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According to the international registry ICOPER, right ventricular (RV) dysfunction is the most significant predictor of mortality in patients with pulmonary embolism (PE). To identify the most informative indicators of gated blood pool single photon emission computer tomography (GBP-SPECT) for evaluation of RV function in patients with PE. A total of 52 patients were included in the study. The main group (n = 37) comprised patients with PE, and the comparison group (n = 15) patients suffering from coronary heart disease (NYHA class I-II). All patients received GBP-SPECT, and assessment of plasma levels of endothelin-1, stable nitric oxide (NO) metabolites, and 6-keto-PG F1α. In patients with PE, RV end-systolic volume, stroke volume, ejection fraction, peak ejection rate, peak filling rate, and mean filling rate were significantly lower in comparison with patients without PE. In patients with PE, the levels of endothelin-1, 6-keto-PG F1α, and stable NO metabolites were increased in comparison with patients without PE. GBP-SPECT facilitates verification of RV dysfunction in patients without massive PE or severe pulmonary hypertension. Dissociation between the volume of PE and degree of RV dysfunction may be caused by an unbalance between humoral vasoactive factors.

Oncogenic osteomalacia is a rare metabolic bone disease characterized by phosphaturia and hypophosphatemia. Certain tumors secrete a phosphaturic factor, which results in this metabolic abnormality; this factor called as phosphatonin, is in fact a fibroblast growth factor 23 (FGF-23) involved closely in phosphate homeostasis and skeletogenesis. Complete excision of these tumors facilitates reversal of the problem. We have reported here the case of a patient who was crippled with this disease and on thorough investigation revealed an oncogenic osteomalacia with tumor focus in the right tibia. The tumor was identified as a mesenchymal tumor, i.e., hemangiopericytoma. Tumor excision alleviated patient symptoms with rapid symptomatic and biochemical improvement.

Background Magnetic resonance imaging (MRI) is well accepted for the contemporary diagnosis of venous malformation (VM), providing hemodynamic and anatomic information on the lesion, including its relationship with surrounding tissues and organs. Study design A total of 196 clinically suspected VM patients were reviewed retrospectively to assess the accuracy and reliability of MRI for the diagnosis of VM. Initial workup included MRI, duplex ultrasonography, and whole-body blood pool scintigraphy, along with additional transarterial lung perfusion scintigraphy and lymphoscintigraphic assessment when indicated. Phlebography or arteriography, or both, were generally reserved as a road map for the treatment. A total of 294 MRI findings for 196 patients were also compared with the matching duplex ultrasonography findings available for 178 patients and matching whole-body blood pool scintigraphy findings for 136 patients. The phlebographic findings available for 87 patients were also compared. Results Among the 196 patients with clinically suspected VM, 174 were confirmed as having VM by MRI with true-positive findings and 2 as false-positive findings by MRI (sensitivity, 98.9%; positive predictive value, 98.9%). MRI ruled out VM for 18 patients with true-negative findings, though 2 were false-negative (specificity, 90%; negative predictive value, 90.0%). Two positive and two false-negative findings of VM, made by MRI, were subsequently confirmed by angiography. Among the 87 patients for whom phlebographic findings were available, 73 were confirmed as true-positive diagnoses of VM, 1 as false-positive, 11 as true-negative, and 2 as false-negative (sensitivity, 97.3%; specificity, 91.7%; positive predictive value, 98.7%; negative predictive value, 84.6%). Conclusions MRI is likely to modify the traditional role of angiography for the management of VM and become a new standard, at least for diagnosis. MRI also is an excellent parameter in the assessment of treatment results.

El proposito de este estudio ha sido valorar la eficacia de la tomogammagrafia miocardica de esfuerzo-reposo con 99mTc-MIBI en la prediccion de la mejoria de la contractilidad ventricular izquierda posrevascularizacion. Material y metodos Se valoro una serie prospectiva y consecutiva de 82 pacientes (59 ± 9 anos, 12 mujeres) que tenian algun segmento con alteracion severa de la contractilidad y que fueron sometidos a revascularizacion coronaria mediante cirugia (n = 64) o angioplastia (n = 18). A todos los pacientes se les practico una tomogammagrafia de reposo con 99mTc-MIBI y a 40 de estos pacientes tambien se les practico una tomogammagrafia de esfuerzo. Antes y a los 3-6 meses de la revascularizacion se practico una ventriculografia isotopica en equilibrio de tres proyecciones. Se valoro la mejoria de la contractilidad segmentaria posrevascularizacion en relacion con la cuantificacion de la captacion de 99mTc-MIBI en reposo y con la presencia de reversibilidad (captacion en esfuerzo Resultados El valor medio de la fraccion de eyeccion del ventriculo izquierdo no se modifico tras la revascularizacion (41,1 ± 14,5% frente a 41,8 ± 15,7%). En el control posrevascularizacion se observo una mejoria de la contractilidad en un 40% (113/282) de los segmentos con hipocinesia severa, acinesia o discinesia. La reversibilidad esfuerzo-reposo y un valor de captacion en reposo > 30% fueron criterios que se observaron en un 62 (p = 0,002) y un 89% (p Conclusiones Para el 99mTc-MIBI SPET, la presencia de reversibilidad esfuerzo-reposo y un grado de captacion en reposo > 30% son criterios predictivos de recuperacion contractil posrevascularizacion.

Vascular malformations and hemangiomas are common in children, but gastric hemangioma is extremely rare with less than 15 reported cases in the pediatric age group. Gastric hemangioma accounts for only 0.05% of all gastrointestinal neoplasms, and intra-abdominal hemangiomas are rarely found outside of the liver. We present a unique case of gastric hemangioma, and multiple hemangiomas were detected in a single scan by 99mTc-labeled RBC blood pool imaging. This case also depicts the incremental role of SPECT/CT over planar acquisition for detecting multiple hemangiomas, especially for those lesions located adjacent to physiological blood pool activity.

To evaluate the ability of low-dose dobutamine and isosorbite dinitrate (ISDN) gated blood pool scintigraphy (GBPS) and thallium SPECT with reinjection to identify viability in asynergic myocardium, both procedures were performed in 38 consecutive patients with chronic coronary artery disease and left ventricular dysfunction. Twenty-two of the 38 patients with successful revascularization were analyzed. GBPS was performed at the baseline and during continuous infusion of low dose dobutamine (5 micrograms/kg/min) and ISDN (2 micrograms/kg/min). Cine mode GBPS wall motion was scored from normal (0) to dyskinesis (4) semiquantitatively. Forty-seven of 110 segments with severe asynergy at the baseline were analyzed. Viability determined by GBPS was defined as wall motion score improvement by more than 1 grade. Thallium viability was defined as the segment with redistribution or fill in with severe initial perfusion defect. GBPS was 76.7% sensitive and 70.6% specific for predicting post vascularization wall motion improvement (p0.005). Of 47 segments with severe asynergy, concordance of judgement was obtained in 40 segments (85.1%), and reversibility was correctly diagnosed in 34 of 40 patients (85.0%), but thallium with reinjection correctly identified tissue viability in 6 of 7 segments with discordance between 2 studies. These data suggest that most cases of reversible asynergy (hibernating myocardium) respond to ISDN and dobutamine, suggesting the possibility of predicting improvement by revascularization, although some underestimation of tissue viability remained to be resolved. Thallium with reinjection is superior to low-dose dobutamine + ISDN GBPS for the assessment of myocardial viability.

Gastrointestinal hemorrhage, especially small bowel hemorrhage has various causative diseases, sometimes presents as massive or intermittent bleeding, and hence, the preoperative diagnosis and proper selection of treatment are often difficult. Here 3 cases of small bowel hemorrhage, in which bleeding sites were preoperatively determined with satisfactory outcomes, are described. Case 1: Angiographic study revealed a jejunal tumor and partial resection was performed. Pathological diagnosis was leiomyoma. Case 2: X-ray examination of the small intestine and angiographic study revealed ulcerative lesions of the terminal ileum, followed by partial resection. Pathological diagnosis was non-specific multiple ulcer of the small intestine. Case 3: Blood pool scintigraphy suggested active bleeding from the terminal ileum. Intraoperative endoscopy showed a small elevated lesion and partial resection was performed. Pathological diagnosis was cavernous hemangioma. When small bowel hemorrhage is clinically suspected, active use of angiography, blood pool scintigraphy, or intraoperative endoscopy is recommended to detect the source of bleeding.

Hemangiomas are rare tumors in the calvarium and represent 2% of osseous calvarial lesions. Dynamic Tc-99m RBC blood pool scintigraphy has a high positive predictive value for cavernous hemangiomas of the liver. This scintigraphic technique can be used for identifying cavernous hemangiomas at other anatomic sites. We present a case in which a tagged RBC blood pool scan was used for further characterizing a symptomatic calvarial lesion as a cavernous hemangioma. This avoided an unnecessary workup for metastatic disease and was valuable in surgical planning for anticipated increased intra-operative blood loss. Histological confirmation of a cavernous hemangioma was made after surgical resection.

Three nuclear imaging techniques can be used for the study of congenital vascular malformations (CVM): whole body blood pool scintigraphy (WBBPS), lymphoscintigraphy and transarterial lung perfusion scintigraphy (TLPS). WBBPS is able to demonstrate the whole vascular system and to recognize truncular and extratruncular vessel malformations. High flow malformations are indicated by the form of the activity-time curves. Lymphoscintigraphy for the study of CVM is best performed by a separate demonstration of the deep and superficial lymphatic systems. TLPS is effective to confirm or rule out the presence of an arteriovenous (AV) shunt.

In a prospective study, an attempt was made to determine the specificity of various imaging methods for defining tumours of the liver rather than their ability to demonstrate them. It was based on 130 patients with histologically confirmed lesions (33 haemangiomas, 17 FNH, 4 hepatocellular adenomas, 28 HCC, 36 adenocarcinoma metastases). The methods were MRT (130 cases), sonography (119), CT (122), dynamic arterial angio-CT (15), 99TC-EHIDA or blood pool scintigraphy (4 FNH, haemangiomas, HCC, 44 cases). MRT showed somewhat better results (accuracy 80%) than CT (73%) and angio-CT (73%) in demonstrating the type of lesion. The results of scintigraphy (53%) and sonography (69%) were rather worse. The range of accuracy for MRT, CT and sonography varied from 94% (haemangiomas with MRT) to 47% (FNH with sonography).

An analysis program for ECG gated, blood pool, single photon emission tomography (SPET GBP) is available. This program permits the automatic evaluation of left and right ventricular function, but its reliability has not been thoroughly assessed. The objective of this investigation was to examine the reliability of the parameters derived from SPET GBP. Fifty-three patients who had undergone both SPET GBP and planar, ECG gated, blood pool scintigraphy (planar GBP) were enrolled in the study. Planar GBP was performed with a single-headed gamma camera. From a left anterior oblique projection, data were acquired at 24 frames/cardiac cycle with ECG gating during the equilibrium state. SPET GBP was carried out utilizing a triple-headed gamma camera, with 60 projection views over 360°, with 60 s per view, in 16 frames/cardiac cycle. Left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) were calculated by using the analysis program. The reproducibility of these values and the correlation between SPET and planar GBP were assessed. To evaluate the effect of cut-off frequencies of a Butterworth filter, six different cut-off frequencies (order = 8, 0.3-1.0 Nyquist) were tested with data obtained from 12 patients. The reproducibility of LVEF by SPET GBP was satisfactory (intra-observer, r = 0.95; inter-observer, r = 0.96), whereas reproducibility of RVEF by SPET GBP was fair (intra-observer, r = 0.83; inter-observer, r = 0.83). LVEF with SPET GBP was well correlated (y = 1.1x+6.62, r = 0.85, P < 0.01) with LVEF readings of planar GBP. However, LVEF with SPET GBP was overestimated (mean difference of 12) in comparison with that of planar GBP. The RVEF derived from SPET GBP showed poor correlation (y = 0.52x+33, r = 0.53, P < 0.01) with planar GBP. No significant effect of cut-off frequencies of Butterworth filters was evident in the calculation of LVEF and RVEF (P = 0.48 and 0.67) with SPET GBP. It is concluded that SPET GBP with QBS is useful for the evaluation of LVEF. However, measurement of the RVEF showed lower reproducibility compared with measurement of the LVEF.

Purpose: Six arteriovenous malformations were assessed to determine the effectiveness of perfusion and blood pool scintigraphy to diagnose arteriovenous malformations of soft tissue. Methods: After injection of Tc-99m RBC or Tc-99m DTPA-HSA, dynamic perfusion and early and delayed blood pool images were analyzed. Results: Four of six arteriovenous malformations showed increased activity on perfusion images and slightly increased activity on blood pool images; the remaining two arteriovenous malformations showed increased activity on perfusion and normal activity on blood pool studies. Conclusions: This expansion of the authors' previous studies of hemangiomas shows that perfusion and blood pool scintigraphy are useful methods to differentiate arteriovenous malformations from various types of hemangiomas.

A rare case of malignant fibrous histiocytoma (MFH) of the ilium was presented and blood-pool scintigraphic images and angiographic images were correlated. Hypervascular tumor and lacking of contrast material with arteriovenous shunts were shown by angiography. Intensive tracer accumulation was shown by blood-pool scintigraphy. After radiation therapy and transcatheter arterial embolization of the tumor, tracer accumulation was noticeable reduced. These findings suggested a vascular tumor such as angiosarcoma, but surgery revealed MFH of the bone. Blood-pool scintigraphy was useful in the evaluation of the vascular characteristics of the tumor.

A patient with suspected splenic hemangioma showed an area of absent radioactivity at the lower pole of the spleen on Tc-99m stannous colloid imaging. Increased activity was seen in the same area on Tc-99m RBC blood pool imaging. These findings were consistent with a splenic hemangioma.

Arteriovenous (AV) malformation or angiodysplasia of the gastrointestinal tract is a very rare cause of bleeding in children. These lesions are congenital anomalies and thought to be of hamartomatous origin. We report on a 4-year-old child with an AV malformation of the distal ileum treated by local resection. A brief review of the relevant literature is included. The importance of radionuclide blood pool scanning in the evaluation of these patients is emphasized.

Blood pool scintigraphy, as well as dynamic computed tomography, with Tc-99m labeled red blood cells is known to be one of the most accurate methods for the diagnosis of hemangioma of the liver. The authors report a hemangioma of the liver incidentally visualized during dynamic renoscintigraphy with Tc-99m DTPA. Dynamic CT scanning supported the diagnosis of hepatic hemangioma

Primary splenic tumors are extremely rare. The authors report the successful diagnosis of splenic hemangioma with radionuclide blood pool scintigraphy.

Radionuclide angiography has been used for visualization of aortic arch pathology. Gated blood pool scintigraphy generally has been reserved for the evaluation of ventricular function. By observing the aorta in relation to other cardiac structures, additional information about relative size and shape is available, and can be integrated with ventriculographic observations. This may enhance understanding of the mechanism of disease in the individual patient. Five selected case histories illustrating this point are presented. The last example demonstrates the ability of the technique to uncover unsuspected thoracic aorta pathologic findings. The sensitivity and specificity of this technique to diagnose aortic disease requires further study.

Progressive redistribution of pulmonary blood flow to the lung apices occurs with increasing degrees of left ventricular failure, and correlates with increasing pulmonary capillary wedge pressure (PCWP). If similar changes in pulmonary blood volume (PBV) occur, then technetium-99m equilibrium blood pool scintigraphy, by assessing relative distribution of PBV, may allow prediction of PCWP. Therefore 30 patients being monitored with pulmonary artery balloon flotation catheters underwent imaging. PCWP was compared with the average radioactive count density arising from apical (A) and basal (B) regions of interest within the right lung, expressed as an A B ratio. Correlation was strong for patients imaged erect, either posteriorly ( r = 0.864, p = 0.001) or in the 45 ° left anterior oblique position ( r = 0.842, p = 0.001), and only slightly less impressive for patients imaged supine ( r = 0.678, p = 0.001). Especially when imaging was performed with patients erect, an A B ratio greater than unity identified with high sensitivity (100%) and specificity (83 to 88%) an abnormally elevated PCWP (> 12 mm Hg). Moreover, directional changes in the A B ratio reflected concomitant changes in PCWP after intervention. Thus, analysis of lung A B radioactive count ratios obtained by equilibrium blood pool scintigraphy may be used to evaluate PCWP.

Upright and supine multiple gated cardiac blood pool scintigraphy was performed at rest and during maximum exercise in 37 patients, 15 with normal coronary arteriograms, 12 with coronary artery disease (CAD) without myocardial infarction (MI), and 10 with CAD and previous MI. Heart rate and systolic blood pressure were similar during upright and supine exercise in normal patients, but were significantly lower during supine exercise in both CAD groups. Left ventricular (LV) ejection fraction (EF), right ventricular (RV) EF, and LV segmental wall motion were similar in the upright and supine positions at rest or during maximum exercise within each group and showed high concordance of exercise responses. Although LV end-diastolic volume increased in all three groups during upright exercise and in both CAD groups when exercised supine, it did not change during supine exercise in patients without CAD. The fall of LV end-systolic volume in normals was greater during supine exercise than during upright exercise. LV end-systolic volume rose in the CAD patients in both positions. Therefore, although LVEF, RVEF, and LV segmental wall motion responses are similar in the upright and supine positions, LV end-systolic and LV end-diastolic volume changes are not. For detecting and evaluating CAD, the two different positions of exercise appear to have similar diagnostic content.

Interventricular septal motion was studied prospectively by echocardiography in 45 patients examined before and after cardiac surgery. In addition, nine of the patients underwent pre- and postoperative gated cardiac blood pool scintigraphy. All had normal septal motion preoperatively. Of the 40 patients whose surgery included cardiopulmonary bypass, 31 had abnormal and 9 had normal postoperative septal motion. All five patients without cardiopulmonary bypass had normal postoperative septal motion (p

Left ventricular (LV) systolic timing and relative volume variations were simultaneously measured by electromagnetic flowmeter (EMF) and high frame rate ECG-gated blood pool scintigraphy in five baboons. No significant differences (p greater than 0.1, paired t test) were observed in the time (from R wave) to peak aortic flow (maximum LV ejection rate), time to cessation of aortic flow (end-systole) or in the duration of aortic flow (LV ejection time). A small (approximately 15 msec) but significant systematic difference (p less than 0.02) was noted in the time to onset of aortic flow. The shape of each scintigraphic time-activity curve during systole was compared to an equivalent curve synthesized from 10 EMF flow profiles obtained in the same baboon. Comparison of these paired curves over systolic ejection yielded an average correlation or r = 0.95 (range 0.90--0.99). The ratio of peak flow to stroke volume determined from these data did not differ significantly (p greater than 0.05). In the baboon, quantitative high temporal resolution ECG-gated scintigraphy appears to reflect closely the detailed timing and relative magnitude variation of LV volume during the entire period of systolic ejection. We conclude that the assumptions underlying the scintigraphic method are valid in the baboon during the ejection interval.

Scintigraphic techniques offer a variety of computer aided analytic methods for the assessment of ventricular size and function. They are objective, quantitative, and reproducible, and contribute to the clinical evaluation of all forms of cardiac disease. In some cases complementary to other methods, the scintigraphic assessment of ventricular function is often unique in the valuable clinical data which they supply.

Summary. Forty-six subjects (11 normals with no cardiac disease, 13 persons with a ‘false’ positive exercise ECG test, and 22 patients with coronary artery disease) were investigated with ECG-gated cardiac blood-pool imaging at rest, during cold pressor stimulation, and during supine bicycle exercise. Changes in left ventricular ejection fraction and intervention induced regional wall motion abnormalities were measured. Cold pressure stimulation did not induce anginal pain in any person, but were generally found more unpleasant than dynamic exercise. Dynamic exercise detected significantly more coronary artery disease patients (20/22, 91%) than did cold stimulation (13/22, 59%) (P < 0·02). Specificity of dynamic exercise and cold stimulation was not significantly different. It is concluded that cold stimulation is less sensitive than dynamic exercise in the detection of patients with ischaemic heart disease with gated cardiac blood-pool imaging.

Gastrointestinal blood pool scintigraphy, using a modified in-vivo red blood cell labelling technique with technetium-99, is a new, easily performed, non-invasive procedure. It is valuable in screening patients with acute or intermittent gastrointestinal blood loss in whom duodenoscopic and sigmoidoscopic findings are unhelpful. This paper reviews the value of this scintigraphic technique over the first eight months of its use in a major teaching hospital, and compares the results with other published data. The high sensitivity of this procedure, and its ability to demonstrate gastrointestinal bleeding very strikingly, are illustrated with several examples. If used and interpreted appropriately, scintigraphy is sensitive in detecting and localizing the bleeding site, and is very helpful in indicating the optimal timing of emergency contrast angiography. The study further supports the view that scintigraphy should be the initial diagnostic imaging procedure in this group of patients, and that emergency angiography should be reserved primarily for patients in whom there is scintigraphic evidence of continuing blood loss.

Although left ventricular diastolic filling patterns can be examined by both Doppler velocity recordings and gated blood pool scintigraphy, few data exist regarding a comparison of these techniques. Therefore, Doppler echocardiography and scintigraphy were compared in 25 patients. Pulsed Doppler echocardiography was performed using an apical four chamber view with the sample volume at the level of the mitral anulus. Doppler measurements included peak velocity of the early diastolic filling wave, time to peak early diastolic velocity from both end-systole and end-diastole, diastolic time period and diastolic integrated velocity (early, atrial and total). The cross-sectional area of the mitral anulus and the left ventricular end-diastolic volume were estimated from measurements made on the apical four chamber view. Scintigraphic measurements included normalized peak filling rate, time to normalized filling rate from both end-diastole and end-systole, diastolic time period and relative diastolic filling during early and atrial filling. Doppler echocardiography and scintigraphy com- pared favorably in assessment of fractional Ailing during early diastole (r = 0.84) and atrial systole (r = 0.85), ratio of early to atrial filling (r = 0.83), diastolic filling period (r = 0.94) and interval from end-diastole to peak early diastolic flow (r = 0.88). Normalized peak filling rate and time to normalized peak filling rate from end-systole did not correlate closely by these two techniques. The differences in normalized peak filling rate may be explained by difficulties in estimating mitral anulus cross-sectional area and left ventricular end-diastolic volume. The weak correlation for time from end-systole to peak flow was a result of the inclusion of isovolumic relaxation by scintigraphy, as opposed to its exclusion by Doppler echocardiography. Thus, both Doppler echocardiography and gated blood pool scintigraphy provide comparable information regarding left ventricular filling when identical variables are measured, and both methods may be of value in assessing left ventricular diastolic properties.

Gated blood-pool scintigraphy (GBPS) has become a well established noninvasive method of measuring the left ventricular ejection fraction (LVEF), which is used to assess patients with a variety of heart conditions (Maisey et al., 1980; Rodger et al., 1980). In addition, the change in LVEF under stress during GBPS is employed as a test for ischaemic heart disease (Borer et al., 1977; Wainwright et al., 1979; Railton et al., 1980). The usefulness of such procedures is, however, limited by the reproducibility of the LVEF measurements. The variability of the LVEF measured is greatly affected by operator decisions, such as the selection of a region of interest (ROI) for background subtraction and the definition of an ROI for the left ventricle. The magnitude of the measured LVEF may also be affected by these decisions. Modern gamma camera systems are normally supplied with a computer and appropriate software for analysing GBPS studies. In many systems a high degree of automation in the selection of ROI's is us...

Cavernous hemangiomas are the most common benign tumors of the liver. Although their clinical course is usually uncomplicated, an accurate diagnosis may be important to exclude conditions that need treatment, (or to avoid an unnecessarily risky percutaneous biopsy). Although blood pool scintigraphy using planar gamma camera imaging is a reliable examination for the diagnosis of liver hemangiomas, it may fail to depict small, deeply seated lesions, and hence miss the diagnosis. Two cases are reported in which SPECT demonstrated delayed pooling in small, deep, space-occupying lesions, which were poorly seen on planar images, and therefore made a cavernous hemangioma the most likely diagnosis.

Global as well as regional left ventricular function can both be compromized in coronary heart disease (CHD). It has been demonstrated in various studies that both these parameters might be influenced by nitrates indicating a reversible or irreversible myocardial damage [2, 4, 5]. We therefore investigated regional as well as global function in 19 patients with angiographically proven coronary heart disease and left ventricular asynergy with a gated blood pool scintigraphy (GBPS), allowing not only the study of global but also of regional function [1]. The studies were done under rest before and after sublingual application of 10 mg isosorbide dinitrate. As alterations in myocardial blood flow and function are best seen under conditions of stress, left ventricular function was studied in another eight patients with CHD under exercise, again before and after 10 mg isosorbide dinitrate.

Cardiac wall motion was evaluated in 54 patients by ECG-gated blood pool scintigraphy (GBPS) and computer assisted cine-radionuclide-equilibrium study (CRES). The cine format in CRES enhances the subtle aspects of great vessel and cardiac chamber motion and volume abnormalities. An off-line system using a general purpose computer permitted CRES to be initiated in smaller nuclear medicine facilities without large financial investiments.

Blunt abdominal trauma in a 9-year-old girl caused a subcapsular hematoma in the right liver lobe. One week following surgical evacuation of the hematoma severe hemobilia appeared. Blood pool scintigraphy of the liver demonstrated accumulation in the central part of the right liver lobe. After embolization of the right hepatic artery the bleeding ceased immediately, and blood pool scintigraphy became normal.

Patients receiving heterotopic ("piggyback") cardiac transplants, when the patient's own and transplanted donor hearts are connected in parallel, present special problems in determining their relative contributions to total cardiac function. Three patients who had transplants because of intractable heart failure were studied using first pass and gated equilibrium technetium-99m-labeled blood pool scintigraphy. In one patient, thallium-201 myocardial perfusion scans were obtained. These nuclear cardiology techniques provided anatomic and functional information noninvasively that proved helpful in patient management.

Conventional anterior and 45-degree left anierior oblique (LAO) views are limited in the evaluation of inferior segmental wall motion by multiple gated equilibrium cardiac blood pool scintigraphy. This study evaluated the addition of a 70-degree LAO view by comparing scintigraphic and contrast ventriculography in 25 patients, of whom 17 demonstrated abnormal inferior wall motion. Abnormal inferior wall motion was correctly identified in only 10 of 17 patients in the anterior view, but in 16 of 17 patients in the 70-degree LAO view. The number of assessable inferior segments was improved from 58% in the anterior view to 98% in the 70-degree LAO view. When the inferior segments could be visualized in the anterior view, inferior wall motion was accurately assessed. The addition of the 70-degree LAO view aids in the multiple gated equilibrium scintigraphic detection of inferior wall motion abnormalities with a minor loss in specificity.

The diagnosis of active pericardial bleeding has traditionally depended on an invasive documentation by needle aspiration, angiography, or direct inspection. Blood pool scintigraphy performed in 2 patients just before and after the development of hemopericardium revealed unique images in which acute pericardial bleeding manifested itself by an additional blood pool adjacent to the cardiac chambers. With appropriate attention to technical factors, such distinctive images should be highly specific for active bleeding into the pericardial sac.

This study assesses the utility of a scintigraphic, nongeometric technique for the determination of left ventricular volumes. Accordingly, gated blood pool scintigraphy and cineangiography were performed within a 24 hour period in 22 patients. Scintigraphic volume measurements were calculated from individual frames of a modified 35 degrees left anterior oblique projection using an algorithm designed to consider (1) the background-corrected left ventricular activity normalized for activity per milliliter of peripheral venous blood; (2) total study time; (3) number of frames acquired per cardiac cycle; and (4) percent of the cardiac cycle acquired. Angiographic volumes were calculated by the area-length method and the Kennedy regression equation. There was an excellent correlation between scintigraphic and angiographic methods for all volume measurements grouped together (r = 0.985, standard error of the estimate [SEE] = 14.6 ml) as well as for segregated end-diastolic volumes (r = 0.985, SEE = 16.2 ml) and end-systolic volumes (r = 0.988, SEE = 14.7 ml). Prospective testing of the independent ability of scintigraphy to estimate ventricular volumes was provided for by studying an additional 13 patients, and good agreement was found between scintigraphic and angiographic determinations of left ventricular end-systolic and end-diastolic volumes. Thus, radionuclide techniques, which are independent of geometric assumptions, may be utilized for the quantitation of left ventricular volumes.