Myocardial SPECT in the study of ischemic heart disease detection of hibernating myocardium and evaluation of cost/benefit ratio.

From over ten years, the assessment of myocardial viability in akinetic zones (stunned or hibernating myocardium) is considered fundamental to the correct management of postinfarction patients. The assessment can be performed with myocardial scintigraphy (201Thallium rest-redistribution, dobutamine stress echocardiography, MRI, 18F-fluorodeoxyglucose PET). A number of experiences have shown that scintigraphy is very sensitive but poorly specific in the assessment of myocardial akinetic zones with contractile functional recovery after revascularization. However, most recent reports have highlighted that the recovery of contractile function is not the single purpose of myocardial revascularization; in fact, it is able to prevent or attenuate remodeling, the contractile reserve is maintained or enhanced, the diastolic function is improved, arrhythmias are prevented, symptoms and functional capacity are improved. Therefore, the role of very sensitive procedures as myocardial scintigraphy or MRI of the heart is still of major diagnostic and prognostic significance. The present socioeconomic situation and the most recent advances in cardiology tend to shift the clinician's interest from the diagnosis to the prognosis of patients with ischemic heart disease and consequently, from maximum diagnostic accuracy to the highest prognostic value and maximum cost/effective benefit. Therefore, the nuclear cardiologist must become familiar with this novel terminology and new diagnostic and prognostic end-points.

[Tc99m-sestamibi SPECT and head and neck tumors: preliminary data]. / Tc99m-sestamibi spet e tumori della testa e del collo: dati preliminari.

After underlining recent progress in nuclear medicine diagnostics, even in oncology, the authors describe the most important methods used and oncotropic capacity of some radiodrugs currently used in clinical practice: i.e. perfusion tracers. Then they present the results of a personal experience using Tc99m-SestaMIBI SPET in detail. Fifteen patients suffering from various primary head and neck neoplasms underwent systematic clinical evaluation, endoscopy, CT and/or MRI and Tc99m-SestaMIBI SPET. The authors then briefly describe the method and underline the fact that the literature lacks any homogeneous data on the use of Tc99m-SestaMIBI SPET in the study of head and neck neoplasms. The results indicate that the method is reliable in identifying both primary tumors and laterocervical metastases. Then, taking indication from the only case currently available on post-radiotherapy recurrence, the authors suggest an interesting field of application for this technique: the study of post-radio-chemotherapy and/or surgery recurrences. In conclusion, the authors underline the valid contribution this method currently offers both in diagnosis and follow-up as well as its future of ever expanding clinical applications.