BACKGROUND AND OBJECTIVES: Dual isotope myocardial SPECT, rest thallium-201/dipyridamole stress Tc-99m sestamibi is used to diagnose coronary artery disease. We examined predictive value of myocardial SPECT for the prognosis of patients having or suspected coronary artery disease. MATERIALS AND METHOD: We examined 692 patients referred for dipyridamole stress myocardial perfusion SPECT. Cardiac events (hard and soft events) were followed up with medical record review and telephone interview. Survival analysis and multivariate Cox proportional hazard model were used to find significant predictors and the incremental predictive value of myocardial SPECT. Patients with coronary angiography (n=246) were analyzed in separate group. RESULTS: There were 4 hard events and 3 soft events in 341 normal SPECT group (1.20%/yr). There were 5 hard events and 21 soft events in 351 abnormal SPECT group (4.69%/yr). Survival curve was separated between normal SPECT group and abnormal SPECT group (p<0.01). In univariate analysis, smoking, history of myocardial infarction, typical chest pain and SPECT findings were important variables. In multivariate analysis, SPECT result was the single most independent predictor. Large reversible perfusion abnormality predicted worse prognosis. In patients with coronary angiography, SPECT did not add statistically significant predictive value to the coronary angiography. CONCLUSION: Dipyridamole stress Tl-201/ MIBI dual isotope myocardial perfusion SPECT provided excellent prognostic information. Extent of reversible perfusion decrease was the independent predictor of future cardiac events.
Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Dipyridamole ; Humans ; Interviews as Topic ; Medical Records ; Multivariate Analysis ; Myocardial Infarction ; Perfusion ; Prognosis ; Proportional Hazards Models ; Smoke ; Smoking ; Tomography, Emission-Computed, Single-Photon*

No abstract available.
Brain Injuries* ; Brain* ; Disability Evaluation* ; Humans ; Perfusion* ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. MATERIALS AND METHODS: 118 patients (M: F=66:52, 62.7+/-10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest T1-201/stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heart failure and unstable angina) were surveyed through perioperative periods (14.6+/-5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. RESULTS: Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted` out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. CONCLUSION:: We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.
Death ; Electrocardiography ; Heart Failure ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Perioperative Period ; Retrospective Studies ; Risk Factors ; Tomography, Emission-Computed, Single-Photon*

No abstract available.

No abstract available.
Aviation* ; Humans*

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 T1-20l/stress Tc-99m-MIBI gated SPECT in 25 patients before and 3 months after bypass surgery. Myocardial wall motion was graded as normal, hypokinesia, a kinesia, and dyskinesia by pair-wise visual analysis of gated pre and postoperative SPECT's on the same monitor wall motion abnormalities before operation, 69 (75%) improved and 23 did not. Before operation, we could find segments with good systolic thickenining 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.
Coronary Artery Disease* ; Coronary Vessels* ; Dobutamine ; Dyskinesias ; Echocardiography ; Humans ; Hypokinesia ; Myocardium ; Perfusion* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been proven to be useful in the differential diagnosis of breast mass and staging of breast cancer. This study assessed the diagnostic accuracy of F-18-FDG PET in the differentiation of breast mass and staging of breast cancer. MATERIALS AND METHODS: Total 42 patients who had breast mass underwent F-18-FDG PET (all female, 40+/-10 year old). We compared F-18 FDG PET results with pathologic findings in 24 patients RESULTS: In the differentiation of breast mass, sensitivity and specificity were 95% (19/20) and 77% (7/9) respectively. Three false positive cases were due to inflammation and one false negative patient had small tumor less than 1 cm. In the assessment of axillary lymph node status, sensitivity and specificity were 73% (8/11) and 100% (7/7) respectively. We found distant metastasis that were not suspected before F-18-FDG PET in 2 patients. CONCLUSION: F-18-FDG PET shows good diagnostic performance in differentiation of breast mass and staging of breast cancer.
Breast Neoplasms* ; Breast* ; Diagnosis, Differential* ; Female ; Humans ; Inflammation ; Lymph Nodes ; Neoplasm Metastasis ; Positron-Emission Tomography ; Sensitivity and Specificity

Embryos of most mammalian species grown in vitro would undergo developmental arrest at the approximate time of genomic activation. Stage-specific cell block and the resulting rapid loss of embryo viability in conventional culture media have limited the duration for which embryos may be cultured prior to transfer. As a result, embryos are usually transferred to the uterus at the 4-to 8-cell stage to avoid the loss of viability associated with long-term in vitro culture. Early transfer has led to asynchrony of the endometrium-trophectoderm interaction at the time of implantation and a resultant reduction in the rate of implantation. To overcome these problems, a variety of co-culture systems has been devised in which embryos can develop for a longer period prior to embryo transfer. Vero cells, derived from African green monkey kidney, share a common embryologic origin with cells from the genital tract. In addition, they are potentially safe to use, since they are highly controlled for viruses and other contaminants. Therefore, co-culture using Vero cells has been widely utilized to enhance embryo viability and development, although not without controversies. We thus designed a series of experiments to demonstrate whether Vero cells do indeed enhance mouse embryo development as well as to compare the efficacy of co-culturing mouse 1-cell embryos on Vero cell monolayer in both Ham's F-10 and human tubal fluid (HTF) culture media. 1-cell stage ICR mouse embryos were cultured either in the presence of Vero cells (Group A) or in conventional culture medium alone (Group B). In Ham's F-10 significantly more 3-to-8cell embryos developed in group A than group B (59.8 versus 10.0%; F<0.01). In contrast, there was no significant difference in embryonic development both group A and group B in HTF. However, significant differences were noted only in later embryonic stage (13 and 0%; p<0.05 of group A and B respectively, hatching or hatched). In Ham's F-10, we also could observe the beneficial effect of Vero cell on hatching process (70.7 and 42.1%; p<0.05 of group A and group B respectively).
Animals ; Cercopithecus aethiops ; Coculture Techniques* ; Culture Media ; Embryo Transfer ; Embryonic Development* ; Embryonic Structures* ; Female ; Humans ; Kidney ; Mice* ; Mice, Inbred ICR ; Pregnancy ; Uterus ; Vero Cells*

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*

PURPOSE: 99mTc-HMPAO is a radiopharmaceutical for imaging cerebral blood flow. HMPAO (RR, SS)-4,8- diaza-3,6,6,9-tetramethylundecan-2,10- dione bisoxime) has three stereoismers such as, meso-, d-, and l-HMPAO. Techentium complexes of meso-HMPAO and d,l-HMPAO are known to have different in vivo brain uptakes. In this study, enantiomers of HMPAO (d-HMPAO and l-HMPAO) were separated from d,l-HMPAO. These enantiomers were labeled with 99mTc and the biodistribution studies were performed in mice. MATERIALS AND METHODS: An intermediate imine product was produced from 2,3-butanedione monooxime and 2,2-dimethyl- 1,3-propanediamine (54% yield) and was reduced into a mixture of three isomers (35% yield). The meso-isomer was separated from d,l-mixture by repeated fractional crystallization (11% yield). The d- and l-enantiomers were subsequently separated by co-crystallization with optical isomers of tartaric acid (25% and 5% yield, respectively). Each enantiomeric HMPAO was labeled with 99mTc by reacting with SnCl2 2H2O and 99mTc-pertechnetate. Biodistribution study was performed 1 hr after tail vein injection to ICR mice. RESULTS: Radiochemical purities of each compound were over 80%. In biodistribution study, the brain uptakes of d,l- d- and l-form were 1.34, 1.12 and 1.67% ID/g, respectively. In case of l-Isomer the brain uptake was higher (1.5 fold) than d-isomer. CONCLUSION: We successfully purified each enantiomeric HMPAO. In biodistribution study of stereoismers of 99mTc-HMPAO in mice, l-HMPAO may show better brain image than d,l-HMPAO which was supplied in a commercial kit.
Animals ; Brain* ; Crystallization ; Dental Calculus ; Diacetyl ; Mice ; Mice, Inbred ICR ; Stereoisomerism ; Technetium Tc 99m Exametazime* ; Veins