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1.
Purpose
Thromboembolic complication is a serious concern following coil embolization for aneurysms involving the anterior choroidal artery (AChA). To minimize this complication and to improve packing density, we present a technical concept of coil embolization.Methods
We attempted packing of the aneurysmal sac by lowering the microcatheter approach angle into an aneurysm to secure AChA origin as well as to improve coil packing density of the aneurysm. This technical concept involves approaching the aneurysm sac with an adjusted shaping of the microcatheter tip to achieve the effect which was not obtained when the microcatheter approach angle into the aneurysm sac was high (≥90°). We evaluated immediate angiographic outcome by the Raymond classification, coil packing density, and follow-up results (modified Rankin Scale (mRS) and recurrence) in seven aneurysms involving AChA in six patients.Results
We achieved immediate angiographic outcome of the Raymond classes I or II with 31% mean packing density. The AChA origin was preserved without any procedure-related complication. There was neither clinical event (mRS = 0) nor aneurysm recurrence confirmed on the source image of magnetic resonance angiography during 6–9 months follow-up.Conclusions
The technical concept of low-angled microcatheter approach can be useful to improve coil packing density and to secure AChA origin when AChA arises near the aneurysm.2.
Xiaoyi?Chen Huilin?Zhao Zhensen?Chen Huiyu?Qiao Yuanyuan?Cui Dongye?Li Zechen?Zhou Le?He Rui?Li Chun?Yuan Xihai?Zhao
Purpose
Significant stenosis or occlusion in carotid arteries may lead to diffuse wall thickening (DWT) in the arterial wall of downstream. This study aimed to investigate the correlation between proximal internal carotid artery (ICA) steno-occlusive disease and DWT in ipsilateral petrous ICA.Methods
Symptomatic patients with atherosclerotic stenosis (>0%) in proximal ICA were recruited and underwent carotid MR vessel wall imaging. The 3D motion sensitized-driven equilibrium prepared rapid gradient-echo (3D-MERGE) was acquired for characterizing the wall thickness and longitudinal extent of the lesions in petrous ICA and the distance from proximal lesion to the petrous ICA. The stenosis degree in proximal ICA was measured on the time-of-flight (TOF) images.Results
In total, 166 carotid arteries from 125 patients (mean age 61.0 ± 10.5 years, 99 males) were eligible for final analysis and 64 showed DWT in petrous ICAs. The prevalence of severe DWT in petrous ICA was 1.4%, 5.3%, 5.9%, and 80.4% in ipsilateral proximal ICAs with stenosis category of 1%–49%, 50%–69%, 70%–99%, and total occlusion, respectively. Proximal ICA stenosis was significantly correlated with the wall thickness in petrous ICA (r = 0.767, P < 0.001). Logistic regression analysis showed that proximal ICA stenosis was independently associated with DWT in ipsilateral petrous ICA (odds ratio (OR) = 2.459, 95% confidence interval (CI) 1.896–3.189, P < 0.001].Conclusion
Proximal ICA steno-occlusive disease is independently associated with DWT in ipsilateral petrous ICA.3.
Objectives
To evaluate the efficiency and safety of emergency department (ED) coronary computed tomography angiography (CTA) during a 3-year clinical experience.Methods
Single-center registry of coronary CTA in consecutive ED patients with suspicion of acute coronary syndrome (ACS). The primary outcome was efficiency of coronary CTA defined as the length of hospitalization. Secondary endpoints of safety were defined as the rate of downstream testing, normalcy rates of invasive coronary angiography (ICA), absence of missed ACS, and major adverse cardiac events (MACE) during follow-up, and index radiation exposure.Results
One thousand twenty two consecutive patients were referred for clinical coronary CTA with suspicion of ACS. Overall, median time to discharge home was 10.5 (5.7-24.1) hours. Patient disposition was 42.7 % direct discharge from the ED, 43.2 % discharge from emergency unit, and 14.1 % hospital admission. ACS rate during index hospitalization was 9.1 %. One hundred ninety two patients underwent additional diagnostic imaging and 77 underwent ICA. The positive predictive value of CTA compared to ICA was 78.9 % (95 %-CI 68.1-87.5 %). Median CT radiation exposure was 4.0 (2.5-5.8) mSv. No ACS was missed; MACE at follow-up after negative CTA was 0.2 %.Conclusions
Coronary CTA in an experienced tertiary care setting allows for efficient and safe management of patients with suspicion for ACS.Key points
? ED Coronary CTA using advanced systems is associated with low radiation exposure. ? Negative coronary CTA is associated with low rates of MACE. ? CTA in ED patients enables short median time to discharge home. ? CTA strategy is characterized by few downstream tests including unnecessary ICA.4.
Timothy M. Brock Paul N. Baker Steven Rushton Michelle Bardgett David Deehan 《Knee surgery, sports traumatology, arthroscopy》2017,25(9):2676-2681
Purpose
The aim was to investigate the interplay between patient characteristics and (1) length of hospital stay and (2) one-year patient-reported outcome following total knee and hip arthroplasty.Methods
Event (survival) analysis and structural equation modelling were performed for 1001 patients undergoing knee (n = 566) and hip (n = 435) arthroplasty in a single institution.Results
Age, body mass index and co-morbidities were independent predictors of length of stay in both event analysis and structural equation modelling. These patient characteristics and type of arthroplasty had both small direct and indirect effects on patient-reported outcome measures at one year. Length of stay had a small effect (<2 %) in SF-36 scores at one year.Conclusion
Predictors that influence length of stay also impact on one-year post-operative outcome and therefore should be taken into account during patient selection and discharge planning.Level of evidence
Retrospective cohort study, Level III.5.
Purpose
To determine if long-term endurance exercise improves quality of life (QOL) in patients with multiple sclerosis (MS).Methods
89 patients with relapsing–remitting MS and an EDSS of <3.5 participated in a prospective non-randomized controlled exploratory trial. The exercise program comprised a walking exercise three times weekly for 30 min (“interval training” twice weekly, “endurance training” once weekly) for 12 months. Participants were tested every 3 months on a treadmill according to a modified Naughton protocol. Fatigue was assessed by the Fatigue Severity Scale (FSS) and QOL by a German version of the Short Form Health Survey (SF-36). Data were analyzed using analysis of variance (ANOVA) with repeated measurements.Results
20 patients without and 24 with fatigue completed the program. QOL was reduced in several subscales of the SF-36 in MS patients with fatigue at baseline: physical functioning (p < 0.001), physical role functioning (p < 0.002), bodily pain (p ≤ 0.04), vitality (p ≤ 0.001), social role functioning (p ≤ 0.004), emotional role functioning (p ≤ 0.03), mental health (p ≤ 0.006). Exercise training resulted in a significant improvement of the subscale general health perceptions (p ≤ 0.01).Conclusions
Fatigue contributes significantly to QOL in MS patients. A significant improvement in the subscale general health perceptions was demonstrated by a 12-month endurance walking program in MS patients with fatigue.6.
Jiasharete Jielile Ayinazi Badalihan Bayixiati Qianman Tuerde Satewalede Jianati Wuerliebieke Mailamuguli Kelamu Ayidaer Jialihasi 《Knee surgery, sports traumatology, arthroscopy》2016,24(7):2148-2155
Purpose
Treatment of neglected Achilles tendon rupture is very challenging. This randomized study aimed to compare the clinical outcome of early post-operative rehabilitation (EPR) with post-operative cast immobilization (PCI).Methods
Fifty-seven patients with neglected Achilles tendon rupture were randomized to receive EPR (n = 26) or PCI (n = 31) management following surgery. Clinical outcome was monitored by follow-up at weeks 8, 12, 18 and 26 and year 2. The significance of intergroup differences from the Leppilahti scoring system (LSS), ultrasonography, multislice spiral computerized tomography (MSCT) and electromyography was assessed.Results
Ultrasonography and MSCT revealed no occurrence of tendon elongation or adhesion. Four patients could perform sustained single-leg heel-raise exercise for 60 s at post-operative day 40. The PCI group also showed increased post-operative LSS score, but recovery was slower. Post-operative complications, such as ankle joint ankylosis and osteoporosis, only occurred in the PCI group.Conclusions
Compared with cast immobilization, early post-operative rehabilitation results in better clinical outcome and faster overall tendon regeneration of neglected Achilles tendon rupture.Level of evidence
II.7.
Amir Imanzadeh Elizabeth George Takeshi Kondo Shinichi Takase Makoto Amanuma Frank J. Rybicki Kanako K. Kumamaru 《Japanese journal of radiology》2016,34(2):140-147
Purpose
To evaluate the role of coronary artery calcium scoring (CACS) and/or coronary CT angiography (CCTA) in asymptomatic elderly patients with high pretest probability for coronary artery disease (CAD).Materials and methods
Forty-eight consecutive asymptomatic elderly (>65 years) subjects who had a high pretest probability and underwent CACS/CCTA were included. Each CCTA was evaluated for adequacy for assessment of coronary stenosis. Significant stenosis (>50 % diameter narrowing) was assessed on evaluable CT images and by invasive catheter angiography (ICA).Results
All subjects were men with mean CACS of 880 ± 1779. Among those with low (0–99), intermediate (100–399), and high (400–999) CACS, ICA-verified significant stenosis was present in 8 % (1/13), 23 % (2/13), and 67 % (8/12), respectively. Among those with very high CACS (≥1000) (n = 10), 90 % of CCTAs were not evaluable for stenosis.Conclusion
In asymptomatic elderly subjects with high pretest probability, CACS followed by CCTA may be considered for those with intermediate to high CACS.8.
Cristian Petri Gabriele Mascherini Luca Pengue Giorgio Galanti 《Sport Sciences for Health》2016,12(1):113-119
Purpose
Physical training involves a balance among dietary intake, energy used and increasing physical activity. The keys to improve performance are diet and nutritional assessments. Accordingly, the purpose of this study is to assess dietary habits in a team of soccer players.Methods
This study includes 28 elite soccer players (aged 27.88 ± 4.55 years, height 1.84 ± 0.06 m). Dietary habits, bio impedance analysis and skinfold thickness were examined throughout the soccer season of 2014–2015.Results
Body composition was found to be in the normal range. A significant decrease in fat-free mass occurred in the end-season (T2, 72.8 ± 5.2; T3, 71.7 ± 5.6; p ≤ 0.001). These results show dietary habits which are not in accordance with the recommended international guidelines.Conclusions
Results suggest that development of a nutrition programme would be helpful to maintain health and to improve performance.9.
Kristina Harris Christopher R. Lim Jill Dawson Ray Fitzpatrick David J. Beard Andrew J. Price 《Knee surgery, sports traumatology, arthroscopy》2017,25(9):2736-2742
Purpose
In this study, we examined whether the OKS demonstrated a floor or a ceiling effect when used to measure the outcome of knee replacement surgery in a large national cohort.Methods
NHS PROMs database, containing pre- to 6 month post-operative OKS on 72,154 patients, mean age 69 (SD 9.4), undergoing knee replacement surgery, was examined to establish the proportion of patients achieving top or bottom OKS values pre- and post-operatively.Results
Pre-operatively, none of patients achieved the maximum/‘best’ (48) and minimum (0) scores. Post-operatively, no patients (0 %) achieved the minimum/‘worst’ score, but the percentage achieving the maximum score increased to 2.7 %. Subgroup analyses demonstrated that the highest post-operative overall ceiling percentage was 3 %, in a subgroup of patients between 60 and 79 years of age and 13.7 % in a group of patients who had a pre-operative OKS above 41. Furthermore, 10.8 % of patients achieved the top post-operative OKS-PCS and 4.7 % top post-operative OKS-FCS.Conclusion
Based on NHS PROMs data, the OKS does not exhibit a ceiling or floor effect overall, or for both its pain and function subscales, and remains a valid measure of outcomes for patients undergoing TKA.Level of evidence
Large-scale retrospective observations study, Level II.10.
Benedict U. Nwachukwu Conan So William W. Schairer Daniel W. Green Emily R. Dodwell 《Knee surgery, sports traumatology, arthroscopy》2016,24(3):760-767
Purpose
The goal of this study was to perform a comparative review to determine whether there is a significant difference in the rate of repeat dislocation and clinical outcome between surgical and conservative management of acute patellar dislocation in children and adolescents.Methods
A systematic review of the MEDLINE database was performed. English-language clinical outcome studies with a primary outcome/treatment specific to acute patella dislocation in a paediatric population were included. Eleven studies met inclusion criteria; Chi-square analysis, independent t tests and weighted mean pooled cohort statistics were performed where appropriate.Results
A total of 470 conservatively managed and 157 operatively treated knees were included. Conservatively managed patients were on average 17.0 years and had a mean follow-up of 3.9 years; surgically managed patients were on average 16.1 years and had a mean follow-up of 4.7 years. Conservatively managed knees had a 31 % rate of recurrent dislocation rate compared to 22 % in surgical knees (p = 0.04). Trochlear dysplasia and skeletal immaturity confer greater risk for recurrent instability. Surgical treatment may provide clinically important quality of life and sporting benefit.Conclusions
Surgical treatment of first time patella dislocation in children and adolescents is associated with a lower risk of recurrent dislocation and higher health-related quality of life and sporting function. There is a paucity of evidence on MPFL reconstruction for first time traumatic patella dislocation in this population.Level of evidence
IV.11.
Christoph Böhler Mirnic Dragana Stephan Puchner Reinhard Windhager Johannes Holinka 《Knee surgery, sports traumatology, arthroscopy》2016,24(10):3147-3154
Purpose
The aim of this study was to compare the efficacy of arthroscopy and arthrotomy in patients with septic monarthritis of the knee.Methods
Seventy consecutive patients who underwent surgery because of a bacterial monarthritis were evaluated. Patients were either treated with arthroscopy or with arthrotomy. Our primary outcome was the early recurrence of infection (>3 months after surgery), which made a second surgical procedure necessary. Furthermore, the influence of potential confounders on treatment outcome was analysed.Results
Of the 70 patients, 41 were treated arthroscopically and 29 with arthrotomy. Eight patients (11.4 %) had to undergo a second surgical procedure because of early re-infection. The rate was significantly higher in patients treated with arthrotomy (n = 6; 20.7 %) compared with those treated by arthroscopy (n = 2) (p = 0.041). Range of motion was significantly better in patients who underwent arthroscopy (p < 0.001). Male sex had negative influence on the treatment success (p = 0.03).Conclusions
Patients with bacterial monarthritis of the knee who were treated with arthroscopy had a significantly lower re-infection rate and a better functional outcome than those treated with arthrotomy. As arthroscopy is the less invasive method, it should be considered the routine treatment, according to our data.Level of evidence
Therapeutic study, Level III.12.
S. Hopf-Jensen M. Preiß L. Marques S. Lehrke J. Schattschneider H. Stolze S. Müller-Hülsbeck 《Cardiovascular and interventional radiology》2016,39(11):1620-1628
Background and Purpose
To evaluate feasibility and impact of dual aspiration technique (DAT) within stent-assisted mechanical thrombectomy on procedural parameters and clinical outcome.Materials and Methods
Within 16 months, 76 consecutive patients (mean age 70.7 year; range 33–89) underwent stent-assisted mechanical thrombectomy. Of 52 enrolled patients (68.4 %) with occlusion of the anterior circulation, 22 patients (42.3 %) underwent DAT; 30 patients (57.7 %) were treated in conventional monoaspiration technique (MAT). Epidemiological data, clinical and imaging characteristics (mRS, NIHSS, ASPECTS) as well as procedural details were analyzed (TICI, number of retrieval, procedure time). Clinical outcome was determined with mRS at discharge and after 90 days.Results
In the context of DAT additional carotid artery stenting was required in 45.5 % (10/22) in underlying tandem lesion (vs. 0/30 MAT). No differences were found in NIHSS at admission (MAT: 20.5, range 15–29; DAT: 18.6; range 11–25), mRS at admission (MAT: 4.6 vs. DAT: 4.57) or ASPECT score (MAT: 8.3, ±1.5; DAT: 8.4, ±1.5; P > 0.05). TICI ≥ 2b/3 was conducted in 90 % (MAT) and 100 % (DAT), respectively. The procedure time was longer in the MAT group (65 min, ±25.9, range 18–126) compared to the DAT group (49.7 min, ±15, range 32–101; P = 0.016). The clinical outcome increased from admission to discharge and in follow-up after 90 days (mRS ≥ 2: MAT: 53.3 %, DAT: 54.5 %; P > 0.05).Conclusions
The dual aspiration technique with an additional intermediate guide catheter placed closed to the stent retriever leads to decreased procedure time in the anterior circulation. Even in cases with higher thrombus load and treated in DAT, clinical outcome improved.13.
Purpose
Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment.Methods
Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4).Results
Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1–C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3–C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1–C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion.Conclusion
High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site.14.
Purpose
The present study aims to recommend appropriate urinary marker metabolites for documenting EG-018 consumption by investigating its metabolism in human hepatocytes.Methods
For metabolite profiling, 10 µM EG-018 was incubated in human hepatocytes for 3 h. Metabolite identification in hepatocyte samples was accomplished with high-resolution mass spectrometry via information-dependent data acquisition.Results
EG-018 was highly metabolized in human hepatocytes. A total of eight metabolites were characterized, mainly generated from hydroxylation and carbonylation on the pentyl chain. Dihydrodiol formation, N-dealkylation, and glucuronidation of hydroxylated metabolites were the other major pathways.Conclusions
The primary metabolites of EG-018 in human hepatocyte incubation were pentyl hydroxylated EG-018 (M6) and pentyl carbonylated EG-018 (M8). These two metabolites are proposed as the best urinary markers for confirming EG-018 intake.15.
Introduction
In acute internal carotid artery dissection (a-ICAD) with concomitant intracranial large vessel occlusion or haemodynamic impairment, the effectiveness of medical treatment is limited and endovascular therapy (EVT) can be considered. Feasibility, safety and outcome of EVT in a-ICAD are not well described yet.Methods
From an institutional database, we retrospectively selected consecutive patients treated for a-ICAD between January 2007 and July 2015. We assessed recanalization results defining <50 % residual stenosis and mTICI ≥2b as successful. Procedural adverse events and symptomatic haemorrhages were reported as well as clinical outcome at 90 days defining a mRS ≤2 as favourable. Follow-up angiographies were reviewed and retreatments reported.Results
In the defined period, 73 patients (mean age 48 years (31–73), mean NIHSS 11 (0–27)) received EVT for a-ICAD. The majority (60 %) had tandem occlusions. Cervical artery reconstruction was successful in 100 % and intracranial thrombectomy in 85 %. Thrombus formation (18 %) and thromboembolism (20 %) were the most frequent adverse events but clinically relevant only in 8 %. Symptomatic haemorrhage occurred in 5 %. Clinical outcome was favourable in 64 %, with a lower chance after tandem occlusion (55 vs. 79 %, p = 0.047). Death rate was 10 %. None of the patients developed recurrent ischaemic symptoms, but control angiography revealed abnormal findings of the reconstructed ICA in 38 % leading to retreatment in 17 %.Conclusion
EVT of a-ICAD is feasible with a predominantly favourable clinical outcome. Improvement of devices and techniques is warranted to reduce the risk of thrombus formation and thromboembolism during treatment and insufficient vessel wall healing thereafter.16.
Purpose
To report the 3-year results of the MAJESTIC first-in-human study of the Eluvia Drug-Eluting Vascular Stent System for treating femoropopliteal artery lesions.Methods
The prospective, single-arm, multicenter clinical trial enrolled 57 patients with symptomatic lower limb ischemia (Rutherford category 2, 3, or 4) and lesions in the superficial femoral artery or proximal popliteal artery. Mean lesion length was 70.8 ± 28.1 mm, and 46% of lesions were occluded. Efficacy measures at 2 years included primary patency, defined as duplex ultrasound peak systolic velocity ratio of ≤2.5 and the absence of target lesion revascularization (TLR) or bypass. Safety monitoring through 3 years included adverse events and TLR.Results
Primary patency was estimated as 83.5% (Kaplan–Meier analysis) at 24 months, and 90.6% (48/53) of patients maintained an improvement in Rutherford class. At 36 months, the Kaplan–Meier estimate of freedom from TLR was 85.3%. No stent fractures were identified, and no major target limb amputations occurred.Conclusion
MAJESTIC results demonstrated long-term treatment durability among patients whose femoropopliteal arteries were treated with the paclitaxel-eluting Eluvia stent.Level of Evidence
Level 2b, cohort study17.
Di?Ningning Pang?Haopeng Dang?Xuefei Cheng?Wenna Ren?Yan Wu?Jingsong Yao?Chengjun Yao?Zhenwei Feng?Xiaoyuan
Introduction
This study was designed to determine if cerebral blood flow (CBF) derived from arterial spin labeling (ASL) perfusion imaging could be used to quantitatively evaluate the microvascular density (MVD) of brain gliomas on a “point-to-point” basis by matching CBF areas and surgical biopsy sites as accurate as possible.Methods
The study enrolled 47 patients with treatment-naive brain gliomas who underwent preoperative ASL, 3D T1-weighted imaging with gadolinium contrast enhancement (3D T1C+), and T2 fluid acquisition of inversion recovery (T2FLAIR) sequences before stereotactic surgery. We histologically quantified MVD from CD34-stained sections of stereotactic biopsies and co-registered biopsy locations with localized CBF measurements. The correlation between CBF and MVD was determined using Spearman’s correlation coefficient. P ≤ .05 was considered statistically significant.Results
Of the 47 patients enrolled in the study, 6 were excluded from the analysis because of brain shift or poor co-registration and localization of the biopsy site during surgery. Finally, 84 biopsies from 41 subjects were included in the analysis. CBF showed a statistically significant positive correlation with MVD (ρ = 0.567; P = .029).Conclusion
ASL can be a useful noninvasive perfusion MR method for quantitative evaluation of the MVD of brain gliomas.18.
Purpose
Flame-shaped pseudo-occlusion of the extracranial internal carotid artery (ICA) is a flow-related phenomenon that creates computed tomographic angiography (CTA) and digital subtraction angiography (DSA) findings that mimic tandem intracranial-extracranial ICA occlusion or dissection. We aim to determine the diagnostic performance of mid-cervical flame-shaped extracranial ICA sign on CTA in hyperacute ischemic stroke patients.Methods
We retrospectively included consecutive anterior circulation ischemic stroke patients presenting within 6 h of symptom onset who underwent 4D brain CTA and arterial-phase neck CTA using a 320-detector CT scanner during August 2012 to July 2015. Two blinded readers independently reviewed arterial-phase neck CTA and characterized the extracranial ICA configurations into mid-cervical flame-shaped, proximal blunt/beak-shaped, and tubular-shaped groups. 4D whole brain CTA was used as a reference standard for intracranial ICA occlusion detection. Diagnostic performance of the mid-cervical flame-shaped extracranial ICA sign and interobserver reliability were calculated.Results
Of the 81 cases, 11 had isolated intracranial ICA occlusion, and 6 had true extracranial ICA occlusion. Mid-cervical flame-shaped extracranial ICA sign was found in 45.5% (5/11) of isolated intracranial ICA occlusions but none in the true extracranial ICA occlusion group. The sensitivity, specificity, PPV, NPV, and accuracy of the mid-cervical flame-shaped extracranial ICA sign for the detection of isolated intracranial ICA occlusion were 45.5, 100, 100, 92.1, and 92.6%, respectively. Interobserver reliability was 0.90.Conclusion
The mid-cervical flame-shaped extracranial ICA sign may suggest the presence of isolated intracranial ICA occlusion and allow reliable exclusion of tandem extracranial-intracranial ICA occlusion in hyperacute ischemic stroke setting.19.
Tali Sharir Marina Pinskiy Abraham Pardes Arik Rochman Vitali Prokhorov Gil Kovalski Konstantine Merzon Andrzej Bojko Boris Brodkin 《Journal of nuclear cardiology》2016,23(1):11-20
Background
Previous studies have demonstrated accurate diagnosis of reduced dose myocardial perfusion imaging (MPI) using Cadmium-Zinc-Telluride (CZT) technology. We compared the diagnostic performances of very low stress-dose (<2 mSv) with standard-dose stress-first, quantitative MPI using a CZT camera.Methods
Patients without known coronary artery– disease who underwent a stress-first Tc-99 m sestamibi CZT-MPI and invasive coronary angiography (ICA), and low-risk patients without ICA were included. A stress-rest standard-dose (10/30 mCi) MPI and a low-dose (5/15 mCi) MPI were compared. Normal limits for quantification were developed from 40 (20 males) low-risk patients, and total perfusion deficit (TPD) was derived.Results
208 patients who underwent MPI and ICA, and 76 low-risk patients were included. Of these, 128 had a standard-dose MPI and 156 had a low-dose MPI. Stress-doses in low-dose and standard-dose groups were 5.9 ± 1.2 vs 10.2 ± 0.5 mCi (1.7 ± 0.3 vs 3.0 ± 0.1 mSv), respectively, P < 0.001, and stress-rest effective radiation was 6.9 ± 1.1 vs 11.7 ± 0.4 mSv, respectively, P < 0.001. Sensitivity, specificity, and accuracy values in the low-dose and standard-dose groups were 86.1%, 76.6%, and 81.4%; and 90.6%, 78.1%, and 84.4%, respectively, P = ns. Using TPD prone, specificity values were 84.9% and 80.3%, respectively, P = ns.Conclusion
One-day stress-first MPI with 50% radiation reduction and a very low stress-dose (<2 mSv) using CZT technology and quantitative supine and prone analysis provided a high diagnostic value, similar to standard-dose MPI.20.
Linda C. Chu Joel Price Allen Young Duke E. Cameron Elliot K. Fishman 《Emergency radiology》2017,24(2):165-170