Abstract: Aim: was to make preclinical and imaging tests of the trans-1,2-diaminocyclohexane-N,N,N',N'-tetraacetic acid (DCTA) complex as a universal contrast agent for MRI and single-photon emission imaging, with Mn (Cyclomang) and 99mTc- (Cyclotech), respectively. Material and Methods: the complex of trans-1,2-diaminocyclohexane-N,N,N',N'-tetraacetic acid (DCTA) was synthesized at the department of organic chemistry of National Research Tomsk Polytechnic university, using the original technology in the nanopowder phase using manganese (II) carbonate, or generator eluate 99mTc, and NaH2DCTA, resulting in a 0.5 M solution of Мn-DCTA or 99mTc-DCTA. LD50 values were determined in experiments on laboratory mice. A visualization study was performed in 4 cats and 3 dogs with malignant neoplasms of chest organs and in one dog with a tumor of the left pontocerebellar angle. All of them underwent consecutively MRI with contrast enhancement with Mn-DCTA and SPECT - with 99mTc-DCTA. Results: for Cyclotech LD50 >18/ml/kg, for 0.5 M Mn-DCTA (Cyclomang) solution, the LD50 index significantly exceeds 16.9 ml/kg BW. Changes in the content of manganese in the blood plasma of rats when they were administered Mn-DCTA, did not occur. LD50 values allow us to assign the drug in accordance with Russian regulation GOST 12.1.007-76. to group 4 (low-hazard substances). In both cases, in the range of physiological pH, the thermodynamic stability constant is >19.3. In studies in animals with MRI, the enhancement index of T1-weighted spin-echo image of the tumor in all cases exceeded 1.7 (mean 1.82±0.10). When calculating the «tumor/back-ground» index for 99mTc-DCTA, it was 2.6-7.3 (mean 4.12±1.05). Conclusion: DCTA complexes with manganese (II) - for enhancement in MRI and with 99mTc- for SPECT- have very close pharmacokinetic properties, are non-toxic, do not dissociate in physiological environments and can be further used for contrast enhancement in multimodal MRI-SPECT studies. Chelate agents of the 99mTc with thermodynamic stability constants over 16 may be employed in the nearest future as important source for the development of paramagnetic contrast agents binding Mn. References 1. Panov VO, Shimanovskiy NL. The diagnostic efficacy and safety of macrocyclic gadolinium-based magnetic resonance contrast agents. Russian J Radiol. 2017; 98(3): 159-166 [In Russ]. http://doi.org/10.20862/0042-4676-2017-98-3-159-166 2. Shimanovskiy NL, Epinetov MA, Melnikov MYa. Molecular and nanopharmacology. Moscow, 2009; 624 [In Russ]. 3. National guidebook on nuclear medicine. Vol.1. Ed. by Lishmanov YuB, Chernov VI. Tomsk. STT Publ. 2010; 432 [In Russ]. 4. Litvinenko IV. 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Abstract: The aim of the study was to evaluate results of percutaneous coronary interventions (PCI) in patients with ischemic cardiomyopathy (ICMP) - potential candidates for heart transplantation. The study included 37 patients with ICMP. All the patients before PCI and within the 7 days after it undergo ec-hocardiography and ECG-gated SPECT. The amount of irreversibly damaged myocardium of the left ventricle (LV) was about 50 % of its volume. In these patients ECG-gated SPECT did not show sufficient amount of the viable myocardium, capable to restore the heart function after revascularization. The main result of intervention was increase in survival rate of patients with ICMP within 4 years of observation in comparison with traditional methods of conservative therapy. The first clinical effect of PCI was disappearance or reduction of dyspnea, noted in the majority of the patients. These changes had been confirmed by improvement of a functional class of patients (NYHA class score increase to 3,2±0,5 from 1,7+65; p=0,007) and increase of tolerance to physical excersise. Positive changes of a clinical condition after PCI have taken place due to decrease in rigidity of LV myocardium: It became apparent due to decrease of LV end-diastolic pressure (35,7+9,3 vs. 23,5+9,9 Hg mm; p=0,04) and pressure in pulmonary artery (44+1 2 vs. 33+7 Hg mm; p=0,03). No changes of LV volumes and ejection fraction values in the given category of patients were seen.
Reference
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Abstract: Lipid core coronary plaques (LCPs), which cannot be reliably detected by conventional diagnostic measures, are widely considered to be the cause of most acute coronary syndromes. Accumulating evidence also indicates that LCPs may increase the risk of stenting complications. A catheter-based near-infrared spectroscopy (NIRS) system is now available for the detection of LCPs in the arteries of patients undergoing coronary angiography The system, which uses the well-documented ability of NIRS to determine the chemical composition of unknown substances, has been validated in an autopsy study and a clinical trial. The system has now been used in more than 300 patients and has provided novel information for use in assessment of coronary disease. Multiple studies are in progress to assess the full clinical benefit of NIRS for the goals of 1) improving the safety of stenting, 2) preventing a second coronary event in patients with known coronary disease, and 3) use as a possible component in a strategy for the primary prevention of coronary events. References 1. Lloyd-Jones D., Adams R., Carnethon M. et al. Heart disease and stroke statistics-2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009; 119:480-486. 2. Clarke M.C., Figg N., Maguire J.J. et al. Apoptosis of vascular smooth muscle cells induces features of plaque vulnerability in atherosclerosis. Nat Med 2006; 12:1075-1080. 3. Ross R. Atherosclerosis - an inflammatory disease. N Engl J Med 1999, 340:115-126. 4. Kagan A., Livsic A.M., Sternby N., Vihert A.M. Coronary-artery thrombosis and the acute attack of coronary heart-disease. Lancet 1968; 2:1199-1200. 5. Goldsteinc J.A. CT angiography: imaging anatomy to deduce coronary physiology. Catheter Cardiovasc Interv 2009; 73:503-505. 6. Giroud D., Li J.M., Urban P., et al. Relation of the site of acute myocardial infarction to the most severe coronary arterial stenosis at prior angiography. Am J Cardiol 1992; 69:729-732. 7. Gonzalo N., GarcHa-GarcHa H.M., Ligthart J. et al. Coronary plaque composition as assessed by greyscale intravascular ultrasound and radiofrequency spectral data analysis. Int J Cardiova,sc Imaging 2008; 24:811-818. 8. Schaar J.A., Mastik F., Regar E., et al. Current diagnostic modalities for vulnerable plaque detection. Curr Pharm Des 2007; 13:995-1001. 9. Kips J.G., Segers P, Van Bortel L.M. Identifying the vulnerable plaque: a review of invasive and non-invasive imaging modalities. Artery Res 2008; 2:21-34. 10. Uchida Y., Nakamura F., Tomaru T., et al. Prediction of acute coronary syndromes by percutaneous coronary angioscopy in patients with stable angina. Am. Heart J. 1995; 130:195-203. 11. Ohtani T., Ueda Y., Mizote I., et al. Number of yellow plaques detected in a coronary artery is associated with future risk of acute coronary syndrome detection of vulnerable patients by angioscopy. J Am Coll Cardiol 2006; 47:2194-2200. 12. Ishibashi F., Aziz K., Abela G., Waxman S. Update on coronary angioscopy: review of a 20-year experience and potential application for detection of vulnerable plaque. J. Interv. Cardiol. 2006; 19:17-25. 13. Patel N.A., Stamper D.L., Brezinski M.E. Review of the ability of optical coherence tomography to characterize plaque, including a comparison with intravascular ultrasound. Cardiovasc Intervent Radiol 2005; 28:1-9. 14. Yabushita H., Bouma B.E., Houser S.L., et al.Characterization of human atherosclerosis by optical coherence tomography. Circulation 2002; 106:1640-1645. 15. Tearney G.J., Yabushita H., Houser S.L., et al. Quantifi cation of macrophage content in atherosclerotic plaques by optical coherence tomography. Circulation 2003; 107:113-119. 16. Yun S.H., Tearney G.J., Vakoc B.J. et al. Comprehensive volumetric optical microscopy in vivo. Nat Med 2007; 12:1429-1433. 17. Lavine B., Workman J. Chemometrics. Ana,l Chem 2008, 80:4519-4531. 18. Williams P., Norris K. Near-Infrared Technology in the Agriculture and Food Industries, edn 2. St. Paul, MN: American 19. Association of Cereal Chemists Inc.; 2001; Ciurczak EW, Drennen JK: Pharmaceutical and Medical Applications of Near-Infrared Spectroscopy. New York: Marcel Dekker, 2002; 20. Mendelson Y: Pulse oximetry: theory and applications for noninvasive monitoring. Clin Chem 1992; 38:1601-1607. 21. Moreno PR., Muller J.E.: Identification of high-risk atherosclerotic plaques: a survey of spectroscopic methods. Curr Opin Cardiol 2002; 17:638-647. 22. Lodder R.A., Cassis L., Ciurczak E.W.: Arterial analysis with a novel near-IR fi ber-optic probe. Spectroscopy 1990; 5:12-17.
Possibilities of beam loading decrease during coronary arteries MSCT
DOI: https://doi.org/10.25512/DIR.2011.05.1.03
For quoting:
Sinitsyn V.E., Mershina E.A., Glazkova M.A., Arhipova I.M. "Possibilities of beam loading decrease during coronary arteries MSCT". Journal Diagnostic & interventional radiology. 2011; 5(1); 21-29.
Abstract: Purpose. Was to compare beam loading and quality of coronary arteries’ imaging (CA) in case of using the 64-lise computed tomography (MSCT) in retro-and prospective electrocardiographic synchronization mode. Materials and methods. 57 patients with coronar arteries disease suspicious were examined with the help of computed tomography (CT) coronarography in prospective (n = 27) and retrospective (n = 30) EKG-synchronization modes. All the experiments were held on multislice Discovery CT 750 MD («General Electric»). The quality of obtained CR images was estimated subjectively – from 1 (perfect quality) to 4 (non- diagnostic). Results. The analyses of obtained images during retro-and prospective EKG-synchronization did not reveal serious differences (1,4 ± 0,38 and 1,5 ± 0,46 accordingly). The effective dose during prospective EKG-synchronization was 59% less than during retrospective EKG-synchronization (3,8 ± 0,83 mSv and 9,3 ± 2,5 mSv, р < 0,05). Conclusion. CT-coronarography in prospective EKG-synchronization mode leads to essential decrease in beam loading on the patient without deterioration of the received image quality. References 1. Gaemperli O. et al. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT. Eur. J Nucl. Med. Mol. Imaging. 2007; 34: 1162–1171. 2. Mollet N.R. et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation. 2005; 112: 2318–2323. 3. Raff G.L. et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J. Am. Col. Cardiol. 2005; 46: 552–557. 4. Scheffel H. et al. Accuracy of dual-source CT coronary angiography. First experience in a high pre-test probability population without heart rate control. Eur. Radiol. 2006; 16: 2739–2747. 5. Husmann L. et al. Comparison of diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low, intermediate and high cardiovascular risk. 6. Acad. Radiol. 2008; 15: 452–461. Leschka S. et al. Low kilovoltage cardiac dual-source CT. Аttenuation, noise, and radiation dose. Eur. Radiol. 2008; 18: 1809–1817. 7. Hausleiter J. et al. Radiation dose estimates from cardiac multislice computed tomography in daily practice. Impact of different scanning protocols on effective dose estimates. Circulation. 2006; 113: 1305–1310. 8. Husmann L. et al. Feasibility of low-dose coronary CT angiography. First experience with prospective ECGgating. Eur. Heart. J. 2008; 29:191–197. 9. Herzog B.A. et al. Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram triggering. First clinical experience. Eur. Heart. J. 2008; 29: 3037–3042. 10. Husmann L. et al. Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography / computed tomography hybrid imaging. Сomparison of prospective electrocardiogram-triggering vs. retrospective gating. Eur. Heart. J. 2009; 30:600–607. 11. Hsieh J. et al. Step-and-shoot data acquisition and reconstruction for cardiac x-ray computed tomography. Med. Phys. 2006; 33:4236–4248. 12. Earls J.P. et al. Prospectively gated trans-verse coronary CT angiography versus retrospectively gated helical technique. Improved image quality and reduced radiation dose. Radiology. 2008; 246: 742–753. 13. Shuman W.P. et al. Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries.
Abstract: Background: according to the international registry ICOPER, right ventricular (RV) dysfunction is the most significant predictor of mortality in patients with pulmonary embolism (PE). Diagnosis of PE should include not only verification of thrombus in branches of pulmonary arteries, but also estimation of RV contractile function. Aim: was to identify the most informative indicators of Gated Blood Pool SPECT (GBPS) for estimation of RV function in patients with PE. Methods: 52 patients were included in the study Main group (n=37) included patients with PE; comparison group (n=15) included patients suffering from coronary heart disease (NYHA I-II). All patients received ventilation-perfusion lung scintigraphy, gated blood pool single photon emission computer tomography (GBPS), and estimation of plasma levels of endothelin-1, stable nitric oxide (NO) metabolites, and 6-keto-PG F1a. Results: in patients with PE, RV end-systolic volume, stroke volume, ejection fraction, peak ejection rate, peak filling rate, and mean filling rate were significantly lower in comparison with patients without PE. In patients with PE volume from 3 to 7 bronchopulmonary segments, we have not found any correlations between PE volume and functional status of the right ventricle. In patients with PE, levels of endothelin-1, 6-keto-PG F1a, and stable NO metabolites were increased in comparison with patients without PE. Conclusion: GBPS allows to verify RV dysfunction in patients without massive PE and severe pulmonary hypertension. Dissociation between volume of PE and the degree of RV dysfunction may be caused by humoral vasoactive factors disbalance. Reference 1. Torbicki A., Perrier A., Konstantinides S., et al. ESC Committee for Practice Guidelines (CPG). Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur. Heart J. 2008; 29 (18): 2276-2315. 2. Anderson F.A. Jr., Spencer F.A. Risk factors for venous thromboembolism. Circulation. 2003; 107: 9-16. 3. Heit J.A. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J. Thromb Thrombolysis. 2006; 21: 23-29. 4. White R.H. The Epidemiology of Venous Thromboembolism. Circulation. 2003; 107: 1-4. 5. Golghaber S.Z. Echocardiography in the Management of Pulmonary Embolysm. Ann. Intern. Med. 2002; 136 (99): 691-700. 6. Haddad F., Hunt 7. MacNee W. Pathophysiology of cor pulmonale in chronic obstructive pulmonary disease: part one. Am. J. Respi. Crit. Care Med. 1994; 150: 833-852. 8. Zavadovskij K.V., Pan'kova A.N., Krivonogov N.G. i dr. Radionuklidnaja diagnostika trombojembolii legochnoj arterii: vizualizacii perfuzii i ventiljacii legkih, ocenka sokratimosti pravogo zheludochka [Radionuclide diagnosis of pulmonary embolism: perfusion and ventilation, assessment of right ventricular contractility]. Sibirskij medicinskij zhurnal. 2011; 26(2), vypusk 1:14-21 [In Russ]. 9. Petri A., Sjebin K. Nagljadnaja statistika v medicine. Per. s angl. V.P. Leonova. M.: GJeOTAR-MED. 2003; 144 s.: il. (Serija «Jekzamen na otlichno») [In Russ]. 10. Mansencal N., Joseph T., Vieillard-Baron A., et al. Diagnosis of right ventricular dysfunction in acute pulmonary embolism using helical computed tomography. Am. J. Cardiol. 2005; 95 (10): 1260-1263. 11. Contractor S., Maldjian P.D., Sharma V.K. Role of helical CT in detecting right ventricular dysfunction secondary to acute pulmonary embolism. J. Comput. Assist. Tomogr. 2002;
Abstract: Good response to neoadjuvant chemotherapy is a favorable prognostic factor in patients with breast cancer. Early response evaluation might spare unnecessary chemotherapy in bad responders. Clinically mammography and ultrasound are used to evaluate response to treatment while being bac predictors of early response. MRI is getting wider acceptance but still lacks necessary accuracy to the absence of functional evaluation. Thus novel methods are being evaluated in early response prediction. Diffusion-weighted MRI, MR-spectroscopy, mammoscintigraphy PET as well as diffusion optic tomography are discussed in the review as potential ways to improve early prediction of response in breast cancer patients undergoing neoadjuvant chemotherapy. References 1. Davydov M.I., Aksel' E.M. Statistika zlokachestvennyh novoobrazovanij v Rossii i stranah SNG v 2012 g [Statistics of malignancies in Russian Federation and the CIS countries in 2012.]. Moskva, 2014;63-64 [In Russ]. 2. 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