1. Nuclear Imaging in Cardiology Dr. Muhammad Ayub Diplomate Certification Board of Nuclear Cardiology Diplomate Certification Board of Cardiovascular CT Assistant Professor of Cardiology Punjab Institute of Cardiology, Lahore
17. 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
18.
19. 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
24. Myocardial Scintigraphy for Acute Coronary Syndromes Onset of Symptoms Unclear Diagnosis Clinical Management Sestamibi injection Sestamibi SPECT One Hour
25. Abn NI Chest Pain + Non-diagnostic ECG) Abn NI 2 hours NI Abn NI Abn 13 hours 3 sets Patients with Abnormal Tests are Admitted Rest SPECT Immediate Ex ECG Ex ECG Enzymes
26. Infarct Imaging “ Hot Spot” Annexin V Perfusion Imaging THE LANCET • Vol 356 • July 15, 2000
40. 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
41. Right to Left Shunt Body uptake of MAA > 6% of lung uptake
For a patient with low pretest likelihood (10%), ECG testing can shift the posttest likelihood from 5% and 35% for a negative and positive test result, respectively. In contrast, nuclear testing can shift the posttest likelihood from 1% and 75% for a negative and positive test result, respectively. For patients with an intermediate pretest likelihood (50%), the ECG can shift posttest likelihood to 20% and 80% for negative and positive test results, respectively, while nuclear tests can shift posttest likelihood to 5% and 95%, respectively. For patients with a high pretest likelihood (90%), the ECG can shift posttest likelihood to 75% and 95% for negative and positive test results, respectively, while nuclear tests can shift posttest likelihood to 25% and 99%, respectively. The overall result is that both tests are more useful in the patient with intermediate likelihood of disease. In addition, the more accurate the test, the greater the shift in posttest likelihood, and the greater the clinical utility of the test.
The gated portion of the SPECT study allows both the visual and quantitative assessment of left ventricular function. These measures include left ventricular ejection fraction and end-diastolic and end-systolic volumes. In addition, this modality achieves excellent visualization of both the endocardial and epicardial surfaces, allowing for the evaluation of left ventricular wall motion and wall thickening. In this scan, the top row represents 3 short axis images (apical, mid, and basal short-axis slices) and the bottom row represents the mid, horizontal, and vertical long-axis slices.