Usefulness of quantitative 99mTc-pyrophosphate SPECT/CT for predicting the prognosis of patients with wild-type transthyretin cardiac amyloidosis.

PURPOSE: Wild-type transthyretin-related amyloidosis cardiomyopathy (ATTRwt-CM) is an increasingly recognized cause of heart failure especially in elderly patients. The purpose of the present study was to determine retrospectively whether the quantitative indices of 99mTc-pyrophosphate (PYP) SPECT/CT help to predict the prognosis of ATTRwt-CM patients when compared with other clinical parameters. MATERIALS AND METHODS: Sixty-eight patients with biopsy-proven ATTRwt-CM who underwent PYP SPECT/CT were enrolled. Baseline clinical characteristics, echocardiographic parameters, and qualitative and/or quantitative indices of planar and SPECT/CT imaging in PYP scintigraphy for each patient were included. For quantitative analysis of SPECT/CT, the accumulation ratio of PYP in the septum, posterior, anterior, lateral, and apex walls to the cavity pool was calculated as the septal wall-to-cavity ratio (Se/C), lateral wall-to-cavity ratio (La/C), anterior wall-to-cavity ratio (An/C), inferior wall-to-cavity ratio (In/C), and apical wall-to-cavity ratio (Ap/C), respectively. Endpoints for prognostic accuracy evaluation were cardiac death or hospitalization due to heart failure. Event-free survival rate was evaluated through Cox proportional hazards regression analysis, providing estimated hazard ratios (HRs) with 95% confidence intervals (CIs) and Kaplan-Meier curves. RESULTS: High-sensitivity cardiac troponin T (hs-cTnT), La/C, age, interventricular septal thickness in diastole, and E/e' ratio in the septal wall were significantly associated with event-free survival (P < 0.05). For a multivariable Cox proportional hazards analysis, hs-cTnT (HR 1.153; 95% CI 1.034-1.286; P < 0.01), La/C (HR 2.091; 95% CI 1.012-4.322; P = 0.046), and age (HR 1.116; 95% CI 1.007-1.238; P = 0.037) were significant independent prognostic factors. CONCLUSION: This study indicated that the quantitative indices of PYP SPECT/CT can help to predict the prognosis of ATTRwt-CM patients.

Diagnostic Performance of 123I-FPCIT SPECT Specific Binding Ratio in Progressive Supranuclear Palsy: Use of Core Clinical Features and MRI for Comparison.

OBJECTIVE. Progressive supranuclear palsy (PSP) is listed as a core clinical feature in the Movement Disorder Society 2017 criteria, along with ocular motor dysfunction, postural instability, akinesia, and cognitive dysfunction. Imaging evidence shows predominant mid-brain atrophy and postsynaptic striatal dopaminergic degeneration as two supportive features. The purpose of this study was to investigate the diagnostic performance of 123I-N- ω-fluoropropyl-2ß-carbomethoxy-3ß-(4-iodophenyl) nortropane (123I-FP-CIT) SPECT by comparing it with evaluation of core clinical features and MRI in the diagnosis of PSP. MATERIALS AND METHODS. The study included 53 patients with clinically suspected PSP who had undergone 123I-FP-CIT SPECT and MRI examinations. MR parkinsonism index (MRPI) was used as the MRI index. For the 123I-FP-CIT SPECT index, specific binding ratio (SBR) was calculated as the average of the right and left SBRs. RESULTS. In regard to core clinical features, ocular motor dysfunction was present in 15 of 20 (75.0%) patients with the diagnosis of probable PSP (p < 0.0001). Calculation of the diagnostic performance of the imaging parameters showed that MRPI (cutoff > 11.6) had 85.0% sensitivity, 100% specificity, and 94.3% accuracy. SBR (cutoff < 3.7) had 95.0% sensitivity, 36.4% specificity, and 58.5% accuracy. CONCLUSION. Iodine-123-labeled FP-CIT SPECT has high sensitivity, and MRI has high specificity in the diagnosis of PSP. Because these tools have complementary roles, reach ing a more confident clinical diagnosis of PSP may be possible when both are used.

A diagnostic strategy for Lewy body disease using DAT-SPECT, MIBG and Combined index.

PURPOSE: The functional imaging methods widely used for the diagnosis of Lewy body disease (LBD) are 123I-N-ω-fluoropropyl-2ß-carbomethoxy-3ß-(4-iodophenyl) nortropan (FP-CIT) with dopamine transporter single photon emission computed tomography (DAT-SPECT) and 123I-iodobenzylguanidine (MIBG) myocardial scintigraphy. The aim of this study was to determine whether DAT-SPECT or 123I-MIBG myocardial scintigraphy should be examined first and to evaluate whether the combined use of DAT-SPECT and MIBG myocardial scintigraphy is superior to using either modality alone for diagnosing suspected LBD. METHODS: In this retrospective study, a total of 117 patients suspected of having LBD underwent DAT-SPECT imaging followed by MIBG myocardial scintigraphy. The delayed heart-to-mediastinum (H/M) ratio of MIBG scintigraphy, and the specific binding ratio (SBR) of DAT-SPECT imaging, and Combined index (defined as SBR mean × H/M in the delayed phase) were used as semi-quantitative measures. The diagnostic ability was evaluated using these indexes. RESULTS: The sensitivity, specificity, and accuracy of diagnosing Lewy body disease were 59.6%, 71.4%, and 67.5% by SBR mean of DAT-SPECT, 85.1%, 91.4%, and 88.9% by delayed H/M ratio of MIBG myocardial scintigraphy, 76.6%, 74.3%, and 75.2% by Combined index, respectively. CONCLUSION: In the diagnosis of LBD, DAT-SPECT, MIBG myocardial scintigraphy, and Combined index may be reliable indices. In particular, MIBG myocardial scintigraphy was the specific modality for LBD diagnosis. Understanding the effectiveness and limits of DAT-SPECT and MIBG myocardial scintigraphy and using both properly will lead to a more accurate diagnosis and better treatment.

Diagnostic Value of FDG-PET/CT for the Identification of Extranodal Extension in Patients With Head and Neck Squamous Cell Carcinoma.

BACKGROUND/AIM: We evaluated the diagnostic value of functional imaging with [18F]-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography/computed tomography (PET/CT) for the identification of extranodal extension (ENE) in patients with head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS: In this study, 94 patients with HNSCC who underwent FDG-PET/CT were enrolled. We recorded the maximum standardized uptake value (SUVmax), compared the results with pathologic findings, and evaluated the diagnostic performance of using a SUVmax cut-off value for ENE. RESULTS: Of the 566 dissected levels examined, 53 (9.4%) exhibited ENE. The mean SUVmax of LN with and without ENE were 6.67 and 1.64, respectively (p<0.001). A receiver operating characteristics (ROC) curve analysis for SUVmax showed an area under the ROC curve of 0.913. A SUVmax cut-off of 3.0 achieved diagnostic performance for identifying ENE with sensitivity, specificity, and accuracy of 81.1%, 94.3% and 93.1%, respectively. CONCLUSION: FDG-PET/CT findings using a SUVmax cut-off of 3.0 provides appropriate diagnostic value in identifying ENE.

Coccidian Parasite in Sea Cucumber (Apostichopus japonicus) Ovaries.

We investigated an unknown ellipsoidal body that is sometimes found in the ovaries of the sea cucumber Apostichopus japonicus. Its external morphology, comprising an ellipsoidal dark central body (about 150 µm in length) and a surrounding transparent layer (about 50 µm in thickness), resembled that of a protozoan cyst, particularly an oocyst. Histological observations of the developing A. japonicus ovaries clarified that a small mass of organisms appeared in the cytoplasm of young oocytes, proliferated in these cells through budding, became rod shaped and arranged radially, and, finally, formed an outer layer. These processes were considered to be the formation of a cyst by a protozoan parasite. The small subunit ribosomal RNA (18S rRNA) gene was amplified from the DNA extracted from unknown ellipsoidal bodies by using polymerase chain reaction with universal primers for eukaryote 18S rRNA. The determined sequence was not identical to any of the known sequences in DNA databases, but it clustered in a clade of coccidian species belonging to Eucoccidiorida in phylogenetic analyses. From these results, we concluded that the unknown ellipsoidal body is a cyst (possibly an oocyst) of a coccidian parasite (order Eucoccidiorida) that is formed in the A. japonicus oocyte, though its lower taxonomic position is uncertain. In a survey of the gonads of wild A. japonicus at Esashi, Hokkaido, during the reproductive season, these cysts were detected in more than 50% of females but were never found in males. We consider that the cysts of this parasite can only be formed in A. japonicus ovaries.

Clinical usefulness of quantification of myocardial blood flow and flow reserve using CZT-SPECT for detecting coronary artery disease in patients with normal stress perfusion imaging.

BACKGROUND: Relative myocardial perfusion imaging can misdiagnose "balanced" ischemia caused by coronary artery disease (CAD). We assessed the feasibility of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) using dynamic single-photon emission computed tomography (SPECT) with a cadmium-zinc-telluride (CZT) camera for estimating underlying CAD in patients with normal stress myocardial perfusion SPECT (MPS). METHODS: 125 patients with normal stress MPS (summed stress score ≤3) were enrolled. All patients underwent coronary angiography (CAG) and stress/rest 201Tl dynamic SPECT for MBF and MPR calculation. The diagnostic accuracy of both these quantitative values and other clinical risk factors for predicting occult CAD were validated by CAG. RESULTS: MPR was 2.85 in patients with no CAD, 2.47 with 1-, 1.98 with 2-, and 1.76 with 3-vessel CAD. The patient's age, morbidity of diabetes mellitus (DM), chronic kidney disease (CKD), stress MBF, and MPR were significantly associated with the presence of CAD (age, p=0.02; DM, p=0.005; CKD, p=0.005; creatinine level, p= 0.012, stress MBF, p=0.019, and MPR, p<0.001). Independent predictors in the multivariate regression analysis were as follows: DM, p=0.011, CKD, p=0.028, and MPR, p<0.001. The combined index was calculated from three independent predictors. Area under the receiver operating characteristic curve was 0.75 for MPR and 0.81 for the combined index. To identify CAD, sensitivity, and specificity for MPR were 77% and 66%, and for the combined index they were 79% and 66%, respectively. CONCLUSION: Quantification of MPR and MBF using dynamic SPECT with a CZT camera can be useful to identify balanced ischemia caused by occult CAD in patients with normal stress MPS findings.

A case series of the dynamics of lipid mediators in patients with sepsis.

BACKGROUND: Bioactive lipid mediators play a crucial role during infection. Previously, we showed the expression level of FAAH mRNA in septic patients was lower than in healthy controls. CASE PRESENTATION: Four patients with a Sequential Organ Failure Assessment (SOFA) score of <7 recovered from sepsis. One patient with SOFA score of 12 on day 7 died on day 21. In the fatal case, eicosapentaenoic acid, docosahexaenoic acid, arachidonic acid, and linoleic acid-derived lipid mediators, including 9-hydroxyoctadecadienoic acid (9-HODE), 13-HODE, 9,10-dihydroxy-12-octadecenoic acid (9,10-DiHOME), and 12,13-DiHOME, were elevated on day 1. Increase in anti-inflammatory prostaglandin E1 ethanolamide together with persistently lower transcription level of FAAH mRNA was detected on day 7 in the fatal case. CONCLUSION: Lipidomic analysis on day 1 revealed elevated linoleic acid metabolites, whereas on day 7, elevated prostaglandin E1 ethanolamide and low level of FAAH mRNA transcription were observed in the fatal case of sepsis.

Tc-99m PMT scintigraphy in the diagnosis of pediatric biliary atresia.

PURPOSE: Hepatobiliary scintigraphy plays an important role in the differentiation of biliary atresia (BA) and non-BA. The usefulness of 99mTc-iminodiacetic acid (IDA) derivatives in BA diagnosis is reported in several papers. In contrast, there are no comprehensive data on differentiating BA from non-BA using 99mTc-N-pyridoxyl-5-methyl-tryptophan (PMT). Our objective was to evaluate the usefulness of 99mTc-PMT scintigraphy in the diagnosis of BA. MATERIALS AND METHODS: 52 infants who received 99mTc-PMT scintigraphy for suspected BA were retrospectively evaluated. Preoperative cholangiograms or follow-ups were used as the gold standard for diagnosis of BA. We analyzed the utility of 99mTc-PMT scintigraphy, various clinical and investigational parameters in the diagnosis of BA. RESULTS: The final diagnoses in this group were BA (67.3%) and non-BA (32.7%). 99mTc-PMT scintigraphy, stool color change, total bilirubin, direct bilirubin, aspartate aminotransferase (AST) and γ-glutamyl transferase (γ-GTP) led to distinguishing between BA and non-BA in univariate analysis. Subsequent multivariate logistic regression analysis indicated that 99mTc-PMT scintigraphy and γ-GTP were independent predictors of BA. The diagnostic accuracy of 99mTc-PMT scintigraphy was 94.2%. CONCLUSIONS: 99mTc-PMT scintigraphy is more accurate in the diagnosis of BA than other conventional examinations. In addition, false positives of 99mTc-PMT scintigraphy could be reduced by combining γ-GTP level monitoring.

Impact of 99mTc-GSA SPECT Image-Guided Inverse Planning on Dose-Function Histogram Parameters for Stereotactic Body Radiation Therapy Planning for Patients With Hepatocellular Carcinoma: A Dosimetric Comparison Study.

PURPOSE: To evaluate the impact of 99mTc-labeled diethylene triamine pentaacetate-galactosyl human serum albumin (99mTc-GSA) single-photon emission computed tomography (SPECT) image-guided inverse planning on the dose-function histogram (DFH) parameters for stereotactic body radiation therapy planning in patients with hepatocellular carcinoma (HCC). METHODS: Eleven patients were enrolled in this study. The functional liver structure (FLS) was derived from SPECT thresholds of 60% to 80% of the maximum pixel value. Two treatment plans optimized without FLS (plan C) and with FLS (plan F) were designed for 50 Gy to the planning target volume (PTV). The DFH parameters were calculated as follows: Fx = (sum of the counts within the liver volume receiving a dose >x Gy/sum of the counts within the whole liver volume) × 100. Other parameters for the PTV included D95, mean dose, conformity index (CI), and homogeneity index (HI). RESULTS: Compared with plan C, plan F significantly reduced DFH parameters of F5 to F40 (P < .05). There were no significant differences in the parameters of the PTV of D95, mean dose, CI, and HI and organs at risks (stomach, duodenum, spinal cord, and kidneys) between plans C and F. CONCLUSION: DFH analyses revealed that 99mTc-GSA SPECT image-guided inverse planning provided dosimetric benefits related to sparing of liver function and may reduce hepatic toxicities.

Impact of hybrid FDG-PET/CT on gross tumor volume definition of cervical esophageal cancer: reducing interobserver variation.

Intensity-modulated radiation therapy is being increasingly used to treat cervical esophageal cancer (CEC); however, delineating the gross tumor volume (GTV) accurately is essential for its successful treatment. The use of computed tomography (CT) images to determine the GTV produces a large degree of interobserver variation. In this study, we evaluated whether the use of [18F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/CT fused images reduced interobserver variation, compared with CT images alone, to determine the GTV in patients with CEC. FDG-PET/CT scans were obtained for 10 patients with CEC, imaged positioned on a flat tabletop with a pillow. Five radiation oncologists independently defined the GTV for the primary tumors using routine clinical data; they contoured the GTV based on CT images (GTVCT), followed by contouring based on FDG-PET/CT fused images (GTVPET/CT). To determine the geometric observer variation, we calculated the conformality index (CI) from the ratio of the intersection of the GTVs to their union. The interobserver CI was compared using Wilcoxon's signed rank test. The mean (±SD) interobserver CIs of GTVCT and GTVPET/CT were 0.39 ± 0.15 and 0.58 ± 0.10, respectively (P = 0.005). Our results suggested that FDG-PET/CT images reduced interobserver variation when determining the GTV in patients with CEC. FDG-PET/CT may increase the consistency of the radiographically determined GTV in patients with CEC.

Liver Function in Areas of Hepatic Venous Congestion After Hepatectomy for Liver Cancer: 99mTc-GSA SPECT/CT Fused Imaging Study.

Background/Aim: The sacrifice of a major hepatic vein can cause hepatic venous congestion (HVC). We evaluated the effects of HVC on regional liver function using the liver uptake value (LUV), that was calculated from 99m Tc-labeled-galactosyl-human-serum-albumin ( 99m Tc-GSA) single-photon emission computed tomography (SPECT) /contrast-enhanced computed tomography (CE-CT) fused images. Patients and Methods: Sixty-two patients underwent 99m Tc-GSA SPECT/CE-CT prior to hepatectomy for liver cancer and at 7 days after surgery were divided into groups with (n=8) and without HVC (n=54). In the HVC group, CT volume (CTv) and LUV were separately calculated in both congested and non-congested areas. Results: The remnant LUV/CTv of the HVC group was significantly smaller than that of the non-HVC group (p<0.01). The mean functional ratio was 0.47±0.05, and all ratios were ≥0.39. Conclusion: After hepatectomy with sacrifice of major hepatic vein, liver function per unit volume in the congested areas was approximately 40% of that in the non-congested areas.

Dose-function Histogram Evaluation Using 99mTc-GSA SPECT/CT Images for Stereotactic Body Radiation Therapy Planning for Hepatocellular Carcinoma Patients: A Dosimetric Parameter Comparison.

BACKGROUND/AIM: We evaluated the influence of previous treatments on the parametric discrepancies between dose-volume histograms (DVHs) and dose-function histograms (DFHs) generated based on 99mTc-GSA SPECT images of hepatocellular carcinoma (HCC) patients treated with stereotactic body radiation therapy (SBRT). PATIENTS AND METHODS: Twelve patients underwent SBRT at 30-40 Gy. Registration between planning CT and SPECT/CT images was performed, and DFH parameters were calculated as follows: Fx=(sum of the counts within the liver volume receiving a dose of more than x Gy/sum of the counts within the whole liver volume) ×100. The discrepancy between Fx and Vx (Dx) was also calculated. RESULTS: The number of previous treatments for lesions other than SBRT-treated lesions (≥2 vs. <2) exhibited a significant influence on the absolute values of D10, D15, and D20 (p<0.05). CONCLUSION: Previous treatment significantly influences the parametric discrepancy between DFH and DVH.

Quantification of myocardial perfusion reserve using dynamic SPECT images of patients with chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disorders. The aim of this study was to examine whether the quantitatively measured myocardial blood flow (MBF) or myocardial perfusion reserve (MPR), calculated by dynamic single photon emission computed tomography (SPECT) analysis using a cardiac cadmium zinc telluride (CZT) gamma camera, was related to renal dysfunction in patients with normal myocardial perfusion imaging (MPI) findings. METHODS: The study population consisted of 46 patients with CKD and 46 individuals without CKD (controls). Their MPR index was quantitatively measured using adenosine MPI with a cardiac CZT gamma camera. All assessments were with a single tissue compartment kinetic model. The K1 value was calculated on stress and at-rest images. To obtain the MPR index we divided K1 stress-by K1 at-rest values. RESULTS: The at-rest K1 value was significantly higher and the MPR index was significantly lower in patients with CKD than those without CKD [CKD vs. CONTROLS: at-rest K1 value, 0.21 (0.17-0.25) vs. 0.19 (0.16-0.22), p=0.040; MPR index, 1.86 (1.69-2.22) vs. 2.19 (1.93-2.41), p<0.001]. The stress K1 values were not significantly different. CONCLUSION: The MPR index is significantly lower in CKD patients; this is considered as being mainly due to an increase in the at-rest K1 value.

3D hybrid profile order technique in a single breath-hold 3D T2-weighted fast spin-echo sequence: Usefulness in diagnosis of small liver lesions.

PURPOSE: We compared the efficacy of three-dimensional (3D) isotropic T2-weighted fast spin-echo imaging using a 3D hybrid profile order technique with a single-breath-hold (3D-Hybrid BH) with a two-dimensional (2D) T2-weighted fast spin-echo conventional respiratory-gated (2D-Conventional RG) technique for visualising small liver lesions. MATERIALS AND METHODS: This study was approved by our institutional review board. The requirement to obtain written informed consent was waived. Fifty patients with small (≤15mm) hepatocellular carcinomas (HCC) (n=26), or benign cysts (n=24), had undergone hepatic MRI including both 2D-Conventional RG and 3D-Hybrid BH. We calculated the signal-to-noise ratio (SNR) and tumour-to-liver contrast (TLC). The diagnostic performance of the two protocols was analysed. RESULTS: The image acquisition time was 89% shorter with the 3D-Hybrid BH than with 2D-Conventional RG. There was no significant difference in the SNR between the two protocols. The area under the curve (AUC) of the TLC was significantly higher on 3D-Hybrid BH than on 2D-Conventional RG. CONCLUSION: The 3D-Hybrid BH sequence significantly improved diagnostic performance for small liver lesions with a shorter image acquisition time without sacrificing accuracy.

Correlation of left ventricular dyssynchrony on gated myocardial perfusion SPECT analysis with extent of late gadolinium enhancement on cardiac magnetic resonance imaging in hypertrophic cardiomyopathy.

Myocardial perfusion-single-photon emission computed tomography (MP-SPECT) is used to evaluate microvascular dysfunction and coexisting coronary artery disease in patients with hypertrophic cardiomyopathy (HCM). Phase analysis in gated MP-SPECT can provide additional information on left ventricular (LV) dyssynchrony, while the extent of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging is an important prognostic factor in patients with HCM. We, therefore, sought to investigate the relationship of dyssynchrony by phase analysis on gated MP-SPECT and LGE on CMR imaging in 22 patients with HCM who underwent both stress/rest-gated MP-SPECT and contrast-enhanced CMR imaging. LV dyssynchrony parameters [phase standard deviation (SD) and histogram bandwidth] from gated MP-SPECT were compared with LGE parameters from CMR imaging [L/C contrast and %LGE calculated, respectively, as LGE intensity/LV cavity intensity and (LGE volume/myocardial volume) × 100]. Phase SD and histogram bandwidth showed strong correlation with %LGE (r = 0.73, p < 0.0001 and r = 0.73, p < 0.0001, respectively), although they did not significantly correlate with L/C contrast (r = 0.30, p = 0.17 and r = 0.26, p < 0.25, respectively). The LV dyssynchrony derived from gated MP-SPECT strongly correlated with the extent of LGE on CMR imaging. In conclusion, our investigation suggests that gated MP-SPECT may be useful not only for the assessment of myocardial ischemia but also the extent of myocardial replacement fibrosis.

Cardiovascular magnetic resonance myocardial T1 mapping to detect and quantify cardiac involvement in familial amyloid polyneuropathy.

OBJECTIVES: This study sought to explore the potential role of non-contrast T1 mapping for the detection and quantification of cardiac involvement in familial amyloid polyneuropathy (FAP). METHODS: Japanese patients with FAP [n = 41, age 53.2 ± 13.9 years, genotype Val30Met (n = 25), non-Val30Met (n = 16)] underwent cardiac magnetic resonance imaging that included T1 mapping (saturation-recovery method) and late gadolinium-enhanced (LGE) imaging on a 3.0-T MR scanner. Their native T1 was measured on mid-ventricular short-axis images and compared with 30 controls. RESULTS: Of the 41 FAP patients 29 were LGE positive. The native T1 was significantly higher in FAP patients than in the controls (1,634.1 ± 126.3 ms vs. 1,432.4 ± 69.0 ms, p < 0.01), significantly higher in LGE-positive- than LGE-negative FAP patients (1,687.1 ± 104.4 ms vs. 1,505.4 ± 68.5 ms, p < 0.01), and significantly higher in LGE-negative FAP patients than the controls (p < 0.01). A native T1 cutoff value of 1,610 ms yielded 85.4% accuracy for identifying LGE-positive FAP. The native T1 significantly correlated with the interventricular septum wall thickness, the left ventricular mass, the LGE volume, the plasma B-type natriuretic peptide level, and the E/e' ratio (all p < 0.01). CONCLUSION: T1 mapping is of high diagnostic accuracy for the detection of LGE-positive FAP. The native myocardial T1 may be correlated with the severity of cardiac amyloid deposition. KEY POINTS: • The native T1 was higher in FAP patients than the controls. • The native T1 was higher in LGE-positive- than LGE-negative FAP patients. • The native T1 was higher in LGE-negative FAP patients than the controls. • The native T1 correlated with clinical markers of systolic and diastolic dysfunction. • Myocardial T1 mapping is of high diagnostic accuracy for detecting LGE-positive FAP.

Diagnosis of dementia with Lewy bodies: can 123I-IMP and 123I-MIBG scintigraphy yield new core features?

OBJECTIVE: Since the clinical symptoms of different types of dementia frequently overlap, especially in the earlier stages at onset, it is difficult to distinguish dementia with Lewy bodies (DLB) from other neurodegenerative dementias based on their clinical manifestations alone. Nuclear medicine imaging has been reported as a high-value index for the objective evaluation and diagnosis of DLB. The aim of this study was to evaluate whether nuclear medicine imaging findings may yield core features to be added to the diagnosis of DLB. METHODS: We enrolled 332 patients with suspected DLB. All were evaluated by both 123I-metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy and 123I-labelled N-isopropyl-p-iodoamphetamine (123I-IMP). brain perfusion single-photon emission CT. The final clinical diagnosis indicated probable DLB in 92 patients (40 males, 52 females; mean age ± standard deviation, 77.4 ± 6.4 years; range, 56-89 years); 240 patients (98 males, 142 females; mean age, 75.5 ± 9.0 years; range, 70-87 years) were recorded as being without DLB. The accepted core features used for clinical evaluations were fluctuating cognition, visual hallucinations and Parkinsonism. The nuclear medicine evaluation indices were the severity score of cerebral blood flow on 123I-IMP scintigraphs of the posterior cingulate and praecuneus and a reduction in the blood flow in the occipital lobe. For 123I-MIBG evaluation, we recorded the early and delayed heart-to-mediastinum (H/M) ratios and the washout rate. RESULTS: Univariate and multivariate analyses of fluctuating cognition, visual hallucinations, Parkinsonism and early H/M ratio in patients with probable and without DLB revealed significant differences. Parameters based on 123I-IMP studies did not show any significant differences by multivariate analysis. The area under the curve for the early H/M ratio was 0.918; for fluctuating cognition, visual hallucinations and Parkinsonism, it was 0.693, 0.760 and 0.611, respectively, by receiver-operating characteristic analysis. The early H/M ratio of <2.0 on 123I-MIBG scintigraphs was of the highest diagnostic accuracy. The sensitivity, specificity and accuracy for the diagnosis of probable DLB were 82.4%, 96.3% and 92.5%, respectively. CONCLUSION: The early H/M ratio obtained by 123I-MIBG myocardial scintigraphy can serve as a reliable diagnostic index for the core clinical features of DLB. It can be used for the early diagnosis and treatment of DLB. Advances in knowledge: 123I-MIBG myocardial scintigraphy performed at the initial clinical examination can facilitate the early identification or exclusion of DLB and the early H/M ratio may be a diagnostic biomarker for DLB.

123I-MIBG myocardial scintigraphy for the evaluation of Lewy body disease: are delayed images essential? Is visual assessment useful?

OBJECTIVE:: We performed 123I-meta-iodobenzylguanidine (123I-MIBG) myocardial scintigraphy for the diagnosis of Lewy body disease (LBD) and assessed whether the early heart-to-mediastinum (H/M) ratio was diagnostic and whether visual image analysis was useful. METHODS:: Our study included 453 patients with clinically suspected LBD who had undergone 123I-MIBG myocardial scintigraphy. We evaluated semi-quantitative values (early and delayed H/M ratio, washout rate) and performed visual image analysis. The sensitivity, specificity, accuracy, positive-predictive value (PPV) and negative-predictive value (NPV) of both analyses were calculated. RESULTS:: The early H/M ratio exhibited the best diagnostic ability. Its overall sensitivity, specificity, accuracy, PPV and NPV were 72.2%, 93.1%, 84.3%, 88.5% and 82.2%, respectively (cut-off value 2.2 or less). However, there was no significant difference from the delayed H/M ratio or the results of visual assessment. CONCLUSION:: 123I-MIBG myocardial scintigraphy accurately differentiates between patients with and without LBD and a correct diagnosis can be established based on the early H/M ratio. We also document that visual evaluation of scintigrams is useful. Therefore, patients may benefit from the single performance of the procedure because a correct diagnosis can be obtained early in the disease process and their prognosis and appropriate treatment can be determined. ADVANCES IN KNOWLEDGE:: 123I-MIBG myocardial scintigraphy on the early H/M ratio makes it possible to differentiate between patients with LBD and patients without LBD.

(99m)Tc-GSA SPECT/CT fused images for assessment of hepatic function and hepatectomy planning.

To assure safe hepatectomy, accurate estimation of the functional reserve of the future remnant liver is crucial. The combination of indocyanine green retention rate at 15 min and CT volumetry is widely used in deciding on the extent of hepatectomy. On the other hand, there are quantitative indices calculated from (99m)Tc-GSA scintigraphy that reflect the number and function of hepatocytes. Therefore, there are many indices calculated from (99m)Tc-GSA scintigraphy that have been reported. In recent Annals of Surgical Oncology on Oct. 2014 the Uptake Index (UI) calculated from (99m)Tc-GSA scintigraphy was reported to be useful for hepatectomy planning and postoperative liver failure prediction. In this paper, we report on the usefulness and limits of quantitative indices calculated from (99m)Tc-GSA SPECT/CT for preoperative simulation.