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SPECT
Single Photon Emission Computed Tomography
A nuclear medicine
tomography imaging
technique using gamma rays
and gamma camera to
acquire multiple 2-D images
from multiple angles
SPECT Principles
SPECT Display
Thallium Protocols
Procedures Tracer is administered during stress or at rest
Result :
Reversibly
Thallium injected during stress
ischemic, Viable Thallium defect redistribution delayed 3 to 4 hrs
or 24 hrs
myocardium
Viable
Thallium injected at rest
myocardium,
Delayed redistribution images
resting
hypoperfusion
Scarred
Thallium defect persist overtime
myocardium
Patient with severe CAD but viable myocardium no
redistribution phase because of decline of blood thallium
level
Test for viable myocardium re-injecting small dose of
Thallium at rest
Thallium Protocols
TC-99m Protocols
Require two separates injection (at
peak stress and at rest)
Basic protocols :
1)Single day study
2) 2-day study
3)Dual isotope technique
2-Day Study
Combined Tracers
At rest : Thallium
At stress : Tc-99m
Advantages
High quality of imaging (Tc-99m)
Potential of acquiring redistribution
Visual
Subjective interpretation
Describing perfusion pattern
on stress dan whether the
defect is reversible or
irreversibel
Semi Quantitative
Divided myocardium
17
segments
into
Grade of perfusion
from
0-4
SSS-SRS
The extent and
severity of stressinduced ischemia
Quantitative
Creation of a
circumferential profile
of relative tracers
activity around
tomogram
Highly
reproducible
Disadvatages
Account potential
artifact
Principles
Scintigraphic acquisition
data conjunction with ECG
Detecting R wave
Images :
end diastole
end systole wall
thickening and
brightening
Visual
analysis :
Normal : brighten normally
Hypokinetic : diminished but
apparent brightening
Severe hypokinetic : slight
brightening
Akinetic : no apparent
brightening
Quantitative
analysis :
Apparent epicardial and
endocardial borders in all three
orthogonal planes
creating a 3D surface-rendered
image of LV
Accompanied by automated
calculation of EF and LV
volumes
Risk Stratification
Based on extent of ischemia region :
<4 : low risk
4-8 : moderate
8-13 : high risk
> 13 : very high risk
LVEF < 30% : high risk
high ESV : high risk
Take a
Deep
Breath....
Pharmacological stress
For the patients who are unable to
exercise or unable to achieve
maximal exercise
Classified into 2 categories :
vasodilator (adenosine and dipyridamol)
adrenergic stimulant (dobutamine)
Vasodilator
Mechanism :
Systemic
effect
8 to 10 mm
Hg in systolic
and diastolic BP
heart rate
Vasodilator
agents
(dipyridamole
& adenosine)
Side effect
(effect os
adenosine
stimulation)
AV block
10 % : 1st degree
5 % : 2nd&3rd
degree
Ischemic ST
depression
Flushing, chest
pain, shortness
of breathiness
Antagonize
Metilxanthine
compounds
(Teophylline,
aminophylline)
Adrenergic stimulants
For patient who contraindicated with vasodilator
agent because of reactive bronchospasm or
taking metilxanthine
Dobutamine is given starting at a dose of 5
mcg/kg/min and increased in a stepwise fashion
by 5 mcg/kg/min every 3 minutes, to a
maximum dose of 40 mcg/kg/min
Side effect : palpitations and chest pain, and
arrhythmias (inc. PVC, VT), hypotension
SPECT imaging :
Sensitivity to detect CAD was 87% (71-97%)
Specificity to rule out CAD was 73% (36-100%)
NSTEMI :
Patient with positive biomarkers, intermediate or
low TIMI risk stress MPI for risk stratification
ACC/AHA/ASNC Radionuclide Imaging Guidelines :
Indication : detecting residual ischemia (class I)
STEMI :
Patients surviving the initial acute period may
have a relatively stable course MPI for risk
stratification
Heart Failure
To determine etiology of heart failure
CAD or non ischemic disease
Non-ischemic cardiomyopathy may
have patchy and large confluent
territories of fibrosis or scaring with
MRI, and manifest as fixed defect on
SPECT MPI
SUMMARY
INDICATIONS CARDIAC NUCLEAR
IMAGING
SUMMARY
CONTRAINDICATIONS OF CARDIAC NUCLEAR
IMAGING
Thank
You....