How is gated myocardial perfusion single-photon emission computed tomography (SPECT) performed in the workup of myocardial ischemia?

Answer

As previously noted, gated images are obtained after the stress test is performed. With the use of a single-headed camera, a 180° acquisition is usually obtained with 32 stops. ECG gating is used, even when the patient has a cardiac arrhythmia, such as atrial fibrillation. After image acquisition, processing generates cine images that show wall motion and wall thickening. In addition, ventricular volumes and polar maps are generated.^{[27, 28, 29, 30, 36, 45, 10, 17]}

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Media Gallery

The risk of coronary artery disease (CAD) can quickly be stratified by determining whether the patient's pain is nonanginal, atypical, or typical. For men in their 30s with nonanginal chest pain, the pretest probability of disease is approximately 5%; however, men in their 30s with typical chest pain have a 70% likelihood of disease (a 14-fold increase).
In women, the risk of CAD can quickly be stratified on the basis of the type of chest pain. For example, a woman in her 50s with nonanginal chest pain has a pretest probability of disease of approximately 10%, whereas a woman in her 50s with typical chest pain has a pretest likelihood of approximately 80%; this rate is an 8-fold increase.
An exercise stress test is inadequate for excluding CAD when the pretest probability of disease is intermediate to high. Of 1000 American men older than 60 years who have nonanginal chest pain, the exercise stress test causes clinicians to miss almost one third of CAD cases.
Adding nuclear cardiac imaging to the stress ECG test greatly increases the clinical value of the test. Of 1000 American men older than 60 years who have nonanginal chest pain, CAD is misdiagnosed in 25 of the 281 men who have the disease; however, of these 25 patients, the annual rate of severe cardiac events (myocardial infarction or cardiac death) is still less than 1% per year.
Normal perfusion on a single-photon emission computed tomography (SPECT) perfusion study.
A SPECT perfusion study in a patient with a large degree of tracer redistribution affecting the left anterior descending and right coronary artery territories.
This study in a patient with normal findings on myocardial perfusion scanning represents the value of gated imaging in nuclear cardiac scans. The gated images show akinesis of the distal anterior wall along with a reduced left ventricular ejection fraction and an elevated end-systolic volume.
Polar maps can help identify abnormal findings on nuclear cardiac images. The polar map shows fairly good end-diastolic perfusion, a decreased regional ejection fraction and motion by the septum, and fairly normal thickening.

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