Diagnostic performance of coronary computed tomography angiography stenosis score for coronary stenosis.

BACKGROUND: Coronary computed tomography angiography stenosis score (CCTA-SS) is a proposed diagnosis score that considers the plaque characteristics, myocardial function, and the diameter reduction rate of the lesions. This study aimed to evaluate the diagnostic performance of the CCTA-SS in seeking coronary artery disease (CAD). METHODS: The 228 patients with suspected CAD who underwent CCTA and invasive coronary angiography (ICA) procedures were under examination. The diagnostic performance was evaluated with the receiver operating curve (ROC) for CCTA-SS in detecting CAD (defined as a diameter reduction of ≥ 50%) and severe CAD (defined as a diameter reduction of ≥ 70%). RESULTS: The area under ROC (AUC) of CCTA-SS was 0.909 (95% CI: 0.864-0.943), which was significantly higher than that of CCTA (AUC: 0.826; 95% CI: 0.771-0.873; P = 0.0352) in diagnosing of CAD with a threshold of 50%. The optimal cutoff point of CCTA-SS was 51% with a sensitivity of 90.66%, specificity of 95.65%, positive predictive value of 98.80%, negative predictive value of 72.13%, and accuracy of 91.67%, whereas the optimal cutoff point of CCTA was 55%, and the corresponding values were 87.36%, 93.48%, 98.15%, 65.15%, and 88.60%, respectively. With a threshold of 70%, the performance of CCTA-SS with an AUC of 0.927 (95% CI: 0.885-0.957) was significantly higher than that of CCTA with an AUC of 0.521 (95% CI: 0.454-0.587) (P < 0.0001). CONCLUSIONS: CCTA-SS significantly improved the diagnostic accuracy of coronary stenosis, including CAD and severe CAD, compared with CCTA.

Bile acid predicts congenital portosystemic venous shunt in patients with pulmonary arterial hypertension.

The etiology of pulmonary arterial hypertension (PAH) is complex, especially the investigation of rare pathogeny is difficult. Congenital portosystemic venous shunt (CPSS) is a rare congenital anomaly in which the portal blood completely or partially bypasses the liver through a congenital portosystemic shunt, and drains directly into the inferior vena cava (IVC) (Howard and Davenport in J Pediatr Surg 32:494-497, 1997).CPSS is an uncommon cause of PAH (Christiane et al. in J Pediatr Gastroenterol Nutr 56:675-681, 2013), and often covered by other pathogenic factors. The clinical manifestations of CPSS-associated PAH are not specific, thus making it difficult to distinguish from PAH caused by other pathogenetic factors based on clinical presentations alone. This is a retrospective analysis of data from six patients with CPSS at a single center. Of these, five were diagnosed as PAH: four were also associated with other predisposing factors of pulmonary hypertension (PH). All patients had high serum bile concentration and high cardiac output. The aim of this retrospective study was to investigate the clinical recognition of PAH secondary to CPSS. The concentration of serum bile acid and cardiac output can be used as two important non-invasive indicators in clinical practice. Thus far, few studies have reported the clinical outcomes of CPSS-associated PAH specifically (Anna et al. in Hepatology 71:658-669, 2020;Franchi-Abella et al. in J Pediatr Gastroenterol Nutr 51:322-330, 2010;Uike et al. in Pediatr Pulmonol 53:505-511, 2018;). In the current study, such patients carried a poor prognosis if left untreated, or treated with pulmonary vasodilators alone.

A rare unclassified coronary anomaly: Right coronary artery with dual ostia origin from the right aortic sinus of Valsalva.

BACKGROUND: The dual ostia of coronary artery is extremely rare entity. We present a case of old woman with right coronary artery with dual ostia origin from the right aortic sinus of Valsalva. METHODS AND RESULTS: A 52-year-old woman presented with discontinuous chest tightness and palpitation. she was referred to coronary computed tomography angiography (CCTA). The CCTA suggested an anomalous right coronary artery (RCA) origin from the right sinus of Valsalva (RSV) with dual ostia. DISCUSSION: The dual ostia of coronary anomaly is extremely rare entity. Though catheter angiography may be performed for preoperative identification of coronary anomalies, it is limited in the description of the relationship of the coronary arteries to the cardiac structures and great vessels. CCTA can help in noninvasive characterization of coronary anomalies with respect to their origin, course, and spatial relations. Interventional cardiologists and cardiac surgeons should be aware of the new coronary anomaly for appropriate procedural planning and intra-procedural management. CONCLUSION: The important imaging valueof CCTA can help in noninvasive characterization of coronary anomalies with respect to their origin, course, and spatial relations.

Optimal blood pressure control for patients after thoracic endovascular aortic repair of type B aortic dissection.

BACKGROUND: Guidelines recommend tight systolic blood pressure (SBP) control for favorable outcomes of type B aortic dissection (BAD) but are still limited by the optimal cut-off value of SBP. The purpose of this study was to evaluate the optimal cut-off value of SBP in BAD patients after thoracic endovascular aortic repair (TEVAR). METHODS: From January 2011 to April 2017, 269 consecutive patients with BAD after TEVAR were included in the study. All patients were followed up according to a strict follow-up protocol. Cox regression analysis was used to examine the association between SBP at discharge and 90-day aortic related adverse events (ARAE). RESULTS: All 269 patients completed 90 days of follow-up, and the unadjusted ARAE-free rates at 90-day was 95.1 ± 1.3%. The cut-off value of SBP at discharge identified by receiver operator curve was 130 mmHg for 90-day ARAE. In multivariable models, binary SBP at discharge was significant associated with 90-day ARAE (HR 3.780; 95% CI 1.236-11.556; p = 0.020). Hybrid operation (OR 2.046; 95%CI 1.015-4.122; p = 0.045) and insertion of ≥2 stents (OR 2.950; 95%CI 1.172-7.426; p = 0.022) were demonstrated to be independently associated with poor SBP control (SBP > 130 mmHg) using Logistic analysis. CONCLUSIONS: The optimal cut-off value of SBP at discharge was 130 mmHg which can be used to predict short-term ARAE. Blood pressure in patients with hybrid operation and ≥ 2 stents should be given more focus.

Evaluation of 188Re-DTPA-deoxyglucose as a potential cancer radiopharmaceutical.

OBJECTIVE: We aimed to synthesize diethylenetriamine pentaacetic acid-deoxyglucose (DTPA-DG) radiolabeled with (188)Re and to evaluate its biologic characteristics using mammary tumor-bearing mice. MATERIALS AND METHODS: The biodistribution of the radiolabeled compound was determined by tissue counting at 3, 12, and 24 hours after injection in experimental animals. Scintigraphic examinations of nude mice bearing breast cancer (MCF-7 cells) were performed after (188)Re-DTPA-DG (18.5 MBq) was injected in the tail vein. For the tumor inhibitory portion of this work, tumor volumes were measured and recorded every 3 days until the 21st day after injection. RESULTS: The radiochemical purity of (188)Re-DTPA-DG was 95.0%. Based on biodistribution measurements, (188)Re-DTPA-DG was taken up at high levels by the tumor. The mean tumoral percent injected dosages per gram (% ID/g) were 1.98 +/- 0.29 (SD), 2.89 +/- 0.43, and 0.42 +/- 0.06 % ID/g at 3, 12, and 24 hours, respectively, after injection. In the (188)Re-DTPA-DG scintigraphic examinations, the tumors were clearly delineated on the images recorded 2, 4, 8, 12, and 24 hours after injection. In the tumor inhibitory evaluations, the tumor volume of the (188)Re-DTPA-DG-treated group increased more slowly than that of the control groups, which were treated with (188)Re-perrhenate or saline (p < 0.01). Rhenium-188-DTPA-DG showed excellent tumor targeting and tumor growth suppression properties on MCF-7 tumor cells. CONCLUSION: Rhenium-188-DTPA-DG may be a potential agent for the diagnosis and radiotherapy of tumors.

Review: Deoxyglucose compounds labeled with isotopes different from 18-fuoride: is there a future in clinical practice?

There are several radionuclide-labeled derivatives of deoxyglucose (DG) that have been developed including 2-fluro-deoxyglucose, ethylenedicysteine-deoxyglucose, diethylenetriaminepentaacetate-deoxyglucose, N-(2'-hydroxybenzyl)-2-amino-2-deoxy-D-glucose, and methyl D-glucoside that were synthesized and successfully labeled in high labeling fields. The former 4 were used for tumor imaging and methyl-D-glucoside for the diagnosis and the monitoring of the functional status of renal tubules. These derivatives are suitable for imaging examinations when labeled with either fluorine-18 (18F), technetium-99m (99mTc), carbon-11 (11C), or gallium-68 (68Ga). These compounds are suitable both for imaging and for therapy if labeled with rhenium-188 (188Re). In the area of molecular imaging of nuclear medicine, derivatives of radionuclide-labeled deoxyglucose will become an important tool for the diagnosis and carcinoma treatment in the clinic.

Study of apoptosis induced by 188Re-DTPA-DG in MCF-7 breast carcinoma and A549 pulmonary carcinoma cells.

OBJECTIVE: To evaluate apoptosis induced by rehenium-188-labeled diethylenetriamine pentaacetic acid-glucosamine (188Re-DTPA-DG) in MCF-7 breast carcinoma cells and A549 pulmonary carcinoma cells. METHODS: Through the use of flow cytometry (FCM) with CBA software to detect apoptosis, cells of both the MCF-7 and A549 cell lines were divided into groups exposed to 188Re-DTPA-DG, 188Re-perrhenate (188ReO4-), and saline, respectively. The first two groups were further divided into subgroups on the basis of their exposure to radioactivity at 37, 55.5, or 74 kBq/mL, with the saline-exposed group divided into three corresponding subgroups. Each subgroup was introduced into 5 replicate wells of a culture plate, and the morphology of the cells in each well was determined by flow cytometry at 6-hour intervals for 18 hours. In order to determine the affinity of 188Re-DTPA-DG for tumor tissue, the biodistribution of the radiolabeled agent was assessed in breast tumor-bearing nude mice. RESULTS: Change in morphology of the cell nucleus was more evident in the 188Re-DTPA-DG-treated than in the 188ReO4--treated group, and no change in nuclear morphology was seen in the saline-exposed group. The study data suggested that there was a greater ratio of apoptotic to nonapoptotic cells among the 188Re-DTPA-DG-treated than among the 188ReO4--treated or saline-exposed cells (p<0.01), and a greater change in cell-nuclear morphology in the 188Re-DTPA-DG-treated than in the 188ReO4--treated cells. Furthermore, 188Re-DTPA-DG had a more significant apoptosis-inducing effect on both MCF-7 and A549 cells than did 188ReO4-. The biodistribution study in tumor-bearing nude mice showed that the concentration of 188Re-DTPA-DG in tumor tissue was much higher than in normal tissue, that 188Re-DTPA-DG was rapidly cleared from the blood, and that the main route of its clearance was via the kidneys. CONCLUSIONS: 188Re-DTPA-DG has a significant apoptotic effect on carcinoma cells. 188Re-DTPA-DG is an effective radiopharmaceutical for intratumoral radiation therapy.

Preparation and imaging research on 188Re-DTPA-deoxyglucose in MCF-7 tumor-bearing mice.

OBJECTIVE: To investigate the preparation of (188)Re-diethylenetriaminepentaacetic acid-2-deoxyglucose ((188)Re-DTPA-DG) and its imaging quality and therapeutic effect. METHODS: Labeling of DTPA-DG with (188)Re was performed in the presence of stannous ion and sodium D-gluconate at a pH of 5.5 with 3 hours of incubation at 37 degrees C. The radiolabeling yields of (188)Re-DTPA-DG were determined by paper chromatography with a solution of acetone and saline (0.9% NaCl) as a developing agent. The imaging quality of (188)Re-DTPA-DG was determined by injecting 0.1 mL of a preparation having a radioactivity of 92.5GBq/L into the tail vein of nude mice bearing MCF-7 mammary tumors and imaging the tumors at 2, 4, 8, 12, and 24 hours after injection of the radiolabeled agent. Tumor volume was recorded every 2 or 3 days for 21 days. RESULTS: The radiochemical purity of the (188)Re-DTPA-DG complex was 95.0%. In the imaging study, the tumor-to-nontumor-tissue ratios (T/NT) of radioactivity at 12 and 24 hours after intravenous injection of the radiolabeled agent were 5.9 and 7.8, respectively. The tumor volume in the (188)Re-DTPA-DG-treated group of mice increased more slowly than that in the control group, and the two groups differed greatly in this measure at 21 days, with tumor volumes of 823.6 +/- 50.58 mm(3) and 1162.7 +/- 73.08 mm(3) in the (188)Re-DTPA-DG treated and control groups, respectively (p < 0.01). CONCLUSIONS: (188)Re-DTPA-DG showed excellent tumor targeting and tumor-growth-suppressing effects, and holds promise as an internal agent for tumor radiotherapy.

Noninvasive scintigraphic detection of tumor with 99mTc-DTPA-deoxyglucose: an experimental study.

OBJECTIVES: Glucosamine is a highly attractive scaffold for a glucosyl ligand, and shows activity with glucose transporters and hexokinase. In the study reported here, diethylenetriamine-pentaacetic acid-D-glucosamine (DTPA-DG) was synthesized by conjugating D-glucosamine to DTPA, and was labeled with technetium-99m ((99m)Tc). We investigated (99m)Tc-DTPA-DG for tumor detection. METHODS: The biodistribution and imaging of (99m)Tc-DTPA-DG in mammary tumor-bearing mice were compared to those in a control group of mice with oleum terebinthinae (turpentine oil)-induced inflammation. Both groups of mice were given an intravenous injection of 3.7 MBq/0.1 mL of (99m)Tc-DTPA-DG through the tail vein. RESULTS: (99m)Tc-DTPA-DG accumulated in the tumor tissue to a percentage of 2.10 +/- 0.02% of the injected dose per gram of tissue (%ID/g) at 2 hours after injection, versus an accumulation of 0.81 +/- 0.03%ID/g in the inflamed tissue. The tumor-to-contralateral muscle tissue ratio of (99m)Tc-DTPA-DG was 5.01 +/- 1.02, while the inflamed tissue-to-contralateral muscle tissue ratio was 1.2 +/- 0.08. Gamma-camera imaging revealed the tumor tissue at 2 hours after injection of (99m)Tc-DTPA-DG. The tumor-to-background ratio of (99m)Tc-DTPA-DG (3.8 +/- 0.95) at 2 hours was significantly (p < 0.05) higher in mammary tumor-bearing mice than was the inflamed tissue-to-background ratio (1.2 +/- 0.62) in the mice with inflammation. CONCLUSIONS: (99m)Tc-DTPA-DG showed excellent tumor targeting and has promise as an imaging agent for clinical tumor targeting.