:: PRODUCTS ::
CEqual Plus
Developed jointly at Emory University and Cedars- Sinai Medical Center, CEqual (Cedars-Emory quantitative analysis) is a quantitative program with a database approach for quantifying myocardial perfusion.
The CEqual® program provides normal data bases for the following imaging protocols: Same-Day Sestamibi, Two-Day Sestamibi, Tetrofosmin, Dual Isotope (Tc-99m stress, Tl-201 rest), and Tl-201.
A new side-by- side reconstruction and reformatting capability allows any two datasets of stress, rest or delay data to be reconstructed and reformatted into vertical long axis (VLA), horizontal long axis (HLA) and short axis (SA) datasets.
Different default parameters are employed, based on the type of the acquisition and the protocol used. These default parameters include reconstruction type, prefilter, decay correction and slice thickness. The operator is able to change the reconstruction and reformatting limits/angle.
Plot processing is simple with minimal operator intervention. The user has the option of automatic or manual selection of apex slice, bi-plane base slice, radius and center.
Upon completion, plots for stress, rest (or delay), reversibility, blackened pixel and standard deviation are generated. Vascular territories (LAD, RCX, RCA) can overlay the polar plots for comparison with a normal, gender-matched database.
The CEqual protocol also includes quality control and multiple review screens for enhanced diagnostic confidence. The slices and planar review screens allow comparisons of all stress and rest (or delay) slices. For quality control purposes, rest and stress planar data is displayed in synchronized cine to look for patient motion artifacts. Apical slices are automatically aligned. Three normalization choices are offered.
Generated Distance Plots, with or without coronary territory overlays, and Volume Plots for stress, rest (or delay) or reversibility, include blackened pixel and standard deviation plots. Several review screens include myocardial polar plots; normal file comparison; an analysis of the extent and severity of a stress perfusion defect; and, the percent that normalizes or reverses at rest (or delay). A new Summed Stress Scoring option allows manual entering of myocardial defect scoring for rest and stress raw polar maps on a 20- segment grid.
Perfusion Scores, generated after quantification, give more in-depth information about the defect. Stress blackout and Reversed polar maps are displayed with coronary artery overlays. Corresponding tables are generated to show the severity of the defect and the reversibility for each of the three coronary territories (LAD, RCX, RCA). The left ventricular mass, and each defect’s mass, is estimated from gated and ungated data. The scores for Stress Total Severity and Probability of Survival are also calculated. The patient’s viability is estimated utilizing a series of tools, such as the Threshold Rest Polar Map which characterizes each defects’ viability.
Perfusion Display & Analysis
CEqual® Display. The CEqual® quantitative display for the Emory Cardiac Toolbox™ is presented below. This example demonstrates abnormal myocardial perfusion (black pixels) in both the Stress and Rest studies. Note that the Stress Polar Maps demonstrate more extensive perfusion defects than do the Rest images. The white pixels in the 3rd column of the defect extent row show the area of potentially ischemic myocardium, which is better perfused at Rest than at Stress.
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Integrated Display. This screen demonstrates the Emory Cardiac Toolbox™ integrated display which includes the CEqual® quantitative perfusion output, the Emory Gated SPECT functional output, and selected tomograms demonstrating both perfusion (stress and rest) and function (end-diastole and end-systole). Functional parameters include % wall thickening, end diastolic and end systolic volumes, and ejection fraction.
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Quantitative Extent Display Window. This display presents the stress extent (left) and reversibility (right) CEqual® quantitative polar maps. The identified defects are numbered and quantitative values for extent and reversibility for the total, LAD, LCX, and RCA are listed. In addition, an index of defect severity is provided along with a 1-4 year probability of survival based on the patients CEqual® quantitative results.
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Quantitative Mass Display Window. This display presents the stress extent (left) and reversibility (right) CEqual® quantitative polar maps. The stress defect mass is indicated both in total grams and as a percent of the total LV myocardial mass. Reversible mass is indicated in grams, in terms of percent of Stress Defect Mass, and in terms of percent of the total LV myocardium. In addition, an index of defect severity is provided along with a 1-4 year probability of survival based on the patients CEqual® quantitative results.
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Summed Score Display. The visual scores for 20 myocardial perfusion segments of the CEqual stress and rest polar maps are generated and displayed in this output. The visual scores are based on a 5 point scoring system and the key for this system is listed at the bottom of the display. The Summed Stress Score (SSS) represents the sum of the visual scores for stress, the Summed Rest Score (SRS) represents the sum of the visual scores for rest, and the Summed Difference Score represents the difference between the SSS and SRS values. This display allows for the integration of visual scores and the quantitative analysis of myocardial perfusion.
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