Length-based Fourier analysis in the pre-excitation syndrome.

Length-based Fourier analysis (LFA) was applied to tomographic gated blood-pool study, and phase and percent-shortening diagrams were generated. In 22 patients with pre-excitation syndrome and ten control subjects, the most basal short-axis section was used for tomographic analysis. When the initial abnormal phase was considered as the location of accessory conduction pathway (ACP), correct diagnosis for the localization of ACP was given in 19 of 22 patients. In ten control subjects, no specific segments of initial phase were noted, although six patients had initial phase in the septal or paraseptal segments. The tomographic LFA was more effective for pinpointing the segment of the earliest phase than tomographic count-based phase analysis. The LFA provided objective three-dimensional information for contraction sequence. Because movements of ventricular edges are essential in tomography, the LFA was considered to be a reasonable approach for the analysis of tomographic gated blood-pool study.

Bone mineral density of the lumbar spine by dual photon absorptiometry: age-related regression in normal Japanese subjects and fracture threshold in osteoporotics.

The bone mineral density (BMD) of the lumbar spine was determined by DPA in 280 normal Japanese volunteers and 11 osteoporotic women with compression fractures. In women, bone loss started from the mid thirties and accelerated after the age of 50 years at the rate of 0.75% (0.0074 g/cm2) per year. In men, bone loss started from the mid twenties and occurred linearly at the rate of 0.30% (0.0032 g/cm2). The overall diminutions in vertebral BMD throughout life in men and women were 13.0% and 24.3%, respectively. The mean vertebral BMD of the osteoporotic women with recent compression fractures was 37.5% lower than that of age-matched controls. The 90th percentile for vertebral BMD in this group was 0.584 g/cm2. By the age of 80 years, approximately one-fifth of normal Japanese women have BMD values less than this.

Intracaval invasion of left adrenal cortical carcinoma extending into the right atrium.

A case of adrenal carcinoma with advanced inferior vena cava (IVC) involvement is reported. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large mass over the upper pole of the left kidney, with tumor thrombus from the IVC to the right atrium of the heart. Angiography demonstrated that this mass received its blood supply mainly from the left superior adrenal artery, and, parasitically, the left middle adrenal artery, splenic artery, and lumbar arteries. Venacavography revealed obstruction of the IVC and the collateral, dilated azygos vein. Radical surgery was performed, including resection of the tumor and the tumor thrombus in the IVC and right atrium with the aid of cardiopulmonary bypass. Although renal carcinoma with tumor thrombus invasion of the IVC or atrium is common, adrenal tumor thrombus invasive to the atrium is very rare.

[Evaluation of cerebral perfusion imaging with N-isopropyl-p-[123I]iodoamphetamine (IMP) in the cases of antiphospholipid syndrome].

Five cases of antiphospholipid syndrome with mild headache, but without any neurological deficits and abnormal findings by CT and MRI, were examined by cerebral blood perfusion SPECT using N-isopropyl-p-[123I]iodoamphetamine (IMP). Although three cases were performed quantification of cerebral blood flow with a microsphere method simultaneously, their values were within normal limits. Two of them showed focal low perfusion areas. One case had relatively low perfusion areas in the bilateral occipital lobes and the right temporal lobe, which improved after treatment. One of two had low perfusion in the bilateral occipital lobes. Other three cases only showed uniformity of radioisotope uptake on the cerebral blood perfusion SPECT. Low perfusion areas in antiphospholipid syndrome might be caused by microarterial thrombosis, microvenous thrombosis or spasms, although they could be reversible. As early detection of cerebral abnormality admit to protect irreversible progress of cerebral blood flow, cerebral blood flow SPECT should be performed in cases of antiphospholipid syndrome with neurological complaints.

[Automatic calculation of left ventricular volume and ejection fraction from gated myocardial perfusion SPECT--basic evaluation using phantom].

We evaluated accuracy of Quantitative Gated SPECT Program that enabled calculation of the left ventricular (LV) volume and ejection fraction by automatically tracing the contour of the cardiac surface. Cardiac phantoms filled with 99mTc-solution were used. Data acquisition was made by 180-degree projection in L type and 360-degree projection in opposed type. Automatic calculation could be done in all processes, which required 3-4 minutes. Reproducibility was sufficient. The adequate cut off value of a prefilter was 0.45. At this value LV volume was 93% of the actual volume in L type acquisition and 95.9% in opposed type acquisition. The LV volume obtained in L type was smaller than that obtained in opposed type (p < 0.05). The tracing of the defects was fair, on the cardiac phantoms with all of 90-degree defects and 180-degree defects of the septal and lateral wall. The LV volume was estimated to be larger on the phantom with 180-degree defect of the anterior wall, and to be smaller on the phantom of 180-degree defect of the inferoposterior wall. Because tracing was deviated anteriorly at the defects. In the patients with similar conditions to 180-degree defect of the anterior wall or inferoposterior wall, the LV volume should be carefully evaluated.

[Evaluation of hypertrophic cardiomyopathy with 123I-metaiodobenzylguanidine].

Single-photon emission computed tomography was performed in 29 patients with hypertrophic cardiomyopathy (HCM) using 123I-metaiodobenzylguanidine (MIBG). Segmental myocardial uptake of MIBG and 201T1 was calculated in 21 patients with primary HCM without history of hypertension. Septal thickness was measured by echocardiography and the relationship to septal MIBG uptake was studied. Initial MIBG uptake and 201T1 uptake showed positive correlation with the septal thickness (R = 0.581, p = 0.0058 and R = 0.677, p = 0.0007). When the septal MIBG uptake was divided by the corresponding 201T1 uptake (MIBG/T1), both the early and delayed MIBG/T1 showed negative correlation with the septal thickness (R = -0.485, p = 0.0255 and R = -0.535, p = 0.0125). Significant positive correlation was observed between septal MIBG clearance and the thickness (R = 0.510, p = 0.0182). In patients with severe septal hypertrophy (greater than 20 mm), the MIBG clearance was significantly higher compared with less hypertrophic (less than or equal to 20 mm) group (13.4 +/- 8.0%/hr vs. 3.2 +/- 4.7%/hr, p = 0.0028). Thus, MIBG was useful for the evaluation of sympathetic innervation and activity in HCM. The MIBG clearance and uptake in conjunction with 201T1 study seemed to reflect the severity of hypertrophy in HCM.

[Evaluation of ischemic heart disease by thallium-201 washout-rate map using SPECT].

In thallium-201 myocardial perfusion scintigraphy, washout rate (WR) has been used for the evaluation of the severity of ischemic heart disease (IHD). The WR was calculated from the polar map (Bull's-eye display) of myocardial perfusion using SPECT. To analyze the abnormality of WR map, we computed the extent and severity scores of WR. Applications of two types of standards, absolute and relative standards from control group (n = 16), were compared. The multiple regression analysis showed that the global WR was a function of the severity of coronary artery stenosis and exercise level, i.e. WR (%) = -2.38 X (number of stenotic artery) + 0.093 X (rate-pressure product/100) + 19.7 (n = 62, r = 0.63). Thus in evaluating the severity of IHD by absolute WR, the correction of WR was necessary according to the exercise level. Whereas, to evaluate the score of WR abnormality in polar map, the relative standard separated each group with different number of stenotic artery better than absolute standard did. In conclusion, calculation of WR score from relative standard is recommended for the analysis of polar WR map, although absolute global WR is useful for the evaluation of severity of coronary artery disease.

[Evaluation of ischemia by exercise stress Tl-201 myocardial SPECT in silent and symptomatic ischemia].

Forty patients with ischemic heart disease confirmed by coronary arteriography were performed Tl-201 stress myocardial scintigraphy using SPECT. Fifteen patients had anginal attack during exercise Tl-201 myocardial perfusion study (symptomatic group), and 25 patients had horizontal or downsloping ST segment depression more than 0.1 mV without angina (asymptomatic group). The washout maps were derived from circumferential profile analyses of tomographic short-axis slices, and the data were plotted as a bull's eye map. The patient's washout map was compared with the lower limit of normal (mean--2 SD), and the extent and severity scores were calculated. On visual analysis 87% (13/15) of symptomatic patients showed redistribution, while only 56% (14/25) of asymptomatic patients showed redistribution (p less than 0.05). The extent score was significantly higher in the symptomatic group than in asymptomatic group (37.2 + 23.6 vs. 19.6 + 20.8, p less than 0.05), but severity score was slightly higher in symptomatic group (56.1 + 59.4 vs. 30.0 + 54.8, NS). In conclusion, symptomatic ischemia may be more severe than asymptomatic one and the degree of ischemia may be one of the factors that determine the presence of angina during ischemia.