April Mann - Academia.edu (original) (raw)

Papers by April Mann

Research paper thumbnail of Effect of time on liver clearance of technetium-99m-tetrofosmin in patients with acute chest pain: when should imaging begin?

Journal of Nuclear Medicine Technology

Due to stable myocardial retention and technetium imaging characteristics, 99mTc-tetrofosmin has ... more Due to stable myocardial retention and technetium imaging characteristics, 99mTc-tetrofosmin has been considered potentially useful for acute chest pain imaging. Tetrofosmin also has favorable biokinetics with reported rapid liver clearance, 5 min poststress and 30-45 min post-rest injection. Since comparable data are not available, the effect of time on liver clearance was evaluated in patients with acute chest pain. One hundred six patients received an intravenous injection of 25-30 mCi 99mTc-tetrofosmin to evaluate acute chest pain. SPECT imaging was performed 15-120 min after injection of the tracer. Patient images were grouped according to the time of acquisition after acute injection: 15-30 min, 31-45 min, 46-60 min, 61-90 min and > 90 min. Quantitative analysis was performed of a similar anterior projection for each patient consisting of 6 X 6-pixel region of interest over the myocardium and adjacent liver. Average counts per pixel were determined and a heart/liver (H/Li) ratio was calculated. The mean H/Li ratio was < 1.0 for patient images acquired 15-45 min after injection, and > 1.0 for patient images acquired after 45 min. The difference was statistically significant (p < 0.05). Quantitative analysis suggests that the optimal imaging time should be at least 45 min after the injection of 99mTc-tetrofosmin to allow adequate liver clearance before image acquisition of acute chest pain syndromes.

Research paper thumbnail of Evaluation of technetium-99m red blood cell labeling efficiency in adults receiving chemotherapy and the clinical impact on pediatric oncology patients

Journal of Nuclear Medicine Technology

Technetium-99m-labeled RBCs are used to evaluate ventricular function and are the preferred metho... more Technetium-99m-labeled RBCs are used to evaluate ventricular function and are the preferred method for monitoring the cardiac function of patients receiving chemotherapy. Optimal imaging quality is critical for monitoring small but important changes in ventricular function. The labeling efficiency of three products from two manufacturers and images from 30 patients (21 men, 9 women; age 60.3 +/- 11.9 yr) referred for clinical radionuclide ventriculograms before chemotherapy were evaluated to determine the best labeling technique. Patients received RBCs labeled in one of three ways. Two pyrophosphate methods used a modified in vitro method and the manufacturer's instructions were used for the in vitro method. Imaging was performed and, upon completion (42.1 +/- 9.6 min), blood samples were drawn, separated and counted to determine labeling efficiency. The labeling efficiencies were: (a) 88.1% +/- 4.2% and (b) 88.4% +/- 4.8% for the two modified in vitro methods; and (c) 95.3% +/- 1.7% for the in vitro method. The difference between the methods was statistically significant (p = 0.019). Twenty pediatric oncology patients (6.4 +/- 5.2 yr) received in vitro labeled RBCs through their Hickman catheters. All 20 pediatric studies were of high quality. In vitro labeling demonstrated a higher labeling efficiency than the modified in vitro methods. In vitro labeling also yielded high-quality images when the labeled RBCs were injected through existing chronic in-dwelling catheters.

Research paper thumbnail of Fasting and nonfasting iodine-123-idophenylpentadecanoic acid myocardial SPECT imaging in coronary artery disease

Journal of Nuclear Medicine

Iodine-123-labeled idophenylpentadecanoic acid (IPPA) metabolic imaging has been shown to be clin... more Iodine-123-labeled idophenylpentadecanoic acid (IPPA) metabolic imaging has been shown to be clinically useful for the identification of myocardial viability in patients with coronary artery disease and left ventricular dysfunction. Imaging is usually performed under fasting conditions since nonfasting conditions may affect myocardial uptake of 123I-IPPA. The purpose of this study was to examine the impact of dietary condition on 123I-IPPA metabolic imaging. Forty patients with stable coronary artery disease underwent, in randomized order and on separate days, 123I-IPPA SPECT myocardial imaging under fasting and nonfasting conditions. Patients were injected with 123I-IPPA (4-5 mCi) at rest with imaging performed at 4 (initial) and 30 (delay) min. For each image (initial and delay images), 10 segments were analyzed by three experienced observers without knowledge of patient identity or dietary condition using a 5-point grading system (O = no uptake to 4 = normal uptake). A summed glo...

Research paper thumbnail of Clinical Research: The Future of the Molecular Imaging Technologist--A White Paper Presented by Members of the Graduate Stakeholders Committee of the SNMMI Technologist Section

Journal of Nuclear Medicine Technology, 2014

Research paper thumbnail of Examining the Nuclear Medicine Advanced Associate: Past, Present, and Future--A White Paper Presented by Members of the Graduate Stakeholders Committee of the SNMMI Technologist Section

Journal of Nuclear Medicine Technology, 2014

Research paper thumbnail of Comparison of gated sestamibi myocardial perfusion imaging between upright solid state and standard supine gamma systems

Journal of Nuclear Cardiology, 2004

Background: Ischemic left ventricular (LV) dysfunction may occur after exercise, but is regarded ... more Background: Ischemic left ventricular (LV) dysfunction may occur after exercise, but is regarded as uncommon after vasodilator stress. We evaluated the prevalence of LV dysfunction post-adenosine (ado) in relation to the extent of reversible perfusion defects (PD) and angiographic coronary artery disease (CAD). Methods: 86 patients (pts.) referred for adenosine dual-isotope gated SPECT were studied: 43 with Ն 1 reversible PD, and 43 age and sex matched controls without CAD who had normal LV perfusion and function. Extent of reversible PD was defined by 20-segment/5-point summed difference score (SDS), and SDSՆ 8 defined severe PD. LV ejection fraction (EF) and segmental wall thickening (WT) were quantified at rest and 60 minutes post-adenosine by QGS (Cedars-Sinai

Research paper thumbnail of Visual assessment of left ventricular perfusion and function with electrocardiography-gated SPECT has high intraobserver and interobserver reproducibility among experienced nuclear cardiologists and cardiology trainees

Journal of Nuclear Cardiology, 2002

Research paper thumbnail of Gated SPECT imaging 101

Journal of Nuclear Cardiology, 1998

Research paper thumbnail of Role of the technologist in nuclear cardiology

Journal of Nuclear Cardiology, 1998

ABSTRACT

Research paper thumbnail of Comparison of exercise, dipyridamole, adenosine, and dobutamine stress with the use of Tc-99m tetrofosmin tomographic imaging1, 2

Journal of Nuclear Cardiology, 1999

The purpose of this study was to compare defect extent and severity and myocardial uptake with ex... more The purpose of this study was to compare defect extent and severity and myocardial uptake with exercise and pharmacologic stress with technetium-99m (Tc-99m) tetrofosmin tomographic myocardial perfusion imaging. Detection of stress-induced myocardial perfusion defects depends on both a disparity in blood flow between normal and stenotic vessels and the extraction fraction and linearity of myocardial uptake of the tracer. There are limited clinical data for exercise or pharmacologic stress with Tc-99m tetrofosmin tomographic myocardial perfusion imaging. Thirty-one patients with coronary artery disease and 7 with a < 5% likelihood of coronary artery disease underwent on separate days Tc-99m tetrofosmin single-photon emission computed tomographic imaging at rest and after exercise, dipyridamole, adenosine, and dobutamine stress. Images were interpreted by a blinded consensus of 3 experienced readers with a 17-segment model and 5-point scoring system. Compared with exercise, the summed stress score was smaller with dipyridamole (P < .01), and the reversibility score was smaller with both dipyridamole (P < .01) and dobutamine (P < .05), whereas the number of abnormal and reversible segments was less with both dipyridamole (P < .01 and P < .001, respectively) and dobutamine (both P < .05). No significant differences were found in the summed stress or reversibility scores and the number of abnormal or reversible segments between exercise and adenosine. Compared with exercise, defect extent, severity, and reversibility are less with dipyridamole and dobutamine with Tc-99m tetrofosmin single photon emission computed tomographic imaging.

Research paper thumbnail of Influence of arm positioning on rest/stress technetium-99m labeled sestamibi tomographic myocardial perfusion imaging

Journal of Nuclear Cardiology, 1999

Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is routinel... more Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is routinely performed with patients' arms positioned above their heads to avoid potential attenuation artifact and reduced image quality. Currently no data are available to support the use of this practice using 99mTc SPECT MPI: Forty-one patients referred for routine rest/stress MPI were imaged using the standard protocol with arms positioned above their heads and again with their arms at their sides. The patients were injected with 10 to 45 mCi (370 to 1665 MBq) of 99mTc-labeled sestamibi (99mTc-sestamibi), and SPECT images were acquired 30 to 90 minutes later. Thirty patients were imaged on an ADAC Vertex dual-head camera and 11 patients on an ADAC Cirrus single-head camera. Images were interpreted by 3 nuclear cardiologists without knowledge of patient identity, arm position, or camera type using a 17-segment scoring model. No significant differences were noted in the percentage of abnormal study results, reversibility extent, or location of MPI defects between the 2 arm positions in the same patients. Image quality was also similar. Arm positioning does not influence the interpretation of 99mTc-sestamibi SPECT myocardial perfusion imaging with regard to image quality or defect location and extent.

Research paper thumbnail of Acute myocardial perfusion imaging for the technologist

Journal of Nuclear Cardiology, 1998

Research paper thumbnail of ASNC Model Coverage Policy: Cardiac positron emission tomographic imaging

Journal of Nuclear Cardiology, 2013

Research paper thumbnail of Comparison of electrocardiographic-gated technetium-99m sestamibi single-photon emission computed tomographic imaging and rest-redistribution thallium-201 in the prediction of myocardial viability

The American Journal of Cardiology, 2000

Although the combined assessment of perfusion and function using rest electrocardiographic (ECG)-... more Although the combined assessment of perfusion and function using rest electrocardiographic (ECG)-gated technetium-99m (Tc-99m) sestamibi single-photon emission computed tomographic (SPECT) imaging has been shown to improve sensitivity and accuracy over perfusion alone in the prediction of myocardial viability, no data are available comparing this technique with restredistribution thallium-201. Thirty patients with coronary artery disese and left ventricular dysfunction (ejection fraction <40%) underwent rest-redistribution thallium-201 and rest ECG-gated Tc-99m sestamibi SPECT imaging before revascularization and rest ECGgated Tc-99m sestamibi SPECT imaging at 1 or 6 weeks after revascularization. All thallium-201 and Tc-99m sestamibi images were interpreted by a consensus agreement of 3 experienced readers without knowledge of patient identity or time of imaging with Tc-99m sestamibi (before or after revascularization) using a 17-segment model. Concordance between techniques for the prediction of viability was 89% ( 0.556 ؎ 0.109). With rest-redistribution thallium-201, sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy were 95%, 59%, 88%, 78%, and 86%, respectively. With rest ECG-gated Tc-99m sestamibi SPECT imaging, sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy were 96%, 55%, 87%, 80%, and 86%, respectively (p ‫؍‬ NS vs rest-redistribution thallium-201). Although both techniques are comparable for detecting viable myocardium, rest ECG-gated Tc-99m sestamibi SPECT imaging allows direct assessment of both myocardial perfusion and ventricular function, which may be clinically useful in patients who require assessment of myocardial viability. ᮊ2000 by

Research paper thumbnail of Combined assessment of myocardial perfusion and left ventricular function with exercise technetium-99m sestamibi gated single-photon emission computed tomography can differentiate between ischemic and nonischemic dilated cardiomyopathy

The American Journal of Cardiology, 1998

Research paper thumbnail of Dipyridamole-dobutamine stress with Tc-99m sestamibi tomographic myocardial perfusion imaging

The American Journal of Cardiology, 1998

In 66 patients unable to exercise referred for pharmacologic stress single-photon emission comput... more In 66 patients unable to exercise referred for pharmacologic stress single-photon emission computed tomographic myocardial perfusion imaging, a moderate dose of dobutamine was combined with intravenous dipyridamole and the results were compared with standard intravenous dipyridamole stress. The combined stress protocol resulted in increased defect size and reversibility with technetium-99m sestamibi single-photon emission computed tomographic myocardial perfusion imaging.

Research paper thumbnail of Usefulness of electrocardiographic-gated stress technetium-99m sestamibi single-photon emission computed tomography to differentiate ischemic from nonischemic cardiomyopathy

The American Journal of Cardiology, 2004

The noninvasive differentiation between ischemic and nonischemic cardiomyopathy is frequently dif... more The noninvasive differentiation between ischemic and nonischemic cardiomyopathy is frequently difficult. We examined the clinical value of stress electrocardiographic gated (ECG-gated) single-photon emission computed tomography (SPECT) to identify ischemic cardiomyopathy and detect coronary artery disease (CAD) in 164 patients without known CAD, ejection fraction <40% by ECG-gated SPECT, and subsequent coronary angiography. Summed stress, rest, and difference scores were measured from the SPECT studies, and regional wall motion variance was calculated from the ECGgated images. Sensitivity and 95% confidence intervals for the diagnosis of ischemic cardiomyopathy and for detection of any CAD (>50% diameter stenosis) were estimated using previously defined cutoffs for summed stress score and regional wall motion variance. For the diagnosis of ischemic cardiomyopathy, sensitivity of stress SPECT (summed stress score >8) was 87% (95% confidence interval [CI] 78 to 95), with a specificity of 63% (95% CI 60 to 82). The addition of wall motion information (summed stress score >8 or regional wall motion variance >0.114) increased sensitivity to 88% (95% CI 80 to 96) and decreased specificity to 45% (95% CI 35 to 55). If reversibility was also taken into account (summed stress score >8, regional wall motion variance >0.114, or summed difference score >0), sensitivity further increased to 94% (95% CI 88 to 100) and specificity decreased to 32% (95% CI 23 to 41). For detection of any CAD, the combined approach using stress perfusion, reversibility, and region of wall motion had a sensitivity of 94% (95% CI 89 to 99) and a specificity of 45% (95% CI 35 to 57). Therefore, ECG-gated SPECT is very sensitive for detection of ischemic cardiomyopathy and CAD among patients with moderate to severe systolic dysfunction. ᮊ2004

Research paper thumbnail of Myocardial perfusion and function: Single photon emission computed tomography

Journal of Nuclear Cardiology, 2007

Christopher L. Hansen, MD,a Richard A. Goldstein, MD,a Olakunle O. Akinboboye, MBBS, MPH, MBA,b D... more Christopher L. Hansen, MD,a Richard A. Goldstein, MD,a Olakunle O. Akinboboye, MBBS, MPH, MBA,b Daniel S. Berman, MD,b Elias H. Botvinick, MD,b Keith B. Churchwell, MD,b C. David Cooke, MSEE,b James R. Corbett, MD,b S. James Cullom, PhD,b Seth T. ...

Research paper thumbnail of Effect of time on liver clearance of technetium-99m-tetrofosmin in patients with acute chest pain: when should imaging begin?

Journal of Nuclear Medicine Technology

Due to stable myocardial retention and technetium imaging characteristics, 99mTc-tetrofosmin has ... more Due to stable myocardial retention and technetium imaging characteristics, 99mTc-tetrofosmin has been considered potentially useful for acute chest pain imaging. Tetrofosmin also has favorable biokinetics with reported rapid liver clearance, 5 min poststress and 30-45 min post-rest injection. Since comparable data are not available, the effect of time on liver clearance was evaluated in patients with acute chest pain. One hundred six patients received an intravenous injection of 25-30 mCi 99mTc-tetrofosmin to evaluate acute chest pain. SPECT imaging was performed 15-120 min after injection of the tracer. Patient images were grouped according to the time of acquisition after acute injection: 15-30 min, 31-45 min, 46-60 min, 61-90 min and &gt; 90 min. Quantitative analysis was performed of a similar anterior projection for each patient consisting of 6 X 6-pixel region of interest over the myocardium and adjacent liver. Average counts per pixel were determined and a heart/liver (H/Li) ratio was calculated. The mean H/Li ratio was &lt; 1.0 for patient images acquired 15-45 min after injection, and &gt; 1.0 for patient images acquired after 45 min. The difference was statistically significant (p &lt; 0.05). Quantitative analysis suggests that the optimal imaging time should be at least 45 min after the injection of 99mTc-tetrofosmin to allow adequate liver clearance before image acquisition of acute chest pain syndromes.

Research paper thumbnail of Evaluation of technetium-99m red blood cell labeling efficiency in adults receiving chemotherapy and the clinical impact on pediatric oncology patients

Journal of Nuclear Medicine Technology

Technetium-99m-labeled RBCs are used to evaluate ventricular function and are the preferred metho... more Technetium-99m-labeled RBCs are used to evaluate ventricular function and are the preferred method for monitoring the cardiac function of patients receiving chemotherapy. Optimal imaging quality is critical for monitoring small but important changes in ventricular function. The labeling efficiency of three products from two manufacturers and images from 30 patients (21 men, 9 women; age 60.3 +/- 11.9 yr) referred for clinical radionuclide ventriculograms before chemotherapy were evaluated to determine the best labeling technique. Patients received RBCs labeled in one of three ways. Two pyrophosphate methods used a modified in vitro method and the manufacturer&#39;s instructions were used for the in vitro method. Imaging was performed and, upon completion (42.1 +/- 9.6 min), blood samples were drawn, separated and counted to determine labeling efficiency. The labeling efficiencies were: (a) 88.1% +/- 4.2% and (b) 88.4% +/- 4.8% for the two modified in vitro methods; and (c) 95.3% +/- 1.7% for the in vitro method. The difference between the methods was statistically significant (p = 0.019). Twenty pediatric oncology patients (6.4 +/- 5.2 yr) received in vitro labeled RBCs through their Hickman catheters. All 20 pediatric studies were of high quality. In vitro labeling demonstrated a higher labeling efficiency than the modified in vitro methods. In vitro labeling also yielded high-quality images when the labeled RBCs were injected through existing chronic in-dwelling catheters.

Research paper thumbnail of Fasting and nonfasting iodine-123-idophenylpentadecanoic acid myocardial SPECT imaging in coronary artery disease

Journal of Nuclear Medicine

Iodine-123-labeled idophenylpentadecanoic acid (IPPA) metabolic imaging has been shown to be clin... more Iodine-123-labeled idophenylpentadecanoic acid (IPPA) metabolic imaging has been shown to be clinically useful for the identification of myocardial viability in patients with coronary artery disease and left ventricular dysfunction. Imaging is usually performed under fasting conditions since nonfasting conditions may affect myocardial uptake of 123I-IPPA. The purpose of this study was to examine the impact of dietary condition on 123I-IPPA metabolic imaging. Forty patients with stable coronary artery disease underwent, in randomized order and on separate days, 123I-IPPA SPECT myocardial imaging under fasting and nonfasting conditions. Patients were injected with 123I-IPPA (4-5 mCi) at rest with imaging performed at 4 (initial) and 30 (delay) min. For each image (initial and delay images), 10 segments were analyzed by three experienced observers without knowledge of patient identity or dietary condition using a 5-point grading system (O = no uptake to 4 = normal uptake). A summed glo...

Research paper thumbnail of Clinical Research: The Future of the Molecular Imaging Technologist--A White Paper Presented by Members of the Graduate Stakeholders Committee of the SNMMI Technologist Section

Journal of Nuclear Medicine Technology, 2014

Research paper thumbnail of Examining the Nuclear Medicine Advanced Associate: Past, Present, and Future--A White Paper Presented by Members of the Graduate Stakeholders Committee of the SNMMI Technologist Section

Journal of Nuclear Medicine Technology, 2014

Research paper thumbnail of Comparison of gated sestamibi myocardial perfusion imaging between upright solid state and standard supine gamma systems

Journal of Nuclear Cardiology, 2004

Background: Ischemic left ventricular (LV) dysfunction may occur after exercise, but is regarded ... more Background: Ischemic left ventricular (LV) dysfunction may occur after exercise, but is regarded as uncommon after vasodilator stress. We evaluated the prevalence of LV dysfunction post-adenosine (ado) in relation to the extent of reversible perfusion defects (PD) and angiographic coronary artery disease (CAD). Methods: 86 patients (pts.) referred for adenosine dual-isotope gated SPECT were studied: 43 with Ն 1 reversible PD, and 43 age and sex matched controls without CAD who had normal LV perfusion and function. Extent of reversible PD was defined by 20-segment/5-point summed difference score (SDS), and SDSՆ 8 defined severe PD. LV ejection fraction (EF) and segmental wall thickening (WT) were quantified at rest and 60 minutes post-adenosine by QGS (Cedars-Sinai

Research paper thumbnail of Visual assessment of left ventricular perfusion and function with electrocardiography-gated SPECT has high intraobserver and interobserver reproducibility among experienced nuclear cardiologists and cardiology trainees

Journal of Nuclear Cardiology, 2002

Research paper thumbnail of Gated SPECT imaging 101

Journal of Nuclear Cardiology, 1998

Research paper thumbnail of Role of the technologist in nuclear cardiology

Journal of Nuclear Cardiology, 1998

ABSTRACT

Research paper thumbnail of Comparison of exercise, dipyridamole, adenosine, and dobutamine stress with the use of Tc-99m tetrofosmin tomographic imaging1, 2

Journal of Nuclear Cardiology, 1999

The purpose of this study was to compare defect extent and severity and myocardial uptake with ex... more The purpose of this study was to compare defect extent and severity and myocardial uptake with exercise and pharmacologic stress with technetium-99m (Tc-99m) tetrofosmin tomographic myocardial perfusion imaging. Detection of stress-induced myocardial perfusion defects depends on both a disparity in blood flow between normal and stenotic vessels and the extraction fraction and linearity of myocardial uptake of the tracer. There are limited clinical data for exercise or pharmacologic stress with Tc-99m tetrofosmin tomographic myocardial perfusion imaging. Thirty-one patients with coronary artery disease and 7 with a &lt; 5% likelihood of coronary artery disease underwent on separate days Tc-99m tetrofosmin single-photon emission computed tomographic imaging at rest and after exercise, dipyridamole, adenosine, and dobutamine stress. Images were interpreted by a blinded consensus of 3 experienced readers with a 17-segment model and 5-point scoring system. Compared with exercise, the summed stress score was smaller with dipyridamole (P &lt; .01), and the reversibility score was smaller with both dipyridamole (P &lt; .01) and dobutamine (P &lt; .05), whereas the number of abnormal and reversible segments was less with both dipyridamole (P &lt; .01 and P &lt; .001, respectively) and dobutamine (both P &lt; .05). No significant differences were found in the summed stress or reversibility scores and the number of abnormal or reversible segments between exercise and adenosine. Compared with exercise, defect extent, severity, and reversibility are less with dipyridamole and dobutamine with Tc-99m tetrofosmin single photon emission computed tomographic imaging.

Research paper thumbnail of Influence of arm positioning on rest/stress technetium-99m labeled sestamibi tomographic myocardial perfusion imaging

Journal of Nuclear Cardiology, 1999

Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is routinel... more Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is routinely performed with patients&amp;amp;#39; arms positioned above their heads to avoid potential attenuation artifact and reduced image quality. Currently no data are available to support the use of this practice using 99mTc SPECT MPI: Forty-one patients referred for routine rest/stress MPI were imaged using the standard protocol with arms positioned above their heads and again with their arms at their sides. The patients were injected with 10 to 45 mCi (370 to 1665 MBq) of 99mTc-labeled sestamibi (99mTc-sestamibi), and SPECT images were acquired 30 to 90 minutes later. Thirty patients were imaged on an ADAC Vertex dual-head camera and 11 patients on an ADAC Cirrus single-head camera. Images were interpreted by 3 nuclear cardiologists without knowledge of patient identity, arm position, or camera type using a 17-segment scoring model. No significant differences were noted in the percentage of abnormal study results, reversibility extent, or location of MPI defects between the 2 arm positions in the same patients. Image quality was also similar. Arm positioning does not influence the interpretation of 99mTc-sestamibi SPECT myocardial perfusion imaging with regard to image quality or defect location and extent.

Research paper thumbnail of Acute myocardial perfusion imaging for the technologist

Journal of Nuclear Cardiology, 1998

Research paper thumbnail of ASNC Model Coverage Policy: Cardiac positron emission tomographic imaging

Journal of Nuclear Cardiology, 2013

Research paper thumbnail of Comparison of electrocardiographic-gated technetium-99m sestamibi single-photon emission computed tomographic imaging and rest-redistribution thallium-201 in the prediction of myocardial viability

The American Journal of Cardiology, 2000

Although the combined assessment of perfusion and function using rest electrocardiographic (ECG)-... more Although the combined assessment of perfusion and function using rest electrocardiographic (ECG)-gated technetium-99m (Tc-99m) sestamibi single-photon emission computed tomographic (SPECT) imaging has been shown to improve sensitivity and accuracy over perfusion alone in the prediction of myocardial viability, no data are available comparing this technique with restredistribution thallium-201. Thirty patients with coronary artery disese and left ventricular dysfunction (ejection fraction <40%) underwent rest-redistribution thallium-201 and rest ECG-gated Tc-99m sestamibi SPECT imaging before revascularization and rest ECGgated Tc-99m sestamibi SPECT imaging at 1 or 6 weeks after revascularization. All thallium-201 and Tc-99m sestamibi images were interpreted by a consensus agreement of 3 experienced readers without knowledge of patient identity or time of imaging with Tc-99m sestamibi (before or after revascularization) using a 17-segment model. Concordance between techniques for the prediction of viability was 89% ( 0.556 ؎ 0.109). With rest-redistribution thallium-201, sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy were 95%, 59%, 88%, 78%, and 86%, respectively. With rest ECG-gated Tc-99m sestamibi SPECT imaging, sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy were 96%, 55%, 87%, 80%, and 86%, respectively (p ‫؍‬ NS vs rest-redistribution thallium-201). Although both techniques are comparable for detecting viable myocardium, rest ECG-gated Tc-99m sestamibi SPECT imaging allows direct assessment of both myocardial perfusion and ventricular function, which may be clinically useful in patients who require assessment of myocardial viability. ᮊ2000 by

Research paper thumbnail of Combined assessment of myocardial perfusion and left ventricular function with exercise technetium-99m sestamibi gated single-photon emission computed tomography can differentiate between ischemic and nonischemic dilated cardiomyopathy

The American Journal of Cardiology, 1998

Research paper thumbnail of Dipyridamole-dobutamine stress with Tc-99m sestamibi tomographic myocardial perfusion imaging

The American Journal of Cardiology, 1998

In 66 patients unable to exercise referred for pharmacologic stress single-photon emission comput... more In 66 patients unable to exercise referred for pharmacologic stress single-photon emission computed tomographic myocardial perfusion imaging, a moderate dose of dobutamine was combined with intravenous dipyridamole and the results were compared with standard intravenous dipyridamole stress. The combined stress protocol resulted in increased defect size and reversibility with technetium-99m sestamibi single-photon emission computed tomographic myocardial perfusion imaging.

Research paper thumbnail of Usefulness of electrocardiographic-gated stress technetium-99m sestamibi single-photon emission computed tomography to differentiate ischemic from nonischemic cardiomyopathy

The American Journal of Cardiology, 2004

The noninvasive differentiation between ischemic and nonischemic cardiomyopathy is frequently dif... more The noninvasive differentiation between ischemic and nonischemic cardiomyopathy is frequently difficult. We examined the clinical value of stress electrocardiographic gated (ECG-gated) single-photon emission computed tomography (SPECT) to identify ischemic cardiomyopathy and detect coronary artery disease (CAD) in 164 patients without known CAD, ejection fraction <40% by ECG-gated SPECT, and subsequent coronary angiography. Summed stress, rest, and difference scores were measured from the SPECT studies, and regional wall motion variance was calculated from the ECGgated images. Sensitivity and 95% confidence intervals for the diagnosis of ischemic cardiomyopathy and for detection of any CAD (>50% diameter stenosis) were estimated using previously defined cutoffs for summed stress score and regional wall motion variance. For the diagnosis of ischemic cardiomyopathy, sensitivity of stress SPECT (summed stress score >8) was 87% (95% confidence interval [CI] 78 to 95), with a specificity of 63% (95% CI 60 to 82). The addition of wall motion information (summed stress score >8 or regional wall motion variance >0.114) increased sensitivity to 88% (95% CI 80 to 96) and decreased specificity to 45% (95% CI 35 to 55). If reversibility was also taken into account (summed stress score >8, regional wall motion variance >0.114, or summed difference score >0), sensitivity further increased to 94% (95% CI 88 to 100) and specificity decreased to 32% (95% CI 23 to 41). For detection of any CAD, the combined approach using stress perfusion, reversibility, and region of wall motion had a sensitivity of 94% (95% CI 89 to 99) and a specificity of 45% (95% CI 35 to 57). Therefore, ECG-gated SPECT is very sensitive for detection of ischemic cardiomyopathy and CAD among patients with moderate to severe systolic dysfunction. ᮊ2004

Research paper thumbnail of Myocardial perfusion and function: Single photon emission computed tomography

Journal of Nuclear Cardiology, 2007

Christopher L. Hansen, MD,a Richard A. Goldstein, MD,a Olakunle O. Akinboboye, MBBS, MPH, MBA,b D... more Christopher L. Hansen, MD,a Richard A. Goldstein, MD,a Olakunle O. Akinboboye, MBBS, MPH, MBA,b Daniel S. Berman, MD,b Elias H. Botvinick, MD,b Keith B. Churchwell, MD,b C. David Cooke, MSEE,b James R. Corbett, MD,b S. James Cullom, PhD,b Seth T. ...