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Biomedical subjects

M Clausen

Publications and source records attributed to M Clausen.

At least 109 records · Page 6Linked to original sources
PubMed1990

[Localization of premature and ectopic ventricular depolarization using a new nuclear medicine tomographic technique].

In planar radionuclide ventriculography (RNV) identification of the site of initial contraction is possibly by the Fourier phase. First clinical experiences will be presented with a new integrated tomographic technique--ISPECT--in noninvasively assessing the site of ectopic or premature ventricular depolarization. In six patients Fourier phases of RNV and ISPECT were performed and compared in five with results from the corresponding electrophysiologic study. It was possible to exactly localize the beginning of mechanical contraction in the two orthogonal planes: during pacemaker stimulation at the apex of the right ventricle, at the lateral border of a large aneurysm during ventricular tachycardia, and at the site of three of five WPW bundles. In the other two bundles the site of first contraction was near the area found during invasive mapping procedure. Thus, this new ISPECT approach together with planar radionuclide imaging may help in noninvasively localizing the site of ectopic and premature depolarization in addition to surface ECG.

Adult↗
PubMed1990

Validation of a simplified carbon-14-urea breath test for routine use for detecting Helicobacter [correction of Heliobacter] pylori noninvasively.

A carbon-14 (14C) urea breath test for detecting Helicobacter pylori with multiple breath sampling was developed. Carbon-14-urea (110 kBq) administered orally to 18 normal subjects and to 82 patients with Helicobacter infection. The exhaled 14C-labeled CO2 was trapped at 10-min intervals for 90 min. The total 14C activity exhaled over 90 min was integrated and expressed in %activity of the total dose given. In normals, a mean of 0.59% +/- 0.24% was measured, resulting in an upper limit of normal of 1.07%. In 82 patients, a sensitivity of 90.2%, a specificity of 83.8%, and a positive predictive value of 90.2% was found. The single probes at intervals of 40-60 min correlated best with the integrated result, with r ranging from 0.986 to 0.990. The test's diagnostic accuracy did not change at all when reevaluated with the 40-, 50-, or 60-min sample data alone. Thus, the 14C-urea breath test can be applied routinely as a noninvasive, low-cost and one-sample test with high diagnostic accuracy in detecting Helicobacter pylori colonization.

Adult↗
PubMed1990

[The role of radionuclide ventriculograms in determining the indications for valve replacement in chronic aortic valve insufficiency].

Timing of aortic valve replacement (AVR) in chronic aortic regurgitation (AR) remains a difficult problem in clinical practice. Radionuclide ventriculography (RNV) yields information on the extent of valvular regurgitation, the enlargement and the systolic function of the left ventricle. A "well-timed" AVR is defined by 1) postoperative improvement of clinical symptoms, decrease in left ventricular end-diastolic volume (EDV) and normalization of ejection fraction (EF) as well as by 2) greater improvement under surgical therapy as compared to conservative management. In "too early" AVR the latter condition is not fulfilled, while in "too late" AVR the first condition is not accomplished. In this study 54 patients with chronic aortic incompetence were evaluated by RNV to see whether these three groups ("too early", "well timed", "too late" AVR, resp.) can be separated by the relation between EDV and regurgitant volume (RV), the level of the EDV and the clinical status. The examination was based on pre- and postoperative RNV studies as well as on follow-up studies. A good postoperative result can be expected in cases with a preoperative EDV/RV-ratio similar to that observed in 30 patients with AR in whom AVR was not indicated. In contrast, in the majority of those cases with an EDV/RV-ratio exceeding this normal range the postoperative outcome will be unsatisfactory. If the EDV/RV-ratio is normal, AVR should be performed in cases with an EDV exceeding 400 ml, while in cases with an EDV between 300-400 ml AVR is only indicated in the presence of additional symptoms (NYHA greater than or equal to II).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Reconstruction of Fourier coefficients: a fast method to get polar amplitude and phase images of gated SPECT.

Gated SPECT (GASPECT) during radionuclide ventriculography (RNV) is a time-consuming procedure requiring extended hard- and software. Furthermore, the procedure suffers from poor count statistics. Our method tries to overcome these difficulties by exploiting the count summation effect of Fourier analysis. The sine and cosine coefficients of the first harmonic are extracted from the gated views and reconstructed. This, in fact, results in an improvement of the count statistics by a factor of four combined with a tremendous reduction of disc space requirements. Using short-axis slices, bull's-eye plots of the amplitude and phase of the left ventricle are calculated. Cardiac functions and localization and extent of any malfunction are documented three-dimensionally without superposition.

Data Interpretation, Statistical↗
PubMed1990

[The effect of 3-dimensional data stabilization in radionuclide ventriculography on the statistical numerical error in the ejection fraction].

The suitability of a 3-dimensional filter in diminishing the statistical noise of left ventricular volume curves without any systematical error in the left ventricular ejection fraction (EF) was investigated. The EF values were compared in 50 studies on 24 patients. There was no significant systematical difference between the EFs before and after filtering. The filter diminishes the statistical uncertainty of the EF by a factor of 0.47. Therefore, the method may possibly be employed in processing the left ventricular volume curves.

Adult↗
PubMed1989

[Stress testing of long-term type I diabetic patients with radionuclide ventriculography].

Left ventricular function was assessed by means of radionuclide ventriculography in 42 patients with long-standing (13 +/- 5 yrs) insulin-dependent diabetes mellitus and in eleven healthy age matched control subjects. Only diabetics were included in the study without diabetes related cardiac risk factors such as hypertension and CAD in order to evaluate diabetes specific changes of cardiac function. No differences were seen between diabetics and controls concerning heart rate and functional parameters of left ventricle in systole and diastole. The rapid filling period was not prolonged. According to our radionuclide data there is no evidence of diabetes related impairment of ventricular function in young patients with long-standing type-1-diabetes mellitus.

Adult↗
PubMed1989

The contraction fraction (CF) in myocardial studies with technetium-99m-isonitrile (MIBI)--correlations with radionuclide ventriculography and infarct size measured by SPECT.

Criteria for the detection of coronary artery disease in nuclear cardiology include visualization of perfusion defects and functional impairment of contraction. The purpose of this study is to combine both methods in one procedure with the new myocardial perfusion tracer, 99mTc-methoxy-isobutyl-isonitril (MIBI), reducing time and radiation burden to the patient. Following an uncomplicated recovery, ten patients with first myocardial infarction participated in this study. Radionuclide ventriculography (RNV) was performed at rest and during exercise. Within 2-3 days, 370 MBq 99mTc-MIBI were injected and SPECT acquisition commenced 1 h later. Data processing included a scar image in polar coordinates. Areas of significantly reduced tracer uptake were expressed as a percentage of the total myocardial area. Directly following SPECT, resting and maximum exercise gated planar LAO images were recorded and the contraction was quantified. The concept of the contraction fraction (CF) rested on the end systolic change in count distribution: their increase in density and their centripetal concentration. For comparison, geometrical inner edge detection techniques were also applied. All algorithms for describing an EF equivalent were verified by computer simulations, showing a perfect correlation over a wide range of preset EFs. When applied to the patient studies only the non geometric methods revealed a good correlation with the ejection fraction (EF) obtained by RNV, and with the infarct size measured by SPECT.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

[Quantitative image analysis in nuclear cardiology as a decision aid in addition to visual assessment of findings].

Quantitative analysis of nuclear cardiology procedures has stimulated tremendous work in the past and will continue to do so in the future. The impact on routine patient care has grown at a slower pace and should be assessed separately for tissue perfusion and for myocardial contraction. The current status will be presented, focusing on patients with coronary heart disease. In the preinfarct period myocardial scintigraphy with thallium-201 and emission computer tomography (ECT) is the preferred method. The procedure for quantitation includes transfer of all data into a standard polar map and comparing the numbers with a normal, gender-matched data base. The result reveals areas of reduced tracer uptake, color-coded according to the level of significance. Interpretation of these colored polar maps might appear simple, but in fact requires a substantial amount of knowledge to avoid overinterpretation of the results. This has led us to a restricted use of this quantitative tool: following an initial step of reading the original data in terms of short and long axes slices of the left myocardium, the polar map is utilized for verification and for suggestions of any additional lesions. This has to be confirmed by a second reading of the slices, and only this last step defines the lesions to be reported. Quantitation used in this dialectic approach avoids inclusion of artefacts, and at the same time is useful experience for trainees. Furthermore, it allows easy presentation during the clinical conference and statistical analysis of groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1989

Quantification of amplitude images of gated radionuclide heart studies: a new universal method.

Absolute quantification in nuclear medicine is difficult because of the individual shape, size, and position of human organs. In this study, a general data processing procedure is presented that allows inter-individual comparison and definition of normal count density pattern of unevenly shaped scintigraphic structures. This new method is demonstrated on Fourier amplitude images of gated heart studies. The information contained in the original irregularly shaped left ventricular amplitude scans was transformed into a standard sized circle by interpolating the radiant profiles of varying length from the original left ventricular ROI into the radii of the standard circle using 720, 360, 180, and 72 sampling angles. Retransformation of the individual left ventricular amplitude image from the standard circle area is feasible with only approximately 1% error with the 180, 360, or 720 sampling steps. As a first application of this new method 20 normal amplitude studies were transferred into the standard circle, which allowed the definition of a statistically normal reference image against which individual left ventricular amplitude images may be compared for documenting areas of significantly depressed amplitudes quantitatively. This simple and unique approach may be applied to most organ-related scans such as brain, kidneys, lung, and liver both in planar and tomographic studies to first create a normal reference image and second, to quantify the significance of locally increased or decreased activity in routine scans automatically.

Heart↗
PubMed1989

[Quantification of the myocardial scar with technetium-99m-isonitrile (MIBI) in emission computerized tomography (SPECT)--comparison with serial creatine kinase determinations and radionuclide ventriculography].

Estimation of the size of myocardial infarction is of major interest for clinical patient management and a simple and reliable method is still searched for. In this study the potential of the new myocardial perfusion tracer, Technetium-99m (Tc-99m) methoxy-isobutyl-isonitril (MIBI) combined with emission computertomography (SPECT), is tested vs. the standard procedures of serial plasma creatine kinase (CK) measurements and radionuclide ventriculography (RNV). In 10 patients with first myocardial infarction, integral values for CK were obtained during the acute phase. Following three weeks of uncomplicated recovery the patient was referred for both types of myocardial imaging within four days. 370 MBq Tc-99m-MIBI were injected with the patient supine and at rest. One hour later SPECT acquisition commenced. The reconstructed slices were rearranged to long and short axes slices, which served to calculate a functional "scar image" in polar coordinates. The color-coded areas of significantly reduced tracer uptake were expressed in percent of the total myocardial area. RNV was performed with the patient supine and at rest, the left anterior oblique angle being optimized for septum visualization. Infarct localizations were antero-apical (three), anterolateral (two), postero-lateral (one), and posterior (four).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

The Schilling test cannot be replaced by an absorption test with unlabeled vitamin B12.

It was the purpose of this study to evaluate the diagnostic usefulness of an oral absorption test using nonlabeled Vit B12 suggested by a commercial distributor as an alternative for the more expensive Schilling test (ST). Plasma levels of Vit B12 were measured with a commercial kit before and 4 h after oral administration of 1 mg Vit B12 in 32 normals, in 16 patients with normal ST, and in 14 patients with abnormal ST for determination of sensitivity and specificity with the ST as golden standard. In normals, a mean of 767 +/- 404 pg/ml before and 1096 +/- 776 pg/ml after oral Vit B12 with a mean increase of 331 +/- 453 pg/ml was measured. Because of the obvious large variation, no meaningful range for normal absorption could be established. In the two patient subsets, there was no Gaussian distribution of the results, with a meridian of Vit B12 increase after absorption of 142 pg/ml, range 27-2668 pg/ml, in the group with normal ST and a meridian of 244 pg/ml ranging from 40 to 2453 pg/ml in the group with abnormal ST. Statistical nonparametric analysis did not reveal any difference between the two groups. Assuming a minimum required increase of 100 pg/ml, as suggested by the kit distributor, a sensitivity of only 27% and a specificity of 75% was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Integrated volume-selective/spectral editing 1H NMR and postdetection signal processing for the sensitive determination of lactate.

A new volume selection/spectral editing pulse sequence (VOSING) is presented. The features specific to the technique are that the volume selection and the editing intervals coincide and that no decoupling is necessary. The pulse sequence can be applied under both homo- and heteronuclear conditions. Phantom experiments with lactate solutions and human serum led to water suppression factors of about 20,000. A postdetection signal processing method has been implemented. The final sensitivity for lactate determinations could thus be improved by a factor of more than 4. Ischemia-induced lactate could easily be detected in serum. At present, the lower detection limit of lactate is 1 mmol/liter for a (1.2 cm)3 voxel and 32 scans in a 4.7-T/40-cm magnet.

Humans↗
PubMed1988

Radionuclide ventriculography (equilibrium gated blood pool scanning)--its present clinical position and recent developments.

Myocardial scanning (MS) and radionuclide ventriculography (RNV) are the foundation of nuclear cardiology. These procedures aim in two completely different directions: RNV tries to image heart motion, that is, mechanical (pump) function, and therefore belongs to the group of first-order functional imaging (FI, imaging mechanical function), whereas MS is based on myocardial metabolism, and therefore can be attributed to third-order functional imaging (metabolism). This statement is relevant for the assessment of the clinical position of RNV: Third-order (metabolism) functional imaging is the domain of nuclear medicine (NM), whereas first-order FI has to face the competition of alternative noninvasive procedures such as ultrasound (US), digital subtraction angiography (DSA), computer tomography (CT), and nuclear magnetic resonance (NMR). The domain of RNV includes stages two (acute infarction) and three (postinfarction period) of coronary arterial disease (CAD). The advantageous combination of quantitative data on global, left ventricular (LV) function and imaging of regional motion ensures the superiority of RNV over US. However, RNV is inferior to MS in physical examinations in the preinfarction stage of CAD, whereas US is clearly inferior to both NM procedures. Recent progress could be attained by gated SPECT (GASPECT). A proposal is presented for simplification of this time-consuming procedure. Technetium-labeled isonitriles offer the chance for the combination of "perfusion-motion" imaging of the myocardium. However, even standard RNV offers new possibilities. The multitude of parameters produced by quantitation has not yet been exploited completely. This can be done by discriminant analysis. The computer finds out an optimal subset from the whole set of parameters for the solution of a significant clinical problem. The software "learns" to find the "label" of a special pathognomonic entity. This computer work is supported by a relational data bank (Oracle) and an optical disk. Two examples for the effectiveness of the computer in problem solving are presented. It is concluded that RNV, even in the very competitive class of first-order functional imaging, enjoys a preferred position. The future indeed seems brighter because labeled isonitriles offer the chance for the combination of perfusion-motion imaging of the myocardium.

Coronary Disease↗
PubMed1988

Short-axis circumferential profiles of the heart in healthy subjects: comparison of T1-201 SPECT and two-dimensional echocardiography.

To correlate the findings at thallium-201 single photon emission computed tomography (SPECT) with left ventricular anatomy, circumferential wall thickness was measured in 12 healthy subjects with two-dimensional echocardiography. At the midpapillary level, eight anatomic structures were identified with echocardiography, as were four maxima (papillary muscles and junctions of the left ventricular myocardium with the right ventricle, both anteriorly and posteriorly) and the intervening minima (including the septum). Tl-201 SPECT was performed in the same subjects. The normalized circumferential count profiles of the short-axis sections that included the papillary muscles showed the same basic pattern as that on echocardiograms. In most cases, the posterior papillary muscle and the posterior junction with the right ventricle were not distinguishable from each other, which produced three circumferential profile maxima instead of four. When values from all subjects were averaged, left ventricular anatomy was less evident in the circumferential profile. Left ventricular anatomic structures were reflected to a similar degree with either 180 degrees or 360 degrees data sampling.

Adult↗
PubMed1988

Differentiation between infarction and cardiomyopathy in left bundle branch block by parametric radionuclide imaging.

In LBBB the diagnosis of the underlying disease, i.e. infarction (MI) or cardiomyopathy (CMP), is still a challenge. In this study, the usefulness of radionuclide ventriculography (RNV) for solving this problem noninvasively was tested. The hypothesis was that quantitation of the space-time sequence of left ventricular (LV) contraction by Fourier analysis may differentiate among MI, CMP, and LBBB-specific wall motion abnormalities (WMA). Forty-seven patients (pts) with LBBB were divided into 3 groups: 1) 20 pts with MI, 2) 7 pts with CMP, 3) 20 pts without MI or CMP. Regional parametric amplitude and phase data of eight LV sectors were calculated and expressed in standard deviation units (SDU) of normal. Out of the many regional data only the values of the mean amplitude and the standard deviation of the mean phase shift showed high discriminative power for separating the three groups, with an average squared canonic correlation of 0.5 and a Wilks lambda of 0.22, respectively. In other words, 17 of 20 pts in group 1, 6 of 7 pts in group 2, and 19 of 20 pts in group 3 were truly diagnosed by RNV alone. Such a separation also seems reasonable physiologically, since the mean amplitude reflects global left ventricular function and standard deviation of phase is a measure of time homogeneity of contraction. Furthermore, there was a significant septal phase delay of -4.92 +/- 5.3 SDU in 15 pts with septal MI compared to group 3 pts, who had a subtle premature septal motion of +0.75 +/- 2.64 SDU, whereas the septal amplitude was not different and slightly decreased in both.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Comparison of transaxial resolution in 180 degrees and 360 degrees SPECT with a rotating scintillation camera.

Using circular 180 degrees and 360 degrees SPECT acquisition modes the transaxial resolution of line sources in air and water were measured at different positions in the field of view. With the 180 degrees acquisition mode, all line sources in air located off the axis of camera rotation (AoR) showed an oval distortion. This distortion was systematically related to the starting point of the rotating detector. On axis line sources in air were undistorted, regardless of the 180 degrees acquisition starting angle. The 360 degrees acquisition images of the line sources in air showed a similar effect but in a very mild form. In water, transaxial reconstructions of line sources (off axis) showed an enhancement of the oval distortion for both the 180 degrees and 360 degrees acquisitions. Computer simulations of the line source measurements were performed and correlated well with the experimental data. The line source results are explainable by the inherent depth dependent response of the scintillation camera. In clinical SPECT studies, distortions of this nature will be most appreciable with 180 degrees imaging of small organs that are located off the AoR.

Air↗