Atlas of Myocardial Perfusion SPECT

Finn Mannting
Puneet K Chandak	Yanina V Zabrodina	B Leonard Holman

GENERAL TUTORIALS
Normal Myocardial Perfusion SPECT Imaging	Nomenclature and abbreviations Anatomical orientation Coronary artery territories Normal study
Cardiac Pathophysiology	Myocardial perfusion LV - mass LV - volume RV - mass RV - volume
Basic Imaging Quality Control	Motion Normalization / Extracardiac activity Count rates Alignment
Radiopharmaceuticals	Thallium-201 Technetium-99m-Sestamibi Technetium-99m-Tetrofosmin
Stress Protocols	Bicycle Treadmill Pharmacological
Imaging Protocols	One-day Technetium-99m protocol Two-day Technetium-99m protocol Thallium-201 Myocardial viability
Quantification	CEqual
TEACHING CASES These include case histories, stress test data, images, findings (text explanations and annotated images), and comments. Short tutorials are also provided with some cases.
Normal Variants	Short septum (Case 1) Short septum (Case 2) Apical thinning Short septum and Apical thinning Breast attenuation Diaphragmatic attenuation Papillary muscle
Artifacts - Pitfalls	Horizontal motion Vertical motion Liver uptake Bowel uptake Bowel and liver uptake Low counts Infiltration
Fixed Perfusion Defects (Myocardial Infarction)	Nontransmural inferior wall MI Transmural inferior wall MI True posterior-lateral wall MI Transmural anterior-apical-inferior wall MI Typical LAD MI in young man
Reversible Perfusion Defects (Myocardial Ischemia)	Severe stress-induced ischemia with Normal Baseline Moderate severe ischemia Severe and extensive ischemia Severe ischemia in residual myocardium Peri-infarct / residual myocardial ischemia Transmural / nontransmural MI with stress-induced ischemia Septal ischemia Collateral insufficiency
Multivessel Disease	Two-vessel disease (RCA+LCX) Two-vessel disease (RCA+LAD) Three-vessel disease (treadmill) Three-vessel disease (dipyridamole) Left main disease
LV Volume / Pressure Overload	TUTORIAL Primary dilated CMP Primary dilated CMP and CAD Dilated CMP sec to Hypertension (Case 1) Dilated CMP sec to Hypertension (Case 2) Dilated CMP LV dilatation sec to CAD (Case 1) LV dilatation sec to CAD (Case 2) LV dilatation sec to CAD (Case 3) LV dilatation sec to AS, AR, and MR LV dilatation sec to AS and CAD LV dilatation sec to AS / AR LV dilatation sec to AR
RV Pressure Overload	TUTORIAL Mitral stenosis Ischemic cardiomyopathy Chronic obstructive pulmonary disease Primary pulmonary hypertension Restrictive pulmonary disease Idiopathic pulmonary fibrosis
Special Cases	Left bundle branch block (case 1) Left bundle branch block (case 2) Cocaine abuse Silent ischemia False-positive stress ECG Small artery diseases A case of stabbing chest pain! A case of broken heart! Increased lung uptake Myocarditis Reverse changes LV "dilatation"(Case 1) LV "dilatation"(Case 2) Subendocardial ischemia An unusual heart Acute embolic MI A Predictable False Positive ECG
Difficult Cases	Triple vessel disease Lateral wall ischemia Idiopathic subvalvular septal hypertrophy Anatomy versus function Apical ischemia Global ischemia Severe stress-induced inferior wall ischemia Early post PTCA imaging Early and late post PTCA imaging with restenosis Post PTCA + stent imaging
Myocardial Viability	Stress-induced and chronic ischemia Chronic ischemia: Hibernating myocardium (1) Chronic ischemia: Hibernating myocardium (2) Stunned Myocardium 24-hour imaging
Special Techniques	Gated SPECT Attenuation correction: simple linear Attenuation correction: transmission Dual isotope imaging

INTRO

COVER
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GLOSSARY OF ABBREVIATIONS USED

Atlas of Myocardial Perfusion SPECT
© Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Comments and errors to atlasspect@yahoo.com
Contributions and case related information through Fmannting@bics.bwh.harvard.edu
Initiated: Nov 19, 1995. Last updated: April 26, 1999.

Atlas of Myocardial Perfusion SPECT

CONTENTS