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CUDURADA FAAFA

Myocardial perfusion 

(Hubin sida dhiigu u waraabiyo murqaha wadnaha)                                                   

Photo by: biomed.brown.edu

• Name of the procedure

• Indications

• Contraindications

• Patient Prep

• Radiopharmaceuticals

• Adjunct pharmaceuticals

• Acquisition parameters

• Computer processing  parameters

• Normal results

• Abnormal result

 

1-     Name of the procedure: S/R (persantine) myocardial perfusion (gated SPECT)

2-     Indications:

·        To evaluate the presence of myocardial infarction.

·        To assess the presence and extent of myocardial ischemia (reduced of blood flow due to obstruction in the vessels) 

3-       Contraindications:  Active asthma, COPD, wheezing; if patient using xanthenes (aminophylline, caffeine, and theophylline) in the last 12 hrs; systemic hypotension (systolic<90mmHg); or prior hypersensitivity to persantine. Sever aortic stenosis, sever obstructive hypertrophy cardiomyopathy, and sever orthostatic hypotension. For pregnant women can not be used for persantine.

 

4-       Patient Preparation:

·        Patient is not to have food and liquids. The patient should not take heart medication 6 hrs before the stress test. No caffeine after midnight (regular and decaf), chocolate products, and tea. No theophylline medications 48 hrs before the test ( Aerolite, Constant-T, Elixophylline, Primatene tablets, Quiborn, Slo-bid, TPHYL, Tedral SA, Theo-24, and Theox)

·        Rest injected myocardial perfusion: Patient should be fasting for at least 4 hrs before the test. Cardiac medications should be taken as usual when the test is performed to determine the effectiveness of medical therapy. Radiopaque objects (metal silicon, etc) in the area of the thorax should be removed before the imaging. In patient with sever coronary disease, it is good to administer nitroglycerin sublingually about 3 minutes before rest injection of the radiopharmaceutical.

·        When persantine administered, aminophylline or caffeinated beverage can be employed after administration of the radiopharmaceutical to reverse the effects of the vasodilator.

 

5-     Radiopharmaceuticals:  These following radiopharmaceuticals are FDA approved for use as myocardial perfusion tracers: Tc-99m sestamibi (40 mCi). Root of administration Intravenously (I.V) and time to inject is 30 min. before imaging. When rest and stress studies are performed on separate days, the dose of the technetium-labeled agents may be 30 mCi.

 

·        Time to inject: Normally, this test takes 3 hrs. The first part takes about 1hr. Example: If you inject (Radiopharmaceutical) 8:00am, the imaging (Rest) will take place after 30 min (8:30am), and usually takes about 25 min. After the first test is done, the second test (stress) will take about 2 hrs. During the stress test, inject the second dose (30mCi of Tc-99m Sastemibi). Again the stress imaging will take place after 30-40 min the injection time. The stress imaging will take about 25 min.

·        How to inject: The patient will be given a small injection of Sestamibi in to a vein in his/her arm.

·        Route of injection:  Intravenous infusion of persantine in antecubital vein with patient supine: rate, 0.5mg/kg over 4 min in 20-40 ml of normal saline. Interavenous administration of Tl-201 or Tc-99m Sestamibi.

 

6-     Adjunct Pharmaceutical: side effects may be reversed by intravenous administration of 100-200 mg of aminophylline over 1 min

  

7-     Acquisition Parameters:  This can be either Planar or SPECT:

·        Planar Imaging: Images are usually performed with the patient supine position in three standard views: Anterior view, Left anterior oblique (LAO), and Left lateral view. Low energy all-purpose or high-resolution parallel-hole collimator is used.  Images are obtained with a minimum of 500,000 counts in each view or 10 min. Matrix is 64 x 64.

·        SPECT images: 180 degree collection is taken for this test. Images with Tl-201 will take 5-10 minutes after injection. Imaging with Tc-99m sestamibi will take 15-30 min after stress injection and 30-40 minutes after a rest injection. Either a step and shoot acquisition with 32 or 64 stops seprated by 3-6 degree is used. 40 seconds/image for Tl-201 and low dose Tc-99m Sestamibi, and 25 seconds/image for high dose Tc-99m Sestamibi. High resolution collimator is used for SPECT acquisition. Matrix is 64 x 64.

 

8-     Computer Processing Parameters:  Click Auto-perfusion twice, Click today and choose the patient’s name (choose Gated first and then rest second), hit Ok three times, Click set limits, done, then click accepted twice, and then choose the color (Gray scale or Spectrum), then click done; Set angles stress and while using the arrow center the image; Click accept; then set angles rest; click save oblique; then click done. After you make sure that rest pictures are similar to the stress ones, choose gray scale color to print the images.  For the second part (motion), click Goblique from the list of the patient’s name, click Ok, select inner + ED, then click surface display, and then type the EF % , type an amount and the radiopharmaceutical used; and then Print the images.

10- Normal Results: No Ischemia and Myocardial Infarction (MI). Normal Myocardial Blood Perfusion.

11-  Abnormal results:  There are Ischemia and Myocardial Infarction (MI). Abnormal Myocardial Blood Perfusion.

Photo by: Prighamrad. harvard.edu

This procedure manual was prepared by:

A/Razaq H. Nuurre

Nuclear Medicine

Ohio, USA