Failure of gated SPECT and echocardiography to detect large apical aneurysm secondary to hyperdynamic left ventricular wall at the aneurysm neck

We present a patient with a history of coronary artery disease and exertional angina after an acute anterior myocardial infarction. Angiography and ventriculography revealed multivessel coronary artery disease and a large apical aneurysm. Echocardiography and gated SPECT studies were performed for further evaluation of ischemia and assessment of left ventricular function. Gated SPECT and echocardiography failed to detect a large apical aneurysm due to a hyperdynamic left ventricular wall at the neck of the aneurysm. This case demonstrates the importance of using multiple imaging modalities in the evaluation of ventricular function in the setting of coronary artery disease.     

原发性高血压病在平衡法核素心血池显像中的表现(与超声心动图及心机械图比较)

用44例原发性高血压(EH)患者及15例健康人对照组(N)的平衡法心血池显像(MGBP)心功能参数,对比分析了EH组多普勒超声心动图(UCG)及心机械图(MCG)的心脏检测指标.结果示,MGBP检测中 EH 组的左室高峰充盈率(PFR)、右室射血分数(RVEF)、局部射血分数_4(EF_4)及局部轴缩短率_4(RS_4)明显低于对照组(P<0.05～0.01).反映左室舒张功能的PFR与E/A峰比值(UCG)之间呈正相关(r=0.44,P<0.05),PFR与a/Eo(MCG)之间呈负相关(r=-0.87 P<0.01),PFR与左房内径(UCG)之间呈负相关(r=-0.48 P<0.05),反映左室间隔部位改变的EF_4,RS_4与室间隔厚度(UCG)均呈负相关(r=-0.3 P<0.05,;γ=-0.47 P<0.05).     

Regional myocardial motion and thickening assessed at rest by ECG-gated99mTc-MIBI emission tomography and by magnetic resonance imaging

We have validated ECG-gated emission tomography using technetium-99m methoxyisobutylisonitrile for the assessment of regional ventricular function by comparing it with cine magnetic resonance imaging (MRI). Gated tomography was performed at rest in 24 patients referred for myocardial perfusion imaging [17 males and seven females with a mean age of 58 years, nine of whom had had a previous myocardial infarction (MI)]. Scores were assigned to each of nine myocardial segments for wall motion and for thickening. Cine MRI was analysed in an identical fashion. Four out of 216 (2%) segments were uninterpretable by gated tomography because of inadequate tracer uptake. In eight patients without coronary artery disease (CAD), wall motion and thickening were normal by both methods. Gated tomography showed abnormal wall motion or thickening in all patients with previous MI and in five of seven patients with CAD but no prior MI. Association between wall motion and thickening was good (r _s=0.86). Overall, there was good agreement between gated tomography and MRI for both wall motion (178/212 segments, =0.66) and wall thickening (184/212 segments, =0.69). In segments with severely reduced perfusion, however, there was poorer agreement (=0.31). Interobserver and intraobserver agreement was high ( from 0.61 to 0.78). Thus, in patients investigated for CAD, there is good overall agreement between gated tomography and MRI but the agreement is lower in segments with severe perfusion defects.     

32例生长激素缺乏症患者的心功能探讨

目的评价原发性生长激素缺乏症患者的心功能状况，以探讨生长激素对心功能的作用。方法用平衡法核素心血池显像技术及运动试验，对３２例儿童期诊断为垂体发育不良所致的生长激素缺乏症患者及１０例正常健康儿童进行心功能评价。结果３２例患者左心室总体射血分数和左心室舒张末期高峰充盈率明显低于正常健康组小儿；２５例（７８％）患者局部心室收缩功能降低；１５例（４７％）患者左心室总体收缩或（和）舒张功能降低；２５例（７８％）运动试验后出现心率改变、轻度ＳＴ段降低及Ｔ波改变。结论大部分生长激素缺乏症者在没有生长激素治疗的情况下，存在不同程度的心室收缩和舒张功能损害及心肌缺血和劳损。生长激素缺乏症者应尽早检测心功能、尽早给予生长激素治疗以预防成年后心血管疾病的发生     

Person-by-person prediction of intuitive economic choice

Decision making is an interdisciplinary field, which is explored with methods spanning from economic experiments to brain scanning. Its dominant paradigms such as utility theory, prospect theory, and the modern dual-process theories all resort to formal algebraic models or non-mathematical postulates, and remain purely phenomenological. An approach introduced by Grossberg deployed differential equations describing neural networks and bridged the gap between decision science and the psychology of cognitive–emotional interactions. However, the limits within which neural models can explain data from real people’s actions are virtually untested and remain unknown. Here we show that a model built around a recurrent gated dipole can successfully forecast individual economic choices in a complex laboratory experiment. Unlike classical statistical and econometric techniques or machine learning algorithms, our method calibrates the equations for each individual separately, and carries out prediction person-by-person. It predicted very well the behaviour of 15%–20% of the participants in the experiment–half of them extremely well–and was overall useful for two thirds of all 211 subjects. The model succeeded with people who were guided by gut feelings and failed with those who had sophisticated strategies. One hypothesis is that this neural network is the biological substrate of the cognitive system for primitive–intuitive thinking, and so we believe that we have a model of how people choose economic options by a simple form of intuition. We anticipate our study to be useful for further studies of human intuitive thinking as well as for analyses of economic systems populated by heterogeneous agents.     

~(99m)Tc-MIBI门控心肌舒张末期影像与非门控心肌影像检测老年冠心病人的比较

目的　评价 99m Tc- MIBI门控心肌舒张末期影像 (EDI)与非门控心肌影像 (NGI)对检测老年人冠心病的实际应用价值。方法　对 58例己确诊和可疑冠心病患者 (47例有冠脉造影 )进行了 99m Tc- MIBI门控心肌灌注断层显像 ,并比较了门控舒张末期影像 (EDI)与非门控心肌影像(NGI)检测冠心病的诊断效能和一致性。结果　 EDI和 NGI检测冠心病的灵敏度分别为 84.84% (2 8/ 33)和 72 .72 % (2 4 / 33)。 5例冠心病患者中有4例 NGI未检出异常而 EDI发现有缺血。 EDI特异性为 85.71 % (1 2 / 1 4 ) ,NGI为 78.57% (1 1 / 1 4 )。总共检测 2 90个节段中 ,NGI检出 50个节段有心肌缺血 ,EDI为 83个节段 (P<0 .0 5)。两种方法间检测心肌节段异常的一致性为 85.1 7% (2 4 7/ 2 90 )。 EDI显示出比 NGI能检出更多的心肌缺血。结论　 99m Tc- MIBI电路控制心肌灌注断层显像的 EDI是一种有临床实用价值的老年冠心病检测方法     

实时三维超声与门控心肌灌注显像对心衰患者CRT术前心功能的评价

目的 应用实时三维超声与门控心肌灌注显像评价慢性心力衰竭患者CRT术前心功能.方法 选择心力衰竭患者58例,其中扩张性心肌病31例、陈旧前壁心梗27例,正常对照组为健康者30例,分别进行实时三维超声心动图(RT-3DE)与门控心肌灌注显像检查(GSPECT MPI)),两种检查间隔1～2 d,测定左室整体舒张末期容积(EDV)、左室收缩末期容积(ESV)、射血分数(EF);应用RT-3DE测定心衰患者的局部舒张末期容积(rEDV)、局部左室收缩末期容积(rESV)、局部射血分数(rEF);应用GSPECT MPI评价心衰患者的心肌灌注情况.结果 RT-3DE与GSPECT MPI测定各组患者CRT术前整体心功能相关性良好;RT-3DE可以准确评价心衰患者的局部心功能;GSPECT MPI能够有效地反映心衰患者的心肌灌注情况.结论 RT-3DE与GSPECT MPI在评价心衰患者心功能及心肌灌注情况各有优势,将两者结合对于综合评价心衰患者CRT术前的心功能具有互补作用.     

平衡法门控核素心室显像评价生长激素对扩张型心肌病心功能的影响

目的　评价基因重组生长激素 (rhGH)对扩张型心肌病 (DCM)心功能的影响及疗效。方法　采用99Tcm RBC平衡法门控心室显像 ,将 5 6例DCM伴中、重度心力衰竭患者随机分为rhGH治疗组 (2 8例 )和对照组 (2 8例 )。rhGH组 :在常规内科治疗基础上隔日肌肉注射rhGH 4.5U ;对照组采用单纯内科常规治疗方法。疗程均为 3个月。治疗前后进行超声心动图和门控心室显像 ,观察各项心功能指标。结果　rhGH治疗 3个月后DCM患者二维超声心动图所测左室收缩末内径 (LVEsd)由用药前 (5 9.8± 7.2 )mm缩小至用药后 (5 3 .6± 8.4)mm(P <0 .0 1)。99Tcm RBC平衡法门控心室显像 :rhGH组中左室扩大为主 7例 :左室射血分数 (LVEF)由治疗前 (2 8.3 2± 6.95 ) %升至用药后 (3 8.3 0±5 91) % (P <0 .0 1) ,左室高峰射血率 (PER ,EDV/s)由治疗前 2 .11± 0 .91升至用药后 2 .96± 0 .6(P <0 .0 1) ;双心室扩大组 2 1例 :LVEF由治疗前 (2 3 .6± 9.65 ) %升至 (3 5 .65± 9.2 1) % (P <0 .0 1) ,左室PER由治疗前 0 .94± 0 .65升至 1.76± 0 .82 (P <0 .0 1) ;右室射血分数 (RVEF)由 (2 2 .40± 7.5 1) %升至(3 3 .65± 5 .11) % (P <0 .0 1) ,右室PER由 0 .89± 0 .46升至 1.3 7± 0 .5 1(P <0 .0 5 )。结论　rhGH治疗3个月后DCM患     

Myocardial viability assessment in patients with highly impaired left ventricular function: comparison of delayed enhancement, dobutamine stress MRI, end-diastolic wall thickness, and TI201-SPECT with functional recovery after revascularization

This study compared different magnetic resonance imaging (MRI) methods with Tl²⁰¹ single photon emission computerized tomography (SPECT) and the gold standard for viability assessment, functional recovery after coronary artery bypass grafting (CABG). Twenty patients (64±7.3 years) with severely impaired left ventricular function (ejection fraction [EF] 28.6±8.7%) underwent MRI and SPECT before and 6 months after CABG. Wall-motion abnormalities were assessed by stress cine MRI using low-dose dobutamine. A segment with a nonreversible defect in Tl²⁰¹-SPECT and a delayed enhancement (DE) in an area >50% of the entire segment, as well as an end-diastolic wall thickness <6 mm, was defined as nonviable. The mean postoperative EF (n=20) improved slightly from 28.6±8.7% to 32.2±12.4% (not significant). Using the Tl²⁰¹-SPECT as the reference method, end-diastolic wall thickness, MRI-DE, and stress MRI showed high sensitivity of 94%, 93%, and 84%, respectively, but low specificities. Using the recovery of contractile function 6 months after CABG as the gold standard, MRI-DE showed an even higher sensitivity of 99%, end-diastolic wall thickness 96%, stress MRI 88%, and Tl²⁰¹-SPECT 86%. MRI-DE showed advantages compared with the widely used Tl²⁰¹-SPECT and all other MRI methods for predicting myocardial recovery after CABG.     

A realistic 3-D gated cardiac phantom for quality control of gated myocardial perfusion SPET: the Amsterdam gated (AGATE) cardiac phantom

A realistic 3-D gated cardiac phantom with known left ventricular (LV) volumes and ejection fractions (EFs) was produced to evaluate quantitative measurements obtained from gated myocardial single-photon emission tomography (SPET). The 3-D gated cardiac phantom was designed and constructed to fit into the Data Spectrum anthropomorphic torso phantom. Flexible silicone membranes form the inner and outer walls of the simulated left ventricle. Simulated LV volumes can be varied within the range 45–200 ml. The LV volume curve has a smooth and realistic clinical shape that is produced by a specially shaped cam connected to a piston. A fixed 70-ml stroke volume is applied for EF measurements. An ECG signal is produced at maximum LV filling by a controller unit connected to the pump. This gated cardiac phantom will be referred to as the Amsterdam 3-D gated cardiac phantom, or, in short, the AGATE cardiac phantom. SPET data were acquired with a triple-head SPET system. Data were reconstructed using filtered back-projection following pre-filtering and further processed with the Quantitative Gated SPECT (QGS) software to determine LV volume and EF values. Ungated studies were performed to measure LV volumes ranging from 45 ml to 200 ml. The QGS-determined LV volumes were systematically underestimated. For different LV combinations, the stroke volumes measured were consistent at 60–61 ml for 8-frame studies and 63–65 ml for 16-frame studies. QGS-determined EF values were slightly overestimated between 1.25% EF units for 8-frame studies and 3.25% EF units for 16-frame studies. In conclusion, the AGATE cardiac phantom offers possibilities for quality control, testing and validation of the whole gated cardiac SPET sequence, and testing of different acquisition and processing parameters and software.An erratum to this article can be found at