II. Definitions
- Single Photon Emission Computed Tomography (SPECT)
- Radiolabeled Contrast Material is injected
- Emitted radiation from Contrast Material uptake is measured by an external gamma camera
- Contrast with CT in which applies x-ray source through a patient to detectors
- Other detectors of emitted radiation include scintigraphy and positron emission tomography (PET)
- Hybrid CT and SPECT Scanners
- CT adds precise anatomic positioning to the SPECT's physiologic data
- CT also facilitates correction of attenuation artifacts
III. Medications
- Thallium T1 201 chloride
- Originally used for imaging
- Technetium agents replaced Thallium for higher efficacy
- Technetium 99mTc-Sestamibi (Cardiolite)
- Technetium Tc-99m-tetrofosmin (Myoview)
IV. Indications
- See Exercise Stress Test
- Nondiagnostic Stress EKG, Intermediate CAD likelihood
- Resting ST-T Wave abnormalities
- Left Bundle Branch Block
- Ventricular paced rhythm
- Left Ventricular Hypertrophy
- Digoxin treatment
- Suspected Acute Coronary Syndrome, nondiagnostic tests
- CAD Diagnosis, risk stratification, and therapy
- Assess ventricular function
- Identify lesions in planning for PTCA intervention
- Risk stratification prior to noncardiac surgery
- Specific conditions
- Cocaine-associated Chest Pain
- Well-controlled Diabetes Mellitus
V. Contraindications
VI. Protocol
VII. Advantages
- High Test Sensitivity for ischemia (>85%)
- Distinguishes baseline wall motion abnormality from CAD
- In above cases angiography may be needed
VIII. Disadvantages
- Test Sensitivity decreases significantly when patient is not actively experiencing Chest Pain
IX. Efficacy: Coronary Ischemia
- Overall SPECT
- Pharmacologic with Dobutamine
- Test Sensitivity: 89%
- Test Specificity: 75%
- Multi-vessel Disease Test Sensitivity: 44%
- Geleinjnse (2000) J Am Coll Cardiol 36(7): 2017-27
- Symptomatic
- Test Sensitivity: >85%
- Test Specificity >80%
- References
X. Prognosis
- Normal perfusion scan: Cardiac event rate <1% per year
- Factors suggestive of worse prognosis
- Increased numbers of involved vascular territories
- Increased severity and extent of defect size
- Decreased reversibility
- Post-stress ejection fraction <45%
- End-systolic volume >70 ml
- Transient ischemic dilation
XI. References
- Broder (2022) Crit Dec Emerg Med 36(6): 20-1
- Cayley (2024) Am Fam Physician 110(6): 577-84 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Diagnostic Procedure (T060) |
SnomedCT | 252432008, 702759004 |
Italian | Diagnostica per imagini perfusionale miocardica, Scansione perfusionale miocardica NAS, Scansione miocardica perfusionale |
English | Radionuc myocard perfusn study, Scan NOS myocardial perfusion, myocardial perfusion scans, myocardial perfusion scan, myocardial perfusion scanning, Scan myocardial perfusion, Radionuclide imaging of heart for assessment of myocardial viability (procedure), Radionuclide imaging of heart for assessment of myocardial viability, Radionuclide myocardial perfusion study, Radionuclide myocardial perfusion study (procedure), Myocardial perfusion scan |
Dutch | scan myocardperfusie, myocardperfusiescan NAO, myocardperfusiescan |
French | Scintigraphie myocardique de perfusion SAI, Scan myocardique de perfusion, Examen de perfusion myocardiaque |
German | Scan NNB Myokardperfusion, Myokardperfusionsscan |
Portuguese | Scan NE da perfusão miocárdica, Cintigrafia de perfusão do miocárdio, Scan de perfusão do miocárdio |
Spanish | Tomografía NEOM con perfusión miocárdica, Prueba de perfusión miocárdica, estudio de perfusión miocárdica con radioisótopos (procedimiento), estudio de perfusión miocárdica con radioisótopos, Gammagrafía de perfusión miocárdica |
Japanese | 心筋血流スキャンNOS, 心筋血流スキャン, シンキンケツリュウスキャンNOS, シンキンケツリュウスキャン |
Czech | Sken myokardiální perfuze NOS, Sken myokardiální perfuze |
Hungarian | Szívizom perfúziós scan k.m.n., Szívizom perfúziós scan |
Ontology: Myocardial perfusion stress imaging using Thallium 201 (C2316301)
Concepts | Diagnostic Procedure (T060) |
SnomedCT | 431511008 |
English | Myocardial perfusion stress imaging using Thallium 201 (procedure), Myocardial perfusion stress imaging using Thallium 201 |
Spanish | estudio de perfusión miocárdica de esfuerzo con talio 201, estudio de perfusión miocárdica de esfuerzo con talio 201 (procedimiento) |
Ontology: Myocardial Perfusion Imaging (C2350390)
Definition (MSH) | The creation and display of functional images showing where the blood is flowing into the MYOCARDIUM by following over time the distribution of tracers injected into the blood stream. |
Definition (NCI_CDISC) | A procedure that obtains pictures that reflect blood flow in the heart muscle. |
Definition (NCI) | A procedure that captures pictures of blood flow throughout the heart muscle. |
Concepts | Diagnostic Procedure (T060) |
MSH | D055414 |
English | Myocardial Perfusion Imaging, Imaging, Myocardial Perfusion, Perfusion Imaging, Myocardial |
Spanish | Imagen de Perfusión Miocárdica |
French | Imagerie de perfusion du myocarde, Imagerie de perfusion myocardique |
Italian | Scintigrafia miocardica di perfusione, Imaging di perfusione miocardia |
Russian | MIOKARDA PERFUZII IZOBRAZHENIE, MIOKARDIOSTSINTIGRAFIIA, MIOKARDA STINTIGRAFIIA, МИОКАРДА СТИНТИГРАФИЯ, МИОКАРДА ПЕРФУЗИИ ИЗОБРАЖЕНИЕ, МИОКАРДА КРОВОСНАБЖЕНИЯ ВИЗУАЛИЗАЦИЯ, МИОКАРДИОСЦИНТИГРАФИЯ, MIOKARDA KROVOSNABZHENIIA VIZUALIZATSIIA |
Portuguese | Imagem de Perfusão do Miocárdio |
Swedish | Myokardskintigrafi |
German | Myokardperfusionsszintigraphie, Myokardperfusionsszintigrafie |
Czech | myokard - zobrazení perfúze, myokardiální perfúze - zobrazování, myokardiální perfúze - zobrazení |
Polish | Obrazowanie perfuzji mięśnia sercowego, Badanie obrazowe perfuzji mięśnia sercowego, Scyntygrafia perfuzyjna mięśnia sercowego, Badanie scyntygraficzne perfuzji mięśnia sercowego |
Japanese | 心筋血流画像, 心筋血流撮像法, 心筋血流シンチグラフィ, 心筋シンチグラフィー, シンチグラフィー-心筋, 心筋血流イメージング, 心筋血流撮像, 心筋血流像 |
Norwegian | Myokard perfusjonsscintigrafi, Myokard perfusjonsavbildning |
Ontology: Myocardial Scintigraphy (C2350391)
Definition (MSH) | Imaging blood flow to the MYOCARDIUM by following the distribution of radioactively labeled tracers injected into the blood stream. |
Concepts | Diagnostic Procedure (T060) |
MSH | D055414 |
English | Scintigraphy, Myocardial, Myocardial Scintigraphy, Myocardial scintigraphy |
French | Scintigraphie du myocarde, Scintigraphie myocardique |
German | Myokardszintigrafie, Myokardszintigraphie, Myokard-Szintigraphie |
Czech | myokardiální perfúzní scintigrafie, Scintigrafie myokardu, perfúzní scintigrafie myokardu, scintigrafie myokardiální perfúze |
Spanish | Cintigrafía miocárdica |
Portuguese | Cintigrafia miocárdica |
Italian | Scintigrafia miocardica |
Dutch | myocardiale scintigrafie |
Japanese | シンキンシンチグラフィ, 心筋シンチグラフィ |
Hungarian | Myocardialis izotópos vizsgálata |
Norwegian | Myokardscintigrafi |