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R Folks

Publications and source records attributed to R Folks.

14 recordsLinked to original sources
PubMed2000

Echocardiographic validation of gated SPECT ventricular function measurements.

UNLABELLED: Left ventricular (LV) volumes are valuable prognostic indicators in the management of coronary artery disease and traditionally have been obtained by x-ray contrast angiography or echocardiography. There now are several scintigraphic methods to compute volumes that are based on different LV modeling assumptions. Both the reasons that calculations from different nuclear techniques can disagree with one another and the relationship of these values to the more conventional echocardiographic measurements must be investigated thoroughly for calculations to be interpretable for individual patients. METHODS: Echocardiographic volumes were determined in 33 retrospective subjects with coronary artery disease (mean age, 61 +/- 12 y; 42% men; 70% with abnormal perfusion and 58% with abnormal segmental wall motion) using the modified Simpson's rule technique applied to digitized apical 4-chamber and apical 2-chamber views of 4 averaged heartbeats. These volumes were compared with those from 3 gated SPECT methods based on Simpson's rule LV modeling similar to standard echocardiographic algorithms (SPECT EF from St. Luke's-Roosevelt Hospital) (method 1), Gaussian myocardial count profile curve fitting (QGS from Cedars-Sinai Medical Center) (method 2), and an endocardial model based on perfusion sampling and count-based thickening (Cardiac Toolbox from Emory University) (method 3). RESULTS: By ANOVA, there were no significant differences among ejection fractions (EFs), but there were for volumes. Paired t test analysis showed volumes from methods 2 and 3 to be significantly larger than echocardiographic volumes and larger than those of method 1. Linear regression analysis comparing gated SPECT and echocardiographic volumes showed a nearly identical strong correlation (r = 0.92; P < 0.000001) for all 3 methods. Excellent correlation also was found among gated SPECT volumes from the 3 methods (r = 0.94). Bland-Altman analysis and t tests showed that method 1 volumes (70 +/- 61 mL) were the same as for echocardiography (77 +/- 55 mL), but volumes were overestimated by method 2 (105 +/- 74 mL) and method 3 (127 +/- 92 mL), particularly for larger volumes. Pearson coefficients for EFs compared with echocardiography were r = 0.82, 0.75, and 0.72 for methods 1-3, respectively. EFs correlated strongly among the 3 gated SPECT methods (r = 0.86-0.92). The Fisher z test showed no differences among these methods for any of the volume or EF linear correlation analyses. CONCLUSION: All gated SPECT parameters correlated well with echocardiographic values. However, the gated SPECT method for which underlying assumptions most closely resembled those commonly used in echocardiography produced mean volume values closest in agreement with echocardiographic measurements.

Analysis of Variance↗
PubMed1998

A quantitative evaluation of the three dimensional reconstruction of patients' coronary arteries.

BACKGROUND: Through extensive training and experience angiographers learn to mentally reconstruct the three dimensional (3D) relationships of the coronary arterial branches. Graphic computer technology can assist angiographers to more quickly visualize the coronary 3D structure from limited initial views and then help to determine additional helpful views by predicting subsequent angiograms before they are obtained. METHODS: A new computer method for facilitating 3D reconstruction and visualization of human coronary arteries was evaluated by reconstructing biplane left coronary angiograms from 30 patients. The accuracy of the reconstruction was assessed in two ways: 1) by comparing the vessel's centerlines of the actual angiograms with the centerlines of a 2D projection of the 3D model projected into the exact angle of the actual angiogram; and 2) by comparing two 3D models generated by different simultaneous pairs on angiograms. The inter- and intraobserver variability of reconstruction were evaluated by mathematically comparing the 3D model centerlines of repeated reconstructions. RESULTS: The average absolute corrected displacement of 14,662 vessel centerline points in 2D from 30 patients was 1.64 +/- 2.26 mm. The average corrected absolute displacement of 3D models generated from different biplane pairs was 7.08 +/- 3.21 mm. The intraobserver variability of absolute 3D corrected displacement was 5.22 +/- 3.39 mm. The interobserver variability was 6.6 +/- 3.1 mm. CONCLUSIONS: The centerline analyses show that the reconstruction algorithm is mathematically accurate and reproducible. The figures presented in this report put these measurement errors into clinical perspective showing that they yield an accurate representation of the clinically relevant information seen on the actual angiograms. These data show that this technique can be clinically useful by accurately displaying in three dimensions the complex relationships of the branches of the coronary arterial tree.

Adult↗
PubMed1997

Multicenter trial validation of a camera-based method to measure Tc-99m mercaptoacetyltriglycine, or Tc-99m MAG3, clearance.

PURPOSE: To evaluate an improved camera-based method for calculating the clearance of technetium-99m mercaptoacetyltriglycine (MAG3) in a multicenter trial. MATERIALS AND METHODS: Tc-99m MAG3 scintigraphy was performed in 49 patients at three sites in the United States and Canada. The percentage of the injected dose of Tc-99m MAG3 in the kidney at 1-2, 1.0-2.5, and 2-3 minutes after injection was correlated with the plasma-based Tc-99m MAG3 clearances. The data were combined with the results obtained in 20 additional patients in a previously published pilot study. RESULTS: Regression models correlating the plasma-based Tc-99m MAG3 clearance with the percentage uptake in the kidney for each time interval were developed; there was no statistically significant difference among sites in the regression equations. Correction for body surface area statistically significantly (P < .005) improved the correlation coefficient for each time interval. For the 1.0-2.5-minute interval, the body surface area-corrected correlation coefficient for the four combined sites was .87, and it improved to .93 when one outlier was omitted from the analysis. Similar results were obtained with the other time intervals. Independent processing by two observers showed no clinically important differences in the percentage dose in the kidney or in relative function. CONCLUSION: An improved camera-based method to calculate the clearance of Tc-99m MAG3 was validated in a multicenter trial.

Adolescent↗
PubMed1997

Background subtraction in technetium-99m-MAG3 renography.

UNLABELLED: Correction represents a potential source of error in estimating split renal function and camera-based clearances. The purpose of this study was to determine which of five background options and four time intervals was associated with the least error for 99mTc-mercaptoacetyltriglycine (MAG3). METHODS: Fifteen single-kidney patients were imaged supine after 111-370 MBq (3-10 mCi) 99mTc-MAG3 injection. A phantom kidney was drawn on the 2-3-min images, approximately equal in size to the solitary kidney and used for all time intervals. Counts in the phantom and native kidneys were calculated using manual inferior and lateral regions of interest (ROIs), automated elliptical and perirenal background ROIs and no background correction at various time intervals (1-2, 1-2.5, 1.5-2.5 and 2-3 min) postinjection. With optimal background correction, counts and the relative function in the phantom kidney should be zero. The error was measuring by estimating both the relative function and absolute function expressed as the percent injected dose in the phantom kidney. RESULTS: The percent injected dose in the phantom kidney as well as the error in measuring relative function were significantly greater than zero for the inferior background correction and the no background correction options at all time intervals, p < 0.05. The percent dose in the kidney and the error associated with the lateral, elliptical and perirenal ROIs were not significantly different from zero. CONCLUSION: Regardless of time interval, the greatest error was associated with no background correction. The inferior ROI consistently underestimated the background correction and probably should not be used for 99mTc-MAG3. There was no significant difference between errors generated using the lateral and automated ROIs, although automated ROIs are probably more reproducible for sequential studies.

Adult↗
PubMed1997

Comparison of technetium-99m-ll-EC isomers in rats and humans.

UNLABELLED: Technetium-99m-L,L-ethylenedicysteine (99mTc-LL-EC) is a new renal imaging agent with pharmacokinetic properties reported to be slightly superior to those of 99mTc-mercaptoacetyltriglycine (99mTc-MAG3); however, to better define the potential of the enantiomer 99mTc-DD-EC and the diastereomer 99mTc-DL-EC as renal imaging agents, we compared the three EC stereoisomers with 131I-orthoiodohippurate (OIH) in a series of rats and humans. METHODS: Each 99mTc-EC stereoisomer was coinjected with OIH in six Sprague-Dawley rats for measurements of clearance and extraction fraction. Each stereoisomer was also coinjected with OIH in three human volunteers followed by sequential imaging, plasma clearance measurements and timed urine collections. RESULTS: Technetium-99m-DD-EC had the highest clearance and extraction efficiency in rats (p < or = 0.02). In humans, image quality was good with all three agents. The clearance ratio (EC/OIH) was 82% +/- 8% for 99mTc-DD-EC compared to 70% +/- 3% and 40% +/- 5% for 99mTc-LL-EC and 99mTc-DL-EC, respectively. Technetium-99m-DD and 99mTc-LL-EC were excreted more rapidly than 99mTc-DL-EC. CONCLUSION: Technetium-99m-DD-EC has excellent imaging properties and the data suggest that its clearance may approach that of OIH more closely than any other 99mTc renal agent. A potential limitation is the fact that both 99mTc-DD and LL-EC exist in dianionic (80%) and monoanionic (20%) forms at physiological pH and it is unlikely that these two forms have the same clearance or protein binding affinity.

Animals↗
PubMed1995

Measuring technetium-99m-MAG3 clearance with an improved camera-based method.

UNLABELLED: Because commercially available camera-based methods are not optimized, they fail to account for dose infiltration, table attenuation and correspondence between time of injection and starting the camera. We have developed a more optimized technique to calculate camera-based clearances and applied this technique in the design of a camera-based clearance method for 99mTc-MAG3. METHODS: Technetium-99m-MAG3 scintigraphy was performed in 20 patients who had varying degrees of renal function. Data were acquired posteriorly in supine patients at 2 sec/frame for 24 frames, 15 sec/frame for 16 frames and 30 sec/frame for 40 frames. Background correction was performed using an automated elliptical region of interest. Renal depth was estimated using improved regression equations and an empirically determined attenuation coefficient derived from phantom studies. Corrections were made for table attenuation and time discrepancies between dose injection and starting the camera. The percent injected dose in the kidney at 1-2, 1-2.5 and 2-3 min postinjection and the percent injected dose at those time periods corrected for body surface area were correlated with MAG3 clearance based on a single injection, two-compartment model. RESULTS: There was high correlation between the percent injected dose in the kidney at all three time periods and the multisample clearance. Correcting for body surface areas significantly improved the correlation coefficients. Consequently, regression equations were developed to predict multisample clearance based on percent dose and body surface area. CONCLUSION: The optimization features described in this method should improve precision when sequential studies are conducted in the same patient.

Adult↗
PubMed1994

Evaluation of technetium-99m-triamide-mercaptide complexes designed to identify properties favoring renal tubular transport.

UNLABELLED: To aid in the design of an improved 99mTc-labeled renal agent, several new [99mTcO(MAG3)]2- analogs were synthesized to determine the effects of varying the position and chemical form of the terminal charged group on renal clearance. METHODS: Clearance, extraction efficiency and plasma protein binding were measured in six Sprague-Dawley rats per complex for ortho, meta and para isomers of [99mTcO(MAG2-ABA)]2-, with MAG2- = mercaptoacetylglycylglycyl- and ABA = aminobenzoate; [99mTcO(MAG2-pASA)]2-, with pASA = p-aminosalicylate; [99mTcO(MAG2-AMS]2-, with AMS = aminomethylsulfonate; and [99mTcO(MAG2-AMP]3-, with AMP = aminomethylphosphonate. For agents with relatively poor clearances, hepatobiliary excretion was evaluated by using a camera-based method. RESULTS: The clearances of the ortho, meta and para isomers of [99mTcO(MAG2-ABA)]2- were 17%, 20% and 59% of those of OIH, respectively. The clearances of [99mTcO(MAG2-pASA)]2-, [99mTcO(MAG2-AMS)]2- and [99mTcO(MAG2-AMP)]3- were 32%, 46% and 39% those of OIH, respectively. CONCLUSION: Optimal tubular transport appears to require a terminal anionic group; a planar carboxylate is preferred over nonplanar -SO3- or -PO3(2-) substituents, suggesting that the smaller size and/or planar shape of the carboxylate group are probably more important than the total charge or charge distribution. Optimal transport also appears to depend on the oxo-carboxylate conformation (syn or anti) and the oxo-carboxylate distance, although these relationships can be modulated by steric interactions. These structure-distribution relationships are important factors to consider in the future design of renal radiopharmaceuticals.

Animals↗
PubMed1994

Multicenter trial validation for quantitative analysis of same-day rest-stress technetium-99m-sestamibi myocardial tomograms.

UNLABELLED: The accuracy of an automated quantitative analysis of same-day rest/stress 99mTc sestamibi SPECT images for detection and localization of coronary artery disease (CAD) was assessed in a multicenter trial consisting of 161 patients from 7 different clinical sites utilizing various camera computer systems. METHODS: Of the 161 patients, 102 had angiographically documented coronary artery disease, 22 had normal coronary arteriograms, and 37 had a low (< 5%) likelihood of coronary artery disease based on their age, sex, symptoms and the results of their exercise electrocardiograms. The patients were studied using previously optimized image acquisition and processing protocols. An additional population consisting of 45 patients with single-vessel disease were evaluated to determine the optimal criteria for detection of CAD. RESULTS: The quantitative analysis method was associated with an overall sensitivity of 87%, specificity of 36%, and normalcy rate (true negative rate in the low likelihood patients) of 81%. Sensitivity for overall detection of disease was similar (90%) in patients with and without myocardial infarction (90% versus 89%). The sensitivities and specificities for identification of disease in individual coronary arteries were, respectively, 69% and 76% for LAD, 70% and 80% for LCX, and 77% and 85% for RCA. CONCLUSION: The results of this study demonstrate that the new objective quantitative method for analysis of same-day rest/stress 99mTc sestamibi SPECT images is accurate for detection and localization of CAD and correlates highly with expert visual interpretation.

Adolescent↗
PubMed1993

Three-dimensional coronary angiography.

For at least two decades coronary cine-angiograms have been reviewed on film projectors. The cardiologist most often reviews the multiple two-dimensional projections of the coronary arterial tree on a screen, and then mentally create a three-dimensional (3-D) model of the patient's arteries. The ability to synthesize this data and grasp the three-dimensionality of a patient's specific anatomy is quite difficult and requires extensive training and experience to perfect. Fortunately, with advances in computer hardware and software, cardiologists, with all levels of experience, will have assistance with this difficult task. It is now possible, with the use of computers, to reconstruct and display a patient's coronary angiogram in 3-D, allowing the cardiologist to review this data in ways not previously available. In the near future, enhancements in the technique will allow this technology to be placed on-line, directly in the cardiac catheterization laboratory, greatly facilitating the ability to diagnose abnormalities and more appropriately plan treatment strategies.

Cineangiography↗
PubMed1993

Quantitative same-day rest-stress technetium-99m-sestamibi SPECT: definition and validation of stress normal limits and criteria for abnormality.

Gender-matched stress normal limits and criteria for abnormality for rest-stress 99mTc-sestamibi same-day myocardial perfusion imaging were developed and validated in 160 patients who were imaged using previously developed optimized acquisition, processing and quantitative protocols. The gender-matched mean and standard deviation of the normal response were calculated using 35 male and 25 female patients with a < 5% likelihood of coronary artery disease. Receiver-operating curve analysis using expert visual interpretation as the "gold standard" was used to determine the optimal criteria for abnormality detection, in terms of standard deviations from the mean and minimum defect size for each of the four major zones of the polar map, in a pilot population consisting of an additional 35 male and 25 female patients with a variety of perfusion defects. The optimum standard deviations resulted in the following true-positive/true-negative rates when quantitative results were compared to visual analysis for the anterior, septal, lateral, and inferior segments in the combined male and female pilot populations: 84%/86%, 70%/75%, 86%/76% and 69%/76%, respectively. The final criteria were then applied to a prospective population consisting of 33 male and 7 female patients. This analysis resulted in the following true-positive/true-negative rates for overall perfusion abnormalities and abnormalities of the LAD, LCX and RCA vascular territories: 97%/67%, 94%/73%, 73%/90% and 72%/91%, respectively. The optimized 99mTc-sestamibi stress normal limits and criteria for abnormality correlate well with expert visual interpretation of stress myocardial perfusion defects.

Coronary Disease↗
PubMed1992

Prospective validation of a single sample technique to determine technetium-99m-MAG3 clearance.

Technetium-99m-MAG3 clearance is proportional to OIH clearance and can be used directly as a measure of renal function. Multiple plasma sample, two-compartment clearance data from three studies were recently pooled to develop a single-sample regression equation for determining the clearance of 99mTc-MAG3. To test this published equation, a prospective study was conducted in 34 patients with a wide range of renal function. Multiple plasma samples were obtained from 9 to 60 min following the bolus injection of 99mTc-MAG3 and the clearances were calculated based on a single injection, two-compartment model. Clearances were also calculated using a single 43-min plasma sample and the published regression equation. There was an excellent correlation (r = 0.976) between the two clearances; the slope of the regression line was 1.01 with an intercept of -26.6; the standard error of the estimate was 24 ml/min. In conclusion, the current regression equation provides a good estimate of 99mTc-MAG3 clearance.

Chromatography, High Pressure Liquid↗
PubMed1990

Technical aspects of myocardial SPECT imaging with technetium-99m sestamibi.

Most reports to date using single photon emission computed tomography (SPECT) with technetium-99m (Tc-99m) sestamibi have used acquisition parameters that were optimized for thallium-201. To fully utilize the superior imaging characteristics of Tc-99m sestamibi, there is a need to optimize the technical aspects of SPECT imaging for this agent. Performance can be enhanced through the careful selection of optimal radiopharmaceutical doses, imaging sequences, acquisition parameters, reconstruction filters, perfusion quantification methods and multidimensional methods for visualizing perfusion distribution. The current report describes theoretical considerations, phantom studies and preliminary patient results that have led to optimized protocols, developed at Emory University and Cedars-Sinai Medical Center, for same-day rest-stress studies, given existing instrumentation and recommended dose limits. The optimizations were designed to fit a low-dose-high-dose rest-stress same-day imaging protocol. A principal change in the acquisition parameters compared with previous Tc-99m sestamibi protocols is the use of a high-resolution collimator. The approach is being developed in both prone and supine positions. A new method for extracting a 3-dimensional myocardial count distribution has been developed that uses spherical coordinates to sample the apical region and cylindrical coordinates to sample the rest of the myocardium. New methods for visualizing the myocardial distribution in multiple dimensions are also described, with improved 2-dimensional, as well as 3- and 4-dimensional (3 dimensions plus time) displays. In the improved 2-dimensional display, distance-weighted and volume-weighted polar maps are used that appear to significantly improve the representation of defect location and defect extent, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Graphics↗
PubMed1990

Reversibility bull's-eye: a new polar bull's-eye map to quantify reversibility of stress-induced SPECT thallium-201 myocardial perfusion defects.

Myocardial ischemia is currently interpreted from SPECT thallium-201 (201Tl) tomograms by the subjective visual finding of stress-induced perfusion defects which "normalize" or "reverse" by 4 hr. Thus, we have developed a computer method to quantify and display the three-dimensional distribution of reversible segments. Circumferential profiles generated from the short axis slices are normalized to the reference area in the stress study. The stress is subtracted from the normalized delayed data, and then displayed as a polar bull's-eye plot so that positive values show areas that have "reversed" or "improved." Patient profiles are compared to means and standard deviations of reversibility for all pixels determined from the Emory normal male files. Criteria for reversibility were developed from studies of 42 male patients found to have 48 defects, as determined by the consensus of five blinded expert observers. There was computer agreement with the experts on 25 of 31 relatively fixed and 14 of 17 reversible defects. Our preliminary results indicate that this new method promises to aid observers to more consistently identify and quantify the reversibility of SPECT 201Tl myocardial perfusion defects.

Adult↗