Radiopharmaceuticals for Cardiac Imaging

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Author:
asparkle23
ID:
205497
Filename:
Radiopharmaceuticals for Cardiac Imaging
Updated:
2013-03-06 20:09:05
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Pharmacy
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Description:
Tc, SPECT, and PET imaging
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  1. What is the sequence of events in CAD?
    • Endothelial inflammation
    • Plaque formation
    • Flow limiting CA stenoiss
    • Ischemia
    • Ventricular dysfunction
    • ECG abnormality
    • Chest pain
    • Infarctions
  2. What are the 4 cardiac imaging SPECT agents?
    1. Tl 201 Thallous Chloride

    2. Sestamibi<Cardiolite> (used for heart and breast img)

    3. Tetrofosmin <Myoview>(used for heart img)

    4. RBC's
  3. How is sestamibi labeled?
    1. Add Tc 04 to kit and heat in boiling water for 10 min

    Tc04 + citrate ------> Tc Citrate

    2.  Copper complex is broken; free MIBI ligands displace citrate forming Tc Sestamibi

    **MIBI is an oily liquid that has to be compounded to coppper**
  4. How is tetrofosmin labeled?
    1. Add up to 240 mCi of Na99mTcO4 in 4-8 mL in kit.

    2. Remove 2ml of N2 gas from vial to admit air.

    3. Incubate 15min, use w/n 12 hrs.

    *Hydrogen radical H+ and hydrated electron e- are reducing species.  Letting air into the vial allowes O2 to scavenge the reducing species*

    *Tetrofosmin is mixed with gluconate to keep it soluble*
  5. What are 3 PET imaging agents?
    • 1.Rb 82
    • 2. F18-FDG
    • 3. N-13 Ammonia
  6. Thallium has what type of transport and heart retention?
    • Active transport
    • Redistribution
    • -K+ analog, remains in heart longer than K+
  7. Which PET agents are perfusion markers and which are viability markers?
    • Blood flow markers:
    • -Rb82
    • -N13 Ammonia

    • Viability:
    • F18 FDG
  8. What are the 2 requirements for a MYOCARDIAL PERFUSION agent?
    • 1. High first pass extraction
    • 2. Remain fixed in the heart long enough to image
  9. What is the typical blood flow for rest and stress?
    • REST: .6-.8 mL/min/g
    • STRESS: 3-4 mL/min/g
  10. What are the 3 axis for cardiac tomography?
    • 1. Short axis
    • 2. Vertical long axis
    • 3. Horizontal long axis
  11. How does adenosine and dipyridamole work?
    • Both are vasodilators
    • Increase CA blood flow 4-5x

    • *Adenosine directly stimulates CA receptors WHILE
    • dipyridamole blocks adenosine re-uptake

    **Caffiene BAD bc it blocks adenosine from reaching receptors...stop 12 hrs prior**
  12. How is a Thallium redistribution study performed and what are the problems with it?
    • 1. STRESS: Inject 3-4 mCi; DTST 15 min
    • 2. WAIT 2.5-4 hr; take rest images

    • PROBLEMS:
    • Sensitivity is high but specificity is low
  13. What are the infusion rates for regadenosine, adenosine, dipyridamole?
    regadenosine:  BOLUS (inj given after)

    dipyridamole:  4 min (inj given after)

    adenosine: 6 min (inj given half way)
  14. How are cardiac images interpreted?
    • 1. Extent: Large, med, or small
    • 2. Severity: marked, moderate, mild, or questionable.
    • 3. Reversibility:
    •    Ischemia: completely reversible-partially reversible
    •    Scar: permanent (not reversible)
    • 4. Interpretation can be:
    • -Qualitative, semi-quantitative, quantitative
  15. Is survival better with revascularization or medical therapy?
    • REVASCULARIZATION
    • >10%
  16. What are 3 benefits of PET perfusion studies?
    • 1. Less attenuation artifacts
    • 2. Quantitative
    • 3. High signal to noise ratio
  17. Name the study sequence for Rb82 Chloride stress test
    • 1. Rest CT
    • 2. Rest Study (40 mCi)
    • 3. Stress Study (Regadenosine + 2nd inj)
    • 4. Stress CT
  18. What is special about F18 Flurpidaz?
    • Has a higher 1st pass extraction flow compared to MIBI and Tl 201
    • CAN DO exercise study
  19. What are the 3 goals of Myocardial Ventriculography?
    • 1. Assess ventricular wall motion abnormalities
    • (Hypokenesis, akenesis, dyskenesis)
    • 2. Assess systolic wall thickening
    • 3. Measure EF and volumes
  20. What are the 2 types of Myocardial Ventriculography studies?
    • 1. FIRST-PASS Angiogram Study
    • -IV bolus TcO4
    • evaluate R and L EF

    • 2. ECG Gated Equilibrium Study (MUGA)
    • -IV inj of RBC's, MIBI, Tetrofosmin
    • -Assess L EF only!!
  21. What are the 2 methods of tagging 99m Tc to RBC's?
    • 1. In Vivo
    • -Inject Sn-PYP (Sn associates with hemoglobin, reducing the Tc and allowing it to tag to hemoglobin)
    • -Wait 20 min
    • -Inj 30 mCi of TcO4

    • 2. Modified In Vivo Method
    • -Inject PYP; wait 20 min
    • -Remove 10mL blood w/ heparinized syringe containing 30 mCi of TcO4
    • -Incubate 10 min; reinject pt.
  22. State the formula for EF
     

    = EF
  23. What is the purpose of Viability assessment?
    Determine if revascularization would benefit the patient

    SPECT : Tl201 Thallium Chloride (Rest/Redistribution Study)

    PET: N13 or F18 FDG (Perfusion/ Metabolism Study)
  24. How do you perform a PET perfusion study with N13 Ammonia?
    • 1. High carb meal
    • 2. Inject 25 mCi
    • 3. Acquire CT image
    • 4. Wait 4 min to allow blood clearance
    • 5. Acquire PET images

    **Follow with F-18 FDG Metabolism Study (make sure glucose is within range; inj 15 mCi)**

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