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Gregg S, Keramida G, Peters AM. Measuring myocardial blood flow with 82rubidium using Gjedde-Patlak-Rutland graphical analysis. Ann Nucl Med 2021; 35:777-784. [PMID: 34076856 DOI: 10.1007/s12149-021-01591-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Myocardial blood flow (MBF) is measured with 82Rb using non-linear, least-squares computerised modelling. The study aim was to explore the feasibility of Gjedde-Patlak-Rutland (GPR) graphical analysis as a simpler method for measuring MBF. METHODS Patients had myocardial perfusion imaging using adenosine (n = 45) or regadenoson (n = 33) for stressing. Blood 82Rb clearance into myocytes (K1) was measured from Cedar-Sinai QPET software using the modified Crone-Renkin equation of Lortie et al. (K1 = [1-0.77 × e-B/MBF] × MBF) to convert K1 to MBF (ml/min/100 ml), where B (63 ml/min/100 ml) is myocardial permeability-surface area product. Using aorta or left ventricular cavity (LV) to measure arterial blood 82Rb concentration, blood 82Rb clearance into myocardium (Z) was measured from GPR analysis based on data acquired between 1 and 3 min post-injection. As units of K1 and Z are, respectively, ml/min/ml intracellular space and ml/min/ml total tissue including extracellular space, myocardial extracellular fluid volume (ECV) is 1 - [Z/K1]. Using Z/K1 (see Results) to modify its index, the Lortie equation was changed to Z = (1-0.77 × [Formula: see text]e-BZ/MBFZ)*MBFZ, following which MBFZ was calculated from Z. In GPR analysis, spillover of activity from LV to myocardium conveniently 'drops out' in the intercept of the plot. RESULTS Both agents increased myocardial blood flow almost equally. ECV was ~ 35 ml/100 ml at rest, increasing to ~ 40 ml/100 ml after stress. Z/K1, averaged between stress, rest, stressing agents and arterial ROI, was 0.62, so BZ was taken as 39 (i.e. 0.62 × 63) ml/min/100 ml. Based on LV, MBFZ (y) correlated with MBF (x): y = 0.43x + 22 ml/min/100 ml; r = 0.84; n = 156). Their respective stress/rest ratios showed a moderate correlation (r = 0.64; n = 78). CONCLUSIONS GPR analysis offers promise as a valid and analytically simpler technique for measuring myocardial blood flow, which, as with any clearance measured from GPR analysis, has units of ml/min/ml total tissue volume, and merits development as a polar map display.
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Affiliation(s)
- Sima Gregg
- Department of Nuclear Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Georgia Keramida
- Department of Nuclear Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - A Michael Peters
- Department of Nuclear Medicine, King's College Hospital NHS Foundation Trust, Denmark Hill, Brixton, London, SE5 9RS, UK.
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2
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Lang JK, Canty JM. The complexity of using resting myocardial perfusion to assess myocardial viability and predict functional recovery. J Nucl Cardiol 2021; 28:274-277. [PMID: 31087267 PMCID: PMC6851455 DOI: 10.1007/s12350-019-01742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jennifer K Lang
- Division of Cardiovascular Medicine and the Clinical and Translational Research Center, Department of Medicine, University at Buffalo, Buffalo, USA
- The Veterans Affairs Western New York Health Care System, Buffalo, USA
| | - John M Canty
- Division of Cardiovascular Medicine and the Clinical and Translational Research Center, Department of Medicine, University at Buffalo, Buffalo, USA.
- The Veterans Affairs Western New York Health Care System, Buffalo, USA.
- Clinical and Translational Research Center, University at Buffalo, Suite 7030, 875 Ellicott Street, Buffalo, NY, 14203, USA.
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3
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Benz DC, Ferro P, Safa N, Messerli M, von Felten E, Huang W, Patriki D, Giannopoulos AA, Fuchs TA, Gräni C, Gebhard C, Pazhenkottil AP, Kaufmann PA, Buechel RR. Role of quantitative myocardial blood flow and 13N-ammonia washout for viability assessment in ischemic cardiomyopathy. J Nucl Cardiol 2021; 28:263-273. [PMID: 30895563 DOI: 10.1007/s12350-019-01684-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Positron emission tomography (PET) integrating assessment of perfusion with 13N-ammonia (NH3) and viability with 18F-fluorodeoxyglucose (FDG) has high accuracy to identify viable, hibernating myocardium. We tested whether quantification of myocardial blood flow (MBF) and washout (k2) can predict myocardial viability using FDG as standard of reference. METHODS In 180 consecutive patients with ischemic cardiomyopathy, myocardium was categorized on a segment-level into normal, ischemic, hibernating, and scar. From dynamic images, stress MBF, rest MBF, and k2 were derived and myocardial flow reserve (MFR) and volume of distribution (VD) were calculated. RESULTS Across myocardial tissues, all parameters differed significantly. The area under the curve (AUC) was 0.564 (95% CI 0.527-0.601), 0.635 (0.599-0.671), 0.553 (0.516-0.591), 0.520 (0.482-0.559), and 0.560 (0.522-0.597) for stress MBF, rest MBF, MFR, k2, and VD. The generalized linear mixed model correctly classified 81% of scar as viable, hibernating myocardium. If the threshold of rest MBF to predict viability was set to 0.45 mL·min-1·g-1, sensitivity and specificity were 96% and 12%, respectively. CONCLUSION Quantitative NH3 PET parameters have low to moderate diagnostic performance to predict viability in ischemic cardiomyopathy. However, if rest MBF falls below 0.45 mL·min-1·g-1, viability testing by FDG-PET may be safely deferred.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Paola Ferro
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Nico Safa
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Wenjie Huang
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dimitri Patriki
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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4
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Parent EE, Sethi I, Nye J, Holder C, Olson JJ, Switchenko J, Tade F, Akin-Akintayo OO, Abiodun-Ojo OA, Akintayo A, Schuster DM. 82Rubidium chloride PET discrimination of recurrent intracranial malignancy from radiation necrosis. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2019; 66:74-81. [PMID: 31820882 DOI: 10.23736/s1824-4785.19.03173-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Accurate identification and discrimination of post treatment changes from recurrent disease remains a challenge for patients with intracranial malignancies despite advances in molecular and magnetic resonance imaging. We have explored the ability of readily available Rubidium-82 chloride (82RbCl) PET to identify and distinguish progressive intracranial disease from radiation necrosis in patients previously treated with radiation therapy. METHODS Six patients with a total of 9 lesions of either primary (n=3) or metastatic (n=6) intracranial malignancies previously treated with stereotactic radiation surgery (SRS) and persistent contrast enhancement on MRI underwent brain 82RbCl PET imaging. Two patients with arteriovenous malformations previously treated with SRS, also had brain 82RbCl PET imaging for a total of 11 lesions studied. Histological confirmation via stereotactic biopsy/excisional resection was obtained for 9 lesions with the remaining 2 classified as either recurrent tumor or radiation necrosis based on subsequent MRI examinations. 82RbCl PET time activity curve analysis was performed which comprised lesion SUVmax, contralateral normal brain SUVmax, and tumor to background ratios (TBmax). RESULTS 82RbCl demonstrates uptake greater than normal brain parenchyma in all lesions studied. Time activity curves demonstrated progressive uptake of 82RbCl in all lesions without evidence of washout. While recurrent disease demonstrated a greater mean SUVmax compared to radiation necrosis, no statistically significant difference between lesion SUVmax nor TBmax was found (p>0.05). CONCLUSIONS 82RbCl PET produces high-contrast uptake of both recurrent disease and radiation necrosis compared to normal brain. However, no statistically significant difference was found between recurrent tumor and radiation necrosis.
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Affiliation(s)
| | - Ila Sethi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA -
| | - Jonathon Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Chad Holder
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey Switchenko
- Bioinformatics and Biostatistics Shared Resource, Winship Cancer Institute of Emory, University, Atlanta, GA, USA
| | - Funmilayo Tade
- Department of Radiology, Loyola University, Chicago, IL, USA
| | - Oladunni O Akin-Akintayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Olayinka A Abiodun-Ojo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Akinyemi Akintayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - David M Schuster
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Stephansen C, Sommer A, Kronborg MB, Jensen JM, Nørgaard BL, Gerdes C, Kristensen J, Jensen HK, Fyenbo DB, Bouchelouche K, Nielsen JC. Electrically vs. imaging-guided left ventricular lead placement in cardiac resynchronization therapy: a randomized controlled trial. Europace 2019; 21:1369-1377. [DOI: 10.1093/europace/euz184] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/06/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
To test in a double-blinded, randomized trial whether the combination of electrically guided left ventricular (LV) lead placement and post-implant interventricular pacing delay (VVd) optimization results in superior increase in LV ejection fraction (LVEF) in cardiac resynchronization therapy (CRT) recipients.
Methods and results
Stratified according to presence of ischaemic heart disease, 122 patients were randomized 1:1 to LV lead placement targeted towards the latest electrically activated segment identified by systematic mapping of the coronary sinus tributaries during CRT implantation combined with post-implant VVd optimization (intervention group) or imaging-guided LV lead implantation by cardiac computed tomography venography, 82Rubidium myocardial perfusion imaging and speckle tracking echocardiography targeting the LV lead towards the latest mechanically activated non-scarred myocardial segment (control group). Follow-up was 6 months. Primary endpoint was absolute increase in LVEF. Additional outcome measures were changes in New York Heart Association class, 6-minute walk test, and quality of life, LV reverse remodelling, and device related complications. Analysis was intention-to-treat. A larger increase in LVEF was observed in the intervention group (11 ± 10 vs. 7 ± 11%; 95% confidence interval 0.4–7.9%, P = 0.03); when adjusting for pre-specified baseline covariates this difference did not maintain statistical significance (P = 0.09). Clinical response, LV reverse remodelling, and complication rates did not differ between treatment groups.
Conclusion
Electrically guided CRT implantation appeared non-inferior to an imaging-guided strategy considering the outcomes of change in LVEF, LV reverse remodelling and clinical response. Larger long-term studies are warranted to investigate the effect of an electrically guided CRT strategy.
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Affiliation(s)
- Charlotte Stephansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Anders Sommer
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Jesper Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Bjarne Linde Nørgaard
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Daniel Benjamin Fyenbo
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
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Ananthasubramaniam K, Arumugam P. Quantitative 82Rb dynamic pet perfusion analysis with kinetic modeling for myocardial viability: Can we get away with just 82Rb perfusion kinetics? J Nucl Cardiol 2019; 26:387-390. [PMID: 30809756 DOI: 10.1007/s12350-019-01616-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 11/29/2022]
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7
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Moody JB, Hiller KM, Lee BC, Poitrasson-Rivière A, Corbett JR, Weinberg RL, Murthy VL, Ficaro EP. The utility of 82Rb PET for myocardial viability assessment: Comparison with perfusion-metabolism 82Rb- 18F-FDG PET. J Nucl Cardiol 2019; 26:374-386. [PMID: 30809755 DOI: 10.1007/s12350-019-01615-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/01/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND 82Rb kinetics may distinguish scar from viable but dysfunctional (hibernating) myocardium. We sought to define the relationship between 82Rb kinetics and myocardial viability compared with conventional 82Rb and 18F-fluorodeoxyglucose (FDG) perfusion-metabolism PET imaging. METHODS Consecutive patients (N = 120) referred for evaluation of myocardial viability prior to revascularization and normal volunteers (N = 37) were reviewed. Dynamic 82Rb 3D PET data were acquired at rest. 18F-FDG 3D PET data were acquired after metabolic preparation using a standardized hyperinsulinemic-euglycemic clamp. 82Rb kinetic parameters K1, k2, and partition coefficient (KP) were estimated by compartmental modeling RESULTS: Segmental 82Rb k2 and KP differed significantly between scarred and hibernating segments identified by Rb-FDG perfusion-metabolism (k2, 0.42 ± 0.25 vs. 0.22 ± 0.09 min-1; P < .0001; KP, 1.33 ± 0.62 vs. 2.25 ± 0.98 ml/g; P < .0001). As compared to Rb-FDG analysis, segmental Rb KP had a c-index, sensitivity and specificity of 0.809, 76% and 84%, respectively, for distinguishing hibernating and scarred segments. Segmental k2 performed similarly, but with lower specificity (75%, P < .001) CONCLUSIONS: In this pilot study, 82Rb kinetic parameters k2 and KP, which are readily estimated using a compartmental model commonly used for myocardial blood flow, reliably differentiated hibernating myocardium and scar. Further study is necessary to evaluate their clinical utility for predicting benefit after revascularization.
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Affiliation(s)
- Jonathan B Moody
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA.
| | - Keri M Hiller
- Cardiac Imaging Program, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin C Lee
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA
| | | | - James R Corbett
- Cardiac Imaging Program, University of Michigan, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Richard L Weinberg
- Cardiac Imaging Program, University of Michigan, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Cardiac Imaging Program, University of Michigan, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA
- Cardiac Imaging Program, University of Michigan, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Holden NE, Coplen TB, Böhlke JK, Tarbox LV, Benefield J, de Laeter JR, Mahaffy PG, O’Connor G, Roth E, Tepper DH, Walczyk T, Wieser ME, Yoneda S. IUPAC Periodic Table of the Elements and Isotopes (IPTEI) for the Education Community (IUPAC Technical Report). PURE APPL CHEM 2018. [DOI: 10.1515/pac-2015-0703] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
The IUPAC (International Union of Pure and Applied Chemistry) Periodic Table of the Elements and Isotopes (IPTEI) was created to familiarize students, teachers, and non-professionals with the existence and importance of isotopes of the chemical elements. The IPTEI is modeled on the familiar Periodic Table of the Chemical Elements. The IPTEI is intended to hang on the walls of chemistry laboratories and classrooms. Each cell of the IPTEI provides the chemical name, symbol, atomic number, and standard atomic weight of an element. Color-coded pie charts in each element cell display the stable isotopes and the relatively long-lived radioactive isotopes having characteristic terrestrial isotopic compositions that determine the standard atomic weight of each element. The background color scheme of cells categorizes the 118 elements into four groups: (1) white indicates the element has no standard atomic weight, (2) blue indicates the element has only one isotope that is used to determine its standard atomic weight, which is given as a single value with an uncertainty, (3) yellow indicates the element has two or more isotopes that are used to determine its standard atomic weight, which is given as a single value with an uncertainty, and (4) pink indicates the element has a well-documented variation in its atomic weight, and the standard atomic weight is expressed as an interval. An element-by-element review accompanies the IPTEI and includes a chart of all known stable and radioactive isotopes for each element. Practical applications of isotopic measurements and technologies are included for the following fields: forensic science, geochronology, Earth-system sciences, environmental science, and human health sciences, including medical diagnosis and treatment.
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Affiliation(s)
- Norman E. Holden
- National Nuclear Data Center, Brookhaven National Laboratory , Upton, NY , USA
| | | | | | | | | | | | | | | | - Etienne Roth
- Commissariat à l’énergie atomique (CEA) , Gif-sur-Yvette, France
| | | | - Thomas Walczyk
- Department of Chemistry , National University of Singapore , Singapore , Singapore
| | - Michael E. Wieser
- Department of Physics and Astronomy , University of Calgary , Calgary , Canada
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Stephansen C, Sommer A, Kronborg MB, Jensen JM, Bouchelouche K, Nielsen JC. Electrically guided versus imaging-guided implant of the left ventricular lead in cardiac resynchronization therapy: a study protocol for a double-blinded randomized controlled clinical trial (ElectroCRT). Trials 2018; 19:600. [PMID: 30382923 PMCID: PMC6211399 DOI: 10.1186/s13063-018-2930-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/24/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an established treatment in patients with heart failure and prolonged QRS duration where a biventricular pacemaker is implanted to achieve faster activation and more synchronous contraction of the left ventricle (LV). Despite the convincing effect of CRT, 30-40% of patients do not respond. Among the most important correctable causes of non-response to CRT is non-optimal LV lead position. METHODS We will enroll 122 patients in this patient-blinded and assessor-blinded, randomized, clinical trial aiming to investigate if implanting the LV lead guided by electrical mapping towards the latest LV activation as compared with imaging-guided implantation, causes an excess increase in left ventricular (LV) ejection fraction (LVEF). The patients are randomly assigned to either the intervention group: preceded by cardiac computed tomography of the cardiac venous anatomy, the LV lead is placed according to the latest LV activation in the coronary sinus (CS) branches identified by systematic electrical mapping of the CS at implantation and post-implant optimization of the interventricular pacing delay; or patients are assigned to the control group: placement of the LV lead guided by cardiac imaging. The LV lead is targeted towards the latest mechanical LV activation as identified by echocardiography and outside myocardial scar as identified by myocardial perfusion (MP) imaging. The primary endpoint is change in LVEF at 6-month follow up (6MFU) as compared with baseline measured by two-dimensional echocardiography. Secondary endpoints include relative percentage reduction in LV end-systolic volume, all-cause mortality, hospitalization for heart failure, and a clinical combined endpoint of response to CRT at 6MFU defined as the patient being alive, not hospitalized for heart failure, and experiencing improvement in NYHA functional class or/and > 10% increase in 6-minute walk test. DISCUSSION We assume an absolute increase in LVEF of 12% in the intervention group versus 8% in the control group. If an excess increase in LVEF can be achieved by LV lead implantation guided by electrical mapping, this study supports the conduct of larger trials investigating the impact of this strategy for LV-lead implantation on clinical outcomes in patients treated with CRT. TRIAL REGISTRATION ClinicalTrials.gov, NCT02346097 . Registered on 12 January 2015. Patients were enrolled between 16 February 2015 and 13 December 2017.
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Affiliation(s)
- Charlotte Stephansen
- Department of Cardiology – Research, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Anders Sommer
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Jesper Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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10
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Klein R, Ocneanu A, deKemp RA. Time-frame sampling for 82Rb PET flow quantification: Towards standardization of clinical protocols. J Nucl Cardiol 2017; 24:1530-1534. [PMID: 28687966 DOI: 10.1007/s12350-017-0981-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Ran Klein
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Department of Nuclear Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Adrian Ocneanu
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Robert A deKemp
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Opacic T, Paefgen V, Lammers T, Kiessling F. Status and trends in the development of clinical diagnostic agents. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2016; 9. [DOI: 10.1002/wnan.1441] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/02/2016] [Accepted: 09/15/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Tatjana Opacic
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
| | - Vera Paefgen
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
| | - Twan Lammers
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
- Department of Pharmaceutics; Utrecht University; Utrecht The Netherlands
- Department of Targeted Therapeutics; University of Twente; Enschede The Netherlands
| | - Fabian Kiessling
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
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12
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Dorbala S, Di Carli MF. Cardiac PET perfusion: prognosis, risk stratification, and clinical management. Semin Nucl Med 2015; 44:344-57. [PMID: 25234079 DOI: 10.1053/j.semnuclmed.2014.05.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Myocardial perfusion imaging (MPI) with PET has expanded significantly over the past decade. With the wider availability of PET scanners and the routine use of quantitative blood flow imaging, the clinical use of PET MPI is expected to increase further. PET MPI is a powerful tool to identify risk, to quantify risk, and to guide therapy in patients with known or suspected coronary artery disease. A large body of evidence supports the prognostic value of PET MPI and ejection fraction in intermediate- to high-risk subjects, in women, in obese individuals, and in post-coronary artery bypass grafting individuals. A normal perfusion study indicates low risk (<1% annualized rate of cardiac events of cardiac death and non-fatal myocardial infarction), while an abnormal study indicates high risk. With accurate risk stratification, high-quality images, and quantitation, PET MPI may transform the management of patients with known or suspected coronary artery disease.
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Affiliation(s)
- Sharmila Dorbala
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Center, Department of Radiology; Department of Medicine (Cardiology), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Marcelo F Di Carli
- Noninvasive Cardiovascular Imaging Program, Heart and Vascular Center, Department of Radiology; Department of Medicine (Cardiology), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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13
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Murthy VL, Lee BC, Sitek A, Naya M, Moody J, Polavarapu V, Ficaro EP, Di Carli MF. Comparison and prognostic validation of multiple methods of quantification of myocardial blood flow with 82Rb PET. J Nucl Med 2015; 55:1952-8. [PMID: 25429160 DOI: 10.2967/jnumed.114.145342] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR) using PET with (82)Rb in patients with known or suspected coronary artery disease has been demonstrated to have substantial prognostic and diagnostic value. However, multiple methods for estimation of an image-derived input function and several models for the nonlinear first-pass extraction of (82)Rb by myocardium have been used. We sought to compare the differences in these methods and models and their impact on prognostic assessment in a large clinical dataset. METHODS Consecutive patients (n = 2,783) underwent clinically indicated rest-stress myocardial perfusion PET with (82)Rb. The input function was derived using a region of interest (ROI) semiautomatically placed in the region of the mitral valve, factor analysis, and a hybrid method that creates an ROI from factor analysis. We used 5 commonly used extraction models for (82)Rb to estimate MBF and MFR. Pearson correlations, bias, and Cohen κ were computed for the various measures. The relationship between MFR/stress MBF and annual rate of cardiac mortality was estimated with spline fits using Poisson regression. Finally, incremental value was assessed with the net reclassification improvement using Cox proportional hazards regression. RESULTS Correlations between MFR or stress MBF measures made with the same input function derivation method were generally high, regardless of extraction model used (Pearson r > 0.90). However, correlations between measures derived with the ROI method and other methods were only moderate (Pearson r = 0.42-0.62). Importantly, substantial biases were seen for most combinations. We saw that the relationship between cardiac mortality and stress MBF was variable depending on the input function method and extraction model, whereas the relationship between MFR and risk was highly consistent. Net reclassification improvement was comparable for most methods and models for MFR but was highly variable for stress MBF. CONCLUSION Although both stress MBF and MFR can improve prognostic assessment, MFR is substantially more consistent, regardless of choice of input function derivation method and extraction model used.
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Affiliation(s)
- Venkatesh L Murthy
- Noninvasive Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Benjamin C Lee
- INVIA Medical Imaging Solutions, Ann Arbor, Michigan; and
| | - Arkadiusz Sitek
- Division of Nuclear Medicine, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Masanao Naya
- Noninvasive Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Moody
- INVIA Medical Imaging Solutions, Ann Arbor, Michigan; and
| | - Vivek Polavarapu
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Edward P Ficaro
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan INVIA Medical Imaging Solutions, Ann Arbor, Michigan; and
| | - Marcelo F Di Carli
- Noninvasive Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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14
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Evaluation of 68Ga-labeled tracers for PET imaging of myocardial perfusion in pigs. Nucl Med Biol 2012; 39:715-23. [DOI: 10.1016/j.nucmedbio.2011.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 10/27/2011] [Accepted: 11/08/2011] [Indexed: 11/19/2022]
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15
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Chien DT, Bravo P, Higuchi T, Merrill J, Bengel FM. Washout of 82Rb as a marker of impaired tissue integrity, obtained by list-mode cardiac PET/CT: relationship with perfusion/metabolism patterns of myocardial viability. Eur J Nucl Med Mol Imaging 2011; 38:1507-15. [DOI: 10.1007/s00259-011-1820-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 04/06/2011] [Indexed: 11/28/2022]
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16
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Cardiac PET: A Versatile, Quantitative Measurement Tool for Heart Failure Management. JACC Cardiovasc Imaging 2011; 4:292-302. [DOI: 10.1016/j.jcmg.2010.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/20/2010] [Accepted: 12/23/2010] [Indexed: 11/21/2022]
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17
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Quantification of regional myocardial blood flow in a canine model of stunned and infarcted myocardium: comparison of rubidium-82 positron emission tomography with microspheres. Nucl Med Commun 2010; 31:67-74. [PMID: 19823095 DOI: 10.1097/mnm.0b013e328332b32a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myocardial viability and quantification of regional myocardial blood flow (MBF) are important for the diagnosis of heart disease. Positron emission tomography is the current gold standard for determining myocardial viability, but most positron-emitting perfusion tracers require an on-site cyclotron. Rubidium-82 ((82)Rb) is a myocardial perfusion tracer that is produced using an on-site generator. This study investigates (82)Rb-measured MBF in canine models of stunned and infarcted myocardium compared with selected measurements obtained concurrently using microspheres. METHODS Myocardial stunning and infarction were created in canines by occluding the left anterior descending for 15 min and 2 h, respectively. Stunning was produced in all animals; six animals were reperfused after the 2 h occlusion, whereas the other six animals remained occluded permanently. Regional MBF was measured in each group during rest and dobutamine stress at acute and chronic (8 weeks postinsult) time points using dynamic (82)Rb perfusion imaging and radioactively labeled microspheres. RESULTS Average resting MBF with microspheres and Rb was 0.68+/-0.02 versus 0.73+/-0.01 (P<0.001) in nonischemic tissue, and 0.53+/-0.03 versus 0.42+/-0.02 (P<0.001) in the region-at-risk tissue, respectively. Average MBF during stress with microspheres and Rb was 2.78+/-0.15 versus 3.53+/-0.16 (P<0.05) in the nonischemic tissue, and 1.90+/-0.20 versus 2.31+/-0.26 (P = NS) in the region-at-risk tissue, respectively. CONCLUSION Despite the small significant differences, the dynamic (82)Rb measurements provide estimates of MBF in stunned and acutely and chronically infarcted tissue at rest and during hyperemia that correspond with clinical interpretation.
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Schwaiger M, Ziegler SI, Nekolla SG. PET/CT challenge for the non-invasive diagnosis of coronary artery disease. Eur J Radiol 2010; 73:494-503. [PMID: 20206454 DOI: 10.1016/j.ejrad.2009.12.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/15/2009] [Indexed: 10/19/2022]
Abstract
This review will focus on the clinical potential of PET/CT for the characterization of cardiovascular diseases. We describe the technical challenges of combining instrumentation with very different imaging performance and discuss the clinical applications in the field of cardiology.
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Affiliation(s)
- Markus Schwaiger
- Klinikum rechts der Isar, Technische Universität München, Nuklearmedizinische Klinik und Poliklinik, München, Germany
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20
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El Fakhri G, Kardan A, Sitek A, Dorbala S, Abi-Hatem N, Lahoud Y, Fischman A, Coughlan M, Yasuda T, Di Carli MF. Reproducibility and accuracy of quantitative myocardial blood flow assessment with (82)Rb PET: comparison with (13)N-ammonia PET. J Nucl Med 2009; 50:1062-71. [PMID: 19525467 DOI: 10.2967/jnumed.104.007831] [Citation(s) in RCA: 212] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED (82)Rb cardiac PET allows the assessment of myocardial perfusion with a column generator in clinics that lack a cyclotron. There is evidence that the quantitation of myocardial blood flow (MBF) and coronary flow reserve (CFR) with dynamic (82)Rb PET is feasible. The objectives of this study were to determine the accuracy and reproducibility of MBF estimates from dynamic (82)Rb PET by using our methodology for generalized factor analysis (generalized factor analysis of dynamic sequences [GFADS]) and compartment analysis. METHODS Reproducibility was evaluated in 22 subjects undergoing dynamic rest and dipyridamole stress (82)Rb PET studies at a 2-wk interval. The inter- and intraobserver variability of MBF quantitation with dynamic (82)Rb PET was assessed with 4 repeated estimations by each of 4 observers. Accuracy was evaluated in 20 subjects undergoing dynamic rest and dipyridamole stress PET studies with (82)Rb and (13)N-ammonia, respectively. The left ventricular and right ventricular blood pool and left ventricular tissue time-activity curves were estimated by GFADS. MBF was estimated by fitting the blood pool and tissue time-activity curves to a 2-compartment kinetic model for (82)Rb and to a 3-compartment model for (13)N-ammonia. CFR was estimated as the ratio of peak MBF to baseline MBF. RESULTS The reproducibility of the MBF estimates in repeated (82)Rb studies was very good at rest and during peak stress (R(2)= 0.935), as was the reproducibility of the CFR estimates (R(2) = 0.841). The slope of the correlation line was very close to one for the estimation of MBF (0.986) and CFR (0.960) in repeated (82)Rb studies. The intraobserver reliability was less than 3% for the estimation of MBF at rest and during peak stress as well as for the estimation of CFR. The interobserver reliabilities were 0.950 at rest and 0.975 at peak stress. The correlation between myocardial flow estimates obtained at rest and those obtained during peak stress in (82)Rb and (13)N-ammonia studies was very good (R(2) = 0.857). Bland-Altman plots comparing CFR estimated with (82)Rb and CFR estimated with (13)N-ammonia revealed an underestimation of CFR with (82)Rb compared with (13)N-ammonia; the underestimation was within +/-1.96 SD. CONCLUSION MBF quantitation with GFADS and dynamic (82)Rb PET demonstrated excellent reproducibility as well as intra- and interobserver reliability. The accuracy of the absolute quantitation of MBF with factor and compartment analyses and dynamic (82)Rb PET was very good, compared with that achieved with (13)N-ammonia, for MBF of up to 2.5 mL/g/min.
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Affiliation(s)
- Georges El Fakhri
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Lortie M, Beanlands RSB, Yoshinaga K, Klein R, Dasilva JN, DeKemp RA. Quantification of myocardial blood flow with 82Rb dynamic PET imaging. Eur J Nucl Med Mol Imaging 2007; 34:1765-74. [PMID: 17619189 DOI: 10.1007/s00259-007-0478-2] [Citation(s) in RCA: 309] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 04/22/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE The PET tracer (82)Rb is commonly used to evaluate regional perfusion defects for the diagnosis of coronary artery disease. There is limited information on the quantification of myocardial blood flow and flow reserve with this tracer. The goal of this study was to investigate the use of a one-compartment model of (82)Rb kinetics for the quantification of myocardial blood flow. METHODS Fourteen healthy volunteers underwent rest and dipyridamole stress imaging with both (13)N-ammonia and (82)Rb within a 2-week interval. Myocardial blood flow was estimated from the time-activity curves measured with (13)N-ammonia using a standard two-compartment model. The uptake parameter of the one-compartment model was estimated from the time-activity curves measured with (82)Rb. To describe the relationship between myocardial blood flow and the uptake parameter, a nonlinear extraction function was fitted to the data. This function was then used to convert estimates of the uptake parameter to flow estimates. The extraction function was validated with an independent data set obtained from 13 subjects with documented evidence of coronary artery disease (CAD). RESULTS The one-compartment model described (82)Rb kinetics very well (median R-square = 0.98). The flow estimates obtained with (82)Rb were well correlated with those obtained with (13)N-ammonia (r = 0.85), and the best-fit line did not differ significantly from the identity line. Data obtained from the subjects with CAD confirmed the validity of the estimated extraction function. CONCLUSION It is possible to obtain accurate estimates of myocardial blood flow and flow reserve with a one-compartment model of (82)Rb kinetics and a nonlinear extraction function.
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Affiliation(s)
- Mireille Lortie
- Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, ON K1Y 4W7, Canada
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Affiliation(s)
- James A Arrighi
- Brown Medical School/Rhode Island Hospital, Providence, RI 02903, USA.
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Abstract
Cardiac positron emission tomography (PET) imaging has advanced from primarily a research tool to a practical, high-performance clinical imaging modality. The widespread availability of state-of-the-art PET gamma cameras, the commercial availability of perfusion and viability PET imaging tracers, reimbursement for PET perfusion and viability procedures by government and private health insurance plans, and the availability of computer software for image display of perfusion, wall motion, and viability images have all been a key to cardiac PET imaging becoming a routine clinical tool. Although myocardial perfusion PET imaging is an option for all patients requiring stress perfusion imaging, there are identifiable patient groups difficult to image with conventional single-photon emission computed tomography imaging that are particularly likely to benefit from PET imaging, such as obese patients, women, patients with previous nondiagnostic tests, and patients with poor left ventricular function attributable to coronary artery disease considered for revascularization. Myocardial PET perfusion imaging with rubidium-82 is noteworthy for high efficiency, rapid throughput, and in a high-volume setting, low operational costs. PET metabolic viability imaging continues to be a noninvasive standard for diagnosis of viability imaging. Cardiac PET imaging has been shown to be cost-effective. The potential of routine quantification of resting and stress blood flow and coronary flow reserve in response to pharmacologic and cold-pressor stress offers tantalizing possibilities of enhancing the power of PET myocardial perfusion imaging. This can be achieved by providing assurance of stress quality control, in enhancing diagnosis and risk stratification in patients with coronary artery disease, and expanding diagnostic imaging into the realm of detection of early coronary artery disease and endothelial dysfunction subject to risk factor modification. Combined PET and x-ray computed tomography imaging (PET-CT) results in enhanced patient throughput and efficiency. The combination of multislice computed tomography scanners with PET opens possibilities of adding coronary calcium scoring and noninvasive coronary angiography to myocardial perfusion imaging and quantification. Evaluation of the clinical role of these creative new possibilities warrants investigation.
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Affiliation(s)
- Josef Machac
- Department of Radiology, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, NY 10029, USA.
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Matsunari I, Taki J, Nakajima K, Tonami N, Hisada K. Myocardial viability assessment using nuclear imaging. Ann Nucl Med 2003; 17:169-79. [PMID: 12846538 DOI: 10.1007/bf02990019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Myocardial assessment continues to be an issue in patients with coronary artery disease and left ventricular dysfunction. Nuclear imaging has long played an important role in this field. In particular, PET imaging using 18F-fluorodeoxyglucose is regarded as the metabolic gold standard of tissue viability, which has been supported by a wide clinical experience. Viability assessment using SPECT techniques has gained more wide-spread clinical acceptance than PET, because it is more widely available at lower cost. Moreover, technical advances in SPECT technology such as gated-SPECT further improve the diagnostic accuracy of the test. However, other imaging techniques such as dobutamine echocardiography have recently emerged as competitors to nuclear imaging. It is also important to note that they sometimes may work in a complementary fashion to nuclear imaging, indicating that an appropriate use of these techniques may significantly improve their overall accuracy. In keeping these circumstances in mind, further efforts are necessary to further improve the diagnostic performance of nuclear imaging as a reliable viability test.
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Affiliation(s)
- Ichiro Matsunari
- The Medical and Pharmacological Research Center Foundation, Hakui, Ishikawa, Japan.
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25
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Abstract
Accurate assessment of myocardial viability is critical for identifying patients likely to benefit from coronary revascularization. Positron emission tomography (PET) has several advantages over single photon emission computed tomography (SPECT), including higher sensitivity and specificity, as well as the ability to measure myocardial blood flow and myocardial metabolism in absolute terms, which is important in understanding the pathophysiology of ischemic cardiomyopathy. The most commonly used PET tracer is [18F]2-fluoro-2deoxy-D-glucose (FDG). The dependence of ischemic myocardium on glucose metabolism makes FDG an ideal tracer in this setting. Studies have shown positive and negative predictive values for the detection of viable myocardium in the range of 48-94%, and 73-96%, respectively. FDG is superior to SPECT using thallium or technetium myocardial perfusion agents, as well as echocardiography with dobutamine infusion. FDG PET also provides important prognostic information. Patients with evidence of myocardial viability by FDG PET have fewer cardiac events and survive longer if revascularized compared to patients who are treated medically. This article will review myocardial metabolism, PET procedures and interpretive criteria, as well as problems and limitations. Data from the literature regarding diagnostic and prognostic information will also be summarized.
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Affiliation(s)
- George Segall
- Nuclear Medicine Service, VA Palo Alto Health Care System, Palo Alto CA 94304, USA.
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26
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Palka P, Lange A, Ferrington C, Fox KA. Mean myocardial velocity mapping in quantifying regional myocardial contractile reserve in patients with impaired left ventricular systolic function: Doppler myocardial imaging study. J Am Soc Echocardiogr 2000; 13:96-107. [PMID: 10668012 DOI: 10.1016/s0894-7317(00)90020-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to use Doppler myocardial imaging-derived mean myocardial velocity (MMV) at baseline and during low-dose dobutamine stress echocardiography (DSE) to quantify regional contractile reserve of the left ventricle (LV). Sixteen patients (mean age 59 +/- 7 years) with coronary artery disease and regional left ventricular wall motion abnormalities were studied. During each increment of Dobutamine infusion, 6 2-dimensional transthoracic apical images were acquired in standard gray-scale and Doppler myocardial imaging modes at 30 degrees steps over 180 degrees. For the analysis, the LV was divided into 18 segments. For each segment, both wall motion score and MMV obtained in systole and both early and late diastole were measured at baseline and at each stage of DSE. In viable segments by wall motion score, MMV increased during DSE in systole and in early and late diastole. In contrast, in nonviable segments, MMV did not change during DSE. Mean myocardial velocity mapping is a promising new approach to quantify regional myocardial contractile reserve of the LV.
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Affiliation(s)
- P Palka
- Department of Cardiology, The Royal Hospital for Sick Children, Edinburgh, UK
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Alvarez-Diez TM, deKemp R, Beanlands R, Vincent J. Manufacture of strontium-82/rubidium-82 generators and quality control of rubidium-82 chloride for myocardial perfusion imaging in patients using positron emission tomography. Appl Radiat Isot 1999; 50:1015-23. [PMID: 10355104 DOI: 10.1016/s0969-8043(98)00170-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe a protocol to manufacture 82Sr/82Rb generators and 82RbCl for myocardial imaging with PET. The generators are manufactured in 3 stages: (1) preparation of a tin oxide column, (2) leak test of the generator column and (3) loading of the generator with 82Sr. The generators produced sterile and non-pyrogenic 82RbCl for i.v. injection. No significant 82Sr/85Sr breakthroughs were observed after elution with 20 1 of saline. The automated system delivered human doses of 82RbCl accurately.
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Borchard U, Manz M. Studies on the efficacy and prognostic significance of drug therapy of ventricular tachyarrhythmias. Herz 1997; 22 Suppl 1:1-2. [PMID: 9259190 DOI: 10.1007/bf03044566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Saha GB, MacIntyre WJ, Brunken RC, Go RT, Raja S, Wong CO, Chen EQ. Present assessment of myocardial viability by nuclear imaging. Semin Nucl Med 1996; 26:315-35. [PMID: 8916320 DOI: 10.1016/s0001-2998(96)80007-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prospective delineation of viable from nonviable myocardium in patients with coronary artery disease in an important factor in deciding whether a patient should be revascularized or treated medically. Two common techniques--single-photon emission computed tomography (SPECT) and positron-emission computed tomography (PET)--are used in nuclear medicine using various radiopharmaceuticals for the detection of myocardial viability in patients. Thallium-201 (201Tl) and technetium-99m (99mTc)-sestamibi are the common radiopharmaceuticals used in different protocols using SPECT, whereas fluoride-18 (18F)-fluorodeoxyglucose (FDG) and rubidium-82 (82Rb) are most widely used in PET. The SPECT protocols involve stress/redistribution, stress/redistribution/reinjection, and rest/redistribution imaging techniques. Many studies have compared the results of 201Tl and (99mTc)-sestamibi SPECT with those of FDG PET; in some studies, concordant results have been found between delayed thallium and FDG results, indicating that 201Tl, although considered a perfusion agent, shows myocardial viability. Discordant results in a number of studies have been found between sestamibi and FDG, suggesting that the efficacy of sestamibi as a viability marker has yet to be established. Radiolabeled fatty acids such as iodine-123 (123I)-para-iodophenylpentadecanoic acid and carbon-11 (11C)-palmitic acid have been used for the assessment of myocardial viability with limited success. 11C-labeled acetate is a good marker of oxidative metabolism in the heart and has been used to predict the reversibility of wall motion abnormalities. (18F)-FDG is considered the marker of choice for myocardial viability, although variable results are obtained under different physiological conditions. Detection of myocardial viability can be greatly improved by developing new equipment and radiopharmaceuticals of better quality.
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Affiliation(s)
- G B Saha
- Department of Nuclear Medicine, Cleveland Clinic Foundation, OH 44195-5074, USA
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