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A 34-year-old lady presented with acute allograft dysfunction four years after renal transplant. She had stopped her immunosuppression five months prior to presentation. Biopsy of the transplanted kidney showed acute cellular rejection and a leiomyoma was reported as an incidental finding. Allograft dysfunction was attributed to rejection, that was treated with pulse dose of steroids and anti-thymocyte globulin after which renal function improved significantly. New immunosuppression regimen with Sirolimus, Mycophenolate and corticosteroid was started, and calcineurin inhibitor was excluded. Close follow up with periodic Epstein Barr Virus (EBV) testing and allograft ultrasound were planned to monitor the progression of the leiomyoma.

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Several quality-control measures take place before (patient and camera preparation) and during SPECT acquisition to achieve high-quality images. Not uncommonly, technologists and physicians are left with suboptimal images that have to be addressed to reach the “right answer” for patient diagnosis and hence management. In many cases patients may be reimaged, especially if the problem is detected early, but in other cases either the patient has left the nuclear laboratory or there is an inevitable problem that, even with reimaging, will not be resolved. In these situations the technologist and physician have to seek the available techniques to obtain the best images possible. These resources are discussed in this issue as an aid in quality control to obtain the best possible images.

Background: While post-systolic shortening is a common finding on 2D speckle tracking by echocardiography, its significance for diagnosis relative to other imaging modalities has not been defined Methods: We studied 21 patients (14 males, mean age 56±14 years) with echocardiography and positron emission tomography (PET). Longitudinal strain by 2D speckle tracking (Echo pac PC GE medical) was performed in the standard 2, 3 and 4-chamber views. The patients also underwent PET resting rubidium and FDG cardiac scan within two weeks of the echo study.Holosystolic stretch with post-systolic shortening was defined as stretching of the myocardial segment >50% of the systolic time coupled to shortening after aortic valve closure. PET studies were analyzed using a 17-segment model as normal, hibernating or scarred myocardium Results: Longitudinal strain by 2D speckle tracking was feasible in 316 out of 357 segments. Holosystolic stretch with postsystolic shortening occurred in 69 out of 82 scarred myocardial segments. It also occurred in 9 non-scarred segments. Specificity and sensitivity of these findings were 96 % and 84% respectively, with positive, negative predictive value and accuracy of 88%, 94%, and 93% respectively. Conclusions: Holosystolic stretch with post systolic shortening is a highly specific and fairly sensitive measure to identify scarred myocardial segments on 2D strain imaging

Background: While post-systolic shortening is a common finding on 2D speckle tracking by echocardiography, its significance for diagnosis relative to other imaging modalities has not been defined Methods: We studied 21 patients (14 males, mean age 56±14 years) with echocardiography and positron emission tomography (PET). Longitudinal strain by 2D speckle tracking (Echo pac PC GE medical) was performed in the standard 2, 3 and 4-chamber views. The patients also underwent PET resting rubidium and FDG cardiac scan within two weeks of the echo study.Holosystolic stretch with post-systolic shortening was defined as stretching of the myocardial segment >50% of the systolic time coupled to shortening after aortic valve closure. PET studies were analyzed using a 17-segment model as normal, hibernating or scarred myocardium Results: Longitudinal strain by 2D speckle tracking was feasible in 316 out of 357 segments. Holosystolic stretch with postsystolic shortening occurred in 69 out of 82 scarred myocardial segments. It also occurred in 9 non-scarred segments. Specificity and sensitivity of these findings were 96 % and 84% respectively, with positive, negative predictive value and accuracy of 88%, 94%, and 93% respectively. Conclusions: Holosystolic stretch with post systolic shortening is a highly specific and fairly sensitive measure to identify scarred myocardial segments on 2D strain imaging

Whether coronary artery calcium (CAC) screening in pretransplant patients may help predict silent myocardial ischemia is unknown. Accordingly, we performed CAC imaging on 46 nondiabetic patients awaiting kidneytransplant. All patients underwent multidetector computed tomography imaging for CAC quantification, and a vasodilator myocardial perfusion stress (MPS) test was performed only in patients with a total CAC score>300 or>100 in a single coronary artery. The mean patient's age was 46+/-14 years and the median dialysis vintage was 33 months (interquartile range 19-53). The median CAC score was 82 (interquartile range 0-700) and correlated with patients' age (p=0.006) and dialysis vintage (p=0.02). Nineteen patients qualified for MPS, but 5 refused the test. Of the remaining 14 patients, 7 patients had normal scans and 7 showed a minimal perfusion defect in the inferoposterior segment of the left ventricle. At the time of writing, 12 patients have undergone successful kidney transplantation without untoward complications. CAC screening does not appear to be associated with silent ischemia in pretransplant patients. Though CAC is extensive in dialysis patients, calcium may be associated with nonobstructive atherosclerotic lesions or calcification of the media layer of the vessel wall.