Radioisotope Angiography Research Articles

Development of an 123I-metaiodobenzylguanidine Myocardial Three-Dimensional Quantification Method for the Diagnosis of Lewy Body Disease.

Objective(s):We recently developed a new uptake index method for 123I-metaiodobenzylguanidine (123I-MIBG) heart uptake measurements by using planar images (radioisotope angiography and planar image) for the diagnosis of Lewy body disease (LBD), including Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). However, the diagnostic accuracy of the uptake index was approximately equal to that of the heart-to-mediastinum ratio (H/M) for the discrimination of the LBD and non-LBD patients. A simple and pain-free uptake index method using 123I-MIBG SPECT images by modifying the uptake index method may show better diagnostic accuracy than the planar uptake index method. We hypothesized that the development of a new uptake index method for the determination of 123I-MIBG using single-photon emission computed tomography (SPECT) imaging would provide a reliable and reproducible diagnostic tool for clinical application. Regarding this, the purpose of this study was to develop a new uptake index method with a simple protocol to determine 123I-MIBG uptake on SPECT.Methods:The 123I-MIBG input function was determined from the input counts of the pulmonary artery, assessed by analyzing the pulmonary artery time-activity curves. The 123I-MIBG output function was obtained from 123I-MIBG SPECT counts on the polar map. The uptake index was calculated through dividing the output function by the input function (SPECT uptake method). For the purpose of the study, 77 patients underwent 123I-MIBG SPECT, with an average of 31.5 min after clinical assessment and injection of the tracer. The H/M values, as well as planar and SPECT uptake indices were calculated, and then correlated with clinical features. Results:According to the results, values obtained for LBD were significantly lower than those for non-LBD in all analyses (P<0.01). The overlap of the H/M values between the LBD and non-LBD cases ranged from 2.06 to 2.50. Furthermore, the overlap in uptake index values between LBD and non-LBD cases in planar image analysis was 1.05-1.29. The SPECT uptake index method showed the least overlap of 1.23-1.25, with the highest value for LBD patients clearly distinguished from the lowest value for the non-LBD patients.Conclusion:The new 123I-MIBG SPECT quantification method, developed by the input counts of the pulmonary artery, clearly distinguished LBD from non-LBD. Therefore, this method may be appropriate for routine clinical study.

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.

New Regression Equation for 123I-IMP Non-invasive Cerebral Blood Flow Measurement Using the Graph Plot Method.

A graph plot (GP) method using 123I-N-isopropyl-p-iodoamphetamine (123I-IMP) has been proposed as a simple and non-invasive estimation of quantitative cerebral bloodflow (CBF). A regression equation for the GP method was estimated by the data of resting state. Therefore, the accuracy of CBF values in high flow range may be an underestimated possibility in this method.The aim of this study was to formulate a new regression equation for the GP method by the data of resting state and acetazolamide (ACZ) challenge, and to clarify the accuracy of it. The images of 26 consecutive patients who underwent both 123I-IMP chest radioisotope-angiography (RIA) and single photon emission computed tomography (SPECT) examinations were used to construct the new regression equation. Examinations of the resting state and ACZ challenge were performed in different days. All patients were analyzed by both the GP method and autoradiography (ARG) method which is the conventional examination with the one-point arterial blood sampling. A linear regression equation between the index of the input function was obtained by the GP method and CBF value of ARG. The linear regression equation based on the resting data was compared with the equation based on the resting and ACZ challenge (rest+stress) data. Goodliner correlation was obtained between the index of the input function obtained by the GP method and CBF value of the ARG method in the rest+stress state (y=2.75x+15.1, r=0.78). In contrast, correlation results between the index of the input function obtained by the GP method and CBF value of the ARG method in the resting state was expressed as y=2.28x+18.4, r=0.54 rCBF values based on the resting data was 20% underestimated in the high flow range compared with values based on the rest+stress data. The new linear regression equation for the GP method is useful for clinical study. Key words: non-invasive cerebral blood flow measurement method, graph plot (GP), autoradiography (ARG), 123I-N-isopropyl-p-iodoamphetamine (123I-IMP).

頬粘膜癌術後に続発した急性出血性直腸潰ようの１例

A 65-year-old man visited our hospital on November 8, 2000 because of pain in the right cheek mucosa. He had diabetes mellitus and hypertension and was a carrier of hepatitis B virus. After excision of the tumor, right conservative neck dissection and microvascular reconstruction with a free rectus abdominis muscle flap, he received ventilatory assistance for 3 days. He was given antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs) for postoperative pneumonia and a wound infection. On 17th postoperative day, the hemoglobin level suddenly decreased from 9.5g/dl to 8.0g/dl over the course of 2 days. Gastrointestinal examination showed no bleeding points. A new episode of massive bleeding occurred on the 21st day. The bleeding point could not be identified by colonoscopicexamination, radioisotope angiography, or angiography of the artery. However, a wide shallow ulcer of the rectum was finally found 2cm from the anal verge on another colonoscopic examination on the 28th day. The AHRU in this patient might have been caused by postoperative stress, a large dose of NSAIDs, underlying disease, or a combination of these factors.

A case of pulmonary arteriovenous fistula in which venous air embolism during cesarean section may have caused postoperative subendocardial infarction

The patient was a 30-year-old woman in her 38th week of pregnancy, who was 156cm tall and weighed 58kg. She had shown cyanosis since 6 years of age. At the age of 8, dyspnea on exertion developed, and cardiac disease was suspected. At the age of 14, she was examined by cardiac catheterization, but no abnormalities were found. No special therapy was performed. In the present pregnancy period, polycythemia [red blood cell count (RBC) 533 • 104.~1-1, hemoglobin concentration (Hb) 17.1g.d1-1, and hematocrit (Ht) 51.6%] were observed. Although she underwent further examinations such as computed tomography (CT), magnetic resonance imaging (MRI), radioisotope (RI)angiography, and chest X-ray, no abnormal findings other than hypoxemia and right aortic arch were ob-

Pulseless Disease (Takayasu??s Disease) Demonstrated by Radioisotope Angiography

A 20-year-old woman with bilateral nonpalpable radial pulse had radioisotope angiography on the neck and thoracic inlet, which demonstrated nonvisualization of the bilateral subclavian arteries on the dynamic phase in comparison with the images on the blood pool phase. Digital subtraction angiography showed severe narrowing of the right subclavian artery and complete obstruction of the left subclavian artery

Clinical and radiographic correlates of femoral artery visualization on bone scan

In order to determine if the linear pattern of thigh uptake medial to the femur often seen on a 99mTc diphosphonate bone scan (DiP) is caused by calcification of the femoral artery, 42 patients with and without this pattern were studied by a combination of conventional radiographs, radioisotope angiography and/or computed tomography. Risk factors for arteriosclerotic disease were recorded for all patients. These techniques identified the postulated femoral artery pattern on bone scan as always corresponding to calcified femoral arteries. The prevalence of diabetes, cigarette use, hypertension and a family or clinical history of arteriosclerotic vascular disease was the same in the groups with or without DiP uptake.

The Usefulness of Radioisotope Angiography in Management of Reflex Sympathetic Dystrophy Syndrome

The Usefulness of Radioisotope Angiography in Management of Reflex Sympathetic Dystrophy Syndrome

Re-evaluation of Radioisotope Angiography as a Screening Test for Ischemic Cerebral Diseases

Old patients need a non-invasive screening test instead of conventional angiography for diagnosis of cerebrovascular diseases (CVD). The availability of radioisotope (RI) angiography as a screening test was studied on ischemic cerebral diseases, and compared with computed tomography findings or conventional angiographic findings. RI angiography was performed with a bolus injection of 20 mCi 99mTcO4- via a cephalic vein using a scintillation camera and an on-line computer system. One hundred images were obtained during 50 seconds. RI angiography was found useful for detecting occluded major arteries and perfusion through collateral circulations in acute stage of the ischemic CVD. Sequential examinations of RI angiography were performed without complications even in old patients. Recanalization of the major arteries was also detected without the help of conventional angiography. Occlusion of an internal carotid artery with no cross circulation indicated a poor prognosis, whereas good collateral circulation such as the presence of the flip-flop sign indicated a good recovery. A patent extracranial-intracranial (EC-IC) bypass after an operation and a patent internal carotid artery after a carotid endarterectomy were well detected. Increased perfusion of the distal middle cerebral arteries from the EC-IC bypass was revealed. The intracranial non-filling phenomenon in patients with brain death was also well detected. RI angiography is suitable for screening of ischemic cerebral diseases, especially in old patients, reconstructive vascular surgery, and brain death.

Radioisotope angiography in diagnosis of varicocele

A varicocele, the most common surgically correctable cause of subfertility in men, is a manifestation of abnormal retrograde venous blood flow through the internal spermatic vein into the peritesticular pampiniform plexus. Methods of diagnosing the varicocele, including careful physical examination using a Valsalva maneuver as well as a Doppler stethoscope, remain somewhat subjective. Venography, while a reliable and objective technique, is invasive and not without morbidity. In the present study, 16 patients with clinically detectable varicoceles of various sizes were studied using a testicular radioisotope angiogram developed in our laboratory. Following the injection of 15 mg. of stannous pyrophosphate which results in tagging of the circulating red cell pool, 20 mCi. of 99m-technetium were administered in an intravenous bolus injection. The isotope binds to the pyrophosphate thus tagging the red blood cells and creating a blood-pooling agent with a relatively short half-life (six hours). Perfusion studies as well as static views of the scrotal contents, both in the supine and erect position, with and without Valsalva maneuver, were obtained using a gamma camera. The activity in each hemiscrotum then was quantitated using a digital computer. It is proposed that quantitation of this differential blood pool will make the identification of even sub-clinical varicoceles a potentially objective determination.

TWO-DIMENSIONAL ECHOCARDIOGRAPHY

This article will attempt to place in appropriate perspective the present role of two-dimensional echocardiography in the evaluation of patients with potential cardiovascular disease. The basic aspects of this modality have been presented by James et al. and Price et al. in the introductory articles, and certain clinical aspects have been discussed by Cooperberg and by Baker in their articles in this symposium. M-mode echocardiography has well-known capabilities. No other noninvasive diagnostic modality based on modern electronic methods provides the "hands-on" characteristics that allow a physician to examine cardiac anatomy, confirm diagnostic impressions, and immediately direct and accomplish further clinical examination as well as echocardiography does. Presently, a similar clinical enthusiasm has been generated for two-dimensional echocardiography; however, there has been insufficient time to develop a mature understanding of this very promising imaging technique. Practical systems for clinical use of two-dimensional echocardiography have been developed only in the past few years. The demand for two-dimensional echocardiographic services has accelerated rapidly since that time. The ultimate clinical capabilities of this method are still uncertain; and some confusion exists regarding the indications for its use, particularly in comparison with the more traditional methods of evaluating cardiac size, shape, and performance. The use of any cardiac imaging procedure should be based on an appreciation of the type of information it provides. Cardiac images based upon common static techniques (chest radiography) or dynamic studies (fluoroscopy, cineventriculography, or radioisotope angiography) provide images of the heart and individual cardiac chambers as silhouettes. Two-dimensional echocardiography images the heart in cross section and therefore is a unique imaging modality for evaluating not only the size of the chambers, but also the thickness of myocardial walls and the performance of valves.

Evaluation of left ventricular function (ejection fraction and segmental wall motion) by single pass radioisotope angiography

Evaluation of left ventricular function (ejection fraction and segmental wall motion) by single pass radioisotope angiography

Evaluation of left ventricular function (ejection fraction and segmental wall motion) by single pass radioisotope angiography.

Changes in ejection fraction (EF) and segmental wall motion (SWM) have been shown to be sensitive indicators of left ventricular (LV) function. This information is only obtainable by contrast angiography or gated blood pool scans. Gated studies assume a fixed geometry for the LV for EF determinations, are lengthy and limited primarily to the LAO projection. We correlated contrast and Tc-99m pertechnetate angiograms by singl pass radioisotope angiography (immediately preceding the contrast study) in 12 patients. EF was calculated from the LV time/activity curve and values ranged from .21 to .72. Angiographic correlation yielded r = 0.97. Regional LV wall motion was evaluated by dividing a summated cardiac cycle into 16 frames and dynamically and sequentially displaying these frames. Regional wall motion evaluation of four LV quadrants correlated well with angiography (r = 0.97). For quantitation these images were divided into four anterior and four inferior segments and the areas of respective segments were compared and expressed as a shortening fraction. SWM compared favorably with angiographic determinations (r ranged from 0.70 to 0.99). Thus, single pass radioisotopic determinations of EF and SWM in the RAO projection correlated well with the angiographic values and provide essential quantitative information of LV function otherwise unobtainable at the bedside.

Serial measurements of left ventricular ejection fraction by radionuclide angiography early and late after myocardial infarction

The left ventricular ejection fraction was determined serially with radioisotope angiography in 63 patients with acute myocardial infarction. After the peripheral injection of a bolus of technetium-99m, precordial radioactivity was recorded with a gamma scintillation camera and the ejection fraction calculated from the high frequency left ventricular time-activity curve. Since this technique requires no assumptions with respect to left ventricular geometry, it is particularly useful in patients with segmental left ventricular dysfunction. Serial measurements during the first 5 days after hospital admission were made in 50 patients, 30 of whom were studied during the subsequent 2 to 39 months (mean 19.9 months). Late follow-up serial studies were also performed in an additional 13 patients who had only one measurement of the left ventricular ejection fraction during the early postinfarction period. Early after infarction, the left ventricular ejection fraction was normal (more than 0.52) in only 15 of the 63 patients, and averaged 0.52 ± 0.05 (standard deviation) in the 27 patients with an uncomplicated infarct. The ejection fraction was reduced in 24 patients with mild to moderate left ventricular failure (0.40 ± 0.05, P < 0.0001) and in the 12 patients with overt pulmonary edema (0.33 ± 0.07, P < 0.0001). In 35 patients the ejection fraction correlated with the mean pulmonary arterial wedge pressure ( r = 0.72). In 15 patients with normal left ventricular wall motion by heart motion videotracking, the ejection fraction was significantly higher (0.53 ± 0.08) than in the 26 patients with regional left ventricular dysfunction (0.41 ± 0.10, P < 0.0001). During the early postinfarction period, the left ventricular ejection fraction improved in 55 percent of patients and remained unchanged or decreased in 45 percent. A further increase in the ejection fraction was noted in 61 percent of patients during the late follow-up period. Patients with an initially low or decreasing ejection fraction had a significantly greater incidence of early mortality and left ventricular dysfunction ( P < 0.02) than those whose ejection fraction was normal or improved to normal early after infarction. These data indicate that the ejection fraction is a sensitive indicator of left ventricular function after acute myocardial infarction and that serial measurements are helpful in predicting early mortality and morbidity.

A computer processing system for ECG-gated radioisotope angiography of the human heart

Various methods of radioisotope angiography have shown considerable promise as a noninvasive tool for cardiac diagnosis. Some of these methods use ECG gating and several cardiac cycles to build up scintigraphic images at end-systole and end-diastole. None of these methods result in data points between end-systole and end-diastole which could be used to construct ventricular volume curves or cineangiograms of a complete cycle. The purpose of this paper is to describe a computer processing system which extracts a set of 80–100 scintigraphic images from 1200–1500 heartbeats. This set of images representing a complete, typical cardiac cycle can be displayed as a cineangiogram or can be further analyzed and processed to yield various parameters of ventricular performance, such as ejection fraction, fractional ejection rate (mean and peak values), rate of circumferential fiber shortening (mean and peak), ejection duration, and time to peak flow.

Abdominal aortic aneurysm in childhood. A noninvasive approach to the diagnosis.

A case of an abdominal aortic aneurysm in a 9 year old Black male is reported.Abdominal roentgenograms, intravenous urograms and upper gastrointestinal series showed a bilobed calcified mass in the retroperitoneal space without defining the organ of origin.This case illustrates the usefulness of noninvasive techniques such as sonography and radioisotope angiography in determining the vascular origin of an unusual mass in a child. The principal purpose of arteriography was to rule out unsuspected lesions in other arteries.Although the pathologic findings were somewhat equivocal, the clinical information strongly suggested that this represented a mycotic aneurysm.

Detection of regional myocardial dyskinesia by ECG-gated, computerized radioisotope angiography

Detection of regional myocardial dyskinesia by ECG-gated, computerized radioisotope angiography

Brain Scanning and Cerebral Radioisotope Angiography (CRA) in Children

The incidence of abnormal brain scans was high in children with symptoms of increased intracranial pressure, focal motor signs or meningitis. In patients with seizure disorders, headache (alone) and mental retardation, abnormal brain scan findings occurred in 1%, 2%, and 4% of the cases, respectively; thus the routine use of brain scanning as a screening procedure of the patients may be questionable. The true-positive rate of brain scans in this series was 83%. Cerebral radioisotope angiography (CRA) increased the true-positive rate by 3% when done selectively. Cerebral radioisotope angiography was frequently abnormal in patients referred for early diagnosis of cerebrovascular accidents, when the brain scan was most frequently normal. The high yield and sensitivity of brain scanning for diagnosis of brain abscess was confirmed in this study. The brain scan was found very useful in localizing brain abscess for surgical drainage and to assess the results of therapy.

Use of Radioisotope Angiography and Infrared Thermography as a Screening Procedure for Carotid Occlusive Disease.

Excerpt This study establishes a safe and yet reliable screening procedure to detect patients with carotid occlusive disease. During the past 1½ years all patients referred to the nuclear diagnosti...

Intravenous radioisotope angiography using 113mInFeDTPA-ascorbic acid.

AN IDEAL combination of the rapid imaging properties of the gamma-ray scintillation camera and a large dose of a short-lived nuclide makes possible a dynamic study of the heart, the major blood vessels, and the kidneys by a simple intravenous injection. It is suggested that this new diagnostic method be named intravenous radioisotope angiography inasmuch as it provides morphologic information similar to that of x-ray angiography. The method itself was initiated by Rosenthall who employed 99mTc pertechnetate as a test agent (1, 2). While 99mTc has many advantageous physical properties, it is not convenient in Japan, owing to the relatively short shelf life of the 99Mo-99mTc generator. The 113Sn-113mIn generator, however, has a long shelf life, and recently we have succeeded in obtaining good radioisotope angiograms with 113mIn. Our preliminary results with 113mInFe DTPA-ascorbic acid are reported in this communication. Methods and Materials Radioisotope angiography was performed with the Pho/Gamma camera m...