Prognostic value of ventricular mechanical dyssynchrony in patients with left ventricular aneurysm: A comparative study of medical and surgical treatment.

BACKGROUND: The prognostic value of left ventricular (LV) mechanical dyssynchrony (MD) in patients with LV aneurysm (LVA) is unclear. This study aimed to investigate the long-term prognostic value of LVMD in LVA patients. METHODS: 92 consecutive patients who underwent 99mTc-sestamibi-gated SPECT myocardial perfusion imaging (GSPECT) were retrospectively analyzed and followed-up for a median of 63 months (range, 1-73 months). LV function and histogram bandwidth (BW) were analyzed by QGS software. LVMD was defined by ROC analysis. Cardiac death was defined as the primary endpoint, and the composite of cardiac deaths and severe or acute heart failure (MACE) as the secondary endpoint. RESULTS: The annual cardiac mortality rate of LVA patients with LVMD and treated by surgical therapy was significantly lower than those treated by medical therapy (2.40% vs. 6.40%, P < .05) but not annual MACE rate (6.61% vs. 10.06%, P > .05). In patients without LVMD, no significant difference in survival and MACE-free survival between medical and surgical treatment. In addition, the occurrence of LVMD is related to the worsen cardiac outcome in terms of MACE and cardiac death, independent of the treatment methods. BW was an independent predictor for MACE (HR 1.010, P < .01) and LVEF (HR .928, P < .05) was an independent predictor for cardiac death in all LVA patients. CONCLUSIONS: LVA patients with LVMD might be associated with high risk for cardiac death and surgical treatment might improve cardiac survival compared to medical therapy in these patients.

The impacts of severe perfusion defects, akinetic/dyskinetic segments, and viable myocardium on the accuracy of volumes and LVEF measured by gated 99mTc-MIBI SPECT and gated ¹8F-FDG PET in patients with left ventricular aneurysm: cardiac magnetic resonance imaging as the reference.

BACKGROUND: To compare the accuracy of end-diastolic and end-systolic volumes (EDV, ESV) and LV ejection fraction (LVEF) measured by both GSPECT and GPET, using cardiac magnetic resonance imaging (CMR) as a reference. Furthermore, the impacts of severe perfusion defects, akinetic/dyskinetic segments, and residual viable myocardium on the accuracy of LV functional parameters were investigated. METHODS: Ninety-six consecutive patients with LV aneurysm and LV dysfunction (LVEF 32 ± 9%) diagnosed by CMR were studied with GSPECT and GPET. EDV, ESV, and LVEF were calculated using QGS software. RESULTS: Correlations of volumes were excellent (r 0.81-0.86) and correlation of LVEF was moderate (r 0.65-0.76) between GSPECT vs CMR and between GPET vs CMR. Compared with CMR, ESV was overestimated by GSPECT (P < .01) and underestimated by GPET (P < .0001); EDV was underestimated by GPET (P < .001); LVEF was underestimated by GSPECT but overestimated by GPET (both P < .001). Multivariate regression analysis revealed that the number of segments with severe perfusion defects (P < .001) was the only independent factor which was correlated to the EDV difference between GSPECT and CMR, the number of akinetic/dyskinetic segments with absent wall thickening (WT) was the only independent factor which was significantly correlated to the differences of ESV and LVEF measurements between GSPECT vs CMR and between GPET vs CMR (P < .0001), respectively. Neither the mismatch score nor the segments with viable myocardium were correlated to the differences of LV volumes and LVEF measurements between different imaging modalities. CONCLUSIONS: In LV aneurysm patients, LV volumes and LVEF measured by both GSPECT and GPET imaging correlated well with those determined by CMR, but should not be interchangeable in individual patients. The accuracy of LVEF measured by GSPECT and GPET was affected by the akinetic/dyskinetic segments with absent WT.

Confirmation of intestinal and bladder perforations in a peritoneal dialysis patient using SPECT/CT: a case report and review of literature.

Background: Peritoneal dialysis (PD) is a common treatment method for patients with renal failure. While peritonitis and tube floating migration are commonly observed complications, visceral perforation caused by PD is relatively rare. We present a case report of a patient undergoing PD due to renal failure, who encountered two instances of visceral perforation. In both occurrences, Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) played a pivotal role in providing accurate diagnoses and precise localization of the perforation sites. This report underscores the paramount significance of SPECT/CT in diagnosing visceral perforations in the context of PD. Case presentation: A 73-year-old elderly male has been undergoing PD for 1 year due to renal failure. Recently, there has been impaired drainage of the PD catheter. The clinical team suspected the occurrence of peritonitis. The patient underwent a 99mTc Sodium Pertechnetate (99mTc-NaTcO4) SPECT/CT examination, which identified intestinal perforation. After 20 days of conservative treatment, a SPECT/CT follow-up examination revealed the resolution of the intestinal perforation, but a new bladder perforation emerged. The dialysis catheter was methodically and gradually withdrawn in stages while simultaneously performing bladder decompression. Following these interventions, the patient remained free from peritonitis and cystitis. Conclusion: The utilization of SPECT/CT proved to be highly valuable in the accurate diagnosis of visceral perforation, a relatively rare complication observed in PD patients.

Disseminated cryptococcosis mimicking malignant lymphoma on 18F-FDG PET/CT: A case report.

RATIONALE: Disseminated cryptococcosis is extremely rare and is easily misdiagnosed as a malignant lymphoma. 18F-Fluorodeoxyglucose Positron Emission Tomography (PET)/ computed tomography (CT) may be useful to assess the involvement of disseminated cryptococcosis and to evaluate residual disease after treatment. PATIENT CONCERNS: A 21-years-old man presented with fever and cough for a month, with multiple red nodules scattered on the skin. 18F- Fluorodeoxyglucose PET/CT revealed multiple hypermetabolic lymph nodes in the upper and lower parts of the diaphragmatic region and hypermetabolic nodules in the skin. According to the PET/CT results, malignant lymphoma was considered a possibility, especially T-cell lymphoma involving the skin. DIAGNOSIS: Cryptococcosis was diagnosed using inguinal lymph node biopsy and blood culture. INTERVENTIONS: The patient received two months of amphotericin B, fluconazole, and half a month of meropenem. OUTCOMES: The patient's body temperature returned to normal and the red nodules on the skin disappeared. Most of the hypermetabolic enlarged lymph nodes disappeared, which was confirmed by reexamination with PET/CT. LESSONS: Disseminated cryptococcosis is easily misdiagnosed as malignant lymphoma, especially when the lymph nodes are more involved. When multiple hypermetabolic enlarged lymph nodes appear on PET/CT, except for lymphoma, specific infections should also be considered.

18F-FDG PET/CT Findings in a Patient With Primary Mucinous Cystadenocarcinoma of the Breast.

A 50-year-old woman presented with a mass in the upper outer quadrant of her left breast, which proved to be a mucinous cystadenocarcinoma by biopsy. An F-FDG PET/CT was performed for staging, which showed that the breast tumor was the only lesion with abnormal F-FDG avidity. Breast-conserving surgery was performed following a negative sentinel lymph node biopsy of the left axilla, and primary mucinous cystadenocarcinoma of the breast was finally diagnosed.

Diagnosis of Multiple Primary Intestinal-Type Adenocarcinoma in the Lung by 18F-FDG PET/CT.

A 74-year-old man with multiple soft tissue lesions in the lung, which were suspected to be metastatic neoplasms, underwent F-FDG PET/CT scan to detect primary malignancy. The images demonstrated that the lung and 2 retroperitoneal lymph nodes were the only affected organ or tissues with suspected primary lung neoplasms. Multiple intestinal-type adenocarcinoma was eventually diagnosed by CT-guided transthoracic needle aspiration biopsy.

Cardiac death in patients with left ventricular aneurysm, remodeling and myocardial viability by gated 99mTc-MIBI SPECT and gated 18F-FDG PET.

(1) To evaluate the prognostic value of LV remodeling parameters in patients with LV aneurysm by gated SPECT (GSPECT), gated PET (GPET) and CMR; (2) to evaluate the impact of myocardial viability and LV remodeling on the long-term cardiac survival in patients with LV aneurysm. One hundred and twenty-six consecutive patients underwent GPET, GSPECT and CMR within two weeks, with a mean follow-up of 3.9 ± 1.5 years. End-diastolic volume (EDV, mL) and end-systolic volume (ESV, mL) measured by GPET, GSPECT and CMR and corrected for BSA; EDVI and ESVI were calculated. Patients were divided into three groups by aneurysmal viability [mismatch score (MMS) of aneurysm ≥2.0] and LV remodeling (ESVI by GPET > 60 mL/m2). Group 1 (Viability -, LV remodeling -); Group 2 (Viability -, LV remodeling +) and Group 3 (Viability +, LV remodeling -/+). ESVI by GPET, MMS of aneurysm and summed rest score of aneurysm by multivariate regression analysis; as well as ESVI by GPET (HR 1.024, 95% CI 1.011-1.037, p = .0004), MMS of aneurysm (HR 1.284, 95% CI 1.051-1.577, p = .015) by interaction analysis were approved being independent predictors for cardiac death (p < .05). The long-term cardiac survival was significantly improved by revascularization in comparison with medical therapy in Group3 (p < .01), but did not significantly differ between Groups 1 and 2. ESVI by GPET showed a significant positive predictive value for cardiac death. Patients with viable myocardial aneurysm were most likely at increased risk for cardiac death and coronary revascularization was significantly associated with improved long-term cardiac survival. In contrast, the long-term cardiac survival of patients without LV remodeling and without aneurysmal viability was promising and, thus, could be treated by medical therapy.

Three Primary Carcinomas on 18F-FDG PET/CT: Intrahepatic Cholangiocarcinoma, Papillary Renal Cell Carcinoma, and Clear Cell Renal Cell Carcinoma.

A CT scan was performed on a 67-year-old man newly diagnosed with acute pancreatitis. The scan revealed a low-density lesion in the liver, a left renal nodule, and a right renal cystic mass. Intense F-FDG uptake was observed in the liver lesion and left renal nodule. No abnormal uptake was observed in the right renal mass. In addition, another focal intense uptake was observed in segment VII of the liver. Biopsies revealed intrahepatic cholangiocarcinomas in the 2 liver lesions, papillary renal cell carcinoma in the left renal lesion and clear cell renal cell carcinoma in the right renal lesion.

Enhanced Stim1 expression is associated with acquired chemo-resistance of cisplatin in osteosarcoma cells.

Osteosarcoma is the most common primary malignant bone tumor. Although cisplatin is the primary chemotherapy used in osteosarcoma treatment, the cisplatin resistance remains a big challenge for improving overall survival. The store-operated calcium (Ca2+) entry (SOCE) and its major mediator Stim1 have been shown to be implicated in a number of pathological processes typical for cancer. In this study, we showed that Stim1 expression was significantly increased in chemo-resistant osteosarcoma tissues compared with chemo-sensitivity tissues. Patients with Sitm1 expression exhibited poorer overall survival than Stim1-negative patients. Moreover, un-regulation of Stim1 expression and SOCE were also observed in cisplatin-resistant MG63/CDDP cells compared with their parental cells. Cisplatin treatment obviously reduced Stim1 expression and SOCE in cisplatin-sensitivity MG63 cells, but had no effects on MG63/CDDP cells. In addition, cisplatin resulted in a more pronounced increase of endoplasmic reticulum (ER) stress in MG63 cells than in their resistant variants, which was evidenced by the activation of molecular markers of ER stress, GRP78, CHOP and ATF4. Knockdown of Stim1 using siRNA remarkably enhanced cisplatin-induced apoptosis and ER stress in MG63/CDDP cells, thereby sensitizing cancer cells to cisplatin. On the other hand, overexpression of Stim1 markedly reversed apoptosis and ER stress following cisplatin treatment. Taken together, these results demonstrate that Stim1 as well as Ca2+ entry contributes cisplatin resistance via inhibition of ER stress-mediated apoptosis, and provide important clues to the mechanisms involved in cisplatin resistance for osteosarcoma treatment. Stim1 represents as a target of cisplatin and blockade of Stim1-mediated Ca2+ entry may be a useful strategy to improve the efficacy of cisplatin to treat osteosarcoma.