OBJECTIVE:To assess the intra- and inter-observer repeatability of popular software packages for the quantitative determination of abnormality size in stress myocardial perfusion scintigraphy.SUBJECTS AND METHODS:A total of 182 tomographic stress myocardial perfusion scans were processed in duplicate by an experienced and trainee observer to assess SSSext (summed stress score multiplied by 100/68) and total defect extent (TDE), as % of the left ventricle, with 4 dimension-myocardial (4DM), emory cardiac toolbox (ECTb) and quantitative perfusion SPECT (QPS) packages. The Bland-Altman (B-A) analysis and Lin's concordance correlation coefficient (CCC) were used to assess agreement.RESULTS:In SSSext's intra-observer repeatability, CCC showed substantial agreement for 4DM and QPS, and moderate agreement for ECTb for both observers. In inter-observer repeatability, CCC revealed substantial agreement for 4DM and QPS, and poor agreement for ECTb. Regarding TDE, CCC showed substantial intra-observer repeatability for both operators using all packages, while the inter-observer repeatability was substantial for 4DM and QPS, and moderate for ECTb.In SSSext's intra-observer repeatability for 4DM, ECTb and QPS, the B-A analysis provided (mean±1.96SD of paired measurements) 0.0±4.3, 0.2±7.8, -0.6±7.6 for the experienced physician and 0.2±5.9, 0.0±7.5, -0.5±5.4 for the trainee, respectively; in inter-observer repeatability it provided 0.2±5.4, 0.1±9.6, 0.2±8.1, respectively. Regarding TDE, the B-A values for intra-observer repeatability were 0.1±5.2, 0.1±7.9, 0.1±2.8 for the experienced reader and 0.3±6.6, -0.1±6.4, -0.1±2.4 for the trainee, respectively; in inter-observer agreement the B-A provided 0.6±6.4, -0.2±10.3, -0.1±4.3, respectively.CONCLUSION:Considerable differences in intra- and inter- observer agreement were noted for the quantitative determination of defect size using widely employed software packages, suggesting limitations in the clinical use of these measurements. Quantitative perfusion SPECT appears preferable, but with no significant advantage over 4DM. There were no significant differences between the observers.

Background: Angina pectoris, the main manifestation of coronary artery disease has an unfavorable impact on quality of life. The aim of this study was to assess Health-Related Quality Of Life (HRQoL) in patients with Stable Coronary Artery Disease (SCAD) and to explore possible relationships between HRQoL and the risk factors for ischaemic heart disease, the Canadian Cardiovascular Society (CCS) angina severity class, and the extent of myocardial ischaemia on Single Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT-MPI). Methods: HRQoL was assessed with the use of two generic questionnaires, EQ-5D-3L and SF-36v2 in one hundred consecutive patients with SCAD. Results: Most of the patients presented problems on the dimensions of mobility, pain/discomfort, and anxiety/depression of the EQ5D questionnaire. The EQ-VAS score was 61.96 ± 20.99, and the mean EQ-5D index value was 0.54 ± 0.31. The mean scores of the Physical Component Summary and the Mental Component Summary of the SF-36 questionnaire were 43.49 and 41.01 respectively. Higher CCS angina class, female gender and poor physical activity were significantly correlated with worse HRQoL. No statistically significant association was detected between HRQoL and the extent of ischaemia on myocardial perfusion imaging. Conclusions: Patients with SCAD have an impaired HRQoL, which can be reliably assessed by generic HRQoL questionnaires. Angina severity could be used as a surrogate of HRQoL, but individual perception of health status should be measured independently of the amount of ischaemiaon cardiac perfusion scintigraphy Keywords: health related quality of life; myocardial perfusion imaging; coronary artery disease.

A 34-year-old woman with no significant past medical history was admitted to our hospital complaining of shortness of breath on exertion, which had worsened over the last 6 months, a fever of up to 37.5oC, malaise, and postural dizziness. Laboratory examination showed an erythrocyte sedimentation rate of 33 mm/hr, a C-reactive protein level of 5.1 mg/dL, and elevated N-terminal pro B-type natriuretic peptide (615 pg/mL). Transthoracic echocardiogram revealed a dilated and hypokinetic right ventricle, with impaired systolic function, and an estimated right ventricular systolic pressure of 65 mmHg (Videos S1 and S2). Turbulence within the pulmonary artery was noted (Video S3). A computed tomography (CT) pulmonary angiogram demonstrated pulmonary arterial wall thickening and narrowing of the left and right pulmonary artery branches (Figure 1A and B ). A positron emission tomography (PET)–CT scan revealed increased 18F-fluorodeoxyglucose (18FDG) accumulation at the pulmonary artery (Figure 1C), aorta, and right ventricular free wall (Figure 1D). A diagnosis of Takayasu arteritis was made, and medical therapy with corticosteroids and methotrexate was initiated. Echocardiography at 9 months showed improved right ventricular function (Video S4).

Conventional diagnostic imaging is often ineffective in revealing the underlying cause in a considerable proportion of patients with fever of unknown origin (FUO). The aim of this study was to assess the diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients with FUO. We retrospectively reviewed 18F-FDG-PET/CT scans performed on 50 consecutive adult patients referred to our department for further investigation of classic FUO. Final diagnosis was based on histopathological and microbiological findings, clinical criteria, or clinical follow-up. Final diagnosis was established in 39/50 (78%) of the patients. The cause of FUO was infection in 20/50 (40%), noninfectious inflammatory diseases in 11/50 (22%), and malignancy in 8/50 (16%) patients. Fever remained unexplained in 11/50 (22%) patients. 18F-FDG-PET/CT scan substantially contributed to the diagnosis in 70% of the patients, either by identifying the underlying cause of FUO or by directing to the most appropriate site for biopsy. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of 18F-FDG-PET/CT for active disease detection in patients with FUO were 94.7%, 50.0%, 84.0%, 85.7%, and 75.0%, respectively. In conclusion, whole-body 18F-FDG-PET/CT is a highly sensitive method for detection of the underlining cause of FUO or for correctly targeting suspicious lesions for further evaluation.

Aims: To investigate the agreement of glomerular filtration rate (GFR) determination between Cr-51- ethylenediaminetetraacetic acid (Cr-51- EDTA) plasma clearance (GFR(EDTA)) and Tc-99m-diethylenetriaminepentaacetic acid (Tc-99m-DTPA) plasma clearance (GFR(DTPA)), the Gates Tc-99m- DTPA renographic method (GFRGates) and the serum creatinine Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI, GFR(SCr)) in patients with type 2 diabetes mellitus (T2DM). Methods: Ninety-nine T2DM patients underwent GFR determinations simultaneously with Cr-51-EDTA and Tc-99m-DTPA (using the slope-intercept technique and the Brochner-Mortensen correction) and also with GFR(Gates) and GFR(SCr). Results: In the comparison between GFR(EDTA) versus GFR(DTPA), GFR(Gates) and GFR(SCr), the Bland-Altman statistic provided 0.0 +/- 13.2, 17.4* +/- 28.8 and -5.9* +/- 30.1 (*p < 0.001 for the difference from 0). Lin's concordance correlation coefficient showed substantial (0.976), poor (0.737) and poor (0.872) agreement, respectively. The proportion of the index results within the 30% and 10% of GFR(EDTA) measurements were 95% and 74% for GFR(DTPA), 53% and 19% for GFR(Gates), and 83% and 26% for GFR(SCr), respectively. Conclusion: In T2DM patients, a clinically acceptable agreement is demonstrated between Cr-51-EDTA and Tc-99m-DTPA plasma clearance for GFR measurements, suggesting conditional interchangeability between those compounds. Both the CKD-EPI prediction equation and the Gates' renographic method cannot assess GFR reliably, the latter appearing less unfailing than the former. (C) 2020 Elsevier B.V. All rights reserved.

Peritoneal lymphomatosis, defined as the disseminated intraperitoneal lymphomatous infiltration, is a rare presentation usually of non-Hodgkin lymphoma and is associated with aggressive histological subtypes of the malignancy. Recently, the term "peritoneal super scan" has been introduced in positron emission tomography/computed tomography (PET/CT) in a patient with Burkitt lymphoma to describe hypermetabolic lymphomatous involvement of the entire peritoneum, leading to suppression of tracer uptake in organs with otherwise normally increased fluorine-18-fluorodeoxyglucose (18F-FDG) uptake. Herein, we report on a patient with Burkitt lymphoma, initially presenting with a peritoneal super scan in PET/CT demonstrating complete metabolic response to R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone) therapy.

This study aimed to assess intra- and inter-observer agreement in assessing the systolic and diastolic function with equilibrium radionuclide angiography (ERNA). Thirty-two adults underwent baseline and repeat ERNA. An experienced and a trainee operator analyzed the data by assigning regions of interest manually, fully automatically, and semi-automatically. The Bland-Altman statistic (mean ± 1.96 standard deviations of the differences) was used to assess the repeatability (two different assessments of a single acquisition) and reproducibility (assessments of two different acquisitions). Using the semi-automated technique the intraobserver repeatability and reproducibility of left ventricular ejection fraction for the experienced physician were − 0.1 ± 3.7 and 0.0 ± 3.8 and for the trainee 2.2 ± 10.6 and 1.9 ± 8.4, respectively. The inter-observer repeatability and reproducibility were − 1.8 ± 6.4 and 0.4 ± 9.0, respectively. Among the parameters of diastolic function, the intraobserver repeatability and reproducibility of the peak filling rate for the experienced physician were − 0.0 ± 1.1 and − 0.1 ± 1.1 and for the trainee 0.2 ± 3.5 and 0.4 ± 3.7, respectively. The inter-observer repeatability and reproducibility were 0.3 ± 1.5 and 0.5 ± 4.0, respectively. Similar was the pattern for the other diastolic indices. In all cases the limits of agreement varied according to the quantification approach. A good repeatability but a moderate reproducibility was found in the assessment of the LVEF. Less good were the findings in the assessment of diastolic function.