OBJECTIVE:While nuclear myocardial perfusion imaging (MPI) offers many benefits to patients with known or suspected cardiovascular disease, concerns exist regarding radiation-associated health effects. Little is known regarding MPI practice in Africa. We sought to characterise radiation doses and the use of MPI best practices that could minimise radiation in African nuclear cardiology laboratories, and compare these to practice worldwide.METHODS:Demographics and clinical characteristics were collected for a consecutive sample of 348 patients from 12 laboratories in six African countries over a one-week period from March to April 2013. Radiation effective dose (ED) was estimated for each patient. A quality index (QI) enumerating adherence to eight best practices, identified a priori by an IAEA expert panel, was calculated for each laboratory. We compared these metrics with those from 7 563 patients from 296 laboratories outside Africa.RESULTS:Median (interquartile range) patient ED in Africa was similar to that of the rest of the world [9.1 (5.1-15.6) vs 10.3 mSv (6.8-12.6), p = 0.14], although a larger proportion of African patients received a low ED, ≤ 9 mSv targeted in societal recommendations (49.7 vs 38.2%, p < 0.001). Bestpractice adherence was higher among African laboratories (QI score: 6.3 ± 1.2 vs 5.4 ± 1.3, p = 0.013). However, median ED varied significantly among African laboratories (range: 2.0-16.3 mSv; p < 0.0001) and QI range was 4-8.CONCLUSION:Patient radiation dose from MPI in Africa was similar to that in the rest of the world, and adherence to best practices was relatively high in African laboratories. Nevertheless there remain opportunities to further reduce radiation exposure to African patients from MPI.

Mathew Mercuri, PhD; Thomas N. B. Pascual, MD; John J. Mahmarian, MD; Leslee J. Shaw, PhD; Maurizio Dondi, MD; Diana Paez, MD; Andrew J. Einstein, MD, PhD; for the INCAPS Investigators Group

This study estimates current rates of stress-only imaging in cardiology patients in the United States and worldwide, as well as the potential effect of changes in this rate on the radiation burden to the US population.

BackgroundInterim PET after two ABVD cycles (iPET2) predicts treatment outcome in classical Hodgkin's lymphoma. To test whether an earlier assessment of chemosensitivity would improve the prediction accuracy, we launched a prospective, multicenter observational study aimed at assessing the predictive value of iPET after one ABVD (iPET1) and the kinetics of response assessed by sequential PET scanning.Patients and methodsConsecutive patients with newly diagnosed classical Hodgkin's lymphoma underwent interim PET scan after one ABVD course (iPET1). PETs were interpreted according to the Deauville score (DS) as negative (-) (DS 1-3) and positive (+) (DS 4, 5). Patients with iPET1 DS 3-5 underwent iPET2.ResultsAbout 106 early (I-IIA) and 204 advanced (IIB-IV) patients were enrolled between January 2008 and October 2014. iPET1 was (-) in 87/106 (82%) or (+) in 19/106 (18%) of early, and (-) in 133/204 (65%) or (+) in 71/204 (35%) of advanced stage patients, respectively. Twenty-four patients were excluded from response analysis due to treatment escalation. After a median follow-up of 38.2 (3.2-90.2) months, 9/102 (9%) early and 43/184 (23%) advanced patients experienced a progression-free survival event. At 36 months, negative and positive predictive value for iPET1 were 94% and 41% (early) and 84% and 43% (advanced), respectively. The kinetics of PET response was assessed in 198 patients with both iPETs. All 116 patients with iPET1(-) remained iPET2(-) (fast responders), 41/82 with IPET1(+) became iPET2(-) (slow responders), and the remaining 41 stayed iPET2(+) (non-responders); progression-free survival at 36 months for fast, slow and non-responders was 0.88, 0.79 and 0.34, respectively.ConclusionThe optimal tool to predict ABVD outcome in HL remains iPET2 because it distinguishes responders, whatever their time to response, from non-responders. However, iPET1 identified fast responders with the best outcome and might guide early treatment de-escalation in both early and advanced-stage HL.

Aims To characterize patient radiation doses from nuclear myocardial perfusion imaging (MPI) and the use of radiation-optimizing ‘best practices’ worldwide, and to evaluate the relationship between laboratory use of best practices and patient radiation dose. Methods and results We conducted an observational cross-sectional study of protocols used for all 7911 MPI studies performed in 308 nuclear cardiology laboratories in 65 countries for a single week in March–April 2013. Eight ‘best practices’ relating to radiation exposure were identified a priori by an expert committee, and a radiation-related quality index (QI) devised indicating the number of best practices used by a laboratory. Patient radiation effective dose (ED) ranged between 0.8 and 35.6 mSv (median 10.0 mSv). Average laboratory ED ranged from 2.2 to 24.4 mSv (median 10.4 mSv); only 91 (30%) laboratories achieved the median ED ≤ 9 mSv recommended by guidelines. Laboratory QIs ranged from 2 to 8 (median 5). Both ED and QI differed significantly between laboratories, countries, and world regions. The lowest median ED (8.0 mSv), in Europe, coincided with high best-practice adherence (mean laboratory QI 6.2). The highest doses (median 12.1 mSv) and low QI (4.9) occurred in Latin America. In hierarchical regression modelling, patients undergoing MPI at laboratories following more ‘best practices’ had lower EDs. Conclusion Marked worldwide variation exists in radiation safety practices pertaining to MPI, with targeted EDs currently achieved in a minority of laboratories. The significant relationship between best-practice implementation and lower doses indicates numerous opportunities to reduce radiation exposure from MPI globally.

Purpose: In overweight patients extravascular expression of inflammatory mediators may adversely influence coronary lesion formation and plaque stability through outside-to-inside signaling. Additionally, maximal standardized uptake value (SUV) of 18-fluorodeoxyglucose (FDG) detected by positron emission tomography has been shown to be proportional to macrophage density. Accordingly, we examined peri-coronary adipose tissue (PVAT) radiodensity (RD), and inflammatory activity using FDG-PET/CT in patients with stable coronary artery disease (CAD) and in controls. Methods: 35 consecutive (20 with BMI>25), non-diabetic patients with angiographicaly confirmed CAD underwent FDG-PET/CT. RD and SUV were measured in fat surrounding three main coronary arteries on the sections corresponding to proximal segments (RCA, LCX, LAD, respectively). Additionally SUV was measured in subcutaneous fat (SC), visceral thoracic fat (VS), epicardial fat over right ventricle (EPI), Same measurements were taken in a group of healthy volunteers matched for age and BMI (n=17). In the group of CAD patients, associations of SUV with gender, age, body mass index (BMI), serum glucose, were further analyzed. Extent of CAD was determined by % stenosis using QCA in segments corresponding to PET/CT sections. Results: PVAT SUV was significantly greater than SUV in other fat locations for all patients (SC: 0.27; VS: 0.54; EPI: 0.59; RCA SUV: 1.11; LCX SUV: 1.26; LAD SUV: 1.30; p<0.0001). RD and PVAT SUV were significantly greater in CAD patients than in the control group (RCA RD[HU]: -95 vs -81; p<0.05; LCX RD: -98 vs -81, p<0.05, LAD RD: -104 vs -90, p<0.05), (RCA SUV: 1.34 vs 0.62; p<0.0001; LCX SUV: 1.53 vs 0.71, p<0.0001, LAD SUV: 1.58 vs 0.71, p<0.0001). PVAT SUV was not related to gender, age, BMI, or serum glucose. Finally, PVAT SUV was positively related to % stenosis of respective coronary artery (RCA: 0.50; p<.03; LCX 0.59; p<.006; LAD 0.73 p<.0002), but only if BMI>25. In univariate and multivariate models correlations between PVAT SUV and % stenosis were independent of history of hypertension, myocardial infarction, dyslipidemia, smoking, diabetes and fasting glucose. Conclusions: 1. Inflammatory activity of PVAT reflected by RD and SUV is greater than in subcutaneous, visceral thoracic, or epicardial tissue; 2. PVAT RD and SUV are higher in CAD patients, than in non-CAD controls; 3. Among overweight patients PVAT SUV correlates with the vessel stenosis. In conclusion, the greater pro-inflammatory activity of PVAT in overweight patients with CAD may contribute to plaque formation, vessel narrowing and plaque rupture.

Aim: The aim of this study was to assess the usefulness of routine 18F FDG PET/CT examination in patients with temporal lobe epilepsy before surgery.

Background: Epicardial adipose tissue (EAT) inflammatory capacity was shown to correlate with coronary vessels' narrowing’s in stable and unstable coronary artery disease. It has been also shown, that maximal standardized uptake value (SUV) of 18-fluorodeoxyglucose (FDG) detected by positron emission tomography is proportional to macrophage density. EAT contains abundant ganglionated plexi contributing to the occurrence of atrial fibrillation (AF). Accordingly, we examined EAT inflammatory activity using FDG-PET/CT in patients with AF and in controls. Methods: 21 consecutive patients with confirmed history of AF underwent FDG-PET/CT. SUV were measured in fat adjacent to the right roof of left atrium (LAF), right ventricle (RVF), atrioventricular groove (AGF), and left main artery (LMF). Additionally SUV was measured in subcutaneous fat (SC), visceral thoracic fat (VS). Similar measurements of SUV were taken in a group of healthy volunteers matched for age and BMI (n=16). In the group of AF patients, associations of SUV with gender, age, body mass index (BMI), serum glucose, were further analyzed. Results: EAT SUV in all locations was significantly greater in FA patients than in the control group (LAF: 1.21 vs. 0.60, p<0.0001; RVF: 0.75 vs. 0.40, p<0.0001; AGF: 1.46 vs. 0.66, p<0.0001; LMF 1.41 vs. 0.69, p<0.0001, respectively). In addition, LAF, RVF, AGF, and LMF was significantly greater than SUV in SC and VS for both FA and controls (SC: 0.33; VS: 0.58; LAF: 1.21; RVF: 0.75; AGF 1.46; LMF: 1.41; p<0.01). EAT SUV was not related to gender, age, BMI, or serum glucose. Article: Epicardial adipose tissue (EAT) contains abundant ganglionated plexi that might contribute to the occurrence of atrial fibrillation (AF). Maximal standardized uptake value (SUV) of 18-fluorodeoxyglucose (FDG)-positron emission tomography (PET) reflects glucose metabolism of the tissue. It has also been shown that FDG-PET is proportional to macrophage density. We examined EAT inflammatory activity using FDG-PET/computerized tomography in patients with AF and in controls. Retrospective analysis of patients who underwent FDG-PET/computerized tomography was performed. About 21 consecutive patients with confirmed history of AF and 21 non-AF control group matched for age, gender, and body mass index (BMI) were included. SUV was measured in fat adjacent to the roof of left atrium, right ventricle, atrioventricular groove, and left main artery. Additionally SUV was measured in subcutaneous fat and visceral thoracic fat. In both groups, associations of SUV with gender, age, BMI, and serum glucose were further analyzed. EAT SUV measured near the roof of left atrium, atrioventricular groove, and left main artery was significantly greater in patients with AF than in control group (1.66 ± 0.36 vs. 1.23 ± 0.32, p = 0.00015; 2.07 ± 0.50 vs. 1.51 ± 0.24, p = 0.00003; and 1.95 ± 0.48 vs. 1.52 ± 0.26, p = 0.0007, respectively). In addition, EAT SUV was significantly greater than subcutaneous and visceral thoracic fat for patients with AF and controls. EAT SUV was not related to gender, age, BMI, or serum glucose. In conclusion, inflammatory activity of EAT reflected by SUV is higher in patients with AF than that in controls. Inflammatory activity of EAT adjacent to left atrium, atrioventricular groove, and left main artery is greater than in subcutaneous or visceral thoracic tissue.

The results of study on T-wave alternans in the group of patients with ischemic heart disease are shown. The body surface potential maps were recorded with use of 67 channel high-resolution ECG system. Electrocardiographic stress test was performed during the patient examinations. The T-wave alternans ratio was calculated and results were compared with data obtained by single-photon emission computed tomography (SPECT). Significant correlations between results of T-wave alternans analysis and SPECT test have been found.