Dual-time-point FDG PET/CT imaging in prosthetic heart valve endocarditis

Purpose: FDG PET/CT has been of increasing interest in the diagnostic workup of prosthetic heart valve endocarditis (PVE). Some reports advocate later imaging time points to improve the diagnostic accuracy for PVE. In this study, we compared standard and late FDG PET/CT images in patients with a clinical suspicion of PVE. Materials and Methods: Fourteen scans in 13 patients referred for FDG PET/CT for suspicion of PVE performed at standard (60 min post injection) and late (150 min post injection) time points were scored based on visual interpretation and semi-quantitatively with SUVmax and target-to-background ratio (TBR, defined as [SUVmax valve/SUVmean blood pool]). Final diagnosis was based on surgical findings in all cases of infection (n = 6) and unremarkable follow-up in all others (n = 8). Results: Late images were more prone to false positive interpretation for both visual and semi-quantitative analyses. Visual analysis of the standard images yielded 1 false negative and 1 false positive result. On the late images, no scans were false negative but 5 scans were false positive. Conclusion: Late FDG PET/CT imaging for PVE seem

Segmenting Critical Factors for Enhancing the use of IT in Humanitarian Supply Chain Management

AbstractThis study intends to explore and segment the critical factors (CFs) to enhance the use of Information Technology (IT) in Humanitarian Supply Chain (HSC), particularly in the Indian context. In this study, ten influencing factors has been identified through an extensive literature review and expert opinion. A structural model and cause–effect relationship diagram was developed using decision-making trial and evaluation laboratory (DEMATEL) method for the identification of CFs. The present study adopt a comprehensive and rigorous procedure to identify six CFs namely, top management support, Government support, feedback mechanism to facilitate learning from prior experiences, transparent and accountable supply chain, strategic planning, and mutual learning with other commercial organizations (COs). The developed framework provides a simple, effective and efficient way to enhance the utilization of IT in HSC and in large to improve the competencies and performance of HSC

Relationship of promising methods in the detection of anthracycline-induced cardiotoxicity in breast cancer patients

Purpose\ud It remains challenging to identify patients at risk of anthracycline-induced cardiotoxicity. To better understand the different risk-stratifying approaches, we evaluated 123I-metaiodobenzylguanidine (123I-mIBG) scintigraphy and its interrelationship with conventional echocardiography, 2D strain imaging and several biomarkers.\ud \ud Methods\ud We performed 123I-mIBG scintigraphy, conventional and strain echocardiography and biomarker (NT-proBNP, TNF-α, galectin-3, IL-6, troponin I, ST-2 and sFlt-1) assessment in 59 breast cancer survivors 1 year after anthracycline treatment. Interobserver and intermethod variability was calculated on planar and SPECT 123I-mIBG scintigraphy, using the heart/mediastinum (H/M) ratio and washout (WO). Pearson’s r and multivariate analyses were performed to identify correlations and independent predictors of 123I-mIBG scintigraphy results.\ud \ud Results\ud Delayed planar anterior whole-heart ROI (WH) H/M ratios and WO were the most robust 123I-mIBG parameters. Significant correlations were observed between 123I-mIBG parameters and several conventional echo parameters, global longitudinal and radial strain (GLS and GRS) and galectin-3. The highest Pearson’s r was observed between delayed H/M ratio and GRS (Pearson’s r 0.36, p = 0.01). Multivariate analysis showed that GRS was the only independent predictor of the delayed WH H/M ratio (p = 0.023).\ud \ud Conclusion\ud The delayed planar H/M ratio is the most robust 123I-mIBG parameter. It correlates with several conventional echocardiographic parameters, GLS, GRS and galectin-3. Of these, only GRS predicts the H/M ratio

The role of myocardial innervation imaging in different clinical scenarios: an expert document of the European Association of Cardiovascular Imaging and Cardiovascular Committee of the European Association of Nuclear Medicine

Cardiac sympathetic activity plays a key role in supporting cardiac function in both health and disease conditions, and nuclear cardiac imaging has always represented the only way for the non-invasive evaluation of the functional integrity of cardiac sympathetic terminals, mainly through the use of radiopharmaceuticals that are analogues of norepinephrine and, in particular, with the use of I-123-mIBG imaging. This technique demonstrates the presence of cardiac sympathetic dysfunction in different cardiac pathologies, linking the severity of sympathetic nervous system impairment to adverse patient's prognosis. This article will outline the state-of-the-art of cardiac I-123-mIBG imaging and define the value and clinical applications in the different fields of cardiovascular diseases.Cardiolog

Preoperative and postoperative agreement in fat free mass (FFM) between bioelectrical impedance spectroscopy (BIS) and dual-energy X-ray absorptiometry (DXA) in patients undergoing cardiac surgery.

Background & aims: To measure undernutrition in terms of fat free mass (FFM), there are several options. The aim of this study was to assess agreement in FFM between the portable, bedside bioelectrical impedance spectrometry (BIS) and relatively expensive, non-portable dual-energy X-ray absorptiometry (DXA) in patients undergoing cardiac surgery. Methods: In a prospective study, body composition measurements by BIS and DXA were performed two weeks prior and two months after cardiac surgery. Preoperative and postoperative agreement in FFM between BIS and DXA were analyzed with Bland and Altman plots. Results: Twenty-six patients were analyzed. BIS overestimated preoperative and postoperative FFM by 2 kg compared to DXA (2.3 kg (95%CI: -3.5-8.1 kg) and 2.1 kg (95%CI: -4.5-8.7 kg), respectively). BIS underestimated FFM change by -0.5% (95%CI: -8.4-7.5%). Conclusions: There is a large inter-individual variation between BIS and DXA. This hinders the interchange-ability of BIS and DXA in routine clinical practice and may lead to misclassifications and thereby inappropriate nutritional treatment and possible postoperative complications. To evaluate nutritional therapy in patients undergoing cardiac surgery, we advocate the use of DXA assessed FFM in parallel to BIS assessed extracellular and intracellular water and FFM. (C) 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserve