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Annals of Nuclear Medicine (v.21, #3)

¹²³I-MIBG imaging can be used to evaluate microvascular disturbance caused by embolization by microdebris after rotational atherectomy by Takashi Hatori; Takuji Toyama; Shu Kasama; Masahiko Suguta; Akihiko Nakano; Akira Hasegawa; Keigo Endo; Masahiko Kurabayashi (pp. 137-144).

During rotational atherectomy (RA), the coronary atherosclerotic plaque is largely pulverized into microdebris, which may cause serious hemodynamic instability owing to significant segmental left ventricular asynergy embolization of the distal microvasculature by atheromatous debris and associated vasospasm.To evaluate the usefulness of ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) in the examination of microvascular embolization after RA.Nineteen patients with stable effort angina pectoris who had undergone RA were evaluated in this study. Left ventricular ejection fraction (LVEF) was determined by left ventriculography immediately before and after RA. The serum concentration of creatine phosphokinase (CPK), creatine phosphokinase-myocardial band (CPK-MB) isozyme, and cardiac troponin-T was determined after RA. ^99mTc-methoxyisobutylisonitrile (^99mTc-MIBI) and ¹²³I-MIBG scintigraphic examinations were also performed 1 day after RA. The regional defect score (RDS) was determined from ^99mTc-MIBI scintigraphic findings, while early and delayed RDS, heart-to-mediastinum count ratios (H/M ratios), and washout rate (WR) were determined from ¹²³I-MIBG scintigraphy. After RA, the left ventriculographic LVEF mildly decreased by ≤10% in ten patients (group A), but it decreased by >10% in the remaining nine patients (group B). There were no differences in baseline clinical characteristics between the two groups. The CPK, CPK-MB isozyme, troponin-T, RDS by ^99mTc-MIBI, H/M ratios, and WR after RA were similar in the two groups. However, the RDSs determined from early and delayed ¹²³I-MIBG in group A were significantly lower than those in group B (4.5 ± 3.8 vs. 13.4 ± 10.8, P < 0.05; 9.0 ± 6.3 vs. 17.7 ± 10.0, P < 0.05, respectively). Moreover, there were significant correlations between delta LVEF and troponin-T (r = 0.54, P < 0.05) and RDSs of early and delayed ¹²³I-MIBG (r = 0.46, P < 0.05; r = 0.64, P < 0.05, respectively).These findings suggest that ¹²³I-MIBG imaging can be used to evaluate microvascular disturbance caused by embolization by microdebris after RA.

Keywords: ¹²³I-MIBG imaging; Rotational atherectomy; Microvascular disturbance

Diagnostic performances of double-phase Tc-99m MIBI scintimammography in patients with indeterminate ultrasound findings: visual and quantitative analyses by Seong-Jang Kim; Young-Tae Bae; Jung S. Lee; In-Ju Kim; Yong-Ki Kim (pp. 145-150).

The aim of the study was to compare the diagnostic performances of visual and quantitative analyses of double-phase Tc-99m methoxyisobutylisonitrile (MIBI) scintimammography (SMM) in patients with ultrasonographically indeterminate findings. SMM (early: 10 min; delayed: 3 h) was performed on 78 patients (malignant 66, benign 12). For visual analysis, the five-scoring method was used. For quantitative analysis, ratios of early and delayed lesions to non-lesion (L/Ns) were calculated. When a visual grade of over 3 was used as the cut-off value for the detection of primary breast cancer, the sensitivity and specificity were 86.4% and 100%, respectively. The area under the curve (AUC) was 0.972. The optimal L/N ratios were 1.22 for early and 1.1 for delayed images. When early L/N 1.22 was used as the cut-off point, the sensitivity and specificity of SMM were 92.4% and 91.7%, respectively. The AUC was 0.952. When delayed L/N 1.1 was used as the cut-off value, the sensitivity and specificity were 78.8% and 91.7%, respectively. The AUC was 0.863. Visual interpretation and early L/N were superior to delayed L/N for the detection of breast cancer. This study suggests the possible diagnostic role of visual and quantitative analyses of double-phase SMM for differentiating malignant breast lesions in patients with ultrasonographically indeterminate findings.

Keywords: Breast cancer; Tc-99m MIBI; Scintimammography; Ultrasound; Indeterminate

Evaluation of cerebral perfusion in patients with neuropsychiatric systemic lupus erythematosus using ¹²³I-IMP SPECT by Atsuko Yoshida; Fumio Shishido; Kazuo Kato; Hiroshi Watanabe; Osamu Seino (pp. 151-158).

In the course of systemic lupus erythematosus (SLE), central nervous system (CNS) complications occur at a high frequency. An accurate diagnosis of CNS lupus, differentiated from secondary CNS involvement, is difficult. CNS lupus is indicative of advancing primary disease and is treated by steroid pulse therapy or increased dosage of steroids. In contrast, if symptoms are caused by secondary CNS complications, it is possible to observe or treat these complications using symptomatic therapy. We examined whether quantitative cerebral blood flow (CBF) measured using cerebral perfusion single photon emission computed tomography (SPECT) can be used to differentiate CNS lupus from secondary CNS involvement.We divided 18 SLE patients with CNS symptoms into a CNS lupus group and a non-CNS lupus group, and then compared the mean cerebral blood flow (mCBF) of each group of patients. SPECT was performed with N-isopropyl-p-[¹²³I] iodoamphetamine (IMP), with quantitation carried out by table look-up and autoradiographic methods.The mCBF of both groups was decreased; however, the mCBF of patients with CNS lupus was significantly lower than that of non-CNS lupus patients.Quantitative CBF may provide a useful tool to distinguish CNS lupus from non-CNS lupus.

Keywords: Systemic lupus erythematosus (SLE); Central nervous system (CNS) lupus; N-isopropyl-p-[¹²³I] iodoamphetamine (¹²³I-IMP); Single photon emission computed tomography (SPECT); Mean cerebral blood flow (mCBF)

Comparison of gated blood pool SPECT and spiral multidetector computed tomography in the assessment of right ventricular functional parameters: validation with first-pass radionuclide angiography by Jung S. Lee; Jun S. Lee; Seong-Jang Kim; In-Ju Kim; Yong-Ki Kim; Ki S. Choo (pp. 159-166).

The aim of this study was to compare gated blood pool single photon emission computed tomography (SPECT) (GBPS) and multidetector row computed tomography (MDCT) for the determination of right ventricular ejection fraction (RVEF) and right ventricular volumes (RVV) and to compare first-pass radionuclide angiography (FP-RNA) as the gold standard.Twenty consecutive patients (11 men, 9 women) referred for MDCT for the evaluation of the presence of coronary artery disease underwent FP-RNA and GBPS.The mean right ventricular end-diastolic volume (EDV) calculated with GBPS revealed a statistically significant lower value than that of MDCT. The mean right ventricular end-systolic volume (ESV) calculated with GBPS was also lower than that of MDCT. A comparison of right ventricular EDV from GBPS and MDCT yielded a correlation coefficient of 0.5972. Right ventricular ESV between GBPS and MDCT showed a correlation coefficient of 0.5650. The mean RVEFs calculated with FP-RNA (39.8% ± 4.0%), GBPS (43.7% ± 6.9%), and MDCT (40.4% ± 7.7%) showed no statistical differences (Kruskal–Wallis statistics 4.538, P = 0.1034). A comparison of RVEFs from FP-RNA and GBPS yielded a correlation coefficient of 0.7251; RVEFs between FP-RNA and MDCT showed a correlation coefficient of 0.6166 and between GBPS and MDCT showed a correlation coefficient of 0.6367.The RVEF, EDV, and ESV calculated by GBPS had good correlation with those obtained with MDCT. In addition, there were no statistical differences of RVEF calculated from FP-RNA, GBPS, and MDCT. However, with regard to RVV, EDV and ESV from GBPS revealed statistically significantly lower values than those of MDCT. Although reasonable correlations among these modalities were obtained, the agreement among these three modalities was not good enough for interchangeable use in the clinical setting. Also, these results should be confirmed in patients with cardiac diseases in future larger population-based studies.

Keywords: Gated blood pool SPECT; Right ventricular ejection fraction; End-diastolic volume; End-systolic volume; MDCT

Bone scintigraphy as a prognostic indicator for bone collapse in the early phases of femoral head osteonecrosis by Irena Sedonja; Vladimir Jevtic; Metka Milcinski (pp. 167-173).

Destructive and reconstructive processes at the reactive interface in femoral head osteonecrosis (FHO) are not well defined or predictable. The objectives of our study were to analyze scintigraphic characteristics of the reactive interface in the early stages of FHO and to assess the prognostic value of the reactive interface on scintigraphy (SC).Thirty-six hips in 27 patients (21 men, 6 women; mean age 41 years, range 20–64 years) with a final diagnosis of radiographic stage 1 (4 hips) or stage 2 FHO (32 hips) were evaluated by planar and pinhole SC. Tracer uptake at the reactive interface on pinhole SC was assessed visually. Three categories were formed: normal, moderately increased, and highly increased activities. The time to head collapse was observed.Tracer uptake at the reactive interface was more frequently increased in hips with stage 2 of the disease than in those with stage 1. In hips with the same stage of the disease, different activities were detected [stage 1 FHO: moderately increased in 1 of 4 (25%) and highly increased in 1 of 4 (25%) hips; stage 2 FHO: moderately increased in 8 of 32 hips (25%) and highly increased in 20 of 32 (63%) hips]. Femoral heads with highly increased activity at the reactive interface collapsed more frequently and earlier: 13/15 conservatively treated hips in stage 2 collapsed in 1–6 months, whereas no hips with normal uptake at the reactive interface collapsed in 12 months follow-up and only one of six hips with moderately increased activity collapsed after 11.5 months (P < 0.05).Our results indicate that the tracer uptake at the reactive interface can be different in the same stage of FHO. High tracer uptake at the reactive interface in the early phases of FHO seems to be a bad prognostic sign for femoral head collapse.

Keywords: Femoral head osteonecrosis; Reactive interface; Bone scintigraphy; Magnetic resonance imaging

Respiratory lung motion analysis using a nonlinear motion correction technique for respiratory-gated lung perfusion SPECT images by Hidenori Ue; Hideaki Haneishi; Hideyuki Iwanaga; Kazuyoshi Suga (pp. 175-183).

This study evaluated the respiratory motion of lungs using a nonlinear motion correction technique for respiratory-gated single photon emission computed tomography (SPECT) images.The motion correction technique corrects the respiratory motion of the lungs nonlinearly between two-phase images obtained by respiratory-gated SPECT. The displacement vectors resulting from respiration can be computed at every location of the lungs. Respiratory lung motion analysis is carried out by calculating the mean value of the body axis component of the displacement vector in each of the 12 small regions into which the lungs were divided. In order to enable inter-patient comparison, the 12 mean values were normalized by the length of the lung region along the direction of the body axis.This method was applied to 25 Technetium (Tc)-99m-macroaggregated albumin (MAA) perfusion SPECT images, and motion analysis results were compared with the diagnostic results. It was confirmed that the respiratory lung motion reflects the ventilation function. A statistically significant difference in the amount of the respiratory lung motion was observed between the obstructive pulmonary diseases and other conditions, based on an unpaired Student's t test (P < 0.0001).A difference in the motion between normal lungs and lungs with a ventilation obstruction was detected by the proposed method. This method is effective for evaluating obstructive pulmonary diseases such as pulmonary emphysema and diffuse panbronchiolitis.

Keywords: Respiratory-gated imaging; Single photon emission computed tomography; Motion correction; Motion analysis

Tumor thrombus in the inferior vena cava from colon cancer detected by ¹⁸F-FDG-PET by Hayato Kaida; Masatoshi Ishibashi; Seiji Kurata; Masafumi Uchida; Naofumi Hayabuchi (pp. 185-188).

We present a case of inferior vena cava (IVC) tumor thrombus detected by fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET). A man underwent operations for the treatment of sigmoid colon cancer at the age of 63. Because tumor markers [carcinoembryonic antigen (CEA) and CA19-9] were increased at the age of 67, abdominal contrast-enhanced computed tomography (CT) was performed. CT revealed IVC dilatation, including a low-attenuation area. ¹⁸F-FDG-PET was performed to make the differential diagnosis between tumor thrombus and clot. ¹⁸F-FDG-PET showed that ¹⁸F-FDG had accumulated in the IVC region. We considered the IVC tumor thrombus because of the ¹⁸F-FDG uptake in the IVC region and the patient's clinical course. To our knowledge, there are a few reports concerning ¹⁸F-FDG-PET and IVC tumor thrombus. ¹⁸F-FDG-PET may be useful in diagnosing tumor thrombus.

Keywords: Fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG-PET); Tumor thrombus; Inferior vena cava; Colon cancer

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Annals of Nuclear Medicine (v.21, #3)

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Annals of Nuclear Medicine (v.21, #3)