FMTVDM Quantitative Measurements of Regional Blood Flow and Metabolic Differences
Independent of the type of nuclear imaging camera used - a static SPECT (planar), SPECT or PET camera, the concept of measuring this information was fundamental when first applied by Blumgart with his original Circulation Time studies carried out in 1925.
Once the FMTVDM images are acquired and reconstructed for display, the nuclear technologist - the person responsible for acquiring and developing the study - can then either carry out the process of measuring changes in isotope occurring between the enhanced and baseline images, or use the software package to do this automatically.
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Here is the result of an enhanced (pharmacologic stress) image taken from a person following FMTVDM quantification.
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In the image you can see measured (quantified) regions of interest (ROI) showing the number of isotope count events and the spread of those counts in each labelled area of the heart.
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When done by computer, each pixel is measured and compared between the enhanced and baseline studies to derive information throughout the entire heart - defining differences between the endocardial and epicardial regions, as well as, the different epicardial coronary arteries.
After the enhancing agent is no longer effective and the coronary arteries have returned to their baseline blood flow - without additional isotope being given to the patient - these same ROIs can be drawn to measure the regional coronary blood flow at baseline.
Again, using the FMTVDM software, instead of individually drawing ROIs, the computer can compare pixel to pixel differences between enhanced and baseline results.
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When you compare the measured results from the matching ROIs (regions) of the heart in these two images, you will see that the second baseline FMTVDM measurements are lower than the first enhanced FMTVDM results.
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The first thing we can conclude from the data is that there is no critical coronary artery disease (CAD) in these regions of the heart, since critical CAD demonstrates "washin" - a phenomena revealed by delayed uptake of the isotope, with lower FMTVDM measurements occurring during the 5-minute enhanced measured result, compared to the later 60-minute baseline result.
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If the isotope didn't redistribute and was merely taken up into the cells of the heart and stayed there, the only difference between enhanced and baseline images would be accounted for by the 10% decay of this technetium-99m (Tc-99m) isotope. There could be no "washin" phenomenon and there could be no "washout" phenomena demonstrated by a greater than 10% isotope decay.
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One could play devils advocate and propose that the redistribution confusion by BigPharma was because they only tested the Tc-99m tracers on hearts without disease.
Under these circumstances the continuous uptake-release, uptake-release, ... , of the Tc-99m isotopes (aka. tracers) would give the visual qualitative appearance of an isotope "stuck" inside the cells of the heart being unable to move around (redistribute).
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However, since measured CAD shows this not to be true, revealing that Tc-99m isotopes do not "stick" inside cells anywhere in the body; the scientific evidence shows that Tc-99m isotopes do in fact redistribute when measured.
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Even the qualitative images would be unable to show washout if Tc-99m isotopes were stuck inside cells. A finding frequently masked by giving a second injection of the isotope.
When this information is taken together with (1) the fact that I informed BigPharma and the FDA, that these Tc-99m isotopes have been shown to redistribute by measuring changes in the isotope present in heart tissue over time, and (2) that this redistribution has been confirmed by others presenting their findings at scientific conferences including the Society of Nuclear Medicine and the American Society of Nuclear Cardiology, in addition to (3) the admissions by the FDA and CDERs to New York A.G. Letitia James - last page of this website - it is clear that, that BigPharma has knowingly and intentionally hidden this information from physicians, technologists and patients.
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Based upon the knowledge we have about decay curves of Tc-99m isotopes, if there is no CAD present and the cells of the heart are functioning without problems, then the continuous uptake and release of the Tc-99m isotope as measured by FMTVDM will only show a 10% change based upon the decay of Tc-99m. Anything greater demonstrates CAD with the cells being unable to maintain uptake of the isotope - i.e. washout.
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Below I have tabulated the FMTVDM measurements for each of the regions shown above. While many clinicians might easily report no abnormal findings based upon their qualitative (visual) interpretation of the nuclear images, the measured (quantitative) results demonstrate there was more than the expected 10% reduction in counts due to isotope decay; demonstrating washout, i.e. the patient has CAD.
Of course knowing there is a problem, I suspect many clinicians will report they are able to see the differences.
Comparing these results, even without further FMTVDM analysis, show us is that this person has coronary artery disease with regional blood flow differences evidenced by the measured differences in these regions (ROIs) of the heart.
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How severe is the Coronary Artery Disease?
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Redistribution of an isotope is the result of the constant delivery of the isotope to the cells of the heart, followed by those cells taking the isotope into the cells. The isotope is then released from the cell and re-enters the area around the cell.
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This is followed by the continuous uptake and release of the isotope. This uptake-release, uptake-release, ... is dependent upon how well the cell is working as well as how metabolically active the cell is. The isotope can also re-enter nearby blood vessels - capillaries - which are present throughout the body and move to other areas of the heart/body. These capillaries are responsible for the delivery of nutrients to cells and removal of waste products from cells - including isotopes. Human heart cells are roughly 20-35 microns wide and 100-150 microns long. Each cell is within 100 microns of a capillary. A micron is one-thousandth of a millimeter. One millimeter is 0.039 inches - so one-thousandth of that.
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If there is no InflammoThrombotic Immunologic material deposited to produce impaired coronary flow reserve (i.e. CAD) and the cells of the heart are not damaged or injured, the uptake and release of the isotope will be continuous.
Measuring the change in isotope over time will demonstrate changes (reductions) based upon how much time has passed. The more time, the more isotope decay. The standard example used above results in approximately a 10% reduction in measured isotope due to decay of the Tc-99m between enhanced and baseline imaging.
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If; however, the regional blood flow is reduced, but sufficient to adequately delivery the isotope to the cardiomyocytes (heart cells), but this regional blood flow is less than other areas of the heart, and/or these cardiomyocytes are less healthy and not as metabolically active as other areas of the heart, then these cells will be less able to actively take up and hold onto the isotope for the expected period of time seen with healthy heart tissue. When this happens, a greater loss of isotope is seen compared with other healthy regions of the heart. This is effect is called Washout.
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As discussed and first detected/measured by FMTVDM imaging, an area of the heart may have such critically severe CAD, that delivery and uptake of the isotope is initially impaired; but, only during the first 5-minute post enhanced imaging of coronary blood flow. This reduction can only be seen and measured within the first 5-10 minutes of enhanced imaging.
Under these circumstances it will take longer for the isotope to reach this area of the heart and the initial FMTVDM counts for the enhanced imaging will be lower than the later baseline FMTVDM counts. This more critically diseased phenomena is called Washin (or Wash-in).
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All of this must be taken into consideration during the calibration of the imaging camera based upon the decay of the isotope and the timing of the isotope delivered images being used in the FMTVDM study.
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Myocardial Infarction, Stenosis & Condition
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Using this information, FMTVDM measurements can be used to determine regional reductions in flow reserve (CAD), assessment of cardiomyocyte state of health and severity of anatomic coronary lumen narrowing (CLD) as shown in the following FMTVDM derived graphics.
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During the 2018, 25th Annual American Society of Nuclear Cardiology (ASNC) Conference held in San Francisco, CA, our group presented the results of the Multi Center Clinical Trial using FMTVDM to measure the extent of InflammoThrombotic Immunologic Response Coronary Artery Disease (ITIRD) in 300 men and women.
The results demonstrated the quantitative importance of FMTVMD measuring (quantifying) ITIRD reductions in flow reserve as well as AI derived regional metabolic and blood flow differences.
This presentation in San Francisco followed our publication in the Journal of Nuclear Cardiology, that occurred three months earlier, where we defined and emphasized the important differences between FMTVDM quantification and the semi-quantitative and qualitative imaging methods.
The publication also included clarification of misinformation surrounding Tc-99m isotope redistribution as well as correcting incorrectly used terms commonly employed in nuclear imaging of the heart.
The following graphic shows the results of sequential research and the development of AI associated with FMTVDM.
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The results demonstrate that quantitative measurements of regional flow reserve using FMTVDM can be used along with the proprietary Fleming QCA CFR/SFR/FFR equation to derive anatomic Coronary Lumen Disease (CLD) information that matches that obtained by Quantitative Coronary Arteriography (QCA) following invasive cardiac catheterization (coronary arteriography).
