Editorial

Radioisotope studies in cardiology have been a standardfor myocardial perfusion and function assessment since the lateseventies. The rapid development of echocardiography, computedtomography and cardiovascular magnetic resonance providednew insight into the diagnostic role of nuclear cardiologyRadioisotope studies in cardiology have been a standardfor myocardial perfusion and function assessment since the lateseventies. The rapid development of echocardiography, computedtomography and cardiovascular magnetic resonance providednew insight into the diagnostic role of nuclear cardiology

The prognostic value of myocardial perfusion scintigraphy compared to coronary angiography in women with positive stress test results

BACKGROUND: Modern diagnostic strategy in coronary arterydisease (CAD) makes it necessary not only to establish a diagnosisbut also to assess the cardiovascular risk. It is not clearwhich strategy should be followed in the case of women withpositive ECG stress test results to assess prognosis and startappropriate diagnostics and treatment.The aim of the study was to assess the prognostic value ofmyocardial perfusion scintigraphy in comparison with coronaryangiography in women suspected of CAD and with positive ECGstress test results.MATERIAL AND METHODS: The study population comprised115 women (mean age 58.08 ± 8.8 years) suspected of CAD, witha history of chest pain and positive stress test results, who underwent myocardial perfusion scintigraphy. In 58 women coronaryangiography was performed as the next step of the diagnosticprocedure. All the patients were interviewed and had a physicalexamination, including the assessment of the cardiovascularrisk in accordance with the SCORE (Systematic Coronary RiskEvaluation) scale and the probability of CAD (POST-TEST) inaccordance with the ESC guidelines. The gated single photonemission computed tomography (GSPECT) with Tc-99m-MIBIwas considered positive if moderate perfusion changes wereobserved in at least two segments or severe reversible perfusiondisorders were found, regardless of the number of involved segments.The degree of coronary stenosis was assessed visuallyand changes greater than 50% stenosis of the luminal diameterwere considered haemodynamically significant.RESULTS: The evaluation period covered 43.2 ± 30.8 monthson average. The sensitivity of myocardial perfusion scintigraphyagainst cardiovascular events was 100% and the sensitivity ofcoronary angiography was 92.3%. The specificity was 93.1%and 88.9% respectively.The PPV of scintigraphy for cardiovascular events was 65% and ofcoronary angiography was 70.6%. The NPV was 100% and 97.6%respectively. The accuracy of myocardial perfusion scintigraphy forcardiovascular events was 93.9% and the accuracy of coronaryangiography for cardiovascular events was 89.7%. The survivalanalysis confirmed the high prognostic value of SPECT and coronaryangiography. However, if compared, myocardial perfusionscintigraphy was a better predictor of survival without cardiovascularevents than coronary angiography was (c2 = 9.39, p < 0.01).The most important factors in assessing the cardiovascular riskin the study population included: positive result of myocardialperfusion scintigraphy, positive result of coronary angiography,and high SCORE and high POST-TEST values.CONCLUSIONS: Myocardial perfusion scintigraphy is superiorto coronary angiography in the prediction of necessary revascularisation procedures in women suspected of coronary arterydisease and with positive stress test results

Metabolic activity assessment of cardiac angiosarcoma by 18FDG PET-CT

Angiosarcoma is a neoplasm of an endothelial origin, whichcould arise from blood or lymphatic vessels, respectively hemangiosarcomaor lymphosarcoma

Veteran player tips the scale — V/Q SPECT-CT proves decisive in blunt chest trauma. Case report and brief literature review

A 29-year-old patient after blunt chest trauma with right lung atelectasis and pulmonary empyema was referred for lung ventilation and perfusion scintigraphy before right-sided pneumonectomy. Radionuclide imaging revealed severely reduced perfusion and lack of ventilation in the collapsed right lung. Additionally, it showed a matching lobar perfusion-ventilation defect in the lower left lobe, which, apart from consolidation area in posterior basal segment, appeared normal in computed tomography. A normal perfusion and ventilation pattern was observed in the upper left lobe. Since it was found to be the only functioning lobe, pneumonectomy was excluded from possible treatment options.A 29-year-old patient after blunt chest trauma with right lung atelectasis and pulmonary empyema was referred for lung ventilation and perfusion scintigraphy before right-sided pneumonectomy. Radionuclide imaging revealed severely reduced perfusion and lack of ventilation in the collapsed right lung. Additionally, it showed a matching lobar perfusion-ventilation defect in the lower left lobe, which, apart from consolidation area in posterior basal segment, appeared normal in computed tomography. A normal perfusion and ventilation pattern was observed in the upper left lobe. Since it was found to be the only functioning lobe, pneumonectomy was excluded from possible treatment options

Metody hybrydowe (SPECT-CT, PET-CT) w diagnostyce choroby wieńcowej i ocenie żywotności mięśnia sercowego

Tomografia emisyjna pojedynczego fotonu (SPECT, single-photon emission-computed tomography) jest uznaną, nieinwazyjną techniką stosowaną w diagnostyce niedokrwienia i martwicy miokardium, o wysokiej czułości i swoistości. Współczesne techniki badań scyntygraficznych, dzięki zastosowaniu nowoczesnych stacji komputerowych połączonych z gamma-kamerą i sekwencyjnej (zgodnej z zapisem EKG) rejestracji obrazów perfuzji podczas cyklu pracy serca (bramkowana emisyjna tomografia komputerowa pojedynczego fotonu, czyli gated SPECT — GSPECT), umożliwiają uzyskanie informacji zarówno na temat żywotności, perfuzji, jak i funkcji mięśnia sercowego. Naturalnym rozszerzeniem dotychczas stosowanych metod w diagnostyce choroby wieńcowej jest połączenie tomografii komputerowej (CT, computed tomography) z obrazowaniem perfuzji za pomocą SPECT. W ciągu ostatniej dekady ukazało się wiele publikacji wskazujących na wartość CT zarówno pod względem oceny zwapnień w tętnicach wieńcowych, jak i możliwości wykonywania nieinwazyjnej angiografii tętnic wieńcowych. Zaletą CT jest możliwość wykrywania miażdżycy tętnic wieńcowych w najwcześniejszych stadiach. Pozwala to na wdrożenie odpowiedniego leczenia zanim pojawią się istotne zwężenia. Z kolei SPECT, na podstawie czynnościowej oceny perfuzji miokardium, pozwala wyjaśnić znaczenie obrazu anatomicznego stwierdzonego w CT. Pozytonowa tomografia emisyjna (PET, positron emission tomography) umożliwia badanie metabolizmu komórek serca, ich perfuzję, unerwienie i funkcję lewej komory. Stanowi metodę referencyjną w rozpoznawaniu żywotności mięśnia sercowego. Większość nowych urządzeń PET to systemy hybrydowe, wyposażone w wielorzędowe tomografy komputerowe, które wykorzystuje się w celu korekcji osłabienia na obrazach PET. Skraca to łączny czas obrazowania i pozwala na uzupełnienie badania PET o strukturalną ocenę serca i naczyń oraz identyfikację zwapnień w tętnicach wieńcowych. Technika PET-CT może się stać unikatową kompleksową metodą diagnostyczną i prognostyczną w ocenie chorych z przewlekłą niewydolnością serca o etiologii niedokrwiennej. Dane anatomiczne i czynnościowe oraz ocena żywotności mięśnia sercowego pomogą w identyfikowaniu pacjentów ze wskazaniami do rewaskularyzacji, a także w uniknięciu poddawania chorych niepotrzebnym procedurom inwazyjnym

Feasibility of myocardial perfusion imaging studies in morbidly obese patients with a cadmium-zinc-telluride cardiac camera

BACKGROUND: A novel cardiac SPECT camera with cadmium-zinc-telluride (CZT) based technology has a fixed array of semiconductor detectors paired with pinhole collimators focused on the heart. Image acquisition in obese patients can be challenging because of much smaller detector field of view compared to conventional gamma cameras. The aim of this study was to evaluate the impact on high body mass on the feasibility of CZT myocardial perfusion imaging (MPI). The additional aim was to investigate the mechanism of the banana-shaped/obesity artifact, as referred to in literature, and to attempt at simulating it on a phantom study. MATERIAL AND METHODS: Study group consisted of 43 patients with morbid obesity (BMI ≥ 40 kg/m2). All these patients underwent myocardial perfusion imaging on both CZT cardiac camera and general purpose SPECT/CT gamma camera. Control group consisted of all patients who underwent myocardial perfusion imaging on CZT camera throughout one calendar year and whose BMI was lower than 40 kg/m2. In this group, all repeated studies were re-analyzed for estimating the frequency of heart mispositioning in the camera field of view. The number of studies performed was 1180. A static cardiac phantom was used to simulate a banana-shaped artifact. A series of phantom acquisitions during which the phantom position was altered in the camera field of view was performed. RESULTS: In control group, 3.7% of all cardiac scintigrams required repetition, 18.9% of which were repeated due to wrong heart positioning; median BMI in this group of patients was 36.0. A banana-shaped artifact was observed in one female patient with BMI 36.0. In morbid obesity group, 32.6% of the studies were non-diagnostic with “truncation effect” on Scan Quality Control (QC). Median BMI in patients with diagnostic scans was 42.0, while in patients with not acceptable quality control test it was 45.0 (p < 0.05). Banana-shaped artifacts were observed in 5 non-diagnostic studies. In a phantom study an artifact of banana shape was obtained when gantry was distant from the phantom and target was on the edge of the camera field of view and was slightly truncated. CONCLUSIONS: Problem with heart mispositioning during imaging on the CZT camera affects less than 1% of all performed studies. Morbid obesity is not a contraindication to perform myocardi

Novel KCNQ1 mutations in patients after myocardial infarction

Background: Patients after myocardial infarction (MI) are at greater risk of sudden cardiac death (SCD) than people in the overall population. The aim of this study was to detect mutations, including intronic ones, in the KCNQ1 gene coding for proteins of cardiac potassium channels and evaluate their possible effects on the clinical course in patients after MI. Methods: The study group was composed of 100 Polish patients after MI, which included 27 women (mean age 69 years) and 73 men (mean age 67 years). All patients underwent clinical examinations and genetic tests. The genetic test results have been correlated with the clinical data. The following parameters have been chosen as endpoints for this survey: sudden cardiac arrest (SCA) or SCD, complex ventricular arrhythmia, QT interval and QT dispersion values assessed during 24-hour Holter ECG monitoring in relation to ventricular arrhythmias as well as the minimum and maximum heart rate (HR) observed during the examination. Results: Six new mutations in the KCNQ1 gene: C2505734T, A2753831C in exons and C2505846A, G2753881A, T2755854C, T2755875G in introns. Detected intronic mutations in patients after MI were related to a worse clinical course and frequent occurrence of SCA. Conclusions: The novel intronic mutations may have a significant influence on the clinical course of the disease. (Cardiol J 2008; 15: 252-260

Brain metastases in patient with prostate cancer found in 18F-choline PET/CT

Brain metastases are a rare complication of prostate cancer. They are usually diagnosed in an end-stage disease when the tumor has already spread to the other organs and tissues. We present a case of a male with castration-resistant prostate cancer with bone metastases visualized in 18F-fluorocholine PET/CT scan. Brain metastases are a rare complication of prostate cancer. They are usually diagnosed in an end-stage disease when the tumour has already spread to the other organs and tissues. We present a case of a male with castration-resistant prostate cancer with bone metastases visualized in 18F-fluorocholine PET/CT scan

Znaczenie przypadkowo rozpoznanego ogniskowego wychwytu 99mTc- sestamibi w tarczycy w trakcie scyntygrafii perfuzyjnej mięśnia sercowego

  Introduction: 99mTc-sestamibi, a radiopharmaceutical widely used in the assessment of myocardial perfusion, can be used as an indicator of thyroid disease due to its oncophilic character. The aim of this study was to establish the usefulness of performing additional examinations of radiotracer uptake in the thyroid gland during standard stress scintigraphy with sestamibi in order to identify thyroid diseases. Material and methods: After a retrospective evaluation of 330 consecutive myocardial perfusion scintigraphies performed in our hospital during one year, 41 patients with a focal accumulation of 99mTc-sestamibi in the thyroid were enrolled in the study. The patients underwent clinical examinations, including thyroid ultrasonography and TSH, fT4, fT3, aTPO, TRAB, calcitonin, and CEA levels. Based on the thyroid ultrasounds, 21 patients were referred for fine-needle aspiration biopsy of the thyroid. Results: An abnormal accumulation of radiotracer in the thyroid was found in 41(12.4%) of 330 patients who underwent stress cardiac scintigraphy. Thirteen (31.7%) of those patients had multinodular euthyroid goitres, 12 (29.2%) had a single thyroid nodule (including two autonomous nodules), 11 (26.8%) had autoimmune thyroid disease, and one (2.4%) had papillary thyroid carcinoma. In 12 (29.2%) with thyroid tracer uptake there was no thyroid pathology. Conclusions: Additional evaluation of radiotracer uptake in the thyroid during standard myocardial perfusion scintigraphy is a valuable tool in the detection of thyroid diseases. The additional or parallel evaluation of radiotracer uptake in the thyroid should be considered during every myocardial scintigraphy. (Endokrynol Pol 2015; 66 (6): 521–525)    Wstęp: 99mTc-sestamibi jest radiofarmaceutykiem stosowanym standardowo między innymi w ocenie perfuzji mięśnia sercowego. Ze względu na właściwości onkofilne może być także wykorzystywany w diagnostyce chorób tarczycy. Celem pracy była analiza przydatności dodatkowej oceny gruczołu tarczowego podczas scyntygraficznej próby wysiłkowej z wykorzystaniem sestamibi do wykrywania chorób tarczycy. Materiał i metody: Po ocenie 330 kolejnych badań scyntygrafii perfuzyjnej serca w Zakładzie Medycyny Nuklearnej WIM wykonanych w okresie od 01.01.2009 do 1.01.2010 do dalszych badań zakwalifikowano 41 chorych, u których rozpoznano ogniskowe gromadzenie 99mTc- sestamibi w tarczycy. Następnie przeprowadzono badanie kliniczne, wykonano USG tarczycy oraz oznaczono stężenie: TSH, fT4, fT3, aTPO, TRAb, kalcytoniny, CEA. Na podstawie wyniku badania ultrasonograficznego tarczycy 21 osób skierowano na biopsję cienkoigłową tarczycy. Wyniki: U 41 (12,4%) z 330 chorych poddanych scyntygrafii serca stwierdzono nieprawidłowe gromadzeniem radioznacznika w tarczycy. U 13 ( 31,7%) z nich rozpoznano wole wieloguzkowe, 12 (29,2%) miało pojedynczy guzek tarczycy ( w tym dwóch chorych guzek autonomiczny), 11 chorych (26,8%) prezentowało autoimmunizacyjną chorobę tarczycy, u jednej (2,4%) znaleziono raka brodawkowatego tarczycy. W 12 przypadkach (29,2%) nieprawidłowego gromadzenia radioznacznika nie potwierdzono choroby tarczycy. Wnioski: Dodatkowa ocena wychwytu radioznacznika w tarczycy podczas standardowej scyntygrafii perfuzyjnej serca jest cennym narzędziem w wykrywaniu chorób tarczycy. W opisie wyniku badania scyntygrafii perfuzyjnej serca powinno się także uwzględniać ocenę wychwytu radioznacznika w tarczycy. (Endokrynol Pol 2015; 66 (6): 521–525)