Nieinwazyjna diagnostyka choroby niedokrwiennej serca — którą opcję diagnostyczną wybrać?

Non-invasive methods for assessment of myocardial ischaemia or anatomy of coronary arteries are widely used in diagnostics of coronary disease. Nowadays, more weight is given to considering the pre-test probability of the presence of coronary disease before making choice of further management strategy. Assuming that patients with low PTP (< 15%) do not have obstructive coronary disease, no further specific non-invasive stress testing is recommended. At the same time, in patients with high PTP (> 85%), the clinical likelihood of coronary disease with significant changes in epicardial arteries is so high, that it seems justified to refer them directly to invasive diagnostics and revascularization. Non-invasivetests (exercise test, SPECT, PET, MRI, MSCT) are appropriate for patients at intermediate risk of coronary disease (15–85%), who might potentially benefit from invasive diagnostics and revascularization, and for risk stratification of future cardiovascular events. Nieinwazyjne badania oceniające niedokrwienie mięśnia sercowego lub anatomię tętnic wieńcowych mają szerokie zastosowanie w diagnostyce choroby wieńcowej. Aktualnie zwraca się dużą uwagę na kliniczną ocenę prawdopodobieństwa jej wystąpienia przed wyborem dalszej strategii postępowania. Zakłada się, że u pacjentów z niskim prawdopodobieństwem wystąpienia choroby przed testem (PTP < 15%) nie występują istotne zwężenia w tętnicach wieńcowych i można odstąpić od dalszej diagnostyki. Z kolei u pacjentów z wysokim PTP (> 85%) prawdopodobieństwo wystąpienia choroby wieńcowej z istotnymi zmianami w tętnicach nasierdziowych jest tak wysokie, że zaleca się u nich od razu przeprowadzenie diagnostyki inwazyjnej i ewentualnie rewaskularyzację. Nieinwazyjne badania (test wysiłkowy, badania SPECT, PET, MRI, MSCT) mają zastosowanie przede wszystkim u pacjentów z pośrednim ryzykiem wystąpienia choroby wieńcowej (15–85%) w celu identyfikacji chorych, którzy potencjalnie mogą odnieść korzyść z diagnostyki inwazyjnej i rewaskularyzacji, oraz w celu stratyfikacji ryzyka wystąpienia przyszłych incydentów sercowo-naczyniowych

Radionuclide imaging and therapy in a patient with coexistent diabetic foot syndrome and psoriatic arthritis

We report a case of 67-year-old man suffering from psoriatic arthritis, type 2 diabetes and diabetic foot syndrome. The patient presented symptoms of inflammation of the right ankle joint. Scintigraphic imaging with radiolabeled white blood cells was performed to differentiate whether the inflammation was related to psoriatic arthritis or diabetic foot syndrome. After revealing that, the inflammatory process was restricted only to the articular space of subtalar joint, the patient was diagnosed with exacerbation of psoriatic arthritis and qualified for radionuclide synovectomy. In patients with coexistent diabetic foot syndrome and inflammatory arthritis of the foot it is of vital importance to accurately differentiate these two conditions. We conclude that this can be potentially achieved with radiolabeled white blood cells scintigraphic imaging

Myocardial viability assessment in 18FDG PET/CT study (18FDG PET myocardial viability assessment)

Accurate identification of viable myocardium is crucial in patientqualification for medical or surgical treatment. Only personswith confirmed cardiac viability will benefit from revascularizationprocedures. It is also well known, that the amount of viablemyocardium assessed preoperatively is the best indicator oflong term cardiac event free survival after cardiac intervention.There are several diagnostic approaches used in current clinicalpractice for assessment of myocardial viability. Analysis ofwall thickness or myocardial contraction, evaluation of cardiacperfusion or metabolism can be assessed using followingmodalities: Echocardiography, Cardiac Molecular Imagingtechniques (PET, SPECT), Cardiovascular MR or CardiovascularCT. The article describes the methods and problems ofviability assessment in 18FDG PET study. PET imaging hasproved its accuracy and reproducibility for myocardial ischemiaand viability assessment. However this unique in its ability forshowing the particular substrate metabolism technique has unfortunately some disadvantages: currently achieved PETresolution is 0.4 cm. However the combined devices multislicecomputed tomography scanners with PET (PET/CT) are nowwidely used in clinical practice. This combination allows forwider morphologic assessments: coronary calcium scoring andnon-invasive coronary angiography may be added to myocardialperfusion/metabolic imaging if necessary

Computer program for analysis of parathyroid scintigraphy examinations: combination of dual-tracer (subtraction) and double phase single-tracer washout techniques

There is no controversy in the published literature that sensitivity and specificity of parathyroid scintigraphy is superior to other imaging techniques. However no uniform protocol has been established for scintigraphy. In order to analyze parathyroid scintigraphic images in the Department of Nuclear Medicine at the Medical University of Warsaw we have developed a program that allows qualitative and quantitative evaluation of recorded images and motion artifacts correction. This program offers a uniform procedure of analysis of parathyroid imaging results in diagnostic centers, accelerates the analysis of parathyroid tests performed with use of single radioactive tracer, that require the acquisition of consecutive images of the patient, without altering his body position between successive stages of registration. This program allows for automation of previously time consuming procedures and thus saves time and decreases a risk of operator’s errors.There is no controversy in the published literature that sensitivity and specificity of parathyroid scintigraphy is superior to other imaging techniques. However no uniform protocol has been established for scintigraphy. In order to analyze parathyroid scintigraphic images in the Department of Nuclear Medicine at the Medical University of Warsaw we have developed a program that allows qualitative and quantitative evaluation of recorded images and motion artifacts correction. This program offers a uniform procedure of analysis of parathyroid imaging results in diagnostic centers, accelerates the analysis of parathyroid tests performed with use of single radioactive tracer, that require the acquisition of consecutive images of the patient, without altering his body position between successive stages of registration. This program allows for automation of previously time consuming procedures and thus saves time and decreases a risk of operator’s errors

Assessment of the myocardial FDG-PET image quality with the use of maximal Standardized Uptake Value myocardial to background index. Application of the results in regard to semiquantitative assessment of myocardial viability with cardiac dedicated softwar

BACKGROUND: The objective of this study was to semiquantitatively assess the degree of myocardial fluorodeoxyglucose (FDG) uptake in glucose-loaded myocardial viability positron emission tomography/computed tomography (PET/CT) scans, to calculate the myocardial to background index, and correlate the index with image quality assessed on the basis of visual qualitative assessment. MATERIAL AND METHODS: The myocardial FDG-PET/CT study was carried out in 69 non-diabetic patients, who had known coronary artery disease, by intravenous injection of 250 ± 70 MBq (range: 180–320 MBq) FDG. Images were interpreted visually and patients were divided into three groups according to the grade of myocardial uptake: optimal, suboptimal, and uninterpretable. Semiquantitative analysis was performed by calculating the standardized uptake value (SUVmax) for myocardium and background (blood pool) activity, and expressed as the myocardial to background (M/B) activity ratio. RESULTS: On the basis of visual (qualitative) analysis, 60/69 (86.96%) patients showed optimal quality of FDG cardiac uptake, 3/69 (4.35%) were suboptimal, and uninterpretable FDG PET scan results were found in 6/69 (8.70%) patients. The M/B index was found to be significantly higher in images of optimal vs. suboptimal quality (6.87 ± 3.99 vs. 1.65 ± 0.78 respectively; p < 0.0001). CONCLUSIONS: The index ratio of 2.2, which is consistent with the upper borderline value for visually uninterpretable images, was considered the cut-off value for scans of optimal and non-optimal quality

Czy choremu z mostkiem mięśniowym nad tętnicą wieńcową należy zalecić zaniechanie uprawiania ekstremalnych wysiłków? Przypadek chorego z podwyższonym stężeniem troponiny I po wysiłku

Elevated levels of cardiac troponins are an established method of diagnosis of heart muscle necrosis. A case of a long distance amateur-marathon runner, who showed significant elevation of plasma troponin I after extreme physical effort is reported. The diagnostic examinations did not reveal atherosclerosis burden, but myocardial bridging of coronary artery. The authors describe the significance of the pathology in the view of extreme sport effort performed by the described patient.Elevated levels of cardiac troponins are an established method of diagnosis of heart muscle necrosis. A case of a long distance amateur-marathon runner, who showed significant elevation of plasma troponin I after extreme physical effort is reported. The diagnostic examinations did not reveal atherosclerosis burden, but myocardial bridging of coronary artery. The authors describe the significance of the pathology in the view of extreme sport effort performed by the described patient

Relationship between parathyroid gland scintigraphy and its histopathology, oxyphil cell content and volume: a retrospective study

BACKGROUND: Mechanisms that are responsible for positive 99mTc-MIBI uptake in parathyroid glands are not clearly understood, some authors suggest there is a correlation between 99mTc MIBI accumulation and oxyphil cell content or parathyroid gland volume. The aim of our work was to assess the relationship between the pathological structure of parathyroids, their volume, oxyphil cell content and parathyroid 99mTc-MIBI retention. MATERIAL AND METHODS: A total of 62 hyperfunctioning parathyroid glands in 46 patients were retrospectively analyzed. Preoperative 99mTc-MIBI scintigraphy was performed according to the double-phase and subtraction protocol. After surgery all glands were evaluated histologically, oxyphil cell content was assessed and volume of each excised gland was calculated. RESULTS: Scintigraphy was positive in 41 of 62 parathyroid glands (66%). The median volume of positive glands was larger than that of negative glands (1.33 ml vs 0.7 ml, p = 0.015). Of the parathyroid lesions, there were 14 (22.6%) cases of nodular hyperplasia, 23 (37.1%) cases of diffuse hyperplasia, and 25 (40.3%) cases of adenomas. A high (≥ 25%) oxyphil cell content was found in 16 glands (25.8%) and a low ( < 25%) oxyphil cell content in 46 (74.2%) glands. Histopathology of parathyroid glands was related to the scintigraphy result (p = 0.002), but not to the 99mTc-MIBI uptake pattern (p = 0.868). The overall result of scintigraphy was not related to the oxyphil cell content (p = 0.797). 99mTc-MIBI uptake pattern wasn’t related to the oxyphil cell content (p = 0.833). In general, parathyroid lesions with low oxyphil cell content were larger than parathyroid glands with high oxyphil cell content (1.33 ml vs 0.5 ml, respectively; p = 0.01). The median volume of parathyroids containing a high number of oxyphil cells and having a prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.62 ml vs 0.3 ml, respectively; p = 0.008). The median volume of parathyroids with low oxyphil cells content and showing prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.95 ml vs 1.07 ml, respectively; p = 0.014). CONCLUSIONS: Our findings suggest that a positive scintigraphy result depends on parathyroid histopathology and gland volume and does not depend on the presence of oxyphil cells. Prolonged 99mTc-retention is not related to the parathyroid gland histopathology and the presence of oxyphil cells but to the gland volume

Right atrial tumour in a patient with acute pancreatitis

W diagnostyce różnicowej guzów serca należy uwzględnić m.in. skrzepliny, wegetacje i nowotwory. W niniejszej pracy przedstawiono przypadek 72-letniego mężczyzny z napadowym migotaniem przedsionków, leczonego uprzednio dabigatranem, u którego w trakcie hospitalizacji z powodu ostrego zapalenia trzustki zamieniono dabigatran na enoksaparynę. Początkowo u pacjenta podejrzewano obecność guza brodawki Vatera. W badaniu echokardiograficznym w prawym przedsionku uwidoczniono policykliczną, balotującą strukturę, wychodzącą z żyły głównej dolnej. Na podstawie tomografii komputerowej, rezonansu magnetycznego i gastroskopii wykluczono raka brodawki Vatera. Wykonano pozytonową tomografię emisyjną, w której nie stwierdzono cech aktywnego metabolicznie procesu rozrostowego. Włączono leczenie przeciwkrzepliwe acenokumarolem, uzyskując całkowitą rezolucję zmiany w prawym przedsionku i żyle głównej dolnej.Differential diagnosis of intracardiac tumours should include i.a. thrombi, vegetations and neoplasms. We present a case of a 72-year-old male with paroxysmal atrial fibrillation, who had been previously treated with dabigatran and whose anticoagulant treatment was subsequently changed to enoxaparin during hospitalisation due to acute pancreatitis. Initially, tumour of the ampulla of Vater was suspected. Echocardiography revealed a polycyclic, balloting tumour in the right atrium, originating from the inferior vena cava. Based on computed tomography, magnetic resonance imaging and gastroscopy, carcinoma of the ampulla of Vater was ruled out. Positron emission tomography was performed, showing no signs of metabolically active neoplastic growth. Anticoagulation with acenocoumarol was initiated, leading to a complete resolution of the mass in the right atrium and inferior vena cava