine, Tsu, Mie (Japan)

    2010-11-15

    Quantitative analysis of myocardial perfusion MRI can provide noninvasive assessments of myocardial perfusion reserve (MPR), which is associated with endothelial function. Endothelial function is influenced by various factors, including hypertension, diabetes, dyslipidemia, renal dysfunction and anemia. The purpose of this study was to evaluate which risk factor is the strongest effector of MPR in subjects without regional myocardial ischemia. We studied 110 patients (66 years {+-}10, male 68%, hypertension 76%, diabetes mellitus (DM) 40% and dyslipidemia 65%) without regional myocardial ischemia. Adenosine triphosphate (ATP) stress and rest first-pass perfusion magnetic resonance (MR) images were acquired with a 1.5-T MR system, and MPR was calculated as the ratio of stress to rest myocardial blood flow (MBF). Average rest MBF in 110 patients was 1.07{+-}0.62 ml min{sup -1} g{sup -1}, whereas stress MBF was 3.15{+-}1.93 ml min{sup -1} g{sup -1} and the MPR was 3.33{+-}1.82. Rest MBF correlated significantly with hematocrit, whereas stress MBF showed a strong correlation with estimated glomerular filtration rate (e-GFR). MPR was associated with hypertension, age, e-GFR, hematocrit and left ventricular mass index (LVMI). In multiple regression analysis, hypertension (P=0.003, {beta}=-0.274) showed the strongest correlation with MPR among other risk factors, such as diabetes (P=ns), dyslipidemia (P=ns), e-GFR (P=ns), LVMI (P=0.007, {beta}=-0.248) and hematocrit (P=ns) after adjusting age and gender. Hypertension is the most important effector of MPR in subjects without myocardial ischemia. (author)

  1. Myocardial perfusion SPECT in diabetic patients for detection of coronary artery disease

    International Nuclear Information System (INIS)

    Saeed, M.A.; Fatima, S.; Fatmi, S.; Kureshi, S.

    2003-01-01

    The aim of this study was to evaluate the efficacy of myocardial SPECT perfusion scan in the diagnosis of coronary artery disease in diabetic patients. A total number of thirty diabetic patients (21 males, 9 females) were included in the study. All the patients had strong risk-factors for coronary artery disease (strong family history, chronic smokers, hyperlipidemia, history of chest pain). All patients underwent coronary angiography and stress/rest myocardial perfusion SPECT scans with Tc-99m MIBI (two days protocol). Twenty two patients had significant coronary artery stenosis and 8 had normal coronary arteries. Myocardial perfusion scintigraphy (MPS) was positive in 19 subjects out of the 22 patients with significant stenosis (Sensitivity 86.4%) and negative (false negative) in only three. Out of 8 patients with normal angiography 7 had normal MPS (Specificity 87.5%) whereas only one patient revealed abnormality in the myocardial perfusion study. When compared with coronary angiography the positive predictive value and negative predictive value for Tc-99m MIBI myocardial perfusion scan was 86.4% and 87.5% respectively. In conclusion, Tc-99m MIBI myocardial perfusion scintigraphy is a useful screening modality for the detection of coronary artery disease in diabetic patients. (author)

  2. Impact of intracoronary injection of mononuclear bone marrow cells in acute myocardial infarction on left ventricular perfusion and function: a 6-month follow-up gated 99mTc-MIBI single-photon emission computed tomography study

    International Nuclear Information System (INIS)

    Lipiec, Piotr; Krzeminska-Pakula, Maria; Plewka, Michal; Kasprzak, Jaroslaw D.; Kusmierek, Jacek; Plachcinska, Anna; Szuminski, Remigiusz; Robak, Tadeusz; Korycka, Anna

    2009-01-01

    We investigated the impact of intracoronary injection of autologous mononuclear bone marrow cells (BMC) in patients with acute ST elevation myocardial infarction (STEMI) on left ventricular volumes, global and regional systolic function and myocardial perfusion. The study included 39 patients with first anterior STEMI treated successfully with primary percutaneous coronary intervention. They were randomly assigned to the treatment group or the control group in a 2:1 ratio. The patients underwent baseline gated single-photon emission computed tomography (G-SPECT) 3-10 days after STEMI with quantitative and qualitative analysis of left ventricular perfusion and systolic function. On the following day, patients from the BMC treatment group were subjected to bone marrow aspiration, mononuclear BMC isolation and intracoronary injection. No placebo procedure was performed in the control group. G-SPECT was repeated 6 months after STEMI. Baseline and follow-up G-SPECT studies were available for 36 patients. At 6 months in the BMC group we observed a significantly enhanced improvement in the mean extent of the perfusion defect, the left ventricular perfusion score index, the infarct area perfusion score and the infarct area wall motion score index compared to the control group (p=0.01-0.04). However, the changes in left ventricular volume, ejection fraction and the left ventricular wall motion score index as well as the relative changes in the infarct area wall motion score index did not differ significantly between the groups. Intracoronary injection of autologous mononuclear BMC in patients with STEMI improves myocardial perfusion at 6 months. The benefit in infarct area systolic function is less pronounced and there is no apparent improvement of global left ventricular systolic function. (orig.)

  3. Influence of Respiratory Gating, Image Filtering, and Animal Positioning on High-Resolution Electrocardiography-Gated Murine Cardiac Single-Photon Emission Computed Tomography

    Directory of Open Access Journals (Sweden)

    Chao Wu

    2015-01-01

    Full Text Available Cardiac parameters obtained from single-photon emission computed tomographic (SPECT images can be affected by respiratory motion, image filtering, and animal positioning. We investigated the influence of these factors on ultra-high-resolution murine myocardial perfusion SPECT. Five mice were injected with 99m technetium (99mTc-tetrofosmin, and each was scanned in supine and prone positions in a U-SPECT-II scanner with respiratory and electrocardiographic (ECG gating. ECG-gated SPECT images were created without applying respiratory motion correction or with two different respiratory motion correction strategies. The images were filtered with a range of three-dimensional gaussian kernels, after which end-diastolic volumes (EDVs, end-systolic volumes (ESVs, and left ventricular ejection fractions were calculated. No significant differences in the measured cardiac parameters were detected when any strategy to reduce or correct for respiratory motion was applied, whereas big differences (> 5% in EDV and ESV were found with regard to different positioning of animals. A linear relationship (p < .001 was found between the EDV or ESV and the kernel size of the gaussian filter. In short, respiratory gating did not significantly affect the cardiac parameters of mice obtained with ultra-high-resolution SPECT, whereas the position of the animals and the image filters should be the same in a comparative study with multiple scans to avoid systematic differences in measured cardiac parameters.

  4. Electrocardiographic gating in positron emission computed tomography

    International Nuclear Information System (INIS)

    Hoffman, E.J.; Phelps, M.E.; Wisenberg, G.; Schelbert, H.R.; Kuhl, D.E.

    1979-01-01

    Electrocardiographic (ECG) synchronized multiple gated data acquisition was employed with positron emission computed tomography (ECT) to obtain images of myocardial blood pool and myocardium. The feasibility and requirements of multiple gated data acquisition in positron ECT were investigated for 13NH3, ( 18 F)-2-fluoro-2-D-deoxyglucose, and ( 11 C)-carboxyhemoglobin. Examples are shown in which image detail is enhanced and image interpretation is facilitated when ECG gating is employed in the data collection. Analysis of count rate data from a series of volunteers indicates that multiple, statistically adequate images can be obtained under a multiple gated data collection format without an increase in administered dose

  5. Prospective versus retrospective ECG-gated multislice CT coronary angiography: A systematic review of radiation dose and diagnostic accuracy

    International Nuclear Information System (INIS)

    Sun Zhonghua; Ng, Kwan-Hoong

    2012-01-01

    Purpose: To perform a systematic review of the radiation dose and diagnostic accuracy of prospective versus retrospective ECG-gated multislice CT coronary angiography. Materials and methods: A search of Pubmed/Medline and Sciencedirect databases for English literature was performed to identify studies comparing prospective and retrospective ECG-gated multislice CT angiography in the diagnosis of coronary artery disease. Effective dose, dose length product, image quality and diagnostic value were compared between two groups of studies. Results: 22 studies were included for analysis. The mean effective dose of prospective ECG-gated scans was 4.5 mSv (95% CI: 3.6, 5.3 mSv), which is significantly lower than that of retrospective scans, which is 13.8 mSv (95% CI: 11.5, 16.0 mSv) (p < 0.001). The mean dose length product was 225 mGy cm (95% CI: 188, 262 mGy cm) and 822 mGy cm (95% CI: 630, 1013 mGy cm) for the prospective and retrospective ECG-gated scans, respectively, indicating a statistically significant difference between these two protocols (p < 0.0001). The mean sensitivity and specificity of multislice CT angiography in the diagnosis of coronary artery disease was 97.7% (95% CI: 93.7%, 100%) and 92.1% (95% CI: 87.2%, 97%) for prospective ECG-gated scans; 95.2% (95% CI: 91%, 99.5%) and 94.4% (95% CI: 88.5%, 100%) for retrospective ECG-gated scans, respectively, with no significant difference for sensitivity but significant difference for specificity (p = 0.047). Conclusion: Multislice CT coronary angiography with prospective ECG-gating leads to a significant reduction of radiation dose when compared to that of retrospective ECG-gating, while offering comparable image quality and diagnostic value.

  6. Experimental and clinical analyses of optimum Fourier filtering in ECG-gated blood pool scintigraphy

    International Nuclear Information System (INIS)

    Shimabukuro, Kunisada

    1988-01-01

    A phantom study was undertaken to determine the optimum order harmonics in Fourier analysis for volume curves obtained by ECG-gated blood pool scintigraphy. The volume curve obtained by Tc-99m scintigraphy was computed by the 1st through 10th order harmonics of Fourier transform. The shape of each volume curve fitted by Fourier transform was compared with the shape of the generated ideal curve. Curves fitted with the 3rd or more order harmonics were approximate to the ideal curve in shape during the systolic phase. The 6th to 10th order harmonics were suitable for the early diastole phase. As determined by peak ejection rate and peak filling rate (PFR), the 6th order harmonics was superior to the 3rd order harmonics in evaluating early diastolic abnormalities. In the clinical settings, there was no difference between the 3rd and 6th order harmonics in evaluating systolic abnormalities; however, the 6th order harmonics was more sensitive than the 3rd order harmonics in evaluating early diastolic abnormalities. The 6th order harmonics significantly reflected PFR in the group of hypertrophic cardiomyopathy (n=10) and time to PFR in the groups of old myocardial infarction (n=10) and angina pectoris (n=10). In conclusion, the 6th to 9th order harmonics of Fourier analysis may be useful in analyzing both systolic and early diastolic phases inf left ventricular volume curves obtained from ECG-gated cardiac blood pool scintigraphy. (Namekawa, K)

  7. Diagnosis of accessory conduction pathway using ECG-gated emission CT analysis. Studies in patients with WPW syndrome who underwent surgery

    Energy Technology Data Exchange (ETDEWEB)

    Misaki, Takuro; Mukai, Keiichi; Tsubota, Makoto; Iwa, Takashi; Nakajima, Ken-ichi; Hisada, Kin-ichi

    1987-09-01

    Pinpointing the location of accessory conduction pathway (ACP) is of great importance in the surgical treatment for Wolff-Parkinson-White (WPW) syndrome. For this purpose, this study explored the usefulness of ECG-gated emission computed tomography (Gated-ECT) in 30 patients who preoperatively underwent Gated-ECT. The site of earliest contraction at level of atrioventicular valves, obtained on tomographic phase analysis, was compared with the site of earliest activation, obtained on epicardial mapping during surgery. The concordance rate of the two methods was 94 % (28/30). Among them, one patient was found to have the association of corrected transposition of great arteries on Gated-ECT. Gated-ECT was, however, of limited value in differentiating right posterior ACP from right postseptal ACP. The discordance between the sites of earliest contraction and activation, which was observed in the two others, was likely due to decreased wall motion resulting from myocardial disturbance. Gated-ECT may have a diagnostic potential for the location of ACP, especially in view of providing images that corresponded to the surgical anatomy. (Namekawa, K.).

  8. Application of myocardial perfusion quantitative imaging for the evaluation of therapeutic effect in canine with myocardial infarction

    International Nuclear Information System (INIS)

    Liang Hong; Chen Ju; Liu Sheng; Zeng Shiquan

    2000-01-01

    Myocardial blood perfusion (MBP) ECT and quantitative analysis were performed in 10 canines with experimental acute myocardial infarct (AMI). The accuracy of main myocardial quantitative index, including defect volume (DV) and defect fraction (DF), was estimated and correlated with histochemical staining (HS) of infarcted area. Other 21/AMI canines were divided into Nd:YAG laser trans-myocardial revascularization treated group LTMR and control group. All canines were performed MBP ECT after experimental AMI. Results found that the infarcted volume (IV) measured by HS has well correlated (r 0.88) with DV estimated by myocardial quantitative analysis. But the DF values calculated by both methods was not significantly different (t = 1.28 P > 0.05). In LTMR group 27.5% +- 3.9%, the DF is smaller than control group 32.1% +- 4.6% (t = 2.49 P 99m Tc-MIBI myocardial perfusion SPECT and quantitative study can accurately predict the myocardial blood flow and magnitude of injured myocardium. Nd:YAG LTMR could improve myocardial blood perfusion of ischemic myocardium and decrease effectively the infarct areas

  9. GAMMAGRAFÍA DE PERFUSIÓN MIOCÁRDICA EN MUJERES POSMENOPÁUSICAS CON ANGINA Y CORONARIAS EPICÁRDICAS ANGIOGRÁFICAMENTE NORMALES / Myocardial perfusion scintigraphy in postmenopausal women with angina and angiographically normal epicardial coronary

    Directory of Open Access Journals (Sweden)

    Sherien Sixto Fernández

    2011-03-01

    Full Text Available Introduction and Objectives: Microvascular angina is common in postmenopausal women. Myocardial ischemia was induced by stress testing, and reports have been published about the relationship between endothelial dysfunction and myocardial perfusion. The objective of this research was to determine whether myocardial ischemia can be evidenced by abnormalities in perfusion and function, as detected by myocardial scintigraphy in women with typical angina, normal coronary angiography and endothelial dysfunction. Methods: 59 women underwent lipid and endothelial function measurements by brachial artery ultrasound, in addition, a 24-hour ECG study (Holter. During the scintigraphy a stress-rest protocol was applied. Patients were divided into two groups according to presence (group I or absence (group II of myocardial perfusion defects. Results: 21 patients showed perfusion defects. 57 % of group I exhibited greater endothelial dysfunction. Only twelve patients showed reversible perfusion defects, and 75 % of the cases was associated with a reduction of post-stress left ventricular ejection fraction, greater than 5 %, and regional abnormalities of wall motion. Three patients in group I showed evidence of ischemia compared with four in Group II. Conclusions: The stress-induced ischemia was associated with a reduced post-stress ejection fraction and endothelial dysfunction in the studied women, and no ischemic changes in the Holter were found.

  10. Myocardial perfusion scintigraphy with exercise and pharmacological stress

    Energy Technology Data Exchange (ETDEWEB)

    Sundram, F X [General Hospital of Singapore, Dept. of Nuclear Medicine (Senegal)

    1996-12-31

    Cardiac studies including myocardial perfusion scintigraphy was begun in the Singapore General Hospital, nuclear medicine department in 1983. From a few patients per year using planar imaging, we have in 1994 studied 1500 patients for myocardial perfusion, using mainly SPECT (single-photon emission computerised tomography) and radionuclides such as Thallium-201, Technetium-99m sestamibi and Tc-99m tetrofosmin. Patients have been stressed using treadmill exercise or pharmacological agents; we have used dipyridamole, and dobutamine for pharmacological stress but have no experience with intravenous adenosine.

  11. Myocardial perfusion scintigraphy with exercise and pharmacological stress

    International Nuclear Information System (INIS)

    Sundram, F.X.

    1995-01-01

    Cardiac studies including myocardial perfusion scintigraphy was begun in the Singapore General Hospital, nuclear medicine department in 1983. From a few patients per year using planar imaging, we have in 1994 studied 1500 patients for myocardial perfusion, using mainly SPECT (single-photon emission computerised tomography) and radionuclides such as Thallium-201, Technetium-99m sestamibi and Tc-99m tetrofosmin. Patients have been stressed using treadmill exercise or pharmacological agents; we have used dipyridamole, and dobutamine for pharmacological stress but have no experience with intravenous adenosine

  12. Residual motion compensation in ECG-gated interventional cardiac vasculature reconstruction

    Science.gov (United States)

    Schwemmer, C.; Rohkohl, C.; Lauritsch, G.; Müller, K.; Hornegger, J.

    2013-06-01

    Three-dimensional reconstruction of cardiac vasculature from angiographic C-arm CT (rotational angiography) data is a major challenge. Motion artefacts corrupt image quality, reducing usability for diagnosis and guidance. Many state-of-the-art approaches depend on retrospective ECG-gating of projection data for image reconstruction. A trade-off has to be made regarding the size of the ECG-gating window. A large temporal window is desirable to avoid undersampling. However, residual motion will occur in a large window, causing motion artefacts. We present an algorithm to correct for residual motion. Our approach is based on a deformable 2D-2D registration between the forward projection of an initial, ECG-gated reconstruction, and the original projection data. The approach is fully automatic and does not require any complex segmentation of vasculature, or landmarks. The estimated motion is compensated for during the backprojection step of a subsequent reconstruction. We evaluated the method using the publicly available CAVAREV platform and on six human clinical datasets. We found a better visibility of structure, reduced motion artefacts, and increased sharpness of the vessels in the compensated reconstructions compared to the initial reconstructions. At the time of writing, our algorithm outperforms the leading result of the CAVAREV ranking list. For the clinical datasets, we found an average reduction of motion artefacts by 13 ± 6%. Vessel sharpness was improved by 25 ± 12% on average.

  13. Prospective and retrospective ECG-gating for CT coronary angiography perform similarly accurate at low heart rates

    Energy Technology Data Exchange (ETDEWEB)

    Stolzmann, Paul, E-mail: paul.stolzmann@usz.ch [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland); Goetti, Robert; Baumueller, Stephan [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland); Plass, Andre; Falk, Volkmar [Clinic for Cardiovascular Surgery, University Hospital Zurich (Switzerland); Scheffel, Hans; Feuchtner, Gudrun; Marincek, Borut [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland); Alkadhi, Hatem [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Leschka, Sebastian [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)

    2011-07-15

    Objective: To compare, in patients with suspicion of coronary artery disease (CAD) and low heart rates, image quality, diagnostic performance, and radiation dose values of prospectively and retrospectively electrocardiography (ECG)-gated dual-source computed tomography coronary angiography (CTCA) for the diagnosis of significant coronary stenoses. Materials and methods: Two-hundred consecutive patients with heart rates {<=}70 bpm were retrospectively enrolled; 100 patients undergoing prospectively ECG-gated CTCA (group 1) and 100 patients undergoing retrospectively-gated CTCA (group 2). Coronary artery segments were assessed for image quality and significant luminal diameter narrowing. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and accuracy of both CTCA groups were determined using conventional catheter angiography (CCA) as reference standard. Radiation dose values were calculated. Results: Both groups were comparable regarding gender, body weight, cardiovascular risk profile, severity of CAD, mean heart rate, heart rate variability, and Agatston score (all p > 0.05). There was no significant difference in the rate of non-assessable coronary segments between group 1 (1.6%, 24/1404) and group 2 (1.4%, 19/1385; p = 0.77); non-diagnostic image quality was significantly (p < 0.001) more often attributed to stair step artifacts in group 1. Segment-based sensitivity, specificity, PPV, NPV, and accuracy were 98%, 98%, 88%, 100%, and 100% among group 1; 96%, 99%, 90%, 100%, and 98% among group 2, respectively. Parameters of diagnostic performance were similar (all p > 0.05). Mean effective radiation dose of prospectively ECG-gated CTCA (2.2 {+-} 0.4 mSv) was significantly (p < 0.0001) smaller than that of retrospectively ECG-gated CTCA (8.1 {+-} 0.6 mSv). Conclusion: Prospectively ECG-gated CTCA yields similar image quality, performs as accurately as retrospectively ECG-gated CTCA in patients having heart rates {<=}70 bpm

  14. Magnetic resonance myocardial perfusion imaging-First experience at 3.0 T

    Energy Technology Data Exchange (ETDEWEB)

    Klumpp, B. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: bernhard.klumpp@med.uni-tuebingen.de; Hoevelborn, T. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Cardiology, Otfried-Mueller-Str. 10, 72076 Tuebingen (Germany)], E-mail: tobias.hoevelborn@gmx.de; Fenchel, M. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: michael.fenchel@med.uni-tuebingen.de; Stauder, N.I. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: norbert.stauder@stgag.ch; Kramer, U. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: ulrich.kramer@med.uni-tuebingen.de; May, A. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Cardiology, Otfried-Mueller-Str. 10, 72076 Tuebingen (Germany)], E-mail: andreas.may@med.uni-tuebingen.de; Gawaz, M.P. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Cardiology, Otfried-Mueller-Str. 10, 72076 Tuebingen (Germany)], E-mail: meinrad.gawaz@med.uni-tuebingen.de; Claussen, C.D. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: claus.claussen@med.uni-tuebingen.de; Miller, S. [Eberhard-Karls-University Tuebingen, University Hospital Tuebingen, Department of Diagnostic Radiology, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)], E-mail: stephan.miller@med.uni-tuebingen.de

    2009-01-15

    Objective: MR myocardial perfusion imaging (MRMPI) is an established technique for the evaluation of the hemodynamical relevance of coronary artery disease. Perfusion imaging at 3.0 T provides certain advantages compared to 1.5 T. Aim of this study was to evaluate myocardial MR perfusion imaging at 3.0 T. Materials and methods: Twelve patients with stable Angina pectoris and known or suspected coronary artery disease were examined at 3.0 T. Myocardial perfusion was assessed using a saturation recovery gradient echo 2D sequence (TR 1.9 ms, TE 1.0 ms, FA 12 deg.) with 0.05 mmol Gd-DTPA per kg body weight at stress during injection of 140 {mu}g adenosine/kg body weight/min and at rest in short axis orientation. Perfusion analysis was based on a least square fit of the signal/time curve (peak signal intensity, slope). Perfusion series were assessed by two independent observers. Reference for the presence of relevant coronary artery stenoses was invasive coronary angiography. Two experienced observers evaluated the coronary angiograms in biplane projections for the presence and grade of stenoses. Results were compared with the MR perfusion analysis. Results: All MR examinations could be safely performed and yielded high image quality. In eight patients stress-induced hypoperfusion was detected (stenosis >70% in coronary angiography). In four patients myocardial hypoperfusion was ruled out (stenosis <70%). The myocardial perfusion reserve index was significantly reduced in hypoperfused myocardium with 1.9 {+-} 1.6 compared to 2.5 {+-} 1.6 in regularly perfused myocardium (p < 0.05). In coronary angiography, eight patients were found to suffer from coronary artery disease, whereas in four patients coronary artery disease was ruled out. Conclusion: Our initial results show that MRMPI at 3.0 T provides reliably high-image quality and diagnostic accuracy.

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

    International Nuclear Information System (INIS)

    Pons, G.

    2011-01-01

    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)

  16. Clinical investigation of large perfusion defect cases with 201Tl exercise myocardial scintigraphy

    International Nuclear Information System (INIS)

    Morota, Motoi; Kobayashi, Yasuhiko

    1999-01-01

    We investigated retrospectively the clinical significance of large perfusion defect on 201 Thallium myocardial scintigraphy from the records of 833 patients during the past 3 years from 1991 to 1994. The patients were divided into 3 groups according to the extent of perfusion defect; cases with normal perfusion (n=561), with small perfusion defect (n=211) and with large perfusion defect (n=61). We found that the proportions of cases with large perfusion defect was significantly larger than that of cases with small perfusion defect in myocardial disease (MD; hypertrophic cardiomyopathy, dilated cardiomyopathy, and post myocarditis combined) (P 201 Thallium myocardial scintigraphy and that complication of diabetes mellitus and clinical symptoms may be useful in differentiating IHD from MD. (author)

  17. Prospective ECG triggering versus low-dose retrospective ECG-gated 128-channel CT coronary angiography: comparison of image quality and radiation dose

    International Nuclear Information System (INIS)

    Feng, Q.; Yin, Y.; Hua, X.; Zhu, R.; Hua, J.; Xu, J.

    2010-01-01

    Aim: To evaluate image quality and radiation dose for 128-detector prospective electrocardiogram (ECG)-gated computed tomography coronary angiography (CTCA) compared with a low-dose retrospective ECG-gated imaging protocol. Materials and methods: Thirty-one and 47 patients suspected of having coronary artery disease were enrolled into groups examined using prospective and low-dose retrospective ECG-gated CT protocols respectively. All examinations were performed on a 128-detector CT system (Definition AS, Siemens Healthcare, Forchheim, Germany). Prospective CTCA was performed using following parameters: tube voltage 100 kV; tube current 205 mAs; centre of acquisition window 70% of the RR interval. The tube current for low-dose retrospective ECG-gated CTCA was full dose during 40-70% of the RR interval and partial dose for the rest of RR interval. The pitch varied between 0.2 and 0.5 depending on heart rate and patient size. Image quality of coronary arteries was evaluated using a four-point grading scale. The signal-to-noise ratios (SNRs) of enhanced arteries and myocardium were also measured, corresponding contrast-to-noise ratios (CNRs) were calculated, and the radiation doses received were recorded. Results: There was a significant difference in the image quality scores between the retrospective and prospective gating protocols (Chi-square = 15.331, p = 0.009). There was no significant difference between the SNRs of the contrasted artery and myocardium in these two groups, but the CNRs were increased in the prospective group. The mean radiation dose of prospective gating group was 2.71 ± 0.67 mSv (range, 1.67-3.59 mSv), which was significantly lower than that of the retrospective group (p < 0.001). Conclusion: Prospective CT angiography can achieve lower radiation dose than that of low-dose retrospective CT angiography, with preserved image quality.

  18. Prospective ECG triggering versus low-dose retrospective ECG-gated 128-channel CT coronary angiography: comparison of image quality and radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Feng, Q.; Yin, Y.; Hua, X.; Zhu, R.; Hua, J. [Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai (China); Xu, J., E-mail: xujianr@hotmail.co [Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai (China)

    2010-10-15

    Aim: To evaluate image quality and radiation dose for 128-detector prospective electrocardiogram (ECG)-gated computed tomography coronary angiography (CTCA) compared with a low-dose retrospective ECG-gated imaging protocol. Materials and methods: Thirty-one and 47 patients suspected of having coronary artery disease were enrolled into groups examined using prospective and low-dose retrospective ECG-gated CT protocols respectively. All examinations were performed on a 128-detector CT system (Definition AS, Siemens Healthcare, Forchheim, Germany). Prospective CTCA was performed using following parameters: tube voltage 100 kV; tube current 205 mAs; centre of acquisition window 70% of the RR interval. The tube current for low-dose retrospective ECG-gated CTCA was full dose during 40-70% of the RR interval and partial dose for the rest of RR interval. The pitch varied between 0.2 and 0.5 depending on heart rate and patient size. Image quality of coronary arteries was evaluated using a four-point grading scale. The signal-to-noise ratios (SNRs) of enhanced arteries and myocardium were also measured, corresponding contrast-to-noise ratios (CNRs) were calculated, and the radiation doses received were recorded. Results: There was a significant difference in the image quality scores between the retrospective and prospective gating protocols (Chi-square = 15.331, p = 0.009). There was no significant difference between the SNRs of the contrasted artery and myocardium in these two groups, but the CNRs were increased in the prospective group. The mean radiation dose of prospective gating group was 2.71 {+-} 0.67 mSv (range, 1.67-3.59 mSv), which was significantly lower than that of the retrospective group (p < 0.001). Conclusion: Prospective CT angiography can achieve lower radiation dose than that of low-dose retrospective CT angiography, with preserved image quality.

  19. Direct myocardial perfusion imaging in valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Soto, R.C.; Durante, M.L.; Villacorta, E.V.; Torres, J.F.; Monzon, O.P.

    1981-02-01

    Twenty two patients with rheumatic valvular heart disease - 21 having a history of heart failure - were studied using direct coronary injection of /sup 99m/Tc labelled MAA particles during the course of hemodynamic and arteriographic studies. Myocardial perfusion deficit patterns have been shown to be consistent or indicative of either patchy, regional or gross ischemia. In patients with history of documented heart failure 90% (18 cases) had ischemic perfusion deficit in the involved ventricle. We conclude that diminished myocardial blood flow is an important mechanism contributing to the development of heart failure.

  20. Direct myocardial perfusion imaging in valvular heart disease

    International Nuclear Information System (INIS)

    Soto, R.C.; Durante, M.L.; Villacorta, E.V.; Torres, J.F.; Monzon, O.P.

    1981-01-01

    Twenty two patients with rheumatic valvular heart disease - 21 having a history of heart failure - were studied using direct coronary injection of sup(99m)Tc labelled MAA particles during the course of hemodynamic and arteriographic studies. Myocardial perfusion deficit patterns have been shown to be consistent or indicative of either patchy, regional or gross ischemia. In patients with history of documented heart failure 90% (18 cases) had ischemic perfusion deficit in the involved ventricle. We conclude that diminished myocardial blood flow is an important mechanism contributing to the development of heart failure. (orig.) [de

  1. ECG and enzymatic indicators of therapeutic success after intravenous streptokinase for acute myocardial infarction

    DEFF Research Database (Denmark)

    Clemmensen, P; Grande, P; Pedersen, F

    1990-01-01

    Thrombolytic therapy has been documented to result in reperfusion of jeopardized myocardium and reduction in the size of the acute myocardial infarction (AMI). The effect of intravenous streptokinase on a creatine kinase-MB (CK-MB) reperfusion index and an ECG estimate of myocardial salvage...... was therefore studied in 65 patients with a first AMI, randomized to treatment with streptokinase (n = 33) or placebo (control group, n = 32). Reperfusion was defined as a CK-MB appearance rate constant (k1) greater than 0.185. The final AMI size was first predicted from the admission standard ECG by previously...... developed formulas based on ST segment elevation. The final AMI size was estimated from the QRS score on the predischarge ECG. Myocardial salvage was defined as a greater than or equal to 20% decrease from predicted to final AMI size. The k1 value in the control group was significantly lower than...

  2. Myocardial perfusion scintigraphy 2006 in Germany. Results of the query and current status

    International Nuclear Information System (INIS)

    Lindner, O.; Burchert, W.; Bengel, F.M.; Zimmermann, R.; Dahl, J. vom; Schaefer, W.; Schober, O.; Kluge, R.; Schaefers, M.

    2008-01-01

    Aim: this second survey was to deliver further information on myocardial perfusion scintigraphy (MPS) in Germany in 2006. Method: 351 questionnaires were evaluated: 207 private practices (PP), 117 hospitals (HO), 27 from university hospitals (UH). Results: MPS of 106 331 patients were reported, 85% were investigated with 99m Tc-perfusion tracers. 74% [2005 = 72%] were performed in PP, 17% [2005 = 15%] in HO and 9% [2005 = 13%] in UH. PP, which participated in 2005 and 2006, demonstrated an increase by 3,9% (HO 0%, UH -13,0%). The type of stress was pharmacological in 27% [2005 = 22%]; 54% adenosine (of these 29% with exercise), 37% dipyridamole (of these 56% with exercise), and 9% dobutamine. Gated SPECT was performed in 42% [2005 = 36%] of all rest- and in 39% [2005 32%] of all stress MPS. An attenuation correction was used by 69 [2005 = 78] institutions. 40% of all MPS were performed in patients suspected to have CAD. 24% of all institutions reported changes in the use of MPS by competing methods. Conclusion: there is a small increase of MPS between 2005 and 2006 despite competing methods. Gated SPECT has experienced more acceptance. Suspicion of CAD is an important indication of MPS. In order to tap the full potential of MPS a gated SPECT should be performed routinely. (orig.)

  3. Imaging of ventilation/perfusion ratio by gated regional spirometry

    International Nuclear Information System (INIS)

    Touya, J.J.; Jones, J.P.; Price, R.R.; Patton, J.A.; Erickson, J.J.; Rollo, F.D.

    1981-01-01

    Gated 133 Xe images of patients rebreathing into a closed system can provide images of the distribution of lung volumes, ventilation and specific ventilation. These have been shown to be accurate, precise, and do not require unusually sophisticated equipment or skills. A mathematical transformation is used to correct the images for lung movement, which does not alter the total number of counts in the image. Perfusion images are gated to remove motion blurring but not transformed. Ventilation/perfusion images showing the distribution of V/Q ratio are then generated from the individual ventilation and perfusion images. (author)

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

    International Nuclear Information System (INIS)

    Padua, Rodrigo Donizete Santana de; Oliveira, Lucas Ferrari de; Marques, Paulo Mazzoncini de Azevedo; Groote, Jean-Jacques Georges Soares de; Castro, Adelson Antonio de; Ana, Lauro Wichert; Simoes, Marcus Vinicius

    2008-01-01

    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)

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

  6. Machine learning improves the accuracy of myocardial perfusion scintigraphy results

    International Nuclear Information System (INIS)

    Groselj, C.; Kukar, M.

    2002-01-01

    Objective: Machine learning (ML) an artificial intelligence method has in last decade proved to be an useful tool in many fields of decision making, also in some fields of medicine. By reports, its decision accuracy usually exceeds the human one. Aim: To assess applicability of ML in interpretation of the stress myocardial perfusion scintigraphy results in coronary artery disease diagnostic process. Patients and methods: The 327 patient's data of planar stress myocardial perfusion scintigraphy were reevaluated in usual way. Comparing them with the results of coronary angiography the sensitivity, specificity and accuracy of the investigation were computed. The data were digitized and the decision procedure repeated by ML program 'Naive Bayesian classifier'. As the ML is able to simultaneously manipulate with whatever number of data, all reachable disease connected data (regarding history, habitus, risk factors, stress results) were added. The sensitivity, specificity and accuracy of scintigraphy were expressed in this way. The results of both decision procedures were compared. Conclusion: Using ML method, 19 more patients out of 327 (5.8%) were correctly diagnosed by stress myocardial perfusion scintigraphy. In this way ML could be an important tool for myocardial perfusion scintigraphy decision making

  7. Evaluation of global and regional left ventricular function obtained by quantitative gated SPECT using {sup 99m}Tc-tetrofosmin for left ventricular dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Ban, Kazunobu; Nakajima, Tohru; Iseki, Harukazu; Abe, Sumihisa; Handa, Shunnosuke; Suzuki, Yutaka [Tokai Univ., Isehara, Kanagawa (Japan). School of Medicine

    2000-08-01

    The quantitative gated SPECT (QGS) software is able to calculate LV volumes and visualize LV wall motion and perfusion throughout the cardiac cycle using an automatic edge detection algorithm of the left ventricle. We evaluated the reliability of global and regional LV function assessment derived from QGS by comparing it with the results from left ventriculo-cineangiography (LVG). In 20 patients with left ventricular dysfunction who underwent ECG gated {sup 99m}Tc-tetrofosmin SPECT, the end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (LVEF) were calculated. The QGS-assessed regional wall motion was determined using the cinematic display. QGS-derived EDV, ESV and LVEF correlated well with those by LVG (p<0.001 for each). There was a good correlation between wall motion score (WMS) derived from the QGS and the LVG (r=0.40, p<0.05). In some patients with extensive myocardial infarction, there was a discrepancy in the regional wall motion results between QGS and LVG. The ECG-gated SPECT using QGS is useful to evaluate global and regional LV functions in left ventricular dysfunction. (author)

  8. Myocardial perfusion MRI with sliding-window conjugate-gradient HYPR.

    Science.gov (United States)

    Ge, Lan; Kino, Aya; Griswold, Mark; Mistretta, Charles; Carr, James C; Li, Debiao

    2009-10-01

    First-pass perfusion MRI is a promising technique for detecting ischemic heart disease. However, the diagnostic value of the method is limited by the low spatial coverage, resolution, signal-to-noise ratio (SNR), and cardiac motion-related image artifacts. In this study we investigated the feasibility of using a method that combines sliding window and CG-HYPR methods (SW-CG-HYPR) to reduce the acquisition window for each slice while maintaining the temporal resolution of one frame per heartbeat in myocardial perfusion MRI. This method allows an increased number of slices, reduced motion artifacts, and preserves the relatively high SNR and spatial resolution of the "composite images." Results from eight volunteers demonstrate the feasibility of SW-CG-HYPR for accelerated myocardial perfusion imaging with accurate signal intensity changes of left ventricle blood pool and myocardium. Using this method the acquisition time per cardiac cycle was reduced by a factor of 4 and the number of slices was increased from 3 to 8 as compared to the conventional technique. The SNR of the myocardium at peak enhancement with SW-CG-HYPR (13.83 +/- 2.60) was significantly higher (P < 0.05) than the conventional turbo-FLASH protocol (8.40 +/- 1.62). Also, the spatial resolution of the myocardial perfection images was significantly improved. SW-CG-HYPR is a promising technique for myocardial perfusion MRI. (c) 2009 Wiley-Liss, Inc.

  9. Refined staging in hilar bronchial neoplasms with ECG-gated multislice-CT. Case report

    International Nuclear Information System (INIS)

    Ohlmann, S.; Daliri, A.; Froelich, J.J.; Nowak, R.; Michulla, R.

    2008-01-01

    Equivocal initial CT-based staging in 2 patients with hilar bronchial neoplasms was reassessed with retrospective ECG-gated Multislice-CT and optimized examination parameters prior to definition of treatment. An initially suspected irresectable T 4 tumor with mediastinal infiltration was downstaged to T 2 in one case, while tumor infiltration into the left atrium could be confirmed in the other case. In doubtful conditions, ECG-gated multislice CT with optimized examination parameters may be helpful for refined staging in patients with hilar bronchial neoplasma, thus possibly influencing treatment strategies. (orig.)

  10. Residual motion compensation in ECG-gated interventional cardiac vasculature reconstruction

    International Nuclear Information System (INIS)

    Schwemmer, C; Müller, K; Hornegger, J; Rohkohl, C; Lauritsch, G

    2013-01-01

    Three-dimensional reconstruction of cardiac vasculature from angiographic C-arm CT (rotational angiography) data is a major challenge. Motion artefacts corrupt image quality, reducing usability for diagnosis and guidance. Many state-of-the-art approaches depend on retrospective ECG-gating of projection data for image reconstruction. A trade-off has to be made regarding the size of the ECG-gating window. A large temporal window is desirable to avoid undersampling. However, residual motion will occur in a large window, causing motion artefacts. We present an algorithm to correct for residual motion. Our approach is based on a deformable 2D–2D registration between the forward projection of an initial, ECG-gated reconstruction, and the original projection data. The approach is fully automatic and does not require any complex segmentation of vasculature, or landmarks. The estimated motion is compensated for during the backprojection step of a subsequent reconstruction. We evaluated the method using the publicly available CAVAREV platform and on six human clinical datasets. We found a better visibility of structure, reduced motion artefacts, and increased sharpness of the vessels in the compensated reconstructions compared to the initial reconstructions. At the time of writing, our algorithm outperforms the leading result of the CAVAREV ranking list. For the clinical datasets, we found an average reduction of motion artefacts by 13 ± 6%. Vessel sharpness was improved by 25 ± 12% on average. (paper)

  11. Dynamic CT myocardial perfusion imaging identifies early perfusion abnormalities in diabetes and hypertension : Insights from a multicenter registry

    NARCIS (Netherlands)

    Vliegenthart, Rozemarijn; De Cecco, Carlo N.; Wichmann, Julian L.; Meinel, Felix G.; Pelgrim, Gert Jan; Tesche, Christian; Ebersberger, Ullrich; Pugliese, Francesca; Bamberg, Fabian; Choe, Yeon Hyeon; Wang, Yining; Schoepf, U. Joseph

    2016-01-01

    Background: To identify patients with early signs of myocardial perfusion reduction, a reference base for perfusion measures is needed. Objective: To analyze perfusion parameters derived from dynamic computed tomography perfusion imaging (CTPI) in patients with suspected coronary artery disease

  12. Myocardial viability assessment with gated SPECT Tc-99m tetrofosmin % wall thickening. Comparison with F-18 FDG-PET

    International Nuclear Information System (INIS)

    Maruyama, Atsushi; Hasegawa, Shinji; Paul, A.K.; Xiuli, M.; Yoshioka, Jun; Maruyama, Kaoru; Hori, Masatsugu; Nishimura, Tsunehiko

    2002-01-01

    This study was designed to assess the value of gated SPECT Tc-99m-tetrofosmin (TF) wall thickening (WT) in addition to TF exercise (Ex)/rest myocardial SPECT, in comparison with F-18 fluorodeoxyglucose (FDG)-PET. The study population consisted of 33 patients with old myocardial infarction (27 men and 6 women; mean age, 62±8 years old). All patients underwent Ex/rest TF SPECT and glucose loading FDG-PET. Polar map images of Ex/rest TF were generated and divided into 24 segments for further analysis. We classified LV segments according to the exercise-rest perfusion scintigraphy. LV segments with less than 70% of the maximum TF activity on the exercise image were defined as stress-induced defects. Among these, the segments whose TF acitvity increased by 10% from exercise to rest images or exceeded 70% of the maximum uptake were defined as reversible (viable) defects. The remaining defects on the rest image were irreversible (non-viable) defect segments, and were considered for viability study on the basis of %WT. %WT was calculated according to the standard method: {(counts ES-counts ED)/ counts ED} x 100. A viable segment on gated SPECT was defined as a segment whose %WT exceeded the lower limit of the normal value (mean-SD). PET viability was defined as FDG uptake exceeding 50% of the maximum count. Among the 792 segments evaluated in the 33 patients studied, there were 689 PET viable segments. Of the 689 segments analyzed, 198 (29%) were identified as having defects on Ex images. Among these defects, 55 (8%) were reversible or partially reversible, as evidenced by rest images, and 143 (21%) were irreversible. Of the irreversible segments on Ex/rest images, 106 (15%) demonstrated no apparent WT by gated TF SPECT, whereas 37 (6%) segments with irreversible defects did have apparent WT. Overall, the sensitivity of Ex/rest TF perfusion imaging was 79%. Sensitivity was improved from 79% to 85% by combining %WT and perfusion data, but specificity was reduced from 70

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

    International Nuclear Information System (INIS)

    Liu Li; Zhao Shujun; Yao Zhiming; Wang Daoyu

    1999-01-01

    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

  14. [Myokard-Perfusions-SPECT. Myocardial perfusion SPECT - Update S1 guideline].

    Science.gov (United States)

    Lindner, Oliver; Bengel, Frank; Burchert, Wolfgang; Dörr, Rolf; Hacker, Marcus; Schäfer, Wolfgang; Schäfers, Michael A; Schmidt, Matthias; Schwaiger, Markus; Vom Dahl, Jürgen; Zimmermann, Rainer

    2017-08-14

    The S1 guideline for myocardial perfusion SPECT has been published by the Association of the Scientific Medical Societies in Germany (AWMF) and is valid until 2/2022. This paper is a short summary with comments on all chapters and subchapters wich were modified and amended.

  15. Optimization of Rb-82 PET acquisition and reconstruction protocols for myocardial perfusion defect detection

    Science.gov (United States)

    Tang, Jing; Rahmim, Arman; Lautamäki, Riikka; Lodge, Martin A.; Bengel, Frank M.; Tsui, Benjamin M. W.

    2009-05-01

    The purpose of this study is to optimize the dynamic Rb-82 cardiac PET acquisition and reconstruction protocols for maximum myocardial perfusion defect detection using realistic simulation data and task-based evaluation. Time activity curves (TACs) of different organs under both rest and stress conditions were extracted from dynamic Rb-82 PET images of five normal patients. Combined SimSET-GATE Monte Carlo simulation was used to generate nearly noise-free cardiac PET data from a time series of 3D NCAT phantoms with organ activities modeling different pre-scan delay times (PDTs) and total acquisition times (TATs). Poisson noise was added to the nearly noise-free projections and the OS-EM algorithm was applied to generate noisy reconstructed images. The channelized Hotelling observer (CHO) with 32× 32 spatial templates corresponding to four octave-wide frequency channels was used to evaluate the images. The area under the ROC curve (AUC) was calculated from the CHO rating data as an index for image quality in terms of myocardial perfusion defect detection. The 0.5 cycle cm-1 Butterworth post-filtering on OS-EM (with 21 subsets) reconstructed images generates the highest AUC values while those from iteration numbers 1 to 4 do not show different AUC values. The optimized PDTs for both rest and stress conditions are found to be close to the cross points of the left ventricular chamber and myocardium TACs, which may promote an individualized PDT for patient data processing and image reconstruction. Shortening the TATs for <~3 min from the clinically employed acquisition time does not affect the myocardial perfusion defect detection significantly for both rest and stress studies.

  16. Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Boogers, Mark J.; Chen, Ji; Garcia, Ernest V.; Bommel, Rutger J. van; Borleffs, C.J.W.; Schalij, Martin J.; Wall, Ernst E. van der; Bax, Jeroen J.; Dibbets-Schneider, Petra; Hiel, Bernies van der; Younis, Imad Al

    2011-01-01

    The aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV) lead position and response to cardiac resynchronization therapy (CRT). The patient population consisted of consecutive patients with advanced heart failure in whom CRT was currently indicated. Before implantation, 2-D echocardiography and GMPS were performed. The echocardiography was performed to assess LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF). The site of latest mechanical activation was assessed by phase analysis of GMPS studies and related to LV lead position on fluoroscopy. Echocardiography was repeated after 6 months of CRT. CRT response was defined as a decrease of ≥15% in LVESV. Enrolled in the study were 90 patients (72% men, 67±10 years) with advanced heart failure. In 52 patients (58%), the LV lead was positioned at the site of latest mechanical activation (concordant), and in 38 patients (42%) the LV lead was positioned outside the site of latest mechanical activation (discordant). CRT response was significantly more often documented in patients with a concordant LV lead position than in patients with a discordant LV lead position (79% vs. 26%, p<0.01). After 6 months, patients with a concordant LV lead position showed significant improvement in LVEF, LVESV and LVEDV (p<0.05), whereas patients with a discordant LV lead position showed no significant improvement in these variables. Patients with a concordant LV lead position showed significant improvement in LV volumes and LV systolic function, whereas patients with a discordant LV lead position showed no significant improvements. (orig.)

  17. Erroneous cardiac ECG-gated PET list-mode trigger events can be retrospectively identified and replaced by an offline reprocessing approach: first results in rodents

    International Nuclear Information System (INIS)

    Böning, Guido; Todica, Andrei; Vai, Alessandro; Lehner, Sebastian; Xiong, Guoming; Mille, Erik; Ilhan, Harun; Fougère, Christian la; Bartenstein, Peter; Hacker, Marcus

    2013-01-01

    The assessment of left ventricular function, wall motion and myocardial viability using electrocardiogram (ECG)-gated [ 18 F]-FDG positron emission tomography (PET) is widely accepted in human and in preclinical small animal studies. The nonterminal and noninvasive approach permits repeated in vivo evaluations of the same animal, facilitating the assessment of temporal changes in disease or therapy response. Although well established, gated small animal PET studies can contain erroneous gating information, which may yield to blurred images and false estimation of functional parameters. In this work, we present quantitative and visual quality control (QC) methods to evaluate the accuracy of trigger events in PET list-mode and physiological data. Left ventricular functional analysis is performed to quantify the effect of gating errors on the end-systolic and end-diastolic volumes, and on the ejection fraction (EF). We aim to recover the cardiac functional parameters by the application of the commonly established heart rate filter approach using fixed ranges based on a standardized population. In addition, we propose a fully reprocessing approach which retrospectively replaces the gating information of the PET list-mode file with appropriate list-mode decoding and encoding software. The signal of a simultaneously acquired ECG is processed using standard MATLAB vector functions, which can be individually adapted to reliably detect the R-peaks. Finally, the new trigger events are inserted into the PET list-mode file. A population of 30 mice with various health statuses was analyzed and standard cardiac parameters such as mean heart rate (119 ms ± 11.8 ms) and mean heart rate variability (1.7 ms ± 3.4 ms) derived. These standard parameter ranges were taken into account in the QC methods to select a group of nine optimal gated and a group of eight sub-optimal gated [ 18 F]-FDG PET scans of mice from our archive. From the list-mode files of the optimal gated group

  18. Myocardial perfusion scintigraphy in Germany. Results of the 2005 query and current status

    International Nuclear Information System (INIS)

    Lindner, O.; Burchert, W.; Bengel, F.M.; Zimmermann, R.; Dahl, J. vom; Schaefer, W.; Buell, U.; Schober, O.; Schwaiger, M.; Kluge, R.; Schaefers, M.

    2007-01-01

    The working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine (DGN), in cooperation with the working group Nuclear Cardiology of the German Cardiac Society (DGK), decided to conduct a national survey on myocardial perfusion scintigraphy (MPS). Method: a questionnaire to evaluate MPS for the year 2005 was sent. Results: 346 completed questionnaires had been returned (213 private practices, 99 hospitals and 33 university hospitals). MPS of 112 707 patients were reported with 110 747 stress and 95 878 rest studies. The majority (> 75%) was performed with 99m Tc-MIBI or tetrofosmin. 201 Tl stress-redistribution was used in 22 637 patients (20%). The types of stress were exercise in 78%, vasodilation with adenosine or dipyridamol in 21% and dobutamine in 1%. 99.97% of all MPS were SPECT studies. Gated SPECT was performed in 36% of the stress and in 32% of the rest studies. An attenuation correction was used in 21%. 29 institutions (8%) performed gated SPECT (stress and rest) and attenuation correction. 47% of all MPS were requested by ambulatory care cardiologists, 17% by internists, 12% by primary care physicians, 21% by hospital departments and 2% by others. Conclusion: in Germany, MPS is predominantly performed with 99m Tc-perfusion agents. The common type of stress is ergometry. Gated SPECT and attenuation correction do not yet represent standards of MPS practice in Germany, which indicates some potential of optimization. (orig.)

  19. Dose modulated retrospective ECG-gated versus non-gated 64-row CT angiography of the aorta at the same radiation dose: Comparison of motion artifacts, diagnostic confidence and signal-to-noise-ratios

    International Nuclear Information System (INIS)

    Schernthaner, Ruediger E.; Stadler, Alfred; Beitzke, Dietrich; Homolka, Peter; Weber, Michael; Lammer, Johannes; Czerny, Martin; Loewe, Christian

    2012-01-01

    Purpose: To compare ECG-gated and non-gated CT angiography of the aorta at the same radiation dose, with regard to motion artifacts (MA), diagnostic confidence (DC) and signal-to-noise-ratios (SNRs). Materials and methods: Sixty consecutive patients prospectively randomized into two groups underwent 64-row CT angiography, with or without dose-modulated ECG-gating, of the entire aorta, due to several pathologies of the ascending aorta. MA and DC were both assessed using a four-point scale. SNRs were calculated by dividing the mean enhancement by the standard deviation. The dose-length-product (DLP) of each examination was recorded and the effective dose was estimated. Results: Dose-modulated ECG-gating showed statistically significant advantages over non-gated CT angiography, with regard to MA (p < 0.001) and DC (p < 0.001), at the aortic valve, at the origin of the coronary arteries, and at the dissection membrane, with a significant correlation (p < 0.001) between MA and DC. At the aortic wall, however, ECG-gated CT angiography showed statistically significant fewer MA (p < 0.001), but not a statistically significant higher DC (p = 0.137) compared to non-gated CT angiography. At the supra-aortic vessels and the descending aorta, the ECG-triggering showed no statistically significant differences with regard to MA (p = 0.861 and 0.526, respectively) and DC (p = 1.88 and 0.728, respectively). The effective dose of ECG-gated CT angiography (23.24 mSv; range, 18.43–25.94 mSv) did not differ significantly (p = 0.051) from that of non-gated CT angiography (24.28 mSv; range, 19.37–29.27 mSv). Conclusion: ECG-gated CT angiography of the entire aorta reduces MA and results in a higher DC with the same SNR, compared to non-gated CT angiography at the same radiation dose.

  20. Detecting Regional Myocardial Abnormalities in Patients With Wolff-Parkinson-White Syndrome With the Use of ECG-Gated Cardiac MDCT.

    Science.gov (United States)

    Lee, Hye-Jeong; Uhm, Jae-Sun; Joung, Boyoung; Hong, Yoo Jin; Hur, Jin; Choi, Byoung Wook; Kim, Young Jin

    2016-04-01

    Myocardial dyskinesia caused by the accessory pathway and related reversible heart failure have been well documented in echocardiographic studies of pediatric patients with Wolff-Parkinson-White (WPW) syndrome. However, the long-term effects of dyskinesia on the myocardium of adult patients have not been studied in depth. The goal of the present study was to evaluate regional myocardial abnormalities on cardiac CT examinations of adult patients with WPW syndrome. Of 74 patients with WPW syndrome who underwent cardiac CT from January 2006 through December 2013, 58 patients (mean [± SD] age, 52.2 ± 12.7 years), 36 (62.1%) of whom were men, were included in the study after the presence of combined cardiac disease was excluded. Two observers blindly evaluated myocardial thickness and attenuation on cardiac CT scans. On the basis of CT findings, patients were classified as having either normal or abnormal findings. We compared the two groups for other clinical findings, including observations from ECG, echocardiography, and electrophysiologic study. Of the 58 patients studied, 16 patients (27.6%) were found to have myocardial abnormalities (i.e., abnormal wall thinning with or without low attenuation). All abnormal findings corresponded with the location of the accessory pathway. Patients with abnormal findings had statistically significantly decreased left ventricular function, compared with patients with normal findings (p syndrome. These abnormal findings might reflect the long-term effects of dyskinesia, suggesting irreversible myocardial injury that ultimately causes left ventricular dysfunction.

  1. The effect of captopril on thallium 201 myocardial perfusion in systemic sclerosis

    International Nuclear Information System (INIS)

    Kahan, A.; Devaux, J.Y.; Amor, B.; Menkes, C.J.; Weber, S.; Venot, A.; Strauch, G.

    1990-01-01

    In systemic sclerosis, abnormalities of myocardial perfusion are common and may be caused by a disturbance of the coronary microcirculation. We evaluated the long-term effect of captopril (75 to 150 mg per day) on thallium 201 myocardial perfusion in 12 normotensive patients with systemic sclerosis. Captopril significantly decreased the mean (+/- SD) number of segments with thallium 201 myocardial perfusion defects (6.5 +/- 1.9 at baseline and 4.4 +/- 2.7 after 1 year of treatment with captopril; p less than 0.02) and increased the mean global thallium score (9.6 +/- 1.7 at baseline and 11.4 +/- 2.1 after captopril; p less than 0.05). In a control group of eight normotensive patients with systemic sclerosis who did not receive captopril, no significant modification in thallium results occurred. Side effects with captopril included hypotension (six patients), taste disturbances (one patient), and skin rash (one patient). These side effects subsided when the dosage was reduced. These findings demonstrate that captopril improves thallium 201 myocardial perfusion in patients with systemic sclerosis and may therefore have a beneficial effect on scleroderma myocardial disease

  2. MR flow measurements for assessment of the pulmonary, systemic and bronchosystemic circulation: Impact of different ECG gating methods and breathing schema

    International Nuclear Information System (INIS)

    Ley, Sebastian; Ley-Zaporozhan, Julia; Kreitner, Karl-Friedrich; Iliyushenko, Svitlana; Puderbach, Michael; Hosch, Waldemar; Wenz, Heiner; Schenk, Jens-Peter; Kauczor, Hans-Ulrich

    2007-01-01

    Purpose: Different ECG gating techniques are available for MR phase-contrast (PC) flow measurements. Until now no study has reported the impact of different ECG gating techniques on quantitative flow parameters. The goal was to evaluate the impact of the gating method and the breathing schema on the pulmonary, systemic and bronchosystemic circulation. Material and methods: Twenty volunteers were examined (1.5 T) with free breathing phase-contrast flow (PC-flow) measurements with prospective (free-prospective) and retrospective (free-retrospective) ECG gating. Additionally, expiratory breath-hold retrospective ECG gated measurements (bh-retrospective) were performed. Blood flow per minute; peak velocity and time to peak velocity were compared. The clinically important difference between the systemic and pulmonary circulation (bronchosystemic shunt) was calculated. Results: Blood flow per minute was lowest for free-prospective (6 l/min, pulmonary trunc) and highest for bh-retrospective measurements (6.9 l/min, pulmonary trunc). No clinically significant difference in peak velocity was assessed (82-83 cm/s pulmonary trunc, 109-113 cm/s aorta). Time to peak velocity was shorter for retro-gated free-retrospective and bh-retrospective than for pro-gated free-prospective. The difference between systemic and pulmonary measurements was least for the free-retrospective technique. Conclusion: The type of gating has a significant impact on flow measurements. Therefore, it is important to use the same ECG gating method, especially for follow-up examinations. Retrospective ECG gated free breathing measurements allow for the most precise assessment of the bronchosystemic blood flow and should be used in clinical routine

  3. Effect of nicorandil on the myocardial tissue perfusion and myocardial cell injury in patients with diabetes after PCI

    Directory of Open Access Journals (Sweden)

    Xue-Li Ren1

    2017-04-01

    Full Text Available Objective: To study the effect of nicorandil on the myocardial tissue perfusion and myocardial cell damage in patients with diabetes after percutaneous coronary intervention (PCI. Methods: 68 patients with coronary heart disease and type 2 diabetes mellitus who received PCI in our hospital between May 2011 and September 2015 were collected and then divided into observation group and control group (n=34 according to the single-blind randomized control method. Control group of patients received PCI alone, and the observation group of patients received nicorandil therapy after PCI. After treatment, real-time myocardial ultrasound contrast was used to evaluate the myocardial perfusion of two groups of patients; blood biochemical analyzer was used to detect the contents of peripheral blood myocardial enzyme spectrum indexes; the ELISA method was used to detect the contents of serum oxidative stress indicators; RIA method was used to detect the contents of serum apoptosis molecules. Results: After treatment, the myocardial tissue perfusion parameters plateau peak intensity (A, slope rate of curve (β and myocardial blood flow (A×β levels of observation group were significantly higher than those of control group (P<0.05; peripheral blood myocardial enzyme spectrum indexes creatine kinase (CK, lactate dehydrogenase (LDH, troponin I (cTnI and glutamic oxalacetic transaminase (GOT contents of observation group were significantly lower than those of control group (P<0.05; serum vitamin E (VitE and vitamin C (VitC contents of observation group were significantly higher than those of control group while malondialdehyde (MDA, advanced oxidation protein products (AOPPs, soluble apoptosis-associated factor (sFas and soluble apoptosis-associated factor ligand (sFasL contents were lower than those of control group (P<0.05. Conclusion: Adjuvant nicorandil therapy can improve the myocardial perfusion and reduce the myocardial cell injury in patients with coronary

  4. Incremental Diagnostic Performance of Combined Parameters in the Detection of Severe Coronary Artery Disease Using Exercise Gated Myocardial Perfusion Imaging.

    Directory of Open Access Journals (Sweden)

    Chia-Ju Liu

    Full Text Available Myocardial perfusion imaging (MPI using gated single-photon emission tomography (gSPECT may underestimate the severity of coronary artery disease (CAD. This study aimed to evaluate the significance of combined parameters derived from gSPECT, as well as treadmill stress test parameters, in the detection of severe CAD.A total of 211 consecutive patients referred for exercise MPI between June 2011 and June 2013 (who received invasive coronary angiography within six months after MPI were retrospectively reviewed. Exercise MPI was performed with Bruce protocol and 201Tl injected at peak exercise. Gated SPECT was performed using a cadmium-zinc-telluride camera and processed by QPS/QGS software. Perfusion defect abnormalities such as sum stress score (SSS; sum difference score, algorithm-derived total perfusion deficits, transient ischemic dilatation ratios of end-diastolic volumes and end-systolic volumes, post-stress changes in ejection fraction, and lung/heart ratio (LHR were calculated. Treadmill parameters, including ST depression (STD at the 1st and 3rd minutes of recovery stage (1'STD and 3'STD, maximal STD corrected by heart rate increment (ST/HR, heart rate decline in 1st and 3rd minutes of recovery stage, recovery heart rate ratio (HR ratio, systolic and mean blood pressure ratios (SBP ratio and MAP ratio during recovery phase were recorded. Diagnostic performances of these parameters were analyzed with receiver operating characteristic (ROC analysis and logistic regression for detection of left main (≥ 50% or 3-vessel disease (all ≥ 70% luminal stenosis on invasive angiography.Among various MPI and treadmill parameters used for detection of severe CAD, SSS and ST/HR had the highest AUC (0.78, 0.73, p = NS and best cut-off values (SSS > 6, ST/HR > 17.39 10-2mV/bpm, respectively. By univariate logistic regression, all parameters except 1'HRR, 3'HRR, SBP and MAP ratios increased the odds ratio of severe CAD. Only increased L/H ratio, 3'STD

  5. Objective evaluation of Tl-201 image efficacy for detection of myocardial infarction

    International Nuclear Information System (INIS)

    Nagai, Teruo; Murata, Kazuhiko; Torizuka, Kanji

    1982-01-01

    As the 3rd report of the objective analysis of radioactive 201 Tl scintigraphy of myocardial infarction, detection of infarction and extent of the lesion was discussed. In 114 cases with relatively definite findings, their images were rereaded and evaluated by 2 physicians. Segmental analysis in each direction was employed for localization of perfusion defects. Comparison between the sites of myocardial infarction on ECG and that of perfusion defects by segmental analysis revealed that, in infarction of the anterior wall, many segments showed defects, and that the lesions of the posterior and lateral wall had a few segments showing defects. This standard of correlation was applied to other cases of myocardial infarction, and the result suggested possible improvement in detection of infarction. As regards the extent of the lesion, no significant correlation between number of segments with defect and ECG and/or the serum enzyme levels were seen. (Ueda, J.)

  6. Perfusion Computed Tomography for the Assessment of Myocardial Viability — a Case Series

    Directory of Open Access Journals (Sweden)

    Morariu Mirabela

    2016-06-01

    Full Text Available Myocardial viability plays an important role in preventing the development of left ventricular remodeling following an acute myocardial infarction. A preserved viability in the infarcted area has been demonstrated to be associated with a lower amplitude of the remodeling process, while the extent of the non-viable myocardium is directly correlated with the amplitude of the remodeling process. A number of methods are currently in use for the quantification of the viable myocardium, and some of them are based on the estimation of myocardial perfusion during pharmacologic stress. 64-slice Multi-detector Computed Tomography (MDCT during vasodilator stress test, associated with CT Coronary Angiography (CCTA has a high diagnostic accuracy in evaluating myocardial perfusion. In this article, we present a sequence of 3 clinical cases that presented with symptoms of myocardial ischemia, who underwent 64-slice MDCT imaging at rest and during adenosine stress test, in order to assess the extent of the hypoperfused myocardial areas. Coronary artery anatomy and the Coronary Calcium Score was assessed for all 3 patients by performing CT Coronary Angiography. The combination of CT Angiography and adenosine stress CT myocardial perfusion imaging can accurately detect atherosclerosic lesions that cause perfusion abnormalities, compared with the combination of invasive angiography and single-photon emission computed tomography (SPECT.

  7. Left ventricular function in response to dipyridamole stress: head-to-head comparison between {sup 82}Rubidium PET and {sup 99m}Tc-sestamibi SPECT ECG-gated myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Giorgi, Maria Clementina; Meneghetti, Jose Claudio; Soares, Jose; Izaki, Marisa; Falcao, Andrea; Imada, Rodrigo; Chalela, William; Oliveira, Marco Antonio de; Nomura, Cesar [Department of Radiology and Nuclear Medicine and Molecular Imaging Service - Heart Institute of the University of Sao Paulo Medical School, Sao Paulo (Brazil); Verberne, Hein J. [University of Amsterdam, Department of Nuclear Medicine, Academic Medical Center, P.O. Box 22700, Amsterdam (Netherlands)

    2017-05-15

    Myocardial perfusion imaging (MPI) with {sup 99m}Tc-sestamibi (sestamibi) SPECT and rubidium-82 ({sup 82}Rb) PET both allow for combined assessment of perfusion and left ventricular (LV) function. We sought to compare parameters of LV function obtained with both methods using a single dipyridamole stress dose. A group of 221 consecutive patients (65.2 ± 10.4 years, 52.9% male) underwent consecutive sestamibi and {sup 82}Rb MPI after a single dipyridamole stress dose. Sestamibi and {sup 82}Rb summed rest (SRS), stress (SSS) and difference (SDS) scores, and LV end-diastolic (EDV) and end-systolic (ESV) volumes and left ventricular ejection fraction (LVEF) were compared. Bland-Altman analysis showed that with increasing ESV and EDV the difference between the two perfusion tracers increased both at rest and post-stress. The mean difference in EDV and ESV between the two perfusion tracers at rest could both be independently explained by the {sup 82}Rb SDS and the sestamibi SRS. The combined models explained approximately 30% of the variation in these volumes between the two perfusion tracers (R{sup 2} = 0.261, p = 0.005; R{sup 2} = 0.296, p < 0.001, for EDV and ESV respectively). However, the mean difference in LVEF between sestamibi and {sup 82}Rb showed no significant trend post-stress (R{sup 2} = 0.001, p = 0.70) and only a modest linear increase with increasing LVEF values at rest (R{sup 2} = 0.032, p = 0.009). Differences in left ventricular volumes between sestamibi and {sup 82}Rb MPI increase with increasing volumes. However, these differences did only marginally affect LVEF between sestamibi and {sup 82}Rb. In clinical practice these results should be taken into account when comparing functional derived parameters between sestamibi and {sup 82}Rb MPI. (orig.)

  8. Myocardial perfusion as an indicator of graft patency after coronary artery bypass surgery

    International Nuclear Information System (INIS)

    Kolibash, A.J.; Call, T.D.; Bush, C.A.; Tetalman, M.R.; Lewis, R.P.

    1980-01-01

    Stress and resting myocardial perfusion were assessed in 38 patients who received 96 grafts. Stress perfusion was evaluated with thallium-201 and resting myocardial blood flow distribution with radiolabeled particles. When both stress and rest perfusion were normal, graft patency was 82% (51 of 62 grafts). Graft patency was also high (81%, 13 of 16) in areas where stress perfusion abnormalities resolved or become less apparent at rest. However, when stress perfusion defects remained unchanged at rest, the graf was likely to be occuluded (73%, 11 of 15). Maintenance of normal rest perfusion or improvement of rest perfusion postoperatively was also associated with a high graft patency rate (80%, 35 of 44), whereas the development of new rest perfusion defects postoperatively implied graft occlusion

  9. Decreased perfusion in myocardial region of normal donor artery secondary to collateral development

    International Nuclear Information System (INIS)

    Koga, Y.; Takahashi, M.; Kojima, A.; Takaki, Y.; Tomiguchi, S.; Hirota, Y.; Kugiyama, K.; Yasue, H.; Hayasaki, K.; Kumamoto Saiseikai Hospital

    1992-01-01

    Thirty-one patients suffering from single vessel exertional angina with collaterals (Group A) were evaluated by stress 201 Tl myocardial emission CT (Tl-SPECT) with 16 controls of severely stenotic single vessel exertional angina without collaterals (Group B). Group A included 21 patients (68%) who showed an extensive perfusion defect in double artery myocardial regions, including the normal donor artery myocardial region (DMR). However, there were no such cases in Group B, giving a significant difference between these 2 groups (p < 0.001). Four patients in Group A, having a perfusion defect both in DMR and in the collateral dependent myocardial region (CMR) underwent a successful percutaneous transluminal coronary angioplasty (PTCA) with disappearance of collaterals. Tl-SPECT findings after PTCA showed no perfusion defect either in CMR or in DMR. This has been explained on the basis that the coronary collaterals stole blood and produced perfusion defect in DMR. (orig.)

  10. Selective Cerebro-Myocardial Perfusion in Complex Neonatal Aortic Arch Pathology: Midterm Results.

    Science.gov (United States)

    Hoxha, Stiljan; Abbasciano, Riccardo Giuseppe; Sandrini, Camilla; Rossetti, Lucia; Menon, Tiziano; Barozzi, Luca; Linardi, Daniele; Rungatscher, Alessio; Faggian, Giuseppe; Luciani, Giovanni Battista

    2018-04-01

    Aortic arch repair in newborns and infants has traditionally been accomplished using a period of deep hypothermic circulatory arrest. To reduce neurologic and cardiac dysfunction related to circulatory arrest and myocardial ischemia during complex aortic arch surgery, an alternative and novel strategy for cerebro-myocardial protection was recently developed, where regional low-flow perfusion is combined with controlled and independent coronary perfusion. The aim of the present retrospective study was to assess short-term and mid-term results of selective and independent cerebro-myocardial perfusion in neonatal aortic arch surgery. From April 2008 to August 2015, 28 consecutive neonates underwent aortic arch surgery under cerebro-myocardial perfusion. There were 17 male and 11 female, with median age of 15 days (3-30 days) and median body weight of 3 kg (1.6-4.2 kg), 9 (32%) of whom with low body weight (cerebro-myocardial perfusion was 30 ± 11 min (15-69 min). Renal dysfunction, requiring a period of peritoneal dialysis was observed in 10 (36%) patients, while liver dysfunction was noted only in 3 (11%). There were three (11%) early and two late deaths during a median follow-up of 2.9 years (range 6 months-7.7 years), with an actuarial survival of 82% at 7 years. At latest follow-up, no patient showed signs of cardiac or neurologic dysfunction. The present experience shows that a strategy of selective and independent cerebro-myocardial perfusion is safe, versatile, and feasible in high-risk neonates with complex congenital arch pathology. Encouraging outcomes were noted in terms of cardiac and neurological function, with limited end-organ morbidity. © 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  11. Comparative study of image quality and radiation dose between prospective and retrospective ECG gating technique in coronary artery imaging with 64-slice spiral CT

    International Nuclear Information System (INIS)

    Liu Jianxin; Liu Jian; Dou Yanbin; Wang Jichen; Sun Hongyue

    2009-01-01

    Objective: To compare the image quality and radiation dose between prospective ECG-trigering and retrospective ECG gating technique in coronary artery imaging. Methods: 33 patients suspected coronary artery disease were included in this study and divided into experimental group (prospective ECG-triggering coronary artery imaging, heart rate 0.05). The mean DLP of experimental group (234.4 mGy · cm) was DLP of control group (974.4 mGy · cm) 24.1%. The mean effective dose of prospective ECG gating coronary artery imaging was 3.2 mSv. Effective dose reduced 76.47 %. Conclusions: Prospective ECG gating coronary artery imaging can obtain the similar image quality compared with prospective ECG gating coronary artery imaging but the effective dose reduced 76.47 %. Prospective ECG gating coronary artery imaging has clinical value to peoples who are able to not accept high radiation dose and with low heart rate. (authors)

  12. Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study

    International Nuclear Information System (INIS)

    Nasis, Arthur; Ko, Brian S.; Leung, Michael C.; Antonis, Paul R.; Wong, Dennis T.; Kyi, Leo; Cameron, James D.; Meredith, Ian T.; Seneviratne, Sujith K.; Nandurkar, Dee; Troupis, John M.

    2013-01-01

    To determine the diagnostic accuracy of combined 320-detector row computed tomography coronary angiography (CTA) and adenosine stress CT myocardial perfusion imaging (CTP) in detecting perfusion abnormalities caused by obstructive coronary artery disease (CAD). Twenty patients with suspected CAD who underwent initial investigation with single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI) were recruited and underwent prospectively-gated 320-detector CTA/CTP and invasive angiography. Two blinded cardiologists evaluated invasive angiography images quantitatively (QCA). A blinded nuclear physician analysed SPECT-MPI images for fixed and reversible perfusion defects. Two blinded cardiologists assessed CTA/CTP studies qualitatively. Vessels/territories with both >50 % stenosis on QCA and corresponding perfusion defect on SPECT-MPI were defined as ischaemic and formed the reference standard. All patients completed the CTA/CTP protocol with diagnostic image quality. Of 60 vessels/territories, 17 (28 %) were ischaemic according to QCA/SPECT-MPI criteria. Sensitivity, specificity, PPV, NPV and area under the ROC curve for CTA/CTP was 94 %, 98 %, 94 %, 98 % and 0.96 (P < 0.001) on a per-vessel/territory basis. Mean CTA/CTP radiation dose was 9.2 ± 7.4 mSv compared with 13.2 ± 2.2 mSv for SPECT-MPI (P < 0.001). Combined 320-detector CTA/CTP is accurate in identifying obstructive CAD causing perfusion abnormalities compared with combined QCA/SPECT-MPI, achieved with lower radiation dose than SPECT-MPI. (orig.)

  13. Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Nasis, Arthur; Ko, Brian S.; Leung, Michael C.; Antonis, Paul R.; Wong, Dennis T.; Kyi, Leo; Cameron, James D.; Meredith, Ian T.; Seneviratne, Sujith K. [Southern Health and Monash University, Monash Cardiovascular Research Centre, Monash Heart, Department of Medicine Monash Medical Centre (MMC), Melbourne (Australia); Nandurkar, Dee; Troupis, John M. [MMC, Southern Health, Department of Diagnostic Imaging, Melbourne (Australia)

    2013-07-15

    To determine the diagnostic accuracy of combined 320-detector row computed tomography coronary angiography (CTA) and adenosine stress CT myocardial perfusion imaging (CTP) in detecting perfusion abnormalities caused by obstructive coronary artery disease (CAD). Twenty patients with suspected CAD who underwent initial investigation with single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI) were recruited and underwent prospectively-gated 320-detector CTA/CTP and invasive angiography. Two blinded cardiologists evaluated invasive angiography images quantitatively (QCA). A blinded nuclear physician analysed SPECT-MPI images for fixed and reversible perfusion defects. Two blinded cardiologists assessed CTA/CTP studies qualitatively. Vessels/territories with both >50 % stenosis on QCA and corresponding perfusion defect on SPECT-MPI were defined as ischaemic and formed the reference standard. All patients completed the CTA/CTP protocol with diagnostic image quality. Of 60 vessels/territories, 17 (28 %) were ischaemic according to QCA/SPECT-MPI criteria. Sensitivity, specificity, PPV, NPV and area under the ROC curve for CTA/CTP was 94 %, 98 %, 94 %, 98 % and 0.96 (P < 0.001) on a per-vessel/territory basis. Mean CTA/CTP radiation dose was 9.2 {+-} 7.4 mSv compared with 13.2 {+-} 2.2 mSv for SPECT-MPI (P < 0.001). Combined 320-detector CTA/CTP is accurate in identifying obstructive CAD causing perfusion abnormalities compared with combined QCA/SPECT-MPI, achieved with lower radiation dose than SPECT-MPI. (orig.)

  14. Reproducibility of an automatic quantitation of regional myocardial wall motion and systolic thickening on gated Tc-99m-MIBI myocardial SPECT

    International Nuclear Information System (INIS)

    Paeng, Jin Chul; Lee, Dong Soo; Cheon, Gi Jeong; Kim, Yu Kyeong; Chung, June Key; Lee, Myung Chul

    2000-01-01

    The aim of this study is to investigate the reproducibility of the quantitative assessment of segmental wall motion and systolic thickening provided by an automatic quantitation algorithm. Tc-99m-MIBI gated myocardial SPECT with dipyridamole stress was performed in 31 patients with known or suspected coronary artery disease (4 with single, 6 with two, 11 with triple vessel disease; ejection fraction 51±14%) twice consecutively in the same position. Myocardium was divided into 20 segments. Segmental wall motion and systolic thickening were calculated and expressed in mm and % increase respectively, using AutoQUANT TM software. The reproducibility of this quantitative measurement of wall motion and thickening was tested. Correlations between repeated measurements on consecutive gated SPECT were excellent for wall motion (r=0.95) and systolic thickening (r=0.88). On Bland-Altman analysis, two standard deviation was 2 mm for repeated measurement of segmental wall motion, and 20% for that of systolic thickening. The weighted kappa values of repeated measurements were 0.807 for wall motion and 0.708 for systolic thickening. Sex, perfusion, or segmental location had no influence on reproducibility. Segmental wall motion and systolic thickening quantified using AutoQUANT TM software on gated myocardial SPECT offers good reproducibility and is significantly different when the change is more than 2 mm for wall motion and more than 20% for systolic thickening

  15. 99 mTc-MIBI washout as a complementary factor in the evaluation of idiopathic dilated cardiomyopathy (IDCM) using myocardial perfusion imaging.

    Science.gov (United States)

    Shiroodi, Mohammad Kazem; Shafiei, Babak; Baharfard, Nastaran; Gheidari, Mohammad Esmail; Nazari, Babak; Pirayesh, Elaheh; Kiasat, Ali; Hoseinzadeh, Samaneh; Hashemi, Abolghassem; Akbarzadeh, Mohammad Ali; Javadi, Hamid; Nabipour, Iraj; Assadi, Majid

    2012-01-01

    Rapid technetium-99 m methoxyisobutylisonitrile (99 mTc-MIBI) washout has been shown to occur in impaired myocardia. This study is based on the hypothesis that scintigraphy can be applied to calculate the myocardial 99 mTc-MIBI washout rate (WR) to diagnose and evaluate heart failure severity and other left ventricular functional parameters specifically in idiopathic dilated cardiomyopathy (IDCM) patients. Patients with IDCMP (n = 17; 52.65 ± 11.47 years) and normal subjects (n = 6; 49.67 ± 10.15 years) were intravenously administered 99 mTc-hexakis-2-methoxyisobutylisonitrile (99 mTc-MIBI). Next, early and delayed planar data were acquired (at 3.5-h intervals), and electrocardiogram (ECG)-gated myocardial perfusion single photon emission computed tomography (SPECT) was performed. The 99 mTc-MIBI WR was calculated using early and delayed planar images. Left ventricular functional parameters were also analyzed using quantitative gated SPECT (QGS) data. In target group, myocardial WRs (29.13 ± 6.68%) were significantly higher than those of control subjects (14.17 ± 3.31%; P 99 mTc-MIBI WR increased with the increasing severity of the NYHA functional class (23.16 ± 1.72% for class I, 30.25 ± 0.95% for class II, 32.60 ± 6.73% for class III, and 37.50 ± 7.77% for class IV; P = 0.02). The WR was positively correlated with the end-diastolic volume (EDV) index (r (2) = 0.216; β = 0.464; P = 0.02 [ml/m(2)], the end-systolic volume (ESV) index (r (2) = 0.234; β = 0.484; P = 0.01 [ml/m(2)]), the summed motion score (SMS) (r (2) = 0.544; β = 0.738; P = 0.00), and the summed thickening score (STS) (r (2) = 0.656; β = 0.810; P = 0.00); it was negatively correlated with the left ventricular ejection fraction (LVEF) (r (2) = 0.679; β = -0.824; P = 0.00). It can be concluded that 99 mTc-MIBI scintigraphy might be a valuable molecular imaging tool for the diagnosis and evaluation of myocardial damage or dysfunction severity.

  16. Consideration of Normal Variation of Perfusion Measurements in the Quantitative Analysis of Myocardial Perfusion SPECT: Usefulness in Assessment of Viable Myocardium

    International Nuclear Information System (INIS)

    Paeng, Jin Chul; Lim, Il Han; Kim, Ki Bong; Lee, Dong Soo

    2008-01-01

    Although automatic quantification software of myocardial perfusion SPECT provides highly objective and reproducible quantitative measurements, there is still some limitation in the direct use of quantitative measurements. In this study we derived parameters using normal variation of perfusion measurements, and tried to test the usefulness of these parameters. In order to calculate normal variation of perfusion measurements on myocardial perfusion SPECT, 55 patients (M:F=28:27) of low-likelihood for coronary artery disease were enrolled and 201 Tl rest / 99m Tc-MIBI stress SPECT studies were performed. Using 20-segment model, mean (m) and standard deviation (SD) of perfusion were calculated in each segment. As a myocardial viability assessment group, another 48 patients with known coronary artery disease, who underwent coronary artery bypass graft surgery (CABG) were enrolled. 201 Tl rest / 99m Tc-MIBI stress / 201 Tl 24-hr delayed SPECT was performed before CABG and SPECT was followed up 3 months after CABG. From the preoperative 24-hr delayed SPECT, Q delay (perfusion measurement), Δ delay (Q delay .m) and Z delay ((Q delay .m)/SD) were defined and diagnostic performances of them for myocardial viability were evaluated using area under curve (AUC) on receiver operating characteristic (ROC) curve analysis. Segmental perfusion measurements showed considerable normal variations among segments. In men, the lowest segmental perfusion measurement was 51.8±6.5 and the highest segmental perfusion was 87.0±5.9, and they are 58.7±8.1 and 87.3±6.0, respectively in women. In the viability assessment, Q delay showed AUC of 0.633, while those for Δ delay and Z delay were 0.735 and 0.716, respectively. The AUCs of Δ delay and Z delay were significantly higher than that of Q delay (p=0.001 and 0.018, respectively). The diagnostic performance of Δ delay , which showed highest AUC, was 85% of sensitivity and 53% of specificity at the optimal cutoff of -24.7. On automatic

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  18. Protective effect of active perfusion in porcine models of acute myocardial ischemia

    Science.gov (United States)

    Feng, Zanxiang; Mao, Zhifu; Dong, Shengjun; Liu, Baohui

    2016-01-01

    Mortality rates associated with off-pump coronary artery bypass (CAB) are relatively high, as the majority of patients requiring CAB are at a high risk for cardiac events. The present study aimed to establish porcine models of acute myocardial ischemia, and evaluate the protective role of shunt and active perfusion. A total of 30 pigs were randomly assigned to five groups, as follows: i) Sham (control); ii) A1 (shunt; stenosis rate, 55%); iii) A2 (shunt; stenosis rate, 75%); iv) B1 (active perfusion; stenosis rate, 55%); and v) B2 (active perfusion; stenosis rate, 75%) groups. Aortic pressure (P0), left anterior descending coronary pressure (P1), and coronary effective perfusion pressure (P1/P0) were measured. The expression levels of tumor necrosis factor-α (TNF-α), cardiac troponin (cTnI), creatine kinase-myocardial band (CK-MB), interleukin (IL)-6, IL-10, B-cell lymphoma 2 (Bcl-2), and caspase-3 were detected using enzyme-linked immunosorbent assay or western blotting. The myocardial apoptosis rate was determined using the terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Ischemia models with stenosis rates of 55 and 75% were successfully constructed following suturing of the descending artery. Compared with the control, the 55 and 75% stenosis groups demonstrated significantly decreased P1/P0, increased expression levels of TNF-α, cTnI, CK-MB, IL-6, IL-10 and caspase-3, an increased rate of myocardial apoptosis, and a decreased expression level of anti-apoptotic protein, Bcl-2. At 30 min following successful establishment of the model (ST segment elevation to 1 mm), group B demonstrated significantly increased P1/P0, decreased expression levels of TNF-α, cTnI, CK-MB, IL-6, IL-10 and caspase-3, a decreased rate of myocardial apoptosis, and an increased expression level of anti-apoptotic protein, Bcl-2. Furthermore, the current study indicated that active perfusion was more efficacious in maintaining myocardial perfusion and alleviating

  19. Myocardial scintigraphy (thallium-201) and electrocardiography at rest and during exercise in angina pectoris

    International Nuclear Information System (INIS)

    Minning, E.; Scharf-Bornhofen, E.; Brueggeman, Th.; Chen, T.; Barthel, W.; Bluemchen, G.; Sankt-Josef-Hospital, Oberhausen

    1980-01-01

    Ecg (at rest and during exercise) was compared to Thallium-201 myocardial perfusion imaging (at rest and after exercise) in 65 patients with coronary heart disease (myocardial infarction in 53 patients) and angina pectoris. These results were compared to coronary angiography and left ventricular angiography. (orig./AJ) [de

  20. Perfusion vector - a new method to quantify myocardial perfusion scintigraphy images: a simulation study with validation in patients

    DEFF Research Database (Denmark)

    Minarik, David; Senneby, Martin; Wollmer, Per

    2015-01-01

    Background The interpretation of myocardial perfusion scintigraphy (MPS) largely relies on visual assessment by the physician of the localization and extent of a perfusion defect. The aim of this study was to introduce the concept of the perfusion vector as a new objective quantitative method...

  1. Evaluation of left ventricular ejection fraction using quantitative gated SPECT (QGS)

    International Nuclear Information System (INIS)

    Musa, M. A. A.

    2010-07-01

    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

  2. Correlation of the myocardial perfusion corrected by attenuation with the coronariography. Preliminary results

    International Nuclear Information System (INIS)

    Garcia C, S.E.; Garcia O, R.

    2005-01-01

    The attenuation that suffers the radiation in the soft tissues of the hinders the appropriate interpretation of the myocardial perfusion studies, for what have been implemented attenuation correction systems to reduce the attenuation for soft tissues and to provide myocardial perfusion images more accurate in the diagnosis of coronary illness. The objective was to evaluate the utility of an attenuation correction system (with source of Gadolinium 153) to minimize the devices that look like true defects of myocardial perfusion, caused by soft tissues (mammary tissue, thoracic wall, abdomen, left hemi diaphragm), and to compare those interpretations of the studies with the interpretations of the corresponding coronariographies. The method consists of 95 electronic files which were revised with the concept of heart catheterization, being identified 20 patients from the masculine sex to those that underwent coronariography among May 1999 and December 2002, and that they had study of myocardial perfusion in a maximum period of 3 months foresaw to the invasive procedure. (Author)

  3. Relationship between normalization of negative T waves on exercise ECG and residual myocardial viability in patients with previous myocardial infarction and no post-infarction angina

    Energy Technology Data Exchange (ETDEWEB)

    Ajisaka, Ryuichi; Watanabe, Shigeyuki; Masuoka, Takeshi; Yamanouchi, Takayoshi; Saitoh, Takumi; Toyama, Masahiro; Takeda, Tohru; Itai, Yuji; Sugishita, Yasuro [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine

    1998-03-01

    The usefulness of normalization of negative T waves in exercise ECG was investigated as an index of myocardial viability in patients with previous myocardial infarction with no symptoms or ischemic ST-segment change during exercise test. A total of 39 patients, 20 with T-wave normalization (POS group) and 19 without T-wave normalization (NEG group) on exercise ECG, were studied. Myocardial viability was evaluated by thallium-201 single-photon emission computed tomography (SPECT) during exercise or at rest. We also assessed left ventricular ejection fraction (LVEF) by contrast ventriculography before (n=39) and after percutaneous transluminal coronary angioplasty (PTCA) (n=17). SPECT detected myocardial viability in 16 (80%) of the 20 patients in the POS group and in 4 (21%) of the 19 patients in the NEG group (p<0.01). LVEF increased after successful PTCA in the POS group (from 53{+-}13% to 63{+-}8%, p<0.025), but fell in the NEG group (from 57{+-}10% to 51{+-}8%). It is concluded that normalization of negative T waves on exercise ECG is a useful, simple index of myocardial viability in patients with previous myocardial infarction with no symptoms or ischemic ST-segment change during exercise testing. (author)

  4. Selective cerebro-myocardial perfusion in complex congenital aortic arch pathology: a novel technique.

    Science.gov (United States)

    De Rita, Fabrizio; Lucchese, Gianluca; Barozzi, Luca; Menon, Tiziano; Faggian, Giuseppe; Mazzucco, Alessandro; Luciani, Giovanni Battista

    2011-11-01

    Simultaneous cerebro-myocardial perfusion has been described in neonatal and infant arch surgery, suggesting a reduction in cardiac morbidity. Here reported is a novel technique for selective cerebral perfusion combined with controlled and independent myocardial perfusion during surgery for complex or recurrent aortic arch lesions. From April 2008 to April 2011, 10 patients with arch pathology underwent surgery (two hypoplastic left heart syndrome [HLHS], four recurrent arch obstruction, two aortic arch hypoplasia + ventricular septal defect [VSD], one single ventricle + transposition of the great arteries + arch hypoplasia, one interrupted aortic arch type B + VSD). Median age was 63 days (6 days-36 years) and median weight 4.0 kg (1.6-52). Via midline sternotomy, an arterial cannula (6 or 8 Fr for infants) was directly inserted into the innominate artery or through a polytetrafluoroethylene (PTFE) graft (for neonates cerebro-myocardial perfusion was 39 ± 18 min (17-69). Weaning from cardiopulmonary bypass was achieved without inotropic support in three and with low dose in seven patients. One patient required veno-arterial extracorporeal membrane oxygenation. Four patients, body weight cerebro-myocardial perfusion is feasible in patients with complex or recurrent aortic arch disease, starting from premature newborn less than 2.0 kg of body weight to adults. The technique is as safe as previously reported methods of cerebro-myocardial perfusion and possibly more versatile. © 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  5. Evaluation of coronary artery disease by helical CT using retrospective ECG-gating

    International Nuclear Information System (INIS)

    Kawawa, Yoko

    2001-01-01

    The purpose of this study is to evaluate the usefulness of helical CT using retrospective ECG-gating for visualization of the coronary artery and detection of coronary artery disease. We performed a coronary artery phantom study and established this new application, with 1-mm collimation, 1-mm table increment, and 0.1-mm reconstruction (0.8 sec/rotation). Helical CT of 31 patients with 39 coronary artery diseases (34 coronary artery stenoses, 1 vasospastic angina, 1 coronary artery dissection, 1 coronary artery ectasia and 2 coronary artery aneurysms) was performed in a single breath hold and ECG-gating without and with intravenous injection of nonionic iodine contrast material. We selected the images which were not affected by cardiac motion from the reconstruction images, in order to visualize the coronary artery for detection of coronary artery disease. The coronary artery was well visualized in 32 out of 39 vessels (82%). A good visualization of the coronary artery was correlated with the heart rate. Further, in this well visualized group, coronary artery diseases were detected in 24 out of 31 cases (77%). One case of vasospastic angina was not included. It was difficult to detect coronary artery disease in cases of heavily calcified vessels or in the left circumflex artery. Helical CT using this retrospective ECG-gating is a useful noninvasive examination for evaluation of coronary artery disease. (author)

  6. Prevalence of myocardial ischaemia as assessed with myocardial perfusion scintigraphy in patients with diabetes mellitus type 2 and mild anginal symptoms

    International Nuclear Information System (INIS)

    Wiersma, Jacobijne J.; Trip, Mieke D.; Piek, Jan J.; Tijssen, Jan G.P.; Verberne, Hein J.; Eck-Smit, Berthe L.F. van; Holt, Wik L. ten

    2006-01-01

    To determine the prevalence and predictors of reversible myocardial perfusion defects, indicative of myocardial ischaemia, in patients with mild, stable anginal complaints [Canadian Cardiovascular Society classification (CCS) I-II/IV] and diabetes mellitus type 2 (T2DM). A total of 329 patients with T2DM and stable, mild anginal symptoms (CCS I-II/IV) underwent myocardial perfusion scintigraphy. Perfusion images were assessed using a five-point (semi)-quantitative scoring system according to a 17-segment myocardial model. One-hundred and fifty-six (47%) patients showed reversible myocardial perfusion defects defined as a summed difference score of ≥3. Male gender [odds ratio (OR) 2.28, 95% CI 1.4-3.71, p=0.001], previous myocardial infarction (MI) without revascularisation (OR 3.04, 95% CI 1.28-7.24, p=0.01), and the use of two or more classes of anti-anginal medication (OR 2.36, 95% CI 1.48-3.76, p<0.001) were independent predictors for the presence of reversible defects. By contrast, lipid-lowering therapy reduced the possibility of reversible perfusion defects (OR 0.56, 95% CI 0.33-0.95, p=0.03). Approximately half of the patients with mild, stable angina pectoris and T2DM showed evidence of myocardial ischaemia. Male gender, previous MI and the use of anti-anginal medication were positive predictors and lipid-lowering therapy was a negative predictor for the results of the scintigraphic stress test. (orig.)

  7. Prevalence of myocardial ischaemia as assessed with myocardial perfusion scintigraphy in patients with diabetes mellitus type 2 and mild anginal symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Wiersma, Jacobijne J.; Trip, Mieke D.; Piek, Jan J.; Tijssen, Jan G.P. [Academic Medical Center, Department of Cardiology, Amsterdam (Netherlands); Verberne, Hein J.; Eck-Smit, Berthe L.F. van [Academic Medical Center Amsterdam, Department of Nuclear Medicine, Amsterdam (Netherlands); Holt, Wik L. ten [Amstelland Hospital, Department of Cardiology, Amstelveen (Netherlands)

    2006-12-15

    To determine the prevalence and predictors of reversible myocardial perfusion defects, indicative of myocardial ischaemia, in patients with mild, stable anginal complaints [Canadian Cardiovascular Society classification (CCS) I-II/IV] and diabetes mellitus type 2 (T2DM). A total of 329 patients with T2DM and stable, mild anginal symptoms (CCS I-II/IV) underwent myocardial perfusion scintigraphy. Perfusion images were assessed using a five-point (semi)-quantitative scoring system according to a 17-segment myocardial model. One-hundred and fifty-six (47%) patients showed reversible myocardial perfusion defects defined as a summed difference score of {>=}3. Male gender [odds ratio (OR) 2.28, 95% CI 1.4-3.71, p=0.001], previous myocardial infarction (MI) without revascularisation (OR 3.04, 95% CI 1.28-7.24, p=0.01), and the use of two or more classes of anti-anginal medication (OR 2.36, 95% CI 1.48-3.76, p<0.001) were independent predictors for the presence of reversible defects. By contrast, lipid-lowering therapy reduced the possibility of reversible perfusion defects (OR 0.56, 95% CI 0.33-0.95, p=0.03). Approximately half of the patients with mild, stable angina pectoris and T2DM showed evidence of myocardial ischaemia. Male gender, previous MI and the use of anti-anginal medication were positive predictors and lipid-lowering therapy was a negative predictor for the results of the scintigraphic stress test. (orig.)

  8. Clinical values of left ventricular mechanical dyssynchrony assessment by gated myocardial perfusion SPECT in patients with acute myocardial infarction and multivessel disease

    International Nuclear Information System (INIS)

    Cho, Sang-Geon; Park, Ki Seong; Kim, Jahae; Kim, Jong Sang; Song, Ho-Chun; Jabin, Zeenat; Kang, Sae-Ryung; Kwon, Seong Young; Jeong, Geum-Cheol; Song, Minchul; Min, Jung-Joon; Bom, Hee-Seung; Cho, Jae Yeong; Kim, Hyun Kuk

    2017-01-01

    The aim of this study was to evaluate the prognostic value of additional evaluation of left ventricular mechanical dyssynchrony (LVMD) by gated myocardial perfusion single-photon emission computed tomography (GMPS) in patients with acute myocardial infarction (MI) and multivessel disease. One hundred and nine acute MI patients with >50 % stenosis in at least one non-culprit artery who underwent GMPS within 2 weeks were enrolled. All patients underwent successful revascularization of the culprit arteries. Those with previous MI, atrial fibrillation, or frequent ventricular premature complexes, cardiac devices, significant patient motion, or procedure-related events were excluded. Phase standard deviation (PSD) and phase histogram bandwidth (PBW) were measured for assessment of LVMD. Patients were followed up for a median of 26 months after index MI, for composite major adverse cardiac events (MACE), which consisted with all-cause death, unplanned hospitalization due to heart failure and severe ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation). Independent predictors of MACE were evaluated. MACE occurred in 22 patients (20 %). Stress PSD (53.3 ± 17.3 vs. 35.3 ± 18.9 ; p <0.001), stress PBW (147.6 ± 54.6 vs. 96.8 ± 59.2 ; p = 0.001) and resting PBW (126.8 ± 37.5 vs. 96.6 ± 48.9 ; p = 0.001) were significantly higher in patients with MACE compared to those without. Multivariate analysis revealed that stress PSD ≥45.5 and stress PBW ≥126.0 were predictive of MACE, as well as suboptimal non-culprit artery revascularization (SNR) and renin-angiotensin system (RAS) blockade medication. Higher stress PSD and stress PBW were associated with poorer prognosis both in patients with and without SNR, and those with RAS blockade medication, but not in those without RAS blockade medication. LVMD measured by GMPS showed added prognostic value in acute MI with multivessel disease. GMPS could serve as a comprehensive evaluation imaging

  9. Clinical values of left ventricular mechanical dyssynchrony assessment by gated myocardial perfusion SPECT in patients with acute myocardial infarction and multivessel disease

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sang-Geon; Park, Ki Seong; Kim, Jahae; Kim, Jong Sang; Song, Ho-Chun [Chonnam National University Hospital, Department of Nuclear Medicine, Gwang-ju (Korea, Republic of); Jabin, Zeenat; Kang, Sae-Ryung; Kwon, Seong Young; Jeong, Geum-Cheol; Song, Minchul; Min, Jung-Joon; Bom, Hee-Seung [Chonnam National University Hwasun Hospital, Department of Nuclear Medicine, Hwasun-gun, Jeonnam (Korea, Republic of); Cho, Jae Yeong; Kim, Hyun Kuk [Chonnam National University Hospital, Department of Cardiology, Gwang-ju (Korea, Republic of)

    2017-02-15

    The aim of this study was to evaluate the prognostic value of additional evaluation of left ventricular mechanical dyssynchrony (LVMD) by gated myocardial perfusion single-photon emission computed tomography (GMPS) in patients with acute myocardial infarction (MI) and multivessel disease. One hundred and nine acute MI patients with >50 % stenosis in at least one non-culprit artery who underwent GMPS within 2 weeks were enrolled. All patients underwent successful revascularization of the culprit arteries. Those with previous MI, atrial fibrillation, or frequent ventricular premature complexes, cardiac devices, significant patient motion, or procedure-related events were excluded. Phase standard deviation (PSD) and phase histogram bandwidth (PBW) were measured for assessment of LVMD. Patients were followed up for a median of 26 months after index MI, for composite major adverse cardiac events (MACE), which consisted with all-cause death, unplanned hospitalization due to heart failure and severe ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation). Independent predictors of MACE were evaluated. MACE occurred in 22 patients (20 %). Stress PSD (53.3 ± 17.3 vs. 35.3 ± 18.9 ; p <0.001), stress PBW (147.6 ± 54.6 vs. 96.8 ± 59.2 ; p = 0.001) and resting PBW (126.8 ± 37.5 vs. 96.6 ± 48.9 ; p = 0.001) were significantly higher in patients with MACE compared to those without. Multivariate analysis revealed that stress PSD ≥45.5 and stress PBW ≥126.0 were predictive of MACE, as well as suboptimal non-culprit artery revascularization (SNR) and renin-angiotensin system (RAS) blockade medication. Higher stress PSD and stress PBW were associated with poorer prognosis both in patients with and without SNR, and those with RAS blockade medication, but not in those without RAS blockade medication. LVMD measured by GMPS showed added prognostic value in acute MI with multivessel disease. GMPS could serve as a comprehensive evaluation imaging

  10. Myocardial perfusion imaging, coronary angiography and histological examination in experimental treatment of Ad-HGF for myocardial infarction

    International Nuclear Information System (INIS)

    Li Jianhua; Feng Jianlin; Cheng Xu; Li Dianfu; Zhang Youfu

    2007-01-01

    Objective: Gene therapy has drawn a great attention. A swine model of adenovirus hepatocyte growth factor(Ad-HGF) treated myocardial infarction(MI) was utilized, with the effect being assessed by rest myocardial perfusion imaging, coronary angiography and histological examination. Methods: Three groups of MI swine treated with Ad-HGF at low dose [n=5, Ad-HGF 10 8 plague forming unit (PFU)/ site], medium dose(n=5, 4 x 10 8 PFU/site), and high dose (n=5, 5 x 10 9 PFU/site), a control group treated with normal saline(NS, n=5) and a blank control group (n=5) underwent rest myocardial perfusion imaging and coronary angiography before and after treatment. The imaging results were analyzed along with histological findings in each group. Results: The state of myocardial perfusion and Rentrop scores remained unchanged in the blank control and NS groups after treatment. Whereas there was a significant improvement in the two variables in all three groups treated with Ad-HGF. The scores of left circumflex coronary artery (LCX) before and after treated were 7.8 ± 1.3 and 16.4 ± 1.1 (low-dose), 8.2 ± 1.6 and 17.6 ± 0.9 (medium-dose), 8.4 ± 1.5 and 19.0 ± 0.7 (high-dose), respectively. No significant differences were noted among the 3 groups. The number of vessels of NS group was markedly less than that of other groups. Conclusion: Myocardial perfusion imaging seems to be more accurate than coronary angiography and histological examination in evaluating the effects of Ad-HGF on myocardial infarction. (authors)

  11. Reduction of the estimated radiation dose and associated patient risk with prospective ECG-gated 256-slice CT coronary angiography

    International Nuclear Information System (INIS)

    Efstathopoulos, E P; Kelekis, N L; Pantos, I; Brountzos, E; Argentos, S; Grebac, J; Ziaka, D; Seimenis, I; Katritsis, D G

    2009-01-01

    Computed tomography (CT) coronary angiography has been widely used since the introduction of 64-slice scanners and dual-source CT technology, but high radiation doses have been reported. Prospective ECG-gating using a 'step-and-shoot' axial scanning protocol has been shown to reduce radiation exposure effectively while maintaining diagnostic accuracy. 256-slice scanners with 80 mm detector coverage have been currently introduced into practice, but their impact on radiation exposure has not been adequately studied. The aim of this study was to assess radiation doses associated with CT coronary angiography using a 256-slice CT scanner. Radiation doses were estimated for 25 patients scanned with either prospective or retrospective ECG-gating. Image quality was assessed objectively in terms of mean CT attenuation at selected regions of interest on axial coronary images and subjectively by coronary segment quality scoring. It was found that radiation doses associated with prospective ECG-gating were significantly lower than retrospective ECG-gating (3.2 ± 0.6 mSv versus 13.4 ± 2.7 mSv). Consequently, the radiogenic fatal cancer risk for the patient is much lower with prospective gating (0.0176% versus 0.0737%). No statistically significant differences in image quality were observed between the two scanning protocols for both objective and subjective quality assessments. Therefore, prospective ECG-gating using a 'step-and-shoot' protocol that covers the cardiac anatomy in two axial acquisitions effectively reduces radiation doses in 256-slice CT coronary angiography without compromising image quality.

  12. Myocardial ischemia and angina pectoris. The clinical problem in patients

    Energy Technology Data Exchange (ETDEWEB)

    Selwyn, A.P.; Fox, K.M.; Jonathan, A.; Lavender, P.; Watson, I.

    1981-02-01

    Ambulatory monitoring of ST segment changes was performed in 60 patients presenting with angina, positive ECG stress tests and coronary artery disease, 85% of ischemic ECG events were asymptomatic, 37% occurred with no increase in heart rate and 15% of episodes either lasted 20 minutes or more or fluctuated in severity. A controlled pilot study in ten patients showed depression. Radionuclide studies in 50 patients with angina and coronary artery disease have shown that stress (i.e., atrial pacing) produced different patterns of disturbed regional myocardial perfusion related to the patient's exercise capacity and eventually leading to a decrease in regional myocardial perfusion during the ischemic episode. ST segment depression appeared only after the decrease in regional myocardial perfusion. These findings combined with past research suggest that patients with angina and coronary artery disease can suffer frequent asymptomatic disturbances of the regional myocardial perfusion. The frequency of these episodes and the time course for the recovery of the metabolic consequences mean that segments of ventricular myocardium may be constantly abnormal. The relative importance of changes in coronary tone and malfunction of platelets in the diseased coronary tree needs to be examined in clinical research. Pilot studies of antiplatelet agents have shown a significant beneficial effect on episodes of ischemia occurring at night and those occurring without any increase in heart rate. The techniques and observations in these patients with coronary artery disease all suggest that acute transient regional myocardial ischemia is caused by a variety of mechanisms. Further research using objective methods is required to discover the causes of ischemia and to rationalize treatment.

  13. Asymptomatic myocardial ischemia following cold provocation

    International Nuclear Information System (INIS)

    Shea, M.J.; Deanfield, J.E.; deLandsheere, C.M.; Wilson, R.A.; Kensett, M.; Selwyn, A.P.

    1987-01-01

    Cold is thought to provoke angina in patients with coronary disease either by an increase in myocardial demand or an increase in coronary vascular resistance. We investigated and compared the effects of cold pressor stimulation and symptom-limited supine bicycle exercise on regional myocardial perfusion in 35 patients with stable angina and coronary disease and in 10 normal subjects. Regional myocardial perfusion was assessed with positron emission tomography and rubidium-82. Following cold pressor stimulation 24 of 35 patients demonstrated significant abnormalities of regional myocardial perfusion with reduced cation uptake in affected regions of myocardium: 52 +/- 9 to 43 +/- 9 (p less than 0.001 vs normal subjects). Among these 24 patients only nine developed ST depression and only seven had angina. In contrast, 29 of 35 patients underwent supine exercise, and abnormal regional myocardial perfusion occurred in all 29, with a reduction in cation intake from 48 +/- 10 to 43 +/- 14 (p less than 0.001 vs normal subjects). Angina was present in 27 of 29 and ST depression in 25 of 29. Although the absolute decrease in cation uptake was somewhat greater following cold as opposed to exercise, the peak heart rate after cold was significantly lower than that after exercise (82 +/- 12 vs 108 +/- 16 bpm, p less than 0.05). Peak systolic blood pressures after cold and exercise were similar (159 +/- 24 vs 158 +/- 28). Thus, cold produces much more frequent asymptomatic disturbances of regional myocardial perfusion in patients with stable angina and coronary disease than is suggested by pain or ECG changes

  14. Improvement of myocardial perfusion status in response to indian vedic breathing

    International Nuclear Information System (INIS)

    Anand, Y.N.I.; Muthu, G.S.

    2004-01-01

    Introduction: Yoga is the buzz word all over the world today. Amidst their busy schedule, people tend to ignore their personal health. Management of various disorders, especially those involving interventions, surgical or radiological, is very expensive. The Indian Vedic Exercises, of which Pranaayaama is one, emphasize on prevention of the diseases in order to keep the individual in good health. It is equally applicable to those who have already suffered from various disorders and in whom both improvement and/or avoidance of further deterioration are required. However, no Objective assessment of the disease status in response to these exercises has been reported so far. Objectives: This pilot study has been undertaken on patients with reversible myocardial perfusion defects to Objectively monitor the improvements in the myocardial perfusion in response to a breathing exercise, Pranayama, a breathing technique prescribed in the Indian Vedic Sciences. Methods: Two patients who were found to have reversible myocardial perfusion defects were taken up in this study. These defects were diagnosed from the myocardial perfusion SPECT done in stressed (on Tread Mill) and resting states with 99m Technetium labeled MIBI.These patients were taught the pranayama technique which is done for about 30 minutes every day. At the end of four months from the commencement of this technique, the myocardial perfusion SPECT studies were repeated. Details of the exercise in the form of a CD are available on request. Results: Overall good improvements were observed in all the quantitative parameters in the TMT and SPECT studies in the studies done after the pranayama procedures in both the patients. Perfusion defects seen in the stress images of the initial studies have almost completely reversed in the stress images of the later study. Patients are asymptomatic and are leading a comfortable life. Conclusion: This is only a study of two cases to Objectively evaluate the effects of pranayama

  15. Improving the accuracy of myocardial perfusion scintigraphy results by machine learning method

    International Nuclear Information System (INIS)

    Groselj, C.; Kukar, M.

    2002-01-01

    Full text: Machine learning (ML) as rapidly growing artificial intelligence subfield has already proven in last decade to be a useful tool in many fields of decision making, also in some fields of medicine. Its decision accuracy usually exceeds the human one. To assess applicability of ML in interpretation the results of stress myocardial perfusion scintigraphy for CAD diagnosis. The 327 patient's data of planar stress myocardial perfusion scintigraphy were reevaluated in usual way. Comparing them with the results of coronary angiography the sensitivity, specificity and accuracy for the investigation was computed. The data were digitized and the decision procedure repeated by ML program 'Naive Bayesian classifier'. As the ML is able to simultaneously manipulate of whatever number of data, all reachable disease connected data (regarding history, habitus, risk factors, stress results) were added. The sensitivity, specificity and accuracy for scintigraphy were expressed in this way. The results of both decision procedures were compared. With ML method 19 patients more out of 327 (5.8 %) were correctly diagnosed by stress myocardial perfusion scintigraphy. ML could be an important tool for decision making in myocardial perfusion scintigraphy. (author)

  16. Paradoxical motion of interventricular septum on Tc-99m MIBI gated SPECT study

    International Nuclear Information System (INIS)

    Ergun, E.L.; Erbas, B.; Beylergil, V.; Demirturk, O.S.; Pasaoglu, I.

    2004-01-01

    After uncomplicated cardiac surgery, abnormal motion of the interventricular septum is frequently observed. The interventricular septum has often been found to display dyskinetic, or paradoxical motion by echocardiographic studies. This study was undertaken to describe instances of paradoxical motion of interventricular septum on Tc-99m MIBI gated SPECT studies in patients after coronary artery by pass graft surgery. Tc-99m MIBI gated SPECT in conjunction with stress myocardial perfusion SPECT was performed in 18 patients who had history of cardiac bypass graft surgery. Paradoxical motion of the interventricular septum was defined visually from Tc-99m MIBI gated SPECT. Perfusion of the interventricular septum was examined from myocardial perfusion images in the same study. Paradoxical motion of the interventricular septum was observed in 4 patients (22%). The interventricular septum was normally perfused in all patients. It was concluded that paradoxical motion of the interventricular septum in patients who had a history of cardiac by-pass graft surgery is not an uncommon finding and it can be observed with gated SPECT. The exact mechanism of this phenomenon is not well-known. A normal perfusion in interventricular wall helps to discriminate this situation from a real abnormality. (author)

  17. The new 99mTc myocardial perfusion imaging agents: 99mTc-sestamibi and 99mTc-teboroxime

    International Nuclear Information System (INIS)

    Berman, D.S.; Kiat, H.; Maddahi, J.

    1991-01-01

    The two new 99m (99mTc) labeled myocardial perfusion agents, 99mTc-Sestamibi and 99mTc-Teboroxime, are now available for routine clinical application. Both agents allow assessment of ejection fraction by the first-pass technique at rest or during exercise, thus providing additional information not available with thallium-201. 99mTc-Sestamibi has long myocardial residence time, as well as adequate myocardial extraction, providing images of higher count density and superior quality compared with thallium-201. 99mTc-Teboroxime has excellent myocardial uptake characteristics but is cleared very rapidly from the myocardium. Both tracers have shown results similar to those obtained with thallium-201 for detection of coronary artery disease and the assessment of defect reversibility. 99mTc-Sestamibi studies using the rest/stress imaging sequence can be accomplished in approximately 5 hours; studies using dual-isotope imaging (rest thallium-201 and stress 99mTc-Sestamibi injection) can be completed in 1 to 2 hours. Gated stress images can be performed with 99mTc-Sestamibi, providing simultaneous information of myocardial perfusion at stress and resting wall motion or thickening and allowing rapid differentiation of ischemic from infarcted tissue. Because of its slow myocardial clearance and absence of redistribution, 99mTc-Sestamibi allows uncoupling of the time of injection from the time of imaging and thus can be valuable in the evaluation of acute myocardial infarction and outcome of thrombolytic therapy. With 99mTc-Teboroxime, rapid serial studies are feasible. Pharmacologic stress and rest studies with 99mTc-Teboroxime single photon emission computed tomography potentially can be completed in under 30 minutes. 73 references

  18. Parallel imaging for first-pass myocardial perfusion

    NARCIS (Netherlands)

    Irwan, Roy; Lubbers, Daniel D.; van der Vleuten, Pieter A.; Kappert, Peter; Gotte, Marco J. W.; Sijens, Paul E.

    Two parallel imaging methods used for first-pass myocardial perfusion imaging were compared in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and image artifacts. One used adaptive Time-adaptive SENSitivity Encoding (TSENSE) and the other used GeneRalized Autocalibrating

  19. Assessment of left ventricular performance by ECG-gated SPECT. Comparison with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Tadamura, Eiji; Inubushi, Masayuki; Kubo, Shigeto; Matsumoto, Keiichi; Yokoyama, Hiroshi; Fujita, Toru; Konishi, Junji [Kyoto Univ. (Japan). Faculty of Medicine

    1999-10-01

    In the measurement of a left ventricular volume, MIBI-QGS was compared with MRI. Because it became clear by the experiment using phantom that a volume calculated with QGS was smaller than the actual volume, data of clinical study were corrected. Subjects were 20 patients with coronary artery disease. Fourteen patients had anamnesis of myocardial infarct. ECG-gated SPECT was performed one hour after intravenous injection of MIBI (600 MBq) in rest. End diastolic volume (EDV), end systolic volume (ESV) and ejection fraction (EF) were calculated using QGS. Cine-MR image was obtained by using MR system of 1.5 Tesla within 1 week after SPECT. A condition was as follows; segmented k-space gradient echo with view sharing, TR=11 ms, TE=1.4 ms, flip angle 20 degree, field of view 32 cm, matrix 256 x 196, 8 lines per segment. LVEF, ESV and EF were analysed by Bland-Altman method, and the difference between MIBI-gated-SPECT and MRI was no problem. Horizontal dislocation image and vertical major axis dislocation image were provided. Minor axis crossing images of 10-12 slice were also filmed in order to cover all left ventricles. As a result, availability of MIBI-QGS became clear. Some factors which produces the measurement error are examined. (K.H.)

  20. Prognostic significance of stress myocardial gated SPECT among Japanese patients referred for coronary angiography: A study of data from the J-ACCESS database

    Energy Technology Data Exchange (ETDEWEB)

    Momose, Mitsuru [Tokyo Women' s Medical University, Department of Radiology, Tokyo (Japan); Nakajima, Kenichi [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science, Kyoto (Japan)

    2009-08-15

    The J-ACCESS [Japanese investigation of prognosis based on gated single photon emission computed tomography (SPECT)] study found that quantitative gated myocardial SPECT (QGS) is valuable for predicting the prognosis of Japanese patients with known or suspected ischaemic heart disease. The present study evaluates the incremental prognostic value of myocardial perfusion imaging (MPI) with QGS among patients referred for coronary angiography (CAG). Among 4,031 Japanese patients registered at 117 hospitals for the J-ACCESS study, we selected 1,011 who underwent CAG within 3 months before or after MPI with QGS. Summed stress, rest and difference scores (SSS, SRS and SDS) were generated from myocardial perfusion images using a 20-segment scoring system. Myocardial ischaemia was judged visually. End-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were determined by QGS. Numbers of diseased (> 75% stenosis) coronary vessels (CDV) were assessed by CAG. All patients were followed up for 3 years to determine cardiac events (CE) including cardiac death, non-fatal myocardial infarction and severe heart failure. Univariate and multivariate analyses of prognostic ability included age, cardiac risk factors (hypertension, hyperlipidaemia, diabetes mellitus and prior myocardial infarction), angiographic findings and the QGS parameters as independent variables. Cardiac events occurred more frequently with increasing numbers of coronary vessel lesions (p=0.0016). Cox univariate analysis revealed that diabetes, CDV, SSS, SDS, EDV, ESV and EF were significant predictors (Wald {chi}{sup 2}=5.99, 12.9, 8.39, 9.11, 35.5, 42.1 and 31.1, respectively), whereas multivariate analysis selected only ESV and SDS as significant predictors (Wald {chi}{sup 2}=36.4, 8.4; p = 0.0038, p < 0.001). MPI with QGS, especially with gated functional data, has incremental prognostic value in addition to angiographic findings. MPI with QGS findings predominantly contribute to the

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

    International Nuclear Information System (INIS)

    Ouvrier, M.J.; Hitzel, A.; Vera, P.; Manrique, A.; Bernard, M.; Manrique, A.

    2009-01-01

    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 99m Tc-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)

  2. Value of myocardial perfusion SPECT in pediatric population

    International Nuclear Information System (INIS)

    Massardo, T.; Coll, C.; Prat, H.; Gonzalez, P.; Doggenweiller, P.; Castillo, M.E.; Solis, A.

    2002-01-01

    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

  3. Detecting Myocardial Ischemia With 99mTechnetium-Tetrofosmin Myocardial Perfusion Imaging in Ischemic Stroke.

    Science.gov (United States)

    Giannopoulos, Sotirios; Markoula, Sofia; Sioka, Chrissa; Zouroudi, Sofia; Spiliotopoulou, Maria; Naka, Katerina K; Michalis, Lampros K; Fotopoulos, Andreas; Kyritsis, Athanassios P

    2017-10-01

    To assess the myocardial status in patients with stroke, employing myocardial perfusion imaging (MPI) with 99m Technetium-tetrofosmin ( 99m Tc-TF)-single-photon emission computed tomography (SPECT). Fifty-two patients with ischemic stroke were subjected to 99m Tc-TF-SPECT MPI within 1 month after stroke occurrence. None of the patients had any history or symptoms of coronary artery disease or other heart disease. Myocardial perfusion imaging was evaluated visually using a 17-segment polar map. Myocardial ischemia (MIS) was defined as present when the summed stress score (SSS) was >4; MIS was defined as mild when SSS was 4 to 8, and moderate/severe with SSS ≥9. Patients with SSS >4 were compared to patients with SSS SSS >9 were compared to patients with SSS SSS, with the oldest age exhibiting the highest SSS ( P = .01). The association of age with SSS remained statistically significant in the multivariate analysis ( P = .04). The study suggested that more than half of patients with stroke without a history of cardiac disease have MIS. Although most of them have mild MIS, we suggest a thorough cardiological evaluation in this group of patients for future prevention of severe myocardial outcome.

  4. A decision support system improves the interpretation of myocardial perfusion imaging

    DEFF Research Database (Denmark)

    Tagil, K.; Bondouy, M.; Chaborel, J.P.

    2008-01-01

    PURPOSE: The aim of this study was to investigate the influence of a computer-based decision support system (DSS) on performance and inter-observer variability of interpretations regarding ischaemia and infarction in myocardial perfusion scintigraphy (MPS). METHODS: Seven physicians independently...... with the advice of the DSS showed less inter-observer variability than those made without advice. CONCLUSION: This study shows that a DSS can improve performance and reduces the inter-observer variability of interpretations in myocardial perfusion imaging. Both experienced and, especially, inexperienced...

  5. Long-term cigarette smoking is associated with increased myocardial perfusion heterogeneity assessed by positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Meeder, J.G. [Department of Cardiology and National Research PET Center, University Hospital, Groningen (Netherlands); Blanksma, P.K. [Department of Cardiology and National Research PET Center, University Hospital, Groningen (Netherlands); Wall, E.E. van der [Department of Cardiology, University Hospital, Leiden (Netherlands); Anthonio, R.L. [Department of Cardiology and National Research PET Center, University Hospital, Groningen (Netherlands); Willemsen, A.T.M. [Department of Cardiology and National Research PET Center, University Hospital, Groningen (Netherlands); Pruim, J. [Department of Cardiology and National Research PET Center, University Hospital, Groningen (Netherlands); Vaalburg, W. [Department of Cardiology and National Research PET Center, University Hospital, Groningen (Netherlands); Lie, K.I. [Department of Cardiology and National Research PET Center, University Hospital, Groningen (Netherlands)

    1996-11-01

    The pathophysiology of smoking-related coronary events in patients with normal coronary arteries is incompletely understood. This study was conducted to explore, in subjects without symptoms of cardiovascular disease, the long-term effects of smoking on regional coronary artery vasoactivity, especially during sympathetic stimulation. In ten smoking and ten non-smoking sex- and age-matched healthy volunteers, segmental myocardial perfusion was studied using dynamic parametric nitrogen-13 ammonia positron emission tomography at rest and during sympathetic stimulation evoked by the cold pressor stimulation. Smokers demonstrated a higher myocardial perfusion at rest (116{+-}17 ml/min/100 g vs 96{+-}20 ml/min/100 g, P <0.01) and an impaired myocardial perfusion increase during cold pressor stimulation (1.02{+-}0.15 vs 1.18{+-}0.17, P <0.05). The heterogeneity of perfusion, expressed as coefficient of variation, was significantly different between the smoking and the non-smoking group. The coefficient of variation of segmental myocardial perfusion was higher in smokers at rest (17.5%{+-}4.2% vs 13.5%{+-}1.9%, P <0.05) and during cold pressor stimulation (17.0%{+-}3.2% vs 13.9%{+-}1.8%, P <0.05). We conclude that the long-term effects of smoking in healthy volunteers are associated with (1) increased myocardial perfusion at rest, (2) impaired myocardial perfusion response to cold pressor stimulation, and (3) increased myocardial perfusion heterogeneity both at rest and during cold pressor stimulation. These results may suggest that in healthy subjects the long-term effect of smoking is related to abnormal coronary artery vasoactivity, presumably induced by an interplay of regional endothelial dysfunction and autonomic dysregulation. (orig.). With 1 fig., 1 tab.

  6. [Myocardial perfusion scintigraphy - short form of the German guideline].

    Science.gov (United States)

    Lindner, O; Burchert, W; Hacker, M; Schaefer, W; Schmidt, M; Schober, O; Schwaiger, M; vom Dahl, J; Zimmermann, R; Schäfers, M

    2013-01-01

    This guideline is a short summary of the guideline for myocardial perfusion scintigraphy published by the Association of the Scientific Medical Societies in Ger-many (AWMF). The purpose of this guideline is to provide practical assistance for indication and examination procedures as well as image analysis and to present the state-of-the-art of myocardial-perfusion-scintigraphy. After a short introduction on the fundamentals of imaging, precise and detailed information is given on the indications, patient preparation, stress testing, radiopharmaceuticals, examination protocols and techniques, radiation exposure, data reconstruction as well as information on visual and quantitative image analysis and interpretation. In addition possible pitfalls, artefacts and key elements of reporting are described.

  7. Combined 201Th myocardial scintiscanning and ECG-triggered ventricular scintiscanning for an evaluation of the left ventricular function after myocardial infarction

    International Nuclear Information System (INIS)

    Nuetzel, W.

    1978-01-01

    74 patients in whom old transmural myocardial infarctions had been detected by catheterisation of the heart were examined by 201 Th myocardial scintiscanning and ECG-triggered ventricular scintiscanning. There was a control group of 16 patients where coronary disease was excluded by the catheter examination. The findings of the nuclear methods are compared with those of invasive and non-invasive cardiological diagnostics. Nuclear techniques were more sensitive (95%) than ECG (77%) in detecting old infarctions. In volumina determination, there was a satisfactory correlation with angiography for the telediastolic volume (r = 0.77) and a good correlation for the telesystolic volume (r = 0.84) and the ejection fraction (r = 0.89). (orig./AJ) [de

  8. Nuclear cardiology: Myocardial perfusion and function

    International Nuclear Information System (INIS)

    Seldin, D.W.

    1991-01-01

    Myocardial perfusion studies continue to be a major focus of research, with new investigations of the relationship of exercise-redistribution thallium imaging to diagnosis, prognosis, and case management. The redistribution phenomenon, which seemed to be fairly well understood a few years ago, is now recognized to be much more complex than originally thought, and various strategies have been proposed to clarify the meaning of persistent defects. Pharmacologic intervention with dipyridamole and adenosine has become available as an alternative to exercise, and comparisons with exercise imaging and catheterization results have been described. Thallium itself is no longer the sole single-photon perfusion radiopharmaceutical; two new technetium agents are now widely available. In addition to perfusion studies, advances in the study of ventricular function have been made, including reports of studies performed in conjunction with technetium perfusion studies, new insights into cardiac physiology, and the prognostic and case-management information that function studies provide. Finally, work has continued with monoclonal antibodies for the identification of areas of myocyte necrosis. 41 references

  9. Myocardial scintigraphy: methods and indications

    International Nuclear Information System (INIS)

    Knapp, W.H.

    1993-01-01

    Myocardial scintigraphy comprises perfusion imaging using TI-201 or - more recently - Tc-99m-labeled compounds with high affinity to myocytes. Imaging with these agents has become an important procedure in the detection of coronary artery disease, particularly in patients with non-diagnostic stress-ECG, in the functional evaluation of coronary stenoses after angiographical documentation in order to meet the adequate therapy decision, in therapy monitoring and follow-up, in the post infarction assessment of myocardial viability and differentiation between severe ischemia and scar and, occasionally, in acute ischemia. The use of positron emitters does not offer significant advantages for mere perfusion imaging, but is indispensable for the scintigraphic investigation of certain aspects of myocardial metabolism, particularly for the differentiation of viable ischemic wall segments from irreversibly damaged tissue. Imaging of myocardial necrosis has been improved by the introduction of labeled antimyosin antibody fragments and offers a considerable clinical potential in the diagnosis of myocarditis and cardiac transplant rejection. Neurohumoral aspects are increasingly involved in our understanding of myocardial failure. Scintigraphy of innervation/neurotransmission contributes to the investigation of pathophysiological alterations in myocardial insufficiency and in heart transplants. (orig.) [de

  10. An incidental finding of myocardial uptake on HDP bone scan

    International Nuclear Information System (INIS)

    Smith, T.

    1998-01-01

    Full text: A 75 year old male referred with a history of wrist pain for a HDP bone scan(700Mbq) had dynamic and blood pool images. A posterior sweep and planar images were performed after 2 hours. The scan demonstrated a fracture of the left radial styloid, other degenerative arthritis and diffuse tracer uptake throughout the myocardium. The differential diagnoses included cardiac amyloid, myocardial infarction (MI) and calcific pericarditis. The patient, a non insulin dependent diabetic with previous MI in 1978 and hypertension had nocturnal dyspnoea and no chest pain. Chest X-ray was normal. ECG revealed old inferior infarct. Echocardiography showed mild hypokinesis of the inferior wall, low normal LV contractility, normal pericardium and no evidence of amyloid. A Rest (400Mbq) / Stress(1200Mbq) Sestamibi(MIBI) was performed to assess status of ischaemic heart disease (IHD). The patient experienced leg fatigue and shortness of breath but no chest pain. Rest ECG showed sinus bradycardia with ST/T wave changes. Stress ECG showed ST segment depression (0.5mm). Planar and SPECT studies showed reversible perfusion defects in the anterior wall and apex with a fixed inferolateral defect. Gated SPECT showed normal wall motion apart from the inferolateral infarct. The exact cause of the HDP uptake in the myocardium is unknown. The echo findings exclude amyloid or pericarditis. The MIBI study confirmed a small inferolateral infarct and myocardial ischaemia in the anterior wall and apex. The scan has affected patient management by diagnosing a fracture of the radial styloid and confirming previous infarction and myocardial ischaemia. An open view must be taken of the cardiac HDP uptake. The most likely diagnosis in this patient is silent IHD, which has been demonstrated in one other case known to us

  11. Adenosine stress and exercise 99Tcm-MIBI myocardial perfusion imaging in the diagnosis and risk stratification of patients with unstable angina

    International Nuclear Information System (INIS)

    Jia Peng; Guo Wanhua; Xu Shoulin; Feng Xuefeng

    2008-01-01

    Objective: The aim of this study was to evaluate the clinical value of adenosine stress or exercise 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging in the diagnosis and risk stratification of patients with unstable angina. Methods: Eighty-seven hospitalized patients with unstable angina [54 men and 33 women, aged of (56.5±12.5) years] underwent adenosine stress or exercise myocardial perfusion imaging and coronary angiography. Patients were followed up. Results: Fifty-seven patients had abnormal myocardial perfusion imaging and significant coronary artery stenosis. Ten patients had abnormal myocardial perfusion imaging but normal coronary angiography. Eight patients had normal myocardial perfusion imaging but significant coronary artery stenosis. Twelve patients had normal myocardial perfusion imaging and normal coronary angiography. Patients with abnormal myocardial perfusion imaging had worse prognosis. There was relationship between cardiac events and the extent and severity of myocardial ischemia. Conclusion: Adenosine stress and exercise myocardial perfusion imaging is of important clinical value in the diagnosis and risk stratification of patients with unstable angina. (authors)

  12. Myocordial perfusion SPECT with dipyridamole stress test in cardiac syndrome X

    International Nuclear Information System (INIS)

    Czepczynski, R.; Smolarek, I.; Sowinski, J.; Rogacka, D.; Kazmierczak, M.; Wysocki, H.

    2006-01-01

    Cardiac syndrome X defines patients with typical anginal chest pain, a positive exercise ECG stress test and angiographically normal coronary arteries. Aim of this study was to evaluate the role of myocardial perfusion SPECT with dipyridamole stress in the diagnosis of cardiac syndrome X. Patients, methods: 68 patients with syndrome X aged 32 to 60 years were subjected to myocardial imaging using 99m Tc-MIBI according to the two-days protocol: at rest and after dipyridamole infusion. Semiquantitative evaluation of the images was based on the assessment of 99m Tc-MIBI uptake in 17 myocardial segments using a 5-points scale (0 point - normal uptake, 4 points - no uptake). Scores obtained in each segment were summed up, constituting the summed rest score (SRS) and summed stress score (SSS). Results: mean SRS was 7.9 ± 4.8 and mean SSS was 7.2 ± 4.4 (non-significant difference). Individual comparison of SRS and SSS values revealed three patterns of scintigraphic images: (1) in 25 patients (36.8%), a paradoxical improvement of perfusion at stress images was found, (2) in 23 patients (33.8%), the myocardial perfusion deteriorated after dipyridamole, (3) in 20 patients (29.4%), no significant change of the myocordial perfusion between rest and stress images occurred. Conclusions: in cardiac syndrome X, myocardial SPECT with dipyridamole stress shows different patterns of myocardial perfusion that reflects heterogeneity of this pathology. (orig.)

  13. An attempt of thallium-201 myocardial perfusion imaging during transient coronary arterial occlusion by PTCA

    International Nuclear Information System (INIS)

    Nakagawa, Tatsuya; Sugihara, Hiroki; Katahira, Toshio

    1989-01-01

    To evaluate the myocardial perfusion during transient coronary occlusion, we attempted to obtain the myocardial scintigraphy during percutaneous transluminal coronary angioplasty (PTCA). Tl-201 was injected at the last inflation of angioplastic balloon and occlusion was kept on for 60 sec. Planar images or SPECT were obtained immediately after PTCA. With this protocol, myocardial perfusion defects were observed during PTCA and fully redistributed 3 hours after Tl injection. Extent of ischemic lesions were almost same as that observed during exercise in two cases without collateral vessels. In a case with well visualized collateral vessels, perfusion defect was smaller in PTCA images than that in exercise stressed images. We conclude that intravenous injection of Tl-201 during PTCA is useful to assess the alteration of myocardial perfusion due to transient coronary occlusion without increasing the risk of angioplastic procedure. (author)

  14. Tc99m-sestamibi dosimetry in myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Toledo, Janine M.; Trindade, Bruno M.; Campos, Tarcisio P.R.

    2015-01-01

    This paper addressed myocardial perfusion imaging providing a spatial dosimetric investigation of the 99m Tc-radiopharmaceutical dose distribution at the myocardium. Radiological data manipulation was performed in order to create a computational voxel model of the heart. A set of images obtained by thoracic angiotomography and abdominal aorta was set up providing anatomic and functional information for heart modeling in SISCODES code. A homogeneous distribution of 99m Tc was assumed into the cardiac muscle. Simulations of the transport of particles through the voxel and the interaction with the heart tissues were performed on the MCNP - Monte Carlo Code. The spatial dose distribution in the heart model is displayed as well as the dose versus volume histogram of the heart muscle. The present computational tools can generate spatial doses distribution in myocardial perfusion imaging. Specially, the dosimetry performed elucidates imparted dose distribution in the myocardial muscle per unit of injected 99m Tc activity, which can contribute to future deterministic effect investigations. (author)

  15. ECG-gated scintillation probe measurement of left ventricular function

    International Nuclear Information System (INIS)

    Bacharach, S.L.; Green, M.V.; Borer, J.S.; Ostrow, H.G.; Redwood, D.R.; Johnston, G.S.

    1977-01-01

    A nonimaging, ECG-gated scintillation-probe system is described that permits real-time quantification, at high temporal resolution, of the time variation of left ventricular (LV) volume over a complete, average cardiac cycle. Linearity between counting rate and volume, probe positioning, and background correction were investigated for both cylindrically collimated (CC) and parallel-hole-collimated (PC) detectors. In 53 patient studies, results obtained with these probes were compared with results obtained from an ECG-gated gamma camera system (CS) with high temporal resolution. Time-activity curves obtained by all three devices were essentially identical in shape (for CC against CS, r = 0.93; for PC against CS, r = 0.98) and in intracycle timing. Left-ventricular ejection fractions obtained with the probes showed workable agreement with the camera: for CC against CS, r = 0.85 (N = 31); for PC against CS, r = 0.90 (N = 21). When LV background is removed as a source of error, the correlation between (PC) probe and camera is improved (r = 0.95, N = 21). This suggests that the portable probe system be used in circumstances where exact knowledge of LV background is minimally important--e.g., continuous bedside monitoring of changes in LV function

  16. Measurement of extracellular volume and transit time heterogeneity using contrast-enhanced myocardial perfusion MRI in patients after acute myocardial infarction.

    Science.gov (United States)

    Kunze, Karl P; Rischpler, Christoph; Hayes, Carmel; Ibrahim, Tareq; Laugwitz, Karl-Ludwig; Haase, Axel; Schwaiger, Markus; Nekolla, Stephan G

    2017-06-01

    To assess the ability of dynamic contrast-enhanced myocardial perfusion MRI to measure extracellular volume (ECV) and to investigate the possibility of estimating capillary transit time heterogeneity (CTH) in patients after myocardial infarction and successful revascularization. Twenty-four perfusion data sets were acquired on a 3 Tesla positron emission tomography (PET)/MRI scanner. Three perfusion models of different complexity were implemented in a hierarchical fashion with an Akaike information criterion being used to determine the number of fit parameters supported by the data. Results were compared sector-wise to ECV from an equilibrium T 1 mapping method (modified look-locker inversion recovery (MOLLI)). ECV derived from the perfusion analysis correlated well with equilibrium measurements (R² = 0.76). Estimation of CTH was supported in 16% of sectors (mostly remote). Inclusion of a nonzero CTH parameter usually led to lower estimates of first-pass extraction and slightly higher estimates of blood volume and flow. Estimation of the capillary permeability-surface area product was feasible in 81% of sectors. Transit time heterogeneity has a measurable effect on the kinetic analysis of myocardial perfusion MRI data, and Gd-DTPA extravasation in the myocardium is usually not flow-limited in infarct-related pathology. Measurement of myocardial ECV using perfusion imaging could provide a scan-time efficient alternative to methods based on T 1 mapping. Magn Reson Med 77:2320-2330, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  17. Reliability of the exercise ECG in detecting silent ischemia in patients with prior myocardial infarction

    International Nuclear Information System (INIS)

    Yamagishi, Takashi; Matsuda, Yasuo; Satoh, Akira

    1991-01-01

    To assess the reliability of the exercise ECG in detecting silent ischemia, ECG results were compared with those of stress-redistribution thallium-201 single-photon emission computed tomography (SPECT) in 116 patients with prior myocardial infarction and in 20 normal subjects used as a control. The left ventricle (LV) was divided into 20 segmental images, which were scored blindly on a 5-point scale. The redistribution score was defined as thallium defect score of exercise subtracted by that of redistribution image and was used as a measure of amount of ischemic but viable myocardium. The upper limit of normal redistribution score (=4.32) was defined as mean+2 standard deviations derived from 20 normal subjects. Of 116 patients, 47 had the redistribution score above the normal range. Twenty-five (53%) of the 47 patients showed positive ECG response. Fourteen (20%) of the 69 patients, who had the normal redistribution score, showed positive ECG response. Thus, the ECG response had a sensitivity of 53% and a specificity of 80% in detecting transient ischemia. Furthermore, the 116 patients were subdivided into 4 groups according to the presence or absence of chest pain and ECG change during exercise. Fourteen patients showed both chest pain and ECG change and all these patients had the redistribution score above the normal range. Twenty-five patients showed ECG change without chest pain and 11 (44%) of the 25 patients had the abnormal redistribution. Three (43%) of 7 patients who showed chest pain without ECG change had the abnormal redistribution score. Of 70 patients who had neither chest pain nor ECG change, 19 (27%) had the redistribution score above the normal range. Thus, limitations exist in detecting silent ischemia by ECG in patients with a prior myocardial infarction, because the ECG response to the exercise test may have a low degree of sensitivity and a high degree of false positive and false negative results in detecting silent ischemia. (author)

  18. Long-term cigarette smoking is associated with increased myocardial perfusion heterogeneity assessed by positron emission tomography

    International Nuclear Information System (INIS)

    Meeder, J.G.; Blanksma, P.K.; Wall, E.E. van der; Anthonio, R.L.; Willemsen, A.T.M.; Pruim, J.; Vaalburg, W.; Lie, K.I.

    1996-01-01

    The pathophysiology of smoking-related coronary events in patients with normal coronary arteries is incompletely understood. This study was conducted to explore, in subjects without symptoms of cardiovascular disease, the long-term effects of smoking on regional coronary artery vasoactivity, especially during sympathetic stimulation. In ten smoking and ten non-smoking sex- and age-matched healthy volunteers, segmental myocardial perfusion was studied using dynamic parametric nitrogen-13 ammonia positron emission tomography at rest and during sympathetic stimulation evoked by the cold pressor stimulation. Smokers demonstrated a higher myocardial perfusion at rest (116±17 ml/min/100 g vs 96±20 ml/min/100 g, P <0.01) and an impaired myocardial perfusion increase during cold pressor stimulation (1.02±0.15 vs 1.18±0.17, P <0.05). The heterogeneity of perfusion, expressed as coefficient of variation, was significantly different between the smoking and the non-smoking group. The coefficient of variation of segmental myocardial perfusion was higher in smokers at rest (17.5%±4.2% vs 13.5%±1.9%, P <0.05) and during cold pressor stimulation (17.0%±3.2% vs 13.9%±1.8%, P <0.05). We conclude that the long-term effects of smoking in healthy volunteers are associated with (1) increased myocardial perfusion at rest, (2) impaired myocardial perfusion response to cold pressor stimulation, and (3) increased myocardial perfusion heterogeneity both at rest and during cold pressor stimulation. These results may suggest that in healthy subjects the long-term effect of smoking is related to abnormal coronary artery vasoactivity, presumably induced by an interplay of regional endothelial dysfunction and autonomic dysregulation. (orig.). With 1 fig., 1 tab

  19. Low flip angle spin-echo MR imaging to obtain better Gd-DTPA enhanced imaging with ECG gating

    International Nuclear Information System (INIS)

    Sugimura, Kazuro; Kawamitsu, Hideaki; Yoshikawa, Kazuaki; Kasai, Toshifumi; Yuasa, Koji; Ishida, Tetsuya

    1992-01-01

    ECG-gated spin-echo imaging (ECG-SE) can reduce physiological motion artifact. However, ECG-SE does not provide strong T1-weighted images because repetition time (TR) depends on heart rate (HR). We investigated the usefulness of low flip angle spin-echo imaging (LFSE) in obtaining more T1-dependent contrast with ECG gating. In computer simulation, the predicted image contrast and single-to-noise ratio (SNR) obtained for each flip angle (0-180deg) and each TR (300 msec-1200 msec) were compared with those obtained by conventional T1-weighted spin-echo imaging (CSE: TR=500 msec, TE=20 msec). In clinical evaluation, tissue contrast [contrast index (CI): (SI of lesion-SI of muslce) 2* 100/SI of muscle] obtained by CSE and LFSE were compared in 17 patients. At a TR of 1,000 msec, T1-dependent contrast increased with decreasing flip angle and that at 38deg was identical to that with T1-weighted spin-echo. SNR increased with the flip angle until 100deg, and that at 53deg was identical to that with T1-weighted spin-echo. CI on LFSE (74.0±52.0) was significantly higher than CI on CSE (40.9±35.9). ECG-gated LFSE imaging provides better T1-dependent contrast than conventional ECG-SE. This method was especially useful for Gd-DTPA enhanced MR imaging. (author)

  20. [Acute stent thrombosis and reverse transient left ventricular dilatation after performing a single-photon emission computed tomography myocardial perfusion].

    Science.gov (United States)

    Miranda, B; Pizzi, M N; Aguadé-Bruix, S; Domingo, E; Candell-Riera, J

    2015-01-01

    A 63-year-old male patient with a history of stent implantation in the left anterior descending three months before. Due to the presentation of vegetative symptoms, he was referred for gated-SPECT myocardial perfusion. During acquisition of the resting images he presented chest pain and ST segment elevation, so that urgent cardiac catheterization was performed, showing stent thrombosis. Rest perfusion imaging showed a defect in anterior and apical perfusion, more severe and extensive than in the stress images, with striking left ventricular dilatation and a fall in the ejection fraction related to the acute ischemia phenomenon. Intense exercise is associated with a transient activation of the coagulation system and hemodynamic changes that might induce thrombosis, especially in recently implanted coronary stents that probably still have not become completely endothelialized. Copyright © 2014 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  1. Myocardial perfusion studies in coronary diseases

    International Nuclear Information System (INIS)

    Mut, Fernando

    1994-01-01

    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

  2. Perfusion scintigraphy in acute myocardial infarction

    International Nuclear Information System (INIS)

    Schricke, U.; Schwaiger, M.; Kastrati, A.; Schoemig, A.

    1999-01-01

    The Tc-99m sestamibi perfusion SPECT scintigraphy in acute myocardial infarction is a feasible method to assess the size of area at risk and the residual blood flow to this area as the most important determinants of final infarct size without any delay in treatment. In combination with a follow-up study final infarct size as well as myocardial salvage can be quantified. Clinical indications for the use of Tc-99m sestamibi scintigraphy are the noninvasive identification of arterial occlusion in patients suspected to acute myocardial infarction without electrocardiographic ST-elevation and the assessment of reperfusion success. In clinical trials Tc-99m sestamibi scintigraphy has proven to be a useful method to assess the impact of varying reperfusion therapies. The present review article discusses the indication, the study protocol, the interpretation of results and the clinical and scientifically importance of this method. (orig.) [de

  3. Prospectively ECG-triggered sequential dual-source coronary CT angiography in patients with atrial fibrillation: comparison with retrospectively ECG-gated helical CT

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Lei; Yang, Lin; Zhang, Zhaoqi [Capital Medical University, Department of Radiology, Beijing Anzhen Hospital, Beijing (China); Wang, Yining; Jin, Zhengyu [Chinese Academy of Medical Sciences, Department of Radiology, Peking Union Medical College Hospital, Beijing (China); Zhang, Longjiang; Lu, Guangming [Nanjing University, Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing, Jiangsu (China)

    2013-07-15

    To investigate the feasibility of applying prospectively ECG-triggered sequential coronary CT angiography (CCTA) to patients with atrial fibrillation (AF) and evaluate the image quality and radiation dose compared with a retrospectively ECG-gated helical protocol. 100 patients with persistent AF were enrolled. Fifty patients were randomly assigned to a prospective protocol and the other patients to a retrospective protocol using a second-generation dual-source CT (DS-CT). Image quality was evaluated using a four-point grading scale (1 = excellent, 2 = good, 3 = moderate, 4 = poor) by two reviewers on a per-segment basis. The coronary artery segments were considered non-diagnostic with a quality score of 4. The radiation dose was evaluated. Diagnostic segment rate in the prospective group was 99.4 % (642/646 segments), while that in the retrospective group was 96.5 % (604/626 segments) (P < 0.001). Effective dose was 4.29 {+-} 1.86 and 11.95 {+-} 5.34 mSv for each of the two protocols (P < 0.001), which was a 64 % reduction in the radiation dose for prospective sequential imaging compared with retrospective helical imaging. In AF patients, prospectively ECG-triggered sequential CCTA is feasible using second-generation DS-CT and can decrease >60 % radiation exposure compared with retrospectively ECG-gated helical imaging while improving diagnostic image quality. (orig.)

  4. Dipyridamole-thallium-201 tomography documenting improved myocardial perfusion with therapy in Kawasaki disease

    International Nuclear Information System (INIS)

    Nienaber, C.A.; Spielmann, R.P.; Hausdorf, G.

    1988-01-01

    Thallium-201 tomographic perfusion studies after pharmacologic vasodilation were performed in seven children (aged 2 years 8 months to 8 years 7 months), 3 to 20 months after the acute stage of the disease. In all patients coronary aneurysms were seen on cross-sectional echocardiograms. The scintigrams of six children showed no significant regional reduction of myocardial thallium-201 uptake. These children had remained asymptomatic in the follow-up period after the acute inflammatory stage of Kawasaki disease. Persistent and transient thallium defects were present in one child with acute posterolateral myocardial infarction; obstruction of two coronary vessels supplying the defect zones was confirmed by contrast angiography. After 8 months of treatment a follow-up nuclear scan showed marked reduction in the size of the defect and almost complete abolishment of the ischemic reaction. Thus tomographic thallium-201 perfusion scintigraphy in conjunction with vasodilation stress is useful to assess myocardial perfusion in children with Kawasaki disease and demonstrates marked improvement in regional perfusion after adequate medical therapy

  5. Thallium-201 myocardial perfusion imaging during transient coronary occlusion at the time of PTCA

    International Nuclear Information System (INIS)

    Nakagawa, Tatsuya; Sugihara, Hiroki; Inagaki, Suetsugu

    1989-01-01

    To evaluate myocardial perfusion during transient coronary arterial occlusion, thallium-201 was administered intravenously during percutaneous transluminall coronary angioplasty (PTCA) in 12 patients with effort angina, and the resulting perfusion images were compared with those of exercise stress obtained before PTCA. Thallium-201 was injected at the last inflation of an angioplastic baloon and occlusion was maintained for 60 to 90 sec. Three projections of planar images were obtained immediately after PTCA, using a portable gamma camera in an angiography room. These perfusion images obtained during PTCA and exercise were visually interpreted and compared. Myocardial perfusion defects due to the responsible vessel occlusion were observed at early imaging after PTCA, and were fully redistributed three hrs post injection. In 10 patients without angiographically imaged collateral vessels, there were no significatn differences in perfusion between images during PTCA and during exercise. Two patients whose collaterals were observed during coronary angiography before PTCA had higher perfusion scores during PTCA than during exercise. We concluded that intravenous injection of thallium-201 during PTCA is a useful means for assessing alteration of myocardial perfusion due to transient coronary occlusion without increasing the risk of angioplastic procedures, and that it provides more precise information about the jeopardized myocardium, perfused by antegrade blood flow. (author)

  6. ECG strain pattern in hypertension is associated with myocardial cellular expansion and diffuse interstitial fibrosis: a multi-parametric cardiac magnetic resonance study.

    Science.gov (United States)

    Rodrigues, Jonathan C L; Amadu, Antonio Matteo; Ghosh Dastidar, Amardeep; McIntyre, Bethannie; Szantho, Gergley V; Lyen, Stephen; Godsave, Cattleya; Ratcliffe, Laura E K; Burchell, Amy E; Hart, Emma C; Hamilton, Mark C K; Nightingale, Angus K; Paton, Julian F R; Manghat, Nathan E; Bucciarelli-Ducci, Chiara

    2017-04-01

    In hypertension, the presence of left ventricular (LV) strain pattern on 12-lead electrocardiogram (ECG) carries adverse cardiovascular prognosis. The underlying mechanisms are poorly understood. We investigated whether hypertensive ECG strain is associated with myocardial interstitial fibrosis and impaired myocardial strain, assessed by multi-parametric cardiac magnetic resonance (CMR). A total of 100 hypertensive patients [50 ± 14 years, male: 58%, office systolic blood pressure (SBP): 170 ± 30 mmHg, office diastolic blood pressure (DBP): 97 ± 14 mmHg) underwent ECG and 1.5T CMR and were compared with 25 normotensive controls (46 ± 14 years, 60% male, SBP: 124 ± 8 mmHg, DBP: 76 ± 7 mmHg). Native T1 and extracellular volume fraction (ECV) were calculated with the modified look-locker inversion-recovery sequence. Myocardial strain values were estimated with voxel-tracking software. ECG strain (n = 20) was associated with significantly higher indexed LV mass (LVM) (119 ± 32 vs. 80 ± 17 g/m2, P ECG strain (n = 80). ECG strain subjects had significantly impaired circumferential strain compared with hypertensive subjects without ECG strain and controls (-15.2 ± 4.7 vs. -17.0 ± 3.3 vs. -17.3 ± 2.4%, P ECG strain subjects to hypertensive subjects with elevated LVM but no ECG strain, a significantly higher ECV (30 ± 4 vs. 28 ± 3%, P ECG strain in multivariate logistic regression analysis [odds ratio (95th confidence interval): 1.07 (1.02-1.12), P ECG strain is a marker of advanced LVH associated with increased interstitial fibrosis and associated with significant myocardial circumferential strain impairment. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

  7. The consequences of a new software package for the quantification of gated-SPECT myocardial perfusion studies

    International Nuclear Information System (INIS)

    Veen, Berlinda J. van der; Dibbets-Schneider, Petra; Stokkel, Marcel P.M.; Scholte, Arthur J.

    2010-01-01

    Semiquantitative analysis of myocardial perfusion scintigraphy (MPS) has reduced inter- and intraobserver variability, and enables researchers to compare parameters in the same patient over time, or between groups of patients. There are several software packages available that are designed to process MPS data and quantify parameters. In this study the performances of two systems, quantitative gated SPECT (QGS) and 4D-MSPECT, in the processing of clinical patient data and phantom data were compared. The clinical MPS data of 148 consecutive patients were analysed using QGS and 4D-MSPECT to determine the end-diastolic volume, end-systolic volume and left ventricular ejection fraction. Patients were divided into groups based on gender, body mass index, heart size, stressor type and defect type. The AGATE dynamic heart phantom was used to provide reference values for the left ventricular ejection fraction. Although the correlations were excellent (correlation coefficients 0.886 to 0.980) for all parameters, significant differences (p < 0.001) were found between the systems. Bland-Altman plots indicated that 4D-MSPECT provided overall higher values of all parameters than QGS. These differences between the systems were not significant in patients with a small heart (end-diastolic volume <70 ml). Other clinical factors had no direct influence on the relationship. Additionally, the phantom data indicated good linear responses of both systems. The discrepancies between these software packages were clinically relevant, and influenced by heart size. The possibility of such discrepancies should be taken into account when a new quantitative software system is introduced, or when multiple software systems are used in the same institution. (orig.)

  8. First-pass myocardial perfusion MR imaging with gadolinium-enhanced turbo FLASH

    International Nuclear Information System (INIS)

    Teresi, L.M.; Smith, C.; Messenger, J.; Watanabe, A.; Herbst, M.; O'Sullivan, R.M.; Lee, R.; Remer, J.; Rappaport, A.; Bradley, W.G.

    1990-01-01

    This paper determines the efficacy of MR first-pass myocardial perfusion imaging using gadolinium-enhanced Turbo--fast low-angle shot (FLASH) ultrafast imaging combined with MR systolic wall thickening data for the determination of myocardial viability. Five normal volunteers and five patients with remote myocardial infarction were studied on a 1.5-T imaging system (Siemans, Ehrlangen, NJ). Turbo-FLASH imaging utilized a 180 degrees inversion pulse followed by a rapid gradient-echo sequence (TI 400 msec, TE2 msec, TR 4.9 msec, FA 8 degrees) with a complete 64 x 64 matrix image (300 mm FOV) being acquired in 300 msec. First-pass myocardial perfusion imaging was performed in the short-axis and long-axis oblique projections with a concantenated series of Turbo-FLASH images triggered to end-systole acquired immediately before and during a rapid bolus injection of 5cc gadolinium-DTPA

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

    International Nuclear Information System (INIS)

    Wang Ruihua; Ruan Qiao; Sun Ke; Han Xingmin; Sun Bingqi; Xie Xinli; Cheng Bing; Chen Yanlin; Liu Baoping

    2013-01-01

    Objective: To compare the results of 99 Tc m -tetrofosmin (TF) and 99 Tc m -MIBI G-MPI in evaluating left ventricular myocardial perfusion and other functional parameters. Methods: TF and MIBI were both labeled by 99 Tc m 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 99 Tc m -TF group (47 patients) and 99 Tc m -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 99 Tc m -TF G-MPI and two-day 99 Tc m -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 χ 2 test, two-sample t test, paired t test and linear correlation analysis by SPSS 17.0. Results: The radiochemical purities of 99 Tc m -TF and 99 Tc m -MIBI were (97.5±0.4) % and (99.1±0.2) % respectively. The coincidence rates of 99 Tc m -TF and 99 Tc m -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 (χ 2 =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

  10. Coronary Artery Stent Evaluation Using a Vascular Model at 64-Detector Row CT: Comparison between Prospective and Retrospective ECG-Gated Axial Scans

    International Nuclear Information System (INIS)

    Suzuki, Shigeru; Furui, Shigeru; Kaminaga, Tatsuro; Miyazawa, Akiyoshi; Ueno, Yasunari; Konno, Kumiko; Kuwahara, Sadatoshi; Mehta, Dhruv

    2009-01-01

    We wanted to evaluate the performance of prospective electrocardiogram (ECG)-gated axial scans for assessing coronary stents as compared with retrospective ECG-gated helical scans. As for a vascular model of the coronary artery, a tube of approximately 2.5-mm inner diameter was adopted and as for stents, three (Bx-Velocity, Express2, and Micro Driver) different kinds of stents were inserted into the tube. Both patent and stenotic models of coronary artery were made by instillating different attenuation (396 vs. 79 Hounsfield unit [HU]) of contrast medium within the tube in tube model. The models were scanned with two types of scan methods with a simulated ECG of 60 beats per minute and using display field of views (FOVs) of 9 and 18 cm. We evaluated the in-stent stenosis visually, and we measured the attenuation values and the diameter of the patent stent lumen. The visualization of the stent lumen of the vascular models was improved with using the prospective ECG-gated axial scans and a 9-cm FOV. The inner diameters of the vascular models were underestimated with mean measurement errors of -1.10 to -1.36 mm. The measurement errors were smaller with using the prospective ECG-gated axial scans (Bx-Velocity and Express2, p < 0.0001; Micro Driver, p = 0.0004) and a 9-cm FOV (all stents: p < 0.0001), as compared with the other conditions, respectively. The luminal attenuation value was overestimated in each condition. For the luminal attenuation measurement, the use of prospective ECG-gated axial scans provided less measurement error compared with the retrospective ECG-gated helical scans (all stents: p < 0.0001), and the use of a 9-cm FOV tended to decrease the measurement error. The visualization of coronary stents is improved by the use of prospective ECG-gated axial scans and using a small FOV with reduced blooming artifacts and increased spatial resolution

  11. Simultaneous cardiac output and regional myocardial perfusion determination with PET and nitrogen 13 ammonia

    DEFF Research Database (Denmark)

    Hove, Jens D; Kofoed, Klaus F; Wu, Hsiao M

    2003-01-01

    The purpose of this study was to evaluate the possibility of measuring cardiac output during positron emission tomography (PET) examination of myocardial perfusion with nitrogen 13 ammonia.......The purpose of this study was to evaluate the possibility of measuring cardiac output during positron emission tomography (PET) examination of myocardial perfusion with nitrogen 13 ammonia....

  12. Comparison of Nitrate-augmented resting gated 99mTc-Sestamibi imaging with Low Dose Dobutamine SPECT for the detection of Myocardial Viability

    International Nuclear Information System (INIS)

    Parameswaran, R.V.; Dash, P.K.; Barooah, B.; Guruprasad, H.P.; Purantharan, N.

    2002-01-01

    Background: Dobutamine Echocardiography and Radionuclide imaging with Tl-201 and Technetium agents are two of the most established techniques available for the detection of viable myocardium. The purpose of this study was to evaluate the utility of Low dose Dobutamine gated Myocardial SPECT in identifying additional areas of dysfunctional, but viable myocardium when compared to nitrate-augmented rest gated SPECT with SestaMIBI. Materials and Methods: 20 patients (19 males and 1 female, with an age range of 40- 65 yrs and a mean of 52.75yrs) all with history of MI or severe LV dysfunction were included in this study. Patients with LBBB, recent revascularisation, arrhythmias etc were excluded from the study. A routine stress-rest study was initially performed on them with 99mTc-SestaMIBI and both the stress as well as resting studies was gated and the resting study was augmented with 10mg of sublingual nitrate. After the resting study was over, the patient was infused with Low dose Dobutamine(5μg/kg/min), at which time the gated acquisition was started and the infusion was continued till the acquisition got completed. In the perfusion study with SestaMIBI, all infarct segments which have uptake less than 50% as compared to the maximally perfused area was deemed non-viable Results: A 17-segment Myocardial model was used for both perfusion as well as quantification of wall motion and wall thickening. 110 akinetic/dyskinetic segments were taken up for analysis. 93 of these segments were non-viable and improvement in wall motion was seen in 17 segments (15.4%) in the nitrate-augmented SPECT. Dobutamine study showed improvement in totally in 27 segments (24.5%), 10 of which were additional segments which were non-viable in Nitrate SPECT study, apart from the 17 segments which showed improvement in the Nitrate study. In Dobutamine study, there was also improvement in wall thickening in 10 (10.7%) out of 93 segments which had showed less than 50% of MIBI uptake. Conclusion

  13. Usefulness of {sup 201}Tl myocardial perfusion SPECT in prediction of left ventricular remodeling following an acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Seok Nam; Park, C. H.; Hwang, Kyung Hoon [Ajou Univ. College of Medicine, Suwon (Korea, Republic of)

    2000-02-01

    We investigated the role of myocardial perfusion SPECT in prediction of ventricular dilatation and the role of revascularization including thrombolytic therapy and PTCA in prevention of ventricular dilatation after an acute myocardial linfarction (AMI). We performed dipyridamole stress, 4 hour redistribution, and 24 hour reinjection Tl-201 SPECT in 6 patients with AMI two to nine days after attack. Perfusion and wall motion abnormalities were quantified by perfusion index(PI) and wall motion index (WMI). Left ventricular ejection fraction (LVEF), WMI and ventricular volume were measured within 1 week of AMI and after average of 6 months. According to serial changes of left ventricular end-diastolic volume (LVEDV), patients were divided into two groups. We compared WMI, PI and LVEF between the two groups. Relationships among degree of volume, stress-rest PI, WMI, CKMB,Q wave, LVEF and revascularization were analysed using multivariate analysis. Only initial rest perfusion index was significantly different between the two groups (p<0.05). While initial LVEF, stress PI, CKMB, trial of revascularization procedure, presence of Q wave and WMI were not significantly different between the two groups. Eight of 16 patients (50%) showed LV dilatation on follow-up echocardiography. Three of 3 patients (100%) who did not undergo revascualrization procedure documented LV dilatation. And only 5 (38%) of the remaining 13 patients who underwent revascularization revealed LV dilatation. There was no difference in infarct location between the two groups. By multivariate linear regression analysis in patients only undergoing revascularization, rest perfusion index was the only significant factor. Myocardial perfusion SPECT performed prior to revascularization was useful in prediction of LV dilatation after an AMI. Rest perfusion index on myocardial perfusion plays as a significant predictor of left ventricular dilatation after AMI. And revascularization appears to be a valuable

  14. Role of myocardial perfusion scintigraphy post invasive coronary angiography in patients with myocardial infarction

    International Nuclear Information System (INIS)

    Harisankar, C.N.B.; Mittal, Bhagwant Rai; Kamaleshwaran, K.K.; Bhattacharya, Anish; Singh, Baljinder; Mahajan, Rajiv

    2010-01-01

    The presence of severe hypokinesia or akinesia and near complete stenotic lesions on coronary angiography, in a patient with acute myocardial infarction raises a question of viability in the involved territory and its response to revascularization. The decision of revascularization can be effectively taken after myocardial perfusion scintigraphy (MPS). Aim: To evaluate the role of MPS in patients with acute or recent myocardial infarction after invasive coronary angiography. Materials and Methods: Thirty-five patients (27 Males, 8 Females; Mean age 54 years) with acute myocardial infarction, who underwent invasive angiography, were included prospectively. Invasive angiography was attempted during the episode of acute chest pain in 20 patients. Fifteen patients underwent angiography without MPS because of non-availability of MPS at the time of initial presentation in the referring hospital. Revascularization was deferred because of complete/near complete block of artery with hypokinesia/akinesia of the distal LV segments in 32/35 patients and 50 to 70% block in 3/35. These patients were subjected to MPS. Results: Twenty patients underwent stress MPS and 15 underwent nitrate-augmented rest re-distribution study (RR study). Imaging was performed using the hybrid SPECT/CT system. The average defect size of the perfusion defect was 34% (5 - 57% range). Sixteen patients (46%) had fixed perfusion defects. Reversible ischemia was present in 19 (54%). Ten patients had a 10% of the LV myocardium, and underwent the invasive revascularization procedure. Conclusion: MPS is invaluable in patients who have total/near total occlusion of the coronary artery and distal segment hypokinesia or akinesia on invasive angiography. One in four patients, deemed to have non-viable myocardium, underwent an invasive revascularization after undergoing MPS. (author)

  15. Changes in myocardial perfusion due to physical exercise in patients with stable coronary artery disease

    International Nuclear Information System (INIS)

    Kendziorra, Kai; Foerster, Marcus; Sabri, Osama; Kluge, Regine; Walther, Claudia; Moebius-Winkler, Sven; Conradi, Katrin; Schuler, Gerhard; Hambrecht, Rainer

    2005-01-01

    Percutaneous transluminal coronary angioplasty (PTCA) is one of the main therapy options for patients with coronary artery disease (CAD), resulting in an improvement in myocardial perfusion and exercise capacity. Nevertheless, studies have also demonstrated a positive effect of regular exercise training on myocardial perfusion and maximum exercise capacity. The aim of this study was to evaluate changes in myocardial stress perfusion after 1 year of exercise training in comparison with the effects of PTCA in patients with CAD. In 66 male patients with angiographically confirmed significant coronary artery stenosis in one target vessel, myocardial perfusion scintigraphy was performed at baseline and 12 months after randomisation into either a physical exercise group or a PTCA group. Circumferential count rate profiles in 16 wall segments were classified according to their relative count rate and localisation within or outside the area supplied by the stenosed vessel. Ischaemic segments showed a significant improvement in myocardial count rate within the target area after 12 months in both the PTCA and the training group (PTCA group: from 76.8±4.9% to 86.6±10.9%, p=0.03; training group: from 74.0±7.3% to 83.7±10.8%, p<0.01). Outside the target area only the training group showed a significant improvement (from 77.7±4.4% to 91.7±4.8%, p<0.01). Our data indicate a significant improvement in stress myocardial perfusion in the training group after 12 months. The ischaemia is reduced not only in the target region of the leading stenosis but also in other ischaemic myocardial areas. In contrast, after PTCA stress perfusion improves only in the initially ischaemic parts of the target area. (orig.)

  16. Gated SPECT evaluation of myocardial perfusion defects and left ventricular function in chronic atrial fibrillation (CAF) patients - a prevalence study between a General Hospital (GH) and a referral Cardiology Hospital (CH)

    International Nuclear Information System (INIS)

    Rocha, G.; Guimaraes, M.; Marroni, B.; Zagoury, E.; Sprinz, C.; Andrea, S.; Louzada, A.; Ludwig, R.; Graef, C.

    2002-01-01

    Aims: to evaluate myocardial perfusion defects (MPD) prevalence and left ventricular function in CAF patients from a distinct referral basis (a GH and CH populations). Materials and Methods: a retrospective cross-sectional survey including 171 CAF (43 from GH and 128 from CH) and 5415 control patients (2222 from GH and 3193 from CH) submitted to rest/stress myocardial perfusion gated SPECT with Tc99m-MIBI. The following items were collected from CAF patients: the percentage of patients with MPD, the type (fixed, reversible or mixed) and number of segments with MPD and left ventricular ejection fraction (LVEF). The control patients percentage of MPD, their type and number were also collected. Results: CAF from GH and CH were not significantly different in the number of patients with MPD, mean number of segments affected, and LVEF. In GH patients, the CAF group had more segments with MPD (2,4x1,6 p<0,01) and lower LVEF (37%x52% p<0,01) than control group. CAF patients from CH also showed lower LVEF (40%x58% p<0,01) and more fixed MPD (40%x18% p<0,01) than their control group population. Conclusion: our data showed similar prevalence of MPD and reduced LVEF values between CAF patients from a GH and referral CH. The CAF group from CH seemed to have more fixed MPD perhaps reflecting more severe coronary artery disease population or referral bias. The data appears to support the evaluation of myocardial ischemia as a part of CAF possible etiologies. Caution is advised in LVEF evaluation of CAF patients due to increased variability of R-R interval

  17. Ventricular dyssynchrony assessed by gated myocardial perfusion SPECT using a geometrical approach: a feasibility study

    International Nuclear Information System (INIS)

    Veen, Berlinda J. van der; Younis, Imad Al; Ajmone-Marsan, Nina; Bax, Jeroen J.; Westenberg, Jos J.M.; Roos, Albert de; Stokkel, Marcel P.M.

    2012-01-01

    Left ventricular dyssynchrony may predict response to cardiac resynchronization therapy and may well predict adverse cardiac events. Recently, a geometrical approach for dyssynchrony analysis of myocardial perfusion scintigraphy (MPS) was introduced. In this study the feasibility of this geometrical method to detect dyssynchrony was assessed in a population with a normal MPS and in patients with documented ventricular dyssynchrony. For the normal population 80 patients (40 men and 40 women) with normal perfusion (summed stress score ≤2 and summed rest score ≤2) and function (left ventricular ejection fraction 55-80%) on MPS were selected; 24 heart failure patients with proven dyssynchrony on MRI were selected for comparison. All patients underwent a 2-day stress/rest MPS protocol. Perfusion, function and dyssynchrony parameters were obtained by the Corridor4DM software package (Version 6.1). For the normal population time to peak motion was 42.8 ± 5.1% RR cycle, SD of time to peak motion was 3.5 ± 1.4% RR cycle and bandwidth was 18.2 ± 6.0% RR cycle. No significant gender-related differences or differences between rest and post-stress acquisition were found for the dyssynchrony parameters. Discrepancies between the normal and abnormal populations were most profound for the mean wall motion (p value <0.001), SD of time to peak motion (p value <0.001) and bandwidth (p value <0.001). It is feasible to quantify ventricular dyssynchrony in MPS using the geometrical approach as implemented by Corridor4DM. (orig.)

  18. Myocardial perfusion in patients with left bundle branch block and without coronary artery disease

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa; Honda, Minoru

    1992-01-01

    For the evaluation of myocardial perfusion in patients with left bundle branch block (LBBB), we performed exercise stress (Ex)-redistribution (RD) myocardial tomography with thallium-201 ( 201 Tl) in 23 patients with LBBB and without coronary artery disease (CAD). Myocardial images in patients with LBBB were compared with those of 9 patients with CAD who showed Ex induced transient septal defect. Bull'-eye maps ( 201 Tl distribution maps at Ex and RD and 201 Tl washout rate [WOR] map) were made from myocardial tomograms. In 23 patients with LBBB, 15 patients (65%) developed myocardial perfusion abnormality. In 10 (67%) of these 15 patients, transient perfusion defect appeared in the entire septum (diffuse type). On the other hand in 5 patients (33%), localized fixed perfusion defect developed at the boundary between septum and anterior wall (focal type). In focal type, every patient had other disease such as hypertension, aortic stenosis or sick sinus syndrome. While in patients with diffuse type, other diseases were observed in 30% (p 201 Tl WOR and 201 Tl uptake ratio of septum to lateral wall indicated that exercise induced septal defect was slighter in diffuse type than CAD. These points might be useful to differentiate whether CAD participates in the septal defect or not in patients with LBBB. (author)

  19. Homocysteine plasma levels in patients suspected coronary artery disease: Relation to myocardial perfusion image

    International Nuclear Information System (INIS)

    Yao, Z.Y.; He, Q.; Qu, W.

    2002-01-01

    Purpose: Although there is considerable epidemiologic evidence for a relationship between plasma homocysteine (Hcy) levels and coronary artery disease (CAD), not all studies, especially prospective ones have shown such a relationship. The purpose of this study was to investigate a possible association between Hcy plasma levels and myocardial perfusion defect by SPECT in patients suspected CAD. Methods and Materials: A cohort of 238 patients suspected CAD (age: 60.65±10.43, male to female: 172: 66) was examined for Hcy, tetrahydrofolic acid (FH4), vitamine B12 and coronary angiography (CAG). Furthermore, 42 patients also underwent 99m Tc-MIBI myocardial perfusion images (MPI) to assess the myocardial perfusion. Results: There were 69 patients with normal CAG and 63, 60, 42 and 4 patients with 1 vessel, two vessel, 3 vessel and left main coronary stenosis. The plasma Hcy of this group was significantly increased, p 0.05. In patients with >=3 segments myocardial perfusion defect, 10 of them had normal Hcy, and 7 with hyperhomocysteinemia, in patients with 0.05). Conclusion: Our data may indicate that hyperhomocysteinemia represents an independent risk factor in patients with high possibility of CAD rather than a mark of myocardial ischemia or coronary stenosis

  20. Correlation of the myocardial perfusion corrected by attenuation with the coronariography. Preliminary results; Correlacion de la perfusion miocardica corregida por atenuacion con la coronariografia

    Energy Technology Data Exchange (ETDEWEB)

    Garcia C, S.E.; Garcia O, R. [Servicio de Medicina Nuclear, Centro Medico ABC, Campis Observatorio, IAP (Mexico)

    2005-07-01

    The attenuation that suffers the radiation in the soft tissues of the hinders the appropriate interpretation of the myocardial perfusion studies, for what have been implemented attenuation correction systems to reduce the attenuation for soft tissues and to provide myocardial perfusion images more accurate in the diagnosis of coronary illness. The objective was to evaluate the utility of an attenuation correction system (with source of Gadolinium 153) to minimize the devices that look like true defects of myocardial perfusion, caused by soft tissues (mammary tissue, thoracic wall, abdomen, left hemi diaphragm), and to compare those interpretations of the studies with the interpretations of the corresponding coronariographies. The method consists of 95 electronic files which were revised with the concept of heart catheterization, being identified 20 patients from the masculine sex to those that underwent coronariography among May 1999 and December 2002, and that they had study of myocardial perfusion in a maximum period of 3 months foresaw to the invasive procedure. (Author)

  1. Gated listmode acquisition with the QuadHIDAC animal PET to image mouse hearts

    International Nuclear Information System (INIS)

    Schaefers, K.P.; Lang, N.; Stegger, L.; Schober, O.; Schaefers, M.

    2006-01-01

    Purpose: the aim of this study was to develop ECG and respiratory gating in combination with listmode acquisition for the quadHIDAC small-animal PET scanner. Methods: ECG and respiratory gating was realized with the help of an external trigger device (BioVET) synchronized with the listmode acquisition. Listmode data of a mouse acquisition (injected with 6.5 MBq of 18 F-FDG) were sorted according to three different gating definitions: 12 cardiac gates, 8 respiratory gates and a combination of 8 cardiac and 8 respiratory gates. Images were reconstructed with filtered back-projection (ramp filter), and parameters like left ventricular wall thickness (WT), wall-to-wall separation (WS) and blood to myocardium activity ratios (BMR) were calculated. Results: cardiac gated images show improvement of all parameters (WT 2.6 mm, WS 4.1 mm, BRM 2.3) in diastole compared to ungated images (WT 3.0 mm, WS 3.4 mm, BMR 1.3). Respiratory gating had little effect on calculated parameters. Conclusion: ECG gating with the quadHIDAC can improve myocardial image quality in mice. This could have a major impact on the calculation of an image-derived input function for kinetic modelling. (orig.)

  2. Determination of improved myocardial perfusion after aortocoronary bypass surgery by exercise 81Rb scintigraphy

    International Nuclear Information System (INIS)

    Lurie, A.J.; Salel, A.F.; Berman, D.S.; DeNardo, G.L.; Hurley, E.J.; Mason, D.T.

    1976-01-01

    Practical and noninvasive means are needed for evaluating efficacy of coronary bypass surgery (CBS) in improving blood flow (CBF) to ischemic myocardium in coronary patients. Revascularization was assessed in 15 patients by pre- and post-CBS rest and exercise rubidium-81 myocardial images with a scintillation camera equipped with pinhole collimator and high-energy shield. Ischemic areas were detected by decreased 81 Rb activity after exercise compared to rest. Before CBS all patients had exercise angina (EA), positive treadmill ECG (TECG), and abnormal exercise 81 Rb scans. After CBS all 15 patients had increased physical activity before angina or completion of treadmill exercise with increased heart rate-blood pressure product (HRBP) (+63 +/- 3.2 x 10(2) bpm - mm Hg) in 14 of 15 patients indicating increased CBF; four had positive TECG, and five had EA. The increased HRBP in 14 patients was associated with improved post-CBS exercise 81 Rb scans: six had normal patterns while nine were improved with less ischemic patterns. Further, lack of angina and increased exercise tolerance correlated closely with increased 81 Rb myocardial perfusion. Thus pre- and postoperative rest and exercise 81 Rb scintigraphy gives an accurate, noninvasive, objective approach for evaluation of CBF following CBS and demonstrates the usefulness of this revascularization procedure in coronary patients

  3. Myocardial perfusion alterations observed months after radiotherapy are related to the cellular damage

    Energy Technology Data Exchange (ETDEWEB)

    Dogan, I.; Sonmez, B. [Karadeniz Technical Univ., Trabzon (Turkey). Dept. of Nuclear Medicine; Sezen, O.; Zengin, A.Y.; Bahat, Z. [Karadeniz Technical Univ., Trabzon (Turkey). Dept. of Radiation Oncology; Yenilmez, E.; Yulug, E. [Karadeniz Technical Univ., Trabzon (Turkey). Dept. of Histology and Embryology; Abidin, I. [Karadeniz Technical Univ., Trabzon (Turkey). Dept. of Biophysics

    2010-07-01

    Myocardial perfusion scintigraphy (MPS) is one of the widely used tools to follow developing radiation-induced heart disease (RIHD). But the clinical significance of MPS defects has not been fully understood. We have investigated the biodistribution alterations related to perfusion defects following radiotherapy (RT) and showed coexisting morphological changes. Animals, methods: A total of 18 Wistar rats were divided into three groups (1 control and 2 irradiated groups). A single cardiac 20 Gy radiation dose was used to induce long term cardiac defects. Biodistribution studies with technetium ({sup 99m}Tc) sestamibi and histological evaluations were performed 4 and 6 months after irradiation. The percent radioactivity (%ID/g) was calculated for each heart. For determination of the myocardial damage, positive apoptotic cardiomyocytes, myocardial cell degeneration, myocardial fibrosis, vascular damage and ultrastructural structures were evaluated. Results: Six months after treatment, a significant drop of myocardial uptake was observed (p < 0.05). Irradiation-induced apoptosis rose within the first 4 months after radiation treatment and were stayed elevated until the end of the observation period (p < 0.05). Also, the irradiation has induced myocardial degeneration, perivascular and interstitial fibrosis in the heart at the end of six and four months (p < 0.01). The severity and extent of myocardial injury has became more evident at the end of six month (p < 0.05). At ultrastructural level, prominent changes have been observed in the capillary endothelial and myocardial cells. Conclusion: Our findings suggest that the reduced rest myocardial perfusion, occuring months after the radiation, indicates a serious myocard tissue damage which is characterized by myocardial degeneration and fibrosis. (orig.)

  4. Myocardial perfusion alterations observed months after radiotherapy are related to the cellular damage

    International Nuclear Information System (INIS)

    Dogan, I.; Sonmez, B.; Sezen, O.; Zengin, A.Y.; Bahat, Z.; Yenilmez, E.; Yulug, E.; Abidin, I.

    2010-01-01

    Myocardial perfusion scintigraphy (MPS) is one of the widely used tools to follow developing radiation-induced heart disease (RIHD). But the clinical significance of MPS defects has not been fully understood. We have investigated the biodistribution alterations related to perfusion defects following radiotherapy (RT) and showed coexisting morphological changes. Animals, methods: A total of 18 Wistar rats were divided into three groups (1 control and 2 irradiated groups). A single cardiac 20 Gy radiation dose was used to induce long term cardiac defects. Biodistribution studies with technetium ( 99m Tc) sestamibi and histological evaluations were performed 4 and 6 months after irradiation. The percent radioactivity (%ID/g) was calculated for each heart. For determination of the myocardial damage, positive apoptotic cardiomyocytes, myocardial cell degeneration, myocardial fibrosis, vascular damage and ultrastructural structures were evaluated. Results: Six months after treatment, a significant drop of myocardial uptake was observed (p < 0.05). Irradiation-induced apoptosis rose within the first 4 months after radiation treatment and were stayed elevated until the end of the observation period (p < 0.05). Also, the irradiation has induced myocardial degeneration, perivascular and interstitial fibrosis in the heart at the end of six and four months (p < 0.01). The severity and extent of myocardial injury has became more evident at the end of six month (p < 0.05). At ultrastructural level, prominent changes have been observed in the capillary endothelial and myocardial cells. Conclusion: Our findings suggest that the reduced rest myocardial perfusion, occuring months after the radiation, indicates a serious myocard tissue damage which is characterized by myocardial degeneration and fibrosis. (orig.)

  5. Pulmonary artery and right ventricle assessment in pulmonary hypertension. Correlation between functional parameters of ECG-gated CT and right-side heart catheterization

    International Nuclear Information System (INIS)

    Abel, Elodie; Jankowski, Adrien; Pison, Christophe; Bosson, Jean Luc; Bouvaist, Helene; Ferretti, Gilbert R.

    2012-01-01

    Background: Right ventricular function predicts outcome in patients with pulmonary hypertension (PH). Therefore accurate assessment of right ventricular function is essential to graduate severity, assess follow-up, and response to therapy. Purpose: To evaluate whether PH severity could be assessed using electrocardiography-gated CT (ECG-gated CT) functional parameters. A further objective was to evaluate cardiac output (CO) using two ECG-gated CT methods: the reference Simpson technique and the fully automatic technique generated by commercially available cardiac software. Material and Methods: Our institutional review board approved this study; patient consent was not required. Twenty-seven patients who had undergone ECG-gated CT and right heart catheterization (RHC) were included. Two independent observers measured pulmonary artery (PA) diameter, PA distensibility, aorta diameter, right ventricular cardiac output (CT-RVCO) and right ventricular ejection fraction (CT-RVEF) with automatic and Simpson techniques on ECG-gated CT. RHC-CO and mean pulmonary arterial pressure (mPAP) were measured on RHC. Relationship between ECG-gated CT and RHC measurements was tested with linear regression analysis. Results: Inter-observer agreement was good for all measurements (r > 0.7) except for CT-RVCO calculated with Simpson's technique (r = 0.63). Pulmonary artery (PA) distensibility was significantly correlated to mPAP (r = -0.426, P = 0.027). CT-RVEF was correlated with mPAP only when issued from Simpson technique (r = -0.417, P = 0.034). CT-RVEF was not significantly correlated to RHC-CO (P > 0.2). CT-RVCO measured with Simpson technique (r = 0.487, P = 0.010) and automatic segmentation (r = 0.549, P 0.005) correlated equally with RHC-CO. Conclusion: CT-RVEF and CT-RVCO measured on ECG-gated CT are significantly correlated, respectively, to mPAP and RHC-CO in this population with severe reduction of the right ventricular ejection fraction and could be useful for evaluating

  6. Navigator-gated 3D blood oxygen level-dependent CMR at 3.0-T for detection of stress-induced myocardial ischemic reactions.

    Science.gov (United States)

    Jahnke, Cosima; Gebker, Rolf; Manka, Robert; Schnackenburg, Bernhard; Fleck, Eckart; Paetsch, Ingo

    2010-04-01

    This study determined the value of navigator-gated 3-dimensional blood oxygen level-dependent (BOLD) cardiac magnetic resonance (CMR) at 3.0-T for the detection of stress-induced myocardial ischemic reactions. Although BOLD CMR has been introduced for characterization of myocardial oxygenation status, previously reported CMR approaches suffered from a low signal-to-noise ratio and motion-related artifacts with impaired image quality and a limited diagnostic value in initial patient studies. Fifty patients with suspected or known coronary artery disease underwent CMR at 3.0-T followed by invasive X-ray angiography within 48 h. Three-dimensional BOLD images were acquired during free breathing with full coverage of the left ventricle in a short-axis orientation. The BOLD imaging was performed at rest and under adenosine stress, followed by stress and rest first-pass perfusion and delayed enhancement imaging. Quantitative coronary X-ray angiography (QCA) was used for coronary stenosis definition (diameter reduction > or =50%). The BOLD and first-pass perfusion images were semiquantitatively evaluated (for BOLD imaging, signal intensity differences between stress and rest [DeltaSI]; for perfusion imaging, myocardial perfusion reserve index [MPRI]). The image quality of BOLD CMR at rest and during adenosine stress was considered good to excellent in 90% and 84% of the patients, respectively. The DeltaSI measurements differed significantly between normal myocardium, myocardium supplied by a stenotic coronary artery, and infarcted myocardium (p exogenous contrast-enhancement studies. Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  7. Characteristics of myocardial perfusion imaging and coronary artery angiography in patients of NIDDM complicated with AMI

    International Nuclear Information System (INIS)

    Zhao Peiqin; Zhao Jinhua; Qin Mingzhao; Dai HaoJie; Zhang Runwu; Xiao Fen

    2001-01-01

    Objective: To investigate the characteristic changes of myocardial perfusion imaging and coronary artery angiography in patients of acute myocardial infarction (AMI) with underlined type 2 diabetes mellitus. Methods: 25 type 2 diabetes mellitus patients were enrolled for having clinical manifestation of AMI. Ten inpatients with AMI of simple coronary heart disease origin were served as controls. All subjects underwent both myocardial perfusion imagings (resting and nitroglycerine invention) and coronary artery angiography. Results: Compared to controls (40%), type 2 diabetes mellitus + AMI group had higher rate of multivessel disease (60%). For type 2 diabetes mellitus + AMI patients, 129/400 segments (32.25%) showed fixed defect, 25/160 segments (15.62%) in controls. Conclusions: For type 2 diabetes mellitus + AMI group, myocardial perfusion defects are widely distributed and multivessel or severe stenosis is more often presented. Good correlation exists between abnormal segments and angiographic lesions in both the number of segments involved and the severity of the lesions. Radionuclide myocardial perfusion is therefore considered a useful screening test not inferior to angiography, especially for those who are not tolerant enough to undergoing angiography

  8. CT myocardial perfusion imaging. Ready for prime time?

    Energy Technology Data Exchange (ETDEWEB)

    Takx, Richard A.P.; Celeng, Csilla [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Schoepf, U.J. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Ashley River Tower, Heart and Vascular Center, Charleston, SC (United States)

    2018-03-15

    The detection of functional coronary artery stenosis with coronary CT angiography (CCTA) is suboptimal. Additional CT myocardial perfusion imaging (CT-MPI) may be helpful to identify patients with myocardial ischaemia in whom coronary revascularization therapy would be beneficial. CT-MPI adds incremental diagnostic and prognostic value over obstructive disease on CCTA. It allows for the quantitation of myocardial blood flow and calculation of coronary flow reserve and shows good correlation with {sup 15}O-H{sub 2}O positron emission tomography and invasive fractional flow reserve. In addition, patients prefer CCTA/CT-MPI over SPECT, MRI and invasive coronary angiography. CT-MPI is ready for clinical use for detecting myocardial ischaemia caused by obstructive disease. Nevertheless, the clinical utility of CT-MPI to identify ischaemia in patients with non-obstructive/microvascular disease still has to be established. (orig.)

  9. Ventricular Repolarization Evaluation From Surface ECG for Identification of the Patients With Increased Myocardial Electrical Instability

    National Research Council Canada - National Science Library

    Lass, Jaanus

    2001-01-01

    In order to reveal the possible correlation between the level of myocardial electrical instability assessed at Holter monitoring and certain ECG parameters characterizing ventricular repolarization...

  10. Use of ultrafast computed tomography to quantitate regional myocardial perfusion: a preliminary report

    International Nuclear Information System (INIS)

    Rumberger, J.A.; Feiring, A.J.; Lipton, M.J.; Higgins, C.B.; Ell, S.R.; Marcus, M.L.

    1987-01-01

    The purpose of this study was to assess the potential for rapid acquisition computed axial tomography (Imatron C-100) to quantify regional myocardial perfusion. Myocardial and left ventricular cavity contrast clearance curves were constructed after injecting nonionic contrast (1 ml/kg over 2 to 3 seconds) into the inferior vena cava of six anesthetized, closed chest dogs (n = 14). Independent myocardial perfusion measurements were obtained by coincident injection of radiolabeled microspheres into the left atrium during control, intermediate and maximal myocardial vasodilation with adenosine (0.5 to 1.0 mg/kg per min, intravenously, respectively). At each flow state, 40 serial short-axis scans of the left ventricle were taken near end-diastole at the midpapillary muscle level. Contrast clearance curves were generated and analyzed from the left ventricular cavity and posterior papillary muscle regions after excluding contrast recirculation and minimizing partial volume effects. The area under the curve (gamma variate function) was determined for a region of interest placed within the left ventricular cavity. Characteristics of contrast clearance data from the posterior papillary muscle region that were evaluated included the peak myocardial opacification, area under the contrast clearance curve and a contrast clearance time defined by the full width/half maximal extent of the clearance curve. Myocardial perfusion (microspheres) ranged from 35 to 450 ml/100 g per min (mean 167 +/- 125)

  11. Prevalence and predictors of an abnormal stress myocardial perfusion study in asymptomatic patients with type 2 diabetes mellitus

    International Nuclear Information System (INIS)

    Scholte, Arthur J.H.A.; Schuijf, Joanne D.; Wall, Ernst E. van der; Bax, Jeroen J.; Kharagjitsingh, Antje V.; Dibbets-Schneider, Petra; Stokkel, Marcel P.

    2009-01-01

    The purpose of this study was to evaluate the prevalence of an abnormal stress myocardial perfusion study in a cohort of truly asymptomatic patients with type 2 diabetes mellitus using myocardial perfusion imaging by means of single photon emission computed tomography (SPECT). Secondly, we determined which clinical characteristics may predict an abnormal stress myocardial perfusion study in this population. A total of 120 asymptomatic patients (mean age 53±10 years) with type 2 diabetes mellitus and one or more risk factors for coronary artery disease were prospectively recruited from an outpatient diabetes clinic. All patients underwent myocardial perfusion imaging by means of adenosine 99m Tc sestamibi SPECT. Images were evaluated for the presence of perfusion abnormalities as well as other nonperfusion abnormalities that may indicate extensive ischaemia, including left ventricular dysfunction (defined as a left ventricular ejection fraction <45%), transient ischaemic dilatation and adenosine-induced ST segment depression. Multivariable analysis was performed using a backward selection strategy to identify potential predictors for an abnormal stress myocardial perfusion study. Finally, all patients were followed up for 12 months to determine the occurrence of cardiovascular events: (1) cardiac death, (2) nonfatal myocardial infarction, (3) unstable angina requiring hospitalization, (4) revascularization, or (5) stroke. Of the 120 patients, 40 (33%) had an abnormal stress study, including myocardial perfusion abnormalities in 30 patients (25%). In 10 patients (8%), indicators of extensive (possibly balanced ischaemia) were observed in the absence of abnormal perfusion. The multivariable analysis identified current smoking, duration of diabetes and the cholesterol/high-density lipoprotein (HDL) ratio as independent predictors of an abnormal stress study. During a follow-up period of 12 months six patients (5%) had a cardiovascular event. The current study revealed

  12. Prevalence and predictors of an abnormal stress myocardial perfusion study in asymptomatic patients with type 2 diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

    Scholte, Arthur J.H.A.; Schuijf, Joanne D.; Wall, Ernst E. van der; Bax, Jeroen J. [Leiden University Medical Center, Department of Cardiology, Albinusdreef 2, PO Box 9600, Leiden (Netherlands); Kharagjitsingh, Antje V. [Medisch Centrum Haaglanden, Department of Internal Medicine, The Hague (Netherlands); Dibbets-Schneider, Petra; Stokkel, Marcel P. [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands)

    2009-04-15

    The purpose of this study was to evaluate the prevalence of an abnormal stress myocardial perfusion study in a cohort of truly asymptomatic patients with type 2 diabetes mellitus using myocardial perfusion imaging by means of single photon emission computed tomography (SPECT). Secondly, we determined which clinical characteristics may predict an abnormal stress myocardial perfusion study in this population. A total of 120 asymptomatic patients (mean age 53{+-}10 years) with type 2 diabetes mellitus and one or more risk factors for coronary artery disease were prospectively recruited from an outpatient diabetes clinic. All patients underwent myocardial perfusion imaging by means of adenosine {sup 99m}Tc sestamibi SPECT. Images were evaluated for the presence of perfusion abnormalities as well as other nonperfusion abnormalities that may indicate extensive ischaemia, including left ventricular dysfunction (defined as a left ventricular ejection fraction <45%), transient ischaemic dilatation and adenosine-induced ST segment depression. Multivariable analysis was performed using a backward selection strategy to identify potential predictors for an abnormal stress myocardial perfusion study. Finally, all patients were followed up for 12 months to determine the occurrence of cardiovascular events: (1) cardiac death, (2) nonfatal myocardial infarction, (3) unstable angina requiring hospitalization, (4) revascularization, or (5) stroke. Of the 120 patients, 40 (33%) had an abnormal stress study, including myocardial perfusion abnormalities in 30 patients (25%). In 10 patients (8%), indicators of extensive (possibly balanced ischaemia) were observed in the absence of abnormal perfusion. The multivariable analysis identified current smoking, duration of diabetes and the cholesterol/high-density lipoprotein (HDL) ratio as independent predictors of an abnormal stress study. During a follow-up period of 12 months six patients (5%) had a cardiovascular event. The current study

  13. Impact of patient motion on myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Huang Kemin; Feng Yanlin; He Xiaohong; Wen Guanghua; Yu Fengwen; Liu Shusheng; Liu Dejun; Yuan Jianwei; Yang Ming

    2008-01-01

    Objective: It is well known that patient motion may cause artifacts in myocardial SPECT images and affect clinical diagnosis. The aim of the study was to evaluate the effects of motion on quality and semi-quantitative results of myocardial perfusion images. Methods: Six healthy volunteers un- derwent myocardial perfusion SPECT. The raw data in each case was manually shifted 1-6 frames and 1 4 pixels, respectively by using the motion correction software. The shifted raw data were then reconstructed. A semi-quantitative software was used to assess the myocardial perfusion of left ventricle. The quality and semi-quantitative results of the tomographic images reconstructed from the raw data with and without motion were compared and analyzed. SPSS 12.0 was used for data analysis. Results: There was no visible artifact and semi-quantitative difference on the data with 1 frame and (or) 1 pixel shift when compared with the original data without shift. The image artifacts became significantly deteriorated when the number of flame and (or) pixel shift was increased. In general, the image artifact of inferior and posterior wall was related to the upward shift, and that of anterior and infero-posterior wall was related to the downward shift, that of septal, anterior, infero-postefior wall and apex was related to right-ward shift, and the septal and infero-posterior wall was related to the left-ward shift. The differences along the x-axis shift were more prominent than that of the y-axis (t=2.848, P<0.01), and the differences in the downward and rightward shift were more severe than the upward and leftward shift (t=2.941, 6.598; all P<0.01), respectively. Conclusions: Image artifacts became significant when there was motion induced by manual shift of more than one flame and (or) one pixel. Different motion directions were closely related to different segments of left ventricle. (authors)

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    %, respectively, for SPECT. CONCLUSION: The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis ≥50%), as demonstrated with the Az, was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease.......PURPOSE: To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography....... 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...

  15. Regional wall thickening in gated myocardial perfusion SPECT in a Japanese population: effect of sex, radiotracer, rotation angles and frame rates

    Energy Technology Data Exchange (ETDEWEB)

    Akhter, Nasima; Nakajima, Kenichi; Okuda, Koichi; Matsuo, Shinro; Yoneyama, Tatsuya; Taki, Junichi; Kinuya, Seigo [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa, Ishikawa (Japan)

    2008-09-15

    Gated single-photon emission computed tomography (SPECT) imaging of myocardium by {sup 99m}Tc and {sup 201}Tl is used extensively to measure quantitative cardiac functional parameters. However, factors affecting normal values for myocardial functional parameters and population-specific standards have not yet been established. The aim of the study was to determine the effect of sex, radiotracer, rotation angles and frame rates on resting myocardial wall thickening (WT) and to develop a Japanese standard of normal values for WT. Data from a total of 202 patients with low possibility of having cardiac problems were collected from nine hospitals throughout Japan. Patients were divided into five groups according to study protocol, and WT was evaluated according to the 17-segment and four-region (basal, mid and apical regions and the apex) polar map distribution. WT was generally higher in women than in men irrespective of the use of radiotracers, rotation angles or frame rates, and the difference was highly significant in the mid and apical regions. In any protocol used, resting myocardial thickening in the apex was higher than in the mid and apical regions, and thickening was lowest in the basal region, suggesting heterogeneous regional myocardial thickening (%) in normal subjects. Different rotation angles showed no significant change on WT, but different frame rates and tracers showed significant WT change in both sexes. Percent thickening of the myocardium was significantly higher in imaging by {sup 99m}Tc-labelled tracers than in {sup 201}Tl. Sex, radiotracers and frame rates had a significant effect on myocardial thickening, and the importance of population-specific standards should be emphasized. A normal database can serve as a standard for gated SPECT evaluation of myocardial thickening in a Japanese population and might be applicable to Asian populations having a similar physique. (orig.)

  16. Subendocardial versus transmural ischaemia in myocardial perfusion SPECT--a Monte Carlo study

    DEFF Research Database (Denmark)

    Bartosik, Jolanta; El-Ali, Henrik Hussein; Nilsson, Ulf

    2006-01-01

    Myocardial perfusion imaging with single-photon emission computed tomography (SPECT) is useful for the evaluation of patients with known or suspected coronary artery disease. Parameters of interest are the reduction in the blood perfusion (severity) and the lesion volume (extent). The aim of this...

  17. Impact of ECG gating in contrast-enhanced MR angiography for the assessment of the pulmonary veins and the left atrium anatomy

    International Nuclear Information System (INIS)

    Katoh, M.; Buecker, A.; Muehlenbruch, G.; Guenther, R.W.; Spuentrup, E.; Schauerte, P.

    2006-01-01

    Purpose: Implementation of ECG gating in contrast-enhanced MR angiography (ceMRA) for improved visualization of the pulmonary veins, the left atrium, and the thoracic vessels. Materials and Methods: CeMRA was performed on twelve patients with a history of recurrent atrial fibrillation for the purpose of an intra-individual comparison with and without ECG gating on a 1.5 Tesla MR system (Gyroscan Intera, Philips Medical Systems, Best, NL). Objective image quality parameters such as the signal-to-noise ratio (SNR) of the blood and the contrast-to-noise ratio (CNR) between the blood and myocardium or lung parenchyma were analyzed. The contour sharpness of the pulmonary veins, left atrium, ascending aorta, and pulmonary trunk was also measured. In addition, the artifact level was subjectively assessed by two observers blinded with respect to the sequence parameters. Statistically significant differences (p<0.05) between the procedures were analyzed using the Wilcoxon test and Pearson Chi-square test. Results: The use of ECG gating in ceMRA significantly reduced artifacts caused by cardiac motion and vessel pulsation. This in turn lead to a significant increase in the contour sharpness of the left atrium and the thoracic vessels. In addition, higher SNR and CNR were found using ECG-gated ceMRA compared to standard ceMRA. Conclusion: The use of ECG gating in ceMRA results in artifact-free and sharper delineation of the structures of the heart and thoracic vessels. (orig.)

  18. Impact of ECG gating in contrast-enhanced MR angiography for the assessment of the pulmonary veins and the left atrium anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Katoh, M.; Buecker, A.; Muehlenbruch, G.; Guenther, R.W.; Spuentrup, E. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum RWTH Aachen (Germany); Schauerte, P. [Medizinische Klinik 1, Universitaetsklinikum RWTH Aachen (Germany)

    2006-02-15

    Purpose: Implementation of ECG gating in contrast-enhanced MR angiography (ceMRA) for improved visualization of the pulmonary veins, the left atrium, and the thoracic vessels. Materials and Methods: CeMRA was performed on twelve patients with a history of recurrent atrial fibrillation for the purpose of an intra-individual comparison with and without ECG gating on a 1.5 Tesla MR system (Gyroscan Intera, Philips Medical Systems, Best, NL). Objective image quality parameters such as the signal-to-noise ratio (SNR) of the blood and the contrast-to-noise ratio (CNR) between the blood and myocardium or lung parenchyma were analyzed. The contour sharpness of the pulmonary veins, left atrium, ascending aorta, and pulmonary trunk was also measured. In addition, the artifact level was subjectively assessed by two observers blinded with respect to the sequence parameters. Statistically significant differences (p<0.05) between the procedures were analyzed using the Wilcoxon test and Pearson Chi-square test. Results: The use of ECG gating in ceMRA significantly reduced artifacts caused by cardiac motion and vessel pulsation. This in turn lead to a significant increase in the contour sharpness of the left atrium and the thoracic vessels. In addition, higher SNR and CNR were found using ECG-gated ceMRA compared to standard ceMRA. Conclusion: The use of ECG gating in ceMRA results in artifact-free and sharper delineation of the structures of the heart and thoracic vessels. (orig.)

  19. Effects of smoking on lung uptake of 201Tl during exercise myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Ouyang Wei; He Guorong; Liu Jinhua

    2004-01-01

    Objective: To investigate the influence of smoking on lung uptake of 201 Tl during myocardial perfusion imaging. Methods: Ninety-two healthy subjects, with normal 201 Tl myocardial perfusion imaging findings but no evidence of left ventricular hypertrophy and pulmonary disease, were divided into three groups, smoker, nonsmoker and quitted smoker groups. Exercise/delay 201 Tl myocardial perfusion imaging was performed on all subjects included. Lung/heart ratio was defined on the anterior planar image obtained during exercise tomography. Results: Both the lung/heart ratios during exercise in smoker (0.40 ± 0.07, F=10.635, P 201 Tl lung/heart ratios in smokers are higher than in nonsmokers and this must be kept in mind when 201 Tl lung/heart ratios are used clinically, even in quitted smokers

  20. Dynamic CT myocardial perfusion imaging: detection of ischemia in a porcine model with FFR verification

    Science.gov (United States)

    Fahmi, Rachid; Eck, Brendan L.; Vembar, Mani; Bezerra, Hiram G.; Wilson, David L.

    2014-03-01

    Dynamic cardiac CT perfusion (CTP) is a high resolution, non-invasive technique for assessing myocardial blood ow (MBF), which in concert with coronary CT angiography enable CT to provide a unique, comprehensive, fast analysis of both coronary anatomy and functional ow. We assessed perfusion in a porcine model with and without coronary occlusion. To induce occlusion, each animal underwent left anterior descending (LAD) stent implantation and angioplasty balloon insertion. Normal ow condition was obtained with balloon completely de ated. Partial occlusion was induced by balloon in ation against the stent with FFR used to assess the extent of occlusion. Prospective ECG-triggered partial scan images were acquired at end systole (45% R-R) using a multi-detector CT (MDCT) scanner. Images were reconstructed using FBP and a hybrid iterative reconstruction (iDose4, Philips Healthcare). Processing included: beam hardening (BH) correction, registration of image volumes using 3D cubic B-spline normalized mutual-information, and spatio-temporal bilateral ltering to reduce partial scan artifacts and noise variation. Absolute blood ow was calculated with a deconvolutionbased approach using singular value decomposition (SVD). Arterial input function was estimated from the left ventricle (LV) cavity. Regions of interest (ROIs) were identi ed in healthy and ischemic myocardium and compared in normal and occluded conditions. Under-perfusion was detected in the correct LAD territory and ow reduction agreed well with FFR measurements. Flow was reduced, on average, in LAD territories by 54%.

  1. Gated single photon emission computer tomography for the detection of silent myocardial ischemia

    International Nuclear Information System (INIS)

    Pena Q, Yamile; Coca P, Marco Antonio; Batista C, Juan Felipe; Fernandez-Britto, Jose; Quesada P, Rodobaldo; Pena C; Andria

    2009-01-01

    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

  2. Property of electrocardiogram gated single photon emission tomography by 99mTc-methoxy isobutyl isonitrile

    International Nuclear Information System (INIS)

    Imai, Kamon; Nishio, Yukari; Araki, Yasushi; Saito, Satoshi; Ozawa, Yukio; Yasugi, Tadao; Hagiwara, Kazuo; Kamata, Rikisaburo

    1992-01-01

    99m Tc-methoxy isobutyl isonitrile (MIBI) is a new developed myocardial perfusion imaging agent. Because this compound has higher photon energy than thallium (Tl), electrocardiogram gated single photon emission tomography (SPECT): end-diastolic (ED) and end-systolic (ES) short axis (SA) images could be taken. To investigate property of gated MIBI SPECT, MIBI myocardial scintigraphy, Tl scintigraphy (TMS) and analysis of left ventricular wall motion were performed in 6 patients with myocardial infarction. Left ventricule was divided into 8 segments. Perfusion defect (PD) was scored: '0' (normal), '1' (hypo-perfusion), '2' (defect). Wall motion abnormality (WMA) was also scored: '0' (normo-kinesis), '1' (hypo-kinesis), '2' (a-, dys-kinesis). Severity and extent of PD and WMA were calculated. Severity of WMA was 3.0±2.0 (M±SD), severity of PD was 3.3±1.7 in TMS, 3.7±1.3 in no-gated MIBI, 5.0±0.6 in ES-MIBI, 7.3±2.0 in ED-MIBI. Extent of WMA was 2.3±1.0. Extent of PD was 2.5±1.3 in TMS, 3.0±1.6 in no-gated MIBI, 3.5±0.8 in ES-MIBI, 4.8±1.0 in ED-MIBI. Compared with wall motion abnormality, severity and extent of PD in ED-MIBI was larger. From our data, it is concluded that perfusion defect in ED-MIBI was overestimated significantly. When we evaluate gated MIBI image, we must consider this property. (author)

  3. Dynamic CT myocardial perfusion imaging: performance of 3D semi-automated evaluation software

    Energy Technology Data Exchange (ETDEWEB)

    Ebersberger, Ullrich [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); Heart Center Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich (Germany); Marcus, Roy P.; Nikolaou, Konstantin; Bamberg, Fabian [University of Munich, Institute of Clinical Radiology, Munich (Germany); Schoepf, U.J.; Gray, J.C.; McQuiston, Andrew D. [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); Lo, Gladys G. [Hong Kong Sanatorium and Hospital, Department of Diagnostic and Interventional Radiology, Hong Kong (China); Wang, Yining [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Department of Radiology, Beijing (China); Blanke, Philipp [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); University Hospital Freiburg, Department of Diagnostic Radiology, Freiburg (Germany); Geyer, Lucas L. [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); University of Munich, Institute of Clinical Radiology, Munich (Germany); Cho, Young Jun [Medical University of South Carolina, Heart and Vascular Center, Charleston, SC (United States); Konyang University College of Medicine, Department of Radiology, Daejeon (Korea, Republic of); Scheuering, Michael; Canstein, Christian [Siemens Healthcare, CT Division, Forchheim (Germany); Hoffmann, Ellen [Heart Center Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich (Germany)

    2014-01-15

    To evaluate the performance of three-dimensional semi-automated evaluation software for the assessment of myocardial blood flow (MBF) and blood volume (MBV) at dynamic myocardial perfusion computed tomography (CT). Volume-based software relying on marginal space learning and probabilistic boosting tree-based contour fitting was applied to CT myocardial perfusion imaging data of 37 subjects. In addition, all image data were analysed manually and both approaches were compared with SPECT findings. Study endpoints included time of analysis and conventional measures of diagnostic accuracy. Of 592 analysable segments, 42 showed perfusion defects on SPECT. Average analysis times for the manual and software-based approaches were 49.1 ± 11.2 and 16.5 ± 3.7 min respectively (P < 0.01). There was strong agreement between the two measures of interest (MBF, ICC = 0.91, and MBV, ICC = 0.88, both P < 0.01) and no significant difference in MBF/MBV with respect to diagnostic accuracy between the two approaches for both MBF and MBV for manual versus software-based approach; respectively; all comparisons P > 0.05. Three-dimensional semi-automated evaluation of dynamic myocardial perfusion CT data provides similar measures and diagnostic accuracy to manual evaluation, albeit with substantially reduced analysis times. This capability may aid the integration of this test into clinical workflows. (orig.)

  4. Quantitative and morphological analysis of the computed tomographic images in experimental myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Teshima, Yasuaki

    1984-12-01

    Experimental myocardial infarction in the dog was evaluated by the cardiac scan system developed together by the Department of Radiology, Dokkyo University Hospital, and Toshiba Co. Ltd. Analysis of the CT image of myocardial infarction treated by ligating the coronary arteries demonstrated the following: 1) In perfusion phase representing initial 4 min after injection of the contrast material, infarcted areas were shown as areas of low density. Pattern of these low dense areas appeared homogeneous and correlated quite well with the infarcted areas proved on necropsy. 2) In delayed scan performed between 8-12 min after the infusion of the contrast material, delayed enhancement occurred, for which visual pattern was quite variable from case to case. 3) In gated scan, time-related to ECG cycle, pictures of end-diastole (ED) and end-systole (ES) in cardiac cycle were aquired. And alteration rates of endocardial space, (ED-ES/ED) x 100%, were obtained by dividing CT sliced endocardial space into 16 segments. By using these rates, abnormal motion of the infarcted area and compensatory motion of the normal myocardium were analyzed quantitatively. (author).

  5. The evaluation of dobutamine 99mTc-MIBI myocardial perfusion imaging in the diagnosis of coronary heart disease

    International Nuclear Information System (INIS)

    He Qing; Qu Wanying; Gong Junhui; Zhou Ying

    1996-01-01

    The method and the clinical value of dobutamine stress test as a substitute for exercise test in 99m Tc-MIBI myocardial perfusion imaging was investigated. 40 Patients were intravenously infused with dobutamine through IVAC syringe pumps by incremental doses, and 99m Tc-MIBI was injected at the peak dobutamine heart rate. The myocardial imaging was then performed. The rest myocardial imaging was done after 48 hours. 30 of the 31 patients with coronary heart disease showed reversible perfusion defects in dobutamine 99m Tc-MIBI myocardial perfusion images and 7 of the 9 patients without coronary heart disease showed normal images. The sensitivity of this test was 96.8% and the specificity 77.8%. None of the studies was discontinued due to dobutamine side effect. Dobutamine 99m Tc-MIBI myocardial perfusion imaging is a safe and sensitive method in the diagnosis of coronary heart disease

  6. Educational technology improves ECG interpretation of acute myocardial infarction among medical students and emergency medicine residents.

    Science.gov (United States)

    Pourmand, Ali; Tanski, Mary; Davis, Steven; Shokoohi, Hamid; Lucas, Raymond; Zaver, Fareen

    2015-01-01

    Asynchronous online training has become an increasingly popular educational format in the new era of technology-based professional development. We sought to evaluate the impact of an online asynchronous training module on the ability of medical students and emergency medicine (EM) residents to detect electrocardiogram (ECG) abnormalities of an acute myocardial infarction (AMI). We developed an online ECG training and testing module on AMI, with emphasis on recognizing ST elevation myocardial infarction (MI) and early activation of cardiac catheterization resources. Study participants included senior medical students and EM residents at all post-graduate levels rotating in our emergency department (ED). Participants were given a baseline set of ECGs for interpretation. This was followed by a brief interactive online training module on normal ECGs as well as abnormal ECGs representing an acute MI. Participants then underwent a post-test with a set of ECGs in which they had to interpret and decide appropriate intervention including catheterization lab activation. 148 students and 35 EM residents participated in this training in the 2012-2013 academic year. Students and EM residents showed significant improvements in recognizing ECG abnormalities after taking the asynchronous online training module. The mean score on the testing module for students improved from 5.9 (95% CI [5.7-6.1]) to 7.3 (95% CI [7.1-7.5]), with a mean difference of 1.4 (95% CI [1.12-1.68]) (p<0.0001). The mean score for residents improved significantly from 6.5 (95% CI [6.2-6.9]) to 7.8 (95% CI [7.4-8.2]) (p<0.0001). An online interactive module of training improved the ability of medical students and EM residents to correctly recognize the ECG evidence of an acute MI.

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

    International Nuclear Information System (INIS)

    Perez-Iruela, Juan; Pastor, Purificacion; Lumbreras, Luis; Martin, Ana M.; Ruiz, Francisco J.; Posadas, A.; Puentes, Carmen

    2009-01-01

    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 99m Tc-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 99m Tc-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) [es

  8. Evaluation of diastolic phase by left ventricular volume curve using s2-gated equilibrium method among radioisotope angiography

    International Nuclear Information System (INIS)

    Watanabe, Yoshirou; Sakai, Akira; Inada, Mitsuo; Shiraishi, Tomokuni; Kobayashi, Akitoshi

    1982-01-01

    S2-gated (the second heart sound) method was designed by authors. In 6 normal subjects and 16 patients (old myocardial infarction 12 cases, hypertension 2 cases and aortic regurgitation 2 cases), radioisotope (RI) angiography using S2-gated equilibrium method was performed. In RI angiography, sup(99m)Tc-human serum albumin (HSA) 555MBq (15mCi) as tracer, PDP11/34 as minicomputer and PCG/ECG symchromizer (Metro Inst.) were used. Then left ventricular (LV) volume curve by S2-gated and electrocardiogram (ECG) R wave-gated method were obtained. Using LV volume curve, left ventricular ejection fraction (EF), mean ejection rate (mER, s -1 ), mean filling rate (mFR, -1 ) and rapid filling fraction (RFF) were calculated. mFR indicated mean filling rate during rapid filling phase. RFF was defined as the filling fraction during rapid filling phase among stroke volume. S2-gated method was reliable in evaluation of early diastolic phase, compared with ECG-gated method. There was the difference between RFF in normal group and myocardial infarction (MI) group (p < 0.005). RFF in 2 groups were correlated with EF (r = 0.82, p < 0.01). RFF was useful in evaluating MI cases who had normal EF values. The comparison with mER by ECG-gated and mFR by S2-gated was useful in evaluating MI cases who had normal mER values. mFR was remarkably lower than mER in MI group, but was equal to mER in normal group approximately. In conclusion, the evaluation using RFF and mFR by S2-gated method was useful in MI cases who had normal systolic phase indices. (author)

  9. Correlation between semiquantitative myocardial perfusion score and absolute myocardial flow in 13N-ammonia PET

    International Nuclear Information System (INIS)

    Lee, Byeong Il; Kim, Jung Young; Min, Jung Joon; Song, Ho Chun; Bom, Hee Seung; Kim, Kye Hun; Kim, Su Jin; Lee, Jae Sung

    2007-01-01

    13 N-ammonia is a well known radiopharmaceutical for the measurement of a myocardial blood flow (MBF) non-invasively using PET-CT. In this study, we investigated a correlation between MBF obtained from dynamic imaging and myocardial perfusion score (MPS) obtained from static imaging for usefulness of cardiac PET study. Twelve patients (11 males, 1 female, 57.9 ± 8.6 years old) with suspicious coronary artery disease underwent PET-CT scan. Dynamic scans (6 min: 5 sec X 12, 10 sec X 6, 20 sec X 3, and 30 sec X 6) were initiated simultaneously with bolus injection of 11 MBq/kg 13 N-ammonia to acquire rest and stress image. Gating image was acquired during 13 minutes continuously. Nine-segment model (4 basal walls, 4 mid walls, and apex) was used for a measurement of MBF. Time activity curve of input function and myocardium was extracted from ROI methods in 9 regions for quantification. The MPS were evaluated using quantitative analysis software. To compare between 20-segment model and 9-segment model, 6 basal segments were excluded and averaged segmental scores were used. There are weak correlation between MBF (rest, 0.18-2.38 ml/min/g; stress, 0.40-4.95 ml/min/g) and MPS (rest 22-91%, stress, 14-90%), however the correlation coefficient between corrected MBF and MPS in rest state was higher than stress state (rest r=0.59; stress r=0.80). As a thickening increased, correlation between MBF and MPS also showed good correlation at each segments. Corrected and translated MPS as its characteristics using 13 N-ammonia showed good correlation with absolute MBF measured by dynamic image in this study. Therefore, we showed MPS is one of good indices which reflect MBF. We anticipate PET-CT could be used as useful tool for evaluation of myocardial function in nuclear cardiac study

  10. [Stress-ECG is adequate to detect myocardial ischemia: when are additional diagnostic tests needed?].

    Science.gov (United States)

    Baer, F M

    2007-09-01

    The stress-ECG is the most often adopted and most cost effective initial diagnostic test for the assessment of myocardial ischemia in patients with suspected coronary artery disease (CAD). Prerequisites for the diagnostic usefullness of stress-ECG are a clearly interpretable ST-segment, ability to reach the predicted work load, an intermediate pretest probability for CAD ranging between 10% and 90% and the absence of any contraindications for dynamic exercise. Because of the limited diagnostic sensitivity of about 70%, and a high percentage of patients, who are unable to exercise, a negative stress ECG can definitely not exclude hemodynamically significant CAD. Therefore, stress imaging techniques like myocardial scintigraphy, stress-echocardiography and stress magnetic resonance imaging play a major role in the stepwise diagnostic work-up of patients with suspected CAD. These stress imaging techniques are basically interchangeable since no method is definitely superior to one of the others. However, each method has its specific pros and cons and inherent contraindications. Therefore the choice of the stress imaging method and the form of stress applied should be based on the individual patients characteristics to gain optimal image quality and diagnostic accuracy. Moreover, the decision for one method should take the local availability and institutional expertise of diagnostic centers into account. Although partly substituted by stress imaging techniques the stress-ECG still remains the workhorse for a stepwise diagnostic work-up of patients with suspected CAD.

  11. Optimization of imaging before pulmonary vein isolation by radiofrequency ablation: breath-held ungated versus ECG/breath-gated MRA

    Energy Technology Data Exchange (ETDEWEB)

    Allgayer, C.; Haller, S.; Bremerich, J. [University Hospital Basel, Department of Radiology, Basel (Switzerland); Zellweger, M.J.; Sticherling, C.; Buser, P.T. [University Hospital Basel, Department of Cardiology, Basel (Switzerland); Weber, O. [University Hospital Basel, Department of Medical Physics, Basel (Switzerland)

    2008-12-15

    Isolation of the pulmonary veins has emerged as a new therapy for atrial fibrillation. Pre-procedural magnetic resonance (MR) imaging enhances safety and efficacy; moreover, it reduces radiation exposure of the patients and interventional team. The purpose of this study was to optimize the MR protocol with respect to image quality and acquisition time. In 31 patients (23-73 years), the anatomy of the pulmonary veins, left atrium and oesophagus was assessed on a 1.5-Tesla scanner with four different sequences: (1) ungated two-dimensional true fast imaging with steady precession (2D-TrueFISP), (2) ECG/breath-gated 3D-TrueFISP, (3) ungated breath-held contrast-enhanced three-dimensional turbo fast low-angle shot (CE-3D-tFLASH), and (4) ECG/breath-gated CE-3D-TrueFISP. Image quality was scored from 1 (structure not visible) to 5 (excellent visibility), and the acquisition time was monitored. The pulmonary veins and left atrium were best visualized with CE-3D-tFLASH (scores 4.50 {+-} 0.52 and 4.59 {+-} 0.43) and ECG/breath-gated CE-3D-TrueFISP (4.47 {+-} 0.49 and 4.63 {+-} 0.39). Conspicuity of the oesophagus was optimal with CE-3D-TrueFISP and 2D-TrueFISP (4.59 {+-} 0.35 and 4.19 {+-} 0.46) but poor with CE-3D-tFLASH (1.03 {+-} 0.13) (p < 0.05). Acquisition times were shorter for 2D-TrueFISP (44 {+-} 1 s) and CE-3D-tFLASH (345 {+-} 113 s) compared with ECG/breath-gated 3D-TrueFISP (634 {+-} 197 s) and ECG/breath-gated CE-3D-TrueFISP (636 {+-} 230 s) (p < 0.05). In conclusion, an MR imaging protocol comprising CE-3D-tFLASH and 2D-TrueFISP allows assessment of the pulmonary veins, left atrium and oesophagus in less than 7 min and can be recommended for pre-procedural imaging before electric isolation of pulmonary veins. (orig.)

  12. Assessment of regional lung functional impairment with co-registered respiratory-gated ventilation/perfusion SPET-CT images: initial experiences

    International Nuclear Information System (INIS)

    Suga, Kazuyoshi; Yasuhiko, Kawakami; Zaki, Mohammed; Yamashita, Tomio; Seto, Aska; Matsumoto, Tsuneo; Matsunaga, Naofumi

    2004-01-01

    In this study, respiratory-gated ventilation and perfusion single-photon emission tomography (SPET) were used to define regional functional impairment and to obtain reliable co-registration with computed tomography (CT) images in various lung diseases. Using a triple-headed SPET unit and a physiological synchroniser, gated perfusion SPET was performed in a total of 78 patients with different pulmonary diseases, including metastatic nodules (n=15); in 34 of these patients, it was performed in combination with gated technetium-99m Technegas SPET. Projection data were acquired using 60 stops over 120 for each detector. Gated end-inspiration and ungated images were reconstructed from 1/8 data centered at peak inspiration for each regular respiratory cycle and full respiratory cycle data, respectively. Gated images were registered with tidal inspiration CT images using automated three-dimensional (3D) registration software. Registration mismatch was assessed by measuring 3D distance of the centroid of the nine selected round perfusion-defective nodules. Gated SPET images were completed within 29 min, and increased the number of visible ventilation and perfusion defects by 9.7% and 17.2%, respectively, as compared with ungated images; furthermore, lesion-to-normal lung contrast was significantly higher on gated SPET images. In the nine round perfusion-defective nodules, gated images yielded a significantly better SPET-CT match compared with ungated images (4.9±3.1 mm vs 19.0±9.1 mm, P<0.001). The co-registered SPET-CT images allowed accurate perception of the location and extent of each ventilation/perfusion defect on the underlying CT anatomy, and characterised the pathophysiology of the various diseases. By reducing respiratory motion effects and enhancing perfusion/ventilation defect clarity, gated SPET can provide reliable co-registered images with CT images to accurately characterise regional functional impairment in various lung diseases. (orig.)

  13. [Myocardial perfusion imaging by digital subtraction angiography].

    Science.gov (United States)

    Kadowaki, H; Ishikawa, K; Ogai, T; Katori, R

    1986-03-01

    Several methods of digital subtraction angiography (DSA) were compared to determine which could better visualize regional myocardial perfusion using coronary angiography in seven patients with myocardial infarction, two with angina pectoris and five with normal coronary arteries. Satisfactory DSA was judged to be achieved if the shape of the heart on the mask film was identical to that on the live film and if both films were exactly superimposed. To obtain an identical mask film in the shape of each live film, both films were selected from the following three phases of the cardiac cycle; at the R wave of the electrocardiogram, 100 msec before the R wave, and 200 msec before the R wave. The last two were superior for obtaining mask and live films which were similar in shape, because the cardiac motion in these phases was relatively small. Using these mask and live films, DSA was performed either with the continuous image mode (CI mode) or the time interval difference mode (TID mode). The overall perfusion of contrast medium through the artery to the vein was adequately visualized using the CI mode. Passage of contrast medium through the artery, capillary and vein was visualized at each phase using TID mode. Subtracted images were displayed and photographed, and the density of the contrast medium was adequate to display contour lines as in a relief map. Using this DSA, it was found that regional perfusion of the contrast medium was not always uniform in normal subjects, depending on the typography of the coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Research on comparison of exposure with electrocardiographic gated mA modulation (ECG) and ECG and CAREDose 4D mode in coronary multi-slice spiral CT angiography

    International Nuclear Information System (INIS)

    Liu Bin; Guo Senlin; Wei Lan; Fei Xiaolu; Bai Mei

    2009-01-01

    Objective: The objective of this article was to compare patients dose with electrocardiographic gated mA modulation (ECG) and ECG and CAREDose 4D mode during coronary MSCT angiography. Methods: The research was based on phantom experiment and computer simulation to get the mean value of peak skin dose data and effective dose data respectively and to analyze deterministic and stochastic radiation risk. Results: The peak skin dose using ECG mode alone and using ECG and CAREDose 4D mode with the same image noise level was (87.4 ± 0.9) and (45.9 ± 1.2) mGy respectively. Effective dose was 17 and 10 rosy for ECG mode and ECG and CAREDose 4D mode respectively. Comparing with ECG mode alone, ECG and CAREDose 4D mode reduced organ dose of gonad, red marrow, lung, stomach, breast and thyroid by 40.0%, 36.7%, 39.3%, 37.7%, 38.8% and 38.9%, respectively. Conclusion: Results showed that ECG and CAREDose 4D mode can reduce radiation dose effectively comparing using ECG mode alone, and that ECG and CAREDose 4D mode should be widely applied clinically with appropriate initial settings. (authors)

  15. Pulmonary artery and right ventricle assessment in pulmonary hypertension. Correlation between functional parameters of ECG-gated CT and right-side heart catheterization

    Energy Technology Data Exchange (ETDEWEB)

    Abel, Elodie; Jankowski, Adrien [Clinique univ. de radiologie et imagerie medicale, CHU Grenoble (France); Pison, Christophe [Clinique univ. de pneumologie, CHU Grenoble (France); Bosson, Jean Luc [Dept. of Statistics, CIC, CHU Grenoble (France); Bouvaist, Helene [Clinique univ. de cardiologie, CHU Grenoble (France); Ferretti, Gilbert R. [Clinique univ. de radiologie et imagerie medicale, CHU Grenoble (France); Univ. J. Fourier, Grenoble (France); INSERM U 823, Inst. A. Bonniot, la Tronche (France)], e-mail: gferretti@chu-grenoble.fr

    2012-09-15

    Background: Right ventricular function predicts outcome in patients with pulmonary hypertension (PH). Therefore accurate assessment of right ventricular function is essential to graduate severity, assess follow-up, and response to therapy. Purpose: To evaluate whether PH severity could be assessed using electrocardiography-gated CT (ECG-gated CT) functional parameters. A further objective was to evaluate cardiac output (CO) using two ECG-gated CT methods: the reference Simpson technique and the fully automatic technique generated by commercially available cardiac software. Material and Methods: Our institutional review board approved this study; patient consent was not required. Twenty-seven patients who had undergone ECG-gated CT and right heart catheterization (RHC) were included. Two independent observers measured pulmonary artery (PA) diameter, PA distensibility, aorta diameter, right ventricular cardiac output (CT-RVCO) and right ventricular ejection fraction (CT-RVEF) with automatic and Simpson techniques on ECG-gated CT. RHC-CO and mean pulmonary arterial pressure (mPAP) were measured on RHC. Relationship between ECG-gated CT and RHC measurements was tested with linear regression analysis. Results: Inter-observer agreement was good for all measurements (r > 0.7) except for CT-RVCO calculated with Simpson's technique (r = 0.63). Pulmonary artery (PA) distensibility was significantly correlated to mPAP (r = -0.426, P = 0.027). CT-RVEF was correlated with mPAP only when issued from Simpson technique (r = -0.417, P = 0.034). CT-RVEF was not significantly correlated to RHC-CO (P > 0.2). CT-RVCO measured with Simpson technique (r = 0.487, P = 0.010) and automatic segmentation (r = 0.549, P 0.005) correlated equally with RHC-CO. Conclusion: CT-RVEF and CT-RVCO measured on ECG-gated CT are significantly correlated, respectively, to mPAP and RHC-CO in this population with severe reduction of the right ventricular ejection fraction and could be useful for

  16. Local experience on radionuclide myocardial imaging in the Philippines at the Philippine Heart Center for Asia

    International Nuclear Information System (INIS)

    Villacorta, E.V.

    1977-01-01

    The Nuclear Medicine Department of the Philippine Heart Center has introduced the detection of coronary heart disease through myocardiac perfusion imaging. The cardiovascular procedures are availed of free-of-charge to registered PHCA patients excepting for the costly TI-201 imaging. In summary, coronary perfusion in imaging should be an integral part of coronary arteriography. Barring the expensive cost of TI-120, myocardial perfusion imaging is ideal for detection of coronary heart disease. Experience shows better sensitivity of TI-201 than exercise ECG for detection of ischemia. Another non-invasive procedure for the detection of acute infarction is the radionuclide imaging using a bone radiopharmaceutical Tc99m prophosphate. In conclusion, acute infarct imaging is a valuable adjunct to ECG and enzyme studies. (RTD)

  17. Complications of myocardial infarction on multidetector-row computed tomography of chest

    International Nuclear Information System (INIS)

    Raj, V.; Karunasaagarar, K.; Rudd, J.H.F.; Screaton, N.; Gopalan, D.

    2010-01-01

    Myocardial infarction (MI) secondary to coronary artery disease remains the leading cause of death in the western world. The advent of early reperfusion therapy has substantially decreased in-hospital mortality and has improved the outcome in survivors of the acute phase of MI. Complications of MI include ischaemic, mechanical, arrhythmic, embolic and inflammatory disturbances. Although some of these complications may be infrequent, their importance is underscored because of the potential ability to correct them with early diagnosis and appropriate treatment. The majority of these complications will be detected on clinical examination and confirmed by echocardiography. Some patients may undergo non-electrocardiogram (ECG)-gated thoracic multidetector-row computed tomography (MDCT) due to non-specific presentation. In this group, it is imperative for the radiologist to be aware of and be confident in diagnosing the complications secondary to MI. This review illustrates the spectrum and imaging features of acute and chronic complications of MI that can be visualized on both ECG-gated cardiac and non-ECG-gated thoracic MDCT.

  18. Complications of myocardial infarction on multidetector-row computed tomography of chest

    Energy Technology Data Exchange (ETDEWEB)

    Raj, V.; Karunasaagarar, K. [Department of Radiology, Papworth and Addenbrookes Hospital, Cambridge (United Kingdom); Rudd, J.H.F. [Division of Cardiovascular Medicine, University of Cambridge, Cambridge (United Kingdom); Screaton, N. [Department of Radiology, Papworth and Addenbrookes Hospital, Cambridge (United Kingdom); Gopalan, D., E-mail: deepa.gopalan@btopenworld.co [Department of Radiology, Papworth and Addenbrookes Hospital, Cambridge (United Kingdom)

    2010-11-15

    Myocardial infarction (MI) secondary to coronary artery disease remains the leading cause of death in the western world. The advent of early reperfusion therapy has substantially decreased in-hospital mortality and has improved the outcome in survivors of the acute phase of MI. Complications of MI include ischaemic, mechanical, arrhythmic, embolic and inflammatory disturbances. Although some of these complications may be infrequent, their importance is underscored because of the potential ability to correct them with early diagnosis and appropriate treatment. The majority of these complications will be detected on clinical examination and confirmed by echocardiography. Some patients may undergo non-electrocardiogram (ECG)-gated thoracic multidetector-row computed tomography (MDCT) due to non-specific presentation. In this group, it is imperative for the radiologist to be aware of and be confident in diagnosing the complications secondary to MI. This review illustrates the spectrum and imaging features of acute and chronic complications of MI that can be visualized on both ECG-gated cardiac and non-ECG-gated thoracic MDCT.

  19. Serial assessment of myocardial thallium perfusion and fatty acid utilization in spontaneously hypertensive rats

    International Nuclear Information System (INIS)

    Sago, Masayoshi; Nishimura, Tsunehiko

    1989-01-01

    To evaluate the advantage of free fatty acid imaging on the detection of hypertrophied myocardium, we compared sequentially myocardial thallium and BMIPP (15-(p-iodophenyl)-3-(R,S)-methyl pentadecanoic acid) distribution in spontaneously hypertensive rat (SHR) using dual tracer autoradiography and in vivo pin-hole imaging. Autoradiography and pin-hole imaging showed uniform myocardial distribution of BMIPP and thallium within less than 27 weeks age SHR. In 40 weeks age SHR, thallium myocardial distribution showed uniform, however, BMIPP had focal decrease. Quantitative analysis of pin-hole images showed that myocardial BMIPP and thallium uptake ratio decreased according to the ages of SHR. Our data suggest that hypertension is associated with uniform myocardial perfusion and focal alternation in the substrate used for the performance of myocardial work. Based on the above autoradiographic and in vivo pin-hole imagings, I-123 BMIPP imaging may have a potential for early detection on hypertrophic myocardium compared to thallium perfusion in clinically hypertensive patients. (author)

  20. Evaluation of hemodynamic significance of coronary fistulae. Diagnostic integration between coronary angiography and stress/rest myocardial scintigraphy

    International Nuclear Information System (INIS)

    Rubini, G.; Sebastiani, M.

    2000-01-01

    It is here reported on the importance of the integration of data obtained from digital coronary angiography and stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography in evaluationing the hemodynamic significance of coronary arteriovenous fistulae. Coronary fistulae were detected with coronary angiography in 9 patients. All patients underwent clinical examination, trans thoracic echocardiography, stress electrocardiogram and stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography. Stress/rest 99m Tc sestamibi myocardial perfusion single photon tomography and stress electrocardiogram showed stress-induced myocardial ischemia in 2 patients. The first patient with familial predisposition and risk factors for ischemic heart disease presented a mesocardic heart murmur on clinical examination. At stress ECG (125 Watt, 153 b/m max frequency 93%, arterial pressure 230 mmHg, max frequency pressure product 35200) ischemic alterations were recorded at the first minute of the second stage of the Bruce protocol. Coronary angiography detected a circumflex artery fistula in the coronary sinus. Stress/rest 99m Tc sestamibi myocardial perfusion single photon emission tomography for the evaluation of stress/rest perfusion detected a reversible perfusion defect of the proximal portion of the posterolateral and lateral walls, thus confirming the hemodynamic importance of the flow through the fistula during stress cycloergometric testing. In the second patient familial predisposition to ischemic heart disease and previous inferior wall myocardial infarction and non-significant stress ECG, coronary angiography identified a seclusive stenosis of the right coronary artery and anomaly between the anterior interventricular artery and the left pulmonary artery. The presence of the contrast medium in the left pulmonary artery identified a flow from the left ventricle to the left pulmonary artery. Good angiographic results were obtained

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

    International Nuclear Information System (INIS)

    Song Liping; He Zuoxiang; Liu Xiujie; Shi Rongfang; Liu Yunzhong; Tian Yueqin; Zhang Xiaoli; Qin Xuewen; Chen Jilin; Gao Runlin

    2001-01-01

    Objective: Exercise 99 Tc m -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

  2. Single photon emission computed tomography of technetium-99m tetrofosmin myocardial perfusion imaging in patients with systemic lupus erythematosus-A preliminary report

    International Nuclear Information System (INIS)

    Lin, Jen-Jhy; Hsu, Hsiu-Bao; Sun, Shung-Shung; Kao, Chia-Hung; Ho, Shung-Tai

    2003-01-01

    The purpose of this study was to evaluate the utility of single-photon emission computed tomography (SPECT) of technetium-99m tetrofosmin (Tc-99m TF) myocardial perfusion imaging to detect myocardial involvement in patients with systemic lupus erythematosus (SLE). Three groups of subjects-group 1: 25 SLE female patients with non-specific cardiac symptoms and signs, group 2: 25 female SLE patients without any cardiac symptoms and signs, and group 3: 25 female healthy controls-were evaluated by comparing rest and dipyridamole-stress Tc-99m TF myocardial perfusion SPECT. Tc-99m TF myocardial perfusion SPECT revealed perfusion defects in 88% and 40% of the cases in groups 1 and 2, respectively. However, no cases in group 3 demonstrated myocardial perfusion defects. Tc-99m TF myocardial perfusion SPECT is a useful noninvasive imaging modality to detect cardiac involvement in SLE patients with or without cardiac symptoms and signs. (author)

  3. Electrocardiographic left ventricular hypertrophy without echocardiographic abnormalities evaluated by myocardial perfusion and fatty acid metabolic imaging

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi

    2000-01-01

    The pathophysiologic process in patients with electrocardiographic left ventricular hypertrophy with ST, T changes but without echocardiographic abnormalities was investigated by myocardial perfusion imaging and fatty acid metabolic imaging. Exercise stress 99m Tc-methoxy-isobutyl isonitrile (MIBI) imaging and rest 123 I-beta-methyl-p-iodophenyl pentadecanoic acid (BMIPP) imaging were performed in 59 patients with electrocardiographic hypertrophy including 29 without apparent cause including hypertension and echocardiographic hypertrophy, and 30 with essential hypertension. Coronary angiography was performed in 6 patients without hypertension and 4 with hypertension and biopsy specimens were obtained from the left ventricular apex from 6 patients without hypertension. Myocardial perfusion and 123 I-BMIPP images were classified into 3 types: normal, increased accumulation of the isotope at the left ventricular apex (high uptake) and defect. Transient perfusion abnormality and apical defect observed by 123 I-BMIPP imaging were more frequent in patients without hypertension than in patients with hypertension (32% vs. 17%, p=0.04671 in perfusion; 62% vs. 30%, p=0.0236 in 123 I-BMIPP). Eighteen normotensive patients with apical defect by 123 I-BMIPP imaging included 3 of 10 patients with normal perfusion at exercise, 6 of 10 patients with high uptake and 9 of 9 patients with perfusion defect. The defect size revealed by 123 I-BMIPP imaging was greater than that of the perfusion abnormality. Coronary stenoses were not observed and myocardial specimens showed myocardial disarray with hypertrophy. Moreover, 9 patients with hypertension and apical defects by 123 I-BMIPP showed 3 different types of perfusion. Many patients without hypertension show a pathologic process similar to hypertrophic cardiomyopathy. Perfusion and 123 I-BMIPP imaging are useful for the identification of these patients. (author)

  4. A decision support system for stress only myocardial perfusion scintigraphy may save unnecessary rest studies

    DEFF Research Database (Denmark)

    Tägil, K; Jakobsson, D; Lomsky, M

    2013-01-01

    The aim of this study was to investigate the influence of a computer-based decision support system (DSS) on performance and inter-observer variability of interpretations regarding ischaemia and infarction in myocardial perfusion scintigraphy (MPS).......The aim of this study was to investigate the influence of a computer-based decision support system (DSS) on performance and inter-observer variability of interpretations regarding ischaemia and infarction in myocardial perfusion scintigraphy (MPS)....

  5. Influence of angiographic collateral circulation on myocardial perfusion in patients with chronic total occlusion of a single coronary artery and no prior myocardial infarction.

    Science.gov (United States)

    Aboul-Enein, Fatma; Kar, Saibal; Hayes, Sean W; Sciammarella, Maria; Abidov, Aiden; Makkar, Raj; Friedman, John D; Eigler, Neal; Berman, Daniel S

    2004-06-01

    The functional role of various angiographic grades for coronary collaterals remains controversial. The aim of this study was to assess the influence of the Rentrop angiographic grading of coronary collaterals on myocardial perfusion in patients with single-vessel chronic total occlusion (CTO) and no prior myocardial infarction (MI). The study included 56 patients with single-vessel CTO and no prior MI who underwent rest-stress myocardial perfusion SPECT and coronary angiography within 6 mo. All patients had angiographic evidence of coronary collaterals. Patients were divided according to the Rentrop classification: Group I had grade 1 or 2 (n = 25) and group II had grade 3 collaterals (n = 31). Group I had a higher frequency of resting regional wall motion abnormalities on left ventriculography (52.6% vs. 19.2% [P = 0.019]). The mean perfusion scores of the overall population showed severe and extensive stress perfusion defects (summed stress score of 14.1 +/- 7.1 and summed difference score of 12.9 +/- 6.9) but minimal resting perfusion defects (summed rest score of 1.0 +/- 2.7). No perfusion scores differed between the 2 groups. The perfusion findings suggested that chronic stunning rather than hibernation is the principal cause of regional wall motion abnormalities in these patients. In the setting of single-vessel CTO and no prior MI, coronary collaterals appear to protect against resting perfusion defects. Excellent angiographic collaterals may prevent resting regional wall motion abnormalities but do not appear to protect against stress-induced perfusion defects.

  6. Scintigraphy for the detection of myocardial damage in the indeterminate form of Chagas disease

    International Nuclear Information System (INIS)

    Pedroso, Enio Roberto Pietra; Rezende, Nilton Alves de

    2010-01-01

    Background: non-invasive cardiological methods have been used for the identification of myocardial damage in Chagas disease. Objective: to verify whether the rest/stress myocardial perfusion scintigraphy is able to identify early myocardial damage in the indeterminate form of Chagas disease. Methods: eighteen patients with the indeterminate form of Chagas Disease and the same number of normal controls, paired by sex and age, underwent rest/stress myocardial scintigraphy using sestamibi-99mTc, aiming at detecting early cardiac damage. Results: the results did not show perfusion or ventricular function defects in patients at the indeterminate phase of Chagas disease and in the normal controls, except for a patient who presented signs of ventricular dysfunction in the myocardial perfusion scintigraphy with electrocardiographic gating. Conclusion: the results of this study, considering the small sample size, showed that the rest/stress myocardial scintigraphy using sestamibi-99mTc is not an effective method to detect early myocardial alterations in the indeterminate form of Chagas disease (author)

  7. Scintigraphy for the detection of myocardial damage in the indeterminate form of Chagas disease

    Energy Technology Data Exchange (ETDEWEB)

    Pedroso, Enio Roberto Pietra; Rezende, Nilton Alves de, E-mail: narezende@terra.com.b [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Abuhid, Ivana Moura [Instituto de Medicina Nuclear e Diagnostico Molecular, Belo Horizonte, MG (Brazil)

    2010-07-15

    Background: non-invasive cardiological methods have been used for the identification of myocardial damage in Chagas disease. Objective: to verify whether the rest/stress myocardial perfusion scintigraphy is able to identify early myocardial damage in the indeterminate form of Chagas disease. Methods: eighteen patients with the indeterminate form of Chagas Disease and the same number of normal controls, paired by sex and age, underwent rest/stress myocardial scintigraphy using sestamibi-99mTc, aiming at detecting early cardiac damage. Results: the results did not show perfusion or ventricular function defects in patients at the indeterminate phase of Chagas disease and in the normal controls, except for a patient who presented signs of ventricular dysfunction in the myocardial perfusion scintigraphy with electrocardiographic gating. Conclusion: the results of this study, considering the small sample size, showed that the rest/stress myocardial scintigraphy using sestamibi-99mTc is not an effective method to detect early myocardial alterations in the indeterminate form of Chagas disease (author)

  8. Absolute quantitation of left ventricular wall and cavity parameters using ECG-gated PET

    DEFF Research Database (Denmark)

    Freiberg, Jacob; Hove, Jens D; Kofoed, Klaus F

    2004-01-01

    in a heart phantom and in healthy subjects. Twelve healthy men aged 64 +/- 8 years were studied by use of cine magnetic resonance imaging (MRI) and ECG-gated FDG-PET during euglycemic glucose-insulin clamp. At increasing image noise levels, the estimated cavity volume of the heart phantom was within 2 m...

  9. Diagnostic performance of combined noninvasive coronary angiography and myocardial perfusion imaging using 320 row detector computed tomography

    DEFF Research Database (Denmark)

    Vavere, Andrea L; Simon, Gregory G; George, Richard T

    2013-01-01

    Multidetector coronary computed tomography angiography (CTA) is a promising modality for widespread clinical application because of its noninvasive nature and high diagnostic accuracy as found in previous studies using 64 to 320 simultaneous detector rows. It is, however, limited in its ability...... to detect myocardial ischemia. In this article, we describe the design of the CORE320 study ("Combined coronary atherosclerosis and myocardial perfusion evaluation using 320 detector row computed tomography"). This prospective, multicenter, multinational study is unique in that it is designed to assess...... the 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...

  10. Reverse Redistribution in Myocardial Perfusion Imaging: Revisited with 64-slice MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Min Kyung; Kim, Jeong Ho; Hwang, Kyung Hoon; Choi, In Suck; Choi, Soo Jin; Choe, Won Sick [Gachon University Gil Hospital, Incheon (Korea, Republic of); Yoon, Min Ki [Good Samaritan Hospital, Pohang (Korea, Republic of)

    2010-06-15

    The authors report myocardial perfusion imaging of a patient showing reverse redistribution (RR) and a 64-slice multidetector-row computed tomography (MDCT) with corresponding findings. The patient had subendocardial myocardial infarction (MI) with positive electrocardiogram (EMG) findings and elevated levels of cardiac isoenzymes. Experiencing this case emphasizes the importance of complementary correlation of a new diagnostic modality that helps us to understand the nature of RR.

  11. Outcome of Patients With Adenosine-Induced ST Segment Depression and Normal Myocardial Perfusion

    International Nuclear Information System (INIS)

    El-Refaei, S.; Selim, M.

    2011-01-01

    The aim of the present study was to determine the outcome of patients with normal MPS and adenosine-induced ST segment depression. A total of 1867 patients underwent adenosine Tc99m-tetrofosmin MPS in nuclear medicine unit in Saudi German Hospital, Saudi Arabia, between January 2004 and May 2008. Their ECGs were checked for ST segment depression during adenosine infusion. All patients with ≥ 1 mm horizontal or down-sloping ST segment depression or≥ 1.5 mm up-sloping ST segment depression were included in the study. Fifty-six patients met our inclusion criteria, of which 45 (80%) were females. During the follow-up period, a total of 15 of patients ended up doing coronary angiography, either for high clinical suspicion or following a second positive MPS performed 6-18 months after the first study. Seven of them were positive for coronary artery disease and were subsequently treated with revascularization procedure, and 8 returned either normal angiography or non-obstructive coronary artery disease. Male diabetic smoking patients were more prevalent and underwent revascularization. The patients were followed up for a mean of 22.8 ±7.8 months. No cardiac deaths or myocardial infarctions were reported. It could be concluded that adenosine-induced ST segment depression in patients with normal myocardial perfusion was a benign finding and did not increase the very low risk of cardiac events in those patients. However, male smokers and/or diabetics might need further investigation. This suggestion needs further evaluation

  12. Use of high flip angle in T1-prepared FAST sequences for myocardial perfusion quantification

    International Nuclear Information System (INIS)

    Vallee, Jean-Paul; Ivancevic, Marko; Lazeyras, Francois; Didier, Dominique; Kasuboski, Larry; Chatelain, Pascal; Righetti, Alberto

    2003-01-01

    This study reports on the first use of high flip angle and radio-frequency (RF) spoiling in T1-prepared fast acquisition in steady state (FAST) sequence for myocardial perfusion in patients. T1 dynamic range was measured in vitro with a FAST, an RF FAST and a snapshot fast low-angle shot (FLASH) sequences with a 90 flip angle. Myocardial perfusion was then measured twice in 6 patients during the same MR session. The RF FAST and FLASH, but not the FAST sequence, demonstrated an extended T1 dynamic range; however, the FLASH images were degraded by artifacts not present on the RF FAST images. The myocardial perfusion indices K1 (first-order transfer constant from the blood to the myocardium for the Gd-DTPA) and Vd (distribution volume of Gd-DTPA in myocardium) did not differ significantly between the two injections. K1 was 0.48±0.12 ml/min g -1 and Vd was 12.5±2.9%. With an extended T1 dynamic range and the sensitivity required for myocardial perfusion quantification, the RF FAST sequence with a 90 flip angle outperformed the snapshot FLASH sequence in terms of image quality and the FAST sequence in terms of contrast dynamic range. (orig.)

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

    International Nuclear Information System (INIS)

    Tian Yueqin; Wei Hongxing; Guo Xinhua; Guo Feng; He Zuoxiang

    2008-01-01

    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 99 Tc m -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 99 Tc m -MIBI myocardial perfusion imaging and coronary angiography. Results: Of the 163 patients with significant coronary artery stenosis, 116 showed abnormal 99 Tc m -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 99 Tc m -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: 99 Tc m -MIBI myocardial perfusion imaging has important clinical value for detecting coronary artery disease in patients with metabolic syndrome. (authors)

  14. Prognostic value of myocardial perfusion and ventricular function in a Japanese multicenter cohort study (J-ACCESS). The first-year total events and hard events

    International Nuclear Information System (INIS)

    Nakajima, Kenichi; Kusuoka, Hideo; Nishimura, Shigeyuki; Yamashina, Akira; Nishimura, Tsunehiko

    2009-01-01

    The objective of this study was to determine the prognostic value of myocardial ischemia, function and coronary risk factors on total and hard cardiac events using myocardial perfusion imaging in a Japanese population. A prospective cohort study was performed in 117 Japanese hospitals, each with a nuclear cardiology facility. A total of 4,031 patients with suspected or confirmed ischemic heart disease were registered. The patients were followed up for a year to investigate total and hard events, and those who had any events were followed up for 3 years to evaluate subsequent hard events. A stress-rest gated myocardial perfusion study was performed with 99m Tc-tetrofosmin using gated single-photon emission computed tomography (SPECT) and analyzed by semi-quantitative scores. During the 1-year follow-up period, 263 (6.5%) patients had total events comprising all-cause death, non-fatal myocardial infarction (MI), heart failure, unstable angina, angina pectoris and coronary revascularization. Cardiac death occurred in 23 patients (0.6%) and non-fatal MI in 11 (0.3%). Among patients with ejection fraction (EF) of <45% and a summed difference score (SDS) of ≥2, 18.7% (2.4% for cardiac death and 0.6% for non-fatal MI) experienced total events compared with 3.9% (0.3% for cardiac death and 0.2% for non-fatal MI; P<0.0001) of those with EF≥45% and SDS<2. Multivariate analysis identified EF, SDS, age, history of revascularization and diabetes as significant predictors of all events, while the significant predictors were age and EF for hard events. When the patients who had heart failure in the first year were followed up, 9 of 41 (22.0%) experienced cardiac death in the subsequent 3-year follow-up period. Myocardial ischemia defined by SDS and ventricular function were the main predictors of total events despite the relatively low incidence of hard events in this Japanese population. In patients with cardiac events in a year, closer attention should be paid to subsequent

  15. Value of planar 201Tl imaging in risk stratification of patients recovering from acute myocardial infarction

    International Nuclear Information System (INIS)

    Gibson, R.S.; Watson, D.D.

    1991-01-01

    Although exercise ECG testing has been shown to have important prognostic value after acute myocardial infarction, exercise 201Tl scintigraphy offers several potential advantages, including: (1) increased sensitivity for detecting residual myocardial ischemia; (2) the ability to localize ischemia to a specific area or areas subtended by a specific coronary artery; (3) the ability to identify exercise-induced left ventricular dysfunction, which is manifested by increased lung uptake or transient left ventricular dilation; and (4) more reliable risk stratification of individual patients. The more optimal prognostic efficiency of 201Tl scintigraphy partially results from the fact that the error rate in falsely classifying patients as low risk is significantly smaller with 201Tl scintigraphy than with stress ECG. Because of these substantial advantages, there seems to be adequate rationale for recommending exercise perfusion imaging rather than exercise ECG alone as the preferred method for evaluating mortality and morbidity risks after acute myocardial infarction

  16. Evaluating the effect of PTCA by exercise stress myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Lin Jinghui

    1992-01-01

    In this study, 44 patients after successful percutaneous transluminal coronary angioplasty (PTCA) were followed up by exercise stress myocardial perfusion imaging. In 28 patients with myocardial ischemia after PTCA, myocardial imaging of 75.0% patients reverted to normal or approximately normal. In 16 patients of myocardial infarction with ischemia after PTCA, myocardial imaging of only 37.5% patients reverted to normal or approximately normal, significantly less than myocardial ischemia. But the general efficacious incidence was similar in both groups. Most of 77 myocardial segments with complete or obvious redistribution returned to normal imaging after PTCA. During the follow-up coronary artery restenosis occurred in 6 cases, 5 of which were confirmed by coronary arteriography. Restenosis may be discovered as soon as possible, if a patient was reexamined by myocardial imaging 2-6 months after PTCA. The results of this study indicated that myocardial imaging is a noninvasive and reliable method for the assessment of PTCA therapeutic effect and follow up studies

  17. When is reacquisition necessary due to high extra-cardiac uptake in myocardial perfusion scintigraphy?

    DEFF Research Database (Denmark)

    Johansen, Allan; Lomsky, Milan; Gerke, Oke

    2013-01-01

    Technetium-labeled agents, which are most often used for assessing myocardial perfusion in myocardial perfusion scintigraphy (MPS), are cleared by the liver and excreted by the biliary system. Spillover from extra-cardiac activity into the myocardium, especially the inferior wall, might conceal d...... defects and lower the diagnostic accuracy of the study. The objective was to determine rules of thumb for when reacquisition is useful due to high extra-cardiac uptake, i.e., when interpretation of the studies was affected by poor image quality....

  18. Tomographic myocardial perfusion scintigraphy in children with Kawasaki disease

    International Nuclear Information System (INIS)

    Spielmann, R.P.; Nienaber, C.A.; Hausdorf, G.; Montz, R.

    1987-01-01

    Myocardial infarction and stenotic coronary lesions are serious late complications in children with Kawasaki disease. For the noninvasive assessment of myocardial perfusion, dipyridamole-redistribution 201 Tl emission computed tomography (ECT) was performed in seven children (age 2 8/12-8 7/12 yr) 3-20 mo after the acute stage of the disease. In all patients, coronary aneurysms had been demonstrated by cross-sectional echocardiography. The scintigrams of six children showed no significant regional reduction of myocardial thallium uptake. These children had remained asymptomatic since the acute stage of Kawasaki disease. Persistent and transient thallium defects were present in one child with documented myocardial infarction. For this patient, obstruction of corresponding coronary vessels was confirmed by contrast angiography. It is suggested, that 201 Tl ECT after dipyridamole-induced vasodilation may be used as a safe alternative to invasive coronary angiography for follow-up investigations in patients with Kawasaki disease

  19. Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT: Theoretical Models and Current Implementation

    Directory of Open Access Journals (Sweden)

    G. J. Pelgrim

    2016-01-01

    Full Text Available Technological advances in magnetic resonance imaging (MRI and computed tomography (CT, including higher spatial and temporal resolution, have made the prospect of performing absolute myocardial perfusion quantification possible, previously only achievable with positron emission tomography (PET. This could facilitate integration of myocardial perfusion biomarkers into the current workup for coronary artery disease (CAD, as MRI and CT systems are more widely available than PET scanners. Cardiac PET scanning remains expensive and is restricted by the requirement of a nearby cyclotron. Clinical evidence is needed to demonstrate that MRI and CT have similar accuracy for myocardial perfusion quantification as PET. However, lack of standardization of acquisition protocols and tracer kinetic model selection complicates comparison between different studies and modalities. The aim of this overview is to provide insight into the different tracer kinetic models for quantitative myocardial perfusion analysis and to address typical implementation issues in MRI and CT. We compare different models based on their theoretical derivations and present the respective consequences for MRI and CT acquisition parameters, highlighting the interplay between tracer kinetic modeling and acquisition settings.

  20. The role of pharmacological stress Tc-99m sestamibi myocardial perfusion imaging in an Australian population

    International Nuclear Information System (INIS)

    Howarth, D.M.; Booker, J.A.; Tan, T.S.K.; Bellamy, G.R.; Hardy, D.B.; Howarth, G.C.

    2003-01-01

    This observational study was performed in order to assess the exercise-related incremental diagnostic accuracy of Tc-99m sestamibi myocardial perfusion imaging (MPI) in a hospital-based Australian population, and to assess the relative roles of exercise and pharmacological stress in myocardial perfusion imaging (MPI). Two hundred and eight adult patients who had both Tc-99m sestamibi myocardial perfusion imaging and coronary angiography within a median time of 16 weeks were studied. The diagnostic end-point was coronary artery lesions of ≥50% and >70% stenosis detected on angiography. Using receiver operating characteristic curve analysis, the overall diagnostic accuracy was calculated, as well as the comparative accuracies in patients who undertook various levels of exercise stress testing (n=130) and those who received pharmacological (dipyridamole) stress testing (n=78). The overall respective diagnostic accuracy of Tc-99m sestamibi MPI for the diagnosis of coronary artery disease (>70% stenosis) was 81% and 76% when using the diagnostic criterion of ≥50% stenosis. On direct comparison of perfusion defects with angiographic stenoses, the respective sensitivity and specificity for the detection of >70% stenosis in each coronary artery territory was 73% and 79%. Pharmacological MPI showed a significantly greater sensitivity for the detection of localised stenoses compared to the overall group who had exercise MPI performed. Consequently, exercise stress MPI showed significantly more false negative lesions compared to dipyridamole stress imaging (p<0.003). However, a large proportion of patients were unable to perform to adequate exercise levels in this patient sample. We conclude that Tc-99m sestamibi myocardial perfusion imaging is an accurate non-invasive test for the diagnosis of coronary artery disease. Where any doubt exists as to the patient's ability to achieve exercise levels at or above 85% of the predicted value for age and gender, pharmacological

  1. Comparison of Myocardial Perfusion Scintigraphy and Coronary Angiography Results

    Directory of Open Access Journals (Sweden)

    Umut Elboga

    2017-05-01

    Full Text Available Aim: Coronary artery disease (CAD is one of the most frequent causes of mortality and morbidity worldwide. Coronary angiography is the gold standard for the anatomical diagnosis of coronary artery stenosis. Myocardial Perfusion Scintigraphy (MPS is a non-invasive imaging modality used for the diagnosis of CAD. In this study, we aimed to compare the findings of MPS and coronary angiogram. Material and Method: Eighty-one patients (37 males, 44 females; mean age 55 ± 10.95 years with angina and detected perfusion defects on MPS were included in this study. All of the patients underwent coronary angiogram. A narrowing %u2265 50% was considered pathological on the coronary angiography. Results: Findings of the coronary angiogram and MPS were compared and found consistent in 51 (63% patients. A coronary narrowing < 50% was detected by coronary angiogram in 4 (5% of the remaining patients. Coronary angiogram was found to be normal in the remaining 26 patients (32% and these patients were evaluated as cardiac syndrome X (CSX known as microvascular angina (MA. Discussion: The findings showed that MPS is superior to coronary angiogram in the early diagnosis of myocardial perfusion disorders at the microvascular level. Therefore, we concluded that MPS should be the primary diagnostic tool to begin treatment before an anatomically large narrowing occurs in the coronaries.

  2. Clinical Significance of Reverse Redistribution Phenomenon on Delayed Tc-99m Tetrofosmin Myocardial Perfusion Imaging in Patients with Acute Myocardial Infarction

    International Nuclear Information System (INIS)

    Park, Soon Ah; Kim, Dae Weung; Kim, Chang Guhn; Jeong, Jin Won; Kim, Nam Ho; Yun, Kyeong Ho

    2009-01-01

    This study was performed to investigate the clinical significance of reverse redistribution (RR) phenomenon detected on delayed Tc-99m tetrofosmin myocardial single photon emission computed tomography (SPECT) in patients with acute myocardial infarction after revascularization. A Tc-99m tetrofrosmin myocardial SPECT was performed in 67 consecutive patients after revascularization for acute myocardial infarction. Myocardial SPECT imaging was performed for early imaging at 40 min and for delayed imaging at 180 min after reinjection at myocardial stress. Regional myocardial uptakes were scored by 4-point scoring in the left ventricular wall divided into 17 segments. Reverse redistribution was defined as an increase of more than 2 point in the activity score on the delayed image. Follow-up myocardial SPECT and coronary angiography (CAG) were performed 9 months later. On myocardial SPECT performed following revascularization, RR was observed in 100 of all 319 segments (31%) and in 43 patients (64%). The abnormalities of perfusion and regional wall motion were more severe in the patients with RR compared to those without RR (p<0.05). On follow-up myocardial SPECT, the myocardial perfusion, regional wall motion, and myocardial thickness were significantly improved in the patients with RR (p<0.05) however, these changes were not significant in those without RR. There was no significant difference between the patients with RR and those without RR in the occurrence of restenosis on CAG. In patients with acute myocardial infarction, the regions showing the RR phenomenon on delayed Tc-99m tetrofosmin SPECT may reflect viable myocardium and indicate recovery of salvaged myocardium

  3. ECG-gated interventional cardiac reconstruction for non-periodic motion.

    Science.gov (United States)

    Rohkohl, Christopher; Lauritsch, Günter; Biller, Lisa; Hornegger, Joachim

    2010-01-01

    The 3-D reconstruction of cardiac vasculature using C-arm CT is an active and challenging field of research. In interventional environments patients often do have arrhythmic heart signals or cannot hold breath during the complete data acquisition. This important group of patients cannot be reconstructed with current approaches that do strongly depend on a high degree of cardiac motion periodicity for working properly. In a last year's MICCAI contribution a first algorithm was presented that is able to estimate non-periodic 4-D motion patterns. However, to some degree that algorithm still depends on periodicity, as it requires a prior image which is obtained using a simple ECG-gated reconstruction. In this work we aim to provide a solution to this problem by developing a motion compensated ECG-gating algorithm. It is built upon a 4-D time-continuous affine motion model which is capable of compactly describing highly non-periodic motion patterns. A stochastic optimization scheme is derived which minimizes the error between the measured projection data and the forward projection of the motion compensated reconstruction. For evaluation, the algorithm is applied to 5 datasets of the left coronary arteries of patients that have ignored the breath hold command and/or had arrhythmic heart signals during the data acquisition. By applying the developed algorithm the average visibility of the vessel segments could be increased by 27%. The results show that the proposed algorithm provides excellent reconstruction quality in cases where classical approaches fail. The algorithm is highly parallelizable and a clinically feasible runtime of under 4 minutes is achieved using modern graphics card hardware.

  4. Normal myocardial perfusion imaging in the presence of significant coronary artery stenosis

    International Nuclear Information System (INIS)

    Tian Yueqin; He Zuoxiang; Fang Wei; Yang Minfu; Shen Rui

    2007-01-01

    Objective: The aim of this study was to investigate the factors which might result in normal myocardial perfusion imaging in the presence of significant coronary artery stenosis. Methods: One hundred and thirty-three patients [mean age of (59±10) years, 98 men, 35 women] who underwent coronary angiography and myocardial perfusion SPECT were retrospectively analyzed. Results: Forty-six (35%) patients performed adequate bicycle exercise testing and achieved more than 85% of their predicted maximal heart rates; while 87 (65%) patients did not. Eighty-four (63%) patients had single coronary stenosis, 31(23%) two-vessel and 17(13%) three-vessel diseases. The difference in stenosis severity among the vessels in 13 (76%) cases with three-vessel diseases was not more than 20%. There were totally 202 coronary artery stenosis: 93 (46%) in left anterior descending coronary artery (LAD), 52 (26%) left circumflex coronary artery (LCX), 52(26% ) right coronary artery (RCA) and 5 (2%) left main coronary artery (LM) disease. Eighty-six(43%) vessels had 50%-70% stenosis, 100 (49%) >70%-90% and 16(8% )more than 90%. Conclusion: Normal myocardial perfusion imaging with significant coronary artery stenosis can probably due to inadequate exercise, single vessel disease and mild to moderate stenotic lesion. (authors)

  5. A feed forward neural network for classification of bull's-eye myocardial perfusion images

    International Nuclear Information System (INIS)

    Hamilton, D.; Riley, P.J.; Miola, U.J.; Amro, A.A.

    1995-01-01

    Identification of hypoperfused areas in myocardial perfusion single-photon emission tomography studies can be aided by bull's-eye representation of raw counts, lesion extent and lesion severity, the latter two being produced by comparison of the raw bull's-eye data with a normal data base. An artificial intelligence technique which is presently becoming widely popular and which is particularly suitable for pattern recognition is that of artificial neural network. We have studied the ability of feed forward neural networks to extract patterns from bull's-eye data by assessing their capability to predict lesion presence without direct comparison with a normal data base. Studies were undertaken on both simulation data and on real stress-rest data obtained from 410 male patients undergoing routine thallium-201 myocardial perfusion scintigraphy. The ability of trained neural networks to predict lesion presence was quantified by calculating the areas under receiver operating characteristic curves. Figures as high as 0.96 for non-preclassified patient data were obtained, corresponding to an accuracy of 92%. The results demonstrate that neural networks can accurately classify patterns from bull's-eye myocardial perfusion images and detect the presence of hypoperfused areas without the need for comparison with a normal data base. Preliminary work suggests that this technique could be used to study perfusion patterns in the myocardium and their correlation with clinical parameters. (orig.)

  6. Confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion.

    Science.gov (United States)

    Burg, Matthew M; Meadows, Judith; Shimbo, Daichi; Davidson, Karina W; Schwartz, Joseph E; Soufer, Robert

    2014-10-30

    Depression is prevalent in coronary heart disease (CHD) patients and increases risk for acute coronary syndrome (ACS) recurrence and mortality despite optimal medical care. The pathways underlying this risk remain elusive. Psychological stress (PS) can provoke impairment in myocardial perfusion and trigger ACS. A confluence of acute PS with depression might reveal coronary vascular mechanisms of risk. We tested whether depression increased risk for impaired myocardial perfusion during acute PS among patients with stable CHD. Patients (N=146) completed the Beck Depression Inventory-I (BDI-I), a measure of depression linked to recurrent ACS and post-ACS mortality, and underwent single-photon emission computed tomography myocardial perfusion imaging at rest and during acute PS. The likelihood of new/worsening impairment in myocardial perfusion from baseline to PS as a function of depression severity was tested. On the BDI-I, 41 patients scored in the normal range, 48 in the high normal range, and 57 in the depressed range previously linked to CHD prognosis. A BDI-I score in the depressed range was associated with a significantly greater likelihood of new/worsening impairment in myocardial perfusion from baseline to PS (odds ratio =2.89, 95% CI: 1.26 to 6.63, P=0.012). This remained significant in models controlling ACS recurrence/mortality risk factors and medications. There was no effect for selective serotonin reuptake inhibitor medications. Depressed patients with CHD are particularly susceptible to impairment in myocardial perfusion during PS. The confluence of PS with depression may contribute to a better understanding of the depression-associated risk for ACS recurrence and mortality. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  7. Association between left ventricular perfusion defects and myocardial deformation indexes in heart transplantation recipients.

    Science.gov (United States)

    D'Andrea, Antonello; De Rimini, Maria Luisa; America, Raffaella; Cirillo, Chiara; Riegler, Lucia; Limongelli, Giuseppe; D'Alto, Michele; Salerno, Gemma; Maiello, Ciro; Muto, Pietro; Russo, Maria Giovanna; Calabrò, Raffaele; Bossone, Eduardo; Pacileo, Giuseppe

    2017-10-01

    The aim of the study was to analyze possible correlations between strain echocardiography (STE) and PET myocardial perfusion in a population of heart transplantation (HTx) recipients showing preserved left ventricular (LV) ejection fraction. By STE, LV global longitudinal strain (LV GLS) was lower in HTx. PET showed no transient or chronic ischemia in 83 of 115 HTx (73%). Fixed perfusion defects were observed in 17% of HTx and reversible ischemia in 10%. Significant coronary stenosis was observed only in 10 cases. GLS was independently associated with age at HTx and fixed perfusion defects (HR 0.41; P<.001). Such relationships underline STE ability to early identify HTx pts with subclinical myocardial dysfunction during long-term follow-up. © 2017, Wiley Periodicals, Inc.

  8. Comparison of stress-rest and rest-stress one day myocardial perfusion scintigraphies in detecting coronary artery diseases

    International Nuclear Information System (INIS)

    Bom, Hee Seung; Min, Jung Jun; Song, Ho Cheon; Kim, Ji Yeul

    1997-01-01

    It has been shown that both rest and stress myocardial perfusion imaging with technetium agents can be performed on the same day using two different doses injected within few hours. The purpose of this study was to compare the two protocols (stress-rest and rest-stress) in detecting coronary artery diseases. One hundred and sixty patients (101 males, 59 females, mean age 57±9 years) and 120 patients (79 males, 41 females, mean age 59±10 years) underwent stress-rest myocardial perfusion SPECT and rest-stress myocardial perfusion SPECT, respectively. All of them underwent both myocardial perfusion SPECT and coronary angiography within 1 month. A coronary stenosis was considered significant when it compromised the luminal diameter by ≥50%. The chi square test was used to compare differences in sensitivity, specificity and accuracy between the two groups. The overall sensitivity, specificity and accuracy of stress-rest protocol were 99%, 35% and 68%, respectively. Those of rest-stress protocol were 96%, 47% and 78%, respectively. There was no difference between the two protocols in identifying individual diseased coronary artery branches. Therefore, one day stress-rest and rest-stress myocardial SPECT using 99m Tc agents were comparable and were very sensitive tests in detecting coronary artery diseases

  9. Paradoxical hypotension during dobutamine infusion for myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Erguen, E.L.; Caner, B.; Atalar, E.; Karanfil, A.; Tokgoezoglu, L.

    1998-01-01

    Dobutamine as a predominant beta-1 agonist increases heart rate and myocardial contractility and at sufficient high doses, it also increases systolic blood pressure. This study was undertaken to describe instances of paradoxical hypotension during dobutamine infusion for Tl-201 myocardial perfusion SPECT study and the relationship between scintigraphic findings and hypotension occurred during dobutamine infusion. Methods: In 201 consecutive patients unable to perform adequate exercise, dobutamine Tl-201 myocardial SPECT was performed. Dobutamine was infused starting from 10 μg/kg/min increasing to 40 μ/kg/min. Paradoxical hypotension was defined as a decrease in systolic blood pressure ≥ 20 mmHg compared with baseline study. Paradoxical hypotension was observed in 40 patients (Group A) out of 201 (19.9%) while no significant change in systolic blood pressure was detected in the remaining 161 patients (Group B). Mean maximum fall in systolic blood pressure was 39±18 mmHg (range: 20-90). In 33 of 40 patients (83%) with paradoxical hypotension, scintigraphy was normal compared to 131 (81%) of the remaining 161 patients. In patients of Group A, angiography, echocardiography and tilt table tests were performed in 13, 11 and 6 patients respectively. Nine of 13 angiographic evaluations (69%), 10 of 11 echocardiographic evaluations (91%), all of the tilt table tests were normal. Additionally, all of the patients of Group A were clinically followed up at least 6 months after the myocardial perfusion scintigraphy. None of the patients had a cardiac event except one patient during the follow-up period. Conclusion: Paradoxical hypotension during dobutamine infusion for myocardial scintigraphy is not an uncommon finding and up to 19.9% patients may develop such hypotension. To maximize test safety, precautions should be taken during dobutamine myocardial stress test, since remarkable decrease in systolic blood pressure may occur. Unlike hypotension occurring with exercise

  10. Prediction of revascularization after myocardial perfusion SPECT by machine learning in a large population.

    Science.gov (United States)

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

    2015-10-01

    We aimed to investigate if early revascularization in patients with suspected coronary artery disease can be effectively predicted by integrating clinical data and quantitative image features derived from perfusion SPECT (MPS) by machine learning (ML) approach. 713 rest (201)Thallium/stress (99m)Technetium MPS studies with correlating invasive angiography with 372 revascularization events (275 PCI/97 CABG) within 90 days after MPS (91% within 30 days) were considered. Transient ischemic dilation, stress combined supine/prone total perfusion deficit (TPD), supine 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). Tenfold 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. The sensitivity of machine learning (ML) (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 ML (74.7% ± 4.2%) was also better than both expert readers (67.2% ± 4.9% and 66.0% ± 5.0%, P < .05), but was similar to ischemic TPD (68.3% ± 4.9%, P < .05). The receiver operator characteristics areas under curve for ML (0.81 ± 0.02) was similar to reader 1 (0.81 ± 0.02) but superior to reader 2 (0.72 ± 0.02, P < .01) and standalone measure of perfusion (0.77 ± 0.02, P < .01). ML approach is comparable or better than

  11. A new clinical tool for the quantification of myocardial CT perfusion imaging in patients with suspected Ischemic Heart Disease

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz Muñoz, A.; Dux-Santoy Hurtado, L.; Rodriguez Palomares, J.L.; Piella Fenoy, G.

    2016-07-01

    In the clinical practice, the evaluation of myocardial perfusion by using Computed Tomography (CT) Imaging is usually performed visually or semi-quantitatively. The scarcity of quantitative perfusion data not always allows a proper diagnose of patients which are suspected of suffering from some diseases, such as Ischemic Heart Disease (IHD). In this work, a clinical tool for the automatic quantification of myocardial perfusion in patients with suspected IHD is proposed. Myocardial perfusion is assessed based on a combined diagnosis protocol (CT/CTP protocol) which involves the acquisition of two contrastenhanced CT images, one obtained at rest and another acquired under pharmacological stress. The clinical tool allows the automatic quantification of perfusion in different myocardial segments defined according to the 16-AHA-segmentation model of the left ventricle, by providing the mean of Hounsfield Units in those regions. Based on this analysis, the clinicians can compare the values at baseline and at hyperemia, and they can better determine hypoperfusion defects in patients with IHD. The validation of the clinical tool was performed by comparing automatic and manual perfusion measurements of 10 patients with suspected IHD who were previously assessed with Single Photon Emission Computed Tomography (SPECT) for perfusion analysis. A strong linear correlation was found between the automatic and manual results. Afterwards, perfusion defects obtained from CT/CTP protocol were compared to perfusion defects from SPECT, to assess the applicability of this clinical tool for the diagnosis of IHD. (Author)

  12. Noninvasive evaluation of regional myocardial perfusion in 112 patients using a mobile scintillation camera and intravenous nitrogen-13 labeled ammonia

    International Nuclear Information System (INIS)

    Walsh, W.F.; Harper, P.V.; Resnekov, L.; Fill, H.

    1976-01-01

    The short half-life positron emitter 13 N, as labeled ammonia ( 13 NH 4 + ), was evaluated as a myocardial imaging agent. Regional myocardial uptake of 13 NH 4 correlated with the distribution of labeled microspheres in experimental myocardial infarction. Using intravenous 13 NH 4 + , myocardial scintigraphy was performed in 85 cardiac patients and 27 normal subjects. Ninety-five scintigrams were suitable for analysis. Eighteen of 24 normal subjects had homogeneous myocardial images; six had inhomogeneous images attributable to early technical problems. Perfusion defects were observed in the scintigrams of 82% (57/65) of patients with coronary artery disease, being most common in patients with myocardial infarction (27/28). Six sequential studies showed changes in perfusion consistent with the clinical course of each patient. Scintigraphic abnormalities were also observed in 4/6 patients with valvular heart disease. 13 NH 4 + myocardial scintigraphy is a valid and sensitive method of assessing regional myocardial perfusion and is especially useful for sequential imaging at short intervals

  13. The safety of dipyridamole myocardial perfusion scintigraphy (MPS) in patients with end-stage chronic airways limitations (CAL)

    International Nuclear Information System (INIS)

    Roman, M.R.; Freeman, A.P.; Angelides, S.

    2000-01-01

    Full text: Dipyridamole MPS is a well-established investigative technique in the diagnosis and pre-operative risk stratification of patients with possible coronary artery disease. However, there remains a concern of its use in patients with end-stage chronic airways limitations (CAL). Lung volume reduction surgery (LVRS) is a recent therapeutic option for such patients. The options for non-invasive pre-operative cardiac assessment in such patients are limited. This study reviewed the safety of dipyridamole use in such a clinical setting. 20 patients (10M, 10F, mean age 64.8 yrs) were evaluated. None had any history of ischaemic heart disease. Dipyridamole was administered intravenously at a dose of 0.05 mg/kg. Six patients remained asymptomatic throughout the procedure, while none experienced any chest pain. Two patients experienced moderate dyspnoea, which was rapidly relieved with aminophylline (100mg IV) during the recovery phase of the study. Two others developed mild dyspnoea; one settled spontaneously, while the other responded promptly to aminophylline. Aminophylline was administered to nine other patients to reverse minor symptoms (headache, flushing sensation). One other patient developed marked hypotension (SBP fell >20mmHg) and bradycardia, but no ECG changes for myocardial ischaemia. He responded well to aminophylline. His myocardial perfusion scan demonstrated extensive reversible myocardial ischaemia. Although the population size was small, dipyridamole appears safe to use in patients with end-stage CAL. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  14. Myocardial perfusion abnormalities in asymptomatic patients with systemic lupus erythematosus

    International Nuclear Information System (INIS)

    Hosenpud, J.D.; Montanaro, A.; Hart, M.V.; Haines, J.E.; Specht, H.D.; Bennett, R.M.; Kloster, F.E.

    1984-01-01

    Accelerated coronary artery disease and myocardial infarction in young patients with systemic lupus erythematosus is well documented; however, the prevalence of coronary involvement is unknown. Accordingly, 26 patients with systemic lupus were selected irrespective of previous cardiac history to undergo exercise thallium-201 cardiac scintigraphy. Segmental perfusion abnormalities were present in 10 of the 26 studies (38.5 percent). Five patients had reversible defects suggesting ischemia, four patients had persistent defects consistent with scar, and one patient had both reversible and persistent defects in two areas. There was no correlation between positive thallium results and duration of disease, amount of corticosteroid treatment, major organ system involvement or age. Only a history of pericarditis appeared to be associated with positive thallium-201 results (p less than 0.05). It is concluded that segmental myocardial perfusion abnormalities are common in patients with systemic lupus erythematosus. Whether this reflects large-vessel coronary disease or small-vessel abnormalities remains to be determined

  15. Comparison of the Peripheral Reactive Hyperemia Index with Myocardial Perfusion Reserve byRb PET/CT in HIV-Infected Patients

    DEFF Research Database (Denmark)

    Ørbæk, Mathilde; Hasbak, Philip; Sejersten Ripa, Rasmus

    2017-01-01

    (CAD) seems to be higher in HIV-infected patients and an accurate risk prediction of CAD is of high importance for optimal long term treatment. In this study, we assessed the correlation of the endoPAT, which is an office-based CVD screening tool with the myocardial perfusion reserve by82-rubidium PET...... undergone measurement of the myocardial perfusion reserve by82-rubidium PET/CT for study purposes. We found an inverse correlation between the reactive hyperemia index and the myocardial perfusion reserve which most likely indicates different vascular physiology. This study did not find evidence to suggest...

  16. Myocardial perfusion studies in coronary diseases; Estudios de Perfusion Miocardica en la Enfermedad Coronaria

    Energy Technology Data Exchange (ETDEWEB)

    Mut, Fernando [Universidad de la Republica, Montevideo (Uruguay)

    1994-12-31

    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.

  17. Time course evaluation of myocardial perfusion after reperfusion therapy by 99mTc-tetrofosmin SPECT in patients with acute myocardial infarction.

    Science.gov (United States)

    Tanaka, R; Nakamura, T

    2001-09-01

    Myocardial perfusion imaging with 99mTc-labeled agents immediately after reperfusion therapy can underestimate myocardial salvage. It is also conceivable that delayed imaging is useful for assessing the risk area. However, to our knowledge, very few studies have sequentially evaluated these image changes. We conducted 99mTc-tetrofosmin (TF) and 123I-beta-methyl-p-iodophenylpentadecanoic acid (BMIPP) SPECT before and after reperfusion to treat acute myocardial infarction and quantified changes in TF myocardial accumulation and reverse redistribution. Seventeen patients with a first myocardial infarction underwent successful reperfusion. We examined SPECT images obtained at the onset (preimage), those acquired 30 min (early image) and 6 h (delayed image) after TF injection, and images acquired 1, 4, 7, and 20 d after reperfusion (post-1-d, post-4-d, post-7-d, and post-20-d image, respectively). We also examined BMIPP SPECT images after 7 +/- 1.8 d (BMIPP image). Polar maps were divided into 48 segments to calculate percentage uptake, and time course changes in segment numbers below 60% were observed as abnormal area. Moreover, cardiac function was analyzed by gated TF SPECT on 1 and 20 d after reperfusion. In reference to the abnormal area on the early images, the post-1-d image was significantly improved compared with the preimage (P < 0.01) as was the post-7-d image compared with the post-1-d and post-4-d images (P < 0.05, respectively). However, post-20-d and post-7-d images did not significantly differ. Therefore, the improvement in myocardial accumulation reached a plateau 7 d after reperfusion. On the other hand, the abnormal area on the delayed images was significantly greater (P < 0.01) compared with that on the early images from 4 to 20 d after reperfusion, as the value was essentially constant. The correlations of the abnormal area between the preimage and the post-7-d delayed image, the preimage and the BMIPP image, and the post-7-d delayed image and the

  18. SPET in cardiology. Diagnosis, prognosis and management of patients with coronary artery disease

    International Nuclear Information System (INIS)

    Tamaki, N.; Morita, K.

    2005-01-01

    Stress myocardial perfusion imaging has been considered as a most valuable means for diagnosis and treatment strategy in patients with suspected and known coronary artery disease. 99m TC perfusion imaging agents provide excellent myocardial perfusion images. In addition, greater photon flux from the tracer permits simultaneous assessment of regional perfusion and function with use ECG-gated acquisition. Gated SPET imaging technique has a potential for higher diagnostic accuracy for diagnosis of coronary artery disease and assessment of the disease severity. In addition, radionuclide imaging plays an important role to differentiate reversible ischemic myocardium which may improve LV function after revascularization from irreversible scar in patients with history of myocardial infraction. While FDG-PET is considered as a most reliable means for myocardial assessment, SPET imaging has been widely used for the viability assessment, with gaining higher accuracy for predicting reversible ischemia. Recently a variety of new radiopharmaceutical agents have been introduced to probe myocardial function 'in vivo' ( 123 I)BMIPP, a branched fatty acid analog, has been used for metabolic imaging using SPET. Less uptake of BMIPP than perfusion is often observed in the ischemic myocardium. Such a perfusion metabolic mismatch which seems to be similarly observed in FDG-PET is identified in the stunned or hibernating myocardium with regional dysfunctions. Severe ischemia is identified as reduced BMIPP uptake at rest, suggesting its role as an ischemic memory imaging. These new techniques will provide insights into new pathological states in the ischemic heart disease and enable to select optimal treatment of these patients

  19. Prospective ECG-triggered axial CT at 140-kV tube voltage improves coronary in-stent restenosis visibility at a lower radiation dose compared with conventional retrospective ECG-gated helical CT

    Energy Technology Data Exchange (ETDEWEB)

    Horiguchi, Jun; Fujioka, Chikako; Kiguchi, Masao; Kohno, Shingo [Hiroshima University Hospital, Department of Clinical Radiology, Hiroshima (Japan); Yamamoto, Hideya; Kitagawa, Toshiro [Hiroshima University, Department of Molecular and Internal Medicine, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima (Japan); Ito, Katsuhide [Hiroshima University, Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima (Japan)

    2009-10-15

    The purpose of this study was to compare coronary 64-slice CT angiography (CTA) protocols, specifically prospective electrocardiograph (ECG)-triggered and retrospective ECG-gated CT acquisition performed using a tube voltage of 140 kV and 120 kV, regarding intracoronary stent imaging. Coronary artery stents (n=12) with artificial in-stent restenosis (50% luminal reduction, 40 HU) on a cardiac phantom were examined by CT at heart rates of 50-75 beats per minute (bpm). The subjective visibility of in-stent restenosis was evaluated with a three-point scale (1 clearly visible, 2 visible, and 3 not visible), and artificial lumen narrowing [(inner stent diameter - measured lumen diameter)/inner stent diameter], lumen attenuation increase ratio [(in-stent attenuation - coronary lumen attenuation)/coronary lumen attenuation], and signal-to-noise ratio of in-stent lumen were determined. The effective dose was estimated. The artificial lumen narrowing (mean 43%), the increase of lumen attenuation (mean 46%), and signal-to-noise ratio (mean 7.8) were not different between CT acquisitions (p=0.12-0.91). However, the visibility scores of in-stent restenosis were different (p<0.05) between ECG-gated CTA techniques: (a) 140-kV prospective (effective dose 4.6 mSv), 1.6; (b) 120-kV prospective (3.3 mSv), 1.8; (c) 140-kV retrospective (16.4-18.8 mSv), 1.9; and (d) 120-kV retrospective (11.0-13.4 mSv), 1.9. Thus, 140-kV prospective ECG-triggered CTA improves coronary in-stent restenosis visibility at a lower radiation dose compared with retrospective ECG-gated CTA. (orig.)

  20. Left ventricular diastolic dyssynchrony assessed with phase analysis of gated myocardial perfusion SPECT: a comparison with tissue Doppler imaging

    International Nuclear Information System (INIS)

    Boogers, Mark J.; Veltman, Caroline E.; Chen, Ji; Garcia, Ernest V.; Bommel, Rutger J. van; Mooyaart, Eline A.Q.; Wall, Ernst E. van der; Schalij, Martin J.; Bax, Jeroen J.; Delgado, Victoria; Younis, Imad Al; Hiel, Bernies van der; Dibbets-Schneider, Petra

    2011-01-01

    The aim of the current study was to evaluate the feasibility of phase analysis on gated myocardial perfusion SPECT (GMPS) for the assessment of left ventricular (LV) diastolic dyssynchrony in a head-to-head comparison with tissue Doppler imaging (TDI). The population consisted of patients with end-stage heart failure of New York Heart Association functional class III or IV with a reduced LV ejection fraction of ≤35%. LV diastolic dyssynchrony was calculated using TDI as the maximal time delay between early peak diastolic velocities of two opposing left ventricle walls (diastolic mechanical delay). Significant LV diastolic dyssynchrony was defined as a diastolic mechanical delay of >55 ms on TDI. Furthermore, phase analysis on GMPS was performed to evaluate LV diastolic dyssynchrony; diastolic phase standard deviation (SD) and histogram bandwidth (HBW) were used as markers of LV diastolic dyssynchrony. A total of 150 patients (114 men, mean age 66.0 ± 10.4 years) with end-stage heart failure were enrolled. Both diastolic phase SD (r = 0.81, p 55 ms) showed significantly larger diastolic phase SD (68.1 ± 13.4 vs. 40.7 ± 14.0 , p < 0.01) and diastolic HBW (230.6 ± 54.3 vs. 129.0 ± 55.6 , p < 0.01) as compared to patients without LV diastolic dyssynchrony on TDI (≤55 ms). Finally, phase analysis on GMPS showed a good intra- and interobserver reproducibility for the determination of diastolic phase SD (ICC 0.97 and 0.88) and diastolic HBW (ICC 0.98 and 0.93). Phase analysis on GMPS showed good correlations with TDI for the assessment of LV diastolic dyssynchrony. (orig.)

  1. Quantification of MRI measured myocardial perfusion reserve in healthy humans: A comparison with positron emission tomography

    DEFF Research Database (Denmark)

    Fritz-Hansen, T.; Hove, J.D.; Kofoed, K.F.

    2008-01-01

    Purpose: To validate a noninvasive quantitative MRI technique, the K-i perfusion method, for myocardial perfusion in humans using N-13-ammonia PET as a reference method. Materials and Methods: Ten healthy males (64 +/- 8 years) were examined with combined PET and MRI perfusion imaging at rest and...

  2. Effects of a novel multimodal group intervention on myocardial perfusion in patients with coronary heart disease (CHD)

    International Nuclear Information System (INIS)

    Theissen, P.; Schicha, H.; Albus, C.; Koehle, K.; Griebenow, R.; Son, P.

    2002-01-01

    Full text: Recently, it could be shown that a multimodal intervention can promote health behavior in patients with CHD. Purpose of the actual study was to evaluate the effects on somatic endpoints, e.g. myocardial perfusion. We randomly assigned 77 patients (age 54 ± 6.9 y, male 87 %) with angiographically documented CHD to a multimodal group intervention plus standardized cardiological care (INT n=39) or standardized cardiological care only (CO n = 38). The intervention, for out-patients only, consisted of 77.5 hours of group-psychotherapy, relaxation and exercise training, and teaching lessons for one year. A Thallium myocardial perfusion scintigraphy (MyoSc) (after bicycle exercise test and at rest; 70 - 110 MBq Thallium-201, SPECT-technique, quantitative wash-out (w.-o.) analysis derived from polar maps) was performed at baseline, after 2 years, and 3 years, respectively: A w.-o. increase res. decrease by 5 % or more indicated an improved / a diminished myocardial perfusion within the affected coronary artery territory. Results were analyzed on an intention to treat basis. 70/77 patients (91 %) completed the study (drop-outs CO n=4, INT n=3). After 2 years (1st interval), there was no significant difference between groups. After 3 years (2nd interval) 36/39 patients (92.3 %) of INT showed a stable or improved myocardial perfusion, compared to 18/38 patients (47.4 %) of CO (p= 0.008). The recent data analysis demonstrates the extra benefit of a multimodal intervention, compared to standardized cardiological care alone, on myocardial perfusion in CHD patients. (author)

  3. A Unifying model of perfusion and motion applied to reconstruction of sparsely sampled free-breathing myocardial perfusion MRI

    DEFF Research Database (Denmark)

    Pedersen, Henrik; Ólafsdóttir, Hildur; Larsen, Rasmus

    2010-01-01

    The clinical potential of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is currently limited by respiratory induced motion of the heart. This paper presents a unifying model of perfusion and motion in which respiratory motion becomes an integral part of myocardial perfusion...... quantification. Hence, the need for tedious manual motion correction prior to perfusion quantification is avoided. In addition, we demonstrate that the proposed framework facilitates the process of reconstructing DCEMRI from sparsely sampled data in the presence of respiratory motion. The paper focuses primarily...... on the underlying theory of the proposed framework, but shows in vivo results of respiratory motion correction and simulation results of reconstructing sparsely sampled data....

  4. Diagnostic accuracy of prospective ECG gated coronary computed tomography on a 256 slices scanner: Daily practice experience

    Directory of Open Access Journals (Sweden)

    Ahmed M. Fareed

    2014-03-01

    Conclusions: In a highly prevalence diseased population, prospective ECG-gated CTCA using 256-slice scanner is highly accurate for detection and quantification of the degree of coronary luminal stenosis in comparison to ICA.

  5. Clinical aspects of coronary heart diseases without myocardial infarction and in the chronic infarction phase

    International Nuclear Information System (INIS)

    Kober, G.

    1984-01-01

    Reductions in coronary vessel diameters of more than 50% are usually caused by atherosclerosis, seldom by predominant spasme. They can lead via an inadequate myocardial perfusion to angina pectoris. Whereas in patients with organic coronary stenoses exertional angina is typical, patients with coronary spasms usually tend to angina at rest. Depending on the symptoms, a stable or unstable angina can be distinguished from the status anginosus and a variant form of angina. During anginal attacks signs of myocardial ischemia can often be seen in the electrocardiogram. This applies to patients with and without earlier myocardial infarctions. When pathologic ECG-changes can already be seen in the ECG at rest, difficulties often arise during evaluation of the exercise-ECG. In those cases, diagnosis can be improved by additional investigations, especially with radionuclear techniques. For a conclusive diagnosis, left heart catheterization and a functional coronary angiography is necessary. Coronary heart disease can be treated either by drug therapy, coronary angioplasty or bypass surgery. The same diagnostic procedures are suitable for the evaluation of a therapeutical success and for primary diagnosis. (orig.) [de

  6. Simultaneous assessment of myocardial perfusion and function during mental stress in patients with chronic coronary artery disease.

    Science.gov (United States)

    Arrighi, James A; Burg, Matthew; Cohen, Ira S; Soufer, Robert

    2003-01-01

    Mental stress (MS) is an important provocateur of myocardial ischemia in many patients with chronic coronary artery disease. The majority of laboratory assessments of ischemia in response to MS have included measurements of either myocardial perfusion or function alone. We performed this study to determine the relationship between alterations in perfusion and ventricular function during MS. Methods and results Twenty-eight patients with reversible perfusion defects on exercise or pharmacologic stress myocardial perfusion imaging (MPI) underwent simultaneous technetium 99m sestamibi single photon emission computed tomography (SPECT) MPI and transthoracic echocardiography at rest and during MS according to a mental arithmetic protocol. In all cases the MS study was performed within 4 weeks of the initial exercise or pharmacologic MPI that demonstrated ischemia. SPECT studies were analyzed visually with the use of a 13-segment model and quantitatively by semiautomated circumferential profile analysis. Echocardiograms were graded on a segmental model for regional wall motion on a 4-point scale. Of 28 patients, 18 (64%) had perfusion defects and/or left ventricular dysfunction develop during MS: 9 (32%) had myocardial perfusion defects develop, 6 (21%) had regional or global left ventricular dysfunction develop, and 3 (11%) had both perfusion defects and left ventricular dysfunction develop. The overall concordance between perfusion and function criteria for ischemia during MS was only 46%. Among 9 patients with MS-induced left ventricular dysfunction, 5 had new regional wall motion abnormalities and 4 had a global decrement in function. In patients with MS-induced ischemia by SPECT, the number of reversible perfusion defects was similar during both MS and exercise/pharmacologic stress (2.8 +/- 2.0 vs 3.5 +/- 1.8, P =.41). Hemodynamic changes during MS were similar whether patients were divided on the basis of perfusion defects or left ventricular dysfunction during MS

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

    International Nuclear Information System (INIS)

    Hsu, Bailing; Chen, Fu-Chung; Chen, Chien-Cheng; Wu, Tao-Cheng; Huang, Wen-Sheng; Hou, Po-Nien; Hung, Guang-Uei

    2014-01-01

    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 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 conventional SPECT/CT system and the flow quantitation method is a clinically effective approach to enhance CAD detection. (orig.)

  8. Noninvasive evaluation of regional myocardial perfusion in 112 patients using a mobile scintillation camera and intravenous nitrogen-13 labeled ammonia

    Energy Technology Data Exchange (ETDEWEB)

    Walsh, W.F.; Harper, P.V.; Resnekov, L.; Fill, H.

    1976-08-01

    The short half-life positron emitter /sup 13/N, as labeled ammonia (/sup 13/NH/sub 4//sup +/), was evaluated as a myocardial imaging agent. Regional myocardial uptake of /sup 13/NH/sub 4/ correlated with the distribution of labeled microspheres in experimental myocardial infarction. Using intravenous /sup 13/NH/sub 4//sup +/, myocardial scintigraphy was performed in 85 cardiac patients and 27 normal subjects. Ninety-five scintigrams were suitable for analysis. Eighteen of 24 normal subjects had homogeneous myocardial images; six had inhomogeneous images attributable to early technical problems. Perfusion defects were observed in the scintigrams of 82% (57/65) of patients with coronary artery disease, being most common in patients with myocardial infarction (27/28). Six sequential studies showed changes in perfusion consistent with the clinical course of each patient. Scintigraphic abnormalities were also observed in 4/6 patients with valvular heart disease. /sup 13/NH/sub 4//sup +/ myocardial scintigraphy is a valid and sensitive method of assessing regional myocardial perfusion and is especially useful for sequential imaging at short intervals.

  9. Usefulness of contrast enhanced cardiac computed tomography in myocardial infarction

    International Nuclear Information System (INIS)

    Morooka, Nobuhiro; Yamada, Zenju; Watanabe, Shigeru

    1982-01-01

    Contrast enhanced cardiac computed tomography (CECT) was performed in 33 patients with transmural myocardial infarction. The anterior wall thickness assessed by CECT was well correlated with that by left ventriculography in RAO projection. When the septal wall thickness was compared between ECG gated and non-gated CECT images, the septal wall thickness by non-gated CECT showed a close coincidence with the diastolic wall thickness by ECG gated CECT. In all patients, the thickness of the septal, anterior and postero-lateral walls was measured. The mean wall thickness in patients of antero-septal infarction was 9.0 +- 1.9 mm for the septal wall, 6.3 +- 1.3 mm for the anterior wall, and 10.0 +- 2.1 mm for the postero-lateral wall. In patients of infero-lateral infarction, the mean wall thickness was 12.2 +- 1.7 mm for the septal wall, 10.8 +- 1.6 mm for the anterior wall and 8.9 +- 1.2 mm for the postero-lateral wall. A filling defect was revealed in the infarcted area when CECT was performed in patients with acute myocardial infarction within 1 week from the onset, and late enhancement was demonstrated by plain CT performed 10 min later. Left ventricular aneurysms were noted in 16 of 23 patients of anteroseptal infarction, and 8 of these 16 had mural thrombi in the left ventricle. Coronary artery calcification was found in 11 of 33 myocardial infarction patients. In patients with aortocoronary bypass graft, the sequential scan (dynamic scan) was shown to be a useful non-invasive method because it showed whether the graft was patent or not. (J.P.N.)

  10. Combined use of 64-slice computed tomography angiography and gated myocardial perfusion SPECT for the detection of functionally relevant coronary artery stenoses. First results in a clinical setting concerning patients with stable angina

    International Nuclear Information System (INIS)

    Hacker, M.; Hack, N.; Tiling, R.; Jakobs, T.; Nikolaou, K.; Becker, C.; Ziegler, F. von; Knez, A.; Koenig, A.; Klauss, V.

    2007-01-01

    Aim: In patients with stable angina pectoris both morphological and functional information about the coronary artery tree should be present before revascularization therapy is performed. High accuracy was shown for spiral computed tomography (MDCT) angiography acquired with a 64-slice CT scanner compared to invasive coronary angiography (ICA) in detecting obstructive'' coronary artery disease (CAD). Gated myocardial SPECT (MPI) is an established method for the noninvasive assessment of functional significance of coronary stenoses. Aim of the study was to evaluate the combination of 64-slice CT angiography plus MPI in comparison to ICA plus MPI in the detection of hemodynamically relevant coronary artery stenoses in a clinical setting. Patients, methods: 30 patients (63 ± 10.8 years, 23 men) with stable angina (21 with suspected, 9 with known CAD) were investigated. MPI, 64-slice CT angiography and ICA were performed, reversible and fixed perfusion defects were allocated to determining lesions separately for MDCT angiography and ICA. The combination of MDCT angiography plus MPI was compared to the results of ICA plus MPI. Results: Sensitivity, specificity, negative and positive predictive value for the combination of MDCT angiography plus MPI was 85%, 97%, 98% and 79%, respectively, on a vessel-based and 93%, 87%, 93% and 88%, respectively, on a patient-based level. 19 coronary arteries with stenoses =50% in both ICA and MDCT angiography showed no ischemia in MPI. Conclusion: The combination of 64-slice CT angiography and gated myocardial SPECT enabled a comprehensive non-invasive view of the anatomical and functional status of the coronary artery tree. (orig.)

  11. Combined use of 64-slice computed tomography angiography and gated myocardial perfusion SPECT for the detection of functionally relevant coronary artery stenoses. First results in a clinical setting concerning patients with stable angina

    Energy Technology Data Exchange (ETDEWEB)

    Hacker, M.; Hack, N.; Tiling, R. [Klinikum Grosshadern (Germany). Dept. of Nuclear Medicine; Jakobs, T.; Nikolaou, K.; Becker, C. [Klinikum Grosshadern (Germany). Dept. of Clinical Radiology; Ziegler, F. von; Knez, A. [Klinikum Grosshadern (Germany). Dept. of Cardiology; Koenig, A.; Klauss, V. [Medizinische Poliklinik-Innenstadt, Univ. of Munich (Germany). Dept. of Cardiology

    2007-07-01

    Aim: In patients with stable angina pectoris both morphological and functional information about the coronary artery tree should be present before revascularization therapy is performed. High accuracy was shown for spiral computed tomography (MDCT) angiography acquired with a 64-slice CT scanner compared to invasive coronary angiography (ICA) in detecting ''obstructive'' coronary artery disease (CAD). Gated myocardial SPECT (MPI) is an established method for the noninvasive assessment of functional significance of coronary stenoses. Aim of the study was to evaluate the combination of 64-slice CT angiography plus MPI in comparison to ICA plus MPI in the detection of hemodynamically relevant coronary artery stenoses in a clinical setting. Patients, methods: 30 patients (63 {+-} 10.8 years, 23 men) with stable angina (21 with suspected, 9 with known CAD) were investigated. MPI, 64-slice CT angiography and ICA were performed, reversible and fixed perfusion defects were allocated to determining lesions separately for MDCT angiography and ICA. The combination of MDCT angiography plus MPI was compared to the results of ICA plus MPI. Results: Sensitivity, specificity, negative and positive predictive value for the combination of MDCT angiography plus MPI was 85%, 97%, 98% and 79%, respectively, on a vessel-based and 93%, 87%, 93% and 88%, respectively, on a patient-based level. 19 coronary arteries with stenoses =50% in both ICA and MDCT angiography showed no ischemia in MPI. Conclusion: The combination of 64-slice CT angiography and gated myocardial SPECT enabled a comprehensive non-invasive view of the anatomical and functional status of the coronary artery tree. (orig.)

  12. Prognostic implications of post-stress ejection fraction decrease detected by gated SPECT in the absence of stress-induced perfusion abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Dona, Manjola; Massi, Lucia; Settimo, Leonardo; Bartolini, Matteo; Gianni, Gianluca; Pupi, Alberto; Sciagra, Roberto [University of Florence, Nuclear Medicine Unit, Department of Clinical Physiopathology, Florence (Italy)

    2011-03-15

    The prognostic meaning of a post-stress ejection fraction (EF) decrease detected by perfusion gated SPECT is still unclear. We therefore followed up patients with post-stress EF decrease in the absence of stress-induced perfusion abnormalities. We prospectively enrolled 57 consecutive patients with post-stress EF drop {>=} 5 EF units and summed difference score (SDS) {<=} 1. They were followed up for more than 1 year and their outcome was compared with a group of sex- and age-matched controls with the same SDS but without EF decrease. During follow-up there were 13 events (1 cardiac death, 1 non-fatal myocardial infarction, 1 congestive heart failure and 10 late revascularizations). In the control group we registered six events. There was a significant difference (p < 0.0001) between the event-free survival curves of the two groups. The event rate of patients with post-stress EF decrease {>=} 5 EF units is relatively high and is significantly worse than that of a control group of patients with similarly normal SDS but without EF changes. Therefore, a post-stress EF decrease without stress-induced perfusion abnormalities should be cautiously interpreted. (orig.)

  13. The usefulness of preoperative exercise stress myocardial single photon emission CT with thallium-201 to predict the responses to coronary revascularization

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa; Minamino, Takazoh; Katoh, Osamu; Higashino, Yorihiko.

    1989-01-01

    To evaluate the usefulness of preoperative exercise stress (Ex) myocardial single photon emission CT (SPECT) with thallium-201 to predict the responses to coronary revascularization (CRV), Ex-SPECT's were obtained in 42 patients with coronary artery disease (CAD). In 34 patients angioplasty was performed and in 18 patients coronary bypass surgery was undergone. Before and after CVR, Ex-SPECT's were obtained both at immediately after Ex (Initial) and 3 hours later (RD) by the rotating gamma camera. Initial images before CRV showed definite perfusion defects (+3) in 76 myocardial segments. Perfusion abnormalities at RD images were graded into (+3 to 0) by visual interpretation. '+3' indicated fixed defect and '0' indicated no perfusion abnormality. At RD images 17 segments showed fixed defect and 59 segments showed improved perfusion more than one grade. After CRV, all 59 segments with improved perfusion at RD images showed improvement of perfusion in comparison with initial images before CRV. Out of 17 segments with fixed defect before CRV, 14 segments showed perfusion defect with +3, while 3 segments showed improved perfusion after CRV. These 3 segments had ECG evidence of myocardial infarction. In these 3 segments, Ex-SPECT's before CRV showed abnormally low myocardial Tl washout rate (WOR) despite they indicated fixed defect visually. On the contrary, other 14 segments with fixed defect showed normal WOR before CRV. In conclusion, visually interpreted Ex-SPECT's before CRV predict the myocardial perfusion after CRV in most of cases. In a small number (especially infarction segments) Ex-SPECT's before CRV cannot predict the improvement of myocardial perfusion after CRV by visual inspection, but WOR abnormality before CRV is useful to prospect their results. (author)

  14. Deployment of an Advanced Electrocardiographic Analysis (A-ECG) to Detect Cardiovascular Risk in Career Firefighters

    Science.gov (United States)

    Dolezal, B. A.; Storer, T. W.; Abrazado, M.; Watne, R.; Schlegel, T. T.; Batalin, M.; Kaiser, W.; Smith, D. L.; Cooper, C. B.

    2011-01-01

    INTRODUCTION: Sudden cardiac death is the leading cause of line of duty death among firefighters, accounting for approximately 45% of fatalities annually. Firefighters perform strenuous muscular work while wearing heavy, encapsulating personal protective equipment in high ambient temperatures, under chaotic and emotionally stressful conditions. These factors can precipitate sudden cardiac events like myocardial infarction, serious dysrhythmias, or cerebrovascular accidents in firefighters with underlying cardiovascular disease. PURPOSE: The purpose of this study was to deploy and then evaluate the contribution of resting advanced ECG (A-ECG) in addition to other screening tools (family history, lipid profiles, and cardiopulmonary exercise tests, XT) in assessment of an individual fs cardiac risk profile. METHODS: Forty-four career firefighters were recruited to perform comprehensive baseline assessments including tests of aerobic performance, fasting lipids and glucose. Five-min resting 12-lead A-ECGs were obtained in a subset of firefighters (n=21) and transmitted over a secure networked system to a NASA physician collaborator. Using myocardial perfusion and other imaging as the gold standard, A-ECG scoring has been proven useful in accurately identifying a number of cardiac pathologies including coronary artery disease (CAD), left ventricular hypertrophy, hypertrophic cardiomyopathy, and non-ischemic and ischemic cardiomyopathy. RESULTS: Subjects f mean (SD) age was 43 (8) years, weight 91 (13) kg, and BMI 28 (3) kg/m2. Fifty-one percent of subjects had .3 cardiovascular risk factors. One subject had ST depression on XT ECG, at least one positive A-ECG score for CAD, and documented CAD based on cardiology referral. While all other subjects, including those with fewer risk factors, higher aerobic fitness, and normal exercise ECGs, were classified as healthy by A-ECG, there was no trend for association between risk factors and any of 20 A-ECG parameters in the

  15. Factors affecting accuracy of ventricular volume and ejection fraction measured by gated Tl-201 myocardial perfusion single photon emission computed tomography

    International Nuclear Information System (INIS)

    Pai, Moon Sun; Yang, You Jung; Im, Ki Chun; Hong, Il Ki; Yun, Sung Cheol; Kang, Duk Hyun; Song, Jae Kwan; Moon, Dae Hyuk

    2005-01-01

    Systemic errors in the gated single photon emission computed tomography (SPECT) measurement of left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) may occur. We evaluated whether patient-related factors affected the accuracy of EDV, ESV, and EF measured by electrocardiogram-gated Tl-201 SPECT. A total of 518 patients without perfusion defects on Tl-201 SPECT or coronary artery disease were studied. EDV, ESV, and EF were measured from echocardiography and adenosine stress/redistribution gated Tl-201 SPECT using commercially available software packages (QGS and 4D-MSPECT). We identified factors affecting the accuracy of gated SPECT via multiple linear regression analysis of the differences between echocardiography and gated SPECT. Gated SPECT analyzed with QGS underestimated EDV and ESV, and overestimated EF, but 4D-MSPECT overestimated all those values (p<0.001). Independent variables that increased the difference in EDV between echocardiography and gated SPECT were decreasing LV end-diastolic wall thickness, decreasing body surface area, female sex and increasing EDV (p< 0.001). Those for ESV were decreasing LV end-systolic wall thickness, female sex, and decreasing ESV (p<0.001). Increasing end-systolic wall thickness, male sex and decreasing age were independent determinants associated with an increased difference in EF (p< 0.001). Adenosine stress SPECT showed significantly higher EDV and ESV values and a lower EF than did redistribution SPECT (p< 0.001). In determination of EF, QGS demonstrated a smaller bias than did 4D-MSPECT. However, in men with LV hypertrophy, 4D-MSPECT was superior to QGS. Systemic error by gated Tl-201 SPECT is determined by individual patient-characteristics

  16. Thallium-201 exercise myocardial imaging to evaluate myocardial perfusion after coronary artery bypass surgery

    International Nuclear Information System (INIS)

    Hirzel, H.O.; Nuesch, K.; Sialer, G.; Horst, W.; Krayenbuehl, H.P.

    1980-01-01

    To assess the usefulness of thallium-201 exercise scintigraphy in evaluating myocardial perfusion after coronary artery bypass surgery, imaging was performed after submaximal bicycle ergometry and at rest in 54 patients before and within 24 +- 10 (SD) weeks after operation. Scintigraphy identified 8 out of 20 patients who were symptom free after operation and showed normal exercise electrocardiograms as still having exercise-induced ischaemia and thus as having not truly benefited from the surgical intervention. In contrast, improvement in perfusion was documented in 17 out of 31 patients despite further complaints of chest pain and persistence of a pathological exercise electrocardiogram in 6 of them. Bypass graft patency rate paralleled the scintigraphic findings in the 35 patients who were restudied arteriographically. It was concluded that thallium-201 exercise scintigraphy is a useful technique to document changes in regional perfusion after surgery and is definitely superior to the clinical evaluation of patients including the exercise electrocardiogram. (author)

  17. Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy.

    Science.gov (United States)

    Eftekhari, Mohammad; Anbiaei, Robabeh; Zamani, Hanie; Fallahi, Babak; Beiki, Davood; Ameri, Ahmad; Emami-Ardekani, Alireza; Fard-Esfahani, Armaghan; Gholamrezanezhad, Ali; Seid Ratki, Kazem Razavi; Roknabadi, Alireza Momen

    2015-01-01

    Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right-sided cancer. To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring) were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT) to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions) over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol) was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed) and 36 patients with right-sided cancer (controls)] were enrolled. Dose-volume histogram (DVH) [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46). In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03) and anterolateral (17.1% versus 2.8%, P=0.049) walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS) of>3 was observed in twelve cases (34.3%), while in five of the controls (13.9%),(Odds ratio=1.3). There was no significant difference between the groups regarding left ventricular ejection fraction. The risk of radiation induced myocardial perfusion abnormality in patients treated with CRT on the

  18. Incremental value of myocardial perfusion over coronary angiography by spectral computed tomography in patients with intermediate to high likelihood of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Carrascosa, Patricia M., E-mail: investigacion@diagnosticomaipu.com.ar; Deviggiano, Alejandro; Capunay, Carlos; Campisi, Roxana; López Munain, Marina de; Vallejos, Javier; Tajer, Carlos; Rodriguez-Granillo, Gaston A.

    2015-04-15

    Highlights: •We evaluated myocardial perfusion by dual energy computed tomography (DECT). •We included patients with intermediate to high likelihood of coronary artery disease. •Stress myocardial perfusion by DECT had a reliable accuracy for the detection of ischemia. •Stress myocardial perfusion with DECT showed an incremental value over anatomical evaluation. •DECT imaging was associated to a significant reduction in radiation dose compared to SPECT. -- Abstract: Purpose: We sought to explore the diagnostic performance of dual energy computed tomography (DECT) for the evaluation of myocardial perfusion in patients with intermediate to high likelihood of coronary artery disease (CAD). Materials and methods: Consecutive patients with known or suspected CAD referred for myocardial perfusion imaging by single-photon emission computed tomography (SPECT) constituted the study population and were scanned using a DECT scanner equipped with gemstone detectors for spectral imaging, and a SPECT. The same pharmacological stress was used for both scans. Results: Twenty-five patients were prospectively included in the study protocol. The mean age was 63.4 ± 10.6 years. The total mean effective radiation dose was 7.5 ± 1.2 mSv with DECT and 8.2 ± 1.7 mSv with SPECT (p = 0.007). A total of 425 left ventricular segments were evaluated by DECT, showing a reliable accuracy for the detection of reversible perfusion defects [area under ROC curve (AUC) 0.84 (0.80–0.87)]. Furthermore, adding stress myocardial perfusion provided a significant incremental value over anatomical evaluation alone by computed tomography coronary angiography [AUC 0.70 (0.65–0.74), p = 0.003]. Conclusions: In this pilot investigation, stress myocardial perfusion by DECT demonstrated a significant incremental value over anatomical evaluation alone by CTCA for the detection of reversible perfusion defects.

  19. Myocardial perfusion with multi-detector computed tomography: quantitative evaluation

    International Nuclear Information System (INIS)

    Carrascosa, Patricia M.; Vallejos, J.; Capunay, Carlos M.; Deviggiano, A.; Carrascosa, Jorge M.

    2007-01-01

    The objective of this work is to evaluate the skill of multidetector computer tomography, to quantify the different patterns of intensification during the evaluation of the myocardial perfusion. 45 patients were studied with suspicion of cardiovascular disease. Multi-detector computed tomography was utilized on patients at rest and in effort with pharmacological stress, after the administration of dipyridamole. Also they were evaluated using nuclear medicine [es

  20. 128-slice CT angiography of the aorta without ECG-gating: efficacy of faster gantry rotation time and iterative reconstruction in terms of image quality and radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Russo, Vincenzo; Garattoni, Monica; Buia, Francesco; Attina, Domenico; Lovato, Luigi; Zompatori, Maurizio [University Hospital ' ' S.Orsola' ' , Cardio-Thoracic-Vascular Department, Cardio-Thoracic Radiology Unit, Bologna (Italy)

    2016-02-15

    To evaluate image quality and radiation dose of non ECG-gated 128-slice CT angiography of the aorta (CTAA) with fast gantry rotation time and iterative reconstruction. Four hundred and eighty patients underwent non ECG-gated CTAA. Qualitative and quantitative image quality assessments were performed. Radiation dose was assessed and compared with the dose of patients who underwent ECG-gated CTAA (n = 126) and the dose of previous CTAA performed with another CT (n = 339). Image quality (aortic root-ascending portion) was average-to-excellent in more than 94 % of cases, without any non-diagnostic scan. For proximal coronaries, image quality was average-to-excellent in more than 50 %, with only 21.5 % of non-diagnostic cases. Quantitative analysis results were also good. Mean radiation dose for thoracic CTAA was 5.6 mSv versus 20.6 mSv of ECG-gated protocol and 20.6 mSv of 16-slice CTAA scans, with an average dose reduction of 72.8 % (p < 0.001). Mean radiation dose for thoracic-abdominal CTAA was 9.7 mSv, versus 20.9 mSv of 16-slice CTAA scans, with an average dose reduction of 53.6 % (p < 0.001). Non ECG-gated 128-slice CTAA is feasible and able to provide high quality visualization of the entire aorta without significant motion artefacts, together with a considerable dose and contrast media volume reduction. (orig.)

  1. 128-slice CT angiography of the aorta without ECG-gating: efficacy of faster gantry rotation time and iterative reconstruction in terms of image quality and radiation dose

    International Nuclear Information System (INIS)

    Russo, Vincenzo; Garattoni, Monica; Buia, Francesco; Attina, Domenico; Lovato, Luigi; Zompatori, Maurizio

    2016-01-01

    To evaluate image quality and radiation dose of non ECG-gated 128-slice CT angiography of the aorta (CTAA) with fast gantry rotation time and iterative reconstruction. Four hundred and eighty patients underwent non ECG-gated CTAA. Qualitative and quantitative image quality assessments were performed. Radiation dose was assessed and compared with the dose of patients who underwent ECG-gated CTAA (n = 126) and the dose of previous CTAA performed with another CT (n = 339). Image quality (aortic root-ascending portion) was average-to-excellent in more than 94 % of cases, without any non-diagnostic scan. For proximal coronaries, image quality was average-to-excellent in more than 50 %, with only 21.5 % of non-diagnostic cases. Quantitative analysis results were also good. Mean radiation dose for thoracic CTAA was 5.6 mSv versus 20.6 mSv of ECG-gated protocol and 20.6 mSv of 16-slice CTAA scans, with an average dose reduction of 72.8 % (p < 0.001). Mean radiation dose for thoracic-abdominal CTAA was 9.7 mSv, versus 20.9 mSv of 16-slice CTAA scans, with an average dose reduction of 53.6 % (p < 0.001). Non ECG-gated 128-slice CTAA is feasible and able to provide high quality visualization of the entire aorta without significant motion artefacts, together with a considerable dose and contrast media volume reduction. (orig.)

  2. Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Runza, G. [Department of Radiology, University of Palermo (Italy)], E-mail: grunza@sirm.org; La Grutta, L.; Alaimo, V. [Department of Radiology, University of Palermo (Italy); Evola, S. [Department of Cardiology, University of Palermo (Italy); Lo Re, F.; Bartolotta, T.V. [Department of Radiology, University of Palermo (Italy); Cademartiri, F. [Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam (Netherlands); Department of Radiology and Cardiology, Cardiovascular CT Unit, University Hospital, Parma (Italy); Midiri, M. [Department of Radiology, University of Palermo (Italy)

    2007-10-15

    Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation.

  3. Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain

    International Nuclear Information System (INIS)

    Runza, G.; La Grutta, L.; Alaimo, V.; Evola, S.; Lo Re, F.; Bartolotta, T.V.; Cademartiri, F.; Midiri, M.

    2007-01-01

    Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation

  4. Diabetes patients show different time-course of myocardial perfusion improvement after coronary artery bypass grafting

    International Nuclear Information System (INIS)

    Lee, J. J.; Seok, J. W.; Eo, J. S.

    2005-01-01

    Diabetes mellitus is an independent risk factor of cardiovascular disease. Diabetes is known to cause microangiopathy. The microangiopathy is hardly detectable on the coronary angiography. Myocardial perfusion imaging shows the resultant perfusion status which reflects the microangiopathy. For patients who underwent revascularization, the microangiopathy could affect the myocardial perfusion improvement. Diabetes patients probably experience the different myocardial perfusion improvement as compared to the non-diabetes patients although they have similar angiographic findings. The aim of this study is to find out whether there is a time-course difference of perfusion improvement between the diabetes and non diabetes patients who showed patent angiographic findings after coronary artery grafting surgery (CABG). A total of 129 patients who underwent coronary artery bypass grafting surgery were enrolled in this study. Myocardial SPECTs performed at previous, short-term (3 month), and mid-term (1 year) to CABG. One-year follow up angiography was done 411±121 days after surgery. Graft patency was determined according to the FitzGibbon et al. Segments were assigned to vascular territories using a 20 segment model. The segments of excellent patency were included in this study. Time course differences of concerned segments were analyzed using RMANOVA. The number of segments enrolled was 764 of diabetes and 1083 of non-diabetes. At short-term follow up, reversibility score was 2.8±8.1% in diabetes and 0.3±7.5% in non-diabetes. At long-term follow up, reversibility score was 1.8±8.0% in diabetes and 0.1±7.3% in non-diabetes. The time-course of reversibility score was significantly different between the diabetes and non diabetes (p<0.001) Diabetic segments showed high residual reversibility score than non-diabetic segments after CABG although the angiographic finding was patent in both groups. This result is maybe attributable to microangiopathy induced by diabetes

  5. Detection of Airway Anomalies in?Pediatric?Patients with Cardiovascular Anomalies with Low Dose Prospective ECG-Gated Dual-Source CT

    OpenAIRE

    Jiao, Hui; Xu, Zhuodong; Wu, Lebin; Cheng, Zhaoping; Ji, Xiaopeng; Zhong, Hai; Meng, Chen

    2013-01-01

    OBJECTIVES: To assess the feasibility of low-dose prospective ECG-gated dual-source CT (DSCT) in detecting airway anomalies in pediatric patients with cardiovascular anomalies compared with flexible tracheobronchoscopy (FTB). METHODS: 33 pediatrics with respiratory symptoms who had been revealed cardiovascular anomalies by transthoracic echocardiography underwent FTB and contrast material-enhanced prospective ECG-triggering CT were enrolled. The study was approved by our institution review bo...

  6. Prognostic significance of large perfusion defects on thallium-201 myocardial scintigraphy in dilated cardiomyopathy

    International Nuclear Information System (INIS)

    Takata, Jun; Doi, Yoshinori; Chikamori, Taishiro; Yonezawa, Yoshihiro; Hamashige, Naohisa; Kuzume, Osamu; Ozawa, Toshio

    1989-01-01

    To evaluate the prognostic significance of perfusion abnormalities, particularly large defects, in dilated cardiomyopathy (DCM), we performed thallium-201 myocardial scintigraphy and 24-hour ambulatory ECG monitoring in 27 patients. The abnormal scintigraphic patterns and the presence of ventricular tachycardia (VT) were correlated with causes of death during a follow-up period of 30.0±19.4 months. Eight patients had large defects (LD), 11 had multiple small defects (MSD), and eight had no defects (NL). The patients with LD had extensive ventricular akinesis in the region of the perfusion defect, significantly elevated LVEDP (LD 20.6±7.4 mmHg, MSD 15.5±7.6 mmHg, NL 10.3±2.3 mmHg: LD vs NL; p<0.01, MSD vs NL; p<0.05), and reduced ejection fraction (LD 23.9±9.1%, MSD 32.7±7.2%, NL 40.3±7.7%: LD vs MSD; p<0.05, MSD vs NL; p<0.01). VT was detected in 11 patients; among whom three had LD, six had MSD, and two had no defects. Among seven patients who died during follow-up (five of heart failure, one sudden death, and one non-cardiac death), five had LD and two had MSD. There were no deaths among patients without defects. Among 11 patients with VT, only one died suddenly. In conclusion, large scintigraphic defects correlated well with severe LV dysfunction, and this is an important variable in predicting outcomes in DCM. (author)

  7. Fluorine-18 heart dosimetry in myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Toledo, Janine M.; Trindade, Bruno; Campos, Tarcísio P.R., E-mail: janine.toledo@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Programa de Pós-Graduação em Ciências e Técnicas Nucleares

    2017-07-01

    This paper conducts a recalling in myocardial perfusion imaging (MPI) followed by a spatial dosimetric investigation of the Fluorine-18 distributed at the myocardium by self-absorption of the heart uptake. Methods and Results: Radiological data manipulation was prepared and a computational heart voxelized model was assembled. A set of images from the abdominal aorta and angiotomography of the thorax was set up providing anatomic and functional information for heart modeling in SISCODES code. A homogeneous distribution of fluorine-18 was assumed into the heart myocardial wall. MCNP – Monte Carlo Code was used to provide the photon transport into the heart model taken in consideration the interactions into the tissues. The spatial dose distribution and histogram dose versus volume are presented. An analytical alternative model was addressed to the data validation. The present developed tools can produce spatial dose distribution in MPI at heart. Specially, the dosimetry performed elucidates imparted dose in the myocardial muscle per unit of injected Fluorine-18 activity by self-absorption of the heart uptake, which can contribute to future deterministic effect investigations. (author)

  8. Fluorine-18 heart dosimetry in myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Toledo, Janine M.; Trindade, Bruno; Campos, Tarcísio P.R.

    2017-01-01

    This paper conducts a recalling in myocardial perfusion imaging (MPI) followed by a spatial dosimetric investigation of the Fluorine-18 distributed at the myocardium by self-absorption of the heart uptake. Methods and Results: Radiological data manipulation was prepared and a computational heart voxelized model was assembled. A set of images from the abdominal aorta and angiotomography of the thorax was set up providing anatomic and functional information for heart modeling in SISCODES code. A homogeneous distribution of fluorine-18 was assumed into the heart myocardial wall. MCNP – Monte Carlo Code was used to provide the photon transport into the heart model taken in consideration the interactions into the tissues. The spatial dose distribution and histogram dose versus volume are presented. An analytical alternative model was addressed to the data validation. The present developed tools can produce spatial dose distribution in MPI at heart. Specially, the dosimetry performed elucidates imparted dose in the myocardial muscle per unit of injected Fluorine-18 activity by self-absorption of the heart uptake, which can contribute to future deterministic effect investigations. (author)

  9. Myocardial Perfusion SPECT 2015 in Germany

    Science.gov (United States)

    Burchert, Wolfgang; Schäfer, Wolfgang; Hacker, Marcus

    2016-01-01

    Summary Aim The working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine presents the results of the 7th survey of myocardial perfusion SPECT (MPS) of the reporting year 2015. Method 268 questionnaires (173 practices [PR], 67 hospitals [HO], 28 university hospitals [UH]) were evaluated. Results of the last survey from 2012 are set in squared brackets. Results MPS of 121 939 [105 941] patients were reported. 98 % [95 %] of all MPS were performed with Tc-99m radiopharmaceuticals and 2 % [5 %] with Tl-201. 78 % [79 %] of all patients were studied in PR, 14 % [15 %] in HO, and 8 % [6 %] in UH. A pharmacological stress test was performed in 43 % [39 %] (22 % [24 %] adenosine, 20 % [9 %] regadenoson, 1% [6 %] dipyridamole or dobutamine). Attenuation correction was applied in 25 % [2009: 10 %] of MPS. Gated SPECT was performed in 78 % [70 %] of all rest MPS, in 80 % [73 %] of all stress and in 76 % [67 %] of all stress and rest MPS. 53 % [33 %] of all nuclear medicine departments performed MPS scoring by default, whereas 24 % [41 %] did not apply any quantification. 31 % [26 %] of all departments noticed an increase in their counted MPS and 29 % [29 %] no changes. Data from 89 departments which participated in all surveys showed an increase in MPS count of 11.1 % (PR: 12.2 %, HO: 4.8 %, UH: 18.4 %). 70 % [60 %] of the MPS were requested by ambulatory care cardiologists. Conclusion The 2015 MPS survey reveals a high-grade adherence of routine MPS practice to current guidelines. The positive trend in MPS performance and number of MPS already observed in 2012 continues. Educational training remains necessary in the field of SPECT scoring. PMID:27909712

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

    International Nuclear Information System (INIS)

    Kaminek, M.; Myslivecek, M.; Huyak, V.; Koranda, P.; Skvarilova, M.; Ostransky, J.

    2001-01-01

    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)

  11. Assessment of left ventricular filling in various heart disease, especially in ischemic heart disease, by ECG-gated cardiac blood pool scintigraphy

    International Nuclear Information System (INIS)

    Nakagawa, Hiroaki

    1986-01-01

    Using ECG-gated cardiac blood pool scintigraphy (BPS), left ventricular (LV) diastolic function was evaluated in various heart disease, especially in ischemic heart disease (IHD). LV function indices (2 systolic and 9 diastolic) were obtained from LV time activity curve derived from BPS. Among various diastolic indices, peak filling rate (PFR) and 2 other indices were significantly influenced by heart rate (HR), so corrected values for HR were used for this study. Various degrees of disturbance in diastolic filling were found in many cases without systolic impairment. According to the mechanism responsible for diastolic impairment, LV time activity curve showed a characteristic pattern. In IHD, filling disturbance in early diastole was observed before the impairment of systolic contraction developed, so it was thought to be an early predictor of cardiac failure. In the scar region of myocardial infarction (MI), decrease in regional ejection fraction and asynchrony in wall motion were shown, and these resulted in marked deterioration of early diastolic filling. On the other hand in angina pectoris (AP), such systolic disorders were not shown in the ischemic region perfused by stenotic coronary artery, although the disturbance of regional filling was found. The exercise capacity in AP was more related to the impairment in diastolic function at resting state than in systolic function, and furthermore the reserve of diastolic function as well as of systolic function was shown to be an important determinant of exercise capacity in AP. As HR increased, increase of PFR and decrease in time to peak filling was found, which was thought to be a sort of compensation for the shortening diastolic time due to increase in HR during exercise. Such compensation was decreased in AP with reduced exercise capacity. (J.P.N.)

  12. Low dose dynamic CT myocardial perfusion imaging using a statistical iterative reconstruction method

    Energy Technology Data Exchange (ETDEWEB)

    Tao, Yinghua [Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Chen, Guang-Hong [Department of Medical Physics and Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Hacker, Timothy A.; Raval, Amish N. [Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53792 (United States); Van Lysel, Michael S.; Speidel, Michael A., E-mail: speidel@wisc.edu [Department of Medical Physics and Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States)

    2014-07-15

    Purpose: Dynamic CT myocardial perfusion imaging has the potential to provide both functional and anatomical information regarding coronary artery stenosis. However, radiation dose can be potentially high due to repeated scanning of the same region. The purpose of this study is to investigate the use of statistical iterative reconstruction to improve parametric maps of myocardial perfusion derived from a low tube current dynamic CT acquisition. Methods: Four pigs underwent high (500 mA) and low (25 mA) dose dynamic CT myocardial perfusion scans with and without coronary occlusion. To delineate the affected myocardial territory, an N-13 ammonia PET perfusion scan was performed for each animal in each occlusion state. Filtered backprojection (FBP) reconstruction was first applied to all CT data sets. Then, a statistical iterative reconstruction (SIR) method was applied to data sets acquired at low dose. Image voxel noise was matched between the low dose SIR and high dose FBP reconstructions. CT perfusion maps were compared among the low dose FBP, low dose SIR and high dose FBP reconstructions. Numerical simulations of a dynamic CT scan at high and low dose (20:1 ratio) were performed to quantitatively evaluate SIR and FBP performance in terms of flow map accuracy, precision, dose efficiency, and spatial resolution. Results: Forin vivo studies, the 500 mA FBP maps gave −88.4%, −96.0%, −76.7%, and −65.8% flow change in the occluded anterior region compared to the open-coronary scans (four animals). The percent changes in the 25 mA SIR maps were in good agreement, measuring −94.7%, −81.6%, −84.0%, and −72.2%. The 25 mA FBP maps gave unreliable flow measurements due to streaks caused by photon starvation (percent changes of +137.4%, +71.0%, −11.8%, and −3.5%). Agreement between 25 mA SIR and 500 mA FBP global flow was −9.7%, 8.8%, −3.1%, and 26.4%. The average variability of flow measurements in a nonoccluded region was 16.3%, 24.1%, and 937

  13. Low dose dynamic CT myocardial perfusion imaging using a statistical iterative reconstruction method

    International Nuclear Information System (INIS)

    Tao, Yinghua; Chen, Guang-Hong; Hacker, Timothy A.; Raval, Amish N.; Van Lysel, Michael S.; Speidel, Michael A.

    2014-01-01

    Purpose: Dynamic CT myocardial perfusion imaging has the potential to provide both functional and anatomical information regarding coronary artery stenosis. However, radiation dose can be potentially high due to repeated scanning of the same region. The purpose of this study is to investigate the use of statistical iterative reconstruction to improve parametric maps of myocardial perfusion derived from a low tube current dynamic CT acquisition. Methods: Four pigs underwent high (500 mA) and low (25 mA) dose dynamic CT myocardial perfusion scans with and without coronary occlusion. To delineate the affected myocardial territory, an N-13 ammonia PET perfusion scan was performed for each animal in each occlusion state. Filtered backprojection (FBP) reconstruction was first applied to all CT data sets. Then, a statistical iterative reconstruction (SIR) method was applied to data sets acquired at low dose. Image voxel noise was matched between the low dose SIR and high dose FBP reconstructions. CT perfusion maps were compared among the low dose FBP, low dose SIR and high dose FBP reconstructions. Numerical simulations of a dynamic CT scan at high and low dose (20:1 ratio) were performed to quantitatively evaluate SIR and FBP performance in terms of flow map accuracy, precision, dose efficiency, and spatial resolution. Results: Forin vivo studies, the 500 mA FBP maps gave −88.4%, −96.0%, −76.7%, and −65.8% flow change in the occluded anterior region compared to the open-coronary scans (four animals). The percent changes in the 25 mA SIR maps were in good agreement, measuring −94.7%, −81.6%, −84.0%, and −72.2%. The 25 mA FBP maps gave unreliable flow measurements due to streaks caused by photon starvation (percent changes of +137.4%, +71.0%, −11.8%, and −3.5%). Agreement between 25 mA SIR and 500 mA FBP global flow was −9.7%, 8.8%, −3.1%, and 26.4%. The average variability of flow measurements in a nonoccluded region was 16.3%, 24.1%, and 937

  14. Myocardial perfusion magnetic resonance imaging using sliding-window conjugate-gradient HYPR methods in canine with stenotic coronary arteries.

    Science.gov (United States)

    Ge, Lan; Kino, Aya; Lee, Daniel; Dharmakumar, Rohan; Carr, James C; Li, Debiao

    2010-01-01

    First-pass perfusion magnetic resonance imaging (MRI) is a promising technique for detecting ischemic heart disease. However, the diagnostic value of the method is limited by the low spatial coverage, resolution, signal-to-noise ratio (SNR), and cardiac motion-related image artifacts. A combination of sliding window and conjugate-gradient HighlY constrained back-PRojection reconstruction (SW-CG-HYPR) method has been proposed in healthy volunteer studies to reduce the acquisition window for each slice while maintaining the temporal resolution of 1 frame per heartbeat in myocardial perfusion MRI. This method allows for improved spatial coverage, resolution, and SNR. In this study, we use a controlled animal model to test whether the myocardial territory supplied by a stenotic coronary artery can be detected accurately by SW-CG-HYPR perfusion method under pharmacological stress. Results from 6 mongrel dogs (15-25 kg) studies demonstrate the feasibility of SW-CG-HYPR to detect regional perfusion defects. Using this method, the acquisition time per cardiac cycle was reduced by a factor of 4, and the spatial coverage was increased from 2 to 3 slices to 6 slices as compared with the conventional techniques including both turbo-Fast Low Angle Short (FLASH) and echoplanar imaging (EPI). The SNR of the healthy myocardium at peak enhancement with SW-CG-HYPR (12.68 ± 2.46) is significantly higher (P < 0.01) than the turbo-FLASH (8.65 ± 1.93) and EPI (5.48 ± 1.24). The spatial resolution of SW-CG-HYPR images is 1.2 × 1.2 × 8.0 mm, which is better than the turbo-FLASH (1.8 × 1.8 × 8.0 mm) and EPI (2.0 × 1.8 × 8.0 mm). Sliding-window CG-HYPR is a promising technique for myocardial perfusion MRI. This technique provides higher image quality with respect to significantly improved SNR and spatial resolution of the myocardial perfusion images, which might improve myocardial perfusion imaging in a clinical setting.

  15. ST-vector orientation and location of myocardial perfusion defects during exercise

    International Nuclear Information System (INIS)

    Simoons, M.L.; Withagen, A.; Vinke, R.; Kooy, P.; Bakker, W.; Erasmus Universiteit, Rotterdam

    1978-01-01

    In 34 patients with chest pain the spatial orientation of the ST-vectors in the exercise electrocardiogramm 30 and 80 msec after the end of QRS were compared with the location of exercise induced local defects of myocardial uptake of 201 Tl. The following results were obtained: 1. The sensitivity and specifity of myocardial perfusion imaging after exercise were the same as those of exercise electrocardiograms; 2. No relation could be observed beween the location of reduced 201 Tl uptake during exercise and the spatial orientation of the ST-vectors. (orig.) [de

  16. Predictors of abnormal heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    De Souza Leao Lima, R.; Machado, L.; Azevedo, A.B.; De Lorenzo, A.

    2011-01-01

    The objective of this study was to identify predictors of abnormal HR response to dipyridamole (DIP) in patients undergoing myocardial perfusion SPECT (MPS). Patients with a reduced heart rate (HR) response to DIP have higher cardiac mortality, but the mechanism is unknown. We studied 432 patients who underwent dual-isotope gated MPS. DIP (0.56 mg/kg) was infused over 4 min, and Tc-99m tetrofosmin was injected 3 min after the end of the infusion. MPS was semiquantitatively interpreted. Left ventricular ejection fraction (LVEF) and volumes were automatically calculated. The population was categorized into quartiles according to HR ratio, and characteristics in each quartile were compared. Logistic regression analysis was performed to identify predictors of abnormal HR response, using the lowest quartile as the independent variable. Patients with abnormal HR response were more frequently without chest pain, with a history of chronic renal failure and taking digoxin. Baseline HR was higher and had fewer symptoms during stress. The stress and rest perfusion defects were greater, but reversibility was not; in addition, LVEF was lower. Multivariable logistic regression analysis demonstrated that the independent predictors of abnormal HR response were baseline HR and low LVEF. LV dysfunction is an independent predictor of abnormal HR response to DIP, and the association between low LVEF and low HR ratio may explain the link between abnormal HR ratio and increased mortality. (author)

  17. The additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress cardiac MRI for the detection of myocardial ischemia

    NARCIS (Netherlands)

    Lubbers, Daniel D.; Janssen, Caroline H. C.; Kuijpers, Dirkjan; Van Dijkman, Paul R. M.; Overbosch, Jelle; Willems, Tineke P.; Oudkerk, Matthijs

    Purpose of this study was to assess the additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress Cardiac-MR (CMR). Dobutamine Stress CMR was performed in 115 patients with an inconclusive diagnosis of myocardial ischemia on a 1.5 T system (Magnetom Avanto,

  18. Clinical usefulness of Tc-99m hexakis 2-methoxybutyl isonitrile gated SPECT in patients with dilated cardiomyopathy: retrospective analysis

    International Nuclear Information System (INIS)

    Khan, Z.R.; Khan, A.Z.

    2010-01-01

    Background: In Dilated cardiomyopathy the heart is enlarged and ventricles are dilated. Gated myocardial perfusion single photon emission computed tomography is considered state of the art for myocardial perfusion imaging. A retrospective analysis was conducted to evaluate patients with dilated cardiomyopathy with Tc-99m sestamibi gated myocardial perfusion single photon emission computed tomography to evaluate its clinical utility. Methods: A 10 year retrospective medical record review was done from 1991 to 2001 at Wake Forest University, North Carolina, USA. Eligibility criteria included a diagnosis of dilated cardiomyopathy and availability of coronary angiography and Tc-99m sestamibi cardiac imaging results. 26 cases were selected for the final review and inclusion in the study. The study was done with standard protocols for cardiac sestamibi imaging. Results: A total of 26 cases were included in the final analysis. Cases were divided into two main groups. Group-A included 16 patients with no correlation between Tc-99m sestamibi and cardiac catheterisation reports. Group-B included 10 patients with good correlation between the above tests. There were no significant differences between the left ventricular ejection fraction, angina history, sex distribution and diabetic status between the two groups. We applied Wilcoxon Signed Rank Test and z-test to quantify the difference between the two groups. Data was tabulated and z-test was performed. The calculated p value was <0.0001. This is significantly less than the tabulated p-value at 5% level of significance, i.e., 1.96. Significant differences exist between Group-A and Group-B. Conclusion: Tc-99m sestamibi is an excellent agent for investigating myocardial perfusion in dilated cardiomyopathy. The reversible and fixed perfusion defects (small to medium sized) seen in dilated cardiomyopathy after performance of Tc-99m sestamibi gated single photon emission computed tomography imaging may not be due to coronary

  19. Value of gated SPECT in the analysis of regional wall motion of the interventricular septum after coronary artery bypass grafting

    International Nuclear Information System (INIS)

    Giubbini, Raffaele; Rossini, Pierluigi; Bertagna, Francesco; Bosio, Giovanni; Paghera, Barbara; Pizzocaro, Claudio; Canclini, Silvana; Terzi, Arturo; Germano, Guido

    2004-01-01

    The aim of this study was the evaluation of septal wall motion, perfusion and wall thickening after CABG in two groups of consecutive patients, one with grafted left anterior coronary artery and no history of myocardial infarction, and the other with previous anteroseptal myocardial infarction and impaired septal motion before surgery. The issue addressed was the ability of gated SPECT to differentiate between true paradoxical septal motion, characterised by paradoxical wall motion, depressed ejection fraction (EF), poor viability and compromised wall thickening, and pseudo-paradoxical motion, characterised by abnormal wall motion and regional EF but preserved perfusion and wall thickening. One hundred and thirty-two patients with previous anterior myocardial infarction, 82 patients with left anterior descending coronary disease and no history of myocardial infarction and 27 normal subjects underwent rest gated SPECT after 99m Tc-sestamibi injection, according to the standard QGS protocol. Quantitative regional EF, regional perfusion, regional wall motion and regional wall thickening were determined using a 20-segment model. Despite the presence of similar regional wall motion impairment in patients with and patients without septal infarction, in terms of regional EF (2.5%±3% vs 1.9%±4.9% p=NS) and inward septal motion (3±4.9 mm vs 2.3±6.1 mm p=NS), significant differences were observed in both perfusion (74.7%±6.2% vs 63.3%±13%, p>0.0001) and regional wall thickening (17.2%±7.4% vs 12.6%±7.2%, p>0.0001). Gated SPECT with perfusion tracers can reliably differentiate pseudo-paradoxical from true paradoxical septal motion in patients with previous CABG, and it may be the method of choice for evaluating left ventricular performance in this patient population. (orig.)

  20. Value of gated SPECT in the analysis of regional wall motion of the interventricular septum after coronary artery bypass grafting.

    Science.gov (United States)

    Giubbini, Raffaele; Rossini, Pierluigi; Bertagna, Francesco; Bosio, Giovanni; Paghera, Barbara; Pizzocaro, Claudio; Canclini, Silvana; Terzi, Arturo; Germano, Guido

    2004-10-01

    The aim of this study was the evaluation of septal wall motion, perfusion and wall thickening after CABG in two groups of consecutive patients, one with grafted left anterior coronary artery and no history of myocardial infarction, and the other with previous anteroseptal myocardial infarction and impaired septal motion before surgery. The issue addressed was the ability of gated SPECT to differentiate between true paradoxical septal motion, characterised by paradoxical wall motion, depressed ejection fraction (EF), poor viability and compromised wall thickening, and pseudo-paradoxical motion, characterised by abnormal wall motion and regional EF but preserved perfusion and wall thickening. One hundred and thirty-two patients with previous anterior myocardial infarction, 82 patients with left anterior descending coronary disease and no history of myocardial infarction and 27 normal subjects underwent rest gated SPECT after 99mTc-sestamibi injection, according to the standard QGS protocol. Quantitative regional EF, regional perfusion, regional wall motion and regional wall thickening were determined using a 20-segment model. Despite the presence of similar regional wall motion impairment in patients with and patients without septal infarction, in terms of regional EF (2.5%+/-3% vs 1.9%+/-4.9% p=NS) and inward septal motion (3+/-4.9 mm vs 2.3+/-6.1 mm p=NS), significant differences were observed in both perfusion (74.7%+/-6.2% vs 63.3%+/-13%, p>0.0001) and regional wall thickening (17.2%+/-7.4% vs 12.6%+/-7.2%, p>0.0001). Gated SPECT with perfusion tracers can reliably differentiate pseudo-paradoxical from true paradoxical septal motion in patients with previous CABG, and it may be the method of choice for evaluating left ventricular performance in this patient population.

  1. Value of gated SPECT in the analysis of regional wall motion of the interventricular septum after coronary artery bypass grafting

    Energy Technology Data Exchange (ETDEWEB)

    Giubbini, Raffaele; Rossini, Pierluigi; Bertagna, Francesco; Bosio, Giovanni; Paghera, Barbara; Pizzocaro, Claudio; Canclini, Silvana; Terzi, Arturo [Spedali Civili di Brescia, Department of Nuclear Medicine, Brescia (Italy); Germano, Guido [Cedars-Sinai Medical Center, Artificial Intelligence Program, Department of Medicine, Los Angeles, CA (United States)

    2004-10-01

    The aim of this study was the evaluation of septal wall motion, perfusion and wall thickening after CABG in two groups of consecutive patients, one with grafted left anterior coronary artery and no history of myocardial infarction, and the other with previous anteroseptal myocardial infarction and impaired septal motion before surgery. The issue addressed was the ability of gated SPECT to differentiate between true paradoxical septal motion, characterised by paradoxical wall motion, depressed ejection fraction (EF), poor viability and compromised wall thickening, and pseudo-paradoxical motion, characterised by abnormal wall motion and regional EF but preserved perfusion and wall thickening. One hundred and thirty-two patients with previous anterior myocardial infarction, 82 patients with left anterior descending coronary disease and no history of myocardial infarction and 27 normal subjects underwent rest gated SPECT after {sup 99m}Tc-sestamibi injection, according to the standard QGS protocol. Quantitative regional EF, regional perfusion, regional wall motion and regional wall thickening were determined using a 20-segment model. Despite the presence of similar regional wall motion impairment in patients with and patients without septal infarction, in terms of regional EF (2.5%{+-}3% vs 1.9%{+-}4.9% p=NS) and inward septal motion (3{+-}4.9 mm vs 2.3{+-}6.1 mm p=NS), significant differences were observed in both perfusion (74.7%{+-}6.2% vs 63.3%{+-}13%, p>0.0001) and regional wall thickening (17.2%{+-}7.4% vs 12.6%{+-}7.2%, p>0.0001). Gated SPECT with perfusion tracers can reliably differentiate pseudo-paradoxical from true paradoxical septal motion in patients with previous CABG, and it may be the method of choice for evaluating left ventricular performance in this patient population. (orig.)

  2. Effect of beam hardening on transmural myocardial perfusion quantification in myocardial CT imaging

    Science.gov (United States)

    Fahmi, Rachid; Eck, Brendan L.; Levi, Jacob; Fares, Anas; Wu, Hao; Vembar, Mani; Dhanantwari, Amar; Bezerra, Hiram G.; Wilson, David L.

    2016-03-01

    The detection of subendocardial ischemia exhibiting an abnormal transmural perfusion gradient (TPG) may help identify ischemic conditions due to micro-vascular dysfunction. We evaluated the effect of beam hardening (BH) artifacts on TPG quantification using myocardial CT perfusion (CTP). We used a prototype spectral detector CT scanner (Philips Healthcare) to acquire dynamic myocardial CTP scans in a porcine ischemia model with partial occlusion of the left anterior descending (LAD) coronary artery guided by pressure wire-derived fractional flow reserve (FFR) measurements. Conventional 120 kVp and 70 keV projection-based mono-energetic images were reconstructed from the same projection data and used to compute myocardial blood flow (MBF) using the Johnson-Wilson model. Under moderate LAD occlusion (FFR~0.7), we used three 5 mm short axis slices and divided the myocardium into three LAD segments and three remote segments. For each slice and each segment, we characterized TPG as the mean "endo-to-epi" transmural flow ratio (TFR). BH-induced hypoenhancement on the ischemic anterior wall at 120 kVp resulted in significantly lower mean TFR value as compared to the 70 keV TFR value (0.29+/-0.01 vs. 0.55+/-0.01 pvalues on segments moderately affected or unaffected by BH. In the entire ischemic LAD territory, 120 kVp mean endocardial flow was significantly reduced as compared to mean epicardial flow (15.80+/-10.98 vs. 40.85+/-23.44 ml/min/100g; p<1e-04). At 70 keV, BH was effectively minimized resulting in mean endocardial MBF of 40.85+/-15.3407 ml/min/100g vs. 74.09+/-5.07 ml/min/100g (p=0.0054) in the epicardium. We also found that BH artifact in the conventional 120 kVp images resulted in falsely reduced MBF measurements even under non-ischemic conditions.

  3. Importance of tissue perfusion in ST segment elevation myocardial infarction patients undergoing reperfusion strategies: role of adenosine.

    Science.gov (United States)

    Forman, Mervyn B; Jackson, Edwin K

    2007-11-01

    High risk ST segment elevation myocardial infarction (STEMI) patients undergoing reperfusion therapy continue to exhibit significant morbidity and mortality due in part to myocardial reperfusion injury. Importantly, preclinical studies demonstrate that progressive microcirculatory failure (the "no-reflow" phenomenon) contributes significantly to myocardial reperfusion injury. Diagnostic techniques to measure tissue perfusion have validated this concept in humans, and it is now clear that abnormal tissue perfusion occurs frequently in STEMI patients undergoing reperfusion therapy. Moreover, because tissue perfusion correlates poorly with epicardial blood flow (TIMI flow grade), clinical studies show that tissue perfusion is an independent predictor of early and late mortality in STEMI patients and is associated with infarct size, ventricular function, CHF and ventricular arrhythmias. The mechanisms responsible for abnormal tissue perfusion are multifactorial and include both mechanical obstruction and vasoconstrictor humoral factors. Adenosine, an endogenous nucleoside, maintains microcirculatory flow following reperfusion by activating four well-characterized extracellular receptors. Because activation of adenosine receptors attenuates the mechanical and functional mechanisms leading to the "no reflow" phenomenon and activates other cardioprotective pathways as well, it is not surprising that both experimental and clinical studies show striking myocardial salvage with intravenous infusions of adenosine administered in the peri-reperfusion period. For example, a post hoc analysis of the AMISTAD II trial indicates a significant reduction in 1 and 6-month mortality in STEMI patients undergoing reperfusion therapy who are treated with adenosine within 3 hours of symptoms. In conclusion, adenosine's numerous cardioprotective effects, including attenuation of the "no-reflow" phenomenon, support its use in high risk STEMI undergoing reperfusion.

  4. Use of neural networks to improve quality control of interpretations in myocardial perfusion imaging

    DEFF Research Database (Denmark)

    Tagil, K.; Marving, J.; Lomsky, M.

    2008-01-01

    BACKGROUND: The aim of this study was to explore the feasibility of using a technique based on artificial neural networks for quality assurance of image reporting. The networks were used to identify potentially suboptimal or erroneous interpretations of myocardial perfusion scintigrams (MPS......Tc-sestamibi myocardial perfusion scintigraphy. After a training process, the networks were used to select the 20 cases in each region that were more likely to have a false clinical interpretation. These cases, together with 20 control cases in which the networks detected no likelihood of false clinical interpretation...... cases. Forty-six of the 53 cases (87%) came from the group selected by the neural networks, and only seven (13%) were control cases (P

  5. Altered myocardial perfusion during dobutamine stress testing in silent versus symptomatic myocardial ischaemia assessed by quantitative MIBI SPET imaging

    International Nuclear Information System (INIS)

    Elhendy, A.; Geleijnse, M.L.; Roelandt, J.R.T.C.; Cornel, J.H.; Domburg, R.T van; Reijs, A.E.M.; Nierop, P.R.; Fioretti, P.M.

    1996-01-01

    The aim of the study was to compare the extent and severity of reversible underperfusion in silent versus painful myocardial ischaemia during the dobutamine stress test. A consecutive series of 85 patients with significant coronary artery disease and reversible perfusion defects on technetium-99m methoxyisobutylisonitrile single-photon emission tomography performed at rest and during high-dose dobutamine stress (up to 40 μg kg -1 min -1 ) were studied. The left ventricle was divided into six segments. An ischaemic perfusion score was derived quantitatively by subtracting the rest from the stress defect score. Patients with multivessel disease had a higher ischaemic score (610±762 vs 310±411, P<0.05) and a higher number of reversible perfusion defects (2.1±1.2 vs 1.1±0.8, P<0.01) than patients with single-vessel disease. Typical angina occurred in 37 patients (44%) during the test. There was no significant difference between patients with and patients without angina with respecft to age, gender, peak rate-pressure product, prevalence of previous myocardial infarction, diabetes mellitus, multivessel disease or number of stenotic coronary arteries. Stress, rest and ischaemic scores as well as the number and distribution of reversible defects were not different in patients with and patients without angina. Patients with angina more frequently had a history of typical angina before the test (43% vs 17%, P<0.01) and ST-segment depression during the test (54% vs 25%, P<0.01). It is concluded that in patients with coronary artery disease and ischaemia detected by dobutamine scintigraphy, the extent and severity of coronary artery disease and myocardial perfusion abnormalities are similar with or without angina during stess testing. (orig.)

  6. The Myocardial Perfusion Scintigraphy in Predicting Risk for Coronary Artery Disease in Patients with Anxiety and Depression Symptoms

    Directory of Open Access Journals (Sweden)

    Billur Çalışkan

    2016-06-01

    Full Text Available INTRODUCTION: An association between psychological factors and cardiovascular disease, has long been suspected. However it is not clear whether chest pain is caused by emotional distress or whether coronary spasms are caused by the onset of coronary artery disease (CAD. We aimed to predict the risk for CAD in patients referred to myocardial perfusion imaging (MPI with chest pain using depression, stress, and anxiety symptoms. METHODS: The emotional status of all patients was evaluated using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, the State and Trait Anxiety Inventory (STAI-1 and STAI-2, the Perceived Stress Scale (PSS, and the Anxiety Sensitivity Index-3 (ASI. Myocardial perfusion was measured using a 17-segment model and 5-point scoring system (0: normal perfusion; 4: no perfusion. RESULTS: MPI revealed reversible perfusion defects in 24 of 141 patients and no perfusion defects in 117 patients. The STAI-2 and HADS-A and HADS-D scores were significantly higher in patients with myocardial ischemia than in those without (STAI-2: 50.8 ± 7.5 vs. 46.3 ± 7.1, respectively; p = 0.008; HADS-A: 9.5 ± 3.9 vs. 7.8 ± 3.4, respectively; p = 0.033; HADS-D: 8.7 ± 3.0 vs. 7.3 ± 3.0, respectively; p = 0.05. Unadjusted correlation analysis showed that there was statistically significant correlation between reversible perfusion defects and anxiety scores (r=0.186, p= 0.029. DISCUSSION AND CONCLUSION: The patients with symptoms of depression and high-trait anxiety may be at higher risk of myocardial ischemia than patients without such symptoms. Thus, the emotional status of patients should be taken into consideration during clinical evaluation for CAD.

  7. Assmentment of myocardial perfusion by magnetic resonance imaging: on the way to clinical application

    International Nuclear Information System (INIS)

    Fischer, S.E.; Lorenz, C.H.

    1997-01-01

    Magnetic resonance imaging detects the flow of contrast - enhanced blood and even allows the quantitative assessment of myocardial perfusion. The clinical application of this method is being held back by the difficulties in image evaluation and the limitation of standard techniques to the acquisition of a single slice per heart beat cycle. Recent developments in scanner hardware as well as in image acquisition techniques open up the possibility of assessing myocardial perfusion over the entire heart with a spatial resolution in the range of 2 mm. As an example of such a new scanning strategy, a segmented gradient-echo recalled echo planar imaging sequence with preceding saturation is discussed and results in a patient with an infarction are presented. The clinical use of perfusion assessment covering the entire heart for the diagnosis of coronary artery disease is enhanced by the flexibility of magnetic resonance imaging for the assessment of functional cardiac parameters. (orig.) [de

  8. Simulation evaluation of quantitative myocardial perfusion assessment from cardiac CT

    Science.gov (United States)

    Bindschadler, Michael; Modgil, Dimple; Branch, Kelley R.; La Riviere, Patrick J.; Alessio, Adam M.

    2014-03-01

    Contrast enhancement on cardiac CT provides valuable information about myocardial perfusion and methods have been proposed to assess perfusion with static and dynamic acquisitions. There is a lack of knowledge and consensus on the appropriate approach to ensure 1) sufficient diagnostic accuracy for clinical decisions and 2) low radiation doses for patient safety. This work developed a thorough dynamic CT simulation and several accepted blood flow estimation techniques to evaluate the performance of perfusion assessment across a range of acquisition and estimation scenarios. Cardiac CT acquisitions were simulated for a range of flow states (Flow = 0.5, 1, 2, 3 ml/g/min, cardiac output = 3,5,8 L/min). CT acquisitions were simulated with a validated CT simulator incorporating polyenergetic data acquisition and realistic x-ray flux levels for dynamic acquisitions with a range of scenarios including 1, 2, 3 sec sampling for 30 sec with 25, 70, 140 mAs. Images were generated using conventional image reconstruction with additional image-based beam hardening correction to account for iodine content. Time attenuation curves were extracted for multiple regions around the myocardium and used to estimate flow. In total, 2,700 independent realizations of dynamic sequences were generated and multiple MBF estimation methods were applied to each of these. Evaluation of quantitative kinetic modeling yielded blood flow estimates with an root mean square error (RMSE) of ~0.6 ml/g/min averaged across multiple scenarios. Semi-quantitative modeling and qualitative static imaging resulted in significantly more error (RMSE = ~1.2 and ~1.2 ml/min/g respectively). For quantitative methods, dose reduction through reduced temporal sampling or reduced tube current had comparable impact on the MBF estimate fidelity. On average, half dose acquisitions increased the RMSE of estimates by only 18% suggesting that substantial dose reductions can be employed in the context of quantitative myocardial

  9. [Myocardial perfusion scintigraphy. Exact and cost-effective coronary disease imaging - secondary publication

    DEFF Research Database (Denmark)

    Hesse, B.; Petersen, C.L.; Marcassa, C.

    2008-01-01

    Mortality rates due to coronary arterial disease (CAD) have declined as result of improved prevention, diagnosis and management, but CAD remains the leading cause of death. Myocardial perfusion scintigraphy (MPS) provides a cost-effective tool for early detection of CAD in symptomatic individuals...

  10. Assessment of Double Outlet Right Ventricle Associated with Multiple Malformations in Pediatric Patients Using Retrospective ECG-Gated Dual-Source Computed Tomography.

    Directory of Open Access Journals (Sweden)

    Ke Shi

    Full Text Available To evaluate the feasibility and diagnostic accuracy of retrospective electrocardiographically (ECG-gated dual-source computed tomography (DSCT for the assessment of double outlet right ventricle (DORV and associated multiple malformations in pediatric patients.Forty-seven patients <10 years of age with DORV underwent retrospective ECG-gated DSCT. The location of the ventricular septal defect (VSD, alignment of the two great arteries, and associated malformations were assessed. The feasibility of retrospective ECG-gated DSCT in pediatric patients was assessed, the image quality of DSCT and the agreement of the diagnosis of associated malformations between DSCT and transthoracic echocardiography (TTE were evaluated, the diagnostic accuracies of DSCT and TTE were referred to surgical results, and the effective doses were calculated.Apart from DORV, 109 associated malformations were confirmed postoperatively. There was excellent agreement (κ = 0.90 for the diagnosis of associated malformations between DSCT and TTE. However, DSCT was superior to TTE in demonstrating paracardiac anomalies (sensitivity, coronary artery anomalies: 100% vs. 80.00%, anomalies of great vessels: 100% vs. 88.57%, separate thoracic and abdominal anomalies: 100% vs. 76.92%, respectively. Combined with TTE, DSCT can achieve excellent diagnostic performance in intracardiac anomalies (sensitivity, 91.30% vs. 100%. The mean image quality score was 3.70 ± 0.46 (κ = 0.76. The estimated mean effective dose was < 1 mSv (0.88 ± 0.34 mSv.Retrospective ECG-gated DSCT is a better diagnostic tool than TTE for pediatric patients with complex congenital heart disease such as DORV. Combined with TTE, it may reduce or even obviate the use of invasive cardiac catheterization, and thus expose the patients to a much lower radiation dose.

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

    International Nuclear Information System (INIS)

    Park, Eun Kyung; Lee, Won Woo; So, Young; Eo, Jae Seon; Lee, Dong Soo; Chung, June Key; Lee, Myung Chul; Kim, Sang Eun; Kim, Cheol Ho; Lee, Sang Woo

    2004-01-01

    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

  12. Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy

    Directory of Open Access Journals (Sweden)

    Mohammad Eftekhari

    2015-01-01

    Full Text Available Objective(s: Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right–sided cancer. Methods: To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. Results: A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed and 36 patients with right-sided cancer (controls] were enrolled. Dose-volume histogram (DVH [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46. In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03 and anterolateral (17.1% versus 2.8%, P=0.049 walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS of>3 was observed in twelve cases (34.3%, while in five of the controls (13.9%,(Odds ratio=1.3. There was no significant difference between the groups regarding left ventricular ejection fraction. Conclusion: The risk of radiation induced myocardial

  13. Do thallium myocardial perfusion scan abnormalities predict survival in sarcoid patients without cardiac symptoms

    International Nuclear Information System (INIS)

    Kinney, E.L.; Caldwell, J.W.

    1990-01-01

    Whereas the total mortality rate for sarcoidosis is 0.2 per 100,000, the prognosis, when the heart is involved, is very much worse. The authors used the difference in mortality rate to infer whether thallium 201 myocardial perfusion scan abnormalities correspond to myocardial sarcoid by making the simplifying assumption that if they do, then patients with abnormal scans will be found to have a death rate similar to patients with sarcoid heart disease. The authors therefore analyzed complete survival data on 52 sarcoid patients without cardiac symptoms an average of eighty-nine months after they had been scanned as part of a protocol. By use of survival analysis (the Cox proportional hazards model), the only variable that was significantly associated with survival was age. The patients' scan pattern, treatment status, gender, and race were not significantly related to survival. The authors conclude that thallium myocardial perfusion scans cannot reliably be used to diagnose sarcoid heart disease in sarcoid patients without cardiac symptoms

  14. Four-dimensional MAP-RBI-EM image reconstruction method with a 4D motion prior for 4D gated myocardial perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Taek-Soo; Tsui, Benjamin M.W. [Johns Hopkins Univ., Baltimore, MD (United States). Dept. of Radiology; Gullberg, Grant T. [Lawrence Berkeley National Laboratory, Berkeley, CA (United States)

    2011-07-01

    We evaluated and proposed here a 4D maximum a posteriori rescaled-block iterative (MAP-RBI)-EM image reconstruction method with a motion prior to improve the accuracy of 4D gated myocardial perfusion (GMP) SPECT images. We hypothesized that a 4D motion prior which resembles the global motion of the true 4D motion of the heart will improve the accuracy of the reconstructed images with regional myocardial motion defect. Normal heart model in the 4D XCAT (eXtended CArdiac-Torso) phantom is used as the prior in the 4D MAP-RBI-EM algorithm where a Gaussian-shaped distribution is used as the derivative of potential function (DPF) that determines the smoothing strength and range of the prior in the algorithm. The mean and width of the DPF equal to the expected difference between the reconstructed image and the motion prior, and smoothing range, respectively. To evaluate the algorithm, we used simulated projection data from a typical clinical {sup 99m}Tc Sestamibi GMP SPECT study using the 4D XCAT phantom. The noise-free projection data were generated using an analytical projector that included the effects of attenuation, collimator-detector response and scatter (ADS) and Poisson noise was added to generated noisy projection data. The projection datasets were reconstructed using the modified 4D MAP-RBI-EM with various iterations, prior weights, and sigma values as well as with ADS correction. The results showed that the 4D reconstructed image estimates looked more like the motion prior with sharper edges as the weight of prior increased. It also demonstrated that edge preservation of the myocardium in the GMP SPECT images could be controlled by a proper motion prior. The Gaussian-shaped DPF allowed stronger and weaker smoothing force for smaller and larger difference of neighboring voxel values, respectively, depending on its parameter values. We concluded the 4D MAP-RBI-EM algorithm with the general motion prior can be used to provide 4D GMP SPECT images with improved

  15. The value of myocardial perfusion imaging in differentiating between idiopathic dilated cardiomyopathy from the ischemic form

    International Nuclear Information System (INIS)

    Fad, A.; Emami, F.; Eftekhari, M.; Saghari, M.; Fallahi, B.; Beiki, D.; Tkavar, A.

    2004-01-01

    Introduction: differentiating between ischemic cardiomyopathy and idiopathic dilated cardiomyopathy is important as coronary revascularization can improve prognosis in the ischemic subgroup. Due to inherent problems of coronary angiography in patients with depressed ejection fraction introducing a noninvasive tool to diagnose those who will benefit from angiography seems to be rewarding. We examined usefulness of myocardial perfusion scan in this group of patients. Materials and methods: study was performed on 64 patients (62 male and 2 female) aged 57.1 ± 6.7 y (mean ± SD) all with dilation of the left ventricular cavity and ejection fraction less than 40 % by echocardiography. Myocardial perfusion scan was performed in stress and rest phases. All the patients had coronary angiography which was used as the gold standard test. On each set of images, heart was arbitrary divided into 17 segments and perfusion abnormality in each segment was scored by a 5 grade scoring system (0-4). Summed stress Score was used as the scan criteria to differentiate dilated ischemic from idiopathic cardiomyopathy. Scores more than 17 were considered ischemic, and less than that, idiopathic. Results were compared with angiography. Results: from total 40 cases of ischemic cardiomyopathy (proved by angiography) 39 were correctly diagnosed by scan and only one case was mis categorized as idiopathic dilated cardiomyopathy . All 24 cases of idiopathic dilated cardiomyopathy were correctly diagnosed by scintigraphy. Sensitivity, specificity, positive predictive value, and negative predictive value of myocardial perfusion imaging for discrimination between ischemic and idiopathic dilated cardiomyopathy were 97.5 %, 100 %, 100 %, and 96 % respectively. Conclusion: Considering excellent accuracy of myocardial perfusion scan with scoring system in discrimination of ischemic dilated cardiomyopathy from idiopathic cardiomyopathy, this noninvasive test could be considered the main diagnostic test

  16. Effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI

    Directory of Open Access Journals (Sweden)

    Xiao-Gang Zhu

    2016-10-01

    Full Text Available Objective: To analyze the effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI. Methods: A total of 78 patients with acute ST segment elevation myocardial infarction (STEMI who received PCI therapy in our hospital were randomly divided into control group and observation group, control group accepted routine PCI treatment, observation group received intracoronary injection of tirofiban and anisodamine in PCI, and myocardial perfusion of two groups was compared. Results: QRS duration values of observation group the instant after PCI and 4h after PCI were less than those of control group (P<0.05; 99mTc-MIBI and 18F-FDG intake of observation group after PCI were more than those of control group (P<0.05; serum MCP-1, sFas, Copeptin, OPN and vWF levels of observation group 4 h after PCI were lower than those of control group (P<0.05. Conclusions: Intracoronary injection of tirofiban combined with anisodamine can optimize myocardial perfusion in patients with STEMI after PCI, and has positive clinical significance.

  17. Evaluation of heart perfusion in patients with acute myocardial infarction using dynamic contrast-enhanced magnetic resonance imaging

    DEFF Research Database (Denmark)

    Nielsen, Gitte; Fritz-Hansen, Thomas; Dirks, Christina G

    2004-01-01

    with acute transmural myocardial infarction were studied using a Turbo-fast low angle shot (FLASH) MRI sequence to monitor the first pass of an extravascular contrast agent (CA), gadolinium diethylene triamine pentaacetic acid (Gd-DTPA). Quantitation of perfusion, expressed as Ki (mL/100 g/minute), in five......PURPOSE: To investigate the diagnostic ability of quantitative magnetic resonance imaging (MRI) heart perfusion in acute heart patients, a fast, multislice dynamic contrast-enhanced MRI sequence was applied to patients with acute myocardial infarction. MATERIALS AND METHODS: Seven patients...

  18. Pre-Hospital ECG E-Transmission for Patients with Suspected Myocardial Infarction in the Highlands of Scotland

    Directory of Open Access Journals (Sweden)

    Gordon F. Rushworth

    2014-02-01

    Full Text Available Patients with ST elevation myocardial infarction (STEMI require prompt treatment, best done by primary percutaneous coronary intervention (PPCI. However, for patients unable to receive PPCI, immediate pre-hospital thrombolysis (PHT is the best alternative. Evidence indicates that diagnostic and management support for staff increases the use of PHT. This study aimed to describe the patient demographics and management of patients, to determine any potential inter-area differences in referral rates to the ECG e-transmission service and to explore the views and experiences of key staff involved in ECG e-transmission within NHS Highland. Data from 2,025 patient episodes of ECG e-transmission identified a statistically significant geographical variation in ECG e-transmission and PHT delivery. Scottish Ambulance Service (SAS staff were more likely than GPs to deliver PHT overall, however, GPs were more likely to deliver in remote areas. Interviews with six Cardiac Care Unit (CCU nurses and six SAS staff highlighted their positive views of ECG e-transmission, citing perceived benefits to patients and interprofessional relationships. Poor access to network signal was noted to be a barrier to engaging in the system. This study has demonstrated that a specialist triage service based on e-transmission of ECGs in patients with suspected STEMI can be implemented in a diverse geographical setting. Work is needed to ensure equity of the service for all patients.

  19. Myocardial performance and perfusion during exercise in patients with coronary artery disease caused by Kawasaki disease

    International Nuclear Information System (INIS)

    Paridon, S.M.; Ross, R.D.; Kuhns, L.R.; Pinsky, W.W.

    1990-01-01

    For a study of the natural history of coronary artery lesions after Kawasaki disease and their effect on myocardial blood flow reserve with exercise, five such patients underwent exercise testing on a bicycle. Oxygen consumption, carbon dioxide production, minute ventilation, and electrocardiograms were monitored continuously. Thallium-201 scintigraphy was performed for all patients. One patient stopped exercise before exhaustion of cardiovascular reserve but had no evidence of myocardial perfusion abnormalities. Four patients terminated exercise because of exhaustion of cardiovascular reserve; one had normal cardiovascular reserve and thallium scintiscans, but the remaining patients had diminished cardiovascular reserve. Thallium scintigrams showed myocardial ischemia in two and infarction in one. No patient had exercise-induced electrocardiographic changes. These results indicate that patients with residual coronary artery lesions after Kawasaki disease frequently have reduced cardiovascular reserve during exercise. The addition of thallium scintigraphy and metabolic measurements to exercise testing improved the detection of exercise-induced abnormalities of myocardial perfusion

  20. The clinical value of adenosine triphosphate stress myocardial perfusion tomography for detecting coronary artery disease

    International Nuclear Information System (INIS)

    Yao Zhiming; He Qing; Qu Wanying; Yu Xue; Han Lijun; Yu Zhiguo; Li Wei; Zeng Xuezhai; Zhu Ming; Zhao Hongshan

    2002-01-01

    Objective: To study the clinical value of adenosine triphosphate stress myocardial perfusion tomography imaging (ATP-MPI) in detection of coronary artery disease (CAD). Methods: There were 278 patients underwent ATP-MPI, 51 patients of them also underwent coronary angiography (CAG). Seventy-three patients underwent stress-rest myocardial perfusion tomography imaging with multi-stage submaximal exercise test (ST-MPI) and CAG serving as control group. Results: 1) Side effects: there were 11 different symptoms and atrioventricular conduction block (10 patients), sinoatrial conduction block (2 patients) occurred during ATP stress. Allopathy or interruption of ATP stress did not happen. 2) The sensitivity and specificity of ATP-MPI in detection of CAD were 97.1% and 82.4%, respectively, and those in detection of ≥50% narrowing coronary artery were 91.0% and 94.7%, respectively. 3) In patients without myocardial infarction, the sensitivity and specificity of ATP-MPI in detection of myocardial ischemia were comparable to those of ST-MPI. Conclusion: ATP-MPI is an accurate, safe modality and is comparable to ST-MPI in the detection of CAD