The effect of image translation table on diagnostic efficacy of myocardial perfusion SPECT studies

BACKGROUND: The aim of this study was to determine which of the most popular colour scales used in the Xeleris processing system (GE) should preferably be used during a clinical interpretation of myocardial perfusion images, and to find out whether a colour scale saturation level affects the diagnostic efficacy of the study. MATERIAL AND METHODS: From among 100 patients in whom a myocardial perfusion scintigraphy had been performed, a subgroup of people referred for coronary angiography, with neither prior history nor ECG signs of a myocardial infarction has been selected retrospectively. This group consisted of 41 patients (14 females) in the age group 46 to 76 years. All patients underwent two-day myocardial perfusion SPECT imaging using 99mTc-MIBI as a radiopharmaceutical. Reconstructed slices were interpreted in 3 colour scales: white-red-yellow-green-blue-black with computer-assigned thresholds (French 100%), the same French scale but without a white colour (image maximum set manually to a border value between red and white &#8212; French w.w.), and a white-yellow-violet- pink-blue-black scale (GEcolor), by consensus of two experienced nuclear medicine specialists. A semiquantitative method for evaluation of perfusion images was applied, based on myocardium segmentation. Perfusion in each segment was scored using a five-point system. Study interpretation (normal/ abnormal perfusion) was based on summed stress scores (SSS), being equal/above or below a given threshold value. The choice of optimal SSS threshold value was based on sensitivity and specificity of the study in detection of perfusion defects resulting from critical stenoses of main coronary arteries RESULTS: SSS values differed among colour scales (p < 0.00001). The lowest values were obtained for a French 100% scale (mean value = 5.0, SD = 8.0), the highest for French w.w. (mean values = 8.1, SD = 8.7), and for GE colour scale &#8212; mean value &#8212; 5.6, SD &#8212; 7.9. A French 100% scale gave high sensitivity (88%), as well as specificity (83%), but only when a low SSS threshold value of 2, hardly acceptable for study interpreters, was used. When higher threshold values were applied, they compromised the sensitivity of the study. A French w.w. scale with SSS threshold values lower than 3 provided a slightly higher sensitivity (94%), but with a significant reduction in specificity (to values below 50%). Only a threshold value of 4 provided acceptable, but still low specificity (63%) with preserved high sensitivity (88%). At the same time, the scale GE colour provided indices of diagnostic efficacy with the SSS threshold value of 3 as high as a scale French 100% with threshold value of 2. CONCLUSIONS: A French scale (Xeleris, GE) is not the scale of choice for the interpretation of myocardial perfusion SPECT images. It seems that a GE colour scale is better suited for this purpose. SSS threshold values accepted as diagnostic criteria for the detection of myocardial perfusion abnormalities should be suited separately for every translation table. The choice of optimal value should be verified by results of coronary angiography. Nuclear Med Rev 2010; 13, 2: 64&#8211;6

Perfusion lung scintigraphy for the prediction of postoperative residual pulmonary function in patients with lung cancer

BACKGROUND: Accurate prediction of postoperative pulmonary function in patients with non-small cell lung cancer is crucial for proper qualification for surgery, the only effective therapeutic method. The aim of the study was to select the most accurate method for acquisition and processing of lung perfusion scintigraphy (LPS) combined with spirometry for prediction of postoperative pulmonary function in patients qualified for surgery. MATERIAL AND METHODS: LPS was performed in 70 patients (40 males, 30 females), with preoperative spirometry (mean FEV1preop = 2.26 ± 0.72 L), after administration of 185 MBq of 99mTc-microalbumin/macroaggregate, using planar (appa) and SPECT/CT methods. Predicted postoperative lung function (FEV1pred) was calculated as a part of active lung parenchyma to remain after surgery. A non-imaging segment counting method was also applied. FEV1pred(appa, SPECT, SPECT/CT, segm.) were further compared with actual FEV1postop values obtained from postoperative spirometry. RESULTS: In the whole studied group (47 lobectomies, 23 pneumonectomies) mean value of FEV1postop was equal to 1.76 (± 0.56) L. FEV1pred(appa, SPECT, SPECT/CT, segm.) were equal to 1.75 (± 0.58) L, 1.71 (± 0.57) L, 1.72 (± 0.57) L and 1.57 (± 0.58) L, respectively. A segment counting method systematically lowered predicted FEV1 values (p &lt; 10–5). Moreover, in 31 patients with FEV1preop &lt; 2 L error of predicted values was assessed with Bland-Altman method. Mean absolute differences FEV1postop – FEV1pred amounted to: appa — (0.04 ± 0.13) L, SPECT — (0.07 ± 0.14) L, SPECT/CT — (0.06 ± 0.14) L and segm. — (0.21 ± 0.19) L, respectively. Lower limit of 95% confidence interval calculated for planar — optimal method, was equal to –220 mL (also determined separately in subgroups after lobectomy and pneumonectomy). CONCLUSIONS: This study shows that planar LPS may be applied for prediction of postoperative pulmonary function in patients qualified for pneumonectomy and lobectomy. If actual FEV1postop value is to be ≥ 800 mL, predicted value should exceed 1000 mL

Application of stress-only myocardial perfusion imaging

BACKGROUND: Single-photon emission computed tomography myocardial perfusion study is usually a sequence of stress and rest part. In case of a normal stress study rest part can be given up. The objective of this study was to examine factors affecting concordance of results of stress-only (SO) and stress-rest (SR) studies. MATERIAL AND METHODS: SO and SR studies without and with attenuation correction (AC) of 212 selected patients (without cardiomyopathy, history of myocardial infarction or coronary artery bypass grafting) were analyzed visually. Influence of percutaneous coronary intervention (PCI) in the past, type of stress (physical/pharmacological) and application of AC (in form of combined method of non-corrected and corrected images — CM), patient body mass index (BMI) and gender on concordance rates of SO and SR studies were examined. RESULTS: Neither a history of PCI, nor a type of stress affected concordance rate. AC (in form of CM) improved concordance rate significantly, from 60% to 68% (p = 0.018). Patient BMI affected concordance rates — 72% in non-obese and 59% in obese patients (p = 0.05). In the whole group, risk of overlooking patients with abnormal perfusion in SO study was small (&lt; 2%), but it grew significantly with patient BMI. Rest study was necessary in about 20% of non-obese and in about 50% of obese patients. CONCLUSION: MPS can be limited to stress part in appropriately selected, especially non-obese, patients provided that AC is applied, due to a low risk of overlooking patients with abnormal perfusion. In case of obese patients, careful analysis of exercise images for their normality is particularly important

Usefulness of clearance parametric images in detection of regional renal parenchyma dysfunction

BACKGROUND: The aim of the study was to examine whether parametric clearance images (PAR) enhance diagnostic potential of a dynamic renal scintigraphy with detection of local dysfunction of kidneys, on a model of kidneys after treatment with extracorporeal shock wave lithotripsy (ESWL), MATERIAL AND METHODS: Kidneys after ESWL were accepted as a proper model for the implementation of this objective because of the previously proven damaging effect of a shock wave on renal parenchyma and known region of ESWL application. Forty patients (23 males and 17 females) at the age of 37 to 70 years (mean value 54) with untreated earlier single, one-sided nephrolithiasis, currently treated with ESWL, underwent a study. A dynamic renal 99mTc-EC scintigraphy was performed three times: before ESWL, a week and a month after this therapeutic intervention. PAR images generated with use of an in-house developed software were compared with summation (SUM) of images obtained from radiopharmaceutical uptake phase and quantitative global function parameters (GFP) of each kidney, like split function, MTT — mean transit time and PTT — parenchymal transit time. RESULTS: PAR and SUM images of all 40 kidneys before ESWL were normal. PAR images revealed local or diffused defects a week and a month after therapeutic intervention in statistically significantly larger numbers of kidneys than SUM images (19 vs. 6, p = 0.002 and 16 vs. 5, p = 0.003, respectively). A week after ESWL, when defects in PAR images were observed in about a half of all renal segments (29/57 — 51%) all GFP values were significantly worse than in kidneys without defects. A month after ESWL defects in PAR images could be observed in ab. 1/3 (17/48 — 35%) of segments and were less extensive, whereas GFP values did not differ significantly from values in kidneys without clearance function impairment in the PAR images. CONCLUSIONS: PAR images enhance diagnostic potential of a dynamic renal scintigraphy with detection of local function defects. These images allow to detect more local renal function defects than SUM images

Preliminary assessment of interand intraobserver reproducibility, and normative values of renal mean transit time (MTT) and parenchymal transit time (PTT) for 99mTc-etylenodicysteine

BACKGROUND: The clinical significance of MTT and PTT, determined by deconvolution of renographic curves, is arguable. Their usefulness in diagnosis of obstructive uro- and nephropathy, renovascular hypertension and monitoring of transplanted kidneys is pointed out, but susceptibility of deconvolution methods to errors resulting from “statistical noise” is also stressed. So far there are no reports on normative MTT values for 99mTc-EC, although such values were already determined for 131I-OIH, 99mTc-DTPA and 99mTc-MAG3. The aim of this study is an assessment of inter- and intraobserver reproducibility of MTT and PTT for 99mTc-EC, and determination of normative values for these parameters. MATERIALS AND METHODS: 31 patients (17 women and 14 men aged 19–75, average 44 years) referred for dynamic renal scintigraphy with: unilateral flow impairment (11), unilateral nephrolithiasis (2), control after unilateral lithotripsy (4), moderate hypertension (demographically with &gt; 99% probability of primary hypertension) (4), suspected cirrhosis of one kidney (3), future kidney donors (3), control after abdominal injuries (3), incontinence (1). 42 functionally efficient kidneys were included in the study. Criteria for recognition of a kidney as functionally efficient were: — no earlier history of renal disease, signs of renal damage in basic blood and urine tests, or abnormalities in ultrasonography; — normal result of dynamic renal scintigraphy (in terms of sequential images and renographic curve). MTT and PTT values were determined independently by two operators, using a matrix method for deconvolution of renographic curves. RESULTS: Differences between mean MTT and PTT from two studies by one operator were insignificant and those values were closely correlated (r = 0.99 and r = 0.97, respectively). Differences of values obtained by both operators were practically insignificant for MTT (r = 0.93), and significant for PTT (r = 0.81 and p &lt; 0.001). These differences do not disqualify that processing method. The upper limits of normative values of MTT and PTT were based on the results from first study performed by more experienced operator — 200 s and 170 s, respectively. CONCLUSIONS: The procedure of processing dynamic renal scintigraphy used in this study is reproducible. Normative values of MTT and PTT for 99mTc-EC were established as 200 s and 170 s, respectively. An attempt to optimize and standardize the technique of determining parenchymal ROI in a matrix deconvolution method, followed by an evaluation of clinical usefulness of these parameters in the diagnosis of chosen renal function impairments would be a logical continuation of this initial research

Should non-movement specialists refer patients for SPECT-DaTSCAN?

Background. SPECT with radioligand DaTSCAN (SPECT-DaTSCAN) is a sensitive tool used for assessing the functional integrity of the presynaptic part of the nigrostriatal dopaminergic system. The procedure is useful whenever there is a need to distinguish between neurodegenerative parkinsonism and other parkinsonian syndromes in subjects with equivocal signs and symptoms. It can be assumed that the neurologist’s decision to perform SPECT-DaTSCAN depends on his or her experience and skill in the diagnosis of parkinsonian and tremor syndromes. Aims. To assess the accuracy of referrals to SPECT-DATSCAN made by non-movement disorders specialists. Material and methods. Sixty seven patients referred for SPECT-DaTSCAN by a general neurologist were studied. In all subjects, a movement disorder specialist performed the neurological examination, collected medical history, and analysed previous treatments and the results of diagnostic tests. Results. Evaluation carried out by a movement disorder specialist did not confirm an indication for SPECT-DaTSCAN in 31 patients (46.3%). General neurologists needed support for clinical diagnosis with SPECT-DaTSCAN most frequently in subjects with parkinsonism even though they were presenting a full-blown disease manifestation and even though the patients met the diagnostic criteria for Parkinson’s disease or one of the atypical parkinsonian syndromes. Conclusions. Our presented results probably reflect the limited experience of general neurologists in the evaluation of parkinsonian syndromes and tremor. The use of SPECT-DaTSCAN by non-movement disorders specialists is associated with a significant risk of overuse of this tool. To minimise this risk, the skills of general neurologists in diagnosing parkinsonian and tremor syndromes should be improved. Moreover, patients should be provided with access to movement disorders specialists

Body composition analysis in women aged 50-80 in Kujawsko-Pomorskie Voivodeship

Obesity is a problem which is more and more common in Polish population. The reason for that is excessive energy delivery from food against the quantity used by organism, as well as too small physical activity. These factors lead to excessive increase of body fat quantity which has a detrimental impact on the health condition. The purpose of the study is a body composition assessment in women aged 50-80 living in Kujawsko-Pomorskie Voivodeship. 1902 female inhabitants of Kujawsko-Pomorskie Voivodeship participated in the study which was divided into six age groups. The fat mass level and the fat free mass level of the body was evaluated with the assistance of electrical bioimpedance method. The content of water in the organism and, indirectly, the basic metabolism level were also determined. With age women exhibit the decrease of fat free body mass and water level in the organism; whereas the body mass and, at the same time, the body fat content are observed to increase for women between 50 and 70 years of age. Above the age of 70 this tendency is reversed and the body mass and the body fat level decline. It was also observed that with age the basic metabolism level systematically diminishes within the population.Otyłość to problem coraz częściej występujący w polskiej populacji. Przyczyną jest nadmierne dostarczanie energii z pokarmów w stosunku do ilości zużywanych przez organizm, a także zbyt mała aktywność fizyczna. Czynniki te prowadzą do nadmiernego zwiększenia ilości tkanki tłuszczowej, niekorzystnie wpływającej na stan zdrowia. Celem badania jest ocena składu ciała kobiet między 50 a 80 rokiem życia zamieszkujących województwo kujawsko-pomorskie. W badaniu uczestniczyły 1902 mieszkanki województwa kujawsko-pomorskiego, które podzielono na sześć grup wie-kowych. Oceniono u nich za pomocą metody bioimpedancji elektrycznej poziom masy tłuszczowej i beztłuszczowej ciała. Określono również zawartość wody w organizmie i pośrednio poziom podstawowej przemiany materii. Wraz z wiekiem u kobiet następuje obniżenie beztłuszczowej masy ciała i poziomu wody w organizmie. Obserwuje się natomiast wzrost masy ciała i jednocześnie zawartości tkanki tłuszczowej u kobiet między 50 a 70 rokiem życia. Powyżej 70 roku życia tendencja ta ulega odwróceniu i dochodzi do spadku masy ciała i poziomu tkanki tłuszczowej. Jednocześnie zaobserwowano, że wraz z wiekiem poziom podstawowej przemiany materii systematycznie ulega zmniejszeniu w populacji

Analiza składu ciała kobiet województwa kujawsko-pomorskiego między 50 a 60 rokiem

Obesity is a problem which is more and more common in Polish population. The reason for that is excessive energy delivery from food against the quantity used by organism, as well as too small physical activity. These factors lead to excessive increase of body fat quantity which has a detrimental impact on the health condition.The purpose of the study is a body composition assessment in women aged 50-80 living in Kujawsko-Pomorskie Voivodeship.1902 female inhabitants of Kujawsko-Pomorskie Voivodeship participated in the study which was divided into six age groups. The fat mass level and the fat free mass level of the body was evaluated with the assistance of electrical bioimpedance method. The content of water in the organism and, indirectly, the basic metabolism level were also determined.With age women exhibit the decrease of fat free body mass and water level in the organism; whereas the body mass and, at the same time, the body fat content are observed to increase for women between 50 and 70 years of age. Above the age of 70 this tendency is reversed and the body mass and the body fat level decline. It was also observed that with age the basic metabolism level systematically diminishes within the population.Otyłość to problem coraz częściej występujący w polskiej populacji. Przyczyną jest nadmierne dostarczanie energii z pokarmów w stosunku do ilości zużywanych przez organizm, a także zbyt mała aktywność fizyczna. Czynniki te prowadzą do nadmiernego zwiększenia ilości tkanki tłuszczowej, niekorzystnie wpływającej na stan zdrowia.Celem badania jest ocena składu ciała kobiet między 50 a 80 rokiem życia zamieszkujących województwo kujawsko-pomorskie.W badaniu uczestniczyły 1902 mieszkanki województwa kujawsko-pomorskiego, które podzielono na sześć grup wie-kowych. Oceniono u nich za pomocą metody bioimpedancji elektrycznej poziom masy tłuszczowej i beztłuszczowej ciała. Określono również zawartość wody w organizmie i pośrednio poziom podstawowej przemiany materii.Wraz z wiekiem u kobiet następuje obniżenie beztłuszczowej masy ciała i poziomu wody w organizmie. Obserwuje się natomiast wzrost masy ciała i jednocześnie zawartości tkanki tłuszczowej u kobiet między 50 a 70 rokiem życia. Powyżej 70 roku życia tendencja ta ulega odwróceniu i dochodzi do spadku masy ciała i poziomu tkanki tłuszczowej. Jednocześnie zaobserwowano, że wraz z wiekiem poziom podstawowej przemiany materii systematycznie ulega zmniejszeniu w populacji

The symptoms asymmetry of drug-induced parkinsonism is not related to nigrostriatal cell degeneration: a SPECT-DaTSCAN study

Aim. Drug-induced parkinsonism (DIP) is the most common form of parkinsonism after Parkinson’s disease (PD) itself. It has been widely believed that DIP is characterised by symmetry of symptoms. Studies of patients with DIP in whom PD had been ruled out by SPECT-DaTSCAN have shown that symptom asymmetry is a common element of DIP clinical presentation. The aim of our study was to determine whether the asymmetry of symptoms in DIP is related to any abnormality within the presynaptic part of the nigrostriatal dopaminergic system.Materials and methods. Eleven patients with the diagnosis of DIP and asymmetric symptoms were studied. Their individual SPECT-DaTSCANs were normal. Indices calculated for the whole group of radiotracer uptake in the whole striatum, putamen and caudate contralateral to more severe DIP symptoms were compared to values obtained in the opposite hemisphere.Results. We did not find significant differences in radiotracer uptake in structures contralateral to more severe clinical symptoms when compared to the homolateral hemisphere.Conclusions. Our results have not confirmed the presence of a presynaptic nigrostriatal deficit which could be related to asymmetry of DIP. The factors responsible for the asymmetry of DIP symptoms should be sought in the postsynaptic part of the nigrostriatal dopaminergic system

Assessment of the relation between pelvicalyceal dilatation in ultrasound and features of obstructive uropathy in dynamic renal scintigraphy

BACKGROUND: Ultrasound is the first-line imaging in the diagnostics of the urinary system. It provides valuable morphological information, but its usefulness in assessment of the function of renal parenchyma is limited. Dynamic renal scintigraphy provides much more accurate information about parenchymal function of kidneys and urinary outflow. The aim of the study was to establish morphological ultrasound criteria for high likelihood of obstructive uropathy. MATERIAL AND METHODS: 59 patients (38 women, 21 men, between 18 and 82 years old, average age 50) with the pelvis dilatation &gt; 10 mm in one or both kidneys newly diagnosed in ultrasound, without earlier history of kidney and urinary tract diseases or renal surgery. A total of 79 kidneys were included in the study. Ultrasound and dynamic renal scintigraphy were performed on the same day. In ultrasound, maximum anteroposterior diameter of the renal pelvis (mAPD) and anteroposterior pelvic diameter at hilum (hAPD) were obtained. The ratio of total pelvicalyceal area to the whole kidney area (%PCS) was also calculated. Uropathy was determined by the positive diuretic test in renal scintigraphy performed using 111 MBq of 99mTc-EC. RESULTS: In dynamic renal scintigraphy, features of uropathy were found in 18 out of 79 kidneys (23%). Optimal thresholds for detection of obstructive uropathy for measured ultrasound parameters were determined based on the ROC curves: mAPD ≥ 23 mm (sensitivity 94%, specificity 76%, accuracy 80%, AUROC 0.91) hAPD ≥ 20 mm (sensitivity 78%, specificity 87%, accuracy 85%, AUROC 0.82) PCA/WKA ≥ 22% (sensitivity 83%, specificity 74%, accuracy 76%, AUROC 0.85). CONCLUSIONS: Determined thresholds of parameters measuring pelvicalyceal dilatation in ultrasound, including the easiest one to obtain in routine diagnostics — mADP, provide satisfactory effectiveness in isolating kidneys with high likelihood of obstructive uropathy. Their application can optimize the selection of patients for further kidney diagnostic imaging (dynamic renal scintigrapy or urography)