Seventh annual Mario S. Verani, MD Memorial Lecture: "ASNC and integrating cardiac imaging".

Although cardiovascular mortality is decreasing over the last two decades, the cost of such care is escalating at a pace that is not sustainable for Medicare. Over this same time period, cardiac imaging has grown at an extremely rapid rate and is a leading contributor to this escalation in expense. It is now incumbent on both profession medical societies and individual physicians to demonstrate that cardiovascular care and the imaging growth lead to better patient outcomes and that the level of competent performance in these areas is documented.

Nonsurgical management of a left ventricular pedunculated papillary fibroelastoma: a case report.

Papillary fibroelastoma (PFE) is a benign cardiac tumor that has the potential to cause life-threatening embolic events. Surgical excision of the tumor is recommended for all patients who develop symptoms, but the treatment of asymptomatic patients with an echocardiographically identified PFE is still controversial. Our case report describes a 63-year-old patient with the incidental finding of a probable left ventricular PFE.

Simultaneous assessment of cardiac perfusion and function using 5-dimensional imaging with Tc-99m teboroxime.

Background: Dynamic single photon emission computed tomography (SPECT) acquisition and reconstruction of early poststress technetium 99m teboroxime washout images has been shown to be useful in the detection of coronary disease. Assessment of poststress regional wall motion may offer additional use in assessing coronary disease. Our goal was to investigate the feasibility of simultaneously imaging myocardial ischemia and transient poststress akinesis using gated-dynamic SPECT.

Comparing cardiac ejection fraction estimation algorithms without a gold standard.

Rationale And Objectives: Imaging and estimation of left ventricular function have major diagnostic and prognostic importance in patients with coronary artery disease. It is vital that the method used to estimate cardiac ejection fraction (EF) allows the observer to best perform this task. To measure task-based performance, one must clearly define the task in question, the observer performing the task, and the patient population being imaged.

Initial clinical experience with regadenoson, a novel selective A2A agonist for pharmacologic stress single-photon emission computed tomography myocardial perfusion imaging.

Objectives: Regadenoson, a selective A2A adenosine receptor agonist, was evaluated for tolerability and effectiveness as a pharmacological stress agent for detecting reversible myocardial hypoperfusion when combined with single-photon emission computed tomography (SPECT).

Background: Adenosine and dipyridamole are nonselective adenosine agonists currently used as pharmacologic stressors. Despite proven safety, these agents often cause undesirable side effects and require a continuous infusion.

Myocardial perfusion SPECT reconstruction: receiver operating characteristic comparison of CAD detection accuracy of filtered backprojection reconstruction with all of the clinical imaging information available to readers and solely stress slices iteratively reconstructed with combined compensation.

Background: Past receiver operating characteristic (ROC) studies have demonstrated that single photon emission computed tomography (SPECT) perfusion imaging by use of iterative reconstruction with combined compensation for attenuation, scatter, and detector response leads to higher area under the ROC curve (A(z)) values for detection of coronary artery disease (CAD) in comparison to the use of filtered backprojection (FBP) with no compensations. A new ROC study was conducted to investigate whether this improvement still holds for iterative reconstruction when observers have available all of the imaging information normally presented to clinical interpreters when reading FBP SPECT perfusion slices.

Methods And Results: A total of 87 patient studies including 50 patients referred for angiography and 37 patients with a lower than 5% likelihood for CAD were included in the ROC study.

Human-observer receiver-operating-characteristic evaluation of attenuation, scatter, and resolution compensation strategies for (99m)Tc myocardial perfusion imaging.

Unlabelled: Nonuniform attenuation, scatter, and distance-dependent resolution are confounding factors inherent in SPECT imaging. Iterative reconstruction algorithms permit modeling and compensation of these degradations. We investigated through human-observer receiver-operating-characteristic (ROC) studies which (if any) combination of such compensation strategies best improves the accuracy of detection of coronary artery disease (CAD) when expert readers have only stress images for diagnosis.

Imaging cell injury and death.

Although there has been much emphasis on detecting myocardial viability over the past decade, there is a growing interest in finding a marker for myocyte injury and death. There has been limited clinical utility for infarct-avid imaging with (99m)Technetium ((99m)Tc) pyrophosphate and (111)Indium antimyosin, but recent experience with (99m)Tc-labeled annexin V and contrast-enhanced magnetic resonance imaging has stimulated cell death detection. In the effort to image myocyte damage, it is crucial to understand the pathologic finding and cell signals that can be used as critical in vivo markers for the transition from viable to dead tissue.