Estudo da influência do número de ciclos por projecção no cálculo da fracção de ejecção ventricular esquerda em estudos Gated-SPECT

Introdução - Gated-Single Photon Emission Computed Tomography (Gated-SPECT) do miocárdio usa-se cada vez mais na avaliação conjunta da perfusão do miocárdio e da função ventricular esquerda. O objectivo deste estudo é analisar a possível interferência do número de ciclos cardíacos (ciclos/projecção) e contagens totais por aquisição no cálculo da FEVE (fracção de ejecção do ventrículo esquerdo). Material e métodos - Foram incluídos 35 indivíduos a quem foram realizados estudos Gated-SPECT do miocárdio por indicação clínica. Em todos os pacientes foram adquiridos dois estudos em esforço: um com 25 ciclos! projecção (ES-25) e outro com 50 ciclos! projecção (ES-50), e dois estudos em repouso: um com 25 ciclos/projecção (ER-25) e outro com 12 ciclos! projecção (ER-1 2). Os valores da FEVE obtidos nos diferentes estudos foram tratados estatisticamente com o recurso à versão 14 SPSS. Resultados - Não houve diferenças estatisticamente significativas entre os valores de FEVE ES-25 e ES-50 (p=0.504) nem entre os valores de FEVE ER-25 e ER-12 (p=O.243). Conclusão - No caso da nossa amostra, o número de ciclos!projecção e consequentemente as contagens totais por aquisição não parecem ter influência de forma significativa no cálculo da FEVE%, nem em repouso nem após esforço.

Influência de diferentes parâmetros na diminuição da actividade extra-miocárdica nos estudos Gated-SPECT

A imagem de perfusão do miocárdio por tomografia computorizada de emissão de fotão único (SPECT, do acrónimo inglês Single Photon Emission Computed Tomography) é um dos exames complementares de diagnóstico mais indicados na cardiologia clínica. Os dois agentes tecneciados mais utilizados são o 99mTc-tetrofosmina e o 99mTc-sestamibi. Estes permitem avaliar a distribuição do fluxo sanguíneo no músculo cardíaco. O mecanismo de fixação é idêntico nos dois radiofármacos (RF’s). São excretados, do organismo, a partir do sistema hepatobiliar para o duodeno e para o intestino. Assim, o RF está presente tanto no coração como nos órgãos adjacentes. O coração encontra-se localizado sobre o diafragma, logo acima do lobo esquerdo do fígado e nas proximidades do estômago. Deste modo, os fotões difusos provenientes desses órgãos podem interferir com a interpretação das imagens SPECT, principalmente na parede inferior do ventrículo esquerdo, traduzindo-se na redução da razão alvo-fundo e na qualidade da imagem. Deste modo, a sensibilidade e a especificidade da Cintigrafia de Perfusão do Miocárdio (CPM) diminuem. Têm sido descritos na literatura vários métodos e técnicas para minimizar o efeito da actividade extra-miocárdica, como: a aquisição de imagens mais tardias, a ingestão de líquidos ou alimentos ricos em lípidos. Outras técnicas apontam para a alteração do posicionamento do paciente durante a aquisição. Assim, o objectivo deste estudo é identificar o protocolo da CPM a nível nacional e avaliar a percentagem de repetições de exames provocadas pela interferência de actividade extra-miocárdica.

Cyclic deformation of bidisperse two-dimensional foams

In-plane deformation of foams was studied experimentally by subjecting bidisperse foams to cycles of traction and compression at a prescribed rate. Each foam contained bubbles of two sizes with given area ratio and one of three initial arrangements: sorted perpendicular to the axis of deformation (iso-strain), sorted parallel to the axis of deformation (iso-stress), or randomly mixed. Image analysis was used to measure the characteristics of the foams, including the number of edges separating small from large bubbles N-sl, the perimeter (surface energy), the distribution of the number of sides of the bubbles, and the topological disorder mu(2)(N). Foams that were initially mixed were found to remain mixed after the deformation. The response of sorted foams, however, depended on the initial geometry, including the area fraction of small bubbles and the total number of bubbles. For a given experiment we found that (i) the perimeter of a sorted foam varied little; (ii) each foam tended towards a mixed state, measured through the saturation of N-sl; and (iii) the topological disorder mu(2)(N) increased up to an "equilibrium" value. The results of different experiments showed that (i) the change in disorder, Delta mu(2)(N), decreased with the area fraction of small bubbles under iso-strain, but was independent of it under iso-stress; and (ii) Delta mu(2)(N) increased with Delta N-sl under iso-strain, but was again independent of it under iso-stress. We offer explanations for these effects in terms of elementary topological processes induced by the deformations that occur at the bubble scale.

Influence of reconstruction parameters during filtered backprojection and ordered-subset expectation maximization in the measurement of the left-ventricular volumes and function during gated SPECT

A crucial method for investigating patients with coronary artery disease (CAD) is the calculation of the left ventricular ejection fraction (LVEF). It is, consequently, imperative to precisely estimate the value of LVEF--a process that can be done with myocardial perfusion scintigraphy. Therefore, the present study aimed to establish and compare the estimation performance of the quantitative parameters of the reconstruction methods filtered backprojection (FBP) and ordered-subset expectation maximization (OSEM). Methods: A beating-heart phantom with known values of end-diastolic volume, end-systolic volume, and LVEF was used. Quantitative gated SPECT/quantitative perfusion SPECT software was used to obtain these quantitative parameters in a semiautomatic mode. The Butterworth filter was used in FBP, with the cutoff frequencies between 0.2 and 0.8 cycles per pixel combined with the orders of 5, 10, 15, and 20. Sixty-three reconstructions were performed using 2, 4, 6, 8, 10, 12, and 16 OSEM subsets, combined with several iterations: 2, 4, 6, 8, 10, 12, 16, 32, and 64. Results: With FBP, the values of end-diastolic, end-systolic, and the stroke volumes rise as the cutoff frequency increases, whereas the value of LVEF diminishes. This same pattern is verified with the OSEM reconstruction. However, with OSEM there is a more precise estimation of the quantitative parameters, especially with the combinations 2 iterations × 10 subsets and 2 iterations × 12 subsets. Conclusion: The OSEM reconstruction presents better estimations of the quantitative parameters than does FBP. This study recommends the use of 2 iterations with 10 or 12 subsets for OSEM and a cutoff frequency of 0.5 cycles per pixel with the orders 5, 10, or 15 for FBP as the best estimations for the left ventricular volumes and ejection fraction quantification in myocardial perfusion scintigraphy.

Image quality of myocardial perfusion-gated studies: effect of ingestion of different fat content in the reduction of extra-myocardial abdominal signal

Myocardial perfusion-gated-SPECT (MP-gated-SPECT) imaging often shows radiotracer uptake in abdominal organs. This accumulation interferes frequently with qualitative and quantitative assessment of the infero-septal region of myocardium. The objective of this study is to evaluate the effect of ingestion of different fat content on the reduction of extra-myocardial uptake and to improve MP-gated-SPECT image quality. In this study, 150 patients (65 ^ 18 years) who were referred for MP-gated-SPECT underwent a 1-day-protocol including imaging after stress (physical or pharmacological) and resting conditions. All patients gave written informed consent. Patients were subdivided into five groups: GI, GII, GIII, GIV and GV. In the first four groups, patients ate two chocolate bars with different fat content. Patients in GV – control group (CG) – had just water. Uptake indices (UI) of myocardium (M)/liver(L) and M/stomach–proximal bowel(S) revealed lower UI of M/S at rest in all groups. Both stress and rest studies using different food intake indicate that patients who ate chocolate with different fat content showed better UI of M/L than the CG. The UI of M/L and M/S of groups obtained under physical stress are clearly superior to that of groups obtained under pharmacological stress. These differences are only significant in patients who ate high-fat chocolate or drank water. The analysis of all stress studies together (GI, GII, GIII and GIV) in comparison with CG shows higher mean ranks of UI of M/L for those who ate high-fat chocolate. After pharmacological stress, the mean ranks of UI of M/L were higher for patients who ate high- and low-fat chocolate. In conclusion, eating food with fat content after radiotracer injection increases, respectively, the UI of M/L after stress and rest in MP-gated-SPECT studies. It is, therefore, recommended that patients eat a chocolate bar after radiotracer injection and before image acquisition.

Study of the influence of count’s number in myocardium in the determination of reproducible functional parameters in Gated-SPECT studies simulated with GATE

Myocardial Perfusion Gated Single Photon Emission Tomography (Gated-SPET) imaging is used for the combined evaluation of myocardial perfusion and left ventricular (LV) function. But standard protocols of the Gated-SPECT studies require long acquisition times for each study. It is therefore important to reduce as much as possible the total duration of image acquisition. However, it is known that this reduction leads to decrease on counts statistics per projection and raises doubts about the validity of the functional parameters determined by Gated-SPECT. Considering that, it’s difficult to carry out this analysis in real patients. For ethical, logistical and economical matters, simulated studies could be required for this analysis. Objective: Evaluate the influence of the total number of counts acquired from myocardium, in the calculation of myocardial functional parameters (LVEF – left ventricular ejection fraction, EDV – end-diastolic volume, ESV – end-sistolic volume) using routine software procedures.

Influência de diferentes parâmetros na diminuição da atividade extra-miocárdica nos estudos Gated-SPECT

Introdução – A cintigrafia de perfusão do miocárdio (CPM) é um dos exames complementares de diagnóstico mais indicados na patologia cardiovascular. A atividade extramiocárdica é um problema recorrente na aquisição e avaliação da imagem. Parâmetros como o radiofármaco (RF) administrado, o tipo de esforço, a ingestão de alimentos, o posicionamento e o processamento de imagem influenciam a atividade extramiocárdica na CPM. O objetivo deste estudo é identificar o protocolo da CPM a nível nacional e avaliar a percentagem de repetições das aquisições provocadas por este problema. Metodologia – Para a realização deste estudo, a população selecionada foram os Serviços de Medicina Nuclear (SMN) em Portugal Continental. Foram analisados 15 questionários, respondidos pelos Técnicos Coordenadores dos vários SMN. Foi realizada a associação do comportamento das variáveis, através da estatística descritiva e do Coeficiente de Correlação de Spearman. Resultados – A percentagem de repetições é menor com o uso da 99mTecnécio(Tc)-Tetrofosmina, aquisição de imagens tardias, ingestão de diversos alimentos (água, leite, sumo, pão com manteiga) e com a correção de atenuação. Conclusão – Os resultados obtidos demonstram que a maioria das soluções aplicadas nos SMN resultam numa diminuição das repetições.

Oxorhenium Complexes Bearing the Water-Soluble Tris(pyrazol-1-yl)methanesulfonate, 1,3,5-Triaza-7-phosphaadamantane, or Related Ligands, as Catalysts for Baeyer-Villiger Oxidation of Ketones

New rhenium(VII or III) complexes [ReO3(PTA)(2)][ReO4] (1) (PTA = 1,3,5-triaza-7-phosphaadamantane), [ReO3(mPTA)][ReO4] (2) (mPTA = N-methyl-1,3,5-triaza-7-phosphaadamantane cation), [ReO3(HMT)(2)] [ReO4] (3) (HMT = hexamethylenetetramine), [ReO3(eta(2)-Tpm)(PTA)][ReO4] (4) [Tpm = hydrotris(pyrazol-1-yl)methane, HC(pz)(3), pz = pyrazolyl), [ReO3(Hpz)(HMT)][ReO4] (5) (Hpz = pyrazole), [ReO(Tpms)(HMT)] (6) [Tpms = tris(pyrazol-1-yl)methanesulfonate, O3SC(pz)(3)(-)] and [ReCl2{N2C(O)Ph} (PTA)(3)] (7) have been prepared from the Re(VII) oxide Re2O2 (1-6) or, in the case of 7, by ligand exchange from the benzoyldiazenido complex [ReCl2(N2C-(O)Ph}(Hpz)(PPh3)(2)], and characterized by IR and NMR spectroscopies, elemental analysis and electrochemical properties. Theoretical calculations at the density functional theory (DFT) level of theory indicated that the coordination of PTA to both Re(III) and Re(VII) centers by the P atom is preferable compared to the coordination by the N atom. This is interpreted in terms of the Re-PTA bond energy and hard-soft acid-base theory. The oxo-rhenium complexes 1-6 act as selective catalysts for the Baeyer-Villiger oxidation of cyclic and linear ketones (e.g., 2-methylcyclohexanone, 2-methylcyclopentanone, cyclohexanone, cyclopentanone, cyclobutanone, and 3,3-dimethyl-2-butanone or pinacolone) to the corresponding lactones or esters, in the presence of aqueous H2O2. The effects of a variety of factors are studied toward the optimization of the process.

Variabilidade introduzida pelo operador no processamento dos estudos Gated-SPECT do miocárdio

Introdução – Os estudos Gated – Single Photon Emission Computed Tomography (SPECT) são uma das técnicas de imagiologia cardíaca que mais evoluiu nas últimas décadas. Para a análise das imagens obtidas, a utilização de softwares de quantificação leva a um aumento da reprodutibilidade e exatidão das interpretações. O objetivo deste estudo consiste em avaliar, em estudos Gated-SPECT, a variabilidade intra e interoperador de parâmetros quantitativos de função e perfusão do miocárdio, obtidos com os softwares Quantitative Gated SPECT (QGS) e Quantitative Perfusion SPECT (QPS). Material e métodos – Recorreu-se a uma amostra não probabilística por conveniência de 52 pacientes, que realizaram estudos Gated-SPECT do miocárdio por razões clínicas e que integravam a base de dados da estação de processamento da Xeleris da ESTeSL. Os cinquenta e dois estudos foram divididos em dois grupos distintos: Grupo I (GI) de 17 pacientes com imagens com perfusão do miocárdio normal; Grupo II (GII) de 35 pacientes que apresentavam defeito de perfusão nas imagens Gated-SPECT. Todos os estudos foram processados 5 vezes por 4 operadores independentes (com experiência de 3 anos em Serviços de Medicina Nuclear com casuística média de 15 exames/semana de estudos Gated-SPECT). Para a avaliação da variabilidade intra e interoperador foi utilizado o teste estatístico de Friedman, considerando α=0,01. Resultados e discussão – Para todos os parâmetros avaliados, os respectivos valores de p não traduziram diferenças estatisticamente significativas (p>α). Assim, não foi verificada variabilidade intra ou interoperador significativa no processamento dos estudos Gated-SPECT do miocárdio. Conclusão – Os softwares QGS e QPS são reprodutíveis na quantificação dos parâmetros de função e perfusão avaliados, não existindo variabilidade introduzida pelo operador.

Relação entre função ventricular esquerda e os índices de captação miocárdio/pulmão em estudos Gated-SPECT

Introdução – A tomografia de emissão de fotão simples sincronizada com o sinal eletrocardiográfico (Gated-SPECT) é essencial para a avaliação conjunta da perfusão e da função ventricular esquerda (VE) do miocárdio. Objetivo – Investigar a relação entre a função VE e o índice de captação (IC) miocárdio/pulmão direito (M/PD) e M/P esquerdo (M/PE) nos estudos Gated-SPECT com 99mTc-Tetrofosmina. Metodologia – Amostra de 32 pacientes que realizaram estudos Gated-SPECT por indicação clínica, sendo subdividida em dois grupos: Grupo I (GI) – pacientes com a informação clínica de enfarte agudo do miocárdio (EAM); Grupo II (GII) – pacientes com a informação clínica de isquemia. Por cada paciente adquiriram-se imagens estáticas torácico-abdominais e dois estudos Gated-SPECT do miocárdio (protocolo de um dia esforço/repouso). Nas imagens estáticas definiram-se regiões de interesse (Regions of interest – ROI) para calcular os IC. Nos estudos Gated-SPECT utilizou-se o software Quantitative Gated SPECT/Quantitative Perfusion SPECT para calcular a Fração de Ejeção do Ventrículo Esquerdo (FEVE). Efetuou-se análise estatística descritiva para caracterização da amostra. Aplicou-se o teste de Spearman para avaliar a correlação entre a FEVE e os IC por grupo de pacientes. O Teste de Willcoxon foi usado para comparar FEVE em repouso e em esforço. Resultados – Nos estudos Gated-SPECT em esforço não se verificou correlação estatisticamente significativa entre a FEVE e os IC, para GI e GII; em repouso existe correlação positiva estatisticamente significativa entre a FEVE e os IC, para GI; para GII não se verificou correlação. Na comparação dos valores de FEVE em esforço e repouso nos dois grupos constatou-se a existência de diferenças estatisticamente significativas, sendo a FEVE em Esforço

The influence of count's number in myocardium in the determination of reproducible parameters in Gated-SPECT studies simulated with GATE

Myocardial Perfusion Gated Single Photon Emission Tomography (Gated-SPET) imaging is used for the combined evaluation of myocardial perfusion and left ventricular (LV). The purpose of this study is to evaluate the influence of the total number of counts acquired from myocardium, in the calculation of myocardial functional parameters using routine software procedures. Methods: Gated-SPET studies were simulated using Monte Carlo GATE package and NURBS phantom. Simulated data were reconstructed and processed using the commercial software package Quantitative Gated-SPECT. The Bland-Altman and Mann-Whitney-Wilcoxon tests were used to analyze the influence of the number of total counts in the calculation of LV myocardium functional parameters. Results: In studies simulated with 3MBq in the myocardium there were significant differences in the functional parameters: Left ventricular ejection fraction (LVEF), end-systolic volume (ESV), Motility and Thickness; between studies acquired with 15s/projection and 30s/projection. Simulations with 4.2MBq show significant differences in LVEF, end-diastolic volume (EDV) and Thickness. Meanwhile in the simulations with 5.4MBq and 8.4MBq the differences were statistically significant for Motility and Thickness. Conclusion: The total number of counts per simulation doesn't significantly interfere with the determination of Gated-SPET functional parameters using the administered average activity of 450MBq to 5.4MBq in myocardium.

Avaliação da viabilidade miocárdica pós-enfarte: Gated-SPECT versus Gated-PET

Mestrado em Medicina Nuclear - Ramo de especialização: Tomografia por Emissão de Positrões

The influence of number of counts in the myocardium in the determination of reproducible functional parameters in gated-SPECT studies simulated with GATE

Myocardial perfusion gated-single photon emission computed tomography (gated-SPECT) imaging is used for the combined evaluation of myocardial perfusion and left ventricular (LV) function. The aim of this study is to analyze the influence of counts/pixel and concomitantly the total counts in the myocardium for the calculation of myocardial functional parameters. Material and methods: Gated-SPECT studies were performed using a Monte Carlo GATE simulation package and the NCAT phantom. The simulations of these studies use the radiopharmaceutical 99mTc-labeled tracers (250, 350, 450 and 680MBq) for standard patient types, effectively corresponding to the following activities of myocardium: 3, 4.2, 5.4-8.2MBq. All studies were simulated using 15 and 30s/projection. The simulated data were reconstructed and processed by quantitative-gated-SPECT software, and the analysis of functional parameters in gated-SPECT images was done by using Bland-Altman test and Mann-Whitney-Wilcoxon test. Results: In studies simulated using different times (15 and 30s/projection), it was noted that for the activities for full body: 250 and 350MBq, there were statistically significant differences in parameters Motility and Thickness. For the left ventricular ejection fraction (LVEF), end-systolic volume (ESV) it was only for 250MBq, and 350MBq in the end-diastolic volume (EDV), while the simulated studies with 450 and 680MBq showed no statistically significant differences for global functional parameters: LVEF, EDV and ESV. Conclusion: The number of counts/pixel and, concomitantly, the total counts per simulation do not significantly interfere with the determination of gated-SPECT functional parameters, when using the administered average activity of 450MBq, corresponding to the 5.4MBq of the myocardium, for standard patient types.

Assessing the behaviour of RC beams subject to significant gravity loads under cyclic loads

Gravity loads can affect a reinforced concrete structure's response to seismic actions, however, traditional procedures for testing the beam behaviour do not take this effect into consideration. An experimental campaign was carried out in order to assess the influence of the gravity load on RC beam connection to the column subjected to cyclic loading. The experiments included the imposition of a conventional quasi-static test protocol based on the imposition of a reverse cyclic displacement history and of an alternative cyclic test procedure starting from the gravity load effects. The test results are presented, compared and analysed in this paper. The imposition of a cyclic test procedure that included the gravity loads effects on the RC beam ends reproduces the demands on the beams' critical zones more realistically than the traditional procedure. The consideration of the vertical load effects in the test procedure led to an accumulation of negative (hogging) deformation. This phenomenon is sustained with the behaviour of a portal frame system under cyclic loads subject to a significant level of the vertical load, leading to the formation of unidirectional plastic hinges. In addition, the hysteretic behaviour of the RC beam ends tested was simulated numerically using the nonlinear structural analysis software - OpenSees. The beam-column model simulates the global element behaviour very well, as there is a reasonable approximation to the hysteretic loops obtained experimentally. (C) 2013 Elsevier Ltd. All rights reserved.

Silver coordination polymers with tri- and hexacyanoethyl-functionalized macrocyclic ligands

Tri-and hexa-cyanoethyl functionalized 17-(L-1) and 42-membered (L-2) macrocyclic compounds were obtained by [1 + 1] (for L-1) or [2 + 2] (for L-2) cyclocondensation of the corresponding dialdehyde and diethylenetriamine, followed by hydrogenation by KBH4 and subsequent cyano-functionalization with acrylonitrile. They react with silver nitrate, leading to the formation of [AgL1](NO3) (1) and of the metalorganic coordination polymers [Ag-2(NO3)(2)L-1](n) (2) and {[Ag2L2](NO3)(2)}(n) (3). The complexes were characterized by elemental analysis, H-1 NMR, C-13 NMR, IR spectroscopies, and ESI-MS; moreover, L-2, 1, 2 and 3 were also characterized by single crystal X-ray diffraction. The metal cation in 1 is pentacoordinated with a N3O2 coordination environment; in 2, the metal cations display N4O2 octahedral and N2O3 square-pyramid coordination and in 3 they are in square-planar N-4 sites. In 1, the ligand acts as a pentadentate chelator, and in the other two cases, the ligands behave as octadentate chelators in a 1 kappa N-3:kappa O-2,2 kappa N,3 kappa N,4 kappa N (in 2) or 1 kappa N-3,2 kappa N-3,3 kappa N,4 kappa N fashion (in 3). The cyanoethyl strands of the ligands are directly involved in the formation of the 2D frameworks of 2 and 3, which in the former polymer can be viewed as a net composed of hexametallic 36-membered macrocyclic rings and in the latter generates extra hexametallic 58-membered cyclic sets that form zig-zag layers. The thermal analytical and electrochemical properties of these silver complexes were also studied.