CARDIOVASCULAR SYSTEM :CARDIOVASCULAR SYSTEM BASIC PROCEDURAL ASPECTS OF NUCLEAR CARDIOLOGY STUDIES
CARDIOVASCULAR SYSTEM :CARDIOVASCULAR SYSTEM Material is foundational information on nine NMTCB selected cardiac studies
Preparation for the NMTCB certification exam
Tailored to graduating students or recent graduates of a nuclear medicine program
Review content taken from the NMTCB Components of Preparedness Statements
CARDIOVASCULAR STUDIES :CARDIOVASCULAR STUDIES PURPOSE
INDICATIONS
RADIOPHARMACEUTICAL-DOSE RANGE-ADMINISTRATION
PROCEDURAL STEPS
NORMAL RESULTS
ABNORMAL RESULTS
CARDIOVASCULAR STUDIES :CARDIOVASCULAR STUDIES MYOCARDIAL PERFUSION SPECT(REST)
MYOCARDIAL PERFUSION GATED SPECT(STRESS)
MYOCARDIAL PERFUSION PLANAR
FIRST PASS(EF & WALL MOTION)
GATED CARDIAC BLOOD POOL(REST)
GATED CARDIAC BLOOD POOL(STRESS)
GATED CARDIAC BLOOD POOL(SPECT)
VENOGRAM/THROMBUS LOCALIZATION
CARDIAC PET
CARDIAC SHUNT
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST PURPOSE
Used to determine the adequacy of regional blood flow to the myocardium, specifically the walls of the left ventricle.
Imaging accuracy is an invaluable aid in the diagnosis and management of cardiomyopathies.
Rest-vs.-stress imaging and quantification
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST INDICATIONS
Detection and evaluation of Coronary Artery Disease
Evaluation of myocardial viability in patients who are candidates for surgery
Risk assessment in patients with Coronary Artery Disease
Evaluation of physical indicators: Myocardial Infarction, chest pain, shortness of breath, family history of heart disease
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST Evaluation of laboratory indicators: Elevated levels of creatine phosphokinase, lactate dehydrogenase, troponin, and myoglobin(the latter two specific indicators for heart damage).
Risk assessment in patients with coronary artery disease and post myocardial infarction.
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST RADIOPHARMACEUTICALS
99mTc-sestamibi(Cardiolite) and 99mTc-tetrafosmin(Myoview) binds to myocardial mitochondria and myocytes.
Adult dose range is 8-30mCi depending on a one or two day protocol.
201TlCl(thallous chloride) is an analog of potassium and distributes in the myocardium through the Na/K pump (unique redistribution property).
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST 2.5-3mCi is the normal adult dose range.
All three radiopharmaceuticals are administered by I.V. injection.
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST PROCEDURE
ONE DAY DUAL ISOTOPE PROTOCOL
Inject 2.5-3.0mCi of 201Tl at rest and image between 20 minutes and 2 hours.
Inject 5.0-8.0mCi of Sestamibi/Tetrafosmin and image between 45 minutes and 2 hours.
Imaging: Position patient supine with both arms or left arm above head and heart in center field of view.
Acquire SPECT images per protocol.
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST Processing: Consists of computer analysis of the LV myocardium showing slices of the vertical long axis, horizontal long axis, and short axis.
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST RESULTS
NORMAL: Heterogeneous uptake in the LV myocardium indicating normal perfusion at rest.
ABNORMAL: Area(s) of little or no uptake of radiotracer exhibiting a cold spot indicative of ischemic, hibernating, or infarcted myocardium.
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST QUIZ
1. Elevated levels of troponin and myoglobin are specific indicators of myocardial damage.
True or False
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST ANSWER: TRUE
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST 2. 201Tl redistributes in the myocardium by way of the _____ mechanism.
A. Na/K pump
B. myocyte binding
C. capillary shunt
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST ANSWER: A
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST 3. The normal resting adult dose range for 201Tl administered during a dual isotope study is:
A. 1-2mCi
B. 5-8MCi
C. 2.5-3mci
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST ANSWER: C
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST 4. Areas of little or no uptake in a rest image could indicate hibernating or infarcted myocardium.
True or False
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST ANSWER: True
MYOCARDIAL PERFUSION SPECT-REST :MYOCARDIAL PERFUSION SPECT-REST 5. During a dual isotope study, rest imaging can begin approximately _____ after the injection of 201Tl.
A. 1.5-2 hours
B. 1 hour
C. 20 minutes
MOCARDIAL PERFUSION SPECT-REST :MOCARDIAL PERFUSION SPECT-REST ANSWER: C
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS PURPOSE
Used to determine the adequacy of blood flow to the myocardium during stress or exercise, specifically the LV.
Accomplished by exercise or chemical stress agents.
Used to determine LV ejection fraction.
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS INDICATIONS
Detection and evaluation of CAD.
Evaluation of myocardial viability in patients who are surgical candidates.
Evaluation of physical indicators: SOB, CP, MI.
Evaluation of laboratory indicators: elevated levels of troponin and myoglobin.
Risk assessment of patients with CAD and post MI.
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS RADIOPHARMACEUTICALS
99mTc-sestambi and 99mTc-terafosmin normal adult dose range 20-30mCi.
Both 99mTc-agents administered by I.V. injection.
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS PROCEDURE
ONE DAY DUAL ISOTOPE PROTOCOL
Stress tests can be performed by exercise or pharmacological stress agents( adenosine, dobutamine, dipyridamole, etc.)
Optimal HR should reach 85% of maximum HR(220-age x .85).
During peak exercise or simulated exercise, inject 20-30mCi of 99mTc-agent.
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS Flush immediately and allow patient to exercise 60-90 seconds more after injection.
No flush with adenosine (could cause adenosine bolus).
Flush with dobutamine (used with asthmatics and COPD patients)
Imaging: Sestamibi/Tetrafosmin exercise approximately 15-45 minutes post-exercise.
Chemical patients approximately 45-90 minutes post-stress.
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS Position patient supine with both arms or left arm over head and heart in center field of view.
Connect 3-lead ECG for gated SPECT images and check for strong R-R intervals.
Acquire SPECT images per protocol.
Processing: Consists of computer analysis of LV myocardium in VLA, HLA, and SA views.
Computer generated polar map showing regions and associated coronary arteries.
LV ejection fraction calculated at this stage.
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS RESULTS
Normal: Heterogeneous uptake throughout the LV myocardium.
LVEF of 50-80% with gated study.
LV wall contracting rhythmically and well coordinated, converging vigorously toward the center.
Abnormal: Areas of little or no uptake in LV myocardium during stress but not with rest, myocardium is ischemic and reversible (reversible defect).
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS If defect occurs in both rest and stress images in the same area, infarcted tissue is likely (fixed-irreversible defect).
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS QUIZ
1. After connecting the 3-lead ECG for gated stress images, always check for good QRS intervals on the monitor.
True or False
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS ANSWER: False
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS 2. A pharmacological stress agent used in patients with asthma, COPD, and emphysema is:
A. adenosine
B. aminophylline
C. dobutamine
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS ANSWER: C
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS 3. Stress imaging may begin approximately _______ after 99mTc-cardiolite injection in an exercise patient.
A. Immediately
B. 15-45 minutes
C. next day
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS ANSWER: B
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS 4. The LVEF is calculated during the non-gated rest phase of a myocardial perfusion study.
True or False
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS ANSWER: False
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS 5. If a defect in the myocardium is noted on both rest and stress images, this is indicative of ________.
A. Ischemia
B. hibernating myocardium
C. MI (infarcted tissue)
MYOCARDIAL PERFUSION GATED SPECT-STRESS :MYOCARDIAL PERFUSION GATED SPECT-STRESS ANSWER: C
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR PURPOSE
Used to determine the adequacy of blood flow to the myocardium with rest vs. stress imaging.
Planar method used under extraordinary circumstances with reduced sensitivity.
VLA, HLA, and SA views not available.
This method is typically used for situations where equipment limits are exceeded by extremely large or obese patients.
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR INDICATIONS
Detection and evaluation of CAD.
Assessment of myocardial viability.
Evaluation of physical and laboratory indicators: MI, SOB, CP, family hx. of CAD, elevated levels of troponin, myoglobin, creatine phosphokinase, and lactate dehydrogenase.
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR RADIOPHARMACEUTICAL
201Tl (thallous chloride) administered by I.V. injection.
Normal adult dose range is 2.0-4.0mCi.
201Tl used for its redistribution properties.
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR PROCEDURE
Exercise or chemically stress patient to peak level and inject 201Tl and flush adequately.
Immediately position patient supine with both arms or left arm behind head.
Acquire images immediately with three standard views: 45-degree LAO with best septal separation, ANT, and LLAT.
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR Start redistribution (rest) images 2-4 hours after stress acquisition.
Position patient exactly as in stress images and use identical acquisition protocol.
For a resting study only, inject 201Tl and image immediately and again at 30-60 minutes.
Process the data using 201Tl quantification software for planar images.
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR RESULTS
Normal: Uniform distribution of radiotracer throughout LV myocardium.
Normal RV may or may not be visualized because the muscle is thin in comparison to the LV.
Abnormal: Little or no uptake in areas of LV myocardium.
Fixed defect in stress and redistribution images is indicative of infarcted tissue.
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR Defect in stress images that fills in on rest images (redistribution) is indicative of myocardial ischemia (reversible defect).
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR QUIZ
1. A polar/Bull’s Eye map of the left ventricle is a useful diagnostic tool in myocardial perfusion planar imaging.
True or False
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR ANSWER: False
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR 2. The _____ cannot be generated during a myocardial perfusion planar study.
A. VLA, HLA, SA views
B. ANT, LAO, LLAT views
C. 360 degree cine view
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR ANSWER: A and C
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR 3. 201Tl is an excellent tracer for planar perfusion studies because of its unique redistribution property.
True or False
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR ANSWER: True
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR 4. A patient that weighs 450 pounds would be a candidate for _______.
A. planar imaging
B. SPECT imaging
C. PET imaging
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR ANSWER: A
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR 5. In planar perfusion imaging, the rest study is performed first in order to visualize the 201Tl redistribution during stress imaging.
True or False
MYOCARDIAL PERFUSION PLANAR :MYOCARDIAL PERFUSION PLANAR ANSWER: False
GATED FIRST-PASS :GATED FIRST-PASS PURPOSE
This technique is used to record the initial passage of a radiotracer through the cardiac chambers.
The tracer activity (bolus) is limited to one chamber at a time, making it easier to define ROI’s.
GATED FIRST-PASS :GATED FIRST-PASS INDICATIONS
Determination of ejection fractions of left and right ventricles.
Evaluation of overall heart function for congenital heart disease and defects.
Detection of aortic and mitral valve insufficiency.
Baseline study for surgery candidates.
Evaluation of right and/or left ventricular wall motion.
GATED FIRST-PASS :GATED FIRST-PASS Evaluation of chamber to chamber transit times.
Evaluation and detection of coronary artery disease.
Detection and evaluation of left to right cardiac shunts.
GATED FIRST-PASS :GATED FIRST-PASS RADIOPHARMACEUTICALS
99mTc-agents: DTPA, Sestamibi (Cardiolite), Tetrafosmin (Myoview), RBC’s
Normal adult dose range is 8-30mCi in a small volume (<1ml).
Administer by I.V. catheter, butterfly, or straight stick.
Typically a three-way stopcock is used for radiotracer and 10-20ml of saline for good bolus.
GATED FIRST-PASS :GATED FIRST-PASS Introduced into external jugular or right medial antecubital vein.
GATED FIRST-PASS :GATED FIRST-PASS PROCEDURE
Position patient supine and connect 3-lead ECG for gate.
Position camera anterior, left anterior oblique, or right anterior oblique depending on intent of study.
Start acquisition and inject immediately to catch bolus.
Study is usually 20-120 seconds in length.
GATED FIRST-PASS :GATED FIRST-PASS Acquisition is terminated after tracer travels through the right side of the heart, the lungs, and the left side of the heart.
Processing: Generate time-activity curve and draw ROI’s for LVEF and/or RVEF.
GATED FIRST-PASS :GATED FIRST-PASS RESULTS
Normal: LVEF 50-80% and RVEF 40-60%.
Bolus travels through cardiopulmonary circuit with no obvious obstructions or alteration in path.
Symmetric, well coordinated wall movement in all chambers.
Abnormal: Cine showing abnormal wall movement (dyskinesis), decreased wall motion (hypokinesis), or no wall movement (akinesis).
GATED FIRST-PASS :GATED FIRST-PASS Low LVEF of 35-45% or less.
Interruption or detour of bolus through cardiopulmonary circuit.
GATED FIRST-PASS :GATED FIRST-PASS QUIZ
1. In a first-pass study, administer the tracer bolus in at least a 5-10ml volume.
True or False
GATED FIRST-PASS :GATED FIRST-PASS ANSWER: False
GATED FIRST-PASS :GATED FIRST-PASS 2. The best injection site for a first-pass bolus for optimal results is the:
A. left anticubital vein
B. external jugular vein
C. popliteal vein
GATED FIRST-PASS :GATED FIRST-PASS ANSWER: B
GATED FIRST-PASS :GATED FIRST-PASS 3. A first-pass study typically takes between 5-10 minutes to complete the acquisition.
True or False
GATED FIRST-PASS :GATED FIRST-PASS ANSWER: False
GATED FIRST-PASS :GATED FIRST-PASS 4. A normal result from a first-pass study would be:
A. dyskinesis of the myocardium
B. bolus moving from left to right ventricle
C. LVEF of 50-80%
GATED FIRST-PASS :GATED FIRST-PASS ANSWER: C
GATED FIRST-PASS :GATED FIRST-PASS 5. An advantage to first-pass imaging is the bolus being limited to one chamber at a time making it easier to define ROI’s.
True or False
GATED FIRST-PASS :GATED FIRST-PASS ANSWER: True
GATED CARDIAC BLOOD POOL REST-MUGA :GATED CARDIAC BLOOD POOL REST-MUGA PURPOSE
The Multigated Blood Pool Acquisition is a gated study used to image the blood pool in the heart using radiolabeled RBC’s.
Overall chamber function can be assessed and quantified with this study.
GATED CARDIAC BLOOD POOL REST-MUGA :GATED CARDIAC BLOOD POOL REST-MUGA INDICATIONS
Detection or assessment of CAD.
Evaluation of patients heart condition for pending chemotherapy, radiation therapy, or surgery.
Evaluation of left and right ventricular wall motion for congenital heart failure.
Calculation of LVEF.
Evaluation of physical indicators: MI, CP, SOB, or family history of heart disease.
GATED CARDIAC BLOOD POOL REST-MUGA :GATED CARDIAC BLOOD POOL REST-MUGA Evaluation of laboratory indicators: Elevated levels of CPK (creatine phosphokinase), LDH (lactate dehydrogenase), troponin, and myoglobin.
Detection and evaluation of valvular dysfunction.
Evaluation of pre- and post-cardiac transplantation.
GATED CARDIAC BLOOD POOL REST-MUGA :GATED CARDIAC BLOOD POOL REST-MUGA RADIOPHARMACEUTICAL
99mTc-pertechnetate in combination with UltraTag RBC kit.
In-vitro labeling process.
Normal adult dose range 20-30mCi.
Administered by I.V. injection.
Large bore I.V. setup for blood withdrawal and injection of radiopharmaceutical so RBC’s are not damaged.
GATED CARDIAC BLOOD POOL REST-MUGA :GATED CARDIAC BLOOD POOL REST-MUGA PROCEDURE
Withdraw and prepare blood with UltraTag RBC kit.
Position patient supine on bed.
Connect 3 or 5-lead ECG and check for strong R-R intervals.
Position camera for desired view(s): Anterior, LAO looking for best septal wall separation, left lateral, and sometimes RAO.
GATED CARDIAC BLOOD POOL REST-MUGA :GATED CARDIAC BLOOD POOL REST-MUGA Inject patient slowly with tagged RBC’s.
Acquire gated images per protocol.
Processing: Draw regions of interest for LVEF calculation.
Apply temporal and spatial smoothing filters if applicable for cine wall motion analysis.
Calculate stoke volume (SV) and cardiac output (CO) per protocol.
GATED CARDIAC BLOOD POOL REST-MUGA :GATED CARDIAC BLOOD POOL REST-MUGA RESULTS
Normal: Good tag with RBC’s showing structure of heart and clear circulation.
Separation between right and left ventricle should be easily definable.
Cine showing well coordinated and rhythmical wall motion.
Ejection fraction of left ventricle 50-70%, 40-60% for right ventricle.
GATED CARDIAC BLOOD POOL REST-MUGA :GATED CARDIAC BLOOD POOL REST-MUGA Abnormal: Abnormal, decreased, or absent wall movement in ventricles.
LVEF 35-45%, LVEF below 30% represents severe impairment.
GATED CARDIAC BLOOD POOL STRESS-MUGA :GATED CARDIAC BLOOD POOL STRESS-MUGA Purpose, Radiopharmaceutical, Indications, Normal and Abnormal Results refer to MUGA- REST STUDY.
GATED CARDIAC BLOOD POOL STRESS-MUGA :GATED CARDIAC BLOOD POOL STRESS-MUGA PROCEDURE
Position patient in exercise device, supine or semi-erect with feet in pedals.
Connect 3 or 5-lead ECG and check for strong R-R intervals.
Inject patient with tagged RBC’s slowly.
Position camera per protocol with best septal separation.
GATED CARDIAC BLOOD POOL STRESS-MUGA :GATED CARDIAC BLOOD POOL STRESS-MUGA Physician or PA to determine exercise/stress settings.
Acquire gated images per protocol.
Artifacts from excessive body motion may occur with this technique.
GATED CARDIAC BLOOD POOL SPECT-MUGA :GATED CARDIAC BLOOD POOL SPECT-MUGA Refer to MUGA-REST for Purpose, Indications, Radiopharmaceutical, and Results.
GATED CARDIAC BLOOD POOL SPECT-MUGA :GATED CARDIAC BLOOD POOL SPECT-MUGA Gated blood pool SPECT imaging has the advantage of a 360 degree view given the same acquisition time.
Anatomic overlap is eliminated that occurs in planar imaging.
Regional wall motion assessment is better.
LVEF calculations are enhanced.
RVEF is more accurately assessed.
GATED CARDIAC BLOOD POOL-MUGA :GATED CARDIAC BLOOD POOL-MUGA QUIZ
1. The normal adult dose range for labeled RBC’s in a MUGA study is:
A. 5-10mCi
B. 20-30uCi
C. 20-30mCi
GATED CARDIAC BLOOD POOL-MUGA :GATED CARDIAC BLOOD POOL-MUGA ANSWER: C
GATED CARDIAC BLOOD POOL-MUGA :GATED CARDIAC BLOOD POOL-MUGA 2. When injecting prepared RBC’s back into the patient, inject and pull back vigorously to cause frothing which helps mix the components in the syringe.
True or False
GATED CARDIAC BLOOD POOL-MUGA :GATED CARDIAC BLOOD POOL-MUGA ANSWER: False
GATED CARDIAC BLOOD POOL-MUGA :GATED CARDIAC BLOOD POOL-MUGA 3. Using temporal and spatial smoothing filters helps to determine a more realistic LVEF.
True or False
GATED CARDIAC BLOOD POOL-MUGA :GATED CARDIAC BLOOD POOL-MUGA ANSWER: False
GATED CARDIAC BLOOD POOL-MUGA :GATED CARDIAC BLOOD POOL-MUGA 4. A MUGA stress study is valuable in the detection of:
A. diabetic neuropathy
B. cardiac valvular dysfunction
C. Bundle Branch Block
GATED CARDIAC BLOOD POOL-MUGA :GATED CARDIAC BLOOD POOL-MUGA ANSWER: B
GATED CARDIAC BLOOD POOL-MUGA :GATED CARDIAC BLOOD POOL-MUGA 5. Stroke volume (SV) and cardiac output (CO) can be calculated from a resting MUGA study.
True or False
GATED CARDIAC BLOOD POOL-MUGA :GATED CARDIAC BLOOD POOL-MUGA ANSWER: True
CARDIAC SHUNT :CARDIAC SHUNT PURPOSE
Used to determine if there is a shunt or pathway from the right ventricle to the left ventricle.
Non-oxygenated blood reenters systemic circulation by this route.
Blood that is shunted does not enter the pulmonary circuit.
CARDIAC SHUNT :CARDIAC SHUNT PROCEDURE
Basically a lung perfusion scan (quantitative) using 99mTc-MAA.
Static images of lungs as per protocol.
Acquire anterior, posterior, and right and left laterals of head to verify shunt.
Acquire whole body sweep if quantitation is desired.
CARDIAC SHUNT :CARDIAC SHUNT Right to left cardiac shunt: activity in the cerebral hemispheres.
Quantitation can be performed by drawing ROI’s around lungs , then around whole body.
% shunt=total body counts-lung counts X 100
total body counts
First-pass studies are also useful in shunt detection. Quantitative analysis of first-pass curves can detect left to right shunts.
VENOGRAM/THROMBUS LOCALIZATION :VENOGRAM/THROMBUS LOCALIZATION PURPOSE
This study is performed to localize thrombus formation in the extremities.
Patency of the deep veins in the extremities can also be assessed.
Thrombus formation can eventually lead to fragments (emboli) entering venous circulation and lodging in the vasculature of the lungs (pulmonary embolism).
VENOGRAM/THROMBUS LOCALIZATION :VENOGRAM/THROMBUS LOCALIZATION INDICATIONS
Detection and localization of acute venous thrombosis in the lower extremities.
Differentiation of acute venous thrombosis from chronic venous thrombosis.
Assess patients with high probability of DVT and have a negative ultrasound.
VENOGRAM/THROMBUS LOCALIZATION :VENOGRAM/THROMBUS LOCALIZATION RADIOPHARMACEUTICAL
99mTc-apcitide (AcuTect) a synthetic peptide.
Binds to receptors on activated platelets.
Compartmental localization in blood flow.
Normal adult dose range 20mCi.
Administered by I.V., butterfly, or catheter with flush in upper extremity.
VENOGRAM/THROMBUS LOCALIZATION :VENOGRAM/THROMBUS LOCALIZATION PROCEDURE
Administer injection to patient.
After 10 minutes, position patient supine on table.
Acquire anterior or anterior/posterior images from pelvis to thighs and mid-thigh to mid calf.
Repeat at 60 and 90 minutes up to 180 minutes.
Patient positioning must be the same for all images.
VENOGRAM/THROMBUS LOCALIZATION :VENOGRAM/THROMBUS LOCALIZATION Processing: Using image contrast and intensity is imperative to visualize veins.
Using a color scale may enhance visualization.
Other modalities i.e. MRI, CT, Ultrasonography, Plethysmograpy are incorporated to help identify DVT.
VENOGRAM/THROMBUS LOCALIZATION :VENOGRAM/THROMBUS LOCALIZATION RESULTS
Normal: Lower extremities show bilateral symmetric uptake in deep and superficial veins.
Symmetric low soft tissue uptake.
Bilaterally symmetric limb sizes.
“Halo” of uptake around soft tissue of knees.
VENOGRAM/THROMBUS LOCALIZATION :VENOGRAM/THROMBUS LOCALIZATION Abnormal: Acute DVT presents as an asymmetric uptake in a deep vein segment that persists or becomes apparent on delayed images.
Increased uptake following the course of a deep vein.
Asymmetric vascular linear uptake in both anterior and posterior projections of one or both lower extremities.
CARDIAC PET :CARDIAC PET All of the previous material on SPECT Myocardial Perfusion Imaging can also be accomplished with positron emitters and a PET camera.
Most of the cardiac studies designed for use in PET applications are centered around the detection of coronary artery disease and myocardial viability.
PET has a 10-15% higher specificity than that of SPECT in detection of CAD.
CARDIAC PET :CARDIAC PET POSITRON EMITTERS
Perfusion Tracers: Rubidium-82 chloride, Nitrogen-13 ammonia, Oxygen-15 water
Metabolic Tracers: 18F-fluorodeoxyglucose (FDG), 11C-palmitate, 11C-acetate
CARDIOVASCULAR SYSTEM-CONCLUSION :CARDIOVASCULAR SYSTEM-CONCLUSION Reviewed foundational information on selected cardiac studies.
Material may be seen on the NMTCB certification exam.
Topics taken from the NMTCB Components of Preparedness Statements.
Copies available for review.
CARDIOVASCULAR SYSTEM-CONCLUSION :CARDIOVASCULAR SYSTEM-CONCLUSION GOOD LUCK!!