Kenneth J Nichols

Catholic Health Services of Long Island, New York City, New York, United States

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Publications (114)308.46 Total impact

  • Kenneth J Nichols, Andrew Van Tosh
    Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology. 07/2014;
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    ABSTRACT: Changes in left ventricular (LV) ejection fraction (EF) seen in gated Rb data are of interest because the heart is in a genuinely different physiologic state during stress than at rest. A measure that validates internal consistency of LV EF data would be highly desirable. Left ventricular mass calculations are performed simultaneously with EF determinations, requiring similar operator choices, and although LV volumes may change from rest to stress, mass values should be constant. Constancy of LV mass calculations could provide a useful internal check on the consistency of LV EF computations.
    Clinical nuclear medicine. 05/2014;
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    ABSTRACT: Gated rubidium-82 ((82)Rb) positron emission tomography (PET) imaging studies are acquired both at rest and during pharmacologic stress. Stress-induced ischemic left ventricular dysfunction (LVD) can produce a significant decrease in left ventricular ejection fraction (LVEF) from rest to stress. We determined the prevalence on PET of stress LVD with reduced ejection fraction (EF) and its association with absolute global and regional coronary flow reserve (CFR), and with relative perfusion defect summed difference score (SDS). We studied 205 patients with known or suspected coronary disease (120 M, 75 F, age 69 ± 13 years) who had clinically indicated rest/regadenoson stress (82)Rb PET/CT studies. Data were acquired in dynamic gated list mode. Global and 17-segment regional CFR values were computed from first-pass flow data using a 2-compartment model and factor analysis applied to auto-generated time-activity curves. Rest and stress LVEF and SDS were quantified from gated equilibrium myocardial perfusion tomograms using Emory Cardiac Toolbox software. LVD was defined as a change in LVEF of ≤-5% from rest to stress. A subgroup of 109 patients also had coronary angiography. Stress LVD developed in 32 patients (16%), with mean EF change of -10 ± 5%, vs +6 ± 7% for patients without LVD (P < .0001). EF was similar at rest in patients with and without stress LVD (57 ± 18% vs 56 ± 16%, P = .63), but lower during stress for patients with LVD (47 ± 20% vs 61 ± 16%, P = .0001). CFR was significantly lower in patients with LVD (1.61 ± 0.67 vs 2.21 ± 1.03, Wilcoxon P = .002), and correlated significantly with change in EF (r = 0.35, P < .0001), but not with SDS (r = -0.13, P = .07). The single variable most strongly associated with high risk of CAD (i.e., left main stenosis ≥50%, LAD % stenosis ≥70%, and/or 3-vessel disease) was stress EF (χ(2) = 17.3, P < .0001). There was a higher prevalence of patients with territorial CFR values ≤1.0, consistent with coronary steal, in the LVD group than in the non-LVD group (39% vs 12%, P = .001). LVD developed in 16% of patients undergoing (82)Rb PET myocardial perfusion imaging, and was associated with multivessel coronary artery disease. There was a significant relationship between LVD and coronary blood flow during stress, with LVD corresponding to a low CFR. Territorial CFR ≤1.0 was more common in patients with LVD than those without, suggesting that coronary steal is an important pathophysiologic mechanism contributing to pharmacologic stress-induced LVD.
    Journal of Nuclear Cardiology 10/2013; · 2.85 Impact Factor
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    Kenneth J Nichols, Denny D Watson
    Journal of Nuclear Cardiology 03/2013; · 2.85 Impact Factor
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    ABSTRACT: PURPOSE: Standardized scintigraphic gastric emptying (GE) protocols to detect gastroparesis (GP) require collecting data for 4 h. This investigation was undertaken to compare seven methods to reduce the duration of the test. MATERIALS AND METHODS: This was a retrospective study of GE data collected using a standardized protocol at 0, 1, 2, 3, and 4 h for 602 patients being evaluated for GP. The reference standard was GP defined conventionally as percentage of gastric retention (GR) at 4 h (p4) of greater than 10%. For data up to 2 h the results were derived as follows: (a) confirming as being positive for GP if GR at 2 h was greater than 65%, negative for GP if GR at 2 h was less than 45%, and indeterminate otherwise; (b) by linear extrapolation; and (c) by monoexponential extrapolation. For data beyond 2 h, further evaluations were made and results were derived as follows: (a) confirming as being positive for GP if GR at 2.5 h was greater than 40%; (b) ascertainment of GR at 3 h; (c) by biphasic fit; and (d) by observation of maximum GR for normal patients at time points earlier than 4 h. RESULTS: Thirty percent of all patients had GP. Eighty percent were determinate by Method 1; for these patients sensitivity to detect GP was similar (P=0.11) for Methods 1-3 (69-79%). For data beyond 2 h, sensitivity of the seven methods ranged from 64 to 92%, and the sensitivity of every method was significantly lower than that of the reference standard (P<0.001). CONCLUSION: Considering that sensitivity to detect GP was significantly reduced for data collection limited to 3 h or less, it is not advisable to truncate GE studies earlier than 4 h.
    Nuclear Medicine Communications 11/2012; · 1.38 Impact Factor
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    ABSTRACT: For sestamibi (MIBI) studies in patients with primary hyperparathyroidism, some investigations found that the test sensitivity is lower in patients with multigland disease (MGD) than in those with single-gland disease (SGD), whereas other investigations reported that the sensitivity of MIBI imaging is similar in MGD and SGD. The objectives of this investigation, therefore, were to determine (a) whether there are differences in the sensitivity and specificity of MIBI imaging for detecting parathyroid lesions in patients with MGD and in patients with SGD, (b) whether there is a relationship between test sensitivity and the number of glands involved, (c) whether there are differences in weight between parathyroid lesions in MGD and SGD, (d) whether there are differences in lesion locations between MGD and SGD, and (e) whether MIBI sensitivity in MGD is related to the number, weight, or location of the lesions. This was a retrospective investigation of data for 651 patients with biochemically confirmed primary hyperparathyroidism limited to the neck, who underwent preoperative parathyroid lesion localization using a dual tracer ⁹⁹mTc-MIBI/TcO₄⁻ protocol that included early and late planar pinhole ⁹⁹mTc-MIBI, pinhole thyroid imaging, image subtraction, and single photon emission computed tomography. All patients underwent surgery subsequently. Lesion locations were obtained from operative reports; lesion weights were obtained from pathology reports. One experienced nuclear physician, who had no knowledge of the other test results or the final diagnoses, graded studies on a 5-point scale (0=definitely normal to 4=definitely abnormal) while reading all scintigraphic images simultaneously. There were 851 lesions among the 651 patients. One hundred and thirty-one (20%) patients had MGD and 520 (80%) patients had SGD. Among the patients with MGD, 74 had two lesions, 45 had three lesions, and 12 had four lesions. MIBI imaging was significantly less sensitive (61 vs. 97%, P<0.0001) and specific (84 vs. 93%, P<0.0001) for MGD than for SGD. Weights of MGD lesions were significantly lower than those of SGD lesions [median 190 mg (10-14 600 mg) vs. median 500 mg (48-27 000 mg), Wilcoxon P<0.0001]. Lesion weights decreased significantly with increasing lesion number (r=-0.42, P<0.0001). MIBI sensitivity for 249 MGD lesions (65%) was significantly less (P<0.0001) than for 249 weight-matched SGD lesions (94%). For these weight-matched lesions, the test sensitivity decreased progressively with increasing lesion number (r=0.97, P=0.006). The spatial distribution of MGD and SGD lesions was similar (P=0.19), and the sensitivity was not related to lesion location for MGD (P=0.32) or SGD (P=0.11) lesions. MIBI is significantly less sensitive and specific for detecting parathyroid lesions in MGD than in SGD. Decreased sensitivity is not explained by lesion weight or location, and further studies of factors affecting MIBI imaging in MGD are warranted.
    Nuclear Medicine Communications 01/2012; 33(1):43-50. · 1.38 Impact Factor
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    ABSTRACT: Myocardial perfusion imaging (MPI) with positron emission tomography (PET) has advantages over single-photon emission computerized tomography, particularly for women. This investigation was undertaken to define the prognosis of a normal stress PET MPI study in women. The cohort comprised 457 women evaluated for suspected coronary artery disease (CAD) who had normal pharmacologic stress (82)Rb PET MPI. No patient had clinically evident CAD. Kaplan-Meier estimates were used to determine death and initial nonfatal cardiac event rates over 7 years. Log rank tests were used to assess the relationship between baseline cardiac risk and events during follow-up, and to contrast survival in the cohort with age- and gender-matched US census comparators. During follow-up, there were 11 deaths (all nonischemic), 3 nonfatal myocardial infarctions, 3 percutaneous coronary interventions and 1 coronary artery bypass operation. Average risks of death and initial nonfatal cardiac events were 0.72 and 0.47% per year, respectively. Cardiac events were associated with a history of diabetes (p < 0.0003) and a family history of CAD (p < 0.05). A normal cardiac PET study is associated with a very low rate of future cardiac events. Women with diabetes and a strong family history of CAD are more likely to sustain events and require close surveillance for the development of coronary disease.
    Cardiology 03/2011; 117(4):301-6. · 1.52 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2011; 57(14).
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    ABSTRACT: Left ventricular (LV) wall thickening (WT) assessed from myocardial perfusion (MP) gated SPECT data has been reported to be a marker of functional recovery following myocardial damage. However, the accuracy of WT measurements obtained in the clinical setting rarely has been validated against an independent quantitative reference standard. The purpose of this investigation was to assess the degree to which quantified MP WT agrees with cardiac magnetic resonance (CMR) WT measurements, and to determine whether quantitation is as accurate as visual analysis in detecting abnormal regional WT. MP and ECG-gated True-FISP CMR data were analyzed for 20 patients evaluated after myocardial infarction (age 60 ± 11 years; 95% males). An experienced observer visually graded MP WT on a 5-point scale while viewing MP cines. MP WT was quantified using "Emory Cardiac Toolbox" (ECTb) algorithms. MP algorithms isolated myocardial counts and generated polar maps of WT. CMR data were analyzed by Medis "MASS" software. Manually drawn endocardial and epicardial contours were used to compute WT on CMR. CMR data also were processed for 10 age-matched normal volunteers to define the CMR WT threshold of abnormality. All computations were sampled into conventional 17 ACC/AHA LV wall segments. Receiver operating characteristics (ROC) curve analysis provided discrimination thresholds for optimal accuracy, which subsequently were used to dichotomize the MP methods. WT abnormalities also were assessed for the 3 major arterial territories, and for total numbers of abnormal segments per patient. 25% of all segments had abnormally low WT by CMR. While MP quantitation underestimated CMR WT values for segments with normal WT (26 ± 13% vs. 56 ± 28%, P < 0.0001), measurements were similar for segments with abnormal WT (4 ± 12% vs. 5 ± 9%, P = 0.45). On a segment-by-segment basis, detection of abnormal WT was more accurate by quantitative than visual analysis both for continuous variables (ROC area = 88 ± 2% vs. 80 ± 3%, P < 0.0001) and for dichotomized methods (83% vs. 76%, P = 0.04). Agreement of MP versus CMR for discriminating segments with normal from abnormal WT was significantly better for quantitative than visual analysis (κ = 0.59 vs. 0.40, P < 0.0001), with strongest agreement for left anterior descending artery territories (κ = 0.72). Total numbers of segments with abnormal WT per patient demonstrated significant correlation with CMR (r = 0.83, P < 0.0001). MP quantified LV ejection fractions and volumes also correlated well with CMR (r = 0.87 and 0.90, respectively). Quantified MP WT measurements correlated significantly with CMR values, and discriminated segments with abnormal WT from segments with normal WT more accurately than visual analysis. Therefore, quantification should be performed when analyzing regional WT by scintigraphy.
    The international journal of cardiovascular imaging 11/2010; 27(7):1095-104. · 2.15 Impact Factor
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    Journal of Nuclear Cardiology 10/2010; 17(5):941-73. · 2.85 Impact Factor
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    ABSTRACT: The ability to detect left ventricular (LV) apical dyskinesis, the hallmark of an aneurysm, is an important requirement of diagnostic cardiac imaging modalities that perform wall motion analysis. Our investigation assessed the ability of gated blood pool single-photon emission-computed tomography (GBPS) to automatically detect LV dyskinesis, using cardiac magnetic resonance (CMR) as the reference standard. GBPS data were analyzed for 41 patients with congestive heart failure or cardiomyopathy and compared with ECG-gated TrueFISP CMR evaluations. An experienced nuclear cardiologist without the knowledge of quantitative GBPS or CMR results graded visual impressions of regional wall motion while examining cinematic playbacks of GBPS images. GBPS algorithms automatically isolated LV counts and computed regional phase (phi) values in each of 17 conventional American Heart Association LV segments. LV asynchrony was quantified by the two local measures: maximum apical phi difference (Deltaalpha), and standard deviation among apical phases (sigmaalpha), and by the five global measures: varphi histogram bandwidth (BWHistogram), phi histogram standard deviation (sigmaHistogram), Z-scores, Entropy, and Synchrony. For CMR data, an expert manually drew endocardial LV outlines to measure regional wall motion in 17 LV segments. Apical dyskinesis was present in nine patients. Among GBPS measurements, the method with the greatest accuracy for detecting dyskinesis was Deltaalpha (receiver operating characteristic area=95%). The only method with a sufficiently high kappa statistic to represent 'very good agreement' with CMR was Deltaalpha, with kappa=0.81. Deltaalpha was more sensitive in detecting dyskinesis than visual analysis (100 vs. 33%, P=0.01). Automatic GBPS computations accurately identified patients with LV dyskinesis, and detected dyskinesis more successfully than did visual analysis.
    Nuclear Medicine Communications 10/2010; 31(10):881-8. · 1.38 Impact Factor
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    Journal of Nuclear Cardiology 08/2010; 17(4):709-18. · 2.85 Impact Factor
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    ABSTRACT: In the March/April issue of the Journal, there is a fascinating article by Slomka et al 1 reporting advances in SPECT detector design and image reconstruction techniques. In this essay we shall outline briefly the physical principles that have made these innovations possible and explore ways in which diagnosing cardiac disease may be advanced with this new technology. First, it is useful to understand how it has become possible to improve Nuclear Cardiology image quality. Usually, for any given technology, such as Anger camera tomograms reconstructed by filtered backprojection, improving one property of an image causes degradation of other image properties; for instance, improving signal-to-noise ratio by applying a stronger spatial filter decreases image contrast and spatial resolution. 2 In order to achieve a genuine improvement in image quality it is necessary to replace an older technology with a newer one. One way to accomplish this is to replace filtered backprojection reconstruction approaches with more sophisticated iterative reconstruction algorithms; another approach is to replace the Anger cameras with superior data collecting devices. Ultimately, the reliability of scintigrams is inseparably connected to the amount of information associated with each detected gamma ray. Anger cameras consist of a single large NaI(Tl) crystal with a bank of many photomultiplier tubes and a collimator. Some of the recent improvements in image quality have come about by replacing the NaI(Tl) crystal with a solid state device, such as CZT and CSI(Tl) crystals, which provide considerably more information for each detected gamma ray. For instance, every time a 140 keV gamma ray scintillates in a NaI(Tl) crystal, it produces 5,600 light photons, which are converted to 700 photoelectrons, which then must be amplified in a photomultiplier tube to produce an electronic signal suitable for information processing. 3 The greatest factor contributing to Anger
    Journal of Nuclear Cardiology 08/2009; 16(5):691-6. · 2.85 Impact Factor
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    ABSTRACT: We investigated labeling human leukocytes [white blood cells (WBCs)] in vitro with copper-64 (Cu) comparing labeling efficiency, viability and stability of Cu-WBCs with (111)In-oxine (In) WBCs and (18)F-FDG (FDG) WBCs. Leukocytes from 10 volunteers were labeled with Cu, In and FDG. Forty milliliters of venous blood was collected and leukocyte separation was performed according to standard methods. In-WBCs and FDG-WBCs were labeled according to published methods. For Cu-WBCs, tropolone initially was used as a single chelating agent. Because of poor intracellular Cu retention (54+/-4% at 3 h and 24+/-5% at 24 h), the fluorinated, membrane-permeable divalent cation chelator quin-MF was added. WBCs were incubated in 5 ml saline containing 100 microl of 1mM quin-MF/AM in 2% dimethyl sulfoxide and 74-185 MBq Cu-tropolone for 45 min at 37 degrees C. Labeling efficiencies; in vitro cellular viabilities at 1, 3 and 24 h; and in vitro stabilities at 1, 2, 3, 4 and 24 h (except FDG-WBCs) were determined. Mean Cu-WBCs (87+/-4%) and In-WBCs (86+/-4%) labeling efficiencies were comparable and were significantly higher than FDG-WBCs (60+/-19%, P<.001). Cell viabilities, similar at 1 h, were significantly higher for (64)Cu-WBCs at 3 and 24 h. Intracellular retention of activity was always significantly higher for In-WBCs than for Cu-WBCs and FDG-WBCs. At 24 h, intracellular retention was 88+/-4% for In-WBCs and 79+/-6% for Cu-WBCs. Cu-WBC labeling efficiency and viability were comparable or superior to In-WBCs and significantly higher than FDG-WBCs. Although significantly more activity eluted from Cu-WBCs than from In-WBCs, Cu-WBC probably is adequate for imaging. These data suggest that further investigation of in vitro copper-64-labeled leukocytes for PET imaging of infection is warranted.
    Nuclear Medicine and Biology 07/2009; 36(5):545-9. · 2.52 Impact Factor
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    ABSTRACT: The purpose of this investigation was to describe the rationale and implementation of new totally automated algorithms to compute global and regional left ventricular (LV) function measurements from blood pool (BP) gated SPECT data and to test the hypothesis that automated calculations are as accurate as manual calculations for detecting global and regional LV wall motion abnormalities when compared to independent cardiac magnetic resonance (CMR) measurements. From an Institutional Review Board approved retrospective review of data for 43 patients (age 58 +/- 13 years; 82% males; 59% with CHF; 59% with prior MI) evaluated for cardiac disease, CMR data were analyzed along with automated and manual calculations of BP data. There was no difference among global LV EF values (ANOVA p = 0.90) and strong correlation between automated (r = 0.96, p < 0.0001) and manual (r = 0.95, p < 0.0001) global LV EFs versus CMR, with no significant trends or biases. There was "very good agreement" of automated (kappa = 0.91) and manual (kappa = 0.86) discriminations of cases with LV EF < 50% versus CMR. Detection of LV segments with abnormal regional wall motion was equally accurate (p = 0.68) for automated and manual processings of BP data [ROC areas = 87(+/- 2%) versus 86(+/- 2%)]. The authors conclude that automated and manual computations were equivalent to each other and accurate at identifying both global and regional LV wall motion abnormalities.
    Medical Physics 05/2009; 36(4):1251-7. · 2.91 Impact Factor
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    ABSTRACT: Algorithms have been developed to quantify global and regional left ventricular (LV) function and asynchrony from myocardial perfusion (MP) and blood pool (BP)-gated single-photon emission computer-assisted tomography, but relationships between measurements from these two imaging modalities have not been documented. The objective of this investigation was to determine the degree to which automated BP and MP measurements agree with each other and are accurate, using cardiac magnetic resonance (CMR) as the reference standard. We also sought to determine the extent to which regions of abnormal phase correspond to segments exhibiting abnormal wall motion. We studied 20 patients with prior myocardial infarction (age 60+/-11 years; 95% males) who had BP, MP, and ECG-gated CMR data acquisitions. MP and BP measured parameters included global ejection fraction (EF) and volumes, regional contraction phases, and standard deviations and bandwidths of phase versus R-R histograms. CMR algorithms used manually drawn endocardial and epicardial contours to measure global and regional wall motion and wall thickening. Regional measurements were resampled for all three imaging modalities into 17 conventional LV territories. BP LV counts significantly exceeded MP counts with a ratio of 5.2 : 1. There were no differences among the three methods for global EFs or volumes (analysis of variance P=0.86 and 0.94). MP and BP correlated equally well (P=0.15) versus CMR for global EFs (MP: r=0.87 and BP: r=0.95) and volumes (r=0.91 for both). Phase histogram parameters correlated significantly for MP versus BP for phase standard deviation (r=0.79) and phase bandwidth (r=0.93). Detection of five patients with significantly extended phase bandwidth, indicative of asynchrony, showed 'good agreement' between MP and BP (kappa=0.73; McNemar's difference=0%, P=0.48). Abnormal regional BP EF predicted abnormal wall motion of specific LV segments (receiver-operating characteristic area=85+/-2%), and abnormal regional MP wall thickening predicted abnormal CMR wall thickening (receiver-operating characteristic area=87+/-3%). Abnormal MP phase was present in 25% of 67 dyssynergic segments and 64% of segments adjacent to dyssynergic segments, indicating that locations of phase abnormalities were more widely distributed in the LV than sites of depressed wall motion. MP and BP measures of LV global and regional function agreed well with each other and with independent CMR measurements. MP and BP phase measurements suggested that phase abnormalities were more widespread than localized wall motion abnormalities.
    Nuclear Medicine Communications 03/2009; 30(4):292-9. · 1.38 Impact Factor
  • Journal of Nuclear Cardiology 03/2009; · 2.85 Impact Factor
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    ABSTRACT: Blood-pool (BP)-gated SPECT should be able to detect regional left ventricular (LV) dysfunction, as the modality is fully 3-dimensional and capable of resolving all cardiac chambers. This study investigates the hypothesis that LV segments that have abnormal regional wall motion (WM) on a cardiac MRI scan also have abnormal BP regional ejection fraction (EF) as computed by fully automated quantitation (AQ) of BP data. A total of 34 patients evaluated for coronary artery disease who underwent visual assessment of WM by review of BP cines and cardiac MRI evaluations were included in this retrospective investigation. Cardiac MRI values for these patients were compared with an institutional database of cardiac MRI values for an age-matched cohort of 10 healthy volunteers. An AQ algorithm segmented the LV BPs on the BP tomograms and subdivided volumes into 17 subregions. Count-versus-time curves were fit to third-order Fourier series for each LV subvolume to compute regional EFs. For cardiac MRI data, endocardial and epicardial drawings were performed manually for 60 degrees samples of 11-13 short-axis tomograms spanning the entire heart, from which regional WM values were computed and rebinned into 17 conventional LV segments. Global EF ranged from 12% to 75% on AQ and from 14% to 75% on cardiac MRI (Pearson correlation coefficient=0.95, P<0.0001). Differences were not significant between BP AQ and cardiac MRI in identifying the 12 patients with a global EF less than 35% (McNemar difference, 3%; P=1.0) and the 19 patients with an EF less than 50% (difference, 3%; P=1.0). BP AQ was more accurate than was visual assessment for identifying LV segments with abnormal cardiac MRI WM (receiver-operating-characteristic areas, 88% vs. 80%, P<0.0001) and was more accurate for the left circumflex than for the left anterior descending coronary artery territories (95% vs. 86%, P=0.01). Differences were not significant between BP AQ and cardiac MRI WM for discriminating normal from abnormal LV segments (McNemar difference, 3.2%; P=0.14). AQ BP-gated SPECT assessment of regional and global LV WM agrees with independent cardiac MRI calculations and is superior to visual analysis for detecting regional WM abnormalities.
    Journal of Nuclear Medicine 12/2008; 50(1):53-60. · 5.77 Impact Factor
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    ABSTRACT: This study was undertaken to determine the effects of collimators on the accuracy of preoperative sestamibi parathyroid imaging of the neck. Forty-nine patients with primary hyperparathyroidism underwent preoperative (99m)Tc-sestamibi parathyroid imaging. The protocol included early and late pinhole and parallel-hole imaging. One experienced nuclear physician, without knowledge of other test results or final diagnoses, interpreted studies. For both pinhole and parallel-hole images, focally increased sestamibi accumulation outside the normal tracer biodistribution that persisted or increased in intensity from early to late images was interpreted as positive for a parathyroid lesion. Final diagnoses were operatively confirmed in all patients. Fifty-four parathyroid lesions were resected from the 49 patients. Forty-five patients had single-gland disease. Four patients had multigland disease: 3 had 2 lesions and 1 had 3 lesions. Median lesion weight was 840 mg. Pinhole imaging was significantly more sensitive than parallel-hole imaging (89% vs. 56%; P = 0.0003) for all 54 lesions. Specificity did not significantly differ between pinhole and parallel-hole imaging (93% vs. 96%, P = 0.29). Pinhole imaging was significantly more sensitive than parallel-hole imaging for lesions above (100% vs. 68%, P = 0.003) and below (77% vs. 42%, P = 0.03) the median weight and for single-gland disease (96% vs. 67%, P = 0.001). Pinhole imaging also was more sensitive for multigland disease, although the difference was only marginally significant (55% vs. 0%, P = 0.037). Because sensitivity is significantly higher, sestamibi parathyroid imaging of the neck should be performed with a pinhole collimator.
    Journal of Nuclear Medicine Technology 12/2008; 36(4):189-94.
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    ABSTRACT: To retrospectively compare the accuracy of various parathyroid scintigraphy readings for single-gland disease (SGD) and multigland disease (MGD) in patients with primary hyperparathyroidism, with histologic analysis as the reference standard. Institutional review board approval was obtained for this HIPAA-compliant study. Records of 462 patients with primary hyperparathyroidism who underwent preoperative imaging with a technetium 99m ((99m)Tc) sestamibi and (99m)TcO4- protocol that consisted of early and late pinhole (99m)Tc sestamibi, pinhole thyroid imaging, image subtraction, and single photon emission computed tomography (SPECT) were retrospectively reviewed. An experienced nuclear medicine physician without knowledge of other test results or of the final diagnoses graded images on a scale from 0 (definitely normal) to 4 (definitely abnormal). Early pinhole (99m)Tc sestamibi images, late pinhole (99m)Tc sestamibi images, subtraction images, SPECT images, early and late pinhole (99m)Tc sestamibi images, all planar images, and all images--including SPECT images--were read in seven sessions. Receiver operating characteristic curves were generated for each session and were used to calculate sensitivity, specificity, and accuracy. A total of 534 parathyroid lesions were excised. Of the 462 patients, 409 had one lesion, whereas 53 had multiple lesions. Reading all images together was more accurate (89%, P = .001) than was reading early (79%), late (85%), subtraction (86%), and SPECT (83%) images separately; however, it was not significantly more accurate than reading planar images (88%) or early and late images together (87%). Reading all images was significantly less sensitive in the detection of lesions with a median weight of 600 mg or less than in the detection of lesions with a median weight of more than 600 mg (86% vs 94%, P = .004). Per-lesion sensitivity for reading all images was significantly higher for SGD than for MGD (90% vs 66%, P < .001). Sensitivity of reading all images together in the identification of patients with MGD was 62%. Reviewing early, late, and subtraction pinhole images together with SPECT images maximizes parathyroid lesion detection accuracy. Test sensitivity is adversely affected by decreasing lesion weight and MGD.
    Radiology 08/2008; 248(1):221-32. · 6.34 Impact Factor

Publication Stats

1k Citations
308.46 Total Impact Points


  • 2013
    • Catholic Health Services of Long Island
      New York City, New York, United States
  • 2007–2013
    • North Shore-Long Island Jewish Health System
      • Division of Nuclear Medicine and Molecular Imaging
      New York City, New York, United States
  • 2003–2011
    • St. Francis Hospital
      Roslyn, New York, United States
  • 2009
    • Saint Francis Hospital
      Tulsa, Oklahoma, United States
  • 2004–2005
    • Stony Brook University
      Stony Brook, New York, United States
  • 2003–2004
    • CUNY Graduate Center
      New York City, New York, United States
  • 1998–2004
    • Columbia University
      • • Division of Cardiology
      • • Department of Radiology
      • • Department of Medicine
      New York City, New York, United States
  • 1994–2004
    • Aurora St. Luke's Medical Center
      Milwaukee, Wisconsin, United States
  • 1997–2000
    • St. Luke's Hospital
      Cedar Rapids, Iowa, United States
  • 1999
    • Emory University
      • Department of Radiology
      Atlanta, GA, United States
  • 1996–1999
    • Saint Luke's Hospital (NY, USA)
      New York City, New York, United States
  • 1996–1998
    • St. Luke School of Medicine
      New York City, New York, United States
  • 1991
    • University of California, Los Angeles
      Los Angeles, California, United States