Nuclear Cardiac Imaging: Principles and Applications

 

Description:

Nuclear cardiac imaging refers to cardiac radiological diagnostic techniques performed with the aid of radiopharmaceuticals, which are perfused into the myocardium as markers. These imaging studies provide a wide range of information about the heart, including the contractility of the heart, the amount of blood supply to the heart and whether parts of the heart muscle are alive or dead. This is essential information for cardiologists, and nuclear imaging has become an increasingly important part of the cardiologist's armamentarium. Chapters in Nuclear Cardiac Imaging cover historical, technical and physiological considerations, diagnosis and prognosis, conditions other than Coronary Artery Disease (CAD), advanced cardiac imaging, and challenges and opportunities. New to the fifth edition are key point summaries at the start of each chapter, clinical cases with videos, and a question and answer chapter on practical issues. This volume is ideal for nuclear cardiologists in training and nuclear clinicians alike who are searching for quick answers to important clinical and technical questions.

 

 

Table of Contents:

 

SECTION I: HISTORICAL, TECHNICAL, AND PHYSIOLOGIC CONSIDERATIONS

1 NUCLEAR CARDIOLOGY

ABBREVIATIONS

INTRODUCTION

HEART FUNCTION AND CIRCULATORY DYNAMICS

MYOCARDIAL PERFUSION IMAGING

PROGNOSIS

INFARCT IMAGING

VIABILITY

CARDIAC INFLAMMATION

INSTRUMENTATION

METABOLIC IMAGING

FUTURE IMAGING AGENTS/MOLECULAR IMAGING

RECOGNITION AS A SUBSPECIALTY

REFERENCES

2 RADIATION PHYSICS AND RADIATION SAFETY

ABBREVIATIONS

INTRODUCTION

STRUCTURE OF THE ATOM

RADIOACTIVITY

PRODUCTION OF RADIONUCLIDES

INTERACTION OF RADIATION WITH MATTER

DOSIMETRY

RADIATION SAFETY

REFERENCES

3 SPECT AND PET INSTRUMENTATION

ABBREVIATIONS

INTRODUCTION

SPECT VERSUS PET RADIONUCLIDES

CONVENTIONAL SPECT GAMMA CAMERA

DIGITAL SCINTILLATION CAMERA

MULTIHEADED SPECT CAMERAS

RESOLUTION, SIGNAL-TO-NOISE, AND EFFICIENCY

STATISTICS, NOISE LEVEL VERSUS TOTAL COUNTS

ECG-GATED ACQUISITION AND DISPLAY

ADVANCES IN CARDIAC SPECT INSTRUMENTATION

ROTATING CAMERA DEVELOPMENTS

CAMERA COMPARISONS

POSITRON EMISSION TOMOGRAPHY

IMAGE PROCESSING

IMAGE FILTERING

ADVANCES IN IMAGE RECONSTRUCTION

FUTURE PERSPECTIVES

REFERENCES

4 KINETICS OF CONVENTIONAL AND NEW CARDIAC RADIOTRACERS

ABBREVIATIONS

INTRODUCTION

THALLIUM-201

TC-99M SESTAMIBI

TC-99M TEBOROXIME

TC-99M TETROFOSMIN

IODINE-123 FATTY ACIDS

POSITRON-EMITTING RADIOTRACERS

CONCLUSIONS

REFERENCES

5 RADIONUCLIDE ANGIOGRAPHY

ABBREVIATIONS

INTRODUCTION

COMPARISON WITH OTHER TECHNIQUES FOR VENTRICULAR FUNCTION: A PRACTICAL PERSPECTIVE

RADIOPHARMACEUTICALS FOR RNA

PERFORMANCE ASPECTS OF RNA

IMAGE INTERPRETATION OF RNA

CLINICAL USES

USE IN SELECT PATIENT POPULATIONS

REFERENCES

6 GATED SPECT MPI

ABBREVIATIONS

INTRODUCTION

TRACER-SPECIFIC PROTOCOLS

BIBLIOGRAPHY

7 GATED SPECT MPI PROCESSING AND QUANTITATION

ABBREVIATIONS

INTRODUCTION

LEFT VENTRICLE SEGMENTATION

QUANTIFICATION OF FUNCTION

QUANTIFICATION OF PERFUSION

NEW TECHNIQUES AND APPROACHES

REFERENCES

8 IMAGE ARTIFACTS

ABBREVIATIONS

INTRODUCTION

ARTIFACTS ASSOCIATED WITH INSTRUMENTATION ERROR

PATIENT-RELATED ARTIFACTS

IMAGE PROCESSING ARTIFACTS

INTERPRETATION ERRORS SECONDARY TO IMPROPER IMAGE DISPLAY

ERRORS AND ARTIFACTS CAUSED BY ECG GATING

ARTIFACTS UNIQUE TO NEW CAMERA TECHNOLOGIES

CONCLUSION

COMMENTARY

REFERENCES

9 SPECT ATTENUATION CORRECTION

ABBREVIATIONS

INTRODUCTION

CARDIAC SPECT AC TECHNIQUES

CT AC

ALTERNATIVE TECHNIQUES

CONCLUSIONS

REFERENCES

10 PHARMACOLOGIC STRESS TESTING

ABBREVIATIONS

INTRODUCTION

PHARMACOLOGY AND MECHANISMS OF ACTION

PHARMACOLOGIC STRESS AGENTS AND MBF

PHARMACOLOGIC MPI PROTOCOLS

HEMODYNAMIC EFFECTS

SAFETY AND SIDE EFFECTS

NONPERFUSION ABNORMALITIES

USE OF PHARMACOLOGIC STRESS TESTING IN DIAGNOSIS AND RISK ASSESSMENT

REFERENCES

SECTION II: DIAGNOSIS AND RISK ASSESSMENT

11 TREADMILL EXERCISE TESTING

ABBREVIATIONS

INTRODUCTION

EXERCISE PHYSIOLOGY

HEMODYNAMIC RESPONSES TO EXERCISE

EXERCISE TESTING

RESPONSES TO EXERCISE TESTING

RESULTS OF EXERCISE TESTING

BEYOND ISCHEMIC ECG CHANGES

REFERENCES

12 GATED SPECT PERFUSION IN DIAGNOSIS AND RISK ASSESSMENT IN STABLE PATIENTS

ABBREVIATIONS

INTRODUCTION

OPTIMAL USEFULNESS OF STRESS MYOCARDIAL PERFUSION IMAGING (MPI)

PATIENT-CENTERED IMAGING

COMPARATIVE DIAGNOSTIC ACCURACY: WHAT IS THE STANDARD?

DIAGNOSTIC ACCURACY

PROGNOSTIC ACCURACY

LOW-RISK FINDINGS AND CARDIOVASCULAR EVENT RISK

WARRANTY PERIOD AND LONG-TERM FOLLOW-UP IN LOW-RISK MPI

HIGH-RISK FINDINGS AND CARDIOVASCULAR EVENT RISK

SERIAL MPI

HYBRID OR COMBINED STRESS MPI AND CCTA MEASUREMENTS

COMPARATIVE EFFECTIVENESS EVIDENCE

CONCLUSIONS

REFERENCES

13 RISK ASSESSMENT IN ACUTE CORONARY SYNDROMES

ABBREVIATIONS

INTRODUCTION

CLINICAL PREDICTORS OF RISK

ROLE OF MPI IN THE ACUTE PHASE OF ACS

ROLE OF MPI WITHIN 3 MONTHS OF ACS: RISK STRATIFICATION AND PREDICTORS

ROLE OF MPI IN GUIDING THERAPEUTIC DECISIONS

INVASIVE VERSUS CONSERVATIVE APPROACH: PROPOSED ALGORITHM

CONCLUSION

REFERENCES

14 RISK ASSESSMENT BEFORE NONCARDIAC SURGERY

ABBREVIATIONS

SURGERY-RELATED RISK

EXERCISE FUNCTIONAL CAPACITY

CLINICAL PREDICTORS OF PERIOPERATIVE RISK

ALGORITHMS

RISK ASSESSMENT WITH PERIOPERATIVE STRESS IMAGING

PERIOPERATIVE EVALUATION IN SPECIAL GROUPS

PREOPERATIVE MEDICAL MANAGEMENT

REVASCULARIZATION PREOPERATIVELY

PROGNOSTIC VALUE OF PREOPERATIVE EVALUATION

LIMITATIONS OF PERIOPERATIVE ASSESSMENT

CONCLUSIONS

REFERENCES

15 MYOCARDIAL PERFUSION IMAGING BEFORE AND AFTER CARDIAC REVASCULARIZATION

ABBREVIATIONS

INTRODUCTION

CLINICAL TRIALS: REVASCULARIZATION VERSUS MEDICAL THERAPY

GUIDELINES FOR REVASCULARIZATION

ROLE OF MPI IN GUIDING REVASCULARIZATION STRATEGY

ISCHEMIC BURDEN, REVASCULARIZATION, AND OUTCOMES

CHRONIC KIDNEY DISEASE

CHRONIC TOTAL OCCLUDED ARTERY

DIABETES MELLITUS

VIABILITY AND SEVERE LV DYSFUNCTION

IDENTIFICATION OF APPROPRIATE CANDIDATES FOR REVASCULARIZATION IN SIHD

IDENTIFYING THE CULPRIT LESION

COST-EFFECTIVENESS

ROLE OF MPI AFTER REVASCULARIZATION

RESIDUAL ISCHEMIC BURDEN AFTER REVASCULARIZATION

APPROPRIATE CANDIDATES FOR STRESS MPI AFTER REVASCULARIZATION: WHO AND WHEN

CONCLUSIONS

REFERENCES

16 SCREENING ASYMPTOMATIC SUBJECTS

ABBREVIATIONS

INTRODUCTION

SCOPE OF THE PROBLEM

EXERCISE STRESS TESTING

MYOCARDIAL PERFUSION IMAGING

ECHOCARDIOGRAPHY

CAROTID ULTRASOUND

ANKLE–BRACHIAL BP INDEX

CAC SCORE

ADDITIONAL METHODS

SCREENING IN SPECIAL POPULATIONS

SUMMARY

REFERENCES

17 ROLE OF IMAGING IN CHRONIC KIDNEY DISEASE

ABBREVIATIONS

INTRODUCTION

MPI FOR CAD DIAGNOSIS AND RISK ASSESSMENT

MYOCARDIAL BLOOD FLOW RESERVE

OTHER IMAGING MODALITIES

SAFETY OF REGADENOSON IN CKD

HEMODYNAMIC RESPONSE TO VASODILATOR STRESS

MPI ARTIFACTS IN CKD

REFERENCES

18 ROLE OF IMAGING IN DIABETES MELLITUS

ABBREVIATIONS

INTRODUCTION

DM AND CORONARY ARTERY DISEASE

CLINICAL PREDICTION MODELS IN DM

TESTING ASYMPTOMATIC DM PATIENTS

NONINVASIVE IMAGING FOR DETECTING CORONARY ATHEROSCLEROSIS

ASSESSMENT OF LV FUNCTION BY ECHOCARDIOGRAPHY

WHICH DM PATIENTS SHOULD BE REFERRED TO MPI?

WARRANTY PERIOD

IMPACT OF REVASCULARIZATION ON OUTCOME IN DM PATIENTS WITH SILENT MYOCARDIAL ISCHEMIA

CONCLUSIONS

REFERENCES

19 IMAGING PATIENTS WITH CHEST PAIN IN THE EMERGENCY DEPARTMENT

ABBREVIATIONS

INTRODUCTION

LIMITATIONS OF THE CURRENT APPROACHES USED TO ASSESS CHEST PAIN IN THE ED

RATIONALE FOR USING NONINVASIVE IMAGING FOR THE ASSESSMENT OF CHEST PAIN IN THE ED

A DIAGNOSTIC VERSUS PROGNOSTIC CONSTRUCT FOR EVALUATING CHEST PAIN IN THE ED

EFFICACY VERSUS EFFECTIVENESS: RANDOMIZED TRIALS OF ED MPI TO IMPROVE OUTCOMES AND DECISION MAKING

SPECIAL CONSIDERATIONS FOR THE USE OF MPI FOR CHEST PAIN ASSESSMENT

COST-EFFECTIVENESS OF MPI IN THE ED

COMPARISON OF THE UTILITY OF MPI AND BIOMARKERS FOR THE ASSESSMENT OF CHEST PAIN IN THE ED

ECHOCARDIOGRAPHY

OTHER APPROACHES TO ASSESSMENT OF CHEST PAIN IN THE ED

PRACTICAL IMPLEMENTATION

REFERENCES

20 ROLE OF PET IN DIAGNOSIS AND RISK ASSESSMENT IN PATIENTS WITH KNOWN OR SUSPECTED CAD

ABBREVIATIONS

INTRODUCTION

RADIOTRACERS FOR PET MPI

IMAGING PROTOCOLS FOR PET MPI

IMAGE INTERPRETATION

DIAGNOSTIC ACCURACY

PROGNOSTIC VALUE

WHEN TO CHOOSE PET IMAGING

RADIATION CONSIDERATIONS

PET MPI TO GUIDE CLINICAL DECISION MAKING IN PATIENTS WITH KNOWN OR SUSPECTED CAD

FUTURE DEVELOPMENTS

CONCLUSIONS

REFERENCES

21 MYOCARDIAL VIABILITY ASSESSMENT

ABBREVIATIONS

INTRODUCTION

DEFINING MYOCARDIAL VIABILITY

SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT)

PET

CONCLUSION

REFERENCES

SECTION III: ROLE OF NUCLEAR IMAGING BEYOND CAD

22 PHASE ANALYSIS FOR DYSSYNCHRONY BY MPI AND MUGA

ABBREVIATIONS

INTRODUCTION

BASIC PRINCIPLES OF FOURIER ANALYSIS

PHASE ANALYSIS FOR DYSSYNCHRONY BY MUGA

PHASE ANALYSIS FOR DYSSYNCHRONY BY GATED BLOOD-POOL SPECT

PHASE ANALYSIS FOR DYSSYNCHRONY BY GATED SPECT MPI

CARDIAC RESYNCHRONIZATION THERAPY IN HEART FAILURE

OPTIMIZING CRT BY MUGA AND BLOOD-POOL SPECT

OPTIMIZING CRT BY PHASE ANALYSIS OF GATED SPECT MPI

SUMMARY

REFERENCES

23 IMAGING OF MYOCARDIAL INNERVATION

ABBREVIATIONS

INTRODUCTION

CONCLUSIONS

REFERENCES

24 IMAGE-BASED MEASUREMENTS OF MYOCARDIAL BLOOD FLOW

ABBREVIATIONS

INTRODUCTION

PRINCIPLES AND TECHNICAL ASPECTS

MBF BY PET IN NORMAL INDIVIDUALS

REGULATION OF MBF AND ASSESSMENT OF CORONARY VASOMOTOR FUNCTION

SUMMARY

ACKNOWLEDGMENT

REFERENCES

25 IMAGING OF MYOCARDIAL METABOLISM

ABBREVIATIONS

INTRODUCTION

IMPORTANCE OF PLASTICITY IN MYOCARDIAL METABOLISM

ADVANCES IN IMAGING METHODOLOGY

NEW INSIGHTS ON CARDIOVASCULAR DISEASE GLEANED FROM RADIONUCLIDE METABOLIC IMAGING

FUTURE DIRECTIONS

REFERENCES

26 INFLAMMATORY AND INFILTRATIVE DISEASES AND TUMORS

ABBREVIATIONS

INTRODUCTION

RADIONUCLIDE IMAGING OF CARDIAC AMYLOIDOSIS

MYOCARDIAL INFLAMMATORY DISEASES

CARDIAC SARCOIDOSIS

RADIONUCLIDE IMAGING OF CARDIOVASCULAR INFECTIONS

VASCULAR INFLAMMATION

18F-FDG PET/CT IMAGING OF CARDIAC TUMORS

REFERENCES

27 RADIONUCLIDE IMAGING IN HEART FAILURE

ABBREVIATIONS

INTRODUCTION

DETERMINING ETIOLOGY OF HF

MEASUREMENT AND SERIAL EVALUATION OF LV FUNCTION

LV SHAPE INDICES

REFERENCES

SECTION IV: ADVANCES IN CARDIAC IMAGING

28 HYBRID CARDIAC IMAGING

ABBREVIATIONS

INTRODUCTION

INSTRUMENTATION

CLINICAL DATA WITH HYBRID IMAGING

HYBRID IMAGING COMBINING CACS AND MPI

PERSPECTIVES OF HYBRID IMAGING

REFERENCES

29 CARDIOVASCULAR MOLECULAR IMAGING

ABBREVIATIONS

INTRODUCTION

MOLECULAR IMAGING TECHNOLOGY

MOLECULAR IMAGING OF CARDIOVASCULAR DISEASE

CONCLUSIONS

REFERENCES

30 USE OF ARTIFICIAL INTELLIGENCE INCLUDING DECISION SUPPORT SYSTEMS IN CARDIAC IMAGING

ABBREVIATIONS

INTRODUCTION

WHAT IS ARTIFICIAL INTELLIGENCE (AI)?

AI TECHNIQUES TO AUTOMATE IMAGE ANALYSIS

AI TECHNIQUES TO AID IMAGE INTERPRETATION

KEEPING THE CDSS RELEVANT

STRUCTURED REPORTING—THE CDSS/HUMAN INTERFACE

SUMMARY

ACKNOWLEDGMENTS

REFERENCES

SECTION V: CHALLENGES FOR NUCLEAR CARDIOLOGY

31 PHYSICIAN CERTIFICATION AND LAB ACCREDITATION

ABBREVIATIONS

INTRODUCTION

GOVERNMENT REGULATION IN NUCLEAR CARDIOLOGY

CLINICAL TRAINING IN NUCLEAR CARDIOLOGY

PHYSICIAN CERTIFICATION

CBNC EXAM DEVELOPMENT

CHALLENGES IN CERTIFICATION FOR THE FUTURE

LAB ACCREDITATION

CHALLENGES IN LAB ACCREDITATION FOR THE FUTURE

A CULTURE OF QUALITY WITH A PRAGMATIC PATIENT FOCUS

REFERENCES

32 COST EFFECTIVENESS OF IMAGING WITH NUCLEAR CARDIOLOGY

ABBREVIATIONS

INTRODUCTION

COST-EFFECTIVENESS DEFINITIONS

TECHNICAL EFFICIENCY

COST OR ALLOCATIVE EFFECTIVENESS

COST EFFECTIVENESS OF NUCLEAR CARDIOLOGY

CONCLUSIONS

REFERENCES

33 GUIDELINES AND APPROPRIATE USE CRITERIA

ABBREVIATIONS

INTRODUCTION

CPG

AUC

CONCLUSION

REFERENCES

34 RADIATION CONSIDERATIONS

ABBREVIATIONS

INTRODUCTION

PRINCIPLES OF RADIOLOGIC PROTECTION

JUSTIFICATION IN NUCLEAR CARDIAC IMAGING

OPTIMIZATION IN NUCLEAR CARDIAC IMAGING

DOSE LIMITATION IN NUCLEAR CARDIAC IMAGING

SPECIAL POPULATIONS: PREGNANT, NURSING, AND PEDIATRIC PATIENTS

REFERENCES

35 PRACTICAL ISSUES

ABBREVIATIONS

INTRODUCTION

QUESTION 1: WHAT ARE THE MOST IMPORTANT THINGS TO KNOW ABOUT THE USE OF TRACERS (OR RADIOPHARMACEUTICALS)?

QUESTION 2: WHAT ARE THE IMPORTANT ISSUES TO CONSIDER WITH STRESS PERFUSION IMAGING?

QUESTION 3: WHICH SPECT PERFUSION IMAGING PROTOCOL SHOULD BE USED?

QUESTION 4: WHAT ARE THE PRINCIPLES OF SPECT IMAGING?

QUESTION 5: WHAT ARE THE QUALITY MEASURES IN IMAGING?

QUESTION 6: WHAT TYPES OF SPECT ARTIFACTS ARE THERE?

QUESTION 7: WHAT IS THE RADIATION EXPOSURE FROM SPECT AND PET IMAGING?

QUESTION 8: WHAT ARE THE METHODS OF ATTENUATION CORRECTION, AND DO THEY WORK?

QUESTION 9: IS BALANCED ISCHEMIA THE ACHILLES HEEL OF NUCLEAR IMAGING?

QUESTION 10: WHAT IS TID AND WHAT DOES IT MEAN?

QUESTION 11: WHAT IS WORTH KNOWING ABOUT QUANTIFICATION OF PERFUSION IMAGES?

QUESTION 12: WHAT IS WORTH KNOWING ABOUT QUANTIFICATION OF LV FUNCTION FROM GATED SPECT?

QUESTION 13: WHAT ARE THE IMPLICATIONS OF DISCORDANT STRESS ECG AND PERFUSION RESULTS?

QUESTION 14: WHAT IS THE GOLD STANDARD FOR COMPARING NUCLEAR STUDIES?

QUESTION 15: HOW DOES ONE USE THE PROGNOSTIC INFORMATION IN PATIENT CARE?

QUESTION 16: WHAT IS MYOCARDIAL VIABILITY, AND WHAT IS THE PROTOCOL TO USE?

QUESTION 17: WHAT ARE THE SPECIAL IMAGING ISSUES IN PATIENTS AFTER PCI/CABG?

QUESTION 18: CAN INFARCT SIZING BE DONE?

QUESTION 19: CAN WE DIFFERENTIATE PRIMARY DILATED FROM ISCHEMIC CARDIOMYOPATHY BY NUCLEAR IMAGING?

QUESTION 20: ARE THERE ADVANTAGES OF ASSESSING MYOCARDIAL PERFUSION BY PET OVER SPECT? IS RUBIDIUM WORTH USING ALONE? IS FDG WORTH USING ALONE?

QUESTION 21: DO FIXED DEFECTS REPRESENT SCAR AND REVERSIBLE DEFECTS ISCHEMIA?

QUESTION 22: HOW DOES ONE REPORT A STUDY—SEGMENTAL VERSUS VASCULAR TERRITORY ABNORMALITY?

QUESTION 23: IS RADIONUCLIDE ANGIOGRAPHY ALIVE OR DEAD?

QUESTION 24: SHOULD EMERGENCY DEPARTMENT IMAGING BE DONE? IF SO, HOW?

QUESTION 25: CAN LV DYSSYNCHRONY BE EVALUATED WITH NUCLEAR IMAGING?

QUESTION 26: CAN WE USE SERIAL STUDIES TO ASSESS THERAPY?

QUESTION 27: HOW ARE WE BETTER THAN OTHER COMPETING IMAGING MODALITIES?

QUESTION 28: WHICH GAMMA SPECT CAMERA SHOULD WE BUY: THE OLD, THE NEW, OR THE NEWEST?

QUESTION 29: WHAT IS THE BEST WAY TO PROCESS GATED SPECT IMAGES?

QUESTION 30: WHICH TEST TO USE, WHEN, AND WHY?

INDEX

 

An aparitie	10 Dec 2015
Dimensiuni	223 x 284 x 38 mm
Editura	Oxford University Press
Format	Hardcover
ISBN	9780199392094
Limba	Engleza
Nr pag	768