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Planar and SPECT multi-gated acquisition

Case Study
SPECT/CT Clinical Science Philips Healthcare

Courtesy of Hartford Hospital in Hartford, CT, USA.

Clinical history

A 68 year-old male with a history of cancer and subsequent chemotherapy agreed to participate in a research study for implantation of a mechanical device. The patient has a family history of cardiac disease and cancer. He had a previous ultrasound echocardiology (Echo) exam to evaluate wall motion, ejection fraction, ventricular volumes and phase analysis of the right and left ventricle.

The patient was referred to Nuclear Cardiology for a Multi-Gated Acquisition (MUGA) study to evaluate wall motion, ejection fraction, ventricular volumes and phase analysis of ventricles.

Scan parameters
  • Patient receives IV to draw Red Blood Cells (RBC). After the cells are obtained, an in-vitro procedure begins for labeling them.
  • In a three step process the RBC are labeled with Technetium 99m. This process takes approximately 30 minutes.
  • A total of 30mCi of Technetium 99m was used to tag the cells
  • The patient's labeled RBC are re-injected and gated equilibrium images are obtained (Anterior, Left Anterior Oblique, and Left Posterior Oblique 2D Planar images). Total time: approximately 10 minutes per image.
  • After imaging in 2D, the patient underwent Gated 3D SPECT MUGA imaging. Total scan time: approximately 10 minutes.

Images and interpretation

 QBS Counts 3D QBS Surface
QBS Counts 3D
QBS Surface
 Planar MUGA QBS Views
Planar MUGA
QBS Views

Clinical findings

The right atrium was moderately dilated with normal function. The right ventricle was normal in size and function. The left ventricle was mildly to moderately dilated with regional wall motion abnormalities. The distal anterior, inferior and septal regions were all severely hypokinetic while the apex was akinetic. The rest ventricular function was normal. These findings are consistent with aneurysmal formation.

The calculated left ventricular ejection fraction was 19% on planar and 16% on SPECT.  Correlation was performed between the different exams, the wall motion abnormalities were seen in all three exams. EFs varied slightly: 2D = 19%; 3D = 16%; Echo = 18%.  More information is obtained using the SPECT protocol with Quantitative Blood Pool SPECT (QBS) than with standard planar. Right ventricle info is available as is phase analysis.

Physician impression

Right atrium enlargement with normal function. Normal right ventricular size and function. Left ventricular dysfunction due to regional wall motion abnormalities (LVEF = 31%; 28% on SPECT). Left ventricular aneurysmal formation.

More information is obtained using the SPECT protocol with Quantitative Blood Pool SPECT (QBS) than with standard planar.

* Results from case studies are not predictive of results in other cases. Results in other cases may vary.


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Case Study
cancer, Cardiac, left ventricle, Right atrium, right ventricle
 

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