Quantitative Tools in Nuclear Cardiology: SPECTDr. Erick Alexánderson Rosas

• Myocardial perfusion» Visual evaluation» Semiquantitative» Quantative

• Infarct Size» Transmurality » Viability» Percent of myocardial burden

• Gated SPECT» Wall thickness - Wall motion» Left Ventricular Ejection Fraction» Ventricular Volumes

How do we do it?First point

3 axis orientation

Visual asessmentSecond point

Severity of ischemia

E

R

E

R

E

R

E

RNormal

Moderately abnormal

Severelyabnormal

Mildlyabnormal

Infarction

Stress

Rest

Stress

Rest

Rest

Stress

SPECT

Author, year (reference) Number of pts Tracer Stress Sensitivity% Specificity%

Iskandrian, 1989 (4) 193 Thalium 201 Physical 86 62Maddahi, 1989 (5) 110 Thalium 201 Physical 95 56Mahmarian, 1990 (6) 296 Thalium 201 Physical 87 87Cramer, 1994 (11) 38 Thalium 201 Dipiridamol 90 71Kapur, 2002 (14) 2560 MIBI Adenosine 91 87

SENSITIVITY: 90 %SPECIFICITY: 73%

Semiquantitative asessmentThird point

Perfusion defectNormalMild ModerateSevereAbsent

Score01234

Perfusion defects scale

Wall motionMotion defect

NormalMild hipokinesisModerate hipokinesisSevere hipokinesisAkinesisDyskinesis

Score012345

Quantitative asessmentFourth point

SPECTSPECT

Generalidades

ViabilidadPerfusión

Miocárdica

Función ventricular

SPECT / CT

Fifth point

Case 1

• 56 yo male• Hypertension 3 years• Dyslipidemia 7 years before• Actual symptoms

– Effort angina– Dyspnea to minimal exercise, ocassionally

orthopnea

In the very near future . . .