Pulmonary Embolism With Radionuclide Imaging Of The Heart Failure Study

Partâ… Comparison of Lung Scintigraphy with Multi-slice Spiral CT in the Diagnosis of Pulmonary EmbolismPurpose:To compare the diagnostic efficacy of lung perfusion scan combined with lung ventilation(V/Q) scan and/or chest radiography with contrast-enhanced multi-slice spiral computed tomography pulmonary angiography(CTPA) in diagnosing pulmonary embolism(PE).Furthermore, perfusion scan was compared with CTPA on a segment-by-segment basis.Methods:Eighty-two consecutive patients with suspected PE were enrolled. All patients underwent CTPA,lung perfusion imaging,and chest radiography.Twenty-eight patients underwent lung ventilation imaging. The final diagnosis was made using a composite reference test.Results:For all 82 patients,the sensitivity,specificity,positive predictive value(PPV) and negative predictive value(NPV) were 89.2%, 92.1%,91.7%and 89.7%respectively for V/Q scan or perfusion scan combined with chest radiography,and 97.3%,97.4%,97.3%and 97.4% respectively for CTPA,excluding 7(8.5%) patients with non-diagnostic results.For the 28 patients with V/Q scan,the sensitivity,specificity, PPV and NPV were 91.7%,92.9%,91.7%and 92.9%respectively for V/Q scan, and 91.7%,100.0%,100.0%and 93.3%respectively for CTPA,excluding 2(7.1%) patients with non-diagnostic results.For the 54 patients without ventilation scan,chest radiography was used instead.Five(9.3%) patients with non-diagnostic results were excluded.The sensitivity, specificity,PPV and NPV were 88.0%,91.7%,91.7%and 88.0%respectively for perfusion scan combined with chest radiography,and were 100.0%, 95.8%,96.2%and 100.0%respectively for CTPA.In the 42 patients with PE,five(11.9%) patients with non-diagnostic results were excluded. For the remaining 37 patients,perfusion scan showed 70 lobar perfusion defects,174 segmental perfusion defects,and 59 sub-segmental perfusion defects;CTPA revealed emboli in 31 main arteries,in 74 lobar arteries,in 164 segmental arteries,and in 10 sub-segmental arteries. In the segment-based analysis,a total of 629 segments were evaluated. The segmental agreement rate between perfusion scan and CTPA was 69.5% (Kappa=0.30,p<0.05).Perfusion scan revealed significantly more sub-segmental abnormalities than CTPA(59 vs.10,Test x²,p<0.05).Conclusions:V/Q scan,perfusion scan combined with chest radiography and CTPA all show high efficacy in diagnosing PE.V/Q scan or perfusion scan combined with chest radiography is as accurate as CTPA.The concordance between perfusion scan and CTPA was intermediate on the segmental basis. Partâ…¡1.Diagnostic and Prognostic Value of Gated SPECT in Patients with Chronic Heart FailurePurpose:To evaluate the diagnostic and prognostic value of quantitative rest electrocardiogram-gated single photon emission computed tomography(SPECT) with^99m Tc-sestamibi(99mTc-MIBI) in patients with chronic heart failure(CHF).Methods:One hundred and forty-one consecutive patients who had CHF were enrolled prospectively between August 2007 and October 2008.Eighteen patients were excluded for meeting exclusion criteria and three patients were excluded for lost to follow up.Finally,120 patients were included (male,94,female,26,mean age,56±16 years).The diagnosis of CHF was made by physicians based upon the patients' symptoms,signs, laboratory recorders,imaging tests,and medical history.All patients underwent rest gated SPECT myocardial perfusion imaging.During the mean follow-up period of 236±94 days,the patients or their relatives were contacted using telephone or mail.The study endpoints were defined as cardiac death,or acute coronary syndrome(ACS),or CHF requiring hospitalization,or clinical need for cardiac surgery.Gated SPECT images were analyzed by Quantitative Gated SPECT(QGS) and Quantitative Perfusion SPECT(QPS),and then the left ventricular ejection fraction (LVEF),cardiac index(CI),summed rest scores(SRS),summed motion score(SMS),summed thickening score(STS),peak filling rate(PFR), and time to peak filling(TTPF) were calculated.Gated SPECT imaging results were analyzed,and survival analyses were performed using the Cox proportional-hazards model to establish the combined risk of cardiac events or disease progression for the variables assessed.Results:Among the 120 patients with CHF,39 patients were ischemic cardiomyopathy,81 patients were non-ischemic cardiomyopathy.Mean LVEF was 25.7%±12.2%and mean SRS was 10.2±10.4 for all patients on gated SPECT.SRS of the patients with ischemic cardiomyopathy were significantly higher than the patients with non-ischemic cardiomyopathy (19.0±12.5 vs 6.0±5.5,t test,p<0.05).During follow-up,there were three cases of cardiac death,four cases of ACS,23 cases of hospitalization for CHF,and nine cases of cardiac surgery.Cox regression demonstrated that SRS≥9(RR=2.86,p<0.05) and Def Ext≥14%(RR=2.71,p