Imaging -Yasmer

Question 1

What is nuclear medicine assessing?

Answer 1

physiology, not anatomy

–> myocardial perfusion study is the most common (look at images at rest and with stress)

Question 2

What 2 things have to occur for a normal myocardial perfusion study?

Answer 2

1. radiotracer has to be delivered to the myocardium (there must be blood flow)
2. myocardial cells have to take up the radio tracer (cells must be viable)

Question 3

What is the major difference in the Thallium-201 and the Tc-99m Sestambi test?

Answer 3

Thallium (TI)-201 has redistribution (gives more information about myocardial viability) while there is no redistribution in Tc-99m Sestambi

image quality is better for Tc-99m sestamibi

Question 4

Why do we do stress tests in studies?

Answer 4

we want to see how the coronary blood flow responds to an increased oxygen demand

image under stress to see if ischemia is present (hemodynamically significant)

Question 5

What are the areas that have decreased radio tracer uptake during stress but not at rest?

Answer 5

ischemia

can be reversible

Question 6

What are the areas that have decreased uptake in stress AND rest?

Answer 6

infarct

not viable—> will NOT benefit from revascularization

Question 7

What are the benefits of Cardiac CT?

Answer 7

you can directly see coronary artery stenosis

there is also a low chance of missing significant stenosis (no benefit in asymptomatic pts)

Question 8

What is the gold standard for coronary artery anomalies?

Answer 8

CT

Question 9

What is an MRI beneficial for?

Answer 9

quantifying chamber volume, myocardial mass and detecting infarcts without ionizing radiation (can see physiology)

-infarcts will show enhancement (white) on delayed images

Question 10

What is the major malignant coronary anomaly?

Answer 10

Left Main with right sided origin between aorta and pulmonary artery