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Myocardial Perfusion Imaging
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Elin Trägårdh, David Minarik, Mark Lubberink
The use of radionuclide imaging, such as MPS and PET, is often part of the imaging of IHD. Stress and rest myocardial perfusion imaging can be performed to detect, localize, and quantify the degree of ischemia and infarction, as well as quantify the systolic function. Quantification of absolute myocardial perfusion can be done with PET. The results of an MPS or PET are related to the prognostic outcome of cardiac events (myocardial infarction and death). Therefore, MPS and PET are used to diagnose IHD and to guide treatment in patients with known IHD. They can also be used to determine the culprit lesion in order to only treat significant stenosis. MPS is a well-established technique and one of the most commonly used cardiac imaging modalities. There are international guidelines on when to use [3, 4], how to perform [5], and how to report [6, 7] MPS. PET is a newer nuclear medicine imaging technique. Its use in cardiology is increasing because of advantages compared with MPS, such as better image resolution and the possibility for quantification of absolute myocardial perfusion. However, the limited availability of the equipment (especially of the perfusion tracer) and higher costs are influencing the choice of method.
Radiotracer Imaging of Unstable Plaque
Published in Robert J. Gropler, David K. Glover, Albert J. Sinusas, Heinrich Taegtmeyer, Cardiovascular Molecular Imaging, 2007
MRI and computerized tomographic angiography (CTA) provide anatomic information on atherosclerosis including location, extent of wall thickening and with the higher resolution of MRI can provide information on plaque composition. Myocardial perfusion imaging using radionuclides provides information on regional vascular flow reserve and thereby provides information on the physiological significance of anatomic lesions. None of these approaches provides the information on plaque stability, which is the most important factor determining near future risk from acute ischemic events including stroke and MI. While MR molecular targeting approaches are being developed using specially engineered probes, nuclear medicine is the only imaging modality that routinely uses targeting probes in nanomolar concentrations having no biological effects and high affinity for relatively low abundance targets. Despite lower spatial resolution than MRI or CT small targets can be visualized as beacons on in vivo imaging when there are sufficient binding sites such as apoptotic macrophages and through radiotracer development to amplify the radioactive signal. The tracers that are presently under investigation that show considerable promise for clinical vascular imaging are 18F-FDG for PET and 99mTc-annexin V for SPECT. The coronary arteries present a further challenge but from the results of experimental studies in large animals, it is probably feasible to see focal areas of radiotracer uptake in the coronary arteries in patients. Evidence from a number of sources supports the premise that plaque inflammation that characterizes vulnerability is a systemic and not just focal process. Nuclear medicine is suited for whole body imaging including imaging of the carotids, thoracic aorta, and coronaries. The advent of multi-modality imaging provides the ability to register SPECT or PET images with CT angiograms for better localization of focal uptake to atherosclerotic lesions as well as providing additional anatomic and biologic information on the lesion such as calcification.
Non-invasive imaging techniques to assess myocardial perfusion
Published in Expert Review of Medical Devices, 2020
Olivier Villemain, Jérôme Baranger, Zakaria Jalal, Christopher Lam, Jérémie Calais, Mathieu Pernot, Barbara Cifra, Mark K. Friedberg, Luc Mertens
Myocardial perfusion is a critical parameter in cardiology. In basic research, in physiology, and in clinical practice. Its analysis has given us a better understanding of the normal heart function and its perfusion abnormalities. Over the last 10 years, technological improvements in various imaging techniques have made it possible to perform reliable and noninvasive analysis of myocardial perfusion. Each imaging technique brings added value and perspective essential to optimize patient management. Ultrasound naturally has a special place in the future. Its excellent spatial resolution and above all its potential very high image rate (with the advent of ultrafast imaging) make it an extremely interesting tool to better understand myocardial microperfusion and its variation in real time. Nuclear myocardial perfusion imaging could be interesting to diagnose early asymptomatic CAD or to know the functional significance of known CAD. Its relatively low spatial and temporal resolution and the need to use tracers are its main limitations. Nevertheless, NMPI provides access to metabolic and functional analysis that no other imaging technique can provide. Finally, cut imaging techniques with MRI and CT. They are a perfect complement to the previous techniques mentioned.
Toward applying a device to reduce motion artifact during imaging: a randomized controlled trial
Published in Expert Review of Medical Devices, 2022
Seyed Mohsen Zahraei-Moghaddam, Mahdi Haghighatafshar, Fatemeh Shekoohi-Shooli, Shima Miladi, Farinaz Farhoudi
Myocardial perfusion imaging (MPI) is the most widely used approach in the diagnosis, treatment planning, risk stratification, and evaluation of the prognosis for coronary artery disease (CAD) over the last three decades [1,2].