PURPOSE: We investigated reproducibility of the quantification of left ventricular volume and ejection fraction, and grading of myocardial wall motion and systolic thickening when we used gated myocardial SPECT and Cedars quantification software. MATERIALS AND METHODS: We performed gated myocardial SPECT in 33 consecutive patients twice in the same position after Tc-99m-MIBI SPECT. We used 16 frames per cycle for the gatingof sequential Tc-99m-MTBI SPECT. After reconstruction, we used Cedars quantitative gated SPECT and calculated ventricular volume and ejection fraction (EF), Wall motion was graded using 5 point score. Wall thickening was graded using 4 point score. Coefficient of variation for re-examination of volume and fraction were calculated. Kappa values (k-value) for assessing reproducibility of wall motion or wall thickening were calculated. RESULTS: Enddiastolic volumes (EDV) ranged from 58 mi to 248 ml (122 ml +/- 42 ml), endsystolic volumes (ESV) from 20 mi to 174 mi (65 ml +1- 39 ml), and EF from 20% to 68% (51% +/- 14%). Geometric mean of standard deviations of 33 patients was 5.0 ml for EDV, 3.9 ml for ESV and 1.9% for EF. Their average differences were not different from zero (p>0.05). k-value for wall motion using 2 consecutive images was 0.76 (confidence interval: 0.71-0.81). k-value was 0.87 (confidence interval:0.83-0.90) for assessment of wall thickening. CONCLUSION: We concluded that quantification of functional indices, assessment of wall motion and wall thickening using gated Tc-99m-MIBI SPECT was reproducible and we could use this method for the evaluation of short-acting drug effect.
Heart ; Humans ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND AND OBJECTIVES: We investigated if gated and/or attenuation-corrected SPECT improved performance of experienced or in-experienced operators in the diagnosis of coronary artery disease (CAD) or stenosed arteries in patients having intermediate or high pretest likelihood. MATERIALS AND METHODS: Rest/dipyridamole stress gated attenuation-corrected SPECT was performed in 81 patients (M:F=48:33, 62+/-8.6 years old, of high (n=38) or intermediate (n=43) pre-test likelihood for CAD, 1 vessel; 14, 2 vessel; 19, 3 vessel disease; 31, normal; 17). Two experienced and one novice physicians graded 1 (normal) to 5 (definitely abnormal) for each artery 1) by conventional rest Tl-201/stress Tc-99m-MIBI SPECT, 2) 1) plus viewing gated SPECT (+gated) and 3) 2) plus attenuation-corrected SPECT (+AC gated). Areas under curves (AUC) of receiver operating characteristic (ROC) curves were compared. RESULTS: AUC was greater in patients with high likelihood than intermediate likelihood. Novice physician performed better in diagnosing RCA stenosis (AUC: 0.53 for usual, 0.58 for +gated, and 0.66 for +AC gated) in patients with intermediate likelihood. AUC was not different for the diagnosis of CAD and LAD or LCx. Performance of experienced physicians was not different regardless of pre-test likelihood. Novice operator's specificity increased from 53% to 73% for CAD, and 62% to 89% (p<0.05) for RCA in patients with intermediate likelihood. CONCLUSION: We conclude that gated attenuation-corrected SPECT was helpful only for novice physician to diagnose RCA stenosis by increasing specificity in patients with intermediate likelihood. Even for inexperienced physician, these methods were not helpful in patients with high pre-test likelihood or for LAD or LCX.
Area Under Curve ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Humans ; ROC Curve ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: Either gated myocardial perfusion SPECT or attenuation corrected SPECT can be used to improve specificity in the diagnosis of coronary artery disease. We investigated in this study whether gating or attenuation correction improved diagnostic performance of rest/stress perfusion SPECT in patients having intermediate pre-test likelihood of coronary artery disease. MATERIALS AND METHODS: Sixty-eight patients underwent rest attenuation-corrected T1-20l/dipyridamole stress gated attenuation-corrected Tc-99m-MIBI SPECT using an ADAC vertex camera (M:F=29:39, aged 59+/-12 years, coronary artery stenosis> or =70%. one vessel: 13, two vessel: 18, three vessel: 8, normal: 29). Using a five-point scale, three physicians graded the post-test likelihood of coronary artery disease for each arterial territory (1 normal, 2: possibly normal 3:equivocal, 4: possibly abnormal, 5: abnormal). Sensitivity, specificity and area under receiver-operating-characteristic curves were compared for each operator between three METHODS: (A) non-attenuation-corrected SPECT; (B) gated SPECT added to (A); and (C) attenuation-corrected SPECT added to (B). RESULTS: When grade 3 was used as the criteria for coronary artery disease, no differences in sensitivity and specificity were found between the three methods for each operator Areas under receiver- operating-characteristic curves for diagnosis of coronary artery disease revealed no differences between each modality (p>005). CONCLUSION: In patients at intermediate risk of coronary artery disease, gated SPECT and attenuation-corrected SPECT did not improve diagnostic performance.
Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Humans ; Perfusion* ; ROC Curve ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

No abstract available.
Alkaline Phosphatase* ; Calcium* ; Female ; Humans ; Osteocalcin*

PURPOSE: Dipyridamole stress myocardial perfusion SPECT could predict prognosis, however, long-term follow-up showed change of hazard ratio in patients with suspected coronary artery disease. We investigated how long normal SPECT could predict the benign prognosis on the long-term follow-up. MATERIALS AND METHODS: We followed up 1169 patients and divided these patients into groups in whom coronary angiography were performed and were not. Total cardiac event rate and hard event rate were predicted using clinical, angiographic and SPECT findings. Predictive values of normal and abnormal SPECT were examined using survival analysis with Mantel-Haenszel method, multivariate Cox proportional hazard model analysis and newly developed statistical method to test time-invariance of hazard rate and changing point of this rate. RESULTS: Reversible perfusion decrease on myocardial perfusion SPECT predicted higher total cardiac event rate independently and further to angiographic findings. However, myocardial SPECT showed independent but not incremental prognostic values for hard event rate. Hazard ratio of normal perfusion SPECT was changed significantly (p<0.001) and the changing point of hazard rate was 4.4 years of follow up. However, the ratio of abnormal SPECT was not. CONCLUSION: Dipyridamole stress myocardial perfusion SPECT provided independent prognostic information in patients with known and suspected coronary artery disease. Normal perfusion SPECT predicted least event rate for 4.4 years.
Coronary Angiography ; Coronary Artery Disease ; Dipyridamole* ; Follow-Up Studies ; Humans ; Perfusion ; Prognosis ; Proportional Hazards Models ; Tomography, Emission-Computed, Single-Photon*

We studied to investigate the predictive values of gated SPECT for the improvement of wall motion after bypass surgery. As we compared postoperative SPECT with preoperative ones, we defined viability as wall motion improvement. We performed rest 71-201/stress Tc-99m-MIBI gated SPECT in 25 patients before and 3 months after bypass surgery. Myocardial wall motion was graded as normal, hypokinesia, akinesia, and dyskinesia by pair-wise visual analysis of gated pre and postoperative SPECT's on the same monitor screen. Myocardial wall thickening was determined good or poor Among 92 segments with wall motion abnormalities before operation, 69 (75%) improved and 23 did not. Before operation, we could find segments with good systolic thickening in 64 segments among total 92. Thickening of the remaining 28 was poor. Wall motion improved postoperatively in 45 segments (70%) among 64 with good thickening. Twenty four(86%) among 28 segments with poor thickening had also improved. We grouped segments into mild(hypokinetic) and severe(akinetic/dyskinetic) ones. Among 33 segments with severe motion abnormalities, 14 had good thickening and 19 did not. Nine(60%) improved out of 14 segments having severe abnormality with good thickening. However, 16(84%) segments out of 19 having severe abnormality with poor thickening also improved. Neither degree of perfusion decrease nor severity of wall motion abnormalities could explain the high rate of false negatives. In conclusion, as we defined viability as wall motion improvement by comparing pre and postoperative SPECT, systolic thickening observed by gated Tc-99m-MIBI SPECT in myocardial segments with wall motion abnormalities predicted wall motion improvement after bypass surgery. However, poor thickening could not be referred as evidence of nonviable myocardium both in mild and severe contractile dysfunction, so that we might need stimulation study such as dobutamine echocardiography or dobutamine gated SPECT.
Dobutamine ; Dyskinesias ; Echocardiography ; Humans ; Hypokinesia ; Myocardium ; Perfusion ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: We investigated the difference of glucose metabolism of medial and lateral temporal lobes of patients with temporal lobe epilepsy (TLE) utilizing quantitative comparison of regional metabolic activities using asymmetric index. MATERIALS AND METHODS: We studied 19 pathologically proven mesial TLE and 25 lateral TLE patients. Lateral TLE patients were either normal on magnetic resonance imaging (cryptogenic: n=14) or had structural lesions (lesional: n=11). Asymmetric index (ASI) was calculated as [(ipsilateral-contralateral)/(ipsilateral+ contralateral)]x200. RESULTS: ASI of medial and lateral lobes of mesial TLE was decreased (-16.4+/-8.3 and -12.7+/-5.5, respectively). In cryptogenic lateral TLE, ASI of lateral temporal lobe was decreased (-11.8+/-4.7), whereas that of medial temporal lobe was not decreased (-4.6+/-6.3). ASI of medial lobe of lesional lateral TLE was -7.3+/-9.1, which was significantly different from that of mesial TLE (p<0.05). Patients with lesional lateral TLE had evident metabolic defects or decrease (ASI: -22+/-10.5) in lateral temporal lobe. While we could not find the difference of metabolic activity in lateral temporal lobes between cryptogenic lateral TLE and mesial TLE patients, the difference of metabolic activity was significant in medial temporal lobes which was revealed by ASI quantitation. CONCLUSION: Asymmetric decrease of metabolic activity in both medial and lateral temporal lobes indicates medial temporal epilepsy. Symmetry of metabolic activity in medial temporal lobe combined with asymmetry of that in lateral temporal lobe may give hints that the epileptogenic zone is lateral.
Epilepsy ; Epilepsy, Temporal Lobe* ; Glucose* ; Humans ; Magnetic Resonance Imaging ; Metabolism* ; Temporal Lobe*

PURPOSE: Cost-effectiveness of myocardial SPECT f'or the diagniosis of coronary artery disease was investigated considering the present and amended costs of myocardial SPECT and exercise ECG in Korea. MATERIALS AND METHODS: Four diagnostic tactics such as 1) coronary angiography (CAG) after exercise ECG, 2) CAG after myocardial SPECT, 3) direct CAG, and 4) CAG after myocardial SPECT following exercise ECG were chosen. Costs were calculated using the present costs of various tests and effects represented by Quality Adjusted Life Year (QALY) were estimated. Difference of QALY (deltaQALY) was calculated by subtracting QALY of diagnosed/treated cases from QALY of undiagnosed cases, Cost/delta QALY was calculated and compared between four different tactics according to pre-test probability, RESULTS: When pre-test probability was equal to or larger than 0.6, direct CAG was the most cost-effective. When pre-test probability was between 0.2 and 0.6, CAG after myocardial SPECT following exercise ECG was the most cost-effective. CAG after myocardial SPECT was the second most cost-effective. Cost-effectiveness was similar when the costs of exercise ECG were doubled or quadrupled. CAG after exercise ECG was always the least cost-effective, CONCLUSION: Myocardial SPECT with or without preceding exercise ECG was the most cost-effective method to diagnose coronary artery disease in the present or expected amended cost system.
Coronary Angiography* ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis* ; Electrocardiography* ; Korea* ; Perfusion* ; Quality-Adjusted Life Years ; Tomography, Emission-Computed, Single-Photon*

Stroke is defined as a focal neurological deficit lasting more than 24 hours. The complications related to the central nervous system after general surgery is unusual and is difficult to discover the exact causes. We are going to report a case of an unexpected cerebral infarction after a Whipple's operation. The patient was a sixty-three years old female weighing 53 Kg with a diagnosis of cancer of ampulla of Vater scheduled for a Whipple's operation under general anesthesia. Preanesthetic assessment revealed a history of hypertension and hypercholesterolemia. After surgery, she was alert but she appeared to have right hemiparesis, aphasia and right facial palsy. A brain MRI showed a cerebral infarction in the bilateral basal ganglia, left medial temporal lobe and insular cortex. The cause of the cerebral infarction in this patient was unclear. Cerebral thrombosis was first thought of, but we couldn't completely exclude other possible causes e.g., embolism etc. In cases where risk factors of a stroke were found in preoperative evaluation, it is important to correct risk factors preoperatively. Furthermore, it is necessary to prevent hypotension, keep proper hematocrit levels and temperature during an operation, and use hemocoagulase carefully in cases of patients having risk factors of thrombosis and embolism.
Ampulla of Vater ; Anesthesia, General* ; Aphasia ; Basal Ganglia ; Batroxobin ; Brain ; Central Nervous System ; Cerebral Infarction* ; Diagnosis ; Embolism ; Embolism and Thrombosis ; Facial Paralysis ; Female ; Hematocrit ; Humans ; Hypercholesterolemia ; Hypertension ; Hypotension ; Infarction ; Intracranial Thrombosis ; Magnetic Resonance Imaging ; Paresis ; Risk Factors ; Stroke ; Temporal Lobe

BACKGROUND: A postoperative ileus after anesthesia and surgery may be bothersome to recovery and prolong hospitalization periods. The object of this study was to investigate the effect of lidocaine and ketorolac combined to fentanyl IV PCA on the recovery of bowel function after surgery. METHODS: Forty-nine patients undergoing a total abdominal hysterectomy were divided into three groups (F, FT, LFT). All patients received IV PCA for postoperative pain control. PCA contents were fentanyl 1,000 microgram only in saline 100 ml in group F (n = 16) and fentanyl 500 microgram-ketorolac 150 mg in saline 100 ml in group FT (n = 17) and LFT (n = 16). Group LFT received a lidocaine bolus (1.5 mg/kg) before induction and a continuous infusion of lidocaine (2 mg/min) until one hour after surgery. We measured postoperative pain scores (at postoperative 1 hour, 6 hours, 24 hours, and 48 hours) and checked the first flatus time, the first defecation time, and the side effects. RESULTS: The intravenous lidocaine infusion group showed better pain scores at postoperative 1 hour only. The FT and LFT groups provided a more rapid return of bowel function than group F. A combined infusion of lidocaine and ketorolac had no difference in the return of bowel function. There were no significantly different incidences of nausea, vomiting and other side effects. CONCLUSIONS: Ketorolac allowed an earlier recovery of bowel function after surgery. However, an additional infusion of lidocaine was not helpful in the return of bowel function.
Anesthesia ; Defecation ; Fentanyl* ; Flatulence ; Hospitalization ; Humans ; Hysterectomy ; Ileus ; Incidence ; Ketorolac* ; Lidocaine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis* ; Vomiting