Accuracy of 82Rb PET/CT Myocardial Perfusion Imaging with Regadenoson Stress, Including 3-Year Clinical Outcomes.

The purpose of this study was to determine the clinical accuracy of 82Rb PET/CT myocardial perfusion imaging (MPI) when performed with regadenoson stress in a U.S. Department of Veterans Affairs (VA) population of patients. Methods: The initial cohort of 480 patients undergoing vasodilator PET MPI with regadenoson stress at our institution from September 2009 through July 2010 was closely tracked for short-term outcomes based on correlation with invasive coronary catheterization. Long-term outcomes were determined by major adverse cardiac event rates based on data extraction from the electronic medical record and grouped by summed stress score (SSS) for a 3-y period. Results: At the 3-y follow-up, there had been 31 patient deaths, 5 of which were heart-related. Twenty-four patients had documented myocardial infarctions. Event rates and cardiac death rates were highly predicted by the results of PET MPI. Seventy patients underwent invasive cardiac catheterization within 60 d of the PET MPI. Patients were increasingly likely to undergo catheterization as their SSS increased. Catheterization correlation demonstrated a sensitivity of 95%, a positive predictive value of 88.4% for significant coronary artery disease, and an overall accuracy of 86% for PET MPI with regadenoson stress when compared with invasive catheterization. Conclusion: PET MPI with regadenoson stress demonstrates high accuracy when correlated with invasive catheterization and clinical outcomes. The SSS was highly predictive of cardiac events and patient survival in a VA population over a 3-y period of clinical follow-up.

Predictors of fracture risk and bone mineral density in men with prostate cancer on androgen deprivation therapy.

Decrease of bone mineral density (BMD) and fracture risk is increased in men with prostate cancer receiving androgen deprivation therapy (ADT). We looked at possible predictors of decreased BMD and increased fracture risk in men with prostate cancer; most of whom were on ADT. In a retrospective study, we analyzed serum, BMD, and clinical risk factors used in the Fracture Risk Assessment (FRAX) tool and others in 78 men with prostate cancer with reported height loss. The subjects were divided in two groups: 22 men with and 56 without vertebral fractures. 17 of the 22 men with vertebral fractures on spine X-rays did not know they had a vertebral fracture. Of those 17 men, 9 had not previously qualified for treatment based on preradiograph FRAX score calculated with BMD, and 6 based on FRAX calculated without BMD. Performing spine films increased the predictive ability of FRAX for vertebral fracture. Vertebral fracture was better predicted by FRAX for other osteoporotic fractures than FRAX for hip fractures. The inclusion of BMD in FRAX calculations did not affect the predictive ability of FRAX. The PSA level showed a positive correlation with lumbar spine BMD and accounted for about 9% of spine BMD.