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Stress and rest gated SPECT evaluation of CAD patients: Quantitative and visual comparison
Journal of Nuclear Cardiology Volume 4, Number 1, Part 2
Abstracts Wednesday morning, April 9, 1997
$87
84.8
84.10
ASSESSMENT OF RESTENOTIC LESIONS AFTER PTCA WITH CORONARY ANGIOGRAPHY AND MYOCARDIAL SPECT. Ch.Maunoury, C.Le Feuvre, G.Helft, F.Beygui, JP.Metzger, A.Vacheron. Necker Hospital, Paris, France.
STRESS ANrD REST GATED SPECT EVALUATION OF CAD PATIENTS :QUANTITATIVE AND "vISUAL COMPARISON A. Bestetti. C. Di Leo, L. Tagliabne. G.L. Tarolo Cattedra di Medicina Nucleare. Univcrsit5 degli Studi di Milano c/o HSPaolo
The aim of this prospective study was to assess coronary a n g i o g r a p h y in r e s t e n o t i c lesions after PTCA, with reference to m y o c a r d i a l SPECT. Quantitative c o r o n a r y angiography and stress-redistribution TI-201 myocardial S P E C T w e r e performed in 64 consecutive patients 6+2 months after successful PTCA. A reversible perfusion defect in the territory of a previously dilated artery w a s c o n s i d e r e d as a positive SPECT. Digital computer-assisted c a l i p e r s w e r e used to q u a n t i f y restenotic lesions: percentage of stenosis (S) and minimal lu m in al d i a m e t e r (MLD). R e s t e n o t i c v e s s e l s w e r e narrower in patients with positive S P E C T (n=26): S = 53+15% and M L D = 1.3+0.5mm than in patients with n e g a t i v e S P E C T (n=38): S = 41+_20% and MLD -1.7+_0.7mm (P 5 0 % and in 38% of patients with M L D < I . 4 m m . S P E C T was positive in 33% of patients with S < 5 0 % and in 2 3 % of patients with M L D > I . 4 m m . In conclusion, quantitative coronary a n g i o g r a p h y failed to assess functional significance of restenotic lesions. Six month a n g i o g r a p h i c follow-up and PTCA for restenosis need previous non invasive assessment of myocardial ischemia.
The aim of this study, was to evaluate the accuracy (A) of regional myocardial ~,stolic thickening indexes (STI) assessed on stress and rest polar endiastolic (ED) and endsystolic (ES) maps obtained ~" GSPECT using 99mTc-Tetrofosmin (separate day), dual head digital camera and quantitative gated algoritlun. Each polar map was divided into 16 segments (seg).We defined the normal distribution of stress perfusion on the ED images of ten normal subjects.In a group of 22 consecutive CAD pts, with and ~ithout previous MI, who underwent coronary angiography,was evahiated A of this quantitative segmental analysis (QA) comparing it with perfusion and systolic thickening (ST) score obtained respectively on ungated and GSPECT polar maps ~ visual analysis (VA).Resnlts. No significant difference was found between QA and VA as concern the number of reversible (roy), fixed defects and normal seg.Overall A was non significantly higher for VA in respect to QA while the difference was significant in the detection of LAD stenosis (p=0.005), The seg with roy defects at VA and fixed at QA showed stress STI significandy lfigher than seg with rea, defects at QA and fixed at VA. Stress ST[ discriminated well the seg with preserved ST at VA. Stress and rest STI of seg with fixed defects in non infarcted regions were significantly higher than in infarcted myocardial regions, Conclusion. QA of ED and ES polar maps obtained by GSPECT and fast processing algorithms correlates well with VA of ungated images as concern pcrfusion. Stress STI add information to perfusion SPECT allowing to distingaaish true fixed and roy defects from attenuation artifacts.
84.9
84.11
CAVITY SIZE ENLARGEMENT IN TC 99M SESTAMIBI (MIBI) SPECT IN HYPERTENSIVE PATIENTS WITH NORMAL CORONARY ARTERIES.
Tc-99m ~
E.Milan, RCampini, A.Terzi, A. Vaccari, R.Giubbini. Nuclear Medicine Dpts, SpedaliCivil[ Brescia & FondazioneMaugeri, Veruno (No} Italy. Le~ ventricular (LV) hypertrophy(LVH) is a commonfinding in hypertensivepts. Augmented end-diastolic LV pressure causes an increase of resistances in subendocardial circulation which reign lead to an increase in likelihood of myocardial ischemia. LV cavity dilatation on 13-201 imaging is a marker of severe CAD due to transient LV dysfunction: this mechanism seems unlikely in MIBI studies, due to delayed imaging after tracer injection. We evaluated prevalenceand charastedstics of LV dilatationin post-stress MIBI SPECT in 21 hypertensivepts. with normal coronary angiograrnsin comparison to a Control group (C group) with less than 5% pro-test probabilityof CAD. The study group was divided into pts with (group 1) and without (group2) LVH. LV cavity size (VCS), expressed in arbitrary units, was determinedby automated program able to identify the inner LV border by thresholding method, inducible ischemia was
quantified by evaluation of gender matched polar maps. Results are summarizedin the following table: c group 4CS stress
group 1+2
w 251 _+106
y¢ VCS rest
229 + 67
group 1
group 2
180_+86/
151 +_63
206_+98
16o _+99F *~
68 + 23 J*~
243 + 55
!
IN O]~PARLNIq W f ~ I~U~IU~-201
Z. Burak, H. Akln, S. Buket, A. Sa~can, M. Argon, Y. Atay i. Durmz, Y. Da~n. Fge University ~ , ~URKEY. The aim of this study ~ s to determine the utility of Tc-99 Tetrofos~ (TFM) imaging in diagnosis of significant coronary artery disease in cc~arison to TI-201 cardiac inmging. 18 patients (pts) with angiographically proven significant CAD were studied by one day ex-rest T~I and ex-rest-re inj. TI-201 imaging. For each study, left ventricle ~ s divided into 20 segnents (segm) and sa~iquanti~tive analysis ~is applied using a 4 point scale. Uptakes~ 2 were accepted as perfusion defects. The degree of uptakes were correlated with the significance of coronary edtery stenesis. 15 pts had nmltivessel d ~ , 8 had 1 and 4 had 2 totally ozcluded coronary arteries (TOCA). 128 of 360 segm. were supplied by II~A(35.5%), 191 were supplied by significantly stenetic arteries (53%) and 41 were normft. In TOI~ group, TFM demonstrated 14 reversible (11%=)and 76 fixed (59%0) defects while 15 segm ~_re reversible (12%) anrl 69 (54%) were fixed in TI-201 study. 15 s % m ~ filled in after KI.
* = p< .05; ** = p<.Ool ;*** = p<.oOOl ,*'***= p<.oo5
Significant difference in the extension of inducible ischemiawas found between group1 and 2 (3.8 _+4.2 vs 1.2 + 2.4;p<.05) as well as between group1 and C group (3.8 + 4.2 vs 1 +_ 0.6;p<.05).Thus VCS enlargement after stress is a common finding in hypertensive pts with LVH probably due to functional subendocardialischemia even in the presenceof normal coronaries.
In conclusion, we suggest that, ~ defects have to be interpreted with caution since wa ob~rved more fixed defects corresponding to myocardial regions supplied by TOCA in T~M imaging when c c ~ e d to TI-201 RI myocardial perfusion study.
1
Abstracts Wednesday morning, April 9, 1997
$87
84.8
84.10
ASSESSMENT OF RESTENOTIC LESIONS AFTER PTCA WITH CORONARY ANGIOGRAPHY AND MYOCARDIAL SPECT. Ch.Maunoury, C.Le Feuvre, G.Helft, F.Beygui, JP.Metzger, A.Vacheron. Necker Hospital, Paris, France.
STRESS ANrD REST GATED SPECT EVALUATION OF CAD PATIENTS :QUANTITATIVE AND "vISUAL COMPARISON A. Bestetti. C. Di Leo, L. Tagliabne. G.L. Tarolo Cattedra di Medicina Nucleare. Univcrsit5 degli Studi di Milano c/o HSPaolo
The aim of this prospective study was to assess coronary a n g i o g r a p h y in r e s t e n o t i c lesions after PTCA, with reference to m y o c a r d i a l SPECT. Quantitative c o r o n a r y angiography and stress-redistribution TI-201 myocardial S P E C T w e r e performed in 64 consecutive patients 6+2 months after successful PTCA. A reversible perfusion defect in the territory of a previously dilated artery w a s c o n s i d e r e d as a positive SPECT. Digital computer-assisted c a l i p e r s w e r e used to q u a n t i f y restenotic lesions: percentage of stenosis (S) and minimal lu m in al d i a m e t e r (MLD). R e s t e n o t i c v e s s e l s w e r e narrower in patients with positive S P E C T (n=26): S = 53+15% and M L D = 1.3+0.5mm than in patients with n e g a t i v e S P E C T (n=38): S = 41+_20% and MLD -1.7+_0.7mm (P
The aim of this study, was to evaluate the accuracy (A) of regional myocardial ~,stolic thickening indexes (STI) assessed on stress and rest polar endiastolic (ED) and endsystolic (ES) maps obtained ~" GSPECT using 99mTc-Tetrofosmin (separate day), dual head digital camera and quantitative gated algoritlun. Each polar map was divided into 16 segments (seg).We defined the normal distribution of stress perfusion on the ED images of ten normal subjects.In a group of 22 consecutive CAD pts, with and ~ithout previous MI, who underwent coronary angiography,was evahiated A of this quantitative segmental analysis (QA) comparing it with perfusion and systolic thickening (ST) score obtained respectively on ungated and GSPECT polar maps ~ visual analysis (VA).Resnlts. No significant difference was found between QA and VA as concern the number of reversible (roy), fixed defects and normal seg.Overall A was non significantly higher for VA in respect to QA while the difference was significant in the detection of LAD stenosis (p=0.005), The seg with roy defects at VA and fixed at QA showed stress STI significandy lfigher than seg with rea, defects at QA and fixed at VA. Stress ST[ discriminated well the seg with preserved ST at VA. Stress and rest STI of seg with fixed defects in non infarcted regions were significantly higher than in infarcted myocardial regions, Conclusion. QA of ED and ES polar maps obtained by GSPECT and fast processing algorithms correlates well with VA of ungated images as concern pcrfusion. Stress STI add information to perfusion SPECT allowing to distingaaish true fixed and roy defects from attenuation artifacts.
84.9
84.11
CAVITY SIZE ENLARGEMENT IN TC 99M SESTAMIBI (MIBI) SPECT IN HYPERTENSIVE PATIENTS WITH NORMAL CORONARY ARTERIES.
Tc-99m ~
E.Milan, RCampini, A.Terzi, A. Vaccari, R.Giubbini. Nuclear Medicine Dpts, SpedaliCivil[ Brescia & FondazioneMaugeri, Veruno (No} Italy. Le~ ventricular (LV) hypertrophy(LVH) is a commonfinding in hypertensivepts. Augmented end-diastolic LV pressure causes an increase of resistances in subendocardial circulation which reign lead to an increase in likelihood of myocardial ischemia. LV cavity dilatation on 13-201 imaging is a marker of severe CAD due to transient LV dysfunction: this mechanism seems unlikely in MIBI studies, due to delayed imaging after tracer injection. We evaluated prevalenceand charastedstics of LV dilatationin post-stress MIBI SPECT in 21 hypertensivepts. with normal coronary angiograrnsin comparison to a Control group (C group) with less than 5% pro-test probabilityof CAD. The study group was divided into pts with (group 1) and without (group2) LVH. LV cavity size (VCS), expressed in arbitrary units, was determinedby automated program able to identify the inner LV border by thresholding method, inducible ischemia was
quantified by evaluation of gender matched polar maps. Results are summarizedin the following table: c group 4CS stress
group 1+2
w 251 _+106
y¢ VCS rest
229 + 67
group 1
group 2
180_+86/
151 +_63
206_+98
16o _+99F *~
68 + 23 J*~
243 + 55
!
IN O]~PARLNIq W f ~ I~U~IU~-201
Z. Burak, H. Akln, S. Buket, A. Sa~can, M. Argon, Y. Atay i. Durmz, Y. Da~n. Fge University ~ , ~URKEY. The aim of this study ~ s to determine the utility of Tc-99 Tetrofos~ (TFM) imaging in diagnosis of significant coronary artery disease in cc~arison to TI-201 cardiac inmging. 18 patients (pts) with angiographically proven significant CAD were studied by one day ex-rest T~I and ex-rest-re inj. TI-201 imaging. For each study, left ventricle ~ s divided into 20 segnents (segm) and sa~iquanti~tive analysis ~is applied using a 4 point scale. Uptakes~ 2 were accepted as perfusion defects. The degree of uptakes were correlated with the significance of coronary edtery stenesis. 15 pts had nmltivessel d ~ , 8 had 1 and 4 had 2 totally ozcluded coronary arteries (TOCA). 128 of 360 segm. were supplied by II~A(35.5%), 191 were supplied by significantly stenetic arteries (53%) and 41 were normft. In TOI~ group, TFM demonstrated 14 reversible (11%=)and 76 fixed (59%0) defects while 15 segm ~_re reversible (12%) anrl 69 (54%) were fixed in TI-201 study. 15 s % m ~ filled in after KI.
* = p< .05; ** = p<.Ool ;*** = p<.oOOl ,*'***= p<.oo5
Significant difference in the extension of inducible ischemiawas found between group1 and 2 (3.8 _+4.2 vs 1.2 + 2.4;p<.05) as well as between group1 and C group (3.8 + 4.2 vs 1 +_ 0.6;p<.05).Thus VCS enlargement after stress is a common finding in hypertensive pts with LVH probably due to functional subendocardialischemia even in the presenceof normal coronaries.
In conclusion, we suggest that, ~ defects have to be interpreted with caution since wa ob~rved more fixed defects corresponding to myocardial regions supplied by TOCA in T~M imaging when c c ~ e d to TI-201 RI myocardial perfusion study.
1