Subject(s)
Humans , Male , Aged , Incidental Findings , Heart Aneurysm/diagnostic imaging , Gated Blood-Pool Imaging , RadiopharmaceuticalsABSTRACT
Introducción y objetivos. El objetivo de este estudio es comparar los resultados de la resonancia magnética y la gated-SPECT de perfusión miocárdica en la valoración de la función ventricular y la viabilidad en pacientes con infarto de miocardio en fase crónica. Métodos. Se estudió con resonancia magnética y gated-SPECT a 104 pacientes (media de edad, 61 ± 12 años; el 87,5% varones) con infarto previo. Se correlacionaron los volúmenes y la fracción de eyección del ventrículo izquierdo y los criterios clásicos de viabilidad con realce tardío con gadolino (< 75% de transmuralidad) con los de la SPECT (captación > 50%) en los 17 segmentos del ventrículo izquierdo. Se valoró la motilidad, el engrosamiento y la isquemia en la gated-SPECT de los segmentos no viables o con criterios dudosos con el realce (un 50-75% de transmuralidad). Resultados. Se observó buena correlación entre ambas exploraciones para los volúmenes y la fracción de eyección (p < 0,05) y para la masa necrótica estimada (p < 0,01). De los 264 segmentos con realce > 75%, 82 (31%) tenían captación > 50% en la SPECT. De los 106 segmentos con criterios dudosos de viabilidad (un 50-75% de realce) en la resonancia magnética, en la SPECT 68 (64%) tenían una captación > 50%; 41 (38,7%), motilidad conservada; 46 (43,4%), engrosamiento conservado, y 17 (16%), criterios de isquemia. Conclusiones. Una tercera parte de los segmentos considerados no viables en la resonancia magnética muestran captación > 50% en la SPECT. El análisis de la motilidad, engrosamiento y presencia de isquemia en la gated-SPECT es de utilidad en los segmentos de dudosa viabilidad en la resonancia magnética(AU)
Introduction and objectives. The aim of this study was to compare magnetic resonance and gated-SPECT myocardial perfusion imaging in patients with chronic myocardial infarction. Methods. Magnetic resonance imaging and gated-SPECT were performed in 104 patients (mean age, 61 [12] years; 87.5% male) with a previous infarction. Left ventricular volumes and ejection fraction and classic late gadolinium enhancement viability criteria (<75% transmurality) were correlated with those of gated-SPECT (uptake >50%) in the 17 segments of the left ventricle. Motion, thickening, and ischemia on SPECT were analyzed in segments showing nonviable tissue or equivocal enhancement features (50%-75% transmurality). Results. A good correlation was observed between the 2 techniques for volumes, ejection fraction (P<.05), and estimated necrotic mass (P<.01). In total, 82 of 264 segments (31%) with >75% enhancement had >50% single SPECT uptake. Of the 106 equivocal segments on magnetic resonance imaging, 68 (64%) had >50% uptake, 41 (38.7%) had normal motion, 46 (43.4%) had normal thickening, and 17 (16%) had ischemic criteria on SPECT. Conclusions. A third of nonviable segments on magnetic resonance imaging showed >50% uptake on SPECT. Gated-SPECT can be useful in the analysis of motion, thickening, and ischemic criteria in segments with questionable viability on magnetic resonance imaging(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Tomography, Emission-Computed, Single-Photon/methods , Tomography, Emission-Computed, Single-Photon , Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography/methods , Magnetic Resonance Spectroscopy/methods , Myocardial Infarction , Radionuclide Imaging/methods , Stroke Volume/radiation effects , ROC Curve , Tomography, Emission-Computed/instrumentation , Tomography, Emission-Computed/methods , Tomography, Emission-ComputedABSTRACT
Paciente de 77 años de edad ingresado por un síndrome coronario agudo sin elevación del segmento ST. Se estratificó su riesgo mediante gated-SPECT de perfusión miocárdica, evidenciándose una ligera isquemia inferior, por lo cual se optimizó el tratamiento médico y recibió el alta hospitalaria. El paciente continuó con disnea de esfuerzo, y se le realizó una angiotomografía computarizada coronaria que mostró lesiones intensas en la arteria coronaria derecha (CD) proximal. La fusión SPECT-tomografía computarizada correlacionó el defecto de perfusión miocárdica con la arteria descendente posterior proveniente de la arteria CD en un territorio de irrigación codominante. Posteriormente se indicó un cateterismo cardiaco para su tratamiento. El uso actual de los estudios de fusión de imágenes se limita a pacientes en los cuales es difícil la asignación de un defecto de perfusión a una determinada arteria coronaria. En nuestro paciente, las imágenes de fusión contribuyeron a discernir la arteria responsable del territorio isquémico entre la arteria CD y la arteria circunfleja(AU)
A 77-year old patient was admitted for acute coronary syndrome without ST elevation. His risk was stratified using the myocardial perfusion gated SPECT, mild inferior ischemia being observed. Thus, medical therapy was optimized and the patient was discharged. He continued with exertional dyspnea so a coronary CT angiography was performed. It revealed severe lesions in the proximal RCA. SPECT-CT fusion images correlated the myocardial perfusion defect with a posterior descending artery from the RCA, in a co-dominant coronary area. Subsequently, cardiac catheterism was indicated for his treatment. The current use of image fusion studies is limited to patients in whom it is difficult to attribute a perfusion defect to a specific coronary artery. In our patient, the fusion images helped to distinguish between the RCA and the circumflex artery as the culprit artery of ischemia(AU)
Subject(s)
Humans , Male , Middle Aged , /methods , Tomography, Emission-Computed, Single-Photon/instrumentation , Tomography, Emission-Computed, Single-Photon/methods , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/therapy , Cardiac Catheterization/methods , Electrocardiography/methods , Tomography, Emission-Computed, Single-Photon/trends , Tomography, Emission-Computed, Single-Photon , Dyspnea/complications , Angiography/methodsABSTRACT
A 77-year old patient was admitted for acute coronary syndrome without ST elevation. His risk was stratified using the myocardial perfusion gated SPECT, mild inferior ischemia being observed. Thus, medical therapy was optimized and the patient was discharged. He continued with exertional dyspnea so a coronary CT angiography was performed. It revealed severe lesions in the proximal RCA. SPECT-CT fusion images correlated the myocardial perfusion defect with a posterior descending artery from the RCA, in a co-dominant coronary area. Subsequently, cardiac catheterism was indicated for his treatment. The current use of image fusion studies is limited to patients in whom it is difficult to attribute a perfusion defect to a specific coronary artery. In our patient, the fusion images helped to distinguish between the RCA and the circumflex artery as the culprit artery of ischemia.
