Ryotaro Seki

Pleural amyloidosis in a patient with intractable pleural effusion and multiple myeloma

Pleural involvement of systemic amyloidosis has been rarely reported. We report a case with multiple myeloma presenting an intractable right pleural effusion, in which pleural amyloidosis was diagnosed through pleural biopsy using a Cope needle. The diagnosis of pleural amyloidosis is important, because its refractory pleural effusion should be treated with pleurodesis. Since closed pleural biopsy using a Cope needle is much less invasive than thoracoscopy, the former should be attempted first whenever pleural amyloidosis is suspected.

Prediction of Functional Improvement of Ischemic Myocardium With 123I-BMIPP SPECT and 99mTc-Tetrofosmin SPECT Imaging

BACKGROUND (18)F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) is assumed to be the most useful method of evaluating the viability of the myocardium, but its use is limited by the need for a cyclotron. In the present study, the ability of a combination of (99m)Tc-tetrofosmin (TF) and (123)I-beta-methyliodophenyl pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT), a combination of (18)F-FDG PET and (123)I-BMIPP SPECT, and a combination of (18)F-FDG PET and (99m)Tc-TF SPECT were compared to predict functional improvement of ischemic myocardium after a large acute myocardial infarction (AMI). METHODS AND RESULTS Ten patients with large AMI were studied by (99m)Tc-TF SPECT, (123)I-BMIPP SPECT and (18)F-FDG PET within 3 weeks. Six months later, (99m)Tc-TF imaging was performed. All patients underwent successful revascularization, and had no restenosis. Regional tracer uptake was scored using a 4-point scale in 20 segments of the SPECT and PET images. When the defect score of (123)I-BMIPP SPECT exceeded the defect score of (99m)Tc-TF SPECT or (18)F-FDG PET by 1 point or more, and when the defect score of (99m)Tc-TF SPECT exceeded the defect score of (18)F-FDG PET by 1 point or more, the segment was considered to show mismatching. When the defect score was the same in 2 tracers, the segment was considered to show matching. (99m)Tc-TF imaging at 3 weeks and 6 months used quantitative gated SPECT (QGS) to score wall motion using a 6-point scale (-1= dyskinesis, 0= akinesis, 1= severe hypokinesis, 2= moderate hypokinesis, 3= mild hypokinesis, and 4= normokinesis). The sensitivity of the combination of (123)I-BMIPP and (99m)Tc-TF imaging in predicting functional improvement was 61%, that of (18)F-FDG PET and (123)I-BMIPP SPECT was 94%, and that of (18)F-FDG PET and (99m)Tc-TF SPECT was 76%. The specificity of the combination of (123)I-BMIPP and (99m)Tc-TF imaging in predicting functional improvement was 83%, that of (18)F-FDG PET and (123)I-BMIPP SPECT was 40%, and that of (18)F-FDG PET and (99m)Tc-TF SPECT was 49%. The accuracy of the combination of (123)I-BMIPP and (99m)Tc-TF imaging in predicting functional improvement was 70%, that of (18)F-FDG PET and (123)I-BMIPP SPECT was 71%, and that of (18)F-FDG PET and (99m)Tc-TF SPECT was 63%. CONCLUSION The combination of (123)I-BMIPP and (99m)Tc-TF imaging is a practical modality for predicting the functional improvement of ischemic myocardium after a large AMI.

Nicorandil administration shows cardioprotective effects in patients with poor TIMI and collateral flow as well as good flow after AMI

BackgroundNicorandil (NCR) has been reported to have cardioprotective effects in patients with AMI. And collateral flow and TIMI flow are also important determinants of final salvaged myocardium in patients with AMI. There is no evidence as to whether TIMI or collateral flow modifies the cardioprotective effects of NCR in patients with AMI.Methods and ResultsWe studied 68 initial AMI patients without restenosis which was defined as 50% diameter reduction of the intervention site in the chronic period. On initial CAG, 41 patients with poor flow (collateral: Rentrop 0 or 1 and TIMI 0 or 1) were NCR/Non-NCR = 20/21. Twenty-seven patients with good flow (collateral: Rentrop 2 or 3 or TIMI 2 or 3) were NCR/Non-NCR = 13/14. NCR was administered intravenously (4 mg) via intracoronary injection (2 mg) or continuously (4 mg/h).99mTc-tetrofosmin (TF) and123I-BMIPP SPECT were performed in the subacute and chronic (6 Mo) periods. In 20 SPECT segments, summed defect scores (TDS) and regional wall motion (WMS:-1 = dyskinesis ∼ 4 = normal) of AMI segments using TF-QGS were estimated. In poor flow patients, the following values for NCR patients were higher (p < 0.05) than for Non-NCR patients in the improvement degree of TDS (BMIPP) (NCR: 6.5 ± 3.9 vs. Non-NCR: 4.0 ± 3.4), the improvement degree of TDS (TF) (NCR: 5.7 ± 4.6 vs. Non-NCR: 2.2 ± 4.6), and delta WMS (NCR: 1.4 ± 1.1 vs. Non-NCR: 0.9 ± 1.0). In good flow patients, the following values for NCR patients were better (p < 0.05) than for Non-NCR patients in TDS (BMIPP) (subacute) (NCR: 9.9 ± 5.2 vs. Non-NCR: 16.5 ± 10.4) and (chronic) (NCR: 5.1 ± 5.2 vs. Non-NCR: 12.4 ± 8.5), WMS (subacute) (NCR: 1.7+1.3 vs. Non-NCR: 1.0 ± 1.0), and WMS (chronic) (NCR: 3.0 ± 1.5 vs. Non-NCR: 2.1 ± 1.3).ConclusionWe conclude that the cardioprotective effects of nicorandil administration are observable in both AMI patients with poor collateral and TIMI flow and good flow before reperfusion therapy.

Evaluation of myocardial viability following acute myocardial infarctic using201Tl SPECT after thallium-glucose-insulin infusion —Comparison with18F-FDG positron emission tomography—

Objective and MethodsThe aim of this study was to evaluate myocardial viability in patients after acute myocardial infarction (AMI). We compared2O1T1 SPECT after2O1Tl with GIK (10% glucose 250ml, insulin 5 U and KCl 10 mEq) infusion (GIK-2O1T1) with resting2O1T1 and99mTc-pyrophosphate (PYP) dual SPECT, positron emission computed tomography (PET) using18F-fluorodeoxyglucose (18F-FDG) in 21 patients with their first AMI, who all underwent successful reperfusion. GIK-201Tl SPECT,201T1 and99mTc-PYP dual SPECT were done within 10 days after admission and18F-FDG-PET was performed at 3 weeks. GIK-201Tl SPECT was obtained after 30 min of GIK-201T1 infusion.18F-FDG (370 MBq) was injected intravenously after oral glucose (1 g/ kg) loading, and then PET was obtained. PET and SPECT images were divided into 20 segments. Regional tracer uptake was scored using a 4-point scoring system (3 = normal to 0 = defect), and summed to a regional uptake score (RUS). Regional area means the infarcted area in which99mTc-PYP accumulated. The number of decreased uptake segments (ES) was then determined. The infarcted area was defined as the area of99mTc-PYP uptake.ResultsThe ESs for the GIK-201Tl and18F-FDG-PET images were significantly lower than the number of99mTc-PYP uptake segments. The RUS for GIK-2O1T1 was higher than that for resting-201Tl imaging and similar to those for18F-FDG-PET.ConclusionsIn the detection of myocardial viability following AMI, GIK-2O1T1 imaging is useful with findings similar to those of18F-FDG-PET.

Quantitative Analysis of Iodine Image of Dual-energy Computed Tomography at Rest: Comparison With 99mTc-Tetrofosmin Stress-rest Single-photon Emission Computed Tomography Myocardial Perfusion Imaging as the Reference Standard.

Purpose: Dual-energy computed tomography (DECT) can be used for visual determination of iodine distribution in the myocardium (iodine image); however, the accuracy and reproducibility of the process remains debatable. Because of the low contrast-to-noise ratio of CT, we hypothesized that quantitative measurement may be more accurate for detecting myocardial ischemia. In this study, we evaluated our quantitative method by comparing it with visual analysis using 99mTc-tetrofosmin (TF) stress-rest single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) as the reference standard. Materials and Methods: Forty-three patients who had a significant stenosis on cardiac rest DECT and had received 99mTc-TF stress-rest SPECT MPI within 1 month were retrospectively analyzed. The regions of interest were set on iodine images in accordance with the American Heart Association (AHA) 17-segment model (a total of 731 segments). The regions of interest values were divided by the amount of iodine (mg) per unit weight (kg) and defined as perfusion value (perfusion value analysis). All segments were also visually analyzed and receiver operating characteristic curve analysis performed to identify the superior analysis. Results: The receiver operating characteristic curve analysis showed that perfusion value analysis is significantly superior to visual analysis [the area under the curve: 0.921 (95% confidence interval, 0.860-0.981) versus 0.685 (95% confidence interval, 0.580-0.791), respectively, P<0.05], with 93.8% sensitivity, 99.1% specificity, 98.9% accuracy, 83.3% positive predictive value, and 99.7% negative predictive value (P<0.01). Conclusions: Quantitative analysis of the iodine image of rest DECT, called perfusion value analysis, is more accurate than visual analysis when compared with 99mTc-TF SPECT MPI as the reference standard.

Practical assessment of myocardial viability with a positron coincidence gamma camera using 18F-fluorodeoxyglucose in acute myocardial infarction: Comparison with dedicated positron emission tomography and 201Tl single photon emission computed tomography

OBJECTIVE 2-[(18)F] fluoro-2-deoxy-D-glucose ((18)F-FDG) began to be supplied commercially to our hospital, which does not have a cyclotron, in autumn of 2005. The purpose of this study was to compare the utility of a dual-head positron coincidence detection (PCD) gamma camera in the detection of myocardial viability using (18)F-FDG with that of dedicated positron emission tomography (PET) and with that of thallium-201 ((201)Tl) single photon emission computed tomography (SPECT). METHODS A total of 15 patients (14 men and 1 woman, mean age: 60+/-7 years, range: 46-73) with a large acute myocardial infarction (AMI) underwent (18)F-FDG PET, (18)F-FDG PCD imaging after oral glucose loading (75 g) and (201)Tl SPECT imaging. We divided the SPECT and PET images into a total of 20 segments, and semiquantitative visual analysis was performed by assessing regional tracer activities on a 4-point scoring system (DS): 0=normal uptake, 1=mildly reduced uptake, 2=severely reduced uptake, and 3=no uptake. We summed the DS in each patient as the total DS (TDS). RESULTS The TDS of the (18)F-FDG PET image was 14.4+/-7.7. The TDS of the (18)F-FDG PCD image was 18.7+/-7.7. The TDS of the (201)Tl SPECT image was 24.1+/-11.5. The TDS of the (18)F-FDG PET image was significantly smaller than that of the (18)F-FDG PCD image. The TDS of the (18)F-FDG PET image was significantly smaller than that of the (201)Tl SPECT image. The TDS of the (18)F-FDG PCD image was significantly smaller than that of the (201)Tl SPECT image. CONCLUSION The findings of the project suggest that (18)F-FDG PCD is a good modality based on its accuracy, convenience, and cost-performance for detecting myocardial viability in hospitals that do not have a PET system.