Nuclear cardiology: an overview of radioisotope techniques used in the diagnostic workup of cardiovascular disorders.

Cardiovascular diseases are the most common cause of death in patients over 60 years old. Pivotal imaging modalities in cardiac diagnostic workup are echocardiography, magnetic resonance, multi­row detector computed tomography, coronary angiography, and radioisotope tests. In this study, we summarize the techniques of nuclear medicine (positron emission tomography, single­photon emission computed tomography, radionuclide ventriculography) that could be implemented in the cardiovascular diagnostic algorithms. Despite being acknowledged in a few cardiology guidelines, these imaging methods are still underestimated by practitioners. Nevertheless, noninvasive diagnostic tools are of increasing potential and should be implemented whenever possible. We discuss the usefulness of particular techniques in the management of patients with obstructive and nonobstructive coronary artery disease, including assessment of myocardial perfusion, contractility, viability, and detection of unstable atherosclerotic plaques. Radioisotope imaging can also be valuable in the diagnostic workup of infective endocarditis, as well as cardiac sarcoidosis and amyloidosis. Apart from theoretical principles of nuclear cardiology, we also provide 3 case reports illustrating a practical implementation of these imaging modalities.

The usefulness of SPECT/CT in characterization of skeletal and soft tissue lesions--report of two cases.

SPECT/CT imaging provides detailed information on the radiotracer distribution and enables simultaneous lesion morphology evaluation. This hybrid imaging delivers complementary information about patient's disease. We present two cases in which SPECT/CT imaging and cooperation between the nuclear medicine physician and radiologist quickly clarified the diagnosis, sparing patient unnecessary diagnostic procedures or treatment.

Complex Regional Pain Syndrome type I with atypical scintigraphic pattern--diagnosis and evaluation of the entity with three phase bone scintigraphy. A case report.

Complex Regional Pain Syndrome (CRPS) is a neurological disorder of unknown etiology which may lead to severe disability. Its diagnosis is very difficult and based on diagnostic criteria which have been changing over last years. Still, there is no golden standard in diagnosis of this entity. Three-phase bone scan is a widely used diagnostic modality which has been proved useful in CRPS evaluation. The syndrome may present various scintigraphic patterns. Different diagnostic modalities can also be helpful when CRPS is suspected including plain film radiography, magnetic resonance imaging and ultrasonography. Multidisciplinary approach is necessary for proper and quick diagnosis. We present a case of CRPS in 12-year-old girl in whom the diagnosis was based on the bone scan.

Meteorological parameters and severity of acute pulmonary embolism episodes.

Frequency of acute pulmonary embolism episodes has been previously shown to correlate significantly with meteorological factors in the period preceding their occurrence. The purpose of the study was to analyze the relation of meteorological factors and the severity of acute pulmonary embolism, expressed by the CT-based pulmonary obstruction score. A retrospective analysis of medical data of 182 consecutive patients with acute pulmonary embolism diagnosed with CT pulmonary angiography was performed. Severity of pulmonary obstruction was assessed by analysis of CT pulmonary angiography examinations, and defined with pulmonary obstruction score by Qanadli et al. The study group was divided into low (L group, 95 patients) and high PE severity (H group, 87 patients), with a cutoff value of 50% of maximum pulmonary obstruction score. Meteorological data collected for the relevant time period were: air temperature, humidity, atmospheric pressure, visibility, wind speed and precipitation. No significant differences in seasonal distribution of pulmonary embolism episodes were observed. Episodes of more severe pulmonary embolism were preceded by periods of lower atmospheric pressure (1,016.35 hPA for group H, vs. 1,016.35 hPa for group L, p = 0.022). No significant relations between other meteorological factors and severity of PE were observed. The reported finding shows the need of further research on the nature of meteorological factors influence on the course of pulmonary embolism, which should be analyzed not ony regarding the frequency, but also severity of PE episodes.

Low atmospheric pressure and humidity are related with more frequent pulmonary embolism episodes in male patients.

Pulmonary embolism is a frequent condition, related with high mortality. Frequency of pulmonary embolism episodes has been related with several meteorological factors. The aim of the study was to analyze the influence of meteorological factors on the occurrence of pulmonary embolism in male and female patients. Medical data of patients hospitalized at our institution in 2007-2008 was analyzed. Study group included 400 patients with pulmonary embolism, living in the region located at an average level of about 200 m above sea level, with climate of a transitional character between maritime and continental climates. No significant differences in seasonal distribution of pulmonary embolism episodes were observed. A significant inverse correlation of the number of pulmonary embolism cases and atmospheric pressure, as well as air humidity, was identified in male patients. No significant correlations of temperature, wind velocity, precipitation and number of PE cases were observed. The influence of meteorological factors on the occurrence of pulmonary embolism in males is a new finding. A prospective study is warranted to further analyze this result.