MPI

Question 1

An adjuct to exercise treadmill testing which uses a monovalent cation with biologic properties similar to POTASSIUM

Answer 1

Thallium-201

Question 2

An ion which is virtually absent in scarred myocardium

Answer 2

Potassium

Question 3

Thallium-201 physical half life ?

Answer 3

73 hrs

Question 4

How many percent is the first pass extraction of Thallium-201?

Answer 4

85%

Question 5

What do you mean by first pass extraction fraction?

Answer 5

The proportion of tracer extracted from the blood as it passes through the myocardium?

Question 6

Peak myocardial concentration of Thallium

Answer 6

5 minutes

Question 7

A process wherein there is more rapid thallium clearance from normal myocardium than in an ischemic myocardium.

Answer 7

Differential washout

Question 8

Most common SPECT MPI imaging artifact in women

Answer 8

Breast attenuation

Question 9

Most common SPECT MPI imaging in men

Answer 9

Inferobasal wall attenuation

Question 10

2 examples of lipid soluble cationic compound with first pass extraction fraction ~ 60%

Answer 10

Sestamibi and tetrosformin

Question 11

The only SPECT tracer with physical half life of 73Hours

Answer 11

Thallium 201

Question 12

The only SPECT tracer with active uptake in the myocardium

Answer 12

Thallium 201

Passive uptake: 99m Tc Sestamibi, 99m Tc Tertrosfotmin, 99m Tc Teboroxime

Question 13

How many segments of myocardium in segmentation model?

Answer 13

17

Question 14

The sum of the segmental scores from the stress images which represents the extent and severity of stress perfusion abnormality

Answer 14

Summed stress score

Question 15

Patients with lung uptake after stress that is not present at rest would indicate

Answer 15

Severe multivessel diasease
Elevated PCWP
Low EF during exercise

All implying Extensive Myocardial ischemia

Question 16

Refers to imaging pattern in which the left ventriclular cavity appears larger on the stress imsges than those obtained with patient at rest

Answer 16

TID or transient ischemic dilatation

Question 17

A postive Lung uptake and TID indicates

Answer 17

Extensive CAD

Question 18

Give examples of common normal variations in SPECT imaging

Answer 18

1. Dropout of upper septum 2 to merging of the muscular septum with membranous septum
2. Apical thinning
3. Lateral wall brighter than contralateral septum (spect closer to lateral wall)

Question 19

Refers to undetected events in the heart caused by onteraction of photons with intervening soft tissue, breast or diaphragm

Answer 19

Photon Attenuation

Question 20

This artifact may be caused by extracardiac structures, such as the diaphragm overlapping thr inferior wall

Answer 20

Inferior wall attenuation

Question 21

A maneuver to minimize inferior wall attenuation

Answer 21

prone position

Question 22

Equilibrium technique is also referred to as

Answer 22

multiple gated acquisition (MUGA)

Question 23

FDA approved PET perfusion tracers

Answer 23

82Rb, 13N-ammonia and FDG

Question 24

It is a cation, with biologic properties similar to potassium and thallium, & uptake across the sarcolemmal membrane reflects active transport by the Na-K- ATPasr pump

Answer 24

82Rb

Question 25

An extractable perfusion tracer, transported by passive diffusion or by Na-K transport mechanism

Answer 25

13N Ammonia

Question 26

Anatomic gold standard imaging for CAD

Answer 26

Coronary angiography

Question 27

Functional standard imaging for CAD

Answer 27

FFR or fractional flow reserve

Question 28

The magnitude of blood flow increase 2 to any stress relative to floe values is termed as

Answer 28

Coronary blood flow reserve

Question 29

At what percentage of upstream coronary stenosis will begin to decrease the coronary blood flow reserve

Answer 29

50%

Question 30

Stress-indiced perfusion abnormalities in regions that exhibit normal perfusion at rest are termed as

Answer 30

Reversible perfusion defect

Question 31

The preferred modality to induce coronary hyperemia because it allows a correlation between exertional symtoms and the perfusion pattern and provides information on exercise duration, workload achieved, and presence and extent of ischemic electrocardiographic changes

Answer 31

Exercise Stress

Question 32

A powerful, endogenous molecule that act as refulator of blood flow in many organ beds, including coronary circulation

Answer 32

Adenosine

Question 33

Type of adenosine receptor present in SA and AV nodes

Answer 33

A1 receptor A2b in brochioles and peripheral vasculature

Question 34

An indirect coronary arteriolar vasodilator, increasing intracellular and interstitial concentration of adenosine

Answer 34

Dipyridamole

Question 35

A new agent that directly interacts with A2a receptor

Answer 35

Regadenoson

Question 36

This phenomenon appears to occur when the myocardial perfusion bed supplied by severe epicardial stenosis also is dependent on collateral vessels from remote coronary ateries

Answer 36

Coronary steal phenomenon

Question 37

Side effects of pharmacologic vasodilator stress (50% with dipyridamole and 80% with adenosine)

Answer 37

Flushing, chest pain and SOB

Question 38

AV block may be develop during administration of this pharmacilogic. vasodilator

Answer 38

Adenosine

Question 39

Examples of pharmagoloc vasodilator stress reversal agents

Answer 39

Theophylline, Caffeine and Aminophylline

Question 40

It is abroadadrenergic receptor agonist, at varyinh doses stimulating the B1, B2 and A1 receptors

Answer 40

Dobutamine

Question 41

acute and chronic adaptation to a temporary sustained reduction on coronary blood flow is called

Answer 41

Stunning / Hibernation/ Ischemic preconditioning

Question 42

The myocardial function is depressed at rest, but myocytes remain viable is observe on this type(s) of adaptation

Answer 42

Stunned and hibernating myocardium

Question 43

It most often observed after a transient peripd of ischemia followed by reperfusion (DEPRESSED FUNCTION AT REST BUT PRESERVED PERFUSION)

Answer 43

Stunned myocardium

Question 44

It refers to adaptivr resoonses of the myocardium to repetitive episodes of ischrmka resulting in myocardial hypoperfusion at rest (DEPRESSED FUNCTION AND PERFUSION AT REST)

Answer 44

Hibernating myocardium

Question 45

What are the requirements for myocardial viability?

Answer 45

1) sufficient blood flow 2. ) cell membrane integrity 3. ) preserved metabolic activity

Question 46

2 metabolic sources of ATP generation in the myocardium

Answer 46

Oxidative phosphorylation and Glycolysis

Question 47

The principle of using a metabolic tracer that tracks glycolysis is based on the concept that glucose utilization may be preserved or increased relative to flow in the hypoperfused but viable myocardiuum

Answer 47

Metabolism perfusion mismatch

Question 48

It is a glucose analogue used to image myocardial glucose use with PET

Answer 48

FDG or 2-18F-Fluoro-2-Depxyglucose

Question 49

It is extracted by the myocardium and metabolized by conversion to 11C-acetyl-CoA in the cytosol and by oxidation via the TRicarboxylic acid cycle in the mitochondra to 11C-carbon dioxide and water

Answer 49

11C- Acetate

Question 50

This trial investigates the concept of revascularization among stable outpatients with extensive inducible ischemia

Answer 50

ISCHEMIA trial