Patrick V. Ford

Prognostic Value of Myocardial Perfusion Imaging in Patients With High Exercise Tolerance

BACKGROUND Although high exercise tolerance is associated with an excellent prognosis, the significance of abnormal myocardial perfusion imaging (MPI) in patients with high exercise tolerance has not been established. This study retrospectively compares the utility of MPI and exercise ECG (EECG) in these patients. METHODS AND RESULTS Of 388 consecutive patients who underwent exercise MPI and reached at least Bruce stage IV, 157 (40.5%) had abnormal results and 231 (59.5%) had normal results. Follow-up was performed at 18+/-2.7 months. Adverse events, including revascularization, myocardial infarction, and cardiac death, occurred in 40 patients. Nineteen patients had revascularization related to the MPI results or the patients condition at the time of MPI and were not included in further analysis. Seventeen patients (12.2%) with abnormal MPI and 4 (1.7%) with normal MPI had adverse cardiac events (P<0.001). Cox proportional-hazards regression analysis showed that MPI was an excellent predictor of cardiac events (global chi2=13.2; P<0.001; relative risk=8; 95% CI=3 to 23) but EECG had no predictive power (global chi2=0.05; P=0.8; relative risk=1; 95% CI=0.4 to 3.0). The addition of Dukes treadmill score risk categories did not improve the predictive power of EECG (global chi2=0.17). The predictive power of the combination of EECG (including Duke score categories) and MPI was no better than that of MPI alone (global chi2=13.5). CONCLUSIONS Unlike EECG, MPI is an excellent prognostic indicator for adverse cardiac events in patients with known or suspected CAD and high exercise tolerance.

Grossly abnormal liver-spleen scan in a patient with veno-occlusive disease of the liver that normalized completely on follow-up.

A case of veno-occlusive disease of the liver of unknown etiology is reported. In the case, the gross abnormality of liver parenchyma, ascites, and colloid shift to spleen, bones, and lungs found on a Tc-99m SC liver-spleen scan, and confirmed on liver biopsy, resolved completely on follow-up. Histologic correlation and a brief review of the literature are presented.

False negative Tc-99m hepatobiliary scan in a patient with Osler-Weber- Rendu disease

A 51-year-old woman with Osler-Weber-Rendu disease presented with right upper quadrant pain. Ultrasonography of the gallbladder and Tc-99m cholescintigraphy showed no evidence of acute cholecystitis. CT of the abdomen 9 hours after the hepatobiliary scan was consistent with acute cholecystitis. A gangrenous gallbladder was surgically removed after identification and ligation of an anomalous accessory right hepatic duct inserting directly into the gallbladder. The pathologic examination confirmed the diagnosis of acute ischemic acalculous cholecystitis.

The determination of dual pancreatic and renal transplant graft vascular patency with Tc-99m HMPAO

Combined pancreatic-renal transplants promise the restoration of physiologic control of serum glucose and normal renal function. As pancreatic transplantation becomes more common, there is an increased need for rapid, noninvasive evaluation of vascular graft patency and function. Pancreatic transplants share the renal transplants complications of ischemia at harvest but are at greater risk. Tc-99m HMPAO is a lipophilic complex that clears rapidly from the blood after intravenous injection, and tissue accumulation is proportional to regional perfusion. Using Tc-99m HMPAO to monitor the vascular competency has the advantage of a high count rate during dynamic scintigrams but, in contrast to Tc-99m DTPA, has excellent delayed static images. Four patients who received combined cadaveric pancreaticrenal transplants and had a total of eight Tc-99m HMPAO scintigraphic examinations were reviewed.

Unsuspected meningitis diagnosed by In-111 labeled leukocytes. A case report.

Clinically unsuspected bacterial meningitis was found in a patient with fever of unknown origin. Blood and urine cultures were negative for growth. Chest radiography and abdominal CT were negative for infection. Triple-phase bone imaging was performed to rule out osteomyelitis from a gunshot wound. A left posterior iliac crest hot spot may have represented osteomyelitis, but ln-111 labeled leukocyte imaging instead disclosed unsuspected meningitis. The CSF culture after the imaging was positive for Enterobacter aerogenes.