Performances diagnostiques des tomoscintigraphies myocardiques de stress,réalisées avec une caméra à semi-conducteurs et un protocole très faible dose

IntroductionThis retrospective study aimed to assess the performances in the detection of coronary artery disease patients of the stress myocardial perfusion imaging (MPI) performed with a semiconductor camera, a very low dose stress-rest protocol and short recording times.Material and methodsWe analyzed consecutive MPI exams, which has been routinely planed with the “D-SPECT” semiconductor camera, a 1-day stress-rest protocol, very low doses of Sestamibi-^99mTc (120 MBq at stress and 360 MBq at rest for a 75 kg body weight patient) and short acquisition-times targeting the recording of 500 myocardial kcounts (on average, 8 min for stress and 3 min for rest). The ability to detect coronary artery stenosis (> 50% diameter reduction) was assessed in a group of 118 patients, who had coronary angiography at ≤ 3 months from MPI, and normalcy rate was assessed in a group of 74 patients showing a low pretest probability of coronary artery disease (< 10%).ResultsSensitivity, positive predictive value and global accuracy for identifying the 81 patients with ≥ 1 coronary artery stenosis were 85%, 83% and 78%, respectively; and normalcy rate was 96%. Mean effective doses were: (1) 4.9 ± 1.4 mSv in the group with coronary angiography and where most exams (90%) comprised both stress and rest MPI; and (2) 1.9 ± 1.5 mSv in the low probability group and where most exams (70%) comprised only stress MPI.ConclusionWhen performed with a sensitive semiconductor camera and a very low dose stress-rest protocol, MPI provides high diagnostic performances, equivalent to those documented with conventional cameras in the same study setting, but with dramatic reduction of patients’ radiation.     

Synthesis and characterization of 123I-CMICE-013: A potential SPECT myocardial perfusion imaging agent

Coronary artery disease (CAD) is a major cause of death in Canada and the United States. Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a useful diagnostic test in the management of patients with CAD. The widely used SPECT MPI agents, ^99mTc sestamibi and ^99mTc tetrofosmin, exhibit less than ideal pharmacokinetic properties with decreasing uptake with higher flows. ¹²³I has a similar energy as ^99mTc, an ideal half life, and is readily available from cyclotrons. The objective of this study was to develop an ¹²³I labeled MPI agent based on rotenone, a mitochondrial complex I inhibitor, as an alternative to currently available SPECT MPI agents. Methods: ¹²³I-CMICE-013 was synthesized by radiolabeling rotenone with ¹²³I in trifluoroacetic acid (TFA) with iodogen as the oxidizing agent at 60 °C for 45 min, followed by RP-HPLC purification. The product was formulated in 5% EtOH in 10 mM NaOAc pH 6.5. The inactive analog ¹²⁷I-CMICE-013 was isolated and characterized by NMR and mass spectrometry, and the structure determined. Micro-SPECT imaging studies were carried out in normal and infarcted rats. Biodistribution studies were performed in normal rats at 2 h (n = 6) and 24 h (n = 8) post injection (p.i.). Results: ¹²³I-CMICE-013 was isolated with >95% radiochemical purity and high specific activity (14.8–111 GBq/μmol; 400–3000 mCi/μmol). Structural analysis showed that rotenone was iodinated at 7′-position, with removal of the 6′,7′-double bond, and addition of a hydroxy group at 6′-position. MicroSPECT images in normal rats demonstrated homogeneous and sustained myocardial uptake with minimal interference from lung and liver. Absent myocardial perfusion was clearly identified in rats with permanent left coronary artery ligation and ischemia-reperfusion injury. In vivo biodistribution studies in normal rats at 2 h p.i. showed significant myocardial uptake (2.01 ± 0.48%ID/g) and high heart to liver (2.98 ± 0.93), heart to lung (4.11 ± 1.04) and heart to blood (8.37 ± 3.97) ratios. At 24 h p.i., the majority of ¹²³I-CMICE-013 was cleared from tissues, and a significant amount of tracer was found in the thyroid, indicating in vivo deiodination of the tracer. Conclusion: ¹²³I-CMICE-013 is a promising new radiotracer for SPECT MPI with high myocardial uptake, very good target to background ratios and favorable biodistribution characteristics.     

Ischémie myocardique du diabétique : apports de la scintigraphie myocardique de perfusion

Diabetes is an important risk factor of myocardial ischemia. Myocardial perfusion imaging (MPI) is used for diagnostic, prognostic assessment and for post-therapeutic follow-up of coronary artery disease (CAD). Its usefulness has been documented extensively in the general population. However, in diabetic population, little studies have been published. CAD is more severe and more frequent among diabetic patients. The goal of this work was to assess usefulness of MPI among diabetic patients. This work includes 44 diabetic patients (22 women, 22 men), investigated by stress MPI in nuclear medicine department of Ibn Rochd UH of Casablanca. The studied parameters concerned: age, antecedents of CAD, risk factors of CAD associated to diabetes, duration of the diabetes, diabetes complications, diabetes treatment, indication of MPI, presence or not of anomaly on the ECG performed at rest, existence or not of typical or atypical clinical signs of CAD, investigations and therapy prescribed as well as the occurrence or not of cardiac event during monitoring after MPI. Results of MPI have been compared to clinical, therapeutic and monitoring data of patients. Mean age of patients was 55 years (39 to 75 years), mean diabetes duration was 8.6 years (1 to 30 years), at least one diabetes complication has been noted in 18 patients. The most frequent complication was diabetic retinopathy. MPI has been achieved for diagnosis of ischemia in 37 patients and assessment of anti-ischemic treatment in 7 cases. Treadmill exercise has been achieved in 34 cases and a pharmacological stress in 10 others. During follow-up, which was between 1 and 36 months (mean: 14.9 months), 6 cardiac events occurred among the 44 patients. Patients with abnormal findings at stress MPI had two cardiovascular risk factors or more associated to diabetes (91.3% vs. 9.5% among patients having normal findings, P < 0.001) and had diabetic retinopathy more often (56.5% vs. 9.5% among patients with normal findings, P < 0.001). Cardiac events were more frequent among men (100% vs. 43.2% of patients who did not have a coronary event, P < 0.01). Patients with stress MPI showing ischemia in 3/17 segments or more have presented a cardiac event more often during the follow-up (4/12 Vs 2/32 among patients with normal MPI or defect in less than 3/17 segments, P < 0.01). In this series, coronary artery disease was found more frequently among patients having more than 2 cardiovascular risk factors. In addition, risk of cardiac event seems related to extent of uptake decrease.     

Analyse comparative de 3 logiciels de reconstruction itérative de tomoscintigraphie monophotonique myocardique

ObjectiveThis study makes a comparative analysis of the quality reconstruction of three software: 2D ordered subset expectation maximisation (2D OSEM), 3D ordered subsets expectation maximisation (Flash 3D) and Wallis.Patients and methodsThe data from myocardial scintigraphy acquisitions of 50 patients (38 men and 12 women; average age 61 ± 9 years) were successively reconstructed using three myocardial perfusion SPECT algorithms (Flash 3D, OSEM 2D and Wallis). Different combinations of iterations and subsets were considered. For Wallis, only the cut-off frequency was considered. The image's quality was assessed by determining the maximum contrast and the signal to noise ratio.ResultsThe Wallis software provided a higher signal to noise ratio compared to Flash 3D and OSEM 2D at stress and rest. The Wallis signal to noise ratio increased by a factor 1.93 (P = 0.0010) and 2.28 at stress (P = 0.0009); 1.50 (P = 0.0011) and 2.84 at rest (P = 0.0024) compared to respectively Flash 3D and OSEM 2D. Flash 3D provided better signal to noise ratio than OSEM 2D at stress and at rest. The difference in medians and interquartile ranges of the signal-to-noise ratio in post-stress were 22 % and 54 %, respectively between Flash 3D and OSEM 2D. At rest, the difference between the two methods in signal to noise ratio was 32 % ± 0.,29.ConclusionWallis algorithm was improve image quality with better signal to noise ratio compared to the reference method of Siemens Flash 3D. For both Flash 3D and OSEM 2D methods, the combination with 8 subsets and 12 iterations provided the best contrast and signal to noise ratio.     

Impact d’une réduction d’activité sur la mesure de la fraction d’éjection du ventricule gauche sur caméra D-SPECT

IntroductionRadionuclide ventriculography provides a reproducible measurement of the left ventricular fraction ejection (LVEF) but with a significant body radiation (effective dose of 5,9 mSv for the injection of 850 Mbq of ^99mTc). The highly sensitive semi-conductor (CZT) cameras could allow decreasing the injected activity by a factor 3, similarly to that of myocardial perfusion imaging. Our study was aimed to determine whether the LVEF measurement provided by radionuclide ventriculography on the CZT D-SPECT camera is impacted by a 70% reduction in recorded counts.Materials and methodsAfter the in vivo labeling of red blood cells with 850 MBq of ^99mTc, 49 patients completed a conventional 2D recording (Conv-2D) on Anger camera followed by a 3D recording on the D-SPECT camera (3D-100%). The CZT recordings of all projections were subsequently shortened to 30% of their initial durations (3D-30%) in order to assess the LVEF measured with a 70% reduction in recorded counts.ResultsMean LVEF values were 62.7 ± 11.1% on Conv-2D and higher on both 3D-100% (66.8 ± 14.8%, P < 0.001) and 3D-30% (66.3 ± 15.7%, P < 0.001). The correlation coefficients with the LVEF determined with the reference Conv-2D method were equivalents for 3D-100% (r² = 0.73) and 3D-30% (r² = 0.70) and with a similar level of overestimation for the highest LEVF values.ConclusionA 70% reduction in recorded counts does not significantly impact the LVEF measured with radionuclide ventriculography on the CZT D-SPECT camera. These values are coherent with those obtained with the reference 2D method but with a clear overestimation for the highest LVEF values.     

Increased plasma levels of osteopontin are associated with activation of the renin–aldosterone system and with myocardial and coronary microvascular damage in dilated cardiomyopathy

In patients with dilated cardiomyopathy (DCM) abnormal myocardial blood flow (MBF) has been associated with coronary microvascular dysfunction. The aim of this study was to test the hypothesis that osteopontin (OPN) plasma levels could be associated with the activation of the renin–aldosterone system (RAS) in these patients and be involved in mediating myocardial and coronary damage. In 66 patients with idiopathic left ventricular dysfunction of variable severity the plasma levels of OPN were correlated with biomarkers of systemic metabolism, RAS activation, myocardial dysfunction and with clinical indexes of left ventricle (LV) function and perfusion obtained by 2D-echocardiography and PET. As compared to controls, patients showed a significant increase of inflammatory markers (OPN: 508 ± 30.8 ng/ml vs. 426.9 ± 16.4, p < 0.05 and interleukin (IL)-6: 1.71 ± 0.29 pg/ml vs. 0.38 ± 0.03 pg/ml, p < 0.001) and of indexes of cardiac damage. OPN levels were significantly correlated with the extent of microvascular dysfunction (MBF at rest: p = 0.01; during dipyridamole: p = 0.0003) and with plasma renin activity (PRA) (r = 0.26, p = 0.04). Both in patients with milder or more severe LV dysfunction lower MBF values were associated with higher OPN levels and PRA. These results suggest a interdependent role of RAS and vascular inflammation in cardiomyopathy.     

Magnetic particle imaging for artifact-free imaging of intracranial flow diverter stents: A phantom study

PurposeMagnetic Particle Imaging (MPI) is a new, background- and radiation-free tomographic imaging method that enables near real-time imaging of superparamagnetic iron-oxide nanoparticles (SPIONs) with high temporal and spatial resolution. This phantom study aims to investigate the potential of MPI for visualization of the stent lumen in intracranial flow diverters (FD).MethodsNitinol FD of different dimensions (outer diameter: 3.5 mm, 4.0 mm, 5.5 mm; total length: 22–40 mm) were scanned in vascular phantoms in a custom-built MPI scanner (in-plane resolution: ~ 2 mm, field of view: 65 mm length, 29 mm diameter). Phantoms were filled with diluted (1:50) SPION tracer agent Ferucarbotran (10 µmol (Fe)/ml; NaCL). Each phantom was measured in 32 different projections (overall acquisition time per image: 3200 ms, 5 averages). After image reconstruction from raw data, two radiologists assessed image quality using a 5-point Likert scale. The signal intensity profile was measured using a semi-automatic evaluation tool.ResultsMPI visualized the lumen of all FD without relevant differences between the stented vessel phantom and the reference phantom. At 3.5 mm image quality was slightly inferior to the larger diameters. The FD themselves neither generated an MPI signal nor did they lead to relevant imaging artifacts. Ratings of both radiologists showed no significant difference, interrater reliability was good (ICC 0.84). A quantitative evaluation of the signal intensity profile did not reveal any significant differences (p > 0.05) either.ConclusionMPI visualizes the lumen of nitinol FD stents in vessel phantoms without relevant stent-induced artifacts.     

Temporal resolution measurement of 128-slice dual source and 320-row area detector computed tomography scanners in helical acquisition mode using the impulse method

PurposeTo analyse the temporal resolution (TR) of modern computed tomography (CT) scanners using the impulse method, and assess the actual maximum TR at respective helical acquisition modes.MethodsTo assess the actual TR of helical acquisition modes of a 128-slice dual source CT (DSCT) scanner and a 320-row area detector CT (ADCT) scanner, we assessed the TRs of various acquisition combinations of a pitch factor (P) and gantry rotation time (R).ResultsThe TR of the helical acquisition modes for the 128-slice DSCT scanner continuously improved with a shorter gantry rotation time and greater pitch factor. However, for the 320-row ADCT scanner, the TR with a pitch factor of <1.0 was almost equal to the gantry rotation time, whereas with pitch factor of >1.0, it was approximately one half of the gantry rotation time. The maximum TR values of single- and dual-source helical acquisition modes for the 128-slice DSCT scanner were 0.138 (R/P = 0.285/1.5) and 0.074 s (R/P = 0.285/3.2), and the maximum TR values of the 64 × 0.5- and 160 × 0.5-mm detector configurations of the helical acquisition modes for the 320-row ADCT scanner were 0.120 (R/P = 0.275/1.375) and 0.195 s (R/P = 0.3/0.6), respectively.ConclusionBecause the TR of a CT scanner is not accurately depicted in the specifications of the individual scanner, appropriate acquisition conditions should be determined based on the actual TR measurement.     

Quantification and monitoring of PET/CT data in multicentre trials: The Swiss SAKK 56/07 trial experience

AimTo outline the importance of continuous monitoring of quantitative positron emission tomography (PET) data in multicentre trials to minimize quantitative bias in longitudinal intra-patient PET studies in light of the multicentre SAKK 56/07 experience in quantification and monitoring ¹⁸F-FDG PET/CT data.Patients and methodsWe collected 64 uniform phantom ¹⁸F-FDG PET acquisitions periodically at the enrolling centres (12 European institutions). A core-laboratory analysed them for standard uptake value (SUV) accuracy (desired 1.00 ± 10%) and acceptable image noise was defined by a coefficient of variation (COV) less than 15%. In total, 151 patients ¹⁸F-FDG PET acquisitions (baseline and follow-up) were also collected and analysed to verify longitudinal coherence of main acquisition/reconstruction parameters (DICOM tags verification) and patient preparation, in particular the uptake time (desired uptake time [UT] = 60 ± 10 min).ResultsUniform phantom PET acquisition satisfied the inclusion criteria in 58/64 (89%) examinations. All PET scanner exhibited comparable SUV quantification, but we found large dispersion in terms of noise, with COV ranging 3–15%. Only 1 phantom PET acquisition was out of range with COV = 21.5%. Patient data exhibited important variation in uptake time with UT = 65 ± 10 min (mean ± SD), with only 111/151 (74%) patients’ examinations satisfying inclusion criteria while 26% were out of range.ConclusionsRegular monitoring of PET data in multicentre trials is capital to ensure longitudinal intra-patient PET data consistence and minimize quantitative bias while it helps to spread the culture of quality in participating centre. Recent EARL (EANM Research Ltd) standardization and unification of procedures is a welcome step in this direction.     

Few-view CT reconstruction via a novel non-local means algorithm

PurposeNon-local means (NLM) based reconstruction method is a promising algorithm for few-view computed tomography (CT) reconstruction, but often suffers from over-smoothed image edges. To address this problem, an adaptive NLM reconstruction method based on rotational invariance (ART-RIANLM) is proposed.MethodsThe method consists of four steps: 1) Initializing parameters; 2) ART reconstruction using raw data; 3) Positivity constraint of the reconstructed image; 4) Image updating by RIANLM filtering. In RIANLM, two kinds of rotational invariance measures which are average gradient (AG) and region homogeneity (RH) are proposed to calculate the distance between two patches and a novel NLM filter is developed to avoid over-smoothed image. Moreover, the parameter h in RIANLM which controls the decay of the weights is adaptive to avoid over-smoothness, while it is constant in NLM during the whole reconstruction process. The proposed method is validated on two digital phantoms and real projection data.ResultsIn our experiments, the searching neighborhood size is set as 15 × 15 and the similarity window is set as 3 × 3. For the simulated case of Shepp-Logan phantom, ART-RIANLM produces higher SNR (36.23 dB > 24.00 dB) and lower MAE (0.0006 < 0.0024) reconstructed images than ART-NLM. The visual inspection demonstrated that the proposed method could suppress artifacts or noises more effectively and recover image edges better. The result of real data case is also consistent with the simulation result.ConclusionsA RIANLM based reconstruction method for few-view CT is presented. Compared to the traditional ART-NLM method, SNR and MAE from ART-RIANLM increases 51% and decreases 75%, respectively.     

Comparaison entre les modes d’acquisition 2D et 3D en TEP au FDG

AimSome positron emission tomography (PET) cameras offer the possibility of choosing between the 2D and 3D acquisition modes. Due to the lack of comparative and objective data in the litterature between the two modes in clinical routine conditions, we have performed a comparative study based on the assessment of qualitative and quantitative parameters.Materials and methodsA series of 33 FDG PET studies has been prospectively selected in the nuclear medicine department. All studies have been performed with a Discovery ST^® camera (GE healthcare) first in the 2D or 3D mode according to the usual criteria of the department. Then a new single step was acquired on a pathological region using the other mode. The same single slice was chosen and analyzed in the two modes (blindly and in random order) by seven nuclear physicians in terms of qualitative and quantitative parameters.ResultsThe 2D mode is significantly better than 3D concerning the overall image quality for patients with a body mass index (BMI) > 27.5 (p = 0.006) and concerning the confidence in lesion reporting for patients with a BMI > 25 (p = 0.01). The mean number of detected lesions is not affected by the acquisition mode but it is significantly correlated with the image quality and the confidence in lesion reporting (p = 0.07 and p = 0.013, respectively).ConclusionWith the Discovery ST PET-CT, the 2D mode gives better results than 3D for overweight and obese patients in terms of image quality and confidence in lesion reporting.     

Clinical examples of 3D dose distribution reconstruction,based on the actual MLC leaves movement,for dynamic treatment techniques

AimTo present practical examples of our new algorithm for reconstruction of 3D dose distribution, based on the actual MLC leaf movement.BackgroundDynaLog and RTplan files were used by DDcon software to prepare a new RTplan file for dose distribution reconstruction.Materials and methodsFour different clinically relevant scenarios were used to assess the feasibility of the proposed new approach: (1) Reconstruction of whole treatment sessions for prostate cancer; (2) Reconstruction of IMRT verification treatment plan; (3) Dose reconstruction in breast cancer; (4) Reconstruction of interrupted arc and complementary plan for an interrupted VMAT treatment session of prostate cancer. The applied reconstruction method was validated by comparing reconstructed and measured fluence maps. For all statistical analysis, the U Mann–Whitney test was used.ResultsIn the first two and the fourth cases, there were no statistically significant differences between the planned and reconstructed dose distribution (p = 0.910, p = 0.975, p = 0.893, respectively). In the third case the differences were statistically significant (p = 0.015). Treatment plan had to be reconstructed.ConclusionDeveloped dose distribution reconstruction algorithm presents a very useful QA tool. It provides means for 3D dose distribution verification in patient volume and allows to evaluate the influence of actual MLC leaf motion on the dose distribution.     

Effects of medially posted insoles on foot and lower limb mechanics across walking and running in overpronating men

Anti-pronation orthoses, like medially posted insoles (MPI), have traditionally been used to treat various of lower limb problems. Yet, we know surprisingly little about their effects on overall foot motion and lower limb mechanics across walking and running, which represent highly different loading conditions. To address this issue, multi-segment foot and lower limb mechanics was examined among 11 overpronating men with normal (NORM) and MPI insoles during walking (self-selected speed 1.70 ± 0.19 m/s vs 1.72 ± 0.20 m/s, respectively) and running (4.04 ± 0.17 m/s vs 4.10 ± 0.13 m/s, respectively). The kinematic results showed that MPI reduced the peak forefoot eversion movement in respect to both hindfoot and tibia across walking and running when compared to NORM (p < 0.05–0.01). No differences were found in hindfoot eversion between conditions. The kinetic results showed no insole effects in walking, but during running MPI shifted center of pressure medially under the foot (p < 0.01) leading to an increase in frontal plane moments at the hip (p < 0.05) and knee (p < 0.05) joints and a reduction at the ankle joint (p < 0.05). These findings indicate that MPI primarily controlled the forefoot motion across walking and running. While kinetic response to MPI was more pronounced in running than walking, kinematic effects were essentially similar across both modes. This suggests that despite higher loads placed upon lower limb during running, there is no need to have a stiffer insoles to achieve similar reduction in the forefoot motion than in walking.     

Optimization of 18F-Choline PET/CT acquisition in prostate cancer: Preliminary results concerning the length of the acquisition

ObjectiveFCH-PET/CT protocol for prostate cancer assessment consists of an early and late acquisition. Concerning the early acquisition, this study compares contrast-to-noise ratio of tumoral lesions between 5 and 10 minutes post-injection in order to shorten the time of this early acquisition.Materials and methodsPatients with proven prostate cancer referred for initial staging or recurrence were prospectively included. Patients underwent 10 minutes of pelvic dynamic acquisition for the early phase and late phase was performed at 60 minutes post-injection. Contrast-to-noise of lesions at 5 and 10 min post-injection were compared.ResultsForty-nine patients with 77 lesions were analyzed. No significant difference of prostatic lesions contrast-to-noise ratio was found between 5 min and 10 min post-injection (median contrast-to-noise ratio was respectively 38 and 42, P = 0.128).ConclusionThese results could have an impact on clinical practice with FCH-PET/CT early acquisition shortened to 5 min post-injection for patients with prostate cancer.     

Évaluation de la cinétique globale et segmentaire du ventricule gauche chez les patients connus ou suspects de cardiopathie ischémique : comparaison des données apportées en scintigraphie de perfusion myocardique et en tomoventriculographie isotopique

Background and aimsThe analysis of the left ventricular contractile function plays a major role in the diagnosis and management of patients with cardiopathies. The aim of our study was to compare gated blood pool SPECT and myocardial perfusion scintigraphy for the assessment of the left ventricular wall contractility at the global and the segmental scales.Material and methodsThe data of 23 ^99mTc-Tetrofosmin perfusion scintigraphies, and 50 ²⁰¹Thallium perfusion scintigraphies were compared to those of gated blood pool SPECT performed at close interval.ResultsThe correlations were good (r = 0.81 to 0.94) concerning the global parameters (left ventricular ejection fraction, end-diastolic and end-systolic volumes) in the two groups. Quite good correlations were also found at the segmental scale (r = 0.49 to 0.62), between the segmental ejection fraction calculated in gated blood pool SPECT and the wall thickening or the wall motion estimated in perfusion scintigraphy. These correlations were significantly lower in the “²⁰¹Thallium perfusion scintigraphy” group than in the “^99mTc-Tetrofosmin perfusion scintigraphy” group, especially for hypokinetic segments.ConclusionAlthough they use very different approaches, GBPS and MPS give data about global and segmental left ventricular wall contraction that are well correlated, but not strictly interchangeable.     

The therapeutic responses to I-131 ablation in patients of differentiated thyroid carcinoma complicated with nodular goiter

IntroductionWe applied the response to therapy reclassification system (RTRS) to evaluate the disease status after surgery and I-131 therapy in differentiated thyroid carcinoma (DTC) patients with nodular goiter (NG).Materials and methodsA total of 268 DTC complicated with NG patients who underwent the I-131 treatment and thyroidectomy between 2010 and 2018 were analyzed. The RTRS were classified into excellent (ER), indeterminate (IDR), biochemical incomplete (BIR) and structural incomplete response (SIR). Logistic regression analysis were performed to evaluate the relevant clinicopathologic and laboratory variables in the prediction of non-ER (IDR, BIR and SIR).ResultsIn the logistic analysis, gender (OR: 3.543, P = 0.01), lateral cervical lymph node metastases (N1b) (OR: 6.646, P = 0.005), pre-ablation stimulated thyroglobulin (Ps-Tg) (OR: 0.859, P = 0.000), and anti-Tg antibody (TgAb) (OR: 64.546, P = 0.000) were predictor of non-ER. The cut-off value of ps-Tg for predicting the ER was 19.98 ng/mL with a sensitivity of 92.6% and specificity of 83.2%. The non-ER rate of N1b group was significantly higher than the central cervical LNM (N1a) group.ConclusionFor patients with DTC complicated with NG, the cut-off value of ps-Tg for predicting the ER was 19.98 ng/mL. N1b patients showed inferior responses to I-131 therapy compared to N1a patients.     

Near real-time magnetic particle imaging for visual assessment of vascular stenosis in a phantom model

PurposeThis study aimed to investigate the potential of magnetic particle imaging (MPI) to quantify artificial stenoses in vessel phantoms in near real-time.MethodsCustom-made stenosis phantoms with different degrees of stenosis (0%, 25%, 50%, 75%, and 100%; length 40 mm, inner diameter 8 mm, Polyoxymethylene) were filled with diluted Ferucarbotran (superparamagnetic iron-oxide nanoparticle (SPION) tracer agent, 500 mmol (Fe)/l). A traveling wave MPI scanner (spatial resolution ~ 2 mm, gradient strength ~ 1.5 T/m, field of view: 65 mm length and 29 mm diameter, frequencies f₁ = 1050 Hz and f₂ = 12150 Hz) was used to acquire images of the phantoms (200 ms total acquisition time per image, 10 averages). Standardized grey scaling was used for comparability. All measured stenoses (n = 80) were graded manually using a dedicated software tool.ResultsMPI allowed for accurate visualization of stenoses at a frame rate of 5 frames per second. Less severe stenoses were detected more precisely than higher-grade stenoses and came with smaller standard deviations. In particular, the 0%, 25%, 50%, 75%, and 100% stenosis phantom were measured as 3.7 ± 2.7% (mean ± standard deviation), 18.6 ± 1.8%, 52.8 ± 3.7%, 77.8 ± 14.8% and 100 ± 0%. Geometrical distortions occurred around the center of the high-grade stenosis and led to higher standard deviations compared to lower grade stenoses. In the frame of this study the MPI signal depended linearly on the SPION concentration down to 0.05 mmol (Fe)/l.ConclusionNear real-time MPI accurately visualized and quantified different stenosis grades in vascular phantoms.     

The severity of coronary artery disease and reversible ischemia revealed by N-terminal pro-brain natriuretic peptide in patients with unstable angina and preserved left ventricular function

The association between the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the severity of coronary artery disease (CAD) diagnosed by coronary angiography and other approaches has been investigated. The clinical application of NT-proBNP is restricted by the drawbacks of these techniques now available in screening out patients who need intensive or conservative treatment. Fractional flow reserve (FFR) is superior to coronary angiography and other functional indicators. Accordingly, we designed to investigate the association between NT-proBNP and myocardial ischemia from the perspective of anatomy and physiology in patients with unstable angina and preserved left ventricular function. Plasma samples were collected from 110 patients and NT-proBNP levels were measured by radioimmunoassay. The severity of coronary artery stenosis in patients was measured by coronary angiography and FFR. Stenosis ≥50% in the left main artery or stenosis of 70%, and fractional flow reserve (FFR) ≤0.80 in one or more coronary branches with diameter ≥2 mm were defined as “positive”, which require revascularization. NT-proBNP levels increased progressively between patients with negative and positive angiographic results (p < 0.05), and between FFR-negative and FFR-positive patients (p < 0.05). A significant correlation was observed between log NT-proBNP and log GS (GS = Gensini score, p < 0.001). NT-proBNP level serves as a predictor of positive results of angiographic stenosis and FFR, with the area under the receiver operating characteristic curve being 0.697 and 0.787, respectively. NT-proBNP levels are correlated with the severity of anatomic coronary obstruction and inducible myocardial ischemia, but NT-proBNP per se is insufficient to identify clinically significant angiographic and physiological stenoses.     

The Quételet index revisited in children and adults

BackgroundThe body mass index (BMI) is based on the original concept that body weight increases as a function of height squared. As an indicator of obesity the modern BMI assumption postulates that adiposity also increases as a function of height in states of positive energy balance.ObjectiveTo evaluate the BMI concept across different adiposity magnitudes, in both children and adults.MethodsWe studied 975 individuals who underwent anthropometric evaluation: 474 children and 501 adults. Tetrapolar bioimpedance analysis was used to assess body fat and lean mass.ResultsBMI significantly correlated with percentage of body fat (%BF; children: r = 0.893; adults: r = 0.878) and with total fat mass (children: r = 0.967; adults: r = 0.953). In children, body weight, fat mass, %BF and waist circumference progressively increased as a function of height squared. In adults body weight increased as a function of height squared, but %BF actually decreased with increasing height both in men (r = −0.406; p < 0.001) and women (r = −0.413; p < 0.001). Most of the BMI variance in adults was explained by a positive correlation of total lean mass with height squared (r² = 0.709), and by a negative correlation of BMI with total fat mass (r = −0.193).ConclusionsBody weight increases as a function of height squared. However, adiposity progressively increases as a function of height only in children. BMI is not an ideal indicator of obesity in adults since it is significantly influenced by the lean mass, even in obese individuals.     

Évaluation de la sidération myocardique post-effort immédiat par tomoscintigraphie myocardique au 99mTc-sestamibi couplée à l’ECG

AimRepeated episodes of myocardial stunning may lead to chronic ventricular dysfunction. We attempted to assess the parameters related to post-exercise stunning in patients undergoing gated SPECT.MethodsSix hundred patients undergoing a one-day stress/rest ^99mTc-sestamibi gated SPECT were studied. Stress imaging was acquired within 15 minutes after injection. Summed perfusion scores (SSS, SRS and SDS) were calculated using QPS, and LV function assessed using QGS. Stunning was defined as the association of ischemia (SSS ≥ 4 and SDS > 0) and a minimum of 5% decrease in post-stress EF.ResultsIschemia was found in 225 (37.5%) patients. Among these, 67 (30%) showed myocardial stunning. Patients with stunning had a lower rest ESV (47 ± 24 mL vs 65 ± 52 mL, p < 0.0003) and EDV (108 ± 35 mL vs 122 ± 66 mL, p = 0.03), an increased rest LVEF (58 ± 10% vs 52 ± 13%, p < 0.0001) and a decreased post-stress LVEF (49 ± 10% vs 53 ± 13%, p < 0.02) compared to patients with no stunning. The number of myocardial segments showing reversible perfusion defects was increased in patients with stunning (2.7 ± 2.6 vs 1.7 ± 2.1, p < 0.02). On logistic regression, an extent of ischemia greater than two segments and a rest EF greater than 45% were independent predictors of the occurrence of myocardial stunning in patients with ischemia.ConclusionsIn patients with ischemia, exercise-induced stunning was associated with an increased extent of ischemia but also preserved rest ventricular function.