Cardiac CT and Cardiac PET 82 Rb imaging. Raymond T Endozo Radiographer

Transcription

1 Cardiac CT and Cardiac PET 82 Rb imaging Raymond T Endozo Radiographer

2 Production of Rubidium-82

3 Radiotracer Tracer Half Life Production Method Rb sec Generator N-13 Ammonia 9.8 min Cyclotron O-15 Water 2.4 min Cyclotron Fluorine 18 (18F) flurpiridaz 110 min Cyclotron

4 82 RUBIDIUM 13 N-ammonia Product Generator Cyclotron Half Life 76 s 9.96 min Mean Positron n range 2.6 mm 0.7-mm Second study Without delay 30 mins delay Extraction 50%-60% 80%

5 PET with the use of short-lived radiopharmaceuticals results in substantially lower radiation doses to patients than does SPECT

6 Recommendations for Reducing Radiation Exposure in Myocardial Perfusion Imaging Cerqueira et al, ASNC information statement, Jnucl Cardiol

7 Cardiac PET Imaging Perfusion studies (Rubidium 82) Rest-stress perfusion imaging Detection of coronary artery disease and assessing the progression of coronary artery disease May be used in place of or following an equivocal SPECT study 18F-FDG Perfusion-metabolism imaging Identification of tissue that may recover contractile function following revascularization techniques

8 Cardiac pet (Rubidium) optimizes your clinical environment Faster Imaging, Greater Throughput Ready on Demand,No waiting on delivery A Positive Imaging Experience for Your Patients and Staff PET is suitable for your patients, including those... Result in a suboptimal scan Unable to exercise EMERGENCY

9 Good Quality Cardiac PET Count density -Poor count ( poor intravenous access, inadequate scan duration) Blood Pool Clearance 90s delay 150s delay Transmission-Emission Misalignment

10 CT Transmission-PET Emission Misalignment CT Transmission-PET Emission Alignment stress Rest Misregistration Artefact stress Rest Misregistration Corrected Teaching Point: Carefully review all CT transmission and PET RB emission images for adequate registration prior to finalizing the interpretation of the case

11 List-mode Cardiac PET Acquisition ECG Gated Dynamic LV Function Absolute Quantification

12 Flow Quantification : How it is changing MPI Macrovascular Perfusion Defect MPI Microvascular Reduced MBF Reserve (ml/min/g) FLOW

13 79/ M Reassessment CABG 1991 ( 4x graft) LIMA to LAD, SVG to RCA, DIAGONAL and OM

14 Flow Quantification : How it is changing MPI PET MPI FUSED CCTA and MPI FLOW STRESS REST MPI CT FLOW RCA Normal Occluded Graft-RCA 0.82 LAD Ischemia Occluded Graft -Diag 0.59 CIRC Mild Ischemia 70 % stenosis Graft 0.70

15 Coronary Calcium score Non-contrast-enhanced, ECG gated Easy-to-perform No preparation Radiation dose is minimal

16 Calcium score ROI drawn Measured parameters: area=a; density=d CAC score = A x D coefficient Originally developed with EBCT- subsequent MDCT High reproducibility, low radiation exposure Alternative scoring systems Volume scoring Mass scoring

17 Calcium score >1000 Agaston score

18 0 calcium score > 400 Tip of the Iceberg Calcium > 400 HU Patterns: - Speckled (unstable) - Fragmented - Diffuse

19 A Added value of a Calcium score in patients with Normal PET MPI B STRESS REST Total Score- 0 Total Score- 950

20 Cardiac CT Angiography

21 There are two scanning modes: Spiral and Axial Prospective ECG triggering Retrospective ECG gating

22 Prospective ECG Gating in Action Prospective ECG-Triggered Acquisition

23 Spiral CT Scanning in Action Selected Phase Retrospective ECG-Gated Reconstruction

24 Indications 1. Heart rate >65 bpm Contraindications: 1. Asthma or COPD 2. AV Block 2 nd or 3 rd degree 3. Heart failure 4. Active Bronchospasm 5. Allergy to Beta Blocker 6. Systolic BP <100 mm Hg Beta blocker helps image quality 1.Promote a more stable heart rate 2.Better chance of freezing the motion of the heart 3.Better dose optimization

25 Hiatus hernia Pulmonary embolism lymph nodes Pulmonary nodules Pleural effusion Hepatic cysts Pulmonary infiltrates Interstitial lung disease Incidental findings abound in cardiac CT imaging

26 Incidental findings in Cardiac CT imaging

27 Cardiac PET RB82 and Cardiac CT Protocol Adenosine Rb-82 Rb-82 Scout scout Cardiac CT CT-trans Stress-Dynamic Rest Dynamic Cal score 2 min

28 Case-1 64/F Atypical chest pain Irregular heart beat Hypertensive

29 CT MPI CATH FUSED-MPI and CT

30 Case-2 43 /M Presented with chest pain and ECG changes.? RCA anomalous origin

31 MPI MPI CATH CT

32 47/M Case-3 Chest pain and SOB on exertion. Hypertension??Anomolous RCA origin coming off the Main Pulmonary artery or L PA CT Coronary angiogram and perfusion scan

33 CATH MPI CT

34 Summary Accuracy/ Speed Greater Throughput Positive Experience

35 Acknowledgements Prof Ashley Groves Prof Peter Ell Dr Jamshed Bomanji Dr.John Dickson Ms Marguerite Meintjes Ms Caroline Towsend