Publications by authors named "Lien-Hsin Hu"
2025 Update Consensus of Tc-Pyrophosphate Scintigraphy in the Transthyretin Cardiac Amyloidosis from the Taiwan Society of Cardiology and the Society of Nuclear Medicine of the Republic of China.
Acta Cardiol Sin
January 2025
This 2025 updated consensus outlines the diagnostic strategy for transthyretin amyloid cardiomyopathy (ATTR-CM). Given that ATTR-CM is a significant contributor to heart failure, this article emphasizes the importance of making an early and precise diagnosis, particularly as new therapeutic options become available. Highlighting the critical importance of an early and accurate diagnosis, particularly in light of emerging therapeutic modalities, this consensus underscores the central role of Tc-pyrophosphate (PYP) scintigraphy as a non-invasive diagnostic tool.
View Article and Find Full Text PDFBackground: Boron neutron capture therapy (BNCT) stands out as a propitious anti-cancer modality. F-boronophenylalanine positron emission tomography (BPA-PET) holds the potential to ascertain the concentration of BPA within the tumor, enabling meticulous treatment planning and outcome evaluation. However, no studies have been conducted on comparing the outcomes of those treated with BNCT to those who did not undergo this therapy.
View Article and Find Full Text PDFBackground: Radium-223 dichloride (Ra-223) prolongs overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC) with symptomatic bone metastases. However, there is considerable variation in outcomes among individuals. We aimed to evaluate the prognostic determinants associated with patient survival following National Health Insurance (NHI) reimbursement for Ra-223 therapy in Taiwan.
View Article and Find Full Text PDFWith documented high specificity, 99m Tc-pyrophosphate (PYP) scan enables the diagnosis of transthyretin cardiomyopathy to be made reliably without endomyocardial biopsy in patients who do not have monoclonal gammopathy. We report a case with extensive myocardial uptake of Perugini 3 score in the 3-hour 99m Tc-PYP myocardial SPECT that suggested transthyretin cardiac amyloidosis. However, a followed endomyocardial biopsy revealed no amyloid deposition.
View Article and Find Full Text PDFBackground: Tafamidis has been used for treatment of transthyretin cardiac amyloidosis (ATTR-CA). However, Tc-99 m pyrophosphate (PYP) cardiac scan for follow-up after tafamidis therapy has not been reported.
Methods: From May 2017 to March 2022, five patients with or without tafamidis therapy had received two Tc-99 m PYP cardiac scans.
Article Synopsis
- AI models are effective at diagnosing coronary artery disease (CAD) but can overestimate disease risk due to biased training on high-risk populations.
- A study tested three different training methods, with the third model (using data from low-risk patients) providing the best calibration and predictive accuracy, especially for women.
- Improved AI accuracy in assessing CAD risk is crucial for appropriate patient management, particularly in lower-risk groups where misestimation can lead to unnecessary treatments.
Article Synopsis
- The study analyzed the prognostic value of ischemic total perfusion defect (ITPD) in predicting major adverse cardiac events (MACE) in both men and women, using advanced SPECT imaging in an international registry.
- Data from 17,833 patients revealed that ITPD was a significant predictor of MACE, with an interaction indicating differing impacts between sexes; specifically, men had worse survival rates when ITPD was less than 5%, while women had worse survival when ITPD was 5% or more.
- Overall, the findings suggest that moderate to severe ischemia, as measured by ITPD, poses a greater risk for adverse outcomes in women compared to men.
Article Synopsis
- A study analyzed the risk of major adverse cardiovascular events (MACE) in patients with diabetes mellitus (DM) undergoing cardiac stress testing, comparing those without known coronary artery disease (CAD) to those with CAD but no DM.
- After matching for characteristics, the study found similar MACE rates between both groups, but identified stress testing mode, total perfusion deficit (TPD), and left ventricular function as key predictors of MACE.
- The results highlighted that patients with DM who underwent pharmacologic stress testing and had a TPD greater than 10% experienced significantly higher MACE risk compared to non-ischemic, exercised patients without DM.
Article Synopsis
- The study evaluates the independent prognostic value of phase analysis in single-photon emission computed tomography (SPECT) myocardial perfusion imaging, in relation to major adverse cardiac events (MACE).
- It included data from over 19,000 patients, finding that phase variables like phase entropy were significant predictors of MACE, with a notable increase in MACE rates across different levels of phase entropy.
- This research suggests that incorporating phase analysis into cardiac assessments can improve risk stratification for MACE beyond traditional measures like total perfusion deficit and left ventricular ejection fraction.
Article Synopsis
- The study aimed to simplify risk assessment for major adverse cardiac events (MACE) using machine learning (ML) from myocardial perfusion imaging (MPI) by focusing on the fewest manual and imaging variables needed for accurate predictions.
- The research included over 20,000 patients and compared the performance of various ML models, highlighting that models with fewer variables can still match the accuracy of more complex ones when predicting cardiac risks.
- The findings suggest that reduced ML models maintain a comparable prognostic performance to traditional methods, potentially making cardiac risk assessment more efficient and less error-prone.
Article Synopsis
- Stress-only myocardial perfusion imaging (MPI) can significantly cut down on radiation exposure, scanning time, and costs, leading to the development of an automated algorithm that accurately identifies patients who don't require additional rest imaging.
- A machine learning score (MLS) was created to predict obstructive coronary artery disease (CAD) using clinical data and results from stress-only MPI, showing higher predictive accuracy than traditional reader diagnosis methods.
- The MLS demonstrated a sensitivity of 95% for detecting obstructive CAD, outperforming other assessments and supporting a strategy that prioritizes stress imaging to streamline the diagnostic process.
Article Synopsis
- - This study investigated the benefits of early revascularization in patients with significant ischemia using data from a large international registry of myocardial perfusion imaging (SPECT-MPI) between 2009 and 2014.
- - It found that patients showing greater than 10.2% ischemic total perfusion deficit (TPD) after automatic quantification had a lower risk of major adverse cardiovascular events (MACE) if they underwent revascularization within 90 days.
- - The results suggest that early revascularization may be particularly beneficial for patients with moderate to severe ischemia, contributing to better cardiovascular outcomes compared to those who do not receive early intervention.
Article Synopsis
- Researchers developed a machine learning (ML) method to automatically determine when to cancel rest scans in SPECT myocardial perfusion imaging (MPI), aiming to decrease radiation exposure and costs.
- The study used data from over 20,000 patients to train the ML model, which predicted major adverse cardiac events (MACE) and established three score thresholds to match physician decision-making.
- Results showed that patients recommended for rest scan cancellation by ML had significantly lower MACE and all-cause mortality rates compared to those selected by traditional methods, indicating better prognostic safety with the ML approach.
Article Synopsis
- This study investigates the differences in the risk of major adverse cardiovascular events (MACE) between patients with diabetes and those without, based on the total perfusion deficit (TPD) during myocardial imaging.
- It found that patients with diabetes had a higher risk of MACE at every level of TPD, with those having more severe ischemia facing more than double the risk compared to non-diabetic patients.
- Even minimal ischemia in diabetic patients (TPD < 1%) was associated with a high risk of MACE, suggesting that diabetic individuals are at increased cardiovascular risk even with slight perfusion issues.
There has been an evolutionary leap in SPECT imaging with the advent of camera systems that use solid-state crystals and novel collimator designs configured specifically for cardiac imaging. Solid-state SPECT camera systems have facilitated dramatic reductions in both imaging time and radiation dose while maintaining high diagnostic accuracy. These advances are related to simultaneous improvement in photon sensitivity due to the collimator and imaging geometry, as well as image resolution due to the improved energy resolution of the new crystals.
View Article and Find Full Text PDFAims: To optimize per-vessel prediction of early coronary revascularization (ECR) within 90 days after fast single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) using machine learning (ML) and introduce a method for a patient-specific explanation of ML results in a clinical setting.
Methods And Results: A total of 1980 patients with suspected coronary artery disease (CAD) underwent stress/rest 99mTc-sestamibi/tetrofosmin MPI with new-generation SPECT scanners were included. All patients had invasive coronary angiography within 6 months after SPECT MPI.
Aims: Ischaemia on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is strongly associated with cardiovascular risk. Transient ischaemic dilation (TID) and post-stress wall motion abnormalities (WMA) are non-perfusion markers of ischaemia with incremental prognostic utility. Using a large, multicentre SPECT MPI registry, we assessed the degree to which these features increased the risk of major adverse cardiovascular events (MACE) in patients with less than moderate ischaemia.
View Article and Find Full Text PDFObjectives: This study compared the ability of automated myocardial perfusion imaging analysis to predict major adverse cardiac events (MACE) to that of visual analysis.
Background: Quantitative analysis has not been compared with clinical visual analysis in prognostic studies.
Methods: A total of 19,495 patients from the multicenter REFINE SPECT (REgistry of Fast Myocardial Perfusion Imaging with NExt generation SPECT) study (64 ± 12 years of age, 56% males) undergoing stress Tc-99m-labeled single-photon emission computed tomography (SPECT) myocardial perfusion imaging were followed for 4.
Background: Upper reference limits for transient ischemic dilation (TID) have not been rigorously established for cadmium-zinc-telluride (CZT) camera systems. We aimed to derive TID limits for common myocardial perfusion imaging protocols utilizing a large, multicenter registry (REFINE SPECT).
Methods: One thousand six hundred and seventy-two patients with low likelihood of coronary artery disease with normal perfusion findings were identified.
Background: Short imaging protocol to quantify myocardial blood flow (MBF) and myocardial flow reserve (MFR) may enhance the clinical application of N-ammonia cardiac PET. We assessed the flow quantitation of N-ammonia PET implementing simple retention model and two-compartment model.
Methods: Fourteen healthy volunteers (HVT) and twenty-three clinical patients received N-ammonia PET/CT.
Combined analysis of SPECT myocardial perfusion imaging (MPI) performed with a solid-state camera on patients in 2 positions (semiupright, supine) is routinely used to mitigate attenuation artifacts. We evaluated the prediction of obstructive disease from combined analysis of semiupright and supine stress MPI by deep learning (DL) as compared with standard combined total perfusion deficit (TPD). 1,160 patients without known coronary artery disease (64% male) were studied.
View Article and Find Full Text PDFBackground: We aim to establish a multicenter registry collecting clinical, imaging, and follow-up data for patients who undergo myocardial perfusion imaging (MPI) with the latest generation SPECT scanners.
Methods: REFINE SPECT (REgistry of Fast Myocardial Perfusion Imaging with NExt generation SPECT) uses a collaborative design with multicenter contribution of clinical data and images into a comprehensive clinical-imaging database. All images are processed by quantitative software.
Background: A satisfactory bolus injection is essential for a successful first-pass radionuclide angiography (FPRNA). Rescheduling the FPRNA study is usually needed due to high background interference caused by an unsatisfactory bolus injection. We developed a protocol to correct the pre-existing background activity subsequent to immediately repeating the study.
View Article and Find Full Text PDFObjectives: The aim of this study was to evaluate the accuracy of myocardial blood flow (MBF) quantitation of Tc-Sestamibi (MIBI) single photon emission computed tomography (SPECT) compared with N-Ammonia (NH3) position emission tomography (PET) on the same cohorts.
Background: Recent advances of SPECT technologies have been applied to develop MBF quantitation as a promising tool to diagnose coronary artery disease (CAD) for areas where PET MBF quantitation is not available. However, whether the SPECT approach can achieve the same level of accuracy as the PET approach for clinical use still needs further investigations.
Persistent left superior vena cava (PLSVC) is a development variation of the embryonic thoracic venous system. It can be isolated or associated with congenital heart disease combined with shunting problems. Many image findings of PLSVC have been reported, but few mentioned findings in a first-pass radionuclide angiography.
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