8 research outputs found
The role of quantitative Tc-99m-MIBI gated SPECT/F-18-FDG PET imaging in the monitoring of intracoronary bone marrow cell transplantation
BACKGROUND: A lot of unresolved questions still exist concerning
the exact mechanism of the beneficial effects of bone
marrow cell (BMC) transplantation for myocardial regeneration.
The aim of this communication is to report the cases of patients
with and without post-transplantation left ventricular function
improvement.
MATERIAL AND METHODS: To this study we included consecutive
patients with irreversible damage after a first acute ST-elevation myocardial infarction treated by coronary angioplasty
with stent implantation. The irreversible damage was identified
by dobutamine echocardiography and confirmed by rest
gated Tc-99m-MIBI gated SPECT and in the majority of patients
by F-18-FDG PET imaging as well. Using 4D-MSPECT software,
we quantified MIBI/FDG uptake and gated SPECT left ventricular
ejection fraction, end-diastolic/end-systolic volumes (LVEF,
EDV/ESV) before BMC therapy and 3 months later.
RESULTS: The results obtained in the initial group of patients
in this study (27 patients in the BMC treated group, 16 patients
in the control group) have been published previously [Eur
J Nucl Med 2005; 32 (Suppl 1 ): S46]. Among the BMC group,
we identified 13 responders to therapy with average LVEF improvement
from 43.3% ± 11% to 51.4% ± 10.4% and EDV/ESV
improvement from 145 ml/84 ml to 133 ml/67 ml. The remaining
14 patients were non-responders to therapy with no significant
change in LVEF (39.1% ± 8.1% versus 39.8% ± 7.4%),
the EDV/ESV increased from 166 ml/105 ml to 188 ml/116 ml.
Responders to the cell therapy had prevailing MIBI uptake
in the range of 31-50% of maximum in the infarction territory.
On the other hand, non-responders to BMC therapy had prevailing
MIBI uptake in the range of 0-30% of maximum. Two
cases are presented in this report.
CONCLUSIONS: Further studies with a larger cohort of patients
would be helpful to evaluate our findings. We observed strong
interindividual differences in the effectiveness of the cell therapy.
Prevailing residual MIBI uptake in the range of 31-50% of maximum
was in the subgroup of responders to the cell therapy
Plánování ortognátních operací u obličejových deformit a čelistních anomálií pomocí modelové operace
Successful three-year outcome in a patient with allogenous sternal bone graft in the treatment of massive post-sternotomy defects
Introduction: Deep sternal wound infection is a life-threatening complication of longitudinal median sternotomy with extensive loss of sternal bone tissue and adjacent ribs. Wound dehiscence cases with no loss of bone tissue can be resolved via osteosynthesis using titanium plates. Unfortunately, this cannot be used in cases of massive bone tissue loss defects due to insufficient support for fixing the plate material caused by missing bone surface which increasing the risk of osteosynthesis failure. We describe the treatment outcome of sternal dehiscence with massive bone tissue loss defects using an allogenous sternal bone graft.
Case Presentation: A 62 year old diabetic female was operated for serious sternotomy dehiscence after surgery for aortic valve replacement. There was bone tissue loss and complications. We used allogenous sternal bone graft to close the wound. To monitor the healing of the graft, we performed SPECT/CT examinations of anterior chest wall. We describe the successful healing of the graft with the reduction of defects in osteoblastic activity by 42% 21 months after the graft implantation. The wound was found to be healed on all examinations, The chest wall is stable and the patient reports a good life quality.
Discussion: An allogenous bone transplant contains no vital bone marrow cells, which eliminates immuno-genetic graft rejection by the patient. Significant osteoblastic activity was thus registered, especially in places where crushed spongy bone had been applied.
Conclusions: Transplantation of allogenous bone graft sternum in our experience is the best option for treating extensive post-sternotomy defects
Additional value of the coronary artery calcium score in patients for whom myocardial perfusion imaging is challenging
Background: Determination of prognosis based on ischemia detection, using single‑photon emission computed tomography myocardial perfusion imaging (SPECT‑MPI), can be challenging in patients with multiple affected coronary arteries.
Aims: The aim of the study was to examine the outcomes of SPECT‑MPI combined with the coronary artery calcium score (CACS) to identify predictors of adverse cardiac events (ACEs) in patients for whom ischemia detection may be difficult using SPECT‑MPI.
Methods: The study group included 195 patients with a history of chronic kidney disease, suspected ischemic cardiomyopathy, or left bundle branch block. All patients underwent SPECT‑MPI and CACS evaluation. During the follow‑up, ACEs were recorded. Perfusion and functional parameters as well as the CACS were analyzed to find the predictors of ACEs.
Results: The ACEs were recorded in 58 individuals (29.7%) and were significantly associated with ischemia (P < 0.001), abnormal functional parameters (P = 0.04), and higher CACSs (P < 0.001). The optimal cutoff value of the CACS to predict an ACE was 530. Cox proportional hazards models revealed that age, mild and severe ischemia, functional abnormalities, and a CACS of 530 or higher were significant predictors of ACEs. In the subgroup of individuals without ischemia, a CACS of 530 or higher was significantly associated with poor outcome, while we recorded only 3 ACEs in these patients when the CACS was lower than 530.
Conclusions: The addition of the CACS to SPECT‑MPI improves the identification of patients at higher risk for ACEs, even in individuals for whom SPECT‑MPI is challenging
Cadmium–zinc–telluride SPECT scanners – New perspectives in nuclear cardiology
AbstractNuclear cardiology is one of the most important non-invasive imaging methods in cardiac imaging. It makes possible primarily functional assessment of the heart with quantification of perfusion and systolic function. Development of new types of scanners for nuclear cardiology brings more possibilities in research and clinical practice. This paper describes a brief review of some applications of cadmium–zinc–telluride (CZT) scanners in comparison with conventional cameras