https://cdr.lib.unc.edu/downloads/00000227t

ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging)

This document was approved by the American College of Cardiology Foundation Board of Trustees in July 2003, the American Heart Association Science Advisory and Coordinating Committee in July 2003, and the American Society of Nuclear Cardiology Board of Directors in July 2003. When citing this document, the American College of Cardiology Foundation, the American Heart Association, and the American Society of Nuclear Cardiology request that the following citation format be used: Klocke FJ, Baird MG, Bateman TM, Berman DS, Carabello BA, Cerqueira MD, DeMaria AN, Kennedy JW, Lorell BH, Messer JV, O’Gara PT, Russell RO Jr., St. John Sutton MG, Udelson JE, Verani MS, Williams KA. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Radionuclide Imaging). (2003). American College of Cardiology Web Site. Available at: http://www.acc.org/clinical/ guidelines/radio/rni_fulltext.pdf. This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org), the American Heart Association (www.americanheart.org), and the American Society of Nuclear Cardiology (www.asnc.org). Single copies of this document are available by calling 1-800253-4636 or writing the American College of Cardiology Foundation, Resource Center, at 9111 Old Georgetown Road, Bethesda, MD 20814-1699. Ask for reprint number 71-0266. To obtain a reprint of the Executive Summary published in the October 1, 2003 issue of the Journal of the American College of Cardiology and the September 16, 2003 issue of Circulation, ask for reprint number 71-0265. To purchase bulk reprints (specify version and reprint num© 2003 by the American College of Cardiology Foundation and the American Heart Association, Inc.

http://www.vmkorhaz.hu/bel2/guidelines/AHA%20Cardiac%20Radionuclide%20Imaging%202003.pdf

ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging

https://repub.eur.nl/pub/56524/1-s2.0-S0735109797003525-main.pdf

Accuracy of currently available techniques for prediction of functional recovery after revascularization in patients with left ventricular dysfunction due to chronic coronary artery disease : Comparison of pooled data

The European procedural guidelines for radionuclide imaging of myocardial perfusion and viability are presented in 13 sections covering patient information, radiopharmaceuticals, injected activities and dosimetry, stress tests, imaging protocols and acquisition, quality control and reconstruction methods, gated studies and attenuation-scatter compensation, data analysis, reports and image display, and positron emission tomography. If the specific recommendations given could not be based on evidence from original, scientific studies, we tried to express this state-of-art. The guidelines are designed to assist in the practice of performing, interpreting and reporting myocardial perfusion SPET. The guidelines do not discuss clinical indications, benefits or drawbacks of radionuclide myocardial imaging compared to non-nuclear techniques, nor do they cover cost benefit or cost effectiveness.

/pdf/eanm-esc-procedural-guidelines-for-myocardial-perfusion-4d594mj8j5.pdf

EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology

Sensitivity, specificity, and predictive accuracies of various noninvasive techniques for detecting hibernating myocardium.

The aim of this study was to assess whether nitrate administration improves the imaging capabilities of 99m Tc-MIBI tomography in detecting viable myocardium in coronary artery disease (CAD). Methods : Thirty-one patients with angiographically proven CAD and chronic LV dysfunction (ejection fraction 39% ± 9%) underwent two 99m Tc-MIBI studies on separate days : one under rest conditions and the other after nitroglycerine (0.005 mg/kg per os) administration. Within 1 wk, all patients also underwent rest-redistribution 201 Tl imaging. Eight patients were also studied by echocardiography before and 5 ± 3 mo after coronary revascularization. Results : On resting 99m Tc-MIBI images, 302 segments had normal uptake, 183 segments had moderately reduced uptake and 197 had severely reduced uptake. Of the segments with severely reduced uptake, 54 (27%) had increased uptake after nitroglycerine and were viable on 201 Tl images. Of the 143 (73%) segments with severely reduced 99m Tc-MIBI uptake and no change after nitroglycerine, 81% were nonviable on 201 Tl images. In the eight patients studied before and after revascularization, 87% of segments with reversible 99m Tc-MIBI defects and abnormal LV function demonstrated functional recovery after revascularization, whereas 89% of segments with irreversible 99m Tc-MIBI defects did not. Conclusion : In patients with chronic ischemic LV dysfunction, nitrate administration improved the detection of severely hypoperfused but still viable myocardium on 99m Tc-MIBI images.

http://jnm.snmjournals.org/content/36/11/1945.full.pdf

Enhanced Detection of Viable Myocardium by Technetium-99m-MIBI Imaging after Nitrate Administration in Chronic Coronary Artery Disease

UNLABELLED The purpose of this study was to evaluate whether an additional redistribution image after a rest 99mTc-MIBI injection enhances detection of viable myocardium and predicts functional recovery after coronary revascularization in patients with chronic coronary artery disease (CAD). METHODS Thirty-one patients (29 men, mean age 55 +/- 10 yr) with proven CAD and left ventricular (LV) dysfunction (ejection fraction 39% +/- 9%) underwent resting 99mTc-MIBI tomography with initial (1 hr) and delayed (5 hr) images. Within 1 wk of MIBI imaging, all patients underwent rest-distribution 201Tl imaging. Eight patients also underwent two-dimensional echocardiography before and 5 +/- 3 mo after coronary revascularization. RESULTS On the initial 99mTc-MIBI images, 302 myocardial segments were normal, 183 showed moderate and 197 severe reduction of tracer uptake. Of these 197 segments, 47 (24%) demonstrated increased tracer uptake (> or = 10% versus initial) on delayed images (from 43% +/- 8% to 60% +/- 8%, p < 0.001) and were considered as showing 99mTc-MIBI redistribution. These 47 segments were observed in 20 (65%) patients in whom 201Tl images detected viable myocardium in the same segments. In the eight patients studied before and after revascularization, 83% of segments with 99mTc-MIBI redistribution and abnormal LV function showed functional recovery after revascularization, while 96% of segments without 99mTc-MIBI redistribution did not show functional recovery. CONCLUSION Resting 99mTc-MIBI redistribution frequently occurs in patients with chronic CAD. Acquisition of 99mTc-MIBI redistribution images enhances detection of viable myocardium and predicts functional recovery after revascularization.

http://jnm.snmjournals.org/content/36/11/1953.full.pdf

Myocardial viability index in chronic coronary artery disease: technetium-99m-methoxy isobutyl isonitrile redistribution.

UNLABELLED: We compared the results of adenosine and bicycle exercise 99mTc-methoxy isobutyl isonitrile (MIBI) myocardial SPECT in 22 patients (18 males and 4 females, mean age 51 +/- 11 yr) with angiographically documented coronary artery disease (CAD). METHODS: All patients were submitted on separate days to three intravenous injections of 99mTc-MIBI (20 mCi); one at rest, one during exercise and one during adenosine (140 micrograms/kg per min for 6 min with injection of 99mTc-MIBI at 4 min). A total of 484 myocardial segments were quantitatively analyzed. RESULTS: Adenosine induced a significant increase of heart rate (94 +/- 16 bpm at peak versus 70 +/- 13 bpm at rest, p < 0.01). Systolic and diastolic blood pressure were not significantly different after adenosine infusion compared to rest. In all segments, a significant relationship between exercise and adenosine 99mTc-MIBI uptake was observed (r = 0.90, p < 0.0001). Concordance between the two studies for identification of perfusion status was observed in 438 (90%) of the 484 segments (kappa value of 0.81). Agreement on localization of the perfusion defect to a specific vascular territory was 92%. CONCLUSION: Despite different hemodynamic effects, adenosine and exercise 99mTc-MIBI SPECT imaging provide similar information in the diagnosis and localization of CAD.

http://jnm.snmjournals.org/content/35/7/1110.full.pdf

Adenosine technetium-99m-methoxy isobutyl isonitrile myocardial tomography in patients with coronary artery disease : comparison with exercise

Management of patients with ovarian cancer using monoclonal antibodies

INTRODUCTION Magnetic Resonance Imaging (MRI) has been proposed as the diagnostic technique of choice to characterize adrenal tumors. However, the results of the current studies are controversial. MATERIAL AND METHODS Forty-nine patients with unilateral adrenal masses were submitted to MRI for lesion characterization on the basis of MR signal intensity. Cytology and/or histology demonstrated 14 pheochromocytomas (pheos), 11 adenomas, 3 cysts, 2 myelolipomas, 4 carcinomas, 3 metastases and 1 fibrosarcoma; a clinical diagnosis of adenoma was made in the remaining 11 patients. MR studies were performed using spin-echo (SE) sequences with T1 (TR/TE = 600/17 ms) and T2 (TR/TE = 2000/15-90 ms) weighting. T1-weighted images were also acquired after Gadolinium-DTPA (Gd-DTPA) administration. MR studies were integrated with in- and out-of-phase (TR/TE = 100/4-6 ms) chemical-shift (CS) sequences. MR signal intensity (SI) was analyzed qualitatively and quantitatively; MR results were correlated with tumor type and hormone secretion. RESULTS The qualitative analysis of T2 images showed high signal intensity in the majority (80%) of adrenal lesions (14 pheos, 12 adenomas, 3 cysts, 2 myelolipomas and 8 malignancies). The quantitative analysis of post-Gd-DTPA T1 images permitted to distinguish adenomas, cysts and myelolipomas from pheos and malignancies. The qualitative analysis of post-Gd-DTPA T2 and T1 images permitted to distinguish pheos and cysts from adenomas and malignancies (p < .05); however, pheos and cysts as well as adenomas and malignancies were not differentiated. MR SI was similar in secreting and nonsecreting adenomas from both a qualitative and a quantitative viewpoints. CS MRI permitted to distinguish adenomas (decreased signal intensity on out-phase relative to in-phase images) from other benign and malignant lesions (no signal change from out-phase to in-phase images). CONCLUSIONS The qualitative analysis of MR SI on conventional T1 and T2 images does not permit to differentiate adrenal masses. The qualitative evaluation of T1 images after Gd-DTPA administration, the quantitative analysis and CS sequences are technical options improving lesion characterization.

L Castelli

Papers

Enhanced Detection of Viable Myocardium by Technetium-99m-MIBI Imaging after Nitrate Administration in Chronic Coronary Artery Disease

Myocardial viability index in chronic coronary artery disease: technetium-99m-methoxy isobutyl isonitrile redistribution.

Adenosine technetium-99m-methoxy isobutyl isonitrile myocardial tomography in patients with coronary artery disease : comparison with exercise

Management of patients with ovarian cancer using monoclonal antibodies

Magnetic resonance in the study of suprarenal neoplasms. Qualitative and quantitative analysis of signal intensity