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40. Radioisotope examination of myocardial perfusion (transient and permanent ischaemia, viability). Radioisotope examination of left ventricle pump function and wall motion problems.
- Nuclear medicine studies of heart
- Rest myocardial perfusion study
- Can measure impairment of the myocardial perfusion
- SPECT/CT
- Indications
- Myocardial infarction
- Cardiomyopathy
- Stress/rest myocardial perfusion study
- Physical or pharmacological stress is applied
- SPECT/CT
- Rest SPECT later the same day or the day after
- If perfusion in stress > perfusion in rest -> reversible ischaemia
- If perfusion in stress = perfusion in rest -> necrosis/scar
- Indications
- Angina pectoris
- Coronary artery disease
- Myocardial viability examination
- Myocardium can be:
- Stunned
- Wall is dysfunctional but perfusion is normal
- Ischaemic
- There is decreased perfusion during stress but normal perfusion during rest
- These patient will benefit from revascularization
- Hibernating
- There is decreased perfusion during stress and rest
- But the myocytes are viable and will benefit from revascularization
- Infarcted
- There is no perfusion during stress or rest
- Myocytes are not viable and will therefore not benefit from revascularization
- These examinations determine the viability of the myocardium
- I.e., the possibility for the myocardium to return to normal after revascularization
- With PET
- With SPECT
- 201Tl-chloride (Thallium-201)
- Radionuclide ventriculography (RNVG) = multigated analysis (MUGA)
- Measures ventricular function
- Coupled to ECG
- -> Synchronizes image acquisition to R-waves
- 99mTc-pyrophosphate-RBC
- First-passage radionuclide angiography
- 99mTc-DTPA
- A dynamic series of images as the radiopharmaceutical flows from the right heart to the left heart and out
- Allows measurement of
- Wall motion of ventricles
- Ventricular volumes
- Ejection fraction
- Cardiac output
