Quantitative Assessment Using the Compartment Model for Detecting Regional Coronary Artery Disease by Dynamic Myocardial Perfusion Single-Photon Emission Computed Tomography.

BACKGROUND: This study aimed to quantitatively evaluate myocardial perfusion single-photon emission computed tomography (SPECT) using an original analysis tool in the compartment model for detecting regional significant coronary artery disease (CAD).Methods and Results: This study analyzed 41 patients (median age, 76 years) with suspected or known CAD who underwent both dynamic SPECT using 99 mTc-tetrofosmin and invasive coronary angiography. The quantitative analysis was performed using a single-tissue compartment model to evaluate the diagnostic performance of the myocardial flow reserve (MFR) for regional significant CAD, excluding infarcted territories. In the regional analysis, 114 vessels were assessed, of which 31 were diagnosed as significant coronary lesions (≥70% stenosis and/or fraction flow reserve ≤0.8). The MFR of regional significant CAD was significantly lower than that of non-significant CAD (1.11 [0.97-1.31] vs. 1.74 [1.30-2.27]; P<0.001). In the receiver operating characteristic curve analysis, the MFR displayed an area under the curve (AUC) of 0.81. While analyzing each coronary artery territory, the diagnostic performance of the MFR value in the left anterior descending (LAD) artery territory was found to be significantly higher than that found in qualitative assessment (AUC: 0.84 vs. 0.61). CONCLUSIONS: A quantitative analysis of dynamic SPECT data facilitated detecting regional CAD. For the LAD artery, the MFR displayed a higher diagnostic performance than the qualitative assessment of conventional myocardial perfusion SPECT.

Prognostic value of human epidermal growth factor receptor 2 status and systemic therapy in breast cancer with brain metastases treated with radiotherapy.

PURPOSE: To evaluate the prognostic value of human epidermal growth factor receptor 2 (HER2) status and how to use HER2-targeted therapy in breast cancer (BC) with brain metastases (BM) treated with radiotherapy. METHODS: We retrospectively reviewed the data of 103 BC patients with parenchymal BM treated with radiotherapy. We collected data on the hormone receptor (HR), HER-2 amplification status, and systemic therapy after treatment for BM. The primary outcome was overall survival (OS), which was calculated from the diagnosis of BM to death. RESULTS: The median follow-up time from the diagnosis of the first BM was 9.1 months (range, .7-88 months). The 2-year OS of the HR-positive and HER2-positive (HR+HER2+) BC (31.3 mo) was significantly better than those of the HR-HER2+ (9,5 mo, p=.002), HR+HER2- (9.9mo, p=.003), and triple-negative BC (3.9 mo, p<.001) ( . Of the 36 HER2-positive patients, 31 patients treated with HER2-targeted therapy after radiotherapy for BM had a significantly better 2-year OS than those who did not receive HER2-targeted therapy (43% vs. 0%; p < .001). Among the 31 patients treated with HER2-targeted therapy, the 2-year OS for those treated with multiple anti-HER2 agents during the entire course of treatment was significantly higher than that for patients treated with a single agent (60% vs. 24%; p = .006). CONCLUSIONS: HR+HER2+ BC patients with BM treated with radiotherapy show a better prognosis than other subtypes. For HER2-positive patients with good prognosis, it may be important to continue HER2-targeted therapy appropriately after radiotherapy for BM.