Volume Changes (3.5MB)
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Volume Changes (3.5MB)

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Volume Changes (3.5MB) Volume Changes (3.5MB) Presentation Transcript

  • IMPLICATIONS FOR FALSE POSITIVE ROTATIONAL SPECT (RSPECT) STUDIES BEING CAUSED BY POST-STRESS CHANGES IN CARDIAC VOLUME T.P. Bublitz, D.L. Kirch*, J.E. Koss, P.P. Steele Nuclear Cardiology Research Western Cardiology Associates, PC Englewood, Colorado
  • PREVIOUS INDICATIONS THAT CARDIAC CHAMBER SIZE CHANGES COULD BE A PROBLEM
    • Literature describes dramatic shape and volume changes during and following exercise and change of position
    • Occurrence of unexplainable false positive myocardial perfusion studies (specificity in the 70-80% range)
    • Numerous attempts to identify and correct for sources of artifacts in RSPECT studies have proven inconclusive
    • Visual inspection of cine playback of RSPECT images
    • Ability of NRSPECT to monitor cardiac chamber volume changes over a 20-30 min period following stress
  • METHODOLOGY APPLIED TO SEQUENTIALLY MONITOR CARDIAC VOLUME CHANGES
    • MULTI-PINHOLE NRSPECT IS UNIQUELEY SUITED FOR SERIAL MEASUREMENTS
    • EXCELLENT STATISTICS PERMIT VOLUME COMPUTATIONS TO BE MADE IN THREE MINUTE INTERVALS
    • MIDLINE OR CENTER WALL TRACKING USED TO COMPUTE VOLUMES
    • VISUAL INSPECTION USED TO CORROBORATE THE MAGNITUDE AND DIRECTION OF THE COMPUTED CHANGES
    • CHAMBER SHAPE CHANGES ARE VISUALLY APPRECIATED
  • SIMULTANEOUS DUAL-ISOTOPE (TL-201/TC99m) MYOCARDIAL PERFUSION IMAGING PROTOCOL
    • SETUP IV AND INJECT 6.0 mCi OF Tc AGENT
    • PATIENT DRINKS 8-16 oz OF CLEAR LIQUID DURING 10 min WAIT PRIOR TO EKG HOOK-UP FOR STRESS TEST
    • INJECTION OF 4.0 mCi OF Tl-201 OCCURS 1-2 min PRIOR TO CESSATION OF STRESS MANEUVRE
    • GATED, SIMULTANEOUS DUAL-ISOTOPE IMAGING IS PERFORMED IMMEDIATELY FOLLOWING COOL DOWN
    • LIST-MODE DATA ACQUISITION TAKES ABOUT 20 MINUTES AND RESULTS IN 3 MILLION COUNTS PER VIEW
    • TOTAL DURATION OF TEST IS < 90 min
  • SHORT AXIS RESTING IMAGES Tc-99m SHORT AXIS STRESS IMAGES Tl-201 LONG AXIS RESTING IMAGES LONG AXIS STRESS IMAGES MULTI-PINHOLE TOMOGRAPHIC RECONSTRUCTIONS
  • CENTER WALL TRACKING PERFORMED ON 8 SHORT AXIS SLICES FROM APEX TO BASE CCP CURVES DEVELOPED AT 60 POINTS THROUGH 360 o . SEARCH FOR MAXIMUM VALUE AVERAGED WITH TWO NEAREST RADIAL NEIGHBORS APEX BASE
  • STRESS REST STRESS-REST DIFFERENCE CIRCUMFERENTIAL COUNT PROFILE CURVES
  • STRESS (EARLY) VOLUME IMAGES = 77 cc MID VOL =73cc RESTING (LATE) VOLUME IMAGES = 72cc VOLUME IMAGES UNGATED (TOP) GATED (BOTTOM)
  • ACUTELY DILATED VOLUME (77 cc TO 72 cc) WITH INFERIOR LATERAL SHAPE CHANGES
  • ACUTELY DIMINISHED VOLUME (113 cc TO 130 cc) WITH SUPERIOR LATERAL SHAPE CHANGES
  • NO VOLUME CHANGES (50 cc TO 52 cc) AND NO SIGNIFICANT SHAPE CHANGES
  • ACUTELY DILATED VOLUME (135 cc TO 126 cc) WITH SUPERIOR SEPTAL SHAPE CHANGES
  • NEGLIGIBLE VOLUME CHANGES (110 cc TO 111cc) WITH REDISTRIBUTATIVE SIZE CHANGES
  • ACUTE VOLUME DILATION (102 cc TO 96 cc) WITH INFERIOR SHAPE CHANGES
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  • CORRELATION BETWEEN POST STRESS VOLUME CHANGES AND RATE-PRESSURE PRODUCT
  • CORRELATION BETWEEN POST STRESS VOLUME CHANGES AND AGE (MEN AND WOMEN COMBINED)
  • CORRELATION BETWEEN POST STRESS VOLUME CHANGES AND AGE (MEN ONLY)
  • CORRELATION BETWEEN POST STRESS VOLUME CHANGES AND AGE (WOMEN ONLY)
  • OBESE CORRELATION BETWEEN POST STRESS VOLUME CHANGES AND BODY MASS INDEX
  • CONCLUSIONS FROM ANALYSIS OF 818 DUAL-ISOTOPE GATED PERFUSION STUDIES
    • THE MEAN VALUE OF LV VOLUME CHANGES IS +4.5%
    • MAJORITY OF PATIENTS (70%) SHOW ACUTE DILATION FOLLOWING EXERCISE AND RECLINE FOR IMAGING
    • 23.3% OF PATIENTS SHOW DILATION GREATER THE +10%
    • 3% OF PATIENTS SHOW DIMINATION GREATER THAN -10%
    • IN 13% OF PATIENTS SHOWING VOLUME CHANGES >10% RESOLUTION TO LESS THAN 5% OCCURS BY THE 10 min MID-POINT
    • SIGNIFICANT VENTRICULAR SHAPE CHANGES CAN OCCUR WITH LITTLE CHANGE IN THE COMPUTED VOLUME OF THE VENTRICLE
    • WE HAVE NOT FOUND ANY PRE- OR POST-TEST CORRELATE THAT PREDICTS THE MAGNITUDE OF THESE CHANGES
    • SEQUENTIAL STUDIES ON THE SAME PATIENT ARE UNPREDICTABLE
  • Study Comparison
  • CINE DISPLAY OF TWO SUCCESSIVE RESTING IMAGES ACQUIRED BACK-TO-BACK “ RESTING ” DATA SET “ PSEUDO STRESS ” DATA SET
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  • CINE DISPLAY OF FRAMES 31 AND 32 “ RESTING ” STUDY “ PSEUDO STRESS ” STUDY These are the transitional frames acquired by detector #1 and detector # 2
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