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Objective:To establish the normal reference value of left ventricular function parameters by cadmium-zinc-tellurium (CZT) SPECT stress gated myocardial perfusion imaging (G-MPI) in low-likelihood of stable coronary artery disease (SCAD).Methods:From March 2022 to August 2022, 348 consecutive SCAD patients (146 males, 202 females, age (58±10) years) who underwent exercise or pharmacological stress G-MPI (CZT SPECT) in Beijing Anzhen Hospital, Capital Medical University were retrospectively recruited. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular ejection fraction (LVEF) were acquired using quantitative gated SPECT (QGS) analysis. EDV and ESV were corrected by body surface area (BSA) to obtain EDV index (EDVI) and ESV index (ESVI), respectively. Independent-sample t test, one-way analysis of variance and Mann-Whitney U test were used for data analysis. The influences of EDV, ESV, EDVI, ESVI and LVEF were analyzed by multiple regressions for linear models. Results:There were 314 patients with low-likelihood of SCAD (128 males, 186 females, age (58±10) years) and 34 normal controls (18 males, 16 females, age (55±10) years). There were no significant differences of basic clinical characteristics and left ventricular function parameters in different genders between 2 groups ( z values: from -1.74 to -0.02, t values: from -1.16 to 1.17, all P>0.05). Using the 95% CI as the cut-off value for left ventricular function parameters in patients with a low-likelihood of SCAD, the upper limits of EDV, ESV, EDVI and ESVI in females and males were 84 and 111 ml, 30 and 44 ml, 47 and 54 ml/m 2, 17 and 21 ml/m 2, respectively, and the lower limit of LVEF in females and males were 58% and 55%, respectively. In the low-likelihood of SCAD group, the EDV ((58±13) vs (77±17) ml) and ESV ((16±7) vs (26±9) ml) of females were smaller than those of males ( t values: 10.65, 10.35, both P<0.001), while LVEF of females was higher than that of males ((72±7)% vs (67±6)%; t=-6.23, P<0.001). However, there were no significant differences in left ventricular function parameters among different age groups with the same gender ( F values: 0.12-2.19, all P>0.05). Based on multiple regression for linear models, the primary predictors of EDV, ESV and LVEF were gender and weight ( β values: from -0.380 to 0.358, all P<0.05). Conclusions:Normal reference values of left ventricular function parameters are established by CZT SPECT stress G-MPI in low-likelihood of SCAD patients. Left ventricular EDV and ESV of females are smaller than those of males, while LVEF of females is higher than that of males. The influence of gender on left ventricular function parameters should be considered in clinical practice.
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Objective:To explore the influence of health coaching technology on self-management ability and negative emotions in patients with cirrhosis.Methods:In this single-center, randomized, single-blind controlled trial, 90 patients with cirrhosis hospitalized from May to October 2019 were selected as study subjects by means of convenience sampling method. Subjects were included in the control group (routine chronic disease management in the department of gastroenterology) and the experimental group (health coach technical intervention) with random number table method, with 45 cases each. The self-management Behavior Scale for patients with cirrhosis and the Depression-Anxiety-stress scale (DASS-21) were used to evaluate the intervention effect.Results:Two cases in the experimental group were lost to follow-up, and 3 cases in the control group were lost to follow-up. Finally, 43 cases in the experimental group and 42 cases in the control group completed the study. After the intervention, the experimental group's self-management scores and total scores were (23.02±1.68), (25.07±1.45), (17.72±1.64), (18.95±0.90), (84.77±3.32) points, the control group were (17.14±1.49), (23.43±1.77), (15.24±1.95), (15.88±2.26), (71.69±3.85) points, the difference between the two groups was statistically significant ( t values were 4.678-16.955, P<0.05). The scores of DASS-21 were (8.05±1.73), (7.02±1.85), (12.40±2.20) points in the experimental group and (10.10±1.83), (9.05±2.39), (14.02±1.89) points in the control group. The differences between the two groups were statistically significant ( t values were -5.300, -4.379, -3.659, all P < 0.05). Conclusions:The health coaching technique can effectively improve the self-management ability of patients with cirrhosis and reduce their negative emotions.
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Objective:To evaluate the clinical value of 18F-fluorodexoyglucose (FDG) PET/CT in distinguishing benign from malignant tumors in patients with cardiac tumors. Methods:Between January 2015 and September 2018, 18F-FDG PET/CT was performed in 3 678 patents in Beijing Anzhen Hospital, and 51 of them (51/3 678, 1.39%) were diagnosed as cardiac tumors. Finally, 28 patients (10 males, 18 females; mean age (52±14) years, age range: 18-84 years) with pathological results were included. According to pathological results, patients were divided into 4 groups: group 1 with primary benign cardiac tumor ( n=9), group 2 with primary malignant cardiac tumor ( n=9), group 3 with lymphoma ( n=6) and group 4 with secondary malignant cardiac tumor ( n=4). All patients underwent early (60 min) 18F-FDG PET/CT imaging and 22 patients (6, 7, 6, 3 patients in group 1, group 2, group 3, group 4 respectively) underwent delayed (120 min) imaging. The maximum standardized uptake value (SUV max) and target/backgroud ratio (TBR) of 4 groups in early imaging and delayed imaging were calculated and compared with one-way analysis of viariace and Scheffe Post-hoc test. TBR were calcualted as SUV max/mean standardized uptake value (SUV mean) in the liver. Receiver operating characteristic (ROC) curve analysis was also performed. Results:SUV max during early imaging, defined SUV max(early), was 2.6±1.5, 9.9±4.0, 20.5±6.1, 9.2±5.8 in group 1-4 respectively ( F=21.39, P<0.01), the value of group 1 was lower than that of group 2 and 3, and the value of group 3 was the highest (all P<0.005). TBR early was 1.1±0.6, 4.1±1.6, 9.4±2.6, 3.7±2.0 in the 4 groups ( F=29.15, P<0.01), the value of group 1 was lower than that of group 2 and 3, and the value of group 3 was the highest (all P<0.005). SUV max in delayed imaging (SUV max(delay)) was 2.4±1.2, 11.0±5.9, 25.8±7.7, 13.7±7.7 respectively in the 4 groups ( F=16.01, P<0.01). TBR delay was also significantly different among the 4 groups (1.3±0.7, 5.5±2.9, 14.4±4.9, 7.9±5.0; F=14.78, P<0.01), the value of group 3 was higher than that of group 1 and 2 (all P<0.05). ROC curve analysis showed optimal cut-off values for indicating malignancy were: SUV max(early)=4.2, TBR early=1.6, SUV max(delay)=4.6, TBR delay=1.9. The corresponding sensitivities, specificities, accuracies were 19/19, 8/9, 96.4%(27/28); 19/19, 7/9, 92.9%(26/28); 16/16, 6/6, 100%(22/22); 16/16, 5/6, 95.5%(21/22), respectively. Conclusions:18F-FDG PET/CT imaging can accurately diagnose malignant cardiac tumors. Delayed imaging can further improve the accuracy for diagnosis of malignant cardiac tumors.
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Objective:To evaluate the image quality (IQ) of 18F-fluorodeoxyglucose (FDG) PET/CT imaging and identify its influenfial factors in diabetes mellitus (DM) and non-DM patients with coronary artery disease (CAD). Methods:A total of 196 consecutive CAD patients (174 males, 22 females, 68 DM; age: (57±10) years) in Beijing Anzhen Hospital between June 2016 and February 2018 were retrospectively analyzed. All patients underwent 18F-FDG myocardial PET/CT imaging. The standardized fasting+ oral glucose loading (OGL) and intravenously injection of insulin protocol was performed. According to the FDG uptake by myocardium, background activity in blood and other visceral organ nearby the heart, the IQ was visually evaluated and scored by 0-4. Zero-two was considered as good IQ, 3-4 was regarded as poor IQ. Patients were divided into three groups: group 1 (non-DM+ good IQ), group 2 (DM+ good IQ), group 3 (DM+ poor IQ). Factors which may affect IQ were analyzed, which including OGL, the injection dose of insulin, fasting blood glucose (FBG), peak blood glucose (PBG), blood glucose (BG) level at 18F-FDG injection (BG injnection), BG increasing rate ((PBG-FBG)/FBG, %), and BG decreasing rate ((PBG-BG injection)/PBG, %). One-way analysis of variance, Spearman correlation analysis and logistic regression analysis were used for data analysis. Results:There were significant differences ( F values: 13.074-38.371, all P<0.05) of FBG, PBG, OGL, BG decreasing rate and the injection dose of insulin among group 1 ( n=132, 67.3%), group 2 ( n=53, 27.1%), group 3 ( n=11, 5.6%). All those parameters, except for OGL, were positively correlated with FDG PET/CT IQ ( r s values: 0.142-0.262, all P<0.05). OGL was negatively correlated with IQ ( r s=-0.324, P<0.05). Logistic regression analysis showed that FBG (odds ratio ( OR)=0.687, 95% CI: 0.633-0.746), PBG( OR=0.786, 95% CI: 0.746~0.829), BG injection( OR=0.631, 95% CI: 0.595-0.716), OGL( OR=0.897, 95% CI: 0.873-0.922), the injection dose of insulin( OR=0.680, 95% CI: 0.618-0.748) were predictive factors (all P<0.01) for good IQ in all patients. For DM patients, OGL was the only predictive factor for good IQ( OR =0.940, 95% CI: 0.904-0.960; P<0.01). Conclusions:FBG, PBG, BG injection, OGL, the injection dose of insulin can predict IQ for all patients with CAD. For DM patients with CAD, OGL is the only predictive factor for good IQ. A good IQ of 18F-FDG PET/CT could be obtained in majority of CAD patients, with the standardized fasting + OGL and intravenously injection of insulin protocol and adjust according to the personal status, and prevent the hypoglycemia from happening.
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Objective To investigate the value of pulmonary ventilation/ perfusion (V/ Q) SPECT in evaluation of anticoagulant therapy for patients with pulmonary embolism (PE) and identify factors which may affect the therapy. Methods From July 2014 to December 2016, sixty-three patients (23 males, 40 females, age (60±14) years), who were clinically diagnosed as PE and underwent V/ Q SPECT before and after anticoagulant therapy, were recruited retrospectively in this study. According to the percentage of lung perfusion defect (PD) out of total lung volume, the patients were divided into mild (<20％) PE, moderate (20％-50％) PE, and severe (>50％) PE groups. The lung PD decreased≥50％ after anticoagulant thera-py and no new PD detected was defined as the standard of effective therapy, otherwise the treatment were defined as ineffective. Data of different groups were compared. Factors that may predict the severity of PD or affect the treatment were analyzed. χ2 test and logistic regression were used for data analysis. Results PE were detected in 476 pulmonary segments and sub segments. The distribution of PE in different lung lobes had no statistically significant difference ( χ2 = 4. 995, P > 0. 05). More pulmonary arterial hypertension (PAH) were detected in patients with severe PE (80％, 12/ 15) and moderate PE (66.7％,16/ 24) in comparison with patients with mild PE (41.7％,10/ 24; χ2 = 7.062, P<0.05). The occurrence of PAH was related to the severity of PD, with odds ratio (OR) value of 2.680 (95％ CI: 1.115-6.446, P<0. 05).PAH was an independent risk factor for treatment effect (OR value: 3.134(95％ CI: 1.341-7. 324), P<0. 05). Conclusions V/ Q SPECT has an important value for evaluating the effect of anticoagulant therapy and guiding individual therapy. The more extent of PE involved, the higher prevalence of PAH. Anticoagu-lant therapy may be ineffective in PE patients with moderate or severe PAH.
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Objective To evaluate 18F-fluorodeoxyglucose (FDG) PET/CT in the rabbit model of vulnerable plaques by correlation with 99Tcm-Arg-Gly-Asp (RGD) SPECT/CT imaging,lipid levels,pathological and immunohistochemical results.Methods Sixteen male New Zealand white rabbits were randomly divided into normal diet group (group A,n =4),stable plaque group (group B,n =4) and vulnerable plaque group (group C,n =8) using completely random grouping method.The animals were given abdominal aorta sham operation (groups A and B) or balloon injury of the abdominal aorta (group C) 2 weeks after feeding.Animals were injected with 18F-FDG and 99Tcm-RGD respectively at the end of 4,8 and 12 weeks.PET/CT was performed at 1,2 and 3 h post-injection.SPECT/CT was performed at 30 min post-injection.One rabbit was sacrificed at the end of 4 and 8 weeks after imaging studies,respectively.The others were sacrificed at the end of 12 weeks after imaging studies.All abdominal aortas were harvested.Pathology and immunohistochemistry analysis were performed.The data were analyzed by one-way analysis of variance and Pearson correlation analysis.Results There was no uptake in any group at 4th week and no uptake in group A or group B at 8th week.There was mild uptake in group B at 12th week and group C at 8th week.There was intense uptake in group C at 12th week,whereas both mean standardized uptake value (SUVmean) and maximum standardized uptake value (SUVmax) were significantly higher than the other two groups (F values:7.952,14.279,both P＜0.05).In group C,SUVmax(0.43±0.08,0.68±0.06,1.74±0.63) and SUV (0.37±0.03,0.56±0.03,1.26+0.23) had significant difference at 3 h post-injection for imaging at 4th,8th and 12th week (F values:10.939,39.747,both P＜0.05).At 12th week,there was a strong correlation between the uptake of 18 F-FDG and target/non-target (T/NT) ratio of 99Tcm-RGD in all groups(r values:0.748,0.709,both P＜0.05).Histopathology results showed that the plaques had rich macrophages and a small amount of smooth muscle cells in group C,little macrophages in group B,while no macrophages in group A.Conclusion 18F-FDG PET/CT might be an effective noninvasive method for early assessment of aortic vulnerability to atherosclerotic plaque.
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Objective To discuss the impact of an iterative reconstruction algorithm (True X) implemented with point spread function (PSF) on image quality and SUV in 18F-FDG PET, and compare with other reconstruction algorithms.Methods A total of 79 hypermetabolic lesions from 37 cancer patients (23 males, 14 females, age (63.38±15.25) years) were retrospectively studied.The PET images were reconstructed using the following six reconstruction algorithms, including FBP, FBP+TOF, iteration, iteration+TOF, True X, True X+TOF.Paired t test was used for statistical analysis.Results All six reconstruction algorithms showed significant difference in lesion SUVmax.The adoption of PSF increased SUVmax by 15%-16%, and decreased the dispersion of SUV in the liver parenchyma remarkably.Conclusions Lesion SUVmax calculated from different reconstruction algorithms has significant differences.Caution should be taken in using PSF, as it can improve image quality but may also increase lesion SUVmax.
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Objective To investigate the feasibility of a novel molecular probe 99Tcm-3P4-RGD2 in evaluating arterial plaque stability after atorvastatin intervention in rabbits with SPECT/CT. Methods Eighteen male New Zealand rabbits were randomly divided into group A (stable plaque), group B (vulnerable plaque), and group C (vulnerable plaque with statin intervention). All rabbits were fed with high-fat food for 12 weeks. After high-fat feeding for two weeks, sham surgery was performed on group A. In the meantime, abdominal aorta injury was performed on group B and group C. After that, rabbits of group C were given oral atorvastatin (2.5 mg·kg-1·d-1). 99Tcm-3P4-RGD2 SPECT/CT imaging was performed on each group at the end of 4, 8 and 12 weeks. T/NT ratios were calculated. Animals were sacrificed at the end of 12 week after imaging studies. The abdominal aortas were collected, imaged with SPECT/CT, and evaluated by pathological HE staining and immunohistochemical analysis. MVD was calculated. Differences among 3 groups were analyzed using one-way analysis of variance. Results There was no significant radioactive uptake in the abdominal aortas of three groups on the 4th week′s imaging. The radioactive uptake in abdominal aortas increased slightly on the 8th week, with the highest radioactive uptake in group B. The radioactivity in abdominal aortas of the 3 groups maintained increasing on the 12th week, with T/NT ratios of 1.579±0.217, 1.873±0.226 and 1.524±0.237, respectively (F=8.984, P<0.05). In ex vivo abdominal aorta images, especially images of group B, radioactivity in lesion sites was higher than that in normal tissue. Accordingly, results of HE staining showed that artery plaques of group A and group C were grade Ⅱ and group B was grade Ⅳ. The MVD of group A, B and C was 8.17±1.17, 15.86±1.07 and 7.17±1.60, respectively (F=9036, P<0.05). Conclusion 99Tcm-3P4-RGD2 SPECT/CT imaging has a high sensitivity in the evaluation of arterial plaque stability after statin intervention in rabbits.
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Objective To evaluate the reliability of children anthropometric indicators measured by medical students in clini-cal practice .Methods The convenient sampling was adopted to collect the data of the head circumference (HC) ,recumbent length (RL) and crown-rump length (CRL) of infants and young children measured by the students in clinical practice from entering-de-partment training to exiting-department .The re-measured data by clinical teachers were simultaneously collected .The measurement difference were compared between the students and clinical teachers .The measurements reliability was described by using the indi-cators such as the mean absolute differences (MAD) ,percentages of difference within a critical value (PDCV) and so on .Results MAD of HC ,RL and CRL at entering-department were 0 .46 ,0 .55 ,0 .81 cm respectively ,which at exiting-department were 0 .30 , 0 .43 ,0 .51 cm respectively ,the difference were statistically significant (P<0 .05) .PDCV of HC ,RL and CRL belonging to good quality standard at entering-department were 41 .5% ,58 .0% and 36 .0% respectively ,which at exiting-department were increased to 53 .5% ,70 .0% and 59 .0% respectively .PDCV of HC ,RL and CRL belonging to error data were 19 .0% ,10 .0% and 13 .0% re-spectively .Conclusion RL measured by medical students in clinical practice has good quality ,while the bigger errors exist in the measurement values of HC and CRL .
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Objective To evaluate and compare the therapeutic effect among intravenous rt2PA thrombolysis,thrombolysis plus delayed intracoronary stenting for acute ischemic stroke onset using 99mTc2ECD SPECT imaging.Methods 45 cases of acute ischemic stroke onset were divided into two groups which were the thrombolysis group( n = 23 ) ,thrombolysis plus delayed stenting group (n = 22), 99mTc2MIBI SPECT imaging was performed 3 weeks after thrombolysis therapy or 1 week after intracoronary stenting. The score of 99mTc2MIBI brain uptake were analyzed semiquantitatively and the total score of myocardial 99mTc2ECD uptake was calculated. Results The scores of the 2 groups were( 12. 4 ± 4. 6) and( 9. 7 ± 3. 8 ) respectively, Significant difference was shown in the thrombolysis plus delayed stenting group compared with the thrombolysis group (P ＜ 0. 01 ). Conclusion 99mTc2ECD SPECT imaging had been proved to be an objective parameter for evaluating the therapeutic effect of the various treatments of AMI. Thrombolysis plus delayed stenting was more effective than thrombolysis.