Cardiac PET/CT

PET scans is used to evaluate the chemical function of tissues and organs, while other imaging techniques such as X-ray, CT and MRI scans show structure. How PET works: Rubidium-82, a radioactive tracer that emits subatomic particles called positrons, is injected into the patient's arm. The blood stream carries the positrons to the heart muscle. A special PET camera detects the emitted positrons and constructs a picture of the heart.

Three dimensional imaging of PET is often accomplished with the aid of a CT scan performed on the patient during the same session, in the same machine.
Cardiac CT is a test that uses an x-ray machine to take clear, detailed pictures of the heart.
How cardiac CT works: During the procedure, an x-ray machine moves around the patients body in a circle. The machine takes a picture of each part of the heart. A computer puts the pictures together to make a three-dimensional (3D) picture of the whole heart. Sometimes an iodine-based dye (contrast dye) is injected into one of the veins during the scan. The contrast dye highlights coronary (heart) arteries on the x-ray pictures. This type of CT scan is called a coronary CT angiography.

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Computed Tomography (CT) of a beating heart.

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Coronary CT Angiography showing plaque as white in the center of the image of the heart.

Cardiac CT Indications

Evaluation of chest pain with no previous known disease: able to exercise and no previous tests (intermediate risk) unable to exercise or ECG uninterpretable (low-to-intermediate risk) equivocal or uninterpretable stress test results normal ECG exercise test but ongoing symptoms. Evaluation of acute chest pain (emergency department): normal ECG and cardiac enzymes low-to-intermediate pretest probability of CAD. Evaluation of suspected coronary anomalies/complex congenital heart disease. Exclusion of CAD in new-onset heart failure/cardiomyopathy. Assessment of CABG patency and vascular mapping before repeat CABG surgery. Exclusion of significant CAD before non-coronary cardiac surgery. Investigation of left bundle branch block for suspected CAD as an aetiology.

Cardiac CT Contraindications

Absolute: - Hypersensitivity to iodinated contrast agent Relative:

- History of allergies or allergic reactions to other medications - Renal insufficiency (serum creatinine level of >1.5 mg/dL) - Congestive heart failure - History of thromboembolic disorders - Multiple myeloma - Hyperthyroidism - Pheochromocytoma - Atrial fibrillation - Inability to perform breath hold for 15 s

Cardiac MRI

It describes imaging technology that uses a large magnet and radiofrequency waves to produce high quality images of the heart. It is non-invasive and does not use ionizing radiation (X-rays) or iodinated contrast agents. Using MRI, we can obtain images of the heart and blood vessels from different angles and create moving images of the heart throughout its beating cycle. It is is becoming recognized as the "gold standard" for myocardial viability.

Cardiac MRI

Cardiac MRI Indications

Quantifying left and right ventricular function Cardiomyopathy Heart failure Arrythmogenic right ventircular dysplasia (ARVD) Pulmonary hypertension Defining cardiac anatomy Constrictive pericarditis Cardiac neoplasm or thrombus Congenital heart disease Demonstrating the presence of a patent foramen ovale (PFO) Myocardial Perfusion: for suspected ischemic heart disease (e.g. angina) Quantifying blood flow Valvular disease (e.g. aortic regurgitation, mitral regurgitation, aortic stenosis, etc.) Shunts: ASD, VSD, PAPVR, and PDA Assessing myocardial scar / viability Identifying hibernating myocardium before revascularization Differentiating cardiomyopathy from old myocarditis Coronary Artery MRA: for anomalous coronary arteries Special consideration should be made for patients: That are poor echo candidates (e.g. bad echo windows) That are poor nuclear candidates (e.g. obesity, large breasts, small size / women). Where quantification is important Who want to avoid a more invasive test (e.g. TEE, cardiac catheterization) Who want one comprehensive test rather than multiple tests

Cardiac MRI Contraindications

All patients with metallic implants are individually evaluated prior to MRI.
1.Central nervous system aneurysm clips 2.Cochlear implant 3.Implanted neural stimulator 4.Implanted cardiac pacemaker or defibrillator 5.Insulin pump 6.Ocular foreign body (e.g. metal shavings) 7.Metal shrapnel or bullet. 8.Other implanted medical devices: (e.g. drug infusion ports) 9.Pregnant women (Patients who are uncertain as to whether they are pregnant will be required to have a screening urine or blood pregnancy test).

Cardiac MRI is safe with coronary stents, joint replacements, ASD/PFO closure devices, sternal wires, and most prosthetic heart vales.