Heart Region Of Interest Research Articles

Efficient Extraction of Coronary Artery Vessels from Computed Tomography Angiography Images Using ResUnet and Vesselness.

Accurate and efficient segmentation of coronary arteries from CTA images is crucial for diagnosing and treating cardiovascular diseases. This study proposes a structured approach that combines vesselness enhancement, heart region of interest (ROI) extraction, and the ResUNet deep learning method to accurately and efficiently extract coronary artery vessels. Vesselness enhancement and heart ROI extraction significantly improve the accuracy and efficiency of the segmentation process, while ResUNet enables the model to capture both local and global features. The proposed method outperformed other state-of-the-art methods, achieving a Dice similarity coefficient (DSC) of 0.867, a Recall of 0.881, and a Precision of 0.892. The exceptional results for segmenting coronary arteries from CTA images demonstrate the potential of this method to significantly contribute to accurate diagnosis and effective treatment of cardiovascular diseases.

Diabetes and heart disease identification using biomedical iris data

The World Health Organization (WHO) report shows that Heart disease is the major cause of death all over the world i.e. nearly 21.2 million people die every year directly or indirectly from Cardiovascular (Heart) diseases estimated 32% of all deaths worldwide. Whereas, Diabetes is at the ninth position for the death all over the world i.e. nearly 3.7 million people die every year from diabetes estimated 6.61% of all deaths worldwide. The Heart and Pancreas organ play a most important role in human being. The blood flows in all parts of the body through heart. The function of pancreas is to regulate maintain the insulin levels that is responsible for diabetes. The detection of heart disease and diabetes takes too much time and very costly process. In our research, we develop a Heart Disease and Diabetes Identification System based on Iris Healthcare Kiosk. We proposed a desktop system application that detects these diseases through the Iris. The process starts by taking the left Eye photograph of the patient's through Eyeronec (company name) camera and perform intermediates operations of target cropping, pre-processing, auto-cropping (through integral projection and removing sclera), heart regions of interest (ROI) measuring, pancreatic measuring, extracting the feature and finally classify in the result. The classification result shows that 83% tests are successful, 11% tests are scant whereas 6% tests became fail. The operation is performed on 32 different training digital data sets and final result is labelled as normal or abnormal. The result shows that accuracy of our proposed system in heart disease and diabetes are 86.36% and 90.91% respectively.

A post processing pipeline to prepare raw data for machine learning algorithms in cardiac magnetic resonance imaging

Abstract Funding Acknowledgements Type of funding sources: None. Background Artificial Intelligence is an emergent tool in clinical practice for post processing of medical images. Machine Learning (ML) pipelines are created for data of interest extraction and algorithm application. A common issue in data extraction is represented by noisy datasets, like those of CMR studies, characterized by multiple images, acquired by different techniques, axis orientation and contrast timing. Purpose A ML pipeline for extraction of LGE images from raw DICOM data is presented. Additionally, steps for normalization of image number and automatically heart localization are outlined. Methods and Results 642 consecutive CMR studies were analyzed. Pipeline, Part 1. By looking at the metadata in raw files, ‘SequenceName’ tag was used to discard cine images, ‘ScanningSequence’ tag to select Gradient Recall and Inversion Recovery techniques (Inversion Time > 100 ms), ‘SequenceVariant’ tag to discard Steady State images (See Fig. 1). Orientation of the major axis was computed and ‘Axial’ or ‘Coronal’ images removed. Scans were grouped together by image orientation (requesting a min and max number of elements per group) and only the group with the largest number of files was selected. Finally, DICOMs were grouped by image shape (demanding a min number of elements), and only the series with the highest resolution was retained. Then, for each subject, the extracted series consists of a 3D-array (N,H,W), with N number of slices, and (H,W) image resolution. The attributes were not homogeneous between subjects. Pipeline, Part 2. Given a desired final number of slices and resolution, the 3D-array was reshaped through a spline interpolation. In order to have a focus on the heart, a Region of Interest (ROI) extractor was implemented, based on a YOLO network for object detection. The network was applied on all the slices (Fig. 2); then the images were cropped by keeping the largest bounding box. This step allowed us to remove the background by only selecting the relevant ROIs. To manage the data more easily, images were saved as a NumPy Array, while other useful Dicom metadata (e.g. weight, age, …) were stored using the json standard. At the end of the ML pipeline, images can be reduced to a common resolution and forwarded to ML algorithms. By using this pipeline, a great amount of information not needed for LGE analysis can be discarded, granting a significant reduction in terms of data storage. In our series, the original dataset extended for about 200 GB; by requesting 10 slices per subject with a resolution of 128 by 128 pixels (also extracting heart ROI) the final dimension was reduced to 108 MB. Conclusions In this work, we presented a post-processing pipeline for CRM images and LGE analysis. Given in input raw CRM the pipeline is able to (i) remove unuseful data, (ii) extract heart ROIs storing also Dicom metadata, (iii) normalize slices and image resolution, and (iv) store the processed CRM into ready-format for ML techniques. Fig.1:Pipeline Schematic RepresentationFig.2:YOLO Heart Extraction

Nasal and Parotid Blood Pool Activity Is Significantly Correlated with Metabolic Syndrome Components and Sleep Apnea.

Background: Patients with metabolic syndrome components were frequently noted to have increased nasal and parotid activity on clinically referred scintigraphic whole-body blood pool scans. This increase in activity was not observed in patients without metabolic syndrome. Increased nasal blood pool activity in patients with elevated body mass indices (BMIs) has implications for (1) sleep apnea, (2) risk of nasal infection, and (3) possible impaired nasal lymphatic drainage of brain waste proteins. Methods: To follow-up this clinical observation, a retrospective study was performed on 200 patients having whole-body blood pool scans referred over a 3-year period. The whole-body blood pool scans were evaluated for an association between nose and parotid region of interest (ROI) to heart ROI maximum (max) pixel ratios as correlated with clinical conditions, including obesity, diabetes, hypertension, and sleep apnea. Continuous variables of BMI, hemoglobin A1c (HbA1c), blood glucose, and blood lipids were also correlated with these ratios. Results: A direct association of nose to heart max ratio (NHMR) with diabetes, sleep apnea, and hypertension was found with an increase in the ratio of +0.10 (P = 0.002), +0.13 (P = 0.0002), +0.08 (P = 0.0123), respectively. Correlation of NHMR with continuous variables had moderate correlation with BMI (r = 0.36, P < 0.0001), glucose (r = 0.27, P = 0.0001), HbA1c (r = 0.25, P = 0.0008) and less association with the number of diabetes medications (r = 0.22, P = 0.0021). Similar associations were found for parotid to heart max ratios but were weaker than the NHMR. Conclusions: Patients with metabolic syndrome components have significantly increased nasal and parotid activity on blood pool scans. These associations have implications for the treatment of sleep apnea, for nasal infections involving such agents as Covid-19, and for the risk of dementias related to decreased clearance of brain waste proteins through nasal turbinate lymphatics in patients with metabolic syndrome. If further studies support these findings, the nasal turbinates and the increased parasympathetic activity controlling their dilation could become a new therapeutic target.

Effect of Electrical Impedance Tomography-Guided Early Mobilization in Patients After Major Upper Abdominal Surgery: Protocol for a Prospective Cohort Study

Background: Pulmonary complications are common in patients after upper abdominal surgery, resulting in poor clinical outcomes and increased costs of hospitalization. Enhanced Recovery After Surgery Guidelines strongly recommend early mobilization post-operatively; however, the quality of the evidence is poor, and indicators for quantifying the effectiveness of early mobilization are lacking. This study will evaluate the effectiveness of early mobilization in patients undergoing an upper abdominal surgery using electrical impedance tomography (EIT). Specifically, we will use EIT to assess and compare the lung ventilation distribution among various regions of interest (ROI) before and after mobilization in this patient population. Additionally, we will assess the temporal differences in the distribution of ventilation in various ROI during mobilization in an effort to develop personalized activity programs for this patient population.Methods: In this prospective, single-center cohort study, we aim to recruit 50 patients after upper abdominal surgery between July 1, 2021 and June 30, 2022. This study will use EIT to quantify the ventilation distribution among different ROI. On post-operative day 1, the nurses will assist the patient to sit on the chair beside the bed. Patient's heart rate, blood pressure, oxygen saturation, respiratory rate, and ROI 1-4 will be recorded before the mobilization as baseline. These data will be recorded again at 15, 30, 60, 90, and 120 min after mobilization, and the changes in vital signs and ROI 1-4 values at each time point before and after mobilization will be compared.Ethics and Dissemination: The study protocol has been approved by the Institutional Review Board of Liaocheng Cardiac Hospital (2020036). The trial is registered at chictr.org.cn with identifier ChiCTR2100042877, registered on January 31, 2021. The results of the study will be presented at relevant national and international conferences and submitted to international peer-reviewed journals. There are no plans to communicate results specifically to participants. Important protocol modifications, such as changes to eligibility criteria, outcomes, or analyses, will be communicated to all relevant parties (including investigators, Institutional Review Board, trial participants, trial registries, journals, and regulators) as needed via email or in-person communication.

Uptake Index of 123I-metaiodobenzylguanidine Myocardial Scintigraphy for Diagnosing Lewy Body Disease.

Objective(s):Iodine-123 metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy has been used to evaluate cardiac sympathetic denervation in Lewy body disease (LBD), including Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). The heart-to-mediastinum ratio (H/M) in PD and DLB is significantly lower than that in Parkinson’s plus syndromes and Alzheimer’s disease. Although this ratio is useful for distinguishing LBD from non-LBD, it fluctuates depending on the system performance of the gamma cameras. Therefore, a new, simple quantification method using 123I-MIBG uptake analysis is required for clinical study. The purpose of this study was to develop a new uptake index with a simple protocol to determine 123I-MIBG uptake on planar images.Methods:The 123I-MIBG input function was obtained from the input counts of the pulmonary artery (PA), which were assessed by analyzing the PA time-activity curves. The heart region of interest used for determining the H/M was used for calculating the uptake index, which was obtained by dividing the heart count by the input count.Results:Forty-eight patients underwent 123I-MIBG chest angiography and planar imaging, after clinical feature assessment and tracer injection. The H/M and 123I-MIBG uptake index were calculated and correlated with clinical features. Values for LBD were significantly lower than those for non-LBD in all analyses (P<0.001). The overlapping ranges between non-LBD and LBD were 2.15 to 2.49 in the H/M method, and 1.04 to 1.22% in the uptake index method. The diagnostic accuracy of the uptake index (area under the curve (AUC), 0.98; sensitivity, 96%; specificity, 91%; positive predictive value (PPV), 90%; negative predictive value (NPV), 93%; and accuracy, 92%) was approximately equal to that of the H/M (AUC, 0.95; sensitivity, 93%; specificity, 91%; PPV, 90%; NPV, 93%; and accuracy, 92%) for discriminating patients with LBD and non-LBD.Conclusion:A simple uptake index method was developed using 123I-MIBG planar imaging and the input counts determined by analyzing chest radioisotope angiography images of the PA. The diagnostic accuracy of the uptake index was approximately equal to that of the H/M for discriminating patients with LBD and non-LBD.

EVALUATION OF THYROID TO BACKGROUND RATIOS AND COMPARISON OF VARIOUS SCINTIGRAPHIC MEASUREMENTS AND THEIR CORRELATION TO SERUM T4 IN HYPERTHYROID CATS.

Thyroid-to-salivary ratio and percent dose uptake are the most widely recognized scintigraphic measurements. Recently, the thyroid-to-background ratio has been proposed as an alternate method. However, this method has not been validated. The purpose of this observational, cross-sectional, prospective study was to determine the location of a background region of interest (ROI) that is most reflective of blood pool activity. We also hypothesized that the thyroid-to-background ratio using this background ROI would be a better predictor of thyroid function. Fifty-six cats presented to the Virginia-Maryland College of Veterinary Medicine seeking radioiodine therapy for hyperthyroidism were enrolled in this cross-sectional study to evaluating thyroid-to-background ratio. A blood sample for measuring plasma radioactivity was collected at the time of scintigraphy. The plasma radioactivity was compared to the background ROIs in eight anatomic regions. Scintigraphic measures of thyroid-to-background and thyroid-to-salivary ratios, and percent dose were then compared to serum T4 . The heart ROI was most closely correlated with plasma pertechnetate activity (r = 0.70). Percent dose uptake was most closely correlated with serum T4 (r = 0.74), followed by thyroid-to-salivary ratio (r = 0.66) and thyroid-to-background ratio using the heart ROI (r = 0.59). Thyroid-to-background ratio using the heart background ROI is a good predictor T4 but percent dose uptake and thyroid-to-salivary ratio proved to be better predictors of T4 than any of the thyroid-to-background ratios.

Evaluation of liver perfusion in diabetic patients using 99mTc-sestamibi

The liver is an important organ for various aspects of glucose metabolism, including glucose uptake, storage, and synthesis. It is a major organ in the metabolic process with perfusion provided by both the portal vein and hepatic artery. In diabetic patients organ perfusion is reduced and this is linked to atherosclerosis, and as a result complications occur. In this study, we aimed to evaluate liver perfusion by scintigraphic methods in diabetic patients. We retrospectively investigated 1,100 myocardial perfusion scintigraphies taken between January 2011 and December 2012 at Canakkale Onsekiz Mart University Medical Faculty Nuclear Medicine Department. A total of 66 patients who were diagnosed with diabetes mellitus and had myocardial perfusion scintigraphies were included in the study. The control subjects included 127 patients without diabetes mellitus who were chosen at random. Patients with chronic liver disease were not included in the study. The values from liver regions of interest (liver-ROI) rates and heart regions of interest (heart-ROI) rates were compared between the patients and controls. Patients were grouped according to the presence of diabetes. In the diabetes mellitus group, the liver-ROI average was lower (p = 0.66) than in the controls. In the control group, the average liver-ROI/heart-ROI ratios were higher than the ratio in the diabetes mellitus group (p = 0.019). Multivariate variance analysis showed that the diabetes mellitus liver-ROI/heart-ROI ratio was independent of other risk factors (p = 0.003; F: 9.6). Powered by Editorial Manager(®) and ProduXion Manager(®) from Aries Systems Corporation. This study shows that liver perfusion in diabetic patients is reduced compared with those without diabetes. Prospective studies with larger patient groups are required.

Validation of an optimal analysis method and reproducibility to calculate the heart-to-mediastinum ratio and washout rate in the iodine-123-labeled metaiodobenzylguanidine myocardial scintigraphy

The aim of this study was to investigate an appropriate analysis method and multicenter reproducibility of heart-to-mediastinum ratio (H/M) and washout rate (WR) in iodine-123-labeled metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy with a phantom. We evaluated the optimal region of interest (ROI) setting method about the mediastinum and heart by varying the position and shape of the ROI. The mathematical method was changed to a combination of decay time correction (DTC) and background correction (BC). We evaluated the reproducibility of the H/M and WR between institutions. H/M decreased to 23.49% and WR increased to 20.68% by changing the mediastinum ROI position from upper to lower. H/M increased to 26.03% by changing the heart ROI position from base to apex. H/M decreased to 38.36% with BC, and WR was reduced up to 48.51% with DTC. Reproducibility of the H/M and WR between institutions was improved by performing optimization of the ROI setting and unification of the mathematical method. The position of the mediastinum ROI should be set on the upper mediastinum. The position of the heart ROI should be set on the apex of the heart. WR should be calculated with DTC and BC. Our results suggest that the reproducibility of the H/M and WR between institutions was improved by performing optimization of the ROI setting and unification of the mathematical method.

Improved reproducibility of simple quantitative indices from 99mTc-GSA liver functional imaging

ObjectiveWe evaluated intra- and interoperator reproducibilities in calculating the conventional indices HH15 and LHL15 from 99mTc-diethylenetriamine pentaacetic acid galactosyl human serum albumin (99mTc-GSA) scintigraphy, and proposed new, simple methods for the calculation of quantitative indices.MethodsThe results of 99mTc-GSA scintigraphy in 33 patients were retrospectively analyzed. Heart and liver ROIs were drawn manually to cover cardiac blood pool and entire liver, respectively, and HH15 and LHL15 were calculated. In addition, square regions of interest (ROIs) of fixed sizes were placed at the highest activity in blood pool and the liver. Using the square heart ROI, sHH15, an equivalent of HH15, was computed. Fractional liver uptake at 15 min (FLU15) was calculated using the square heart and liver ROIs. Intra- and interoperator reproducibilities, as well as correlation with Indocyanine green retention rate at 15 min (ICG R15), were assessed for these four indices by linear regression analysis.ResultsSubstantial intra- and interoperator variabilities were found for HH15 and LHL15. The correlation coefficients for intra- and interoperator comparisons were 0.884 and 0.869 for HH15, respectively, and 0.919 and 0.917 for LHL15, respectively. The use of square ROIs instead of hand-drawn ROIs improved reproducibility. The correlation coefficients for intra- and interoperator comparisons were 0.988 and 0.973 for sHH15, respectively, and 0.989 and 0.975 for FLU15, respectively. Correlation with ICG R15 was better for sHH15 (r = 0.619) and FLU15 (r = −0.656) than for HH15 (r = 0.439) and LHL15 (r = −0.490).ConclusionsHH15 and LHL15 showed substantial intra- and interoperator variabilities, and the use of square ROIs are indicated to provide better reproducibility.

Influence of myocardial region of interest definition on quantitative analysis of planar 123I-mIBG images

In planar (123)I-mIBG myocardial imaging, definition of the heart region of interest (ROI) is a critical step in quantifying uptake. The present study evaluated the impact of changes in heart ROI size on quantitative results in subjects with good and poor uptake. Reference irregular whole-heart and square upper mediastinum ROIs were defined visually on 531 planar (123)I-mIBG images. Based on the reference heart ROI, an automated program created two other ROIs: one larger (+1 pixel) and one smaller (-1 pixel), the stated numbers representing the spacing intervals between each epicardial boundary pixel. Two additional smaller ROIs (-2 and -3 pixels) were drawn for the 100 images (19%) with a heart/mediastinum (H/M) ratio ≤1.30. The number of pixels, the counts per pixel, and the H/M ratio for each heart ROI were calculated and compared to that in the reference ROI. Washout rate and changes as a function of ROI size were also calculated for 110 subjects who had both early and late images. The mean changes in heart ROI size ranged from +19.0% for the +1 pixel to -44.4% for the -3 pixels ROI. For the +1 and -1 pixel ROIs, mean relative counts per pixel changes were -1.2% and +0.7%, respectively, with corresponding ranges of change in the H/M ratio of -0.12 to +0.05 and -0.05 to +0.11. For scans with H/M ratio ≤1.30, mean relative counts per pixel changes were 0, 0, -0.7%, and -1.4% for the four ROIs, with range of change in the H/M ratio from -0.13 to +0.05. Mean washout rates were almost identical for the reference ROIs (45.0%) and the +1 pixel and -1 pixel heart ROIs (44.9% and 45.1%, respectively). Significant changes in the size of the best visually defined heart ROI produce minimal, clinically inconsequential changes in the H/M ratio and washout rate, even in subjects with significantly reduced myocardial uptake of (123)I-mIBG.

Letter to the Editor: Interobserver Variability of Heart-to-Mediastinum Ratio in I-123 MIBG Sympathetic Imaging

To the Editor: With great interest we read the article by Chen et al. regarding factors that affect heart-to-mediastinal ratio (H/M ratio) in I-123 meta-iodobenzylguanidine (MIBG) cardiac sympathetic imaging [1]. The authors describe the variation of H/M ratio among institutions and the factors that contribute to this. Furthermore, they provide different protocols that could minimize this variation. One of the significant contributors to the variation of H/M ratio in cardiac imaging, are the settings of the regions of interest (ROIs) that are used. Currently, as correctly described by Chen et al. [1, 2], there are three main approaches for drawing the heart ROI. One is to place the ROI over the whole heart, thereby neglecting the “dilution” effect in patients with a dilated heart (ie, lower blood pool activity in the cavity than the myocardium) but resulting in high reproducibility [1, 3]. The second approach is to place the ROI along the left ventricular (LV) wall, inter alia described by Gerson et al. [4], which possibly leads to greater inter- and intraobserver bias [1]. In the third approach a smaller ROI is placed along the anterior part of the LV wall [2]. In our current ongoing study in pediatric patients by van der Palen et al.., we compared both approaches described by Chen et al. (ie, the “whole heart ROI” and the “small anterior wall ROI”). The reason for comparing those instead of the “LV wall ROI” by Gerson et al. is twofold: possible comparison of our results with Chen’s references and potential inaccurate placement of an ROI along the complete LV wall in small pediatric hearts (ie, the child’s heart is often too small for exact placement over the LV wall). Several studies in pediatric cardiology also use this approach [5, 6]. When studying the subsequently calculated H/M ratios we noticed that the interobserver variability when using these methods of ROI placement was only minor, when H/M ratios were obtained independently by two observers at 4 and 24 h post injection in our population of 30 pediatric patients. Intraclass correlation coefficients (ICCs) were as follows: for the small anterior wall ROI H/M ratio 0.882 (95 % CI: 0.578–0.956) and for the whole heart ROI H/M ratio 0.955 (95 % CI: 0.904–0.979) at 4 h. At 24 h, the ICC was 0.911 (95 % CI: 0.716–0.965) for the small anterior wall ROI H/M ratio and 0.951 (95 % CI: 0.896–0.977) for the whole heart ROI H/M ratio. Therefore, it can be concluded that the use of both ROI definition methods in children results in substantial to almost perfect interobserver agreement concerning H/M ratio. Furthermore, this suggests that whole H/M ratio has better agreement than small H/M ratio for both 4 and 24 h post injection scans. Besides, both methods also showed a high within-patient ICC ratio of 0.865. This implies that intrapatient variability is fairly small and both methods give almost identical results. Although the ICCs of both methods of ROI placement are rather similar, the most promising method is the whole H/M ratio 4 h post injection. To reduce differences in H/M ratios due to interobserver variability the method of ROI placement should be standardized, and it is reasonable to define this method as the gold standard for H/M ratio measurement. However, as stated in the article by Chen et al. [1], this method could underestimate the H/M ratio in patients with a dilated heart (being the target population in the article by Chen et al.) and a relatively high negative contribution of the myocardial cavity. This, however, has no impact on our population, which does not contain patients with cardiomyopathy. Small anterior wall H/M ratios do not have this disadvantage and showed adequate intraobserver agreement. Therefore, we can conclude that the best method to determinate the H/M ratio in cardiac sympathetic imaging depends on the patient characteristics of the study group. In pediatric patients we recommend the use of the whole heart H/M ratio, since it shows the best intraobserver agreement. With Chen we would like to emphasize the importance to standardize ROI placement methods to compare study results and minimize the intrapatient, interpatient, and interinstitutional variation.

Reply to the letter by Ben F. Bulten et al. regarding “Interobserver Variability of Heart-to-Mediastinum Ratio in I-123 MIBG Sympathetic Imaging”

We appreciate the favorable remarks by Dr. Bulten et al. regarding our article and proposed approaches for drawing region of interest (ROI) when computing heart-tomediastinal ratio (H/M ratio) in MIBG cardiac sympathetic imaging [1, 2]. The authors applied two of our proposed approaches (the “whole heart ROI” and the “small anterior wall ROI”) in 30 pediatric patients at their own institution, and verified that the use of both ROI definition methods in children provided an almost perfect interobserver agreement concerning H/M ratio. In addition, they found very high intraclass correlation coefficients (ICCs) for both methods, although the “whole heart ROI” approach was better, and the within-patient ICC ratio was 0.865. We concur with the suggestion that before selecting an approach for determining H/M ratio in MIBG sympathetic imaging, it is important to consider the patient population studied. In pediatric patients, for example, in view of their relatively small heart size, the “whole heart ROI” is the preferred method. On the other hand, in adult patients with heart failure and dilated left ventricular cavity, the “whole heart ROI” method may underestimate the H/M ratio due to the relatively high negative contribution of the myocardial cavity [1]. In the future, standardization of ROI placement methods should be an integral component of procedure guidelines for both adult and pediatric populations. Thank you, Wengen Chen, MD, PhD, Qi Cao, MD, PhD, and Vasken Dilsizian, MD

SPECT 심근영상의 영상분할을 이용한 3차원 재구성

심근영상의 SPECT(Single Photon Emission Computed tomography)검사는 감마선을 방출하는 방사성의약품을 환자에게 정맥주사한 후 이 의약품이 심장에 고루 퍼지면 관심부위를 촬영하여 질병으로 인한 변화를 컴퓨터를 이용하여 진단하는 검사법이다. 기능적인 정보를 담고 있는 심근관류 영상은 비침습적인 심근질환 검사에 유용한 방법이지만, 물리적 인자들에 의해 잡음과 낮은 해상도는 판도하는데 어려움을 주게 된다. 본 논문은 심근영상을 레벨 셋 알고리즘을 이용하여 영상을 분할하고 분할된 영역을 3차원으로 구현하여 판독에 도움을 주는 방안을 제안하였다. 판독의 어려움을 해결하기 위하여 레벨 셋을 이용하여 관심부위인 좌심실 영역을 분할하였고 분할된 영역을 3차원영상으로 모델링 하였다. Myocardial imaging in SPECT (Single Photon Emission Computed tomography) scan of the gamma-ray emitting radiopharmaceuticals to patients after intravenous radiopharmaceuticals evenly spread in the heart region of interest by recording changes in the disease caused by a computer using the PSA test is to diagnose. Containing information on the functional myocardial perfusion imaging is a useful way to examine non-invasive heart disease, but the argument by noise and low resolution of the physical landscape that is difficult to give. For this paper, the level of myocardial imaging by using the three algorithms to split the video into 3-D implementation of the partitioned area to help you read the proposed plan. To solve the difficulty of reading level, interest in using the sheet set, partitioned area of the left ventricle was ranked the partitioned area was modeled as a 3-D images.

Evaluation of 99 mTcN-MPO as a New Myocardial Perfusion Imaging Agent in Normal Dogs and in an Acute Myocardial Infarction Canine Model: Comparison with 99 mTc-Sestamibi

(99) (m)TcN-MPO ([(99) (m)TcN(mpo)(PNP5)](+): mpo = 2-mercaptopyridine oxide and PNP5 = N-ethoxyethyl-N,N-bis[2-(bis(3-methoxypropyl)phosphino)ethyl]amine) is a cationic (99) (m)Tc-nitrido complex, which has favorable biodistribution and myocardial uptake with rapid liver clearance in Sprague Dawley rats. The objective of this study was to compare the biodistribution and pharmacokinetics of (99) (m)TcN-MPO and (99) (m)Tc-Sestamibi in normal dogs, and to evaluate the potential of (99) (m)TcN-MPO as a myocardial perfusion agent in canines with acute myocardial infarction. Five normal mongrel dogs were injected intravenously with (99) (m)TcN-MPO. Venous blood samples were collected via a femoral vein catheter at 0.5, 1, 2, 3, 4, 5, 10, 20, 30, 40, 60, and 90 min post-injection (p.i.). Anterior-posterior planar images were acquired by γ-camera at 10, 20, 30, 60, 90, and 120 min p.i. Regions of interest (ROIs) were drawn around the heart, liver, and lungs. The heart/liver and heart/lung ratios were calculated by dividing the mean counts in heart ROI by the mean counts in the liver and lung ROI, respectively. For comparison, (99) (m)Tc-sestamibi was also evaluated in the same five dogs. The interval period between the two examinations was 1 week to eliminate possible interference between these two radiotracers. In addition, single positron emission computed tomography (SPECT) images in the canine infarct model were collected 24 h after myocardial infarction at 30 and 60 min after the administration of (99) (m)TcN-MPO (n = 4) or (99) (m)Tc-Sestamibi (n = 4). It was found that (99) (m)TcN-MPO and (99) (m)Tc-Sestamibi displayed very similar blood clearance characteristics during the first 90 min p.i. Both (99) (m)TcN-MPO and (99) (m)Tc-Sestamibi had a rapid blood clearance with less than 50% of initial radioactivity remaining at 1 min and less than 5% at 30 min p.i. (99) (m)TcN-MPO and (99) (m)Tc-Sestamibi both showed good heart/lung contrast. The heart/liver ratio of (99) (m)TcN-MPO increased with time (0.53 ± 0.06 at 10 min, 0.90 ± 0.062 at 30 min, and 1.22 ± 0.06 at 60 min p.i.), whereas the heart/liver ratio of (99) (m)Tc-Sestamibi remained low at all time points (0.50 ± 0.03 at 10 min, 0.64 ± 0.03 at 30 min, and 0.60 ± 0.02 at 60 min p.i.). SPECT imaging studies in canines with acute myocardial infarction indicated that good visualization of the left ventricular wall and perfusion defects could be achieved at 30 min after administration of (99) (m)TcN-MPO but not after (99) (m)Tc-Sestamibi. The combination of reasonable heart uptake with rapid hepatobiliary excretion makes (99) (m)TcN-MPO a promising new radiotracer for myocardial perfusion imaging.

Evaluation of 99mTcN-15C5 as a new myocardial perfusion imaging agent in normal dogs and canines with coronary stenosis

This study was designed to evaluate the biodistribution and blood clearance characteristics of 99mTcN-15C5 and its potential as a myocardial perfusion radiotracer. Five normal mongrel dogs were injected with 99mTcN-15C5 intravenously. Blood samples were collected at 0.5, 1, 2, 3, 4, 5, 10, 15, and 30 min postinjection (p.i.). Anterior planar images were acquired at 5, 15, 30, 60, 90, and 120 min p.i. Regions of interest (ROIs) were drawn around heart, liver, and lungs. The raw activity in each ROI was expressed as counts/pixel/min. Heart/liver and heart/lung ratios were calculated by dividing the mean counts in heart ROI by the mean counts in liver and lung ROI, respectively. For comparison, 99mTc-sestamibi was also evaluated in the same five dogs. In dogs with coronary stenoses, single photon emission computed tomography images were acquired at 30, 60, and 120 min after administration of 99mTcN-15C5 with/without adenosine. 99mTcN-15C5 and 99mTc-sestamibi had very similar blood clearance characteristics during the first 30 min p.i. The heart/liver ratio of 99mTcN-15C5 increased from 0.48+/-0.05 at 5 min p.i. to 1.85+/-0.11 at 120 min p.i., whereas the heart/liver ratio of 99mTc-sestamibi was improved only slightly from 0.45+/-0.04 at 5 min p.i. to 0.74+/-0.15 at 120 min p.i. SPECT imaging studies in canines with coronary stenoses indicated that good visualization of the perfusion defect could be achieved at 30 min after administration of 99mTcN-15C5 with the adenosine stress. The combination of high heart uptake and rapid liver clearance makes 99mTcN-15C5 a promising new radiotracer for myocardial perfusion imaging.

Clinical need for both scintigraphy with technetium-99m GSA and per-rectal portal scintigraphy in some patients with chronic liver disease.

Scintigraphy with 99mTc-diethylenetriaminepentaacetate with galactosyl human serum albumin (99mTc-GSA) and per-rectal portal scintigraphy are useful for evaluating hepatic functional reserve and portal circulation, respectively. We did the procedures simultaneously in some patients to examine the relationship between hepatic functional reserve and portal circulation in chronic liver disease. Scintigraphy with 99mTc-GSA was done in 10 healthy subjects, 45 patients with chronic hepatitis, and 165 patients with cirrhosis. Fifty-seven patients (13 with hepatitis and 44 with cirrhosis) also underwent per-rectal portal scintigraphy with 99mTc-pertechnetate within two weeks. A receptor index was calculated by dividing the radioactivity of the liver region of interest (ROI) by that of the liver-plus-heart ROI at 15 min after the injection of 99mTc-GSA. The index of blood clearance was calculated by dividing the radioactivity of the heart ROI at 15 min by that of the heart ROI at 3 min. A solution containing 99mTc-pertechnetate was instilled into the rectum, and serial scintigrams were taken while radioactivity curves for the liver and heart were recorded sequentially. A per-rectal portal shunt index was determined by calculating the ratio of counts for the liver to counts for the heart integrated for 24 seconds immediately after the appearance of the liver time-activity curve. The median receptor index was lower for more severe liver disorders, increasing in the order of chronic hepatitis, compensated cirrhosis and decompensated cirrhosis, and the median index of blood clearance was higher. The median receptor index was significantly lower when a complication (varices, ascites, or encephalopathy) was present, and the median index of blood clearance was higher. The shunt index was correlated significantly with the two other indices, but these values for some one-third of the patients disagreed in either indices. Scintigraphy with 99mTc-GSA and per-rectal portal scintigraphy with 99mTc-pertechnetate are both needed for accurate assessment of the severity of chronic liver disease before treatment-making decisions, because in some patients, results are not correlated.

Use of scintigraphy with 99mtechnetium galactosyl human serum albumin for staging of primary biliary cirrhosis and assessment of prognosis.

Conventional models for prediction of survival in patients with primary biliary cirrhosis (PBC) are based on the results of blood tests and on the clinical condition, which may be affected by treatment. We evaluated the usefulness of hepatic receptor imaging with [99mtechnetium]-diethylenetriaminepentaacetic acid galactosyl human serum albumin (GSA) for the staging and prognosis of PBC without the need for reference to laboratory test results. The subjects were 45 patients with PBC, 10 healthy subjects, 62 patients with chronic hepatitis and 144 patients with cirrhosis. Computer acquisition of gamma-camera data was started just before the injection of 185 MBq [99mTc]-GSA and was stopped 20 min later. Time-activity curves were generated from regions of interest (ROI) for the heart and liver. A receptor index was calculated by dividing the radioactivity of the liver ROI by that of the liver-plus-heart ROI 15 min after the injection. An index of blood clearance was calculated by dividing the radioactivity of the heart ROI 15 min after the injection by that of the heart ROI 3 min after the injection. The median receptor index was higher in patients with PBC than in those with cirrhosis. Among patients with PBC, the receptor index was lower in those with stage IV disease than in those in stages I, II or III. The index of blood clearance was lower in patients with PBC than in those with cirrhosis. Among patients with PBC, the index of blood clearance was higher in those with stage IV disease than in those in stages I, II or III. The receptor index was correlated significantly both to the risk score of the Mayo model and to the prognostic index of the Japanese model. The index of blood clearance was also correlated significantly to this score and prognostic index. Hepatic receptor imaging with [99mTc]-GSA is useful for the evaluation of hepatic functional reserve, staging of PBC and assessment of prognosis.

Use of scintigraphy with 99mtechnetium galactosyl human serum albumin for staging of primary biliary cirrhosis and assessment of prognosis

Abstract Background : Conventional models for prediction of survival in patients with primary biliary cirrhosis (PBC) are based on the results of blood tests and on the clinical condition, which may be affected by treatment. We evaluated the usefulness of hepatic receptor imaging with [99mtechnetium]‐diethylenetriaminepentaacetic acid galactosyl human serum albumin (GSA) for the staging and prognosis of PBC without the need for reference to laboratory test results. Methods : The subjects were 45 patients with PBC, 10 healthy subjects, 62 patients with chronic hepatitis and 144 patients with cirrhosis. Computer acquisition of gamma‐camera data was started just before the injection of 185 MBq [99mTc]‐GSA and was stopped 20 min later. Time–activity curves were generated from regions of interest (ROI) for the heart and liver. A receptor index was calculated by dividing the radioactivity of the liver ROI by that of the liver‐plus‐heart ROI 15 min after the injection. An index of blood clearance was calculated by dividing the radioactivity of the heart ROI 15 min after the injection by that of the heart ROI 3 min after the injection. Results : The median receptor index was higher in patients with PBC than in those with cirrhosis. Among patients with PBC, the receptor index was lower in those with stage IV disease than in those in stages I, II or III. The index of blood clearance was lower in patients with PBC than in those with cirrhosis. Among patients with PBC, the index of blood clearance was higher in those with stage IV disease than in those in stages I, II or III. The receptor index was correlated significantly both to the risk score of the Mayo model and to the prognostic index of the Japanese model. The index of blood clearance was also correlated significantly to this score and prognostic index. Conclusions : Hepatic receptor imaging with [99mTc]‐GSA is useful for the evaluation of hepatic functional reserve, staging of PBC and assessment of prognosis.© 1999 Blackwell Science Asia Pty Ltd

A simplified method for the quantitative analysis of 99Tc(m)-GSA liver scintigraphy using spectral analysis.

The aim of this study was to develop a simplified method for quantitative analysis of liver scintigraphy with 99Tc(m)-diethylenetriamine pentaacetic acid-galactosyl-human serum albumin (GSA) using spectral analysis. Dynamic liver scintigraphy using GSA was performed in three normal volunteers and 19 patients with chronic liver disease. Dynamic data were obtained with a gamma camera for 30 min after the injection of approximately 185 MBq GSA. The rate constant for the liver uptake of GSA from the blood (Ku, min(-1)), total excretion rate (Ke, min(-1)) and non-specific volume of distribution (Vh) were obtained by spectral analysis. Vh was defined as the volume in the liver region of interest (ROI) occupied by GSA which was in equilibrium with that in the blood. It should be noted that Vh had no units, since the counts in both the liver and heart ROIs were normalized by scan length to obtain counts pixel(-1) min(-). For comparison, compartmental analysis was also performed. A receptor index (LHL15) was calculated by dividing the radioactivity of the liver ROI by that of the liver plus heart ROIs 15 min post-injection. The Ku values obtained by spectral analysis (y) agreed well with those obtained by compartmental analysis (x) (y = 0.953x - 0.013, r = 0.992, S.E.E. = 0.016 min(-1)). The Ke and Vh values obtained by spectral analysis (y) correlated significantly with those obtained by compartmental analysis (x) (y = 1.149x - 0.016, r = 0.826, S.E.E. = 0.017 min(-1) for Ke; y = 1.191x + 0.044, r = 0.975, S.E.E. = 0.021 for Vh). The Ku values obtained by spectral analysis decreased as the severity of liver disease progressed, and were non-linearly related to the LHL15 values, suggesting that Ku is more sensitive to liver damage than LHL15, especially in the early stages of liver damage. These results suggest that spectral analysis applied to dynamic liver scintigraphy with GSA provides a simple, non-invasive and useful tool for the quantitative evaluation of liver function.