CARDIOVASCULAR SYSTEM - PowerPoint PPT Presentation

Loading...

PPT – CARDIOVASCULAR SYSTEM PowerPoint presentation | free to download - id: 3d47bc-OGUyN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

CARDIOVASCULAR SYSTEM

Description:

CARDIOVASCULAR SYSTEM BASIC PROCEDURAL ASPECTS OF NUCLEAR CARDIOLOGY STUDIES CARDIOVASCULAR SYSTEM Material is foundational information on nine NMTCB selected cardiac ... – PowerPoint PPT presentation

Number of Views:31
Avg rating:3.0/5.0
Slides: 114
Provided by: keiserstud
Learn more at: http://keiserstudents.tripod.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: CARDIOVASCULAR SYSTEM


1
CARDIOVASCULAR SYSTEM
  • BASIC PROCEDURAL ASPECTS OF NUCLEAR CARDIOLOGY
    STUDIES

2
CARDIOVASCULAR SYSTEM
  • Material is foundational information on nine
    NMTCB selected cardiac studies
  • Preparation for the NMTCB certification exam
  • Tailored to graduating students or recent
    graduates of a nuclear medicine program
  • Review content taken from the NMTCB Components of
    Preparedness Statements

3
CARDIOVASCULAR STUDIES
  • PURPOSE
  • INDICATIONS
  • RADIOPHARMACEUTICAL-DOSE RANGE-ADMINISTRATION
  • PROCEDURAL STEPS
  • NORMAL RESULTS
  • ABNORMAL RESULTS

4
CARDIOVASCULAR STUDIES
  • MYOCARDIAL PERFUSION SPECT(REST)
  • MYOCARDIAL PERFUSION GATED SPECT(STRESS)
  • MYOCARDIAL PERFUSION PLANAR
  • FIRST PASS(EF WALL MOTION)
  • GATED CARDIAC BLOOD POOL(REST)
  • GATED CARDIAC BLOOD POOL(STRESS)
  • GATED CARDIAC BLOOD POOL(SPECT)
  • VENOGRAM/THROMBUS LOCALIZATION
  • CARDIAC PET
  • CARDIAC SHUNT

5
MYOCARDIAL PERFUSION SPECT-REST
  • PURPOSE
  • Used to determine the adequacy of regional blood
    flow to the myocardium, specifically the walls of
    the left ventricle.
  • Imaging accuracy is an invaluable aid in the
    diagnosis and management of cardiomyopathies.
  • Rest-vs.-stress imaging and quantification

6
MYOCARDIAL PERFUSION SPECT-REST
  • INDICATIONS
  • Detection and evaluation of Coronary Artery
    Disease
  • Evaluation of myocardial viability in patients
    who are candidates for surgery
  • Risk assessment in patients with Coronary Artery
    Disease
  • Evaluation of physical indicators Myocardial
    Infarction, chest pain, shortness of breath,
    family history of heart disease

7
MYOCARDIAL PERFUSION SPECT-REST
  • Evaluation of laboratory indicators Elevated
    levels of creatine phosphokinase, lactate
    dehydrogenase, troponin, and myoglobin(the latter
    two specific indicators for heart damage).
  • Risk assessment in patients with coronary artery
    disease and post myocardial infarction.

8
MYOCARDIAL PERFUSION SPECT-REST
  • RADIOPHARMACEUTICALS
  • 99mTc-sestamibi(Cardiolite) and
    99mTc-tetrafosmin(Myoview) binds to myocardial
    mitochondria and myocytes.
  • Adult dose range is 8-30mCi depending on a one or
    two day protocol.
  • 201TlCl(thallous chloride) is an analog of
    potassium and distributes in the myocardium
    through the Na/K pump (unique redistribution
    property).

9
MYOCARDIAL PERFUSION SPECT-REST
  • 2.5-3mCi is the normal adult dose range.
  • All three radiopharmaceuticals are administered
    by I.V. injection.

10
MYOCARDIAL PERFUSION SPECT-REST
  • PROCEDURE
  • ONE DAY DUAL ISOTOPE PROTOCOL
  • Inject 2.5-3.0mCi of 201Tl at rest and image
    between 20 minutes and 2 hours.
  • Inject 5.0-8.0mCi of Sestamibi/Tetrafosmin and
    image between 45 minutes and 2 hours.
  • Imaging Position patient supine with both arms
    or left arm above head and heart in center field
    of view.
  • Acquire SPECT images per protocol.

11
MYOCARDIAL PERFUSION SPECT-REST
  • Processing Consists of computer analysis of the
    LV myocardium showing slices of the vertical long
    axis, horizontal long axis, and short axis.

12
MYOCARDIAL PERFUSION SPECT-REST
  • RESULTS
  • NORMAL Heterogeneous uptake in the LV
    myocardium indicating normal perfusion at rest.
  • ABNORMAL Area(s) of little or no uptake of
    radiotracer exhibiting a cold spot indicative of
    ischemic, hibernating, or infarcted myocardium.

13
MYOCARDIAL PERFUSION SPECT-REST
  • QUIZ
  • 1. Elevated levels of troponin and myoglobin are
    specific indicators of myocardial damage.
  • True or False

14
MYOCARDIAL PERFUSION SPECT-REST
  • ANSWER TRUE

15
MYOCARDIAL PERFUSION SPECT-REST
  • 2. 201Tl redistributes in the myocardium by way
    of the _____ mechanism.
  • A. Na/K pump
  • B. myocyte binding
  • C. capillary shunt

16
MYOCARDIAL PERFUSION SPECT-REST
  • ANSWER A

17
MYOCARDIAL PERFUSION SPECT-REST
  • 3. The normal resting adult dose range for 201Tl
    administered during a dual isotope study is
  • A. 1-2mCi
  • B. 5-8MCi
  • C. 2.5-3mci

18
MYOCARDIAL PERFUSION SPECT-REST
  • ANSWER C

19
MYOCARDIAL PERFUSION SPECT-REST
  • 4. Areas of little or no uptake in a rest image
    could indicate hibernating or infarcted
    myocardium.
  • True or False

20
MYOCARDIAL PERFUSION SPECT-REST
  • ANSWER True

21
MYOCARDIAL PERFUSION SPECT-REST
  • 5. During a dual isotope study, rest imaging can
    begin approximately _____ after the injection of
    201Tl.
  • A. 1.5-2 hours
  • B. 1 hour
  • C. 20 minutes

22
MOCARDIAL PERFUSION SPECT-REST
  • ANSWER C

23
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • PURPOSE
  • Used to determine the adequacy of blood flow to
    the myocardium during stress or exercise,
    specifically the LV.
  • Accomplished by exercise or chemical stress
    agents.
  • Used to determine LV ejection fraction.

24
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • INDICATIONS
  • Detection and evaluation of CAD.
  • Evaluation of myocardial viability in patients
    who are surgical candidates.
  • Evaluation of physical indicators SOB, CP, MI.
  • Evaluation of laboratory indicators elevated
    levels of troponin and myoglobin.
  • Risk assessment of patients with CAD and post MI.

25
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • RADIOPHARMACEUTICALS
  • 99mTc-sestambi and 99mTc-terafosmin normal adult
    dose range 20-30mCi.
  • Both 99mTc-agents administered by I.V. injection.

26
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • PROCEDURE
  • ONE DAY DUAL ISOTOPE PROTOCOL
  • Stress tests can be performed by exercise or
    pharmacological stress agents( adenosine,
    dobutamine, dipyridamole, etc.)
  • Optimal HR should reach 85 of maximum HR(220-age
    x .85).
  • During peak exercise or simulated exercise,
    inject 20-30mCi of 99mTc-agent.

27
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • Flush immediately and allow patient to exercise
    60-90 seconds more after injection.
  • No flush with adenosine (could cause adenosine
    bolus).
  • Flush with dobutamine (used with asthmatics and
    COPD patients)
  • Imaging Sestamibi/Tetrafosmin exercise
    approximately 15-45 minutes post-exercise.
  • Chemical patients approximately 45-90 minutes
    post-stress.

28
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • Position patient supine with both arms or left
    arm over head and heart in center field of view.
  • Connect 3-lead ECG for gated SPECT images and
    check for strong R-R intervals.
  • Acquire SPECT images per protocol.
  • Processing Consists of computer analysis of LV
    myocardium in VLA, HLA, and SA views.
  • Computer generated polar map showing regions and
    associated coronary arteries.
  • LV ejection fraction calculated at this stage.

29
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • RESULTS
  • Normal Heterogeneous uptake throughout the LV
    myocardium.
  • LVEF of 50-80 with gated study.
  • LV wall contracting rhythmically and well
    coordinated, converging vigorously toward the
    center.
  • Abnormal Areas of little or no uptake in LV
    myocardium during stress but not with rest,
    myocardium is ischemic and reversible (reversible
    defect).

30
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • If defect occurs in both rest and stress images
    in the same area, infarcted tissue is likely
    (fixed-irreversible defect).

31
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • QUIZ
  • 1. After connecting the 3-lead ECG for gated
    stress images, always check for good QRS
    intervals on the monitor.
  • True or False

32
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • ANSWER False

33
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • 2. A pharmacological stress agent used in
    patients with asthma, COPD, and emphysema is
  • A. adenosine
  • B. aminophylline
  • C. dobutamine

34
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • ANSWER C

35
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • 3. Stress imaging may begin approximately
    _______ after 99mTc-cardiolite injection in an
    exercise patient.
  • A. Immediately
  • B. 15-45 minutes
  • C. next day

36
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • ANSWER B

37
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • 4. The LVEF is calculated during the non-gated
    rest phase of a myocardial perfusion study.
  • True or False

38
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • ANSWER False

39
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • 5. If a defect in the myocardium is noted on
    both rest and stress images, this is indicative
    of ________.
  • A. Ischemia
  • B. hibernating myocardium
  • C. MI (infarcted tissue)

40
MYOCARDIAL PERFUSION GATED SPECT-STRESS
  • ANSWER C

41
MYOCARDIAL PERFUSION PLANAR
  • PURPOSE
  • Used to determine the adequacy of blood flow to
    the myocardium with rest vs. stress imaging.
  • Planar method used under extraordinary
    circumstances with reduced sensitivity.
  • VLA, HLA, and SA views not available.
  • This method is typically used for situations
    where equipment limits are exceeded by extremely
    large or obese patients.

42
MYOCARDIAL PERFUSION PLANAR
  • INDICATIONS
  • Detection and evaluation of CAD.
  • Assessment of myocardial viability.
  • Evaluation of physical and laboratory indicators
    MI, SOB, CP, family hx. of CAD, elevated levels
    of troponin, myoglobin, creatine phosphokinase,
    and lactate dehydrogenase.

43
MYOCARDIAL PERFUSION PLANAR
  • RADIOPHARMACEUTICAL
  • 201Tl (thallous chloride) administered by I.V.
    injection.
  • Normal adult dose range is 2.0-4.0mCi.
  • 201Tl used for its redistribution properties.

44
MYOCARDIAL PERFUSION PLANAR
  • PROCEDURE
  • Exercise or chemically stress patient to peak
    level and inject 201Tl and flush adequately.
  • Immediately position patient supine with both
    arms or left arm behind head.
  • Acquire images immediately with three standard
    views 45-degree LAO with best septal separation,
    ANT, and LLAT.

45
MYOCARDIAL PERFUSION PLANAR
  • Start redistribution (rest) images 2-4 hours
    after stress acquisition.
  • Position patient exactly as in stress images and
    use identical acquisition protocol.
  • For a resting study only, inject 201Tl and image
    immediately and again at 30-60 minutes.
  • Process the data using 201Tl quantification
    software for planar images.

46
MYOCARDIAL PERFUSION PLANAR
  • RESULTS
  • Normal Uniform distribution of radiotracer
    throughout LV myocardium.
  • Normal RV may or may not be visualized because
    the muscle is thin in comparison to the LV.
  • Abnormal Little or no uptake in areas of LV
    myocardium.
  • Fixed defect in stress and redistribution images
    is indicative of infarcted tissue.

47
MYOCARDIAL PERFUSION PLANAR
  • Defect in stress images that fills in on rest
    images (redistribution) is indicative of
    myocardial ischemia (reversible defect).

48
MYOCARDIAL PERFUSION PLANAR
  • QUIZ
  • 1. A polar/Bulls Eye map of the left ventricle
    is a useful diagnostic tool in myocardial
    perfusion planar imaging.
  • True or False

49
MYOCARDIAL PERFUSION PLANAR
  • ANSWER False

50
MYOCARDIAL PERFUSION PLANAR
  • 2. The _____ cannot be generated during a
    myocardial perfusion planar study.
  • A. VLA, HLA, SA views
  • B. ANT, LAO, LLAT views
  • C. 360 degree cine view

51
MYOCARDIAL PERFUSION PLANAR
  • ANSWER A and C

52
MYOCARDIAL PERFUSION PLANAR
  • 3. 201Tl is an excellent tracer for planar
    perfusion studies because of its unique
    redistribution property.
  • True or False

53
MYOCARDIAL PERFUSION PLANAR
  • ANSWER True

54
MYOCARDIAL PERFUSION PLANAR
  • 4. A patient that weighs 450 pounds would be a
    candidate for _______.
  • A. planar imaging
  • B. SPECT imaging
  • C. PET imaging

55
MYOCARDIAL PERFUSION PLANAR
  • ANSWER A

56
MYOCARDIAL PERFUSION PLANAR
  • 5. In planar perfusion imaging, the rest study
    is performed first in order to visualize the
    201Tl redistribution during stress imaging.
  • True or False

57
MYOCARDIAL PERFUSION PLANAR
  • ANSWER False

58
GATED FIRST-PASS
  • PURPOSE
  • This technique is used to record the initial
    passage of a radiotracer through the cardiac
    chambers.
  • The tracer activity (bolus) is limited to one
    chamber at a time, making it easier to define
    ROIs.

59
GATED FIRST-PASS
  • INDICATIONS
  • Determination of ejection fractions of left and
    right ventricles.
  • Evaluation of overall heart function for
    congenital heart disease and defects.
  • Detection of aortic and mitral valve
    insufficiency.
  • Baseline study for surgery candidates.
  • Evaluation of right and/or left ventricular wall
    motion.

60
GATED FIRST-PASS
  • Evaluation of chamber to chamber transit times.
  • Evaluation and detection of coronary artery
    disease.
  • Detection and evaluation of left to right cardiac
    shunts.

61
GATED FIRST-PASS
  • RADIOPHARMACEUTICALS
  • 99mTc-agents DTPA, Sestamibi (Cardiolite),
    Tetrafosmin (Myoview), RBCs
  • Normal adult dose range is 8-30mCi in a small
    volume (lt1ml).
  • Administer by I.V. catheter, butterfly, or
    straight stick.
  • Typically a three-way stopcock is used for
    radiotracer and 10-20ml of saline for good bolus.

62
GATED FIRST-PASS
  • Introduced into external jugular or right medial
    antecubital vein.

63
GATED FIRST-PASS
  • PROCEDURE
  • Position patient supine and connect 3-lead ECG
    for gate.
  • Position camera anterior, left anterior oblique,
    or right anterior oblique depending on intent of
    study.
  • Start acquisition and inject immediately to catch
    bolus.
  • Study is usually 20-120 seconds in length.

64
GATED FIRST-PASS
  • Acquisition is terminated after tracer travels
    through the right side of the heart, the lungs,
    and the left side of the heart.
  • Processing Generate time-activity curve and
    draw ROIs for LVEF and/or RVEF.

65
GATED FIRST-PASS
  • RESULTS
  • Normal LVEF 50-80 and RVEF 40-60.
  • Bolus travels through cardiopulmonary circuit
    with no obvious obstructions or alteration in
    path.
  • Symmetric, well coordinated wall movement in all
    chambers.
  • Abnormal Cine showing abnormal wall movement
    (dyskinesis), decreased wall motion
    (hypokinesis), or no wall movement (akinesis).

66
GATED FIRST-PASS
  • Low LVEF of 35-45 or less.
  • Interruption or detour of bolus through
    cardiopulmonary circuit.

67
GATED FIRST-PASS
  • QUIZ
  • 1. In a first-pass study, administer the tracer
    bolus in at least a 5-10ml volume.
  • True or False

68
GATED FIRST-PASS
  • ANSWER False

69
GATED FIRST-PASS
  • 2. The best injection site for a first-pass
    bolus for optimal results is the
  • A. left anticubital vein
  • B. external jugular vein
  • C. popliteal vein

70
GATED FIRST-PASS
  • ANSWER B

71
GATED FIRST-PASS
  • 3. A first-pass study typically takes between
    5-10 minutes to complete the acquisition.
  • True or False

72
GATED FIRST-PASS
  • ANSWER False

73
GATED FIRST-PASS
  • 4. A normal result from a first-pass study would
    be
  • A. dyskinesis of the myocardium
  • B. bolus moving from left to right ventricle
  • C. LVEF of 50-80

74
GATED FIRST-PASS
  • ANSWER C

75
GATED FIRST-PASS
  • 5. An advantage to first-pass imaging is the
    bolus being limited to one chamber at a time
    making it easier to define ROIs.
  • True or False

76
GATED FIRST-PASS
  • ANSWER True

77
GATED CARDIAC BLOOD POOL REST-MUGA
  • PURPOSE
  • The Multigated Blood Pool Acquisition is a gated
    study used to image the blood pool in the heart
    using radiolabeled RBCs.
  • Overall chamber function can be assessed and
    quantified with this study.

78
GATED CARDIAC BLOOD POOL REST-MUGA
  • INDICATIONS
  • Detection or assessment of CAD.
  • Evaluation of patients heart condition for
    pending chemotherapy, radiation therapy, or
    surgery.
  • Evaluation of left and right ventricular wall
    motion for congenital heart failure.
  • Calculation of LVEF.
  • Evaluation of physical indicators MI, CP, SOB,
    or family history of heart disease.

79
GATED CARDIAC BLOOD POOL REST-MUGA
  • Evaluation of laboratory indicators Elevated
    levels of CPK (creatine phosphokinase), LDH
    (lactate dehydrogenase), troponin, and myoglobin.
  • Detection and evaluation of valvular dysfunction.
  • Evaluation of pre- and post-cardiac
    transplantation.

80
GATED CARDIAC BLOOD POOL REST-MUGA
  • RADIOPHARMACEUTICAL
  • 99mTc-pertechnetate in combination with UltraTag
    RBC kit.
  • In-vitro labeling process.
  • Normal adult dose range 20-30mCi.
  • Administered by I.V. injection.
  • Large bore I.V. setup for blood withdrawal and
    injection of radiopharmaceutical so RBCs are not
    damaged.

81
GATED CARDIAC BLOOD POOL REST-MUGA
  • PROCEDURE
  • Withdraw and prepare blood with UltraTag RBC kit.
  • Position patient supine on bed.
  • Connect 3 or 5-lead ECG and check for strong R-R
    intervals.
  • Position camera for desired view(s) Anterior,
    LAO looking for best septal wall separation, left
    lateral, and sometimes RAO.

82
GATED CARDIAC BLOOD POOL REST-MUGA
  • Inject patient slowly with tagged RBCs.
  • Acquire gated images per protocol.
  • Processing Draw regions of interest for LVEF
    calculation.
  • Apply temporal and spatial smoothing filters if
    applicable for cine wall motion analysis.
  • Calculate stoke volume (SV) and cardiac output
    (CO) per protocol.

83
GATED CARDIAC BLOOD POOL REST-MUGA
  • RESULTS
  • Normal Good tag with RBCs showing structure of
    heart and clear circulation.
  • Separation between right and left ventricle
    should be easily definable.
  • Cine showing well coordinated and rhythmical wall
    motion.
  • Ejection fraction of left ventricle 50-70,
    40-60 for right ventricle.

84
GATED CARDIAC BLOOD POOL REST-MUGA
  • Abnormal Abnormal, decreased, or absent wall
    movement in ventricles.
  • LVEF 35-45, LVEF below 30 represents severe
    impairment.

85
GATED CARDIAC BLOOD POOL STRESS-MUGA
  • Purpose, Radiopharmaceutical, Indications, Normal
    and Abnormal Results refer to MUGA- REST STUDY.

86
GATED CARDIAC BLOOD POOL STRESS-MUGA
  • PROCEDURE
  • Position patient in exercise device, supine or
    semi-erect with feet in pedals.
  • Connect 3 or 5-lead ECG and check for strong R-R
    intervals.
  • Inject patient with tagged RBCs slowly.
  • Position camera per protocol with best septal
    separation.

87
GATED CARDIAC BLOOD POOL STRESS-MUGA
  • Physician or PA to determine exercise/stress
    settings.
  • Acquire gated images per protocol.
  • Artifacts from excessive body motion may occur
    with this technique.

88
GATED CARDIAC BLOOD POOL SPECT-MUGA
  • Refer to MUGA-REST for Purpose, Indications,
    Radiopharmaceutical, and Results.

89
GATED CARDIAC BLOOD POOL SPECT-MUGA
  • Gated blood pool SPECT imaging has the advantage
    of a 360 degree view given the same acquisition
    time.
  • Anatomic overlap is eliminated that occurs in
    planar imaging.
  • Regional wall motion assessment is better.
  • LVEF calculations are enhanced.
  • RVEF is more accurately assessed.

90
GATED CARDIAC BLOOD POOL-MUGA
  • QUIZ
  • 1. The normal adult dose range for labeled RBCs
    in a MUGA study is
  • A. 5-10mCi
  • B. 20-30uCi
  • C. 20-30mCi

91
GATED CARDIAC BLOOD POOL-MUGA
  • ANSWER C

92
GATED CARDIAC BLOOD POOL-MUGA
  • 2. When injecting prepared RBCs back into the
    patient, inject and pull back vigorously to cause
    frothing which helps mix the components in the
    syringe.
  • True or False

93
GATED CARDIAC BLOOD POOL-MUGA
  • ANSWER False

94
GATED CARDIAC BLOOD POOL-MUGA
  • 3. Using temporal and spatial smoothing filters
    helps to determine a more realistic LVEF.
  • True or False

95
GATED CARDIAC BLOOD POOL-MUGA
  • ANSWER False

96
GATED CARDIAC BLOOD POOL-MUGA
  • 4. A MUGA stress study is valuable in the
    detection of
  • A. diabetic neuropathy
  • B. cardiac valvular dysfunction
  • C. Bundle Branch Block

97
GATED CARDIAC BLOOD POOL-MUGA
  • ANSWER B

98
GATED CARDIAC BLOOD POOL-MUGA
  • 5. Stroke volume (SV) and cardiac output (CO) can
    be calculated from a resting MUGA study.
  • True or False

99
GATED CARDIAC BLOOD POOL-MUGA
  • ANSWER True

100
CARDIAC SHUNT
  • PURPOSE
  • Used to determine if there is a shunt or pathway
    from the right ventricle to the left ventricle.
  • Non-oxygenated blood reenters systemic
    circulation by this route.
  • Blood that is shunted does not enter the
    pulmonary circuit.

101
CARDIAC SHUNT
  • PROCEDURE
  • Basically a lung perfusion scan (quantitative)
    using 99mTc-MAA.
  • Static images of lungs as per protocol.
  • Acquire anterior, posterior, and right and left
    laterals of head to verify shunt.
  • Acquire whole body sweep if quantitation is
    desired.

102
CARDIAC SHUNT
  • Right to left cardiac shunt activity in the
    cerebral hemispheres.
  • Quantitation can be performed by drawing ROIs
    around lungs , then around whole body.
  • shunttotal body counts-lung counts X 100
  • total body counts
  • First-pass studies are also useful in shunt
    detection. Quantitative analysis of first-pass
    curves can detect left to right shunts.

103
VENOGRAM/THROMBUS LOCALIZATION
  • PURPOSE
  • This study is performed to localize thrombus
    formation in the extremities.
  • Patency of the deep veins in the extremities can
    also be assessed.
  • Thrombus formation can eventually lead to
    fragments (emboli) entering venous circulation
    and lodging in the vasculature of the lungs
    (pulmonary embolism).

104
VENOGRAM/THROMBUS LOCALIZATION
  • INDICATIONS
  • Detection and localization of acute venous
    thrombosis in the lower extremities.
  • Differentiation of acute venous thrombosis from
    chronic venous thrombosis.
  • Assess patients with high probability of DVT and
    have a negative ultrasound.

105
VENOGRAM/THROMBUS LOCALIZATION
  • RADIOPHARMACEUTICAL
  • 99mTc-apcitide (AcuTect) a synthetic peptide.
  • Binds to receptors on activated platelets.
  • Compartmental localization in blood flow.
  • Normal adult dose range 20mCi.
  • Administered by I.V., butterfly, or catheter with
    flush in upper extremity.

106
VENOGRAM/THROMBUS LOCALIZATION
  • PROCEDURE
  • Administer injection to patient.
  • After 10 minutes, position patient supine on
    table.
  • Acquire anterior or anterior/posterior images
    from pelvis to thighs and mid-thigh to mid calf.
  • Repeat at 60 and 90 minutes up to 180 minutes.
  • Patient positioning must be the same for all
    images.

107
VENOGRAM/THROMBUS LOCALIZATION
  • Processing Using image contrast and intensity
    is imperative to visualize veins.
  • Using a color scale may enhance visualization.
  • Other modalities i.e. MRI, CT, Ultrasonography,
    Plethysmograpy are incorporated to help identify
    DVT.

108
VENOGRAM/THROMBUS LOCALIZATION
  • RESULTS
  • Normal Lower extremities show bilateral
    symmetric uptake in deep and superficial veins.
  • Symmetric low soft tissue uptake.
  • Bilaterally symmetric limb sizes.
  • Halo of uptake around soft tissue of knees.

109
VENOGRAM/THROMBUS LOCALIZATION
  • Abnormal Acute DVT presents as an asymmetric
    uptake in a deep vein segment that persists or
    becomes apparent on delayed images.
  • Increased uptake following the course of a deep
    vein.
  • Asymmetric vascular linear uptake in both
    anterior and posterior projections of one or both
    lower extremities.

110
CARDIAC PET
  • All of the previous material on SPECT Myocardial
    Perfusion Imaging can also be accomplished with
    positron emitters and a PET camera.
  • Most of the cardiac studies designed for use in
    PET applications are centered around the
    detection of coronary artery disease and
    myocardial viability.
  • PET has a 10-15 higher specificity than that of
    SPECT in detection of CAD.

111
CARDIAC PET
  • POSITRON EMITTERS
  • Perfusion Tracers Rubidium-82 chloride,
    Nitrogen-13 ammonia, Oxygen-15 water
  • Metabolic Tracers 18F-fluorodeoxyglucose (FDG),
    11C-palmitate, 11C-acetate

112
CARDIOVASCULAR SYSTEM-CONCLUSION
  • Reviewed foundational information on selected
    cardiac studies.
  • Material may be seen on the NMTCB certification
    exam.
  • Topics taken from the NMTCB Components of
    Preparedness Statements.
  • Copies available for review.

113
CARDIOVASCULAR SYSTEM-CONCLUSION
  • GOOD LUCK!!
About PowerShow.com