Nuclear imaging in clinical cardiology

Transcription

1 Nuclear imaging in clinical cardiology

2 DEVELOPMENTS IN CARDIOVASCULAR MEDICINE Other volumes in this series: Lancee CT, ed: Echocardiology, ISBN Baan J, Arntzenius AC, Yellin EL, eds: Cardiac dynamics ISBN Thalen HJT, Meere CC, eds: Fundamentals of cardiac pacing ISBN Kulbertus HE, Wellens HJJ, eds: Sudden death ISBN X. Dreifus LS, Brest AN, eds: Clinical applications of cardiovascular drugs ISBN Spencer MP, Reid JM, eds: Cerebrovascular evaluation with Doppler ultrasound ISBN Zipes DP, Bailey JC, Elharrar V, eds: The slow inward current and cardiac arrhythmias ISBN Kesteloot H, Joossens JV, eds: Epidemiology of arterial blood pressure ISBN Wackers FJT, ed: Thallium-201 and technetium-99m-pyrophosphate myocardial imaging in the coronary care unit ISBN Maseri A, Marchesi C, Chierchia S, Trivella MO, eds: Coronary care units ISBN Morganroth J, Moore EN, Dreifus LS, Michelson EL, eds: The evaluation of new antiarrhythmic drugs ISBN Alboni P: Intraventricular conduction disturbanges ISBN X. Rijsterborgh H, ed: Echocardiology ISBN Wagner OS, ed: Myocardial infarction: Measurement and intervention ISBN Meltzer RS, Roelandt J, eds: Contrast echocardiography ISBN Amery A, Fagard R, Lijnen R, Staessen J, eds: Hypertensive cardiovascular disease; pathophysiology and treatment ISBN Bouman LN, Jongsma HJ, eds: Cardiac rate and rhythm ISBN Morganroth J, Moore EN, eds: The evaluation of beta blocker and calcium antagonist drugs ISBN Rosenbaum MB, ed: Frontiers of cardiac electrophysiology ISBN Roelandt J, Hugenholtz PO, eds: Long-term ambulatory electrocardiography ISBN Adgey AAJ, ed: Acute phase of ischemic heart disease and myocardial infarction ISBN Hanrath P, Bleifeld W, Souquet J, eds: Cardiovascular diagnosis by ultrasound. Transesophageal, computerized, contrast, Doppler echocardiography ISBN Roelandt J, ed: The practice of M-mode and two-dimensional echocardiography ISBN Meyer J, Schweizer P, Erbel R, eds: Advances in noninvasive cardiology ISBN Morganroth J, Moore EN, eds: Sudden cardiac death and congestive heart failure: Diagnosis and treatment ISBN Perry HM, ed: Lifelong management of hypertension. ISBN Jaffe EA, ed: Biology of endothelial cells. ISBN Surawicz B, Reddy CP, Prystowsky EN, eds: Tachycardias. ISBN Spencer MP, ed: Cardiac Doppler diagnosis. ISBN Villareal HV, Sambhi MP, eds: Topics in pathophysiology of hypertension. ISBN Messerli FH, ed: Cardiovascular disease in the elderly. ISBN

3 Nuclear imaging in clinical cardiology edited by M.L. SIMOONS, MD J.H.C. REIBER, PhD Thoraxcenter Academic Hospital Dijkzigt Erasmus University, Rotterdam The Netherlands 1984 MARTINUS NIJHOFF PUBLISHERS... a member of the KLUWER ACADEMIC PUBLISHERS GROUP 1111 BOSTON / THE HAGUE / DORDRECHT / LANCASTER...

4 Distributors jor the United States and Canada: Kluwer Boston, Inc., 190 Old Derby Street, Hingham, MA 02043, USA jor all other countries: Kluwer Academic Publishers Group, Distribution Center, P.O.Box 322, 3300 AH Dordrecht, The Netherlands Library of Congress Cataloging in Publication Data Library of Congrt'ss Cataloging in Publil'ation Data Main entry under title: Nuclear imaging in clinical cardiology. (Developments in cardiovascular medicine Includes index. 1. Radioisotope scanning--addresses, essays, lectures. 2. Heart--Diseases--Diagnosis--Addresses, essays, lectures. I. Simoons, M. L. II. Reiber, J. H. C. III. Series. Rc683.5.R33N ' ISBN-13: e-isbn-13: DOl: ISBN-I3: Copyright 1984 by Martinus Nijhoff Publishers, Boston. Softcover reprint of the hardcover 1st edition 1984 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publishers, Martinus Nijhoff Publishers, 190 Old Derby Street, Hingham, MA 02043, USA.

5 Contents Introduction VII List of contributors IX 1. Introduction to imaging of the heart: Contrast angiography, digital angiography, nuclear imaging, echocardiography 1 Maarten L. Simoons 2. Characteristics of radiopharmaceuticals in nuclear cardiology. Implications for practical cardiac imaging 19 Frans 1.Th. Wackers 3. Myocardial blood flow: clinical application and recent advances 39 Richard Wilson, Michael Shea, Christian de Landsheere, 10hn Deanfield, Adrian Lammetsma, David Terton, Andrew Selwyn 4. Value and limitations of myocardial scintigraphy with thallium-201 and long chain fatty acids for the detection of coronary artery disease 55 Robert D. Okada 5. Myocardial imaging with radiolabeled free fatty acids 83 Ernst E. van der Wall 6. Quantitative analysis of the distribution and washout ofthallium-201 in the myocardium: description of the method and its clinical applications 103 lamshid Maddahi, Ernest V. Garcia, Daniel S. Berman 7. First-pass and equilibrium radio nuclide angiocardiography for evaluating ventricular performance 125 Barry L. Zaret, Harvey 1. Berger 8. The detection of intracardiac shunts and valvular regurgitation by radionuclide angiography 153 Pierre Rigo

6 VI 9. Review of methods for computer analysis of global and regional left ventricular function from equilibrium gated blood pool scintigrams 173 Johan H.C. Reiber 10. Probability analysis for noninvasive evaluation of patients with suspected coronary artery disease 219 Jacques Melin, William Wijns, Jean-Marie Detry 11. Standards for acquisition, data analysis and interpretation of myocardial scintigraphy and blood pool scintigraphy 233 Duncan S. Dymond Index of subjects 253

7 Introduction In recent years methods have been developed to study cardiac function, myocardial blood flow and myocardial metabolism with radionuclides. These developments have been facilitated through the introduction of new radiopharmaceuticals, the design of special gamma cameras and dedicated computer systems. However, part of the information provided by nuclear cardiology can also be obtained through other investigations such as echocardiography, exercise electrocardiography and cardiac catheterisation with ventriculography and coronary arteriography. Thus the practising physician must select the most appropriate methodes) of investigation for each patient. Such choices should be based on proper understanding of both the value and the restrictions of each method. In this book the state-of-the-art in nuclear cardiology is reviewed, including radionuclide angiography for analysis of left and right ventricular function and for measurement of shunts and regurgitation volumes, perfusion scintigraphy and other methods for measurement of myocardial bloodflow and metabolism and computer processing of radio nuclide Images. Each chapter has been written by an expert from either Europe or the USA, who has contributed to the developments in his particular field. The principles of each method of investigation are described, as well as the precautions that should be taken in order to obtain high quality data. Guidelines are provided for the interpretation ofthe data based on studies in various centers where the methods were developed and tested. We hope that this book will help the clinical cardiologist or internist to understand the value and the limitations of nuclear cardiology for diagnosis and functional evaluation of patients with heart disease. M.L. Simoons J.H.C. Reiber

8 List of contributors Berger, H.J., MD, Yale University School of Medicine, Section of Nuclear Medicine, 87 LMP, 333 Cedar Street, New Haven, CT 06510, USA. Berman, D.S., MD, Departments of Medicine and Radiology, UCLA School of Medicine, Los Angeles, CA 90048, USA. Deanfield, J., MD, ChB, MRCP, MRC Cyclotron Unit and Cardiovascular Unit, Hammersmith Hospital, Royal Postgraduate Medical School, Ducane Road, London W12 OHS, UK. Detry, J.M., MD, Cliniques Universitaires st. Luc, 10 Avenue Hippocrate, B-1200 Brussels, BELGIUM. Dymond, D.S., MD, Cardiac Department, St. Bartholomew's Hospital, London, EC1A 7BE, UK. Garcia, E.V., PhD, Department of Nuclear Medicine, Cedars-Sinai Medical Center, P.O. Box 48750, Los Angeles, CA 90048, USA. Lammetsma, A., PhD, MRC Cyclotron Unit and Cardiovascular Unit, Hammersmith Hospital, Royal Postgraduate Medical School, Ducane Road, London W12 OHS, UK. Landsheere, Chr. de, MD, MRC Cyclotron Unit and Cardiovascular Unit, Hammersmith Hospital, Royal Postgraduate Medical School, Ducane Road, London W12 OHS, UK. Maddahi, J., MD, Division of Cardiology, Cedars-Sinai Medical Center, P.O. Box 48750, Los Angeles, CA 90048, USA. Melin, J.A., MD, Cliniques Universitaires St. Luc, 10 Avenue Hippocrate, B-1200 Brussels, BELGIUM. Okada, R.D., MD, Cardiac Unit, Massachusetts General Hospital, Boston, MA 02114, USA. Reiber, J.H.C., PhD, Thoraxcenter, Erasmus University, Dr. Molewaterplein 40,3015 GD Rotterdam, THE NETHERLANDS. Rigo, P., MD, Department of Nuclear Medicine & Cardiology, University of Liege, Hopital de Baviere, 66 Boulevard de la Constitution, B-4020 Liege, BELGIUM. Selwyn, A., MD, MRC Cyclotron Unit and Cardiovascular Unit, Hammersmith Hospital, Royal Postgraduate Medical School, Ducane Road, London W12 OHS, UK. Simoons, M.L., MD, Thoraxcenter, Erasmus University, Dr. Molewaterplein 40, 3015 GD Rotterdam, THE NETHERLANDS. Shea, M., MD, MRC Cyclotron Unit and Cardiovascular Unit, Hammersmith Hospital, Royal Postgraduate Medical School, Ducane Road, London W12 OHS, UK. Terton, D., BSc, MRC Cyclotron Unit and Cardiovascular Unit, Hammersmith Hospital, Royal Postgraduate Medical School, Ducane Road, London W12 OHS, UK. Wackers, F.J. Th., MD, University of Vermont, College of Medicine, Section of Cardiology, Burlington, VT 05401, USA. Wall, E.E. van der, MD, Interuniversity Cardiology Institute and Cardiology Department, Free U n i v ~ rhospital, s i t y De Boelelaan 1117, 1007 MB Amsterdam, THE NETHERLANDS.

9 x Wilson, R., MD, MRC Cyclotron Unit and Cardiovascular Unit, Hammersmith Hospital, Royal Postgraduate Medical School, Ducane Road, London W12 OHS, UK. Wijns, W., MD, Cliniques Universitaires St. Luc, 10 Avenue Hippocrate, B-1200 Brussels, BELGIUM. Zaret, B.L., MD, Yale University School of Medicine, Section of Cardiology, 87 LMP, 333 Cedar Street, New Haven, CT 06510, USA.