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Functional (Gated & 1 st Pass) and other Cardiac Imaging

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

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Functional (Gated & 1 st Pass) and other Cardiac Imaging

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  1. Functional (Gated & 1st Pass) and other Cardiac Imaging

  2. 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

  3. Gross Anatomy of the Heart

  4. Mechanical Activity • Systole – ventricular contraction • Diastole – ventricular relaxation

  5. Electrical Activity

  6. 1st 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.

  7. 1st Pass

  8. Shunt?

  9. 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 20-30 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)

  10. MUGA Imaging Procedure • ECG • Anterior and ~45 LAO (best septal separation) w. caudal tilt • 8 to 16 frames/second • 64x64 matrix • 10 minutes/view

  11. 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

  12. Functional Imaging(MUGA)

  13. Myocardial Infarct Imaging15-30 mCiTc-99m Pyrophosphate • Of historical interest – replaced by serum enzyme testing

  14. 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

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