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Radiolabeled human albumin microspheres (HAM) have been used in the past, in order to visualize coronary flow distribution in man. In order to obtain information both on myocardial perfusion and contractility, we applied R-wave synchronized reconstruction of the cardiac cycle in cine mode to HAM imaging. In 20 patients with angina pectoris and coronary stenosis of variable severity and in 1 patient with congestive cardiomyopathy we injected 4 millions of HAM (mean diameter 15 microns) labeled with 15-20 mCi of 99mTc, into the left ventricle during routine cardiac catheterization. Data were collected by a gamma camera, and by the use of a high resolution collimator and were electronically restricted to the cardiac area (64 X 64 matrix). The reconstruction of the cardiac cycle was made according to the technique developed in our laboratory for gated blood pool imaging. From the displayed images we evaluated myocardial flow distribution at the time of injection and regional wall motion (by cine mode) at any subsequent time, with a temporal resolution of 2 to 4 mins. The patterns of contractility of myocardial walls with normal or reduced perfusion were in agreement with those observed by means of contrast ventriculography. Advantages of the technique are: a) simultaneous information on flow and contractility; b) prolonged time for wall motion observation (4 to 6 hours); c) high quality pictures, since the signal to background ratio is much more favourable than with other isotope techniques. The technique appears to be promising from the results obtained in the number of patients included in this study.

Radiolabeled human albumin microspheres (HAM) have been used in the past, in order to visualize coronary flow distribution in man. In order to obtain information both on myocardial perfusion and contractility, we applied R-wave synchronized reconstruction of the cardiac cycle in cine mode to HAM imaging. In 20 patients with angina pectoris and coronary stenosis of variable severity and in 1 patient with congestive cardiomyopathy we injected 4 millions of HAM (mean diameter 15 microns) labeled with 15-20 mCi of 99mTc, into the left ventricle during routine cardiac catheterization. Data were collected by a gamma camera, and by the use of a high resolution collimator and were electronically restricted to the cardiac area (64 X 64 matrix). The reconstruction of the cardiac cycle was made according to the technique developed in our laboratory for gated blood pool imaging. From the displayed images we evaluated myocardial flow distribution at the time of injection and regional wall motion (by cine mode) at any subsequent time, with a temporal resolution of 2 to 4 mins. The patterns of contractility of myocardial walls with normal or reduced perfusion were in agreement with those observed by means of contrast ventriculography. Advantages of the technique are: a) simultaneous information on flow and contractility; b) prolonged time for wall motion observation (4 to 6 hours); c) high quality pictures, since the signal to background ratio is much more favourable than with other isotope techniques. The technique appears to be promising from the results obtained in the number of patients included in this study.

The use of a double sided mu -strip silicon crystal for X-ray detection is being investigated. The detector is 300 mu m thick and the read-out pitch is 100 mu m for both sides. It operates in capacitance charge division mode by means of floating strips between read-out strips. The detector has been irradiated by /sup 241/Am and /sup 109/Cd sources. Different zones within the 100- mu m read-out pitch have been individually exposed. The following characteristics have been studied as a function of the impact point of the photon: (a) the charge collection mechanism; (b) the relative detection efficiency; (c) the energy resolution; and (d) the spatial resolution. The absolute efficiency of the detector has been measured at three energy values. >

To develop criteria for disease activity in systemic sclerosis (SSc) that are valid, reliable, and easy to use.Investigators from 19 European centres completed a standardised clinical chart for a consecutive number of patients with SSc. Three protocol management members blindly evaluated each chart and assigned a disease activity score on a semiquantitative scale of 0-10. Two of them, in addition, gave a blinded, qualitative evaluation of disease activity ("inactive to moderately active" or "active to very active" disease). Both these evaluations were found to be reliable. A final disease activity score and qualitative evaluation of disease activity were arrived at by consensus for each patient; the former represented the gold standard for subsequent analyses. The correlations between individual items in the chart and this gold standard were then analysed.A total of 290 patients with SSc (117 with diffuse SSc (dSSc) and 173 with limited SSc (lSSc)) were enrolled in the study. The items (including Delta-factors-that is, worsening according to the patient report) that were found to correlate with the gold standard on multiple regression were used to construct three separate 10-point indices of disease activity: (a) Delta-cardiopulmonary (4.0), Delta-skin (3.0), Delta-vascular (2.0), and Delta-articular/muscular (1.0) for patients with dSSc; (b) Delta-skin (2.5), erythrocyte sedimentation rate (ESR)30 mm/1st h (2.5), Delta-cardiopulmonary (1.5), Delta-vascular (1.0), arthritis (1.0), hypocomplementaemia (1.0), and scleredema (0.5) for lSSc; (c) Delta-cardiopulmonary (2.0), Delta-skin (2.0), ESR30 mm/1st h (1.5), total skin score20 (1.0), hypocomplementaemia (1.0), scleredema (0.5), digital necrosis (0.5), Delta-vascular (0.5), arthritis (0.5), TLCO80% (0.5) for all patients with SSc. The three indexes were validated by the jackknife technique. Finally, receiver operating characteristic curves were constructed in order to define the value of the index with the best discriminant capacity for "active to very active" patients.Three feasible, reliable, and valid preliminary indices to define disease activity in SSc were constructed.

OBJECTIVE: To investigate the existence of differences among European referral centres for systemic sclerosis (SSc) in the pattern of attendance and referral and in the clinical and therapeutical approaches. METHODS: In 1995 the European Scleroderma Study Group initiated a multicentre prospective one year study whose aim was to define the disease activity criteria in SSc. During the study period each participating European centre was asked to enroll consecutive patients satisfying American College of Rheumatology criteria for SSc and to fill out for each of them a standardised clinical chart. Patients from various centres were compared and differences in epidemiological, clinical, and therapeutical aspects were analysed. RESULTS: Nineteen different medical research centres consecutively recruited 290 patients. The patients could be divided into two subgroups: 173 with the limited (lSSc) and 117 with the diffuse (dSSc) form of the disease. The clinical and serological findings for the series of 290 patients seemed to be similar to data previously reported. However, when the data were analysed to elicit any differences between the participating centres, a high degree of variability emerged, in both epidemiological and clinical features and in the diagnostic and therapeutic approaches to the disease. CONCLUSIONS: The clinical approach to SSc, not only in different countries but also in different centres within the same country, is not yet standardised. To overcome this problem, it will be necessary for the scientific community to draw up a standardised procedure for the management of patients with SSc. This would provide a common research tool for different centres engaged in research on this complex disease. Ann Rheum Dis

OBJECTIVE: To develop criteria for disease activity in systemic sclerosis (SSc) that are valid, reliable, and easy to use. METHODS: Investigators from 19 European centres completed a standardised clinical chart for a consecutive number of patients with SSc. Three protocol management members blindly evaluated each chart and assigned a disease activity score on a semiquantitative scale of 0-10. Two of them, in addition, gave a blinded, qualitative evaluation of disease activity ("inactive to moderately active" or "active to very active" disease). Both these evaluations were found to be reliable. A final disease activity score and qualitative evaluation of disease activity were arrived at by consensus for each patient; the former represented the gold standard for subsequent analyses. The correlations between individual items in the chart and this gold standard were then analysed. RESULTS: A total of 290 patients with SSc (117 with diffuse SSc (dSSc) and 173 with limited SSc (lSSc)) were enrolled in the study. The items (including Delta-factors-that is, worsening according to the patient report) that were found to correlate with the gold standard on multiple regression were used to construct three separate 10-point indices of disease activity: (a) Delta-cardiopulmonary (4.0), Delta-skin (3.0), Delta-vascular (2.0), and Delta-articular/muscular (1.0) for patients with dSSc; (b) Delta-skin (2.5), erythrocyte sedimentation rate (ESR) >30 mm/1st h (2.5), Delta-cardiopulmonary (1.5), Delta-vascular (1.0), arthritis (1.0), hypocomplementaemia (1.0), and scleredema (0.5) for lSSc; (c) Delta-cardiopulmonary (2.0), Delta-skin (2.0), ESR >30 mm/1st h (1.5), total skin score >20 (1.0), hypocomplementaemia (1.0), scleredema (0.5), digital necrosis (0.5), Delta-vascular (0.5), arthritis (0.5), TLCO

The authors have developed a TDC+transputer-based acquisition system to study the X-ray imaging capabilities of a silicon μstrip detector with 100 and 200 μm read-out pitch. This system allows real-time image acquisition and display. The authors present images obtained with an X-ray mammography tube using sub-millimeter high contrast test objects on a 16*16 channels prototype

In the framework of an experimental program to study the possibility of using a silicon crystal for X-ray detection in the diagnostic energy range (10-100 keV), the authors present the first experimental results obtained with a silicon detector (300 mu m thick, 1.4*1.4 cm2 surface) with microstrips deposited on each side: 25 mu m spacing on the junction side and 50 mu m spacing on the ohmic side: 25 mu m spacing on the junction side and 50 mu m spacing on the ohmic side; the read-out pitch is 100 mu m for both sides. Energy and spatial resolutions have been measured by means of collimated radioactive sources: 241Am (E gamma =60 keV) and 109Cd (E gamma =24 and 88 keV). A very good linearity in the response to the photon energy has been measured. Tantalum wires, i.e. high contrast objects, have been used as phantoms when exposing the detector to the 60 keV photons; the authors present the images thus obtained.

Technetium-99m labeled bis(1,2-diethylphosphino)ethane was evaluated as a cardiac perfusion agent in mice, dogs and normal human volunteers. The agent produced as a single cationic compound was prepared by a simple kit type method and had a rapid myocardial uptake in animals. The cardiac uptake of the agent in dogs averaged 4.6% of administered dose and delineated left and right ventricles by in vivo imaging. In dogs with experimental myocardial infarction, the agent was distributed according to the regional myocardial blood flow, had excellent correlation with myocardial distribution of 85Sr microspheres (r = 0.96, 0.93)] and 201 Tl (r = 0.91 and 0.83) , and enabled us to detect perfusion defects by in vivo scintigraphy. The agent, however, failed to have a useful degree of cardiac uptake in humans.

A limitation of first-pass radionuclide angiocardiography is the limited repeatability because of the relatively long half-life of technetium-99m (Tc-99m). The feasibility, reproducibility and validity of multiple sequential quantitative first-pass studies were assessed in humans using the short-lived isotope gold-195m (Au-195m) (half-life of 30.6 seconds, 262 keV), which can be directly obtained from a generator made of its parent isotope, mercury-195m (half-life of 41.6 hours). Thirty-three subjects (13 normal volunteers and 20 cardiac patients) were studied using a large-field gamma camera equipped with a medium-energy collimator. After Au-195m intravenous injections, repeat first-pass studies were performed in the left anterior oblique projection. A left anterior oblique study was then obtained after i.v. injection of Tc-99m. Left ventricular ejection fraction calculations were performed separately by 2 observers. Reproducibility of Au-195m first-pass studies was excellent. The correlation coefficients for left ventricular ejection fraction from the first and the second Au-195m injections were 0.93 and 0.98 for observers 1 and 2, respectively. The correlation coefficients between Au-195m and Tc-99m first-pass studies were 0.95 and 0.98, respectively.