Comparison of SPECT and ectomography for evaluating myocardial perfusion with technetium-99m-sestamibi.

UNLABELLED: This study compared myocardial perfusion scintigraphy performed with ectomography to corresponding SPECT studies. METHODS: In a comparative study between SPECT and ectomography, 19 patients with suspected coronary artery disease were imaged under similar conditions. A two-day protocol using 99mTc-sestamibi was followed. In SPECT, 32 projection images were acquired by rotating the gamma camera detector through 180 degrees, from 45 degrees left posterior oblique to 45 degrees right anterior oblique. Short-axis view sections and polar tomograms were reconstructed. In ectomography, a 30 degrees slant-hole collimator was rotated through 360 degrees in front of a stationary detector to obtain 64 projection images with different projection directions. The gamma camera was orientated perpendicular to the long axis of the left ventricle; the orientation was determined from the SPECT examination. Short-axis section images through the projected conical volume were reconstructed using a two-dimensional filtered back projection technique. In a blind test, the relative diagnostic value and image quality of the two methods were evaluated by three independent observers assessing short-axis view sections and polar tomograms. An objective evaluation based on relative values in the polar tomograms was also performed. The interpretations were evaluated with analysis of variance. RESULTS: After injection during exercise, there was no significant difference between SPECT and ectomography. After injection at rest, visualization of the left ventricle was superior (p < 0.05) and influence of external activity was less (p < 0.005) in ectomography. The activity level within a perfusion defect was significantly lower (p < 0.05) and its extension significantly larger (p < 0.05) in ectomography than in SPECT. There was no difference between the diagnosis based on SPECT or ectomography. CONCLUSION: In myocardial perfusion imaging with 99mTc-sestamibi, ectomography provides information similar to that obtained with SPECT and can, therefore, be used clinically for evaluation of myocardial perfusion when the gamma camera is postitioned perpendicular to the long axis of the left ventricle.

Local convolution in ectomography.

In tomographic imaging, using limited angular sampling, details outside the imaged section are displaced along circles of blur. In ectomography, these are eliminated by a spatial convolution process. It is shown that the convolution function has to be as long as the projected dimension of the imaged object perpendicular to the section and twice the dimension parallel to the section.

Corticospinal motor neurons in the adult rat: degeneration after intracortical axotomy and protection by ciliary neurotrophic factor (CNTF).

Little is known about the neurotrophic factors that may regulate maintenance, growth, and/or repair of corticospinal motor neurons (CSMN) in the developing or the adult mammal. We have developed an adult rat in vivo model of CSMN injury involving (i) bilateral prelabeling of CSMN with a cervical spinal cord injection of cholera toxin B subunit (CTB), (ii) unilateral axotomy close to the cell bodies by an intracortical lesion between cell layer V and the corpus callosum, and (iii) implantation of a continuous infusion device in the cortical parenchyma near the lesion. Two weeks later, coronal sections of the cortex are immunostained for CTB, and CTB-stained neurons are counted over defined section areas and compared to those on the contralateral (nonlesioned, noninfused) side. CTB-stainable neurons were 30-40% of the control side when the lesion was about 200 microns from the deeper face of the cell layer, and survival increased with increasing lesion depths. The model can be used to assess protective effects of potential CSMN trophic factors. The low survival achieved with the more superficial lesions (200 and 300 microns) was markedly improved by continuous infusion of ciliary neurotrophic factor at 0.1 to 1.0 microgram/day.

Myocardial perfusion after coronary artery bypass surgery. A study using ectomographic myocardial scintigraphy and adenosine provocation.

A study was conducted to determine the time dependency of myocardial perfusion improvement after coronary artery bypass graft (CABG) surgery. Seventeen 3-vessel diseased patients (16 male, 1 female) scheduled for CABG surgery from a cardiac surgical and intensive-care unit were examined. Ten of the 17 patients returned for examination after 1 year. A titrated adenosine infusion was used to expose reversible ischemia. Tc99m-sestamibi was injected at rest and at maximum adenosine infusion rate, and isotope distribution was determined using ectomographic myocardial scintigraphy. Visually scored percent isotope uptake defect size and percent uptake reduction were assessed. It was found that resting isotope uptake defects were unchanged 1 h after surgery, increased in severity after 1 week, and after 1 year were 24% less than the preoperative scores (p < 0.01) and 55% less than after 1 week (p < 0.001). It was found that adenosine infusion induced a 57% increase in average defect score preoperatively (p < 0.001) but no increase postoperatively. No differences were seen between regions supplied by arterial or venous grafts. Isotope uptake defects increased between 1 h and 1 week after CABG surgery, and after 1 year the scores were less than those recorded preoperatively and after 1 week. Adenosine-induced reversible isotope uptake changes seen preoperatively were eliminated postoperatively in all vessel regions.