In 53 patients with cerebrovascular disease (CVD), regional cerebral blood flow (CBF) and blood volume (CBV) were imaged by SPECT within one session. Slice division (CBF: CBV) yielded distribution of regional cerebral perfusion reserve (CPR). Semiquantitative evaluation was obtained from manually set ROIs by interhemispherical ratios (for CBF, CBV and CPR), using 2 SD from a normal group (n = 10) as a threshold. Sensitivities were 59% for CBF, 94% for CBV and 83% for CPR. Combined sensitivity was 98%. Establishing three constellations for CBF, CBV and CPR, regionally normal CBFs but quantitatively increased CBVs (+69%) and decreased CPRs (−31 %) were found in relatively early stages of CVD. Very advanced cases showed decreased CBFs (−65%), CBVs (−40%), CPRs (−49%) and a surrounding penumbra. In 87% (46/53 patients), such Theologically postulated constellations could be demonstrated. We conclude that combined CBF and CBV SPECT, assisted by CPR images, is a promising tool to detect CVD and to assess its individual regional severity.
A semiautomated method for three-dimensional quantification of stress/rest 201TI myocardial SPECT of the left ventricle (LV) is introduced. A total of 33 ringsegment-shaped regions of interest (ROIs) are distributed over 6 oblique (short axis cuts) double-slices (thickness 1.3 cm) from LV apex to base, commencing with 1 ROI for the apex up to 8 ROIs for the base (1-4-4-8-8-8). Within the last two double slices an additional adjacent ROI is automatically placed in the upper right quadrant to observe lung Tl-uptake. Correspondence of slices for exercise and rest is achieved by adjusting the long axis outlines rebuilt from summed profiles of 15 oblique slices of each examination. Calculated numeric arrays of the extracted parameters (vitality, washout and redistribution) are “displayed in a target-like two-dimensional polar fashion.
ROI-based polar maps (33 ROIs) were employed to evaluate quantitatively stress/rest myocardial 201TI SPECT in 108 patients with angiographically proven coronary heart disease (CHD) in comparison with 30 controls. Sensitivity in detecting a CHD with stenoses of > 50% of luminal diameter was determined versus normal regional values (± 2.5 SD) employing vitality (VI) and wash-out corrected redistribution (RD). The method was evaluated referring to the severity of the disease, to the number of ROIs displaying changes [(a) 1 ROI, (b) >2 ROIs], to validity of VI, RD or a combination thereof, and for specificity. Wash-out values were found to depend on degree of stress individually achieved and thus were not used as a threshold criterion. Sensitivity in supply areas with old myocardial infarctions was 95% (a) and 86% (b), resp. With no infarction, it was 96% (a) and 79% (b), resp. VI in stenosis > 75% was more sensitive than RD. However, combined evaluation of VI and RD yielded sensitivities from 91-100% (a) and 77-94% (b), resp. for different main supply areas. In stenosis < 50% with normal VI, RD was positive in 18-31 %. Specificity turned out to be 91 % (a) and 97% (b), resp. We conclude that the method presented is reliable to quantify numerically 201TI kinetics in myocardial SPECT, aimed at detecting and describing CHD.
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