RESUMEN
When interpreting amyloid scintigraphy the nuclear cardiology physician should be aware of incidental image findings that may interfere with scan interpretation and may be of potential clinical significance. As for other nuclear cardiac imaging it is important to inspect the entire field of view of the planar and SPECT images. Correlation with the patient's history and physical examination is crucial in interpretation of these incidental findings.
Asunto(s)
Corazón , Tomografía Computarizada de Emisión de Fotón Único , Humanos , Cintigrafía , Tomografía Computarizada de Emisión de Fotón Único/métodos , Corazón/diagnóstico por imagenAsunto(s)
Procesamiento de Imagen Asistido por Computador/métodos , Imagen de Perfusión Miocárdica/métodos , Estómago/diagnóstico por imagen , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada de Emisión de Fotón Único/métodos , Anciano , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Perfusión , RadiofármacosAsunto(s)
Interpretación de Imagen Asistida por Computador/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Imagen de Perfusión Miocárdica , Guías de Práctica Clínica como Asunto , Tomografía Computarizada de Emisión de Fotón Único , Calibración , Tomografía Computarizada por Emisión de Fotón Único Sincronizada Cardíaca , Circulación Coronaria , Humanos , Imagen de Perfusión Miocárdica/instrumentación , Imagen de Perfusión Miocárdica/métodos , Tomografía Computarizada de Emisión de Fotón Único/instrumentación , Tomografía Computarizada de Emisión de Fotón Único/métodos , Tomografía Computarizada por Rayos XRESUMEN
The above position statement originally published containing errors in the author metadata; specifically, the Expert Content Reviewers-Andrew Einstein, Raymond Russell and James R. Corbett-were tagged as full authors of the paper. The article metadata has now been corrected to remove Drs. Einstein, Russell and Corbett from the author line, and the PubMed record has been updated accordingly.
Asunto(s)
Circulación Coronaria , Medicina Nuclear , Tomografía de Emisión de Positrones/métodos , Sociedades Médicas , Adulto , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Humanos , Procesamiento de Imagen Asistido por Computador , Japón , Persona de Mediana Edad , Estrés FisiológicoAsunto(s)
Cardiología/normas , Enfermedades Cardiovasculares/diagnóstico por imagen , Circulación Coronaria , Imagen de Perfusión Miocárdica/métodos , Tomografía de Emisión de Positrones/métodos , Tomografía de Emisión de Positrones/normas , Flujo Sanguíneo Regional , Amoníaco , Sistema Cardiovascular , Ensayos Clínicos como Asunto , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Reserva del Flujo Fraccional Miocárdico , Humanos , Procesamiento de Imagen Asistido por Computador , Radioisótopos de Nitrógeno , Pronóstico , Radiofármacos , Valores de Referencia , Reproducibilidad de los Resultados , Radioisótopos de Rubidio , Sociedades Médicas , Estados UnidosRESUMEN
There are interesting differences between the practice of Nuclear Cardiology in Japan and that in the United States and associated unique challenges. Differences in patient body habitus and the perceived importance of limiting patient radiation dose have resulted in different radiopharmaceutical and imaging protocol preferences. Governmental approval and reimbursement policies for various radiopharmaceuticals have promulgated adoption of different clinical applications. Both countries have experienced a significant decline in the number of nuclear cardiology studies performed, in part due to decreased governmental funding and reimbursement and to the emergence of competing modalities. Whereas precertification and test substitution have impacted negatively on the sustainability and growth of nuclear cardiology in the United States, in Japan those deterrents have not yet been encountered. Instead, communication barriers between nuclear medicine physicians and referring cardiologists are cited as a more significant barrier.
Asunto(s)
Cardiología/estadística & datos numéricos , Medicina Nuclear/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Tomografía Computarizada de Emisión/estadística & datos numéricos , Japón , Estados UnidosRESUMEN
Although the new solid-state dedicated cardiac cameras provide excellent spatial and energy resolution and allow for markedly reduced SPECT acquisition times and/or injected radiopharmaceutical activity, they have some distinct disadvantages compared to traditional sodium iodide SPECT cameras. They are expensive. Attenuation correction is not available. Cardio-focused collimation, advantageous to increase depth-dependent resolution and myocardial count density, accentuates diaphragmatic attenuation and scatter from subdiaphragmatic structures. Although supplemental prone imaging is therefore routinely advised, many patients cannot tolerate it. Moreover, very large patients cannot be accommodated in the solid-state camera gantries. Since data are acquired simultaneously with an arc of solid-state detectors around the chest, no temporally dependent "rotating" projection images are obtained. Therefore, patient motion can be neither detected nor corrected. In contrast, traditional sodium iodide SPECT cameras provide rotating projection images to allow technologists and physicians to detect and correct patient motion and to accurately detect the position of soft tissue attenuators and to anticipate associated artifacts. Very large patients are easily accommodated. Low-dose x-ray attenuation correction is widely available. Also, relatively inexpensive low-count density software is provided by many vendors, allowing shorter SPECT acquisition times and reduced injected activity approaching that achievable with solid-state cameras.
Asunto(s)
Técnicas de Imagen Cardíaca/instrumentación , Cámaras gamma , Aumento de la Imagen/instrumentación , Exposición a la Radiación/prevención & control , Cintigrafía/instrumentación , Tomografía Computarizada de Emisión de Fotón Único/instrumentación , Técnicas de Imagen Cardíaca/métodos , Diseño de Equipo , Análisis de Falla de Equipo , Aumento de la Imagen/métodos , Dosis de Radiación , Cintigrafía/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Evaluación de la Tecnología Biomédica , Tomografía Computarizada de Emisión de Fotón Único/métodosAsunto(s)
Técnicas de Imagen Cardíaca/métodos , Medicina Nuclear/métodos , Medicina Nuclear/tendencias , Tomografía de Emisión de Positrones/instrumentación , Tomografía de Emisión de Positrones/métodos , Baltimore , Velocidad del Flujo Sanguíneo , Congresos como Asunto , Fluorodesoxiglucosa F18 , Humanos , Sociedades MédicasRESUMEN
BACKGROUND: We conducted an exploratory analysis to test whether the addition of a CAC scan can increase the applicability of stress-only SPECT-MPI. METHODS: We studied 162 patients referred for rest/stress SPECT-MPI who underwent a CAC scan. Each scan was interpreted by two readers in stepwise fashion: stress-only images; addition of clinical data; and addition of CAC data. At each step, the reader was asked if rest SPECT-MPI was necessary. RESULTS: Stress-only images were interpreted as normal in 62, probably normal in 42, equivocal in 15, probably abnormal in 5, and definitely abnormal in 38 patients. Rest SPECT-MPI imaging was considered necessary, in 0% of normal studies, but in 88% of probably normal studies, and 100% of those with equivocal/abnormal studies. Addition of the clinical data did not materially change this decision. Additional consideration of the CAC scan results did not influence the deemed lack of need for a rest SPECT-MPI with normal SPECT-MPI or the necessity of rest SPECT-MPI with abnormal SPECT-MPI. However, the CAC scan reduced the deemed need for a rest SPECT-MPI in 72% with a probably normal, 47% with an equivocal, and 40% of those with a probably abnormal SPECT-MPI. CONCLUSIONS: Our exploratory analysis indicates that addition of a CAC scan to stress SPECT-MPI tends to diminish experienced readers' deemed need to perform rest SPECT-MPI studies among patients with probably normal or borderline stress-only SPECT-MPI studies. Thus, further study appears warranted to assess the utility of using CAC scanning as a means for increasing the percent of SPECT-MPI studies that can be performed as stress-only studies.