CLINICAL GATED CARDIAC SPECT.
I remember examining planar thallium images on the computer screen with a cardiologist in 1982, trying to understand why a patient whose study was interpreted as negative was found to have significant coronary vessel disease on cardiac catheterization. The chairman of the nuclear medicine department shared our frustration and decided, based on this and other similar experiences, to begin performing SPECT studies on our exercise and rest thallium scans.
We had no experience with thallium tomography but shortly alter we completed the first one we realized that planar cardiac imaging was a waste of time. I think we performed dual studies (planar and then SPECT) on our exercise and rest cardiac patients for 1 week and then threw out the planar studies altogether. The difficulty was that because thallium SPECT was such a new procedure we had to learn the best protocol for this test and how to interpret the results on our own. We sent many individuals for cardiac catheterizations only to realize that with supine imaging it is not unusual to find a normal inferior wall defect, a problem we eradicated by prone imaging. How nice it would have been to have a textbook that provided the knowledge we gained through experience.
Now the field of nuclear medicine has improved SPECT cardiac imaging through gating and we are fortunate to have a book that provides a first-hand view of the current understanding of this procedure. Clinical Gated Cardiac SPECT, edited by Guido Germano and Daniel Berman, both of the UCLA School of Medicine, is a comprehensive guide to the technical and interpretive aspects of gated SPECT.
The book includes chapters on the applications of nuclear cardiology, quantitative analysis of the images and guidelines on how to interpret the results. It also has chapters on artifacts that may be encountered and a comparison of the cost effectiveness of gated and nongated cardiac SPECT imaging.
Thirteen authors, including the editors, contributed to Clinical Gated Cardiac SPECT. They represent leading institutions in nuclear cardiology such as Cedar-Sinai Medical Center in Los Angeles, Emory University in Georgia and New York's St. Luke's-Roosevelt Hospital. One aspect of this book I especially appreciate is the authors' frequent reliance on timely scholarly research to legitimize their conclusions. For example, 10 sources are referenced for the contention that quantitative measurements of LV volume based on gated perfusion SPECT imaging agree with measurements made by other means.
I had the opportunity to hear Dr. Berman describe his book during a recent lecture. He gave the audience much to think about regarding gated cardiac SPECT, from the protocol to use for acquiring the data, to the choice of radiopharmaceuticals, to a method of scoring abnormal segments of the tomographic exercise and rest slices. It is a great opportunity now to have a reference book that gives us a good intellectual grasp of these issues.
The only topic I would have liked to see included, and one that would make this the only book on the subject you would need on your bookshelf, is a chapter devoted to quality assurance in gated and nongated cardiac SPECT imaging. But this is a minor point on a work that obviously has much serious and worthwhile effort behind it.
Mark S. Lerner, R. T. (N) Children's National Medical Center Washington, D. C.
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|Author:||Lerner, Mark S.|
|Article Type:||Book Review|
|Date:||Jan 1, 2000|
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