Simultaneous Treadmill Testing Reduces the Unfavorable Side Effects of Adenosine $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85295255"; ?>
This study of 41 patients found that adding treadmill exercise (the 1st two stages of the Bruce protocol) to adenosine stress testing reduced the unfavorable side effects of adenosine while improving image quality (primarily by increasing the heart to liver ratio). [ article ]  posted at 7:13 PM by Tom Heston, MD   

Tc99m-RP517 Potential as an Inflammation Imaging Agent $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85301890"; ?>
Using in-vivo labelling of white blood cells with Tc-RP517, these researchers found that this agent has good potential in imaging inflammation, e.g. the inflammation produced by myocardial occlusion. [ article ]  posted at 11:42 AM by Tom Heston, MD   

Attenuation Correction Improves Accuracy of Gated SPECT Imaging $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85295232"; ?>
This study of 66 patients found that motion, blur, and attenuation correction combined with gated SPECT imaging improved accuracy in terms of correlation with angiographic findings.[ article ]  posted at 7:04 PM by Tom Heston, MD   

Thallium SPECT Combined With Dobutamine Echocardiography Best at Predicting Functional Recovery After Revascularization $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85295206"; ?>
This study of 26 patients with coronary artery disease and congestive heart failure found that combining the data from dobutamine echocardiography and thallium-201 SPECT imaging was better than either study alone at predicting the functional recovery of myocardial segments after revascularization. Comment: thallium SPECT imaging, as expected, was more sensitive than dobutamine echocardiography in predicting which akinetic or dyskinetic myocardial segments would show functional recovery after revascularization. Echocardiography was more specific. A limitation of this study is the fact that PET imaging has shown promising results, and most likely with become the standard. [ article ]  posted at 6:55 PM by Tom Heston, MD   

Radioguided Sentinel Lymph Node Biopsy in Malignant Cutaneous Melanoma $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85269165"; ?>
This is an excellent continuing education article on the use of Tc-99m labeled colloids in guiding sentinel lymph node biopsy in patients with cutaneous melanoma. The success rate in localizing the sentinel lymph node in melanoma patients is approximately 98%, and approaches 99% when combined with the vital blue-dye technique. [ article ]  posted at 10:55 AM by Tom Heston, MD   

PET Significantly Impacts Treatment for Lung Cancer $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85269146"; ?>
This survey of 292 referring physicians of 744 consequtive patients with known or suspected lung cancer found that PET imaging significantly impacted their patients' treatment. The reason for ordering a PET scan was for staging (61%), diagnosis (20%), and monitoring therapy (6%). The PET scan caused physicians to change their decision on clinical stage in 44% of all patients: upstaged in 29% and downstaged in 15%. The authors conclude that PET has a major impact on the staging and management of lung cancer. [ article ]  posted at 10:48 AM by Tom Heston, MD   

Lung Heart Ratio More Accurate Than Transient Ischemic Dilation $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85268251"; ?>
This French study looked at 338 patients undergoing Tl-201 SPECT testing and also angiography within 3 months. It found that a) Tl-SPECT was more accurate than exercise stress testing, b) age, percent heart rate achieved, total perfusion defect, and lung to heart ratio were all independent predictors of extensive CAD on angiography, c) right ventricular uptake did not help predict CAD (as diagnosed by angiography), and d) an increased lung to heart ratio was more strongly associated with extensive disease than transient ischemic dilation . [ article ]  posted at 9:23 PM by Tom Heston, MD   

MRI Scans Show Cooperation Beats Defection (Prisoner's Dilemma) $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85259149"; ?>
We now have biological confirmation that in humans, cooperation beats defection. Using MRI scans, researchers from Emory concluded that the brain's default mode was cooperation. Comment: computer models have also identified that the method of Tit-for-Tat, Cooperation First (benevolent tit-for-tat) lead to growth and stability. This is modeled in biology in for example plant growth. Click Here to read more about the Prisoner's Dilemma. I enjoyed the discussion in the book The Selfish Gene and also in Co-Opetition: 1. a Revolutionary Mindset.... [ Article news ]  posted at 6:27 PM by Tom Heston, MD   

sestamibi sensitivity = 86%, specificity = 80% in detection of breast cancer $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85256228"; ?>
This study of 158 women found the above sens and specificity in detecting malignant cancer in women with palpable breast nodules. For the detection of axillary involvement, the sensitivity was 33.3% and specificity 90%. DMSA-V and MDP agents didn't work as well as mibi. [ article ]  posted at 10:49 PM by Tom Heston, MD   

Respiratory Gating Improves PET Pulmonary Imaging $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85256199"; ?>
Respiratory gating of an FDG pulmonary scan showed an improvement in the maximum standardized uptake value. The total lesion glycolysis (SUVm x Lesion Volume) was similar in the gated versus ungated studies. The study included 5 patients with lung cancer. [ article ]  posted at 10:39 PM by Tom Heston, MD   

Dual Time FDG PET Evaluation of Pulmonary Nodules $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85256185"; ?>
Dual time PET imaging of pulmonary nodules to detect malignancy had a sensitivity of 100% and specificity of 89%. The threshold value was 10% increase between scan 1 and scan 2 in the standardized uptake value. Dose used was 2.5 MBq F(18)DG per kg bodyweight. There were 36 patients studied. [ article ]  posted at 10:34 PM by Tom Heston, MD   

Microperfusion Abnormalities Can Cause Defects Independent of Angiography Findings $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85251919"; ?>
This review concludes that we should not blindly attribute perfusion defects to large vessel abnormalities found on catheterization. Defects can occur independently of large vessel stenosis. Comment: the nuclear myocardial perfusion scan is the gold standard for detecting perfusion abnormalities. The catheterization is for determining if there are any large vessel abnormalities that may be helped by intervention. [ article ]  posted at 5:19 PM by Tom Heston, MD   

Myocardial Perfusion SPECT Left Ventricular Ejection Fraction $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85251712"; ?>
This multi-centered study looked at differences in the calculated left ventricular ejection fraction in myocardial SPECT scanning. The two most popular algorithms were analyzed: the QGS system from Cedars-Sinai, and the ECTb from Emory University. The QGS method gave an LVEF of approximately 5% below the LVEF as calculated by the ECTb. The average LVEF for healthy, low risk men was 57% +/- 7% (QGS) versus 63% +/- 6% (ECTb). For women, the LVEF varied from 69% +/- 8% (QGS) and 72% +/- 8% (ECTb). Comment: this article has an excellent table of normals for LVEF and ventricular volumes. QGS tends to give an LVEF of 5% lower than that of the ECTb. [ article ]  posted at 3:57 PM by Tom Heston, MD   

SPECT Imaging in Acute Chest Pain Cost-Effective $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85241368"; ?>
This study of 120 consecutive patients presenting with acute chest pain to a busy Australian emergency room were studied. Overall, use of SPECT imaging reduced costs. SPECT imaging also resulted in 7 patients having their discharge cancelled. Comment: this supports the usefulness of acute SPECT imaging in acute chest pain. [ article ]  posted at 7:21 PM by Tom Heston, MD   

High Intra-Observer Reproducibility Found in SPECT Interpretation $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85241242"; ?>
This study found that there was a high intraobserver reproducibility among the physicians studied. Comment: it is unclear what the backgrounds of the interpreting physicians were. Where they all from the same hospital or clinic? (yes) Then no wonder that the interpretations were reproducible. Were the physicians certified by the Certification Board of Nuclear Cardiology? (yes) CBNC is the gold standard for physician credentialling in nuclear cardiology. [ article ]  posted at 6:15 PM by Tom Heston, MD   

Acute Rest Myocardial Perfusion Imaging Cost-Effective $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85241222"; ?>
This study found that acute rest myocardial perfusion imaging using Tc-99m sestamibi saved the healthcare system money, without compromising patient care. [ article ]  posted at 6:07 PM by Tom Heston, MD   

Acute rest myocardial perfusion imaging in the emergency department: A technique whose time has come ? or gone? $BlogItemSubject"; $newslink[$countera]="http://www.medjournal.com/blog/archives/2002_07_01_nucmedarchive.php#85241209"; ?>
This is an editorial from Dr. Gary Heller advocating the use of acute rest myocardial perfusion imaging. The critical path to overcome is bringing all participating parties together from the emergency physicians to the nuclear cardiology specialist. article ]  posted at 6:01 PM by Tom Heston, MD