0
selected
-
1.
Clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in COVID-19 patients with a moderate to high pre-test probability of PE.
Das, JP, Yeh, R, Schöder, H
European journal of nuclear medicine and molecular imaging. 2021;(3):794-799
-
-
Free full text
-
Abstract
PURPOSE We reviewed the clinical utility of perfusion (Q)-single-photon emission computed tomography (SPECT)/CT for diagnosing pulmonary embolus (PE) in patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). METHODS Following the World Health Organization's declaration of a global pandemic, our department policy recommended Q-only SPECT/CT for all patients undergoing nuclear medicine evaluation for suspected PE to reduce the risk of aerosolization of respiratory droplets. We performed a retrospective review of sequential patients admitted with COVID-19 imaged with Q-SPECT/CT between March 17, 2020, and June 30, 2020, at Memorial Sloan Kettering Cancer Center. We recorded patient demographics, clinical symptoms, Wells score (to stratify patients according to pre-test probability for PE prior to Q-SPECT/CT), and noted ancillary imaging findings on CT. RESULTS Of the 33 patients imaged with Q-SPECT/CT, 6 patients (3 men, 3 women) had a laboratory confirmed diagnosis of COVID-19 (mean age, 55, ± 11.4 years, range 33-68). All patients had a current diagnosis of malignancy and had a moderate or high pre-test probability for PE (mean Wells score 2.8, range 2-4). Q-SPECT/CT was positive in 4/6 (67%) of patients. Distribution of pulmonary emboli was bilateral and segmental in 75% of patients. Ancillary acute findings on SPECT/CT included bilateral parenchymal ground glass opacities (n = 5), pleural effusions (n = 2), and pneumomediastinum (n = 1). CONCLUSION Q-SPECT/CT has clinical utility for diagnosing PE in patients with COVID-19 where there is a contraindication for iodinated contrast media and a moderate or high pre-test probability for PE.
-
2.
The effects of pharmacological interventions, exercise, and dietary supplements on extra-cardiac radioactivity in myocardial perfusion single-photon emission computed tomography imaging.
Molavipordanjani, S, Abedi, SM, Hosseinimehr, SJ, Fatahian, A, Mardanshahi, A
Nuclear medicine communications. 2020;(9):841-847
Abstract
Myocardial perfusion imaging (MPI) as an imaging modality plays a key role in the monitoring of patients with cardiovascular disease. MPI enables the assessment of cardiovascular disease, the effectiveness of therapy, and viable myocardial tissue. However, MPI suffers from some downfalls and limitations, which can influence its clinical applications. These limitations can arise from the patient's condition, equipment, or the actions of the technologist. In this review, we mainly focused on the different effective parameters on radioactivity uptake of organs including liver, intestines, stomach, and gall bladder and how they affect the quality of the acquired images in nuclear medicine. More importantly, we cover how different suggested medicines, foods and exercise alleviative this problem.
-
3.
Intelligent Imaging: Radiomics and Artificial Neural Networks in Heart Failure.
Currie, G, Iqbal, B, Kiat, H
Journal of medical imaging and radiation sciences. 2019;(4):571-574
Abstract
BACKGROUND Our previous work with 123iodine meta-iodobenzylguanidine (123I-mIBG) radionuclide imaging among patients with cardiomyopathy reported limitations associated with the prognostic power of global parameters derived from planar imaging [1]. Employing multivariate analysis, we further showed the regional washout associated with territories adjacent to infarcted myocardium obtained from single-photon emission computed tomography imaging (SPECT) yielded superior prognostic power over the other planar and SPECT indices in predicting future cardiac events [1]. The aim of this study was to apply an artificial neural network (Neural Analyser version 2.9.5) to the original data from the same patient cohort to evaluate the most potent prognostic index for future cardiac events among patient with cardiomyopathy. METHODS The original data were reevaluated using an artificial neural network (Neural Analyser version 2.9.5). There were 84 input variables in the original 22 patients from clinical data, electrocardiogram (rest, stress, and continuous ambulatory electrocardiogram recording), transthoracic echocardiography, coronary angiogram, sestamibi myocardial perfusion SPECT, planar and SPECT 123I-mIBG, and genetic and biomarkers, detailed in the previous work. A single binary output was a cardiac event or no cardiac event in the follow-up period. RESULTS Following training and validation phases, the optimal number of inputs was determined to be two with a training loss of 0.025 and selection loss <0.001. The final architecture had inputs of a change in left ventricular ejection fraction (Δ > -10%) and 123I-mIBG planar global washout (>30%), two hidden layers of 6 and 1 node, respectively, and a binary output. Using receiver operator characteristics analysis demonstrated an area under the curve of 0.75 correlating to a sensitivity of 100% and specificity of 50%. CONCLUSION The premise that regional washout of 123I-mIBG SPECT from noninfarcted tissue is the best predictor of cardiac events was built on has a sound and logical foundation. By artificial neural network analysis; however, 123I-mIBG planar global washout of >30% was shown to be the best indicator for risk of cardiac event when accompanied by a decline in left ventricular ejection fraction of >10%. Further investigation should be undertaken assessing assimilation into big data and the potential for automated feature extraction from raw image datasets with convolutional neural networks.
-
4.
Optimizing the Diagnosis of Parkinsonian Syndromes With 123I-Ioflupane Brain SPECT.
Banks, KP, Peacock, JG, Clemenshaw, MN, Kuo, PH
AJR. American journal of roentgenology. 2019;(2):243-253
Abstract
OBJECTIVE. The purpose of this article is to provide a review of 123I-ioflupane SPECT in the evaluation of suspected parkinsonian syndromes (PSs). This collection of diseases presents frequent diagnostic challenges, even by movement disorder and dementia specialists. CONCLUSION. The 123I-ioflupane scan serves as an imaging biomarker of the status of presynaptic dopamine transporters (DATs) in the striatum. As a result of neuronal death, DATs are greatly reduced in patients with PS neurodegenerative disorders, whereas clinical mimics generally do not show striatal DAT loss. This provides a tremendous opportunity for 123I-ioflupane to aid in the accurate and timely diagnosis of these patients and optimize their management.
-
5.
Neuroimaging Applications in Restless Legs Syndrome.
Rizzo, G, Plazzi, G
International review of neurobiology. 2018;:31-64
Abstract
Neuroimaging studies provide information useful to understand the pathophysiology of restless legs syndrome. Molecular PET and SPECT imaging findings mainly supported dysfunction of dopaminergic pathways involving not only the nigrostriatal but also mesolimbic pathways. Magnetic resonance imaging (MRI) studies have used different techniques. Studies using iron-sensitive sequences supported the presence of a regionally variable low brain iron content, mainly at the level of substantia nigra and thalamus. The search for brain structural or microstructural abnormalities by voxel-based morphometry, diffusion tensor imaging or cortical thickness analysis has reported none or variable findings in restless legs syndrome patients, most of them in regions belonging to sensorimotor and limbic/nociceptive networks. Functional MRI studies have substantially demonstrated activation or connectivity changes in the same networks. Magnetic resonance spectroscopy studies showed metabolic changes in the thalamus, which is a hub of these networks. In summary, neuroimaging findings in restless legs syndrome support the presence of reduction of brain iron content, of dysfunction of mesolimbic and nigrostriatal dopaminergic pathways, and of abnormalities at level of limbic/nociceptive and sensorimotor networks.
-
6.
Clinical imaging in dementia with Lewy bodies.
Surendranathan, A, O'Brien, JT
Evidence-based mental health. 2018;(2):61-65
-
-
Free full text
-
Abstract
Dementia with Lewy bodies (DLB) is a common neurodegenerative dementia in older people; however, the clinical features, particularly cognitive fluctuations and rapid eye movement sleep disorder, are often hard to elicit, leading to difficulty in making the diagnosis clinically. Here we examine the literature for the evidence behind imaging modalities that could assist in making the diagnosis. Dopamine transporter (DAT) imaging remains the best modality for differentiation from dementia of Alzheimer's type with high sensitivity and specificity reported based on pathological diagnoses. 123Iodine-metaiodobenzylguanidine myocardial scintigraphy (MIBG) however is rapidly becoming an alternative imaging modality for the diagnosis of DLB, though studies assessing its accuracy with postmortem verification are still awaited. However, there are suggestions that MIBG may be better in the differentiation of vascular parkinsonism from DLB than DAT scans but may have lower sensitivity for detecting DLB compared with the 80% sensitivity seen in DAT imaging. Structural MRI scans have long been used for the diagnosis of dementia; however, their utility in DLB is limited to revealing the presence of coexisting Alzheimer's disease. Fluorodeoxyglucose (FDG) PET is an alternative biomarker that can also differentiate Alzheimer's disease and DLB but lacks the evidence base of both DAT and MIBG scans.
-
7.
123I-ioflupane SPET and 123I-MIBG in the diagnosis of Parkinson's disease and parkinsonian disorders and in the differential diagnosis between Alzheimer's and Lewy's bodies dementias.
Nuvoli, S, Palumbo, B, Malaspina, S, Madeddu, G, Spanu, A
Hellenic journal of nuclear medicine. 2018;(1):60-68
Abstract
Nuclear medicine procedures are widely used as "in vivo" biomarkers in a large number of brain diseases, especially in the diagnosis of Parkinson's disease (PD) and of parkinsonian disorders (pD). Furthermore, nuclear medicine is used in the differential diagnosis of dementias especially Alzheimer's disease (AD) and dementia with Lewy's bodies (LBD) which share many clinical symptoms and often LBD is misdiagnosed as AD. The differential diagnosis between these clinical entities is crucial for treatment since LBD also shares some clinical symptoms with parkinsonian disorders. We reviewed the most relevant papers that study the usefulness of both iodine-123-ioflupane studied by single photon emission tomography (123I-ioflupane SPET) and of 123I-metaiodobenzylguanidine (123I-MIBG) cardiac scintigraphy in the diagnosis of PD and pD and in the differential diagnosis between AD and LBD in order to contribute to the clinical practice of the diseases.
-
8.
Hybrid SPECT/CT Imaging in the Management of Differentiated Thyroid Carcinoma.
Ahmed, N, Niyaz, K, Borakati, A, Marafi, F, Birk, R, Usmani, S
Asian Pacific journal of cancer prevention : APJCP. 2018;(2):303-308
Abstract
Differentiated thyroid cancer (DTC) has a good prognosis overall; however, lifelong follow-up is required for many cases. Radioiodine planar imaging with iodine-123 (I-123) or radioiodine-131 (I-131) remains the standard in the follow-up after initial surgery and ablation of residual thyroid tissue using I-131 therapy. Radioiodine imaging is also used in risk-stratifying and for staging of thyroid cancer, and in long-term follow-up. Unfortunately, the lack of anatomical detail on planar gamma camera imaging and superimposition of areas presenting with increased radioiodine uptake can make accurate diagnosis and localization of radioiodine-avid metastatic disease challenging, leading to false positive results and potentially to over-treatment of patients. Hybrid SPECT/CT allows precise anatomical localization and superior characterization of foci of increased tracer uptake when compared to planar imaging. This, in turn, allows the differentiation of pathological and physiological uptake, increasing the accuracy of image interpretation and ultimately improving the accuracy of DTC staging and subsequent patient management. In this review, we look at the unique and emerging role that SPECT/CT plays in the management of DTC, illustrated by examples from our own clinical practice.
-
9.
Molecular imaging of advanced thyroid cancer: iodinated radiotracers and beyond.
Santhanam, P, Solnes, LB, Rowe, SP
Medical oncology (Northwood, London, England). 2017;(12):189
Abstract
An important aspect of differentiated thyroid cancer (DTC) management is disease localization by imaging. Functional imaging of thyroid cancer with iodinated radiotracers has been employed for metastatic disease detection for long. More recently, 2-deoxy-2-[18F] fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), a non-iodinated ubiquitous PET tracer, has been used to detect non-radioiodine (RAI) avid disease. Advances in molecular imaging have led to the development of newer tracers like 18F-TFB (18F-tetrafluoroborate) that are transported through the sodium-iodide symporter (NIS) as well as 68 Ga-DOTATATE that image the somatostatin receptors sub-type 2 expressed in medullary thyroid cancer and some DTC. In coming years, there will be focus on newer receptor targets like prostate-specific membrane antigen expression and endoradiotherapies and theranostics.
-
10.
New solid state cadmium-zinc-telluride technology for cardiac single photon emission computed tomographic myocardial perfusion imaging.
Alenazy, AB, Wells, RG, Ruddy, TD
Expert review of medical devices. 2017;(3):213-222
Abstract
Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is well established as diagnostic test for patients with suspected or known coronary artery disease. New camera systems have been developed with cadmium-zinc-telluride (CZT) detectors, novel collimator designs and reconstruction software. Areas covered: We review the current state of cardiac SPECT, advances in conventional camera technology and the development and clinical validation of solid-state CZT cameras. Expert commentary: The development of CZT systems is timely and addresses current issues for clinical SPECT imaging. These systems have a significant increase in photon sensitivity, permitting much lower radiation patient doses at a time when the lay and medical communities are very concerned about the radiation doses resulting from medical imaging. The increased count sensitivity permits shorter acquisition times and greater patient throughput which may address the ongoing and increasing issue of decreased funding for healthcare and, particularly, diagnostic imaging. The improved image resolution should improve diagnostic accuracy and increase the value of SPECT imaging for management of patients with CAD at a time of significant competition from other imaging modalities.