Myocardial Perfusion Imaging
Transcript of Myocardial Perfusion Imaging
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Myocardial Perfusion Imaging
Brandon DraftsM-IV Radiology
April 3, 2008
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Myocardial Perfusion Imaging (Nuclear Stress Test)
• Uses a radioactive compound that is taken up and retained in viable cardiac muscle
• Produces an objective, quantifiable 3-D map of myocardial perfusion
• One of the most widely used nuclear studies and most used diagnostic/prognostic tests in Cardiology
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Indications
• Asses risk of cardiovascular event
• Determine long-term prognosis
• Localize region of ischemia• Assist in therapeutic
decision making• Evaluate efficacy of
therapy• Assess exercise capacity• Detect exercise-related
arrhythmias
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The Tracer
• Isotopes• Thallium-201 or Technetium-99m sestamibi• Both assess LV function and ischemia• Sestamibi (MIBI) has superior imaging quality
» Good for obese or female patients
• Isotopes taken up by viable myocardial cells in quantities proportional to perfusion
• Well perfused regions appear brighter
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The Stress:Exercise vs pharmacologic
• Exercise• Pt walks on treadmill with increasing speed/incline
• Goal = increase myocardial oxygen demand (MVO2)
– CAD: the increased demand exceeds supply = ischemia
• Advantages: flexible protocols• Disadvantages: pt must be able to achieve 85% of maximal HR
• Pharmacologic• dobutamine = increases HR, BP, contractility; mimics exercise• Coronary vasodilators – dipyridamole and adenosine
» Flow mismatch; diseased dilated arteries get less flow
• Sensitivities and specificities comparable to exercise stress• Advantages: useful in pts with ambulation limitations
• Risks: ventricular arrhythmias (dobutamine), bronchospasm (dilators)
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Coronary Artery Review
• Left Coronary– LAD
• Anterior wall• apex
– LCX• Left lateral wall
• Right Coronary• Right ventricle• Posterior wall
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3 Views
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• Short axis = coronal cut (donut)• Vertical long axis = sagittal cut (sideways “U”)• Horizontal long axis = transaxial cut (“U”)
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Short Axis
(apex to base)
Vertical Long Axis
(septum to lateral)
Horizontal Long Axis
(inferior to anterior)
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anterior
inferior
septum lateral
anterior
inferior
apexbase
base
apex
lateralseptum
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Coronary Artery Territories
septum
anterior
lateral
inferior
LAD
RCA
LCX
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Stress
Stress
Stress
Rest
Rest
Rest
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What are we looking for?
• Compare resting images to stress images
• Both sets look the same in a normal patient
• Defects in the stressed imagines suggest ischemia
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Other examples
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Other examples
Ischemia in theInferior/septal region
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References
• Pitman A. 2006. Myocardial perfusion imaging: a validated and mature cardiac imaging modality. Australian Family Physician 35:288-292.
• Bulow H and Schwaiger M. 2005. Nuclear cardiology in acute coronary syndromes. The Quarterly Journal of Nuclear Medicine and Molecular Imaging. 49: 59-71.
• Atlas of Myocardial Perfusion website. Brigham and Women’s Hospital. Harvard Medical School, Boston MA.
• Up-to-Date: Advantages and limitations of different stress testing modalities. Author Donald A Weiner, MD.
• Awtry EH, Jeon C, and Ware MG. Blueprints Cardiology. Second Edition. Copyright 2006. pages 21-25.
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Hannah Michelle Drafts