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Effects of afterload increase on thallium-201 scintigraphy and comparison with conventional exercise imaging
Journal of Nuclear Cardiology Volume 4, Number 1, Part 2
46.57 EFFEC]S OF AFIERLOAD Ik/CP,FJ',SE CN THALL!L~,-2~ SCINTIGRAPHY
ANO ~ A R I S O N Wi~-iCON~NhONAL [~XER~ IMAGI~IG. Athonassios Antonopouios. Dimitrios Nikolopouios. Evangelos Geor~ou, Michael Kyriokidis, Povtos Toolouzos. CharalQmbos Proukakis, Oept o f Medical Physics and Cardiology. Athens University. Athens. Greece, Shoe d!erl0o::i increa~ causes let! venh'~d~ wo~ s!ress as wel~ as oxygen cc~vJr~otba, we hyp0lhes~zed~h~, c~ ~ ...~0#N &gent such as pheny~p~'k~. (l~) may polentidly provoke ctx.,~~c~in myocor~ot t_~.'ffu~;on,Thecim of this stunt was to evobat=, o),he o.ec,s of, on ,,-~0, (,/1)seln,t~,.q~hymd b) ,0 c0mF~ ~ J-201 conventionc~e×erd~e (C} with P-schlicrc~hv res@ 40 pat;enls with &')cumenled CAD by corOndy ,:~o~ophy ( 7 pis ~'[lh ,.~,~a. 22 pts with old Iv! orct 11pfs with c~c,r~ CAD) c',d~=!56*Syrs w~e ;_,~2,.*dedh ,:,~ ..qudy.A cdor:_~y sleno~s;,70% was c,..',nslderOdsi£#fiConL h eQch one of them P (0.invglmi) was inr~ed a! a role of O.8~/,,'T'Yt,Jn,f~ mere blood' procure (BP)hcre~ed at approxtnately ~ % from baseline,byeS.No major cacDc events were deified wilh P-infusbr~One ~ after the b e g ~ g of Pn/usion,2 mCi of TI wo~ njecfed ar:d the nfu~n of # was tudhe~"continued for kS,m~, 1Vschlk,Jc,~hy was 0edonr~d 2mh oiler T[ ~ieclion o~'id 44','s ~O~d.~ge~ re~ts were eompa,'ed with those of o C performed 4 days late~. P produces shik:r rLmbef cA lolal defects (145)c.~-npored to C (156) (p
Abstracts Tuesday morning, April 8, 1997
46.59 Dual l ~ o p ¢ Myocardhil Perfmion Tomography: Separate Versus Shnultaneous Rest TL~*t/Stress"FeT M SestamibL Waheed Radwan; Selama Husslen and Sherlf Mokhtar Critical Care Medicine, Cairo University, Egypt To *mess the degree of isotope eresstalk in dual isotopetomographic studies, and Io compareit with separaterest TL2orstressTc~ images, the following 2 days imagingprotocolwas appliedwhere in day 1, "re~emsestamibi(15 mCi) was injected at peak exerelsefollowed by SPECT 30 rain. later applyingthe usual Tc9~ window (140~20% Key). TL2or (3 mCi) was then injected at rest and SPECT acquisition was performed 30-45 miv_ later using various dual isotope energy
windows. On day 2, adaseof2.SmCiTL2Omwasinjecteddurlngrestfellowedby SPECT 20-30 min. later.
Twlnty patientsknewnto have IHD, HealedQ wave M1 have been subjectedto this protocol whichallowedus to: 1. Comparedual and virginstresssestanuT~iSPECT images. 2. Comparedual and virginrest TL TM SPECTimages. Analysis of results entailed dividing the LV into 20 segmentswiththe degree of perfusien expressedon a scaleof 0-4 and a final scorewas givenfor the whole LV. Results: comparing the virgin sestamibiwith the dual sestamibi(contaminated) images revealed a mean difference of 1.3 segmentsand a score differenceel3.4. Meanwhile comparing the virgin TLTM with dual images shewed a mean difference of 2.8 segmentsanda score differenceof 7.3, Coneh~ian:
1. Using various acquisition windows and processingtechniquesavailablein cur computer system(differentfilters,filterorders, successivefilterlng,background and scattersubstractien)failedte bringcontaminatedup te virgin images. 2. The degreeefcrosstalk of To99~ into lhn TL2°1windowis higherand affectsthe dual TL201 images eousiderably, despitethe use ofvarieus filteringtechniques and ecquM'donwL-~do~.
46.58
49.1
M Y O C A R D I A L U P T A K E OF T H A L L I U M A N D TC-99M TETROFOSMIN : A DETAILED COMPARISON.
IDENTIFYING PATIENTS WITH ACTIVE C O R O N A R Y D I S E A S E IN A N E M E R G E N C Y DEPARTMENT OBSERVATION UNIT
G.McCurrach, LProsser, S.Woldman, A.McQuiston, W.Martin, I.Hutton Dept. Nuclear Cardiology, Glasgow Royal Infirmary, Scotland Tetrofosmin Tc-99m has been proposed as an alternative to thallium-201 in the assessment of myocardiai perfusion. This study compared the percentage myocardial uptake of both agents at rest and at stress in separate groups of patients being routinely assessed for chest pain. In addition, myocardial uptake of tetrofosmin was assessed dynamically post injection both at rest and exercise. The uptake in the myocardium was then calculated as a percentage of the injected dose, and was found to be similar at rest : tetrofosmin 0.32 + 0.12 (n=30) ; thallium 0.33 + 0.12 (n=l 5). However at stress myocardial uptake was significantly higher for thallium (p < 0.05) : tetrofosmin 0.24 + 0.17 (n=20) ; thallium 0.54 + 0.25 (n=50). From the dynamic images we estimate that: at rest, 57 % (+ 23) of maximal tetrofosmin uptake is achieved by 1 minute, 83 % (+l 1) by 2 minutes and maximal uptake by 5 minutes : on exercise, values were similar, with substantial blood pool activity apparent at 3 minutes. In conclusion, uptake of tetrofosnain on exercise is significantly lower than that of thallium whilst at rest the two agents show similar myocardial uptake.
$57
P a u l R . B u r n s , A r i f S h e i k h , G e o r g e R. M c K e n d a l l , S t e v e n R e i n e r t , L y n n e L. J o h n s o n . R h o d e I s l a n d Hospital, B r o w n University, P r o v i d e n c e , R I . USA
The goal of this study was to evaluate non-invasive testing and clinical variables to identify pts f r o m an ER observation unit (EROU) with active CAD. Pts with intermediate suspicion for unstable angina (UA), were admitted to E R O U . After 2-3 n e g C K - M B ' s pts underwent E C G stress with sestamibi S P E C T imaging. There were 138 pts, 71 M, 67 F with m e a n age o f 52 + 13; and 80/138 had abnl rest ECG's. U s i n g clinical, historical and E C G variables pts were further classified into low, m e d i u m , and high suspicion for U A (clinical index). This index and results of stress parameters and scans were evaluated. Only 8/138 ultimately had active C A D (AD) and required hospitalization. T h e clinical index identified 41/138 pts as high suspicion but only 5/8 with AD. Unlvariate logistic regression analysis was used to calc odds ratios on two continuous (exercise stage, s u m severity score SSS) and three categorical variables. variable n value odds ratio clinical index 0.16 1.97 ex ECG 0.0001 18.33 +scan 0.0001 19.9 ex stage 0.017 0.28 SSS 0.002 1.08 There is need to refine criteria for identifying CP pts who need further testing and for identifying w h i c h pts need scanning.
46.57 EFFEC]S OF AFIERLOAD Ik/CP,FJ',SE CN THALL!L~,-2~ SCINTIGRAPHY
ANO ~ A R I S O N Wi~-iCON~NhONAL [~XER~ IMAGI~IG. Athonassios Antonopouios. Dimitrios Nikolopouios. Evangelos Geor~ou, Michael Kyriokidis, Povtos Toolouzos. CharalQmbos Proukakis, Oept o f Medical Physics and Cardiology. Athens University. Athens. Greece, Shoe d!erl0o::i increa~ causes let! venh'~d~ wo~ s!ress as wel~ as oxygen cc~vJr~otba, we hyp0lhes~zed~h~, c~ ~ ...~0#N &gent such as pheny~p~'k~. (l~) may polentidly provoke ctx.,~~c~in myocor~ot t_~.'ffu~;on,Thecim of this stunt was to evobat=, o),he o.ec,s of, on ,,-~0, (,/1)seln,t~,.q~hymd b) ,0 c0mF~ ~ J-201 conventionc~e×erd~e (C} with P-schlicrc~hv res@ 40 pat;enls with &')cumenled CAD by corOndy ,:~o~ophy ( 7 pis ~'[lh ,.~,~a. 22 pts with old Iv! orct 11pfs with c~c,r~ CAD) c',d~=!56*Syrs w~e ;_,~2,.*dedh ,:,~ ..qudy.A cdor:_~y sleno~s;,70% was c,..',nslderOdsi£#fiConL h eQch one of them P (0.invglmi) was inr~ed a! a role of O.8~/,,'T'Yt,Jn,f~ mere blood' procure (BP)hcre~ed at approxtnately ~ % from baseline,byeS.No major cacDc events were deified wilh P-infusbr~One ~ after the b e g ~ g of Pn/usion,2 mCi of TI wo~ njecfed ar:d the nfu~n of # was tudhe~"continued for kS,m~, 1Vschlk,Jc,~hy was 0edonr~d 2mh oiler T[ ~ieclion o~'id 44','s ~O~d.~ge~ re~ts were eompa,'ed with those of o C performed 4 days late~. P produces shik:r rLmbef cA lolal defects (145)c.~-npored to C (156) (p
Abstracts Tuesday morning, April 8, 1997
46.59 Dual l ~ o p ¢ Myocardhil Perfmion Tomography: Separate Versus Shnultaneous Rest TL~*t/Stress"FeT M SestamibL Waheed Radwan; Selama Husslen and Sherlf Mokhtar Critical Care Medicine, Cairo University, Egypt To *mess the degree of isotope eresstalk in dual isotopetomographic studies, and Io compareit with separaterest TL2orstressTc~ images, the following 2 days imagingprotocolwas appliedwhere in day 1, "re~emsestamibi(15 mCi) was injected at peak exerelsefollowed by SPECT 30 rain. later applyingthe usual Tc9~ window (140~20% Key). TL2or (3 mCi) was then injected at rest and SPECT acquisition was performed 30-45 miv_ later using various dual isotope energy
windows. On day 2, adaseof2.SmCiTL2Omwasinjecteddurlngrestfellowedby SPECT 20-30 min. later.
Twlnty patientsknewnto have IHD, HealedQ wave M1 have been subjectedto this protocol whichallowedus to: 1. Comparedual and virginstresssestanuT~iSPECT images. 2. Comparedual and virginrest TL TM SPECTimages. Analysis of results entailed dividing the LV into 20 segmentswiththe degree of perfusien expressedon a scaleof 0-4 and a final scorewas givenfor the whole LV. Results: comparing the virgin sestamibiwith the dual sestamibi(contaminated) images revealed a mean difference of 1.3 segmentsand a score differenceel3.4. Meanwhile comparing the virgin TLTM with dual images shewed a mean difference of 2.8 segmentsanda score differenceof 7.3, Coneh~ian:
1. Using various acquisition windows and processingtechniquesavailablein cur computer system(differentfilters,filterorders, successivefilterlng,background and scattersubstractien)failedte bringcontaminatedup te virgin images. 2. The degreeefcrosstalk of To99~ into lhn TL2°1windowis higherand affectsthe dual TL201 images eousiderably, despitethe use ofvarieus filteringtechniques and ecquM'donwL-~do~.
46.58
49.1
M Y O C A R D I A L U P T A K E OF T H A L L I U M A N D TC-99M TETROFOSMIN : A DETAILED COMPARISON.
IDENTIFYING PATIENTS WITH ACTIVE C O R O N A R Y D I S E A S E IN A N E M E R G E N C Y DEPARTMENT OBSERVATION UNIT
G.McCurrach, LProsser, S.Woldman, A.McQuiston, W.Martin, I.Hutton Dept. Nuclear Cardiology, Glasgow Royal Infirmary, Scotland Tetrofosmin Tc-99m has been proposed as an alternative to thallium-201 in the assessment of myocardiai perfusion. This study compared the percentage myocardial uptake of both agents at rest and at stress in separate groups of patients being routinely assessed for chest pain. In addition, myocardial uptake of tetrofosmin was assessed dynamically post injection both at rest and exercise. The uptake in the myocardium was then calculated as a percentage of the injected dose, and was found to be similar at rest : tetrofosmin 0.32 + 0.12 (n=30) ; thallium 0.33 + 0.12 (n=l 5). However at stress myocardial uptake was significantly higher for thallium (p < 0.05) : tetrofosmin 0.24 + 0.17 (n=20) ; thallium 0.54 + 0.25 (n=50). From the dynamic images we estimate that: at rest, 57 % (+ 23) of maximal tetrofosmin uptake is achieved by 1 minute, 83 % (+l 1) by 2 minutes and maximal uptake by 5 minutes : on exercise, values were similar, with substantial blood pool activity apparent at 3 minutes. In conclusion, uptake of tetrofosnain on exercise is significantly lower than that of thallium whilst at rest the two agents show similar myocardial uptake.
$57
P a u l R . B u r n s , A r i f S h e i k h , G e o r g e R. M c K e n d a l l , S t e v e n R e i n e r t , L y n n e L. J o h n s o n . R h o d e I s l a n d Hospital, B r o w n University, P r o v i d e n c e , R I . USA
The goal of this study was to evaluate non-invasive testing and clinical variables to identify pts f r o m an ER observation unit (EROU) with active CAD. Pts with intermediate suspicion for unstable angina (UA), were admitted to E R O U . After 2-3 n e g C K - M B ' s pts underwent E C G stress with sestamibi S P E C T imaging. There were 138 pts, 71 M, 67 F with m e a n age o f 52 + 13; and 80/138 had abnl rest ECG's. U s i n g clinical, historical and E C G variables pts were further classified into low, m e d i u m , and high suspicion for U A (clinical index). This index and results of stress parameters and scans were evaluated. Only 8/138 ultimately had active C A D (AD) and required hospitalization. T h e clinical index identified 41/138 pts as high suspicion but only 5/8 with AD. Unlvariate logistic regression analysis was used to calc odds ratios on two continuous (exercise stage, s u m severity score SSS) and three categorical variables. variable n value odds ratio clinical index 0.16 1.97 ex ECG 0.0001 18.33 +scan 0.0001 19.9 ex stage 0.017 0.28 SSS 0.002 1.08 There is need to refine criteria for identifying CP pts who need further testing and for identifying w h i c h pts need scanning.