E4713. Going Beyond Ischemia: Maximizing the Value of Myocardial Perfusion Imaging
  1. Michael Dearborn; Brooke Army Medical Center
  2. Rutger Gunther; San Antonio Uniformed Services Health Consortium
Nuclear cardiology comprises approximately half of nuclear medicine studies within the United States, with specific emphasis on myocardial perfusion imaging (MPI). Target patient groups range from those with either acute or nonacute chest pain to asymptomatic individuals at high risk for coronary artery disease or new onset heart failure. Additionally, MPI is utilized for risk stratification for surgical procedures. This wide impact is well suited to optimize data collection and offer more than just an evaluation for myocardial ischemia. This exhibit will illustrate the value of MPI and provide examples that can maximize each patient encounter.

Educational Goals / Teaching Points
After reviewing this exhibit, the viewer should be able to describe simple MPI protocols and interpret routine MPI studies. Moreover, viewers will be able to recognize the potential for acquiring clinically relevant data for each patient in the setting of MPI, thus the examination is optimized to deliver added value to the clinician. Such examples include (but are not limited) obtaining POC glucose prior to imaging acquisition to correlate for diabetes, benefits of different 99Tc-labeled radiotracers (sestamibi versus tetrofosmin), utilizing automated quality control measures during image acquisition to illustrate beat variability and end-diastolic values, quantifying ejection fraction, and identifying diastolic dysfunction through peak filling rate and time to peak filling in the setting of quantitative gated spectroscopy. Lastly, data from the nuclear medicine and nuclear cardiology literature will emphasize how early recognition can positively affect long-term management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will use cases from a level 1 tertiary care center to demonstrate MPI and data collected through MPI acquisition. Cases will be presented SPECT, CT, CTA, 3D reconstructions, and ECG. A dedicated discussion of the pertinent clinical findings and impact on management will be addressed, illustrating findings pertinent to the radiology report.

MPI is well-suited for evaluating myocardial ischemia but can offer much more in the appropriate setting. Typical MPI protocols and workflow can be optimized with minor adjustments and provide the ordering clinician with a more robust dataset, maximizing the value of the study for the patient.