Publications (4) View all
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Article: Prompt-gamma compensation in Rb-82 myocardial perfusion 3D PET/CT.
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ABSTRACT: To compare the diagnostic accuracy of Rb-82 myocardial perfusion three-dimensional (3D) PET with and without prompt-gamma compensation (PGC). Retrospective, single center study of 76 patients who had rest and adenosine stress Rb-82 myocardial perfusion 3D PET. All studies were acquired using a Siemens Biograph-40 PET/CT scanner and were reconstructed with and without PGC. Fifty-seven patients (mean age 63 +/- 11 years, 26 men) had coronary angiography within 40 days of Rb-82 imaging. Nineteen patients (mean age 43 +/- 7 years, 10 men) had low likelihood of coronary artery disease (CAD). All PET images were scored by consensus of two blinded readers on a standard 5-point scale using a 17-segment left ventricular model. A normal PET test was defined as a summed stress score of less than four. Obstructive CAD at coronary angiography was used as the gold-standard and was defined as luminal stenoses > or =50% in one or more major coronary arteries. The prevalence of obstructive disease at coronary angiography was 68% (39/57). The mean summed stress score was 12 +/- 12 for PGC images and was 18 +/- 14 for non-PGC images. Sensitivity and specificity for obstructive CAD were 90% (95% CI 88-99) and 72% (95% CI 52-93) for PGC images and 95% (95% CI 88-100) and 22% (95% CI 3-41) for non-PGC images. PGC in Rb-82 3D PET improves the specificity for obstructive CAD at coronary angiography with no significant loss in sensitivity.Journal of Nuclear Cardiology 11/2009; 17(2):247-53. · 2.67 Impact Factor -
Article: Absent coronary artery calcium excludes inducible myocardial ischemia on computed tomography/positron emission tomography.
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ABSTRACT: We set out to determine whether a coronary artery calcium (CAC) score of zero on computed tomography (CT) would predict a normal myocardial perfusion positron emission tomography (PET) in a population mostly at intermediate pretest likelihood of coronary artery disease (CAD). We enrolled 206 outpatients (36% men, mean age 60 ± 13 years) referred for Rb-82 myocardial perfusion PET/CT for suspected CAD. CAC scoring was performed by the Agatston method. The PET images were scored on a 5-point scale using a 17-segment left ventricular model. A summed stress score ≥ 2 was considered abnormal. Multivariable logistic regression analysis was used to test the independent predictive value of a CAC score of zero to exclude inducible myocardial ischemia. Ninety-nine of 206 patients (48%) had a CAC score of zero and of these only 1 had inducible ischemia on PET. This yielded a negative predictive value of 99% (95% CI 95%-100%). CAC score of zero was the strongest independent predictor of a normal myocardial perfusion PET (OR = 0.05; 95% CI = 0.006-0.38; p = 0.004). In a population of predominately intermediate likelihood of CAD, a CAC score of zero excludes inducible ischemia on myocardial perfusion PET.International journal of cardiology 11/2009; 147(3):424-7. · 7.08 Impact Factor -
Article: Adenosine magnetic resonance imaging versus dobutamine stress echocardiography in patients with low probability for coronary artery disease
Journal of Cardiovascular Magnetic Resonance. 01/2009; -
Article: Coronary artery calcium scoring in the age of CT angiography: what is its role?
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ABSTRACT: It has become commonplace to try to gear the intensity of preventive measures to the degree of risk. It is, however, problematic to merely use traditional risk factors to gauge risk in the individual patient because the tools currently in use are based on population estimates and they may not directly apply to the individual being assessed. Indeed, it is not unusual for patients at low to intermediate risk to suffer unexpected events, whereas some high-risk patients appear unusually healthy. Imaging for atherosclerosis may offer an alternative to this approach. Often, there is a large discrepancy between the burden of atherosclerosis estimated with coronary artery calcium or intima-media thickness and the risk of future cardiovascular events estimated with the Framingham risk score. This may justify some of the clinical discrepancy. Here, we review the current evidence surrounding the use of coronary artery calcium for risk prediction.Current Atherosclerosis Reports 11/2008; 10(5):438-43. · 2.66 Impact Factor
