Noninvasive stress testing of myocardial perfusion defects: head-to-head comparison of thallium-201 SPECT to MRI perfusion

Background: To evaluate the diagnostic value of magnetic resonance imaging (MRI) of myocardial perfusion in the assessment of flow-limiting epicardial stenosis in a head-to-head comparison with abnormal thallium-201 (201TI) single photon emission tomography (SPECT) studies in patients with predominantly known coronary artery disease (CAD). Methods and Results: Twenty-one patients (mean age 65±10years) with reversible myocardial perfusion defects on 201TI-SPECT images during dipyridamole-stimulated hyperemia were recruited for study purpose. Within 5days of the 201TI-SPECT study, myocardial perfusion was studied again with MRI during dipyridamole stimulation and at rest. Overall, 201TI-SPECT identified 30 reversible regional perfusion defects. The sensitivity to detect hypoperfused segments was 70% (21/30) with the GRE-MRI perfusion analysis with 201TI-SPECT as reference. When patients were subgrouped according to the extent of regional reversible perfusion defects on 201TI-SPECT, mild- (SDS: 2-4), moderate- (SDS: 5-8), and severe- (SDS>8) perfusion defects were also identified by GRE-MRI perfusion analysis in 75% (6/8), in 56% (9/16) and 100% (6/6), respectively. Conclusions: GRE-MRI first-pass stress perfusion imaging may not identify up to 30% of mild-to-moderate perfusion defects in a group of preselected patients with predominantly known CAD and abnormal 201TI-SPECT studie

Impact of ¹⁸F-FDG PET/CT on target volume delineation in recurrent or residual gynaecologic carcinoma

Abstract Background To evaluate the impact of 18F-FDG PET/CT on target volume delineation in gynaecological cancer. Methods F-FDG PET/CT based RT treatment planning was performed in 10 patients with locally recurrent (n = 5) or post-surgical residual gynaecological cancer (n = 5). The gross tumor volume (GTV) was defined by 4 experienced radiation oncologists first using contrast enhanced CT (GTVCT) and secondly using the fused 18F-FDG PET/CT datasets (GTVPET/CT). In addition, the GTV was delineated using the signal-to-background (SBR) ratio-based adaptive thresholding technique (GTVSBR). Overlap analysis were conducted to assess geographic mismatches between the GTVs delineated using the different techniques. Inter- and intra-observer variability were also assessed. Results The mean GTVCT (43.65 cm3) was larger than the mean GTVPET/CT (33.06 cm3), p = 0.02. In 6 patients, GTVPET/CT added substantial tumor extension outside the GTVCT even though 90.4% of the GTVPET/CT was included in the GTVCT and 30.2% of the GTVCT was found outside the GTVPET/CT. The inter- and intra-observer variability was not significantly reduced with the inclusion of 18F-FDG PET imaging (p = 0.23 and p = 0.18, respectively). The GTVSBR was smaller than GTVCT p ≤ 0.005 and GTVPET/CT p ≤ 0.005. Conclusions The use of 18F-FDG PET/CT images for target volume delineation of recurrent or post-surgical residual gynaecological cancer alters the GTV in the majority of patients compared to standard CT-definition. The use of SBR-based auto-delineation showed significantly smaller GTVs. The use of PET/CT based target volume delineation may improve the accuracy of RT treatment planning in gynaecologic cancer.</p

Noninvasive stress testing of myocardial perfusion defects: head-to-head comparison of thallium-201 SPECT to MRI perfusion

BACKGROUND: To evaluate the diagnostic value of magnetic resonance imaging (MRI) of myocardial perfusion in the assessment of flow-limiting epicardial stenosis in a head-to-head comparison with abnormal thallium-201 ((201)TI) single photon emission tomography (SPECT) studies in patients with predominantly known coronary artery disease (CAD). METHODS AND RESULTS: Twenty-one patients (mean age 65 +/- 10 years) with reversible myocardial perfusion defects on (201)TI-SPECT images during dipyridamole-stimulated hyperemia were recruited for study purpose. Within 5 days of the (201)TI-SPECT study, myocardial perfusion was studied again with MRI during dipyridamole stimulation and at rest. Overall, (201)TI-SPECT identified 30 reversible regional perfusion defects. The sensitivity to detect hypoperfused segments was 70% (21/30) with the GRE-MRI perfusion analysis with (201)TI-SPECT as reference. When patients were subgrouped according to the extent of regional reversible perfusion defects on (201)TI-SPECT, mild- (SDS: 2-4), moderate- (SDS: 5-8), and severe- (SDS > 8) perfusion defects were also identified by GRE-MRI perfusion analysis in 75% (6/8), in 56% (9/16) and 100% (6/6), respectively. CONCLUSIONS: GRE-MRI first-pass stress perfusion imaging may not identify up to 30% of mild-to-moderate perfusion defects in a group of preselected patients with predominantly known CAD and abnormal (201)TI-SPECT studies

Impact of 18F-FDG PET/CT on target volume delineation in recurrent or residual gynaecologic carcinoma

BACKGROUND: To evaluate the impact of (18)F-FDG PET/CT on target volume delineation in gynaecological cancer. METHODS: F-FDG PET/CT based RT treatment planning was performed in 10 patients with locally recurrent (n = 5) or post-surgical residual gynaecological cancer (n = 5). The gross tumor volume (GTV) was defined by 4 experienced radiation oncologists first using contrast enhanced CT (GTV(CT)) and secondly using the fused (18)F-FDG PET/CT datasets (GTV(PET/CT)). In addition, the GTV was delineated using the signal-to-background (SBR) ratio-based adaptive thresholding technique (GTV(SBR)). Overlap analysis were conducted to assess geographic mismatches between the GTVs delineated using the different techniques. Inter- and intra-observer variability were also assessed. RESULTS: The mean GTV(CT) (43.65 cm(3)) was larger than the mean GTV(PET/CT) (33.06 cm(3)), p = 0.02. In 6 patients, GTV(PET/CT) added substantial tumor extension outside the GTV(CT) even though 90.4% of the GTV(PET/CT) was included in the GTV(CT) and 30.2% of the GTV(CT) was found outside the GTV(PET/CT). The inter- and intra-observer variability was not significantly reduced with the inclusion of (18)F-FDG PET imaging (p = 0.23 and p = 0.18, respectively). The GTV(SBR) was smaller than GTV(CT) p ≤ 0.005 and GTV(PET/CT) p ≤ 0.005. CONCLUSIONS: The use of (18)F-FDG PET/CT images for target volume delineation of recurrent or post-surgical residual gynaecological cancer alters the GTV in the majority of patients compared to standard CT-definition. The use of SBR-based auto-delineation showed significantly smaller GTVs. The use of PET/CT based target volume delineation may improve the accuracy of RT treatment planning in gynaecologic cancer