Cardiac Imaging

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Cardiac Imaging

Nuclear cardiology supports the world class Cardiovascular Medicine program at Cleveland Clinic by having an integrated program providing study interpretation and consultation by 7 nuclear medicine physicians, 2 of whom are Board certified in Cardiovascular Diseases, and 5 full time cardiologists. Our Laboratory is accredited by the American College of Radiology and all of our physicians are certified by the Certification Board of Nuclear Cardiology. We offer full service assessment of myocardial perfusion, viability and ventricular function using our State-of-the-Art SPECT/CT (3) and PET/CT (3) systems in combination with technetium, Rubidium-82, Nitrogen-13 ammonia and FDG tracers.

SPECT (Single Photon Emission Computed Tomographic) Myocardial Perfusion Imaging

  • Detect coronary artery disease and stratify risk for cardiac events in those with suspected or established CAD. We use technetium-99m tetrofosmin (Myoview) and 3 SPECT/CT hybrid imaging systems
    • Ability to get diagnostic studies in morbidly obese patients up to 500 lbs
    • Allow ECG gating to calculate an ejection fraction at rest and following stress
    • Correct for soft tissue attenuation using a CT map
    • Obtain a coronary artery calcium score which provides an independent measure of CAD extent and severity
    • Especially useful in patients in whom a stress ECG would be non-diagnostic for ischemia: paced rhythms, left bundle branch block, abnormal baseline ECGs or use of medications like digitalis
  • Stress Facilities
    • 4 Fully staffed Stress Rooms using Marquette Treadmills and ECG interpretation systems
    • Pharmacologic stress Agents
      • Regadenoson (Lexiscan)- Selective agent that can be used in patients with airway disease
      • Adenosine
      • Dipyridamole
      • Dobutamine
    • Combined Pharmacologic stress with low level exercise

PET/CT Myocardial Perfusion and Metabolic Imaging

  • Detection of CAD
    • PET/CT perfusion imaging using rubidium-82 or nitrogen-13 ammonia with dipyridamole pharmacologic stress has higher diagnostic accuracy than SPECT
    • PET synchronized to the EKG provides information on chamber size, segmental wall motion, and LVEF at rest and close to peak stress
    • 128 slice PET/CT system is capable of performing CT coronary angiography to correlate with perfusion images
  • 18FDG identification of hibernating myocardium
    • In absence of hibernation, non-contractile areas are unlikely to improve following PCI or CABG. Heart transplantation or aggressive medical treatment are best management options
    • The amount of myocardium with ischemia and hibernation predicts benefits of revascularization relative to the surgical risk in those with reduced cardiac pump function
  • PET perfusion images are synchronized to the patient’s EKG, and provide information on chamber size, segmental wall motion, and LVEF at rest and during stress

Gated Radionuclide Ventriculography (MUGA Scan)

  • Used to assess cardiac chamber size and function, monitor the impact of chemotherapy or other interventions on heart function, and identify hypokinetic areas of the left ventricle.
  • Provides a reproducible means of measuring left ventricular ejection fraction on serial studies acquired weeks to months apart.
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