Comparison of optimised planar scintigraphy with SPECT thallium, exercise ECG and angiography in the detection of coronary artery disease.

BACKGROUND: Thallium SPECT has been shown to be more sensitive than planar imaging in the detection of coronary heart disease (CAD) in a number of reported series. Early (< 10 minutes) redistribution on planar imaging has been demonstrated in clinical studies and this may partly contribute to its lower sensitivity. AIM: To determine whether thallium SPECT is superior to planar scintigraphy (with the timing of imaging performed optimally so that it was commenced within five minutes of injection) in the detection of CAD. METHODS: Planar and SPECT studies were performed in 44 patients with significant (> 70% stenosis) CAD, seven patients with borderline stenoses (50-69%) and in 18 patients with no significant CAD. RESULTS: The sensitivity of planar imaging was 66% which was higher than exercise ECG 54% (ns) but significantly lower than SPECT 86% (p < 0.005). The specificity of planar thallium scintigraphy was 100% which was higher than SPECT (83%) and significantly higher than exercise ECG 72% (p < 0.05). SPECT had a significantly higher sensitivity for LAD and single vessel disease than planar imaging and this was unrelated to a history of prior myocardial infarction. CONCLUSION: Even when planar imaging is timed optimally to minimise the impact of early redistribution, SPECT is more sensitive than either planar imaging or exercise ECG in the detection of CAD, but its specificity is lower.

Value of two-dimensional echocardiography, electrocardiography, and clinical signs in detecting right ventricular infarction.

Noninvasive tests for the diagnosis of right ventricular (RV) infarction--two-dimensional echocardiography (2DE), ST elevation in V4R, and clinical parameters--were compared with equilibrium gated blood pool study (GBPS) in 50 patients after acute inferior myocardial infarction. Twenty-two of 50 patients had RV wall motion abnormalities on GBPS and 20 of 50 on 2DE. Sensitivity and specificity of 2DE was 82% and 93%, ST elevation in V4R was 50% and 71%, elevation of venous pressure was 77% and 85%, and a positive Kussmaul's sign was found in 59% and 89% for the detection of RV infarction compared to GBPS. Patients with RV infarction had higher peak creatine kinase levels and lower left ventricular ejection fractions than patients without RV infarction. Three patients died and all had significant left ventricular damage. At 20 weeks' follow-up, two thirds of the patients had no residual RV wall motion abnormalities, and all but two patients showed some recovery.

Acromegaly and the heart--echocardiographic and nuclear imaging studies.

Left ventricular mass (LV mass) and function were assessed in 16 acromegalic patients by echocardiography, and rest and exercise gated blood pool scanning (GBPS) respectively. At the time of study, five patients had active acromegaly, five were hypertensive and three had coexisting coronary artery disease. Increased LV mass was found in six (38%) patients, of whom four were hypertensive and two others had active acromegaly of long duration. One normotensive patient, who did not have coronary disease, had increased LV mass associated with persistently elevated growth hormone (GH) levels for the previous 11 years. Abnormal LV function, as detected by GBPS, occurred only in the three patients with coronary disease. Thus, acromegaly is associated with increased LV mass in hypertensive patients and normotensive patients who have prolonged elevation of GH levels prior to adequate treatment. We found no detectable impairment of LV function, at rest or exercise unless other cardiac disease was present.

Two cases of lymphoma of the parotid gland following ablative radioiodine therapy for thyroid carcinoma.

Two adult patients are described in whom 131I therapy thyroid carcinoma was followed by the development of non-Hodgkin's lymphoma in salivary glands. Histologically one was lymphocytic and the other histiocytic. The total doses of 131I given were 27 GBq (675 mCi) and 14GBq (350 mCi), lymphoma presenting 10 and 3 years respectively after the initial therapeutic dose of 131I. We suggest that the relationship is a causal one, because of the rarity of salivary gland lymphoma and the high dose or radiation to the salivary glands with this mode of therapy.

Transient metastatic calcification in primary hyperparathyroidism.

Metastatic calcification has been visualised on bone scan in many hypercalcaemic states. This report illustrates the phenomenon occurring in a patient with primary hyperparathyroidism and its subsequent disappearance after therapy.

High ectopic kidney presenting as an abnormal liver-lung scan: case report.

An unusual cause for a positive liver-lung scan is presented. A cold area between the base of the right lung and the liver in a 78-year-old woman was reported as being due to a subphrenic abscess. This defect was subsequently found to be a right subphrenic kidney.