[Diagnostic charts: Cardiovascular nuclear medicine. 2. Infarct scintigraphy, radionuclide angiography, radionuclide phlebography].
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Arteries↗
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Acute cholecystitis: diagnosis with radionuclide angiography.
Radionuclide angiography and cholescintigraphy were performed with a bolus injection of technetium-99m disofenin in 65 patients with suspected acute cholecystitis. Acute cholecystitis was surgically confirmed in 23 of 25 cases in which radionuclide angiographic findings were positive (i.e., showed focal increased flow to the gallbladder region) (positive predictive value, 92%). Sensitivity and specificity of radionuclide angiography for detecting acute cholecystitis were 72% and 94% for cholescintigraphy. Three patients with scintigraphically visible gallbladders (at 45 minutes, 2.4 hours, and 4.5 hours) and positive angiograms had severe acute cholecystitis and abscess. All 20 patients with positive radionuclide angiographic and scintigraphic results had transmural acute cholecystitis. None of the nine patients with acute cholecystitis and false-negative angiograms had abscess or gangrene of the gallbladder. Use of radionuclide angiography may enable the prediction of the severity of acute cholecystitis, as nine of 25 patients with positive findings had either gangrenous cholecystitis or pericholecystic abscess. Positive findings on radionuclide angiograms may preclude the need to obtain delayed (beyond 1 hour) cholescintiscans.
Acute Disease↗
Radionuclide angiography.
Radionuclide angiography is an established, widely used diagnostic tool. It is safe, easy to perform, and the low patient radiation dose makes frequent follow-up studies feasible. High-quality scintiscans have contributed to the widespread clinical acceptance of the procedure. The areas of application include virtually every organ of the body. In the brain, abnormalities in cerebral perfusion may be detected with this technique. Hepatic and renal tumors can be differentiated from cysts with radionuclide angiography. Its application to cardiology is achieving rapid growth and acceptance in both congenital and acquired heart disease.
Aortic Diseases↗
Differential shunting in the diagnosis of patent ductus arteriosus with Eisenmenger physiology by radionuclide angiography.
Radionuclide angiography and static whole body imaging performed with technetium-99m-labeled particulates can clearly demonstrate differential shunting in patients with patent ductus arteriosus (PDA) with Eisenmenger physiology. The anatomic arterial relationships in this condition which direct deoxygenated blood into the lower body (differential cyanosis) produce specific radionuclide images characterized by differential shunting of the technetium-99m-labeled particulates into the abdomen and lower extremity.
Adult↗
A noninvasive method for measuring portal venous/total hepatic blood flow by hepatosplenic radionuclide angiography.
Radionuclide angiography was used to generate first-pass radioactivity vs. time curves for the left heart, right hepatic lobe, right lung, spleen, and both kidneys following rapid intravenous injection of 20 mCi (740 MBq) of 99mTc-pertechnetate. Seven normal subjects were examined as well as 57 cirrhotic patients, who also underwent angiographic grading of portal venous perfusion. For analysis, two time points were identified: (a) t0, when 99mTc first entered the liver (the initial rise of either curve); and (b)tc, when 99mTc was maximal in abdominal organs (the renal peak). Analysis was based on the slopes of the two phases of the hepatic curves t0 + 7 seconds and Tc + 7 seconds; this time selection permitted analysis of all curves. The hepatic perfusion index (HPI) = slope (tc + 7 secs)/slope (t0 + 7 secs) + slope (tc + 7 secs). The mean HPI for the normal subjects was 66% +/- 7; for the cirrhotic patients with angiographic Grades I, II, III, and IV, the HPI was 52% +/- 9, 37% +/- 6, 15% +/- 7, and 3% +/- 4, respectively. Correlation between HPI and angiography was significant (p less than 0.001). This method offers a readily available, rapid, relatively inexpensive, and quantitative method of grading the ratio of portal venous to total hepatic blood flow.
Adult↗
Detection of active bleeding from ruptured aortic aneurysm by emergency radionuclide angiography.
Radionuclide angiography of the abdominal aorta provides hemodynamic information of the kidneys, aorta and aneurysm as well as the location and extent of aneurysm. Visualization of early abnormal activity in the pelvic region simultaneously with iliac artery visualization is thought to be a specific finding of active bleeding from a ruptured aneurysm of the abdominal aorta.
Aorta, Abdominal↗
Effect of ventricular pacing on left ventricular function assessed by radionuclide angiography.
Radionuclide angiography was used to evaluate left ventricular contraction on and off ventricular pacing in 35 patients. Twenty patients had permanent rate-adjustable ventricular demand pacemakers whose rate could be programmed to below an underlying sinus rhythm. In these patients there was no difference in left ventricular ejection fraction on and off pacing whether or not heart failure was present (n = 7) or whether or not ventriculoatrial conduction (n = 10) developed during pacing. Eight of the 20 patients also underwent supine bicycle exercise, and rest and exercise ejection fraction values were not significantly different at a similar heart rate and workload when on and off pacing were compared. During pacing, there appeared to be abnormal motion in septal, apical, and inferior walls. In addition, dysynchrony developed, consisting of early right ventricular and anterobasal and posterobasal left ventricular motion with subsequent contraction of the apex. Conversion to atrioventricular pacing produced a clinical improvement in all seven patients with heart failure and reduced ejection fraction and also in one of the remaining 13 patients without heart failure. Fifteen other patients were studied early after cardiac surgery. Temporary ventricular epicardial pacing resulted in a significant increase in right and left atrial pressure and a significant reduction in stroke volume, end-diastolic volume, and end-systolic volume with no significant change in ejection fraction. Conversion from sinus rhythm to ventricular pacing produces a deterioration in cardiac performance and severe regional left ventricular wall motion abnormalities, but no significant change in ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Evaluation of left ventricular systolic function by 3D echocardiography: a comparative study with X-ray angiography and radionuclide angiography.
OBJECTIVE: the aim of this study was to evaluate left ventricular systolic function by 3D ultrasound as compared to with radionuclide and X-ray angiographies. METHODS: one hundred and four patients were examinated by 3D ultrasound (3D-US) but only 72 examinations were successful. Thirty patients were investigated by 3D-US, M-mode US or bidimensional (2D) US, and X-ray angiography (group I) and 42 patients were investigated by 3D-US, M-mode, or 2D, and radionuclide angiography (group II). RESULTS: the correlation between ejection fraction (EF) evaluated by 3D-US and reference methods was found to be good and similar for the two groups (r=0.75; P<10(-4) for group I and r=0.76; P<10(-4) for group II). The correlation between EF calculated by conventional 2D-US and by reference methods was lower (r=0.60; P=0.04 for group I and r=0.54; P=0.001 for group II). The correlation between EF evaluated by 3D- and 2D-US was modest (r=0. 55; P=0.001 for the whole group). The correlation between 3D-US left ventricle end-diastolic volume (EDV) and end-systolic volume (ESV) and those evaluated by X-ray angiography was also modest (r=0.33; NS for EDV and r=0.60; P<10(-4) for ESV). The correlations between EDV and ESV in 3D-US, and those evaluated from radionuclide angiography were fairly good and in the same range (r=0.76; P<10(-4) and r=0.87; P<10(-4)). CONCLUSION: the 3D-US system using a rotating probe in an apical view is valuable for evaluation of left ventricular systolic function.
Angiocardiography↗
Effects of angiographic contrast medium on left ventricular function: evaluation by contrast angiography and radionuclide angiography.
The purpose of this study was to evaluate the effect of angiographic contrast medium on left ventricular (LV) function in 26 patients undergoing diagnostic cardiac catheterization. Beat-by-beat analysis during contrast ventriculography showed that the ejection fraction (EF) was lower in the last beats than in the first beats (P less than .02). Radionuclide angiograms were obtained the day before, as well as 15 to 65 minutes after catheterization, which included contrast ventriculography and coronary anteriography. The EF by radionuclide angiography was lower after catheterization than before (43 +/- 14% vs 47 +/- 17%, P less than .01). The EF decreased by greater than or equal to 5% in 11 of the 26 patients (42%) after catheterization. The decrease in EF in some patients was observed up to 65 minutes after catheterization and was not associated with symptoms or ST-T changes. The EF decreased in only one of nine patients who received nitroglycerin during catheterization, whereas it decreased in 10 of 17 patients who did not receive nitroglycerin (P less than .05). The EF decreased in 9 of 14 patients (64%) who had normal resting LV function, whereas it decreased in only 2 of 12 patients (17%) who had abnormal resting function (P less than .05). Thus, contrast material may depress LV function up to 1 hr and is more frequent in patients with normal resting EF. The use of nitroglycerin during catheterization may mask this effect.
Adult↗
Quantitative assessment of surgically induced mitral regurgitation using radionuclide ventriculography and first pass radionuclide angiography.
Radionuclide ventriculography has been used in humans to evaluate valvular incompetency. The stroke volume ratio, derived from the radionuclide ventriculogram, is used to quantify the severity of mitral regurgitation (MR). Previous studies conducted in humans have shown that left to right stroke volume ratio increases as the severity of MR increases. In this study, we evaluated radionuclide ventriculography as a noninvasive method to detect MR in dogs with surgically created mitral insufficiency. Six male and three female adult, conditioned mongrel dogs were used. Scintigraphic studies were performed prior to and 4 weeks after surgically created MR. Because of the overlap of the left and right ventricles when viewed from a left lateral position, we combined data from a first-pass radionuclide angiocardiogram with the radionuclide ventriculogram to obtain a corrected stroke volume ratio. Blood flow transit parameters were also derived from the first-pass radionuclide angiocardiogram. Standard left ventricular functional indices were also measured from the radionuclide ventriculogram. On the left lateral view of the heart, 25 to 30% of the right ventricular volume overlaps the left ventricle. After correcting for the overlap, the stroke volume ratio of normal dogs was 1.17+/-0.178 (mean+/-SD), which increased to 2.06+/-0.41 (mean+/-SD) (p < .001) 4 weeks after creation of MR. The was no significant change in left ventricular ejection fraction or peak rate of ejection following MR. The transit times of blood through the left ventricle were measured from the first-pass radionuclide angiocardiogram and were expressed as half-time clearance, peak clearance rate, and time to peak clearance rate. The baseline half-time clearance was 2.07+/-0.71 s (mean+/-SD), which increased to 6.70+/-4.89 s (mean+/-SD) (p = .02) after creation of MR. The baseline peak clearance rate was 49.75+/-8.96 cts/s (mean+/-SD), which decreased to 23.12+/-6.84 cts/s (mean+/-SD) (p < .001) after creation of MR. Stroke volume ratios significantly increased following creation of MR. Blood flow transit through the left ventricle slowed following creation of MR. The variability of these parameters were small in the baseline studies, suggesting these techniques may be clinically useful to gauge the severity of MR in dogs.
Angiocardiography↗
[Left ventricular diastolic performance in patients with myocardial infarction: assessment with backward method of radionuclide angiography].
Radionuclide technique in the evaluation of left ventricular (LV) diastolic performance has been applied in patients with myocardial infarction (MI). But the late diastolic LV volume curve obtained from the radionuclide angiogram is unreliable, whenever we sum up radioactivities by ECG-triggered method (conventional method) because of respiratory arrhythmia. The purpose of the present study was (1) to estimate the reliability of diastolic LV volume curve obtained from the radionuclide angiogram by our new method (backward method: backward ECG-gated radionuclide angiogram to the preceding R wave), and (2) to determine the availability of Phase 1 max and Phase 3 max as the indexes of LV diastolic performance. We analyzed LV volume curve and its dV/dt curve in 29 cases by both conventional and backward methods. The LV diastolic period was equally divided into three time intervals. The early, mid and late trisections of the diastolic period were expressed as phase 1, phase 2 and phase 3, respectively. A Phase max was defined as maximum dV/dt in the phase corrected for end-diastolic counts. At first, ejection fraction (EF), Phase 1 max, Phase 2 max and Phase 3 max were compared between the two different methods to estimate the reliability of diastolic LV volume curve obtained from a backward method. The backward method correlated well with the conventional method regarding EF and Phase 1 max (r = 0.965 and r = 0.940, respectively), but there was no correlation regarding Phase 3 max. This indicated that LV diastolic volume curve obtained from the backward method was reliable. In the second place, we analyzed LV dV/dt curve obtained from the backward method in 8 controls and 28 MI patients to determine the availability of Phase max as the indexes of LV diastolic performance. Phase 1 max was reduced earlier than a decrease of EF, and Phase 3 max was increased prior to a decrease of EF in MI. These data indicated that Phase 1 max and Phase 3 max as the indexes of LV diastolic performance were more sensitive than the indexes of LV systolic performance. Also MI patient had an abnormality in early diastolic filling and an increased atrial contraction in late diastolic filling of the left ventricle. The mechanism of abnormal LV early diastolic filling, even in the absence of abnormal systolic function, might be impaired LV suction because of fibrosis or the relatively ischemic myocardium. In mild to moderate LV failure atrial contraction compensated abnormal early diastolic filling, but there was no such a compensation in severe LV failure. It may suggest the limitation of atrial function as a booster pump.
Aged↗
Combined evaluation of first pass radionuclide angiography and equilibrium radionuclide ventriculography in the diagnosis of coronary artery disease. II. Results during exercise.
Results of 203 patients who underwent first pass radionuclide angiography (FP) and quantitative equilibrium radionuclide ventriculography (qERNV) were stored in a data base system and evaluated statistically. Eighty eight of these patients also underwent exercise equilibrium radionuclide ventriculography (E-qERNV). In patients with coronary artery disease (CAD) without previous myocardial infarction (MI), evaluation of global and regional ejection fraction (gEF, rEF) at rest revealed a poor sensitivity of 64%, the specificity was about 71% (qERNV). FP at rest revealed similar values of sensitivity (69%) and specificity (83%). Additional assessment of stress induced changes of gEF, significantly (P less than 0.05) improved sensitivity of qERNV in CAD patients without a history of previous MI to 84% (specificity 86%). In patients with one previous MI, however, similar values of sensitivity were found (R-FP: 87%, R-qERNV: 84%, E-qERNV: 93%). In patients with several MI's, sensitivity was above 90% at rest and during exercise (R-FP: 96%, R-qERNV: 93%, E-qERNV: 100%).
Coronary Disease↗
Combined evaluation of first-pass radionuclide angiography and equilibrium radionuclide ventriculography in the diagnosis of coronary artery disease. I. Results at rest.
The results of 203 patients who underwent first-pass radionuclide angiography (FP), as well as quantitative equilibrium radionuclide ventriculography (qERNV), were stored in a data base system and evaluated statistically. In patients with coronary artery disease (CAD) without previous myocardial infarction (MI), evaluation of global and regional ejection fraction (gEF, rEF) at rest revealed a poor sensitivity of 64% (Rest-qERNV) and 69% (Rest-FP), respectively. In patients with a history of one previous MI, the sensitivity of both methods was equivalent: FP 87% and qERNV 84%. In patients with several MIs, sensitivity was higher than 90%. Concerning localization of MI, remarkable differences between FP and qERNV were found. In posterior wall infarction, the FP sensitivity was 87% and qERNV only 67%, whereas in anterior wall infarction, the results were similar for both methods: 93% (FP) and 96% (qERNV), respectively. Since 30 degrees RAO camera position achieves the best visualization of the anterior and posterior wall, FP is superior to qERNV in the evaluation of posterior wall asynergies. In addition, qERNV often fails to discriminate anterior and posterior wall motion abnormalities.
Coronary Disease↗
Detection of a traumatic renal arterial venous fistula by radionuclide angiography (RNA).
Radionuclide angiography is a valuable screening test for arteriovenous (AV) fistulas. A case is presented of a young man with a post-traumatic AV fistula involving the renal artery and vein initially diagnosed by radionuclide imaging and subsequently confirmed by angiography. In the patient described dynamic flow studies showed concentration at the site of an AV fistula which was successfully treated operatively. We now recommend radionuclide angiography in patients with penetrating abdominal trauma and unexplained abdominal findings.
Abdominal Injuries↗
Assessment of splanchnic blood flow in alcohol and drug abuse using radionuclide angiography.
Computerized radionuclide angiography (RA) is a noninvasive, quantitative, reproducible, and cost-effective method for measuring the portal venous fraction of total hepatic blood flow (represented by the Hepatic Perfusion Index, HPI), and also can be utilized to detect hemodynamic abnormalities in the spleen. A group of 105 men (aged 20-56) were evaluated at the time of admission to the Substance Abuse Program at the Department of Veterans Affairs Medical Center. These patients were classified into three groups: (a) alcohol dependence or abuse (Group A, n = 54); (b) polysubstance abuse without alcohol (Group B, n = 9); and (c) polysubstance abuse with alcohol (Group C, n = 42). Of the respective groups, 69%, 100%, and 79% had abnormal splanchnic flow (liver and/or spleen), whereas only 43%, 78%, and 48% had abnormal liver function tests. This method may be a sensitive, noninvasive detector of early pathophysiological changes in the splanchnic organs of alcohol and drug abusers.
Adult↗
Alterations in left ventricular diastolic function in chronic ischemic heart failure. Assessment by radionuclide angiography.
Using radionuclide angiography at rest, we studied several parameters of left ventricular systolic and diastolic function in 60 patients divided into three groups, a control group (G1) of 15 patients and two groups of patients with chronic ischemic heart disease and previous anterior wall myocardial infarction but without aneurysm or dyskinetic wall motion, a second group (G2) of 23 patients with no history of heart failure, and a third group (G3) of 22 patients in New York Heart Association (NYHA) class II or III of heart failure. Ejection fraction, peak emptying, and peak filling rates, in addition to times to reach peak rates, were evaluated after constructing a global time-activity curve and its first time derivative. In addition, we computed the first time-derivative curves for each image pixel and obtained functional images (MIN/MAX images) representing the distribution of times to peak emptying or filling rates Using a left ventricular region of interest, time histograms were generated, and indexes of dispersion of times to peak rates, defined as the full width at half maximum of the histograms, were obtained. Significant (p less than or equal to 0.01) differences were observed among all groups for ejection fraction, peak emptying rate, and peak filling rate. The decrease of the peak filling rate still remained significant from group G1 to group G3 even after adjustment for differences in ejection fraction and heart rate. Peak filling rate was linearly correlated with ejection fraction in the population with ischemic heart disease (G2 + G3) (r = 0.68, p less than or equal to 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
Coronary Disease↗
Radionuclide angiography and Doppler sonography to detect patients with cerebrovascular disease. A correlation with radiographic angiography.
Cerebral radionuclide angiography with 99mTc pertechnetate (RNA) and directional Doppler sonography (DS) were employed to study patients with cerebrovascular disease (CBVD). The 86 patients investigated were divided following radiographic angiography (RGA) into normals (n = 26) and into patients with intracranial (n = 22) and extracranial (n = 38) vascular lesions. Of the patients with angiographically demonstrated CBVD, RNA detected 90%, DS 53.3%. The combined evaluation had a sensitivity of 93.3%. If intracranial arterial disease was excluded, the sensitivity of the studies was 92.1% for RNA and 84.2% for DS and combined evaluation had a sensitivity of 97.4%. The diagnostic accuracy by combined evaluation was 93.8% for the extracranial arterial lesions if the clinical findings were also used in patients with normal RGA pattern. RNA and DS complement each other as RNA contributes to the detection of intracranial blood flow alterations indicating vascular changes in either the extra- or intra-cranial vessels and helps confirm and complete DS findings.
Arterial Occlusive Diseases↗
Evaluation of left ventricular performance by gated radionuclide angiography.
Gated radionuclide angiography (RVG) in orthogonal projections was used to evaluate left ventricular volume, ejection fraction, and segmental wall motion. Images of the left ventricle at end-diastole and end-systole were outlined in two projections using a simple manual method. The perimeter drawings were digitized on a desktop computer, interfaced to an XY recorder and left ventricular volumes and ejection fraction calculated. The results were compared to contrast left ventriculography (CVG) in the same projections. RVG and CVG gave similar results for end-diastolic volume (r = .87, P less than 0.001), end-systolic volume (r = .95, P less than 0.001), and ejection fraction (r = .89, P less than 0.001) over a wide range of values. In 92% of all left ventricular segments analyzed, RVG and CVG showed only minor differences in the analysis of wall motion. Reproducibility of the method by a trained observer was excellent. Interobserver trials demonstrated that less well-trained observers consistently over- or underestimated volumes, emphasizing the need for prior experience in RVG analysis. Use of this manual method for analysis of gated equilibrium RVG in orthogonal projections appears to be a reasonably accurate, reproducible method for evaluating left ventricular function.
Angiocardiography↗