Functional (Gated & 1 st Pass) and other Cardiac Imaging
Coronary Artery Perfusion Left main coronary artery –Left anterior descending artery I. V. septum L. V. anterior wall –Left circumflex Left atrium L. V. posterior L. V. lateral wall Right coronary artery Right atrium Right ventricle L. V. inferior wall
Gross Anatomy of the Heart
Mechanical Activity Systole – ventricular contraction Diastole – ventricular relaxation
Electrical Activity
1 st pass protocol Patient Preparation NPO 4-12 hours No caffeine Procedure Anterior or 45 LAO Gated or non-gated LFOV camera LEHR collimator 20 mCi pertechnetate, DTPA, Sestamibi Good bolus ( <1.0 ml) – follow with saline flush List mode (16 frames/cycle) or Frame mode (20-35 frames/sec) 64x64 matrix 1-2 minutes total acquisition time.
1 st Pass
Shunt?
MUGA (Multiple Gated Acquisition) Provides functional information Patient preparation NPO 4-12 hours No caffeine Blood preparation In-vivo –Inject cold PYP followed ~20 minutes later by mCi Tc-99m In-vivtro (modified In-vivo) –Inject cold PYP; withdraw 3-5 mLanticoagulated blood into 10 mL syringe containing ~25 mCi Tc-99m; incubate 10 minutes then re-inject. In-vitro commercial kits (UltraTag) RBC)
MUGA Imaging Procedure ECG Anterior and ~45 LAO (best septal separation) w. caudal tilt 8 to 16 frames/second 64x64 matrix 10 minutes/view
Processing EF (ejection fraction) = (ED-ES)/ED x 100 ED = end-diastolic volume ES = end-systolic volume SV (stroke volume) = ED-ES CO (cardiac output) = SV x heart rate
Functional Imaging (MUGA)
Myocardial Infarct Imaging mCi Tc-99m Pyrophosphate Of historical interest – replaced by serum enzyme testing
Positron Emission Tomography Myocardial perfusion –Rubidium-82 chloride –Nitrogen-13 ammonia –Oxygen-15 water Myocardial metabolism –Fluoride-18 FDG –Carbon-11 palmitate –Carbon-11 acetate