Cardiac Radionuclide Imaging After Coronary Artery Revascularization

Cardiovascular magnetic resonance imaging (CMR) has become the gold standard not only for cardiac volume and function quantification, but for a key unique strength: non-invasive myocardial tissue characterization. Several different techniques, separately or in combination, can detect and quantify early and established myocardial pathological processes permitting better diagnosis, prognostication and tracking of therapy. The authors will focus on the histological and pathophysiological evidence of these imaging parameters in the characterization of edema, infarction, scar and fibrosis. In addition to laying out the strengths and weaknesses of each modality, the reader will be introduced to rapid developments in T1 and T2 mapping as well as the use of contrast-derived extracellular volume for quantification of diffuse fibrosis.     

病毒性心肌炎心脏核素门控心血池显像

本文对17例临床诊断为病毒性心肌炎患者应用放射性核素心血池显像进行心脏功能及相位分析,结果显示:17例病人全心相位分布不均,有散在相位延迟灶,其中14例心室相角程增大,占82.35％,8例室壁运动异常,占47.06％,而且病毒性心肌炎患者左室射血分数(LVEF)、左室高峰射血率(PER)较正常人明显降低(P<0.01),尤以PER下降为著(P<0.001),而左室高峰充盈率(PFR)两组对照无显著差异(P>0.05)。提示病毒性心肌各部位代谢不均衡,以收缩功能及其收缩协调性功能障碍为突出表现。     

核素肺显像对鉴别貌似炎症的急性肺栓塞及真正肺部炎症的价值

目的研究核素肺吸入、灌注显像对鉴别貌似炎症的急性肺栓塞及真正肺部炎症的价值。消除由于误诊耽误最佳溶栓时机的危险。方法对１４例伴有胸痛、咳嗽或发热的急性肺栓塞及１０例肺部炎症患者进行核素肺吸入灌注显像。以其损伤肺段当量数占被检肺段的百分比及其形态学改变对两种疾病在两种显像中的表现进行比较分析。并与Ｘ线胸片进行对比。结果急性肺动脉栓塞肺灌注显像示以肺段分布的异常放射性缺损区,损伤肺段当量数占被检肺段的２７％;吸入显像基本正常,仅占０４％。反之,肺部炎症则示吸入损伤明显,按或不按肺段分布,占被检肺段的４０％;灌注显像占２４％,部位与吸入像匹配,多为放射性减低。急性肺栓塞的Ｘ线胸片为正常、血管纹理减少或非特异改变;而肺部炎症则改变明显。结论急性肺动脉栓塞尤其貌似炎症者核素显像诊断价值较高。肺部炎症动态观察Ｘ线胸片诊断价值较高。但核素显像亦有能区别于栓塞的特点。肺栓塞合并炎症者,核素显像、特别是动态观察具有独特价值。灌注显像损伤范围可大于吸入影像损伤范围,病变呈以肺段形态分布的放射性缺损。而单纯炎症吸入影像损伤范围大于灌注,且灌注像可为不按肺段分布的放射性减低     

核素心肌显像的临床应用

心肌显像对于探测心肌梗塞、一过性心肌缺血及其它心肌疾病的诊断是一种无创性简便、灵敏的方法。特别是继２０１ＴＩ之后９９ｍＴＣ—ＭＩＢＩ已被广泛用于心肌断层显像，一些新的显像剂也不断进入临床研究。心肌ＳＰＥＣＴ显像已不只是被用于诊断冠心病，它在冬眠心肌的检测，冠状动脉再血管化的应用已得到临床公认。定量分析心肌灌注ＳＰＥＣＴ显像是将来方法学上的重点研究方向。心肌代谢、１２３Ｉ—ＭＩＢＧ等显像对预后估价、疗效判定、合理选择冠状动脉再血管化的适应症等是心肌ＳｔＥＣＴ的临床应用发展方向。     

Antibiotics and Antiseptics to Prevent Infection in Cardiac Rhythm Management Device Implantation Surgery

Background: Surgical site infections (SSIs) resulting from cardiac implantable electronic device (CIED) implantation cause significant morbidity and mortality, and are increasing at a disproportionately higher rate than the rate of CIED implantation. The prophylactic administration of antibiotics and antiseptics can reduce this infection rate. The objective of this systematic review and meta‐analysis was to determine whether the prophylactic administration of antibiotics and antiseptics in patients undergoing CIED implantation reduces the incidence of SSI in randomized controlled trials. We searched the Cochrane Wounds Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), Ovid MEDLINE, Ovid EMBASE, and EBSCO CINAHL. No date or language restrictions were applied. Methods: Two review authors independently screened papers for inclusion, assessed risk of bias, and extracted data using a data collection form. Data were pooled where appropriate. Results: Fifteen studies (3,970 participants) were included in this review. For patients undergoing a CIED implant, perioperative systemic antibiotics (PSA) plus antiseptics delivered 1 hour before the procedure significantly reduced the incidence of SSI compared with no antibiotics (risk ratio [RR] 0.13; 95% confidence interval [CI] 0.05–0.36; P value < 0.00001). Furthermore, PSA plus antiseptics significantly reduced the incidence of postoperative infection compared to antibiotics delivered postoperatively (RR 0.14; 95% CI 0.03–0.60; P value 0.008). Conclusion: The evidence strongly suggests that antibiotic prophylaxis within 1 hour before CIED implantation is effective at reducing SSI. (PACE 2012; 35:1348–1360)     

核素显像在甲状旁腺功能亢进诊断中的价值

目的 本文探讨甲状旁腺核素显像在诊断甲状旁腺功能亢进(下称甲旁亢)中的作用，并与其他影像检查方法进行比较。方法 32例临床考虑甲旁亢患者分别进行了99Tc—MIBI核素显像、B超检查，其中13例做了CT检查，5例做了MRI检查。结果 32例患者中，PTH增高12例，以PTH结果为诊断标准，核素检查阳性13例，灵敏度91．7％，特异性90％，准确性90．6％；B超检出10例，阴性20例，其灵敏度83．3％，特异性100％，准确性93．8％；CT阳性11例，MRI阳性3例。核素检查阳性13例患者共摘除15枚腺瘤和1枚增生腺体，均经组织病理学诊断印证；核素显像阴性19例，B超检查均为阴性，CT阴性2例，MRI阴性2例。结论 ^99Tc^m-MIBI甲状旁腺核素显像是一种简单易行的方法，是甲旁亢辅助诊断手段之一，结合其他影像学检查，可进一步提高甲状旁腺腺瘤术前定位诊断准确率。     

扩张型心肌病的核素显像诊断

本文对２０例正常人与３１例扩张型心肌病（ＤＣＭ）进行核素心血地显像，结果显示：ＤＣＭ，患者左心室腔异常扩大，室壁活动呈全心性弥漫性明显低下或近于消失；左室振幅灰度明显降低，双室时相灰度绝对不均，相角程异常增宽，平均１４１℃左右；左室收缩及舒张功能的各项指标均严重下降，且具有一定的变化特点。该显像方法可用子ＤＣＭ的诊断。     

Radiation Dose Reduction from Radionuclide Myocardial Perfusion Imaging

Due to a tremendous increase in imaging usage in the last decades, in particular of myocardial perfusion imaging with radionuclide tracers, significant concerns have been recently raised on the possible harmful effect of the exposure of patients and health care operators to ionizing radiation. Recent estimates indicate that cardiac imaging procedures account for almost 40 % of the cumulative dose for imaging procedures. Thus, pertinent scientific associations published recommendations directed to limit patients’ exposure. The key points in the dose optimization process, including appropriate patients selection, stress test and study protocol, new processing software and new hardware, are described.     

强直性脊柱炎患者放射性核素骨显像分析

目的　研究放射性核素骨显像对强直性脊柱炎 (AS)的诊断价值。方法　AS患者和对照组均做了全身、局部及断层骨显像 ,并测定了骶髂关节 /骶骨 (SI/S)的计数比值。结果　早期AS患者的SI/S比值 (1.5 3± 0 .11)与对照组 (1.2 1±0 .10 )、中期 (1.2 8± 0 .2 9)和晚期 (1.19± 0 .3 9)AS患者比较 ,均有显著性差异 (P <0 .0 1) ;中期和晚期AS患者的SI/S比值之间 ,以及中、晚期AS患者的SI/S比值与对照组比较 ,均无差异 (P >0 .0 5 )。 6例X线平片无异常的AS患者全身骨显像则发现腰椎及外周关节放射性异常浓聚 ;AS患者全身骨显像共发现椎骨异常浓聚灶 2 43个 ,而断层显像则检出 3 0 9个异常浓聚灶。结论　放射性核素骨显像测定SI/S比值对AS早期诊断有重要价值 ;对中、晚期AS的诊断意义不大 ;骨显像发现AS骨关节部位的早期病变比X线平片更敏感 ;断层显像对了解AS椎骨诸关节病变比平面显像具有明显的优势     

肺血栓栓塞症的核素影像诊断及临床基础

目的:利用肺核素影像扫描检查及肺动脉造影等其它临床手段,对肺血栓栓塞症(PTE)进行明确诊断;从临床基础探讨PTE致病的危险因素。方法:对1993～2002年问,我院37例肺血栓患者进行临床资料分析。结果:在37例患者中,进行核素影像明确诊断32例(86.4％)。在21～50岁年龄段,女性发病率小于男性,有统计学意义(P<0.05);19例(51.4％)患者存在深静脉血栓。结论:核素影像仍是目前首选的诊断肺栓塞的筛选手段,其结果有较重要的诊断或排除诊断意义。女性PTE的发病年龄晚于男性,与雌激素降低胆固醇血浓度及月经周期改变凝血机制等有关。下肢深静脉血栓作为主要的危险因素,与PTE的发生密切相关。     

放射性核素骨关节显像在风湿性骨关节病中的临床评价

目的:本文分析了39例风湿性骨关节显像结果,显示39例患者骨显像均有不同程度的放射性浓集;18例类风湿关节炎(RA)患者骨显像总分与关节压痛指数,关节肿胀指数,ESR,CRP呈正相关;4例临床疑诊强直性脊柱炎(AS)而X线和/或CT表现正常者骨显像骶髂关节阳性。提示骨显像可反映RA病情活动性,同时对AS的早期诊断有一定的价值。     

The Role of Radionuclide Imaging in Congenital Heart Disease

Purpose of Review

Congenital heart disease is a growing healthcare issue since the majority of children who underwent surgical repair are now surviving into adult life. However, these patients are generally fixed but not cured and many will go on to develop significant morbidity as adults. The purpose of this review is to discuss the utility of radionuclide imaging in the management of these patients with a focus on the longer-term follow-up into adult life.

Recent Findings

Radionuclide imaging is a relatively niche tool in the management of congenital heart disease patients and many of the techniques have been around for decades. What is new is the application of techniques such as fluorodeoxyglucose (FDG) imaging for endocarditis and device infection using anatomic colocalization by MR-PET or PET-CT. There is also growing interest in the quantitative assessment of coronary blood flow with tracers such as rubidium that are available without the need for a cyclotron on site. This is likely to be very useful in the management of patients with coronary anomalies or surgically re-implanted coronary arteries.

Summary

Radionuclide imaging has specific but rather limited application to congenital heart disease at the current time. With the development of new molecular imaging agents, low-dose protocols, and the wider availability of hybrid imaging modalities, we suggest that the ground is prepared for a resurgence of interest in the application of these techniques to the population of patients living with congenital heart disease.

     

Non-Coronary Cardiac CT Imaging

Cardiac multidetector CT (MDCT) has moved from purely anatomic imaging, to assessment of cardiac function. Significant advances since the advent of multidetector CT now make it feasible to assess not only the coronary arteries, but also ejection fraction, ventricular volumes, myocardial mass and the presence of wall-motion abnormalities. Advances include improvements in EKG-gating, including improvements in temporal resolution, as well as the addition of delayed contrast-enhanced methods. Anatomic imaging has improved as well, with thinner collimation and better reconstruction methods. Three-dimensional software programs now permit excellent surface rendered displays and multiplanar reconstructions suitable as surgical and procedural "road maps."     

Molecular Imaging of Cardiac Sarcoidosis

Purpose of Review

Cardiac involvement is increasingly being recognized as a cause of significant morbidity and mortality in patients with sarcoidosis. Unfortunately, imaging cardiac sarcoidosis (CS) remains a challenge and often relies on advanced imaging modalities. The aim of this review is to provide an up-to-date overview of the role of molecular imaging for the diagnosis of cardiac sarcoidosis, with particular emphasis on the use of FDG and non-FDG PET.

Recent Findings

In the last few years, FDG-PET has established itself as an accurate imaging study for the assessment of CS. New diagnostic criteria have recently appeared which incorporate FDG-PET findings in the diagnostic workup for CS. In addition, a joint SNMMI-ASNC Expert Consensus document has appeared on the role of FDG-PET in CS. Recent advances in the field have focused on the role of PET for diagnosis, assessment of therapy, and use of non-FDG tracers to image myocardial inflammation.

Summary

The role of PET is rapidly evolving but is now firmly established as an important component in the imaging assessment of CS.

     

Molecular Imaging of Cardiac Amyloidosis

Purpose of Review

Cardiac amyloidosis is an infiltrative cardiomyopathy, most commonly due to light chain amyloidosis [AL] or transthyretin amyloidosis [ATTR]; both cause significant heart failure and mortality. This review is a comprehensive overview of radionuclide molecular imaging in cardiac amyloidosis, highlighting the latest advancements in aiding diagnosis and prognosis.

Recent Findings

Specific bone scintigraphy agents have a high sensitivity and specificity for the diagnosis of transthyretin cardiac amyloidosis. Amyloid-binding radiotracers, originally developed for imaging Alzheimer’s disease, are being employed to image light chain and transthyretin cardiac amyloidosis. There is ongoing research into the use of these tracers for precise quantification of cardiac amyloidosis, which can be used to guide therapy.

Summary

Radionuclide molecular imaging techniques have a vital role in advancing the field of cardiac amyloidosis. With a broadening armamentarium of novel radio tracers and new therapeutic developments, this is an exciting area, with potential breakthroughs on the horizon.

     

心脏肿瘤的MRI诊断

本文简述了心脏肿瘤的ＭＲＩ扫描技术，重点按心脏肿瘤的发生部位依次介绍了心内膜肿瘤、心腔壁内肿瘤和心包肿瘤的ＭＲＩ诊断，并对ＭＲＩ诊断心脏肿瘤的能力进行评价。     

干燥综合征超声和核素显像评价腮腺受损的比较

目的：探讨超声与核素显像在评价干燥综合征（SS）腮腺受累情况中的价值和作用。方法：对65例SS病人分别进行超声和核素显像检查。结果：超声判为腮腺功能0级、Ⅰ级、Ⅱ-Ⅲ级、Ⅳ级的能力与核素显像判为正常（x~2=0.075,P〉0.05）、轻度（x~2=0.12,P〉0.05）、中度（x~2=0.27,P〉0.05）、重度（x~2=0.097,P〉0.05）受损的能力一致,差异无统计学意义;核素发现单纯摄取功能受损的超声多表现为不均匀型、单纯排泌功能受损的超声多表现为结节型、摄取和排泌功能均受损的超声多表现为纤维化型。结论：超声检查可作为SS患者腮腺受累情况评价的良好手段。