Functional (Gated & 1Functional (Gated & 1stst Pass) and Pass) and other Cardiac Imagingother Cardiac Imaging

Coronary Artery PerfusionCoronary Artery Perfusion

Left main coronary arteryLeft main coronary artery– Left anterior descending arteryLeft anterior descending artery

I. V. septumI. V. septum L. V. anterior wallL. V. anterior wall

– Left circumflexLeft circumflex Left atriumLeft atrium L. V. posteriorL. V. posterior L. V. lateral wallL. V. lateral wall

Right coronary arteryRight coronary artery Right atriumRight atrium Right ventricleRight ventricle L. V. inferior wallL. V. inferior wall

Gross Anatomy of the HeartGross Anatomy of the Heart

Mechanical ActivityMechanical Activity

Systole – ventricular contractionSystole – ventricular contraction Diastole – ventricular relaxationDiastole – ventricular relaxation

Electrical ActivityElectrical Activity

11stst pass protocol pass protocol

Patient PreparationPatient Preparation NPO 4-12 hoursNPO 4-12 hours No caffeineNo caffeine

ProcedureProcedure Anterior or 45 LAOAnterior or 45 LAO Gated or non-gatedGated or non-gated LFOV camera LFOV camera LEHR collimatorLEHR collimator 20 mCi pertechnetate, DTPA, Sestamibi20 mCi pertechnetate, DTPA, Sestamibi Good bolus ( <1.0 ml) – follow with saline flushGood bolus ( <1.0 ml) – follow with saline flush List mode (16 frames/cycle) or Frame mode (20-35 frames/sec)List mode (16 frames/cycle) or Frame mode (20-35 frames/sec) 64x64 matrix64x64 matrix 1-2 minutes total acquisition time.1-2 minutes total acquisition time.

11stst Pass Pass

Shunt?Shunt?

MUGA MUGA (Multiple Gated Acquisition)(Multiple Gated Acquisition)

Provides functional informationProvides functional information

Patient preparationPatient preparation NPO 4-12 hoursNPO 4-12 hours No caffeineNo caffeine

Blood preparationBlood preparation In-vivoIn-vivo

– Inject cold PYP followed ~20 minutes later by 20-30 mCi Tc-99mInject cold PYP followed ~20 minutes later by 20-30 mCi Tc-99m In-vivtro (modified In-vivo)In-vivtro (modified In-vivo)

– Inject cold PYP; withdraw 3-5 mLanticoagulated blood into 10 mL syringe Inject cold PYP; withdraw 3-5 mLanticoagulated blood into 10 mL syringe containing ~25 mCi Tc-99m; incubate 10 minutes then re-inject.containing ~25 mCi Tc-99m; incubate 10 minutes then re-inject.

In-vitro commercial kits (UltraTag) RBC)In-vitro commercial kits (UltraTag) RBC)

MUGA ImagingMUGA Imaging

ProcedureProcedure ECGECG Anterior and ~45 LAO (best septal Anterior and ~45 LAO (best septal

separation) w. caudal tiltseparation) w. caudal tilt 8 to 16 frames/second8 to 16 frames/second 64x64 matrix64x64 matrix 10 minutes/view10 minutes/view

ProcessingProcessing

EF (ejection fraction) = (ED-ES)/ED x 100EF (ejection fraction) = (ED-ES)/ED x 100ED = end-diastolic volumeED = end-diastolic volume

ES = end-systolic volumeES = end-systolic volume

SV (stroke volume) = ED-ESSV (stroke volume) = ED-ES CO (cardiac output) = SV x heart rateCO (cardiac output) = SV x heart rate

Functional ImagingFunctional Imaging(MUGA)(MUGA)

Myocardial Infarct ImagingMyocardial Infarct Imaging15-30 mCi15-30 mCi Tc-99m PyrophosphateTc-99m Pyrophosphate

Of historical interest – replaced by serum enzyme testingOf historical interest – replaced by serum enzyme testing

Positron Emission TomographyPositron Emission Tomography

Myocardial perfusionMyocardial perfusion– Rubidium-82 chlorideRubidium-82 chloride– Nitrogen-13 ammoniaNitrogen-13 ammonia– Oxygen-15 waterOxygen-15 water

Myocardial metabolismMyocardial metabolism– Fluoride-18 FDGFluoride-18 FDG– Carbon-11 palmitateCarbon-11 palmitate– Carbon-11 acetateCarbon-11 acetate