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La medicina nuclear utiliza radiofármacos, conocidos como radiotrazadores, para evaluar la función y el metabolismo de órganos y sistemas del cuerpo. Objetivo. Examinar la relevancia de los radiotrazadores MDP, DTPA y MIBI, marcados con tecnecio-99m (Tc99m), en el diagnóstico en medicina nuclear. Metodología. Se siguió el método PRISMA para identificar estudios publicados entre 2010 y 2022. Las bases de datos consultadas incluyeron Dialnet, Elsevier, Research, Redalyc, PubMed, Google Académico y Scielo. Se utilizaron descriptores específicos como "radiotrazadores Tc99m", "MDP", "DTPA", "MIBI", y "medicina nuclear", centrando la búsqueda en diagnóstico y excluyendo propósitos terapéuticos. Resultados. De 14 estudios analizados, se observó una predominancia en investigaciones sobre radiotrazadores MDP y MIBI marcados con Tc99m, enfocándose en diagnósticos relacionados con lesiones paratiroideas, hiperparatiroidismo, enfermedades esqueléticas, enfermedad arterial coronaria y perfusión miocárdica. Conclusiones. Los radiotrazadores MDP, DTPA y MIBI marcados con Tc99m demuestran eficacia en diversas aplicaciones diagnósticas, incluyendo la localización de adenomas paratiroideos y la detección de condiciones como el mieloma múltiple. A pesar de sus beneficios, es crucial continuar investigando y desarrollando nuevos radiofármacos para expandir su utilidad clínica y mejorar aún más la atención médica en el campo de la medicina nuclear.
Nuclear medicine uses radiopharmaceuticals, known as radiotracers, to assess the function and metabolism of organs and body systems. Objective. To examine the relevance of technetium-99m (Tc99m)-labeled MDP, DTPA, and MIBI radiotracers in nuclear medicine diagnostics. Methodology. The PRISMA method was followed to identify studies published between 2010 and 2022. The databases consulted included Dialnet, Elsevier, Research, Redalyc, PubMed, Google Scholar and Scielo. Specific descriptors such as "Tc99m radiotracers", "MDP", "DTPA", "MIBI", and "nuclear medicine" were used, focusing the search on diagnosis and excluding therapeutic purposes. Results. Of 14 studies analyzed, there was a predominance of research on Tc99m-labeled MDP and MIBI radiotracers, focusing on diagnoses related to parathyroid lesions, hyperparathyroidism, skeletal diseases, coronary artery disease, and myocardial perfusion. Conclusions. Tc99m-labeled MDP, DTPA, and MIBI radiotracers demonstrate efficacy in a variety of diagnostic applications, including localization of parathyroid adenomas and detection of conditions such as multiple myeloma. Despite their benefits, it is crucial to continue researching and developing new radiopharmaceuticals to expand their clinical utility and further improve medical care in the field of nuclear medicine.
A medicina nuclear utiliza radiofármacos, conhecidos como radiotraçadores, para avaliar a função e o metabolismo de órgãos e sistemas corporais. Objetivo. Examinar a importância dos radiotraçadores MDP, DTPA e MIBI, marcados com tecnécio-99m (Tc99m), em diagnósticos de medicina nuclear. Metodologia. O método PRISMA foi usado para identificar estudos publicados entre 2010 e 2022. Os bancos de dados consultados incluíram Dialnet, Elsevier, Research, Redalyc, PubMed, Google Scholar e Scielo. Foram utilizados descritores específicos como "radiotraçadores Tc99m", "MDP", "DTPA", "MIBI" e "medicina nuclear", concentrando a busca em fins diagnósticos e excluindo fins terapêuticos. Resultados. Dos 14 estudos analisados, houve predomínio de pesquisas com os radiotraçadores MDP e MIBI marcados com Tc99m, com foco em diagnósticos relacionados a lesões da paratireoide, hiperparatireoidismo, doenças esqueléticas, doença arterial coronariana e perfusão miocárdica. Conclusões. Os radiotraçadores MDP, DTPA e MIBI marcados com Tc99m demonstram eficácia em uma variedade de aplicações diagnósticas, incluindo a localização de adenomas de paratireoide e a detecção de doenças como o mieloma múltiplo. Apesar de seus benefícios, é fundamental continuar a pesquisa e o desenvolvimento de novos radiofármacos para expandir sua utilidade clínica e melhorar ainda mais o atendimento médico no campo da medicina nuclear.
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Objective:To evaluate the value of 99Tc m-methoxyisobutylisonitrile(MIBI) SPECT/CT imaging for the identification of dystonic muscles in patients with primary cervical dystonia (PCD). Methods:A total of 10 patients with PCD (3 males, 7 females, age (47.3±9.9) years) and 10 healthy subjects (4 males, 6 females, age (43.5±9.4) years; control group) between August 2019 and October 2021 in China-Japan Friendship Hospital were enrolled prospectively. All subjects underwent 99Tc m-MIBI SPECT/CT scan. The SUV max of 8 bilateral representative muscles, including rectus capitis posterior major, obliquus capitis inferior, splenius capitis, semispinalis, sternocleidomastoid, trapezius, musculus scalenus muscle and levator scapulae were evaluated in control group. In PCD group, muscles with abnormal uptake were determined. ROI was drawn and SUV max was measured. Independent-sample t test was used to analyze the differences of SUV max between normal and abnormal muscles. The detecting rates of neck MRI and SPECT/CT for abnormal muscles were analyzed by χ2 test. Results:Normal muscles of healthy subjects showed mild symmetrical radioactivity distribution, with the SUV max of 1.10±0.19. A total of 60 muscles with abnormal uptake in 10 patients were found, including 7 rectus capitis posterior major, 10 obliquus capitis inferior, 8 splenius capitis, 8 semispinalis, 10 sternocleidomastoid, 5 trapezius, 3 musculus scalenus muscle and 9 levator scapulae. The SUV max of muscles with abnormal uptake was 1.81±0.43, which was higher than that of normal muscles ( t=17.05, P<0.001). Only 30 pieces abnormal hypertrophy muscle were found by neck MRI, and the detecting rate was much lower than that of SPECT/CT (18.75%(30/160) vs 37.50%(60/160); χ2=28.03, P<0.001). Conclusion:99Tc m-MIBI SPECT/CT may be a useful method for identifying dystonic muscles and a guide to precision therapy in patients with PCD.
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Abstract Introduction Surgical treatment of hyperparathyroidism related to chronic kidney disease is a real challenge for Brazilian public health care. High cost medications and long waiting lines to perform preoperative exams, especially technetium Tc 99m Sestamibi (MIBI) are some of the reasons. Despite the reality that the aid of localization exams are questionable in this scenario, doctors are too apprehensive in performing surgery without it. Objective The study aimed at evaluating the efficacy of surgery for renal hyperparathyroidism without preoperative MIBI. Methods A total of 114 patients were surgically treated. Total parathyroidectomy with autotransplantation and subtotal parathyroidectomy were carried out without preoperative MIBI. Results and conclusion Among the 114 patients undergoing surgery, 37 had secondary hyperparathyroidism in dialysis replacement, and 77 patients had post-renal transplant persistent disease. We were successful in 107 cases with only 7 failures (93.8% of success rate). Among these failures, only one parathyroid gland was not found in 4 cases, 2 parathyroid glands were not found in 2 cases and in 1 patient the 4 glands were found but this patient remained hypercalcemic and a postoperative diagnosis of supernumerary parathyroid gland was made. Surgery for treatment of renal hyperparathyroidism proved to be an effective (93.8%) and reproductible procedure, even without MIBI.
Resumo Introdução O tratamento cirúrgico do hiperparatireoidismo relacionado à doença renal crônica é um verdadeiro desafio para a saúde pública brasileira. Medicamentos de alto custo e longas filas de espera para exames pré‐operatórios, principalmente a cintilografia com tecnécio Tc‐99m Sestamibi, MIBI, são alguns dos motivos. Apesar da contribuição de exames de localização ser questionável nesse cenário, os médicos ficam muito apreensivos por fazer uma cirurgia sem ele. Objetivo Avaliar a eficácia da cirurgia para hiperparatireoidismo renal sem o MIBI pré‐operatório. Método Foram tratados cirurgicamente 114 pacientes. A paratireoidectomia total com autotransplante e a paratireoidectomia subtotal foram feitas sem MIBI pré‐operatório. Resultados e conclusão Entre os 114 pacientes submetidos à cirurgia, 37 apresentavam hiperparatireoidismo secundário em reposição dialítica e 77 doença persistente pós‐transplante renal. Tivemos sucesso em 107 casos, com apenas 7 falhas (93,8% de taxa de sucesso). Entre essas falhas, uma glândula paratireoide não foi encontrada em 4 casos, 2 glândulas paratireoides não foram encontradas em 2 casos e em um paciente as 4 glândulas foram encontradas, mas ele permaneceu hipercalcêmico com diagnóstico pós‐operatório de glândula paratireoide supranumerária. A cirurgia para tratamento do hiperparatireoidismo renal mostrou‐se um procedimento eficaz (93,8%) e reprodutível mesmo sem MIBI.
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Objective:To investigate differences in cardiac function and perfusion parameters measured by IQ-SPECT and low energy high-resolution (LEHR)-SPECT, as well as effects of scattering correction (SC) and CT attenuation correction (AC) on myocardial perfusion imaging.Methods:From May 2020 to September 2020, 80 patients (58 males, 22 females, age (57±10) years) who underwent SPECT myocardial perfusion imaging were retrospectively enrolled in Fuwai Hospital. According to the standardized left ventricular end-diastolic diameter of body surface measured by two-dimensional echocardiography, patients were divided into 2 groups: A group ( n=34) with significantly enlarged left ventricle and B group ( n=46) with no significant enlargement of left ventricle. LEHR-SPECT and IQ-SPECT gated myocardial perfusion imaging were performed in all patients. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), summed rest score (SRS) and total perfusion defect (TPD) were measured. Parameters measured by two methods and differences before and after SC and AC were compared by using paired t test and Wilcoxon signed rank test. The correlation was analyzed by Pearson correlation or Spearman rank correlation analyses, and the consistency was analyzed by Bland-Altman analysis. Results:In A group, EDV, EF and SRS measured by IQ-SPECT were significantly lower than those assessed by LEHR-SPECT after SC and AC (EDV: (257±137) vs (276±154) ml, EF: (21±11)% vs (26±13)%, SRS: 17(6, 25) vs 18(8, 28); t values: -2.63, -7.46, z=-2.14, all P<0.05); all parameters measured by LEHR-SPECT and IQ-SPECT had well correlation ( r values: 0.965, 0.969, 0.967, rs values: 0.920, 0.960, all P<0.001) and consistency. In B group, EDV and EF measured by IQ-SPECT were significantly lower than those assessed by LEHR-SPECT after SC and AC (EDV: (96±40) vs (107±39) ml, EF: (46±15)% vs (54±16)%; t values: -6.23, -10.71, both P=0.001); SRS and TPD measured by IQ-SPECT after SC and AC were significantly lower than non-SC and non-AC (SRS: 2(1, 4) vs 5(3, 11), TPD: (3%(1%, 5%) vs 7%(3%, 12%); z values: -4.11, -4.16, both P<0.001); all parameters measured by LEHR-SPECT and IQ-SPECT had well correlation ( r values: 0.956, 0.978, 0.958, rs values: 0.926, 0.944, all P<0.001) and consistency. Conclusions:There are good correlation and consistency of left ventricular function and myocardial perfusion parameters acquired by IQ-SPECT and LEHR-SPECT. Moreover, IQ-SPECT is able to shorten acquisition time, resulting in great potential in clinical application.
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Objective:To serially characterize the myocardial perfusion, myocardial hibernation and left ventricular (LV) function as well as LV remodeling in progressive coronary artery stenosis in Chinese mini-pigs.Methods:In 8 Chinese mini-pigs (5 males, 3 females; age: 10 months), chronic progression of coronary stenosis and finally occlusion was established using Ameroid constrictor implantation at the 1 cm below the bifurcation of the first diagonal branch of the left anterior descending (LAD) artery. Serial gated 99Tc m-methoxyisobutylisonitrile(MIBI) SPECT/CT, gated 18F-FDG PET/CT imaging and coronary angiography (CAG) were performed before surgery and at the 1st, 4th and 8th week after surgery. Longitudinally, total perfusion defect (TPD), LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), summed motion score (SMS), summed thickening score (STS) and hibernating myocardium (HM) were analyzed. Repeated measures analysis of variance, Kruskal-Wallis rank sum test and Bonferroni correction method were used to analyze data. Results:One mini-pig died of infection after the Ameroid constrictor implantation. In the remaining 7 mini-pigs, TPD was progressively increased with time prolonged (0, 12.0%(0, 33.0%), (41.1±23.7)% and (49.3±24.5)%; H=17.03, P=0.001); Compared with HM before the surgery (100%), HM was gradually reduced from the 1st (21.0%(6.0%, 100%)) to the 4th (18.0%(3.0%, 33.0%)) week after surgery, and then increased to the 8th week after surgery ((23.0±15.4)%; H=13.09, P=0.004), but there was no significant difference between the 1st and 4th week, or between the 4th and 8th week after surgery (both P>0.05 (Bonferroni correction method)). Accordingly, LVEF gradually decreased ((73.7±8.4)%, (63.7±19.1)%, (53.7±14.6)% and (49.9±15.4)%; F=6.22, P=0.004). LVEDV (9.0(6.0, 21.0), (31.4±16.3), (32.9±17.4) and (36.4±17.5) ml; H=8.58, P=0.035)and LVESV ((3.8±3.2), (15.9±15.3), 12.0(10.0, 17.0)and (19.3±10.9) ml; H=10.51, P=0.015) gradually increased. SMS and STS continuously increased as well ( H values: 16.49, 13.33, P values: 0.001, 0.004). Conclusions:With the progression of coronary artery stenosis to occlusion, myocardial perfusion is gradually decreased, while the global and regional LV function, LV remodeling are gradually aggravated, and HM is gradually reduced. After the chronic coronary artery occlusion, myocardial perfusion has a trend to be improved and HM is gradually recovered.
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Objective:To evaluate the left ventricular diastolic dyssynchrony (LVDD) and its influencing factors early after acute myocardial infarction (AMI) using phase analysis of SPECT gated myocardial perfusion imaging (GMPI).Methods:Bama miniature swines ( n=16) were subjected to establish AMI models. GMPI was performed before and 1 d after AMI to obtain the extent of myocardial perfusion defect (Extent, %) and left ventricular systolic dyssynchrony (LVSD)/LVDD parameters, namely the phase histogram bandwidth (PBW) and phase standard deviation (PSD). Meanwhile, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), and the ratio of early to late peak mitral diastolic flow (E/A) were obtained by echocardiography. Independent-sample t test, paired t test and Pearson correlation analysis were used to analyze the data. Results:Sixteen AMI swines were successfully created. Compared to baseline, Extent, LVEDV and LVESV significantly increased on 1 d after AMI ( t values: -11.14, -4.55, -6.12, all P<0.001), while LVEF and E/A significantly decreased ( t values: 10.16, 2.18, P<0.001, P=0.046). GMPI showed that the LVDD parameters PBW and PSD increased significantly on 1 d after AMI when compared to those at baseline((142.25±72.06)° vs (33.06±8.98)°, (56.15±26.71)° vs (12.51±5.13)°; t values: -6.11, -6.60, both P<0.001). There were significant differences between LVSD parameters and LVDD parameters (PBW: (109.06±62.40)° vs (142.25±72.06)°, PSD: (44.40±25.61)° vs (56.15±26.71)°; t values: -2.73, -2.20, P values: 0.016, 0.044). LVDD parameters PBW, PSD were negatively correlated with E/A after AMI ( r values: -0.569, -0.566, P values: 0.021, 0.022), and positively correlated with the Extent ( r values: 0.717, 0.634, P values: 0.002, 0.008). The phase analysis of SPECT GMPI to evaluate LVDD showed good intra-observer and inter-observe reproducibility (intraclass correlation coefficient (ICC): 0.953-0.984, all P<0.001). Conclusions:LVDD occurs early on 1 d after AMI, and can reflect left ventricular diastolic dysfunction. The Extent is correlated with LVDD significantly. Phase analysis of SPECT GMPI is an accurate method to evaluate LVDD and left ventricular diastolic function.
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Gaucher′s disease (GD) is a lysosomal storage disease, and the etiology of GD is the decreased activity of glucocerebrosidase, which leads to the accumulation of glucocerebroside in the lysosomes of macrophages. Because GD is rare and lacks specific clinical manifestations, it is easy to be misdiagnosed, which delays the best time for treatment. Early diagnosis, clinical evaluation, and regular monitoring of the disease have important clinical significance for enzyme replacement therapy in patients with GD. Recent studies have found that radionuclide imaging is playing an increasingly important role in the diagnosis and treatment of GD. This article introduces the application of radionuclide imaging in the diagnosis and management of GD.
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Objective:To compare the quantitative parameters of myocardial blood flow based on SPECT imaging and those determined by PET imaging in coronary microvascular disease (CMVD) animal models, in order to clarify the accuracy and feasibility of SPECT quantitative analysis in CMVD.Methods:Seven Saanen milk goats (either male or female; (20±5) kg), were selected for establishing CMVD animal models by microsphere embolization. Dynamic myocardial perfusion imaging (DMPI) with one-day method of resting + ATP stress 99Tc m-methoxyisobutylisonitrile (MIBI) SPECT was performed before and after the modeling, respectively. One-day method of resting + ATP stress 13N-ammonia PET DMPI was performed after the modeling. The quantitative parameters determined by SPECT and PET after the modeling, including stress myocardial blood flow (SMBF), resting myocardial blood flow (RMBF) and myocardial flow reserve (MFR), were compared by paired t test. Parameters based on SPECT after modeling were compared with those of baseline levels. Bland-Altman analysis was applied to access the agreement between SPECT and PET. Results:Four of the seven experimental goats were fully imaged. The RMBF(ml·g -1·min -1; 1.52±0.27 vs 1.29±0.20), SMBF(ml·g -1·min -1; 0.74±0.19 vs 0.99±0.26), and MFR (0.53±0.16 vs 0.76±0.10) of the left ventricle (global) obtained by SPECT and PET in CMVD models were not significantly different ( t values: 3.121, 1.195, 1.930, all P>0.05). Among left anterior descending branch (LAD), left circumflex (LCX) and right coronary artery (RCA), the RMBF, SMBF and MFR values quantified by SPECT and PET were neither statistically significant ( t values: 0.182-2.734, all P>0.05). Bland-Altman analysis showed the quantitative parameters measured by SPECT and PET DMPI in left ventricle, LAD, LCX, RCA had a good consistency. The difference between the two methods for determining RMBF was up to 0.63 ml·g -1·min -1, and that of SMBF was up to 0.66 ml·g -1·min -1. All points are within the 95% confidence limit; MFR differs at most by 0.56, and 14/16 points were within 95% confidence limit. The RMBF (ml·g -1·min -1) of left ventricle measured by SPECT after modeling was not significantly different from that before modeling (1.52±0.27 vs 1.57±0.36; t=0.166, P>0.05); the SMBF (ml·g -1·min -1) and MFR after modeling were significantly lower than those before modeling (0.74±0.19 vs 2.34±0.89, 0.53±0.16 vs 1.39±0.31, t values: 3.836, 6.309, both P<0.05). Similar results were found when comparing the parameters of LAD/LCX/RCA after modeling with those before modeling (RMBF t values: 0.191, 0.235, 0.195, all P>0.05; SMBF/MFR t values: 0.411-19.911, all P<0.05). Conclusion:The blood flow quantitative parameters measured by SPECT imaging have a good consistency with those based on PET imaging, and the myocardial blood flow quantitative analysis of SPECT can evaluate the blood flow perfusion of CMVD.
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Objective:To study the feasibility of cardiac 99Tc m-methoxyisobutylisonitrile (MIBI)/ 123I-metaiodobenzylguanidine (MIBG) dual-isotope imaging with cadmium-zinc-telluride (CZT) SPECT. Methods:Using a heart phantom, 99Tc m-MIBI single-isotope imaging and 99Tc m-MIBI/ 123I-MIBG dual-isotope imaging were acquired separately. Model A, B, C represented normal heart, 99Tc m/ 123I matched myocardium, 99Tc m/ 123I mismatched myocardium, respectively. Nineteen patients (9 males, 10 females; age (56±16) years) from September 2018 to June 2020 at Fuwai Hospital were enrolled to participate 99Tc m-MIBI myocardial perfusion imaging and myocardial perfusion/cardiac sympathetic imaging with 99Tc m-MIBI/ 123I-MIBG dual-isotope. Perfusion percent (PP%) and summed rest score (SRS) for all myocardial segments were obtained using quantitative perfusion SPECT (QPS) software by analyzing myocardial perfusion images. Difference and relationship between PP% and SRS were analyzed (Pearson and Spearman correlation analyses). No physical correction was applied for both acquisitions. Analysis of variance for repeated measurement data and Mann-Whitney U test were used. Results:There was no significant difference in myocardial perfusion images between 99Tc m single-isotope and 99Tc m/ 123I dual-isotope imaging with the heart phantom. 123I did not significantly impact on 99Tc m images. For patients, PP% did not differ between 99Tc m single-isotope ((69.2±14.5)%) and 99Tc m/ 123I dual-isotope imaging ((69.5±16.2)%; F=0.005, P=0.946) and correlated well ( r=0.845, P<0.01). SRS for 99Tc m single-isotope was 2(1, 13) and 2(2, 12) for 99Tc m/ 123I dual-isotope imaging ( z=-0.774, P=0.439) and the correlation between the two acquisitions was excellent ( rs=0.975, P<0.01). Conclusions:Even without physical correction, cardiac images interpretation won′t be significantly influenced by the interference of 123I with relatively higher energy on 99Tc m images. Cardiac 99Tc m-MIBI/ 123I-MIBG dual-isotope imaging is feasible.
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Objective:To explore the value of 99Tcm-MIBI SPECT/CT in diagnosis of color Doppler ultrasound (CDUS) uncertain cervical lymph node metastasis after surgical resection of papillary thyroid carcinoma (PTC). Methods: A total of 31 patients with CDUS uncertain cervical lymph node metastasis after surgical resection of PTC were collected. 99Tcm-MIBI SPECT/CT of the neck was performed one month within operation, then 99Tcm-MIBI SPECT/CT, 131I SPECT/CT of the neck were performed within 15 days. The diagnostic efficiency of 99Tcm-MIBI SPECT/CT was observed. Results: Among 31 PTC patients, cervical lymph node metastases were detected in 6 (6/31, 19.35%) patients. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of 99Tcm-MIBI SPECT/CT was 66.67% (4/6), 96.00% (24/25), 90.32% (28/31), 80.00% (4/5) and 92.31% (24/26), respectively. Totally 14 cervical metastatic lesions were found, the sensitivity and PPV of 99Tcm-MIBI SPECT/CT in diagnosis of cervical metastatic lesions was 71.43% (10/14) and 83.33% (10/12), of 131I SPECT/CT was 28.57% (4/14) and 100% (4/4), respectively. 99Tcm-MIBI SPECT/CT showed higher sensitivity than 131I SPECT/CT (χ2=5.14, P0.05). Conclusion: 99Tcm-MIBI SPECT/CT could be used to correctly localize most cervical lymph node metastasis of PTC, providing further information for judging 131I SPECT/CT and CDUS uncertain cervical lymph node metastases in postoperative PTC patients.
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Abstract Objective: The purpose of this study was to evaluate the effects of electrical muscle stimulation (EMS) on muscles, using 99mTc-sestamibi SPECT/CT. Materials and Methods: We prospectively enrolled 20 consecutive male professional water polo players. The mean age was 25 years (range, 18-36 years). All athletes underwent 99mTc-sestamibi SPECT/CT of the thigh (rectus femoris and vastus medialis muscle groups) before and after EMS. Images were quantified to identify increases in perfusion after EMS. Results: Before EMS, there were no significant differences between the right and left thigh (rectus femoris and vastus medialis muscles) in terms of perfusion (p = 0.4). However, the comparison between the pre- and post-EMS analyses of the same muscle groups showed significant differences in radiotracer uptake (p < 0.001), with a mean increase in perfusion of 128% for the rectus femoris muscle group (95% CI: 0.86-1.61) and 118% for the vastus medialis muscle group (95% CI: 0.96-1.79). Conclusion: 99mTc-sestamibi SPECT/CT is an objective means of evaluating blood flow in muscles submitted to EMS, which appears to promote significant increases in such blood flow.
Resumo Objetivo: O objetivo deste estudo foi avaliar o efeito da estimulação elétrica transcutânea na musculatura esquelética utilizando-se SPECT/CT com 99mTc- sestamibi. Materiais e Métodos: Foram prospectivamente avaliados 20 atletas masculinos de polo aquático (18-36 anos de idade; média de 25 anos). Todos os atletas foram submetidos a SPECT/CT com 99mTc- sestamibi das coxas antes e após estimulação elétrica transcutânea dos grupos musculares reto femoral e vasto medial. As imagens foram quantificadas para identificar aumento da perfusão. Resultados: A comparação da perfusão dos grupos musculares (reto femoral e vasto medial) direito versus esquerdo durante o repouso não demonstrou diferença significativa (p = 0,4). Entretanto, quando comparados esses mesmos grupos musculares antes e após a estimulação elétrica, observou-se diferença significativa na captação do traçador (p < 0,001), com aumento perfusional médio de 128% do grupo reto femoral (IC 95%: 0,86-1,61) e 118% do grupo vasto medial (IC 95%: 0,96-1,79) no grupo estimulado. Conclusão: A SPECT/CT com 99mTc- sestamibi é capaz de demonstrar de forma objetiva que a estimulação elétrica transcutânea aumenta significativamente o fluxo sanguíneo muscular.
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Objective@#To evaluate the clinical value of 99Tcm- sestamibi (MIBI) single photon emission computed tomography/computerized tomography (99Tcm-MIBI SPECT/CT) imaging in hyperparathyroidism (HPT), and to investigate the diagnostic significance of different phase tomographic imaging and compare with 99Tcm-MIBI dual phase plane imaging.@*Methods@#All 54 patients underwent 99Tcm-MIBI dual-phase planar imaging, 99Tcm-MIBI SPECT/CT early tomographic fusion imaging, delayed tomographic fusion imaging. According to the clinical diagnostic criteria, the sensitivity of three imaging methods in the diagnosis of hyperparathyroidism and the lesions was analyzed.@*Results@#⑴ The diagnostic sensitivity of the 99Tcm-MIBI dual-phase planar imaging was 75.9%(41/54). The diagnostic sensitivity of the 99Tcm-MIBI SPECT/CT early tomographic fusion imaging was 88.9%(48/54). The diagnostic sensitivity of 99Tcm-MIBI SPECT/CT delayed tomographic fusion imaging was 77.8%(42/54). ⑵ There were 74 lesions diagnosed by 99Tcm-MIBI dual phase planar imaging, 95 lesions diagnosed by 99Tcm-MIBI SPECT/CT early stage fusion imaging, and 78 lesions diagnosed by 99Tcm-MIBI SPECT/CT delayed fusion imaging. The detection rate of positive lesions in early stage tomography was the highest. ⑶ There were 4 cases of ectopic parathyroid lesions diagnosed by early CT fusion imaging, 3 cases by dual phase planar imaging and delayed CT fusion imaging.@*Conclusions@#99Tcm-MIBI SPECT/CT is an effective method to locate the focus of HPT, especially early tomographic fusion imaging combined with serum parathyroid hormone (PTH) value can improve the diagnostic efficiency.
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Objective To explore the optimal and rapid imaging acquisition time and clinical ap-plicability when using high-and low-dose one day rest/stress myocardial perfusion imaging ( MPI) with cad-mium-zinc-telluride heart dedicated SPECT ( CZT-SPECT) . Methods The MPI data with high-dose rest/stress protocol in 51 patients (22 males, 29 females, age:(55.4±8.5) years) between November 2017 and December 2017 and those with low-dose protocol in 50 patients (27 males, 23 females, age:(59.1±12.8) years) between July 2018 and October 2018 were retrospectively analyzed. The MPI was performed with CZT-SPECT. Each patient received 296-370 MBq rest dose of 99Tcm-methoxyisobutylisonitrile (MIBI) for high-dose protocol, 111-222 MBq rest dose of 99 Tcm-MIBI for low-dose protocol. Stress dose was 3 times of the corresponding rest dose. Rest and stress scans were acquired 6 min and 4 min for high-dose protocol, while 8 min and 6 min for low-dose protocol in total. All rest or stress imaging data were reconstructed from list-mode raw data to obtain scan durations of 1 min, 2 min, etc, up to the maximum of acquisition time. Image quality at different acquisition times were evaluated, and myocardial perfusion and function parame-ters were compared. Paired t test, Wilcoxon signed rank test, Pearson correlation and Bland-Altman analyses were used for data analysis. Results The image quality was rated as excellent/good in all patients ( 100％, 51/51) when acquisition time≥3 min and ≥2 min respectively for rest and stress imaging with high-dose protocol, the similar results was obtained ( 100％, 50/50) when acquisition time≥4 min and≥3 min re-spectively for rest and stress imaging with low-dose protocol. The quantitative perfusion parameters(summed rest scores, summed stress scores, total perfusion deficit) and left ventricle ejection fraction ( LVEF) at shor-ter acquisition times (3 min/2 min, 4 min/3 min) were not significantly different from the results at the lon-ger acquisition times (6 min/4 min, 8 min/6 min;t values:from -1.196 to 1.597, z values:from -1.963 to 1. 945, all P>0. 05) . Those parameters at shorter and longer acquisition times showed strong correlations ( all r>0.700, all P<0.001) , and Bland-Altman analysis revealed good agreement between them. Conclusion The opti-mal acquisition time is 3 min/2 min for high-dose one-day rest/stress CZT-SPECT MPI, and 4 min/3 min for low-dose protocol, which can significantly shorten the MPI acquisition time, then reliable perfusion parameters and LVEF can be obtained under the premise of ensuring image quality, making it the better clinical applicability.
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Objective To evaluate the clinical value of 99Tcm-sestamibi (MIBI) single photon emission computed tomography/computerized tomography (99Tcm-MIBI SPECT/CT) imaging in hyperparathyroidism (HPT),and to investigate the diagnostic significance of different phase tomographic imaging and compare with 99Tcm-MIBI dual phase plane imaging.Methods All 54 patients underwent 99Tcm-MIBI dual-phase planar imaging,99Tcm-MIBI SPECT/CT early tomographic fusion imaging,delayed tomographic fusion imaging.According to the clinical diagnostic criteria,the sensitivity of three imaging methods in the diagnosis of hyperparathyroidism and the lesions was analyzed.Results (1) The diagnostic sensitivity of the 99Tcm-MIBI dual-phase planar imaging was 75.9％ (41/54).The diagnostic sensitivity of the 99Tcm-MIBI SPECT/CT early tomographic fusion imaging was 88.9％ (48/54).The diagnostic sensitivity of 99Tcm-MIBI SPECT/CT delayed tomographic fusion imaging was 77.8％ (42/54).(2) There were 74 lesions diagnosed by 99Tcm-MIBI dual phase planar imaging,95 lesions diagnosed by 99Tcm-MIBI SPECT/CT early stage fusion imaging,and 78 lesions diagnosed by 99Tcm-MIBI SPECT/CT delayed fusion imaging.The detection rate of positive lesions in early stage tomography was the highest.(3) There were 4 cases of ectopic parathyroid lesions diagnosed by early CT fusion imaging,3 cases by dual phase planar imaging and delayed CT fusion imaging.Conclusions 99Tcm-MIBI SPECT/CT is an effective method to locate the focus of HPT,especially early tomographic fusion imaging combined with serum parathyroid hormone (PTH) value can improve the diagnostic efficiency.
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Objective To explore the feasibility of electrocardiogram (ECG)-gated coronary artery calcium scoring (CACS) CT scan for attenuation correction of 9gTcm-methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging (MPI) based on a hybrid SPECT/CT scanner.Methods From January 2017 to October 2017,a total of 110 subjects (61 males,49 females;age:(68.4±9.4) years) underwent ECG-gated MPI,ECG-gated CACS CT scan and conventional non-gated cardiac CT scan.The gated and non-gated CT scans were used for attenuation correction of MPI separately,then the relative percentage of radioactive distribution of left ventricular (LV) walls (anterior,lateral,inferior,septal and apex) based on different correction methods were compared,and the influences of CACS CT scan and conventional CT scan on visual assessment for myocardial ischemia were also compared.Paired t test and Kappa test were used to analyze the data.Results The relative radioactive distribution percentages of all LV walls in CACS CT corrected MPI and those in conventional CT corrected MPI were not statistically significant (t values:from-0.782 to 0.456,all P＞0.05).The weighted Kappa values of LV anterior,lateral,inferior,septal and apex from 2 types of corrected images between 2 physicians were 0.864 (95％ CI:0.749-0.979),0.795 (95％ CI:0.717-0.874),0.494(95％ CI:0.076-0.912),0.724(95％ CI:0.321-1.000),0.873 (95％ CI:0.764-0.982),respectively (all P＜0.01).Conclusion ECG-gated CACS CT scan can be used for attenuation correction of 99Tcm-MIBI MPI based on a hybrid SPECT/CT scanner.
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Objective To evaluate the prognostic value of peak ejection rate (PER) and peak filling rate (PFR) in patients with left ventricular systolic dysfunction (LVSD) after acute myocardial infraction (AMI).Methods A total of 123 patients (103 males,20 females,age:(60.6± 11.2) years) with LVSD after AMI who underwent 99Tc-methoxyisobutylisonitnle (MIBI) gated SPECT myocardial perfusion imaging (GSMPI) from January 2014 to December 2015 were retrospectively analyzed.Summed rest score (SRS) and total perfusion deficit (TPD) were acquired by using quantitative perfusion SPECT (QPS) soft-ware.Left ventricular ejection fraction (LVEF),end-diastolic volume (EDV),end-systolic volume (ESV),PER,and PFR were calculated by using quantitative gated SPECT (QGS) software.The clinical parameters of patients were recorded and the cardiac events were taken as the endpoint of follow-up (median time:27 (range:9-50) months).Pearson correlation was used to analyze the correlation between PER and PFR.Receiver operating characteristic (ROC) curve was used to evaluate optimal cut-off values of PER and PFR for predicting cardiac events.Kaplan-Meier survival analysis and Cox proportional hazards model were also used for data analysis.Results There was a great correlation between PER and PFR (r =-0.931,P＜0.001).Optimal cut-off values of PER and PFR for predicting cardiac events were-1.10 EDV/s and 1.09 EDV/s respectively.Kaplan-Meier survival analysis showed that cumulative survival rate without cardiac events was lower in patients (n=48) with-PER≤ 1.10 EDV/s than that in patients (n=75) with-PER＞ 1.10 EDV/s (16.7％ vs 66.7％;x2=60.096,P＜0.001),and the same rate in patients (n=50) with PFR ≤ 1.09 EDV/s was lower than that in patients (n=73) with PFR＞1.09 EDV/s (16.0％ vs 68.5％;x2=74.771,P＜0.001).Cox multivariate analysis showed that PER (hazard ratio (HR)=0.40,95％ CI:0.20-0.83) and PFR (HR=0.22,95％ CI:0.12-0.47) were independent predictors for cardiac events.Conclusion There is a great correlation between PER and PFR in patients with LVSD after AMI and they are independent predictors for cardiac events.
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Objective To evaluate the value of a novel laser navigation system (LNS) designed for a SPECT/ CT platform in improving efficiency of molecular imaging-guided percutaneous transthoracic needle biopsy (PTNB). Methods From January 2017 to October 2017, a total of 25 patients (17 males, 8 fe-males, age (58.9±10.8) years) with thoracic lesions suspicious for malignancy underwent 99 Tcm-methoxy-isobutylisonitrile (MIBI) SPECT/ CT-guided PTNB, and the hyperactivity areas were chosen as the sam-pling areas. Thirteen patients underwent traditional free hand puncture (control group), and 12 patients had LNS-assisted puncture (LNS group). The operation time, CT-guided times, average effective radiation dose of the two methods were compared. Two-sample t test was used to analyze the data. Results Comparing to control group, LNS-assisted PTNB puncture significantly reduced operation time ((7.6±2.2) vs (24. 2± 9. 8) min; t= 5.693, P<0.001), CT-guided times (1.9±0.9 vs 4.0±1.5; t= 4.108, P<0.001) and average effective radiation dose ((7.7±0.9) vs (10.5±2.1) mSv; t= 4.306, P<0.01). Conclusion The novel LNS is helpful in improving efficiency of molecular imaging-guided PTNB based on a SPECT/ CT platform.
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Objective To assess left ventricular remodeling (LVRM) after acute myocardial in-farction (AMI) quantitatively by SPECT gated myocardial perfusion imaging (GMPI), and further explore its influencing factors. Methods Twelve Ba-Ma miniature swine were used to establish AMI model. GMPI was performed at the baseline (before AMI), 24 h, 1 and 4 weeks after AMI. Infarct expansion index, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction ( LVEF) and myocardial perfusion defect were measured. Meanwhile, creatine kinase isozyme MB (CK-MB) and hypersensitive cardiac troponin I (hs-cTn I) were detected. The changes of LVEDV and LVESV before and after AMI (ΔLVEDV and ΔLVESV) were calculated. Repeated measurement analy-sis of variance, the least significant difference t test and Pearson correlation analysis were performed. Re?sults Nine AMI swine were successfully created. LVRM was present 24 h after AMI. LVEDV and LVESV were significantly greater than those before AMI and aggravated within 1 week after AMI, then were down-wards at 4 weeks after AMI. Before AMI, 24 h, 1 and 4 weeks after AMI, the LVEDV was (34.44±7. 90), (47.56±22.66), (71.89±14.90) and (70.33±19.47) ml (F = 28.836, P<0.001), and the LVESV was (10.11±5.49), (25.33±11.62), (40.89±15.88) and (35.44±17.11) ml (F = 22.450, P<0. 001). In-farct expansion index increased progressively within 4 weeks after AMI (F= 16.054, P<0.001). LVEF was significantly lower after AMI than that before AMI (F = 18.267, P<0.001) and improved at 4 weeks after AMI compared to that at 1 week ((52.56±14.96)％ vs (45.11±15.80)％; t= 2.440, P<0. 05). There was a significant correlation between the change in perfusion defect and the ΔLVEDV or ΔLVESV (r values:0. 731 and 0.700, both P<0.05) at 1 week after AMI. In addition, hs-cTn I at 24 h was correlated withΔLVEDV at 24 h and 4 weeks after AMI, respectively (r values: 0.669 and 0.693, both P<0.05). Conclu?sions LVRM and cardiac dysfunction occur in the early period after AMI. LVRM and cardiac dysfunction are most severe at 1 week after AMI, and recover at 4 weeks after AMI, whereas infarct expansion is aggra-vated within 4 weeks. Infarct size and hs-cTn I are closely related to the degree of LVRM.
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Objective To investigate the predictive value of preoperative viable myocardium and postoperative left ventricular mechanical dyssynchrony (LVMD) for adverse cardiovascular events(ACE) after coronary artery bypass graft (CABG) in patients with coronary artery disease (CAD) using myocardial perfusion imaging (MPI).Methods From September 2012 to March 2016,49 patients (44 males,5 females,average age:(64±8) years) with CAD were prospectively recruited.All patients underwent 99Tcmmethoxyisobutylisonitrile (MIBI) SPECT gated MPI (GMPI) and 18F-fluorodeoxyglucose (FDG) PET myocardial metabolic imaging to assess myocardial viability preoperatively.GMPI was repeated 4-6 months after CABG to record postoperative LVMD.Phase analysis was used to measure bandwidth (BW) and standard deviation (SD).Regular follow-up was performed,and ACE were taken as the end point.Cox proportional hazard model,Kaplan-Meier method and log-rank test were used to analyze the data.Results The mean duration of follow-up was (3.82±0.80) years,and ACE were present after CABG in 17 CAD patients (34.7％,17/49).Cox multi-analysis revealed that the number of preoperative viable segments (hazard ratio (HR)=0.208,95％ CI:0.068-0.642) and postoperative BW (HR=1.245,95％ CI:1.099-1.411)were independent influencing factors of ACE in CAD patients after CABG (both P＜0.01).Kaplan-Meier survival analysis showed that the incidence of ACE in patients with ＜ 3 viable segments was significantly higher than those with ≥ 3 viable segments (57.1％ (12/21) vs 17.9％ (5/28);x2 =21.023,P＜0.01).The incidence of ACE was significantly higher in the postoperative BW≥98° group than that in the postoperative BW＜98° group (14/19 vs 10％ (3/30);x2 =38.395,P＜0.01).Conclusions Less preoperative viable segments and severe postoperative LVMD are independent risk factors of ACE after CABG in CAD patients.Postoperative LVMD in CAD patients undergoing CABG may have important clinical value in the riskrestratification and prognosis evaluation.
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Objective To evaluate the features of myocardial perfusion imaging (MPI) in patients with homozygous familial hypercholesterolemia (HoFH) and its influence factors.Methods Forty-two consecutive HoFH patients (21 males,21 females;average age:(14.8±8.4) years) were retrospectively enrolled in this study from June 2010 to November 2016.Diagnosis was proved by clinical and chromosome tests,and all patients underwent ATP stress and rest 99Tcm-methoxyisobutylisonitrile (MIBI) SPECT MPI with a two-day protocol.Summed stress score (SSS) and summed rest score (SRS) were acquired,and summed difference score (SDS;SSS-SRS) was calculated.Relations between SSS,SRS,SDS and age,lipid profile were analyzed.Two-sample t test,x2 test,multiple linear regression analysis and multivariate logistic regression were used to analyze the data.Results There were 24 patients with positive MPI results (SSS≥1),and females (76.2％,16/21) showed more positive MPI results than males (38.1％,8/21;x2=6.22,P＜0.05).Eighteen patients had negative MPI results.There were 6,8,10 patients with MPI positive results in ＜ 10 years group (n =14),10-18 years group (n =14) and ≥ 19 years group,respectively (x2=2.33,P＞0.05).Positive electrocardiograph (ECG) in ATP stress test was observed in 9 females (42.9％,9/21) and 3 males (14.3％,3/21;x2 =4.20,P＜0.05).Sixty-three (8.8％,63/714) abnormal myocardial perfusion segments (SSS≥ 1) were found,which was mainly (60.3％,38/63) distributed in myocardial regions supplied by left anterior descending branch (LAD).SSS was positively correlated with age and high density lipoprotein cholesterol (HDLC).SRS,SDS were positively correlated with HDLC and age respectively.Multivariate logistic regression analysis indicated that the female was the only independent risk factor to predict positive MPI (odds ratio=5.2,95％ CI:1.363-19.774).Conclusions In HoFH patients,abnormal myocardial perfusion had a rising trend with age increasing.Female patients are more likely to have abnormal MPI.Abnormal myocardial perfusion segments are mainly located in myocardial regions supplied by LAD.Age and gender are influence factors of abnormal MPI in HoFH patients.