PET myocardial

Question 1

which Rp used for PET myocardial perfusion?

Answer 1

N13-ammonia
Rb82-Rubidium Chloride

Question 2

Which Pet Rp used for myocardial viability?

Answer 2

F-18-FDG

Question 3

Identify characteristic of Rb82? production, t1/2, imaging time?

Answer 3

• Sr82/Rb-82 generator
• T1/2 75secs
• can evaluate myocardial viability
• image 70sec after infusion
  may complete both rest and stress in 1 hr

Question 4

Identify characteristic of N13

Answer 4

• cyclotron product
• t1/2= 10mins
• Fasting 4-6hr
• image 3min post injection
• Uptake proportional to blood flow, Diffusion

Question 5

Identify indication for Myocardial PET?

Answer 5

• detection of CAD
• detection of hibernating myocardium in conjunction with F18-FDG

Question 6

Identify patient prep for Myocardial PET imaging

Answer 6

• NPO 4-6 hr
• discontinue all cardioactive medication
• ## Nothing containing caffeine for 12hr

Question 7

Rp/Dose and Equipment for myocardial PET imaging?

Answer 7

• N13-Ammonia 20mCi for both rest and stress
• Rb82Rubidium Chloride 40-60mCi at both rest and stress less than 30 secs
• Equipment: Collimator 2D mode (septa in FOV), Collimator 3D mode for Rb-82

Question 8

Acquisition protocol for N13-Ammonia

Answer 8

• supine
• arms up
• Inject N13 bolus and wait 1.5-3min
• Acquire rest image 10-15mins
• Perform pharmacologic stress then inject N13 at peak
• wait 1.5-3min then stress image

Question 9

Acquisition protocol for Rb-82 Rubidium Chloride

Answer 9

• Supine, arm up
• Rest images first
• Infuse Rb82 in 30sec
• Image time is dependent on LVEF>50% start 70-90 sec after infusion
  LEVF 30-50% 90-110 secs after infusion
  LVEF <30% 110-130 secs afer infusion
• After rest, patient remains in scanner and start dipyridamole stress test
• inject rate 142 ug/kg/min over 4min
• Start infusion Rb82 4 min post
• acquire stress images

Question 10

what happen with an area with decreased perfusion FDG image but relatively increased in viability FDG image?

Answer 10

identifies ischemic but viable tissue

Question 11

Identify the indication for myocardial PET viability?

Answer 11

• Detection of ischemic but viable, myocardium particularly hibernating myocardium
• evaluation of patient with cardiomyopathy who are being considered for either coronary revascularization or heart transplantation

Question 12

patient prep for PET F18-FDG perfusion

Answer 12

-Fasting 6hr, water is permitted
- eat high carbohydrate 2hrs
- Diabetic should take medication with high carbohydrate meal
- BG level 100-140 mg/dl

Question 13

Identify the Rp/dose and equipment for PET viability

Answer 13

Rp: F18-FDG 5-15 mCi
Equipment collimator 2D mode (septa FOV), 3D may used, ECG gating device

Question 14

Acquisition Myocardial PET viability

Answer 14

• Patient empty bladder
• Supine, arm up
• Image around 45 post injection
• Emission data acquisition with gating 15mins
• transmission data acquisition

Question 15

What is the advantage of myocardial PET imaging

Answer 15

• High energy level decrease amount of attenuation
• Transmission image can be obtained which allow accurate attenuation correction to be performed better accuracy
• Better collimation better resolution
• True stress function analysis
• Reduce radiation

Question 16

What is the disadvantage of myocardial PET imaging?

Answer 16

• Cost higher
• PET camera and cyclotron must be available
• Technical expertise limited

Question 17

What are three standard reconstructed cardiac view?

Answer 17

• Vertical long axis
• Horizontal long axis
• Short axis

Question 18

Why cinematic displat is necessary?

Answer 18

Detect motion, major changes in cardiac position during acquisition, and technical problems such as missed or duplicated angles.
- Maximum amount 2pixel allowed in motion detection

Question 19

why we imaging patient in the prone position?

Answer 19

better images of the inferior wall
elimination of attenuation from diaphragm

Question 20

what time frame used for F18 viability imaging?

Answer 20

45mins