Implicancia pronóstica de los estudios gated-SPECT normales en pacientes mayores de 70 años / Pronostic implication of normal gated SPECT studies in patients over 70 years old

Introducción: un resultado normal en la centellografía de perfusión miocárdica gatillada (gated-SPECT) tiene un alto valor predictivo negativo para enfermedad coronaria grave; existe un período de tiempo variable en que los pacientes permanecen con una tasa de eventos baja (menor a 1%). Sin embargo, algunas evidencias sugieren que este período de garantía (PG) no es el mismo en todos los grupos etarios. Objetivo: establecer el período de tiempo en el cual los pacientes ancianos (mayores de 70 años) mantienen una tasa de eventos cardíacos por debajo de 1%. Material y método: se estudiaron 554 pacientes mediante gated-SPECT, divididos en dos grupos: Grupo 1: (n=354) con gated-SPECT normal, y Grupo 2: (n=200) con gated-SPECT anormal. Definimos un gated-SPECT normal como aquel con score de suma en estrés (SSS) < 4 y parámetros funcionales normales. El seguimiento medio fue de 30,6 meses (rango: 12-62 meses) para la pesquisa de los eventos cardiovasculares (EC): muerte cardíaca (MC) e infarto agudo de miocardio no fatal (IAMNF), y eventos combinados (ECB): EC+ angioplastia coronaria, cirugía de revascularización miocárdica e implante de cardiodesfibrilador. Se utilizó prueba no paramétrica de Pearson y se calculó el estadístico x2, con un valor de p ?0,05 para el rechazo de la hipótesis nula (IC: 95%). Resultados: la comparación entre ambos grupos muestra diferencias en los tres primeros años para la aparición de EC (p <0,0001), MC (p <0,0001) y ECB (p <0,0001). La tasa de EC en el Grupo 1 para cada año fue de 0,56%, 0,59% y 0,50%, respectivamente, con una tasa acumulada a tres años de 1,65%. La tasa en el Grupo 2 fue de 2,50%, 1,58% y 3,84%, respectivamente (tasa acumulada: 7,92%). El período de tiempo en el cual los pacientes del Grupo 1 mantuvieron un riesgo de EC por debajo de 1% fue de 18 meses. Conclusión: el pronóstico de los pacientes ancianos que presentan un resultado normal en el gated-SPECT es muy bueno, con una tasa de EC menor a 1% por un lapso de 18 meses.

Introduction: a normal result in myocardial perfusion scintigraphy (gated-SPECT) has a high negative predictive value for severe coronary artery disease; there is a period of time in which patients remain with a low event rate (less than 1%). However, some evidence suggests that this guarantee period (PG) is not the same in all age groups. Objectives: to establish the period of time in which elderly patients (older than 70 years) maintain a rate of cardiac events below 1%. Material and methods: 554 patients were studied through gated-SPECT, divided into two groups: Group 1: (n = 354) with normal gated-SPECT, and Group 2: (n = 200) with abnormal gated-SPECT. We define a normal gated-SPECT as that with a stress sum score (SSS) <4 and normal functional parameters. The mean follow-up was 30.6 months (range: 12-62 months), for the investigation of cardiovascular events (CE): cardiac death (CD) and nonfatal infarction (NFAMI), and combined events (CBE): CE + coronary angioplasty, myocardial revascularization surgery and implanted cardiodefibrillator (ICD). Pearson's nonparametric test was used and the Χ2 statistic was calculated, with a value of p <0.05 for the rejection of the null hypothesis (CI: 95%). Results: the comparison between both groups shows differences for the appearance of CE: (p <0.0001), CD: (p <0.0001) and CBE: (p <0.0001). The CE rate in Group 1 for each year was 0.56, 0.59 and 0.50%, respectively, with a cumulative 3-year rate of 1.65%. The rate in Group 2 was 2.5, 1.58 and 3.84%, respectively (cumulative rate: 7.92%). The period in which Group 1 patients maintained a risk of CD below 1% was 18 months. Conclusion: the prognosis of elderly patients presenting a normal gated-SPECT result is very good, with a cardiac event rate of less than 1% for a period of 18 months.

Prognostic Value of Infarct size Measured by Gated sPECT scintigraphy / Valor pronóstico del tamaño del infarto de miocardio cuantificado mediante SPECT gatillada

Background: Despite the improved sensitivity and specificity of SPECT myocardial perfusion imagingto detect myocardial involve-ment after acute myocardial infarction (AMI), there is little information about the usefulness of early infarct size (IS) measurement by this method for risk stratification and prognosis. Objectives: The goal of this study was to evaluate the usefulness of quantifying IS by gated SPECT scintigraphy to predict cardio­vascular events in patients with a first AMI. Methods: Patients with a first ST-segment elevation AMI were included from 2009 to 2014. Infarct size was estimated using the Cedars QPS software. The incidence of events (heart failure, ventricular arrhythmias, mortality and a composite of the three events) was evaluated at one year. Results: One-hundred and forty nine patients were included in the study; mean age was 59±11 years and 81.9% were men. Diabetes was present in 16.1% of cases, 9.4% had a history of myocardial revascularization, 84.6% were admitted in Killip and Kimball class A, 43% of AMIs were located in the anterior wall and 69.8% of the patients underwent reperfusion. Left ventricular ejection fraction estimated by gated SPECT scintigraphy was 51%±14%. Follow-up was completed in 95.9% of cases. An IS cutoff point of 22% (ROC curve) was established to predict the composite endpoint at follow-up (sensitivity 92%, specificity 81%, AUC: 0.94%), dividing the sample into two groups: Group I (IS <22%) and Group II (IS ≥22%). The prevalence of the composite endpoint was greater in Group II (2.1% Group I vs. 50% Group II; p<0.001). Infarct size ≥ 22% was the only variable identified as predictor of events during follow-up (OR 1.978; 95% CI 1.887-1.996; p<0.001). Conclusion: Early quantification of IS by gated SPECT scintigraphy is an independent risk predictor at one year that allows risk stratification in patients with a first AMI.

Introducción: Si bien la SPECT de perfusión miocárdica ha mejorado la sensibilidad y la especificidad en la detección del compromiso miocárdico luego de un infarto agudo de miocardio (IAM), aún es escasa la información sobre la determinación precoz del tamaño del infarto (TI) con este método para la estratificación del riesgo y su valor pronóstico. Objetivos: Evaluar la utilidad de la cuantificación del TI estimado por SPECT gatillada en la predicción de complicaciones cardio­vasculares en pacientes con un primer IAM. Material y métodos: Se analizaron los pacientes con IAM con elevación del ST desde 2009 a 2014, excluyéndose aquellos con IAM previo. El cálculo del TI se realizó con el softwareCedars QPS. Se evaluaron eventos al año: insuficiencia cardíaca, arritmias ventri-culares, muerte y la combinación de los tres eventos. Resultados: Se incluyeron 149 pacientes, con edad media de 59±11 años,el 81,9% de sexo masculino. El 16,1% eran diabéticos y el 9,4% presentaban revascularización previa. El 84,6% ingresaron en Killip y Kimball A, el 43% de los IAM fueron de territorio anterior y el 69,8% de los pacientes fueron reperfundidos. La fracción de eyección del ventrículo izquierdo por SPECT gatillada fue del 51% ±14%. Se realizó seguimiento clínico en el 95,9% de los casos. El punto de corte del TI (curva ROC) para predecir eventos combinados al seguimiento se estableció en 22% (sensibilidad: 92%, especificidad: 81%, ABC: 0,94),con el cual la muestra se dividió en dos grupos: Grupo I (TI<22%) y Grupo II (TI≥22%). La prevalencia de eventos combinados fue mayor en el Grupo II (2,1% Grupo Ivs. 50% Grupo II; p<0,001). El TI ≥22% se identificó como la única variable predictora de eventos al seguimiento (OR 1,978; IC 95% 1,887-1,996; p<0,001). Conclusión: La cuantificación precoz del TI mediante SPECT es un predictor independiente de riesgo al año que permite establecer una estratificación del riesgo en pacientes con un primer IAM.

Application of 18F-fluorothymidine PET/CT in diagnosis of tumor / 中国介入影像与治疗学

18F fluorodeoxyglucose, as a kind of tracer, has its limitations in positron emission tomography/computed tomography (PET/CT). 18F-fluorothymidine (18F-FLT) is a kind of new tracer. The value of 18F-FLT in diagnosis of tumor, tumor staging and assessment of therapeutic effects was reviewed in this article.

Therapeutic Evaluation of ~(18)F-FDG Coincidence SPECT Imaging in Malignant Lymphoma / 上海第二医科大学学报

Objective To study the clinical value of ~(18)F-fluorodeoxyglucose(~(18)F-FDG) coincidence SPECT imaging in the therapy of malignant lymphoma. Methods Serial ~(18)F-FDG SPECT imaging were performed on 42 patients with malignant lymphoma before and after treatment.The results were compared with other conventional imaging.Patients were divided into two groups. Twenty-seven new-diagnosed patients(group Ⅰ) and 15 operated patients(group Ⅱ) had ~(18)F-FDG imaging pre-and post-chemotherapy. Results(In group Ⅰ,) 15 cases(achieved) clinical remission,five cases relapsed and one case progressed.In group Ⅱ,tumor residues were detected in four patients,and one patient relapsed. Conclusion Serial ~(18)F-FDG imaging during treatment is very useful for therapeutic evaluation in malignant lymphoma.

Main Technical Parameters and Clinical Application of Biograph 64 TruePoint PET/CT / 医疗卫生装备

The basic structure, primary parameters of PET/CT and the clinical application value on tumor system, cardio-vascular system and nerval system are simply introduced. The 64 slices PET/CT is significant in directing coronary heart disease diagnosis and treatment. The PET of the 18F-FDG cardiac muscle metabolism and coronary artery imaging can be operated by this equipment at the same time, which can confirm the activeness of the cardiac muscle and the blood-supply for the coronary arterial distributing. This has a determinative meaning for the choosing of Rx.

The diagnostic value of PET/CT fusion images in metastatic tumors of the body: research based on the comparison of CT,SPECT or PET images / 重庆医科大学学报

Objective:To evaluate the diagnostic value of PET/CT fusion images in the research field of metastatic tumors of the body by the comparison of CT,SPECT or PET images.Methods:The analysis was based on 19 cases with 60 metastatic lesions.The final diagnoses were confirmed by surgery,biopsy and pathology.CT,SPECT or PET and PET/CT were applied in all cases.CT scanning was applied in 19 cases.Among them,there were 9 plain examinations,and on the basis of that,the other 10 cases were applied enhancement scanning.SPECT was applied in 11 cases.Among them,there were also another 8 cases which were applied PET.Combined PET/CT examinations were performed in 19 cases.PET/CT was separately compared with CT,SPECT or PET findings,and the its numbers,localization,size,the distrubution of radionuclide,the involvement of lymph node and local swelling of soft tissues of the lesions were recorded.Results: There were 9 cases of pulmonary metastasis and the detective rate of PET/CT was 100%(29/29 cases),SPECT or PET 86.2%(25/29 cases),CT 82.8%(24/29 cases);7 cases of spine metastasis and the detective rate of PET/CT was 100%(17/17 cases),SPECT or PET 88.2%(15/17 cases),CT 76.5%(13/17 cases);3 cases of hepatic metastasis,and the detective rate of PET/CT was 100%(14/14 cases),SPECT or PET 71.4%(10/14 cases),CT 78.6%(11/14 cases)respectively.Conclusion:The shape and anatomic position of metastatic lesion can be clearly detected on CT image;nuclear medicine images such as SPECT,PET can provide excellent information on functional biology.Referring to PET/CT,it is a very useful method in detecting lesions of the shape and construction,and it can also provide more functional information,localization and characterization of metastatic lesion,PET/CT image can differentiate physiologic uptake,and meanwhile promote the differentiation of its physiologic intake.

A Preliminary Study on the Diagnostic Value of SPECT rCBF Imaging in Acute Closed Brain Injury / 中国医师杂志

Objective To explore the diagnostic value of SPECT rCBF imaging for acute closed brain injury. Methods SPECT rCBF imaging and X-ray CT were perfomed in 60 patients with acute closed brain injury, and the results of two detection methods were compared. Results Among 60 patients, SPECT examination found 54 cases(90%) of brain lesions, while x-ray CT only found 27 cases(45%). The positive diagnostic rate of SPECT was higher than that of CT(? 2=25.68,P

Evaluation of ~(18)F-FDG hPET/CT in primary carcinoma of gastric cardia / 中国癌症杂志

Background and Purpose:dPET/CT is very expensive,so although the accuracy of hPET/CT is less than dPET/CT,it is better than CT,and is useful for guiding the tumor staging before operation.This paper is evaluate the role of ~(18)F-fluorodeoxyglucose(FDG) hPET/CT in primary carcinoma of gastric cardia detection.Methods:26 patients with histologically proven primary carcinoma of gastric cardia underwent whole body hPET/CT imaging.Visual and semiquantitative analysis and standardized uptake value(SUV) were used to analyze the images.The results of hPET/CT study were compared with those of CT.Results:1.The sensitivity of hPET/CT in primary carcinoma of gastric cardia detection was 92.3%(24/26);two cases of signet ring cell carcinoma gave false negative results,and the primary lesions were small(

Differential diagnosis of Parkinson disease and vascular Parkinsonism by single photon emission computed tomography imaging / 西安交通大学学报(医学版)

Objective To investigate the differential diagnosis of early-stage Parkinson disease(PD) and vascular Parkinsonism(VP) by 99Tcm-TRODAT-1 single photon emission computed tomography brain imaging.Methods 99Tcm-TRODAT-1 SPECT brain imaging was performed on 47 patients with early-stage PD,26 with early-stage VP and 30 age-matched healthy control subjects.The radioactive ratio of striatum to cerebullum was calculated by region of interest(ROI) technique.The results were analyzed and compared.Results The distribution and quantities of 99Tcm-TRODAT-1 uptake were reduced in contralateral striatum to clinically symptomatic side of the patients with early-stage PD(P0.05).The radioactive ratio of striatum to cerebullum contralateral to the affected limb in the patients with early-stage PD was lower than that in the healthy control subjects while that to patients with early-stage VP were similar to that in the healthy control subjects.Conclusion 99Tcm-TRODAT-1 single photon emission computed tomography brain imaging and semiquantitative analysis are useful to differentiate VP from PD.