Gated SPECT myocardial perfusion imaging: the further improvements of an excellent tool.

Cardiac imaging with gated single-photon emission computed tomography (SPECT) allows the evaluation of myocardial perfusion and analysis of global and regional left ventricular function. Gated SPECT is a validated and established diagnostic and prognostic method for evaluation of patients with suspected and known coronary artery disease. Significant improvements in software and gamma camera technology in SPECT cardiac imaging have been obtained. New detectors open a scenario for faster imaging with lower radiation dose to the patient. Appropriate use of the SPECT imaging is regulated by evidence-based guidelines and appropriateness criteria as well as by third-party payers in an effort to restrain the unsustainable growth of imaging testing recently observed. Future of cardiac SPECT imaging will be driven by societal demand for cost effective, accurate, and safe testing, which will improve meaningfully patients' management and outcomes.

The role of calprotectin in predicting endoscopic post-surgical recurrence in asymptomatic Crohn's disease: a comparison with ultrasound.

BACKGROUND AND OBJECTIVES: Faecal calprotectin is predictive of clinical relapse in inflammatory bowel disease and ultrasound is sensitive in detecting its post-surgical recurrence. However, no data regarding the role of calprotectin in predicting post-surgical recurrence in asymptomatic Crohn's disease are available. The aim of this study was to prospectively evaluate the role of calprotectin as a predictive marker for one year post-surgical endoscopic recurrence in comparison with ultrasound in patients with asymptomatic Crohn's disease. MATERIAL AND METHODS: We consecutively enlisted 50 patients who had undergone a resection for Crohn's disease. Faecal calprotectin was analysed and ultrasound were performed at the third month, and a colonoscopy after one year. The sensitivity and specificity of these two techniques were evaluated using endoscopic findings as a golden standard. A Receiver Operator Curve (ROC) curve was plotted, in order to identify the best-cut off value for calprotectin. RESULTS: 39 out of 50 patients were evaluated by performing a colonoscopy after one year; 19 patients had an endoscopic recurrence after one year. Calprotectin sensitivity and specificity were calculated for 5 different cut-off values; the best cut-off value for calprotectin sensitivity (63%) and specificity (75%) was > 200 mg/L. The US sensitivity and specificity at the third month were 26% and 90% respectively. CONCLUSIONS: When performed three months after surgery ultrasound is more specific than calprotectin in predicting endoscopic recurrence. Faecal calprotectin at a dosage > 200 mg/L seems to have a better sensitivity than ultrasound. Values of calprotectin > 200 mg can be an indication to colonoscopy in the group of patients with negative ultrasound in order to detect early recurrence.

Infliximab in the treatment of extra-intestinal manifestations of Crohn's disease.

BACKGROUND: Crohn's disease (CD) is frequently associated with extra-intestinal manifestations (EIMs) and infliximab has been recently proposed for the treatment of CD with EIMs. Our aim was to evaluate the short-term efficacy of infliximab in this treatment. PATIENTS AND METHODS: Thirty CD patients were treated with infliximab. Fifteen patients (50%) showed EIMs before starting therapy. Ten patients presented an arthritis (five sacroiliitis, five spondylitis), with six also reporting peripheral arthralgias. Four patients presented cutaneous EIMs while three patients had an ocular EIM. RESULTS: At week 10, all patients reported an improvement in EIMs. Regarding arthritis, ASAS20 and ASAS40 improvement was observed in 80% and 60% of patients, respectively. In the four patients with cutaneous EIMs and in the three with ocular EIMs, complete healing was observed. Recurrence was observed in 10 out of 15 patients (66%) and a second course of treatment with infliximab was required. This proved to be effective in all cases except for one patient who stopped treatment because of a severe adverse reaction. CONCLUSIONS: Infliximab is an effective drug in the short-term treatment of EIMs complicating CD. Although relapse of EIMs occurs frequently, retreatment ensures effective control of the symptoms.

Small bowel Crohn's disease: comparison of enteroclysis, bowel sonography and Tc-99m-HMPAO leukocyte scintigraphy.

BACKGROUND: Crohn's disease (CD) frequently involves the small bowel. Actually, the diagnosis of CD is made by ileocolonoscopy (IC) and small bowel enteroclysis (SBE), while trans-abdominal bowel sonography (BS) and Tc-99m-HMPAO leukocyte scintigraphy (LS) are only partially used in spite of their minimal invasiveness. AIM: to compare the diagnostic accuracy of these procedures for the diagnosis of small bowel CD. PATIENTS AND METHODS: in about two years a series of consecutive subjects underwent IC, SBE, BS and LS for either suspected or known small bowel CD. RESULTS: Sensitivity, specificity, positive and negative predictive value for CD diagnosis of the studied procedures were respectively: 98%, 97%, 98% and 97% for SBE; 92%, 97%, 98%, and 88% for BS; 90%, 93%, 96% and 85% for LS. In addition, the parallel combined use of BS and LS led to overall sensitivity, specificity, positive and negative predictive value of 100%, 93%, 96%, 100%, respectively. CONCLUSION: SBE, BS and LS are accurate procedures for the diagnosis of small bowel Crohn's disease. The use of BS and LS, particularly in combination, can be proposed as early diagnostic approach to subjects with a suspicion of disease.