Reproducibility of Tl-201 and Tc-99m sestamibi gated myocardial perfusion SPECT measurement of myocardial function.

BACKGROUND: We compared the reproducibility of thallium 201 and technetium 99m sestamibi (MIBI) gated single photon emission computed tomography (SPECT) measurement of myocardial function using the Germano algorithm (J Nucl Med 1995;36:2138-47). METHODS AND RESULTS: Gated SPECT acquisition was repeated in the same position in 30 patients who received Tl-201 and in 26 who received Tc-99m-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on Tl-201 and Tc-99m-MIBI gated SPECT was processed independently with Cedars-Sinai QGS (Quantitative Gated SPECT) software. The reproducibility of the measurement of ventricular function on Tl-201 gated SPECT was compared with that of Tc-99m-MIBI gated SPECT. Correlation between the 2 measurements for volumes and EF was excellent for the repeated gated SPECT studies of Tl-201 (r = 0.928 to 0.986, P <.05) and Tc-99m-MIBI (r = 0.979 to 0.997, P <.05). However, Bland-Altman analysis revealed the 95% limits of agreement (2 SDs) for volumes and EF were narrower by repeated Tc-99m-MIBI gated SPECT (EDV 14.1 mL, ESV 9.4 mL, EF 5.5%) than by repeated Tl-201 gated SPECT (EDV 24.1 mL, ESV 18.6 mL, EF 10.3%). The root-mean-square values of the coefficient of variation for volumes and EF were smaller by repeated Tc-99m-MIBI gated SPECT (EDV 2.1 mL, ESV 2.7 mL, EF 2.3%) than by repeated Tl-201 gated SPECT (EDV 3.2 mL, ESV 3.5 mL, EF 5.2%). CONCLUSIONS: QGS provides an excellent correlation between repeated gated SPECT with Tl-201 and Tc-99m-MIBI. However, Tc-99m-MIBI provides more reproducible volumes and EF than Tl-201. Tc-99m-MIBI gated SPECT is the preferable method for the clinical monitoring of ventricular function.

Different uptake of (99m)Tc-ECD and (99m)Tc-HMPAO in the same brains: analysis by statistical parametric mapping.

The purpose of this study was to investigate the differences between technetium-99m ethyl cysteinate dimer ((99m)Tc-ECD) and technetium-99m hexamethylpropylene amine oxime ((99m)Tc-HMPAO) uptake in the same brains by means of statistical parametric mapping (SPM) analysis. We examined 20 patients (9 male, 11 female, mean age 62±12 years) using (99m)Tc-ECD and (99m)Tc-HMPAO single-photon emission tomography (SPET) and magnetic resonance imaging (MRI) of the brain less than 7 days after onset of stroke. MRI showed no cortical infarctions. Infarctions in the pons (6 patients) and medulla (1), ischaemic periventricular white matter lesions (13) and lacunar infarction (7) were found on MRI. Split-dose and sequential SPET techniques were used for (99m)Tc-ECD and (99m)Tc-HMPAO brain SPET, without repositioning of the patient. All of the SPET images were spatially transformed to standard space, smoothed and globally normalized. The differences between the (99m)Tc-ECD and (99m)Tc-HMPAO SPET images were statistically analysed using statistical parametric mapping (SPM) 96 software. The difference between two groups was considered significant at a threshold of uncorrected P values less than 0.01. Visual analysis showed no hypoperfused areas on either (99m)Tc-ECD or (99m)Tc-HMPAO SPET images. SPM analysis revealed significantly different uptake of (99m)Tc-ECD and (99m)Tc-HMPAO in the same brains. On the (99m)Tc-ECD SPET images, relatively higher uptake was observed in the frontal, parietal and occipital lobes, in the left superior temporal lobe and in the superior region of the cerebellum. On the (99m)Tc-HMPAO SPET images, relatively higher uptake was observed in the medial temporal lobes, thalami, periventricular white matter and brain stem. These differences in uptake of the two tracers in the same brains on SPM analysis suggest that interpretation of cerebral perfusion is possible using SPET with (99m)Tc-ECD and (99m)Tc-HMPAO.

Effect of peritoneal glucose load on plasma leptin concentration in continuous ambulatory peritoneal dialysis patients.

This study was performed to investigate the effect of peritoneal glucose load on plasma leptin concentrations in the continuous ambulatory peritoneal dialysis (CAPD) performed on 13 non-diabetic ESRD patients. Plasma leptin and insulin concentrations were measured for 2 hours during a single 2 liter exchange of 1.5% glucose-based dialysate (SPD, n = 6), for 7 days of daily peritoneal dialysis (DPD, n = 7). In DPD, standard full volume (2,000 ml x 4 times/day) exchange was performed immediately after operation. In SPD, plasma leptin and insulin concentrations remained unchanged during the study. In DPD, the plasma leptin concentration increased significantly after CAPD on the first day (PD1) (11.2 +/- 5.4 to 17.0 +/- 6.0 ng/mL, p < 0.05) and this elevation seemed to persist until 7 days after operation. After CAPD, there was no significant day-to-day variation in peritoneal glucose absorption (391-465 cal). Oral intake seemed to decrease on operation day (PD0) and PD1 and then increased slowly. Plasma insulin and glucose concentrations did not significantly change after CAPD. Changes of leptin concentration were significantly correlated with the changes of peritoneal glucose absorption at PD1. In conclusion, continuous peritoneal glucose load may affect plasma leptin concentrations in CAPD patients.

Late postictal residual perfusion abnormality in epileptogenic zone found on 6-hour postictal SPECT.

BACKGROUND: Temporal evolution of regional hyperperfusion in the late postictal stage in epilepsy has not been clearly defined. OBJECTIVE: To establish the late temporal evolution of the perfusion in epileptogenic zones using 6-hour postictal SPECT. METHODS: Ictal 99mTc-hexamethylpropyleneamine oxime (99mTc-HMPAO) SPECT was performed in 10 patients with intractable epilepsy (4 temporal lobe epilepsy, 6 neocortical epilepsy) followed by delayed acquisition and another 6-hour postictal SPECT after reinjection of 99mTc-HMPAO. The delayed acquired SPECT was subtracted from the reinjection SPECT to yield the 6-hour postictal SPECT. Interictal SPECT was acquired on another day. Late postictal perfusion was examined visually, and asymmetric indexes were compared with each other on ictal, 6-hour postictal, and interictal SPECT. RESULTS: Ictal SPECT images of delayed acquisition were visually and quantitatively similar to those of early acquisition. In 7 of 10 patients, 6-hour postictal SPECT showed hyperperfusion. In one patient, the 6-hour postictal SPECT image showed less perfusion than the interictal SPECT image in the epileptogenic zone. CONCLUSIONS: Late postictal hyperperfusion was found in more than half of the patients. Postictal perfusion abnormalities did not come back to the interictal phase 6 hours after ictus and these were identified on ictal/postictal 99mTc- HMPAO SPECT.

Bone scan appearance of renal osteodystrophy in diabetic chronic renal failure patients.

To investigate Tc-99m methylenediphosphonate (MDP) bone scan appearance in diabetic chronic renal failure patients, we compared the bone scan images of chronic renal failure patients with and without diabetes. The number of patients studied was 134, of whom 43 had diabetes. Two nuclear medicine physicians read Tc-99m MDP bone scan images and for six areas - the axial skeleton, long bone, skull and mandible, periarticular areas, costochondral junction, and sternum - assigned a score of either 1 or 0. The sums of scores were compared. We also performed multivariate analysis including sex, age, and serum creatinine level using analysis of covariance. DM group patients scored significantly lower (2.01+/-0.95) than those of the non-DM group (3.26+/-1.16). Analysis of covariance revealed that the lower DM group score was independent of sex, age, and serum creatinine level. The bone scans of diabetic chronic renal failure patients showed less Tc-99m MDP uptake than those of non-diabetic patients. Thus, diagnosing renal osteodystrophy in diabetic chronic renal failure patients on bone scan images could be difficult.