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PubMed1999

Combined Tc-99m sestamibi first-pass radionuclide angiography and cardiac SPECT imaging during arbutamine infusion delivered by a computerized closed-loop system.

PURPOSE: This study evaluated the feasibility, hemodynamic responses, and relation of combined Tc-99m sestamibi SPECT imaging and first-pass radionuclide angiography during the infusion of a new beta agonist arbutamine. METHODS: Arbutamine was administered to 15 patients and constantly adjusted by a closed-loop computerized system. Rest and arbutamine Tc-99m sestamibi radionuclide angiography was performed with a multicrystal gamma camera followed by SPECT imaging with a rotating triple-head, single-crystal gamma camera. RESULTS: The mean differences (paired t-test) between rest and arbutamine studies for heart rate (HR), end-diastolic volume (EDV), stroke volume (SV), cardiac output (CO), and ejection fraction (EF) were as follows: 55 bpm for HR (P < 0.001), 5 ml for EDV (P=ns), 7.5 ml for SV (P=0.04), 4.4 l/min for CO (P < 0.001), and 6.4% for EF (P < 0.001), respectively. The results of SPECT studies were abnormal in six patients and normal in nine. Findings of radionuclide angiography were normal in 12 patients and abnormal in three. Interpretation of the perfusion and functional studies were concordant in 10 and discordant in five patients. CONCLUSIONS: Simultaneous cardiac radionuclide angiography and SPECT imaging are feasible during arbutamine infusion. This potent beta agonist increases cardiac output through a chronotropic effect with no significant changes in EDV. The discordance in SPECT and radionuclide angiography results may represent incremental diagnostic and prognostic information provided by both studies.

Adrenergic beta-Agonists↗
PubMed1984

First transit and equilibrium radionuclide angiography in patients with inferior transmural myocardial infarction: criteria for the diagnosis of associated hemodynamically significant right ventricular infarction.

To define radionuclide criteria for identifying hemodynamically significant right ventricular infarction, 33 consecutive men with inferior transmural infarction were evaluated prospectively by right heart catheterization and first transit and equilibrium radionuclide angiography within 36 hours of the onset of symptoms. Hemodynamically significant right ventricular infarction was present in 6 of the 33 patients (Group I); the remaining 27 patients did not demonstrate the hemodynamics characteristic of right ventricular infarction (Group II). A right ventricular ejection fraction of less than 40% separated Group I and Group II patients by equilibrium (p = 0.003) but not by first transit (p = NS) radionuclide angiography. However, a right ventricular ejection fraction of less than 35% separated Group I and II patients by both techniques (p = 0.02 and p = 0.005, respectively). The presence of a right ventricular regional wall motion abnormality on either first transit or equilibrium radionuclide angiograms separated Group I and II patients (p less than 0.001). The combination of both a right ventricular ejection fraction of less than 40% and a regional wall motion abnormality separated Group I and II patients using either equilibrium (p less than 0.001) or first transit (p = 0.02) radionuclide angiography. It is concluded that in patients with acute inferior transmural myocardial infarction, a right ventricular regional wall motion abnormality alone or in combination with a right ventricular ejection fraction of less than 40% by either first transit or equilibrium radionuclide angiography is a useful criterion for establishing the presence of hemodynamically significant right ventricular infarction, while its absence argues against the diagnosis of right ventricular infarction.

Aged↗
PubMed1988

[Diagnostic potential of indirect radionuclide angiography in kidney cancer].

Indirect radionuclide angiography was performed in 95 suspects for renal tumor. The data obtained by the said procedure were compared to those yielded by surgery, autopsy and X-ray contrast angiography. The majority of renal tumors were found to have specific angionephroscintigraphic features. The sensitivity of the method in detecting renal carcinoma was 90.2%, specificity--86.3 and diagnostic reliability--88.4%. The procedure proved functional, sparing and highly informative.

Aged↗
PubMed1984

[Evaluation of left ventricular function and regional kinetics following myocardial infarction. Comparative study of angiocardiography, echography and radionuclide angiography].

Left ventricular function and regional wall motion were studied three weeks after a myocardial infarction in 25 patients who had undergone L.V. monoplane cineangiography. The patients were studied by echocardiography (TM and 2D) and radionuclide angiography. Evaluation of global ejection fraction provides evidence of a close correlation between left ventricular angiography and radionuclide examination (r= 0.79). Measurement of ejection fraction by echocardiography (TM) remains clearly correlated with the same evaluation by angiography (r = 0.68). The correlations are markedly increased in the patients without significant wall motion defects (r = 0.87 for radionuclide angiography and r = 0.82 for echographic measurement). Sensitivity in the detection of L.V. aneurysms is excellent with our method of radionuclide examination (12/13) and can be compared with angiography (12/13). Two-dimensional echocardiography performed on a routine basis is less sensitive than radionuclide angiography in this diagnosis (4/13).

Angiocardiography↗
PubMed2005

Evaluating benign and malignant musculoskeletal lesions with radionuclide angiography and SPECT using Tc-99m MIBI.

PURPOSE: The purpose of this study was to evaluate the use of radionuclide angiography and single photon emission computed tomography (SPECT) using Tc-99m hexakis-2-methoxyisobutylisonitrile (Tc-99m MIBI) for analyzing musculoskeletal lesions. MATERIALS AND METHODS: Radionuclide angiography and SPECT using Tc-99m MIBI were performed in 36 patients with various soft tissue and bone pathologies (18 benign and 18 malignant lesions). The ratio of the counts of the lesion to that of the contralateral normal area was calculated from the region of interest drawn on the MIBI scan. The MIBI-uptake ratio was calculated using SPECT and the MIBI-perfusion index was calculated using radionuclide angiography. RESULTS: The MIBI-uptake ratio in malignant lesions (4.80 +/- 4.43) was significantly higher (P < 0.05) than that in benign lesions (1.83+/-2.48). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the MIBI-uptake ratio for malignant lesions were 72%, 83%, 78%, 81%, and 75%, respectively. The MIBI-perfusion index in malignant lesions (17.68 +/- 21.19) was significantly higher (P < 0.05) than that in benign lesions (2.25 +/- 2.56). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the MIBI-perfusion index for malignant lesions were 87%, 75%, 81%, 77%, and 86%, respectively. CONCLUSIONS: The MIBI-uptake ratio and MIBI-perfusion index using Tc-99m MIBI can yield important additional information with which to differentiate musculoskeletal lesions.

Adolescent↗
PubMed1988

Prognostic value and limitations of exercise radionuclide angiography in medically treated coronary artery disease.

We investigated whether exercise radionuclide angiography provides prognostic information in addition to that identified by resting left ventricular function and coronary anatomy in patients with medically treated coronary artery disease. Clinical follow-up (median, 21.7 months) was obtained in 424 medically treated patients who underwent exercise radionuclide angiography and coronary angiography. The mean age of the study population was 58 years, and 67% were men. Cardiac death occurred in 16 patients, nonfatal myocardial infarction in 16, and nonfatal out-of-hospital cardiac arrest in 1. Univariate analysis showed that multiple variables were associated with future cardiac events, including number of diseased vessels, exercise and rest radionuclide ejection fraction, history of myocardial infarction, exercise and rest left ventricular end-systolic and end-diastolic volume indices, peak exercise workload, age, abnormal resting electrocardiogram, and peak exercise ST-segment depression. Only three variables were independently associated with cardiac events on follow-up: number of diseased vessels, radionuclide ejection fraction at rest, and age. In patients with three-vessel disease and a resting radionuclide ejection fraction of more than 40%, a subgroup with higher risk could not be identified on the basis of exercise radionuclide response.

Coronary Angiography↗
PubMed1981

Tricuspid regurgitation by radionuclide angiography and contrast right ventriculography: a preliminary observation.

In a retrospective study correlating the degree of tricuspid regurgitation seen on first-pass radionuclide angiography with that seen on contrast right ventriculography in 51 patients, ten had no tricuspid regurgitation by contrast ventriculography, whereas by radionuclide angiography nine had no regurgitation and one had minimal regurgitation. Of eight patients with minimal tricuspid regurgitation by contrast ventriculography, five had minimal regurgitation by nuclide angiography and three had no regurgitation. Of the 11 patients with mild to moderate tricuspid regurgitation by contrast studies, ten had mild to moderate regurgitation and one had severe regurgitation by nuclide angiography. Of 22 patients with moderate to severe tricuspid regurgitation by contrast studies, 15 had moderate to severe regurgitation and seven had mild to moderate regurgitation by nuclear angiography. In this preliminary study comparing radionuclide angiography with contrast right ventriculography, there were three false-negative and one false-positive nuclide angiograms, giving a sensitivity of 93% and a specificity of 90%.

Adult↗
PubMed1990

[Assessment of left ventricular diastolic function with color Doppler flow-comparison with pulsed Doppler and radionuclide angiography].

To determine the relations among color Doppler echocardiographic, pulsed Doppler echocardiographic and radionuclide angiographic fractions of left ventricular filling, 37 patients were studied using the three techniques. Favorable correlations of the filling fractions were found between color Doppler (flow area/left ventricular cavity area) and radionuclide angiography both during early diastole (r = 0.94) and atrial systole (r = 0.90). The above results were better than those obtained from pulsed Doppler (E area/Total, A area/Total) and radionuclide angiography: during early diastole (r = 0.78) and atrial systole (r = 0.76). Color Doppler can be used as a new method for assessing the pattern of left ventricular filling.

Adult↗
PubMed1989

Radionuclide angiography in suspected acute cholecystitis: further observations.

Radionuclide angiography (RNA) and cholescintigraphy were performed prospectively in 300 patients with suspected acute cholecystitis (AC). Of 79 patients with positive RNA, 63 had AC (80%). Positive RNA was seen in 23 of 26 cases with gangrenous AC (88%) while 12 of the 26 had a positive "rim" sign (46%). All 12 patients with a positive "rim" sign had positive RNA. The "rim" sign may be caused by increased perfusion. Five of 6 patients with positive RNA and "obstructive" pattern had AC (83%). Patients with negative RNA and positive cholescintigraphy had a positive predictive value of 54% (31/57), while those with positive RNA and positive cholescintigraphy had a positive predictive value of 85% (57/67). RNA showed increased perfusion to nonbiliary pathology such as liver abscesses and pyelonephritis. Positive RNA increases the predictive value of cholescintigraphy and may be useful to shorten cholescintigraphic examinations.

Adult↗
PubMed1979

[Multi-parameter evaluation of cerebral perfusion curves in cerebrovascular diseases results of computer-assisted radionuclide angiography (author's transl)].

The validity of computer-assisted radionuclide angiography was assessed in 189 patients with cerebrovascular disease including TIA (transient ischemic attack), PRIND (prolonged reversible ischemic neurological deficit), completed stroke and a-v. angioma. Time-activity curves were derived from regions of interest established over the right as well as the left side vascular supply territories of both middle and anterior cerebral arteries. Employing Fortran programs, parameters (right to left) A (ratio of maximal count rates), B (ratio of mean count rates) and C (relative perfusion efficiency) were computed. In patients with completed stroke, C revealed 85% and combined evaluation of A and C, 93% correct positive findings as compared with clinical and/or angiographic findings. In patients with asymptomatic stenoses, TIA and PRIND, C revealed an overall sensitivity of 83%, but was correct positive in unilateral extra- and intracranial vascular abnormalities in 96%. Out of seven a-v. angioma, five were diagnosed correctly by parameter C. These high success rates indicate the usefulness of computer-assisted radionuclide angiography (CARNA) supplementary to visual evaluation in patients suspected of having stenoses or occlusion of the major extra- or intracranial cerebral arteries.

Adolescent↗
PubMed1982

Low radiation iridium 191m radionuclide angiography: detection and quantitation of left-to-right shunts in infants.

Radionuclide angiography using iridium 191m was carried out in 34 premature infants and young children for detection and quantitation of left-to-right shunts. Ir-191m has a physical half-life of 4.96 seconds and can be imaged with conventional gamma scintillation cameras. The whole body radiation absorbed dose from Ir-191m is 3.5 mrad/mCi, which is about 40 times less radiation than with technetium 99m. Other advantages of Ir-191m include high photon flux for improved imaging and the possibility of multiple studies within a short period of time without background. Nine patients had simultaneous measurement of pulmonary-to-systemic flow ratio by Ir-191m angiography and oxymetry during cardiac catheterization; the correlation coefficient was 0.90. Radionuclide angiography with Ir-191m is a method with virtually no risk, rapid, accurate, and reproducible, and is ideally suited for the evaluation of left-to-right shunts in small children.

Angiography↗
PubMed1985

Radionuclide angiography in pulmonary sequestration.

We report a case diagnosed as pulmonary sequestration by radionuclide angiography prior to operation which showed anomalous arteries. Radionuclide angiography clearly revealed the condition of both the pulmonary artery and aorta, and is considered to be extremely useful in the diagnosis of pulmonary sequestration. It will probably be applied to more patients in the future.

Aorta, Thoracic↗
PubMed1988

Long-term follow-up by exercise radionuclide angiography of patients after valve replacement for aortic regurgitation.

The long-term effects of valve replacement for chronic isolated aortic regurgitation as assessed by first-pass exercise radionuclide angiography have never been reported. We studied 20 males and 5 females before, 15 months postoperatively, and from 29 to 109 (mean 62 +/- 21) months following valve replacement with exercise radionuclide angiography. Mean peak heart rate did not change for the three studies. Peak systolic blood pressure decreased from 201 +/- 42 mmHg to 185 +/- 24 mmHg at 15 months and further declined to 177 +/- 32 mmHg by the long-term study (p less than 0.03). The mean resting left ventricular ejection fraction improved from 44 +/- 15% preoperatively to 57 +/- 18% at 15 months (p less than 0.002) with no further improvement by the long-term evaluation. The postexercise ejection fraction improved from 42 +/- 13% preoperatively to 61 +/- 21% at 15 months (p less than 0.002) also with no change by the long-term study. The duration of exercise improved from 9.7 +/- 4.6 min to 11.9 +/- 3.4 min (p less than 0.03) at 15 months with no additional improvement long term. Improvement in resting and postexercise ejection fraction and in exercise duration is maximal at 15 months. Accuracy and cost containment suggest that assessment of the maximal change in ejection fraction by exercise radionuclide angiography after aortic valve replacement in asymptomatic patients be limited to the 15-month interval.

Adult↗
PubMedDate not supplied

Assessment of left ventricular function by ECG-gated myocardial perfusion scintigraphy with image inversion technique: comparison with equilibrium radionuclide angiography.

BACKGROUND: Inversion of gated myocardial perfusion imaging has been proposed for the evaluation of left ventricular function. This study compared the results of inversion technique of gated left anterior oblique 45 degrees images (G-LAO 45 degrees) with those provided by equilibrium radionuclide angiography in the assessment of global left ventricular function in the same patients with suspected or known coronary artery disease. METHODS AND RESULTS: A total of 107 patients (85 men and 22 women, mean age 59 +/- 9 years) with suspected or documented coronary artery disease were studied. Eighty-seven underwent a 2-day stress/rest technetium-99m sestamibi single photon emission computed tomography with acquisition of G-LAO 45 degrees images on the day of rest, and 20 underwent thallium-201 stress/redistribution single photon emission computed tomography with G-LAO 45 degrees image acquisition immediately after redistribution imaging. An excellent correlation (P < .001) with no significant differences was found between left ventricular ejection fraction values provided by inversion G-LAO 45 degree and radionuclide angiography in 87 patients studied with Tc-99m sestamibi and 20 patients studied with TI-201. The Bland-Altman analysis demonstrated the difference in absolute ejection fraction values obtained by inversion G-LAO 45 degree images and radionuclide angiography as <8%. The inversion G-LAO 45 degrees left ventricular ejection fraction distinguishes the patients with myocardial infarction (ejection fraction = 43% +/- 13%) and without myocardial infarction (ejection fraction = 60% +/- 5%) (P < .001). In patients with left ventricular ejection fraction <40%, inversion G-LAO 45 degree images provide evaluation of left ventricular function comparable with that obtained by RNA. CONCLUSIONS: Semiautomated myocardial perfusion gated inversion technique analyzed with a count-based method is useful in the evaluation of left ventricular function and provides similar results to those of radionuclide angiography.

Coronary Circulation↗
PubMedDate not supplied

The combined use of radionuclide angiography and Doppler-sonography in the screening of carotid lesions.

The aim of our research is to check if the combined use of radionuclide angiography and Doppler-sonography leads to correct screening of carotid lesions in the neck, independently from the indexes of reliability of the individual examinations. 125 cerebrovascular patients (for a total of 250 carotid studies) were investigated with radionuclide angiography and Doppler-sonography. 100 of these carotids were also angiographically investigated. On the basis combined angioscintigraphic and Doppler results, these patients have been classified in four groups. When both non-invasive examinations result negative, the angiography shows pathological arteries only in 22% of cases. When only radionuclide angiography is positive, the angiography shows pathological findings in 63% of cases: when only Doppler is positive, the angiography confirmation occurs in 72% of cases. Finally, when both non-invasive tests results positive, there is always arterial pathology in the angiography.

Adult↗
PubMed1992

Evaluation of patients with chest pain and nondiagnostic ECG using thallium-201 myocardial planar imaging and technetium-99m first-pass radionuclide angiography in the emergency department.

STUDY OBJECTIVE: The purpose of this study was to determine if thallium-201 myocardial planar imaging and technetium-99m first-pass radionuclide angiography, performed in the emergency department, could predict which patients with acute chest pain and nondiagnostic ECGs were more likely to have an acute myocardial infarction (AMI). DESIGN: Retrospective analysis. SETTING: Urban, county ED. TYPE OF PARTICIPANTS: Convenience sample of 47 patients with acute chest pain suggestive of myocardial ischemia and nondiagnostic ECG. INTERVENTIONS: Thallium-201 myocardial imaging and technetium-99m first-pass radionuclide angiography in the ED. MEASUREMENTS AND MAIN RESULTS: Four patients had an AMI (ie, CK-MB greater than or equal to 6% total CK). The combined scans had a sensitivity of 75%, (95% confidence interval [Cl], 19-99%), a specificity of 42% (95% CI, 27-58%), an accuracy of 45% (95% CI, 19-99%), a positive predictive value of 11% (95% CI, 2-29%), and a negative predictive value of 95% (95% CI, 75-100%) in predicting AMI. CONCLUSION: Thallium-201 myocardial planar imaging and technetium-99m first-pass radionuclide angiography performed in the ED do not appear to be useful in determining which patients with acute chest pain and nondiagnostic ECG are likely to have an AMI.

Adult↗
PubMed2003

[Assessment of left ventricular ejection fraction and wall motion in patients after myocardial infarction with and without persistent electrocardiographic ST-segment elevation--using gated radionuclide angiography].

UNLABELLED: In everyday practice two-dimensional echocardiography is a routine method used to diagnose left ventricular (LV) wall motion abnormalities and determine ejection fraction (EF). However, in some patients, for technical reasons, it is possible to apply only apical projections and EF and LV wall motion abnormalities cannot be therefore obtained. The aim of the study was to measure LV EF and wall motion abnormalities in the patients healed from MI, with and without persistent electrocardiographic ST segment elevation, in whom echocardiographic diagnosis was difficult. LV wall motion abnormalities and EF were determined using non-invasive method--gated radionuclide angiography. Gated radionuclide angiography was performed in 45 patients, 3 months after previous anterior MI. The study was acquired after technetium 99mTc red cell labeling in vivo. The data were collected using a Toshiba scintillation gamma camera with a MODUMED computer system coupled with a gating device. Patients were divided into two groups. Group I consisted of 24 patients with persistent electrocardiographic ST segment elevation and group II--of 21 patients without persistent elevation of this segment. RESULTS: In the group I, left ventricular ejection fraction ranged between 10 and 36% (mean: 24%). In 9/24 patients (38%) diffuse hypokinesis, in 7/24 patients (29%) regional akinesis and in the last 8/24 patients (33%) regional dyskinesis with impaired dilated left ventricular systolic and diastolic function were observed. In the group II, left ventricular ejection fraction ranged from 19 to 47%. Mean value of this parameter equaled 32% and was statistically significantly higher than in patients from group II. In 9/21 patients (42%) diffuse hypokinesis, in 2/21 patients (10%) regional anterior wall hypokinesis with the normal function of other walls, and in the last 10/21 patients (48%) regional anterior wall akinesis with the diffuse hypokinesis of other walls were localized. In the patients without persistent electrocardiographic ST segment elevation, diffuse hypokinesis was observed in majority of cases. In none of those patients ventricular aneurysm was diagnosed. In the patients with persistent electrocardiographic ST segment elevation, three types of decreased left ventricular function (diffuse hypokinesis, regional akinesis and ventricular aneurysm) were observed. It should be noted that in 1/3 of those patients ventricular aneurysm was diagnosed. Presence of diskinetic wall motion abnormalities in group I (in 8/24 patients) was statistically significantly more frequent (p < 0.01) than in group II (in 0/21 patients). CONCLUSIONS: 1. Presence of persistent electrocardiographic ST segment elevation in a patient with post infarction myocardial failure is a prerequisite for suspicion of post myocardial infarction left-ventricular aneurysm. 2. In patients without persistent electrocardiographic ST segment elevation and post infarction myocardial failure diffuse hipokinesis (sometimes with regional akinesis) is predominantly observed.

Adult↗