Simona Ben-Haim

Tel Aviv Sourasky Medical Center, Tell Afif, Tel Aviv, Israel

Are you Simona Ben-Haim?

Claim your profile

Publications (51)225.84 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Bone marrow stem cell (BMSC) therapy for cardiovascular disease has shown considerable preclinical and clinical promise, but there remains a need for mechanistic studies to help bridge the transition from bench to bedside. We have designed a substudy to our REGENERATE-IHD trial (ClinicalTrial.gov Identifier: NCT00747708) to assess the feasibility of a novel imaging technique to detect angiogenesis following BMSC therapy. Nine patients who had been randomized to receive intracoronary injection of G-CSF-mobilized BMSCs or control (serum) were included in this substudy. Patients underwent SPECT imaging using a novel radiolabelled peptide (Tc-NC100692), which has a high affinity for the αvβ3 integrin, an angiogenesis-related integrin. This was repeated 4 days after intracoronary injection of BMSCs/control to assess for neoangiogenesis. The imaging study was well tolerated with no adverse effects. Myocardial tracer uptake was detectable at baseline in all nine patients, with no myocardial uptake seen in two control patients used for comparison. Baseline uptake appeared to correlate with baseline ejection fraction but changes with therapy did not reach statistical significance. SPECT imaging with a Tc-NC100692 is feasible in patients with heart failure, with baseline activity suggesting persistent angiogenesis in patients with remote myocardial infarction.
    Nuclear Medicine Communications 04/2014; · 1.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We have assessed whether additional upright imaging increases the confidence of interpretation of stress only supine myocardial perfusion imaging (MPI) in obese patients. Tc-MIBI stress MPI of 101 consecutive patients (M = 49, 62 ± 12 years) with BMI ≥30 scanned on the D-SPECT cardiac camera were assessed. Images were interpreted as diagnostic or equivocal and the need for a rest study was recorded. Stress supine MPI was interpreted first, then gated and finally upright data were added. Defects on supine but not on upright were defined as artefacts and defects seen on both as abnormal. The total perfusion deficit (TPD) was also quantified. There were 27 normal, 22 abnormal, and 52 equivocal supine scans. The median EF was 52%, unaffecting the need for rest imaging. Upright imaging reclassified 32/52 (62%) equivocal studies as normal and 6/52 (11%) as abnormal (P < 0.001). Rest scan was deemed needed in 74/101 patients on supine vs 42/101 on supine/upright (P < 0.001). Supine TPD was normal in 53 and supine/upright TPD was normal in 70 patients (P < 0.001). Supine stress MPI is inadequate in obese patients. The addition of upright imaging significantly increases the ability to interpret scans as diagnostic and may reduce considerably the need for rest imaging.
    Journal of Nuclear Cardiology 01/2014; · 2.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim: The novel solid state dedicated cardiac cameras provide fast high resolution cardiac imaging. The D-SPECT camera enables semi-reclining (upright) positioning, increasing comfort and potentially reducing movement during myocardial perfusion imaging. Physicians are generally familiar with supine imaging and the different positioning in upright imaging could potentially cause diagnostic challenges. The aim of this study was to compare the upright and supine imaging for diagnostic ability to assess Physician confidence and determine any artefacts in upright imaging. Methods: Fifty-five patients underwent myocardial perfusion imaging on the D-SPECT camera in both upright and supine positions. Where both images showed the same defects the 2 techniques were regarded as equally diagnostic. Where only one set showed a defect this was regarded as artefact and was defined as non-diagnostic. The location and cause of the artefact was recorded. Results: In 13 /55 patients either form of imaging was regarded as equally diagnostic. In 24/55 the supine images revealed artefact affecting interpretation. The reasons for this were most frequently large BMI, motion and gut uptake. In 18/55 upright images were considered non-diagnostic. In 16/18 this was due to an infero-apical defect seen in female patients (14/16) with raised BMI and/or large breasts. Conclusion: Upright myocardial perfusion imaging on D-SPECT shows a common artefact (in up to 1/3 of cases) in the infero-apical region mainly in overweight female patients. Getting acquainted with this artefact this may increase Physician confidence in reporting, similarly as to conventional supine imaging. Indeed, some of the artefacts seen on supine imaging appear less commonly with upright imaging. Thus, upright imaging can potentially be used alone for diagnosis with D-SPECT. Performance of both supine and upright imaging can be reserved for overweight patients thereby minimizing impact on scanning time and clinical throughput in busy departments.
    The quarterly journal of nuclear medicine and molecular imaging: official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of... 06/2013; · 1.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: High-speed (HS) single-photon emission computed tomography (SPECT) with a recently developed solid-state camera shows comparable myocardial perfusion abnormalities to those seen in conventional SPECT. We aimed to compare HS and conventional SPECT images from multiple centres with coronary angiographic findings. METHODS: The study included 50 patients who had sequential conventional SPECT and HS SPECT myocardial perfusion studies and coronary angiography within 3 months. Stress and rest perfusion images were visually analysed and scored semiquantitatively using a 17-segment model by two experienced blinded readers. Global and coronary territorial summed stress scores (SSS) and summed rest scores (SRS) were calculated. Global SSS ≥3 or coronary territorial SSS ≥2 was considered abnormal. In addition the total perfusion deficit (TPD) was automatically derived. TPD >5 % and coronary territorial TPD ≥3 % were defined as abnormal. Coronary angiograms were analysed for site and severity of coronary stenosis; ≥50 % was considered significant. RESULTS: Of the 50 patients, 13 (26 %) had no stenosis, 22 (44 %) had single-vessel disease, 6 (12 %) had double-vessel disease and 9 (18 %) had triple-vessel disease. There was a good linear correlation between the visual global SSS and SRS (Spearman's ρ 0.897 and 0.866, respectively; p < 0.001). In relation to coronary angiography, the sensitivities, specificities and accuracies of HS SPECT and conventional SPECT by visual assessment were 92 % (35/38), 83 % (10/12) and 90 % (45/50) vs. 84 % (32/38), 50 % (6/12) and 76 % (38/50), respectively (p < 0.001). The sensitivities, specificities and accuracies of HS SPECT and conventional SPECT in relation to automated TPD assessment were 89 % (31/35), 57 % (8/14) and 80 % (39/49) vs. 86 % (31/36), 77 % (10/13) and 84 % (41/49), respectively. CONCLUSION: HS SPECT allows fast acquisition of myocardial perfusion images that correlate well with angiographic findings with overall accuracy by visual assessment better than conventional SPECT. Further assessment in a larger patient population may be needed to confirm this observation.
    European Journal of Nuclear Medicine 04/2013; · 4.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Myocardial perfusion imaging (MPI) is well established in the diagnosis and workup of patients with known or suspected coronary artery disease (CAD); however, it can underestimate the extent of obstructive CAD. Quantification of myocardial perfusion reserve with PET can assist in the diagnosis of multivessel CAD. We evaluated the feasibility of dynamic tomographic SPECT imaging and quantification of a retention index to describe global and regional myocardial perfusion reserve using a dedicated solid-state cardiac camera. METHODS: Ninety-five consecutive patients (64 men and 31 women; median age, 67 y) underwent dynamic SPECT imaging with (99m)Tc-sestamibi at rest and at peak vasodilator stress, followed by standard gated MPI. The dynamic images were reconstructed into 60-70 frames, 3-6 s/frame, using ordered-subsets expectation maximization with 4 iterations and 32 subsets. Factor analysis was used to estimate blood-pool time-activity curves, used as input functions in a 2-compartment kinetic model. K1 values ((99m)Tc-sestamibi uptake) were calculated for the stress and rest images, and K2 values ((99m)Tc-sestamibi washout) were set to zero. Myocardial perfusion reserve (MPR) index was calculated as the ratio of the stress and rest K1 values. Standard MPI was evaluated semiquantitatively, and total perfusion deficit (TPD) of at least 5% was defined as abnormal. RESULTS: Global MPR index was higher in patients with normal MPI (n = 51) than in patients with abnormal MPI (1.61 [interquartile range (IQR), 1.33-2.03] vs. 1.27 [IQR, 1.12-1.61], P = 0.0002). By multivariable regression analysis, global MPR index was associated with global stress TPD, age, and smoking. Regional MPR index was associated with the same variables and with regional stress TPD. Sixteen patients undergoing invasive coronary angiography had 20 vessels with stenosis of at least 50%. The MPR index was 1.11 (IQR, 1.01-1.21) versus 1.30 (IQR, 1.12-1.67) in territories supplied by obstructed and nonobstructed arteries, respectively (P = 0.02). MPR index showed a stepwise reduction with increasing extent of obstructive CAD (P = 0.02). CONCLUSION: Dynamic tomographic imaging and quantification of a retention index describing global and regional perfusion reserve are feasible using a solid-state camera. Preliminary results show that the MPR index is lower in patients with perfusion defects and in regions supplied by obstructed coronary arteries. Further studies are needed to establish the clinical role of this technique as an aid to semiquantitative analysis of MPI.
    Journal of Nuclear Medicine 04/2013; · 5.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clinical (123)I-2-β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)nortropane ((123)I-FP-CIT) SPECT studies are commonly performed and reported using visual evaluation of tracer binding, an inherently subjective method. Increased objectivity can potentially be obtained using semiquantitative analysis. In this study, we assessed whether semiquantitative analysis of (123)I-FP-CIT tracer binding created more reproducible clinical reporting. A secondary aim was to determine in what form semiquantitative data should be provided to the reporter. METHODS: Fifty-four patients referred for the assessment of nigrostriatal dopaminergic degeneration were scanned using SPECT/CT, followed by semiquantitative analysis calculating striatal binding ratios (SBRs) and caudate-to-putamen ratios (CPRs). Normal reference values were obtained using 131 healthy controls enrolled on a multicenter initiative backed by the European Association of Nuclear Medicine. A purely quantitative evaluation was first performed, with each striatum scored as normal or abnormal according to reference values. Three experienced nuclear medicine physicians then scored each striatum as normal or abnormal, also indicating cases perceived as difficult, using visual evaluation, visual evaluation in combination with SBR data, and visual evaluation in combination with SBR and CPR data. Intra- and interobserver agreement and agreement between observers and the purely quantitative evaluation were assessed using κ-statistics. The agreement between scan interpretation and clinical diagnosis was assessed for patients with a postscan clinical diagnosis available (n = 35). RESULTS: The physicians showed consistent reporting, with a good intraobserver agreement obtained for the visual interpretation (mean κ ± SD, 0.95 ± 0.029). Although visual interpretation of tracer binding gave good interobserver agreement (0.80 ± 0.045), this was improved as SBRs (0.86 ± 0.070) and CPRs (0.95 ± 0.040) were provided. The number of striata perceived as difficult to interpret decreased as semiquantitative data were provided (30 for the visual interpretation; 0 as SBR and CPR values were given). The agreement between physicians' interpretations and the purely quantitative evaluation showed that readers used the semiquantitative data to different extents, with a more experienced reader relying less on the semiquantitative data. Good agreement between scan interpretation and clinical diagnosis was seen. CONCLUSION: A combined approach of visual assessment and semiquantitative analysis of tracer binding created more reproducible clinical reporting of (123)I-FP-CIT SPECT studies. Physicians should have access to both SBR and CPR data to minimize interobserver variability.
    Journal of Nuclear Medicine 03/2013; · 5.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Accurate assessment of splenic disease is important for staging Hodgkin lymphoma. OBJECTIVE: The purpose of this study was to assess T2-weighted imaging with and without dynamic contrast-enhanced (DCE) MRI for evaluation of splenic Hodgkin disease. MATERIALS AND METHODS: Thirty-one children with Hodgkin lymphoma underwent whole-body T2-weighted MRI with supplementary DCE splenic imaging, and whole-body PET-CT before and following chemotherapy. Two experienced nuclear medicine physicians derived a PET-CT reference standard for splenic disease, augmented by follow-up imaging. Unaware of the PET-CT, two experienced radiologists independently evaluated MRI exercising a locked sequential read paradigm (T2-weighted then DCE review) and recorded the presence/absence of splenic disease at each stage. Performance of each radiologist was determined prior to and following review of DCE-MRI. Incorrect MRI findings were ascribed to reader (lesion present on MRI but missed by reader) or technical (lesion not present on MRI) error. RESULTS: Seven children had splenic disease. Sensitivity/specificity of both radiologists for the detection of splenic involvement using T2-weighted images alone was 57%/100% and increased to 100%/100% with DCE-MRI. There were three instances of technical error on T2-weighted imaging; all lesions were visible on DCE-MRI. CONCLUSIONS: T2-weighted imaging when complemented by DCE-MRI imaging may improve evaluation of Hodgkin disease splenic involvement.
    Pediatric Radiology 02/2013; · 1.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Currently, there is a lack of data on the role of combined positron emission tomography-computed tomography (PET-CT) in the staging of early invasive primary breast cancer. We therefore evaluated the role of (18)F-fluorodeoxyglucose ((18)F-FDG)-PET-CT in this patient population. We prospectively recruited 70 consecutive patients (69 women, one man; mean age, 61.9 ± 8.1 years) with early primary breast cancer for staging with (18)F-FDG-PET-CT. All PET-CT images were interpreted by two readers (independently of each other). A third reader adjudicated any discrepancies. All readers had ≥5 years of specific experience. Ethics board approval and informed consent were obtained. The mean clinical follow-up was 22.7 ± 12.6 months. The primary tumor was identified with PET-CT in 64 of 70 patients. Of the unidentified lesions, surgical pathology revealed two intraductal carcinomas, one invasive tubular carcinoma, and three invasive lobular carcinomas. Undiagnosed multifocal breast disease was shown in seven of 70 patients. PET-CT identified avid axillary lymph nodes in 19 of 70 patients, compared with 24 of 70 confirmed during surgery. There were four patients who were axillary node positive on PET but had no axillary disease at surgery. Five patients were reported with avid metastases. Two of those patients were treated for metastatic disease (nodal, lung, and liver in one and bone metastases in the other) following further imaging and clinical assessment. In the other three patients, lesions (lung, n = 1; pleural, n = 1; paratrachael node, n = 1) were subsequently diagnosed as benign lesions. Integrated (18)F-FDG-PET-CT may have a role in staging patients presenting with early breast cancer.
    The Oncologist 04/2012; 17(5):613-9. · 4.10 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We present a method of correcting self-scatter and crosstalk effects in simultaneous technetium-99m/thallium-201 stress/rest myocardial perfusion (single photon emission computed tomography) SPECT scans. The method, which is in essence a hybrid between the triple energy window method and scatter modelling, is based on a model of spatial and spectral distribution of projection counts in several selected energy windows. The parameters of the model are determined from measurements of thin rod sources in air when no in-object scatter or attenuation effects are present. The model equations are solved using the iterative maximum likelihood expectation maximization algorithm in the projection space to find estimates of the primary photopeak counts of both radionuclides. The method has been developed particularly for a novel dedicated cardiac camera based on CdZnTe pixellated detectors, although it can also be adapted to a conventional scintillator camera. The method has been validated in anthropomorphic phantom experiments. Significant improvement in defect contrast has been observed with only moderate increase in image noise. The application of the method to patient data is illustrated.
    Physics in Medicine and Biology 03/2011; 56(5):1397-414. · 2.70 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This prospective, multicenter trial compared quantitative results of myocardial perfusion imaging and function using a high-speed single-photon emission computed tomography (SPECT) system with those obtained with conventional SPECT. A novel SPECT camera was shown in a pilot study to detect a similar amount of myocardial perfusion abnormality compared with conventional SPECT in one-seventh of the acquisition time. A total of 238 patients underwent myocardial perfusion imaging with conventional and high-speed SPECT at 4 U.S. centers. An additional 63 patients with a low pre-test likelihood of coronary artery disease underwent myocardial perfusion imaging with both technologies to develop method- and sex-specific normal limits. Rest/stress acquisition times were, respectively, 20/15 min and 4/2 min for conventional and high-speed SPECT. Stress and rest quantitative total perfusion deficit, post-stress left ventricular end-diastolic volume, and ejection fraction were derived for the 238 patients by the 2 methods. High-speed stress and rest total perfusion deficit correlated linearly with conventional SPECT total perfusion deficit (r = 0.95 and 0.97, respectively, p < 0.0001), with good concordance in the 3 vascular territories (kappa statistics for the left anterior descending coronary artery, left circumflex coronary artery, and right coronary artery were 0.73, 0.73, and 0.70, respectively; >90% agreement). The percentage of ischemic myocardium by both imaging modalities was significantly larger in patients with a high coronary artery disease likelihood than in those with a low and intermediate likelihood (p < 0.001). The average amount of ischemia was slightly but significantly larger by high-speed SPECT compared with conventional SPECT in high-likelihood patients (4.6 +/- 4.6% vs. 3.9 +/- 4.0%, respectively; p < 0.05). Post-stress ejection fraction and end-diastolic volume by the 2 methods were linearly correlated (r = 0.89 and 0.97, respectively). The high-speed SPECT technology provides quantitative measures of myocardial perfusion and function comparable to those with conventional SPECT in one-seventh of the acquisition time.
    Journal of the American College of Cardiology 05/2010; 55(18):1965-74. · 14.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We compared simultaneous dual-radionuclide (DR) stress and rest myocardial perfusion imaging (MPI) with a novel solid-state cardiac camera and a conventional SPECT camera with separate stress and rest acquisitions. Of 27 consecutive patients recruited, 24 (64.5+/-11.8 years of age, 16 men) were injected with 74 MBq of (201)Tl (rest) and 250 MBq (99m)Tc-MIBI (stress). Conventional MPI acquisition times for stress and rest are 21 min and 16 min, respectively. Rest (201)Tl for 6 min and simultaneous DR 15-min list mode gated scans were performed on a D-SPECT cardiac scanner. In 11 patients DR D-SPECT was performed first and in 13 patients conventional stress (99m)Tc-MIBI SPECT imaging was performed followed by DR D-SPECT. The DR D-SPECT data were processed using a spill-over and scatter correction method. DR D-SPECT images were compared with rest (201)Tl D-SPECT and with conventional SPECT images by visual analysis employing the 17-segment model and a five-point scale (0 normal, 4 absent) to calculate the summed stress and rest scores. Image quality was assessed on a four-point scale (1 poor, 4 very good) and gut activity was assessed on a four-point scale (0 none, 3 high). Conventional MPI studies were abnormal at stress in 17 patients and at rest in 9 patients. In the 17 abnormal stress studies DR D-SPECT MPI showed 113 abnormal segments and conventional MPI showed 93 abnormal segments. In the nine abnormal rest studies DR D-SPECT showed 45 abnormal segments and conventional MPI showed 48 abnormal segments. The summed stress and rest scores on conventional SPECT and DR D-SPECT were highly correlated (r=0.9790 and 0.9694, respectively). The summed scores of rest (201)Tl D-SPECT and DR-DSPECT were also highly correlated (r=0.9968, p<0.0001 for all). In six patients stress perfusion defects were significantly larger on stress DR D-SPECT images, and five of these patients were imaged earlier by D-SPECT than by conventional SPECT. Fast and high-quality simultaneous DR MPI is feasible with D-SPECT in a single imaging session with comparable diagnostic performance and image quality to conventional SPECT and to a separate rest (201)Tl D-SPECT acquisition.
    European Journal of Nuclear Medicine 04/2010; 37(9):1710-21. · 4.53 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Increased uptake of 18F-fluorodeoxyglucose (18F-FDG) in atherosclerotic plaque on Positron Emission Tomography (PET), predicts vulnerability. Recent studies have shown that the PET signal is reproducible over a 2-week period and as a result drug trials are underway. However, the natural history of these lesions is unknown. The aim of this study is determine the natural history of increased vascular wall uptake of 18F-fluorodeoxyglucose (18F-FDG). Following institutional ethics committee approval, we retrospectively examined PET/CT images of patients from our Institution that had at least 4 examinations in the last 5 years. This represented 205 studies in total, from 50 patients (29 men, 21 women, mean age 49.4+/-12.1 years, mean 5.1+/-1.7 studies/patient). The mean follow-up was 27.2+/-11.8 months. The carotids and the aorta were evaluated for increased 18F-FDG uptake with a maximum Standardized Uptake Value (SUVmax)>2.5, and >3.0, and calcification. Plots of SUVmax and Hounsfield units (HU) were made versus time. The initial prevalence of increased focal arterial 18F-FDG uptake was 17/50 patients and of arterial calcification 19/50. 132 sites of 18F-FDG uptake in total were observed longitudinally. 18F-FDG vascular uptake did not persist with time. There was no correlation between 18F-FDG uptake and HU. No calcifications developed at sites of focal increased 18F-FDG uptake. Arterial lesions with increased 18F-FDG uptake represent transient phenomena. This data is important for the interpretation of findings of clinical trials using arterial 18F-FDG uptake as an imaging biomarker to monitor pharmacological intervention.
    Atherosclerosis 01/2010; 211(1):136-40. · 3.71 Impact Factor
  • Simona Ben-Haim, Ora Israel
    [Show abstract] [Hide abstract]
    ABSTRACT: Breast cancer is the most common cause of bone metastases in women. Imaging studies are useful to identify bone involvement and associated complications, for follow-up of disease spread and for the assessment of response to therapy. Bone scintigraphy with (99m)technetium-labeled diphosphonates is most widely used, due to its availability, high sensitivity, and low cost, despite the relatively low specificity. The addition of single-photon emission computed tomography and recently single-photon emission computed tomography/computed tomography improves the diagnostic accuracy of this modality. Serial follow-up scans can demonstrate disease progression, but this method is less accurate in determining response to treatment. Positron emission tomography (PET), a tomographic modality with improved resolution shows improved sensitivity and specificity. (18)F-fluorodeoxyglucose (FDG)-PET is the most common clinically used procedure. FDG is taken up by the tumor cells and has therefore the advantage of demonstrating the presence of disease in both bone and soft tissues. FDG-PET is highly sensitive mainly in diagnosis of early metastatic disease, which may still be confined to the bone marrow, as well as for the detection of lytic bone metastases and can be also reliably used to monitor response to therapy. For the detection of sclerotic lesions, however, imaging with a bone-seeking tracer such as (18)F-fluoride, may have a complementary role. As a nonspecific skeletal imaging tracer, (18)F-fluoride has great potential, being more sensitive than bone scintigraphy and when PET/computed tomography is performed it is highly accurate for detection of both lytic and sclerotic lesions and to distinguish benign from malignant skeletal findings.
    Seminars in nuclear medicine 11/2009; 39(6):408-15. · 3.96 Impact Factor
  • Simona Ben-Haim, Svetislav Gacinovic, Ora Israel
    [Show abstract] [Hide abstract]
    ABSTRACT: Infectious and inflammatory processes, in particular those involving the cardiovascular system, are not a story of the past. New aggressive pathogens are responsible for difficult-to-treat infections. Present-day problems such as diabetes are associated with frequent and at times severe infectious processes, with high morbidity related to the disease or to available therapeutic options. Infections involving the heart or vessels pose clinical challenges in diagnosing and planning the most appropriate therapeutic strategy. Inflammatory processes are diagnosed more frequently today, acknowledged as pathologic conditions of high clinical significance, and much is invested in developing efficient therapeutic options. Nuclear medicine procedures are an important component of the evaluation armamentarium used in patients with suspected or confirmed infectious and inflammatory processes. Their role relies on the strength of noninvasive scintigraphic imaging tests that provide functional and metabolic information early during the course of the disease. Drawbacks of nuclear medicine procedures related to either the use of specific radiolabeled tracers or to their rather low resolution are overcome to a large extent during the last decade by the introduction of hybrid positron emission tomography/computed tomography and single-photon emission computed tomography/computed tomography imaging devices. Initial validated results regarding the role of nuclear medicine and of hybrid imaging using various radiotracers in the evaluation of cardiovascular infections and inflammatory processes are emerging over the last few years. They indicate the potentially important role of these modalities for early and precise diagnosis, in defining the whole extent of disease, for individualized treatment tailoring and for monitoring response to treatment. Attention needs to be given to match the appropriate imaging test and radiolabeled agent to the clinical question at hand. Nuclear medicine in general and hybrid imaging procedures in particular will redefine in future the diagnostic and therapeutic capabilities in patients with suspected or known infections and inflammations of the cardiovascular system.
    Seminars in nuclear medicine 04/2009; 39(2):103-14. · 3.96 Impact Factor
  • Source
    Simona Ben-Haim, Peter Ell
    [Show abstract] [Hide abstract]
    ABSTRACT: Multimodality imaging, as represented by its greatest exponent, PET/CT, has a firm place in the evaluation of a patient presenting with cancer. With 18F-FDG, PET/CT is rapidly becoming the key investigative tool for the staging and assessment of cancer recurrence. In the last 5 y, PET/CT has also gained widespread acceptance as a key tool used to demonstrate early response to intervention and therapy. In this setting, a major clinical need is being addressed with 18F-FDG PET/CT, because of its inherent ability to demonstrate (before other markers of response) if disease modification has occurred. This review presents available evidence to this effect.
    Journal of Nuclear Medicine 02/2009; 50(1):88-99. · 5.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We propose a method of separating primary <sup>99m</sup>Tc and <sup>201</sup>Tl photons in projections acquired on a SPECT camera based on CdZnTe detectors during a simultaneous dual radionuclide rest-stress myocardial perfusion scan. The method is based on a model of spectral and spatial distribution of counts in the measured projections. We use the Maximum Likelihood Expectation Maximisation (ML-EM) iterative algorithm to solve the model equations for the pure primary counts. The deconvolved primary count projections are then reconstructed using the standard OSEM algorithm. Considerable improvement of defect contrast can be observed in anthropomorphic phantom scans.
    Nuclear Science Symposium Conference Record, 2008. NSS '08. IEEE; 11/2008
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to compare myocardial perfusion imaging (MPI) with high-speed single-photon emission computed tomography (SPECT) with conventional SPECT imaging for the evaluation of myocardial perfusion in patients with known or suspected coronary artery disease. A novel technology has been developed for high-speed SPECT MPI by employing a bank of independently controlled detector columns with large-hole tungsten collimators and multiple cadmium zinc telluride crystal arrays. A total of 44 patients (39 men) underwent same-day Tc-99m sestamibi stress/rest MPI. High-speed SPECT images were performed within 30 min after conventional SPECT. Stress and rest acquisition times were 16 and 12 min for conventional imaging and 4 and 2 min for high-speed SPECT, respectively. Myocardial counts/min (cpm) were calculated for both conventional SPECT and high-speed SPECT. Images were visually analyzed, and the summed stress score (SSS) and summed rest score (SRS) were calculated. Image quality and diagnostic confidence were qualitatively assessed. High-speed SPECT SSS and SRS correlated linearly with conventional SPECT respective scores (r = 0.93, p < 0.0001 for SSS, and r = 0.93, p < 0.0001 for SRS). Image quality was rated good and higher in 17 (94%) cases for high-speed SPECT and 16 (89%) cases for conventional SPECT. Of the 44 patients studied, 36 (81.8%) and 35 (79.5%) were diagnosed definitely normal or abnormal by conventional and high-speed SPECT, respectively (p = NS). Myocardial count rate was significantly higher in high-speed versus conventional SPECT (384 x 10(-3) +/- 134 x 10(-3) cpm/min vs. 47 x 10(-3) +/- 14 x 10(-3) cpm/min, respectively, p < 0.0001) for stress and (962 x 10(-3) +/- 426 x 10(-3) cpm/min vs. 136 x 10(-3) +/- 37 x 10(-3) cpm/min, respectively, p < 0.001) for rest. High-speed SPECT provides fast MPI with high image quality and up to 8 times increased system sensitivity. The amount of perfusion abnormality visualized by high-speed SPECT is highly correlated to conventional SPECT, with an equivalent level of diagnostic confidence.
    JACC. Cardiovascular imaging 04/2008; 1(2):156-63. · 14.29 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Myocardial perfusion with PET/CT has advantages over conventional SPECT. We describe our initial European experience using (82)Rubidium-PET/CT, as part of a clinical myocardial perfusion service. We studied the first 100 patients (64 male; 36 female, mean age = 60: SD +/-12.5y, mean body mass index = 30: SD +/-6.9kg/m( 2 )) who underwent (82)Rubidium cardiac PET/CT in our institution. Thirty patients had recently undergone coronary angiography. Patients underwent imaging during adenosine infusion and at rest. Images were acquired over 5 minutes using a GE-PET/CT instrument. Image quality was described as good, adequate or inadequate. Images were reported patient-by-patient by a minimum of five nuclear medicine physicians. A segment-by-segment analysis (17-segment model) was also performed. Image quality was good in 77%, adequate 23% and inadequate 0%. There was no statistical difference in image quality between obese and non-obese patients (Fisher's exact test, p = 0.2864). 59% had normal perfusion studies, 29% had inducible ischaemia, 12% had myocardial infarction (11% with super added ischaemia). There was reduced (82)Rubidium uptake in 132/1700 segments during stress. There was reduced (82)Rubidium uptake at rest in 42/1700 segments. The (82)Rubidium PET/CT findings were consistent with the angiographic findings in 28/30 cases. We show that, even from initial use of (82)Rubidium, it is possible to perform myocardial perfusion studies quickly with good image quality, even in the obese. The PET findings correlated well in the third of the cases where angiography was available. As such, (82)Rubidium cardiac PET/CT is likely to be an exciting addition to the European nuclear physician/ cardiologist's radionuclide imaging arsenal.
    European journal of nuclear medicine and molecular imaging 01/2008; 34(12):1965-72. · 5.11 Impact Factor
  • Journal of Nuclear Cardiology 01/2008; 15(4). · 2.85 Impact Factor
  • Journal of Nuclear Cardiology 01/2008; 15(4). · 2.85 Impact Factor

Publication Stats

713 Citations
225.84 Total Impact Points

Institutions

  • 2010
    • Tel Aviv Sourasky Medical Center
      Tell Afif, Tel Aviv, Israel
  • 2006–2010
    • University College London Hospitals NHS Foundation Trust
      • Institute of Nuclear Medicine (INM)
      Londinium, England, United Kingdom
  • 2009
    • University College London
      • Department of Metabolism and Experimental Therapeutics
      London, ENG, United Kingdom
  • 1988–2007
    • Rambam Medical Center
      • Department of Nuclear Medicine
      H̱efa, Haifa District, Israel
  • 2000–2006
    • Carmel Medical Center
      H̱efa, Haifa District, Israel
  • 1988–2004
    • Technion - Israel Institute of Technology
      • Rambam Medical Center
      H̱efa, Haifa District, Israel