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Sample records for underwent myocardial perfusion

  1. : Myocardial Perfusion

    OpenAIRE

    Dacher, Jean-Nicolas; Lefebvre, V.; Dubourg, Bernard; Deux, Jean-François; Caudron, Jérôme

    2013-01-01

    International audience; The analysis of myocardial perfusion is a key step in the cardiac MRI examination. In routine work, this exploration carried out at rest is based on the qualitative first pass study of gadolinium with an ECG-triggered saturation recovery bFFE sequence. In view of recent knowledge, the analysis of the myocardial perfusion under vasodilator stress may be carried out by scintigraphy or MRI, the latter benefiting from the absence of exposure to ionizing rays and a lower co...

  2. Measuring myocardial perfusion

    DEFF Research Database (Denmark)

    Qayyum, A A; Kastrup, J

    2015-01-01

    Recently, focus has changed from anatomical assessment of coronary arteries towards functional testing to evaluate the effect of stenosis on the myocardium before intervention. Besides positron-emission tomography (PET), cardiac MRI (CMR), and cardiac CT are able to measure myocardial perfusion......-known and is used in routine clinical practice. However, PET uses radioactive tracers and has a lower spatial resolution compared to CMR and CT. CMR and CT are emerging techniques in the field of myocardial perfusion imaging. CMR uses magnetic resonance to obtain images, whereas CT uses x-rays during first....... Myocardial perfusion abnormalities are the first sign of the ischaemic cascade in the development of coronary artery disease (CAD). PET is considered the non-invasive clinical reference standard for absolute quantification of myocardial perfusion. The diagnostic and prognostic value of PET is well...

  3. MRI of myocardial perfusion.

    Science.gov (United States)

    Jerosch-Herold, Michael; Muehling, Olaf; Wilke, Norbert

    2006-02-01

    An overwhelming number of myocardial perfusion studies are done by nuclear isotope imaging. Magnetic resonance imaging during the first pass of an injected, contrast bolus has some significant advantages for detection of blood flow deficits, namely higher spatial resolution, absence of ionizing radiation, and speed of the test. Previous clinical studies have demonstrated that excellent sensitivity and specificity can be achieved with MR myocardial perfusion imaging for detecting coronary artery disease, and assessment of patients with acute chest pain. Furthermore, an absolute quantification of myocardial blood flow is feasible, as was demonstrated by comparison of MR perfusion imaging, to measurements with isotope labeled microspheres in experimental models. An integrated assessment of perfusion, function, and viability, is thus feasible by MRI to answer important clinical challenges such as the identification of stunned or hibernating, but viable myocardium.

  4. 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...

  5. 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.

  6. Cardiovascular magnetic resonance: myocardial perfusion

    Energy Technology Data Exchange (ETDEWEB)

    Nagel, E.; Al-Saadi, N.; Fleck, E. [Dept. of Internal Medicine/Cardiology, German Heart Inst. Berlin and Charite, Campus Virchow, Humboldt Univ. (Germany)

    2000-06-01

    There is growing evidence that the noninvasive assessment of myocardial perfusion with cardiovascular magnetic resonance is a valid and accurate tool for the assessment of ischemic heart disease and its introduction into routine clinical evaluation of patients is rapidly expected. Magnetic resonance measurements allow the evaluation of reversible and irreversible myocardial ischemia, the assessment of acute myocardial infarction, as well as the recognition and detection of viable myocardium. Magnetic resonance perfusion measurements are mainly performed with T1-shortening contrast agents such as gadolinium-DTPA either by visual analysis or based on the analyses of signal intensity time curves. For the detection of myocardial ischemia the first pass kinetics of a gadolinium-DTPA bolus and for the detection of myocardial necrosis and the definition of viable myocardium steady state distribution kinetics are assessed. Quantitative analysis of myocardial perfusion can be performed but requires complex modeling due to the characteristics of gadolinium-DTPA. Thus, semi-quantitative parameters are preferred. There is accumulating evidence in the literature that magnetic resonance imaging can be used for the detection of coronary artery stenosis with high diagnostic accuracy both with semi-quantitative or visual analysis. Myocardial infarction can be reliably detected and the infarcted area determined. Non-reperfused infarcted myocardium can be differentiated from reperfused myocardium by different enhancement patterns that correlates with viability. (orig.) [German] Die Magnetresonanztomographie (MR) erlangt bei der nichtinvasiven Diagnostik der koronaren Herzerkrankung eine zunehmende Bedeutung. Mit dieser Technik koennen sowohl die globale und regionale Myokardfunktion als auch die myokardiale Perfusion exakt beurteilt werden. Bisher liegen die meisten Daten fuer die Analyse von Wandbewegungsstoerun-gen unter Belastung vor, wobei sich eine deutliche diagnostische

  7. 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...... 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...... in the anterior myocardial wall were (mean +/- SD) Ki = 54 +/- 10 ml/100 g/min, lambda = 30 +/- 3 ml/100 g, Vb = 9 +/- 2 ml/100 g, delta T = 3.2 +/- 1.1 s. These results are in good agreement with similar results obtained by other methods....

  8. 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)

  9. 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)

  10. 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)

  11. 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.)

  12. 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...

  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. 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

  15. 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

  16. 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

  17. 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 using...... scanner and CT/PET 64-slice scanner. CT measured myocardial attenuation density (AD) and perfusion index (PI) were correlated to absolute PET myocardial perfusion values. RESULTS: Rest AD, rest and stress PI did not correlate to PET findings (r = 0·412, P = 0·113; r = 0·300, P = 0·259; and r = 0·508, P...... PET and to detect stenotic territories in patients with severe coronary artery disease. MATERIALS AND METHODS: Eighteen patients with stenosis narrowing coronary arteries ≥70% demonstrated on invasive coronary angiography underwent rest and adenosine stress imaging obtained by 320-multidetector CT...

  18. Nonrigid registration of myocardial perfusion MRI

    DEFF Research Database (Denmark)

    Ólafsdóttir, Hildur

    2005-01-01

    This paper describes a fully automatic registration of 10 multi-slice myocardial perfusion magnetic resonance image sequences. The registration of these sequences is crucial for the clinical interpretation, which currently is subjected to manual labour. The approach used in this study is a nonrig...

  19. 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)

  20. Myocardial perfusion at fatal infarction

    DEFF Research Database (Denmark)

    Hvid-Jacobsen, K; Møller, J T; Kjøller, E

    1992-01-01

    In a consecutive study of myocardial scintigraphy in acute ischemic syndrome, four patients had 99mTc-hexamibi injected intravenously before they developed fatal cardiogenic shock. Planar scintigraphy was performed after death. Slices of the hearts after autopsy were analyzed for scintigraphic...

  1. 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

  2. An alternative method for neonatal cerebro-myocardial perfusion

    Science.gov (United States)

    Luciani, Giovanni Battista; De Rita, Fabrizio; Faggian, Giuseppe; Mazzucco, Alessandro

    2012-01-01

    Several techniques have already been described for selective cerebral perfusion during repair of aortic arch pathology in children. One method combining cerebral with myocardial perfusion has also been proposed. A novel technique is reported here for selective and independent cerebro-myocardial perfusion for neonatal and infant arch surgery. Technical aspects and potential advantages are discussed. PMID:22307393

  3. 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.

  4. 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

  5. Adenosine stress protocols for myocardial perfusion imaging

    Directory of Open Access Journals (Sweden)

    Baškot Branislav

    2008-01-01

    Full Text Available Background/Aim. Treadmill test combined with myocardial perfusion scintigraphy (MPS is a commonly used technique in the assessment of coronary artery disease. There are many patients, however, who may not be able to undergo treadmill test. Such patients would benefit from pharmacological stress procedures combined with MPS. The most commonly used pharmacological agents for cardiac stress are coronary vasodilatators (adenosine, dipyridamol and catecholamines. Concomitant low-level treadmill exercise with adenosine pharmacologic stress (AdenoEX during MPS has become commonly used in recent years. A number of studies have demonstrated a beneficial impact of AdenoEX protocol. The aim of the study was, besides introducing into practice the two types of protocols of pharmatological stress test with adenosine, as a preparation for MPS, to compare and monitor the frequency of their side effects to quality, acquisition, as well as to standardize the onset time of acquisition (diagnostic imaging for both protocols. Methods. A total of 130 patients underwent pharmacological stress test with adenosine (vasodilatator. In 108 of the patients we performed concomitant exercise (AdenoEX of low level (50W by a bicycle ergometar. In 28 of the patients we performed Adenosine abbreviated protocol (AdenoSCAN. Side effects of adenosine were followed and compared between the two kinds of protocols AdenoEX and AdenoSCAN. Also compared were image quality and suggested time of acquisition after the stress test. Results. Numerous side effects were found, but being short-lived they did not require any active interventions. The benefit of AdenoEX versus AdenoSCAN included decreased side effects (62% vs 87%, improved safety and patients tolerance, improved target-to-background ratios because of less subdiaphragmatic activity, earlier acquisition, and improved sensitivity. Conclusion. The safety and efficacy of adenosine pharmacological stress is even better with concomitant

  6. 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.

  7. 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)

  8. 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.)

  9. 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

  10. Myocardial perfusion tomography with 7-pinhole collimator

    Energy Technology Data Exchange (ETDEWEB)

    Yonekura, Y.; Mukai, T.; Yamamoto, K. (Kyoto Univ. (Japan). Faculty of Medicine)

    1980-12-01

    The clinical efficacy of tomographic presentation of myocardial perfusion imaging with 7-pinhole collimator was evaluated. 35 cases including 5 normals, 4 patients with diffuse left ventricular hypertrophy, 21 with coronary artery disease (CAD) and 5 with hypertrophic cardiomyopathy (HCM) documented by coronary angiography and left ventriculography were selected for this study. Following the conventional /sup 201/Tl myocardial perfusion imaging (MPI), myocardial perfusion tomography (MPT) with 7-pinhole collimator was performed in both LAO and RAO projection. In addition, to examine wall motion abnormalities tomographically, /sup 201/Tl MPI as well as sup(99m)Tc-RBC blood pool imaging were gated to reconstruct multigated MPT (MGMPT) and multigated cardiac pool tomography (MGCPT). The detectability of the defect of the 7-pinhole tomography was compared with that of the conventional image using a cardiac phantom. The same degree of detectability was shown with both these two images. The MPT in LAO projection revealed superior sensitivity to the conventional MPI in the case of inferior wall infarction, and the MPT in RAO projection revealed superior sensitivity in the case of anterior wall infarction. A combination of the MGMPT and MGCPT succeeded in visualizing a subendocardial infarction as a focal gap between these two images. In the case of the small infarction undetectable in the conventional MPI, it can be seen as subtle wall motion abnormalities in the tomographic presentation in movie format. An asymmetrical hypertrophy in HCM can readily be localized in tomographic visualization. Tomographic reconstruction with 7-pinhole collimator from the optimal tomographic plane should be attempted, when the conventional display is equivocal.

  11. 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.

  12. 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

  13. Prior CT May Improve Diagnostic Confidence in Myocardial Perfusion Imaging.

    Science.gov (United States)

    Mehta, Pareen; Wassef, Heidi; Colletti, Patrick M

    2015-10-01

    Many patients with matching myocardial perfusion imaging defects may have prior CT examinations that include the myocardial region of interest, such as a CT chest or CT abdomen. We correlate these perfusion defects with available prior CT examinations to determine if this will improve diagnostic confidence. Myocardial perfusion scans were reviewed to identify cases with myocardial perfusion defects and prior CT imaging that included the myocardium. The CT was reviewed for evidence of myocardial injury that correlated with the perfusion defect. A retrospective review of 732 myocardial perfusion scans was performed, of which 69 cases with perfusion defects were identified that also had prior CT imaging available for review. Of this subset of patients, 19 patients had findings on the CT scan compatible with ischemia or infarction in the expected region of the perfusion defect, which allowed for a more confident diagnosis. Reviewing a prior CT scan, if available, during the interpretation of a myocardial perfusion scan, can help improve diagnostic confidence in over 25% of cases. This can lead to decreased indeterminate results and can be used to potentially avoid unhelpful further testing.

  14. The efficacy of 99Tcm-MIBI myocardial perfusion imaging in detecting myocardial ischemia in patients with Kawasaki disease

    International Nuclear Information System (INIS)

    Zhang Qi; Li Huanbin; Wang Ling; Chu Maoping; Qiang Rulian

    2007-01-01

    Objective: 99 Tc m -MIBI myocardial perfusion imaging was undertaken to detect myocardial ischemia in children with Kawasaki disease in order to evaluate its diagnostic value. Methods: The subjects included 53 children with Kawasaki disease and 10 children with fever but no Kawasaki disease or other cardiomyopathy. The 53 patients were classified into three subgroups by their clinical manifestations: acute phase (n=25), sub-acute phase (n=9), and chronic phase (n=19). All subjects underwent 99 Tc m -MIBI myocardial perfusion SPECT imaging and echocardiography. The patients were reclassified into two subgroups with (n=20) or without (n=33) coronary artery dilation according to the results of echocardiography. The patients with positive SPECT repeated their SPECT imaging 6 months later. Results: The myocardial perfusion SPECT imaging and echocardiography was normal in the control group. Twenty-nine of 53 (54.7%) patients were positive in perfusion imaging. Fourteen of 25 patients in acute phase had SPECT imaging again 6 months later, 9 were normal, 4 improved significantly, only 1 unchanged. Among 9 patients in sub-acute phase and 19 patients in recovery periods, 7 and 8 had positive results respectively (4, 2, 1 of 7 and 2, 2, 4 of 8 showed improved, normal and unchanged in their repeated SPECT imaging respectively). In 20 of 53 patients, echocardiography shown coronary, artery dilation, 14 of them (70%) had myocardial ischemia to different extent in myocardial perfusion imaging. And 15 of 33 (45.5%) cases with normal coronary artery also had myocardial ischemia in SPECT imaging. Conclusion: 99 Tc m -MIBI myocardial perfusion imaging is a useful noninvasive method for diagnosis and evaluation of myocardial ischemia in Kawasaki disease. (authors)

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

    International Nuclear Information System (INIS)

    Pruthi, Ankur; Asopa, Ramesh; Rajan, M.G.R.; Basu, Sandip

    2010-01-01

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

  16. 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

  17. 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)

  18. 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.

  19. Stress-only myocardial perfusion scintigraphy

    DEFF Research Database (Denmark)

    Ejlersen, June A; May, Ole; Mortensen, Jesper

    2017-01-01

    and no previous coronary artery disease underwent a 2-day stress (exercise)/rest, gated, and attenuation-corrected (AC), 99m-technetium-sestamibi perfusion study, followed by invasive coronary angiography. The stress datasets were evaluated twice by four physicians with two different training levels (expert...... and novice): familiar and unfamiliar with AC. The two experts also made a consensus reading of the integrated stress-rest datasets. The consensus reading and quantitative data from the invasive coronary angiography were applied as reference methods. RESULTS: The sensitivity/specificity were 0...

  20. Myocardial CT perfusion imaging for ischemia detection

    Science.gov (United States)

    Capunay, Carlos

    2017-01-01

    Coronary computed tomography angiography (CCTA) plays an important role in many specific scenarios such as in symptomatic patients with intermediate pretest of coronary artery disease (CAD), as well as in the triage of patients with acute chest pain with TIMI risk ≤2. However, it cannot detect the presence of associated ischemia, which is critical for clinical decision making among patients with moderate to severe stenosis. Although functional information can be obtained with different non-invasive tools, cardiac CT is the unique modality that can perform a comprehensive evaluation of coronary anatomy plus the functional significance of lesions. Myocardial CT perfusion (CTP) can be performed with different approaches such as static and dynamic CTP. In addition, static CTP can be performed using single energy CT (SECT) or dual energy CT (DECT). In this review, we will discuss the technical parameters and the available clinical evidence of static CTP using both SECT and DECT. PMID:28540208

  1. 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)

  2. 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)

  3. Quantification of myocardial perfusion using free-breathing MRI and prospective slice tracking

    DEFF Research Database (Denmark)

    Pedersen, Henrik; Kelle, Sebastian; Ringgaard, Steffen

    2009-01-01

    Quantification of myocardial perfusion using first-pass magnetic resonance imaging (MRI) is hampered by respiratory motion of the heart. Prospective slice tracking (PST) potentially overcomes this problem, and may provide an attractive alternative or supplement to current breath-hold techniques....... This study demonstrates the feasibility of patient-adapted 3D PST on a 3.0 Tesla MR system. Eight patients underwent free-breathing studies of myocardial perfusion, simultaneously collecting data with and without PST. On average, PST reduced residual in-plane motion by a factor of 2, compared...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-04-15

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

  5. 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

  6. Diagnostic Performance of Dual-Energy CT Stress Myocardial Perfusion Imaging: Direct Comparison With Cardiovascular MRI

    Science.gov (United States)

    Ko, Sung Min; Song, Meong Gun; Chee, Hyun Kun; Hwang, Hweung Kon; Feuchtner, Gudrun Maria; Min, James K.

    2014-01-01

    OBJECTIVE The purpose of this study was to assess the diagnostic performance of stress perfusion dual-energy CT (DECT) and its incremental value when used with coronary CT angiography (CTA) for identifying hemodynamically significant coronary artery disease. SUBJECTS AND METHODS One hundred patients with suspected or known coronary artery disease without chronic myocardial infarction detected with coronary CTA underwent stress perfusion DECT, stress cardiovascular perfusion MRI, and invasive coronary angiography (ICA). Stress perfusion DECT and cardiovascular stress perfusion MR images were used for detecting perfusion defects. Coronary CTA and ICA were evaluated in the detection of ≥ 50% coronary stenosis. The diagnostic performance of coronary CTA for detecting hemodynamically significant stenosis was assessed before and after stress perfusion DECT on a pervessel basis with ICA and cardiovascular stress perfusion MRI as the reference standard. RESULTS The performance of stress perfusion DECT compared with cardiovascular stress perfusion MRI on a per-vessel basis in the detection of perfusion defects was sensitivity, 89%; specificity, 74%; positive predictive value, 73%; negative predictive value, 90%. Per segment, these values were sensitivity, 76%; specificity, 80%; positive predictive value, 63%; and negative predictive value, 88%. Compared with ICA and cardiovascular stress perfusion MRI per vessel territory the sensitivity, specificity, positive predictive value, and negative predictive value of coronary CTA were 95%, 61%, 61%, and 95%. The values for stress perfusion DECT were 92%, 72%, 68%, and 94%. The values for coronary CTA and stress perfusion DECT were 88%, 79%, 73%, and 91%. The ROC AUC increased from 0.78 to 0.84 (p = 0.02) with the use of coronary CTA and stress perfusion DECT compared with coronary CTA alone. CONCLUSION Stress perfusion DECT plays a complementary role in enhancing the accuracy of coronary CTA for identifying hemodynamically

  7. Dilated cardiomyopathy - approach made simplified with myocardial perfusion scintigraphy and cardiac viability studies

    International Nuclear Information System (INIS)

    Pawar, Shwetal; Maitra, R.; Tilve, G.H.

    2010-01-01

    Full text: To differentiate the ischemic vs nonischemic dilated cardiomyopathy and to assess myocardial viability in the ischemic cardiomyopathy. Materials and Methods: 34 patients (24 males and 10 females) with dilated cardiomyopathy diagnosed on echocardiography with reduced left ventricular ejection fraction and global hypokinesia were included between the period of Jan 2009 and July 2010. All the patients underwent rest myocardial perfusion scintigraphy first; 45 minutes after intravenous injection of 7 mCi of 99m Tc MIBI. The stress myocardial perfusion imaging (after physical stress or gm/kg/min; 6 min infusion) was pharmacological stress with adenosine; 140 performed in the patients with normal perfusion at rest. The 18 F FDG (5 mCi) cardiac viability studies were performed in patient with abnormal rest myocardial perfusion. The images were acquired on GE Infinia systems and processed on Emory toolbox (ECT) to study the ischemia and viability. Results: The mean left ventricular ejection fraction was found to be 27.38% at rest. The stress and rest perfusion scintigraphy was carried out in 20/34(58%) patients in whom 9(45%) patients underwent pharmacological stress with Inj adenosine and 11(55%) patients underwent physical stress. The stress induced ischemia was diagnosed in 12(60%) patients and infarct in 2(10%) patients with mixed ischemia and infarct pattern in 2(10%) patients. The nonischemic cause was diagnosed in 4 patients. The cardiac viability study was carried out in 14/34 (42%) patients with 6(42%) viable, 5(35%) nonviable and 3(21%) mixed viable and nonviable patterns were identified. Conclusion: The myocardial perfusion scintigraphy was the simplified approach for differentiating ischemic verses nonischemic dilated cardiomyopathy with addition of cardiac viability study ( 18 FDG) made it one stop shop for the complete work-up of patients for further management

  8. Abnormal perfusion on myocardial perfusion SPECT in patients with WPW syndrome: clinical implications

    International Nuclear Information System (INIS)

    Kang, Do Young; Cha, Kwang Soo; Kim, Moo Hyun; Kim, Young Dae; Kim, Duk Kyu

    2001-01-01

    Myocardial perfusion is altered significantly in patients with rhythm disturbances such as CLBBB and right ventricular pacing rhythm. 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 SPECT in patients with WPW syndrome. Adenosine Tc-99m MIBI or Tl-201 myocardial SPECT with or without coronary angiography were performed in 11 patients with WPW syndrome. Perfusion defects (PD) were compared to AP location based on ECG or electrophysiologic study. Small to large extent (11.0 8.5%, range: 0 35%) and mild to moderate severity (-71.8 42.7%, range: -217 0%) of reversible (n=9) or fixed (n=1) perfusion defects were noted. One patient with right free wall AP showed normal. Other defect locations were as follows. Myocardial perfusion defect showed variable extent, severity and location in patients with WPW syndrome. It was not specifically correlated with location of accessory pathway, but most of all patients were abnormal perfusion pattern. Therefore myocardial perfusion SPECT was interpreted carefully in patients with WPW syndrome

  9. 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

  10. Increases in myeloperoxidase levels after exercise in myocardial perfusion scintigraphy are not induced by myocardial ischemia

    NARCIS (Netherlands)

    van der Zee, P. M.; Meuwese, M. C.; Verberne, H. J.; de Ruijter, M.; van Straalen, J. P.; Fischer, J. C.; Sturk, A.; van Eck-Smit, B. L. F.; Stroes, E. S. G.; de Winter, R. J.

    2008-01-01

    Background: Increased systemic levels of myeloperoxidase (MPO) have been reported in patients with acute myocardial ischemia. We studied the association between exercise-induced myocardial ischemia measured by myocardial perfusion scintigraphy (MPS) and the magnitude and time course of changes in

  11. Acute myocardial infarction: estimation of at-risk and salvaged myocardium at myocardial perfusion SPECT 1 month after infarction.

    Science.gov (United States)

    Romero-Farina, Guillermo; Aguadé-Bruix, Santiago; Candell-Riera, Jaume; Pizzi, M Nazarena; Pineda, Victor; Figueras, Jaume; Cuberas, Gemma; de León, Gustavo; Castell-Conesa, Joan; García-Dorado, David

    2013-11-01

    To estimate at-risk and salvaged myocardium by using gated single photon emission computed tomography (SPECT) myocardial perfusion imaging after acute myocardial infarction (AMI). The study was approved by the hospital's Ethical Committee on Clinical Trials (trial register number, PR(HG)36/2000), and all patients gave informed consent. Forty patients (mean age, 61.78 years; eight women) with a first AMI underwent two gated SPECT examinations--one before percutaneous coronary intervention (PCI) and one 4-5 weeks after PCI. Myocardium at risk was estimated by assessing the perfusion defect at the first gated SPECT examination, and salvaged myocardium was estimated by assessing the risk area minus necrosis at the second examination. Myocardium at risk was estimated by determining the discordance between the areas of left ventricular (LV) wall motion and perfusion at the second examination. Concordance between tests was analyzed by means of linear regression analysis, the Pearson correlation, the intraclass correlation coefficient, and Bland-Altman analysis. An improvement in perfusion, wall motion, wall thickening, and LV ejection fraction (P Myocardial perfusion gated SPECT performed 1 month after early PCI in a first AMI provides potentially useful information on at-risk and salvaged myocardium. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13122324/-/DC1. RSNA, 2013

  12. Prevalence of ECG changes during adenosine stress and its association with perfusion defect on myocardial perfusion scintigraphy.

    Science.gov (United States)

    Taywade, Sameer K; Ramaiah, Vijayaraghavan L; Basavaraja, Harish; Venkatasubramaniam, Parameswaran R; Selvakumar, Job

    2017-04-01

    Myocardial perfusion scintigraphy (MPS) is a valuable, noninvasive imaging modality in the evaluation of patients with coronary artery disease. Adenosine stress may occasionally be associated with ECG changes. This study evaluated the strength of association between adenosine stress-related ECG changes and perfusion defects on Tc-MPS. 117 (mean age: 61.25±9.27 years; sex: men 87, women 30) patients with known/suspected coronary artery disease underwent adenosine stress MPS. ECG was monitored continuously during adenosine stress for ST-depression. On the basis of the summed difference score, reversible perfusion defects were categorized as follows: normal: less than 4, mild: 4-8, moderate: 9-13, and severe: more than 13. ST-depression was observed in 27/117 (23.1%) and reversible perfusion defects were observed in 18/27 (66.66%) patients. 2/27, 6/27, and 10/27 patients had mild, moderate, and severe ischemia, respectively. 9/27 patients had normal perfusion. ECG changes and perfusion defects showed a moderate strength of association (correlation coefficient r=0.35, P=0.006). The sensitivity, specificity, positive predictive value, and negative predictive value of ECG findings for prediction of ischemia were 35.29, 86.36, 67.67, and 63.33%, respectively. ECG changes during adenosine stress are not uncommon. It shows a moderate strength of association with reversible perfusion defects. ECG changes during adenosine merit critical evaluation of MPS findings.

  13. 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

  14. 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

    2018-03-06

    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.

  15. Quantification of myocardial perfusion using cardiac magnetic resonance imaging correlates significantly to rubidium-82 positron emission tomography in patients with severe coronary artery disease

    DEFF Research Database (Denmark)

    Qayyum, Abbas A; Hasbak, Philip; Larsson, Henrik B W

    2014-01-01

    INTRODUCTION: Aim was to compare absolute myocardial perfusion using cardiac magnetic resonance imaging (CMRI) based on Tikhonov's procedure of deconvolution and rubidium-82 positron emission tomography (Rb-82 PET). MATERIALS AND METHODS: Fourteen patients with coronary artery stenosis underwent ...

  16. 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)

  17. Discrepancy between myocardial perfusion and fatty acid metabolism following acute myocardial infarction for evaluating the dysfunctional viable myocardium.

    Science.gov (United States)

    Biswas, Shankar K; Sarai, Masayoshi; Toyama, Hiroshi; Hishida, Hitoshi; Ozaki, Yukio

    2012-01-01

    Following acute myocardial infarction (AMI) the area of myocardial perfusion and metabolism mismatch is designated as dysfunctional viable myocardium. (123)I-beta-methyl iodophenyl pentadecanoic acid (BMIPP) is clinically very useful for evaluating myocardial fatty acid metabolism, and (99)mTc-Tetrofosmin (TF) is a widely used tracer for myocardial perfusion. This study was designed to evaluate the degree of discrepancy between BMIPP and TF at the subacute state of AMI. Fifty-two patients (aged 59 ± 10 years; mean 46 years) with AMI were enrolled, and all of them underwent percutaneous coronary intervention (PCI). Patients were classified according to ST-T change and PCI timing. (123)I-beta-methyl iodophenyl pentadecanoic acid and TF cardiac scintigraphy were performed on 7 ± 3.5 days of admission using a dual headed gamma camera. Perfusion and fatty acid metabolism defect were scored on a 17 segments model. The mean BMIPP defect score on early and delayed images were 16.67 ± 10.19 and 16.25 ± 10.40, respectively. The mean TF defect score was 10 ± 7.69. Defect score of BMIPP was significantly higher than that of the TF (P TF), and 5 (10%) patients showed matched defect (BMIPP = TF). Mismatched defect score (MMDS) was significantly higher in patients with ST-segment elevation myocardial infarction (STEMI) than that of non-ST-segment elevation myocardial infarction (NSTEMI) (P < 0.041; 95% CI 0.11-5.19). At the subacute state of AMI, most of the patients showed perfusion-metabolism mismatch, which represents the dysfunctional viable myocardium, and patients with STEMI showed higher mismatch. Copyright © 2012 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  18. 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

  19. 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

  20. 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)

  1. 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

    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...... or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (Az...

  2. 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

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Byeong Cheol; Bae, Sun Keun; Lee, Sang Woo; Jeong, Sin Young; Lee, Jae Tae; Lee, Kyu Bo [Kyungpook National University Medical School, Daegu (Korea, Republic of)

    2002-12-01

    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.

  3. Regional heterogeneity of myocardial perfusion in healthy human myocardium: assessment with magnetic resonance perfusion imaging.

    Science.gov (United States)

    Muehling, Olaf M; Jerosch-Herold, Michael; Panse, Prasad; Zenovich, Andrey; Wilson, Betsy V; Wilson, Robert F; Wilke, Norbert

    2004-01-01

    The knowledge of myocardial perfusion in healthy volunteers is fundamental for evaluation of patients with ischemic heart disease. The study was conducted to determine range, regional variability, and transmural gradient of myocardial perfusion in normal volunteers with Magnetic Resonance Perfusion Imaging (MRPI). Perfusion was assessed in 17 healthy volunteers (age: 20-47 yr, 11 males) at rest and adenosine-induced hyperemia using a 1.5 T MR scanner. Perfusion was quantified (mL/g/min) for the transmural myocardium and separately for the endo- and epimyocardium in the anterior, lateral, posterior, and septal left ventricular wall using the Fermi model for constrained deconvolution. Regional variabilities for resting, hyperemic perfusion, and perfusion reserve were 22 +/- 8%, 21 +/- 10%, and 35 +/- 18%. Mean resting, hyperemic perfusion, and perfusion reserve were 1.1 +/- 0.4 mL/g/min, 4.2 +/- 1.1 mL/g/min, and 4.1 +/- 1.4. Perfusion in the septum was higher at rest (1.3 +/- 0.3 mL/g/min vs. 1.0 +/- 0.3 mL/g/min, p < 0.05) and lower during hyperemia (3.6 +/- 0.8 mL/g/min vs. 4.5 +/- 1.1 mL/g/min, p < 0.03), resulting in a reduced perfusion reserve (PR) (3.2 +/- 0.9 vs. 4.5 +/- 1.4, p < 0.01) in the septum vs. the combined anterior, lateral, and posterior segments. Resting (0.9 +/- 0.3 mL/g/min vs. 1.4 +/- 0.5 mL/g/min, p < 0.01), but not hyperemic perfusion, was lower in the epi- vs. endomyocardium, resulting in a higher epimyocardial PR (4.8 +/- 1.8 vs. 3.5 +/- 1.4, p < 0.01) in all regions but the septum, where endo- and epimyocardial perfusion and perfusion reserve were not different. A considerable regional variability of myocardial perfusion was confirmed with MRPI. The exceptional anatomical position of the septum is reflected by the lack of a perfusion gradient, which was demonstrated in all other regions but the septum.

  4. Myocardial perfusion defects and the left ventricular ejection fraction disclosed by scintigraphy in patients with primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Ogard, Christina Gerlach; Søndergaard, Susanne Bonnichsen; Vestergaard, Henrik

    2005-01-01

    Patients with primary hyperparathyroidism (PHPT) have increased risk of cardiovascular disease. For patients undergoing preoperative parathyroid imaging with 99mTc-sestamibi single photon emission computed tomography (SPECT), we combined cervical SPECT and gated cardiac SPECT to achieve information...... about the localization of parathyroid adenomas, myocardial perfusion, and the left ventricular ejection fraction (LVEF) at rest. A series of 22 patients with PHPT and no history of myocardial infarction or angina pectoris were recruited consecutively. At 60 minutes after injection of 700 MBq 99m......Tc-sestamibi, SPECT of the neck and gated myocardial perfusion SPECT were performed at the same time. All of the patients who underwent parathyroidectomy had the parathyroid adenoma localized as predicted from the SPECT. Five patients (23%) had myocardial perfusion defects extending more than 15% (range 15...

  5. 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

  6. 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.

  7. 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

  8. Myocardial perfusion or multi cuts CT: When and how?

    International Nuclear Information System (INIS)

    Grossman, G.

    2015-01-01

    Multi Slice CT: in patients with intermediate probability mainly to exclude coronary artery disease (acute chest pain), Myocardial perfusion in patients with intermediate probability of coronary disease. To exclude and confirm ischemia and definition of conduct. There is no definition of superiority between strategies

  9. 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

  10. 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.

  11. Detection of resting myocardial perfusion defects by SonoVue myocardial contrast echocardiography.

    Science.gov (United States)

    Nahar, Tamanna; Li, Peng; Kuersten, Bettina; Batra, Sanjay; Vannan, Mani A

    2003-08-01

    SonoVue is a new microbubble contrast agent containing sulfur hexafluoride. We assessed the efficacy of SonoVue myocardial contrast echocardiography (MCE) to detect resting perfusion abnormalities. Nineteen adult patients with a wall motion abnormality in a screening echocardiogram were studied. Each patient received up to four bolus injections of 2.0 mL SonoVue (Bracco Diagnostics, Inc.) during echocardiographic examination using either B-mode(n = 12)or power Doppler(n = 7)imaging. Each patient also had SPECT nuclear perfusion imaging performed. Segmental assessment of myocardial perfusion from SonoVue MCE images were compared with corresponding SPECT nuclear images. Using B-mode imaging, the mean number of views obtained with a single SonoVue injection ranged from 1.4 to 1.9, with 2 or 3 injections required for a complete examination. Ninety-four percent of segments were scored as diagnostic. Agreement between B-mode and SPECT images was 72% for segments with a perfusion defect, 86% for normal perfusion, and 80% for segments with either perfusion defect or normal perfusion (all views combined). Using power Doppler imaging, the mean number of views obtained with a single SonoVue injection ranged from 1.0 to 1.3, with 2 to 4 injections required for a complete examination. Sixty-eight percent of segments were scored as diagnostic. Agreement between power Doppler and SPECT images was 67% for perfusion defects, 53% for segments with normal perfusion, and 59% for segments with either perfusion defect or normal perfusion (all views combined). SonoVue MCE has the potential to assess myocardial perfusion at rest. B-mode imaging was more accurate than power Doppler imaging when compared with SPECT nuclear imaging.

  12. Non-invasive imaging in detecting myocardial viability: Myocardial function versus perfusion

    Directory of Open Access Journals (Sweden)

    Iqbal A. Elfigih

    2014-12-01

    Full Text Available Coronary artery disease (CAD is the most prevalent and single most common cause of morbidity and mortality [1] with the resulting left ventricular (LV dysfunction an important complication. The distinction between viable and non-viable myocardium in patients with LV dysfunction is a clinically important issue among possible candidates for myocardial revascularization. Several available non-invasive techniques are used to detect and assess ischemia and myocardial viability. These techniques include echocardiography, radionuclide images, cardiac magnetic resonance imaging and recently myocardial computed tomography perfusion imaging. This review aims to distinguish between the available non-invasive imaging techniques in detecting signs of functional and perfusion viability and identify those which have the most clinical relevance in detecting myocardial viability in patients with CAD and chronic ischemic LV dysfunction. The most current available studies showed that both myocardial perfusion and function based on non-invasive imaging have high sensitivity with however wide range of specificity for detecting myocardial viability. Both perfusion and function imaging modalities provide complementary information about myocardial viability and no optimum single imaging technique exists that can provide very accurate diagnostic and prognostic viability assessment. The weight of the body of evidence suggested that non-invasive imaging can help in guiding therapeutic decision making in patients with LV dysfunction.

  13. 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

  14. Preoperative evaluation of myocardial viability by thallium-201 imaging in patients with old myocardial infarction who underwent coronary revascularization

    International Nuclear Information System (INIS)

    Naruse, Hitoshi; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Miyamoto, Takashi; Fukuchi, Minoru

    1992-01-01

    The myocardial uptake and redistribution in thallium scintigraphy and the regional wall motion by echocardiography were evaluated by a semi-quantitative method in 42 patients who previously had myocardial infarction (50 target vessels) and underwent coronary revascularization. The aim of this study was to elucidate the significance of the initial image, delayed image and redistribution on thallium-201 scintigraphy for clinical diagnosis of the myocardial viability. As a semi-quantitative analysis, we used a bull's-eye display for thallium image and centerline method for echocardiographic wall motion, and compared the results before and after revascularization. As a result, the thallium grade improved postoperatively in all 17 areas which preoperatively had showed redistribution, and also in 11 of the 32 areas without preoperative redistribution. The sensitivity, specificity and accuracy of preoperative thallium redistribution for predicting myocardial viability were 61%, 100% and 78%, respectively, when the postoperative improvement in the thallium grade was used as the standard. The postoperative probability of improvement in the thallium grade increased in proportion to the preoperative grade (delayed image)(p<0.01). There was no correlation between the preoperative thallium delayed image and postoperative improvement in wall motion. Postoperative improvement in thallium image and wall motion could not be predicted from the preoperative wall motion. Thus, postoperative improvement in thallium images can be anticipated if redistribution is present on the preoperative thallium image, and the preoperative thallium delayed image is useful for predicting myocardial viability. Improvement in wall motion could not be predicted preoperatively by these methods. (author)

  15. Applicability of the Appropriate use Criteria for Myocardial Perfusion Scintigraphy

    International Nuclear Information System (INIS)

    Oliveira, Anderson de; Rezende, Maria Fernanda; Corrêa, Renato; Mousinho, Rodrigo; Azevedo, Jader Cunha; Miranda, Sandra Marina; Oliveira, Aline Ribeiro; Gutterres, Ricardo Fraga; Mesquita, Evandro Tinoco; Mesquita, Cláudio Tinoco

    2014-01-01

    Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a private nuclear medicine service of a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2005 and 2009 and compare the level of indication of both. We included records of 383 patients that underwent MPS, November 2008 up to February 2009. Demographic characteristics, patient's origin, coronary risk factors, time of medical graduation and appropriateness criteria of medical applications were studied. The criteria were evaluated by two independent physicians and, in doubtful cases, defined by a medical expert in MPS. Mean age was 65 ± 12 years. Of the 367 records reviewed, 236 (64.3%) studies were performed in men and 75 (20.4%) were internee. To ACC 2005, 255 (69.5%) were considered appropriate indication and 13 (3.5%) inappropriate. With ACC 2009, 249 (67.8%) were considered appropriate indications and 13 (5.2%) inappropriate. We observed a high rate of adequacy of medical indications for MPS. Compared to the 2005 version, 2009 did not change the results

  16. Applicability of the Appropriate use Criteria for Myocardial Perfusion Scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Oliveira, Anderson de [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Comissão Nacional de Energia Nuclear - CNEN (Brazil); Rezende, Maria Fernanda [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Corrêa, Renato; Mousinho, Rodrigo [Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Azevedo, Jader Cunha [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Miranda, Sandra Marina; Oliveira, Aline Ribeiro [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Gutterres, Ricardo Fraga [Comissão Nacional de Energia Nuclear - CNEN (Brazil); Mesquita, Evandro Tinoco; Mesquita, Cláudio Tinoco [Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil)

    2014-11-15

    Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a private nuclear medicine service of a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2005 and 2009 and compare the level of indication of both. We included records of 383 patients that underwent MPS, November 2008 up to February 2009. Demographic characteristics, patient's origin, coronary risk factors, time of medical graduation and appropriateness criteria of medical applications were studied. The criteria were evaluated by two independent physicians and, in doubtful cases, defined by a medical expert in MPS. Mean age was 65 ± 12 years. Of the 367 records reviewed, 236 (64.3%) studies were performed in men and 75 (20.4%) were internee. To ACC 2005, 255 (69.5%) were considered appropriate indication and 13 (3.5%) inappropriate. With ACC 2009, 249 (67.8%) were considered appropriate indications and 13 (5.2%) inappropriate. We observed a high rate of adequacy of medical indications for MPS. Compared to the 2005 version, 2009 did not change the results.

  17. 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

  18. Detecting Myocardial Ischemia With99mTechnetium-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 9 were compared to patients with SSS 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.

  19. 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

  20. Stress Myocardial Perfusion CT in Patients Suspected of Having Coronary Artery Disease: Visual and Quantitative Analysis-Validation by Using Fractional Flow Reserve.

    Science.gov (United States)

    Yang, Dong Hyun; Kim, Young-Hak; Roh, Jae-Hyung; Kang, Joon-Won; Han, Dongjin; Jung, Joonho; Kim, Namkug; Lee, Jung Bok; Ahn, Jung-Min; Lee, Jong-Young; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Lee, Cheol Whan; Park, Seong-Wook; Park, Seung-Jung; Lim, Tae-Hwan

    2015-09-01

    To assess the diagnostic accuracy of stress myocardial perfusion computed tomography (CT) by using visual and quantitative analytic methods in patients with coronary artery disease, with fractional flow reserve (FFR) as a reference standard. The institutional review board approved the study, and written informed consent was obtained from all patients. The diagnostic accuracy of myocardial perfusion CT was assessed for 75 patients who underwent myocardial perfusion CT and conventional coronary angiography with reference to hemodynamically significant stenosis, defined as the presence of an FFR of 0.8 or less or an angiographically severe (≥90%) stenosis. Results of quantitative analysis of myocardial perfusion CT data were compared with those of visual analysis by using areas under the receiver operating characteristic curve (AUCs). Among the 75 patients and 210 epicardial arteries, 61 patients (81%) with 86 arteries (41%) had hemodynamically significant stenosis. The per-patient sensitivity and specificity of the visual assessment of myocardial perfusion CT data for all patients were 89% and 86%, respectively. At per-vessel analysis, the sensitivities and specificities, respectively, of myocardial perfusion CT were 80% and 95% for all vessels, 85% and 100% for 63 vessels with severe coronary calcification (defined as an Agatston score > 400), and 76% and 91% for 56 vessels in patients with multivessel disease. In severely calcified vessels, visual assessment of myocardial perfusion CT data in combination with CT angiography provided incremental value over CT angiography alone for the detection of myocardial ischemia (integrated discrimination improvement index, 0.38; P perfusion ratio had a lower AUC than visual analysis of myocardial perfusion CT (0.759 vs 0.877, P = .002). Stress myocardial perfusion CT provides incremental value over CT angiography in patients with a high calcium score for the detection of myocardial ischemia as defined by FFR.

  1. Incidental Detection of a Benign Thymoma on Tc-99m MIBI Myocardial Perfusion Study

    Directory of Open Access Journals (Sweden)

    Funda Aydın

    2011-08-01

    Full Text Available Technetium-99m methoxy-isobutylisonitrile (Tc-99m MIBI is a routinely used radiopharmaceutical for myocardial perfusion scintigraphy (MPS. It is also a tumor seeking agent. Here, we present a case of 51 year old male who underwent Tc-99m MIBI myocardial perfusion study due to permanent chest pain after coronary angiography. Abnormal MIBI uptake in the thorax was detected in the raw images. This single finding led to further investigation and thoracotomy proved that the lesion was benign thymoma. Thymomas are often asymptomatic or have a non-specific presentation. They are often detected coincidentally on images performed for any other reasons. We wanted to emphasize that during of MPS, the raw data should always be reviewed as occasionally valuable additional information on noncardiac pathology could be recognized by extracardiac uptake, as in this case. (MIRT 2011;20:73-75

  2. Incidental detection of a benign thymoma on Tc-99m MIBI myocardial perfusion study.

    Science.gov (United States)

    Aydın, Funda; Sürer Budak, Evrim; Dertsiz, Levent; Belgi, Aytül; Arslan, Gökhan; Güngör, Fırat

    2011-08-01

    Technetium-99m methoxy-isobutylisonitrile (Tc-99m MIBI) is a routinely used radiopharmaceutical for myocardial perfusion scintigraphy (MPS). It is also a tumor seeking agent. Here, we present a case of 51 year old male who underwent Tc-99m MIBI myocardial perfusion study due to permanent chest pain after coronary angiography. Abnormal MIBI uptake in the thorax was detected in the raw images. This single finding led to further investigation and thoracotomy proved that the lesion was benign thymoma. Thymomas are often asymptomatic or have a non-specific presentation. They are often detected coincidentally on images performed for any other reasons. We wanted to emphasize that during of MPS, the raw data should always be reviewed as occasionally valuable additional information on noncardiac pathology could be recognized by extracardiac uptake, as in this case. None declared.

  3. 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

  4. Effect of improving spatial or temporal resolution on image quality and quantitative perfusion assessment with k-t SENSE acceleration in first-pass CMR myocardial perfusion imaging.

    Science.gov (United States)

    Maredia, Neil; Radjenovic, Aleksandra; Kozerke, Sebastian; Larghat, Abdulghani; Greenwood, John P; Plein, Sven

    2010-12-01

    k-t Sensitivity-encoded (k-t SENSE) acceleration has been used to improve spatial resolution, temporal resolution, and slice coverage in first-pass cardiac magnetic resonance myocardial perfusion imaging. This study compares the effect of investing the speed-up afforded by k-t SENSE acceleration in spatial or temporal resolution. Ten healthy volunteers underwent adenosine stress myocardial perfusion imaging using four saturation-recovery gradient echo perfusion sequences: a reference sequence accelerated by sensitivity encoding (SENSE), and three k-t SENSE-accelerated sequences with higher spatial resolution ("k-t High"), shorter acquisition window ("k-t Fast"), or a shared increase in both parameters ("k-t Hybrid") relative to the reference. Dark-rim artifacts and image quality were analyzed. Semiquantitative myocardial perfusion reserve index (MPRI) and Fermi-derived quantitative MPR were also calculated. The k-t Hybrid sequence produced highest image quality scores at rest (P = 0.015). Rim artifact thickness and extent were lowest using k-t High and k-t Hybrid sequences (P spatial resolution by k-t SENSE acceleration produces the greatest reduction in dark rim artifact. There is good agreement between k-t SENSE and standard acquisition methods for semiquantitative and fully quantitative myocardial perfusion analysis. Copyright © 2010 Wiley-Liss, Inc.

  5. Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

    Directory of Open Access Journals (Sweden)

    Esdras Marques Lins

    2013-12-01

    Full Text Available BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours. RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6% of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

  6. Coronary-to-pulmonary artery fistula in adults: Evaluation with thallium-201 myocardial perfusion SPECT.

    Directory of Open Access Journals (Sweden)

    Seul Ki Lee

    Full Text Available With the increasing use of multi-detector CT, the number of detected cases with coronary-to-pulmonary artery fistula (CPAF has increased. Several previous studies reported severe cases of angina, but no appropriate tests to evaluate myocardial perfusion for patients with CPAF have been established. We evaluated the hemodynamic characteristics of CPAF using thallium-201 (Tl-201 single photon emission computed tomography (SPECT.Tl-201 SPECT was performed in 17 patients with CPAF, but without evidence of coronary artery disease on coronary computed tomography angiography (CCTA (age, 58.5±13.3 years; 8 men. Quantitative analysis of scintigraphic data was performed. Additionally, perfusion abnormalities were compared with CCTA findings. Medical records were obtained to define clinical data, diagnostic findings, symptoms, management, follow-up data, and major adverse cardiac events (MACE.Six patients (35.2% showed perfusion abnormalities on SPECT studies and could be classified as follows: 3 patients, no reversible ischemia (3/17, 17.6%; 1 patient, mild ischemia (1/17, 5.8%; and 2 patients, moderate ischemia (2/17, 11.7%. During the follow-up, ten patients (58.8% improved under medical management and 5 patients (29.4% underwent surgical ligation for CPAF with symptomatic improvement in 4 patients. Seven patients performed follow-up myocardial perfusion SPECT, and symptomatic improvement correlated well with scintigraphic perfusion improvement in 6 patients No MACE was observed.Tl-201 myocardial perfusion SPECT might be useful for determining the hemodynamic status and for risk stratification in patients with CPAF.

  7. 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

  8. Myocardial perfusion abnormalities in asymptomatic patients with systemic lupus erythematosus

    Energy Technology Data Exchange (ETDEWEB)

    Hosenpud, J.D.; Montanaro, A.; Hart, M.V.; Haines, J.E.; Specht, H.D.; Bennett, R.M.; Kloster, F.E.

    1984-08-01

    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.

  9. 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.

  10. The clinical value of planar thallium-201 myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Niemeyer, M.G.

    1989-01-01

    The clinical value of planar thalium-201 myocardial perfusion scintigraphy was examined, using visual and quantitative analysis, for the detection of presence, localization and extent of coronary disease, using coronary arteriography as gold standard. The indremental diagnostic yield of different noninvasive tests for the diagnosis and the severity of coronary artery disease was quantified by using multivariate discriminant analysis. (author). 284 refs.; 14 figs.; 37 tabs

  11. 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

  12. Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson

    Energy Technology Data Exchange (ETDEWEB)

    Noel, Cory V. [Baylor College of Medicine, Department of Pediatric Cardiology, Houston, TX (United States); Texas Children' s Hospital, Department of Pediatric Cardiology, Houston, TX (United States); Krishnamurthy, Ramkumar; Krishnamurthy, Rajesh [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Moffett, Brady [Texas Children' s Hospital, Department of Pharmacology, Houston, TX (United States)

    2017-03-15

    Dipyridamole and adenosine are traditional pharmacological stressors for myocardial perfusion. Regadenoson, a selective adenosine A2A agonist, has a lower side effect profile with lower incidence of bronchospasm and bradycardia. There is a growing need for myocardial perfusion assessment within pediatrics. There is no report on the utility of regadenoson as a stress agent in children. To observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric patients weighing more than 40 kg who have congenital heart disease and pediatric acquired heart disease. We reviewed our initial experience with regadenoson stress cardiac MR in 31 pediatric patients 15.8 ± 1.7 years (range 12-22 years) with congenital heart disease and acquired heart disease. Mean patient weight was 60 ± 15 kg (range of 40-93 kg). All patients underwent cardiac MR because of concern for ischemia. The cohort included a heterogeneous group of patients at a pediatric institution with potential risk for ischemia. Subjects' heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of 400 mcg of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images. One child was unable to complete the stress perfusion portion of the examination, but did complete the remaining portion of the CMR. Resting heart rate was 72 ± 14 beats per minute (bpm) and rose to peak of 124 ± 17 bpm (95 ± 50% increase, P < 0.005) with regadenoson. Image quality was considered good or diagnostic in all cases. Three patients had irreversible perfusion defects. Four patients had reversible perfusion defects. Nine of the patients underwent cardiac catheterization with angiography and the findings showed excellent agreement. Regadenoson might be a safe and

  13. Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson

    International Nuclear Information System (INIS)

    Noel, Cory V.; Krishnamurthy, Ramkumar; Krishnamurthy, Rajesh; Moffett, Brady

    2017-01-01

    Dipyridamole and adenosine are traditional pharmacological stressors for myocardial perfusion. Regadenoson, a selective adenosine A2A agonist, has a lower side effect profile with lower incidence of bronchospasm and bradycardia. There is a growing need for myocardial perfusion assessment within pediatrics. There is no report on the utility of regadenoson as a stress agent in children. To observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric patients weighing more than 40 kg who have congenital heart disease and pediatric acquired heart disease. We reviewed our initial experience with regadenoson stress cardiac MR in 31 pediatric patients 15.8 ± 1.7 years (range 12-22 years) with congenital heart disease and acquired heart disease. Mean patient weight was 60 ± 15 kg (range of 40-93 kg). All patients underwent cardiac MR because of concern for ischemia. The cohort included a heterogeneous group of patients at a pediatric institution with potential risk for ischemia. Subjects' heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of 400 mcg of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images. One child was unable to complete the stress perfusion portion of the examination, but did complete the remaining portion of the CMR. Resting heart rate was 72 ± 14 beats per minute (bpm) and rose to peak of 124 ± 17 bpm (95 ± 50% increase, P < 0.005) with regadenoson. Image quality was considered good or diagnostic in all cases. Three patients had irreversible perfusion defects. Four patients had reversible perfusion defects. Nine of the patients underwent cardiac catheterization with angiography and the findings showed excellent agreement. Regadenoson might be a safe and

  14. 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)

  15. A direct comparison of the sensitivity of CT and MR cardiac perfusion using a myocardial perfusion phantom.

    OpenAIRE

    Otton, James; Morton, Geraint; Schuster, Andreas; Bigalke, Boris; Marano, Riccardo; Olivotti, Luca; Nagel, Eike; Chiribiri, Amedeo

    2013-01-01

    BACKGROUND: Direct comparison of CT and magnetic resonance (MR) perfusion techniques has been limited and in vivo assessment is affected by physiological variability, timing of image acquisition, and parameter selection. OBJECTIVE: We precisely compared high-resolution k-t SENSE MR cardiac perfusion at 3 T with single-phase CT perfusion (CTP) under identical imaging conditions. METHODS: We used a customized MR imaging and CT compatible dynamic myocardial perfusion phantom to represe...

  16. Development of an Ex Vivo, Beating Heart Model for CT Myocardial Perfusion

    NARCIS (Netherlands)

    Pelgrim, Gert Jan; Das, Marco; Haberland, Ulrike; Slump, Cees; Handayani, Astri; van Tuijl, Sjoerd; Stijnen, Marco; Klotz, Ernst; Oudkerk, Matthijs; Wildberger, Joachim E.; Vliegenthart, Rozemarijn

    2015-01-01

    Objective. To test the feasibility of a CT-compatible, ex vivo, perfused porcine heart model for myocardial perfusion CT imaging. Methods. One porcine heart was perfused according to Langendorff. Dynamic perfusion scanning was performed with a second-generation dual source CT scanner. Circulatory

  17. Comparison of Adenosine Stress Myocardial Perfusion Scintigraphy and Oral Dipyridamole Stress Myocardial Perfusion Scintigraphy for Hemodynamic Changes and Adverse Effects

    Directory of Open Access Journals (Sweden)

    Ahmet Yanarateş

    2016-08-01

    Full Text Available Objective: Similar effects can be achieved during stress myocardial perfusion scintigraphy (MPS using pharmacological agents to create cardiac stress for patients who are unable to exercise. In our study, we aimed to show the hemodynamic changes and adverse effects caused by adenosine and to compare the results with dipyridamole stress MPS. Materials and Methods: Sixty-five patients with suspected coronary artery disease were included in our study. Fifty patients in whom stress MPS with intravenous adenosine was performed (group A and 15 patients who underwent oral dipyridamole stress MPS (group B were retrospectively evaluated. During the test, blood pressure measurements and electrocardiographic follow-up were performed in all patients and side effects were noted. Results: At least one side effect occurred in 68% of the group A and in 46% of the group B patients. There was no statistically significant difference between the two groups in terms of side effects that occurred during the pharmacological stress. During the maximum stress, there was an increase of 15.80±11.60 beats/min in heart beats in group A and 5.53±4.54 beats/min in group B. There was a statistically significant difference between the groups in terms of heart rate increase per minute. When we compared reduction in systolic blood pressure and diastolic blood pressure, there was no statistically significant difference between the two groups. Conclusion: Although side effects are more often seen with adenosine, rapid decline in complaints was observed when adenosine infusion was terminated and there was no need for patient follow-up due to short half life of adenosine. We believe that these favourable advantages will increase the use of adenosine in clinical practice.

  18. Study on the un-conformable results between myocardial perfusion SPECT and coronary angiography

    International Nuclear Information System (INIS)

    Yao Zhiming; Liu Xiujie; Yu Quanjun

    1997-01-01

    PURPOSE: To analyze the un-conformable results between myocardial perfusion SPECT and coronary angiography (CAG). METHODS: The data of 408 in-patients who underwent myocardial perfusion SPECT and CAG were analyzed. RESULTS: Among them, twenty five patients, 22 males and 3 females (average age 51.7 +- 10.5 years old) had un-conformable results of SPECT and CAG. Group A included 15 cases with myocardial defect on SPECT and normal coronary artery or coronary stenosis<50% on CAG, which were 3 old myocardial infarction, 7 X syndrome, 1 30%∼40% coronary stenosis, 1 essential hypertension, 1 dilated cardiomyopathy, 1 cardiac tumor and 1 sleep dyspnea syndrome. Group B included 10 cases with normal SPECT and coronary stenosis≥50% on CAG. There were 5 coronary artery stenosis between 50%∼60%, 5 right coronary artery stenosis, 5 terminal branches stenosis, 2 collateral circulation, and 1 insufficient exercise involved in 10 patients. CONCLUSION: It can not be considered that all abnormal SPECT without significant coronary stenosis is false positive; while all normal SPECT with significant coronary stenosis is truly negative, probably due to terminal branch stenosis, coronary stenosis between 50%∼60% on right coronary artery stenosis

  19. 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

  20. Creation and characterization of normal myocardial perfusion imaging databases using the IQ·SPECT system.

    Science.gov (United States)

    Okuda, Koichi; Nakajima, Kenichi; Matsuo, Shinro; Kondo, Chisato; Sarai, Masayoshi; Horiguchi, Yoriko; Konishi, Takahiro; Onoguchi, Masahisa; Shimizu, Takeshi; Kinuya, Seigo

    2017-01-03

    Image acquisition by short-time single-photon emission-computed tomography (SPECT) has been made feasible by IQ·SPECT. The aim of this study was to generate normal databases (NDBs) of thallium-201 ( 201 Tl) myocardial perfusion imaging for IQ·SPECT, and characterize myocardial perfusion distribution. We retrospectively enrolled 159 patients with a low likelihood of cardiac diseases from four hospitals in Japan. All patients underwent short-time 201 Tl myocardial perfusion IQ·SPECT with or without attenuation and scatter correction (ACSC) in either supine or prone position. The mean myocardial counts were calculated using 17-segment polar maps. Three NDBs were derived from supine and prone images as well as supine images with ACSC. Differences between the supine and prone positions were observed in the uncorrected sex-segregated NDBs in the mid-inferolateral counts (p ≤ 0.016 for males and p ≤ 0.002 for females). Differences between IQ·SPECT and conventional SPECT were also observed in the mid-anterior, inferolateral, and apical lateral counts (p ≤ 0.009 for males and p ≤ 0.003 for females). Apical low counts attributed to myocardial thinning were observed in the apical anterior and apex segments in the supine IQ·SPECT NDB with ACSC. There were significant differences between uncorrected supine and prone NDBs, between uncorrected supine NDB and supine NDB with ACSC, and between uncorrected supine NDB and conventional SPECT NDB. Understanding the pattern of normal distribution in IQ-SPECT short-time acquisitions with and without ACSC will be helpful for interpretation of imaging findings in patients with coronary artery disease (CAD) or low likelihood of CAD and the NDBs will aid in quantitative analysis.

  1. Delayed heart rate recovery after treadmill test: comparison with clinical, exercise and myocardial perfusion parameters

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-07-01

    Imbalance autonomic nervous tone are fundamental risk factors for cardiac death. Recent studies reported abnormal heart rate recovery(HRR) after the treadmill exercise test is a powerful predictor of significant excess mortality. To evaluate HRR as an index of coronary artery disease(CAD). we have compared perfusion defect. 252 patients(147 men) underwent exercise myocardial perfusion imaging were included. The value for HRR was defined as the decrease in heart rate from peak exercise to 1 minute after termination of exercise. Myocardial perfusion imaging was acquired at 1 hour after 740MBq {sup 99m}Tc-MIBI injection using dual head gamma camera(Vertex Plus, ADAC, USA). Summed stress score(SSS) and stress ejection fraction(sEF) were obtained from AutoQUANT program. 23 beats/min was defined as the lowest normal value for HRR. Patients were divided two groups: abnormal HRR(abHRR) and normal HRR(nHRR). We compared clinical(age, sex, pervious CAD history, DM, HTN), exercise test(exercise capacity, duration) and myocardial perfusion parameters(SSS, sEF) between two groups. Mean value of HRR was 50.814.2 beat/min. There were 25 patients(9.9%) with an abHRR. Patient with abHRR were generally in older age(61.59.2 vs 54.48.9yr), were more likely men(72 vs 56.8%), had a higher frequency of DM(16.7 vs 9%), HTN(52 vs 27.6%) and CAD history (28 vs 7%) compared to nHRR. In exercise and myocardial perfusion parameters, abHRR were showed more positive result(60 vs 30%), had short exercise duration(7.0{+-}3.0 vs 9.1{+-}2.7min) and small exercise capacity(7.2{+-}2.3 vs 10.0{+-}2.7Mets) compared to nHRR, had a higher frequency of CAD(76 vs 41.4%) and multivessel disease(25 vs 6.5%), had larger SSS(8.1{+-}8.8 vs 3.7{+-}6.3) and had smaller sEF(47.7{+-}14.3 vs 57.9{+-}10.3%) compared to nHRR. AbHRR was frequently found in patients with CAD, large myocardial perfusion defect and decreased LV function. It seems that the HRR may be considered a reliable index of the severity of CAD.

  2. Myocardial perfusion assessment with contrast echocardiography

    Science.gov (United States)

    Desco, Manuel; Ledesma-Carbayo, Maria J.; Santos, Andres; Garcia-Fernandez, Miguel A.; Marcos-Alberca, Pedro; Malpica, Norberto; Antoranz, Jose C.; Garcia-Barreno, Pedro

    2001-05-01

    Assessment of intramyocardial perfusion by contrast echocardiography is a promising new technique that allows to obtain quantitative parameters for the assessment of ischemic disease. In this work, a new methodology and a software prototype developed for this task are presented. It has been validated with Coherent Contrast Imaging (CCI) images acquired with an Acuson Sequoia scanner. Contrast (Optison microbubbles) is injected continuously during the scan. 150 images are acquired using low mechanical index U/S pulses. A burst of high mechanical index pulses is used to destroy bubbles, thus allowing to detect the contrast wash-in. The stud is performed in two conditions: rest and pharmacologically induced stress. The software developed allows to visualized the study (cine) and to select several ROIs within the heart wall. The position of these ROIs along the cardiac cycle is automatically corrected on the basis of the gradient field, and they can also be manually corrected in case the automatic procedure fails. Time curves are analyzed according to a parametric model that incorporates both contrast inflow rate and cyclic variations. Preliminary clinical results on 80 patients have allowed us to identify normal and pathological patterns and to establish the correlation of quantitative parameters with the real diagnosis.

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

    Science.gov (United States)

    Kamínek, M; Myslivecek, M; Husák, V; Koranda, P; Skvarilová, M; Ostransky, J; Lang, O

    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 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).

  4. 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

  5. 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.

  6. 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)

  7. 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

  8. Detection of extracardiac disease during Tl-201 myocardial perfusion study

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan H.; Lee, Myoung Hoon; Yoon, Seok Nam; Hwang, Kyung Hoon [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

    2001-07-01

    It is important to observe extracardiac disease processes (ECD) during cardiac perfusion imaging for valuable information can be obtained at no extracost to patients. The aim of the study is to find out the frequency of ECD during Tl-201 stress myocardial perfusion imaging (TSMPI). Retrospective evaluation of 552 TSMPI was done. There were 229 males and 223 females reffered for evaluation of possible ischemic heart disease. Their ages range from 20 to 80 with mean age of 58.8 years. Three mCi (111 MBq) of 201 TlCl is used for adenosine or treadmil exercise testing and myocardial SPECT is performed utilizing low energy high resolution collimators and a triple-head camera ( MultiSPECT, Siemens medical systems, Inc., Hoffman Estate, III., USA). In addition to routine cardiac Tl-201 SPECT acquisition, included in the protocol is 1 min, anterior planar views in 128 128 matrix after stress and rest SPECT studies for evaluation of lung uptake and chamber size. Utilizing these views ECD is assessed. Five patients had focal increased activity suggesting tumor and 3 of 5 cases were confirmed as malignancy. The malignancies were thyroid cancer (Hurthle cell), lung cancer, and breast cancer. Benign lesions were autonomous thyroid nodule and pheochromocytoma. Other ECDs include pericardial effusion, pleural effusion, and paralyzed hemidiapharm.. Extracardiac disease processes such as benign or malignancy are easily detected during Tl-201 myocardial perfusion imaging using our acquisition protocol at no cost to the patients. This information could be life saving in some patients for early detection of clinically unsuspected malignancy.

  9. 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

  10. Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis.

    Science.gov (United States)

    Coenen, Adriaan; Lubbers, Marisa M; Kurata, Akira; Kono, Atsushi; Dedic, Admir; Chelu, Raluca G; Dijkshoorn, Marcel L; Rossi, Alexia; van Geuns, Robert-Jan M; Nieman, Koen

    2017-06-01

    To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR). Subjects with suspected or known coronary artery disease were prospectively included and underwent a CT-MPI examination. From the CT-MPI time-point data absolute myocardial blood flow (MBF) values were temporally resolved using a hybrid deconvolution model. An absolute MBF value was measured in the suspected perfusion defect. TPR was defined as the ratio between the subendocardial and subepicardial MBF. TPR and MBF results were compared with invasive FFR using a threshold of 0.80. Forty-three patients and 94 territories were analysed. The area under the receiver operator curve was larger for MBF (0.78) compared with TPR (0.65, P = 0.026). No significant differences were found in diagnostic classification between MBF and TPR with a territory-based accuracy of 77 % (67-86 %) for MBF compared with 70 % (60-81 %) for TPR. Combined MBF and TPR classification did not improve the diagnostic classification. Dynamic CT-MPI-based transmural perfusion ratio predicts haemodynamically significant coronary artery disease. However, diagnostic performance of dynamic CT-MPI-derived TPR is inferior to quantified MBF and has limited incremental value. • The transmural perfusion ratio from dynamic CT-MPI predicts functional obstructive coronary artery disease • Performance of the transmural perfusion ratio is inferior to quantified myocardial blood flow • The incremental value of the transmural perfusion ratio is limited.

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

    International Nuclear Information System (INIS)

    Siennicki, J.; Kovacevic-Kusmierek, K.; Bienkiewicz, M.; Plachcinska, A.; Kusmierek, J.; Chizynski, K.

    2010-01-01

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

  12. 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)

  13. Radiation dose to radiosensitive organs in PET/CT myocardial perfusion examination using versatile optical fibre

    Science.gov (United States)

    Salasiah, M.; Nordin, A. J.; Fathinul Fikri, A. S.; Hishar, H.; Tamchek, N.; Taiman, K.; Ahmad Bazli, A. K.; Abdul-Rashid, H. A.; Mahdiraji, G. A.; Mizanur, R.; Noor, Noramaliza M.

    2013-05-01

    Cardiac positron emission tomography (PET) provides a precise method in order to diagnose obstructive coronary artery disease (CAD), compared to single photon emission tomography (SPECT). PET is suitable for obese and patients who underwent pharmacologic stress procedures. It has the ability to evaluate multivessel coronary artery disease by recording changes in left ventricular function from rest to peak stress and quantifying myocardial perfusion (in mL/min/g of tissue). However, the radiation dose to the radiosensitive organs has become crucial issues in the Positron Emission Tomography/Computed Tomography(PET/CT) scanning procedure. The objective of this study was to estimate radiation dose to radiosensitive organs of patients who underwent PET/CT myocardial perfusion examination at Centre for Diagnostic Nuclear Imaging, Universiti Putra Malaysia in one month period using versatile optical fibres (Ge-B-doped Flat Fibre) and LiF (TLD-100 chips). All stress and rest paired myocardial perfusion PET/CT scans will be performed with the use of Rubidium-82 (82Rb). The optic fibres were loaded into plastic capsules and attached to patient's eyes, thyroid and breasts prior to the infusion of 82Rb, to accommodate the ten cases for the rest and stress PET scans. The results were compared with established thermoluminescence material, TLD-100 chips. The result shows that radiation dose given by TLD-100 and Germanium-Boron-doped Flat Fiber (Ge-B-doped Flat Fiber) for these five organs were comparable to each other where the p>0.05. For CT scans,thyroid received the highest dose compared to other organs. Meanwhile, for PET scans, breasts received the highest dose.

  14. 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

  15. Effects of permanent dual chamber pacing on myocardial perfusion in symptomatic hypertrophic cardiomyopathy

    NARCIS (Netherlands)

    Posma, JL; Blanksma, PK; VanderWall, EE; Vaalburg, W; Crijns, HJGM; Lie, KI

    1996-01-01

    Objective-Angina and the presence of myocardial ischaemia are common in hypertrophic cardiomyopathy. Dual chamber pacing results in clinical improvement in these patients. This study evaluates the effects of permanent dual chamber pacing on absolute regional myocardial perfusion and perfusion

  16. Comparison of non-attenuation corrected and attenuation corrected myocardial perfusion SPE

    Directory of Open Access Journals (Sweden)

    Hasan Raza

    2016-09-01

    Conclusion: This study demonstrates that CT based attenuation corrected Tc-99mm sestamibi SPECT myocardial perfusion imaging significantly improved the specificity of the RCA territory compared with non-attenuation corrected Tc-99mm sestamibi SPECT myocardial perfusion imaging in both genders irrespective of BMI.

  17. Myocardial perfusion imaging in patients with a recent, normal exercise test

    DEFF Research Database (Denmark)

    Bovin, Ann; Klausen, Ib C; Petersen, Lars J

    2013-01-01

    To investigate the added value of myocardial perfusion scintigraphy imaging (MPI) in consecutive patients with suspected coronary artery disease (CAD) and a recent, normal exercise electrocardiography (ECG).......To investigate the added value of myocardial perfusion scintigraphy imaging (MPI) in consecutive patients with suspected coronary artery disease (CAD) and a recent, normal exercise electrocardiography (ECG)....

  18. Update on myocardial perfusion imaging: role of regadenoson

    Directory of Open Access Journals (Sweden)

    Robert C Hendel

    2009-02-01

    Full Text Available Robert C HendelMidwest Heart Specialists, Central DuPage Hospital, Winfield, Illinois, USAAbstract: Pharmacologic stress myocardial perfusion imaging (MPI is a noninvasive method for the evaluation of coronary artery disease in patients unable to exercise adequately. Commonly used pharmacologic stress agents (adenosine, dipyridamole, and dobutamine have a high incidence of bothersome and potentially serious side-effects, several contraindications to testing, and require continuous infusion with weight-adjusted doses. Newer agents are, therefore, needed. Selective activation of A2A adenosine receptors on the coronary vasculature should provide coronary vasodilation for MPI with fewer or less severe side-effects associated with nonspecific agonists, such as adenosine and dipyridamole. Regadenoson is the first selective A2A receptor agonist to be approved as a pharmacologic stress agent for use with radionuclide MPI. Regadenoson is administered at a standard, fixed dose of 400 μg from a prefilled syringe or single-use vial by intravenous injection over 10 seconds. In clinical trials, regadenoson provided good quality images yielding accurate diagnostic information, and was safe and well tolerated. No infusion pump is required and the stress protocol is brief. Further studies are now required to evaluate regadenoson as a stress agent in combination with low-level exercise, with prior caffeine intake, and in patients with asthma or chronic obstructive pulmonary disease.Keywords: myocardial perfusion imaging, pharmacologic stress, A2A receptor agonist, regadenoson, ischemic heart disease, SPECT, diagnosis

  19. 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)

  20. 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...

  1. Validation of myocardial perfusion quantification by dynamic CT in an ex-vivo porcine heart model

    NARCIS (Netherlands)

    Pelgrim, Gert Jan; Das, Marco; van Tuijl, Sjoerd; van Assen, Marly; Prinzen, Frits W; Stijnen, Marco; Oudkerk, Matthijs; Wildberger, Joachim E; Vliegenthart, Rozemarijn

    2017-01-01

    To test the accuracy of quantification of myocardial perfusion imaging (MPI) using computed tomography (CT) in ex-vivo porcine models. Five isolated porcine hearts were perfused according to Langendorff. Hearts were perfused using retrograde flow through the aorta and blood flow, blood pressure and

  2. 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)

  3. Myocardial perfusion assessment at rest and after dipyridamole: MR signal intensity characteristics of reversible and persistent hypoperfusion

    International Nuclear Information System (INIS)

    Wintersperger, B.J.; Penzkofer, H.V.; Huber, A.; Meininger, M.; Scheidler, J.; Reiser, M.; Knez, A.; Haberl, R.; Kerner, M.; Knesewitsch, P.

    2000-01-01

    Methods: Sixteen patients with CAD underwent MR myocardial perfusion assessment at rest and after dipyridamole-induced hyperemia. Qualitative parameters (SI increase, SI upslope) of the SI time-curves were evaluated and characteristics of normal, reversible and persistent hypoperfused myocardium as assessed by 99m TC-SestaMIBI SPECT were compared. Results: Compared with the rest values, normal myocardium showed a significant increase of the SI upslope during hyperemia (P [de

  4. 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)

  5. Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson.

    Science.gov (United States)

    Noel, Cory V; Krishnamurthy, Ramkumar; Moffett, Brady; Krishnamurthy, Rajesh

    2017-03-01

    Dipyridamole and adenosine are traditional pharmacological stressors for myocardial perfusion. Regadenoson, a selective adenosine A2A agonist, has a lower side effect profile with lower incidence of bronchospasm and bradycardia. There is a growing need for myocardial perfusion assessment within pediatrics. There is no report on the utility of regadenoson as a stress agent in children. To observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric patients weighing more than 40 kg who have congenital heart disease and pediatric acquired heart disease. We reviewed our initial experience with regadenoson stress cardiac MR in 31 pediatric patients 15.8 ± 1.7 years (range 12-22 years) with congenital heart disease and acquired heart disease. Mean patient weight was 60 ± 15 kg (range of 40-93 kg). All patients underwent cardiac MR because of concern for ischemia. The cohort included a heterogeneous group of patients at a pediatric institution with potential risk for ischemia. Subjects' heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of 400 mcg of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images. One child was unable to complete the stress perfusion portion of the examination, but did complete the remaining portion of the CMR. Resting heart rate was 72 ± 14 beats per minute (bpm) and rose to peak of 124 ± 17 bpm (95 ± 50% increase, P stress agent for use in cardiac MR in older pediatric patients with congenital heart disease and acquired heart disease. The ease of use as a bolus and the advantage of a prolonged hyperemia make its use appealing in pediatrics. In a limited number of cases, regadenoson stress perfusion showed excellent

  6. 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)

  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. 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

  9. Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease

    NARCIS (Netherlands)

    Wichmann, Julian L.; Meinel, Felix G.; Schoepf, U. Joseph; Lo, Gladys G.; Choe, Yeon Hyeon; Wang, Yining; Vliegenthart, Rozemarijn; Varga-Szemes, Akos; Muscogiuri, Giuseppe; Cannao, Paola M.; De Cecco, Carlo N.

    OBJECTIVE. The purpose of this study was to evaluate differences in the diagnostic accuracy of absolute and relative territorial myocardial blood flow (MBF) derived from stress dynamic CT myocardial perfusion imaging (MPI) for the detection of significant coronary artery stenosis. MATERIALS AND

  10. Relation of global and regional left ventricular function to tomographic thallium-201 myocardial perfusion in patients with prior myocardial infarction

    International Nuclear Information System (INIS)

    Stratton, J.R.; Speck, S.M.; Caldwell, J.H.; Martin, G.V.; Cerqueira, M.; Maynard, C.; Davis, K.B.; Kennedy, J.W.; Ritchie, J.L.

    1988-01-01

    To determine the relation between regional myocardial perfusion and regional wall motion in humans, tomographic thallium-201 imaging and two-dimensional echocardiography at rest were performed on the same day in 83 patients 4 to 12 weeks after myocardial infarction. Myocardial perfusion and wall motion were assessed independently in five left ventricular regions (total 415 regions). Regional myocardial perfusion was quantitated as a percent of the region infarcted (range 0 to 100%) using a previously validated method. Wall motion was graded on a four point scale as 1 = normal (n = 266 regions), 2 = hypokinesia (n = 64), 3 = akinesia (n = 70), 4 = dyskinesia (n = 13) or not evaluable (n = 2). Regional wall motion correlated directly with the severity of the perfusion deficit (r = 0.68, p less than 0.0001). Among normally contracting regions, the mean perfusion defect score was only 2 +/- 4. Increasingly severe wall motion abnormalities were associated with larger perfusion defect scores (hypokinesia = 6 +/- 5, akinesia = 11 +/- 7 and dyskinesia = 18 +/- 5, all p less than 0.01 versus normal. Among regions with normal wall motion, only 3% had a perfusion defect score greater than or equal to 10. Conversely, among 68 regions with a large (greater than or equal to 10) perfusion defect, only 13% had normal motion whereas 87% had abnormal wall motion. The relation between perfusion and wall motion noted for the entire cohort was also present in subgroups of patients with anterior or inferior infarction. In patients with prior myocardial infarction, the severity of the tomographic thallium perfusion defect correlates directly with echocardiographically defined wall motion abnormalities, both globally and regionally

  11. Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Coenen, Adriaan; Lubbers, Marisa M.; Dedic, Admir; Chelu, Raluca G.; Geuns, Robert-Jan M. van; Nieman, Koen [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Cardiology, Rotterdam (Netherlands); Kurata, Akira; Kono, Atsushi; Dijkshoorn, Marcel L. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Rossi, Alexia [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Barts Health NHS Trust, NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London and Department of Cardiology, London (United Kingdom)

    2017-06-15

    To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR). Subjects with suspected or known coronary artery disease were prospectively included and underwent a CT-MPI examination. From the CT-MPI time-point data absolute myocardial blood flow (MBF) values were temporally resolved using a hybrid deconvolution model. An absolute MBF value was measured in the suspected perfusion defect. TPR was defined as the ratio between the subendocardial and subepicardial MBF. TPR and MBF results were compared with invasive FFR using a threshold of 0.80. Forty-three patients and 94 territories were analysed. The area under the receiver operator curve was larger for MBF (0.78) compared with TPR (0.65, P = 0.026). No significant differences were found in diagnostic classification between MBF and TPR with a territory-based accuracy of 77 % (67-86 %) for MBF compared with 70 % (60-81 %) for TPR. Combined MBF and TPR classification did not improve the diagnostic classification. Dynamic CT-MPI-based transmural perfusion ratio predicts haemodynamically significant coronary artery disease. However, diagnostic performance of dynamic CT-MPI-derived TPR is inferior to quantified MBF and has limited incremental value. (orig.)

  12. Diagnostic value of transmural perfusion ratio derived from dynamic CT-based myocardial perfusion imaging for the detection of haemodynamically relevant coronary artery stenosis

    NARCIS (Netherlands)

    A. Coenen (Adriaan); M.M. Lubbers (Marisa); A. Kurata (Akira); A.K. Kono (Atsushi K.); A. Dedic (Admir); R.G. Chelu (Raluca Gabriela); M.L. Dijkshoorn (Marcel); A.G. Rossi (Adriano); R.J.M. van Geuns (Robert Jan); K. Nieman (Koen)

    2017-01-01

    textabstractObjectives: To investigate the additional value of transmural perfusion ratio (TPR) in dynamic CT myocardial perfusion imaging for detection of haemodynamically significant coronary artery disease compared with fractional flow reserve (FFR). Methods: Subjects with suspected or known

  13. Reclassification of cardiovascular risk by myocardial perfusion imaging in diabetic patients with abnormal resting electrocardiogram.

    Science.gov (United States)

    Petretta, M; Acampa, W; Evangelista, L; Daniele, S; Zampella, E; Assante, R; Nappi, C; Cantoni, V; Fiumara, G; Cuocolo, A

    2014-06-01

    Despite an extensive use of stress myocardial perfusion single-photon emission computed tomography (MPS), no study addressed the role of perfusion imaging in diabetic patients with abnormal resting electrocardiogram (ECG). We compared analytical approaches to assess the added value of stress MPS variables in estimating coronary heart disease outcomes in diabetic patients with abnormal resting ECG. A total of 416 patients with diabetes and abnormal resting ECG who underwent stress MPS were prospectively followed up after the index study. The end point was the occurrence of a major cardiac event, including cardiac death and nonfatal myocardial infarction. At the end of follow-up (median 58 months), 42 patients experienced events. MPS data increased the predictive value of a model including traditional cardiovascular risk factors and left ventricular (LV) ejection fraction (likelihood ratio χ² from 17.54 to 24.15, p patients were reclassified to a lower risk category, with a 5-year event rate of 3.5%, and 40 patients were reclassified to a higher risk category, with a 5-year event rate of 20%. The addition of MPS findings to a model based on traditional cardiovascular risk factors and LV ejection fraction improves risk classification for incident cardiac events in diabetic patients with abnormal resting ECG. Copyright © 2013 Elsevier B.V. All rights reserved.

  14. Myocardial perfusion scintigraphy fi ndings in patients with mild coronary atherosclerotic lesions on coronary angiography

    Directory of Open Access Journals (Sweden)

    Zeki Dostbil

    2010-09-01

    Full Text Available Objectives: Myocardial perfusion scintigraphy (MPS iswidely used in functional assessment of myocardial per-fusion. But, some study results are in contradiction withseverity of coronary artery disease detected by coronaryangiography (CA. It is frequently encountered case thatCA is completely normal whereas MPS describes isch-emia. In this study, we aimed to investigate whether mildatherosclerotic lesions cause ischemia.Materials and methods: MPS with 99mTc-MIBI was per-formed in 52 patients who applied to cardiology clinics forhistory of chest pain and underwent diagnostic CA within3 months.Results: In 22 of 52 patients with mild atherosclerotic le-sions, ischemia in various degrees was detected on MPS.In statistical analysis, any signifi cant relationship was notfound between ischemia and gender, hypertension, DM,dyslipidemia, smoking, mitral valve insuffi ciency, left ven-tricular hypertrophy, exercise testing result and affectedcoronary artery.Conclusion: Our study fi ndings have shown that mild ath-erosclerotic lesions even at very early stage may causemyocardial ischemia

  15. Relationships between left ventricular sympathetic innervation and diastolic dysfunction: the role of myocardial innervation/perfusion mismatch.

    Science.gov (United States)

    Gimelli, Alessia; Liga, Riccardo; Avogliero, Francesco; Coceani, Michele; Marzullo, Paolo

    2016-12-27

    A possible relationship between cardiac sympathetic denervation and left ventricular (LV) diastolic dysfunction has been suggested. However, an evaluation of the interactions between myocardial adrenergic tone and LV perfusion and diastolic function is lacking. Seventy-two patients underwent 99m Tc-tetrofosmin/ 123 I-metaiodobenzylguanidine ( 123 I-MIBG) cardiac Cadmium-Zinc-Telluride (CZT) imaging. The summed rest score (SRS) and summed 123 I-MIBG score (SS-MIBG) were computed as measures of regional perfusion and innervation heterogeneities. LV segments showing an impaired innervation, despite a relatively preserved perfusion ( 99m Tc-tetrofosmin- 123 I-MIBG tracers' uptake ≥25%), were individuated (innervation/perfusion mismatch). The peak filling rate (PFR) was computed as a measure of LV diastolic function. Nineteen of the 72 (26%) patients presented a normal LV diastolic function, while 29 (40%) and 24 (34%) had a mild and overt diastolic dysfunction. Subjects with diastolic dysfunction showed more abnormal SRS and SS-MIBG values (P mismatch. A modest correlation between the extent of cardiac innervation/perfusion mismatch and PFR values was evident (R = -0.27, P = 0.029). On multivariate analysis, the extent of regional innervation/perfusion mismatch remained an independent predictor of overt LV diastolic abnormalities (P = 0.017). The burden of LV regions showing an innervation/perfusion mismatch associates with the occurrence of overt diastolic dysfunction.

  16. 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.

  17. [Rest gated-SPECT myocardial perfusion post (99m)Tc-MIBI injection in a patient with acute chest pain and with no medical history of ischemic heart disease].

    Science.gov (United States)

    Negre-Busó, M; Muntaner-Muñoz, L; Rubió-Rodríguez, A; Marin-Buriticá, A; Ferran-Sureda, N; Bassaganyas-Vilarrasa, J

    2015-01-01

    Gated-SPECT myocardial perfusion imaging is a widely used technique indicated for assessment of patients with no clear diagnosis of ischemic heart disease. Early rest gated-SPECT myocardial perfusion study in patients with acute chest pain has high sensitivity and high negative predictive value for ruling out coronary disease. We report a case of a patient admitted for the study of her chest pain. She underwent a myocardial perfusion stress-rest whose interpretation could have been equivocal due to the clinical status of the patient during the injection of the radiotracer. Copyright © 2014 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  18. 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%.

  19. Geographic and demographic variabilities of quantitative parameters in stress myocardial computed tomography perfusion.

    Science.gov (United States)

    Park, Jinoh; Kim, Hyun-Sook; Hwang, Hye Jeon; Yang, Dong Hyun; Koo, Hyun Jung; Kang, Joon-Won; Kim, Young-Hak

    2017-09-01

    To evaluate the geographic and demographic variabilities of the quantitative parameters of computed tomography perfusion (CTP) of the left ventricular (LV) myocardium in patients with normal coronary artery on computed tomography angiography (CTA). From a multicenter CTP registry of stress and static computed tomography, we retrospectively recruited 113 patients (mean age, 60 years; 57 men) without perfusion defect on visual assessment and minimal (quantitative parameters of the LV myocardium, including the myocardial attenuation in stress and rest phases, transmural perfusion ratio (TPR), and myocardial perfusion reserve index (MPRI), were evaluated in 16 myocardial segments. In the lateral wall of the LV myocardium, all quantitative parameters except for MPRI were significantly higher compared with those in the other walls. The MPRI showed consistent values in all myocardial walls (anterior to lateral wall: range, 25% to 27%; p = 0.401). At the basal level of the myocardium, all quantitative parameters were significantly lower than those at the mid- and apical levels. Compared with men, women had significantly higher values of myocardial attenuation and TPR. Age, body mass index, and Framingham risk score were significantly associated with the difference in myocardial attenuation. Geographic and demographic variabilities of quantitative parameters in stress myocardial CTP exist in healthy subjects without significant coronary artery disease. This information may be helpful when assessing myocardial perfusion defects in CTP.

  20. General concepts of ventricular function, Myocardial perfusion, and exercise physiology relevant to nuclear cardiology

    International Nuclear Information System (INIS)

    Kronenberg, M.W.; Becker, L.C.

    1988-01-01

    Knowledge of ventricular mechanics, the physiology of the coronary circulation, and exercise physiology is necessary for the accurate interpretation of radionuclide ventriculographic and myocardial perfusion images. This chapter outlines these important basic concepts as applied to the whole heart

  1. Diagnostic accuracy of static CT perfusion for the detection of myocardial ischemia

    DEFF Research Database (Denmark)

    Sørgaard, Mathias Holm; Kofoed, Klaus Fuglsang; Linde, Jesper James

    2016-01-01

    OBJECTIVES: The aim of this study is to provide a meta-analysis of all published studies assessing the diagnostic accuracy of stress CT myocardial perfusion imaging (CTP) in patients suspected of or with known coronary artery disease. This analysis is limited to static stress CTP. METHODS......: Systematic literature review and meta-analysis of studies examining the diagnostic accuracy of static CTP imaging alone or combined with coronary CT angiography (CTA) in comparison to single photon emission computed tomography (SPECT), magnetic resonance perfusion (MRP), and/or invasive coronary angiography......). CONCLUSION: In selected patients, static CT myocardial perfusion has high diagnostic accuracy to detecting myocardial ischemia. Specificity increases significantly when CT myocardial perfusion is combined with coronary CTA....

  2. 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)

  3. Functional reserves of myocardial perfusion in chronic coronary patients with coronary arterial lesions of varying severity

    International Nuclear Information System (INIS)

    Ehventov, A.Z.; Pisareva, N.A.; Matveeva, L.S.; Krol, V.A.; Maevskaya, E.G.; Samojlenko, L.E.

    1986-01-01

    A comparative study of data provided by coronaroangiography and myocardial perfusion scintigraphy (resting and exercise test), and clinical/electrocardiographic results of the exercise test in 102 chronic coronary patients demonstrated that noninvasive myocardial perfusion 201 Tl scintigraphy combined with threshold bicycle-ergometric exercise adds considerably to the clinico-electrocardiographic assessment of the exercise test and thus helps to detect myocardial blood supply (perfusion) disorders in some of coronary patients with doubtful or negative test results. Reduced functional reserves of myocardial blood supply, as reflected in dificient perfusion at the peak threshold exercise, are seen in all coronary arteries and in most patients with both are so-called ''functionally-insignificant'' and marked coronary arterial stenosis (94.7 and 88.3 %, respectively)

  4. Safety of and tolerance to adenosine infusion for myocardial perfusion single-photon emission computed tomography in a Japanese population.

    Science.gov (United States)

    Hatanaka, Kunihiko; Doi, Masayuki; Hirohata, Satoshi; Kamikawa, Shigeshi; Kaji, Yoko; Katoh, Tsutomu; Kusachi, Shozo; Ninomiya, Yoshifumi; Ohe, Tohru

    2007-06-01

    Adenosine has been available for use in myocardial perfusion single-photon emission computed tomography (SPECT) in Japan since 2005. The purpose of this study was to evaluate the safety of and tolerance to thallium-201 myocardial perfusion SPECT with intravenous adenosine infusion in Japanese patients with suspected coronary artery disease. Two hundred and six consecutive patients who underwent an adenosine infusion (120 mug . kg(-1) . min(-1)) SPECT at Sumitomo Besshi Hospital (Niihama, Japan) were investigated. The effects of adenosine infusion were monitored for each patient. A coronary angiography was performed in 81 patients. Adenosine infusion significantly decreased blood pressure and increased heart rate. Adverse reactions were observed in 161 patients (78.2%). Most reactions were transient, disappearing soon after the termination of adenosine infusion. No serious adverse reactions, such as acute myocardial infarction or death, occurred. Adenosine infusion was terminated in 3 patients (1.5%) because of near syncope or sustained 2:1 atrioventricular block. Electrocardiographic changes occurred in 15 patients (7.3%). Self-assessed scoring after SPECT showed that the patients were very tolerant (74.6% of 177 patients) of adenosine infusion myocardial SPECT. The sensitivity and specificity were 75.0% and 69.7%, respectively. Adenosine infusion myocardial SPECT is safe and well tolerated in the Japanese population, despite the frequent occurrence of minor adverse reactions.

  5. Impact of chronic kidney disease and stress myocardial perfusion imaging as a predictor of cardiovascular events

    International Nuclear Information System (INIS)

    Furuhashi, Tatsuhiko; Joki, Nobuhiko; Hase, Hiroki; Masai, Hirofumi; Kunimasa, Taeko; Nakazato, Ryo; Fukuda, Hiroshi; Sugi, Kaoru; Moroi, Masao

    2011-01-01

    Stress myocardial perfusion imaging (MPI) is an established means of predicting cardiovascular events and is suitable in chronic kidney disease (CKD) patients. We aimed to evaluate the prognostic value of CKD parameters and an abnormal stress MPI for cardiovascular events. A total of 495 patients with suspected coronary artery disease (CAD) or history of CAD including 130 CKD patients not undergoing hemodialysis, underwent stress MPI (313 males, mean age 70 years) and were followed up for 14 months (mean period). CKD was defined as an estimated GFR of 2 and/or persistent proteinuria. Cardiovascular events were defined as sudden cardiac death, acute coronary syndrome and congestive heart failure requiring hospitalization. Cardiovascular events occurred in 41 (8.3%) patients. Multivariate Cox regression analysis indicated that CKD [hazard ratio (HR) =3.76, p<0.001] and a stress MPI summed difference score (SDS) of ≥2 (HR=3.78, p<0.001) were independent predictors of cardiovascular events; CKD plus abnormal stress MPI was also a strong predictor of cardiovascular events (non-CKD and SDS <2 vs. CKD and SDS ≥2, HR=15.9, p<0.001). Both CKD and myocardial ischemia detected by stress MPI are independent predictors for cardiovascular events. Coexistence of CKD and myocardial ischemia detected by stress MPI is more useful for short-term risk stratification of cardiovascular events. (author)

  6. Myocardial perfusion/metabolism mismatch and ventricular arrhythmias in the chronic post infarction state

    International Nuclear Information System (INIS)

    Krause, B.J.; Poeppel, T.D.; Vosberg, H.; Mueller, H.W.; Reinhardt, M.; Vester, E.G.; Yong, M.; Mau, J.; Strauer, B.E.

    2005-01-01

    Aim: Ventricular arrhythmias have been shown to originate in the myocardial peri-infarct region due to irregular heterotopic conduction. Hypoperfused but viable myocardium is often localised in those areas and may be involved in the pathogenesis of arrhythmias. We tested the hypothesis that these myocardial perfusion/metabolism mismatches (MM) are significantly associated with ventricular arrhythmias in the chronic post infarction state. Patients, methods: 47 post infarction patients were included in the study. 33 suffered from ventricular arrhythmia whereas 14 did not. All patients underwent 99m Tc tetrofosmin SPECT and 18 F-FDG PET. A region-of-interest(ROI)-analysis was used to assess viable myocardium based on predefined MM-criteria. Univariate analyses as well as a logistic regression model for the multivariate analysis were carried out. Results: 94% of the arrhythmic patients displayed at least one MM-segment as compared to 64% of the non-arrhythmic patients. MM-segments and arrhythmia showed a statistically significant relation (p=0.018). The logistic regression model predicted the occurrence or absence of arrhythmia in 85% of all cases. Multivariate analysis gave consistent results, after adjusting for symptomatic chronic heart failure (CHF), aneurysms and age. Conclusion: Our results support the hypothesis that hypoperfused but viable myocardium represents an arrhyhmogenic substrate and is a relevant risk factor for developing ventricular arrhythmias following myocardial infarction. Therefore, the detection of MM-segments allows the identification of patients with a higher risk for future cardiac events. (orig.)

  7. 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

  8. 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)

  9. The quantitative diagnosis of thallium-201 myocardial perfusion images and vectorcardiograms in myocardial infarction and hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Watanabe, Yoshihiko; Yasui, Shoji; Inagaki, Haruo; Kawai, Naoki; Sotobata, Iwao.

    1981-01-01

    Correlation studies were carried out between thallium-201 myocardial perfusion images and vectorcardiograms in 77 patients with myocardial infarction (48 anterior and 29 inferior infarctions) and 30 patients with hypertrophic cardiomyopathy. A quantitative method was developed; myocardial 201 Tl uptake index (a relative myocardial activity to background, MUI) and myocardial 201 Tl uptake ratio (a ratio of regional myocardial counts to maximal myocardial counts, MUR) were utilized to differentiate myocardial infarction from hypertrophic cardiomyopathy, and evaluate them. A fairly good agreement between left ventriculograms and myocardial perfusion images was obtained in myocardial infarction (diagnostic accuracy 95.1% in anterior and 75.6% in inferior infarction). In anterior infarction the linear relationship of r = -0.58 (p 201 Tl images (septal, apical and anterior, apical and septal, and anterior dominant types). Azimuth angles of instantaneous 10 msec vector were directed right-anteriorly (mean 114.5 degrees) in septal hypertrophy, and left-anteriorly (mean 84.9 degrees) in apical and anterior hypertrophy. Elevation angle of maximal T vector in apical hypertrophy was deviated superiorly (mean 102.6 degrees). There was a good correlation (r = 0.60, p < 0.001) between the magnitude of spatial maximal QRS vector and lateral wall MUR. (author)

  10. Prognostic value of normal exercise {sup 99m}Tc-MIBI myocardial perfusion SPECT: comparison with exercise electrocardiography and coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Woo; Lee, Jae Tae; Chun, Kyung Ah; Kang, Do Young; Kim, Dong Hwan; Cho, Yong Keun; Chae, Shung Chull; Lee, Kyu Bo [Kyungpook National Univ. College of Medicine, Taegu (Korea, Republic of)

    2000-06-01

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

  11. 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.)

  12. 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

  13. Normal stress databases in myocardial perfusion scintigraphy – how many subjects do you need?

    DEFF Research Database (Denmark)

    Trägårdh, Elin; Sjöstrand, Karl; Edenbrandt, Lars

    2012-01-01

    ) for male, NC for female, attenuation‐corrected images (AC) for male and AC for female subjects. 126 male and 205 female subjects were included. The normal database was created by alternatingly computing the mean of all normal subjects and normalizing the subjects with respect to this mean, until...... convergence. Coefficients of variation (CV) were created for increasing number of included patients in the four different normal stress databases. Normal stress databases with ...Commercial normal stress databases in myocardial perfusion scintigraphy (MPS) commonly consist of 30–40 individuals. The aim of the study was to determine how many subjects are needed. Four normal stress databases were developed using patients who underwent 99mTc MPS: non‐corrected images (NC...

  14. 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...... for further assisting the visual interpretation and to test the concept using simulated MPS images as well as patients. Methods The perfusion vector is based on calculating the difference between the anatomical centroid and the perfusion center of gravity of the left ventricle. Simulated MPS images were.......001) but not for patients with infarction. The correlation between the defect size and stress vector magnitude was also found to be significant (p assisting the visual interpretation in MPS studies. Further...

  15. 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...

  16. CT myocardial perfusion and coronary CT angiography: Influence of coronary calcium on a stress-rest protocol.

    Science.gov (United States)

    Ladeiras-Lopes, Ricardo; Bettencourt, Nuno; Ferreira, Nuno; Sampaio, Francisco; Pires-Morais, Gustavo; Santos, Lino; Melica, Bruno; Rodrigues, Alberto; Braga, Pedro; Leite-Moreira, Adelino; Silva-Cardoso, José; Gama, Vasco

    2016-01-01

    High amounts of coronary artery calcium limit image quality and diagnostic accuracy of multidetector computed tomography (MDCT) angiography (CTA) regarding the assessment of obstructive coronary artery disease (CAD). CT myocardial perfusion imaging may represent an opportunity to overcome this limitation. To explore the additive value of CT myocardial perfusion to CTA depending on the patient's calcium score and in comparison to the reference standard of invasive coronary angiography plus fractional flow reserve (FFR) measurement. Symptomatic patients with intermediate pretest probability of CAD were prospectively recruited and underwent both cardiac MDCT (64-slice scanner, retrospectively-gated stress-rest protocol) and invasive coronary angiography including FFR assessment. We defined hemodynamically significant CAD by the presence of occlusive or subocclusive (99%) stenosis, >50% stenosis in left main or FFR≤0.80. Stress CT myocardial perfusion imaging was performed in all patients in addition to CTA. The additive value of CT myocardial perfusion to rule in or rule out the presence of hemodynamically relevant stenosis on a per-patient basis was assessed and analyzed relative to the patient's calcium score. 95 patients were included in the analysis (62 ± 8.2 years, 68%males). Hemodynamically significant CAD was present in 42 patients. Sixty-four patients had a fully evaluable CTA examination. Per-patient, CTA alone had a sensitivity, specificity and AUC of 100%, 59% and 0.79 respectively (77% patients correctly classified). Adding CT myocardial perfusion to evaluate uninterpretable vessel territories in CTA in 66 patients with a calcium score>100 yielded a sensitivity of 88%, a specificity of 74% and an AUC of 0.81 (81% patients correctly classified), and in 52 patients with a calcium score>400 sensitivity was 91%, specificity 70%, and AUC 0.80 (82% patients correctly classified, p = 0.733 versus using perfusion imaging in all patients). From a pragmatic

  17. Clinical investigation of large perfusion defect cases with {sup 201}Tl exercise myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Morota, Motoi; Kobayashi, Yasuhiko [Tokyo Medical Coll. (Japan)

    1999-02-01

    We investigated retrospectively the clinical significance of large perfusion defect on {sup 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<0.001). Analyzing patients with ischemic heart disease (IHD; angina pectoris and myocardial infarction) according to the severity of coronary artery lesion, the proportion of cases with large perfusion defect was significantly larger than that of cases with small perfusion defect in 3 vessel disease (P<0.001). Incidence of diabetes mellitus was significantly higher in patients with IHD than in those with MD in large perfusion defect group (P<0.01). As for symptoms in large perfusion defect group, the incidences of chest pain, chest oppression, and chest discomfort were significantly higher in patients with IHD than in those with MD (P<0.001), whereas the incidences of palpitation and shortness of breath were significantly higher in patients with MD (P<0.001). These results suggest that IHD with multiple artery lesions and MD underlie large perfusion defect on {sup 201}Thallium myocardial scintigraphy and that complication of diabetes mellitus and clinical symptoms may be useful in differentiating IHD from MD. (author)

  18. Quantification of myocardial area at risk in the absence of collateral flow: the validation of angiographic scores by myocardial perfusion single-photon emission computed tomography.

    Science.gov (United States)

    Rodríguez-Palomares, José F; Alonso, Albert; Martí, Gerard; Aguadé-Bruix, Santiago; González-Alujas, M T; Romero-Farina, Guillermo; Candell-Riera, Jaume; García del Blanco, Bruno; Evangelista, Artur; García-Dorado, David

    2013-02-01

    Our study aimed to compare the area at risk (AAR) determined by single-photon emission computed tomography (SPECT) with the Bypass Angioplasty Revascularization Investigation (BARI) and modified Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) angiographic scores in the setting of patients undergoing coronary angioplasty for either unstable angina or an STEMI. Radionuclide myocardial perfusion imaging prior to reperfusion has classically been the most widely practised technique for assessing the AAR and has been successfully used to compare the efficacy of various reperfusion strategies in patients with an ST-segment elevation myocardial infarction (STEMI). The BARI and modified APPROACH scores are angiographic methods widely used to provide a rapid estimation of the AAR; however, they have not been directly validated with myocardial perfusion single-photon emission computed tomography (SPECT). Fifty-five patients with no previous myocardial infarction who underwent coronary angioplasty for single-vessel disease (unstable angina: n = 25 or an STEMI: n = 30) with no evidence of collaterals (Rentrop Collateral Score collateral flow, BARI and APPROACH scores constitute valid methods for AAR estimation in current clinical practice, with more accurate results when used for the LAD territory; both are useful not only in STEMI patients but also in patients with unstable angina.

  19. Influence of the arm position in myocardial perfusion imaging acquisition

    Directory of Open Access Journals (Sweden)

    Marisa Izaki

    2014-07-01

    Full Text Available Objective: despite the technologic advances in myocardial perfusion imaging, we keep using an uncomfortable and sometimes impracticable patient position - supine with arms raised above the head (U. The purpose of this study was to investigate whether perfusion and functional cardiac gated SPECT scan results of acquisition U are equivalent to another position modality: supine with arms down at the sides of the trunk (D. Methods and Results: we performed U acquisition and in sequence D acquisition in 120 patients (pts using a one-day MPI (rest-gated/stress, with 99mTc-sestamibi (370 MBq and 1110 MBq. Images were processed by the iterative reconstruction method (OSEM. Rest (R and stress (S studies were scored using 17-segments model. Functional parameters (left ventricular ejection fraction, and volumes were automatically obtained by the quantitative gated SPECT (QGS program. According to the degree of stress defects observed in U study, the patients were categorized in two subgroups: normal (SSS ≤ 3 or 3 or ≥ 5%. Shoulder/back pain occurred in 23.3% of U patients and in 5% of D. No significant differences between U and D were found for SSS (p = 0.82 and SRS (p = 0.74 in normal group. In abnormal group, good correlation was found between U and D modes for SSS (Rho = 0.95, p = 0.0001 and SRS (Rho = 0.96 p = 0.0001, but the mean SSS (12.53 ± 7.54 and SRS (10.60 ± 7.08 values of D were significantly lower (p < 0.05 than SSS (13.43 ± 6.81 and SRS (11.33 ± 6.97 of U mode. Function measurements presented good correlations, except for end-diastolic volume (p = 0.0001. Conclusion: although D mode appears to be more comfortable and presented a good correlation with U values of SSS and SRS, in abnormal pts, the extent and severity of defects can be underestimated. Considering clinical implications of an accurate perfusion measurement, the acquisition with the arms down should be avoided.

  20. Development of an Ex Vivo, Beating Heart Model for CT Myocardial Perfusion.

    Science.gov (United States)

    Pelgrim, Gert Jan; Das, Marco; Haberland, Ulrike; Slump, Cees; Handayani, Astri; van Tuijl, Sjoerd; Stijnen, Marco; Klotz, Ernst; Oudkerk, Matthijs; Wildberger, Joachim E; Vliegenthart, Rozemarijn

    2015-01-01

    To test the feasibility of a CT-compatible, ex vivo, perfused porcine heart model for myocardial perfusion CT imaging. One porcine heart was perfused according to Langendorff. Dynamic perfusion scanning was performed with a second-generation dual source CT scanner. Circulatory parameters like blood flow, aortic pressure, and heart rate were monitored throughout the experiment. Stenosis was induced in the circumflex artery, controlled by a fractional flow reserve (FFR) pressure wire. CT-derived myocardial perfusion parameters were analysed at FFR of 1 to 0.10/0.0. CT images did not show major artefacts due to interference of the model setup. The pacemaker-induced heart rhythm was generally stable at 70 beats per minute. During most of the experiment, blood flow was 0.9-1.0 L/min, and arterial pressure varied between 80 and 95 mm/Hg. Blood flow decreased and arterial pressure increased by approximately 10% after inducing a stenosis with FFR ≤ 0.50. Dynamic perfusion scanning was possible across the range of stenosis grades. Perfusion parameters of circumflex-perfused myocardial segments were affected at increasing stenosis grades. An adapted Langendorff porcine heart model is feasible in a CT environment. This model provides control over physiological parameters and may allow in-depth validation of quantitative CT perfusion techniques.

  1. Assesment of repeatability of myocardial perfusion 99mTc-MIBI SPECT images

    International Nuclear Information System (INIS)

    Dabrowski, A.; Wnuk, J.; Konieczna, S.; Teresinska, A.

    2004-01-01

    To our knowledge, the repeatability of the myocardial perfusion 99m Tc-MIBI SPECT studies has not been measured. The main aim of this study was to assess the repeatability of rest myocardial perfusion 99m Tc-MIBI SPECT imaging after two MIBI injections on separate days and two different time intervals between radiotracer injection and acquisition. The additional aim was to evaluate the influence of rest variability on the global stress-rest myocardial perfusion study diagnosis. One hundred and seventeen patients with rest perfusion worsening (in first rest investigation-SP1) in routine stress-rest 99m Tc-MIBI SPECT perfusion imaging were studied. The rest study was repeated on another day, 1 hour (second rest investigation-SP2) and 3 hours (third rest investigation-SP3) following the injection of the radiotracer. Regional myocardial perfusion was evaluated quantitatively, in 17 segments of the LV, compered among all the three rest studies (SP1, SP2, SP3) and additionally combined with stress study. Altogether 1939 segments were studied. In 1260 segments (65%) perfusion in all three rest images was equal. In 232 segments (12%) perfusion in both studies performed after the same radiotracer injection (SP2 and SP3) was equal (but different than in SP1 examination). In 99 segments (5%) with the same time interval between injection and acquisition, perfusion was equal (but different than in the third evaluation). Repeated rest studies (SP2 and SP3) were compared to segments with stress defect. In 58% of those defects perfusion in SP2 and SP3 was equal; in 66% of the patients with at least one moderate stress defect, the stress-rest SPECT study result was the same after SP2 and SP3. In the special population of patients with perfusion worse at rest than at stress, our results showed: 1) the repeatability of the segmental myocardial perfusion at rest was 65%; 2) 66% patients had the same results of perfusion examination independently of the rest study used for comparison

  2. Myocardial perfusion imaging with thallium-201: correlation with coronary arteriography and electrocardiography

    Science.gov (United States)

    Sternberg, Leonard; Wald, Robert W.; Feiglin, David H.I.; Morch, John E.

    1978-01-01

    Myocardial perfusion imaging with thallium-201 and electrocardiography with the subject at rest and undergoing submaximal treadmill exercise were performed in 19 men and 3 women. Selective coronary arteriography and left ventriculography showed that 7 had normal coronary arteries and 15 had coronary artery disease. The 11 persons with electrocardiographic evidence of an old myocardial infarct (q waves) had a perfusion defect at rest in the area of the infarct and a segmental abnormality of wall motion apparent on the left ventriculogram corresponding to the perfusion defect. Myocardial perfusion imaging and electrocardiography were equally sensitive in detecting coronary artery disease in exercising individuals: perfusion defects were noted in 7 of the 15 persons with coronary artery disease, and diagnostic ST-segment depression was present in 8 of the 15. Combination of the results of the two tests with exercise permitted the identification of 11 of the 15 persons and improved the sensitivity. Combination of the results of rest and exercise imaging and electrocardiography permitted the identification of 94% of the patients with coronary artery disease. Myocardial perfusion imaging with 201TI in the subject at rest is a sensitive indicator of previous myocardial infarction. Imaging after the subject has exercised is a useful adjunct to conventional exercise electrocardiography, especially in those whose exercise electrocardiogram is non-interpretable. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5 PMID:630487

  3. Is it possible to do without the study of myocardial perfusion in 2013?

    Science.gov (United States)

    Dacher, J-N; Lefebvre, V; Dubourg, B; Deux, J-F; Caudron, J

    2013-12-01

    The analysis of myocardial perfusion is a key step in the cardiac MRI examination. In routine work, this exploration carried out at rest is based on the qualitative first pass study of gadolinium with an ECG-triggered saturation recovery bFFE sequence. In view of recent knowledge, the analysis of the myocardial perfusion under vasodilator stress may be carried out by scintigraphy or MRI, the latter benefiting from the absence of exposure to ionizing rays and a lower cost. Besides coronary disease, the perfusion sequence provides a rich semiology to compare with the clinics and the data from other sequences. Arterial Spin Labeling (ASL) is an alternative technique used in the animal to quantify myocardial perfusion. Copyright © 2013 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  4. The efficacy of 99Tcm-MIBI myocardial perfusion imaging in detecting myocardial ischemia in patients with kawasaki disease

    International Nuclear Information System (INIS)

    Wei Fuxiang; Wang Yaoming; Chen Feng; Guo Jin; Wan Weixing

    2009-01-01

    Objective: 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging was undertaken to detect myocardial ischemia in children with Kawasaki disease in order to evaluate its diagnostic value. Methods: Thirty-one children with Kawasaki disease were included. Five children without cardiovascular disease were enrolled as control group. of these 31 study subjects, there were classified into three groups according to their clinical manifestations. There were acute phase (n=15), sub-acute phase (n=9), and chronic phase (n=7). 99 Tc m -MIBI myocardial perfusion SPECT imaging was proformed in all patients. Eight patients with positive result repeated their SPECT imaging during 6-12 months after their first scan. Results: Thirteen of 31 (41.9%) patients were positive in MIBI perfusion imaging. Six (6/15) were at acute phase, 4 (4/9) were at sub-acute phase, and 3 (3/7) were at chronic phase. Of the 8 patients had second MIBI scans, 4 were normal, 3 improved significantly, only 1 unchanged. Conclusion: 99 Tc m -MIBI myocardial perfusion imasins is a useful noninvasive method for diagnosis evaluation of myocardial ischemia in Kawasaki disease. (authors)

  5. 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

  6. 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.

  7. Quantitative assessment of magnetic resonance derived myocardial perfusion measurements using advanced techniques: microsphere validation in an explanted pig heart system

    NARCIS (Netherlands)

    Schuster, Andreas; Zarinabad, Niloufar; Ishida, Masaki; Sinclair, Matthew; van den Wijngaard, Jeroen P. H. M.; Morton, Geraint; Hautvast, Gilion L. T. F.; Bigalke, Boris; van Horssen, Pepijn; Smith, Nicolas; Spaan, Jos A. E.; Siebes, Maria; Chiribiri, Amedeo; Nagel, Eike

    2014-01-01

    Cardiovascular Magnetic Resonance (CMR) myocardial perfusion imaging has the potential to evolve into a method allowing full quantification of myocardial blood flow (MBF) in clinical routine. Multiple quantification pathways have been proposed. However at present it remains unclear which algorithm

  8. Hyperemic stress myocardial perfusion cardiovascular magnetic resonance in mice at 3 Tesla: initial experience and validation against microspheres.

    Science.gov (United States)

    Jogiya, Roy; Makowski, Markus; Phinikaridou, Alkystsis; Patel, Ashish S; Jansen, Christian; Zarinabad, Niloufar; Chiribiri, Amedeo; Botnar, Rene; Nagel, Eike; Kozerke, Sebastian; Plein, Sven

    2013-07-21

    Dynamic first pass contrast-enhanced myocardial perfusion is the standard CMR method for the estimation of myocardial blood flow (MBF) and MBF reserve in man, but it is challenging in rodents because of the high temporal and spatial resolution requirements. Hyperemic first pass myocardial perfusion CMR during vasodilator stress in mice has not been reported. Five C57BL/6 J mice were scanned on a clinical 3.0 Tesla Achieva system (Philips Healthcare, Netherlands). Vasodilator stress was induced via a tail vein catheter with an injection of dipyridamole. Dynamic contrast-enhanced perfusion imaging (Gadobutrol 0.1 mmol/kg) was based on a saturation recovery spoiled gradient echo method with 10-fold k-space and time domain undersampling (k-t PCA). One week later the mice underwent repeat anaesthesia and LV injections of fluorescent microspheres at rest and at stress. Microspheres were analysed using confocal microscopy and fluorescence-activated cell sorting. Mean MBF at rest measured by Fermi-function constrained deconvolution was 4.1 ± 0.5 ml/g/min and increased to 9.6 ± 2.5 ml/g/min during dipyridamole stress (P = 0.005). The myocardial perfusion reserve was 2.4 ± 0.54. The mean count ratio of stress to rest microspheres was 2.4 ± 0.51 using confocal microscopy and 2.6 ± 0.46 using fluorescence. There was good agreement between cardiovascular magnetic resonance CMR and microspheres with no significant difference (P = 0.84). First-pass myocardial stress perfusion CMR in a mouse model is feasible at 3 Tesla. Rest and stress MBF values were consistent with existing literature and perfusion reserve correlated closely to microsphere analysis. Data were acquired on a 3 Tesla scanner using an approach similar to clinical acquisition protocols, potentially facilitating translation of imaging findings between rodent and human studies.

  9. 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)

  10. Estimating myocardial perfusion from dynamic contrast-enhanced CMR with a model-independent deconvolution method

    Directory of Open Access Journals (Sweden)

    Kadrmas Dan J

    2008-11-01

    Full Text Available Abstract Background Model-independent analysis with B-spline regularization has been used to quantify myocardial blood flow (perfusion in dynamic contrast-enhanced cardiovascular magnetic resonance (CMR studies. However, the model-independent approach has not been extensively evaluated to determine how the contrast-to-noise ratio between blood and tissue enhancement affects estimates of myocardial perfusion and the degree to which the regularization is dependent on the noise in the measured enhancement data. We investigated these questions with a model-independent analysis method that uses iterative minimization and a temporal smoothness regularizer. Perfusion estimates using this method were compared to results from dynamic 13N-ammonia PET. Results An iterative model-independent analysis method was developed and tested to estimate regional and pixelwise myocardial perfusion in five normal subjects imaged with a saturation recovery turboFLASH sequence at 3 T CMR. Estimates of myocardial perfusion using model-independent analysis are dependent on the choice of the regularization weight parameter, which increases nonlinearly to handle large decreases in the contrast-to-noise ratio of the measured tissue enhancement data. Quantitative perfusion estimates in five subjects imaged with 3 T CMR were 1.1 ± 0.8 ml/min/g at rest and 3.1 ± 1.7 ml/min/g at adenosine stress. The perfusion estimates correlated with dynamic 13N-ammonia PET (y = 0.90x + 0.24, r = 0.85 and were similar to results from other validated CMR studies. Conclusion This work shows that a model-independent analysis method that uses iterative minimization and temporal regularization can be used to quantify myocardial perfusion with dynamic contrast-enhanced perfusion CMR. Results from this method are robust to choices in the regularization weight parameter over relatively large ranges in the contrast-to-noise ratio of the tissue enhancement data.

  11. Myocardial perfusion scan: performance, documentation and user-friendly reporting; Myokardszintigraphie: Durchfuehrung, Dokumentation und ueberweiserfreundlicher Befund

    Energy Technology Data Exchange (ETDEWEB)

    Buelow, H.P.; Bengel, F.M. [Nuklearmedizinische Klinik und Poliklinik der Technischen Univ. Muenchen (Germany)

    2004-09-01

    Myocardial perfusion imaging plays an important role in the non-invasive diagnostic work-up of patients with suspected or known coronary artery disease for many years now. As a result of different radiopharmaceuticals, the combination of a resting with a stress study, the application of either physical exercise or pharmacological stress and the availability of different camera systems, several imaging protocols exist. In order to assure relatively standardized perfusion studies, several guidelines concerning the performance of perfusion imaging have been published, which may be used as a reference. The report represents the final part of a perfusion study. As it is the linkage to the clinician, who ordered the scan, it is of particular importance. Therefore, a systematic structure and a commonly used nomenclature is recommended, helping the clinician to interpret the study results. Moreover, an explicit assessment and a clear answer to the clinical question guarantees the acceptance of myocardial perfusion imaging as a clinical method. (orig.)

  12. Effects of acquisition time and reconstruction algorithm on image quality, quantitative parameters, and clinical interpretation of myocardial perfusion imaging

    DEFF Research Database (Denmark)

    Enevoldsen, Lotte H; Menashi, Changez A K; Andersen, Ulrik B

    2013-01-01

    BACKGROUND: Recently introduced iterative reconstruction algorithms with resolution recovery (RR) and noise-reduction technology seem promising for reducing scan time or radiation dose without loss of image quality. However, the relative effects of reduced acquisition time and reconstruction...... time (HT) protocols and Evolution for Cardiac Software. METHODS: We studied 45 consecutive, non-selected patients referred for a clinically indicated routine 2-day stress/rest (99m)Tc-Sestamibi myocardial perfusion SPECT. All patients underwent an FT and an HT scan. Both FT and HT scans were processed...

  13. Quantification of myocardial perfusion using cardiac magnetic resonance imaging correlates significantly to rubidium-82 positron emission tomography in patients with severe coronary artery disease: A preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Qayyum, Abbas A., E-mail: abbas.ali.qayyum@regionh.dk [Department of Cardiology and Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Hasbak, Philip, E-mail: philip.hasbak@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Larsson, Henrik B.W., E-mail: henrik.larsson@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Functional Imaging Unit, Diagnostic Department, Glostrup Hospital, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Ndr. Ringvej 57, 2600 Copenhagen (Denmark); Christensen, Thomas E., E-mail: thomas.emil.christensen@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Ghotbi, Adam A., E-mail: adam.ali.ghotbi@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Mathiasen, Anders B., E-mail: anders.b.mathiasen@gmail.com [Department of Cardiology and Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); and others

    2014-07-15

    Introduction: Aim was to compare absolute myocardial perfusion using cardiac magnetic resonance imaging (CMRI) based on Tikhonov's procedure of deconvolution and rubidium-82 positron emission tomography (Rb-82 PET). Materials and methods: Fourteen patients with coronary artery stenosis underwent rest and adenosine stress imaging by 1.5-Tesla MR Scanner and a mCT/PET 64-slice Scanner. CMRI were analyzed based on Tikhonov's procedure of deconvolution without specifying an explicit compartment model using our own software. PET images were analyzed using standard clinical software. CMRI and PET data was compared with Spearman's rho and Bland–Altman analysis. Results: CMRI results were strongly and significantly correlated with PET results for the absolute global myocardial perfusion differences (r = 0.805, p = 0.001) and for global myocardial perfusion reserve (MPR) (r = 0.886, p < 0.001). At vessel territorial level, CMRI results were also significantly correlated with absolute PET myocardial perfusion differences (r = 0.737, p < 0.001) and MPR (r = 0.818, p < 0.001). Each vessel territory had similar strong correlation for absolute myocardial perfusion differences (right coronary artery (RCA): r = 0.787, p = 0.001; left anterior descending artery (LAD): r = 0.796, p = 0.001; left circumflex artery (LCX): r = 0.880, p < 0.001) and for MPR (RCA: r = 0.895, p < 0.001; LAD: r = 0.886, p < 0.001; LCX: r = 0.886, p < 0.001). Conclusion: On a global and vessel territorial basis, CMRI-measured absolute myocardial perfusion differences and MPR were strongly and significantly correlated with the Rb-82 PET findings.

  14. Steady-state first-pass perfusion (SSFPP): a new approach to 3D first-pass myocardial perfusion imaging.

    Science.gov (United States)

    Giri, Shivraman; Xue, Hui; Maiseyeu, Andrei; Kroeker, Randall; Rajagopalan, Sanjay; White, Richard D; Zuehlsdorff, Sven; Raman, Subha V; Simonetti, Orlando P

    2014-01-01

    To describe and characterize a new approach to first-pass myocardial perfusion utilizing balanced steady-state free precession acquisition without the use of saturation recovery or other magnetization preparation. The balanced steady-state free precession sequence is inherently sensitive to contrast agent enhancement of the myocardium. This sensitivity can be used to advantage in first-pass myocardial perfusion imaging by eliminating the need for magnetization preparation. Bloch equation simulations, phantom experiments, and in vivo 2D imaging studies were run comparing the proposed technique with three other methods: saturation recovery spoiled gradient echo, saturation recovery steady-state free precession, and steady-state spoiled gradient echo without magnetization preparation. Additionally, an acquisition-reconstruction strategy for 3D perfusion imaging is proposed and initial experience with this approach is demonstrated in healthy subjects and one patient. Phantom experiments verified simulation results showing the sensitivity of the balanced steady-state free precession sequence to contrast agent enhancement in solid tissue is similar to that of magnetization-prepared acquisitions. Images acquired in normal volunteers showed the proposed technique provided superior signal and signal-to-noise ratio compared with all other sequences at baseline as well as postcontrast. A new approach to first-pass myocardial perfusion is presented that obviates the need for magnetization preparation and provides high signal-to-noise ratio. Copyright © 2013 Wiley Periodicals, Inc.

  15. Slaughterhouse blood as a perfusate for studying myocardial function under ischemic conditions

    Directory of Open Access Journals (Sweden)

    Bendjelid K.

    2003-01-01

    Full Text Available Metabolic studies using the in vitro non-recirculating blood-perfused isolated heart model require large volumes of blood. The present study was designed to determine whether heterologous pig blood collected from a slaughterhouse can be used as perfusate for isolated pig hearts perfused under aerobic and constant reduced flow conditions. Eight isolated working pig hearts perfused for 90 min at a constant flow of 1.5 ml g-1 min-1 with non-recirculated blood diluted with Krebs-Henseleit bicarbonate buffer at a hematocrit of 23% were compared to eight hearts subjected to the same protocol but perfused only with Krebs-Henseleit bicarbonate buffer solution. Hearts were paced at 100 bpm and subjected to aerobic perfusion at 38ºC. Hearts were weighed before perfusion and at the end of the experiment and the results are reported as percent weight gain (mean ± SD. Comparisons between groups were performed by the Student t-test (P<0.05. After 90 min of perfusion with modified Krebs-Henseleit, perfused hearts presented a larger weight gain than blood-perfused hearts (39.34 ± 9.27 vs 23.13 ± 5.42%, P = 0.003. Left ventricular end-diastolic pressure was higher in the modified Krebs-Henseleit-perfused group than in the blood group (2.8 ± 0.4 vs 2.3 ± 0.3 mmHg, respectively, P = 0.01. We conclude that heterologous blood perfusion, by preserving a more physiological myocardial water content, is a better perfusion fluid than modified Krebs-Henseleit solution for quantitative studies of myocardial metabolism and heart function under ischemic conditions.

  16. Myocardial perfusion imaging determination using an appropriate use smartphone application.

    Science.gov (United States)

    Mahajan, Ashish; Bal, Susan; Hahn, Harvey

    2015-02-01

    Inappropriate cardiac imaging has been a significant cost concern and cause of radiation burden to patients. To assess if a smartphone application (app) based on 2009 Appropriate Use Criteria (AUC) for Cardiac Radionuclide Imaging published by American College of Cardiology would be feasible at the point of order. We evaluated stress myocardial perfusion imaging (MPI) (N = 403) (mean age = 62.23 years; 47.89% males) over a 4 month period using a smartphone app to determine whether the study ordered was Appropriate, Inappropriate, or Uncertain per 2009 AUC. We also monitored the time needed to use the app to determine the level of appropriateness of each stress MPI. The results of the stress MPI were noted. Of the 403 stress MPIs evaluated, 267 (66.25%) were noted to be Appropriate, 118 (29.28%) were Inappropriate, and 13 (3.23%) were Uncertain, per AUC; 5 (1.25%) remained unclassified. Average time needed to use the app to assess each stress MPI for appropriateness was noted to be 44 (±9) seconds. Non-teaching physicians ordered 70 (38.89%) inappropriate stress MPIs as compared to 20 (23.53%) ordered by physicians on resident teaching service, and 28 (23.33%) by cardiologists (P = .0045). Among inappropriately ordered stress MPIs, 87 (42.65%) were ordered in females as compared to 31 (17.13%) in males (P smartphone app provides an easy-to-use tool to assist physicians in determining the level of appropriateness of stress MPI in a time- and cost-effective manner at the point of order. The smartphone app may have potential to promote the usage of the AUC and possibly aid reduction of healthcare cost and ionizing radiation burden.

  17. 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)

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

    Energy Technology Data Exchange (ETDEWEB)

    Nakazato, Masayasu; Maruoka, Yuji; Sunagawa, Osahiko; Kinjo, Kunihiko; Tomori, Masayuki; Fukiyama, Koshiro (Ryukyu Univ., Nishihara, Okinawa (Japan). School of Medicine)

    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{sub 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).

  19. Optimal timing of image acquisition for arterial first pass CT myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Pelgrim, G.J., E-mail: g.j.pelgrim@umcg.nl [University of Groningen, University Medical Center Groningen, Center for Medical Imaging North East Netherlands (CMI-nen), Hanzeplein 1, 9713 GZ Groningen (Netherlands); Nieuwenhuis, E.R., E-mail: e.r.nieuwenhuis@student.utwente.nl [University of Groningen, University Medical Center Groningen, Center for Medical Imaging North East Netherlands (CMI-nen), Hanzeplein 1, 9713 GZ Groningen (Netherlands); University of Twente, P.O. Box 217, 7500 AE, Enschede (Netherlands); Duguay, T.M., E-mail: duguay@musc.edu [Medical University of South Carolina, Dept. of Radiology, 25 Courtenay Drive, SC 29425, Charleston (United States); Geest, R.J. van der, E-mail: R.J.van_der_Geest@lumc.nl [Leiden University Medical Center, Dept. of Radiology, Postbus 9600, 2300 RC, Leiden (Netherlands); Varga-Szemes, A., E-mail: vargaasz@musc.edu [Medical University of South Carolina, Dept. of Radiology, 25 Courtenay Drive, SC 29425, Charleston (United States); Slump, C.H., E-mail: c.h.slump@utwente.nl [University of Groningen, University Medical Center Groningen, Center for Medical Imaging North East Netherlands (CMI-nen), Hanzeplein 1, 9713 GZ Groningen (Netherlands); University of Twente, P.O. Box 217, 7500 AE, Enschede (Netherlands); Fuller, S.R., E-mail: fullerst@musc.edu [Medical University of South Carolina, Dept. of Radiology, 25 Courtenay Drive, SC 29425, Charleston (United States); Oudkerk, M., E-mail: m.oudkerk@umcg.nl [University of Groningen, University Medical Center Groningen, Center for Medical Imaging North East Netherlands (CMI-nen), Hanzeplein 1, 9713 GZ Groningen (Netherlands); Schoepf, U.J., E-mail: schoepf@musc.edu [Medical University of South Carolina, Dept. of Radiology, 25 Courtenay Drive, SC 29425, Charleston (United States); and others

    2017-01-15

    Highlights: • Optimal timing of static, single-shot CT perfusion scans is important to differentiate ischemic from non-ischemic myocardial segments. • Time delay between reaching 150 and 250 HU thresholds in the ascending aorta and optimal contrast in the myocardium are 4 and 2 s, respectively. • Attenuation difference of more than 15 HU between normal and ischemic myocardium is present during approximately 8 s. - Abstract: Purpose: To determine the optimal timing of arterial first pass computed tomography (CT) myocardial perfusion imaging (CTMPI) based on dynamic CTMPI acquisitions. Methods and materials: Twenty-five patients (59 ± 8.4 years, 14 male)underwent adenosine-stress dynamic CTMPI on second-generation dual-source CT in shuttle mode (30 s at 100 kV and 300 mAs). Stress perfusion magnetic resonance imaging (MRI) was used as reference standard for differentiation of non-ischemic and ischemic segments. The left ventricle (LV) wall was manually segmented according to the AHA 16-segment model. Hounsfield units (HU) in myocardial segments and ascending (AA) and descending aorta (AD) were monitored over time. Time difference between peak AA and peak AD and peak myocardial enhancement was calculated, as well as the, time delay from fixed HU thresholds of 150 and 250 HU in the AA and AD to a minimal difference of 15 HU between normal and ischemic segments. Furthermore, the duration of the 15 HU difference between ischemic and non-ischemic segments was calculated. Results: Myocardial ischemia was observed by MRI in 10 patients (56.3 ± 9.0 years; 8 male). The delay between the maximum HU in the AA and AD and maximal HU in the non-ischemic segments was 2.8 s [2.2–4.3] and 0.0 s [0.0–2.8], respectively. Differentiation between ischemic and non-ischemic myocardial segments in CT was best during a time window of 8.6 ± 3.8 s. Time delays for AA triggering were 4.5 s [2.2–5.6] and 2.2 s [0–2.8] for the 150 HU and 250 HU thresholds, respectively. While for

  20. SU-C-201-04: Quantification of Perfusion Heterogeneity Based On Texture Analysis for Fully Automatic Detection of Ischemic Deficits From Myocardial Perfusion Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Fang, Y [National Cheng Kung University, Tainan, Taiwan (China); Huang, H [Chang Gung University, Taoyuan, Taiwan (China); Su, T [Chang Gung Memorial Hospital, Taoyuan, Taiwan (China)

    2015-06-15

    Purpose: Texture-based quantification of image heterogeneity has been a popular topic for imaging studies in recent years. As previous studies mainly focus on oncological applications, we report our recent efforts of applying such techniques on cardiac perfusion imaging. A fully automated procedure has been developed to perform texture analysis for measuring the image heterogeneity. Clinical data were used to evaluate the preliminary performance of such methods. Methods: Myocardial perfusion images of Thallium-201 scans were collected from 293 patients with suspected coronary artery disease. Each subject underwent a Tl-201 scan and a percutaneous coronary intervention (PCI) within three months. The PCI Result was used as the gold standard of coronary ischemia of more than 70% stenosis. Each Tl-201 scan was spatially normalized to an image template for fully automatic segmentation of the LV. The segmented voxel intensities were then carried into the texture analysis with our open-source software Chang Gung Image Texture Analysis toolbox (CGITA). To evaluate the clinical performance of the image heterogeneity for detecting the coronary stenosis, receiver operating characteristic (ROC) analysis was used to compute the overall accuracy, sensitivity and specificity as well as the area under curve (AUC). Those indices were compared to those obtained from the commercially available semi-automatic software QPS. Results: With the fully automatic procedure to quantify heterogeneity from Tl-201 scans, we were able to achieve a good discrimination with good accuracy (74%), sensitivity (73%), specificity (77%) and AUC of 0.82. Such performance is similar to those obtained from the semi-automatic QPS software that gives a sensitivity of 71% and specificity of 77%. Conclusion: Based on fully automatic procedures of data processing, our preliminary data indicate that the image heterogeneity of myocardial perfusion imaging can provide useful information for automatic determination

  1. Changes in myocardial perfusion due to physical exercise in patients with stable coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Kendziorra, Kai; Foerster, Marcus; Sabri, Osama; Kluge, Regine [University of Leipzig, Department of Nuclear Medicine, Leipzig (Germany); Walther, Claudia; Moebius-Winkler, Sven; Conradi, Katrin; Schuler, Gerhard; Hambrecht, Rainer [University of Leipzig, Heart Center, Leipzig (Germany)

    2005-07-01

    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.)

  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 p<1e-05). No significant difference was measured between 120 kVp and 70 keV mean TFR values 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. 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. Electrocardiographic left ventricular hypertrophy without echocardiographic abnormalities evaluated by myocardial perfusion and fatty acid metabolic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi [Sumitomo Hospital, Osaka (Japan)

    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 {sup 99m}Tc-methoxy-isobutyl isonitrile (MIBI) imaging and rest {sup 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 {sup 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 {sup 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 {sup 123}I-BMIPP). Eighteen normotensive patients with apical defect by {sup 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 {sup 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 {sup 123}I-BMIPP showed 3 different types of perfusion. Many patients without hypertension show a pathologic process similar to hypertrophic cardiomyopathy. Perfusion and {sup 123}I-BMIPP imaging are useful for the identification of these patients. (author)

  5. Comparison of Exercise Tc-99m Tetrofosmin Myocardial Perfusion SPECT with Exercise Tl-201 Myocardial Perfusion SPECT in the diagnosis of coronary artery disease in patients with left bundle branch block (LBBB)

    International Nuclear Information System (INIS)

    Kumar, R.; Barai, S.; Malhotra, A.; Karthikeyan, G.; Mishra, S.; Sood, A.K.

    2004-01-01

    Exercise Tl-201 Myocardial Perfusion SPECT (MPS) has poor specificity for the diagnosis of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). Tc-99m-Tetrofosmin is an agent with kinetics similar to Sestamibi. There has not been any study reported in literature comparing exercise Tc-99m Tetrofosmin MPS with that of exercise Tl-201 MPS in patients with LBBB. We compared exercise Tc-99m-Tetrofosmin MPS with exercise Tl-201 MPS in the diagnosis of coronary artery disease (CAD) in patients with LBBB. Exercise Tc-99m Tetrofosmin and Tl-201 myocardial SPECT studies were conducted in 15 patients with LBBB suspected to have CAD. All patients underwent coronary angiography. Both tests were assessed for their ability to differentiate normally perfused coronary artery territories from those supplied by a diseased coronary artery, with special reference to the septum. Tc-99m Tetrofosmin MPS identified 13 out of 15 segments perfused by a stenosed coronary artery as compared to 14 by Tl-201 SPECT. Tc99m-Tetrofosmin and Tl-201 MPS studies revealed perfusion abnormalities in 15 and 16 of 40 normal segments respectively. False positive perfusion defects over the septum identified on the stress thallium scans did not show reversibility in the rest images. There was no difference in the reversibility of the true and false positive segments identified on the Tetrofosmin scans. The results of this study showed comparable efficacy of exercise Tc-99m Tetrofosmin MPS and Tl-201 MPS in the diagnosis of CAD in patients with LBBB. (author)

  6. Nuclear myocardial perfusion imaging with a cadmium-telluride semiconductor detector gamma camera in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Fukushima, Yoshimitsu; Kumita, Shin-ichiro; Kawaguchi, Tsuneaki; Maruyama, Takatoshi; Kawasaki, Yoshiyuki; Shinkai, Yasuhiro

    2014-01-01

    Since myocardial perfusion imaging (MPI) with conventional sodium iodine (NaI) device has low spatial resolution, there have been some cases in which small structures such as non-transmural myocardial infarction could not be properly detected. The purpose of this study was to evaluate potential usefulness of cadmium-telluride (CdTe) semiconductor detector-based high spatial resolution gamma cameras in detecting myocardial infarction sites, especially non-transmural infarction. A total of 38 patients (mean age ± SD: 64 ± 21 year) who were clinically diagnosed with acute myocardial infarction were included. Twenty-eight cases of them were with ST segment elevation myocardial infarction (STEMI) and 10 cases with non-ST segment elevation myocardial infarction (NSTEMI). In all patients, myocardial perfusion single photon emission computed tomography images were acquired with Infinia (NaI device) and R1-M (CdTe device), and the images were compared concerning the detectability of acute myocardial infarction sites. The detection rates of the myocardial infarction site in cases with STEMI were 100% both by NaI and CdTe images. In cases with NSTEMI, detection rate by NaI images was 50%, while that of CdTe images was 100% (p=0.033). The summed rest score (SRS) value derived from CdTe images was significantly higher than that from NaI images in cases with STEMI [NaI images: 12 (7-18) versus CdTe images: 14 (9-20)] (p < 0.001). SRS derived from CdTe images was significantly higher than that derived from NaI images in cases with NSTEMI [NaI images: 2 (0-5) versus CdTe images: 6 (6-8)] (p=0.006). These results indicate that MPI using CdTe-semiconductor device will provide a much more accurate assessment of acute myocardial infarction in comparison to current methods. (author)

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

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa (Sumitomo Hospital, Osaka (Japan))

    1991-02-01

    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

  8. 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......). METHODS: Reversible perfusion defects (ischaemia) in each of five myocardial regions, as interpreted by one experienced nuclear medicine physician during his daily routine of clinical reporting, were assessed by artificial neural networks in 316 consecutive patients undergoing stress/rest 99m......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...

  9. Extracardiac Uptake of Thallium-201 during Myocardial Perfusion Imaging with Pharmacologic Vasodilation

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Chung Il; Kwark, Dong Suk; Chung, Byung Cheon; Park, Moo Keun; Lee, Jae Tae; Lee, Kyu Bo [Kyungpook National University College of Medicine, Daegu (Korea, Republic of)

    1992-03-15

    Myocardial perfusion imaging with {sup 201}T1-chloride following exercise or vasodilator-induced hyperemia has been effective in detecting the presence of coronary artery disease. An increased lung uptake of thallium has been reported as a sensitive marker of severe and extensive coronary artery disease and associated with poor prognosis. Thallium has also been noted to concentrate in a variety of malignant lesions. We report 5 cases of extracardiac uptake of thallium during myocardial perfusion scan with pharmacologic vasodilation. Accumulation of thallium was found in the lesions of a breast cancer, a lung cancer, a Castleman's disease and 2 cases of thymoma. We believe that the presence of focal extracardiac uptake of thallium during myocardial perfusion scan should suggest the need for further clinical evaluation to detect the tumor and must differentiate the increased lung uptake of thallium due to left ventricular dysfunction in coronary artery disease.

  10. Comparison Between the Prognostic Value of Left Ventricular Function and Myocardial Perfusion Reserve in Patients with Ischemic Heart Disease

    NARCIS (Netherlands)

    Tio, Rene A.; Dabeshlim, Ali; Siebelink, Hans-Marc J.; de Sutter, Johan; Hillege, Hans L.; Zeebregts, Clark J.; Dierckx, Rudi A. J. O.; van Veldhuisen, Dirk J.; Zijlstra, Felix; Slart, Riemer H. J. A.

    The purpose of this study was to compare the prognostic value of left ventricular ejection fraction (LVEF) and myocardial perfusion reserve (MPR) assessed with PET in patients with ischemic heart disease (IHD). Myocardial perfusion is the main determinant of left ventricular function in patients

  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. Nitrate-enhanced gated SPECT in patients with primary angioplasty for acute myocardial infarction: evidence of a reversible and nitrate-sensitive impairment of myocardial perfusion

    Energy Technology Data Exchange (ETDEWEB)

    Djaballah, Wassila [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); UHP-INSERM ERI13, Nancy (France); Hopital de Brabois, Service de Medecine Nucleaire, CHU-Nancy, Vandoeuvre Cedex (France); Muller, Marc A.; Karcher, Gilles [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); Angioi, Michael [CHU-Nancy, Department of Cardiology, Nancy (France); UHP-INSERM U684, Nancy (France); Moulin, Frederic; Ethevenot, Gerard; Aliot, Etienne [CHU-Nancy, Department of Cardiology, Nancy (France); Codreanu, Andrei [UHP-INSERM ERI13, Nancy (France); CHU-Nancy, Department of Cardiology, Nancy (France); Mandry, Damien [UHP-INSERM ERI13, Nancy (France); CHU-Nancy, Department of Radiology, Nancy (France); Marie, Pierre Y. [CHU-Nancy, Department of Nuclear Medicine, Nancy (France); UHP-INSERM U684, Nancy (France)

    2007-12-15

    Reperfusion of myocardial infarction (MI) leads to a reversible dysfunction of coronary vessels. We hypothesised that vasodilating drugs such as nitrates might improve sestamibi uptake within viable areas of recently reperfused MI, thereby enhancing prediction of subsequent improvements in perfusion and contractility. This study was aimed at assessing nitrate-enhanced sestamibi gated SPECT after MI reperfusion. Twenty-nine patients underwent rest followed by nitrate sestamibi gated SPECT at 9 {+-} 3 days after primary angioplasty for acute MI and at follow-up, 4-10 months later. Four MBq/kg of {sup 99m}Tc-sestamibi was injected at rest, and 12 MBq/kg after nitroglycerin spray. Follow-up improvements were documented for both perfusion (P+) and contractility (C+) in 18% of the 180 initially abnormal segments, in neither perfusion (P-) nor contractility (C-) in 44%, in contractility only (C+P-) in 16% and in perfusion only (C-P+) in 22%. Perfusion improvement was related to lower sestamibi uptake on baseline rest SPECT (P+: 42 {+-} 15% vs P-: 50 {+-} 15%, p = 0.001) and, moreover, to a higher increase between rest and nitrate uptake (P+: +9.5 {+-} 6.5% vs P-: +2.0 {+-} 5.9%, p < 0.001). Contractility improvement was related to sestamibi uptake on baseline nitrate SPECT (C+: 58 {+-} 15% vs C-: 38 {+-} 16%, p < 0.001), a variable enhancing the prediction provided by sestamibi uptake at rest (p < 0.05). The improvement in perfusion which is documented in the months following MI reperfusion is predicted by initial nitrate enhancement of sestamibi uptake, suggesting a mechanism of reversible vascular injury. In this particular setting, sestamibi uptake is a better predictor of contractility recovery when determined after nitrate administration rather than under conventional resting conditions. (orig.)

  13. Exercise myocardial perfusion imaging to evaluate inducible ischaemia in children with Kawasaki disease.

    Science.gov (United States)

    Kashyap, Raghava; Mittal, Bhagwant Rai; Bhattacharya, Anish; Manojkumar, Rohit; Singh, Surjit

    2011-02-01

    Kawasaki disease (KD) is an acute multi-system vasculitis of unknown aetiology, which occurs predominantly in infants and young children. Coronary artery abnormalities may occur in 15-25% of patients who are not treated in the acute phase of the disease with a high dose of intravenous immunoglobulin. Myocardial perfusion imaging is used as a modality to monitor the cardiovascular effects of the disease. The objective of our study was to assess the feasibility and results of exercise myocardial perfusion scintigraphy in children with Kawasaki disease. We performed stress myocardial perfusion imaging in 84 patients suffering from KD. The diagnosis of KD was based on the criteria laid down by the American Heart Association. Myocardial perfusion imaging was performed using either thallium or technetium-99m tetrofosmin. Physical exercise using the Bruce protocol was the most frequent cardiac stressor (74 patients) whereas in few patients (seven patients) dobutamine was used to increase the heart rate. Stress-induced reversible perfusion defects were found only in 12 of the total number of patients. Among these two had coronary artery abnormalities on echocardiography. Four of these patients had achieved adequate heart rate with stress. Two among these patients had a repeat imaging done after 1 year and the perfusion defects showed complete resolution in them. This study thus suggests that reversible perfusion defects are seen in asymptomatic patients with KD and that the presence of perfusion defects may not be associated with echocardiographic demonstration of coronary abnormalities. The treadmill test is a reasonable stress protocol for these patients.

  14. Important parameters in the detection of left main trunk disease using stress myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Shiba, Chie; Chikamori, Taishiro; Hida, Satoshi

    2009-01-01

    We sought noninvasively to diagnose left main trunk (LMT) disease using myocardial perfusion imaging (MPI). Five hundred and eight patients with suspected coronary artery disease (CAD) underwent both stress MPI and coronary angiography. The extent and severity of perfusion abnormalities were assessed using a 20-segment model. In addition, perfusion defects in both left anterior descending and left circumflex arterial territories were defined as a left main (LM) pattern defect, and those in 3-coronary arterial territories as a 3-vessel pattern defect. In 42 patients with LMT disease, a summed stress score (19.4±10.0 vs. 13.5±10.0; p<0.0001) and a summed rest score (12.1±9.7 vs. 7.0±7.8; p=0.002) were greater than in 466 patients without LMT disease, while a summed difference score was similar (7.3±7.7 vs. 6.5±6.1; p=NS). The prevalence of an LM-pattern defect was low in both groups (12% vs. 8%; p=NS). However, a 3-vessel pattern defect (33% vs. 7%; p<0.0001), lung uptake of radiotracers (38% vs. 11%; p<0.0001), and transient ischemic dilation (31% vs. 13%; p=0.003) were more frequently observed in patients with LMT disease than in those without. Logistic regression analysis showed that a 3-vessel pattern defect (odds ratio (OR)=3.5, 95% confidence interval (CI)=1.4-8.8; p=0.007), lung uptake of radiotracers (OR=2.5, 95% CI=1.1-5.7; p=0.03), and previous myocardial infarction (MI) (OR=2.4, 95% CI=1.0-5.7; p=0.05) were the most important parameters to detect LMT disease. After excluding 163 patients with previous MI, a repeat analysis revealed that lung uptake of radiotracers (OR=8.2, 95% CI=2.3-29.2; p=0.001) and an LM-pattern defect (OR=6.3, 95% CI=1.4-27.2; p<0.02) were independent predictors for LMT disease. In the identification of LMT disease, lung uptake of radiotracers was a single best parameter, which was independent of the presence or absence of previous MI. (author)

  15. Influence of the prevalence of coronary artery disease in patients with normal myocardial perfusion SPECT imaging. Cooperative study in South America

    International Nuclear Information System (INIS)

    Balestrini, V.R.; Arja, V.J.; Sandrin, A.L.; Sala, J.P.; Joekes, S.; Bier, G.; Precoma, D.; Yamada, A.

    2002-01-01

    An important feature of myocardial perfusion imaging is the ability to predict prognosis and identify high- and low-risk patients for coronary events. According to Bayes' theorem, the significance of test's results, relates not only the sensitivity and specificity of a test but also the prevalence of disease in the population under study. Aim: evaluate the relationship between pretest likelihood (PTL) and coronary events (CE) in patients with normal myocardial perfusion SPECT imaging during a long period of time. Material and Methods: The population included 709 patients (411 men and 298 women, mean age 58 years old) who underwent stress/rest myocardial perfusion SPECT imaging at nuclear cardiology laboratories in Argentina and Brazil, with scintigraphic images interpreted as normal. Analyzed variables: clinical, EKG and stress test. Perfusion agents: Tc-99m-tetrofosmin: 36.5%, Tc99m-sestamibi 5.8% and Tl-201 57.7%. Mean follow up: 919 days. CE: soft (unstable angina and need for revascularization) and hard (AMI and cardiac death). Results: Stress test: exercise stress test 72.2%, dipyridamole 25%, adenosine 1.7%, dobutamine 1.1%. PTL [ 9' (M/F): 59/11% (p 78%] 31 vs. 50%. Conclusions: 1) There was a relationship between PTL, events rate and time to event. 2) We found a low hard events rate (0.85%). 3) The results in this group of patients with normal myocardial perfusion SPECT imaging may suggest a guarantee period of low risk of coronary events between 2-3 years. 4) In spite of there is a low event rate in total population with normal myocardial perfusion imaging, patients with highest prevalence of coronary artery disease have more statistical probabilities of coronary events and therefore they have to be watched closely

  16. 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...

  17. 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)

  18. Low dose dynamic myocardial CT perfusion using advanced iterative reconstruction

    Science.gov (United States)

    Eck, Brendan L.; Fahmi, Rachid; Fuqua, Christopher; Vembar, Mani; Dhanantwari, Amar; Bezerra, Hiram G.; Wilson, David L.

    2015-03-01

    Dynamic myocardial CT perfusion (CTP) can provide quantitative functional information for the assessment of coronary artery disease. However, x-ray dose in dynamic CTP is high, typically from 10mSv to >20mSv. We compared the dose reduction potential of advanced iterative reconstruction, Iterative Model Reconstruction (IMR, Philips Healthcare, Cleveland, Ohio) to hybrid iterative reconstruction (iDose4) and filtered back projection (FBP). Dynamic CTP scans were obtained using a porcine model with balloon-induced ischemia in the left anterior descending coronary artery to prescribed fractional flow reserve values. High dose dynamic CTP scans were acquired at 100kVp/100mAs with effective dose of 23mSv. Low dose scans at 75mAs, 50mAs, and 25mAs were simulated by adding x-ray quantum noise and detector electronic noise to the projection space data. Images were reconstructed with FBP, iDose4, and IMR at each dose level. Image quality in static CTP images was assessed by SNR and CNR. Blood flow was obtained using a dynamic CTP analysis pipeline and blood flow image quality was assessed using flow-SNR and flow-CNR. IMR showed highest static image quality according to SNR and CNR. Blood flow in FBP was increasingly over-estimated at reduced dose. Flow was more consistent for iDose4 from 100mAs to 50mAs, but was over-estimated at 25mAs. IMR was most consistent from 100mAs to 25mAs. Static images and flow maps for 100mAs FBP, 50mAs iDose4, and 25mAs IMR showed comparable, clear ischemia, CNR, and flow-CNR values. These results suggest that IMR can enable dynamic CTP at significantly reduced dose, at 5.8mSv or 25% of the comparable 23mSv FBP protocol.

  19. 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.)

  20. 3.0 T magnetic resonance myocardial perfusion imaging for semi-quantitative evaluation of coronary microvascular dysfunction in hypertrophic cardiomyopathy.

    Science.gov (United States)

    Yin, Liang; Xu, Hai-Yan; Zheng, Sui-Sheng; Zhu, Ying; Xiao, Jiang-Xi; Zhou, Wei; Yu, Si-Si; Gong, Liang-Geng

    2017-12-01

    This study aimed to assess coronary microvascular dysfunction (CMD) differences in hypertrophic cardiomyopathy (HCM) patients using cardiac magnetic resonance (CMR) first-pass perfusion and late gadolinium enhancement imaging. Forty-seven patients with HCM and twenty-one healthy volunteers underwent CMR at rest. Imaging protocols included short axis cine, first-pass myocardial perfusion, and late gadolinium enhancement (LGE). Left ventricular end-diastolic wall thickness (EDTH), LGE, time to peak (T peak ), maximal up-slope (Slope max ), and peak signal intensity (SI peak ) were assessed for each myocardial segment. The HCM myocardial segments were grouped by the degree of LGE and hypertrophy. T peak , SI peak , Slope max and EDTH in multiple groups were assessed and compared by ANOVA test/Kruskal-Wallis test. The Spearman correlation test was used to determine the relationships between EDTH, LGE and perfusion parameters (T peak , Slope max and SI peak ). Compared to control group segments, T peak increased while Slope max and SI peak decreased in non-LGE/non-hypertrophic segments and LGE/hypertrophic segments in the HCM group, while T peak increased more significantly in LGE/hypertrophic segments (all p hypertrophic segments of HCM patients, and it may be helpful in the early diagnosis of coronary microvascular dysfunction in HCM. This abnormal perfusion is associated with the severity of myocardial fibrosis and the degree of hypertrophy.

  1. Preservation of Myocardial Perfusion and Function by Keeping Hypertrophied Heart Empty and Beating for Valve Surgery: An In Vivo MR Study of Pig Hearts.

    Science.gov (United States)

    Wang, Jian; Xiang, Bo; Deng, Jixian; Lin, Hung-Yu; Freed, Darren H; Arora, Rakesh C; Tian, Ganghong

    2017-01-01

    Objectives . Normothermic hyperkalemic cardioplegia arrest (NHCA) may not effectively preserve hypertrophied myocardium during open-heart surgery. Normothermic normokalemic beating perfusion (NNBP), keeping hearts empty-beating, was utilized as an alternative to evaluate its cardioprotective role. Materials and Methods . Twelve hypertrophied pig hearts at 58.6 ± 7.2 days after ascending aorta banding underwent NNBP and NHCA, respectively. Near infrared myocardial perfusion imaging with indocyanine green (ICG) was conducted to assess myocardial perfusion. Left ventricular (LV) contractile function was assessed by cine MRI. TUNEL staining and western blotting for caspase-3 cleavage and cardiac troponin I (cTnI) degradation were conducted in LV tissue samples. Results . Ascending aortic diameter was reduced by 52.7% ± 0.4% at approximately fifty-eight days after banding. LV wall thickness was significantly higher in aorta banding than in sham operation. Myocardial blood flow reflected by maximum ICG absorbance value was markedly higher in NNBP than in NHCA. The amount of apoptotic cardiomyocyte was significantly lower in NNBP than in NHCA. NNBP alleviated caspase-3 cleavage and cTnI degradation associated with NHCA. NNBP displayed a substantially increased postoperative ejection fraction relative to NHCA. Conclusions . NNBP was better than NHCA in enhancing myocardial perfusion, inhibiting cardiomyocyte apoptosis, and preserving LV contractile function for hypertrophied hearts.

  2. 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.

  3. 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)

  4. Value of cardiac 320-multidetector computed tomography and cardiac magnetic resonance imaging for assessment of myocardial perfusion defects in patients with known chronic ischemic heart disease

    DEFF Research Database (Denmark)

    Qayyum, Abbas Ali; Kühl, Jørgen T; Mathiasen, Anders B

    2013-01-01

    The challenge for therapies targeting perfusion abnormalities is to identify and evaluate the region of interest. The aim of this study was to compare rest and stress myocardial perfusion measured by cardiac multi-detector computed tomography (MDCT) and cardiac magnetic resonance (CMR) imaging...... in patients with invasive coronary angiography demonstrated occluded vessels. Twenty-four patients with refractory angina due to occluded coronary arteries underwent perfusion imaging obtained by 320-MDCT scanner and 1.5 T MR scanner. Rest and adenosine stress images were obtained and interpreted using...... the modified 17-segment American Heart Association model. For the qualitative analysis, each segment was graded according to the following scoring system: 0 = no defect, 1 = hypoperfusion transmural extent 1/2, and 4 = infarct stigmata. In the semiquantitative analysis the perfusion was either scored 0 (normal...

  5. Perfusion imaging using rubidium-82 ((82)Rb) PET in rats with myocardial infarction

    DEFF Research Database (Denmark)

    Clemmensen, Andreas Ettrup; Ghotbi, Adam Ali; Bodholdt, Rasmus Poul

    2017-01-01

    Assessing myocardial perfusion using 82Rb-PET is emerging as a valuable clinical tool.1,2 The rapid decay (T½ = 76 s) allows for absolute quantification of both rest and stress perfusion within 30 minutes. In addition to evaluation of epicardial disease with perfusion defects, also evaluation...... of balanced coronary and small vessel disease is possible. For further evaluation of how 82Rb-PET can be used clinically, pre-clinical application of the method would be valuable. However, so far no data on the use of 82Rb-PET in small animals have been published nor has the use of 82Rb-PET, to the best...

  6. Diagnostic value of stress-rest myocardial perfusion imaging in detection of coronary disease in elderly patients

    International Nuclear Information System (INIS)

    Han Pingping; Tian Yueqin; Fang Wei; Shen Rui; Yang Minfu; Wei Hongxing; Guo Xinhua; He Zuoxiang

    2009-01-01

    Objective: Coronary artery disease is one of the most common causes of death in elderly people. Yet, definite diagnosis is a dilemma due to the variety of symptoms and signs. The aim of this study was to evaluate the diagnostic value of nuclear stress-rest myocardial perfusion imaging(MPI) in detection of coronary disease in the elderly. Methods: Two hundred and five elderly subjects (≥60 years old, average of 67 ± 5) who were suspected to have coronary disease, underwent both stress-rest myocardial perfusion imaging (185 with exercise stress and 20 with adenosine stress) and coronary angiography (CAG). All had no pereutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Coronary angiography was used as a 'golden standard' to evaluate the sensitivity, specificity and accuracy of the stress-rest myocardial perfusion imaging. χ 2 -test was used in data analysis with SPSS 15.0. Results: Among 205 patients. there were 57 patients with an abnormal CAG result and 148 patients with a normal result. Of the 57 patients, there were 30 one-, 19 two-, and 8 three-vessel stenosis. Fifteen were mild-, 17 were moderate-, 17 were severe stenosis, and 8 were totally occluded.About 63% (36/57) had positive stress-rest MPI. Of the 148 subjects who had a normal CAG, 135 had negative MPL. The sensitivity.specificity and accuracy of stress MPI were 63% (36/57), 91% (135/148) and 83% (171/205) in patient level.respectively. The di-agnostic sensitivities of stress-rest MPI for detection of one-, two-, and three-vessel stenosis were 57%(17/30), 58% (11/19) and 8/8, respectively. All 185 patients who underwent exemise stress MPI were divided into 2 groups according to whether the patients reached the target heart rate or not at the peak of the test. And 53 patients (29%) were group 1 (reached the target heart rate)and 132 patients (71%) were group 2 (did not reach the target heart rate). The sensitivity of group 1 wag higher than that of group 2, but with no

  7. 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

  8. 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

  9. An experimental study on the acute myocardial infarction with CT perfusion scans

    International Nuclear Information System (INIS)

    Liu Yuanjian; Yan Weiqiang; Wang Chenglin; Liu Pengcheng; Feng Xiaoyuan; Shen Tianzhen; Chen Xingrong

    2004-01-01

    Objective: To determine the reliability of CT perfusion scans and its parameters of γ-variate curve in evaluating the acute myocardial infarction for clinical reference of diagnosis on coronary artery disease and myocardial infarction. Methods: Imatron C-150 electron beam CT (EBCT) were used to scan a hydrodynamic model which could mimic a change of contrast medium by intravenous injection in vivo. Then 6 adult canines were employed in the experiment with thoracic operation, and branches of the anterior descending and circumflex of left coronary arteries (LCA) were ligated so that myocardial infarction was made out. After intravenous administration of contrast medium, the hearts were scanned with perfusion EBCT and γ-variate curves were manifested. Some heterogeneities and differentiations between the normality and the infarctions were put forward when the parameters of all these curves were analyzed and statistically processed. Two myocardial infarctions were also verified by SPECT, and all the samples stained with TTC method were compared with those on the perfusion images. The pathological study with optical microscope and electron microscope were further carried on. Results: The ascending slopes of γ-variate curves were different in the perfusion quantity. The normal curve of canine myocardium showed a somewhat quick ascending pattern first, and then a gradual descending pattern successively, with the ascending time of about 10-13 s, ascending CT value of about 34-37 HU, and peak CT value of about 70-81 HU. Whereas the curve on myocardial infarction demonstrated a prolonged ascending time of about 19.9 s, diminished ascending CT value of only about 20 HU, and peak CT value of about 53.8 HU, which were significantly different from the normality (P<0.05). Conclusion: There are some differences in γ-variate curves between normal myocardium and myocardial infarction, which can be detected by CT perfusion scan. (authors)

  10. Exercise myocardial perfusion scintigraphy is useful for evaluating myocardial ischemia even in the elderly

    Energy Technology Data Exchange (ETDEWEB)

    Kurata, Chinori; Uehara, Akihiko; Sugi, Toshihiko; Yamazaki, Keisuke [Hamamatsu Univ. School of Medicine, Shizuoka (Japan); Tawarahara, Kei; Mikami, Tadashi; Matoh, Fumitaka; Odagiri, Keiichi

    2000-06-01

    Pharmacologic stress testing is recommended to elderly patients as a valuable alternative to exercise testing. We examined whether exercise testing is as useful for evaluating myocardial ischemia in the elderly as in the young. The consecutive 1,508 patients who underwent exercise {sup 201}Tl single-photon emission computed tomography (SPECT) were divided into six age groups: 6-29 years (n=56), 30-44 (n=143), 45-54 (n=311), 55-64 (n=498), 65-74 (n=402), and 75-88 (n=98). Both heart rate and rate-pressure product at peak exercise were significantly lower in patients aged 75-88 than in the other five groups. The frequency of ischemic ST depression was higher in patients aged 75-88 than in those aged 6-74, although the difference was not significant. Moreover, the frequency of {sup 201}Tl transient defect was significantly higher in patients aged 75-88 than in those aged 6-74. On the other hand, the sensitivity of ischemic ST depression for {sup 201}Tl transient defect was similar among the six groups, but the specificity was significantly lower in patients aged 75-88 than in those aged 6-74. In conclusion, exercise {sup 201}Tl SPECT is useful for evaluating myocardial ischemia even in the elderly, but exercise electrocardiography has limitations such as lower specificity in the elderly than {sup 201}Tl SPECT. (author)

  11. Exercise myocardial perfusion scintigraphy is useful for evaluating myocardial ischemia even in the elderly

    International Nuclear Information System (INIS)

    Kurata, Chinori; Uehara, Akihiko; Sugi, Toshihiko; Yamazaki, Keisuke; Tawarahara, Kei; Mikami, Tadashi; Matoh, Fumitaka; Odagiri, Keiichi

    2000-01-01

    Pharmacologic stress testing is recommended to elderly patients as a valuable alternative to exercise testing. We examined whether exercise testing is as useful for evaluating myocardial ischemia in the elderly as in the young. The consecutive 1,508 patients who underwent exercise 201 Tl single-photon emission computed tomography (SPECT) were divided into six age groups: 6-29 years (n=56), 30-44 (n=143), 45-54 (n=311), 55-64 (n=498), 65-74 (n=402), and 75-88 (n=98). Both heart rate and rate-pressure product at peak exercise were significantly lower in patients aged 75-88 than in the other five groups. The frequency of ischemic ST depression was higher in patients aged 75-88 than in those aged 6-74, although the difference was not significant. Moreover, the frequency of 201 Tl transient defect was significantly higher in patients aged 75-88 than in those aged 6-74. On the other hand, the sensitivity of ischemic ST depression for 201 Tl transient defect was similar among the six groups, but the specificity was significantly lower in patients aged 75-88 than in those aged 6-74. In conclusion, exercise 201 Tl SPECT is useful for evaluating myocardial ischemia even in the elderly, but exercise electrocardiography has limitations such as lower specificity in the elderly than 201 Tl SPECT. (author)

  12. Evaluation of Staff Radiation Exposure during Transthoracic Echocardiography Close to Myocardial Perfusion Imaging.

    Science.gov (United States)

    Massalha, Samia; Lugassi, Rachel; Raysberg, Elyahu; Koskosi, Amjad; Lechtenberg, Gerson; Israel, Ora; Kennedy, John A

    2018-04-03

    Transthoracic echocardiography (TTE) and myocardial perfusion imaging (MPI) are used in cardiac patients. In this study the radiation exposure of sonographers performing TTE following MPI was evaluated. Of 40 study patients, 30 underwent same-day 99m Tc sestamibi MPI and TTE, while another 10 underwent only TTE. Patients who underwent both studies were divided into three groups: right-handed TTE performed by an echocardiographer and right- and left-handed TTE performed by a cardiac sonographer. Seven thermoluminescent radiation dosimeter badges monitored the forehead, wrists, anterolateral right and left chest, sternal notch, and umbilical region of each examiner. Group characteristics were compared. Radiation exposures were deemed positive if >0.1 mSv. There were no statistical differences in patient weight and body mass index. The left-handed approach group had higher residual radioactivity (979 ± 73 vs 884 ± 73 MBq [P TTE, compared with the other two MPI groups. Radiation exposure was positive in the right anterolateral chest and hand (0.45 and 1 mSv, respectively) for the echocardiographer, the right anterolateral chest and wrist and umbilical region (0.59, 1.06, and 0.15 mSv, respectively) for the right-handed sonographer, and the left chest and hand (0.12 and 0.34 mSv, respectively) for the left-handed sonographer. Dosimeters indicated no radiation exposure in the TTE-only group. Staff members performing TTE after MPI are exposed to radiation that might warrant monitoring. Altering study sequence, adopting a left-handed approach, and using other radiation-reducing techniques can minimize the degree of exposure. Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  13. Intracoronary Administration of Allogeneic Adipose Tissue-Derived Mesenchymal Stem Cells Improves Myocardial Perfusion But Not Left Ventricle Function, in a Translational Model of Acute Myocardial Infarction.

    Science.gov (United States)

    Bobi, Joaquim; Solanes, Núria; Fernández-Jiménez, Rodrigo; Galán-Arriola, Carlos; Dantas, Ana Paula; Fernández-Friera, Leticia; Gálvez-Montón, Carolina; Rigol-Monzó, Elisabet; Agüero, Jaume; Ramírez, José; Roqué, Mercè; Bayés-Genís, Antoni; Sánchez-González, Javier; García-Álvarez, Ana; Sabaté, Manel; Roura, Santiago; Ibáñez, Borja; Rigol, Montserrat

    2017-05-03

    Autologous adipose tissue-derived mesenchymal stem cells (ATMSCs) therapy is a promising strategy to improve post-myocardial infarction outcomes. In a porcine model of acute myocardial infarction, we studied the long-term effects and the mechanisms involved in allogeneic ATMSCs administration on myocardial performance. Thirty-eight pigs underwent 50 minutes of coronary occlusion; the study was completed in 33 pigs. After reperfusion, allogeneic ATMSCs or culture medium (vehicle) were intracoronarily administered. Follow-ups were performed at short (2 days after acute myocardial infarction vehicle-treated, n=10; ATMSCs-treated, n=9) or long term (60 days after acute myocardial infarction vehicle-treated, n=7; ATMSCs-treated, n=7). At short term, infarcted myocardium analysis showed reduced apoptosis in the ATMSCs-treated animals (48.6±6% versus 55.9±5.7% in vehicle; P =0.017); enhancement of the reparative process with up-regulated vascular endothelial growth factor, granulocyte macrophage colony-stimulating factor, and stromal-derived factor-1α gene expression; and increased M2 macrophages (67.2±10% versus 54.7±10.2% in vehicle; P =0.016). In long-term groups, increase in myocardial perfusion at the anterior infarct border was observed both on day-7 and day-60 cardiac magnetic resonance studies in ATMSCs-treated animals, compared to vehicle (87.9±28.7 versus 57.4±17.7 mL/min per gram at 7 days; P =0.034 and 99±22.6 versus 43.3±14.7 22.6 mL/min per gram at 60 days; P =0.0001, respectively). At day 60, higher vascular density was detected at the border zone in the ATMSCs-treated animals (118±18 versus 92.4±24.3 vessels/mm 2 in vehicle; P =0.045). Cardiac magnetic resonance-measured left ventricular ejection fraction of left ventricular volumes was not different between groups at any time point. In this porcine acute myocardial infarction model, allogeneic ATMSCs-based therapy was associated with increased cardioprotective and reparative

  14. The value of myocardial perfusion scintigraphy for elective aortic abdominal aneurysm repair

    Energy Technology Data Exchange (ETDEWEB)

    Tauro, A.J.; Low, R.D.; McKay, W.J. [Austin and Repatriation Medical Centre, Heidelberg, VIC (Australia). Department of Nuclear Medicine and Centre for PET

    1998-06-01

    Full text: The value of pre-operative myocardial perfusion scintigraphy (MPS) in assessing the perioperative cardiac risk associated with elective abdominal aortic aneurysm repair (AAA) is controversial. We reviewed the files of 106 patients over the past 5 years at our institution who underwent MPS prior to elective AAA repair. The patients were stratified according to their clinical risk factors. MPS result (normal risk=normal study or likely artifact, intermediate risk=fixed defect or a single. small non-LAD (left anterior descending) reversible defect, high risk=one large reversible defect or two small non-LAD reversible defects, very high risk=increased lung uptake, post stress left ventricular dilatation or two large reversible defects including LAD territory), any subsequent coronary angiography/intervention and outcome at 12 months post surgery with regard to cardiac morbidity and mortality. 40 patients had normal MPS studies and all had AAA repairs. One patient died of a myocardial infarct 3 days after surgery. Of the 27 patients with intermediate risk MPS studies, 23 were operated on with no cardiac complications (2 refused surgery, one had a small AAA and high clinical risk and one had carcinoma). Of the 24 patients with high risk MPS, 21 underwent surgery (3 were cancelled due in part to the MPS result) with only 3 minor cardiac complications (no deaths). 13 patients had very high risk MPS and of these only 10 had AAA repairs performed (2 were deemed unsuitable for AAA repair after coronary angiography and one without angiography). Three of the 10 patients had significant post-operative cardiac events (one unstable angina and 2 myocardial infarcts). Patients with very high risk MPS had a high peri-operative cardiac complication rate (even after cancellation due to clinical selection and MPS result) and warrant further investigation. Patients with high risk scans had a low complication rate (after cancellation due to clinical selection and MPS results

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

    NARCIS (Netherlands)

    Verberne, Hein J.; Acampa, Wanda; Anagnostopoulos, Constantinos; Ballinger, Jim; Bengel, Frank; De Bondt, Pieter; Buechel, Ronny R.; Cuocolo, Alberto; van Eck-Smit, Berthe L. F.; Flotats, Albert; Hacker, Marcus; Hindorf, Cecilia; Kaufmann, Philip A.; Lindner, Oliver; Ljungberg, Michael; Lonsdale, Markus; Manrique, Alain; Minarik, David; Scholte, Arthur J. H. A.; Slart, Riemer H. J. A.; Tragardh, Elin; de Wit, Tim C.; Hesse, Birger

    2015-01-01

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

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

    NARCIS (Netherlands)

    Verberne, Hein J.; Acampa, Wanda; Anagnostopoulos, Constantinos; Ballinger, Jim; Bengel, Frank; de Bondt, Pieter; Buechel, Ronny R.; Cuocolo, Alberto; van Eck-Smit, Berthe L. F.; Flotats, Albert; Hacker, Marcus; Hindorf, Cecilia; Kaufmann, Philip A.; Lindner, Oliver; Ljungberg, Michael; Lonsdale, Markus; Manrique, Alain; Minarik, David; Scholte, Arthur J. H. A.; Slart, Riemer H. J. A.; Trägårdh, Elin; de Wit, Tim C.; Hesse, Birger

    2015-01-01

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

  18. Wiener filtering improves quantification of regional myocardial perfusion with thallium-201 SPECT

    International Nuclear Information System (INIS)

    Links, J.M.; Jeremy, R.W.; Dyer, S.M.; Frank, T.L.; Becker, L.C.

    1990-01-01

    Quantitation of myocardial perfusion with thallium-201 (201Tl) SPECT is limited by finite resolution and image noise. This study examined whether Wiener filtering could improve quantitation of the severity of myocardial perfusion deficits. In 19 anesthetized dogs, adjustable stenoses were placed on the left anterior descending (LAD, n = 12) or circumflex (LCx, n = 7) arteries. Thallium-201 SPECT images were acquired during maximal coronary vasodilation with dipyridamole, and simultaneous measurements of myocardial blood flow were made with microspheres. The relationship between SPECT and microsphere flow deficits in the LAD region was significantly better (p less than 0.05) with Wiener filtering (Y = 0.90X + 0.03, r = 0.78) than with conventional Hanning filtering (Y = 0.66X + 0.34, r = 0.61). Similarly, in the LCx region the relationship between SPECT and microsphere perfusion deficits was better (p less than 0.01) with the Wiener filter (Y = 0.91X + 0.07, r = 0.66) than with the Hanning filter (Y = 0.36X + 0.50, r = 0.40). Wiener filtering improves quantitation of the severity of regional myocardial perfusion deficits, allowing better assessment of the functional significance of coronary artery stenoses

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  20. Multi-scale parameterisation of a myocardial perfusion model using whole-organ arterial networks

    NARCIS (Netherlands)

    Hyde, Eoin R.; Cookson, Andrew N.; Lee, Jack; Michler, Christian; Goyal, Ayush; Sochi, Taha; Chabiniok, Radomir; Sinclair, Matthew; Nordsletten, David A.; Spaan, Jos; van den Wijngaard, Jeroen P. H. M.; Siebes, Maria; Smith, Nicolas P.

    2014-01-01

    A method to extract myocardial coronary permeabilities appropriate to parameterise a continuum porous perfusion model using the underlying anatomical vascular network is developed. Canine and porcine whole-heart discrete arterial models were extracted from high-resolution cryomicrotome vessel image

  1. Myocardial CT perfusion imaging in a large animal model: comparison of dynamic versus single-phase acquisitions.

    Science.gov (United States)

    Schwarz, Florian; Hinkel, Rabea; Baloch, Elisabeth; Marcus, Roy P; Hildebrandt, Kristof; Sandner, Torleif A; Kupatt, Christian; Hoffmann, Verena; Wintersperger, Bernd J; Reiser, Maximilian F; Theisen, Daniel; Nikolaou, Konstantin; Bamberg, Fabian

    2013-12-01

    This study sought to compare dynamic versus single-phase high-pitch computed tomography (CT) acquisitions for the assessment of myocardial perfusion in a porcine model with adjustable degrees of coronary stenosis. The incremental value of the 2 different approaches to CT-based myocardial perfusion imaging remains unclear. Country pigs received stent implantation in the left anterior descending coronary artery, in which an adjustable narrowing (50% and 75% stenoses) was created using a balloon catheter. All animals underwent CT-based rest and adenosine-stress myocardial perfusion imaging using dynamic and single-phase high-pitch acquisitions at both degrees of stenosis. Fluorescent microspheres served as a reference standard for myocardial blood flow. Segmental CT-based myocardial blood flow (MBFCT) was derived from dynamic acquisitions. Segmental single-phase enhancement (SPE) was recorded from high-pitch, single-phase examinations. MBFCT and SPE were compared between post-stenotic and reference segments, and receiver-operating characteristic curve analysis was performed. Among 6 animals (28 ± 2 kg), there were significant differences of MBFCT and SPE between post-stenotic and reference segments for all acquisitions at 75% stenosis. By contrast, although for 50% stenosis at rest, MBFCT was lower in post-stenotic than in reference segments (0.65 ± 0.10 ml/g/min vs. 0.75 ± 0.16 ml/g/min, p < 0.05), there was no difference for SPE (128 ± 27 Hounsfield units vs. 137 ± 35 Hounsfield units, p = 0.17), which also did not significantly change under adenosine stress. In receiver-operating characteristic curve analyses, segmental MBFCT showed significantly better performance for ischemia prediction at 75% stenosis and stress (area under the curve: 0.99 vs. 0.89, p < 0.05) as well as for 50% stenosis, regardless of adenosine administration (area under the curve: 0.74 vs. 0.57 and 0.88 vs. 0.61, respectively, both p < 0.05). At higher degrees of coronary stenosis, both

  2. Prospective assessment of regional myocardial perfusion before and after coronary revascularization surgery by quantitative thallium-201 scintigraphy

    International Nuclear Information System (INIS)

    Gibson, R.S.; Watson, D.D.; Taylor, G.J.; Crosby, I.K.; Wellons, H.L.; Holt, N.D.; Beller, G.A.

    1983-01-01

    Because thallium-201 uptake relates directly to the amount of viable myocardium and nutrient blood flow, the potential for exercise scintigraphy to predict response to coronary revascularization surgery was investigated in 47 consecutive patients. All patients underwent thallium-201 scintigraphy and coronary angiography at a mean (+/- standard deviation) of 4.3 +/- 3.1 weeks before and 7.5 +/- 1.6 weeks after surgery. Thallium uptake and washout were computer-quantified and each of six segments was defined as normal, showing total or partial redistribution or a persistent defect. Persistent defects were further classified according to the percent reduction in regional thallium activity; PD25-50 denoted a 25 to 50% constant reduction in relative thallium activity and PD greater than 50 denoted a greater than 50% reduction. Of 82 segments with total redistribution before surgery, 76 (93%) showed normal thallium uptake and washout postoperatively, versus only 16 (73%) of 22 with partial redistribution (probability [p] . 0.01). Preoperative ventriculography revealed that 95% of the segments with total redistribution had preserved wall motion, versus only 74% of those with partial redistribution (p . 0.01). Of 42 persistent defects thought to represent myocardial scar before surgery, 19 (45%) demonstrated normal perfusion postoperatively. Of the persistent defects that showed improved thallium perfusion postoperatively, 75% had normal or hypokinetic wall motion before surgery, versus only 14% of those without improvement (p less than 0.001). Whereas 57% of the persistent defects that showed a 25 to 50% decrease in myocardial activity demonstrated normal thallium uptake and washout postoperatively, only 21% of the persistent defects with a decrease in myocardial activity greater than 50% demonstrated improved perfusion after surgery (p . 0.02)

  3. Optimized saturation pulse train for human first-pass myocardial perfusion imaging at 7T.

    Science.gov (United States)

    Tao, Yuehui; Hess, Aaron T; Keith, Graeme A; Rodgers, Christopher T; Liu, Alexander; Francis, Jane M; Neubauer, Stefan; Robson, Matthew D

    2015-04-01

    To investigate whether saturation using existing methods developed for 3T imaging is feasible for clinical perfusion imaging at 7T, and to propose a new design of saturation pulse train for first-pass myocardial perfusion imaging at 7T. The new design of saturation pulse train consists of four hyperbolic-secant (HS8) radiofrequency pulses, whose peak amplitudes are optimized for a target range of static and transmit field variations and radiofrequency power deposition restrictions measured in the myocardium at 7T. The proposed method and existing methods were compared in simulation, phantom, and in vivo experiments. In healthy volunteer experiments without contrast agent, average saturation efficiency with the proposed method was 97.8%. This is superior to results from the three previously published methods at 86/95/90.8%. The first series of human first-pass myocardial perfusion images at 7T have been successfully acquired with the proposed method. Existing saturation methods developed for 3T imaging are not optimal for perfusion imaging at 7T. The proposed new design of saturation pulse train can saturate effectively, and with this method first-pass myocardial perfusion imaging is feasible in humans at 7T. © 2014 The Authors. Magnetic Resonance in Medicine Published by Wiley Periodicals, Inc. on behalf of International Society of Medicine in Resonance.

  4. Optimized Saturation Pulse Train for Human First-Pass Myocardial Perfusion Imaging at 7T

    Science.gov (United States)

    Tao, Yuehui; Hess, Aaron T; Keith, Graeme A; Rodgers, Christopher T; Liu, Alexander; Francis, Jane M; Neubauer, Stefan; Robson, Matthew D

    2015-01-01

    Purpose To investigate whether saturation using existing methods developed for 3T imaging is feasible for clinical perfusion imaging at 7T, and to propose a new design of saturation pulse train for first-pass myocardial perfusion imaging at 7T. Methods The new design of saturation pulse train consists of four hyperbolic-secant (HS8) radiofrequency pulses, whose peak amplitudes are optimized for a target range of static and transmit field variations and radiofrequency power deposition restrictions measured in the myocardium at 7T. The proposed method and existing methods were compared in simulation, phantom, and in vivo experiments. Results In healthy volunteer experiments without contrast agent, average saturation efficiency with the proposed method was 97.8%. This is superior to results from the three previously published methods at 86/95/90.8%. The first series of human first-pass myocardial perfusion images at 7T have been successfully acquired with the proposed method. Conclusion Existing saturation methods developed for 3T imaging are not optimal for perfusion imaging at 7T. The proposed new design of saturation pulse train can saturate effectively, and with this method first-pass myocardial perfusion imaging is feasible in humans at 7T. Magn Reson Med 73:1450–1456, 2015. © 2014 The Authors. Magnetic Resonance in Medicine Published by Wiley Periodicals, Inc. on behalf of International Society of Medicine in Resonance. PMID:24753130

  5. Cardiac risk stratification with myocardial perfusion imaging in potential renal-pancreas transplant recipients

    International Nuclear Information System (INIS)

    McCarthy, M.C.; Larcos, G.; Chapman, J.

    1998-01-01

    Full text: Combined renal/pancreas transplantation is used in patients with severe type-1 diabetes and renal failure. Many patients have asymptomatic coronary artery disease (CAD). Thus, myocardial perfusion imaging (MPI) is widely used for preoperative risk assessment, however, its value has recently been challenged. The purpose of this study was to determine the predictive value of MPI compared to coronary angiography and/or thirty day perioperative cardiac events (cardiac death, myocardial infarction and unstable angina). We reviewed the MPI in 132 patients that were referred for possible renal pancreas transplantation during the period between 1987 - June 1997. Fifty five patients were excluded because of: still awaiting transplantation (n=19) ongoing medical assessment (n=21), received kidney only transplant (n=6) or other factors (n=9). Thus, 77 patients form the basis of this report. Seventy one patients were transplanted, 5 had coronary angiography and one died before transplantation but with coronary anatomy defined at autopsy. All patients (39 male, 38 female; mean age 37 years) had Tl-201 or Tc-99m MIBI SPECT at Westmead (n=54) or elsewhere (n=23). Patients underwent MPI, a mean of 12.1 months before transplantation and a mean of 6 months before coronary angiography or autopsy. MPI was normal in 64 (83%) and abnormal in 13 (17%) patients. Of the abnormal MPI, 7 patients had CAD and one had unstable angina post-operatively (PPV = 8/13; 61%). One patient had a fixed defect post CABG but proceeded to transplant with-out event; the other 4 patients had normal coronary anatomy. Of the normal MPIs there were no transplant related cardiac events, but one patient required CABG >12 months post MPI and a further patient died >12 months post transplant and was shown to have CAD at autopsy (NPV=62/64;97%). In conclusion we have found an excellent NPV and an acceptable PPV for MPI in potential renal pancreas graft recipients

  6. Cardiac risk stratification with myocardial perfusion imaging in potential renal-pancreas transplant recipients

    Energy Technology Data Exchange (ETDEWEB)

    McCarthy, M.C.; Larcos, G.; Chapman, J. [Westmead Hospital, Westmead, Sydney, NSW (Australia). Departments of Nuclear Medicine and Ultrasound

    1998-06-01

    Full text: Combined renal/pancreas transplantation is used in patients with severe type-1 diabetes and renal failure. Many patients have asymptomatic coronary artery disease (CAD). Thus, myocardial perfusion imaging (MPI) is widely used for preoperative risk assessment, however, its value has recently been challenged. The purpose of this study was to determine the predictive value of MPI compared to coronary angiography and/or thirty day perioperative cardiac events (cardiac death, myocardial infarction and unstable angina). We reviewed the MPI in 132 patients that were referred for possible renal pancreas transplantation during the period between 1987 - June 1997. Fifty five patients were excluded because of: still awaiting transplantation (n=19) ongoing medical assessment (n=21), received kidney only transplant (n=6) or other factors (n=9). Thus, 77 patients form the basis of this report. Seventy one patients were transplanted, 5 had coronary angiography and one died before transplantation but with coronary anatomy defined at autopsy. All patients (39 male, 38 female; mean age 37 years) had Tl-201 or Tc-99m MIBI SPECT at Westmead (n=54) or elsewhere (n=23). Patients underwent MPI, a mean of 12.1 months before transplantation and a mean of 6 months before coronary angiography or autopsy. MPI was normal in 64 (83%) and abnormal in 13 (17%) patients. Of the abnormal MPI, 7 patients had CAD and one had unstable angina post-operatively (PPV = 8/13; 61%). One patient had a fixed defect post CABG but proceeded to transplant with-out event; the other 4 patients had normal coronary anatomy. Of the normal MPIs there were no transplant related cardiac events, but one patient required CABG >12 months post MPI and a further patient died >12 months post transplant and was shown to have CAD at autopsy (NPV=62/64;97%). In conclusion we have found an excellent NPV and an acceptable PPV for MPI in potential renal pancreas graft recipients

  7. Clinical studies on myocardial perfusion imaging in patients with right ventricular overload

    International Nuclear Information System (INIS)

    Abo, Kenji; Yamagata, Takashi; Nakajima, Masao; Fujita, Kimiaki; Morita, Nobuo

    1979-01-01

    Patients with heart disease which had been clinically diagnosed underwent 201 Tl myocardial perfusion imaging. The thickness of right ventricular wall measured from original images was directly proportional to systolic pressure of the right ventricle measured by cardiac catheterization, and 201 Tl activity in the right ventricle was more directly proportional to systolic pressure of the right ventricle. Imaging patterns of various diseases were also described. Images of patients with hypertrophic cardiomyopathy revealed that right ventricular wall was thin and right ventricular cavity was small, but the thickness of septal wall and left ventricular wall were maximal. Images of patients with mitral insufficiency revealed that the thickness of right ventricular wall, septal wall, and left ventricular wall was medium, and the right ventricular cavity was smaller than the left ventricular cavity. Images of patients with congestive cardiomyopathy and congestive cardiac failure showed that enlargement of both ventricular cavities was disproportionate to the thickness of each wall. Images of patients with arterial septal defect revealed that the thickness of each wall was comparatively normal, the right ventricular cavity was maximal, and the left ventricular cavity was minimal. Images of patients with primary pulmonary hypertention, pulmonary stenosis and tetralogy of Fallot in whom pressure overload was recognized revealed severe thickenings of right ventricular wall, moderate enlargement of the right ventricle, small left ventricle, and thin left ventricular wall. (Tsunoda, M.)

  8. Prognostic Value of Stress Dynamic Myocardial Perfusion CT in a Multicenter Population With Known or Suspected Coronary Artery Disease.

    Science.gov (United States)

    Meinel, Felix G; Pugliese, Francesca; Schoepf, U Joseph; Ebersberger, Ullrich; Wichmann, Julian L; Lo, Gladys G; Choe, Yeon Hyeon; Wang, Yining; Segreto, Sabrina; Bamberg, Fabian; De Cecco, Carlo N

    2017-04-01

    The purpose of this study was to determine the prognostic value of myocardial perfusion CT for major adverse cardiac events (MACE). Data from six centers in Asia, Europe, and North America on 144 patients with known or suspected coronary artery disease who had undergone coronary CT angiography (CCTA) and dynamic myocardial perfusion CT with a dual-source CT system were analyzed. CCTA studies were acquired at rest. Dynamic myocardial perfusion CT was performed under vasodilator stress. CCTA data were evaluated for the presence of coronary artery stenosis (≥ 50% luminal narrowing) on a per-vessel basis. Myocardial perfusion CT data were qualitatively evaluated for perfusion defects in each vessel territory. Patient follow-up was performed 6, 12, and 18 months after imaging. The prognostic value of CT findings was assessed with Kaplan-Meier statistics and the multivariate Cox proportional hazards regression model. According to the CCTA findings, 62 of 144 patients (43.1%) had at least one 50% or greater stenosis. According to the myocardial perfusion CT findings, 51 patients (35.4%) had one or more perfusion defects. Patients with at least one perfusion defect at myocardial perfusion CT were at increased risk of MACE (hazard ratio, 2.50; 95% CI, 1.34-4.65; p = 0.0040). This association remained significant after adjustment for age, sex, and clinical risk factors (hazard ratio, 2.41; 95% CI, 1.28-4.51; p = 0.0064) and after further adjustment for CCTA findings (hazard ratio, 2.03; 95% CI, 1.04-3.97; p = 0.0390). The number of territories with perfusion defects was strongly predictive of MACE with adjusted hazard ratios of 1.41, 3.44, and 4.76 for one, two, and three affected territories. In assessment for future MACE, myocardial perfusion CT has incremental predictive value over clinical risk factors and detection of coronary artery stenosis with CCTA.

  9. Hyperpolarized13C urea myocardial first-pass perfusion imaging using velocity-selective excitation.

    Science.gov (United States)

    Fuetterer, Maximilian; Busch, Julia; Peereboom, Sophie M; von Deuster, Constantin; Wissmann, Lukas; Lipiski, Miriam; Fleischmann, Thea; Cesarovic, Nikola; Stoeck, Christian T; Kozerke, Sebastian

    2017-06-21

    A velocity-selective binomial excitation scheme for myocardial first-pass perfusion measurements with hyperpolarized 13 C substrates, which preserves bolus magnetization inside the blood pool, is presented. The proposed method is evaluated against gadolinium-enhanced 1 H measurements in-vivo. The proposed excitation with an echo-planar imaging readout was implemented on a clinical CMR system. Dynamic myocardial stress perfusion images were acquired in six healthy pigs after bolus injection of hyperpolarized 13 C urea with the velocity-selective vs. conventional excitation, as well as standard 1 H gadolinium-enhanced images. Signal-to-noise, contrast-to-noise (CNR) and homogeneity of semi-quantitative perfusion measures were compared between methods based on first-pass signal-intensity time curves extracted from a mid-ventricular slice. Diagnostic feasibility is demonstrated in a case of septal infarction. Velocity-selective excitation provides over three-fold reduction in blood pool signal with a two-fold increase in myocardial CNR. Extracted first-pass perfusion curves reveal a significantly reduced variability of semi-quantitative first-pass perfusion measures (12-20%) for velocity-selective excitation compared to conventional excitation (28-93%), comparable to that of reference 1 H gadolinium data (9-15%). Overall image quality appears comparable between the velocity-selective hyperpolarized and gadolinium-enhanced imaging. The feasibility of hyperpolarized 13 C first-pass perfusion CMR has been demonstrated in swine. Comparison with reference 1 H gadolinium data revealed sufficient data quality and indicates the potential of hyperpolarized perfusion imaging for human applications.

  10. Reduced myocardial perfusion reserve and transmural perfusion gradient in heart transplant arteriopathy assessed by magnetic resonance imaging.

    Science.gov (United States)

    Muehling, Olaf M; Wilke, Norbert M; Panse, Prasad; Jerosch-Herold, Michael; Wilson, Betsy V; Wilson, Robert F; Miller, Leslie W

    2003-09-17

    The goal of this study was to detect transplant arteriopathy (Tx-CHD) by a reduced myocardial perfusion reserve (MPR) and resting endomyocardial/epimyocardial perfusion ratio (Endo/Epi ratio). Transplant arteriopathy often lacks clinical symptoms and is the reason for frequent surveillance angiography in heart transplant (Tx) recipients. Magnetic resonance perfusion imaging (MRPI) allows noninvasive assessment of transmural and selective endomyocardial and epimyocardial perfusion. Fifteen healthy volunteers (controls) and three groups (A, B, C) of Tx recipients were included. In controls and patients, MPR (hyperemic/resting perfusion) and Endo/Epi ratio were determined with MRPI after injection of gadolinium-diethylenetriamine pentaacetic acid at rest and during hyperemia (intravenous adenosine). Group A (n = 10) had no left ventricular (LV) hypertrophy and/or prior rejection, while patients in group B (n = 10) had at least one of these characteristics. Patients in group A and B had a normal coronary angiogram and a coronary flow reserve (CFR) of > or =2.5 (CFR = hyperemic/resting blood flow). Group C (n = 7) had Tx-CHD diagnosed by angiography and a reduced CFR (2.3 with sensitivity and specificity of 100% and 85%. If LV hypertrophy and prior rejection are excluded, Tx-CHD can be excluded by an Endo/Epi ratio of >1.3 with 100% and 80%. Magnetic resonance perfusion imaging detects Tx-CHD by a decreased MPR. After exclusion of LV hypertrophy and prior rejection, resting Endo/Epi ratio alone might be sufficient to indicate Tx-CHD.

  11. 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

  12. 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)

  13. Comparison of myocardial perfusion imaging between the new high-speed gamma camera and the standard anger camera

    International Nuclear Information System (INIS)

    Tanaka, Hirokazu; Chikamori, Taishiro; Hida, Satoshi

    2013-01-01

    Cadmium-zinc-telluride (CZT) solid-state detectors have been recently introduced into the field of myocardial perfusion imaging. The aim of this study was to prospectively compare the diagnostic performance of the CZT high-speed gamma camera (Discovery NM 530c) with that of the standard 3-head gamma camera in the same group of patients. The study group consisted of 150 consecutive patients who underwent a 1-day stress-rest 99m Tc-sestamibi or tetrofosmin imaging protocol. Image acquisition was performed first on a standard gamma camera with a 15-min scan time each for stress and for rest. All scans were immediately repeated on a CZT camera with a 5-min scan time for stress and a 3-min scan time for rest, using list mode. The correlations between the CZT camera and the standard camera for perfusion and function analyses were strong within narrow Bland-Altman limits of agreement. Using list mode analysis, image quality for stress was rated as good or excellent in 97% of the 3-min scans, and in 100% of the ≥4-min scans. For CZT scans at rest, similarly, image quality was rated as good or excellent in 94% of the 1-min scans, and in 100% of the ≥2-min scans. The novel CZT camera provides excellent image quality, which is equivalent to standard myocardial single-photon emission computed tomography, despite a short scan time of less than half of the standard time. (author)

  14. 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

  15. 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

  16. Image registration and analysis for quantitative myocardial perfusion: application to dynamic circular cardiac CT

    Science.gov (United States)

    Isola, A. A.; Schmitt, H.; van Stevendaal, U.; Begemann, P. G.; Coulon, P.; Boussel, L.; Grass, M.

    2011-09-01

    Large area detector computed tomography systems with fast rotating gantries enable volumetric dynamic cardiac perfusion studies. Prospectively, ECG-triggered acquisitions limit the data acquisition to a predefined cardiac phase and thereby reduce x-ray dose and limit motion artefacts. Even in the case of highly accurate prospective triggering and stable heart rate, spatial misalignment of the cardiac volumes acquired and reconstructed per cardiac cycle may occur due to small motion pattern variations from cycle to cycle. These misalignments reduce the accuracy of the quantitative analysis of myocardial perfusion parameters on a per voxel basis. An image-based solution to this problem is elastic 3D image registration of dynamic volume sequences with variable contrast, as it is introduced in this contribution. After circular cone-beam CT reconstruction of cardiac volumes covering large areas of the myocardial tissue, the complete series is aligned with respect to a chosen reference volume. The results of the registration process and the perfusion analysis with and without registration are evaluated quantitatively in this paper. The spatial alignment leads to improved quantification of myocardial perfusion for three different pig data sets.

  17. [The effect of SonoVue in endocardial border delineation and myocardial perfusion].

    Science.gov (United States)

    Fang, Li-Gang

    2004-11-01

    To evaluate the enhancement of endocardial border delineation and displaying of myocardial perfusion by the contrast agent SonoVue intravenously. Under mode of fundamental imaging and nonlinear imaging respectively, 90 patients were injected with SonoVue and observed for improvement of endocardial border delineation by two dimension echo. In the meantime, displaying of myocardial perfusion by SonoVue was also investigated under mode of nonlinear imaging. Adverse events were monitored. (1) SonoVue stained the left heart chambers of the patients right away after the right heart chambers had been stained. Endocardial border delineation of the left heart in 90 patients were all improved by SonoVue. (2) SonoVue can well display myocardial opacification (3) No serious adverse events occurred throughout the study. All nonserious adverse events were minor, mild, and rapidly self-resolving. Total incidence of adverse events was 6.8% and the incidence of adverse events possibly related to SonoVue was 1.1%. SonoVue is a safe transpulmonary agent and can satisfactorily improve the endocardial border delineation and show myocardial perfusion.

  18. 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

  19. Serial myocardial perfusion imaging: defining a significant change and targeting management decisions.

    Science.gov (United States)

    Iskandrian, Ami E; Hage, Fadi G; Shaw, Leslee J; Mahmarian, John J; Berman, Daniel S

    2014-01-01

    Myocardial perfusion imaging (MPI) with gated single-photon emission tomography provides important information on the extent and severity of myocardial perfusion abnormalities, including myocardial ischemia. The availability of software for automated quantitative assessment of myocardial perfusion in an objective and more reproducible manner than visual assessment has allowed MPI to be particularly effective in serial evaluation. Serial testing using MPI is widely used in guiding patient care despite the lack of well-defined appropriateness use criteria. This should not be surprising because ischemic heart disease is a life-long malady subject to dynamic changes throughout its natural course and particularly following man-made interventions that may improve or worsen the disease process, such as medical therapy and coronary revascularization. Serial MPI has filled an important clinical gap by providing crucial information for managing patients with changes in clinical presentations or in anticipation of such changes in patients with stable symptoms. In the research arena, serial MPI has been widely applied in randomized controlled trials to study the impact of various medical and interventional therapies on myocardial perfusion, as well as the relative merits of new imaging procedures (hardware and/or software), radiotracers, and stressor agents. Serial testing, however, unlike initial or 1-time testing, has more stringent requirements and is subject to variability because of technical, procedural, interpretational, and biological factors. The intrinsic variability of MPI becomes important in interpreting serial tests in order to define a true change in a given patient and to guide clinical decision making. The purpose of this first comprehensive review on this subject is to illustrate where serial MPI may be useful clinically and in research studies, and to highlight strategies for addressing the various issues that are unique to serial testing in order to derive

  20. Effects of aortic tortuosity on left ventricular diastolic parameters derived from gated myocardial perfusion single photon emission computed tomography in patients with normal myocardial perfusion.

    Science.gov (United States)

    Kurisu, Satoshi; Nitta, Kazuhiro; Sumimoto, Yoji; Ikenaga, Hiroki; Ishibashi, Ken; Fukuda, Yukihiro; Kihara, Yasuki

    2017-12-05

    Aortic tortuosity is often found on chest radiograph, especially in aged patients. We tested the hypothesis that aortic tortuosity was associated with LV diastolic parameters derived from gated SPECT in patients with normal myocardial perfusion. One-hundred and twenty-two patients with preserved LV ejection fraction and normal myocardial perfusion were enrolled. Descending aortic deviation was defined as the horizontal distance from the left line of the aortic knob to the most prominent left line of the descending aorta. This parameter was measured for the quantitative assessment of aortic tortuosity. Peak filling rate (PFR) and one-third mean filling rate (1/3 MFR) were obtained from redistribution images as LV diastolic parameters. Descending aortic deviation ranged from 0 to 22 mm with a mean distance of 4.5 ± 6.3 mm. Descending aortic deviation was significantly correlated with age (r = 0.38, p < 0.001) and estimated glomerular filtration rate (eGFR) (r = - 0.21, p = 0.02). Multivariate linear regression analysis revealed that eGFR (β = 0.23, p = 0.02) and descending aortic deviation (β = - 0.23, p = 0.01) were significantly associated with PFR, and that only descending aortic deviation (β = - 0.21, p = 0.03) was significantly associated with 1/3 MFR. Our data suggest that aortic tortuosity is associated with LV diastolic parameters derived from gated SPECT in patients with normal myocardial perfusion.

  1. 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)

  2. Screening for silent myocardial ischemia caseof diabetics : interest of myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Bahri, Haifa

    2007-01-01

    Silent myocardial ischemia is a major cause of morbidity and mortality in diabetic patients. Its diagnosis by noninvasive means such as myocardial SPECT would improve the management of these patients. The purpose of this study is to assess the frequency of silent myocardial ischemia in asymptomatic diabetics and their evolution. As a result, the myocardial SPECT is a reliable tool for screening for silent myocardial ischemia in diabetic patients. Its prognostic value allows to stratify the cardiac risk and guide therapeutic management. Its integration into a screening strategy in Tunisia seems limited by its low availability and cost. The latter could be reduced by better patient selection.

  3. Prognostic Value of Combined CT Angiography and Myocardial Perfusion Imaging versus Invasive Coronary Angiography and Nuclear Stress Perfusion Imaging in the Prediction of Major Adverse Cardiovascular Events: The CORE320 Multicenter Study.

    Science.gov (United States)

    Chen, Marcus Y; Rochitte, Carlos E; Arbab-Zadeh, Armin; Dewey, Marc; George, Richard T; Miller, Julie M; Niinuma, Hiroyuki; Yoshioka, Kunihiro; Kitagawa, Kakuya; Sakuma, Hajime; Laham, Roger; Vavere, Andrea L; Cerci, Rodrigo J; Mehra, Vishal C; Nomura, Cesar; Kofoed, Klaus F; Jinzaki, Masahiro; Kuribayashi, Sachio; Scholte, Arthur J; Laule, Michael; Tan, Swee Yaw; Hoe, John; Paul, Narinder; Rybicki, Frank J; Brinker, Jeffrey A; Arai, Andrew E; Matheson, Matthew B; Cox, Christopher; Clouse, Melvin E; Di Carli, Marcelo F; Lima, João A C

    2017-07-01

    Purpose To compare the prognostic importance (time to major adverse cardiovascular event [MACE]) of combined computed tomography (CT) angiography and CT myocardial stress perfusion imaging with that of combined invasive coronary angiography (ICA) and stress single photon emission CT myocardial perfusion imaging. Materials and Methods This study was approved by all institutional review boards, and written informed consent was obtained. Between November 2009 and July 2011, 381 participants clinically referred for ICA and aged 45-85 years were enrolled in the Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) prospective multicenter diagnostic study. All images were analyzed in blinded independent core laboratories, and a panel of physicians adjudicated all adverse events. MACE was defined as revascularization (>30 days after index ICA), myocardial infarction, or cardiac death; hospitalization for chest pain or congestive heart failure; or arrhythmia. Late MACE was defined similarly, except for patients who underwent revascularization within the first 182 days after ICA, who were excluded. Comparisons of 2-year survival (time to MACE) used standard Kaplan-Meier curves and restricted mean survival times bootstrapped with 2000 replicates. Results An MACE (49 revascularizations, five myocardial infarctions, one cardiac death, nine hospitalizations for chest pain or congestive heart failure, and one arrhythmia) occurred in 51 of 379 patients (13.5%). The 2-year MACE-free rates for combined CT angiography and CT perfusion findings were 94% negative for coronary artery disease (CAD) versus 82% positive for CAD and were similar to combined ICA and single photon emission CT findings (93% negative for CAD vs 77% positive for CAD, P CT angiography and CT perfusion versus ICA and single photon emission CT for either positive or negative results were not significantly different for MACE or late MACE (P

  4. Prona positioning in patients submitted to myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Cunha, C.J.; Ferreira, F.C.L.; Dullius, M.A.; Souza, S.O.; Souza, D.N.

    2011-01-01

    The myocardium perfusion scintigraphy corresponds at the nuclear medicine to one of best diagnostic methods for myocardium diseases. However, artefacts generated by the diaphragmatic tissue can induce to false positive diagnostic when does not occurs association of the image in supine position with the prone position. Images acquired at the two positions were analysed and the evaluation of tomographic images were estimation and consequently, a more completed diagnostic

  5. Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT : Theoretical Models and Current Implementation

    NARCIS (Netherlands)

    Pelgrim, G J; Handayani, A; Dijkstra, H; Prakken, N H J; Slart, R H J A; Oudkerk, M; Van Ooijen, P M A; Vliegenthart, R; Sijens, P E

    2016-01-01

    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).

  6. Value of Myocardial Perfusion Assessment With Coronary Computed Tomography Angiography in Patients With Recent Acute-Onset Chest Pain

    DEFF Research Database (Denmark)

    Sørgaard, Mathias H; Linde, Jesper J; Kühl, J Tobias

    2018-01-01

    OBJECTIVES: The authors sought to perform a randomized controlled trial to evaluate the clinical efficacy of combined examination with coronary computed tomography angiography (CTA) and computed tomography perfusion imaging (CTP) compared to coronary CTA alone. BACKGROUND: Stress myocardial CTP may...

  7. Evaluation of initial uptake and redistribution on stress thallium-201 myocardial perfusion images in patients with myocardial infarction

    International Nuclear Information System (INIS)

    Watanabe, Yoshihiko; Tonooka, Ichiroh; Kanaya, Tohru; Tsuiki, Kai; Yasui, Shouji.

    1984-01-01

    Stress thallium-201 myocardial perfusion imaging was performed on 29 patients with previous myocardial infarction and 29 patients with angina pectoris at exercise to evaluate thallium-201 kinetics in ischemic heart disease. Four views of thallium-201 images (right anterior oblique, antero-posterior, left anterior oblique and left lateral views) were obtained at 5 min after treadmill exercise with administration of 2 mCi of thallium-201 chloride (initial image) and at 3 hours later (delayed image). Myocardial images were divided into 6 segments (anterior, lateral, inferior, posterior, apical and septal segments) and initial uptake (IU) and redistribution index (RDI, the ratio of the maximal washout rate to a washout rate in each segment) were calculated in order to assess the relations of thallium-201 kinetics to wall motion abnormality and coronary artery stenosis. In myocardial infarction, IU and RDI were decreased in proportion to the severity of wall motion abnormality and coronary artery stenosis. Contrarily, in angina pectoris, IU was decreased but RDI was increased proportionally to the severity of coronary arterial stenosis. In conclusion, IU and redistribution of thallium-201 were affected essentially by both the grade of coronary arterial stenosis and the amount of residual viable heart muscle in patients with ischemic myocardial disease. (author)

  8. Transmural myocardial perfusion gradients in relation to coronary artery stenoses severity assessed by cardiac multidetector computed tomography

    DEFF Research Database (Denmark)

    Linde, Jesper James; Kühl, Jørgen Tobias; Hove, Jens Dahlgaard

    2015-01-01

    To assess the relationship between epicardial coronary artery stenosis severity and the corresponding regional transmural perfusion at rest and during adenosine stress, using multidetector computed tomography (MDCT). We evaluated the relationship between the severity of coronary artery diameter...... stenosis assessed by MDCT angiography and semi-quantitative myocardial MDCT perfusion in 200 symptomatic patients. The perfusion index (PI = mean myocardial attenuation density/mean left ventricular lumen attenuation density) at rest and during adenosine stress, the myocardial perfusion reserve (MPR...... = stress - PI/rest - PI), and the transmural perfusion ratio (TPR = subendocardium/subepicardium) were calculated. A coronary artery stenosis ≥50 % was present in 49 patients (25 %). Rest-PI and rest-TPR values were similar in patients with and without a coronary artery stenosis ≥50 %, whereas stress...

  9. Effects of diltiazem on myocardial perfusion abnormalities during exercise in patients with hypertrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

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

    1998-12-01

    The effect of diltiazem on myocardial ischemia in patients with hypertrophic cardiomyopathy (HCM) was evaluated by exercise myocardial {sup 201}Tl single photon emission computed tomography (SPECT). Exercise myocardial SPECT was performed before and 8 weeks after oral administration of diltiazem (180 mg/day) in 20 patients with HCM who showed transient perfusion defects on exercise myocardial {sup 201}Tl SPECT under control conditions. SPECT images were divided into 17 segments. The {sup 201}Tl perfusion defects were visually scored and evaluated as the defect score. The transient dilation index was calculated as an index of subendocardial ischemia. Improvement of the defect score was demonstrated in 15 patients after the administration of diltiazem. The mean defect score decreased significantly from 9.90{+-}5.17 to 5.50{+-}4.89 (p<0.0001). Although 16 of 20 patients showed an abnormal transient dilation index before diltiazem treatment, 16 showed improvement and 13 of these normalized after diltiazem therapy. The mean transient dilation index decreased from 1.16{+-}0.10 to 1.02{+-}0.09 (p<0.0001). In conclusion, diltiazem prevents or diminishes myocardial ischemia in patients with HCM. (author)

  10. Evaluation of a decision support system for interpretation of myocardial perfusion gated SPECT.

    Science.gov (United States)

    Lomsky, Milan; Gjertsson, Peter; Johansson, Lena; Richter, Jens; Ohlsson, Mattias; Tout, Deborah; van Aswegen, Andries; Underwood, S Richard; Edenbrandt, Lars

    2008-08-01

    We have recently presented a decision support system for interpreting myocardial perfusion scintigraphy (MPS). In this study, we wanted to evaluate the system in a separate hospital from where it was trained and to compare it with a quantification software package. A completely automated method based on neural networks was trained for the interpretation of MPS regarding myocardial ischaemia and infarction using 418 MPS from one hospital. Features from each examination describing rest and stress perfusion, regional and global function were used as inputs to different neural networks. After the training session, the system was evaluated using 532 MPS from another hospital. The test images were also processed with the quantification software package Emory Cardiac Toolbox (ECTb). The images were interpreted by experienced clinicians at both the training and the test hospital, regarding the presence or absence of myocardial ischaemia and/or infarction and these interpretations were used as gold standard. The neural network showed a sensitivity of 90% and a specificity of 85% for myocardial ischaemia. The specificity for the ECTb was 46% (p neural network sensitivity for myocardial infarction was 89% and the specificity 96%. The corresponding specificity for the ECTb was 54% (p neural networks presents interpretations more similar to experienced clinicians compared to a conventional automated quantification software package. This study shows the feasibility of disseminating the expertise of experienced clinicians to less experienced physicians by the use of neural networks.

  11. [99mTcN(PNP5)(NOEt)]+. A novel potential myocardial perfusion imaging agent

    International Nuclear Information System (INIS)

    Jinfeng Chu; Bin Li; Dejing Kong; Xuebin Wang; Junbo Zhang

    2006-01-01

    The asymmetrical [ 99m TcN(PNP5)(NOEt)] + heterocomplex containing a terminal technetium-nitrogen multiple bond coordinated to the diphosphine ligand (PNP5) and the dithiocarbamate ligand (NOEt), was prepared through ligand exchange reaction. Its radiochemical purity was over 90% as measured by TLC and HPLC. Biodistribution in mice and SPECT imaging in dog were studied. The results showed that [ 99m TcN(PNP5)(NOEt)] + possessed high myocardial uptake and good retention, and high target to non-target ratios, suggesting that it may be a potential myocardial perfusion imaging agent. (author)

  12. 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

    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...... 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...... countries worldwide. CT has the potential to assess both anatomy and physiology in a single imaging session. The co-primary aim of the CORE320 study is to define the per-patient diagnostic accuracy of the combination of coronary CTA and myocardial CTP to detect physiologically significant coronary artery...

  13. Influence of arm positioning on tomographic thallium-201 myocardial perfusion imaging and the effect of attenuation correction

    International Nuclear Information System (INIS)

    Prvulovich, E.M.; Jarritt, P.H.; Vorontsova, E.; Bomanji, J.B.; Ell, P.J.

    2000-01-01

    Lateral attenuation in single-photon emission tomography (SPET) myocardial perfusion imaging (MPI) has been attributed to the left arm if it is held by the patient's side during data acquisition. As a result MPI data are conventionally acquired with the arms held above the head. The aims of this study were to determine the effect of imaging arms down on reconstructed tomographic images depicting regional myocardial thallium-201 distribution and to assess whether attenuation-corrected (AC) myocardial perfusion images acquired arms down could replace uncorrected (NC) images acquired arms up for routine clinical service. Twenty-eight patients referred for routine MPI underwent sequential 180 emission/transmission imaging for attenuation correction using an L-shaped dual-headed gamma camera (GE Optima) fitted with two gadolinium-153 scanning line sources. Delay data were acquired twice: once supine with the arms up and then supine with the arms down. Detector radius of rotation (ROR) for arms up and arms-down studies was recorded. For each data set, count density was measured in 17 segments of a polar plot and segmental uptake expressed relative to study maximum. Oblique images were assessed qualitatively by two observers blinded to study type for tracer distribution and overall quality. Transmission maps were assessed for truncation. Mean detector ROR was 190 mm for arms-up studies and 232 mm for arms-down studies (P 201 Tl distribution, particularly anterolaterally. There is lateral undercorrection in approximately 10% of AC arms-down studies, possibly because of attenuation map truncation. Image quality is reduced in about one-third of AC arms-down studies compared with NC arms-up studies. These data suggest that this attenuation correction method is not sufficiently robust to allow routine acquisition of MPI data with the arms down. (orig.)

  14. 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.

  15. Qualitative and quantitative assessment of adenosine triphosphate stress whole-heart dynamic myocardial perfusion imaging using 256-slice computed tomography.

    Science.gov (United States)

    Kurata, Akira; Kawaguchi, Naoto; Kido, Teruhito; Inoue, Katsuji; Suzuki, Jun; Ogimoto, Akiyoshi; Funada, Jun-ichi; Higaki, Jitsuo; Miyagawa, Masao; Vembar, Mani; Mochizuki, Teruhito

    2013-01-01

    The aim of this study was to investigate the correlation of the qualitative transmural extent of hypoperfusion areas (HPA) using stress dynamic whole-heart computed tomography perfusion (CTP) imaging by 256-slice CT with CTP-derived myocardial blood flow (MBF) for the estimation of the severity of coronary artery stenosis. Eleven patients underwent adenosine triphosphate (0.16 mg/kg/min, 5 min) stress dynamic CTP by 256-slice CT (coverage: 8 cm, 0.27 s/rotation), and 9 of the 11 patients underwent coronary angiography (CAG). Stress dynamic CTP (whole-heart datasets over 30 consecutive heart beats in systole without spatial and temporal gaps) was acquired with prospective ECG gating (effective radiation dose: 10.4 mSv). The extent of HPAs was visually graded using a 3-point score (normal, subendocardial, transmural). MBF (ml/100g/min) was measured by deconvolution. Differences in MBF (mean ± standard error) according to HPA and CAG results were evaluated. In 27 regions (3 major coronary territories in 9 patients), 11 coronary stenoses (> 50% reduction in diameter) were observed. In 353 myocardial segments, HPA was significantly related to MBF (P 70%], 119 ± 69). The qualitative transmural extent of HPA using stress whole-heart dynamic CTP imaging by 256-slice CT exhibits a good correlation with quantitative CTP-derived MBF and may aid in assessing the hemodynamic significance of coronary artery disease.

  16. Qualitative and quantitative assessment of adenosine triphosphate stress whole-heart dynamic myocardial perfusion imaging using 256-slice computed tomography.

    Directory of Open Access Journals (Sweden)

    Akira Kurata

    Full Text Available BACKGROUND: The aim of this study was to investigate the correlation of the qualitative transmural extent of hypoperfusion areas (HPA using stress dynamic whole-heart computed tomography perfusion (CTP imaging by 256-slice CT with CTP-derived myocardial blood flow (MBF for the estimation of the severity of coronary artery stenosis. METHODS AND RESULTS: Eleven patients underwent adenosine triphosphate (0.16 mg/kg/min, 5 min stress dynamic CTP by 256-slice CT (coverage: 8 cm, 0.27 s/rotation, and 9 of the 11 patients underwent coronary angiography (CAG. Stress dynamic CTP (whole-heart datasets over 30 consecutive heart beats in systole without spatial and temporal gaps was acquired with prospective ECG gating (effective radiation dose: 10.4 mSv. The extent of HPAs was visually graded using a 3-point score (normal, subendocardial, transmural. MBF (ml/100g/min was measured by deconvolution. Differences in MBF (mean ± standard error according to HPA and CAG results were evaluated. In 27 regions (3 major coronary territories in 9 patients, 11 coronary stenoses (> 50% reduction in diameter were observed. In 353 myocardial segments, HPA was significantly related to MBF (P 70%], 119 ± 69. CONCLUSION: The qualitative transmural extent of HPA using stress whole-heart dynamic CTP imaging by 256-slice CT exhibits a good correlation with quantitative CTP-derived MBF and may aid in assessing the hemodynamic significance of coronary artery disease.

  17. 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......, were presented in random order to a group of three experienced physicians for a consensus re-interpretation; no information regarding clinical or neural network interpretations was provided to the re-evaluation panel. RESULTS: The clinical interpretation and the re-evaluation differed in 53 of the 200...

  18. Value of multidetector computed tomography evaluation of myocardial perfusion in the assessment of ischemic heart disease: comparison with nuclear perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kachenoura, Nadjia; Lodato, Joseph A.; Bardo, Dianna M.E.; Newby, Barbara; Lang, Roberto M.; Mor-Avi, Victor [University of Chicago Medical Center, Chicago, IL (United States); Gaspar, Tamar; Gips, Sarah; Peled, Nathan [Lady Davis Carmel Medical Center, Haifa (Israel)

    2009-08-15

    MDCT-derived myocardial perfusion has not yet been validated against accepted standards. We developed a technique for quantification of myocardial perfusion from MDCT images and studied its diagnostic value against SPECT myocardial perfusion imaging (MPI). Ninety-eight patients were studied. Abnormal perfusion was detected by comparing normalized segmental x-ray attenuation against values obtained in 20 control subjects. Disagreement with resting MPI was investigated in relationship to MDCT image quality, severity of MPI abnormalities, and stress MPI findings. Resting MPI detected mild or worse abnormalities in 20/78 patients. MDCT detected abnormalities in 15/20 patients (sensitivity of 0.75). Most abnormalities missed by MDCT analysis were graded as mild on MPI. Additional abnormalities found in 16/78 patients were not confirmed on resting MPI (specificity of 0.72). However, 8 of these 16 apparently false positive MDCT perfusion tests had abnormal stress MPI; of these 8 patients, 7 had optimal MDCT image quality, while in 6/8 remaining patients, image quality was suboptimal. When compared with resting MPI, MDCT detected perfusion abnormalities with high accuracy. Moreover, half of MDCT perfusion abnormalities not confirmed by resting MPI were associated with abnormal stress MPI. Importantly, this information can be obtained without additional radiation dose or contrast agent. (orig.)

  19. 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

  20. Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: a position statement

    DEFF Research Database (Denmark)

    Marcassa, C.; Bax, J.J.; Bengel, F.

    2008-01-01

    Mortality rates due to coronary artery disease (CAD) have declined in recent years as result of improved prevention, diagnosis, and management. Nonetheless, CAD remains the leading cause of death worldwide with most casualties expected to occur in developing nations. Myocardial perfusion scintigr...... that assists clinical decision-making with regard to medical treatment and intervention. A large body of evidence supports the current applications of MPS, which has become integral to several guidelines for clinical practice Udgivelsesdato: 2008/2...

  1. The progress of research on myocardial perfusion imaging in diabetic coronary disease

    International Nuclear Information System (INIS)

    Zhao Qian; Li Juan

    2007-01-01

    The morbidity of diabetes mellitus is gradually increasing. It's most important complication is cardiovascular disease. The coronary disease is the main cause of death in patients with diabetes mellitus. The stress myocardial perfusion imaging help diagnose diabetic coronary disease and prognosis judgement and risk assessment. So it can improve the living standard of patients with diabetes mellitus, and decrease the mortality of diabetes mellitus. (authors)

  2. Impact of myocardial perfusion abnormality on prognosis in patients with non-ischemic dilated cardiomyopathy

    International Nuclear Information System (INIS)

    Sobajima, Mitsuo; Nozawa, Takashi; Suzuki, Takayuki; Ohori, Takashi; Shida, Takuya; Matsuki, Akira; Inoue, Hiroshi

    2010-01-01

    Myocardial perfusion imaging shows various patterns in patients with non-ischemic dilated cardiomyopathy (DCM). However, influences of regional abnormalities of myocardial perfusion or ventricular wall motion on prognosis in DCM patients remains to be clarified. Accordingly, we investigated a relation between myocardial perfusion patterns and long-term prognosis in DCM patients. Sixty-two patients were divided into 2 groups according to patterns of 99m Tc-Tetrofosmin scintigraphy, id est (i.e.) large focal defects (focal) and minimally impaired perfusion or multiple small defects (non-focal). There were no differences between the 2 groups in left ventricular (LV) end-diastolic dimensions (63.4±9.1 and 63.8.4± 7.5 mm, respectively) and LV ejection fraction (30.3±9.2 and 27.9±7.8%, respectively), indicating LV systolic dysfunction was comparable between the groups. The focal group had a higher prevalence of brain natriuretic peptide ≥200 ng/dl and plasma norepinephrine ≥500 pg/ml than the non-focal group (p<0.05), and had longer QRS durations (p<0.05). The focal group had non-sustained ventricular tachycardia (VT) (p<0.05) on 24-h electrocardiogram recording and a history of VT/ventricular fibrillation more frequently (p<0.05), and had higher New York Heart Association functional class than the non-focal group (p<0.05). The mortality was significantly higher in the focal group (56.0%) than in the non-focal group (28.6%) and the survival curves revealed worse prognosis in the focal group during a follow-up period of 5.3±2.8 years. Non-ischemic DCM patients with focal defects are accompanied by more advanced heart failure and poor prognosis compared to those with minimally impaired perfusion or multiple small defects, despite comparable LV systolic dysfunction. (author)

  3. Beam hardening correction in CT myocardial perfusion measurement

    Science.gov (United States)

    So, Aaron; Hsieh, Jiang; Li, Jian-Ying; Lee, Ting-Yim

    2009-05-01

    This paper presents a method for correcting beam hardening (BH) in cardiac CT perfusion imaging. The proposed algorithm works with reconstructed images instead of projection data. It applies thresholds to separate low (soft tissue) and high (bone and contrast) attenuating material in a CT image. The BH error in each projection is estimated by a polynomial function of the forward projection of the segmented image. The error image is reconstructed by back-projection of the estimated errors. A BH-corrected image is then obtained by subtracting a scaled error image from the original image. Phantoms were designed to simulate the BH artifacts encountered in cardiac CT perfusion studies of humans and animals that are most commonly used in cardiac research. These phantoms were used to investigate whether BH artifacts can be reduced with our approach and to determine the optimal settings, which depend upon the anatomy of the scanned subject, of the correction algorithm for patient and animal studies. The correction algorithm was also applied to correct BH in a clinical study to further demonstrate the effectiveness of our technique.

  4. Comparison of prone and supine positions in myocardial perfusion SPECT on diaphragmatic attenuation

    International Nuclear Information System (INIS)

    Modarres Mosalla, M.M.

    2002-01-01

    Tissue attenuation effect, especially breast and diaphragm can produce artifactual defects in the myocardial perfusion SPECT. Several ways are suggested to minimize such an effect. The aim of this study is evaluation of the effect of supine and prone position on the anterior and inferior left ventricular walls during myocardial perfusion SPECT. 48 patients, 30 men and 18 women, with age of 42-73 years without typical chest pain, <15% probability of coronary artery disease, significant abdominal fat pad, and hypo activity of the inferior wall in supine position were selected. SPECT was repeated in the prone position. 22(73%) male patients and 8(44%) of female patients showed more activity of the anterior wall in the prone position (p<0.01). The anterior wall became hypoactive in 7(23%) of male patients (p<0.01) in the prone position. The anterior wall showed lesser activity in the supine position in 6(33%) of female patients (p<0.01). Although breast attenuation is more common in female, diaphragmatic attenuation can also be troublesome. In these selected women prone position minimized both effects. Prone position in the male patients decreases the attenuation effect of diaphragm significantly but may cause false defect in the anterior wall. Myocardial perfusion SPECT is preferred to be performed in prone position in both sexes, however possibility of anterior wall false defect should be considered

  5. Automatic Valve Plane Localization in Myocardial Perfusion SPECT/CT by Machine Learning: Anatomic and Clinical Validation.

    Science.gov (United States)

    Betancur, Julian; Rubeaux, Mathieu; Fuchs, Tobias A; Otaki, Yuka; Arnson, Yoav; Slipczuk, Leandro; Benz, Dominik C; Germano, Guido; Dey, Damini; Lin, Chih-Jen; Berman, Daniel S; Kaufmann, Philipp A; Slomka, Piotr J

    2017-06-01

    Precise definition of the mitral valve plane (VP) during segmentation of the left ventricle for SPECT myocardial perfusion imaging (MPI) quantification often requires manual adjustment, which affects the quantification of perfusion. We developed a machine learning approach using support vector machines (SVM) for automatic VP placement. Methods: A total of 392 consecutive patients undergoing 99m Tc-tetrofosmin stress (5 min; mean ± SD, 350 ± 54 MBq) and rest (5 min; 1,024 ± 153 MBq) fast SPECT MPI attenuation corrected (AC) by CT and same-day coronary CT angiography were studied; included in the 392 patients were 48 patients who underwent invasive coronary angiography and had no known coronary artery disease. The left ventricle was segmented with standard clinical software (quantitative perfusion SPECT) by 2 experts, adjusting the VP if needed. Two-class SVM models were computed from the expert placements with 10-fold cross validation to separate the patients used for training and those used for validation. SVM probability estimates were used to compute the best VP position. Automatic VP localizations on AC and non-AC images were compared with expert placement on coronary CT angiography. Stress and rest total perfusion deficits and detection of per-vessel obstructive stenosis by invasive coronary angiography were also compared. Results: Bland-Altman 95% confidence intervals (CIs) for VP localization by SVM and experts for AC stress images (bias, 1; 95% CI, -5 to 7 mm) and AC rest images (bias, 1; 95% CI, -7 to 10 mm) were narrower than interexpert 95% CIs for AC stress images (bias, 0; 95% CI, -8 to 8 mm) and AC rest images (bias, 0; 95% CI, -10 to 10 mm) ( P learning with SVM allows automatic and accurate VP localization, decreasing user dependence in SPECT MPI quantification. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

  6. Outcome of patients with significant coronary stenosis but without ischemic evidence on exercise myocardial perfusion scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Kawaguchi, Ren; Toyama, Takuji; Sekiguchi, Makoto; Takama, Noriaki; Adachi, Hitoshi; Naito, Shigeto; Hoshizaki, Hiroshi; Oshima, Shigeru; Taniguchi, Koichi [Gunma Prefectural Cardiovascular Center, Maebashi (Japan)

    2001-03-01

    The rates of cardiac events and coronary revascularization were evaluated in patients with significant coronary stenosis of more than 75% by the American Heart Association (AHA) classification but no ischemic evidence by exercise myocardial perfusion scintigraphy. Subjects were 171 patients (113 males, 58 females, mean age 66{+-}9 years) undergoing coronary angiography and without scintigraphic evidence of myocardial ishemia. They were divided into two groups according to the severity of coronary artery stenosis based on AHA classification. Group A was composed of 139 patients with more than 75% stenosis (101 patients with 75% stenosis and 38 patients with more than 90% stenosis), and Group B was composed of 32 patients with 50% stenosis. Cardiac events including angina pectoris (n=63), myocardial infarction (n=1), heart failure (n=2) and cardiac death (n=0), coronary revascularization and predictive factors were evaluated during follow-up of 34{+-}21 months. Furthermore, the interval between coronary revascularization and exercise myocardial perfusion scintigraphy was estimated. The rates of cardiac events (45%) and coronary revascularization (29%) in Group A were significantly higher than the rate of cardiac events (9%, p<0.05) and coronary revascularization (6%, p<0.05) in Group B. Only percentage stenosis and the number of diseased vessels affected the rates of cardiac event and coronary revascularization. Patients with significant coronary stenosis, but without ischemic evidence by exercise myocardial perfusion scintigraphy, have a relatively high rate of cardiac event and coronary revascularization, especially in patients with severe stenosis or multivessel disease. However, coronary revascularization should not be performed in all patients with significant coronary stenosis. (author)

  7. Nuclear medicine and coronary artery disease: evaluation of tracers of myocardial perfusion and vulnerable atherosclerotic plaque

    International Nuclear Information System (INIS)

    Broisat, A.

    2005-04-01

    Coronary artery disease is one of the primary cause of mortality worldwide. Nuclear medicine is the major imaging technique for diagnosis and following of this disease. perfusion: nowadays, major radioactive agents used in clinical practice are myocardial perfusion tracers. The reference tracer is thallium-201. However, 201 Tl presents some drawbacks. 99m Tcn-noet has been proposed for its replacement. This study shows that in contrast with previous studies realized in vitro on cardio myocytes, verapamil, an l-type calcium channel inhibitor, does not inhibit myocardial fixation of 99m Tcn-noet in vivo in dog. This data is in agreement with the hypothesis of a non specific endothelial fixation of this tracer. Moreover, this study shows that as a pure tracer of myocardial perfusion, 99m Tcn-noet can also be used to assess myocardial viability on a model of myocardial chronic infarction in rat. atherosclerosis: disruption of vulnerable atherosclerotic plaques is the main event leading to coronary accidents. The second part of this study concerns the evaluation of new potential tracers of the vulnerable atherosclerotic plaque in an experimental model of rabbit with an inheritable hypercholesterolemia. The four tracers evaluated (b2702(r), b2702-I, b2702-Tc and Tc-raft-b2702) are synthetic peptides comprising the residues 75-84 of hla-b2702, a molecule known to link vcam-1, an adhesion molecule expressed in vulnerable atherosclerotic plaque. The autoradiography studies show that all tracers accumulate within atherosclerotic plaque expressing vcam- and that. i-b2702 shows the best plaque/control fixation ratio. (author)

  8. 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

  9. Myocardial first-pass perfusion imaging with hybrid-EPI: frequency-offsets and potential artefacts

    Directory of Open Access Journals (Sweden)

    Ferreira Pedro F

    2012-06-01

    Full Text Available Abstract Background First-pass myocardial perfusion is often imaged with a tailored hybrid centric interleaved echo-planar-imaging sequence, providing rapid image acquisition with good contrast enhancement. The centric interleaved phase-encode order minimises the effective time-of-echo but it is sensitive to frequency-offsets. This short article aims to show possible artefacts that might originate with this sequence, in the context of first-pass perfusion imaging, when frequency-offsets are present. Non-uniform magnitude modulation effects were also analysed. Methods Numerical and phantom simulations were used to illustrate the effects of frequency-offsets and non-uniform magnitude modulation with this sequence in a typical perfusion protocol. In vivo data was post-processed to analyse the h-EPI’s sensitivity to the frequency-offsets. Results The centric phase-order was shown to be highly sensitive to frequency-offsets due to its symmetrical phase slope. Resulting artefacts include blurring, and splitting of the image into two identical copies along the phase-encode direction. It was also shown that frequency-offsets can introduce signal loss and ghosting of the right ventricle signal into the myocardium. The in vivo results were confirmed by numerical and phantom simulations. Magnitude modulation effects were found to be small. Conclusions Imaging first-pass myocardial perfusion with an hybrid centric echo-planar-imaging sequence can be corrupted with ghosting and splitting of the image due to frequency-offsets.

  10. Prevalence of myocardial perfusion abnormalities in end-stage liver disease

    International Nuclear Information System (INIS)

    Fathala, Ahmed; Safar, Bander; Al Muhaideb, Ahmed

    2011-01-01

    The prevalence of coronary artery disease (CAD) in end-stage liver disease (ESLD) being evaluated for orthotopic liver transplantation (OLT) is unclear based on variable definition used for CAD. The aim of this study to investigate the prevalence of abnormal stress myocardial perfusion single-photon emission computed tomography (MPS) imaging, as a marker for CAD, among patients with ESLD who were referred for stress MPS imaging as a routine work up before OLT. This was a single-center, retrospective study. We reviewed data on 167 patients who were referred for MPS as a routine work up before OLT over the last 2 years. All patients underwent evaluation for CAD risk factors [age, hypercholesterolemia, diabetes mellitus (DM), hypertension (HTN), and smoking], and stress MPS as per standard protocol. The total number of patients referred for stress MPS was 167. Seven patients (4% of total study population) were excluded from the study due to poor and/or nondiagnostic studies. 147 patients (92%) had normal, but only 13 patients (8%) had abnormal MPS scans. DM and male gender were the most independent risk factors for abnormal MPS with P value of 0.046, and 0.26, respectively. There was no significant association between the abnormal MPS result and HTN, hypercholesterolemia, smoking, age or etiology of the liver disease. Based on our data, the prevalence of abnormal MPS and left ventricular ejection fraction in patients with ESLD was found to be 8%. DM and male gender were the most independent predictor factors for abnormal MPS. True prevalence of CAD and usefulness of MPS in patients with ESLD can only be studied using a very large and randomized prospective study

  11. Chest Pain with Normal Thallium-201 Myocardial Perfusion Image – Is It Really Normal?

    Science.gov (United States)

    Liu, Pang-Yen; Lin, Wen-Yu; Lin, Li-Fan; Lin, Chin-Sheng; Lin, Wei-Shiang; Cheng, Shu-Meng; Yang, Shih-Ping; Liou, Jun-Ting

    2016-01-01

    Background Thallium-201 myocardial perfusion image (MPI) is commonly used to detect coronary artery disease in patients with chest pain. Although a normal thallium-201 MPI result is generally considered to be a good prognosis and further coronary angiogram is not recommended, there are still a few patients who suffer from unexpected acute coronary events. The aim of this study was to investigate the clinical prognosis in patients with normal thallium-201 MPI. Methods From January 2006 to August 2012, a total 22,003 patients undergoing thallium-201 MPI in one tertiary center were screened. Of these, 8092 patients had normal results and were investigated retrospectively. During follow-up, 54 patients underwent coronary angiogram because of refractory typical angina pectoris or unexpected acute coronary events. These 54 patients were divided into 2 groups: group I consisted of 26 (48.1%) patients with angiography-proven significant coronary artery stenosis, and group II consisted of 28 (51.9%) patients without significant stenosis. Results Patients in group I had a higher prevalence of prior coronary stenting and electrocardiographic features of ST depression compared with patients in group II. The multivariate analysis demonstrated that both prior coronary stenting and ST depression were risk predictors of unexpected acute coronary events in the patients with normal thallium-201 MPI [odds ratio (OR), 5.93; 95% confidence interval (CI): 1.03-34.06, p = 0.05 and OR, 7.10; 95% CI: 1.28-39.51, p = 0.03,respectively]. Conclusions Although there is a low incidence of unexpected acute coronary events in patients with chest pain and normal thallium-201 MPI, physicians should be aware of the potentials risk in certain patients in this specific population. PMID:27274174

  12. The effect of patient anxiety and depression on motion during myocardial perfusion SPECT imaging

    International Nuclear Information System (INIS)

    Lyra, Vassiliki; Kallergi, Maria; Rizos, Emmanouil; Lamprakopoulos, Georgios; Chatziioannou, Sofia N.

    2016-01-01

    Patient motion during myocardial perfusion SPECT imaging (MPI) may be triggered by a patient’s physical and/or psychological discomfort. The aim of this study was to investigate the impact of state anxiety (patient’s reaction to exam-related stress), trait anxiety (patient’s personality characteristic) and depression on patient motion during MPI. All patients that underwent MPI in our department in a six-month period were prospectively enrolled. One hundred eighty-three patients (45 females; 138 males) filled in the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI), along with a short questionnaire regarding their age, height and weight, level of education in years, occupation, and marital status. Cardiovascular and other co-morbidity factors were also evaluated. Through inspection of raw data on cinematic display, the presence or absence of patient motion was registered and classified into mild, moderate and severe, for both phases involved in image acquisition. The correlation of patient motion in the stress and delay phases of MPI and each of the other variables was investigated and the corresponding Pearson’s coefficients of association were calculated. The anxiety-motion (r = 0.43, P < 0.0001) and depression-motion (r = 0.32, P < 0.0001) correlation results were moderately strong and statistically significant for the female but not the male patients. All the other variables did not demonstrate any association with motion in MPI, except a weak correlation between age and motion in females (r = 0.23, P < 0.001). The relationship between anxiety-motion and depression-motion identified in female patients represents the first supporting evidence of psychological discomfort as predisposing factor for patient motion during MPI

  13. Temporal trends of stress myocardial perfusion imaging: Influence of diabetes, gender and coronary artery disease status.

    Science.gov (United States)

    Chhabra, Lovely; Ahlberg, Alan W; Henzlova, Milena J; Duvall, W Lane

    2016-01-01

    Temporal trends of myocardial perfusion imaging (MPI) among diabetics and non-diabetics and the influence of gender and prior coronary artery disease (CAD) status has not been previously investigated. Consecutive patients who underwent clinically indicated stress-MPI over a 17-year period (1996 through 2012) were studied. Data were collected prospectively as a part of the ongoing clinical databases. Study patients were divided into 4 temporal subgroups (1996 to 2000, 2001 to 2004, 2005 to 2008 and 2009 to 2012) to compare the trends of cardiac risk factors and the frequency of abnormal and ischemic MPI. Of 78,344 total stress MPI studies, 30.2% were in diabetics. The frequency of abnormal MPI studies, while substantially higher in diabetics, significantly declined over time both in diabetics (53.6% in 1996 to 39.8% in 2012) and non-diabetics (37% in 1996 to 27.4% in 2012), despite an increase in the cardiac risk factor profile. Furthermore, among patients with no known CAD, the temporal prevalence of abnormal MPI was highest in diabetic men (57.5% in 1996 to 31.9% in 2012), lowest in non-diabetic women (18.8% in 1996 to 11% in 2012), and both intermediate and comparable in non-diabetic men and diabetic women (36.4% and 35.7% in 1996 and 20.7% and 17.5% in 2012, respectively). Despite a temporal reduction in the prevalence of abnormal studies from 1996 through 2012, stress MPI continues to play an important clinical role, particularly in diabetics, men and patients with known-CAD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Assessment of left ventricular function and volumes by myocardial perfusion scintigraphy - comparison of two algorithms

    International Nuclear Information System (INIS)

    Zajic, T.; Fischer, R.; Brink, I.; Moser, E.; Krause, T.; Saurbier, B.

    2001-01-01

    Aim: Left ventricular volume and function can be computed from gated SPECT myocardial perfusion imaging using emory cardiac toolbox (ECT) or gated SPECT quantification (GS-Quant). The aim of this study was to compare both programs with respect to their practical application, stability and precision on heart-models as well as in clinical use. Methods: The volumes of five cardiac models were calculated by ECT and GS-Quant. 48 patients (13 female, 35 male) underwent a one day stress-rest protocol and gated SPECT. From these 96 gated SPECT images, left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) were estimated by ECT and GS-Quant. For 42 patients LVEF was also determined by echocardiography. Results: For the cardiac models the computed volumes showed high correlation with the model-volumes as well as high correlation between ECT and GS-Quant (r ≥0.99). Both programs underestimated the volume by approximately 20-30% independent of the ventricle-size. Calculating LVEF, EDV and ESV, GS-Quant and ECT correlated well to each other and to the LVEF estimated by echocardiography (r ≥0.86). LVEF values determined with ECT were about 10% higher than values determined with GS-Quant or echocardiography. The incorrect surfaces calculated by the automatic algorithm of GS-Quant for three examinations could not be corrected manually. 34 of the ECT studies were optimized by the operator. Conclusion: GS-Quant and ECT are two reliable programs in estimating LVEF. Both seem to underestimate the cardiac volume. In practical application GS-Quant was faster and easier to use. ECT allows the user to define the contour of the ventricle and thus is less susceptible to artifacts. (orig.) [de

  15. Importance of correct patient positioning in myocardial perfusion SPECT when using a CZT camera.

    Science.gov (United States)

    Hindorf, Cecilia; Oddstig, Jenny; Hedeer, Fredrik; Hansson, Magnus J; Jögi, Jonas; Engblom, Henrik

    2014-08-01

    Myocardial perfusion single photon emission computed tomography (MPS) is one of the most widely used diagnostic methods in patients with suspected ischemic heart disease (IHD). Recently, a novel technique based on cadmium-zinc-telluride (CZT) detectors, pinhole collimators, and a stationary gantry was introduced for MPS. The aim of this work was to investigate how patient positioning affects the reconstructed MPS images using this novel technique. Eighteen patients referred for a clinical MPS due to suspected IHD were included in the study. All patients underwent MPS imaging on a GE Discovery NM 530c CZT camera. After image acquisition with the heart positioned in the center of the quality field of view (QFOV), the patients were re-imaged in different positions 5-20 mm off-center. The heart was still positioned within the limits of the QFOV during the off-center scans. The summed stress score and/or the summed rest score (SSS and/or SRS) for the acquisition performed in the center was compared to the same parameter for the acquisitions performed off-center. There was a statistically significant increase in SSS and/or SRS when imaging was performed with the heart 5-20 mm outside the center of the QFOV compared to optimal positioning (7.7 ± 1.3 vs 6.6 ± 1.3, P = .006). The SSS and/or SRS increased with ≥2 U in 35% (14/40) of the off-center examinations. It is important to carefully position the patient's heart within the center of the QFOV when performing MPS with the Discovery NM 530c CZT camera to avoid positioning-related image artifacts that could affect the diagnostic accuracy.

  16. Quantitative evaluation of right ventricular overload with thallium-201 myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Watanabe, Toshiya; Miyakoda, Hiroyuki; Koike, Yoshihiro; Itatsu, Hidetaka; Kawai, Naoki; Sotobata, Iwao.

    1983-01-01

    Thallium-201 myocardial perfusion scintigraphy and right-heart catheterization were performed on patients with right ventricular pressure overload (RVPO) or right ventricular volume overload (RVVO). In 18 patients with RVPO, right ventricular systolic pressure correlated significantly both with the RV/LV wall thallium-201 uptake ratios (r=0.54, p<0.02) and the RV wall/background thallium-201 uptake ratios (r=0.70, p<0.01). RV/LV work ratios also significantly correlated with RV/LV wall thallium-201 uptake ratios (r=0.57, p<0.02). In 19 patients with RVVO, Qp/Qs and RV/LV work ratios both significantly correlated with RV/LV wall thallium-201 uptake ratios (r=0.78 and 0.87, respectively; p<0.001 for both) and RV wall/background thallium-201 uptake ratios (r=0.69, p<0.01 for both parameters). Right ventricular systolic pressure also correlated with RV/LV wall thallium-201 uptake ratios (r=0.57, p<0.02). Feasibility of the differentiation between RVPO and RVVO was suggested with use of ''transitional view angle'' and RV/LV diameter ratios obtained from the scintigram. In patients who underwent cardiac surgery, post-operative alleviations of the right ventricular overload were evaluated. There was a significant decrease in RV/LV wall thallium-201 uptake ratios, but no significant decrease in RV wall/background thallium-201 uptake ratios in patients with RVPO. On the other hand, there was a significant decrease both in RV/LV wall thallium-201 uptake ratios and RV wall/background thallium-201 uptake ratios in patients with RVVO. No significant changes were observed between the scintigraphic measurements obtained 1 month and 1 year after the surgery, irrespective of the type of right ventricular overloading. (J.P.N.)

  17. 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

  18. 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

  19. Myocardial uptake of cocaine and effects of cocaine on myocardial substrate utilization and perfusion in hypertensive rats

    Energy Technology Data Exchange (ETDEWEB)

    Som, P.; Wang, G.J. [Brookhaven National Lab., Upton, NY (United States); Oster, Z.H. [State Univ. of New York, Stony Brook, NY (United States); Knapp, F.F. Jr. [Oak Ridge National Lab., TN (United States); Yonekura, Y. [Kyoto Univ. (Japan). Faculty of Medicine; Fujibayashi, Y. [Kyoto Univ. (Japan). Hospital; Yamamoto, K. [Fukui Univ. (Japan). Medical School; Kubota, K. [Tohoku Univ., Sendai (Japan)

    1992-12-31

    Cocaine abuse is a problem causing world-wide concern and the number of deaths following cocaine use is increasing. Cardiovascular complications following cocaine include severe tachyarrythmias, pulmonary edema, myocardial infarction, and acute renal failure, which are major problems confronting emergency facilities. While the studies of cocaine effects on the brain have been given the most attention, it is clear that the effects of cocaine on the cardiovascular system are of great importance, given the increasing number of reports on sudden death and myocardial infarctions in young adults related to cocaine use. The precise mechanisms of cardiotoxic actions of cocaine are unclear. We investigated the whole-body distribution of C-14-labeled cocaine to determine the cocaine-binding sites, including blocking experiments to determine the nature of regional binding sites, and differential response of the normal vs. diseased heart (hypertensive cardiomyopathy) in an animal model to mimic a potentially high risk population. We investigated the acute effects of cocaine on myocardial metabolism using two myocardial energy substrate analogs, fatty acid and glucose with comparison with regional perfusion.

  20. Myocardial uptake of cocaine and effects of cocaine on myocardial substrate utilization and perfusion in hypertensive rats

    Energy Technology Data Exchange (ETDEWEB)

    Som, P.; Wang, G.J. (Brookhaven National Lab., Upton, NY (United States)); Oster, Z.H. (State Univ. of New York, Stony Brook, NY (United States)); Knapp, F.F. Jr. (Oak Ridge National Lab., TN (United States)); Yonekura, Y. (Kyoto Univ. (Japan). Faculty of Medicine); Fujibayashi, Y. (Kyoto Univ. (Japan). Hospital); Yamamoto, K. (Fukui Univ. (Japan). Medical School); Kubota, K. (Tohoku Univ., Sendai

    1992-01-01

    Cocaine abuse is a problem causing world-wide concern and the number of deaths following cocaine use is increasing. Cardiovascular complications following cocaine include severe tachyarrythmias, pulmonary edema, myocardial infarction, and acute renal failure, which are major problems confronting emergency facilities. While the studies of cocaine effects on the brain have been given the most attention, it is clear that the effects of cocaine on the cardiovascular system are of great importance, given the increasing number of reports on sudden death and myocardial infarctions in young adults related to cocaine use. The precise mechanisms of cardiotoxic actions of cocaine are unclear. We investigated the whole-body distribution of C-14-labeled cocaine to determine the cocaine-binding sites, including blocking experiments to determine the nature of regional binding sites, and differential response of the normal vs. diseased heart (hypertensive cardiomyopathy) in an animal model to mimic a potentially high risk population. We investigated the acute effects of cocaine on myocardial metabolism using two myocardial energy substrate analogs, fatty acid and glucose with comparison with regional perfusion.

  1. Correlative studies between Frank vectorcardiograms and thallium-201 myocardial perfusion images in patients with old anterior myocardial infarction

    International Nuclear Information System (INIS)

    Kawai, Naoki; Sotobata, Iwao; Inagaki, Haruo; Kondo, Teruo; Yamauchi, Kazunobu

    1982-01-01

    A correlative study was performed on 70 patients with old anterior myocardial infarction between each of the orthogonal components of instantaneous QRS vectors and the anterior-wall, lateral-wall and septal myocardial uptake ratios (A-MUR, L-MUR and S-MUR, respectively). These MURs were calculated from the thallium-201 myocardial perfusion images at 5 projections and used as the index of the infarct size of the respective LV wall. The Z components of the 14-msec and 24-msec instantaneous QRS vectors significantly correlated with the S-MUR (r = -0.51) and the A-MUR (r = -0.66) respectively. The X component of the 32-msec instantaneous QRS vector also showed a significant correlation with the L-MUR (r = 0.59). The regression equations obtained in the present study seemed also applicable to patients with complete right bundle branch block. It is concluded that the quantitative analysis of the Frank vectorcardiograms could afford valuable information as to the size as well as the site of myocardial infarctions. (author)

  2. Myocardial perfusion in type 2 diabetes with left ventricular hypertrophy: normalisation by acute angiotensin-converting enzyme inhibition

    Energy Technology Data Exchange (ETDEWEB)

    Hesse, Birger; Meyer, Christian; Hove, Jens D.; Holm, Soeren; Kofoed, Klaus F. [Department of Clinical Physiology and Nuclear Medicine, KF 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen (Denmark); Nielsen, Flemming S.; Sato, Asako; Parving, Hans-Henrik [Steno Diabetes Center, Gentofte (Denmark); Bang, Lia E.; Svendsen, Tage L. [Department of Internal Medicine, Naestved County Hospital (Denmark); Opie, Lionel H. [Department of Medicine, Cape Heart Center, University of Cape Town (South Africa)

    2004-03-01

    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 PET using nitrogen-13 ammonia infused at rest and during dipyridamole hyperaemia. Twelve healthy control subjects were included in the study, five of whom were also studied with perindoprilat. Mean blood pressure in normo-albuminuric, asymptomatic patients was 123{+-}7/65{+-}9 mmHg. Compared with controls, maximal perfusion was reduced in patients (1.8{+-}0.6 vs 2.5{+-}1.0 ml min{sup -1} g{sup -1}; P<0.05), and perfusion reserve was also lower, at borderline significance (2.7{+-}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<0.001) due to normalisation of maximal perfusion (2.3{+-}0.5 ml min{sup -1} g{sup -1}, P<0.01). In the five control subjects both resting and hyperaemic perfusion remained unchanged during perindoprilat infusion. It is concluded that acute ACE inhibition with perindoprilat improves maximal achieved myocardial perfusion in non-hypertensive patients with diabetes and LVH. (orig.)

  3. 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)

  4. IQ-SPECT for thallium-201 myocardial perfusion imaging: effect of normal databases on quantification.

    Science.gov (United States)

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

    2017-07-01

    Although IQ-single-photon emission computed tomography (SPECT) provides rapid acquisition and attenuation-corrected images, the unique technology may create characteristic distribution different from the conventional imaging. This study aimed to compare the diagnostic performance of IQ-SPECT using Japanese normal databases (NDBs) with that of the conventional SPECT for thallium-201 ( 201 Tl) myocardial perfusion imaging (MPI). A total of 36 patients underwent 1-day 201 Tl adenosine stress-rest MPI. Images were acquired with IQ-SPECT at approximately one-quarter of the standard time of conventional SPECT. Projection data acquired with the IQ-SPECT system were reconstructed via an ordered subset conjugate gradient minimizer method with or without scatter and attenuation correction (SCAC). Projection data obtained using the conventional SPECT were reconstructed via a filtered back projection method without SCAC. The summed stress score (SSS) was calculated using NDBs created by the Japanese Society of Nuclear Medicine working group, and scores were compared between IQ-SPECT and conventional SPECT using the acquisition condition-matched NDBs. The diagnostic performance of the methods for the detection of coronary artery disease was also compared. SSSs were 6.6 ± 8.2 for the conventional SPECT, 6.6 ± 9.4 for IQ-SPECT without SCAC, and 6.5 ± 9.7 for IQ-SPECT with SCAC (p = n.s. for each comparison). The SSS showed a strong positive correlation between conventional SPECT and IQ-SPECT (r = 0.921 and p IQ-SPECT with and without SCAC was also good (r = 0.907 and p IQ-SPECT without SCAC; and 88.5, 86.8, and 87.3%, respectively, for IQ-SPECT with SCAC, respectively. The area under the curve obtained via receiver operating characteristic analysis were 0.77, 0.80, and 0.86 for conventional SPECT, IQ-SPECT without SCAC, and IQ-SPECT with SCAC, respectively (p = n.s. for each comparison). When appropriate NDBs were used, the diagnostic performance of 201 Tl IQ

  5. Prognostic factors for perioperative myocardial infarction and immediate mortality in patients who underwent coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Mirtha López Ramírez

    2016-03-01

    Conclusions: Older age and higher body mass index were protective prognostic factors for perioperative acute myocardial infarction events. Prolonged surgical time and complications were independently associated with perioperative infarction and mortality after coronary artery bypass graft surgery. Low preoperative glomerular filtration rate was also associated with mortality.

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

    International Nuclear Information System (INIS)

    Taegil, K.; Bondouy, M.; Chaborel, J.P.; Franken, P.R.; Djaballah, W.; Grandpierre, S.; Marie, P.Y.; Poisson, T.; Hesse, B.; Lomsky, M.; Edenbrandt, L.

    2008-01-01

    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). Seven physicians independently interpreted 97 MPS studies, first without and then with the advice of a DSS. Four physicians had long experience and three had limited experience in the interpretation of MPS. Each study was interpreted regarding myocardial ischaemia and infarction in five myocardial regions. The patients had undergone a gated MPS using a 2-day stress/gated rest 99m Tc sestamibi protocol. The gold standard used was the interpretations made by one experienced nuclear medicine specialist on the basis of all available clinical and image information. The sensitivity for ischaemia of the seven readers increased from 81% without the DSS to 86% with the DSS (p 0.01). The increase in sensitivity was higher for the three inexperienced physicians (9%) than for the four experienced physicians (2%). There was no significant change in specificity between the interpretations. The interpretations of ischaemia made with the advice of the DSS showed less inter-observer variability than those made without advice. 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 physicians can improve their interpretation with the advice from such a system. (orig.)

  7. Quantification of myocardial perfusion based on signal intensity of flow sensitized MRI

    Science.gov (United States)

    Abeykoon, Sumeda B.

    The quantitative assessment of perfusion is important for early recognition of a variety of heart diseases, determination of disease severity and their cure. In conventional approach of measuring cardiac perfusion by arterial spin labeling, the relative difference in the apparent T1 relaxation times in response to selective and non-selective inversion of blood entering the region of interest is related to perfusion via a two-compartment tissue model. But accurate determination of T1 in small animal hearts is difficult and prone to errors due to long scan times. The purpose of this study is to develop a fast, robust and simple method to quantitatively assess myocardial perfusion using arterial spin labeling. The proposed method is based on signal intensities (SI) of inversion recovery slice-select, non-select and steady-state images. Especially in this method data are acquired at a single inversion time and at short repetition times. This study began by investigating the accuracy of assessment of perfusion using a two compartment system. First, determination of perfusion by T1 and SI were implemented to a simple, two-compartment phantom model. Mathematical model developed for full spin exchange models (in-vivo experiments) by solving a modified Bloch equation was modified to develop mathematical models (T1 and SI) for a phantom (zero spin exchange). The phantom result at different flow rates shows remarkable evidence of accuracy of the two-compartment model and SI, T1 methods: the SI method has less propagation error and less scan time. Next, twelve healthy C57BL/6 mice were scanned for quantitative perfusion assessment and three of them were repeatedly scanned at three different time points for a reproducibility test. The myocardial perfusion of healthy mice obtained by the SI-method, 5.7+/-1.6 ml/g/min, was similar (p=0.38) to that obtained by the conventional T1 method, 5.6+/- 2.3 ml/g/min. The reproducibility of the SI method shows acceptable results: the

  8. Myocardial perfusion of infarcted and normal myocardium in propofol-anesthetized minipigs using 82Rubidium PET

    DEFF Research Database (Denmark)

    Rasmussen, Thomas; Larsen, Bjarke Follin; Kastrup, Jens

    2016-01-01

    propofol, used for anesthesia, can influence myocardial perfusion and coronary flow reserve due to its vasorelaxant effect, and interactions might exist between propofol and used stress agents, potentially affecting the result of the examination. We present cardiac 82Rb-PET studies performed in propofol......Cardiac Rubidium-82 (82Rb) positron-emission-tomography (PET) is a good method for quantification of myocardial blood flow in man. Quantification of myocardial blood flow in animals to evaluate new treatment strategies or to understand underlying disease is also of great interest but raises some...... challenges. Animals, which have been anesthetized during PET acquisition, might react differently to used stress medications, and therefore difficulties might exist while evaluating the resulting PET images using standard software packages from commercial vendors optimized for human hearts. Furthermore...

  9. Quantitative myocardial perfusion by O-15-water PET

    DEFF Research Database (Denmark)

    Thomassen, Anders; Petersen, Henrik; Johansen, Allan

    2015-01-01

    disease (CAD). METHODS AND RESULTS: Forty-four patients with suspected CAD were included prospectively and underwent coronary CT-angiography and quantitative MBF assessment with O-15-water PET followed by invasive, quantitative coronary angiography, which served as reference. MBF was calculated...

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

    International Nuclear Information System (INIS)

    Camilletti, Jorge A.; Erriest, Juan; Mele, Anibal A.

    2007-01-01

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

  11. Assessment of myocardial perfusion abnormalities in patients with apical hypertrophic cardiomyopathy using exercise [sup 201]Tl scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Sugihara, Hiroki; Taniguchi, Yoko; Ohtsuki, Katsuichi (Kyoto Prefectural Univ. of Medicine (Japan)) (and others)

    1993-11-01

    Regional myocardial perfusion abnormalities commonly occur during exercise in patients with hypertrophic cardiomyopathy (HCM). Exercise [sup 201]Tl myocardial scintigraphy has provided a noninvasive means of identifying myocardial perfusion abnormalities in patients with HCM. On the other hand, apical hypertrophic cardiomyopathy (APH) is reported as a subtype of HCM. Whether APH is essentially equal to HCM or not is controversial. To assess myocardial ischemia in patients with APH, we studied 28 patients with APH, with exercise [sup 201]Tl SPECT. Myocardial perfusion images were obtained immediately after submaximal exercise and again after a 3-hour delay. Regional perfusion defects during exercise were identified in 19 of the 28 patients (68%) with APH. Complete reversible defects were observed in 15 (79%) patients with APH. Although perfusion defects were present in all regions of the left ventricle in patients with HCM, they were present only in the apical region in patients with APH. Thus, reversible [sup 201]Tl perfusion abnormalities commonly occur during exercise in patients with APH as well as in patients with HCM. (author).

  12. Computed tomography myocardial perfusion vs {sup 15}O-water positron emission tomography and fractional flow reserve

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Michelle C.; Dweck, Marc R.; Golay, Saroj K. [University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh (United Kingdom); Mirsadraee, Saeed; Weir, Nicholas W.; Fletcher, Alison; Lucatelli, Christophe; Reid, John H. [University of Edinburgh, Clinical Research Imaging Centre, Edinburgh (United Kingdom); MacGillivray, Tom; Van Beek, Edwin J.R.; Newby, David E. [University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh (United Kingdom); University of Edinburgh, Clinical Research Imaging Centre, Edinburgh (United Kingdom); Cruden, Nicholas L.; Henriksen, Peter A.; Uren, Neal [Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh (United Kingdom); McKillop, Graham; Patel, Dilip [Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh (United Kingdom); Lima, Joao A.C. [Johns Hopkins Hospital, Departments of Medicine and Radiology, Baltimore, MD (United States)

    2017-03-15

    Computed tomography (CT) can perform comprehensive cardiac imaging. We compared CT coronary angiography (CTCA) and CT myocardial perfusion (CTP) with {sup 15}O-water positron emission tomography (PET) and invasive coronary angiography (ICA) with fractional flow reserve (FFR). 51 patients (63 (61-65) years, 80 % male) with known/suspected coronary artery disease (CAD) underwent 320-multidetector CTCA followed by ''snapshot'' adenosine stress CTP. Of these 22 underwent PET and 47 ICA/FFR. Obstructive CAD was defined as CTCA stenosis >50 % and CTP hypoperfusion, ICA stenosis >70 % or FFR <0.80. PET hyperaemic myocardial blood flow (MBF) was lower in obstructive than non-obstructive territories defined by ICA/FFR (1.76 (1.32-2.20) vs 3.11 (2.44-3.79) mL/(g/min), P < 0.001) and CTCA/CTP (1.76 (1.32-2.20) vs 3.12 (2.44-3.79) mL/(g/min), P < 0.001). Baseline and hyperaemic CT attenuation density was lower in obstructive than non-obstructive territories (73 (71-76) vs 86 (84-88) HU, P < 0.001 and 101 (96-106) vs 111 (107-114) HU, P 0.001). PET hyperaemic MBF corrected for rate pressure product correlated with CT attenuation density (r = 0.579, P < 0.001). There was excellent per-patient sensitivity (96 %), specificity (85 %), negative predictive value (90 %) and positive predictive value (94 %) for CTCA/CTP vs ICA/FFR. CT myocardial attenuation density correlates with {sup 15}O-water PET MBF. CTCA and CTP can accurately identify obstructive CAD. (orig.)

  13. The value of 99mTc-MIBI myocardial perfusion imaging in detecting myocardial ischemia and judging treatment in patients with kawasaki disease

    International Nuclear Information System (INIS)

    Yu Chunjing; Du Xiaoqing; Wan Weixin; Wang Yaoming

    2010-01-01

    Objective: 99m Tc-MIBI myocardial perfusion imaging was undertaken to detect myocardial ischemia in children with Kawasaki disease in order to evaluate its diagnostic value. Methods: The subjects included 41 children with Kawasaki disease. The control group included 8 children without cardiovascular disease. The 41 patients were classified into three groups by their clinical manifestations: acute phase (n=19), sub-acute phase (n=12), and chronic phase (n=10). All patients undertaken 99m Tc-MIBI myocardial perfusion SPECT imaging. The 10 patients with positive SPECT repeated their SPECT imaging from 6 to 12 months later. Results: In the control group normal SPECT imaging was performed. Sixteen of 41 (39.02%) patients were positive in perfusion imaging. The positive rates in acute phase, sub-acute phase and chronic phase were 36.84% (7/19), 41.67% (5/12) and 40% (4/10). Ten patients with positive perfusion imaging had SPECT imaging again from 6 to 12 months later, 5 were normal, 4 improved significantly, only 1 unchanged. Conclusion: 99m Tc-MIBI myocardial perfusion imaging is a useful noninvasive method for diagnosis evaluation of myocardial ischemia in Kawasaki disease. (authors)

  14. Usefulness of the novel risk estimation software, Heart Risk View, for the prediction of cardiac events in patients with normal myocardial perfusion SPECT.

    Science.gov (United States)

    Sakatani, Tomohiko; Shimoo, Satoshi; Takamatsu, Kazuaki; Kyodo, Atsushi; Tsuji, Yumika; Mera, Kayoko; Koide, Masahiro; Isodono, Koji; Tsubakimoto, Yoshinori; Matsuo, Akiko; Inoue, Keiji; Fujita, Hiroshi

    2016-12-01

    Myocardial perfusion single-photon emission-computed tomography (SPECT) can predict cardiac events in patients with coronary artery disease with high accuracy; however, pseudo-negative cases sometimes occur. Heart Risk View, which is based on the prospective cohort study (J-ACCESS), is a software for evaluating cardiac event probability. We examined whether Heart Risk View was useful to evaluate the cardiac risk in patients with normal myocardial perfusion SPECT (MPS). We studied 3461 consecutive patients who underwent MPS to detect myocardial ischemia and those who had normal MPS were enrolled in this study (n = 698). We calculated cardiac event probability by Heart Risk View and followed-up for 3.8 ± 2.4 years. The cardiac events were defined as cardiac death, non-fatal myocardial infarction, and heart failure requiring hospitalization. During the follow-up period, 21 patients (3.0 %) had cardiac events. The event probability calculated by Heart Risk View was higher in the event group (5.5 ± 2.6 vs. 2.9 ± 2.6 %, p risk estimation by Heart Risk View adds more prognostic information, especially in patients with normal MPS.

  15. Noninvasive diagnosis of coronary arterial lesions by exercise thallium-201 myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Kawai, Naoki; Okada, Mitsuhiro; Miyakoda, Hiroyuki

    1983-01-01

    The value of exercise thallium-201 myocardial perfusion imaging (Ex MPI) for identifying diseased coronary arteries was evaluated in 57 effort angina patients without previous myocardial infarction. The territory of the individual major coronary artery on myocardial images was determined by analysis of the site of perfusion defects in 29 patients with single vessel or isolated left main disease. The anteroseptal wall was considered as the territory of the left anterior descending artery (LAD). The inferior and the posterolateral walls were assumed to be supplied by the right coronary (RCA) and the left circumflex (LCX) arteries, respectively. Ex MPI was sensitive for identifying the diseased artery in single vessel disease, the sensitivity being 86% for LAD, 66% for LCX and 71% for RCA. However, the sensitivity tended to decrease as the number of diseased vessels increased. An improved sensitivity was observed by analysis of the regional myocardial washout rate of thallium-201 in patients with triple vessel disease, in which the criterion of Tl-201 perfusion defect was not sensitive. Ex MPI was highly specific for individual coronary artery disease. Several factors supposed to affect the sensitivity of Ex MPI for detection of individual lesions were analysed. The sensitivity increased, in general, with the severity of stenosis and it was lower for a less severely diseased artery in multiple vessel disease. The presence or absence of coronary collaterals seemed not to affect the sensitivity of Ex MPI. In conclusion, Ex MPI was considered to be a useful noninvasive technique to detect the diseased coronary arteries in patients with single vessel disease or the most severely diseased artery in patients with multiple vessel disease

  16. Measurement of myocardial perfusion with electron beam tomography: comparison with {sup 99m}Tc-MIBI scan

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Koo; Choi, Jin Young; Yoo, Seok Jong [Research Institute of Radiological Science, Seoul (Korea, Republic of); And Others

    2000-07-01

    To compare the accuracy with which electron beam tomography (EBT) and {sup 99m}Tc-MIBI scanning measure myocardial perfusion valve. Twenty-two subjects (normal volunteers (n=3D6), patients in whom ischemic heart disease was diagnosed (n=3D5), and those in whom ischemic heart disease was suspected but who were found to be normal (n=3D11)) were involved in this study. EBT was performed after bolus injection of contrast media (50 ml of Iopamiro 370 or Optiray 350, 3 ml/sec). The myocardium was divided into 16 segments according to the classification devised by the American Society of Echocardiography, and each myocardial perfusion value was calculated by post-image processing. A pharmacologic stress test was performed in all subjects except four patients with acute myocardial infarction, and myocardial perfusion reserve ratios were assessed. Single photon emission computed tomography (SPECT) was performed after the injection of 20 mCi of {sup 99m}Tc-MIBI. Any segment with moderate to severe photon defect on visual analysis of SPECT were identified and perfusion values determined by EBT in normal and ischemic segments were compared. No difference in myocardial perfusion was found between volunteers and the suspected group. Their perfusion values were 0.71{+-}0.14 ml/g/min in the resting state and 1.16{+-}0.24 ml/g/min on the stress test and the myocardial perfusion reserve ratio was, therefore, 1:1.68{+-}0.38. In ischemic patients, {sup 99m}Tc-MIBI scanning revealed a perfusion defect in 28 segments, and on EBT the measurement obtained was 0.54{+-}0.19 ml/g/min. The remaining 324 perfusion segments shown by SPECT to be normal showed a perfusion value of 0.79{+-}0.22 ml/g/min on EBT. Compared with {sup 99m}Tc-MIBI scanning, the measurement of myocardial perfusion by EBT provides absolute quantification of perfusion value and more detailed anatomic information. (author)

  17. Quantification of left ventricular dilatation in myocardial perfusion scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, Mauren B. Azambuja, E-mail: medicinanuclear@hsvp.com.b, E-mail: mauren.gonzalez@gmail.co [Pontificia Universidade Catolica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS (Brazil). Clinica Medica. Programa de Pos-Graduacao em Medicina e Ciencias da Saude; Azambuja, Roberto Alves [Hospital Sao Vicente de Paulo, Passo Fundo, RS (Brazil); Bodanese, Luiz Carlos [Pontificia Universidade Catolica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS (Brazil). Hospital Sao Lucas. Serv. de Cardiologia

    2011-05-15

    Background: the rate of transient dilatation can be determined by exercise testing or pharmacological stress test. It is unknown whether the type of stress has an impact on average transient dilatation index values. Objective: to compare average transient dilation index values in 99mTc-sestamibi scintigraphy in patients undergoing treadmill stress test, versus dipyridamole stress test. The secondary purpose was to evaluate the impact on the average index value by demographic characteristics, risk factors for coronary artery disease and severity of ischemia. Methods: the cross-sectional study included 200 patients between 40 and 70 years old, with or without risk factors for ischemic heart disease, with or without a previous diagnosis of ischemic heart disease. The separation between groups was sequential. The software 4D-MSPECT calculated the transient dilatation index and provided a scoring system for perfusion analysis. Results: the average transient dilation index value of the group undergoing exercise stress test was 1.06 ({+-}0.23). For the group undergoing the dipyridamole stress test, it was 1.10 ({+-}0.22); (p = 0.200). There was no association between the type of stress and the average transient dilatation index values. An association was found between the average index values and age only for those patients from the exercise test group (p = 0.009). Conclusion: the results of our study demonstrate that the transient dilation index does not differ when patients undergo exercise stress test on a treadmill or pharmacological stress by dipyridamole. (author)

  18. Long-term prognostic implications of myocardial perfusion imaging in octogenarians: an all-comer, cohort study

    Energy Technology Data Exchange (ETDEWEB)

    Katsikis, Athanasios [Onassis Cardiac Surgery Center, Nuclear Medicine Department, Athens (Greece); 401 General Military Hospital of Athens, Cardiology Department, Athens (Greece); Theodorakos, Athanasios; Manira, Vassiliki; Koutelou, Maria [Onassis Cardiac Surgery Center, Nuclear Medicine Department, Athens (Greece); Papaioannou, Spyridon [Athens Naval Hospital, Cardiology Department, Athens (Greece); Kolovou, Genovefa; Voudris, Vassilios [Onassis Cardiac Surgery Center, Cardiology Department, Athens (Greece)

    2017-08-15

    Evaluation of the long-term prognostic value of myocardial perfusion imaging (MPI) in octogenarians. Six hundred and twenty-nine octogenarians [51% previous myocardial infarction (MI) or revascularization] who underwent single-isotope MPI (78% {sup 201}Tl, 22% {sup 99m}Tc-tetrofosmin) with exercise (38% Bruce, 2% leg ergometry) or pharmacologic (58% adenosine, 2% dobutamine) stress were studied. All patients had LVEF determined by echocardiography within 1 month from MPI. Myocardial perfusion scoring was performed on a 17-segment LV-model with a 5-point grading system and three summed stress score (SSS)-based risk categories were formed [high-(SSS > 12), low-(SSS < 4), medium]. Prospective follow-up was performed to document all-cause (ACD), cardiac death (CD), MI, and revascularization. Revascularization was used to censor follow-up in survival analysis regarding ACD, CD, and CD/MI. For analysis of the CD, MI, or late revascularization (LR) composite, only revascularizations within 3 months from MPI (early revascularizations) were used for censoring. After 9.3 years there were 187 ACDs, 86 CDs, 28 MIs, and 77 revascularizations, including 28 early revascularizations. Adjusting for LVEF and stress-modality type, SSS was identified as an independent predictor of ACD [HR 1.03 (1.01-1.05)], CD [HR 1.05 (1.03-1.08)], CD,MI [HR 1.05 (1.02-1.07)], and CD,MI or LR [HR 1.05 (1.03-1.07)] (p ≤ 0.001 in all cases). Increased lung uptake had independent prognostic value only for the CD, MI, or LR end-point [HR 3 (1.2-7.7), p = 0.02]. Survival modeling demonstrated that LVEF and SSS, but not non-perfusion scintigraphic data provided incremental prognostic value over pre-test available clinical and historical information for all end-points. Differences between Kaplan-Meier survival curves of SSS-based risk groups were significant for all end-points (p < 0.001 in all cases). In octogenarians, MPI provides effective long-term risk stratification, regardless of stress type used

  19. 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

  20. Physiological basis for angina and ST-segment change PET-verified thresholds of quantitative stress myocardial perfusion and coronary flow reserve.

    Science.gov (United States)

    Johnson, Nils P; Gould, K Lance

    2011-09-01

    This study aimed to determine the quantitative low-flow threshold for stress-induced perfusion defects with severe angina and/or significant ST-segment depression during dipyridamole hyperemia. Vasodilator stress reveals differences in regional perfusion without ischemia in most patients. However, in patients with a perfusion defect, angina, and/or significant ST-segment depression during dipyridamole stress, quantitative absolute myocardial perfusion and coronary flow reserve (CFR) at the exact moment of definite ischemia have not been established. Defining these low-flow thresholds of angina or ST-segment changes may offer insight into physiological disease severity in patients with atherosclerosis. Patients underwent rest-dipyridamole stress positron emission tomography (PET) with absolute flow quantification in ml/min/g. Definite ischemia was defined as a new or worse perfusion defect during dipyridamole stress with significant ST-segment depression and/or severe angina requiring pharmacological treatment. Indeterminate clinical features required only 1 of these 3 abnormalities. The comparison group included patients without prior myocardial infarction, or angina or electrocardiographic changes after dipyridamole. In 1,674 sequential PET studies, we identified 194 (12%) with definite ischemia, 840 (50%) studies with no ischemia, and 301 (18%) that were clinically indeterminate. A vasodilator stress perfusion cutoff of 0.91 ml/min/g optimally separated definite from no ischemia with an area under the receiver-operator characteristic curve (AUC) of 0.98 and a CFR cutoff of 1.74 with an AUC = 0.91, reflecting excellent discrimination at the exact moment of definite ischemia. Thresholds of low myocardial vasodilator stress perfusion in ml/min/g and CFR sharply separate patients with angina or ST-segment change from those without these manifestations of ischemia during dipyridamole stress with excellent discrimination. Stress flow below 0.91 ml/min/g in dipyridamole

  1. Investigation of the potential causes of partial scan artifacts in dynamic CT myocardial perfusion imaging

    Science.gov (United States)

    Tao, Yinghua; Speidel, Michael; Szczykutowicz, Timothy; Chen, Guang-Hong

    2014-03-01

    In recent years, there have been several findings regarding CT number variations (partial scan artifact or PSA) across time in dynamic myocardial perfusion studies with short scan gated reconstruction. These variations are correlated with the view angle range corresponding to the short scan acquisition for a given cardiac phase, which can vary from one cardiac cycle to another due to the asynchrony between heart rate and gantry rotation speed. In this study, we investigate several potential causes of PSA, including noise, beam hardening and scatter, using numerical simulations. In addition, we investigate partial scan artifact in a single source 64-slice diagnostic CT scanner in vivo data sets, and report its effect on perfusion analysis. Results indicated that among all three factors investigated, scatter can cause obvious partial scan artifact in dynamic myocardial perfusion imaging. Further, scatter is a low frequency phenomenon and is not heavily dependent on the changing contrasts, as both the frequency method and the virtual scan method are effective in reducing partial scan artifact. However, PSA does not necessarily lead to different blood volume maps compared to the full scan, because these maps are usually generated with a curve fitting procedure.

  2. Prognostic estimation of coronary artery disease risk with resting perfusion abnormalities and stress ischemia on myocardial perfusion SPECT.

    Science.gov (United States)

    Shaw, Leslee J; Hendel, Robert C; Heller, Gary V; Borges-Neto, Salvador; Cerqueira, Manuel; Berman, Daniel S

    2008-01-01

    The extent and severity of stress ischemia are strong predictors of coronary artery disease (CAD) events. Prognosis associated with myocardial perfusion single photon emission computed tomography (MPS) abnormalities on the resting scan as it relates to stress ischemia has been incompletely described. The Myoview Prognosis Registry was a prospective consecutive series of 7849 outpatients enrolled from 5 geographically diverse centers. Patients were followed up for the occurrence of CAD events (nonfatal myocardial infarction [MI] or death related to MI, heart failure, or sudden cardiac death). Time to CAD event (n = 545) was estimated by use of univariable and multivariable Cox proportional hazards models (risk adjusted by symptoms, risk factors, and comorbid conditions). For patients with no resting defects, overall CAD event rates were 1.2%, 8%, and 10% for patients with 0% ischemic myocardium, 1% to 4.9% ischemic myocardium, and 5% ischemic myocardium or greater, respectively (P ischemic myocardium, there was a 7% increased risk of CAD events (P disease, and MPS with provocative ischemia.

  3. Identification of residual ischemia in the occluded coronary artery irrigation area using myocardial perfusion scintigraphy

    Directory of Open Access Journals (Sweden)

    Baškot Branislav

    2007-01-01

    Full Text Available Background. Inspite the indisputable significance of coronarography, the implications of a revealed stenosis - and how close it is to occlusion could vary in regard to its physiological importance. Myocardial perfusion scintigraphy (MPS possibility to prove and objectivise the presence of ischemia and myocardial viability within an occlusion found coronarographically is especially significant since it makes possible to the clinician to choose an adequate therapy. Case report. We reported a 43- year-old male patient who had been hospitalized to another institution due to acute myocardial infarction (AMI of posterolateral localisation. Following the acute AMI stage the ergometric test per Bruce protocole was performed, negative to ischemic heart disease, while multislice computed tomography showed no significant changes on the coronary arteries. The performed one-day-protocole MPS showed a massive area of residual ischemia within myocardial infarction (MI type culprit lesion of the posterolateral zone starting from the subapical level to the basal cross-section. According to the MPS findings coronarography was indicated due to a revascularisation assessment. The performed coronarography revealed an occlusion of the circumflex coronary artery (CCA right after the division of obtuse branch (OB that presented discretely in the distal parts from the homo- and heterocolaterals. The distal portion of CCA presented discretely out off the right coronary artery (RCA. Echocardiography confirmed an ejection fraction of 50% with hypokinesia of inferior and posterior walls, as well as the septum, showing a mild reduction of the general contractility. Flows through confluences were well. A month after MI a percutane coronary intervention (PCI was performed with the implantation of a drug-releasing stent (Taxus. Early after PCI (within two weeks a control MPS was done to evaluate the effects of the therapy giving the normal findings of myocardial perfusion

  4. Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block

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    Estêvan Vieira Cabeda

    2015-01-01

    Full Text Available AbstractBackground:Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB.Objective:To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA (stenosis ≥ 70% as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA and compare the results with those of single photon emission computed tomography (SPECT myocardial perfusion scintigraphy.Methods:Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution’s ethics committee.Results:The patients’ mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001. The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001. In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001.Conclusion:The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB.

  5. Rest/exercise thallium myocardial perfusion imaging: a new and rapid technique to evaluate coronary artery disease

    International Nuclear Information System (INIS)

    Segall, G.M.; Zipkin, R.E.; Stanford Univ., CA

    1993-01-01

    Twenty-six patients underwent conventional exercise/4-h redistribution thallium myocardial perfusion imaging as well as rest/exercise imaging on different days. For the rest/exercise study, patients were inmaged 10 min after receiving 1 mCi thallium at rest. The resting study was immediately followed by symptom-limited treadmill exercise. Patients were injected with 2 mCi thallium at peak exercise and imaged 10 min later. The entire rest/exercise study was completed in 2 h. There was a high degree of correlation between the two studies. Of the 130 segments analysed, 84 were normal and 46 were abnormal by exercise/redistribution imaging whereas 88 were normal and 42 were abnormal by rest/exercise imaging. Among the 14 patients who had coronary arteriography, both exercise/redistribution and rest/exercise imaging correctly identified 23/35 segments as abnormal (sensitivity [pi003] 66% and 34/35 segments as normal (specificity=97%). Furthermore, abnormal segments were more likely to be reversible on the rest/exercise study. The results suggest that the accuracy of rest/exercise thallium imaging is equal to conventional exercise/redistribution imaging in the evaluation of coronary artery disease. The significant time economy and possible improvement in assessing myocardial viability are important potential advantages of this new technique. (Author)

  6. 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)

  7. Tc{sup 99m}-sestamibi dosimetry in myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Toledo, Janine M.; Trindade, Bruno M.; Campos, Tarcisio P.R., E-mail: janine.toledo@gmail.com [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Departamento de Engenharia Nuclear. Programa de Pos-Graduaco em Ciencias e Tecnicas Nucleares

    2015-07-01

    This paper addressed myocardial perfusion imaging providing a spatial dosimetric investigation of the {sup 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 {sup 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 {sup 99m} Tc activity, which can contribute to future deterministic effect investigations. (author)

  8. MRS algorithm: a new method for searching myocardial region in SPECT myocardial perfusion images.

    Science.gov (United States)

    He, Yuan-Lie; Tian, Lian-Fang; Chen, Ping; Li, Bin; Mao, Zhong-Yuan

    2005-10-01

    First, the necessity of automatically segmenting myocardium from myocardial SPECT image is discussed in Section 1. To eliminate the influence of the background, the optimal threshold segmentation method modified for the MRS algorithm is explained in Section 2. Then, the image erosion structure is applied to identify the myocardium region and the liver region. The contour tracing method is introduced to extract the myocardial contour. To locate the centriod of the myocardium, the myocardial centriod searching method is developed. The protocol of the MRS algorithm is summarized in Section 6. The performance of the MRS algorithm is investigated and the conclusion is drawn in Section 7. Finally, the importance of the MRS algorithm and the improvement of the MRS algorithm are discussed.

  9. Theoretical considerations in measurement of time discrepancies between input and myocardial time-signal intensity curves in estimates of regional myocardial perfusion with first-pass contrast-enhanced MRI.

    Science.gov (United States)

    Natsume, Takahiro; Ishida, Masaki; Kitagawa, Kakuya; Nagata, Motonori; Sakuma, Hajime; Ichihara, Takashi

    2015-11-01

    The purpose of this study was to develop a method to determine time discrepancies between input and myocardial time-signal intensity (TSI) curves for accurate estimation of myocardial perfusion with first-pass contrast-enhanced MRI. Estimation of myocardial perfusion with contrast-enhanced MRI using kinetic models requires faithful recording of contrast content in the blood and myocardium. Typically, the arterial input function (AIF) is obtained by setting a region of interest in the left ventricular cavity. However, there is a small delay between the AIF and the myocardial curves, and such time discrepancies can lead to errors in flow estimation using Patlak plot analysis. In this study, the time discrepancies between the arterial TSI curve and the myocardial tissue TSI curve were estimated based on the compartment model. In the early phase after the arrival of the contrast agent in the myocardium, the relationship between rate constant K1 and the concentrations of Gd-DTPA contrast agent in the myocardium and arterial blood (LV blood) can be described by the equation K1={dCmyo(tpeak)/dt}/Ca(tpeak), where Cmyo(t) and Ca(t) are the relative concentrations of Gd-DTPA contrast agent in the myocardium and in the LV blood, respectively, and tpeak is the time corresponding to the peak of Ca(t). In the ideal case, the time corresponding to the maximum upslope of Cmyo(t), tmax, is equal to tpeak. In practice, however, there is a small difference in the arrival times of the contrast agent into the LV and into the myocardium. This difference was estimated to correspond to the difference between tpeak and tmax. The magnitudes of such time discrepancies and the effectiveness of the correction for these time discrepancies were measured in 18 subjects who underwent myocardial perfusion MRI under rest and stress conditions. The effects of the time discrepancies could be corrected effectively in the myocardial perfusion estimates. Copyright © 2015 Elsevier Inc. All rights

  10. Combined magnetic resonance coronary artery imaging, myocardial perfusion and late gadolinium enhancement in patients with suspected coronary artery disease

    Directory of Open Access Journals (Sweden)

    Dreysse Stephan

    2008-10-01

    Full Text Available Abstract Background Cardiovascular Magnetic Resonance (CMR imaging offers methods for the detection of ischemia and myocardial infarction as well as visualization of the coronary arteries (MRCA. However, a direct comparison of adenosine perfusion (PERF, late gadolinium enhancement (LGE and MRCA or the results of their combination has not been performed. Aim of the study was to evaluate the feasibility/diagnostic performance of rest/stress perfusion, late gadolinium enhancement and MRCA and their combination in patients with suspected coronary artery disease (CAD in comparison to invasive angiography. Methods Fifty-four patients (60 ± 10 years, 35 men, CAD 48% underwent CMR including MRCA (steady state free precession, navigator whole heart approach, spatial resolution 0.7 × 0.7 × .0.9 mm, trigger delay and temporal resolution adjusted individually, stress PERF (adenosine 140 μg/min/kg, rest PERF (SSFP, 3 short axis, 1 saturation prepulse per slice and LGE (3D inversion recovery technique using Gd-BOPTA. Images were analyzed visually. Stenosis >50% in invasive angiography was considered significant. Results Mean study time was 68 ± 11 minutes. Sensitivity for PERF, LGE, MRCA and the combination of PERF/LGE and PERF/LGE/MRCA was 87%, 50%, 91%, 88% and 92%, respectively and specificity 88%, 96%, 46%, 88% and 56%, respectively. If image quality of MRCA was excellent (n = 18 the combination of MRCA/PERF/LGE yield a sensitivity of 86% and specificity of 91%. However, no test or combination improved diagnostic performance significantly compared to PERF alone. Conclusion In patients with CAD, the combination of stress PERF, LGE and MRCA is feasible. When compared to invasive angiography, adenosine stress perfusion outperforms CMR coronary angiography in direct comparison and yields the best results with non-significant improvement in combination with LGE and significant deterioration in combination with MRCA. MRCA may be of additional value only in

  11. 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

  12. Myocardial perfusion imaging: Lessons learned and work to be done-update.

    Science.gov (United States)

    Iskandrian, Ami E; Dilsizian, Vasken; Garcia, Ernest V; Beanlands, Rob S; Cerqueira, Manuel; Soman, Prem; Berman, Daniel S; Cuocolo, Alberto; Einstein, Andrew J; Morgan, Charity J; Hage, Fadi G; Schelbert, Heinrich R; Bax, Jeroen J; Wu, Joseph C; Shaw, Leslee J; Sadeghi, Mehran M; Tamaki, Nagara; Kaufmann, Philipp A; Gropler, Robert; Dorbala, Sharmila; Van Decker, William

    2018-02-01

    As the second term of our commitment to Journal begins, we, the editors, would like to reflect on a few topics that have relevance today. These include prognostication and paradigm shifts; Serial testing: How to handle data? Is the change in perfusion predictive of outcome and which one? Ischemia-guided therapy: fractional flow reserve vs perfusion vs myocardial blood flow; positron emission tomography (PET) imaging using Rubidium-82 vs N-13 ammonia vs F-18 Flurpiridaz; How to differentiate microvascular disease from 3-vessel disease by PET? The imaging scene outside the United States, what are the differences and similarities? Radiation exposure; Special issues with the new cameras? Is attenuation correction needed? Are there normal databases and are these specific to each camera system? And finally, hybrid imaging with single-photon emission tomography or PET combined with computed tomography angiography or coronary calcium score. We hope these topics are of interest to our readers.

  13. Potential and limitation of myocardial perfusion scintigraphy for detection of viability

    International Nuclear Information System (INIS)

    Knapp, W.H.

    1995-01-01

    Scintigraphic detection of myocardial viability is required for treatment planning and prognostication in patients with contractile dysfunction. There are four pathophysiological entities of dysfunction in coronary artery disease; one of them, ''hibernating'' myocardium, cannot be differentiated from scar or necrosis by mere perfusion imaging. Due to the determinants of delayed activity distribution after 201 Tl injection, optimized imaging protocols using this tracer allow for adequate differentiation in many instants. Differentiation between ''stunned'' and ''hibernating'' myocardium or scar is achieved with all perfusion indicators actually available. Though 201 Tl imaging with optimized protocols is almost as efficacious in viability detection as 18 F-FDG positron emission tomography, the latter actually remains the reference method particularly in patients with severe left ventricular dysfunction at coronary occlusions. (orig.) [de

  14. Contamination of clothing and other items by sweat during exercise 201Tl myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Yokoo, Shigeki; Niio, Yasuo; Yamamoto, Tomoaki; Miyashita, Makoto

    1999-01-01

    We measured the radioactivity on patient's upper and lower garments, towels, broad sashes for the bust, and electrodes contaminated by sweat due to exercise 201 Tl myocardial perfusion scintigraphy. In measuring activity, a scintillation survey meter adjusted to the energy of 201 Tl was used. In measuring the radioactivity of clothing, more than 4 Bq/cm 2 was considered to be a significant level of contamination. We detected contamination in 30% of upper garments and towels, 19% of broad sashes, 8% of lower garments and 4% of electrodes. Among these materials, several items of clothing and other items showed contamination exceeding 40 Bq/cm 2 . Towels were remarkably contaminated, with one towel showing a maximum contamination level of 420 Bq/cm 2 . Examinations done by exercise 201 Tl myocardial perfusion scintigraphy often result in the contamination of clothing and other items through sweating. This contamination is especially common in summer, particularly in upper garments and towels. The contamination ratio for towels was over 50%. The contamination ratio increased as the level of exercise became more difficult. When the exercise load was more than 100 W, the contamination ratio was 50%. In cases of extreme contamination, images of contaminated upper garments could be obtained by the scintigraphy camera. The areas of high activity on the images seemed to correspond to areas of the body where sweating was profuse. Based on these results, we should pay close attention to the handling of clothing and other items used in exercise testing by 201 Tl myocardial perfusion scintigraphy and the points used in measuring contaminated clothing and other items after testing. (author)

  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

    2009-05-21

    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 32x32 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 myocardial perfusion defect detection significantly for both rest and stress studies.

  16. Open artery hypothesis: the impact of late recanalization of infarct related artery on myocardial perfusion. A prospective randomized study -preliminary data

    International Nuclear Information System (INIS)

    Soares, J. Jr.; Silva, J.C.; Izaki, M.; Giorgi, M.C. P.; Rochitte, C.E.; Oliveira, M.A.; Martinez-Filho, E.E.; Meneghetti, J.C.; Nicolau, J.C.

    2002-01-01

    Introduction: Clinical benefits of infarct related artery recanalization later than 12 hours after acute myocardial infarction (MI) still remain unclear. Aim: To investigate whether late recanalization of infarct related artery (IRA) would improve myocardial ischemia and viability at 6-month follow-up (FU). Methods: Eighteen patients (14 male, mean age 52.7 yr.) were studied between 12 hours and 14 days after the first episode of anterior myocardial infarction. All patients showed left anterior descending artery (LAD) occluded (TIMI 0/I) on the coronary angiography. Patients underwent myocardial perfusion scintigraphy with Thallium-201 (Tl-201) dipyridamol-redistribution and reinjection (Pre-angioplasty). Those patients without evidence of myocardial ischemia or significant viability on the LAD territory were randomized to either IRA recanalization by angioplasty (OPEN group- 9 pts) or no intervention (OCCLUDED group- 9 pts). Tl-201 myocardial scintigraphy was repeated 6 months later (Post-angioplasty). The regions of the LV included in the study were divided into 6 segments: anterior wall (3 segments), septal (2), and apical wall (1). The images were analyzed quantitatively by 2 observers and the segments were scored according to the degree of Tl-201 myocardial uptake into: 4 (no uptake), 3 (severe hypoperfusion), 2 (moderate hypoperfusion), 1 (mild uptake) and 0 (normal). Wilcoxon signed-rank tests based on the mean obtained of the score in the analyzed segments according to the phases (stress, redistribution and reinjection) were used to compare the groups. Results: The results obtained are presented in the table.There was no significant difference between groups at pre-angioplasty analysis, however there was a significant decrease of ischemia and improvement on myocardial perfusion at FU in the open group. Conclusion: Patients submitted to late recanalization of IRA had less ischemia in the infarcted segments and more viable myocardium at 6 months follow

  17. 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)

  18. A generator-produced gallium-68 radiopharmaceutical for PET imaging of myocardial perfusion.

    Directory of Open Access Journals (Sweden)

    Vijay Sharma

    Full Text Available Lipophilic cationic technetium-99m-complexes are widely used for myocardial perfusion imaging (MPI. However, inherent uncertainties in the supply chain of molybdenum-99, the parent isotope required for manufacturing 99Mo/99mTc generators, intensifies the need for discovery of novel MPI agents incorporating alternative radionuclides. Recently, germanium/gallium (Ge/Ga generators capable of producing high quality 68Ga, an isotope with excellent emission characteristics for clinical PET imaging, have emerged. Herein, we report a novel 68Ga-complex identified through mechanism-based cell screening that holds promise as a generator-produced radiopharmaceutical for PET MPI.

  19. A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP).

    Science.gov (United States)

    Kim, J Y; Bae, H S

    2001-01-01

    Despite recent advances in the treatment of advanced gastric carcinomas, no satisfactory outcomes are available because of micrometastases and free-floating carcinoma cells already existing in the peritoneal cavity. From 1990, we started using intraperitoneal hyperthermo-chemo-perfusion (IHCP) to prevent and to treat peritoneal metastasis after surgical resection of stomach cancer. We analyzed 103 serosa-invasive gastric carcinoma patients who underwent surgical resection between 1990 and 1995. Fifty-two patients who received surgery plus IHCP were compared with 51 patients who underwent surgery only, as controls. IHCP was administered for 2 h with an automatic IHCP device (closed-circuit system) just after surgical resection, with the patient under hypothermic general anesthesia (32.4 degrees C-34.0 degrees C). As perfusate, we used 1.5% peritoneal dialysis solution mixed with 10 micrograms/ml of mitomycin-C (MMC), warmed at an inflow temperature of over 44 degrees C. The overall 5-year survival rate (5-YSR) of the 103 patients was 29.97%. The 5-YSR was higher in the IHCP group than in the control group, at 32.7% and 27.1%, respectively, but this difference was not significant. However, in the 65 serosa-invasive gastric carcinoma patients (excluding those in stage IV) the 5-YSR was significantly higher (P = 0.0379) in the IHCP group than in the control group, at 58.6% and 44.4%, respectively. On multivariate analysis of all 103 patients, depth of tumor invasion and lymph node metastasis were significant factors for survival, whereas significant factors on univariate analysis, such as combined operation, distant metastasis, and peritoneal metastasis, were not significant. The most common recurrence patterns were loco-regional in the IHCP group and peritoneal in the control group. Complete cytoreductive surgery plus IHCP is effective to prevent and to treat peritoneal metastasis, and it should lead to long-term survival for serosa-invasive gastric carcinoma patients

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

    International Nuclear Information System (INIS)

    Puente B, A.; Roffe G, F.; Aceves C, J.; Gomez A, E.

    2005-01-01

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

  1. Differentiation of myocardial ischemia and infarction assessed by dynamic computed tomography perfusion imaging and comparison with cardiac magnetic resonance and single-photon emission computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Tanabe, Yuki; Kido, Teruhito; Kurata, Akira; Miyagawa, Masao; Mochizuki, Teruhito [Ehime University Graduate School of Medicine, Department of Radiology, Toon, Ehime (Japan); Uetani, Teruyoshi; Kono, Tamami; Ogimoto, Akiyoshi [Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension and Nephrology, Toon, Ehime (Japan); Soma, Tsutomu [FUJIFILM RI Pharma Co., Ltd., QMS Group, Quality Assurance Department, Tokyo (Japan); Graduate School of Medicine, University of Tokyo, Department of Radiology, Tokyo (Japan); Murase, Kenya [Osaka University Graduate School of Medicine, Department of Medical Physics and Engineering, Division of Medical Technology and Science, Faculty of Health Science, Osaka (Japan); Iwaki, Hirotaka [Ehime University Graduate School of Medicine, Center for Clinical Research Data and Biostatistics, Toon, Ehime (Japan)

    2016-11-15

    To evaluate the feasibility of myocardial blood flow (MBF) by computed tomography from dynamic CT perfusion (CTP) for detecting myocardial ischemia and infarction assessed by cardiac magnetic resonance (CMR) or single-photon emission computed tomography (SPECT). Fifty-three patients who underwent stress dynamic CTP and either SPECT (n = 25) or CMR (n = 28) were retrospectively selected. Normal and abnormal perfused myocardium (ischemia/infarction) were assessed by SPECT/CMR using 16-segment model. Sensitivity and specificity of CT-MBF (mL/g/min) for detecting the ischemic/infarction and severe infarction were assessed. The abnormal perfused myocardium and severe infarction were seen in SPECT (n = 90 and n = 19 of 400 segments) and CMR (n = 223 and n = 36 of 448 segments). For detecting the abnormal perfused myocardium, sensitivity and specificity were 80 % (95 %CI, 71-90) and 86 % (95 %CI, 76-91) in SPECT (cut-off MBF, 1.23), and 82 % (95 %CI, 76-88) and 87 % (95 %CI, 80-92) in CMR (cut-off MBF, 1.25). For detecting severe infarction, sensitivity and specificity were 95 % (95 %CI, 52-100) and 72 % (95 %CI, 53-91) in SPECT (cut-off MBF, 0.92), and 78 % (95 %CI, 67-97) and 80 % (95 %CI, 58-86) in CMR (cut-off MBF, 0.98), respectively. Dynamic CTP has a potential to detect abnormal perfused myocardium and severe infarction assessed by SPECT/CMR using comparable cut-off MBF. (orig.)

  2. Myocardial perfusion cardiovascular magnetic resonance: optimized dual sequence and reconstruction for quantification.

    Science.gov (United States)

    Kellman, Peter; Hansen, Michael S; Nielles-Vallespin, Sonia; Nickander, Jannike; Themudo, Raquel; Ugander, Martin; Xue, Hui

    2017-04-07

    Quantification of myocardial blood flow requires knowledge of the amount of contrast agent in the myocardial tissue and the arterial input function (AIF) driving the delivery of this contrast agent. Accurate quantification is challenged by the lack of linearity between the measured signal and contrast agent concentration. This work characterizes sources of non-linearity and presents a systematic approach to accurate measurements of contrast agent concentration in both blood and myocardium. A dual sequence approach with separate pulse sequences for AIF and myocardial tissue allowed separate optimization of parameters for blood and myocardium. A systems approach to the overall design was taken to achieve linearity between signal and contrast agent concentration. Conversion of signal intensity values to contrast agent concentration was achieved through a combination of surface coil sensitivity correction, Bloch simulation based look-up table correction, and in the case of the AIF measurement, correction of T2* losses. Validation of signal correction was performed in phantoms, and values for peak AIF concentration and myocardial flow are provided for 29 normal subjects for rest and adenosine stress. For phantoms, the measured fits were within 5% for both AIF and myocardium. In healthy volunteers the peak [Gd] was 3.5 ± 1.2 for stress and 4.4 ± 1.2 mmol/L for rest. The T2* in the left ventricle blood pool at peak AIF was approximately 10 ms. The peak-to-valley ratio was 5.6 for the raw signal intensities without correction, and was 8.3 for the look-up-table (LUT) corrected AIF which represents approximately 48% correction. Without T2* correction the myocardial blood flow estimates are overestimated by approximately 10%. The signal-to-noise ratio of the myocardial signal at peak enhancement (1.5 T) was 17.7 ± 6.6 at stress and the peak [Gd] was 0.49 ± 0.15 mmol/L. The estimated perfusion flow was 3.9 ± 0.38 and 1.03 ± 0.19

  3. Hybrid CCTA/SPECT myocardial perfusion imaging findings in patients with anomalous origin of coronary arteries from the opposite sinus and suspected concomitant coronary artery disease.

    Science.gov (United States)

    Gräni, Christoph; Benz, Dominik C; Schmied, Christian; Vontobel, Jan; Mikulicic, Fran; Possner, Mathias; Clerc, Olivier F; Stehli, Julia; Fuchs, Tobias A; Pazhenkottil, Aju P; Gaemperli, Oliver; Buechel, Ronny R; Kaufmann, Philipp A

    2017-02-01

    Anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) are associated with adverse cardiac events. Discrimination between ACAOS and coronary artery disease (CAD)-related perfusion defects may be difficult. The aim of the present study was to investigate the value of hybrid coronary computed tomography angiography (CCTA)/SPECT-MPI in patients with ACAOS and possible concomitant CAD. We retrospectively identified 46 patients (mean age 56 ± 12 years) with ACAOS revealed by CCTA who underwent additional SPECT-MPI. ACAOS with an interarterial course were classified as malignant, whereas all other variants were considered benign. CCTA/SPECT-MPI hybrid imaging findings (ischemia or scar) were analyzed according to the territory subtended by an anomalous vessel or a stenotic coronary artery. Twenty-six (57%) patients presented with malignant ACAOS. Myocardial ischemia or scar was found only in patients who had concomitant obstructive CAD in the vessel matching the perfusion defect as evidenced by hybrid CCTA/SPECT imaging. Hybrid CCTA/SPECT-MPI represents a valuable non-invasive tool to discriminate the impact of ACAOS from concomitant CAD on myocardial ischemia. Our results suggest that in a middle-aged population myocardial ischemia due to ACAOS per se may be exceedingly rare and is more likely attributable to concomitant CAD.

  4. Feasibility of continuous venous infusion of SonoVue for qualitative assessment of reversible coronary perfusion defects in stress myocardial contrast echocardiography.

    Science.gov (United States)

    Yip, Gabriel W; Chandrasekaran, Krishnaswamy; Miller, Todd D; Hagen, Mary E; Langins, Andrew P; Khandheria, Bijoy K

    2003-12-01

    To study the feasibility of continuous intravenous SonoVue contrast echocardiography for qualitative assessment of reversible myocardial perfusion in dipyridamole stress tests. Eleven patients (10 male and 1 female, mean age 66 years) with a history of chest pain and a clinical indication for stress sestamibi single photon emission computed tomography (SPECT) underwent concurrent SonoVue 99mTc myocardial contrast echocardiography (MCE). Of the total 176 segments obtained, 53 (30%) were regarded as indeterminate, 39 (22%) as discordant, and 84 (48%) as concordant between MCE and SPECT imaging. Two patients had abnormal SPECT results. The overall feasibility and specificity of MCE were 70 and 74%, respectively. The concordant (p = 0.59) and discordant (p = 0.55) segments were comparable with either MCE technique. However, continuous low-mechanical-index imaging produced fewer indeterminate segments (17 segments, 32%) than intermittent harmonic B-mode imaging (36 segments, 68%) (p = 0.04). Significantly more indeterminate segments were found in the left anterior descending artery territory. However, the overall concordance was similar (p = 0.5) in all three coronary artery territories. The concordance and discordance rates at different left ventricular levels (i.e., basal, mid, and apical) were similar (p = 0.50 and 0.08, respectively). Continuous-infusion SonoVue contrast echocardiography is feasible, with high specificity, for detecting myocardial perfusion defects as assessed by dipyridamole SPECT.

  5. Prediction of left main or 3-vessel disease using myocardial perfusion reserve on dynamic thallium-201 single-photon emission computed tomography with a semiconductor gamma camera.

    Science.gov (United States)

    Shiraishi, Shinya; Sakamoto, Fumi; Tsuda, Noriko; Yoshida, Morikatsu; Tomiguchi, Seiji; Utsunomiya, Daisuke; Ogawa, Hisao; Yamashita, Yasuyuki

    2015-01-01

    Myocardial perfusion imaging (MPI) may fail to detect balanced ischemia. We evaluated myocardial perfusion reserve (MPR) using Tl dynamic single-photon emission computed tomography (SPECT) and a novel cadmium zinc telluride (CZT) camera for predicting 3-vessel or left main coronary artery disease (CAD). METHODS AND RESULTS: A total of 55 consecutive patients with suspected CAD underwent SPECT-MPI and coronary angiography. The MPR index was calculated using the standard 2-compartment kinetic model. We analyzed the utility of MPR index, other SPECT findings, and various clinical variables. On multivariate analysis, MPR index and history of previous myocardial infarction (MI) predicted left main and 3-vessel disease. The area under the receiver operating characteristic curve was 0.81 for MPR index, 0.699 for history of previous MI, and 0.86 for MPR index plus history of previous MI. MPR index ≤1.5 yielded the highest diagnostic accuracy. Sensitivity, specificity, and accuracy were 86%, 78%, and 80%, respectively, for MPR index, 64%, 76%, 73% for previous MI, and 57%, 93%, and 84% for MPR index plus history of previous MI. Quantification of MPR using dynamic SPECT and a novel CZT camera may identify balanced ischemia in patients with left main or 3-vessel disease.

  6. Myocardial perfusion assessed by contrast echocardiography and single photon emission computed tomography in the evaluation of patients with acute chest pain and normal electrocardiogram

    International Nuclear Information System (INIS)

    Soares, J. Jr.; Ferreira, S.M.A.; Matias, W. Jr.; Giorgi, M.C.P.; Izaki, M.; Luz, P.L.; Ramires, J.A.F.; Meneghetti, J.C.

    2002-01-01

    Aim : Evaluation of diagnostic accuracy of myocardial contrast echocardiography (MCE) in comparison with single-photon emission computed tomography (SPECT) for the detection of myocardial ischemia in patients with acute chest pain. Material and Methods : Eighteen patients (pts) with chest pain lasting ≥30 minutes, occurring within 6 hours of emergency room presentation and a normal or no diagnostic electrocardiogram were studied. Pts underwent rest MCE and SPECT. For both exams myocardial perfusion was assessed in the same 7 segments (apical, anterior, inferior, anteroseptal, inferoseptal, lateral and posterior) of left ventricle. A total of 126 segments were analyzed. Images were classified as positive for ischemia if they had a perfusion defect. Coronary angiography was performed if MCE or SPECT images were classified as positive for ischemia or by clinical indication. Otherwise the patients underwent stress SPECT. Significant coronary artery disease (CAD) was defined as ≥70% stenosis in a major coronary artery or its branches. Final diagnosis of an acute coronary event (ACE) was established in the presence of positive findings in MCE or SPECT in addition to significant CAD in the corresponding territory. Kappa statistics were calculated to evaluate the concordance between MCE and SPECT. κ values of ≤0.4, >0.4 and >0.7 indicate fair, good and excellent agreement, respectively. Results: Thirteen out of 18 pts underwent coronary angiography (seven pts had positive findings on SPECT, 2 on MCE, 2 on both exams and 1 had clinical indication). Significant CAD was detected on six. Five pts underwent stress SPECT and no perfusion defect was detected. Therefore, six pts (33.3%) had an ACE and 12 (66.6%) had not. There were no statistical differences between groups according to age, gender, duration of pain, free pain interval, presence of risk factors and antecedents. Concordance between MCE and SPECT for evaluation of perfusion defects showed a ? coefficient of 0

  7. Quantitative assessment of magnetic resonance derived myocardial perfusion measurements using advanced techniques: microsphere validation in an explanted pig heart system.

    Science.gov (United States)

    Schuster, Andreas; Zarinabad, Niloufar; Ishida, Masaki; Sinclair, Matthew; van den Wijngaard, Jeroen Phm; Morton, Geraint; Hautvast, Gilion Ltf; Bigalke, Boris; van Horssen, Pepijn; Smith, Nicolas; Spaan, Jos Ae; Siebes, Maria; Chiribiri, Amedeo; Nagel, Eike

    2014-10-14

    Cardiovascular Magnetic Resonance (CMR) myocardial perfusion imaging has the potential to evolve into a method allowing full quantification of myocardial blood flow (MBF) in clinical routine. Multiple quantification pathways have been proposed. However at present it remains unclear which algorithm is the most accurate. An isolated perfused, magnetic resonance (MR) compatible pig heart model allows very accurate titration of MBF and in combination with high-resolution assessment of fluorescently-labeled microspheres represents a near optimal platform for validation. We sought to investigate which algorithm is most suited to quantify myocardial perfusion by CMR at 1.5 and 3 Tesla using state of the art CMR perfusion techniques and quantification algorithms. First-pass perfusion CMR was performed in an MR compatible blood perfused pig heart model. We acquired perfusion images at physiological flow ("rest"), reduced flow ("ischaemia") and during adenosine-induced hyperaemia ("hyperaemia") as well as during coronary occlusion. Perfusion CMR was performed at 1.5 Tesla (n = 4 animals) and at 3 Tesla (n = 4 animals). Fluorescently-labeled microspheres and externally controlled coronary blood flow served as reference standards for comparison of different quantification strategies, namely Fermi function deconvolution (Fermi), autoregressive moving average modelling (ARMA), exponential basis deconvolution (Exponential) and B-spline basis deconvolution (B-spline). All CMR derived MBF estimates significantly correlated with microsphere results. The best correlation was achieved with Fermi function deconvolution both at 1.5 Tesla (r = 0.93, p Tesla (r = 0.9, p Tesla (p Tesla and showed the weakest correlation to microspheres (r = 0.74, p Tesla exponential deconvolution performed worst (r = 0.49, p model. Amongst the different techniques, Fermi function deconvolution was the most accurate technique at both field strengths. Perfusion CMR based on Fermi

  8. Myocardial Perfusion Tomoscintigraphy With 99mTc MIBI (SPECT MPS 99mTc MIBI) In The Assessment Of Myocardial Viability

    International Nuclear Information System (INIS)

    Pop Gjorcheva, Daniela

    2002-03-01

    Prognosis of the patients with severe coronary artery disease is highly dependent on the degree of left ventricular dysfunction. Impaired contractile performance at rest is not necessarily due to Irreversible tissue damage but may relate to the 'hibernating' myocardium which has been defined as potentially reversible, chronic contractile dysfunction during prolonged, painless ischemia. Recovery of function may occur after successful revascularization only in the presence of substantial amount of viable myocardium. The development of highly precise and predictable diagnostic methods for the identification of viable myocardium and postoperative functional improvement is crucial for reasonable preoperative selection of the patients. Detection of hibernated myocardium Is a real diagnostic challenge when FDG-Fl8 PET, as the most accurate method for myocardial viability assessment is not available and Tl 201, as already established myocardial viability marker is not routinely used. Interest for the 99mTc labeled complexes, most often 99mTc MIBI, as proved myocardial perfusion but not yet viability tracer is constantly increasing, supported by the widespread availability of this radioisotope, its better imaging and radio dosimetric properties when compared to Ti 201. The aim of this study was to evaluate the diagnostic value of different SPECT MIBI Tc99m myocardial perfusion scintigraphy (MPS) modalities performed at rest and after nitrate administration, in the detection of myocardial viability (MV) arid to compare it with rest-redistribution TI 201 MPS (R-Red) and with the control SPECT MPS Tc99m MIBI study after revascularization. In a prospective study, 176 patients (34-77yrs, 25 female, 151 male), with angiographically proved coronary artery disease, most of them with previous myocardial infarction (143/176p (81%),>6 months) and LV dysfunction (110/176p (62%), EF G-MPS 41+/-16%) underwent ECG Gated SPECT MPS Tc 99m MIBI at rest and after s.l. administration of 0,5 mg

  9. Robust dynamic myocardial perfusion CT deconvolution using adaptive-weighted tensor total variation regularization

    Science.gov (United States)

    Gong, Changfei; Zeng, Dong; Bian, Zhaoying; Huang, Jing; Zhang, Xinyu; Zhang, Hua; Lu, Lijun; Feng, Qianjin; Liang, Zhengrong; Ma, Jianhua

    2016-03-01

    Dynamic myocardial perfusion computed tomography (MPCT) is a promising technique for diagnosis and risk stratification of coronary artery disease by assessing the myocardial perfusion hemodynamic maps (MPHM). Meanwhile, the repeated scanning of the same region results in a relatively large radiation dose to patients potentially. In this work, we present a robust MPCT deconvolution algorithm with adaptive-weighted tensor total variation regularization to estimate residue function accurately under the low-dose context, which is termed `MPD-AwTTV'. More specifically, the AwTTV regularization takes into account the anisotropic edge property of the MPCT images compared with the conventional total variation (TV) regularization, which can mitigate the drawbacks of TV regularization. Subsequently, an effective iterative algorithm was adopted to minimize the associative objective function. Experimental results on a modified XCAT phantom demonstrated that the present MPD-AwTTV algorithm outperforms and is superior to other existing deconvolution algorithms in terms of noise-induced artifacts suppression, edge details preservation and accurate MPHM estimation.

  10. Safety of adenosine stress myocardial perfusion imaging by a one-route infusion protocol

    International Nuclear Information System (INIS)

    Kawai, Yuko; Kishino, Koh

    2006-01-01

    When adenosine stress testing is performed, a vein is generally accessed in each arm. To determine whether the one-route infusion protocol, that is, infusion via one upper arm vein, is safe, myocardial perfusion imaging was performed during adenosine stress testing in patients with angina pectoris. Sixty-six consecutive patients (43 men, 68±11 years of age) with suspected coronary artery disease were enrolled in this study. For the stress test, adenosine was injected at 120 μg/kg/min for 6 minutes. Systolic blood pressure, diastolic blood pressure, and heart rate did not show any significant changes after injection of the adenosine and radioisotope (RI) tracer. Adverse events during infusion of the adenosine were seen in 42 (64%) patients and included chest discomfort/oppression in 17 (26%) and dyspnea/throat discomfort in 15 (23%). On the other hand, adverse events just after infusion of the RI tracer occurred in 5 (8%) patients and included chest oppression in 2 (3%) and dyspnea in 1 (2%). Almost all adverse events disappeared quickly without treatment. Therefore, we concluded that adenosine stress myocardial perfusion imaging using a one-route infusion protocol is safe and useful to do for patients unable to secure veins in both arms. (author)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  12. Myocardial CT Perfusion Imaging and SPECT for the Diagnosis of Coronary Artery Disease: A Head-to-Head Comparison from the CORE320 Multicenter Diagnostic Performance Study

    Science.gov (United States)

    Mehra, Vishal C.; Chen, Marcus Y.; Kitagawa, Kakuya; Arbab-Zadeh, Armin; Miller, Julie M.; Matheson, Matthew B.; Vavere, Andrea L.; Kofoed, Klaus F.; Rochitte, Carlos E.; Dewey, Marc; Yaw, Tan S.; Niinuma, Hiroyuki; Brenner, Winfried; Cox, Christopher; Clouse, Melvin E.; Lima, João A. C.; Di Carli, Marcelo

    2014-01-01

    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 or pharmacologic stress SPECT before and within 60 days of coronary angiography. Images from CT perfusion imaging, SPECT, and coronary angiography were interpreted at blinded, independent core laboratories. The primary diagnostic parameter was the area under the receiver operating characteristic curve (Az). Sensitivity and specificity were calculated with use of prespecified cutoffs. The reference standard was a stenosis of at least 50% at coronary angiography as determined with quantitative methods. Results CAD was diagnosed in 229 of the 381 patients (60%). The per-patient sensitivity and specificity for the diagnosis of CAD (stenosis ≥50%) were 88% (202 of 229 patients) and 55% (83 of 152 patients), respectively, for CT perfusion imaging and 62% (143 of 229 patients) and 67% (102 of 152 patients) for SPECT, with Az values of 0.78 (95% confidence interval: 0.74, 0.82) and 0.69 (95% confidence interval: 0.64, 0.74) (P = .001). The sensitivity of CT perfusion imaging for single- and multivessel CAD was higher than that of SPECT, with sensitivities for left main, three-vessel, two-vessel, and one-vessel disease of 92%, 92%, 89%, and 83%, respectively, for CT perfusion imaging and 75%, 79%, 68%, and 41%, respectively, for SPECT. Conclusion The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis ≥50%), as demonstrated with the

  13. Myocardial uptake characteristics of three 99mTc-labeled tracers for myocardial perfusion imaging one hour after rest injection

    International Nuclear Information System (INIS)

    Manka-Waluch, A.; Palmedo, H.; Reinhardt, M.J.; Joe, A.Y.; Manka, C.; Guhlke, S.; Biersack, H.J.; Bucerius, J.

    2006-01-01

    99m Tc-tetrofosmin and 99m Tc-sestamibi are approved tracers for myocardial perfusion studies. Recently, a 99m Tc-methoxyisobutylisonitrile (MIBI) preparation from a different manufacturer ( 99m Tc-cardiospect-MIBI) has been introduced to the market. Therefore, the aim of this study was the evaluation of 99m Tc-tetrofosmin as well as of two different 99m Tc-labeled MIBI tracers with regard to differences in imaging quality under resting conditions. Sixty patients (mean age 63.8 years±1.25) with known or suspected coronary artery disease but without evidence of rest-ischemia were included. Twenty patients in each group were examined by a two-day-rest-stress protocol using the three 99m Tc-labeled tracers. Visual analysis of all images was performed by two experienced physicians blinded with regard to the applied tracer. Regions of interest (ROI) were defined over the heart, lung and whole body only in the rest imaging in order to calculate heart-to-lung, lung-to-whole body-, and heart-to-whole body-ratios. The heart-to-lung ratio was statistically significant higher for 99 m T c-cardiospect-MIBI as compared to 99m Tc-sestamibi as well as to 99m Tc-tetrofosmin. Furthermore, a significantly higher heart-to-lung ratio was found for 99m Tc-sestamibi as compared to 99m Tc-tetrofosmin. The heart-to-whole body-ratio and the lung-to-whole body-ratio were equivalent between all tracers. Visual analysis revealed only slight differences regarding image quality between all tracers. ROI analysis surprisingly revealed a significant higher myocardial uptake and consequently a higher heart-to-lung ratio for 99m Tc-cardiospect-MIBI. Whether this leads to a better visual image quality has to be evaluated in future studies with larger study populations as well as semiquantitative segmental analysis of the myocardial perfusion images. (author)

  14. Reduced myocardial perfusion reserve in myocardium having coronary artery aneurysm of Kawasaki disease

    International Nuclear Information System (INIS)

    Yoon, S. N.; Lee, D. S.; Choi, J. Y.; Kil, H. R.; Jeong, Z. K.; Lee, M. C.; Ko, C. S.

    1997-01-01

    Kawasaki disease is a systemic vasculitis involving the coronary arteries at early childhood and cause coronary artery aneurysms and thrombotic occlusions. These coronary artery aneurysms were usually transformed later into stenotic or obstructive lesions, however, the majority of these aneurysms, even the giant ones, are known to be associated with normal epicardial coronary flow. Flow reserve is difficult to assess in aneurysmal arteries with echo or angiography. We performed this study to question if there are abnormalities in flow reserve in myocardial tissue with normal epicardial arterial flow on angiography in patients with Kawasaki disease, dipyridamole stress and rest Tc-99m-sestamibi SPECT were performed in 37 patients (28 boys, 9 girls, mean age 6.6 years). We compared SPECT findings with coronary angiography (CAG) findings in 21 patients who did both studies after finding abnormality on echocardiaography. On CAG, aneurysms were found in 26 arteries of 16 patients, i.e., 10 left main arteries, 6 left anterior descending arteries (LAD), 2 left circumflex arteries (LCX), and 8 right coronary arteries (RCA). Localized and segmental stenotic lesions were found in 11 arteries in 9 patients (LAD: 4, LCX: 1, RCA: 6). Eight of the 10 patients with aneurysms had no obvious stenosis. On stress-rest SPECT, 16(43%) out of 37 patients showed normal perfusion and the other 21(57%) showed reversible or persistent decrease. Among 11 stenotic artery territories, 3(27%) showed persistent and/or reversible perfusion defects. The other 8 were normal. Among 26 aneurysmal artery territories, 12 artery territories showe perfusion decrease. Three of the 5 patients with normal CAG showed persistent and/or transient perfusion defects. Among 14 artery territories with perfusion decrease in the 16 patients, 3(21%) could be localized to vascular territory having stenosis of supplying coronary arteries, 12(86%) were related to the coronary artery aneurysms. Two were not related to

  15. Myocardial viability in cases with persistent perfusion defects on the dipyridamole thallium-201 scintigram. A comparative study with autopsy findings

    International Nuclear Information System (INIS)

    Nakayama, Masafumi; Mashima, Saburo; Ohkawa, Shin-ichiro; Tanno, Munehiko; Yamada, Hideo.

    1996-01-01

    The aim of this study was to assess the incidence of myocardial infarction among persistent perfusion defects in dipyridamole-stress thallium scintigraphy by inspecting autopsied hearts and to evaluate whether the regional thallium activity of a scintigraphic defect can predict the presence of infarction. Autopsied hearts were compared with dipyridamole myocardial scintigrams undertaken during life in 27 patients (mean age 85±8 years). The time interval from stress testing until death was 428±351 days. Regional thallium uptake of delayed perfusion defect was calculated on the short axis images. The grade of regional myocardial fibrosis in autopsy specimens was also quantified to correlate with the corresponding regional thallium uptake. In 6 of 15 (40%) regions with persistent defects on the scintigram, myocardial infarction was not found at autopsy. Regional thallium-201 uptake of delayed defects < 50% diagnosed infarction with a sensitivity of 82% and a specificity of 80%. A linear correlation (r=-0.67) was observed between percent thallium-201 uptake and the degree of myocardial fibrosis. In conclusion, perfusion defects at 4-hour imaging in dipyridamole-stress testing may overestimate the presence of myocardial infarction and regional thallium-201 activity is helpful in distinguishing between defects with and without infarction. (author)

  16. Left ventricular systolic wall motion after exercise stress and myocardial perfusion in patients with ischemic heart disease. Investigation by ECG gated myocardial tomography

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi; Sindoh, Takashi; Sawada, Yoshihiro; Honda, Minoru [Sumitomo Hospital, Osaka (Japan)

    2001-01-01

    To investigate regional left ventricular (LV) wall motion (WM) after recovery from myocardial ischemia, we performed ECG-gated myocardial perfusion tomography with {sup 99m}Tc-MIBI (G-SPECT) in patients with ischemic heart disease (IHD). In addition, we compared the left ventricular (LV) systolic function obtained by G-SPECT at rest with that obtained by contrast left ventriculography (LVG). We performed G-SPECT at 30 minutes after exercise stress (Ex-30) and 3 hours after exercise (rest). LVWM and LV ejection fractions (EF) were analyzed by the QGS (quantitative gated SPECT) program. The LV was divided into 9 segments and regional WM (RWM) was analyzed quantitatively. In addition, myocardial perfusion was assessed quantitatively. In 64 patients with several different types of heart disease, EF obtained by G-SPECT correlated well with LVG-EF (r=0.907, p<0.001), and RWM of G-SPECT coincided well with that of LVG ({kappa} value 0.67, p<0.01). Eighty patients with suspected IHD were divided according to Ex-Rest myocardial perfusion. In 83% of patients with Ex-induced perfusion abnormalities disappeared completely at rest, and in 58% of patients with Ex-induced abnormalities disappeared incompletely, RWM abnormalities which were observed at Ex-30 improved at rest and as did EF. In 79% of patients with a fixed defect (FD), RWM abnormalities and EF at Ex-30 did not differ with those at rest, but in 12% of the patients, the RWM abnormality of Ex-30 improved at rest. In most myocardial segments that had recovered from transient ischemia, RWM abnormalities persisted at least 30 minutes after Ex (stunning). In a small portion of the myocardial segments regarded as having myocardial necrosis because of a fixed perfusion abnormality, RWM abnormalities at Ex-30 improved at rest. These segments were supposed to contain viable myocardium. In conclusion, G-SPECT is a powerful method for clarifying the relation between the regional systolic function and myocardial perfusion

  17. 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.

  18. Myocardial perfusion in peripheral Raynaud's phenomenon. Evaluation using stress cardiovascular magnetic resonance.

    Science.gov (United States)

    Mavrogeni, Sophie; Bratis, Konstantinos; Koutsogeorgopoulou, Loukia; Karabela, Georgia; Savropoulos, Efthymios; Katsifis, Gikas; Raftakis, John; Markousis-Mavrogenis, George; Kolovou, Genovefa

    2017-02-01

    Peripheral Raynaud's phenomenon (RP) is either primary (PRP), without any coexisting disease or secondary (SRP), due to connective tissue diseases (CTD). We hypothesized that adenosine stress cardiovascular magnetic resonance (CMR) can assess myocardial perfusion in a population of PRP and SRP. Twenty CTDs, aged 30.6±7.5yrs., 16F/4M, including 9 systemic sclerosis (SSc), 4 systemic lupus erythematosus (SLE), 3 mixed connective tissue disease (MCTD), 2 polymyositis (PM) and 2 rheumatoid arthritis (RA), with SRP, under treatment with calcium blockers, were evaluated by stress CMR and compared with age-sex matched PRP and controls. All RP patients were under treatment with calcium blockers. Stress perfusion CMR was performed by 1.5T system using 140mg/kg/min adenosine for 4min and 0.05mmol/kg Gd-DTPA for first-pass perfusion. A rest perfusion was performed with the same protocol. Late gadolinium enhanced (LGE) images were acquired after another dose of Gd-DTPA. In both PRP, SRP, the myocardial perfusion reserve index (MPRI) was significantly reduced compared with the controls (1.7±0.6 vs 3.5±0.4, p<0.001 and 0.7±0.2 vs 3.5±0.4, p<0.001, respectively). Furthermore, in SRP, MPRI was significantly reduced, compared with PRP (0.7±0.2 vs 1.7±0.6, p<0.001). Subendo-cardial LGE=8.2±1.7 of LV mass was revealed in 1 SLE, 1MCTD and 2 SSc, but in none of PR patients. MPRI reduction is common in both PRP and SRP, but it is more severe in SRP, even if RP patients are under treatment with calcium blockers. Occult fibrosis may coexist with the reduced MPRI in SRP but not in PRP. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. The dream of a one-stop-shop: Meta-analysis on myocardial perfusion CT.

    Science.gov (United States)

    Pelgrim, Gert Jan; Dorrius, Monique; Xie, Xueqian; den Dekker, Martijn A M; Schoepf, U Joseph; Henzler, Thomas; Oudkerk, Matthijs; Vliegenthart, Rozemarijn

    2015-12-01

    % CI, 67-93%) and 93% (95% CI, 89-96%). This meta-analysis shows considerable variation in techniques and reference standards for CT of myocardial blood supply. While CT seems sensitive and specific for evaluation of hemodynamically relevant CAD, studies so far are limited in size. Standardization of myocardial perfusion CT technique is essential. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. 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

  1. Observed Influence of Nitroglycerine on Myocardial Perfusion Scintigraphy in Patients with Multiple Vessel Coronary Artery Disease and Well-Developed Collaterals

    International Nuclear Information System (INIS)

    Rasulova, Nigora; Nazirova, Lyudmila; Akhmedov, Khasan; Akhmedova, Dilyafruz; Djalalov, Farrukh; Seydaliev, Amet; Iskandarov, Farkhod; Kok, T. Y.

    2012-01-01

    The objective of this scientific work was to evaluate the extent and severity of perfusion abnormalities on myocardial perfusion scintigraphy (MPS) at rest and with sublingual nitroglycerine, in relation to the presence and anatomical location of collaterals demonstrated by selective coronary angiography (SCA). Twenty-eight patients with unstable angina underwent selective coronary angiography. Eighteen of them were diagnosed with myocardial infarction (MI) 2–15 days prior to examination. Presence or absence of collaterals was noted, with anatomical depiction of donor and recipient arteries as well as evaluation of degree of collateral flow. As an inclusion criterion, collateral flow had to be grade 2 (partial epicardial filling of the occluded artery) or 3 (complete epicardial filling of the occluded artery) in accordance with the Rentrop collateral flow classification. Flow was noted as follows: Complete antegrade (CA), complete retrograde (CR), partial antegrade (PA), and partial retrograde (PR). Myocardial perfusion scintigraphy using Tc-99m Sestamibi at rest and after sublingual administration of nitroglycerine was performed according to a 2-day protocol. Perfusion abnormalities, which were quantified using the 20-segments model and visual 5-point system (0, normal perfusion; 4, absent perfusion), were analyzed according to donor's and recipient's territories, as well as territories with limited or without collateral flow (PA/PR, grade 0–1 flow). A total of 84 arteries were analyzed, with stenosis in 79 of them. Arteries were divided into three groups: Donors (group I), recipients (group II), and arteries with limited or without collaterals (group III). In group I, there were 28 donor arteries, with mean severity of stenosis 71.3 ± 0.65%. In group II, there were 36 recipient arteries and mean severity of stenosis was 94.8 ± 0.26%. In group III, there were 20 arteries, and all of them had either no or poorly developed collaterals (mean severity

  2. Quantitative myocardial perfusion PET parametric imaging at the voxel-level

    Science.gov (United States)

    Mohy-ud-Din, Hassan; Lodge, Martin A.; Rahmim, Arman

    2015-08-01

    Quantitative myocardial perfusion (MP) PET has the potential to enhance detection of early stages of atherosclerosis or microvascular dysfunction, characterization of flow-limiting effects of coronary artery disease (CAD), and identification of balanced reduction of flow due to multivessel stenosis. We aim to enable quantitative MP-PET at the individual voxel level, which has the potential to allow enhanced visualization and quantification of myocardial blood flow (MBF) and flow reserve (MFR) as computed from uptake parametric images. This framework is especially challenging for the 82Rb radiotracer. The short half-life enables fast serial imaging and high patient throughput; yet, the acquired dynamic PET images suffer from high noise-levels introducing large variability in uptake parametric images and, therefore, in the estimates of MBF and MFR. Robust estimation requires substantial post-smoothing of noisy data, degrading valuable functional information of physiological and pathological importance. We present a feasible and robust approach to generate parametric images at the voxel-level that substantially reduces noise without significant loss of spatial resolution. The proposed methodology, denoted physiological clustering, makes use of the functional similarity of voxels to penalize deviation of voxel kinetics from physiological partners. The results were validated using extensive simulations (with transmural and non-transmural perfusion defects) and clinical studies. Compared to post-smoothing, physiological clustering depicted enhanced quantitative noise versus bias performance as well as superior recovery of perfusion defects (as quantified by CNR) with minimal increase in bias. Overall, parametric images obtained from the proposed methodology were robust in the presence of high-noise levels as manifested in the voxel time-activity-curves.

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

    Science.gov (United States)

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

    2015-06-01

    A novel multifocal collimator, IQ-SPECT (Siemens) consists of SMARTZOOM, cardio-centric and 3D iterative SPECT reconstruction and makes it possible to perform MPI scans in a short time. The aims are to delineate the normal uptake in thallium-201 ((201)Tl) SPECT in each acquisition method and to compare the distribution between new and conventional protocol, especially in patients with normal imaging. Forty patients (eight women, mean age of 75 years) who underwent myocardial perfusion imaging were included in the study. All patients underwent one-day protocol perfusion scan after an adenosine-stress test and at rest after administering (201)Tl and showed normal results. Acquisition was performed on a Symbia T6 equipped with a conventional dual-headed gamma camera system (Siemens ECAM) and with a multifocal SMARTZOOM collimator. Imaging was performed with a conventional system followed by IQ-SPECT/computed tomography (CT). Reconstruction was performed with or without X-ray CT-derived attenuation correction (AC). Two nuclear physicians blinded to clinical information interpreted all myocardial perfusion images. A semi-quantitative myocardial perfusion was analyzed by a 17-segment model with a 5-point visual scoring. The uptake of each segment was measured and left ventricular functions were analyzed by QPS software. IQ-SPECT provided good or excellent image quality. The quality of IQ-SPECT images without AC was similar to those of conventional LEHR study. Mid-inferior defect score (0.3 ± 0.5) in the conventional LEHR study was increased significantly in IQ-SPECT with AC (0 ± 0). IQ-SPECT with AC improved the mid-inferior decreased perfusion shown in conventional images. The apical tracer count in IQ-SPECT with AC was decreased compared to that in LEHR (0.1 ± 0.3 vs. 0.5 ± 0.7, p IQ-SPECT was significantly higher than that from the LEHR collimator (p = 0.0009). The images of IQ-SPECT acquired in a short time are equivalent to that of conventional LEHR

  4. 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.

  5. Microheterogeneity of regional myocardial blood flows in low-perfused rat hearts evaluated by double-tracer digital radiography

    International Nuclear Information System (INIS)

    Matsumoto, Takeshi; Asano, Takahisa; Takemoto, Mami; Tachibana, Hiroyuki; Ogasawara, Yasuo; Kajiya, Fumihiko

    2007-01-01

    Using 3 H- and 125 I-labeled desmethylimipramine (DMI) for regional flow tracers, we established a two-time measurement method for the spatial pattern of myocardial perfusion in cross-circulated rat hearts. Myocardial extractions and retentions of these tracers were confirmed to be satisfactory; however, the latter were less than 90% after 3 min at a perfusion rate of 2.9 ml/min/g, limiting the present application to a short-time perfusion measurement. Distributions of myocardial depositions were separated by subtraction digital radiography with 400-μm pixel resolution. Its feasibility was examined by regression analysis between local deposition densities of 3 H- and 125 I-DMI injected simultaneously. The slope, y-intercept, and correlation coefficient (r) of the regression line were 0.98±0.04, 0.02±0.04, and 0.95±0.03, respectively, indicating the validity of the present image subtraction technique. The spatial pattern of myocardial perfusion in response to flow reduction was evaluated by the injections of 3 H- and 125 I-DMI, respectively, before and after a nearly 70% flow reduction. A significant correlation between normalized density distributions of these tracers was found in both subepicardium (r=0.77±0.12) and subendocardium (r=0.73±0.20), indicating the stable pattern of myocardial perfusion. However, the coefficient of variation of tracer densities showed a decrease of subendocardial flow heterogeneity from 35±15% to 31±16%. Thus, flow differences between originally high- and low-flow regions in subendocardium were reduced on a relative basis during low perfusion

  6. The clinical significance of abnormal 99Tcm-MIBI myocardial perfusion tomography in patients with hypertension

    International Nuclear Information System (INIS)

    Yang Yongzhen; Li Zhaoping; Liu Yimin; Zhang Weifang; Zhang Yanyan; Zhang Songlin; Wang Xin; Mao Yuan

    2000-01-01

    Objective: To evaluate the clinical significance of abnormal myocardial perfusion tomography in the hypertensive patients with normal coronary angiography. Methods: Qualitative diagnosis, the average counts ratio of lateral to septal segments (L/S) and the ratio of stress L/S to rest L/S from stress and rest 99 Tc m -sestamibi myocardial perfusion tomography (MPT), and every clinical characteristic and the results from other examinations were compared between hypertensive patients (HP) and normotensive controls (NC). Every risk factor leading to coronary artery disease and related indexes in patients with positive MPT were compared with the results of patients with negative MPT. Results: 1) The positive rate of MPT in HP was obviously higher than that of NC,which was 61.9% vs 9.1%, respectively. Most focuses of MPT were reversible defects (RD), a few of them accompanied by reverse reversible defects (RRD). There were many more angina pectoris and heart arrhythmia attacks in HP than in NC. 2) The ratio of stress L/S to rest L/S of HP was lower than that of NC (P<0.05). 3) The ratio of stress L/S to rest L/S of the patients with positive MPT in HP significantly decreased compared with that of the patients with negative MPT (P<0.01). There were more patients being addicted to smoking and drinking in those with a positive than in those with a negative MPT (53.8% versus 12.5%, P<0.05). 4) The abnormal defects of MPT in HP were almost seen in any segment of left ventricle and most of the patients had no left ventricular hypertrophy, but did smoke and drink. Conclusions: 1)Abnormal MPT exist in the HP with normal coronary angiography and not necessarily with left ventricular hypertrophy. 2)The long-term addiction of smoking and drinking was one of the risk factors leading to arouse myocardial ischemia in HP

  7. Localization of coronary artery disease with exercise electrocardiography: correlation with thallium-201 myocardial perfusion scanning

    International Nuclear Information System (INIS)

    Dunn, R.F.; Freedman, B.; Bailey, I.K.; Uren, R.F.; Kelly, D.T.

    1981-01-01

    In 61 patients with single vessel coronary artery disease (70 percent or greater obstruction of luminal diameter in only one vessel) and no previous myocardial infarction, the sites of ischemic changes on 12 lead exercise electrocardiography and on thallium-201 myocardial perfusion scanning were related to the obstructed coronary artery. The site of exercise-induced S-T segment depression did not identify which coronary artery was obstructed. In the 37 patients with left anterior descending coronary artery disease S-T depression was most often seen in the inferior leads and leads V4 to V6, and in the 18 patients with right coronary artery disease and in the 6 patients with left circumflex artery disease S-T depression was most often seen in leads V5 and V6. Although S-T segment elevation was uncommon in most leads, it occurred in lead V1 or a VL, or both, in 51 percent of the patients with left anterior descending coronary artery disease. A reversible anterior defect on exercise thallium scanning correlated with left anterior descending coronary artery disease (probability [p] less than 0.0001) and a reversible inferior thallium defect correlated with right coronary or left circumflex artery disease (p less than 0.0001). In patients with single vessel disease, the site of S-T segment depression does not identify the obstructed coronary artery; S-T segment elevation in lead V1 or aVL, or both, identifies left anterior descending coronary artery disease; and the site of reversible perfusion defect on thallium scanning identifies the site of myocardial ischemia and the obstructed coronary artery

  8. Clinical impacts of inhibition of renin-angiotensin system in patients with acute ST-segment elevation myocardial infarction who underwent successful late percutaneous coronary intervention.

    Science.gov (United States)

    Park, Hyukjin; Kim, Hyun Kuk; Jeong, Myung Ho; Cho, Jae Yeong; Lee, Ki Hong; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Hong, Young Joon; Kim, Kye Hun; Park, Hyung Wook; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun; Kim, Young Jo; Cho, Myeong Chan; Kim, Chong Jim

    2017-01-01

    Successful percutaneous coronary intervention (PCI) of the occluded infarct-related artery (IRA) in latecomers may improve long-term survival mainly by reducing left ventricular remodeling. It is not clear whether inhibition of renin-angiotensin system (RAS) brings additional better clinical outcomes in this specific population subset. Between January 2008 and June 2013, 669 latecomer patients with acute ST-segment elevation myocardial infarction (STEMI) (66.2±12.1 years, 71.0% males) in Korea Acute Myocardial Infarction Registry (KAMIR) who underwent a successful PCI were enrolled. The study population underwent a successful PCI for a totally occluded IRA. They were divided into two groups according to whether they were prescribed RAS inhibitors at the time of discharge: group I (RAS inhibition, n=556), and group II (no RAS inhibition, n=113). During the one-year follow-up, major adverse cardiac events (MACE), which consist of cardiac death and myocardial infarction, occurred in 71 patients (10.6%). There were significantly reduced incidences of MACE in the group I (hazard ratio=0.34, 95% confidence interval 0.199-0.588, p=0.001). In subgroup analyses, RAS inhibition was beneficial in patients with male gender, history of hypertension or diabetes mellitus, and even in patients with left ventricular ejection fraction (LVEF) ≥40%. In the baseline and follow-up echocardiographic data, benefit in changes of LVEF and left ventricular end-systolic volume was noted in group I. In latecomers with STEMI, RAS inhibition improved long-term clinical outcomes after a successful PCI, even in patients with low risk who had relatively preserved LVEF. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  9. 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.

  10. Determination of culprit lesion in patients undergoing elective percutaneous coronary intervention by myocardial perfusion imaging.

    Science.gov (United States)

    Baskot, Branislav; Obradovic, S; Rafajlovski, S; Jankovic, Z; Rusovic, S; Orozovic, V; Gligic, B; Ratkovic, N; Jung, R; Ivanovic, V; Bikicki, M

    2008-12-01

    The aim of this study was to determine and localize culprit lesion by myocardial perfusion imaging (MPI) in cases of angiographically detected coronary narrowing >or= 75% of at least one coronary artery. One hundred and thirty-two (132) patients with angiographically detected significant coronary narrowing (>or= 75% luminal stenosis of at least one major coronary artery) were studied. All the patients submitted MPI (99m)Tc-MIBI, with pharmacologic dipyridamole stress protocol with concomitant low level bicycle exercise 50W (DipyEX). We measured relative uptake (99m)Tc-MIBI for each myocardial segment using short-axis myocardial tomogram study. A 5-point scoring system was used to assess the difference between uptake degree in stress and rest studies for the same segments, and we created two indices: Sum reversibility score (SRS), Index of sum reversibility score (ISRS). A total of 396 vascular territories (2244 segments) were analyzed before elective percutaneous coronary intervention (ePCI). Overall sensitivity, specificity and accuracy using SRS were 90.2%, 87.5%, and 89.4%, with a positive predictive value of 94.1%. Overall sensitivity, specificity, and accuracy using ISRS were 94.4%, 90.6%, 93.2% and the positive predictive value was 95.7%. DipyEX MPI with the two indices created, SRS and ISRS, significantly improves sensitivity, specificity and accuracy in the determination and localization of culprit lesions in patients undergoing elective PCI.

  11. Mechanisms of cell fixation of TcN-NOET, a new radioactive tracer of myocardial perfusion

    International Nuclear Information System (INIS)

    Riou, L.

    1999-01-01

    The aim of this work is the study of the cell fixation mechanisms of TcN-NOET, a new technetium labelled complex, marker of the coronary blood flow rate. This neutral and lipophilic complex presents some behaviour similarities with thallium 201 (myocardial kinetics and redistribution phenomenon) when tested in vivo on dog and man. It is thus considered as a technetium labelled analogue of thallium 201 but requiring a significantly lower irradiation of the patient. Clinical validation studies are in progress. In vitro studies performed on newborn rat cardio-myocytes indicate that the cell fixation of the tracer is independent of the metabolic state of the cells. This fixation is inhibited and increased by drugs inhibiting and activating the membrane calcic and voltage-dependent channels. The effect of Verapamil, Diltiazem and Nifedipine on the cardiac fixation of TcN-NOET has been evaluated on the isolated and perfused rat heart model. These drugs have no effect on the cardiac activity of TcN-NOET and Verapamil has no effect on the in vivo myocardial fixation of TcN-NOET by the dog. This can be explained by an ex-vivo and in-vivo fixation of the tracer on the vascular endothelium which does not show any voltage-dependent calcic channel. Therefore, a treatment by calcic inhibitors will not affect the myocardial fixation of TcN-NOET during clinical practice. (J.S.)

  12. A study of glycogen storage disease with 99Tcm-MIBI gated myocardial perfusion imaging.

    Science.gov (United States)

    Wei, L G; Gao, J Q; Liu, X M; Huang, J M; Li, X Z

    2013-12-01

    Gated myocardial perfusion imaging (G-MPI) is regularly performed using single-photon emission computed tomography. The objective of this study was to evaluate the clinical value of 99Tcm-methoxyisobutylisonitrile (MIBI) myocardial imaging in glycogen storage disease (GSD). 99Tcm-MIBI G-MPI was performed in nine patients with clinically proven GSD. QGS quantitative software was used for processing and interpretation. Left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) were automatically generated. The myocardium was divided into seven segments, 20 sub-segments and a five-point scoring system was used. Seven out of nine cases were abnormal and the positive rate of G-MPI was 77.8 %. Sixty-two sub-segments of injured myocardium were detected in 140 sub-segments of seven abnormal patients. One injured segment was observed in one patient (14.3 %), two segments were detected in two patients (28.6 %) and three or more abnormal segments were observed in four patients (57.1 %). 99Tcm-MIBI G-MPI can detect myocardial damage in GSD as a non-invasive method. It plays an important role in the clinic.

  13. Myocardial uptake of thallium and rubidium during alterations in perfusion and oxygenation in isolated rabbit hearts

    International Nuclear Information System (INIS)

    Leppo, J.A.

    1987-01-01

    The comparative effects of altered cellular function and coronary perfusion on myocardial 201 Tl and 83 Rb uptake were evaluated in three groups of isolated rabbit hearts having isovolumic contractions. Paired-indication dilution experiments were performed with 201 Tl, 83 Rb, and 111 In-labeled albumin as an intravascular reference marker. In Group A hearts (n = 12), isotope transport was determined during control, hypoxia, and ischemia. In Group B hearts (n = 8), isotope transport was measured at control flow and again at a 50% and 80% reduction. In Group C hearts (n = 8) only 201 Tl uptake was determined at control and following coronary reperfusion. Myocardial 201 Tl and 83 Rb transport were not significantly different and were proportional to flow. Although all interventions caused significant hemodynamic alterations, neither tracer was affected by hypoxia at constant flow. Thallium-201 permeation, however, was transiently decreased immediately after coronary reperfusion. We conclude that myocardial uptake of 201 Tl and 83 Rb are similar and directly related to flow, but do not reflect hypoxia induced cellular dysfunction

  14. Quantitative myocardial perfusion imaging in a porcine ischemia model using a prototype spectral detector CT system

    Science.gov (United States)

    Fahmi, Rachid; Eck, Brendan L.; Levi, Jacob; Fares, Anas; Dhanantwari, Amar; Vembar, Mani; Bezerra, Hiram G.; Wilson, David L.

    2016-03-01

    We optimized and evaluated dynamic myocardial CT perfusion (CTP) imaging on a prototype spectral detector CT (SDCT) scanner. Simultaneous acquisition of energy sensitive projections on the SDCT system enabled projection-based material decomposition, which typically performs better than image-based decomposition required by some other system designs. In addition to virtual monoenergetic, or keV images, the SDCT provided conventional (kVp) images, allowing us to compare and contrast results. Physical phantom measurements demonstrated linearity of keV images, a requirement for quantitative perfusion. Comparisons of kVp to keV images demonstrated very significant reductions in tell-tale beam hardening (BH) artifacts in both phantom and pig images. In phantom images, consideration of iodine contrast to noise ratio and small residual BH artifacts suggested optimum processing at 70 keV. The processing pipeline for dynamic CTP measurements included 4D image registration, spatio-temporal noise filtering, and model-independent singular value decomposition deconvolution, automatically regularized using the L-curve criterion. In normal pig CTP, 70 keV perfusion estimates were homogeneous throughout the myocardium. At 120 kVp, flow was reduced by more than 20% on the BH-hypo-enhanced myocardium, a range that might falsely indicate actionable ischemia, considering the 0.8 threshold for actionable FFR. With partial occlusion of the left anterior descending (LAD) artery (FFR  perfusion defects at 70 keV were correctly identified in the LAD territory. At 120 kVp, BH affected the size and flow in the ischemic area; e.g. with FFR ≈ 0.65, the anterior-to-lateral flow ratio was 0.29  ±  0.01, over-estimating stenosis severity as compared to 0.42  ±  0.01 (p  CT.

  15. 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.)

  16. 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

  17. Use of myocardial perfusion imaging to predict the effectiveness of coronary revascularisation in patients with stable angina pectoris

    International Nuclear Information System (INIS)

    Johansen, Allan; Hoeilund-Carlsen, Poul Flemming; Moeldrup, Mette; Christensen, Henrik Wulff; Vach, Werner; Haghfelt, Torben

    2005-01-01

    Coronary revascularisation is the treatment of choice in patients with stable angina who have significant stenoses. From a pathophysiological point of view, however, mitigation of angina is to be expected only in the presence of reversible ischaemia. Therefore it was the aim of this study to examine the effect of revascularisation on stable angina in relation to the myocardial perfusion imaging (MPI) pattern prior to intervention. Three hundred and eighty-four patients (58.0±8.8 years) referred for angiography underwent MPI. Prior to MPI and at 2-year follow-up, patients were classified as having typical angina, atypical angina, non-cardiac chest pain or no pain, and the severity of chest pain was graded according to the Canadian Cardiovascular Society (CCS) criteria. The patients themselves estimated their pain on a visual analogue scale. Management was based on symptoms and angiographic findings, since the results of MPI were not communicated. Among the 240 patients who were not revascularised, 79% had typical or atypical angina at study entrance versus 40% at follow-up. In comparison, 93% of the 144 revascularised patients had typical or atypical angina before intervention versus only 36% at follow-up. This additional advantage of invasive therapy was present only in patients with reversible defects; revascularisation had no additional effect in patients with normal perfusion or irreversible defects. Similarly, additional, significant reductions in CCS class and visual analogue score were observed exclusively in patients with reversible defects. In patients referred for coronary angiography owing to known or suspected stable angina, revascularisation was significantly more effective than medical treatment exclusively in patients with reversible ischaemia. (orig.)

  18. Use of myocardial perfusion imaging to predict the effectiveness of coronary revascularisation in patients with stable angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Johansen, Allan [Odense University Hospital, Department of Clinical Physiology and Nuclear Medicine, Odense (Denmark); Odense University Hospital, Department of Nuclear Medicine, Odense (Denmark); Hoeilund-Carlsen, Poul Flemming; Moeldrup, Mette [Odense University Hospital, Department of Clinical Physiology and Nuclear Medicine, Odense (Denmark); Christensen, Henrik Wulff [Nordic Institute of Chiropractic and Clinical Biomechanics, Odense (Denmark); Vach, Werner [University of Southern Denmark, Department of Statistics, Odense (Denmark); Haghfelt, Torben [Odense University Hospital, Department of Cardiology, Odense (Denmark)

    2005-12-01

    Coronary revascularisation is the treatment of choice in patients with stable angina who have significant stenoses. From a pathophysiological point of view, however, mitigation of angina is to be expected only in the presence of reversible ischaemia. Therefore it was the aim of this study to examine the effect of revascularisation on stable angina in relation to the myocardial perfusion imaging (MPI) pattern prior to intervention. Three hundred and eighty-four patients (58.0{+-}8.8 years) referred for angiography underwent MPI. Prior to MPI and at 2-year follow-up, patients were classified as having typical angina, atypical angina, non-cardiac chest pain or no pain, and the severity of chest pain was graded according to the Canadian Cardiovascular Society (CCS) criteria. The patients themselves estimated their pain on a visual analogue scale. Management was based on symptoms and angiographic findings, since the results of MPI were not communicated. Among the 240 patients who were not revascularised, 79% had typical or atypical angina at study entrance versus 40% at follow-up. In comparison, 93% of the 144 revascularised patients had typical or atypical angina before intervention versus only 36% at follow-up. This additional advantage of invasive therapy was present only in patients with reversible defects; revascularisation had no additional effect in patients with normal perfusion or irreversible defects. Similarly, additional, significant reductions in CCS class and visual analogue score were observed exclusively in patients with reversible defects. In patients referred for coronary angiography owing to known or suspected stable angina, revascularisation was significantly more effective than medical treatment exclusively in patients with reversible ischaemia. (orig.)

  19. Caffeine intake inverts the effect of adenosine on myocardial perfusion during stress as measured by T1 mapping

    NARCIS (Netherlands)

    Kuijpers, Dirkjan; Prakken, Niek H.; Vliegenthart, Rozemarijn; van Dijkman, Paul R. M.; van der Harst, Pim; Oudkerk, Matthijs

    2016-01-01

    Caffeine intake before adenosine stress myocardial perfusion imaging may cause false negative findings. We hypothesized that the antagonistic effect of caffeine can be measured by T1 relaxation times in rest and adenosine stress cardiac magnetic resonance imaging (CMR), as T1 mapping techniques are

  20. 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.

  1. Sex- and age-related differences of myocardial perfusion at rest assessed with multidetector computed tomography

    DEFF Research Database (Denmark)

    Byrne, Christina; Kühl, J Tobias; Zacho, Mette

    2013-01-01

    The clinical presentation of ischemic heart disease in women differs from men, which could reflect sex-related differences of normal physiology. Cardiac CT angiography provides a noninvasive method to assess both regional and transmural myocardial perfusion in addition to coronary atherosclerosis....

  2. Quantitative Myocardial Perfusion with Dynamic Contrast-Enhanced Imaging in MRI and CT: Theoretical Models and Current Implementation

    Science.gov (United States)

    Handayani, A.; Dijkstra, H.; Prakken, N. H. J.; Slart, R. H. J. A.; Oudkerk, M.; Van Ooijen, P. M. A.; Vliegenthart, R.; Sijens, P. E.

    2016-01-01

    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. PMID:27088083

  3. Effect of contrast dose in the quantification of myocardial extra-cellular volume in adenosine stress/rest perfusion cardiac magnetic resonance examinations.

    Science.gov (United States)

    Caballeros, Meylin; Bartolomé, Pablo; Fernández González, Óscar; Greiser, Andreas; García Del Barrio, Loreto; Pueyo, Jesús; Bastarrika, Gorka

    2017-07-01

    Background Diffuse myocardial fibrosis can be quantified by calculating extra-cellular volume (ECV) from native and post-contrast T1 values using dedicated single bolus contrast medium injection protocols. Purpose To evaluate differences in T1 maps and myocardial ECV measurements in routine stress/rest perfusion cardiovascular magnetic resonance (CMR) examinations after injection of single and double dose of contrast medium. Material and Methods Thirty-seven consecutive patients (30 men; mean age, 62 ± 13 years) underwent clinically indicated adenosine stress/rest perfusion CMR examination to rule out myocardial ischemia following a conventional split-dose contrast medium injection strategy. Native and post-contrast T1 mapping was performed 15 min after the first (0.1 mmol/kg) and second (0.1 mmol/kg) dose of contrast medium using a breath-held Modified Look-Locker Inversion recovery (MOLLI) sequence. Student's t-test for paired samples, Bland-Altman plots, and concordance-correlation coefficients (CCC) for agreement between T1 and ECV calculations after single and double dose of contrast medium were calculated. Intra- and inter-observer agreement for measurements was also analyzed. Results Myocardial T1 values after single and double dose of contrast medium significantly differed (mean difference of 114.1 ± 19.9 ms, P < 0.01). A single dose of contrast agent provided slightly higher ECV values (mean difference of 2.3 ± 1.1%). CCC for ECV calculations was 0.66. Intra- and inter-observer agreement for all measurements was excellent (CCC ≥ 0.83). Conclusion Quantification of myocardial ECV on conventional stress/rest perfusion CMR examination is feasible. T1 maps obtained 15 min after 0.1 mmol/kg of contrast medium provide slightly higher myocardial T1 measurements and ECV values compared with T1 maps obtained after a total dose of 0.2 mmol/kg.

  4. Prevalence of first-pass myocardial perfusion defects detected by contrast-enhanced dual-source CT in patients with non-ST segment elevation acute coronary syndromes

    Energy Technology Data Exchange (ETDEWEB)

    Schepis, Tiziano; Achenbach, Stephan; Marwan, Mohamed; Muschiol, Gerd; Ropers, Dieter; Daniel, Werner G.; Pflederer, Tobias [University of Erlangen, Department of Internal Medicine 2 (Cardiology), Erlangen (Germany)

    2010-07-15

    To investigate the prevalence and diagnostic value of first-pass myocardial perfusion defects (PD) visualised by contrast-enhanced multidetector computed tomography (MDCT) in patients admitted for a first acute coronary syndrome (ACS). Thirty-eight patients with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and scheduled for percutaneous coronary intervention underwent dual-source CT immediately before catheterisation. CT images were analysed for the presence of any PD by using a 17-segment model. Results were compared with peak cardiac troponin-I (cTnI) and angiography findings. PD were seen in 21 of the 24 patients with NSTEMI (median peak cTnI level 7.07 ng/mL; range 0.72-37.07 ng/mL) and in 2 of 14 patients with UA. PD corresponded with the territory of the infarct-related artery in 20 out of 22 patients. In a patient-based analysis, sensitivity, specificity, negative and positive predictive values of any PD for predicting NSTEMI were 88%, 86%, 80% and 91%. Per culprit artery, the respective values were 86%, 75%, 80% and 83%. In patients with non-ST segment elevation ACS, first-pass myocardial PD in contrast-enhanced MDCT correlate closely with the presence of myocardial necrosis, as determined by increases in cTnI levels. (orig.)

  5. 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

  6. Physiological assessment of myocardial perfusion using nuclear cardiology would enhance coronary artery disease patient care. Which imaging modality is best for evaluation of myocardial ischemia? (SPECT-side)

    International Nuclear Information System (INIS)

    Yoshinaga, Keiichiro; Manabe, Osamu; Tamaki, Nagara

    2011-01-01

    Nuclear cardiology has played an important role in both diagnosis and risk assessments of coronary artery disease since early 1970. Among the non-invasive diagnostic tests, the great advantage of nuclear imaging is that this technique can obtain physiological information, such as myocardial perfusion, which is difficult to obtain by other techniques. When patients have inducible myocardial ischemia and sufficient viable myocardium, coronary revascularization treatment should be performed. Both stress myocardial perfusion imaging (MPI) and viability imaging provide important information. Another important aspect of stress perfusion imaging is that normal stress perfusion is associated with low risk for future cardiac events. Therefore, stress MPI plays an important role in the selection of an invasive therapeutic regime and also in avoiding unnecessary invasive procedures. As is the case for other imaging techniques, there have been many technical and instrumental developments in recent years in nuclear cardiology imaging, including new single-photon-emission computed tomography tracers, new pharmacological stress agents, a new generation of γ camera, and positron emission tomography. This review will address the advantages of nuclear cardiology in the clinical setting and recent developments in nuclear cardiology. (author)

  7. Incremental role of resting myocardial computed tomography perfusion for predicting physiologically significant coronary artery disease: A machine learning approach.

    Science.gov (United States)

    Han, Donghee; Lee, Ji Hyun; Rizvi, Asim; Gransar, Heidi; Baskaran, Lohendran; Schulman-Marcus, Joshua; Ó Hartaigh, Bríain; Lin, Fay Y; Min, James K

    2018-02-01

    Evaluation of resting myocardial computed tomography perfusion (CTP) by coronary CT angiography (CCTA) might serve as a useful addition for determining coronary artery disease. We aimed to evaluate the incremental benefit of resting CTP over coronary stenosis for predicting ischemia using a computational algorithm trained by machine learning methods. 252 patients underwent CCTA and invasive fractional flow reserve (FFR). CT stenosis was classified as 0%, 1-30%, 31-49%, 50-70%, and >70% maximal stenosis. Significant ischemia was defined as invasive FFR machine learning. On a per-patient basis, accuracy, sensitivity, specificity, positive predictive, and negative predictive values according to resting CTP when added to CT stenosis (>70%) for predicting ischemia were 68.3%, 52.7%, 84.6%, 78.2%, and 63.0%, respectively. Compared with CT stenosis [area under the receiver operating characteristic curve (AUC): 0.68, 95% confidence interval (CI) 0.62-0.74], the addition of resting CTP appeared to improve discrimination (AUC: 0.75, 95% CI 0.69-0.81, P value .001) and reclassification (net reclassification improvement: 0.52, P value machine learning techniques may improve the predictive utility of significant ischemia over coronary stenosis.

  8. Specificity and sensitivity of SPECT myocardial perfusion studies at the Nuclear Medicine Department of the Limassol General Hospital in Cyprus

    Energy Technology Data Exchange (ETDEWEB)

    Koumna, S [Athens Anticancer - Oncology Hospital ' AgiosSavvas' , Athens (Greece); Yiannakkaras, Ch [Medical Physics Department, Nicosia General Hospital, Nicosia (Cyprus); Avraamides, P [Cardiology Clinic, Limassol General Hospital, Limassol (Cyprus); Demetriadou, O, E-mail: stelkoum@gmail.com [Nuclear Medicine Department, Limassol General Hospital, Limassol (Cyprus)

    2011-09-23

    The aim is to determine the sensitivity and specificity of Myocardial Perfusion Imaging (MPI) performed at the Nuclear Medicine Department of the Limassol General Hospital in Cyprus. Through a retrospective analysis, patient results obtained by MPI were compared to results obtained by Invasive Angiography. We analyzed data from 96 patients that underwent both MPI and Angiography during the years 2009-2010, with a maximum time interval of {+-} 9 months between the two types of medical exams. For 51 patients, the indication was the detection of CAD. For 45 patients, the indication was to assess viability and/or ischemia after MI, PCI or CABG. Out of 84 patients with CAD confirmed by angiography, 80 patients resulted in abnormal MPI (sensitivity of 95% and positive predictive value of 98%). Out of 12 patients with normal coronaries, 10 patients resulted in normal MPI (specificity of 83% and negative predictive value of 71%).In conclusion, for the patients with abnormal MPI and confirmed CAD, MPI was a useful aid for further therapy management.

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

    Science.gov (United States)

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

    2016-03-01

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

  10. 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)

  11. Magnetic resonance imaging for the assessment of myocardial perfusion. Value of various semiquantitative perfusion parameters; MRT zur Beurteilung der Myokardperfusion. Aussagekraft verschiedener semiquantitativer Perfusionsparameter

    Energy Technology Data Exchange (ETDEWEB)

    Huber, Armin; Schweyer, M.; Bauner, K.; Theisen, D.; Rist, C.; Schoenberg, S.; Reiser, M. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany); Muehling, O.; Naebauer, M. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Medizinische Klinik I, Muenchen (Germany)

    2007-04-15

    The aim of this study was to determine the diagnostic accuracy of various semiquantitative perfusion parameters of the magnetic resonance perfusion examination of the myocardium compared to conventional coronary angiography. Twenty patients with suspicion of coronary artery disease who underwent coronary angiography were examined by MR imaging within 14 days before or after coronary angiography. A perfusion examination during adenosine application (140 {mu}g/kg/min) and at rest was performed using a saturation recovery turboFLASH sequence. The semi-quantitative parameters maximum signal intensity (SIM), time-to-peak (TTP), area under the curve (AUC) and upslope (US) were determined using dedicated software (Dynamic Signal Analysis, ARGUS, Siemens Medical Solutions) for the evaluation of the signal-intensity-time curves. In addition, the ratio of these parameters (MPRI: myocardial perfusion reserve index) were determined by dividing the values of the stress examination by the values of the rest examination. Accuracy was 78.4% (SIM), 64.9% (TTP), 64.2% (AUC) and 70.4% (US) for the evaluation of the stress examination. Accuracy for the MPRI of the semi-quantitative parameters was 72.2% (SIM), 50.9% (TTP), 72.2% (AUC) und 89.1% (US). A combined semi-quantitative evaluation of the MPRI values using the ratio of the upslope values of the stress and rest examination was shown to be the most accurate method. MPRI (US{sub Stress}/US{sub Rest}) is superior to an evaluation of the stress examination alone. (orig.) [German] Ziel der Studie war es, die diagnostische Aussagekraft verschiedener semiquantitativer Parameter der MRT-gestuetzten Perfusionsuntersuchung des Myokards im Vergleich zur Herzkatheteruntersuchung zu bestimmen. Zwanzig Patienten mit Verdacht auf koronare Herzerkrankung, bei denen eine Herzkatheteruntersuchung erfolgt war, wurden innerhalb von 14 Tagen vor oder nach der Katheteruntersuchung im MRT untersucht. Es wurde eine Perfusionsuntersuchung waehrend

  12. Outcome of Triple Antiplatelet Therapy Including Cilostazol in Elderly Patients with ST-Elevation Myocardial Infarction who Underwent Primary Percutaneous Coronary Intervention: Results from the INTERSTELLAR Registry.

    Science.gov (United States)

    Jang, Ho-Jun; Park, Sang-Don; Park, Hyun Woo; Suh, Jon; Oh, Pyung Chun; Moon, Jeonggeun; Lee, Kyounghoon; Kang, Woong Chol; Kwon, Sung Woo; Kim, Tae-Hoon

    2017-06-01

    Compared with dual antiplatelet therapy including aspirin and clopidogrel, triple antiplatelet therapy including cilostazol has a mortality benefit in patients with ST-segment elevation myocardial infarction. However, whether the mortality benefit persists in elderly patients is not clear. From 2007 to 2014, 1278 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were retrospectively analyzed. The patients were divided into four groups by age (elderly, respectively) and antiplatelet strategy (triple or dual antiplatelet therapy). We compared the mortality rates between the triple and dual antiplatelet therapy groups. There were 1052 (male, 85%; mean age, 56.3 ± 10.4 years) patients in the young group and 241 (male, 52.7%; mean age, 80.3 ± 4.5 years) patients in the elderly group. In the young and elderly groups, 220 (20.9%) and 28 (12.3%) patients were treated with triple antiplatelet therapy. During a 1-year follow-up period, 80 patients died (4.2% in the young group vs. 15.5% in the elderly group). Kaplan-Meier survival analysis revealed that triple antiplatelet therapy was associated with a lower mortality rate in the young group (log-rank, p = 0.005). Although there were more angiographic high-risk patients in the elderly group, similar mortality rates were reported (log-rank, p = 0.803) without increased bleeding rates (1 vs. 3.6% in the elderly group, p = 0.217). Triple antiplatelet therapy might be a better antiplatelet regimen than dual antiplatelet therapy for patients with ST-segment elevation myocardial infarction. Although this benefit was strong in patients aged elderly patients (aged ≥75 years).

  13. 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

  14. A Comparison of FFD-based Nonrigid Registration and AAMs Applied to Myocardial Perfusion MRI

    DEFF Research Database (Denmark)

    Ólafsdóttir, Hildur; Stegmann, Mikkel Bille; Ersbøll, Bjarne Kjær

    2006-01-01

    -form deformations (FFDs). AAMs are known to be much faster than nonrigid registration algorithms. On the other hand nonrigid registration algorithms are independent of a training set as required to build an AAM. To obtain a further comparison of the two methods, they are both applied to automatically register multi......-slice myocardial perfusion images. The images are acquired by magnetic resonance imaging, from infarct patients. A registration of these sequences is crucial for clinical practice, which currently is subjected to manual labor. In the paper, the pros and cons of the two registration approaches are discussed...... and qualitative and quantitative comparisons are provided. The quantitative comparison is obtained by an analysis of variance of landmark errors, i.e. point to point and point to curve errors. Even though the FFD-based approach does not include a training phase it gave similar accuracy as the AAMs in terms...

  15. Incidentally detected diaphragmatic hernia mimicking angina pectoris with Tc-99m MIBI myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Cınar, Alev; Sadıc, Murat; Demırel, Koray; Korkmaz, Meliha

    2013-01-01

    In recent years 99m Technetium methoxy-isobutyl-isonitrile ( 99m Tc MIBI) is widely used in the evaluation of myocardial perfusion imaging (MPI). In this imaging protocol besides the cardiac evaluation, numerous other organs are included in the field of view. 99m Technetium MIBI is taken up in all metabolically active tissue in the body except for the brain. Extracardiac uptake patterns as benign or serious conditions can be revealed during the MPI. In the imaging protocol, we should be aware of distribution of this radiotracer in order to recognize the abnormal uptake. Here in, we present a large diaphragmatic hernia, seemed as a mirror vision of myocardium that was determined incidentally during the MPI with 99m Tc MIBI

  16. Quantitative myocardial-perfusion SPECT: comparison of three state-of-the-art software packages.

    Science.gov (United States)

    Wolak, Arik; Slomka, Piotr J; Fish, Mathews B; Lorenzo, Santiago; Acampa, Wanda; Berman, Daniel S; Germano, Guido

    2008-01-01

    We aimed to compare the automation and diagnostic performance in the detection of coronary artery disease (CAD) of the 4DMSPECT (4DM), Emory Cardiac Toolbox (EMO), and QPS systems for automated quantification of myocardial perfusion. We studied 328 patients referred for rest/stress Tc-99m sestamibi imaging, 140 low-likelihood patients and 188 with angiography. Contours were corrected when necessary. All other processing was fully automated. A 17-segment analysis was performed, and a summed stress score (SSS) > or =4 was considered abnormal. The average SSSs (+/-SD) for 4DM, EMO, and QPS were 10.5 +/- 9.4, 11.1 +/- 8.3, and 10.1 +/- 8.9, respectively (P = .02 for QPS versus EMO). The receiver operator characteristics areas-under-the-curve for the detection of CAD (+/-SEM) were 0.84 +/- 0.03, 0.76 +/- 0.04, and 0.88 +/- 0.03 for 4DM, EMO, and QPS, respectively (P = .001 for QPS versus EMO, and P = .03 for 4DM versus EMO). Normalcy rate was higher for QPS and 4DM versus EMO, at 91% and 94% versus 77%, respectively (P = .02). Sensitivity was higher for QPS (87%) versus 4DM (80%) (P = .045). Specificity was higher for QPS (71%) versus EMO (49%) (P = .01). The accuracy rate was higher for QPS versus 4DM and EMO, at 83% versus 77% and 76%, respectively (P = .05). There are differences in myocardial-perfusion quantification, diagnostic performance, and degree of automation of software packages.

  17. Development of a new technic for breast attenuation correction in myocardial perfusion scintigraphy using computational methods

    International Nuclear Information System (INIS)

    Oliveira, Anderson de

    2015-01-01

    Introduction: One of the limitations of nuclear medicine studies are false-positive results that lead to unnecessary exams and procedures associated to morbidity and costs to the individual and society. One of the most frequent causes for reducing the specificity of myocardial perfusion imaging (MPI) is photon attenuation, especially by breast in women. Objective: To develop a new technique to compensate the photon attenuation by women breasts in myocardial perfusion imaging with 99m Tc-sestamibi, using computational methods. Materials and methods: A procedure was proposed which integrates Monte Carlo simulation, computational methods and experimental techniques. Initially, were obtained the chest attenuation correction percentages using a phantom Jaszczak and breast attenuation percentages by Monte Carlo simulation method, using the EGS4 program. The percentages of attenuation correction were linked to individual patients' characteristics by an artificial neural network and a multivariate analysis. A preliminary technical validation was done by comparing the results of the MPI and catheterism (CAT), before and after applying the technique to 4 patients. The t test for parametric data, Wilcoxon, Mann-Whitney and X 2 for the others were used. Probability values less than 0.05 were considered statistically significant. Results: Each increment of 1 cm in the thickness of breast was associated to an average increment of 6% on photon attenuation, while the maximum increase related to breast composition was about 2%. The average chest attenuation percentage per unit was 2.9%. Both, the artificial neural network and linear regression, showed an error less than 3% as predictive models for percentage of female attenuation. The anatomical-functional correlation between MPI and CAT was maintained after the use of the technique. Conclusion: Results suggest that the proposed technique is promising and could be a possible alternative to other conventional methods employed

  18. Technetium myocardial perfusion scanning in prerenal transplant evaluation in the United kingdom.

    LENUS (Irish Health Repository)

    Wong, C F

    2008-06-01

    Because death with a functioning graft remains one of the most important causes of long-term renal transplant failure, cardiac risk stratification and screening for coronary artery disease are essential components of pretransplant assessment. Pretransplant screening for occult coronary artery disease in a subset of these patients may improve outcome. The UK follows the European Best practice guideline 1.5.5 E. Although echocardiography, thallium myocardial perfusion scanning (MPS), dobutamine stress echocardiography, and coronary angiography have been suggested as means of cardiovascular assessment, the best means of assessment remains undetermined. Therefore, we investigated the role of 99m technetium sestamibi myocardial perfusion scanning as an assessment tool for identifying those patients with end-stage renal failure at high risk of cardiovascular death after renal transplantation. Retrospectively, we studied 126 patients that had a MPS as part of their pretransplant assessment. Overall unadjusted survival was 65% at 3 years. Twelve deaths resulted from cardiovascular causes. A reversible defect on MPS was associated with a fatal cardiac event and all-cause mortality. The unadjusted hazard ratio of cardiac event with reversible defect on MPS was 3.1 (95% confidence interval, 1.1 to 18.2) and hazard ratio of death with reversible defect on MPS was 1.92 (95% confidence interval, 1.1 to 4.4). Thus, MPS may be a useful tool in cardiac risk stratification and in selecting patients with a favorable outcome after renal transplantation. Our patients with a reversible defect in particular have increased cardiac mortality. This group may benefit from coronary angiography.

  19. Myocardial Perfusion in Rheumatoid Arthritis Patients: Associations with Traditional Risk Factors and Novel Biomarkers

    Directory of Open Access Journals (Sweden)

    Miguel Bernardes

    2017-01-01

    Full Text Available Introduction. Cardiovascular (CV diseases are a major cause of death in rheumatoid arthritis (RA patients. Novel biomarkers [B-type natriuretic peptide (BNP; osteoprotegerin (OPG/receptor activator of nuclear factor-kappa B ligand (RANKL ratio; and dickkopf-1 (DKK-1] have been used in CV risk assessment. We analysed, in established RA patients, the presence of silent myocardial ischemia and its association with clinical variables, BNP, and bone and atheroma biomarkers. Methods. From a single-center tertiary referral hospital, RA patients asymptomatic for CV disease were submitted to myocardial perfusion scintigraphy (MPS under adenosine stress and biomarkers measurements. Logistic regression was used to estimate crude odds ratios (OR and 95% confidence intervals (CI. Results. In 189 patients, perfusion defects were frequent (25% and associated with BNP ≥ 100 pg/mL (OR = 5.68; 95% CI: 2.038–15.830, fourth log OPG/RANKL ratio quartile (OR = 2.88; 95% CI: 1.091–7.622, and DKK-1 ≥ 133 pmol/L (OR = 2.69; 95% CI: 1.058–6.840. Similar associations were confirmed in those with C-reactive protein > or ≤ 3 mg/L. No relationship was found with the majority of traditional CV factors nor with disease variables. Conclusions. Our results corroborated the hypothesis that MPS could reveal subclinical CV dysfunction, supported the utility of BNP measurements as a screening tool, and put in perspective the potential usefulness of complementary approaches in CV risk assessment in RA patients.

  20. Motion detection and correction for dynamic {sup 15}O-water myocardial perfusion PET studies

    Energy Technology Data Exchange (ETDEWEB)

    Naum, Alexandru; Laaksonen, Marko S.; Oikonen, Vesa; Teraes, Mika; Jaervisalo, Mikko J.; Knuuti, Juhani [University of Turku, Turku PET Centre, Turku (Finland); Tuunanen, Helena; Nuutila, Pirjo [University of Turku, Turku PET Centre, Turku (Finland); University of Turku, Department of Medicine, Turku (Finland); Kemppainen, Jukka [University of Turku, Turku PET Centre, Turku (Finland); University of Turku, Department of Clinical Physiology and Nuclear Medicine, Turku (Finland)

    2005-12-01

    Patient motion during dynamic PET studies is a well-documented source of errors. The purpose of this study was to investigate the incidence of frame-to-frame motion in dynamic {sup 15}O-water myocardial perfusion PET studies, to test the efficacy of motion correction methods and to study whether implementation of motion correction would have an impact on the perfusion results. We developed a motion detection procedure using external radioactive skin markers and frame-to-frame alignment. To evaluate motion, marker coordinates inside the field of view were determined in each frame for each study. The highest number of frames with identical spatial coordinates during the study were defined as ''non-moved''. Movement was considered present if even one marker changed position, by one pixel/frame compared with reference, in one axis, and such frames were defined as ''moved''. We tested manual, in-house-developed motion correction software and an automatic motion correction using a rigid body point model implemented in MIPAV (Medical Image Processing, Analysis and Visualisation) software. After motion correction, remaining motion was re-analysed. Myocardial blood flow (MBF) values were calculated for both non-corrected and motion-corrected datasets. At rest, patient motion was found in 18% of the frames, but during pharmacological stress the fraction increased to 45% and during physical exercise it rose to 80%. Both motion correction algorithms significantly decreased (p<0.006) the number of moved frames and the amplitude of motion (p<0.04). Motion correction significantly increased MBF results during bicycle exercise (p<0.02). At rest or during adenosine infusion, the motion correction had no significant effects on MBF values. Significant motion is a common phenomenon in dynamic cardiac studies during adenosine infusion but especially during exercise. Applying motion correction for the data acquired during exercise clearly changed

  1. Usefulness of thallium-201 myocardial perfusion scintigraphy in the diagnosis of chronic cor pulmonale

    Energy Technology Data Exchange (ETDEWEB)

    Kawai, S.; Tanaka, N.; Sawada, M.; Sakaguchi, K.; Fujita, K. (Osaka Prefectural Habikino Hospital, Osaka (Japan))

    1981-09-01

    To open up the possibility of exact clinical diagnoses of chronic cor pulmonale, we performed thallium-201 myocardial perfusion scintigraphy on patients with chronic pulmonary disease. From the thallium activity in the left ventricle (plus ventricular septum) and right ventricle counted scintigraphically, we determined the thallium activity ratio of left to right ventricle (TAR). The intra- and inter-observer variations of this ratio were negligible. We compared TAR with pulmonary hemodynamic findings and with left to right ventricular mass ratio measured at autopsy, and obtained the following results. 1) Left to right ventricular mass ratio determined in 11 autopsied patients by the method of Fulton et al. was closely correlated with TAR values (r = 0.90, p < 0.001). 2) In patients with chronic pulmonary disease, there were highly significant exponential inverse correlations between TAR and pulmonary arterial mean pressure, total pulmonary vascular resistance and right ventricular systolic pressure with the coefficients of -0.75, -0.72 or -0.77, respectively (p < 0.001). These results suggested the possibility that the severity of pulmonary circulatory disturbance may be ascertained non-invasively by TAR measurement. Thus, thallium-201 myocardial perfusion scintigraphy is able to reveal non-invasively right ventricular hypertrophy in patients with chronic pulmonary disease, and it might be a useful means of clinically diagnosing chronic cor pulmonale. If TAR obtained from scintigrams is smaller than 2, the patient concerned may possibly have right ventricular hypertrophy and he or she may be diagnosed as having chronic cor pulmonale.

  2. Comparison of rest and adenosine stress quantitative and semi-quantitative myocardial perfusion using magnetic resonance in patients with ischemic heart disease

    DEFF Research Database (Denmark)

    Qayyum, Abbas A; Qayyum, Faiza; Larsson, Henrik B W

    2017-01-01

    The aim was to compare absolute quantified myocardial perfusion (MP) to semi-quantitative measurements of MP using MRI for detection of ischemia. Twenty-nine patients underwent rest and stress MP imaging obtained by 1.5T MRI and analyzed using own developed software and by commercial available...... software. Linear regression analysis demonstrated that absolute quantitative data correlated stronger to maxSI (rest: r=0.296, p=.193; stress: r=0.583, p=0.011; myocardial perfusion reserve (MPR): r=0.789, p....058; stress: r=0.096, p=0.704; MPR: r=0.682, p=0.004; and Δ MBF: r=0.055, p=0.804). Absolute quantified MP was able to distinguish between ischemic and non-ischemic territories at rest (left anterior descending artery (LAD): 103.1±11.3mL/100g/min vs. 206.3±98.5mL/100g/min; p=0.001, right coronary artery (RCA...

  3. Optimization of a protocol for myocardial perfusion scintigraphy by using an anthropomorphic phantom

    Energy Technology Data Exchange (ETDEWEB)

    Ramos, Susie Medeiros Oliveira; Sa, Lidia Vasconcellos de, E-mail: susie@ird.gov.br [Instituto de Radioprotecao e Dosimetria (IRD/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Glavam, Adriana Pereira; Kubo, Tadeu Takao Almodovar [Clinica de Diagnostico Por Imagem (CDPI/DASA), Rio de Janeiro, RJ (Brazil)

    2014-07-15

    Objective: to develop a study aiming at optimizing myocardial perfusion imaging. Materials and Methods: imaging of an anthropomorphic thorax phantom with a GE SPECT Ventri gamma camera, with varied activities and acquisition times, in order to evaluate the influence of these parameters on the quality of the reconstructed medical images. The {sup 99m}Tc-sestamibi radiotracer was utilized, and then the images were clinically evaluated on the basis of data such as summed stress score, and on the technical image quality and perfusion. The software ImageJ was utilized in the data quantification. Results: the results demonstrated that for the standard acquisition time utilized in the procedure (15 seconds per angle), the injected activity could be reduced by 33.34%. Additionally, even if the standard scan time is reduced by 53.34% (7 seconds per angle), the standard injected activity could still be reduced by 16.67%, without impairing the image quality and the diagnostic reliability. Conclusion: the described method and respective results provide a basis for the development of a clinical trial of patients in an optimized protocol. (author)

  4. Static Myocardial Perfusion Imaging using denoised dynamic Rb-82 PET/CT scans

    DEFF Research Database (Denmark)

    Petersen, Maiken N.M.; Hoff, Camilla; Harms, Hans

    Introduction: Relative and absolute measures of myocardial perfusion are derived from a single 82Rb PET/CT scan. However, images are inherently noising due to the short half-life of 82Rb. We have previously shown that denoising techniques can be applied to dynamic 82Rb series with excellent...... quantitative accuracy. In this study, we examine static images created by summing late frames of denoised dynamic series. Method: 47 random clinical 82Rb stress and rest scans (27 male, age 68+/- 12 y., BMI 27.9 +/- 5.5 kg/m2) performed on a GE Discovery 690 PET/CT scanner were included in the study....... Administered 82Rb dose was 1110 MBq. Denoising using HYPR-LR or Hotelling 3D algorithms was performed as post-processing on the dynamic images series. Static series were created by summing frames from 2.5-5 min. The image data was analysed in QPET (Cedars-Sinai). Relative segmental perfusion (normalized...

  5. Optimization of a protocol for myocardial perfusion scintigraphy by using an anthropomorphic phantom*

    Science.gov (United States)

    Ramos, Susie Medeiros Oliveira; Glavam, Adriana Pereira; Kubo, Tadeu Takao Almodovar; de Sá, Lidia Vasconcellos

    2014-01-01

    Objective To develop a study aiming at optimizing myocardial perfusion imaging. Materials and Methods Imaging of an anthropomorphic thorax phantom with a GE SPECT Ventri gamma camera, with varied activities and acquisition times, in order to evaluate the influence of these parameters on the quality of the reconstructed medical images. The 99mTc-sestamibi radiotracer was utilized, and then the images were clinically evaluated on the basis of data such as summed stress score, and on the technical image quality and perfusion. The software ImageJ was utilized in the data quantification. Results The results demonstrated that for the standard acquisition time utilized in the procedure (15 seconds per angle), the injected activity could be reduced by 33.34%. Additionally, even if the standard scan time is reduced by 53.34% (7 seconds per angle), the standard injected activity could still be reduced by 16.67%, without impairing the image quality and the diagnostic reliability. Conclusion The described method and respective results provide a basis for the development of a clinical trial of patients in an optimized protocol. PMID:25741088

  6. 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.

  7. Unexpected 99mTc-tetrofosmin findings during myocardial perfusion scintigraphy: intraindividual comparison with PET/computed tomography.

    Science.gov (United States)

    Gratz, Stefan; Kempke, Bendix; Kaiser, Wolf; Behr, Thomas M; Pfestroff, Andreas; Höffken, Helmut

    2008-11-01

    99mTc-tetrofosmin single photon emission computed tomography (SPECT) is routinely used in the evaluation of coronary artery disease. A variety of different tumors, however, also demonstrate 99mTc-tetrofosmin uptake. We report six patients found with unexpected mediastinal and thoracic tumor uptake during Tc-tetrofosmin myocardial perfusion scintigraphy (MPS). We investigated 2,155 patients with Tc-tetrofosmin MPS during 2006-2007. One thousand four hundred and eighty-six of these patients had no coronary history and were sent to our department due to newly developed thoracic complaint such as chest pain, dyspnea and others. Six hundred and sixty-nine patients had coronary history. All patients underwent 99mTc-tetrofosmin exercise study. Patients with unexpected extracardiac Tc-tetrofosmin findings during MPS were referred to PET/CT for further diagnostic investigation. Region of interest (ROI; 99mTc-tetrofosmin) and SUVmax (2-[F]fluoro-2-deoxy-D-glucose, F-FDG) were estimated and the results were compared with histological findings. Abnormal mediastinal and/or thoracic activities were visualized in six of the 2,155 patients with 99mTc-tetrofosmin images. Subsequently, the patients underwent resection of a thymoma (n=2), nonsmall cell lung cancer (n=1) and breast cancer (n=3). In the patients with breast cancer one was a male patient with ductal, invasive breast cancer. Benign thymomas showed high 99mTc-tetrofosmin ROI >4.0 and low F-FDG SUVmax 2.5 in these malignant tumors. During Tc-tetrofosmin SPECT exercise stress tests performed in patients with suspected coronary artery disease, much more attention must be given to unexpected extracardiac uptakes. With 99mTc-tetrofosmin a large variety of different unknown tumors can be detected during MPS.

  8. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-11-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Pons, G.

    2011-04-28

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

  11. Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris

    DEFF Research Database (Denmark)

    Linde, Jesper J; Sørgaard, Mathias; Kühl, Jørgen T

    2017-01-01

    The prognostic implications of myocardial computed tomography perfusion (CTP) analyses are unknown. In this sub-study to the CATCH-trial we evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). In 240 patients with acute-onset chest pain, y...... % (64-96), specificity 95 % (91-97)]. Myocardial CT perfusion parameters predict mid-term clinical outcome in patients with recent acute-onset chest pain.......The prognostic implications of myocardial computed tomography perfusion (CTP) analyses are unknown. In this sub-study to the CATCH-trial we evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). In 240 patients with acute-onset chest pain, yet...... normal electrocardiograms and troponins, a clinically blinded adenosine stress CTP scan was performed in addition to conventional diagnostic evaluation. A reversible perfusion defect (PD) was found in 38 patients (16 %) and during a median follow-up of 19 months (range 12-22 months) 25 patients (10...

  12. Myocardial perfusion assessment by dual-energy computed tomography in patients with intermediate to high likelihood of coronary artery disease

    International Nuclear Information System (INIS)

    De Zam, M.C.; Capunay, C.; Rodriguez Granillo, G.A.; Deviggiano, A.; Campisi, R.; Munain, M. López de; Vallejos, J.; Carrascosa, P.M.

    2015-01-01

    Objectives. We sought to explore the feasibility and 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), and to assess the impact of beam hardening artifacts (HAE). Methods. The present prospective study involved patients with known or suspected CAD referred for myocardial perfusion imaging by single-photon emission computed tomography (SPECT). Twenty patients were included in the study protocol, and scanned using DECT imaging (n = 20). The same pharmacological stress was used for DECT and SPECT scans. Results. A total of 680 left ventricular segments were evaluated by DECT and SPECT. The contrast to noise ratio was 8.8±2.9. The diagnostic performance of DECT was very good in identifying perfusion defects [area under ROC curve (AUC) of DECT 0.90 (0.86-0.94)] compared with SPECT, and remained unaffected when including only segments affected by beam hardening artifacts (BHA) [AUC= DECT 0.90 (0.84-0.96)]. Conclusions. In this pilot investigation, myocardial perfusion assessment by DECT imaging in patients with intermediate to high likelihood of CAD was feasible and remained unaffected by the presence of BHA. (authors) [es

  13. 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.

  14. 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)

  15. Dietary red palm oil supplementation reduces myocardial infarct size in an isolated perfused rat heart model

    Directory of Open Access Journals (Sweden)

    Esterhuyse Adriaan J

    2010-06-01

    Full Text Available Abstract Background and Aims Recent studies have shown that dietary red palm oil (RPO supplementation improves functional recovery following ischaemia/reperfusion in isolated hearts. The main aim of this study was to investigate the effects of dietary RPO supplementation on myocardial infarct size after ischaemia/reperfusion injury. The effects of dietary RPO supplementation on matrix metalloproteinase-2 (MMP2 activation and PKB/Akt phosphorylation were also investigated. Materials and methods Male Wistar rats were divided into three groups and fed a standard rat chow diet (SRC, a SRC supplemented with RPO, or a SRC supplemented with sunflower oil (SFO, for a five week period, respectively. After the feeding period, hearts were excised and perfused on a Langendorff perfusion apparatus. Hearts were subjected to thirty minutes of normothermic global ischaemia and two hours of reperfusion. Infarct size was determined by triphenyltetrazolium chloride staining. Coronary effluent was collected for the first ten minutes of reperfusion in order to measure MMP2 activity by gelatin zymography. Results Dietary RPO-supplementation decreased myocardial infarct size significantly when compared to the SRC-group and the SFO-supplemented group (9.1 ± 1.0% versus 30.2 ± 3.9% and 27.1 ± 2.4% respectively. Both dietary RPO- and SFO-supplementation were able to decrease MMP2 activity when compared to the SRC fed group. PKB/Akt phosphorylation (Thr 308 was found to be significantly higher in the dietary RPO supplemented group when compared to the SFO supplemented group at 10 minutes into reperfusion. There was, however, no significant changes observed in ERK phosphorylation. Conclusions Dietary RPO-supplementation was found to be more effective than SFO-supplementation in reducing myocardial infarct size after ischaemia/reperfusion injury. Both dietary RPO and SFO were able to reduce MMP2 activity, which suggests that MMP2 activity does not play a major role in

  16. Rest/stress myocardial perfusion imaging: A means to prevent missed acute ischemic coronary syndrome diagnoses

    International Nuclear Information System (INIS)

    Fink-Bennett, D.; Pattekar, A.M.

    2002-01-01

    Aim: The sensitivity and specificity of rest/stress (R/S) myocardial perfusion imaging (MPI) in detecting an acute ischemic coronary syndrome (AICS) was determined in 100 consecutive patients (pts) admitted to the Chest Pain Clinic-Observation Unit (CPC-OU) with chest pain (CP) of suspected cardiac etiology and a negative (neg) or non diagnostic (dx) EKG. There were 57 females and 43 males, 30-83 years of age. 50 studies were performed from 1/15/98 to 4/2/98; 50 from 11/19/99 to 1/10/00. Material and Methods: An AICS was deemed present if a reversible perfusion defect was demonstrated scintigraphically; a ?50% luminal narrow angiographically. No AICS if the pt had a normal R/S MPI, a fixed defect with normal wall motion and thickening, a neg cardiac catheterization, or was free of cardiac symptoms and had no history of a vascular event for 2-3 years post CPC-OU admission. 13 pts with a positive MPI had a cardiac catheterization, none with a neg MPI. SPECT rest MPI's were performed 30-90 minutes (mins) post 10.0 mCi of technetium 99m Sestamibi. SPECT stress MPI's were performed following a 6-8 hour acute myocardial infarction enzyme (CP-MB/Troponin 1) rule out and 30-90 mins post 30.0 mCi of technetium 99m Sestamibi. Results: 29 pts were lost to follow-up. There were 12 true positive, 5 false positive, 54 true negative and 0 false negative studies. The sensitivity, specificity, positive and negative predictive value of a R/S MPI in detecting an AICS is 100%, 91%, 70% and 100%, respectively. An AICS was detected in 12% of pts admitted to the CPC-OU; a finding that correlates with its reported incidence of 2-12%. 6 were managed medically, 3 required emergent bypass surgery, 3 were stented. Conclusion: R/S MPI should be included in the CPC-OU dx work-up of pts with CP of suspected cardiac etiology to prevent missed AICS diagnoses. Patient care will be optimized and health care and medical malpractice awards for failure to diagnosis an acute myocardial infarction

  17. Comparison of stress-only vs. stress/rest with technetium-99m methoxyisobutylisonitrile myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Worsley, D.F.; Coupland, D.B.; Rexworthy, C.G.; Sexsmith, G.P.; Lentle, B.C. (Vancouver General Hospital, BC (Canada). Div. of Nuclear Medicine); Fung, A.Y. (Vancouver General Hospital, BC (Canada). Div. of Cardiology)

    1992-06-01

    Unlike conventional thallium-201 myocardial imaging, technetium-99m methoxyisobutylisonitrile (MIBI) requires separate stress and rest injections. We prospectively studied 148 consecutive patients referred for myocardial perfusion studies to determine the diagnostic value of rest images once normal exercise or dipyridom tomographic images had been obtained. In patients referred with no history of previous myocardial infarction in whom the diagnosis of coronary artery disease was suspected, 45 to 109 (41%) patients had normal stress tomographic images. Obtaining rest images did not alter the final interpretation in any of these cases. From this we infer that in patients with normal images after exercise or dipyridamole administration and no past history of myocardial infarction, {sup 99}m-Tc-MIBI rest images are not required. This provides several advantages including increased speed of diagnosis, decreased patient radiation exposure, improved cost efficiency and decreased demand on tomographic camera time. (orig.).

  18. Comparison of stress-only vs. stress/rest with technetium-99m methoxyisobutylisonitrile myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Worsley, D.F.; Coupland, D.B.; Rexworthy, C.G.; Sexsmith, G.P.; Lentle, B.C.; Fung, A.Y.

    1992-01-01

    Unlike conventional thallium-201 myocardial imaging, technetium-99m methoxyisobutylisonitrile (MIBI) requires separate stress and rest injections. We prospectively studied 148 consecutive patients referred for myocardial perfusion studies to determine the diagnostic value of rest images once normal exercise or dipyridom tomographic images had been obtained. In patients referred with no history of previous myocardial infarction in whom the diagnosis of coronary artery disease was suspected, 45 to 109 (41%) patients had normal stress tomographic images. Obtaining rest images did not alter the final interpretation in any of these cases. From this we infer that in patients with normal images after exercise or dipyridamole administration and no past history of myocardial infarction, 99 m-Tc-MIBI rest images are not required. This provides several advantages including increased speed of diagnosis, decreased patient radiation exposure, improved cost efficiency and decreased demand on tomographic camera time. (orig.)

  19. Serial assessment of left ventricular performance at rest and during bicycle exercise by ECG-gated myocardial perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Kumita, Shin-ichiro; Cho, Keiichi; Nakajo, Hidenobu [Nippon Medical School, Tokyo (Japan)] [and others

    2002-07-01

    The present study evaluates left ventricular performance during exercise by ECG-gated myocardial perfusion SPECT with short-time data collection. The study population consisted of 10 healthy volunteers (Group N) and 9 patients with ischemic heart disease (Group I). Seven patients in Group I had a history of prior myocardial infarction. Rest ECG-gated SPECT was performed 40 min after an injection of Tc-99m-tetrofosmin (555-740 MBq). After resting data acquisition, Group N underwent up to two 5-min stages of exercise (75 and 125 watts) on a detachable bicycle ergometer. The Group I patients all underwent symptom-limited, maximal testing on the ergometer. ECG-gated SPECT data were acquired from both groups for 3 min at rest and during the last 3 min of each exercise stage. Significant increases occurred in LVEF from rest to peak stress in both groups (from 55.4{+-}5.8 to 66.6{+-}4.1% in group N, p<0.0001; from 49.0{+-}12.8 to 56.7{+-}13.8% in Group I, p<0.001). The LVESV values significantly decreased to peak stress in Group N (from 49.9{+-}13.1 to 37.8{+-}10.0 ml, p<0.0001), whereas LVEDV did not change (from 110.6{+-}18.9 to 112.0{+-}19.0 ml). In contrast, the LVESV values at rest and under peak stress were similar in Group I (from 52.6{+-}23.9 to 51.7{+-}31.4 ml) and LVEDV in Group I at peak exercise tended to increase (from 102.8{+-}36.7 to 111.3{+-}39.0 ml). The changes in LVESV from rest to peak stress were significantly different between Group N and I (-12.1{+-}6.3 vs. -0.9{+-}11.6 ml, p<0.02). ECG-gated SPECT with short-time data collection can assess left ventricular function during exercise and may offer useful information for evaluating patients with ischemic heart disease. (author)

  20. Impact of high-density lipoprotein 3 cholesterol subfraction on periprocedural myocardial injury in patients who underwent elective percutaneous coronary intervention.

    Science.gov (United States)

    Harada, Kazuhiro; Kikuchi, Ryosuke; Suzuki, Susumu; Tanaka, Akihito; Aoki, Toshijiro; Iwakawa, Naoki; Kojima, Hiroki; Hirayama, Kenshi; Mitsuda, Takayuki; Sumi, Takuya; Negishi, Yosuke; Ishii, Hideki; Murohara, Toyoaki

    2018-02-02

    Periprocedural myocardial injury (PMI) is a major complication of percutaneous coronary intervention (PCI) and is associated with atherosclerotic coronary plaque and worse clinical outcomes. High-density lipoprotein cholesterol (HDL-C) is a protective factor for cardiovascular disease. However, the role of HDL-C subfractions, such as HDL2 cholesterol (HDL2-C) or HDL3 cholesterol (HDL3-C), in cardiovascular disease remains unclear. The purpose of the study was to investigate the relationship between HDL2-C and HDL3-C subfractions and the incidence of PMI in patients who underwent elective PCI. We enrolled 129 patients who underwent elective PCI for stable angina pectoris. PMI was defined as an increase in high-sensitivity troponin T levels > 5 times the upper normal limit (> 0.070 ng/mL) at 24 h after PCI. Serum HDL-C subfractions (HDL2-C and HDL3-C) were assessed using ultracentrifugation in patients with and those without PMI. HDL3-C levels were significantly lower in patients with PMI than in those without (15.1 ± 3.0 mg/dL vs. 16.4 ± 2.9 mg/dL, p = 0.016) and had an independent and inverse association with PMI (odds ratio, 0.86; 95% confidence interval, 0.74-0.99; p = 0.038). When divided by the cut-off value of HDL3-C for PMI (14.3 mg/dL), the incidence of PMI was significantly higher in low HDL3-C patients than in high HDL3-C patients (51.2% vs. 30.2%, p = 0.020). HDL3-C was an independent inverse predictor of PMI in patients who underwent elective PCI.

  1. Evaluation of myocardial perfusion and ventricular shape in hypertrophic cardiomyopathy using [sup 99m]Tc-tetrofosmin scintigraphy; Comparison with [sup 201]Tl myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Ohtsuki, Katsuichi; Taniguchi, Yoko (Kyoto Prefectural Univ. of Medicine (Japan)); Sugihara, Hiroki (and others)

    1994-04-01

    Hypertrophic cardiomyopathy (HCM) is known to have the impairment of myocardial perfusion as well as irregularly hypertrophic myocardium. To evaluate myocardial perfusion and ventricular shape in HCM, [sup 99m]Tc-Tetrofosmin scintigraphy was performed after exercise (Ex) and at resting state (Re) in 10 patients with HCM and was compared with early image (Ea) and delayed image (De) of [sup 201]Tl scintigraphy performed after exercise. SPECT images of both [sup 99m]Tc-Tetrofosmin and [sup 201]Tl scintigraphy were analyzed with five scaled visual scores set in 18 segments. The complete concordance ratio between [sup 99m]Tc-Tetrofosmin (Ex and Re) and [sup 201]Tl(Ea and De) images in segmental analysis was 75%. Image quality of [sup 99m]Tc-Tetrofosmin was seemed to be superior to that of [sup 201]Tl scintigraphy. In 9 patients with HCM, [sup 99m]Tc-Tetrofosmin scintigraphy was performed under the ECG gating and the thickness of septal and free wall was measured. Good correlation was observed with the data by ultrasound cardiography (r=0.79, p<0.002 in wall thickness, r=0.84, p<0.01 in the ratio of septal wall thickness to free wall thickness). Left ventricular shape (ventricular long axis) was closely resemble to that of left ventriculography by contrast medium. In conclusion, [sup 99m]Tc-Tetrofosmin scintigraphy is useful for the evaluation of myocardial morphology as well as perfusion abnormality. (author).

  2. 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

  3. Myocardial ischemia detection with single-phase CT perfusion in symptomatic patients using high-pitch helical image acquisition technique.

    Science.gov (United States)

    Bischoff, Bernhard; Deseive, Simon; Rampp, Martin; Todica, Andrei; Wermke, Marc; Martinoff, Stefan; Massberg, Steffen; Reiser, Maximilian F; Becker, Hans-Christoph; Hausleiter, Jörg

    2017-04-01

    Coronary CT angiography (CCTA) suffers from a reduced diagnostic accuracy in patients with heavily calcified coronary arteries or prior myocardial revascularisation due to artefacts caused by calcifications and stent material. CT myocardial perfusion imaging (CTMPI) yields high potential for the detection of myocardial ischemia and might help to overcome the above mentioned limitations. We analysed CT single-phase perfusion using high-pitch helical image acquisition technique in patients with prior myocardial revascularisation. Thirty-six patients with an indication for invasive coronary angiography (28 with coronary stents, 2 with coronary artery bypass grafts and 6 with both) were included in this prospective study at two study sites. All patients were examined on a 2nd generation dual-source CT system. Stress CT images were obtained using a prospectively ECG-triggered single-phase high-pitch helical image acquisition technique. During stress the tracer for myocardial perfusion (MP) SPECT imaging was administered. Rest CT images were acquired using prospectively ECG-triggered sequential CT. MP-SPECT imaging and invasive coronary angiography served as standard of reference. In this heavily diseased patient cohort CCTA alone showed a low overall diagnostic accuracy for detection of hemodynamically relevant coronary artery stenosis of only 31% on a per-patient base and 60% on a per-vessel base. Combining CCTA and CTMPI allowed for a significantly higher overall diagnostic accuracy of 78% on a per-patient base and 92% on a per-vessel base (p CT scans was 0.9 mSv, mean radiation dose for rest CT scans was 5.0 mSv. In symptomatic patients with known coronary artery disease and prior myocardial revascularization combining CCTA and CTMPI showed significantly higher diagnostic accuracy in detection of hemodynamically significant coronary artery stenosis when compared to CCTA alone.

  4. 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 {sup 99m}Tc-MIBI single-photon emission computed tomography study

    Energy Technology Data Exchange (ETDEWEB)

    Lipiec, Piotr [Medical University of Lodz, 2nd Department of Cardiology, Lodz (Poland); Medical University of Lodz, 2nd Department of Cardiology, Bieganski Hospital, Lodz (Poland); Krzeminska-Pakula, Maria; Plewka, Michal; Kasprzak, Jaroslaw D. [Medical University of Lodz, 2nd Department of Cardiology, Lodz (Poland); Kusmierek, Jacek; Plachcinska, Anna; Szuminski, Remigiusz [Medical University of Lodz, Department of Nuclear Medicine, Lodz (Poland); Robak, Tadeusz; Korycka, Anna [Medical University of Lodz, Department of Hematology, Lodz (Poland)

    2009-04-15

    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.)

  5. Baseline stress myocardial perfusion imaging results and outcomes in patients with stable ischemic heart disease randomized to optimal medical therapy with or without percutaneous coronary intervention.

    Science.gov (United States)

    Shaw, Leslee J; Weintraub, William S; Maron, David J; Hartigan, Pamela M; Hachamovitch, Rory; Min, James K; Dada, Marcin; Mancini, G B John; Hayes, Sean W; O'Rourke, Robert A; Spertus, John A; Kostuk, William; Gosselin, Gilbert; Chaitman, Bernard R; Knudtson, Merill; Friedman, John; Slomka, Piotr; Germano, Guido; Bates, Eric R; Teo, Koon K; Boden, William E; Berman, Daniel S

    2012-08-01

    The COURAGE trial reported similar clinical outcomes for patients with stable ischemic heart disease (SIHD) receiving optimal medical therapy (OMT) with or without percutaneous coronary intervention (PCI). The current post hoc substudy analysis examined the relationship between baseline stress myocardial ischemia and clinical outcomes based on randomized treatment assignment. A total of 1,381 randomized patients (OMT n = 699, PCI + OMT n = 682) underwent baseline stress myocardial perfusion single-photon emission computed tomographic imaging. Site investigators interpreted the extent of ischemia by the number of ischemic segments using a 6-segment myocardial model. Patients were divided into those with no to mild (ischemic segments) and moderate to severe ischemia (≥ 3 ischemic segments). Cox proportional hazards models were calculated to assess time to the primary end point of death or myocardial infarction. At baseline, moderate to severe ischemia occurred in more than one-quarter of patients (n = 468), and the incidence was comparable in both treatment groups (P = .36). The primary end point, death or myocardial infarction, was similar in the OMT and PCI + OMT treatment groups for no to mild (18% and 19%, P = .92) and moderate to severe ischemia (19% and 22%, P = .53, interaction P value = .65). There was no gradient increase in events for the overall cohort with the extent of ischemia. From the COURAGE trial post hoc substudy, the extent of site-defined ischemia did not predict adverse events and did not alter treatment effectiveness. Currently, evidence supports equipoise as to whether the extent and severity of ischemia impact on therapeutic effectiveness. Copyright © 2012 Mosby, Inc. All rights reserved.

  6. Diagnostic accuracy and functional parameters of myocardial perfusion scintigraphy using accelerated cardiac acquisition with IQ SPECT technique in comparison to conventional imaging.

    Science.gov (United States)

    Pirich, Christian; Keinrath, Peter; Barth, Gabriele; Rendl, Gundula; Rettenbacher, Lukas; Rodrigues, Margarida

    2017-03-01

    IQ SPECT consists of a new pinhole-like collimator, cardio-centric acquisition, and advanced 3D iterative SPECT reconstruction. The aim of this paper was to compare diagnostic accuracy and functional parameters obtained with IQ SPECT versus conventional SPECT in patients undergoing myocardial perfusion scintigraphy with adenosine stress and at rest. Eight patients with known or suspected coronary artery disease underwent [99mTc] tetrofosmin gated SPECT. Acquisition was performed on a Symbia T6 equipped with IQ SPECT and on a conventional gamma camera system. Gated SPECT data were used to calculate functional parameters. Scores analysis was performed on a 17-segment model. Coronary angiography and clinical follow-up were considered as diagnostic reference standard. Mean acquisition time was 4 minutes with IQ SPECT and 21 minutes with conventional SPECT. Agreement degree on the diagnostic accuracy between both systems was 0.97 for stress studies, 0.91 for rest studies and 0.96 for both studies. Perfusion abnormalities scores obtained by using IQ SPECT and conventional SPECT were not significant different: SSS, 9.7±8.8 and 10.1±6.4; SRS, 7.1±6.1 and 7.5±7.3; SDS, 4.0±6.1 and 3.9±4.3, respectively. However, a significant difference was found in functional parameters derived from IQ SPECT and conventional SPECT both after stress and at rest. Mean LVEF was 8% lower using IQ SPECT. Differences in LVEF were found in patients with normal LVEF and patients with reduced LVEF. Functional parameters using accelerated cardiac acquisition with IQ SPECT are significantly different to those obtained with conventional SPECT, while agreement for clinical interpretation of myocardial perfusion scintigraphy with both techniques is high.

  7. 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.

  8. Combined coronary angiography and myocardial perfusion by computed tomography in the identification of flow-limiting stenosis - The CORE320 study: An integrated analysis of CT coronary angiography and myocardial perfusion.

    Science.gov (United States)

    Magalhães, Tiago A; Kishi, Satoru; George, Richard T; Arbab-Zadeh, Armin; Vavere, Andrea L; Cox, Christopher; Matheson, Matthew B; Miller, Julie M; Brinker, Jeffrey; Di Carli, Marcelo; Rybicki, Frank J; Rochitte, Carlos E; Clouse, Melvin E; Lima, João A C

    2015-01-01

    The combination of coronary CT angiography (CTA) and myocardial CT perfusion (CTP) is gaining increasing acceptance, but a standardized approach to be implemented in the clinical setting is necessary. To investigate the accuracy of a combined coronary CTA and myocardial CTP comprehensive protocol compared to coronary CTA alone, using a combination of invasive coronary angiography and single photon emission CT as reference. Three hundred eighty-one patients included in the CORE320 trial were analyzed in this study. Flow-limiting stenosis was defined as the presence of ≥50% stenosis by invasive coronary angiography with a related perfusion defect by single photon emission CT. The combined CTA + CTP definition of disease was the presence of a ≥50% stenosis with a related perfusion defect. All data sets were analyzed by 2 experienced readers, aligning anatomic findings by CTA with perfusion defects by CTP. Mean patient age was 62 ± 6 years (66% male), 27% with prior history of myocardial infarction. In a per-patient analysis, sensitivity for CTA alone was 93%, specificity was 54%, positive predictive value was 55%, negative predictive value was 93%, and overall accuracy was 69%. After combining CTA and CTP, sensitivity was 78%, specificity was 73%, negative predictive value was 64%, positive predictive value was 0.85%, and overall accuracy was 75%. In a per-vessel analysis, overall accuracy of CTA alone was 73% compared to 79% for the combination of CTA and CTP (P perfusion defect. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  9. Diagnostic value of amplitude-phase analysis in myocardial infarct. Comparison with thallium perfusion scintigraphy and contrast ventrilography

    International Nuclear Information System (INIS)

    Garcheva, M.; Trindev, P.; Shejretova, E.; Stoyanova, N.; Kaloyanova, P.; Khadzhikostova, Kh.

    1990-01-01

    The evaluation is based on the results of investigation of 34 patients who have had myocardial infarct without rhythm disturbances. Compared to contrast ventrilography, the amplitude-phase analysis (APA) of 'rest' radionuclide ventrilography show 80% sensitivity and 100% specificity, as well as high accuracy in determination of the type and localization of the kinetic disturbances. The comparison with the thallium perfusion scintigraphy demonstrates the possibility of APA to vizualize abnormal kinetic area of the myocardial wall and shows its independent significance in the cases of doubtful findings. APA is a powerful tool for unambigious differentiating of hypokinetic from akinetic and diskinetic areas. 1 tab., 1 fig., 4 refs

  10. Myocardial visualization on a routine perfusion lung scintigram: Relationship to the amount of right-to-left shunt

    International Nuclear Information System (INIS)

    Seto, H.; Futatsuya, R.; Kamei, T.; Kakishita, M.; Hisada, K.

    1983-01-01

    Three cases of myocardial visualization on a routine perfusion lung scintigram with sup(99m)Tc-macroaggregaed albumin were reported in patients with congenital heart diseases; two cases of tetralogy of Fallot and one case of truncus arteriosus type IV. Large right-to-left shunts greater than 39% and marked hypertrophy of the ventricle suggesting the presence of increased coronary blood flow were noted in all cases. In the two patients with tetralogy of Fallot myocardial activity appeared to be located in the hypertrophic right venticles. (orig.)

  11. Myocardial visualization on a routine perfusion lung scintigram: Relationship to the amount of right-to-left shunt

    Energy Technology Data Exchange (ETDEWEB)

    Seto, H.; Futatsuya, R.; Kamei, T.; Kakishita, M.; Hisada, K.

    1983-11-14

    Three cases of myocardial visualization on a routine perfusion lung scintigram with sup(99m)Tc-macroaggregated albumin were reported in patients with congenital heart diseases; two cases of tetralogy of Fallot and one case of truncus arteriosus type IV. Large right-to-left shunts greater than 39% and marked hypertrophy of the ventricle suggesting the presence of increased coronary blood flow were noted in all cases. In the two patients with tetralogy of Fallot myocardial activity appeared to be located in the hypertrophic right venticles.

  12. High spatial resolution myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance using k-t SENSE.

    Science.gov (United States)

    Gebker, R; Jahnke, C; Manka, R; Frick, M; Hucko, T; Kozerke, S; Schnackenburg, B; Fleck, E; Paetsch, I

    2012-07-26

    To prospectively evaluate the feasibility and diagnostic accuracy of high spatial resolution myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance (DSMR) for the detection of coronary artery disease (CAD). DSMR-wall motion was combined with perfusion imaging (DSMR-perfusion) in 78 patients prior to clinically indicated invasive coronary angiography. For DSMR-perfusion an in-plane spatial resolution of 1.5 × 1.5mm(2) was attained by using 8 × k-space and time sensitivity encoding (k-t SENSE). Image quality and extent of artifacts during perfusion imaging were evaluated. Wall motion and perfusion data were interpreted sequentially. Significant CAD (stenosis ≥ 70%) was present in 52 patients and involved 86 coronary territories. One patient did not reach target heart rate despite maximum infusion of dobutamine/atropine. Two studies (3%) were non-diagnostic due k-t SENSE related artifacts resulting from insufficient breathhold capability. Overall image quality was good. Dark-rim artifacts were limited to the endocardial border at a mean width of 1.8mm. The addition of DSMR-perfusion to DSMR-wall motion data improved sensitivity for the detection of CAD (92% vs. 81%, P=0.03) and accurate determination of disease extent (85% vs. 66% of territories, Pspatial resolution DSMR-perfusion imaging at maximum stress level was feasible, improved sensitivity over DSMR-wall motion for the detection of CAD and allowed an accurate determination of disease extent. Specificity of DSMR-perfusion with k-t SENSE improved compared to prior studies using lower spatial resolution. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  13. Endoscopic retrograde cholangiopancreatography causes reduced myocardial blood flow

    DEFF Research Database (Denmark)

    Christensen, M; Hendel, H W; Rasmussen, V

    2002-01-01

    ). PATIENTS AND METHODS: 11 patients scheduled for ERCP were monitored with a Holter tape recorder and underwent myocardial perfusion scintigraphies, to evaluate myocardial perfusion at rest and during ERCP. RESULTS: Ten patients completed the study. Eight patients had no sign of myocardial ischemia...... with either of the two methods, while two patients developed signs of ischemia during ERCP with both the Holter tape recording and on myocardial scintigraphy (P = 0.02). CONCLUSIONS: Patients undergoing ERCP may develop true myocardial ischemia with reduced myocardial blood flow. Although this is a small...

  14. Role of myocardial perfusion scintigraphy in type II diabetic patients: a multicentre study

    International Nuclear Information System (INIS)

    Muhammad Shahzad Afzal

    2004-01-01

    Coronary artery disease (CAD) is a major cause of morbidity and mortality in patients with diabetes and this population has high incidence of silent cardiac events. Objective: We evaluated the role of myocardial perfusion scintigraphy (MPS) in detection of coronary artery disease (CAD) in patients with type II diabetes mellitus in correlation with presenting complaints. Methods: This study was conducted at six Nuclear Medicine Institutes of Pakistan as an IAEA sponsored technical Co-operation project from January to December 2003. We conducted stress-redistribution SPECT MPS with intravenous injection of 111 MBq (3mCi) 201Tl-thallous chloride in 288 subjects with type II diabetes mellitus, 186 male and 92 female (age range 20 to 77 years). Average duration since diagnosis of diabetes mellitus was 4.61 + 4.56 years. Upon the bases of clinical history, diabetic patients were divided into six groups, Asym= asymptomatic subjects (n=46), Esob=exertional SOB (n=27), Acp=atypical chest pain without dyspnea (n=61), AcpD= atypical chest pain with dyspnea (n=57), Tcp=typical chest pain without dyspnea (n=36), TcpD=typical chest pain with dyspnea (n=61). We conducted visual analysis on reconstructed tomographic slices. Results: Considering all diabetic patients together 61.45% were having CAD (inducible ischemia 45.48%, myocardial infarction 15.97%). Overall incidence of CAD was higher in Esob group than Asym (55.55% vs. 34.78%), AcpD group than Acp (71.92% vs. 49.18%) and TcpD group than Tcp (83.61% vs. 66.67%). Incidence of stress induced ischemia (SII) and myocardial infarction (MI) in Asym group was 23.91% and 10.87%, in Acp Group 36.07% and 13.11%, and in Tcp group 47.22% and 19.44% respectively. Incidence of SII and MI in Esob group was 44.44% and 11.11%, in AcpD roup 56.14% and 15.79%, and in TcpD group 60.66% and 22.95% respectively. Conclusion: Our study concludes that incidence of silent myocardial ischemia and infarction is quite high in patients with type

  15. Thallium-201 myocardial perfusion imaging in infants and children. Value in distinguishing anomalous left coronary artery from congestive cardiomyopathy.

    Science.gov (United States)

    Gutgesell, H P; Pinsky, W W; DePuey, E G

    1980-03-01

    In infants and children, anomalous origin of the left coronary artery (ALCA) from the pulmonary artery may be difficult to distinguish from congestive cardiomyopathy (CCM) of other causes. We performed thallium-201 myocardial perfusion imaging in seven children with ALCA and in nine with CCM to study the usefulness of this technique in distinguishing between these lesions. Localized abnormalities of thallium uptake were present in each of the seven patients with ALCA, including two asymptomatic 4-year-old children. Thallium distribution was normal in five patients with CCM, diffusely irregular in three, and was absent in the lateral and posterobasal portions of the left ventricle in one patient. We conclude that thallium-201 imaging is a sensitive noninvasive method of detecting ALCA. However, perfusion abnormalities are not limited to patients with coronary artery abnormalities, and may be present in patients with myocardial ischemia or infarction of other causes.

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

    International Nuclear Information System (INIS)

    Xie Wenhui; Zhang Lihua; Hu Shilong; Yang Shunfang; Zeng Jun

    2004-01-01

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