Nuclear Imaging in Cardiology CME

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By: pbsantana (10 month(s) ago)

I need for many imagens for apresentation Thancks for your attention

 

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thank you LJMDUREN

 

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it a very good,I like it.

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Nuclear Imaging in Cardiology:

Nuclear Imaging in Cardiology Dr. Muhammad Ayub Diplomate Certification Board of Nuclear Cardiology Diplomate Board of Cardiovascular Computed Tomography Assistant Professor of Cardiology Punjab Institute of Cardiology, Lahore

Nuclear Cardiology: Where do we stand:

Nuclear Cardiology: Where do we stand 7 million studies per year in the USA 1 million studies per year in Europe <10000 studies per year in Pakistan

Applications of Nuclear Cardiology:

Applications of Nuclear Cardiology Coronary Artery Disease Assessment of LV /RV function Cardiomyopathy /Myocarditis Valvular Heart Disease Cardiac Shunts Secondary Hypertension Pulmonary Hypertension Assessment of Cardiac Transplant

Coronary Artery Disease:

Coronary Artery Disease Diagnosis of CAD Assessment of Prognosis Risk Stratification Stable /Unstable Angina Post MI Perioperative Diabetics Assessment of Myocardial Viability Assessment of Revascularization Procedure Acute chest pain management in ER

Detection of CAD:

Detection of CAD 68 81 92 89 87 0% 20% 40% 60% 80% 100% Sensitivity 77 87 84 90 89 Specificity Ex ECG (150 studies ) Stress echo (14 studies) Thallium SPECT (6 studies ) MIBI SPECT(3 studies) Tetrofosmin SPECT Adapted from Beller GA

Slide 6:

Diagnostic Accuracy: Bayesian Analysis MPI Pretest ECG + + + 5% 35% 80% 20% 75% 95% 1% 75% 95% 5% 25% 99% Higher Sensitivity/Specificity Enhances Posttest Likelihood + + + Posttest Posttest 10% 90% 50%

Normal Scan:

Normal Scan

Visual scoring:

Visual scoring Score

LAD:

LAD

Left Main:

Left Main

LCx:

LCx

Multi Vessel Disease:

Multi Vessel Disease

CAD:

CAD Assessment of Intervention

Slide 14:

Post CABG Pre CABG

Pre PTCA:

Pre PTCA Post PTCA

Coronary Artery Disease:

Coronary Artery Disease Assessment of Prognosis

Slide 17:

Risk Stratification: Prognosis Low <1% per year Intermediate 1-3% per year High >3% per year Adapted from Gibbons RJ, et al. J Am Coll Cardiol. 1999;33:2092-2197. Risk of Cardiac Death: Normal MPI indicates good prognosis

Slide 18:

5.1 7.4 25.0 33.5 33.7 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 Clinical +Ex Clin +Ex +Cath Clin +Ex +SPECT All P =ns P <.01 P <.01 P =ns  2 Iskandrian AS, et al. J Am Coll Cardiol. 1993;22:665-670. Reproduced with permission. Copyright 1993 by the American College of Cardiology. N = 316 Incremental Prognostic Value NS=not significant

High Risk Feature of SPECT MPI:

High Risk Feature of SPECT MPI Following features demonstrate >3% annual mortality Post-stress EF <35% (99m-Technetium). Stress induced large perfusion defect. Stress induced multiple perfusion defects of moderate size. Large, fixed perfusion defect with LV dilation or increased lung uptake (Thallium-201). Stress induced moderate perfusion defect with LV dilation or increased lung uptake (Thallium 201). Gibbons et al. ACC/AHA/ACP-ASIM Chronic Stable Angina Guidelines. JACC . 1999.33: 2092-197.

Slide 20:

Patients with Suspected CAD Anti-anginal Therapy Aggressive RFM Cath if symptoms refractory to therapy A Risk-based Approach to Suspected CAD Cardiac Cath RFM Mod-Severely Abnormal Intermediate to high risk for cardiac death or MI Reassurance Risk factor (RFM) modification Normal Very low risk for cardiac death, Low risk for MI Mildly Abnormal Low risk for cardiac death, Intermediate risk for MI Tc-99 Myocardial Perfusion with Gated SPECT

High Risk Study:

High Risk Study

Low Risk Study Mild 3VD:

Low Risk Study Mild 3VD

Slide 23:

Established Prognostic Role Prognostic role of perfusion imaging has documented accuracy of risk assessment in the following populations and conditions: CAD – suspected or known Angina – stable or unstable Women Diabetics Post-MI Post-revascularization Preoperative screening for noncardiac surgery

Coronary Artery Disease:

Coronary Artery Disease Acute Chest Pain Management in ER

Myocardial Scintigraphy for Acute Coronary Syndromes:

Myocardial Scintigraphy for Acute Coronary Syndromes Onset of Symptoms Unclear Diagnosis Clinical Management Sestamibi injection Sestamibi SPECT One Hour

Slide 26:

Abn NI Chest Pain + Non-diagnostic ECG) Rest SPECT Abn NI Immediate Ex ECG 2 hours NI Abn Ex ECG NI Abn 13 hours 3 sets Enzymes Patients with Abnormal Tests are Admitted

Infarct Imaging :

Infarct Imaging “Hot Spot” Annexin V Perfusion Imaging THE LANCET • Vol 356 • July 15, 2000

Coronary Artery Disease:

Coronary Artery Disease Assessment of LV Function

Slide 29:

Gated Myocardial Perfusion SPECT Courtesy of M Atiar Rahman, MD, of Ochsner Clinic. LA

Perfusion and Function Gated Myocardial Perfusion SPECT:

Perfusion and Function Gated Myocardial Perfusion SPECT

LV Function:

LV Function

Assessment of Myocardial Viability:

Assessment of Myocardial Viability Patients with CAD and LVF carry bad prognosis Patients with CAD and LVF have higher mortality during revascularization procedure Ischemic LVF patients can benefit from revascularization procedures if there is evidence of myocardial viability

Hibernating Myocardium:

Hibernating Myocardium

Scar Myocardium:

Scar Myocardium

Myocarditis Indium 111 Antimyosin AB Scan:

Myocarditis Indium 111 Antimyosin AB Scan

Valvular Heart Disease:

Valvular Heart Disease Baseline and Exercise EF MUGA Scan Regurgitation Index (Stroke Volume Ratio) LV Stroke Counts – RV Stroke Counts Regurg Fraction = ______________________________ LV Stroke Counts LV Stroke Counts SVR = _____________________ RV Stroke Counts SVR >2 Moderately Severe Regurgitation SVR >3 Severe Regurgitation

Cardiac Transplant Assessment Indium-111 Imaging:

Cardiac Transplant Assessment Indium-111 Imaging

Pulmonary Hypertension:

Pulmonary Hypertension Pulmonary Embolism V/Q Scan Left to Right Shunt First Pass Study

Normal First Pass Study:

Normal First Pass Study Left to Right Shunt Qp/Qs= 2.6 A ratio of less than 1.5 indicates a small left-to-right shunt. A ratio of 2.0 or more indicates a large left-to-right shunt

Slide 43:

Right to Left Shunt Body uptake of MAA > 6% of lung uptake

Secondary Hypertension:

Secondary Hypertension Renal Artery Stenosis Captopril Renogram Study Pheochromocytoma I123 MIBG Scan

Pheochromocytoma I123 MIBG Scan:

Pheochromocytoma I 123 MIBG Scan

Thank you for Listening:

Thank you for Listening