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PubMed1987

Prediction of serious arrhythmic events after myocardial infarction: signal-averaged electrocardiogram, Holter monitoring and radionuclide ventriculography.

Noninvasive assessment was undertaken before hospital discharge in 210 patients who had recovered from acute myocardial infarction. This comprised signal-averaged electrocardiography, Holter monitoring and radionuclide left ventriculography. An abnormal signal-averaged electrocardiogram was defined as the presence of a low voltage signal less than 20 microV in the terminal 40 ms of the filtered QRS complex or a long filtered QRS complex greater than 120 ms. During a follow-up period of 6 months to 2 years (median 14 months), 15 patients had arrhythmic events: eight died suddenly and seven presented with sustained, symptomatic ventricular tachycardia. Using univariate analysis, abnormalities in each of the three noninvasive tests were able to predict arrhythmic events. Stepwise logistic regression demonstrated that each test was independently significant in predicting outcome, with a left ventricular ejection fraction less than 40% being the most powerful variable (beta = 2.8, p less than 0.005). This process generated an algorithm that allowed assessment of combinations of variables: the finding of an abnormal signal-averaged electrocardiogram in the presence of an ejection fraction less than 40% identified patients with a 34% probability of arrhythmic events. By contrast, in patients with left ventricular dysfunction but a normal signal-averaged tracing, the risk of arrhythmic events was 4% (p less than 0.001). This combination of variables was associated with a sensitivity of 80% and a specificity of 89%. Hence, using a combination of noninvasive tests after myocardial infarction, patients can be stratified according to risk of serious arrhythmic events.

Arrhythmias, Cardiac↗
PubMed2003

Keystone symposia: antibody-based therapeutics for cancer.

This important conference focused on the latest developments in therapeutic antibodies, particularly for their design, production and formulation for cancer therapy. Engineered antibodies currently represent over 30% of biopharmaceuticals in clinical trials, highlighted by the recent FDA approvals of Zevalin (ibritumomab tiuxetan, IDEC Pharmaceuticals) for cancer radioimmunotherapy and Humira (adalimumab, Abbott Laboratories) for rheumatoid arthritis [1,2]. An impressive array of international speakers was assembled in Banff by the organisers L Weiner (Fox Chase Cancer Center, USA) and P Carter (Amgen and Seattle Genetics). The meeting highlighted emerging new technologies, both for the discovery of novel cancer biomarkers and for innovative immunotherapeutic designs. The latest successes were also presented for antibodies directed to the conventional cancer targets, including CD20, carcinoembryonic antigen (CEA), erbB-family proteins and vascular endothelial growth factor (VEGF). Importantly, recent structural details emerged that will direct future designs of these cancer-targeting molecules, ranging from antibody-dependent cellular-cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC) enhancement to improved cytotoxic payloads using radionuclides, toxins, enzymes, drugs and viral delivery. The conference also highlighted the latest in vitro antibody libraries for the selection of high-affinity reagents against refractory cancer targets, and included the design of small domain modules for highly-efficient in vivo targeting to large, high avidity complexes for enhanced cytotoxicity. The major challenges in this rapidly growing area include the need to initiate and sustain innate and adaptive immune responses for the generation of efficient, long-term tumour therapy. This conference was sponsored by Amgen and accredited by the Accreditation Council for Continuing Medical Education (ACCME).

Animals↗
PubMed1997

Clinical fusion of three-dimensional images using Bremsstrahlung SPECT and CT.

UNLABELLED: Infusional brachytherapy for treatment of neoplasms, with colloidal 32P has been used to treat various tumors in the pancreas, liver, brain, lung, and head and neck. In performing such treatments, anatomical verification of the location of the administered 32P from the image obtained by Bremsstrahlung SPECT alone is not possible due to the lack of internal landmarks, since the radionuclide is distributed only in the tumor and does not usually accumulate in the normal organs. The purpose of this study was to provide a practical three-dimensional approach for image fusion between Bremsstrahlung SPECT and CT. METHODS: The tumors in four cancer patients were injected directly with 32P under CT guidance. A Bremsstrahlung SPECT study using 99mTc backscatter sources to obtain the body contour was then performed. SPECT images were used to generate the skin contours using a threshold detection method. A three-dimensional surface was generated from these contours using a tiling program and fused with a corresponding CT surface generated from a CT scan in the same patient through an iterative surface-fitting algorithm. The three-dimensional surface of the region of high-activity, corresponding to the infused tumor, was then generated using the Bremsstrahlung SPECT data by mapping the iso-count surfaces through a computer program. The three-dimensional image of the organ then was fused with the registered CT-SPECT datasets. RESULTS: The accuracy of fit measured as the mean distance between the SPECT and CT surfaces was in the range of 3-4 mm. CONCLUSION: The anatomical co-registration of Bremsstrahlung SPECT with CT images using the outer surface-fitting algorithm is a reliable tool. This correlation permits direct anatomic confirmation of the region of the 32P activity distribution with the anatomic site selected for injection.

Algorithms↗
PubMed2004

[Experimental study of porous TCP to generate tissue-engineered long bone].

To study bone-forming of a new kind of porous beta-TCP as the scaffold for tissue-engineering, defects at the mid-portion of the left and right ulna were created in dog, the defects were repaired with beta-TCP cylinder coated with BMSCs, and beta-TCP cylinders alone as control. X-rays showed the defects were better bridged by the replant with obscure edge and new bone formed in the canal and at the interface in experimental group after three month of operation, whereas in control group, the replants were obviously deformed into dissociated granule with unequal density with only little new bone formed at the interface. After six month, the defects were bridged by new bone with osteodermatous cavum medullare ossium, but in control group, the defects were bridged by high density in radiography without osteodermatous cavum medullare ossium, the diameter of the ular was obviously less than experimental group. There were significant differences between both groups at month one and two in the development pattern through radionuclide observation. By gross, the diameter of ular was smaller in control group than in experimental at month three, and the replants in control group was difficult to detach from the fibroid tissue around it, but in experimental group, there was much more new bone formation, and the surface was rough for the compound of new bone and beta-TCP undegraded completely. The new bone in experiment had been obviously remodeled at month six, but at this moment, the new bone was of infirmity in volume and form. HE staining of three months demonstrated new bone adhered to the surface on the core of beta-TCP in experimental group, but in control group, at the same place, osteoid was observed with much megacayocytes and capillaries. At month six, beta-TCP disappeared completely with new bone formed in both groups, but the volume and structure of the bone was better in experimental group than in control group. From this study it is concluded that the porous beta-TCP can be combined with BMSCs, and the combination could generate new bone to repair long bone defect.

Animals↗
PubMed1988

[Diagnosis of skeletal tumors using 113mIn-indifor].

A new Soviet osteotropic agent 113mIn-indifor was used in clinical practice in 88 patients with primary (56), secondary (22), and systemic (10) skeletal diseases. The sensitivity of the method was 87.7%, its specificity--75%. The main indication for its use was a search for new or additional metastatic foci in malignant tumors of various sites. Investigations using 113mIn-indifor and 99m Tc-phosphates were conducted in 35 patients with different skeletal lesions. The authors obtained the results indicating the same informative value of both radiopharmaceuticals--90.3%. In view of some difficulties in supplies of generators of technetium, 113mIn-indifor can replace 99m Tc-phosphates in routine investigations of primary and especially metastatic skeletal lesions.

Bone Neoplasms↗
PubMedDate not supplied

Clinical and experimental aspects of myocardial stunning.

Although the mechanisms involved in stunning remain incompletely defined, it appears that intracellular calcium overload, sarcoplasmic reticulum dysfunction, and the generation of OFR are important components of post-ischemic myocyte dysfunction. It is likely that a variety of mechanisms, some possibly remaining to be elucidated, are operative in the pathogenesis of stunning, and that the contribution of a particular process may be influenced by the model and the method of inducing ischemia. Myocardial stunning has been shown to be prevalent in patients with diverse cardiac diseases. Small clinical trials have suggested that electrocardiography, echocardiography, and radionuclide imaging techniques may be useful in identifying patients with stunned myocardium. In patients with depressed cardiac performance due to stunning, therapy with inotropic agents may recruit the viable but injured myocardium to contract and improve cardiac output in the short term. An important issue that will be addressed over the next decade is whether aggressive therapy aimed at reducing myocardial stunning in stable patients should be attempted. Some authorities have suggested that stunning may represent an adaptive response to limit reperfusion injury, and that interfering with this response may not be beneficial in the long term. Further investigation into the cellular and molecular basis of ischemic injury should provide insight into these and other important aspects of myocardial stunning. Methods of attenuating postischemic ventricular dysfunction that appear convincing in the research laboratory may not translate to clinical benefit when applied to humans.

Animals↗
PubMedDate not supplied

Radiopharmaceuticals for assessment of multidrug resistance P-glycoprotein-mediated drug transport activity.

Multidrug resistance (MDR) mediated by overexpression of MDR1 P-glycoprotein (Pgp) is one of the best characterized transporter-mediated barriers to successful chemotherapy in cancer patients. Thus, noninvasive interrogation of Pgp-mediated transport activity in vivo would be beneficial in guiding therapeutic choices. Both small organic medicinals as well as metal complexes characterized as transport substrates for Pgp are amenable to incorporation of PET or SPECT radionuclides and may enable noninvasive imaging of Pgp in cancer patients. Toward this objective, clinically approved agents, exemplified by (99m)Tc-Sestamibi and (99m)Tetrofosmin, have already shown promise for the functional evaluation of Pgp-mediated transport activity in human tumors in vivo. In addition, selected agents from an upcoming class of substituted Schiff-base gallium(III) complexes containing an N(4)O(2) donor core in their organic scaffold and capable of generating both SPECT and PET radiopharmaceuticals have also been shown to be promising for noninvasive assessment of Pgp activity in vitro and in vivo.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed2006

Natural radionuclides in zircon and related radiological impacts in mineral separation plants.

The activity concentration of uranium and thorium present in zircon obtained from mineral sand industries are presented. External gamma radiation levels and inhalation of airborne dust are found to be the significant routes of radiation exposure to occupational workers. The annual average dose attributed to zircon processing is estimated to be 2.3 mSv in the plants under study. This paper presents the results of external gamma measurements, estimation of airborne radioactivity in zircon process locations and radon and thoron in the occupational environment of two mineral separation plants in India. Analyses of the solid wastes and liquid effluent generated and resultant environmental impacts are indicated.

Air Pollutants, Radioactive↗
PubMed2006

[Stochastic model for the spatial visualization of particle-deposition patterns in the lung and their significance in lung medicine].

The present paper provides a detailed description of an extension of the Monte Carlo computer model IDEAL, which enables the generation of spatial particle deposition patterns in the human lung. Randomly determined particle trajectories are transformed to a Cartesian coordinate system within which the orientation of the trachea corresponds to the z-direction. At the same time, the determination of particle deposition sites is carried out by application of a grid composed of specific volume elements (voxel). The calculation of particle deposition are based on the physical mechanisms of Brownian diffusion, sedimentation, and inertial impaction. After their storage in a matrix, the deposition data are subject to graphical processing. This allows the presentation of spatial particle distribution patterns (3d-density plots) and of the lung surface itself as well as the generation of two-dimensional distributions by sectioning the three-dimensional structures at pre-defined positions. The results of different model simulations (variation of particle size and breathing conditions) are discussed in detail.

Computer Simulation↗
PubMed1991

Impact of gamma camera parameters on imaging performance, evaluated by receiver operating characteristic (ROC) analysis.

The relationship between gamma camera variables (total counts in image, collimator type, etc) and diagnostic imaging performance was quantitatively investigated using receiver operating characteristic (ROC) curve analysis. A College of American Pathologists (CAP) liver phantom was used with a 99Tcm flood source to generate anterior and lateral liver images containing 'cold lesions'. These images were interpreted by four nuclear medicine physicians, and the areas under the corresponding ROC curves computed. These medicine physicians, and the areas under the corresponding ROC curves computed. These areas were taken as a quantitative estimate of the imaging performance of the system. The average area under the ROC curve for the four physicians reading the same 'standard' image six times was computed to be 66.8 +/- 5.8. Experiments were performed to show the effect on diagnostic performance of (i) increasing the total image counts from 200k to 2000k, (ii) varying the phantom-to-collimator separation from 0 to 8 cm and (iii) changing the collimator type. In all cases, data were generated which demonstrated the quantitative improvement (or deterioration) resulting from these changes. These data may be used in the design of clinical imaging protocols, for which choices have to be made for each gamma camera variable.

Gamma Cameras↗
PubMed1974

Lipid peroxidation in the killing of phagocytized pneumococci.

To directly examine the role of hydrogen peroxide in the killing of bacteria after ingestion by granulocytes, we have studied some of the events of phagocytosis of a mutant strain of pneumococci which is relatively deficient in peroxide production. The hydrogen peroxide-deficient pneumococci and the otherwise identical wild type were grown with [(14)C]arachidonic and [(3)H]palmitic acid labels to label their lipids with unsaturated and saturated fatty acids, respectively. They were then incubated with both normal and chronic granulomatous disease granulocytes. The rates of ingestion and bacterial killing and the stability of fatty acids in the cell-bacteria complex were followed. Radioactive carbon dioxide released from glucose was also independently followed to measure glucose oxidation. Ingestion was similar for all cell-bacteria combinations. Chronic granulomatous disease cells killed the peroxide-positive wild pneumococci much more effectively (20-fold) than the peroxide-deficient mutant. Normal cells killed both peroxide-positive and -negative strains effectively. A considerable loss of [(14)C]arachidonic acid ( approximately 40%) consistent with lipid peroxidation of this unsaturated fatty acid was observed in all normal cells and in chronic granulomatous disease cells with peroxide-positive pneumococci. However, no loss of [(14)C]arachidonic acid occurred in chronic granulomatous disease cells with the peroxide-deficient pneumococci. No loss tritiated palmitic acid occurred in any cell-bacteria combination. Glucose oxidation was impaired in the chronic granulomatous disease cells in comparison to normal cells at rest and was especially impaired in chronic granulomatous disease cells ingesting the peroxide-deficient mutant pneumococci. This defect was partially corrected after phagocytosis of the peroxide-positive strain. These data directly support the hypothesis that bacterial killing is partially dependent upon an intact peroxide-generating system in the leukocyte-bacteria complex. Moreover, they indicate that bacterial lipid peroxidation is associated with the generation of peroxide during phagocytosis. Finally, they suggest that such peroxidation may contribute to effective phagocytic bacterial killing.

Animals↗
PubMed1988

Temporal Fourier transform of digital angiograms for left ventricular regional wall motion analysis.

To determine whether or not the first harmonic of a temporal Fourier transform, applied pixel-by-pixel on time-intensity curves, can detect the subtle wall motion abnormalities due to ischemia, 6 dogs were instrumented with a micromanometer in the left ventricles, a hydraulic cuff occluder around the circumflex coronary artery, and sonomicrometers on the inferior (ischemic) and anterior (non-ischemic) walls. Left ventricular images, obtained after contrast injection via the pulmonary artery, were compared with dimension signals in control and 3 progressive levels of coronary stenosis (Stenosis I, II and III). Normalized, digital functional images (512 x 512 matrix, 256 shades of gray/pixel) were divided into anterior, apical, and inferior areas to acquire regional mean phase (degrees) and amplitude (intensity units) values. After inducing stenosis, phase in ischemic region significantly increased at all 3 levels of stenosis, whereas amplitude significantly decreased at Stenosis II and III. However, amplitude images showed clearly the topographic site of ischemia. There was a progressive increase in phase and decrease in amplitude in ischemic areas as the percent wall thickening (%WTh) fell (phase vs. %WTh: r = -0.55, p less than 0.005; amplitude vs. %WTh: r = 0.71, p less than 0.001). Heart rate and peak systolic pressure showed no significant changes during stenosis. We conclude that quantitative functional images, generated from a temporal Fourier transform, are sensitive to the detection of left ventricular regional wall motion abnormalities during mild, moderate, and severe degrees of ischemia.

Animals↗
PubMed2001

MIRD Pamphlet no. 18: Administered cumulated activity for ventilation studies.

UNLABELLED: There has been no consensus on a standard calculational approach regarding the concept of administered activity in ventilation studies involving inhaled radioisotope gas or radioaerosols. This is caused in part by a lack of knowledge regarding the actual activity that enters the lung space (as opposed to activity introduced into the delivery system) and to the extended administration times (t(a)) associated with delivery protocols. METHODS: This pamphlet reviewed the three primary ventilation procedures, including rebreathing-system protocols, continuous-flow generator output techniques, and radioaerosol delivery systems. RESULTS: For each technique, an analytic expression has been derived for a new parameter called lung administered cumulated activity, A(L)(0,t(a)), which is the cumulated activity in the lungs during the administration phase. In addition, another potentially useful parameter has been defined-the mean administered activity for ventilation procedures, which normalizes the administered cumulated activity in the lung over the administration period and may serve to standardize descriptions of protocols between patients and institutions. Examples are provided that illustrate these new concepts for typical ventilation protocol administration parameters. CONCLUSION: The models presented can be employed to evaluate lung administered cumulated activity for use in ventilation dose estimate reports as a function of explicit variables (e.g., spirometer volume, generator output rate, wash-in half-time, administration time). In practice, it is recommended that dose estimate reports be based on measurements of cumulated activity in the lung over the administration period and normalized to this administered cumulated activity.

Administration, Inhalation↗
PubMed1990

The use of 3H standards in 125I autoradiography.

To avoid repeated production of 125I tissue mash standards and to decrease inter-experiment variability, a set of commercially available, high activity plastic 3H standards was calibrated for use with 125I autoradiographs. Standards with a range of 2.0-7390 microCi 3H/g plastic were used since they produced autoradiographs of suitable optical density (darkness) at exposure times of 4 to more than 72 h. Tissue mash standards at 12 concentrations of 125I were produced by homogenizing rat brains and adding 125I. These were frozen and sectioned at thicknesses ranging from 6 to 120 microns and mounted on microscope slides. Each set of tissue standards, along with slides bearing the plastic 3H standards, was opposed to film for various times. The calibration of the 3H standards was done separately for each time point and section thickness. Autoradiographs were analyzed using a computer assisted image analysis system. The standard curve generated for each set of 125I-labelled tissue standards was correlated with the 3H standards. It was found that the relationship between the 3H plastic standards and the 125I tissue mash standards was not simple and depended on exposure time, thickness of the section, as well as the concentration of radioactivity in a given standard. However, this accurate calibration of the 3H standards yields long-lived standards for 125I autoradiography useful over a wide range of radionuclide concentrations, tissue thicknesses and exposure times.

Animals↗
PubMed2004

Environmental monitoring and radioecology: a necessary synergy.

Environmental monitoring primarily aims through sampling or by the use of direct detection equipment to quantify the levels of radioactive substances and ionising radiation resulting from human activities and natural sources in the different compartments of the environment. Its objectives are very practical and include the quantification of the environmental sources of ionising radiation and the verification of compliance with regulatory requirements and permit limits for industrial, research and medical activities, as stated by their specific licence. Radioecology is a multidisciplinary science, which attempts to understand and to quantify the behaviour of radionuclides in the environment and the processes ruling their transport through natural and agricultural ecosystems to various receptors such as plants, animals and humans. A second facet of this science covers the assessment of the radiological dose to and effects on man and its environment from present, past or future, even hypothetical, nuclear activities. Despite their different immediate objectives, environmental monitoring and radioecology are complementary. Many examples illustrate the connections between these two approaches. For instance, transfer parameters generated by radioecological studies are necessary to estimate through models the radiological exposure of population, derive from the contamination level measured in a bio-indicator the quantity of radioactivity released from a nuclear installation, or identify potentially important pathways to be monitored. On the other hand, monitoring data will confirm important pathways suggested by radioecological modelling and provide site-specific data for the estimation of model parameters or actual data sets for the validation of transfer models.

Animals↗
PubMed1985

Radioimmunodetection of small human tumor xenografts in spleen of athymic mice by monoclonal antibodies.

The ability of radiolabeled monoclonal antibodies to accumulate in and image small human tumors growing in the spleen of athymic mice was assessed. The antibodies B6.2 and B72.3, which reacted against human breast (Clouser) and colon (LS174T) tumor cells in vitro and in vivo, respectively, and the isotype matched anti-horseradish peroxidase antibody which did not bind to these tumors were used in pharmacokinetic and imaging experiments. Human melanoma cells and tumors (A375) which did not react with any of the three antibodies were used as additional controls. Radioiodinated "tumor specific" and non-specific antibodies were injected i.v. into athymic mice bearing intrasplenic tumors and the mice were sacrificed at various times to assess the specificity of uptake of these antibodies into tumor and normal host tissues. The accumulation of B6.2 in the Clouser tumor was maximal at 24 h as indicated by a localization index (specific/nonspecific antibody in tumor divided by the same ratio in blood) of about 4.0. The uptake of B72.3 in LS174T tumor increased with time with a localization index of about 12.0 observed at 50 h post-antibody injection. Localization indices for the control A375 tumor and for all normal mouse tissues, including the uninvolved portion of the tumor bearing spleen, were between 0.8 and 1.0, thus indicating no specific antibody accumulation. The relative blood flows of the Clouser and A375 tumors, as determined by the 86RbCl method, were similar. The results suggested that immunospecificity was a major factor in antibody localization in vivo. Specific images of approximately 100-mg Clouser tumors with radiolabeled B6.2 and of LS174T tumor with radiolabeled B72.3 were seen by 24 h after antibody injection. Images of smaller (about 20 mg) LS174T tumors were seen by 48 h following B72.3 injection. The control antibody, anti-horseradish peroxidase, did not image either Clouser or LS174T tumor. Also the control tumor was not imaged with any of the three antibodies tested. The data generated with this novel animal model support the concept of using radiolabeled monoclonal antibodies for detecting and possibly treating small metastatic visceral tumors in cancer patients.

Animals↗
PubMedDate not supplied

Cardiac troponin I in patients with hematologic malignancies.

BACKGROUND: The cardiac isoform of troponin I (cTnI) is a myofibrillar protein highly specific for myocardial injury. We used a recently developed new-generation immunoassay with high analytical sensitivity to measure cTnI in patients diagnosed with hematologic malignancies, before chemotherapy and after an intermediate cumulative dose of anthracyclines. We hypothesized that measurement of cTnI with this sensitive method would provide evidence of myocardial injury in these patients. METHODS: Sera from 115 individuals (60 healthy controls, 25 anthracycline-naive patients and 30 patients treated with intermediate cumulative doses of anthracyclines) were assessed for cTnI, creatine kinase MB (CKMB) mass and myoglobin. Radionuclide left ventricular ejection fraction (LVEF) was also determined. RESULTS: Using this sensitive assay, detectable concentrations of cTnl were measured in the healthy population [mean, 19.5 pg/ml, 95% confidence interval (CI) 13.5-25.5 pg/ml]. Anthracycline-naive patients had cTnI mean values (36.5 pg/ml, 95% CI 25.1-47.9 pg/ml) that were significantly (P < 0.01) greater than those in the control group. cTnI was significantly (P < 0.00001) increased in anthracycline-treated patients (76.4 pg/ml, 95% CI 67.0-85.8 pg/ml) compared with both the anthracycline-naive patients and the controls. CKMB, myoglobin and LVEF were within the normal range in all patients. CONCLUSIONS: These data provide evidence for cardiac involvement in patients with hematological malignancies before and during the course of anthracycline chemotherapy. They suggest that detection of myocardial injury may be facilitated by measurement of cTnI with a highly sensitive assay.

Adult↗
PubMed1988

Differential sensitivity of radionuclide ventriculography for the detection of anterior and inferior infarction.

Attenuation of counts from the more distant inferior portion of the left ventricular blood pool in equilibrium radionuclide ventriculography may mean that inferior infarction is less likely to be detected than anterior infarction. Fourier amplitude and phase images can be used to map the extent and timing of regional ventricular wall motion and this study assesses their use for the detection of anterior and inferior infarction. Normal regional values of amplitude and phase were established in 38 individuals without evidence of cardiac abnormality. In 20 patients with anterior infarcts, though the sensitivity of the combined left anterior oblique amplitude and phase images was high (95%) it was lower (77%) in 39 with inferior infarcts, principally because the sensitivity of the phase image for the detection of inferior infarcts was only 39%. Right anterior oblique images generated from a first pass study detected all 13 patients with inferior infarcts. The mean left ventricular ejection fraction was significantly lower in the patients with anterior infarcts (37%) than in those with inferior infarcts (48%). Although the mean wall motion score on x ray contrast ventriculography was slightly lower in the patients with anterior infarction, the high sensitivity of the right anterior oblique amplitude and phase images in inferior infarction suggests that attenuation of counts is an important cause of reduced sensitivity of the left anterior oblique images. This may also partly explain the lower ejection fractions in inferior infarction. It follows that both a right anterior oblique first pass study and a left anterior oblique equilibrium study are necessary for an accurate description of regional wall motion.

Adult↗