RESUMEN
BACKGROUND: The American College of Cardiology/American Society of Nuclear Cardiology published revised appropriate use criteria (AUC) for SPECT MPI in 2009. We assessed adherence to these guidelines and factors associated with inappropriate utilization at the University Medical Center. METHODS: The AUC was applied retrospectively to 420 SPECT MPI studies. Two-sample t test, Fisher's exact test, and multivariable logistic regression models were used for analysis. RESULTS: There were 322 appropriate (86%) and 54 (14%) inappropriate studies. The odds of having an inappropriate test increased with younger age (P < .001) and female gender (P < .001). Subjects with diabetes (P = .007) and chest pain (P < .001) were less likely to have an inappropriate test. Academic outpatients were three times more likely to have an inappropriate study (P = .123), while community PCPs were 5.6 times (P = .011) and community cardiologists eight times more likely to order inappropriate tests (P = .031). CONCLUSIONS: Inappropriate SPECT MPI in low risk younger women is an important issue on the USA-Mexico border. Initiatives to reduce inappropriate SPECT MPI should focus on a few indications and evaluation of cardiovascular symptoms in younger age women in outpatient/community practices.
Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Adhesión a Directriz/estadística & datos numéricos , Imagen de Perfusión Miocárdica/estadística & datos numéricos , Imagen de Perfusión Miocárdica/normas , Tomografía Computarizada de Emisión de Fotón Único/estadística & datos numéricos , Tomografía Computarizada de Emisión de Fotón Único/normas , Procedimientos Innecesarios/estadística & datos numéricos , Distribución por Edad , Cardiología/normas , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/etnología , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Masculino , Área sin Atención Médica , México/epidemiología , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Prevalencia , Distribución por Sexo , Estados Unidos/epidemiología , Procedimientos Innecesarios/normas , Revisión de Utilización de RecursosRESUMEN
Se revisan los protocolos de cardiología nuclear actuales, con énfasis en los estudios tomográficos de fotón único (SPECT) de perfusión miocárdica principalmente en evaluación de enfermedad coronaria (EC). Las indicaciones y protocolos más utilizados son detallados, así como la actualización bibliográfica pertinente, tanto al uso clínico como al control de calidad e interpretación de los estudios.
Asunto(s)
Humanos , Enfermedad Coronaria , Imagen de Perfusión Miocárdica , Tomografía Computarizada de Emisión de Fotón Único/normas , Protocolos Clínicos , Cardiología/normas , Medicina Nuclear/normas , Control de CalidadRESUMEN
OBJECTIVE: In patients with primary hyperparathyroidism, candidates for surgical intervention, the parathyroid pre-operative localization is of fundamental importance in planning the appropriate surgical approach. MATERIALS AND METHODS: The additional acquisition of SPECT and Technetium-99m images, during parathyroid scintigraphy with Sestamibi, is not common practice. Usually, only planar image acquisition, 15 minutes prior and 2 hours after radiopharmaceutical administration, is performed. RESULTS: In our experience, the complete protocol in parathyroid scintigraphy increases the accuracy of pre-operative parathyroid localization. CONCLUSION: The complete utilization of all available nuclear medicine methods (SPECT e 99mTc) and image interpretation in a multidisciplinary context can improve the accuracy of parathyroid scintigraphy.
Asunto(s)
Adenoma/diagnóstico por imagen , Adenoma/patología , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/patología , Radiofármacos , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada de Emisión de Fotón Único/normas , Adulto , Anciano , Protocolos Clínicos/normas , Femenino , Humanos , Masculino , Cuidados Preoperatorios/métodos , Cuidados Preoperatorios/normas , Estudios RetrospectivosRESUMEN
OBJETIVO: Diante de um paciente portador de hiperparatiroidismo primário com indicação de tratamento cirúrgico, a localização pré-operatória da paratiroide é de fundamental importância para definir a melhor abordagem cirúrgica. MATERIAIS E MÉTODOS: A realização adicional de imagens SPECT e da cintilografia com 99mTc durante a cintilografia das paratiroides com Setamibi não é rotina em nosso meio, sendo comum a aquisição apenas das imagens planas − precoce (15 minutos) e tardia (2 horas). RESULTADOS: Na nossa experiência, tem-se percebido que a realização do protocolo completo contribui de maneira decisiva na sensibilidade da localização pré-operatória da paratiroide. CONCLUSÃO: A aplicação completa de todos os métodos cintilográficos disponíveis (SPECT e 99mTc) e a análise cuidadosa das imagens em um contexto multidisciplinar podem aumentar a acurácia da cintilografia das paratiroides.
OBJECTIVE: In patients with primary hyperparathyroidism, candidates for surgical intervention, the parathyroid pre-operative localization is of fundamental importance in planning the appropriate surgical approach. MATERIALS AND METHODS: The additional acquisition of SPECT and Technetium-99m images, during parathyroid scintigraphy with Sestamibi, is not common practice. Usually, only planar image acquisition, 15 minutes prior and 2 hours after radiopharmaceutical administration, is performed. RESULTS: In our experience, the complete protocol in parathyroid scintigraphy increases the accuracy of pre-operative parathyroid localization. CONCLUSION: The complete utilization of all available nuclear medicine methods (SPECT e 99mTc) and image interpretation in a multidisciplinary context can improve the accuracy of parathyroid scintigraphy.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Adenoma/patología , Adenoma , Neoplasias de las Paratiroides/patología , Neoplasias de las Paratiroides , Radiofármacos , Tomografía Computarizada de Emisión de Fotón Único/normas , Protocolos Clínicos/normas , Cuidados Preoperatorios/métodos , Cuidados Preoperatorios/normas , Estudios RetrospectivosRESUMEN
BACKGROUND: Asymptomatic patients with severe coronary atherosclerosis may have a normal resting electrocardiogram and stress test. AIM: To assess the yield of Gated Single Photon Emission Computer Tomography (SPECT) for the screening of silent myocardial ischemia in type 2 diabetic patients. MATERIAL AND METHODS: Electrocardiogram, stress test and gated-SPECT were performed on 102 type 2 diabetic patients aged 60+/-8 years without cardiovascular symptoms. AH subjects were also subjected to a coronary angiography whose results were used as gold standard. RESULTS: Gated-SPECT showed myocardial ischemia on 26.5% of studied patients. The sensibility, specificity accuracy, positive predictive value and negative predictive value were 92.3%, 96%, 95%, 88.8%, 97.3%, respectively. In four and six patients ischemia was detected on resting electrocardiogram and stress test, respectively. Eighty percent of patients with doubtful resting electrocardiogram results and 70% with a doubtful stress test had a silent myocardial ischemia detected by gated-SPECT There was a good agreement between the results of gated-SPECT and coronary angiography (k=0.873). CONCLUSIONS: Gated-SPECT was an useful tool for the screening of silent myocardial ischemia.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Isquemia Miocárdica/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único/normas , Electrocardiografía/métodos , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Reproducibilidad de los ResultadosRESUMEN
Background: Asymptomatic patients with severe coronary atherosclerosis may have a normal resting electrocardiogram and stress test. Aim: To assess the yield of Gated Single Photon Emission Computer Tomography (SPECT) for the screening of silent myocardial ischemia in type 2 diabetic patients. Material and methods: Electrocardiogram, stress test and gated-SPECT were performed on 102 type 2 diabetic patients aged 60 ± 8 years without cardiovascular symptoms. AH subjects were also subjected to a coronary angiography whose results were used as gold standard. Results: Gated-SPECT showed myocardial ischemia on 26.5 percent of studied patients. The sensibility, specifity accuracy, positive predictive value and negative predictive value were 92.3 percent, 96 percent, 95 percent, 88.8 percent, 97.3 percent, respectively. In four and six patients ischemia was detected on resting electrocardiogram and stress test, respectively. Eighty percent of patients with doubtful resting electrocardiogram results and 70 percent with a doubtful stress test had a silent myocardial ischemia detected by gated-SPECT There was a good agreement between the results of gated-SPECT and coronary angiography (k =0.873). Conclusions: Gated-SPECT was an useful tool for the screening of silent myocardial ischemia.
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , /complicaciones , Isquemia Miocárdica , Tomografía Computarizada de Emisión de Fotón Único/normas , Electrocardiografía/métodos , Prueba de Esfuerzo , Isquemia Miocárdica/diagnóstico , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: It is advisable that the intensity of the exercises for rehabilitation of patients with coronary artery disease does not cause myocardial ischemia. OBJECTIVE: Compare the capacity of myocardial tomographic scintigraphy with the electrocardiogram capacity in ischemia detection during rehabilitation session. METHODS: Twenty six patients with coronary artery disease, undergoing the rehabilitation program and with previous scintigraphy, with transient hypo-uptake have been administered a new injection of MIBI-Tc-99m during a training session when they were also monitored with dynamic electrocardiography. The rest scintigraphies, after ergometric treadmill test and rehabilitation session, were assessed in a semi-quantitative way using scores from 0 to 4 to classify each one of the chosen segments (0 = normal; 1 = discrete hypo-uptake; 2 = moderate; 3 = intense; 4 = lack of uptake). RESULTS: The means of the total scores found were: at rest = 12.9; after treadmill test = 19.3; after rehabilitation session = 15.1. There were statistically significant differences among them. An individual assessment showed that in 14 cases (53.8 %) hypo-uptake to some degree was identified during rehabilitation and in 12 cases (46.6%) it was not. Monitoring with the Holter system didn't show in any of the cases a ST segment depression equal or greater than 1mm. CONCLUSION: The exercises prescribed for patients with coronary artery disease, according to recommendations found in the literature, may trigger myocardial ischemia, assessed by scintigraphy during a rehabilitation session.
Asunto(s)
Enfermedad de la Arteria Coronaria/rehabilitación , Ejercicio Físico/fisiología , Isquemia Miocárdica/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Electrocardiografía , Prueba de Esfuerzo , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/prevención & control , Radiofármacos , Descanso , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada de Emisión de Fotón Único/normasRESUMEN
FUNDAMENTO: Recomenda-se que a intensidade dos exercícios na reabilitação de coronariopatas não deva produzir isquemia miocárdica. OBJETIVO: Comparar a capacidade da cintilografia tomográfica do miocárdio com a do eletrocardiograma na detecção de isquemia durante sessão de reabilitação. MÉTODOS: Vinte e seis pacientes coronariopatas, em programa de reabilitação e com cintilografia prévia com hipocaptação transitória, receberam nova injeção de MIBI-Tc-99m durante uma sessão de treinamento, quando também foram monitorizados pela eletrocardiografia dinâmica. As cintilografias de repouso, após teste ergométrico em esteira e após sessão de reabilitação, foram analisadas de forma semiquantitativa utilizando-se um escore, de 0 a 4, classificando cada um dos segmentos escolhidos (0 = normal; 1 = hipocaptação discreta; 2 = moderada; 3 = intensa; 4 = ausência da captação). RESULTADOS: As médias dos somatórios dos escores encontrados foram: repouso = 12,9; após teste em esteira = 19,3; após sessão de reabilitação = 15,1. Houve diferenças estatisticamente significativas entre elas. Uma análise individual mostrou que em 14 casos (53,8 por cento) foi identificado algum grau de hipocaptação durante a reabilitação, e em 12 (46,6 por cento), não. Monitorização com sistema Holter não revelou, em nenhum caso, depressão do segmento ST, igual ou maior do que 1 mm. CONCLUSÃO: Exercícios prescritos em doentes coronariopatas, conforme recomendações da literatura, podem desencadear isquemia miocárdica, avaliada pela cintilografia, durante sessão de reabilitação.
BACKGROUND: It is advisable that the intensity of the exercises for rehabilitation of patients with coronary artery disease does not cause myocardial ischemia. OBJECTIVE: Compare the capacity of myocardial tomographic scintigraphy with the electrocardiogram capacity in ischemia detection during rehabilitation session. METHODS: Twenty six patients with coronary artery disease, undergoing the rehabilitation program and with previous scintigraphy, with transient hypo-uptake have been administered a new injection of MIBI-Tc-99m during a training session when they were also monitored with dynamic electrocardiography. The rest scintigraphies, after ergometric treadmill test and rehabilitation session, were assessed in a semi-quantitative way using scores from 0 to 4 to classify each one of the chosen segments (0 = normal; 1 = discrete hypo-uptake; 2 = moderate; 3 = intense; 4 = lack of uptake). RESULTS: The means of the total scores found were: at rest = 12.9; after treadmill test = 19.3; after rehabilitation session = 15.1. There were statistically significant differences among them. An individual assessment showed that in 14 cases (53.8 percent) hypo-uptake to some degree was identified during rehabilitation and in 12 cases (46.6 percent) it was not. Monitoring with the Holter system didn't show in any of the cases a ST segment depression equal or greater than 1mm. CONCLUSION: The exercises prescribed for patients with coronary artery disease, according to recommendations found in the literature, may trigger myocardial ischemia, assessed by scintigraphy during a rehabilitation session.
Asunto(s)
Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de la Arteria Coronaria/rehabilitación , Ejercicio Físico/fisiología , Isquemia Miocárdica , Análisis de Varianza , Enfermedad de la Arteria Coronaria , Electrocardiografía , Prueba de Esfuerzo , Isquemia Miocárdica/prevención & control , Radiofármacos , Descanso , Tomografía Computarizada de Emisión de Fotón Único/normasRESUMEN
Parkinson's disease (PD) is a common neurodegenerative disorder that is mainly caused by dopaminergic neuron loss in the substantia nigra. Several nuclear medicine radiotracers have been developed to evaluate PD diagnoses and disease evolution in vivo in PD patients. Positron emission tomography (PET) and single photon computerized emission tomography (SPECT) radiotracers for the dopamine transporter (DAT) provide good markers for the integrity of the presynaptic dopaminergic system affected in PD. Over the last decade, radiotracers suitable for imaging the DAT have been the subject of most efforts. In this review, we provide a critical discussion on the utility of DAT imaging for Parkinson's disease diagnosis (sensitivity and specificity).
Asunto(s)
Proteínas de Transporte de Dopamina a través de la Membrana Plasmática , Enfermedad de Parkinson/diagnóstico por imagen , Tomografía de Emisión de Positrones/normas , Tomografía Computarizada de Emisión de Fotón Único/normas , Dopaminérgicos , Humanos , Compuestos de Organotecnecio , Sensibilidad y Especificidad , TropanosRESUMEN
Parkinsons disease (PD) is a common neurodegenerative disorder that is mainly caused by dopaminergic neuron loss in the substantia nigra. Several nuclear medicine radiotracers have been developed to evaluate PD diagnoses and disease evolution in vivo in PD patients. Positron emission tomography (PET) and single photon computerized emission tomography (SPECT) radiotracers for the dopamine transporter (DAT) provide good markers for the integrity of the presynaptic dopaminergic system affected in PD. Over the last decade, radiotracers suitable for imaging the DAT have been the subject of most efforts. In this review, we provide a critical discussion on the utility of DAT imaging for ParkinsonÆs disease diagnosis (sensitivity and specificity).
A doença de Parkinson (DP) é uma desordem neurodegenerativa causada por perda de neurônios dopaminérgicos na substância negra. Vários traçadores da medicina nuclear têm sido desenvolvidos para avaliar o diagnóstico e acompanhamento da DP. Traçadores para o transportador de dopamina (TDA) utilizados na tomografia por emissão de pósitrons (PET) e tomografia por emissão de fóton único (SPECT) demonstram boa marcação na integridade de sistema dopaminergico pré-sináptico, afetada na DP. Na última década, radiotraçadores apropriados para imagens de TDA têm sido mais estudados. Nesta revisão, provemos uma discussão crítica sobre a utilidade dessas imagens de TDA para o diagnóstico de DP (sensibilidade e especificidade).
Asunto(s)
Humanos , Proteínas de Transporte de Dopamina a través de la Membrana Plasmática , Compuestos de Organotecnecio , Enfermedad de Parkinson , Tomografía de Emisión de Positrones/normas , Tomografía Computarizada de Emisión de Fotón Único/normas , Tropanos , Dopaminérgicos , Sensibilidad y EspecificidadRESUMEN
Functional imaging using PET (positron emission tomography) has a great impact on current medical practice. It allows to explore, in a very precise way, different processes such as tissue flow and metabolism. Fluor-deoxyglucose labeled with F18 fluorine represents glucose metabolism. Among its main applications are detection, staging, follow up and recurrence assessment of malignant tumors; myocardial viability detection in patients with myocardial infarction or ischemic cardiomyopathy, and evaluation of hyperactive epileptogenic foci in brain. The basis and clinical applications of PET tomography are reviewed especially oriented to its cost benefit relationship, change in patient management and diagnostic value of the most accepted oncological indications. Important economic resources may be saved with PET in this field, considering appropriate staging and recurrence detection, avoiding expensive therapeutic approaches in advanced disease.