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Kim K, Lee YJ, Kim MH, Byun BH, Woo SK. Automatic Quantitative Assessment for Diagnostic and Therapeutic Response in Rodent Myocardial Infarct Model. Biomedicines 2024; 12:219. [PMID: 38255324 PMCID: PMC10813557 DOI: 10.3390/biomedicines12010219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/24/2024] Open
Abstract
The purpose of this study was to investigate the most appropriate methodological approach for the automatic measurement of rodent myocardial infarct polar map using histogram-based thresholding and unsupervised deep learning (DL)-based segmentation. A rat myocardial infarction model was induced by ligation of the left coronary artery. Positron emission tomography (PET) was performed 60 min after the administration of 18F-fluoro-deoxy-glucose (18F-FDG), and PET was performed after injecting 64Cu-pyruvaldehyde-bis(N4-methylthiosemicarbazone). Single photon emission computed tomography was performed 60 min after injection of 99mTc-hexakis-2-methoxyisobutylisonitrile and 201Tl. Delayed contrast-enhanced magnetic resonance imaging was performed after injecting Gd-DTPA-BMA. Three types of thresholding methods (naive thresholding, Otsu's algorithm, and multi-Gaussian mixture model (MGMM)) were used. DL segmentation methods were based on a convolution neural network and trained with constraints on feature similarity and spatial continuity of the response map extracted from images by the network. The relative infarct sizes measured by histology and estimated R2 for 18F-FDG were 0.8477, 0.7084, 0.8353, and 0.9024 for naïve thresholding, Otsu's algorithm, MGMM, and DL segmentation, respectively. DL-based method improved the accuracy of MI size assessment.
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Affiliation(s)
- Kangsan Kim
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Yong Jin Lee
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Min Hwan Kim
- Research Institute of Radiopharmaceuticals, FutureChem Co., Ltd., Seoul 04794, Republic of Korea
| | - Byung Hyun Byun
- Department of Nuclear Medicine, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
| | - Sang-Keun Woo
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul 01812, Republic of Korea
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Gimelli A, Aimo A, Pasanisi EM, Coceani MA, Clemente A, Emdin M, Shaw LJ. Myocardial stress perfusion scintigraphy for outcome prediction in patients with severe left ventricular systolic dysfunction. Eur J Nucl Med Mol Imaging 2021; 48:3502-3511. [PMID: 33735407 DOI: 10.1007/s00259-021-05312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
Coronary angiography has been recommended in all patients with suspected chronic coronary syndrome and left ventricular ejection fraction (LVEF) ≤35%. The role of ischemia testing, for example, through stress-rest myocardial perfusion scintigraphy (MPS), for risk prediction is not well established. METHODS We evaluated 1576 consecutive patients referred to MPS and stratified into 3 LV ejection fraction (LVEF) categories: ≤35%, 36-49%, and ≥ 50%. RESULTS Patients with LVEF ≤35% were oldest, most often men, and with the highest likelihood of prior early (elective or urgent) coronary revascularization. They had also the highest values or summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS), as well as the highest frequency of significant coronary artery disease, and a greater number of diseased vessels. FOLLOW-UP In this subgroup, 32 cardiovascular death or non-fatal myocardial infarction (MI) (21%), 35 all-cause deaths (22%), and 37 cardiovascular deaths, non-fatal MI, or late revascularizations (27%) were recorded with the shortest survival among all LVEF classes. SRS, SSS, and SDS had very low area under the curve values for the prediction of the 3 endpoints, with very high cut-offs, respectively. SRS and SSS cut-offs predicted a worse outcome in Cox regression models including the number of diseased vessels and early revascularization. CONCLUSIONS In patients with LVEF ≤35%, SRS and SSS are less predictive of outcome than in patients with better preserved systolic dysfunction, but their cut-offs retain independent prognostic significance from the number of vessels with significant stenoses and from early revascularization.
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Affiliation(s)
| | - Alberto Aimo
- Fondazione Toscana G. Monasterio, Pisa, Italy.,Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | | | - Michele Emdin
- Fondazione Toscana G. Monasterio, Pisa, Italy.,Scuola Superiore Sant'Anna, Pisa, Italy
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Padrón K, Peix A, Cabrera L, Garcia J, Rodriguez L, Carrillo R, Mena E, Fernandez Y. Could myocardial viability be related to left ventricular dyssynchrony? Simultaneous evaluation by gated SPECT-MPI. J Nucl Cardiol 2020; 27:1158-1167. [PMID: 32246407 DOI: 10.1007/s12350-020-02047-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/08/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND Left ventricular contraction dyssynchrony (LVCD) has been related to induced ischemia and transmural scar but the interplay of myocardial viability and dyssynchrony is unknown. The aim of the present study was to establish the role of dyssynchrony in the context of a viability study performed with nitrate augmentation gated single photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI). METHODS Fifty-four consecutive patients with ischemic dilated cardiomyopathy (IDC) and depressed left ventricular ejection fraction (LVEF) were included. They underwent a two-day rest/nitroglycerine (NTG) study GSPECT MPI to determine the myocardial viability. Patients with a nitrate-induced uptake increase of > 10% vs baseline, in at least, two consecutive dysfunctional segments were considered viable as well as those who showed no improvement in the uptake but the uptake was > 50% on post NTG study. Patients with no nitrate-induced uptake increase of > 10% and the uptake of < 50% were considered non-viable. Perfusion, function and LVCD were compared in 25 viable patients vs 29 non-viable patients at baseline and after NTG administration. RESULTS After NTG administration, in the viable group, the LVEF increased (36.44 ± 6.64% vs 39.84 ± 6.39%) and the end-systolic volume decreased significantly (119.28 ± 31.77 mL vs 109.08 ± 33.17 mL) (P < 0.01). These patients also experienced a significant reduction in the LVCD variables: phase standard deviation was reduced in the post NTG study (57.77° ± 19.47° vs 52.02° ± 17.09°) as well as the phase histogram bandwidth (190.20° ± 78.83° vs 178.0° ± 76.14°) (P < 0.05). Functional and LVCD variables remained similar in the non-viable patients (P > 0.05). CONCLUSION In patients with IDC and depressed LVEF, the myocardial viability detected by rest/ NTG GSPECT MPI, might determine LVCD improvement.
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Affiliation(s)
- Kenia Padrón
- National Institute of Cardiology, Havana City, Cuba.
| | - Amalia Peix
- National Institute of Cardiology, Havana City, Cuba
| | | | | | | | | | - Erick Mena
- National Institute of Cardiology, Havana City, Cuba
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Ker WDS, Nunes THP, Nacif MS, Mesquita CT. Practical Implications of Myocardial Viability Studies. Arq Bras Cardiol 2018; 110:278-288. [PMID: 29694555 PMCID: PMC5898779 DOI: 10.5935/abc.20180051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
Many non-invasive methods, such as imaging tests, have been developed aiming to
add a contribution to existing studies in estimating patients’ prognosis after
myocardial injury. This prognosis is proportional to myocardial viability, which
is evaluated in coronary artery disease and left ventricular dysfunction
patients only. While myocardial viability represents the likelihood of a dysfunctional muscle
(resulting from decreased oxygen supply for coronary artery obstruction),
hibernation represents post-interventional functional recovery itself. This article proposes a review of pathophysiological basis of viability,
diagnostic methods, prognosis and future perspectives of myocardial viability.
An electronic bibliographic search for articles was performed in PubMed, Lilacs,
Cochrane and Scielo databases, according to pre-established criteria. The studies showed the ability of many imaging techniques in detecting viable
tissues in dysfunctional areas of left ventricle resulting from coronary artery
injuries. These techniques can identify patients who may benefit from myocardial
revascularization and indicate the most appropriate treatment.
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Affiliation(s)
- Wilter Dos Santos Ker
- Setor de Medicina Nuclear, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Thais Helena Peixoto Nunes
- Setor de Medicina Nuclear, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Marcelo Souto Nacif
- Serviço de Radiologia, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Claudio Tinoco Mesquita
- Setor de Medicina Nuclear, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, RJ, Brazil
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Abstract
Background and objectives Since the role of positron emission tomography (PET) scanning in diabetes is not clear, this study sought to assess the usefulness of PET scanning for viability in this patient group. Methods Forty-four per cent insulin-treated, and 56% non-insulin-treated diabetic patients with severely impaired left ventricular function (LVEF 29± 9%) underwent first coronary artery bypass grafting (CABG). Pre-operative viability was assessed by PET scan. Results Eighty-two per cent of patients received ≥3 grafts. Twenty-seven patients were discharged home and followed for a mean 3.5±1.6 years. Postoperative LVEF improved to 40±9 (p<0.0001). Multiple regression analysis indicated that the only variable that predicted improvement in global LV function was presence of hibernating segments at PET scan. The single variable that predicted deterioration of LVEF was the number of segments with reduced perfusion and metabolism at PET scan. Conclusion PET scan is an accurate tool for prediction of global left ventricular function recovery following CABG in people with diabetes.
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Raja S, Singh B, Rohit MK, Manohar K, Kashyap R, Bhattacharya A, Mittal BR. Comparison of nitrate augmented Tc-99m tetrofosmin gated SPECT imaging with FDG PET imaging for the assessment of myocardial viability in patients with severe left ventricular dysfunction. J Nucl Cardiol 2012; 19:1176-81. [PMID: 22872319 DOI: 10.1007/s12350-012-9607-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/14/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Of various nuclear medicine techniques, F-18/flourodeoxyglucose (FDG) positron emission tomography (PET) is considered as the best modality for the assessment of viable myocardium (VM). In this study, we compared the diagnostic accuracy of nitrate augmented Tc-99m tetrofosmin gated G-single-photon emission computed tomography (SPECT) with FDG PET. METHODS 54 consecutive cases of angiographically proven CAD with severe LV dysfunction were enrolled in the study. The patients underwent Tc-99m tetrofosmin G-SPECT and FDG PET as per the standard protocols and were compared. RESULTS SPECT data analysis indicated functional abnormalities in 661/918 myocardial segments. F-18 FDG PET revealed VM in 496/661 segments. The diagnostic accuracy of baseline NAC, postnitrate NAC, baseline AC, and postnitrate AC Tc-99m tetrofosmin SPECT was 84%, 87%, 90%, and 94%, respectively. κ values for NAC baseline, NAC postnitrate, AC baseline, and AC postnitrate Tc-99m tetrofosmin G-SPECT were 0.65, 0.70, 0.77, and 0.85, respectively. Attenuation correction revealed viability additionally in 46 segments which were non-viable on NAC postnitrate study (P < .001). Nitrate augmentation showed viability additionally in 25 segments which were non-viable on AC baseline scan (P = .004). On patient-based analysis FDG PET changes the management only in 13% (7/54) of patients. CONCLUSIONS Nitrate augmented AC Tc-99m tetrofosmin G-SPECT shows excellent (κ = .85) agreement with FDG PET. FDG PET changes management only in 13% of the patients. Tc-99m tetrofosmin G-SPECT being more widely available and cheaper imaging modality can be reliably used to detect VM where FDG PET is not available.
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Affiliation(s)
- Senthil Raja
- Department of Nuclear Medicine & PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Diagnostic value of SPECT, PET and PET/CT in the diagnosis of coronary artery disease: A systematic review. Biomed Imaging Interv J 2011; 7:e9. [PMID: 22287989 PMCID: PMC3265156 DOI: 10.2349/biij.7.2.e9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 10/05/2010] [Accepted: 10/09/2010] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The purpose of the study was to investigate the diagnostic value of SPECT, PET and PET/CT in the diagnosis of coronary artery disease, based on a systematic review. MATERIAL AND METHODS A search of PubMed/Medline and Sciencedirect databases in the English-language literature published over the last 24 years was performed. Only studies with at least 10 patients comparing SPECT, PET or combined PET/CT with invasive coronary angiography in the diagnosis of coronary artery disease (50% stenosis) were included for analysis. Sensitivities and specificities estimates pooled across studies were analysed using a Chi-square test. RESULTS Twenty-five studies met the selection criteria and were included for the analysis. Ten studies were performed with SPECT alone; while another six studies were performed with PET alone. Five studies were carried out with both PET and SPECT modalities, and the remaining four studies were investigated with integrated PET-CT. The mean value of sensitivity, specificity and accuracy of these imaging modalities for the diagnosis of coronary artery disease was 82% (95%CI: 76 to 88), 76% (95%CI: 70 to 82) and 83% (95%CI: 77 to 89) for SPECT; 91% (95%CI: 85 to 97), 89% (95%CI: 83 to 95) and 89% (95%CI: 83 to 95) for PET; and 85% (95%CI: 79 to 90), 83% (95%CI: 77 to 89) and 88% (95%CI: 82 to 94) for PET/CT, respectively. The diagnostic accuracy of these imaging modalities was dependent on the radiotracers used in these studies, with ammonia resulting in the highest diagnostic value. CONCLUSION Our review shows that PET has high diagnostic value for diagnosing coronary artery disease, and this indicates that it is a valuable technique for both detection and prediction of coronary artery disease.
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Giorgetti A, Kusch A, Casagranda M, Tagliavia ID, Marzullo P. Myocardial imaging with 99mTc-Tetrofosmin: Influence of post-stress acquisition time, regional radiotracer uptake, and wall motion abnormalities on the clinical result. J Nucl Cardiol 2010; 17:276-85. [PMID: 20013167 DOI: 10.1007/s12350-009-9172-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 11/12/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We previously demonstrated that early (15', T1) post-stress myocardial imaging with Tetrofosmin could be more accurate than standard acquisitions (45', T2) in identifying coronary artery disease. METHODS AND RESULTS To clarify this phenomenon, 120 subjects (age 61 +/- 10 years) with both T1 and T2 scans were divided into Group 1 (53/120 pts) with more ischemia at T1 vs T2 imaging (T1-T2SDS > or = 3); Group 2 (67/120 pts) with similar results (T1-T2SDS < or = 2). Myocardial areas were categorized as control nonischemic, ischemic, and scarred on the basis of perfusion/contraction properties and coronary anatomy. In each area, regional myocardial count statistic and semiquantitative wall motion/thickening values were obtained. Analysis of T1 and T2 post-stress myocardial counts demonstrated a significant Tetrofosmin wash-out rate that was higher in Group 1 control nonischemic regions (15 +/- 8% vs 13.6 +/- 9.6%, P < .02), significantly lower in Group 1 ischemic regions (7 +/- 10% vs 12.2 +/- 9.5%, P < .0001), and comparable between scarred areas of the two groups (P = NS). Delta post-stress wall thickening (T1-T2) was lower in Group 1 ischemic regions (-4.5 +/- 9.15% vs -1.90 +/- 7.0%, P < .001) and comparable in both control nonischemic and scarred areas of the two groups (P = NS). CONCLUSION The clinical result of Tetrofosmin gated-SPECT can be influenced by the post-stress acquisition time because of ischemic-induced regional wall thickening abnormalities and the existence of a differential radiotracer myocardial wash-out.
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Affiliation(s)
- Assuero Giorgetti
- Monasterio Foundation, National Research Council/Tuscany Region, Via Moruzzi 1, 56124, Pisa, Italy.
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Nitrate-augmented myocardial perfusion imaging for assessment of myocardial viability: recent advances. Nucl Med Commun 2009; 30:415-9. [PMID: 19357548 DOI: 10.1097/mnm.0b013e32832b2ed1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Nitrate-augmented myocardial perfusion imaging has been demonstrated to improve the detection of myocardial viability and accurately predicts recovery of left ventricular (LV) function in patients with severe coronary artery disease and LV dysfunction. Recently, several studies showed the prognostic utility of nitrate imaging in evaluation of event-free survival in ischemic LV dysfunction. Furthermore, the diagnostic power of nitrate imaging compared with positron emission tomography or MRI, as well as the mechanism of nitrate-enhanced imaging, were also studied. We describe recent studies using nitrate-augmented myocardial perfusion imaging for the assessment of myocardial viability.
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Evangelista L, Acampa W, Petretta M, Ferro A, Ricci F, Luongo L, Daniele S, Punzo G, Cuocolo A. Incremental prognostic value of cardiac single-photon emission computed tomography after nitrate administration in patients with ischemic left ventricular dysfunction. J Nucl Cardiol 2009; 16:38-44. [PMID: 19152127 DOI: 10.1007/s12350-008-9004-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 09/08/2008] [Accepted: 09/12/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND We evaluated the incremental prognostic value of viability assessment by nitrate single-photon emission computed tomography (SPECT) in patients with ischemic left ventricular (LV) dysfunction. METHODS AND RESULTS One hundred and sixty-four patients with previous myocardial infarction and LV dysfunction (ejection fraction 29% +/- 15%) underwent two Tc-99m sestamibi SPECT studies, under control conditions and after sublingual nitrate administration, for evaluation of myocardial viability. In each patient, viability was defined as the presence of > or = 2 severely dysfunctional segments with preserved tracer uptake (> or = 55% of peak activity). Cardiac death, myocardial infarction, and late (> 2 months) revascularization were considered events. Follow-up was 98% complete at a mean period of 30 +/- 24 months. At baseline SPECT, 119 (73%) patients had evidence of viable myocardium, while 45 (27%) did not. Of these latter patients, 18 (40%) had evidence of viability after nitrate administration. Cardiac events occurred in 58 (35%) patients. Cumulative probability of event-free survival was similar in patients with and without viability at baseline SPECT (log rank 0.3, P = NS), while it was lower in patients with viability at nitrate SPECT compared to those without (log rank 6.3, P < .01). The addition of nitrate SPECT data significantly improved the prognostic power of the model including clinical, functional, angiographic, and baseline SPECT data (P < .01). CONCLUSIONS In patients with previous myocardial infarction and LV dysfunction, nitrate SPECT imaging provides incremental prognostic information over those obtained from clinical, functional, angiographic variables, and baseline SPECT data.
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Affiliation(s)
- Laura Evangelista
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
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Affiliation(s)
- James A Arrighi
- Brown Medical School/Rhode Island Hospital, Providence, RI 02903, USA.
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