Search

Fifty-four patients with a cardiomyopathy were studied by RNCA and Fourier amplitude and phase image analysis. The study group included patients with ischemic cardiomyopathy (27) and an equal number of patients with a primary cardiomyopathy: drug-induced (22), idiopathic (three), radiation-induced (one), and amyloidosis (one). Twenty-eight patients had rest studies alone and 26 had both rest and stress studies (80 total). The mean rest LVEF in the ischemic group was 27.9%, in the drug-induced group 36.5%, and in the idiopathic group 30%. The stress LVEF decreased in 92% of patients with ischemic cardiomyopathy and 45% of patients with primary (drug-induced) cardiomyopathy. Fourier amplitude and phase images were generated for each study. Amplitude and phase images were abnormal in all patients with an ischemic cardiomyopathy. LV amplitude abnormalities were regional and phase was directional. A zone of dysynergy on phase analysis was present in 44% of patients with ischemic cardiomyopathy. In the drug-induced primary cardiomyopathy group, all patients had abnormal amplitude and 86% had abnormal phase. Amplitude abnormalities were global rather than regional and phase patterns were nondirectional. Only one patient had a zone of dysynergy on the phase image. We conclude that the stress LVEF alone cannot consistently differentiate between ischemic and primary cardiomyopathies and that Fourier amplitude and phase analysis may be useful in determining the etiology of a cardiomyopathy (ischemic vs primary).

The first commercial version of the Massachusetts General Hospital (MGH) positron camera was used to image the relative distributions of 13N (T1/2 = 9.96 min) in the human heart, pancreas, and liver after intravenous administration of [13N]-L-glutamate. The instrument was operated in two imaging modes. Conventional 2-dimensional (2-D) focal-plane images showed high concentrations of 13N in the heart and pancreas, and lower levels in the liver. Five PET tomographic transverse section (3-D) images were made through the heart and three through the pancreas. Our results suggest that further studies designed to gain an improved understanding of the biochemistry of [13N]-L-glutamate aided by PET imaging, especially with newer instrumentation, are worthy of further investigation.

Forty-one patients (25 male, 16 female) were studied by RNCA in our institution. There were 42 rest studies and 24 stress studies (66 studies total). Sixteen patients were normal, 15 had ASHD, seven had a cardiomyopathy, and three had left-sided valvular regurgitation. Each study was preprocessed using both the standard nine-point smoothing method and Fourier filtering. Amplitude and phase images were also generated. Both preprocessing methods were compared with respect to image quality, border definition, reliability and reproducibility of the LVEF, and cine wall motion interpretation. Image quality and border definition were judged superior by the consensus of two independent observers in 65 of 66 studies (98%) using Fourier filtered data. The LVEF differed between the two processes by greater than .05 in 17 of 66 studies (26%) including five studies in which the LVEF could not be determined using nine-point smoothed data. LV wall motion was normal by both techniques in all control patients by cine analysis. However, cine wall motion analysis using Fourier filtered data demonstrated additional abnormalities in 17 of 25 studies (68%) in the ASHD group, including three uninterpretable studies using nine-point smoothed data. In the cardiomyopathy/valvular heart disease group, ten of 18 studies (56%) had additional wall motion abnormalities using Fourier filtered data (including four uninterpretable studies using nine-point smoothed data). We conclude that Fourier filtering is superior to the nine-point smooth preprocessing method now in general use in terms of image quality, border definition, generation of an LVEF, and cine wall motion analysis. The advent of the array processor makes routine preprocessing by Fourier filtering a feasible technologic advance in the development of the RNCA study.

Potassium 38 emits a 2.68-MeV (max) positron, followed promptly by a 2.17-MeV gamma-ray in 99.8% of its disintegrations. A positron is emitted also, followed by a 3.94-MeV gamma-ray, in 0.2% of the decays. The pairs of 511-keV PET +/- gamma-quanta, which are emitted at 180 +/- 0.3 degrees to each other, are in true coincidence with the prompt gamma-rays emitted by the daughter nucleus, within the resolving time of PET instrumentation. Studies made with phantoms by means of a commercial version of the MGH PET camera demonstrated that quantitatively satisfactory images are derived, despite the presence of the prompt gamma-rays. Two-dimensional (2-D) focal-plane images reveal high uptake of 38K promptly in the myocardium of dogs, under barbiturate sedation. Third-dimensional (3-D) transverse section PET tomographic images, through four 1.0-cm-thick heart "slices" orthogonal to the plane of the 2-D images and with 1.4-cm sequential spacing, show 38K uptake to be concentrated especially highly in the left ventricle, as expected. Peak levels of activity were observed over the myocardium at 12 s after intravenous bolus injection of ionic 38K. Dynamic mode 2-D images were taken at intervals as short as 0.5 s and extending to 1 h.