EVALUATION OF RADIONUCLIDE BONE IMAGING FOR SKELETAL DISEASE

Whole body bone scan imaging of 99mTc-MDP was performed in 80 casesfrom Sept 1991 to Feb 1992. Among them 20 patients showed negtive bone imaging and56 patients showed positive bone imaging. There were false-positive bone imaging in 4 pa-tients. Bone scan imaging has been regarded as a useful method in the early diagnosis ofshelatal disease, especially in old patients with bone metastasis. But the final confirmationof malignancy should be still cautious.

Chinese expert consensus on the non-invasive imaging examination pathways of stable coronary artery disease

1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mortality. Clinical decision-making in modem medicine is increasingly dependent on cardiovascular imaging techniques. 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease has been issued by American Heart Association （AHA）. European Society of Cardiology （ESC） has issued 2013 ESC guidelines on the management of stable coronary artery disease.

THE VALUE OF^(99m) Tc-MIBI MYOCARDIAL PERFUSION SPECT IMAGING IN DETECTING CORONARY ARTERY DISEASE IN PATIENTS WITH VALVULAR DISEASE BEFORE OPERATION

The aim of this study was to detect coronary artery disease using 99m Tc MIBI myocardial perfusion imaging in patients with valvular disease. [WT5”BX]Methods.[WT5”BZ] Thirty patients with valvular disease confirmed by echocardiography underwent 99m Tc MIBI myocardial perfusion imaging using multiSPECT 1h after stress test (exercise, dipyridamole or dobutamine test) and were performed coronary angiography within 1 month before valvular operation. [WT5”BX]Results.[WT5”BZ]For 29 out of the 30 patients, the results of 99m Tc MIBI myocardial perfusion imaging were similar with those of coronary angiography, the concordance rate was 96 7% and the negative predictability was 100%. [WT5”BX]Conclusion.[WT5”BZ] 99m Tc MIBI myocardial perfusion imaging is a reliable non invasive method for detecting coronary artery disease in patients with valvular disease and so as to draw up suitable operation programs for them.

Frequency domain cardiography and radionuclide ventriculography for evaluation of left ventricular function in coronary artery disease

Fifty-six patients with chest pain underwent selective coronaryangiography,radionuclide ventriculography (RNV) and frequency domaincardiography (FCG) to evaluate left ventricular function in coronary artery dis-ease (CAD).The sensitivity,specificity and accuracy of FCG were 87.5%,77.8%and 82.9%,respectively,which were slightly less than those of RNV (92.5%,88.9% and 90.8%,respectively).The changes of FCG scores were negatively corre-lated with changes of LVEF (r=-0.586,P【0.01),and TS (r=-0.679,P【0.01).These results indicate that FCG may be useful for the evaluation of leftventricular function in patients with CAD.

Diagnostic Accuracy of Strain Imaging of the Left Ventricle in Detection of Obstructive Coronary Artery Disease

Background: Speckle tracking echocardiography using average global strain and strain rate (SR) parameters for early detection of high risk patients with coronary artery disease (CAD) has gained a substantial clinical interest. Objective: Assessment of the diagnostic accuracy of strain imaging of the left ventricle in detection of obstructive coronary artery disease. Methods: One hundred patients were enrolled. They were divided into 3 groups: Group I (n = 40 patients) presented with ST segment elevation myocardial infarction (STEMI), Group II (n = 40 patients) presented with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and Group III (n = 20 patients) with normal coronary angiography served as a control group. All patients were subjected to 2D speckle tracking echocardiography (2D STE) to assess LV longitudinal strain and strain rate (SR). Sensitivity, specificity and diagnostic accuracy of 2D STE in prediction of CAD and its severity using Gensini score were assessed. Results: The mean age for Group I, II and III was 52.20 ± 11.83, 51.97 ± 14.53 and 52.75 ± 10.75 respectively. LV average global systolic strain (AGS) was significantly lower in group I and II when compared to group III. AGS and average global systolic SR showed significant direct correlation with Gensini score. The diagnostic accuracy of 2D STE in prediction of significant LAD stenosis was 92.5%, and it was 89.5% in prediction of 3 vessels CAD. Conclusion: Strain imaging using 2D STE can predict the territory and severity of CAD with high diagnostic accuracy and can be used as a simple noninvasive diagnostic tool to identify high risk CAD patients.

Quantification of Regional Left Ventricular Systolic Dysfunction in Patients With Coronary Artery Disease by Strain Rate Imaging

Objectives To detect and compare the systolic strain rate (SR) and strain in the infarct and ischemic myocardium by strain rate imaging (SRI), in order to explore the clinical value of SRI in evaluating regional left ventricular systolic dysfunction. Methods Patients with coronary artery disease were divided into angina pectoris (11 cases) and myocardial infarction (21 cases) groups. Twenty age-matched normal subjects served as the control group. Septal, lateral, anterior, inferior, anteroseptal and posterior walls of the left ventricle were respectively scanned using color tissue Doppler imaging (TDI). Then SR and strain curves were derived from TDI for basal, middle and apical segments of each wall. SRI parameters were: Systolic SR (SRsys), systolic strain (εsys) and maximum strain (εmax). Results Compared with normal segments, SRsys, εsys and εmax decreased significantly in the infarct and ischemic segments (P<0.01). Compared with ischemic segments, SRsys, εsys and εmax decreased significantly in the infarct segments (P<0.05). Conclusions SRsys, εsys and εmax measured by SRI can be used to quantitatively analyze regional left ventricular systolic dysfunction in patients with coronary artery disease, and aid in differentiating infarct from ischemic myocardium.

Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease

Coronary artery abnormalities are the most important complications in children with Kawasaki disease(KD).Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD.However,it has inherent limitations with regard to evaluation of mid and distal coronary arteries and,left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group.Catheter angiography(CA)is invasive,has high radiation exposure and fails to demonstrate abnormalities beyond lumen.The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems.In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children.Computed tomography coronary angiography(CTCA)can be performed during acute as well as convalescent phases of KD.It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.

Novel Imaging Approaches for the Diagnosis of Stable Ischemic Heart Disease in Women

Conventional recommendations for diagnostic testing for the evaluation of stable ischemic heart disease in women have largely paralleled those in men.Although they are designed primarily for the identifi cation of obstructive coronary artery disease(CAD),traditional approaches can lead to overtesting in women without differentiating who is truly at risk.Several unique factors related to the presentation,diagnosis,and underlying pathophysiology of stable ischemic heart disease in women necessitate a more specific approach to the assessment of their risk,complete with separate guidelines when appropriate.This overview highlights how advanced noninvasive imaging tools,including cardiac computed tomography angiography,positron emission tomography,and cardiac magnetic resonance imaging,are enabling very sensitive assessments of anatomic atherosclerotic plaque burden,macrovessel-and microvessel-related ischemia,and myocardial fi brosis,respectively.Moving forward,effective diagnostic testing will need to identify women at high risk of adverse cardiovascular events(not anatomically obstructive CAD per se)without overtesting those at low risk.Judicious application of novel imaging approaches will be critical to broadening the defi nitions of CAD and ischemia to better refl ect the whole spectrum of pathological phenotypes in women,including nonobstructive CAD and coronary microvascular dysfunction,and aid in the development of needed evidence-based strategies for their management.

“How many times must a man look up before he can really see the sky?” Rheumatic cardiovascular disease in the era of multimodality imaging

Cardiovascular involvement in rheumatic diseases(RD) is the result of various pathophysiologic mechanisms including inflammation, accelerated atherosclerosis, myocardial ischemia, due to micro- or macro-vascular lesions and fibrosis. Noninvasive cardiovascular imaging, including echocardiography, nuclear techniques, cardiovascular computed tomography and cardiovascular magnetic resonance, represents the main diagnostic tool for early, non-invasive diagnosis of heart disease in RD. However, in the era of multimodality imaging and financial crisis there is an imperative need for rational use of imaging techniques in order to obtain the maximum benefit at the lowest possible cost for the health insurance system. The oligo-asymptomatic cardiovascular presentation and the high cardiovascular mortality of RD necessitate a reliable and reproducible diagnostic approach to catch early cardiovascular involvement. Echocardiography remains the routine cornerstone of cardiovascular evaluation. However, a normal echocardiogram can not always exclude cardiac involvement and/or identify heart disease acuity and pathophysiology. Therefore, cardiovascular magnetic resonance is a necessary adjunct complementary to echocardiography, especially in new onset heart failure and when there are conflicting data from clinical, electrocardiographic and echocardiographic evaluation of RD patients.

Coronary atherosclerosis is already ongoing in pre-diabetic status: Insight from intravascular imaging modalities

Diabetes mellitus is a powerful risk factor of coronary artery disease(CAD), leading to death and disability. In recent years, given the accumulating evidence that prediabetes is also related to increasing risk of CAD including cardiovascular events, a new guideline has been proposed for the treatment of blood cholesterolfor primary prevention of cardiovascular events. This guideline recommends aggressive lipid-lowering statin therapy for primary prevention in diabetes and other patients. The ultimate goal of patient management is to inhibit progression of systemic atherosclerosis and prevent fatal cardiovascular events such as acute coronary syndrome(ACS). Because disruption of atherosclerotic coronary plaques is a trigger of ACS, the high-risk atheroma is called a vulnerable plaque. Several types of novel diagnostic imaging technologies have been developed for identifying the characteristics of coronary atherosclerosis before the onset of ACS, especially vulnerable plaques. According to coronary angioscopic evaluation, atherosclerosis severity and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable to that in diabetic patients. In addition, pharmacological intervention by statin therapy changed plaque color and complexity, and the dynamic changes in plaque features are considered plaque stabilization. In this article, we review the findings of atherosclerosis in prediabetes, detected by intravascular imaging modalities, and the therapeutic implications.

Comprehensive assessment of a post-coronary bypass graft patient with cardiovascular magnetic resonance imaging and multi-detector computed tomography

Coronary bypass graft surgery (CABG) is a revascularization procedure which reduces myocardial ischemia and cardiovascular morbidity and mortality in selected patients;however, up to 40% of saphanous vein grafts may degenerate over 10 years. Although coronary angiography is the gold standard to detect graft patency and native vessel disease, sometimes it is difficult to locate the grafts resulting in increased exposure to radiation and contrast administration. This case highlights the utility of cardiac computerized tomography and magnetic resonance imaging to provide comprehensive noninvasive assessment in a patient post CABG.(J Geriatr Cardiol 2007;4:244-247.)

Evaluation of Left Ventricular Diastolic Function in Patients with Coronary Artery Disease by Cineangiocardiography

Left ventricular diastolic function in 49 subjccts were studiedcineangiographically and compared with relevant indexes of radionuclide angiography(RNA).Normalizcd peak filling rate(NPFR),1/3 filling fraction(FF1/3),lcftventricular compliance in 23 patients with coronary artery disease(CAD)weresignificantly lower than that in normal control group(n=14),and the time to peak fil-ling rate(TPFR)was longer in CAD patients,Hypertension group(n=12)had someslight changes in left ventricular diastolic function.However,50%(6/12)of paticnts inCAD group with normal EF(EF】0.65)had a diminished NPFR also.FF 1/3 ofcineangiography had a good correlation with that of RNA.The results indicated thatdiastolic filling function estimated cinceangiographically might reflcet earlier and more sensi-tive changes than left ventricular systolic function in patients with CAD.FF 1/3 mea-sured by RNA might also be a useful noninvasive index in evaluating diastolic filling fune-tion.

Quantitative Analysis of the Tomographic Technetium-99m MIBI (^(99m)Tc-MIBI) Myocardial Bullseye Display: Application to Diagnosis of Coronary Artery Disease

In this study, the 99mTc-MIBI myocardial bullseye display of 31 healthy persons and 34 patients with myocardial ischemia and 17 patients with myocardial infarction were analyzed quantitatively, and compared with the results of myocardial tomography analysis and qualitative bullseye analysis. The sensitivities of the three methods were 88.2%, 91.2 % and 94.1 % respectively (P>0.05),and the specificities were 93. 5%, 83, 9% and 83. 9% respectively (P<0.05).On the other hand, the quantitative analysis obviously outperformed the other two methods in the detection of ischemic segments of myocardium near infarction zone (P<0. 01). The quantitative analysis of 99mTc-MIBI myocardial bullseye (quantitative bullseye) was an objective, specific and sensitive method for diagnosis of coronary artery disease.

Monitoring the Sequelae of Coronary Microembolization on Myocardium Using Noninvasive Imaging (Review)

Acute myocardial infarction (AMI) is a leading cause of death worldwide. It has been clinically classified into 1) ischemic from a primary coronary event (e.g., plaque rupture or thrombotic occlusion), 2) ischemic from a supply-and-demand mismatch and c) ischemic from a percutaneous coronary interventions (PCI). Catheter-based PCI has been frequently used as an alternative to conventional bypass surgery for patients at high risk. However, this method of treatment is associated with microvascular obstruction (MVO) by dislodged microemboli that results in left ventricular (LV) dysfunction/remodeling, perfusion deficits, microinfarction and arrhythmia. The contributions of microemboli after revascularization of AMI have been acknowledged by major cardiac and interventional societies. Recent studies showed that Emboli Detection and Classification (EDAC) Quantifier offers increased sensitivity and capability for detecting dislodged coronary microemboli during PCI. Coronary microembolization can be detected directly by monitoring intra-myocardial contrast opacification on contrast echocardiography, increasing F-18 fluorodeoxyglucose (FDG) uptake on positron emission tomography, loss/diminution of signal on first pass perfusion and hypoenhanced zone on contrast enhanced magnetic resonance imaging (MRI) and multidetector computed tomography (MDCT) and indirectly by ST-segment elevation on electro-cardiography (ECG). The relations between volumes/sizes of microemboli, visibility of microinfarct, myocardial perfusion and LV function are still under intensive discussions. Non-invasive imaging can play important role in assessing these parameters. This review shed the light on the techniques used for detecting coronary microemboli, microvascular obstruction and microinfarct and the short- and long-term effects of microemboli on LV function, structure and perfusion.

Value of Pulsed Tissue Doppler Imaging in Predicting the Presence of Significant Coronary Artery Insufficiency

Background: Coronary artery disease (CAD) is a paramount cause of death. Global and regional left ventricular (LV) systolic function is an important non-invasive marker of CAD. We can use tissue Doppler imaging (TDI) to measure the low velocities generated by myocardium which are: S'-wave, E'-wave, and A'-wave. We aimed to examine the value of the S'-wave dispersion of TDI across mitral valve annular velocities to predict angiographically significant coronary artery obstruction. Patients and Methods: We included 100 patients with symptoms suggesting CAD. All patients had undergone full history taken and clinical examination;ECG, echocardiographic with assessment of LV function, and Doppler derived mitral valve velocities;TDI with measuring of S'-wave and coronary angiography. Lesions with ≥70% or more stenosis in major epicardial artery or ≥50% stenosis in the left main coronary artery were considered significant. Patients were classified into two groups according to the presence or absence of significant coronary stenosis. Results: Clinical and conventional echocardiographic and Tissue Doppler measures were comparable between the two groups;there was statisticallysignificant difference between Group I and Group II (P value;patients with significant coronary arteries lesions have higher S' wave dispersion as compared with patients with normal or mild significant coronary lesions. Conclusion: S'-wave dispersion may consider a good predictor of angiographically significant coronary artery disease.

INTRAVASCULAR ULTRASOUND EVALUATING CORONARY STENTS FOR PATIENTS WITH CORONARY ARTERY DISEASE：COMPARED OLD WITH NEW MULTILINK STENTS

Objective.It was suggested that coronary stent design and coating may affect stent performance and hence induce varying degrees of thrombogenesis and neointimal hyperplasia.T he purpose of this study is to compare the6-month follow-up results between o ld and new Multilink stents with the method of intravascular ultrasound(IVUS)imaging.Methods.We have performed old(n =40)and new(n =35)Multilink stent implantations on 75patients with coronary artery disease.Coron ary angiography was performed before,immediately after,and 6months after the in-stent procedure respectively.Six-month follow-up IVUS imaging was performed and analyzed off-line.Results.Minimal lumen cross sectional area(CSA)of new Multilink stents was signific antly larger than that of old Multilink stents(P=0.0053).Mean stent lumen area of new Multili nk stents was significantly larger than that of old Multilink stents(P=0.040).Similarly,minimal lumen diameter(MLD)of new Multilink stents was larger than that of old Mul tilink stents(P=0.011).Old Multilink stents had a higher percentage of plaque area than new Multilink stent s.Conclusion.The new Multilink stent is obviously superior to old Multilink stents,in particular,in the stent MLD and lumen CSA---major determinants of the restenosis.

Accuracy of myocardial viability imaging by cardiac MRI and PET depending on left ventricular function

AIM To compare myocardial viability assessment accuracy of cardiac magnetic resonance imaging(CMR)compared to[^(18)F]-fluorodeoxyglucose(FDG)-positron emission tomography(PET)depending on left ventricular(LV)function.METHODS One-hundred-five patients with known obstructive coronary artery disease(CAD)and anticipated coronary revascularization were included in the study and examined by CMR on a 1.5T scanner.The CMR protocol consisted of cine-sequences for function analysis and late gadolinium enhancement(LGE)imaging for viability assessment in 8 mm long and contiguous short axis slices.All patients underwent PET using[^(18)F]-FDG.Myocardial scars were rated in both CMR and PET on a segmental basis by a 4-point-scale:Score 1=no LGE,normal FDG-uptake;score 2=LGE enhancement<50% of wall thickness,reduced FDG-uptake(≥50% of maximum);score 3=LGE≥50% ,reduced FDG-uptake(<50% of maximum);score 4=transmural LGE,no FDG-uptake.Segments with score 1 and 2 were categorized"viable",scores 3 and 4 were categorized as"non-viable".Patients were divided into three groups based on LV function as determined by CMR:Ejection fraction(EF),<30% :n=45;EF:30% -50% :n=44;EF>50% :n=16).On a segmental basis,the accuracy of CMR in detecting myocardial scar was compared to PET in the total collective and in the three different patient groups.RESULTS CMR and PET data of all 105 patients were sufficient for evaluation and 5508 segments were compared in total.In all patients,CMR detected significantly more scars(score 2-4)than PET:45% vs 40% of all segments(P<0.0001).In the different LV function groups,CMR found more scar segments than PET in subjects with EF<30% (55% vs 46% ;P<0.0001)and EF 30% -50% (44% vs 40% ;P<0.005).However,CMR revealed less scars than PET in patients with EF>50% (15% vs 23% ;P<0.0001).In terms of functional improvement estimation,i.e.,expected improvement after revascularization,CMR identified"viable"segments(score 1 and 2)in 72% of segments across all groups,PET in 80% (P<0.0001).Also in all LV function subgroups,CMR judged less segments viable than PET:EF<30% ,66% vs 75% ;EF=30% -50% ,72% vs 80% ;EF>50% ,91% vs 94% .CONCLUSION CMR and PET reveal different diagnostic accuracy in myocardial viability assessment depending on LV function state.CMR,in general,is less optimistic in functional recovery prediction.

Myocardial perfusion imaging and infarct characterization using multidetector cardiac computed tomography

Until recently, computed tomography coronary angiography was restricted to the anatomical assessment of coronary stenosis, whereas the functional significance of coronary lesions remained outside of its scope. Nevertheless, the kinetics of iodinated contrast is similar to gadolinium-diethylenetriamine pentaacetic acid used in contrast-enhanced magnetic resonance imaging, allowing assessment of myocardial perfusion and viability by cardiac computed tomography.

Diagnosis and management of ischemic cardiomyopathy: Role of cardiovascular magnetic resonance imaging

Coronary artery disease(CAD) represents an important cause of mortality. Cardiovascular magnetic resonance(CMR) imaging evolved as an imaging modality that allows the assessment of myocardial function, perfusion, contractile reserve and extent of fibrosis in a single comprehensive exam. This review highlights the role of CMR in the differential diagnosis of acute chest pain by detecting the location of obstructive CAD or necrosis and identifying other conditions like stress cardiomyopathy or myocarditis that can present with acute chest pain. Besides, it underlines the prognostic implication of perfusion abnormalities in the setting of acute chest pain. Furthermore, the review addresses the role of CMR to detect significant CAD in patients with stable CAD. It elucidates the accuracy and clinical utility of CMR with respect to other imaging modalitieslike single-photon emission computed tomography and positron emission tomography. Besides, the prognostic value of CMR stress testing is discussed. Additionally, it summarizes the available CMR techniques to assess myocardial viability and describes algorithm to identify those patient who might profit from revascularization those who should be treated medically. Finally, future promising imaging techniques that will provide further insights into the fundamental disease processes in ischemic cardiomyopathy are discussed.

Screening for cardiovascular disease before kidney transplantation

Pre-kidney transplant cardiac screening has garnered particular attention from guideline committees as an approach to improving post-transplant success. Screening serves two major purposes: To more accurately inform transplant candidates of their risk for a cardiac event before and after the transplant, thereby informing decisions about proceeding with transplantation, and to guide pre-transplant management so that posttransplant success can be maximized. Transplant candidates on dialysis are more likely to be screened for coronary artery disease than those not being considered for transplantation. Thorough history and physical examination taking, resting electrocardiography and echocardiography, exercise stress testing, myocardial perfusion scintigraphy, dobutamine stress echocardiography, cardiac computed tomography, cardiac biomarker measurement, and cardiac magnetic resonance imaging all play contributory roles towards screening for cardiovascular disease before kidney transplantation. In this review, the importance of each of these screening procedures for both coronary artery disease and other forms of cardiac disease are discussed.