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1.
O. Morel P. Pézard A. Furber J. J. Le Jeune B. Vielle B. Denizot P. Jallet 《European journal of nuclear medicine and molecular imaging》1999,26(6):640-646
The aim of this study was to correlate lung thallium-201 uptake on exercise with 201Tl single-photon emission tomography (SPET) myocardial perfusion imaging, rest and exercise equilibrium radionuclide angiographic
and coronary angiographic findings in patients with coronary artery disease (CAD) using a simple, reproducible lung/heart
(L/H) ratio that would be easy to use in clinical practice. L/H ratio was defined on the anterior planar image obtained during
exercise 201Tl SPET acquisition as the mean counts per pixel in an entire right lung field region of interest divided by the mean counts
per pixel in the hottest myocardial wall region of interest. We studied 103 patients. Fifty-nine patients (group I) with <5%
likelihood of CAD were used as a reference group. In 44 CAD patients (group II), L/H ratio was compared with 201Tl SPET, radionuclide angiographic and coronary angiographic variables. The group I L/H ratio of 0.35±0.05 (mean ±1 SD) was
significantly lower (P<0.001) than the group II L/H ratio of 0.45±0.10. An L/H ratio >0.45 (mean + 2 SD in group I) was considered abnormal. In
group II, L/H ratio showed a significant correlation with stress and rest 201Tl perfusion defect size (r
= 0.39 and r
= 0.42, P<0.01, respectively), but not with extent of ischaemic myocardium. The mean L/H ratio was 0.41±0.10 in patients with one-vessel
disease (n = 15), 0.46±0.08 in those with two-vessel disease (n = 17) and 0.47±0.12 in those with three-vessel disease (n = 12), but no significant difference was found between the three subgroups. L/H ratio showed a significant inverse relation
with rest and exercise left ventricular ejection fraction (r = –0.37 and r = –0.50, P<0.05 and P<0.001, respectively). Using stepwise multiple regression analysis, exercise left ventricular ejection fraction and previous
history of hypertension were the sole two variables independently predictive of the L/H ratio. In conclusion, although lung
thallium uptake is usually found to correlate with extent and severity of CAD, increased L/H ratio should primarily be considered
as a marker of exercise-induced left ventricular systolic and perhaps diastolic dysfunction, probably independent of the underlying
cardiac disease.
Received 14 January and in revised form 22 February 1999 相似文献
2.
Evaluation of histopathological differentiation in lung adenocarcinoma patients using 201Tl-chloride and 99Tcm-MIBI SPET 总被引:3,自引:0,他引:3
Yamamoto Y Nishiyama Y Fukunaga K Kobayashi T Satoh K Fujita J Ohkawa M 《Nuclear medicine communications》2001,22(5):539-545
The purpose of this prospective study was to evaluate the relationship between thallium-201 chloride (201Tl) and technetium-99m hexakis 2-methoxyisobutylisonitrile (99Tcm-MIBI) accumulation and histopathological differentiation in primary lung adenocarcinoma. A total of 43 patients with primary lung adenocarcinoma were investigated. The patients were divided into well differentiated (n = 17), moderately differentiated (n = 14) and poorly differentiated (n = 12) carcinoma groups. Simultaneous dual single photon emission tomography (SPET) images with 201Tl and 99Tcm-MIBI were acquired 15 min (early) and 2 h (delayed) after injection. Using a region of interest technique, the tumour-to-normal lung ratio was calculated for both early (early ratio) and delayed (delayed ratio) images. The retention index was calculated using the formula delayed ratio/early ratio. Uptake of the radionuclides was compared with the classification of tumour differentiation grading. The mean (+/- SD) values of the early ratio, delayed ratio and retention index using 201Tl were 2.19+/-0.72, 2.28+/-0.71 and 1.06+/-0.16, respectively, in the well differentiated group, 2.38+/-0.83, 2.48+/-0.84 and 1.08+/-0.23, respectively, in the moderately differentiated group, and 2.87+/-0.75, 3.60+/-1.51 and 1.22+/-0.21, respectively, in the poorly differentiated group. Both the ratios and the retention index using 201Tl were significantly lower in the well differentiated group than in the poorly differentiated group. The delayed ratio using 201Tl in the moderately differentiated group was also significantly lower than that in the poorly differentiated group. There were no significant differences in either ratio or the retention index among the three groups using 99Tcm-MIBI. 201Tl SPET is superior to 99Tcm-MIBI SPET for the grading of histopathological differentiation of primary lung adenocarcinoma. 相似文献
3.
BACKGROUND: In patients with coronary artery disease (CAD), the characteristics of those with discordant exercise thallium 201 single photon emission computed tomography (SPECT) lung uptake (lung-to-heart [L/H] ratio) and left ventricular (LV) transient ischemic dilation (LVTID) are not well defined. METHODS AND RESULTS: The population included 310 patients having exercise Tl-201 SPECT and coronary angiography. The population was subclassified into 4 subgroups: increased L/H ratio only, increased LVTID only, both, and neither. The L/H ratio was weakly correlated to LVTID (r = 0.18). The L/H ratio was correlated to the summed difference score (r = 0.26), summed rest score (r = 0.31), summed stress score (r = 0.5), and rest and stress LV volume (r = 0.5 and r = 0.54, respectively). LVTID was only correlated to the summed difference score (r = 0.32) and stress LV volume (r = 0.17). Increased LVTID only was associated with more frequent ischemia and patients with it tended to be more extensively ischemic, as compared with patients with increased L/H ratio only, but had a similar angiographic extent of CAD. These results were independent of prior myocardial infarction variable. CONCLUSIONS: As compared with patients with increased L/H ratio alone, patients with increased LVTID alone are more frequently ischemic but have a similar angiographic extent of CAD. Increased L/H ratio was correlated to both rest and postexercise LV volume, whereas increased LVTID was correlated only to postexercise LV volume. 相似文献
4.
Pace L Perrone-Filardi P Storto G Della Morte AM Dellegrottaglie S Prastaro M Crisci T Ponticelli MP Piscione F Chiariello M Salvatore M 《European journal of nuclear medicine》2000,27(12):1740-1746
Accurate assessment of myocardial viability permits selection of patients who would benefit from myocardial revascularization. Currently, rest-redistribution thallium-201 scintigraphy and low-dose dobutamine echocardiography are among the most used techniques for the identification of viable myocardium. Thirty-one consecutive patients (all men, mean age 60 +/- 8 years) with chronic coronary artery disease and reduced left ventricular ejection fraction (31% +/- 7%) were studied. Rest 201Tl single-photon emission tomography (SPET), low-dose dobutamine echocardiography and radionuclide angiography were performed before revascularization. Radionuclide angiography and echocardiography were repeated after revascularization. An a/dyskinetic segment was considered viable on 201Tl SPET when tracer uptake was >65%, while improvement on low-dose dobutamine echocardiography was considered a marker of viability. Increase in global ejection fraction was considered significant at > or = 5%. In identifying viable segments, rest 201Tl SPET showed higher sensitivity than low-dose dobutamine echocardiography (72% vs 53%, P<0.05), while specificity was not significantly different (86% vs 88%). In 17 patients, global ejection fraction increased > or = 5% (group 1) while in 14 it did not (group 2). A higher number of a/dyskinetic segments were viable on 201Tl SPET in group 1 than in group 2 (2.6 +/- 1.9 vs 0.6 +/- 1.2, P < 0.005), while no significant differences were observed on low-dose dobutamine echocardiography (1.7 +/- 1.6 vs 1.1 +/- 1.6). A significant correlation was found between the number of a/dyskinetic segments viable on 201Tl SPET and post-revascularization changes in ejection fraction (r = 0.52, P < 0.05), but such a correlation was not observed for low-dose dobutamine echocardiography. Using as the cut-off the presence of at least one viable a/dyskinetic segment, rest 201Tl SPET had a higher sensitivity (82% vs 53%, P = 0.07) and showed a trend towards higher accuracy and specificity (77% vs 58%, and 71% vs 64%, respectively) as compared with low-dose dobutamine echocardiography. In conclusion, these findings suggest that when severely reduced global function is present, rest 201Tl SPET evaluation of viability is more accurate than low-dose dobutamine echocardiography for the identification of patients who will benefit most from revascularization. 相似文献
5.
David N Marie PY Angioi M Rodriguez RM Hassan N Olivier P Grentzinger A Karcher G Claudon O Juillière Y Danchin N Bertrand A 《European journal of nuclear medicine》2000,27(7):788-799
In patients unable to perform a maximal exercise test, dipyridamole single-photon emission tomography (SPET) has a higher capacity than exercise SPET to detect coronary artery disease (CAD). However, in patients with myocardial ischaemia who are able to perform a maximal exercise test, it is not known whether these two tests may be equally used to assess the areas of myocardial ischaemia. This study was aimed at comparing the results provided by dipyridamole and exercise SPET in CAD patients with documented exercise myocardial ischaemia. Forty CAD patients who had undergone exercise thallium-201 SPET and who had myocardial ischaemia documented by an unequivocally positive exercise test underwent an additional 201Tl SPET study after dipyridamole infusion and low-level (40 W) exercise. The extent of defects was compared between the two tests and predictors of discrepant results were sought among data from exercise testing and coronary angiography. The extent of SPET defects was equivalent between the two tests in only 11 patients (28%), larger defects being observed with exercise in 18 [average difference: 12%+/-5% of left ventricle (LV)] and with dipyridamole in 11 (average difference: 15%+/-11% of LV). The best independent predictors of discrepancies between the two tests were: (1) increase in heart rate at exercise SPET, with defects being smaller at exercise than after dipyridamole in none of the patients with an increase >60 bpm (0/14), but in 42% of the others (11/26; P=0.004); and (2) an ischaemic territory related to a <70% coronary stenosis, for which SPET defects were always induced at exercise (10/10) but in only 30% (3/10) with dipyridamole (P=0.0004). Exercise and dipyridamole SPET provide different estimates of myocardial ischaemic areas. Dipyridamole allows the unmasking of perfusion abnormalities in patients who have low increases in heart rate at exercise SPET. However, dipyridamole is also much less efficient at inducing perfusion abnormalities in the ischaemic areas supplied by coronary stenoses of intermediate severity at rest angiography. 相似文献
6.
Nishiyama Y Yamamoto Y Fukunaga K Kiuchi T Satoh K Takashima H Ohkawa M Tanabe M 《European journal of nuclear medicine》2000,27(5):536-541
The purpose of this study was to investigate the relationship between technetium-99m hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) accumulation in tumours and response to radiotherapy in non-small cell lung cancer patients in comparison with the findings obtained using thallium-201 chloride (201Tl). Simultaneous dual single-photon emission tomography (SPET) imaging with 600 MBq 99mTc-MIBI and 111 MBq 201Tl was performed in 31 patients with biopsy- or sputum cytology-proven lung cancer. SPET images were acquired 15 min (early) and 2 h (delayed) after injection, and the early ratio, delayed ratio and retention index were measured. The tumours were classified into two groups on the basis of follow-up computed tomography (CT): responders (at least 50% reduction in tumour size) and non-responders (little or no change in tumour size). The mean (+/-SD) values of early ratio, delayed ratio and retention index using 99mTc-MIBI SPET were 3.0+/-1.1, 2.7+/-1.0 and -9.5+/-12.7, respectively, in responders and 2.4+/-0.7, 2.0+/-0.5 and -18.4+/-9.0, respectively, in non-responders. The corresponding values using 201Tl chloride SPET were 3.7+/-1.0, 4.7+/-1.5 and 24.2+/-22.1 in responders and 3.3+/-1.2, 4.0+/-1.3 and 20.4+/-20.5 in nonresponders. Using 99mTc-MIBI, the delayed ratio and retention index in responders were significantly higher than those in non-responders (P<0.01 and P<0.05, respectively). The results of this study indicate that patients with higher delayed ratio and retention index values using 99mTc-MIBI SPET are likely to respond better to radiotherapy than those with lower values. 99mTc-MIBI SPET may give an indication of the short-term response to radiotherapy in patients with non-small cell lung cancer. 相似文献
7.
S Fukuoka M Maeno S Nakagawa T Fukunaga H Yamada T Eto 《Nuclear medicine communications》2002,23(1):19-29
The clinical feasibility of both dual-isotope single photon emission tomography (SPET) and gated SPET have been described. The present study evaluates the feasibility of combining gated SPET with exercise 201Tl/rest 99mTc-tetrofosmin dual-isotope SPET corrected for scatter. Ninety-one patients with known or suspected coronary artery disease underwent cardiac catheterization and coronary angiography. Twenty-nine of them underwent exercise 201Tl/rest 99mTc-tetrofosmin dual-isotope SPET with a second 201Tl injection 3 h after the initial 201Tl injection (protocol 1). We then segregated a Bull's eye polar map into three coronary artery territories and quantified the relative regional uptake. The remaining 62 patients underwent exercise 201Tl/rest 99mTc-tetrofosmin dual-isotope SPET combined with gated SPET. We visually evaluated exercise and rest images from the three coronary artery territories. Left ventricular (LV) function was assessed globally by means of the LV ejection fraction and regionally by means of visual scoring analysis, compared with left ventriculography (LVG). The correlation between rest 99mTc-tetrofosmin and 201Tl reinjection images in 87 areas of coronary artery territory (r=0.89, P<0.01) and in 13 infarcted areas (r =0.94, P<0.01) was very close in protocol 1. The overall values for vessel-related sensitivity, specificity and accuracy were 88%, 79% and 82%, respectively, in protocol 2. The correlation between gated SPET and LVG was significant and linear with respect to the LV ejection fraction (r=0.77, P<0.01). The wall motion score from visual evaluation in gated SPET revealed a close overall agreement with LVG (concordance rate, 88%; kappa, 0.670). Exercise 201Tl/rest 99mTc-tetrofosmin dual-isotope SPET with scatter correction for assessing the coronary artery disease offers excellent diagnostic accuracy and the additional gated SPET provides useful information about LV function similar to that for LVG. This sequential protocol requires only 2 h to generate much useful clinical information. 相似文献
8.
D Daou N Delahaye R Lebtahi D Vilain C Peker M Faraggi D Le Guludec 《Journal of nuclear medicine》2000,41(4):567-574
Exercise lung 201 TI uptake calculated with planar imaging has an important diagnostic and prognostic value in patients with coronary artery disease (CAD). However, its value with SPECT imaging raises methodological concerns and is controversial. We studied its value for the discrimination between extensive (E) and limited (L) angiographic CAD with exercise SPECT. METHODS: Four methods of lung-to-heart ratio quantification were calculated in patients with a low likelihood (< 5%) of CAD (n = 62). Their dependent variables were defined, and corresponding correction equations were derived. Receiver operating characteristic (ROC) analysis was performed in a pilot group (L-CAD, n = 49; E-CAD, n = 126) to define the optimal method of calculation of the lung-to-heart ratio. Its best threshold providing the best sensitivity for a specificity of 90% was defined. After correction for dependent variables, the 4 methods were also compared by ROC analysis and the optimal corrected method was compared with the optimal uncorrected method using ROC analysis and the best threshold. The consistency of these results in the validation group (L-CAD, n = 41; E-CAD, n = 122) and of the results of visual analysis of lung 201TI uptake were then verified. RESULTS: On ROC analysis in the pilot group, the optimal method of calculation of the lung-to-heart ratio was the mean activity in a region of interest drawn at the base of the lungs to the mean activity over the heart (Lb/H). For the best threshold, Lb/H presented a sensitivity of 34%. Corrected Lb/H still remained the best method of calculation on ROC analysis compared with the other corrected methods. On ROC analysis, there was no difference between corrected and uncorrected Lb/H. For the best threshold, corrected Lb/H presented a similar sensitivity of 37% compared with uncorrected Lb/H. When applied to the validation group (L-CAD, n = 41; E-CAD, n = 122), the best-defined threshold in the pilot group for corrected Lb/H presented a diagnostic value similar to that in the pilot group (sensitivity, 41%; specificity, 90%), but uncorrected Lb/H presented a higher sensitivity (47%; P < 0.04) and a slightly lower specificity (80%). Results of lung 201TI uptake visual analysis were inconsistent between pilot and validation groups (42% versus 58% sensitivity, P = 0.012; 86% versus 66% specificity, P = 0.023). CONCLUSIONS: For evaluation of E-CAD versus L-CAD, quantification of the exercise lung-to-heart 201TI uptake ratio with SPECT is feasible, reproducible, more discriminate than simple visual analysis, and best calculated as Lb/H. It presents an intrinsic diagnostic value even after correction for other clinically valuable dependent variables. 相似文献
9.
Exercise-induced increases in pulmonary uptake of thallium-201 (201Tl) have been associated with exercise-induced myocardial dysfunction. To evaluate this phenomenon more replicably, a quantitative semi-automated computer program was used to generate, from anterior exercise and delayed views, lung-myocardial ratios (LMR) of 201Tl uptake in 78 patients [40 normal, 38 with coronary artery disease (CAD)]. Patients with CAD had a significantly higher mean exercise lung myocardial ratio (EXLMR) than normals (30.8 vs. 27.3; P less than 0.003). In patients with adequate exercise (greater than or equal to 85% of an age-adjusted maximal heart rate), the EXLMRs of CAD patients were significantly higher than those of normals (29.7 vs. 25.5; P = 0.003). However, this difference between CAD and normal patients was not apparent in a patient subgroup with submaximal exercise levels (less than 85% of an age-adjusted maximal heart rate). In both normal and CAD patients, EXLMR decreased with increasing exercise levels (r = -0.555; P = 0.007). In patients with 201Tl scans lacking visually defined perfusion defects (visually normal), an elevated LMR detected 60% of CAD cases with 81% specificity. A considerably elevated EXLMR in patients achieving adequate exercise should suggest the presence of CAD, even if there are no visually apparent cardiac perfusion defects. With submaximal exercise, however, the EXLMR is not a useful discriminator between CAD patients and normals. 相似文献
10.
Chinori Kurata Yasushi Wakabayashi Sakae Shouda Tadashi Mikami Kei Tawarahara 《European journal of nuclear medicine and molecular imaging》1996,23(7):762-767
The purposes of this study were to determine whether quantification of the left ventricular size on exercise thallium-201 single-photon emission tomography (SPET) correlates with echocardiographic measurements, whether the quantification reflects the severity of coronary artery disease, and whether it can provide supplementary information regarding the severity of coronary artery disease. In 42 control subjects and 110 patients who underwent coronary angiography, we performed exercise201Tl SPET and quantified six non-regional markers: lung201Tl uptake on an initial planar image (Lung/Heart), left ventricular width on a tomogram (Width), change in the Width from the initial to delayed tomograms (Width), count ratio of the left ventricular cavity to the myocardium (C/M), count ratio of the lung to the myocardium (UM), and count ratio of the lung to the left ventricular cavity (L/C). In 76 patients, furthermore, the Width was compared with echocardiographic measurements. The Width correlated with echocardiographic measurements (P<0.001). The Width and Width were significantly different among zero-, one-, two- and three-vessel disease (P<0.001). However, the Width and Width could not improve the power of discrimination for multi-vessel disease derived from the Lung/Heart. The six non-regional markers correlated with each other (P<0.001). Among the six markers, the Lung/Heart was only the independent discriminator for multi-vessel disease. In conclusion, quantification of the left ventricular size on exercise201Tl SPET correlated with echocardiographic measurements and reflected the severity of coronary artery disease, but may be replaced with quantitation of the lung201Tl uptake. 相似文献
11.
The dynamic 99Tcm-ethyl cysteinate dimer (99Tcm-ECD) single photon emission tomographic (SPET) characteristics of brain tumours were investigated and compared with 201Tl-chloride SPET indices. Thirty-five patients with histologically confirmed benign and malignant tumours were evaluated using dynamic and standard 99Tcm-ECD. Twenty-eight patients were also examined using standard 201Tl SPET. The following 201Tl indices were calculated: early uptake ratio, delayed uptake ratio, washout rate and retention index. The relationship between uptake of 99Tcm-ECD on dynamic SPET and 201Tl indices was analysed. Nine patients showed positive uptake on dynamic 99Tcm-ECD SPET, all of whom had benign tumours, including five meningothelial meningiomas, three pituitary adenomas of the chromophobe type and one chemodectoma without malignancy. The mean early uptake ratio of the tumours with positive uptake was significantly higher than that of the tumours with negative uptake (17.1 +/- 5.5 vs 9.0 +/- 5.7, P = 0.004). The mean washout rate of the tumours with positive uptake was significantly higher than that of the tumours with negative uptake (61.0 +/- 27.7 vs 0.35 +/- 30.9, P = 0.0004). The mean retention index of the tumours with positive uptake was significantly lower than that of the tumours with negative uptake (0.27 +/- 0.12 vs 0.88 +/- 0.48, P = 0.000006). Only benign tumours showed positive uptake on dynamic 99Tcm-ECD SPET. The 201Tl indices correlated well with the uptake of 99Tcm-ECD on dynamic SPET. The results suggest that dynamic 99Tcm-ECD SPET can identify the benign character of tumours of the brain. 相似文献
12.
Although quantitative analysis of postexercise thallium-201 (201Tl) scintigrams has been employed clinically for the diagnosis of coronary disease, the precise relationship of the quantitated defects to microsphere determined blood flow has not been determined. Accordingly, 201Tl was injected during exercise in 12 control dogs and seven with left circumflex (LCf) artery stenosis. Gamma camera scanning was started 10 min after 201Tl injection and continued for 3 hr. In the control animals, scintigraphic 201Tl activities in left anterior descending (LAD) and LCf perfusion territories were equal 10 min after 201Tl injection and the loss of 201Tl activity over 3 hr was 54.3 +/- 3.4% and 57.0 +/- 3.6% (mean +/- s.e.e.) of initial LAD and LCf activity, respectively (p = N.S.). In the experimental group, LCf activity 10-14 min after 201Tl injection averaged 67.4 +/- 5.9% of LAD activity in the same heart (p less than 0.001). Furthermore, LCf activity in the experimental animals was significantly lower than LCf activity in the control dogs (p less than 0.005), while LAD activities were not different in the two groups. The ratio of LCf/LAD scintigraphic 201Tl activity immediately after exercise was linearly related to, but higher than, the ratio of regional blood flows at peak exercise (r = 0.88, p less than 0.001) as determined by microsphere injection. Scintigraphic redistribution was also correlated with directly measured redistribution determined by well counter analysis (r = 0.83, p less than 0.025). Thus, in this exercise model, quantitative 201Tl scintigraphy accurately assessed the initial postexercise flow disparity and subsequent redistribution. 相似文献
13.
Wahl Richard L. Kumar Bharath Biello Daniel R. Miller Tom R. 《European journal of nuclear medicine and molecular imaging》1986,12(1):5-8
Exercise-induced increases in pulmonary uptake of thallium-201 (201Tl) have been associated with exercise-induced myocardial dysfunction. To evaluate this phenomenon more replicably, a quantitative semi-automated computer program was used to generate, from anterior exercise and delayed views, lung-myocardial ratios (LMR) of201Tl uptake in 78 patients [40 normal, 38 with coronary artery disease (CAD)]. Patients with CAD had a significantly higher mean exercise lung myocardial ratio (EXLMR) than normals (30.8 vs. 27.3;P < 0.003). In patients with adequate exercise (85% of an age-adjusted maximal heart rate), the EXLMRs of CAD patients were significantly higher than those of normals (29.7 vs. 25.5;P=0.003). However, this difference between CAD and normal patients was not apparent in a patient subgroup with submaximal exercise levels (< 85% of an age-adjusted maximal heart rate). In both normal and CAD patients, EXLMR decreased with increasing exercise levels (r=-0.555;P=0.007). In patients with201Tl scans lacking visually defined perfusion defects (visually normal), an elevated LMR detected 60% of CAD cases with 81% specificity. A considerably elevated EXLMR in patients achieving adequate exercise should suggest the presence of CAD, even if there are no visually apparent cardiac perfusion defects. With submaximal exercise, however, the EXLMR is not a useful discriminator between CAD patients and normals. 相似文献
14.
Identification of extensive coronary artery disease: Incremental value of exercise Tl-201 SPECT to clinical and stress test variables 总被引:2,自引:0,他引:2
BACKGROUND: The ability of the size of a total myocardial perfusion defect (MPD) to detect extensive coronary artery disease (CAD) is currently suboptimal with exercise thallium 201 single photon emission computed tomography (SPECT). To improve its performance, exercise electrocardiography and indirect scintigraphic markers of extensive CAD were proposed (increased right ventricular Tl-201 uptake, lung-to-heart [L/H] ratio, and left ventricular transient ischemic dilation ratio). We aimed to determine the additive value of these criteria for the detection of extensive CAD. METHODS AND RESULTS: The population included 338 patients who underwent exercise Tl-201 SPECT and coronary angiography. Patients were classified as having extensive CAD (left main, multivessel, or 1-vessel proximal left anterior descending CAD) or limited CAD (1-vessel disease other than proximal left anterior descending CAD or no CAD). First, Tl-201 SPECT provided higher diagnostic value than exercise electrocardiography. Second, age, percent target heart rate achieved, total MPD, and L/H ratio were independent predictors of extensive CAD. Third, visually estimated abnormal right ventricular Tl-201 uptake did not present additional information. Fourth, L/H ratio presented a higher diagnostic accuracy than left ventricular transient ischemic dilation ratio. CONCLUSIONS: With exercise Tl-201 SPECT, age, percent target heart rate achieved, total MPD, and L/H ratio were independent predictors of extensive CAD. 相似文献
15.
Jan SL Hwang B Fu YC Lee PC Kao CH Liu RS Chi CS 《Nuclear medicine communications》2000,21(5):431-435
About 4% of children with Kawasaki disease ultimately develop ischaemic heart disease. Therefore, the early detection, non-invasive monitoring and long-term follow-up of myocardial ischaemia are essential. We compared the sensitivity and specificity of 201Tl single photon emission tomography (SPET) and treadmill exercise in the detection of myocardial ischaemia in 23 patients (19 boys, 4 girls) with Kawasaki disease. They were divided into two groups according to the results of coronary angiography. Group I consisted of 11 patients with coronary abnormalities; Group II consisted of 12 patients with no coronary abnormalities. The sensitivity, specificity, false-positive and false-negative rates for detecting coronary arterial lesions were 72.7% (8/11), 58.3% (7/12), 38.5% (5/13) and 30% (3/10) for 201Tl SPET, and 45.5% (5/11), 100% (12/12), 0% (0/5) and 33.3% (6/18) for treadmill exercise, respectively. We conclude that 201Tl SPET is more sensitive than treadmill exercise for the detection of coronary arterial abnormalities, but that the specificity of treadmill exercise is better than that of 201Tl scintigraphy. Coronary artery lesions detected by coronary angiography have good concordance of ischaemic areas with perfusion defects detected by 201Tl SPET. When ischaemic findings on 201Tl SPET and/or positive treadmill exercise testing are noted, coronary angiography is strongly indicated to detect possible stenotic lesions in the coronary arteries. 相似文献
16.
T Fujii H Kanai M Tanaka Y Hirose O Kinoshita J Kono J Hirayama M Hongo H Yamada S Okubo 《Kaku igaku. The Japanese journal of nuclear medicine》1989,26(5):601-610
Clinical significance of diffuse lung uptake of 201Tl was studied in 244 cases of various heart diseases. The grade of lung uptake of 201Tl was assessed by total lung uptake ratio (L/T), maximal lung uptake ratio (Max/T), lung to myocardium or mediastinum counts ratio (M/H or M/Med) and visual grade. L/T, Max/T, M/H and M/Med were directly correlated with pulmonary arterial pressure (PCW), and inversely correlated with cardiac output (CO) and cardiac index (CI). Among them, L/T was the best index to assess PCW, that was correlated with PCW (r = 0.65), CO (r = -0.53) and CI (r = -0.45). The visual grade of 201Tl lung uptake was correlated with L/T, and the increased lung uptake was associated with a higher PCW and a lower CO as well as a lower CI. Diffuse increased lung uptake of 201Tl was observed in 29 of 41 cases (70.7%) with myocardial infarction, 25 of 29 cases (86.2%) with mitral valvular diseases and 9 of 10 cases (90.0%) with combined valvular diseases, in addition, in most cases with left heart failure and cases of NYHA 3 and 4, but that was not rarely observed in cases of NYHA 2 and without left heart failure. In heart diseases, 201Tl myocardial scintigraphy seems to be valuable for detection of left heart failure including pulmonary congestion and interstitial pulmonary edema. Total lung uptake ratio (L/T) may be useful for estimation of PCW, and the visual grade of 201Tl lung uptake may be applicable as routine index for grading of lung uptake of 201Tl. 相似文献
17.
C Bacher-Stier T Sharir P B Kavanagh H C Lewin J D Friedman R Miranda G Germano D S Berman 《Journal of nuclear medicine》2000,41(7):1190-1197
This study validated a new automatic algorithm for assessment of lung-to-heart ratio (L/H) of radiotracers in myocardial perfusion SPECT and assessed the diagnostic value of (99m)Tc-sestamibi L/H after exercise. METHODS: The new technique extracts a left ventricular region of interest (ROI) from a summed anterior projection image and generates a lung ROI by reshaping and translating the left ventricular ROI. This algorithm was applied to 230 patients who underwent exercise (99m)Tc-sestamibi SPECT (gated SPECT, n = 88) with first-pass ventriculography. Normal values were established in 26 patients in whom the likelihood of coronary artery disease (CAD) was 5% or less. An abnormality threshold for detecting severe and extensive CAD was defined in a subgroup of 109 patients who underwent coronary angiography and was validated in a prospective group (n = 72). RESULTS: The success rate of the automatic algorithm was 97%. Excellent correlation was found between automatic and manual L/H values (r = 0.95; P < 0.001). The mean L/H was higher in patients with a peak exercise ejection fraction (EF) less than 40% versus 40% or more (0.51 +/- 0.07 versus 0.43 +/- 0.05, P < 0.001) and in patients with a poststress EF less than 40% versus 40% or more (0.50 +/- 0.07 versus 0.44 +/- 0.06, P < 0.01). A threshold of L/H greater than 0.44 yielded a sensitivity and specificity of 63% and 81%, respectively, for identifying severe and extensive CAD in the prospective group and a sensitivity of 86% in identifying stenosis of 90% or more in the proximal left anterior descending artery. CONCLUSION: The new automatic algorithm for assessing L/H correlated well with manually derived L/H for (99m)Tc-sestamibi as well as (201)TI SPECT. An increased postexercise (99m)Tc-sestamibi L/H adds significant diagnostic value to study myocardial perfusion SPECT as a marker of severe and extensive CAD and reduced ventricular function. 相似文献
18.
Nicolas David Pierre Y. Marie Michaël Angioi Rosa M. Rodriguez Nathalie Hassan Pierre Olivier Alain Grentzinger Gilles Karcher Olivier Claudon Yves Juillière Nicolas Danchin Alain Bertrand 《European journal of nuclear medicine and molecular imaging》2000,27(7):788-799
In patients unable to perform a maximal exercise test, dipyridamole single-photon emission tomography (SPET) has a higher
capacity than exercise SPET to detect coronary artery disease (CAD). However, in patients with myocardial ischaemia who are
able to perform a maximal exercise test, it is not known whether these two tests may be equally used to assess the areas of
myocardial ischaemia. This study was aimed at comparing the results provided by dipyridamole and exercise SPET in CAD patients
with documented exercise myocardial ischaemia. Forty CAD patients who had undergone exercise thallium-201 SPET and who had
myocardial ischaemia documented by an unequivocally positive exercise test underwent an additional 201Tl SPET study after dipyridamole infusion and low-level (40 W) exercise. The extent of defects was compared between the two
tests and predictors of discrepant results were sought among data from exercise testing and coronary angiography. The extent
of SPET defects was equivalent between the two tests in only 11 patients (28%), larger defects being observed with exercise
in 18 [average difference: 12%±5% of left ventricle (LV)] and with dipyridamole in 11 (average difference: 15%±11% of LV).
The best independent predictors of discrepancies between the two tests were: (1) increase in heart rate at exercise SPET,
with defects being smaller at exercise than after dipyridamole in none of the patients with an increase >60 bpm (0/14), but
in 42% of the others (11/26; P=0.004); and (2) an ischaemic territory related to a <70% coronary stenosis, for which SPET defects were always induced at
exercise (10/10) but in only 30% (3/10) with dipyridamole (P=0.0004). Exercise and dipyridamole SPET provide different estimates of myocardial ischaemic areas. Dipyridamole allows the
unmasking of perfusion abnormalities in patients who have low increases in heart rate at exercise SPET. However, dipyridamole
is also much less efficient at inducing perfusion abnormalities in the ischaemic areas supplied by coronary stenoses of intermediate
severity at rest angiography.
Received 20 January 2000 and in revised form 18 March 2000 相似文献
19.
Prognostic value of normal exercise 99mTc-sestamibi myocardial tomography in patients with angiographic coronary artery disease 总被引:1,自引:0,他引:1
BACKGROUND AND AIM: Previous studies have documented the prognostic value of normal exercise Tl myocardial perfusion imaging in patients with angiographic coronary artery disease (CAD). However, data on exercise Tc-sestamibi myocardial single photon emission computed tomography (SPECT) are scant. Accordingly, the purpose of this study was to investigate the prognostic value of normal exercise Tc-sestamibi SPECT in patients with angiographic CAD. METHODS: We retrospectively investigated 90 consecutive patients who had a normal exercise Tc-sestamibi myocardial SPECT but angiographic CAD. A group of 69 consecutive patients with both normal exercise Tc-sestamibi myocardial SPECT and coronary arteries were included as control. RESULTS: During a mean follow-up of 50+/-19 months, a total of three hard cardiac events (non-fatal myocardial infarction) and seven soft cardiac events (late revascularization) were observed. The annual hard cardiac event rate between the two groups was not significantly different (0.6% vs. 0.3%, chi=0.47, P=NS), nevertheless the annual soft cardiac event rate was higher in patients with angiographic CAD (1.9% vs. 0, chi=5.74, P=0.02). Moreover, the annual hard cardiac events rate in patients with angiographic CAD who were treated medically was also not significantly different from that of the control group (0.8% vs. 0.3%, chi=0.77, P=NS). Among patients with angiographic CAD, the annual hard cardiac event rate was not statistically different between those treated medically and those who underwent revascularization (0.8% vs. 0, chi=0.53, P=NS). CONCLUSIONS: Our data demonstrate that normal exercise Tc-sestamibi myocardial SPECT despite angiographic CAD suggests a low rate of cardiac death or non-fatal myocardial infarction but a relatively high rate of late revascularization during an intermediate term of follow-up. 相似文献
20.
Choi JY Moon DH Lee CW Shin JW Park SW Hong MK Song JK Park SJ Lee HK 《European journal of nuclear medicine and molecular imaging》2002,29(6):728-734
Progressive ventricular dilatation is an important prognostic factor in patients with acute myocardial infarction. We evaluated clinical, angiographic, echocardiographic and thallium-201 single-photon emission tomography (SPET) imaging variables predictive of the change in left ventricular volume during a 7-month follow-up period after primary angioplasty in patients with acute myocardial infarction. Thirty-six patients with first acute myocardial infarction treated with primary angioplasty within 12 h of onset underwent 201Tl SPET imaging (5.8+/-2.1 days after angioplasty). Changes in left ventricular volume were assessed over the 7-month period. The left ventricle dilated significantly after angioplasty ( P<0.001). Multivariate analysis revealed that the number of segments with 201Tl uptake <40% of peak activity was a single independent predictor of increase in end-diastolic volume index between 1 week and 7 months ( R2=0.41, P< 0.001). The presence of two or more segments with 201Tl uptake <40% predicted an increase in end-diastolic volume index of > or =6 ml/m2 with positive and negative predictive values of 85% (17/20) and 75% (12/16), respectively. It is concluded that, following primary angioplasty in patients with acute myocardial infarction, the extent of myocardial infarction assessed by 201Tl SPET can identify those who will develop ventricular dilatation during the subsequent 7 months. 相似文献