We aimed to investigate the value of bone scintigraphy with additional blood pool phase (BSBP), compared with conventional bone scintigraphy (CBS), in the assessment of rheumatoid arthritis (RA). A total of 242 patients (43 males, 199 females; 14-78 years) with arthralgia, and underwent BSBP were retrospectively analyzed. On the first physical examination, active arthritis was found in 128 of the 242 patients. Clinical diagnosis was made by a rheumatologist on the basis of the 1987 American College of Rheumatology (ACR) criteria, which are considered to be the gold standard. The diagnostic performances and prognostic value of BSBP and CBS were analyzed in the total patients with arthralgia and in the patients with arthritis. The sensitivity of BSBP (84.2%, 80/95) were significantly higher than that of CBS (74.8%, 72/95) in the patients with arthralgia (P = 0.039). When BSBP was interpreted with the results of elevated/positive anti-CCP antibody, its accuracy over CBS also became significantly higher (86.0%, 208/242 vs. 83.1%, 201/242 respectively, P = 0.021). The diagnostic odds ratio of BSBP positivity was higher than CBS positivity in the patients with arthralgia (26.0, 12.9-52.4 vs. 21.1, 10.8-41.3) and with arthritis (12.0, 4.9-29.4 vs. 10.0, 4.2-23.4). Both BSBP and CBS appear to provide acceptable accuracy and comparable diagnostic performance for diagnosis of RA. However, in the patients with arthralgia, BSBP was found to be more sensitive than CBS and more accurate when interpreted with the result of anti-CCP antibody. This could help physicians diagnose RA in daily clinical practice.
Adolescent ; Adult ; Aged ; Arthralgia/complications ; Arthritis, Rheumatoid/complications/*diagnosis ; Autoantibodies/blood ; Bone and Bones/diagnostic imaging ; Female ; *Gated Blood-Pool Imaging ; Humans ; Male ; Middle Aged ; Odds Ratio ; Peptides, Cyclic/immunology ; Positron-Emission Tomography ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Technetium/chemistry ; *Tomography, X-Ray Computed ; Young Adult

This paper is aimed to investigate the influence of gated myocardial perfusion imaging (G-MPI) with 8- and 16-frame acquisition models on the assessment of left ventricular function. Patients prepared for stress and rest G-MPI were prospectively recruited from January 2010 to January 2011 in the Department of Nuclear Medicine of West China Hospital, Sichuan University. Two separate G-MPI studies, one with 8 and the other with 16 frames, were simultaneously acquired during a single gantry orbit using Concurrent Imaging technique. We calculated the left ventricular ejection fraction (EF) and volumes using the Auto Quant software. Forty-eight patients (29 men, 19 women; average age 51 +/- 16 years old) were finally analyzed. The differences in left ventricular EF between 8- and 16-frame were small: 3.27% (95% CI: 6.41%-0.12%) for post-stress and 3.13% (95% CI: 5.93%-0.32%) for rest. Both using 8 and 16 frames, there were significantly larger volumes and lower EF in patients with stress-induced ischemia than without. As for detecting left ventricular EF, 8-frame and 16-frame acquisition models should not be mutually alternated.
Adult ; Aged ; Female ; Gated Blood-Pool Imaging ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnostic imaging ; physiopathology ; Myocardial Ischemia ; diagnostic imaging ; physiopathology ; Myocardial Perfusion Imaging ; methods ; Radiopharmaceuticals ; Stroke Volume ; physiology ; Technetium Tc 99m Sestamibi ; Ventricular Function, Left ; physiology

Medically refractory ventricular tachycardia (VT) storm can be controlled with radiofrequency catheter ablation (RFCA), however, it may be difficult to control in some patients with hemodynamic overload. We experienced a patient with intractable VT storm controlled by hemodynamic unloading. The patient had mid-septal hypertrophic cardiomyopathy with an implantable cardioverter defibrillator (ICD) back-up. Because of the severe mid-septal hypertrophy, his left ventricle (LV) had an hourglass-like morphology and showed apical ballooning; the focus of VT was at the border of apical ballooning. Although we performed VT ablation because of electrical storm with multiple ICD shocks, VT recurred 1 hour after procedure. As the post-RFCA monomorphic VT was refractory to anti-tachycardia pacing or ICD shock, we reduced the hemodynamic overload of LV with beta-blockade, hydration, and sedation. VT spontaneously stopped 1.5 hours later and the patient has remained free of VT for 24 months with beta-blockade alone. In patients with VT storm refractory to antiarrhythmic drugs or RFCA, the mechanism of mechano-electrical feedback should be considered and hemodynamic unloading may be an essential component of treatment.
Cardiomyopathy, Hypertrophic/complications/diagnosis/*physiopathology/therapy ; Catheter Ablation ; Electrocardiography ; Gated Blood-Pool Imaging ; Heart Catheterization ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular/diagnosis/etiology/*physiopathology/therapy ; Takotsubo Cardiomyopathy/complications/diagnosis/*physiopathology/therapy

BACKGROUNDRegional ejection fraction (EF(R)) measured by real-time three-dimensional echocardiography (RT-3DE) provides a novel method for quantifying left-ventricular (LV) regional systolic function. We aimed to explore the diagnostic value of regional ejection fraction (EFR) derived from RT-3DE in detecting LV aneurysms in patients with myocardial infarction.

METHODSThirty-eight patients with myocardial infarction were prospectively enrolled and underwent electrocardiography (ECG), two-dimensional echocardiography (2-DE), RT-3DE and left ventriculography (LVG). Subjects with a negative EFR in at least one segment on RT-3DE were considered as having a ventricular aneurysm. We compared the sensitivity, specificity, Youden's index, and positive and negative predictive values of ECG, 2-DE and RT-3DE in determining LV aneurysm with detection by LVG.

RESULTSOn LVG an LV aneurysm was diagnosed in 16 (42.1%) patients. The sensitivity and specificity were 62.5% and 86.4% for ECG, 81.2% and 95.4% for 2-DE, and 100.0% and 90.9% for RT-3DE in diagnosing LV aneurysm. Youden's indexes for ECG, 2-DE and RT-3DE were 0.49, 0.77 and 0.91, respectively. Positive and negative predictive values were 76.9% and 76.0% for ECG, 92.9% and 87.5% for 2-DE, and 88.9% and 100.0% for RT-3DE.

CONCLUSIONSRT-3DE-derived EFR provides a novel, reliable index in the diagnosis of LV aneurysm and has excellent sensitivity and specificity.

Adult ; Aged ; Coronary Angiography ; methods ; Echocardiography, Three-Dimensional ; methods ; Female ; Heart Aneurysm ; diagnosis ; Humans ; Male ; Middle Aged ; Prospective Studies ; Radionuclide Ventriculography ; methods ; Stroke Volume ; physiology

We report an extremely rare case of a diffuse hepatic hemangiomatosis without extrahepatic involvement in an adult. The imaging findings of this tumor were similar to those of a hepatic hemangioma and included contrast enhancement with a centripetal filling pattern of the entire hepatic tumor on the delayed phase of a dynamic CT and inhomogeneous diffuse uptake of the entire tumor on blood-pool images obtained five hours later on a 99mTc-labeled red blood cell scan. Despite its rarity, diffuse hepatic hemangiomatosis can be suggested in adult patients with diffusely involved hepatic tumors showing the radiological findings of a hepatic hemangioma.
Adult ; Female ; Gated Blood-Pool Imaging ; Hemangioma/*diagnosis/pathology/ultrasonography ; Humans ; Liver Neoplasms/*diagnosis/pathology/ultrasonography ; Tomography, X-Ray Computed

Based on the half sphere-cylinder myocardial model, a quantitative calculating method of gated SPECT myocardial infraction of the left ventricular functional parameters is proposed. To overcome the shortage of the ellipse model and other normal methods, this method uses the half sphere-cylinder myocardial model and its subarea. The experiment result shows that the data from normal men accord very well with those reported in domestic and international literature. The result from use in the case of left ventricular myocardial infarction is also satisfactory. Therefore, this method is of high value clinically.
Coronary Artery Disease ; diagnostic imaging ; physiopathology ; Gated Blood-Pool Imaging ; methods ; Heart Ventricles ; diagnostic imaging ; Humans ; Image Interpretation, Computer-Assisted ; Male ; Models, Cardiovascular ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon ; methods ; Ventricular Function, Left

In this paper are presented and recommended the researches of the left ventricle model and optimization arithmetic based on myocardial radionuclide tomographic images (SPECT and PET). We adopted the hemispheric-cylindrical myocardial model which was largely used in quantitative analysis of myocardium. Then we adopted the radionuclide maximum counts method in LV myocardium and used the Powell optimization arithmetic to fit the myocardial model. Comparing the result from the adopted method against that of the doctors' diagnosis, we found the rate of high relevancy being 83.2%.
Algorithms ; Gated Blood-Pool Imaging ; Heart Ventricles ; diagnostic imaging ; Humans ; Image Interpretation, Computer-Assisted ; methods ; Models, Cardiovascular ; Myocardium ; Positron-Emission Tomography ; methods ; Tomography, Emission-Computed, Single-Photon ; methods

Electrocardiogram-gated single photon emission computed tomography (SPECT) provides valuable information in the assessment of both myocardial perfusion and ventricular function. Tl-201 is a suboptimal isotope for gating. Tl-201 images are more blurred compared with Tc-99m tracers due to the increased amount of scattered photons and use of a smooth filter. The average myocardial count densities are approximately one-half those of conventional technetium tracers. However, Tl-201 is still widely used because of its well-established utility for assessing myocardial perfusion, viability and risk stratification. Gated SPECT with Tl-201 enables us to assess both post-stress and rest left ventricular volume and function. Previous studies with gated Tl-201 SPECT measurements of ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV) have shown high correlation with first-pass radionuclide angiography, gated blood pool scan, Tc-99m-MIBI gated SPECT, contrast ventriculography, echocardiography, and 3-dimensional magnetic resonance imaging. However, problems related to these studies include few agreement data of EDV and ESV, use of a reference method that is likely to have the same systemic errors (gated Tc-99m-MIBI SPECT), and other technical factors related to the count density of gated SPECT. With optimization of gated imaging protocols and more validation studies, gated Tl-201 SPECT would be an accurate method to provide perfusion and function information in patients with coronary artery disease.
Coronary Artery Disease ; Echocardiography ; Humans ; Magnetic Resonance Imaging ; Perfusion* ; Photons ; Technetium ; Tomography, Emission-Computed, Single-Photon ; Ventricular Function ; Ventriculography, First-Pass

OBJECTIVEThe aim of this study was to assess the accuracy of adenosine (99m)Tc-MIBI myocardial perfusion SPECT for the diagnosis of coronary artery disease.

METHODSA total of 89 patients [mean age (57 +/- 9) years,62 men, 27 women] were included in this study. Adenosine was infused intravenously at a rate of 140 microg.kg(-1).min(-1) for 6 minutes. At the end of 3 minute of adenosine infusion, 925MBq of (99m)Tc-MIBI was injected intravenously. SPECT myocardial imaging acquisition was obtained 1 hour after adenosine infusion. Coronary angiography was performed in all patients.

RESULTSThirty-one patients had significant coronary artery stenosis and 58 had normal coronary angiography. Adenosine myocardial perfusion imaging was abnormal in twenty-two out of the 31 patients with significant coronary artery stenosis (sensitivity, 71%). Fifty-three out of the 58 patients with normal angiography had a normal adenosine myocardial perfusion imaging (specificity, 91%). The positive predictive value and negative predictive value of adenosine (99m)Tc-MIBI myocardial perfusion imaging for detection of coronary artery disease was 81% and 84% respectively.

CONCLUSIONAdenosine myocardial perfusion imaging is probably an accurate method for detecting coronary artery disease.

Adenosine ; Adult ; Aged ; Coronary Artery Disease ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Radionuclide Ventriculography ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon ; Young Adult

38 participants of study were divided into two groups. There were 28 subjects (25 males, 3 females) in case group, who had former myocardial infarction (MI) and history of MI. The mean age of case group was 62.5+/-7.4 years. 10 healthy subjects were involved in the control group. It was found that radionuclide ventriculography is a reliable explorative method for evaluation of left ventricular function in the patients with former MI. Sensitivity, specificity and parameters of EFx% (40.3+/-14.0), PER (2.3+/-0.7), 1/3ER (1.9+/-0.8) all decreased significantly in comparison with those of the control group. Left ventricular dysfunction on ventriculography related to site of MI and clinical level of heart failure. In the patient with former MI, there was relative closed correlation between EFx%, 1/3ER and grade of heart failure and PER had modest negative correlation with grade of heart failure
Myocardial Infarction ; Radionuclide Ventriculography