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Journal Reading
ldquoHybird SPECTCT Imaging in the
Evaluation of Coronary Stenosis Role in Diabetic Patientsrdquo
Rahmandra 1102010228
Kepanitraan Klinik Bagian RadiologiFakultas Kedokteran Universitas YARSI
Rumah Sakit Bhayangkata TkI Raden Said Sukanto
Untuk menggabungkan
hasil dari MDCTdata
morfologi dan data
SPECT menggun
akan pencitraan Hybird
untuk mengatas
i kekurangan MDCT
dalam evaluasistenosis
arteri koroner
pada pasien
diabetes dengan kalsium di arteri koroner
Dan juga untuk
membandingkan hasil CT
Scan SPECT
Scan dan Hybird SPECT
TUJUAN
Introduction
1 bullDiabetes mellitus type 2 is strictly related to CAD (coronary artery disease) in fact 70ndash80 of diabetic patients die of cardiovascular complications moreover these patients have a risk of myocardial infarction about four times higher than that found in the general population [1ndash3]
2 bullIn this case it could be useful to work with hybrid imaging merging the anatomical images of CT to the functional images of SPECT overcoming the limits of the two techniques
CT-SCANbull Computer Tomography (CT)
biasa juga disebut Computed axial tomography (CAT) computer-assisted tomography atau (body section roentgenography) yang merupakan suatu proses yang menggunakan digital processing untuk menghasilkan suatu gambaran internal tiga dimensi suatu obyek dari satu rangkaian sinar x yang menghasilkan gambar dua dimensi
APLIKASI CT SCAN
CT Scanner memiliki kemampuan yang unik untuk memperhatikan suatu kombinasi dari jaringan pembuluh darah dan tulang secara bersamaan CT Scanner dapat digunakan untuk mendiagnose permasalahan berbeda seperti
bull Adanya gumpalan darah di dalam paru-paru (pulmonary emboli)
bull Pendarahan di dalam otak (cerebral vascular accident)
bull Batu ginjalbull Inflamed appendixbull Kanker otak hati pankreas tulang dllbull Tulang yang retak
SPECT SCANbull What is SPECT
SPECT is short for single photon emission computed tomography As its name suggests (single photon emission) gamma rays are the sources of the information rather than X-ray emission in the conventional CT scan
bull Why SPECT
Similar to X-ray CT MRI etc SPECT allows us to visualize functional information about patientrsquos specific organ or body system
THEORY AND INSTRUMENTATION
bull SPECT is a technology used in nuclear medicine where the patient is injected with a radiopharmaceutical which will emit gamma rays
bull We seek the position and concentration of radionuclide distribution by the rotation of a photon detector array around the body which acquires data from multiple angles
ADVANTAGES
bull Localization of defects is more precise and more clearly seen by the inexperienced eye
bull Extend and size of
defects is better defined
bull Images free of
background
SPECT APPLICATIONS
bull Heart imaging
bull Brain Imaging
bull SPECT imaging
bull Tumor detection
bull Bone Scans
Anatomi Jantung
Arteri KoronariaArteri koronaria adalah cabang pertama dari sirkulasi sitemikMuara arterikoronaria ini terdapat di dalam sinus valsava dalam aorta tepat di ataskatup aortaSirkulasi koroner memiliki dua cabang besar arteri koroner kanan dan arteri koroner kiri Arteri koroner kiri mempunyai dua cabang besar arteri desendens anterior kiri (LAD) dan arteria sirkumfleksa kiri(Lcx)
Gambaran Normal CT Arteri Koronaria
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
Untuk menggabungkan
hasil dari MDCTdata
morfologi dan data
SPECT menggun
akan pencitraan Hybird
untuk mengatas
i kekurangan MDCT
dalam evaluasistenosis
arteri koroner
pada pasien
diabetes dengan kalsium di arteri koroner
Dan juga untuk
membandingkan hasil CT
Scan SPECT
Scan dan Hybird SPECT
TUJUAN
Introduction
1 bullDiabetes mellitus type 2 is strictly related to CAD (coronary artery disease) in fact 70ndash80 of diabetic patients die of cardiovascular complications moreover these patients have a risk of myocardial infarction about four times higher than that found in the general population [1ndash3]
2 bullIn this case it could be useful to work with hybrid imaging merging the anatomical images of CT to the functional images of SPECT overcoming the limits of the two techniques
CT-SCANbull Computer Tomography (CT)
biasa juga disebut Computed axial tomography (CAT) computer-assisted tomography atau (body section roentgenography) yang merupakan suatu proses yang menggunakan digital processing untuk menghasilkan suatu gambaran internal tiga dimensi suatu obyek dari satu rangkaian sinar x yang menghasilkan gambar dua dimensi
APLIKASI CT SCAN
CT Scanner memiliki kemampuan yang unik untuk memperhatikan suatu kombinasi dari jaringan pembuluh darah dan tulang secara bersamaan CT Scanner dapat digunakan untuk mendiagnose permasalahan berbeda seperti
bull Adanya gumpalan darah di dalam paru-paru (pulmonary emboli)
bull Pendarahan di dalam otak (cerebral vascular accident)
bull Batu ginjalbull Inflamed appendixbull Kanker otak hati pankreas tulang dllbull Tulang yang retak
SPECT SCANbull What is SPECT
SPECT is short for single photon emission computed tomography As its name suggests (single photon emission) gamma rays are the sources of the information rather than X-ray emission in the conventional CT scan
bull Why SPECT
Similar to X-ray CT MRI etc SPECT allows us to visualize functional information about patientrsquos specific organ or body system
THEORY AND INSTRUMENTATION
bull SPECT is a technology used in nuclear medicine where the patient is injected with a radiopharmaceutical which will emit gamma rays
bull We seek the position and concentration of radionuclide distribution by the rotation of a photon detector array around the body which acquires data from multiple angles
ADVANTAGES
bull Localization of defects is more precise and more clearly seen by the inexperienced eye
bull Extend and size of
defects is better defined
bull Images free of
background
SPECT APPLICATIONS
bull Heart imaging
bull Brain Imaging
bull SPECT imaging
bull Tumor detection
bull Bone Scans
Anatomi Jantung
Arteri KoronariaArteri koronaria adalah cabang pertama dari sirkulasi sitemikMuara arterikoronaria ini terdapat di dalam sinus valsava dalam aorta tepat di ataskatup aortaSirkulasi koroner memiliki dua cabang besar arteri koroner kanan dan arteri koroner kiri Arteri koroner kiri mempunyai dua cabang besar arteri desendens anterior kiri (LAD) dan arteria sirkumfleksa kiri(Lcx)
Gambaran Normal CT Arteri Koronaria
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
Introduction
1 bullDiabetes mellitus type 2 is strictly related to CAD (coronary artery disease) in fact 70ndash80 of diabetic patients die of cardiovascular complications moreover these patients have a risk of myocardial infarction about four times higher than that found in the general population [1ndash3]
2 bullIn this case it could be useful to work with hybrid imaging merging the anatomical images of CT to the functional images of SPECT overcoming the limits of the two techniques
CT-SCANbull Computer Tomography (CT)
biasa juga disebut Computed axial tomography (CAT) computer-assisted tomography atau (body section roentgenography) yang merupakan suatu proses yang menggunakan digital processing untuk menghasilkan suatu gambaran internal tiga dimensi suatu obyek dari satu rangkaian sinar x yang menghasilkan gambar dua dimensi
APLIKASI CT SCAN
CT Scanner memiliki kemampuan yang unik untuk memperhatikan suatu kombinasi dari jaringan pembuluh darah dan tulang secara bersamaan CT Scanner dapat digunakan untuk mendiagnose permasalahan berbeda seperti
bull Adanya gumpalan darah di dalam paru-paru (pulmonary emboli)
bull Pendarahan di dalam otak (cerebral vascular accident)
bull Batu ginjalbull Inflamed appendixbull Kanker otak hati pankreas tulang dllbull Tulang yang retak
SPECT SCANbull What is SPECT
SPECT is short for single photon emission computed tomography As its name suggests (single photon emission) gamma rays are the sources of the information rather than X-ray emission in the conventional CT scan
bull Why SPECT
Similar to X-ray CT MRI etc SPECT allows us to visualize functional information about patientrsquos specific organ or body system
THEORY AND INSTRUMENTATION
bull SPECT is a technology used in nuclear medicine where the patient is injected with a radiopharmaceutical which will emit gamma rays
bull We seek the position and concentration of radionuclide distribution by the rotation of a photon detector array around the body which acquires data from multiple angles
ADVANTAGES
bull Localization of defects is more precise and more clearly seen by the inexperienced eye
bull Extend and size of
defects is better defined
bull Images free of
background
SPECT APPLICATIONS
bull Heart imaging
bull Brain Imaging
bull SPECT imaging
bull Tumor detection
bull Bone Scans
Anatomi Jantung
Arteri KoronariaArteri koronaria adalah cabang pertama dari sirkulasi sitemikMuara arterikoronaria ini terdapat di dalam sinus valsava dalam aorta tepat di ataskatup aortaSirkulasi koroner memiliki dua cabang besar arteri koroner kanan dan arteri koroner kiri Arteri koroner kiri mempunyai dua cabang besar arteri desendens anterior kiri (LAD) dan arteria sirkumfleksa kiri(Lcx)
Gambaran Normal CT Arteri Koronaria
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
CT-SCANbull Computer Tomography (CT)
biasa juga disebut Computed axial tomography (CAT) computer-assisted tomography atau (body section roentgenography) yang merupakan suatu proses yang menggunakan digital processing untuk menghasilkan suatu gambaran internal tiga dimensi suatu obyek dari satu rangkaian sinar x yang menghasilkan gambar dua dimensi
APLIKASI CT SCAN
CT Scanner memiliki kemampuan yang unik untuk memperhatikan suatu kombinasi dari jaringan pembuluh darah dan tulang secara bersamaan CT Scanner dapat digunakan untuk mendiagnose permasalahan berbeda seperti
bull Adanya gumpalan darah di dalam paru-paru (pulmonary emboli)
bull Pendarahan di dalam otak (cerebral vascular accident)
bull Batu ginjalbull Inflamed appendixbull Kanker otak hati pankreas tulang dllbull Tulang yang retak
SPECT SCANbull What is SPECT
SPECT is short for single photon emission computed tomography As its name suggests (single photon emission) gamma rays are the sources of the information rather than X-ray emission in the conventional CT scan
bull Why SPECT
Similar to X-ray CT MRI etc SPECT allows us to visualize functional information about patientrsquos specific organ or body system
THEORY AND INSTRUMENTATION
bull SPECT is a technology used in nuclear medicine where the patient is injected with a radiopharmaceutical which will emit gamma rays
bull We seek the position and concentration of radionuclide distribution by the rotation of a photon detector array around the body which acquires data from multiple angles
ADVANTAGES
bull Localization of defects is more precise and more clearly seen by the inexperienced eye
bull Extend and size of
defects is better defined
bull Images free of
background
SPECT APPLICATIONS
bull Heart imaging
bull Brain Imaging
bull SPECT imaging
bull Tumor detection
bull Bone Scans
Anatomi Jantung
Arteri KoronariaArteri koronaria adalah cabang pertama dari sirkulasi sitemikMuara arterikoronaria ini terdapat di dalam sinus valsava dalam aorta tepat di ataskatup aortaSirkulasi koroner memiliki dua cabang besar arteri koroner kanan dan arteri koroner kiri Arteri koroner kiri mempunyai dua cabang besar arteri desendens anterior kiri (LAD) dan arteria sirkumfleksa kiri(Lcx)
Gambaran Normal CT Arteri Koronaria
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
APLIKASI CT SCAN
CT Scanner memiliki kemampuan yang unik untuk memperhatikan suatu kombinasi dari jaringan pembuluh darah dan tulang secara bersamaan CT Scanner dapat digunakan untuk mendiagnose permasalahan berbeda seperti
bull Adanya gumpalan darah di dalam paru-paru (pulmonary emboli)
bull Pendarahan di dalam otak (cerebral vascular accident)
bull Batu ginjalbull Inflamed appendixbull Kanker otak hati pankreas tulang dllbull Tulang yang retak
SPECT SCANbull What is SPECT
SPECT is short for single photon emission computed tomography As its name suggests (single photon emission) gamma rays are the sources of the information rather than X-ray emission in the conventional CT scan
bull Why SPECT
Similar to X-ray CT MRI etc SPECT allows us to visualize functional information about patientrsquos specific organ or body system
THEORY AND INSTRUMENTATION
bull SPECT is a technology used in nuclear medicine where the patient is injected with a radiopharmaceutical which will emit gamma rays
bull We seek the position and concentration of radionuclide distribution by the rotation of a photon detector array around the body which acquires data from multiple angles
ADVANTAGES
bull Localization of defects is more precise and more clearly seen by the inexperienced eye
bull Extend and size of
defects is better defined
bull Images free of
background
SPECT APPLICATIONS
bull Heart imaging
bull Brain Imaging
bull SPECT imaging
bull Tumor detection
bull Bone Scans
Anatomi Jantung
Arteri KoronariaArteri koronaria adalah cabang pertama dari sirkulasi sitemikMuara arterikoronaria ini terdapat di dalam sinus valsava dalam aorta tepat di ataskatup aortaSirkulasi koroner memiliki dua cabang besar arteri koroner kanan dan arteri koroner kiri Arteri koroner kiri mempunyai dua cabang besar arteri desendens anterior kiri (LAD) dan arteria sirkumfleksa kiri(Lcx)
Gambaran Normal CT Arteri Koronaria
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
SPECT SCANbull What is SPECT
SPECT is short for single photon emission computed tomography As its name suggests (single photon emission) gamma rays are the sources of the information rather than X-ray emission in the conventional CT scan
bull Why SPECT
Similar to X-ray CT MRI etc SPECT allows us to visualize functional information about patientrsquos specific organ or body system
THEORY AND INSTRUMENTATION
bull SPECT is a technology used in nuclear medicine where the patient is injected with a radiopharmaceutical which will emit gamma rays
bull We seek the position and concentration of radionuclide distribution by the rotation of a photon detector array around the body which acquires data from multiple angles
ADVANTAGES
bull Localization of defects is more precise and more clearly seen by the inexperienced eye
bull Extend and size of
defects is better defined
bull Images free of
background
SPECT APPLICATIONS
bull Heart imaging
bull Brain Imaging
bull SPECT imaging
bull Tumor detection
bull Bone Scans
Anatomi Jantung
Arteri KoronariaArteri koronaria adalah cabang pertama dari sirkulasi sitemikMuara arterikoronaria ini terdapat di dalam sinus valsava dalam aorta tepat di ataskatup aortaSirkulasi koroner memiliki dua cabang besar arteri koroner kanan dan arteri koroner kiri Arteri koroner kiri mempunyai dua cabang besar arteri desendens anterior kiri (LAD) dan arteria sirkumfleksa kiri(Lcx)
Gambaran Normal CT Arteri Koronaria
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
THEORY AND INSTRUMENTATION
bull SPECT is a technology used in nuclear medicine where the patient is injected with a radiopharmaceutical which will emit gamma rays
bull We seek the position and concentration of radionuclide distribution by the rotation of a photon detector array around the body which acquires data from multiple angles
ADVANTAGES
bull Localization of defects is more precise and more clearly seen by the inexperienced eye
bull Extend and size of
defects is better defined
bull Images free of
background
SPECT APPLICATIONS
bull Heart imaging
bull Brain Imaging
bull SPECT imaging
bull Tumor detection
bull Bone Scans
Anatomi Jantung
Arteri KoronariaArteri koronaria adalah cabang pertama dari sirkulasi sitemikMuara arterikoronaria ini terdapat di dalam sinus valsava dalam aorta tepat di ataskatup aortaSirkulasi koroner memiliki dua cabang besar arteri koroner kanan dan arteri koroner kiri Arteri koroner kiri mempunyai dua cabang besar arteri desendens anterior kiri (LAD) dan arteria sirkumfleksa kiri(Lcx)
Gambaran Normal CT Arteri Koronaria
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
ADVANTAGES
bull Localization of defects is more precise and more clearly seen by the inexperienced eye
bull Extend and size of
defects is better defined
bull Images free of
background
SPECT APPLICATIONS
bull Heart imaging
bull Brain Imaging
bull SPECT imaging
bull Tumor detection
bull Bone Scans
Anatomi Jantung
Arteri KoronariaArteri koronaria adalah cabang pertama dari sirkulasi sitemikMuara arterikoronaria ini terdapat di dalam sinus valsava dalam aorta tepat di ataskatup aortaSirkulasi koroner memiliki dua cabang besar arteri koroner kanan dan arteri koroner kiri Arteri koroner kiri mempunyai dua cabang besar arteri desendens anterior kiri (LAD) dan arteria sirkumfleksa kiri(Lcx)
Gambaran Normal CT Arteri Koronaria
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
Anatomi Jantung
Arteri KoronariaArteri koronaria adalah cabang pertama dari sirkulasi sitemikMuara arterikoronaria ini terdapat di dalam sinus valsava dalam aorta tepat di ataskatup aortaSirkulasi koroner memiliki dua cabang besar arteri koroner kanan dan arteri koroner kiri Arteri koroner kiri mempunyai dua cabang besar arteri desendens anterior kiri (LAD) dan arteria sirkumfleksa kiri(Lcx)
Gambaran Normal CT Arteri Koronaria
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
Arteri KoronariaArteri koronaria adalah cabang pertama dari sirkulasi sitemikMuara arterikoronaria ini terdapat di dalam sinus valsava dalam aorta tepat di ataskatup aortaSirkulasi koroner memiliki dua cabang besar arteri koroner kanan dan arteri koroner kiri Arteri koroner kiri mempunyai dua cabang besar arteri desendens anterior kiri (LAD) dan arteria sirkumfleksa kiri(Lcx)
Gambaran Normal CT Arteri Koronaria
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
Gambaran Normal CT Arteri Koronaria
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
Method and Material
1 Populatio
n
bullBetween January 2009 and December 2011 we enrolled 120 consecutive diabetic patients (84 males and 36 females) mean age 67 years old (range 50ndash78) and performed a coronary CT All the patients had one or more cardiac symptoms such as stable angina atypical chest pain and dyspnea
2 CT Scan
bullWe used a 64-slice CT scanner (LightSpeed VCT General Electric Medical Systems Milwaukee WI USA) and a retrospective synchronization technique Patients with a heart rate higher than 65 bpm were previously (almost 5 days before) treated with oral beta-blocker therapy
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
3 SPECT Scan bull Gated-SPECT was performed on a doubleheaded camera
4 Hybird SPECT CT Images
bull The fusion between stress- SPECT images and CT axial images was done using the Cardiac IQ Fusion protocol on a remote workstation (Advantage Workstation 44 GE Healthcare)
5 Conventional Coronary Angiography
bull CCA was performed using a Philips flat-panel system with multiple projections The video clips were analysed by a blind observer using quantitative software
5 Statistical Analysisbull All data were entered into a database for
statistical processing Data were expressed as means plus one standard deviation (SD) or as percentages
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
Result
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
Discussionbull However the perfusion images obtained
with SPECT show a good sensitivity and a low specificity in the detection of patients with CAD
bull Furthermore SPECT reported some false positives when a patient cannot reach 85 of the theoretical maximum heart rate during the exercise testing this event occurs in obese patients in older patients in patients with arterial disease of the lower limbs and in subjects treated with beta-blockers
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
Discussionbull In our experience hybrid SPECTCT images
provide help in the evaluation and grading of calci1048853ed stenoses in CT and overcome the problem of the abnormal uptake of the radiopharmaceutical by the breast tissue in SPECT
bull Therefore the usefulness of the fusion between CT and SPECT images is to overcome the limits of CT and the limits of SPECT with a high diagnostic accuracy especially in patients with high cardiovascular risk and high presence of physical limitations like the diabetic patients
Terima Kasih
Terima Kasih
