Nuclear Cardiology and Multimodal Cardiovascular Imaging: A Companion to Braunwald's Heart Disease

Cover
Inside front cover
Front matter
Nuclear Cardiology and Multimodal Cardiovascular Imaging
Copyright
Dedication
Contributors
Preface
Contents
Section i instrumentation and principles of imaging 1
Section ii imaging protocols and interpretation 37
Section iii applications of nuclear cardiology in coronary artery disease 79
Section iv applications of nuclear cardiology in select populations 177
Section v applications of nuclear cardiology in heart failure 245
Section vi emerging clinical applications 385
Section vii artificial intelligence in nuclear cardiology 451
Video contents
Braunwalds heart disease family of books
1 Single photon emission computed tomography
Introduction
Detectors
Scintillation detectors
Scintillation crystals
Light sensors
Position of interaction
Cadmium zinc telluride detectors
Collimators
Parallel hole collimaters
Pinhole collimaters
Multifocal collimaters
System designs for cardiac spect imaging
Rotating gamma cameras
Dedicated cardiac systems
Factors affecting image quality
Attenuation
Scatter
Patient motion
Statistical noise in the projection data
Reconstruction
Algorithms
Filtered backprojection
Iterative reconstruction
Maximum a posteriori
Attenuation correction
SPECT/CT versus transmission
Registration
Scatter correction
Energy-based methods
Convolution-based methods
Modeling methods and Monte Carlo
Resolution recovery/collimator modeling
Postreconstruction filtering
Cardiac gating
Future developments
Myocardial blood flow
Motion compensation
Questions
References
2 Positron emission tomography
Introduction
PET physics fundamentals
Positron decay and annihilation
Photon interactions with matter
PET imaging technology
PET detectors
Photon counting technology
PET data acquisition
Types of coincidence events
Noise and noise-equivalent count rate
PET acquisition modes
Static, dynamic, list-mode, and gated acquisitions
PET image reconstruction
Analytic and iterative reconstruction
Attenuation correction
Randoms correction
Scatter correction
Time of flight
PET image quality
Spatial resolution
Sensitivity
Emerging technologies
Total-body PET
PET/MRI
Questions
References
3 Principles of myocardial blood flow quantification with SPECT and PET imaging
Introduction
Myocardial blood flow measurements with PET and SPECT
PET tracers for measuring myocardial blood flow
15O-water
82Rubidium
13N-ammonia
18F flurpiridaz
Kinetic modeling
PET imaging protocols
Quality assessment
Patient motion detection and correction
Myocardial blood flow assessment with SPECT
SPECT tracers for measuring myocardial blood flow
Thallium-201
Technetium-99m tetrofosmin and sestamibi
Investigational agents
SPECT imaging protocols
SPECT absolute blood flow assessment with nonrotating, CZT imaging systems
SPECT absolute blood flow assessment with conventional anger SPECT camera systems
Future of quantitative myocardial blood flow SPECT
Questions
References
4 Radiopharmaceuticals for clinical SPECT and PET and imaging protocols
Introduction
Current radiotracers for cardiac imaging
SPECT radiotracers
201Thallium
Mechanism of retention and property of redistribution
99mTechnetium-based radiotracers
Mechanism of retention
99mTechnetium-Pyrophosphate
123I-Meta-Iodobenzylguanidine
Production
Mechanism of retention
PET radiotracers
82Rubidium
Mechanism of retention
13N-ammonia
Mechanism of retention
18F-fluorodeoxyglucose
Mechanism of retention and production
18F-flurpiridaz
Imaging protocols for cardiac SPECT and PET
SPECT imaging protocols
123I-Meta-Iodobenzylguanidine
99mTechnetium-Pyrophosphate
PET imaging protocols
82Rubidium perfusion imaging
13N-ammonia
Fluorodeoxyglucose imaging
Radiation exposure
Guidelines
Questions
References
5 Recognizing and preventing artifacts with SPECT and PET imaging
Introduction
SPECT imaging
Patient-related artifacts
Patient motion
Attenuation artifacts
Anterior wall
Inferior wall
Increased extracardiac activity
Strategies to reduce artifacts and improve recognition
Instrumentation-related artifacts
Hardware
Center of rotation artifact
Camera head misalignment
Nonuniformity
Software
Ramp filter artifact
Normalization issues
Scatter artifacts
Postprocessing artifacts
Gating errors
Other sources of artifact
Left bundle branch block
Hypertrophic cardiomyopathy
Basal septum
RV insertion artifact
PET imaging
Patient-related artifacts
Breathing
Patient motion
Increased extracardiac uptake
Count density
Physiologic artifacts
Inadequate patient preparation
Instrumentation-related artifacts
Misregistration of transmission and emission images
LV-lung mismatch
LV-diaphragm mismatch
Metal artifact
Gating errors
Infusion system–related artifacts
Conclusion
Questions
References
6 Approaches to minimize patient dose in nuclear cardiology
Introduction
New technology to limit patient dose
Hardware
Collimator redesign
Case vignette #1
Solid state detector cameras
Case vignette #2
PET and PET/CT cameras
Case vignette #3
Software options to reduce patient dose
Best practices to limit patient dose
Appropriate patient selection
Radiopharmaceutical selection
Weight-based radiopharmaceutical dosing
Stress-only imaging protocols
Case vignette #4
Conclusions
Questions
References
7 Patients with new-onset stable chest pain syndromes
Introduction
Initial assessment of patients with new-onset chest pain
Incremental value of imaging tests
Diagnostic value of radionuclide imaging
Added value of coronary artery calcium score
Applications of radionuclide imaging in patients with new-onset stable chest pain syndrome
Case vignette 1: Assessment of a symptomatic low-risk patient
Case vignette 2: Assessment of a symptomatic low-risk patient who can exercise
Case vignette 3: Intermediate-risk patient
Case vignette 4: Symptomatic patient with a high coronary artery calcium score
Case vignette 5: Symptomatic patient with a low coronary artery calcium score
Questions
References
8 Applications of nuclear cardiology in known stable coronary artery disease
Introduction
Role of non-invasive imaging in patients with stable coronary artery disease
Radionuclide MPI in patients with known coronary artery disease
Differences between SPECT and PET myocardial perfusion imaging
Assessment of regional myocardial perfusion
Assessment of left ventricular function
Patient radiation dose
Prognostic markers from radionuclide MPI
Patient-centered applications of radionuclide MPI in patients with known coronary artery disease: Case-based discussion
Case vignette 1: New or worsening symptoms in a patient with stable angina who is able to exercise
Case vignette 2: Worsening symptoms in a patient with prior coronary artery bypass grafting who is unable to exercise
Case vignette 3: Worsening symptoms in a patient with known nonobstructive coronary artery disease with multiple comorbidi ...
Case vignette 4: Syncope of uncertain etiology in a patient with a history of myocardial infarction
Case vignette 5: Symptomatic patients with concern for multivessel disease or microvascular dysfunction—discordant perfu ...
Case vignette 6: Symptomatic patient with concern for multivessel disease and discordant perfusion and flow information on PET
Case vignette 7: Asymptomatic patient with known nonobstructive CAD who is able to exercise
Case vignette 8: Asymptomatic patient with elevated calcium score
Case vignette 9: Symptomatic patient with elevated calcium score
New developments for radionuclide myocardial perfusion imaging
Questions
References
9 Patient with prior revascularization
Introduction
Approach to patient evaluation and test selection
Patient-centered clinical applications
Effects of revascularization on myocardial perfusion and stress MPI
Case vignette 1: Symptomatic patient with ischemia because of “jailed” branches of the left anterior descending (LAD) ...
Case vignette 2: Symptomatic patient with ischemia due to nonrevascularized vessel segments after CABG (serial LAD lesions ...
Case vignette 3: Symptomatic patient managed with CABG and subsequent improvement in stress myocardial flow
Evaluation of symptomatic patients after revascularization with stress MPI to localize ischemia
Case vignette 4: Symptomatic patient after PCI evaluated with exercise SPECT MPI to a jailed diagonal branch of the LAD
Case vignette 5: Symptomatic patient after CABG with ischemia localized by stress PET MPI to a nongrafted artery
Case vignette 6: Symptomatic patient after CABG and recent angiography showing new bypass graft stenosis and progression o ...
Case vignette 7: Symptomatic patient after PCI for stable angina and stress MPI localizing ischemia to new coronary distri ...
Case vignette 8: Symptomatic patient after PCI for inferior STEMI with incomplete revascularization at time of PCI
Case vignette 9: Symptomatic patient after PCI for STEMI with progression of unrevascularized CAD
Evaluation of asymptomatic patients after revascularization with stress MPI to localize ischemia
Case vignette 10: Asymptomatic patient for more than 2 years after PCI with new resting ischemic ECG changes
Future directions and emerging applications
Questions
References
10 Preoperative risk evaluation: When and how?
Introduction
Goals of the perioperative cardiac evaluation
Historic background of the use of radionuclide MPI for preoperative risk stratification
Risk assessment
Surgical factors: Low, intermediate, or high risk and special populations
Patient factors: Individual risk factors and functional capacity
Clinical risk assessment tools
Goldman risk index
Revised cardiac risk index
Gupta myocardial infarction and cardiac arrest risk index
NSQIP surgical risk calculator
Cardiovascular risk index
Noninvasive testing for preoperative risk assessment
Rationale of noninvasive imaging testing
Radionuclide myocardial perfusion imaging
Utility for prediction of perioperative cardiac events
Long-term risk assessment
Patient-centered approach to preoperative risk assessment
Case vignette 1: Preoperative risk assessment before organ transplanation
Hematopoietic stem-cell transplantation
Bariatric surgery
Alternative imaging approaches
Echocardiogram
Computed tomography
Positron emission tomography
Cardiac magnetic resonance
Case vignette 2: Decision to pursue preoperative testing in a high-risk patient
Patient selection
Test selection
Practice guidelines and appropriate use criteria
Case vignette 3: Decision to pursue preoperative testing in a low-risk patient
Case vignette 4: Strategies to reduce risk and the stepwise approach
Coronary revascularization
Medical management
Questions
References
11 Imaging in patients with acute chest pain in the emergency department
Scope of the problem
Evaluation of patients with chest pain in the emergency department
The ischemic cascade and the rationale for use of noninvasive imaging
Patient-centered applications of noninvasive imaging in patients with suspected acute cardiac ischemia
Case vignette 1: Radionuclide myocardial perfusion imaging
Case vignette 2: Coronary computed tomography angiography and computed tomography fractional flow reserve
Case vignette 3: Cardiac magnetic resonance imaging
Case vignette 4: Echocardiography
Conclusion
Questions
References
12 Assessing the biology of high-risk plaque features with molecular imaging
Introduction
Rationale for high-risk plaque imaging
Biology of high-risk atherosclerotic plaques
Histologic descriptions of high-risk plaque features
Imaging to identify high-risk plaques
Role of novel multimodal imaging assessments
Molecular probes for imaging atherosclerotic disease activity
18F-FDG PET imaging of vascular inflammation
18F-FDG signals in atherosclerosis: A critical appraisal
18F-FDG uptake in high-risk plaques
Arterial 18F-FDG signal reproducibility and disease thresholds
Mechanistic insights gained from 18F-FDG imaging
Systemic vascular inflammatory networks
Adipose tissue and vascular inflammation
18F-FDG PET as a readout of drug efficacy
18F-FDG imaging as a marker of future CVD risk
Limitations of 18F-FDG for coronary imaging
18F-NaF imaging of active calcification
Lab-based validation of 18F-NaF binding in atherosclerotic plaques
Clinical 18F-NaF imaging in high-risk plaques and patients
Coronary imaging
Carotid imaging
Other radionuclide probes for plaque imaging
Translocator protein receptor
Choline transport
Mannose receptor
Chemokine receptor
Somatostatin receptor
Folate receptor β
Cell proliferation
Endothelial activation
Other inflammation imaging targets
Cholesterol transport and oxidation
Apoptosis
Hypoxia
Neoangiogenesis
Thrombosis
Imaging plaque biology and composition using pet/mri
Summary
Questions
References
13 Patients with suspected coronary microvascular dysfunction
Introduction
Evaluation of suspected coronary microvascular dysfunction
Noninvasive approaches
Echocardiography
Positron emission tomography
Cardiac magnetic resonance
Invasive approaches
Diagnostic challenges
Patient-centered clinical applications
Case vignette 1: CMD with concomitant obstructive epicardial CAD
Epidemiology and diagnosis
Prognosis
Impact on treatment
Case vignette 2: CMD in INOCA
Epidemiology
Functional impact
Predictors
Prognosis
Treatment
Case vignette 3: CMD in MINOCA
Epidemiology and diagnosis
Prognosis and treatment
Case vignette 4: CMD in special populations
Diabetes mellitus
Chronic kidney disease
Emerging applications
Questions
References
14 Patient with cardiometabolic disease
Introduction
Technical considerations
Patient-centered clinical applications
Case vignette 1: Obese patient with severe attenuation on SPECT but normal PET
Case vignette 2: Obese patient with normal solid-state detector SPECT MPI
Role of PET MPI in obesity
Alternative imaging approaches in obese patients
Case vignette 3: Patient with CAD and coronary microvascular dysfunction
Case vignette 4: Obese patient with diffuse atherosclerosis
Screening for CAD in asymptomatic patients with diabetes mellitus
Alternative imaging approaches in metabolic syndrome and DM
Potential opportunities
Questions
References
15 Patient with chronic kidney disease
Introduction
Patient-centered clinical applications of radionuclide and multimodality imaging in patients with CKD
Case vignette 1: Screening for CAD
Case vignette 2: Evaluation of a patient with CKD and atypical chest pain
Case vignette 3: Evaluation of a patient with CKD and known CAD with heart failure
Case vignette 4: Prerenal transplant risk evaluation
Case vignette 5: Prerenal transplant risk evaluation
Questions
References
16 Women with suspected ischemic heart disease
Introduction
Sex differences in ischemic heart disease
Epidemiology and risk factors
Moving beyond obstructive coronary artery disease
Patient-centered clinical applications of imaging in women
Case vignette 1: Noncardiac chest pain
Emerging role of coronary computed tomography angiography
Case vignette 2: Coronary artery disease without ischemia
Case vignette 3: Ischemia with no obstructive coronary artery disease
Emerging role of positron emission tomography
Case vignette 4: Stress cardiomyopathy
Emerging role of cardiac magnetic resonance imaging
Patient selection for testing
Limitations of conventional pretest probability, exercise testing, myocardial perfusion imaging, and invasive coronary ang ...
Extended algorithm of diagnostic testing strategies
Complementary value of assessing the macrocirculations and microcirculations
Questions
References
17 Key concepts in risk stratification and cost-effectiveness using nuclear scintigraphy in stable coronary artery disease
Introduction
Risk stratification and incremental prognostic value
Principles of prognostication and risk stratification
Radionuclide MPI result and patient risk
Impact of clinical characteristics on risk after a normal stress radionuclide MPI
Risk for adverse events after abnormal MPI
Ancillary markers of risk in radionuclide MPI
Left ventricular function and volumes
Myocardial blood flow and myocardial flow reserve
Additional markers of risk
Integrating information after radionuclide MPI
Post-MPI resource utilization and implications for risk assessment
Radionuclide MPI and patient management
Physiology-based assessments to identify revascularization candidates
SPECT MPI for identification of possible survival benefit
PET/MPI for identification of possible survival benefit
Observational studies versus randomized clinical trials
Cost effectiveness of radionuclide MPI and its relationship to alternative strategies and modalities
Questions
References
18 The patient with new-onset heart failure
Introduction
New-onset heart failure
Patient-centered applications of multimodality imaging in patients with new-onset heart failure
Case vignette 1: A patient with heart failure and angiographic coronary artery disease without evidence of ischemia or scar
Case vignette 2: A patient with heart failure and angiographic coronary artery disease with evidence of ischemia and scar
Case vignette 3: A patient with nonischemic cardiomyopathy
Case vignette 4: A patient with heart failure and acute myocardial injury without obstructive coronary artery disease
Questions
References
19 Metabolic remodeling in heart failure
Introduction
Basic concepts on myocardial metabolism
Methods for measuring substrate metabolism in the human heart
Arteriovenous balance studies
Magnetic resonance techniques
Radionuclide techniques
Assessing key myocardial metabolic pathways
Myocardial oxygen consumption
Carbohydrate metabolism
Case vignette 1: Increased cardiac glucose uptake and possible metastasis
Fatty acid metabolism
Case vignette 2: Decreased myocardial fat uptake with lipoprotein lipase deficiency
Risk factors for heart failure
Obesity/type 2 diabetes
Case vignette 3: Obesity/weight loss
Type 1 diabetes
Hypertension and aging
Myocardial metabolic phenotypes in cardiomyopathy and heart failure
Ischemic cardiomyopathy
Nonischemic cardiomyopathy/heart failure with reduced ejection fraction
Hypertrophic cardiomyopathy
Inflammatory and infiltrative cardiomyopathies
Heart failure with preserved ejection fraction
Myocardial metabolic effects of standard heart failure therapies
Myocardial metabolic modulation in heart failure
Trimetazidine/ranolazine
Acipimox
Future directions
Questions
References
20 Patient with ischemic heart failure: Ischemia and viability assessment and management
Introduction
Ischemic heart failure
Principles of management
Imaging techniques for the evaluation of ischemia and viability
Echocardiography
Cardiac magnetic resonance imaging
Radionuclide imaging approaches
SPECT imaging
PET imaging
Patient preparation for FDG imaging
Fasting
Oral or intravenous glucose loading
Hyperinsulinemic-euglycemic clamp
Free fatty acid inhibition
Patient-centered imaging applications in ischemic heart failure
Case vignette 1
Case vignette 2
Case vignette 3
Case vignette 4
Critical appraisal of the evidence regarding the use of myocardial ischemia and viability testing to guide patient management
Cardiac MRI or FDG PET and the potential role of hybrid PET/MRI
Potential role of circulating biomarkers
Role of noninvasive testing in the management of ischemic heart failure
Future directions for imaging in ischemic heart failure
Questions
References
21 Novel approaches for the evaluation of arrhythmic risk
Introduction
Risk stratification of arrhythmic risk
Patient-centered applications of radionuclide and multimodality imaging for the evaluation of arrhythmic risk
Case vignette 1: Screening for coronary artery disease
Case vignette 2: Evaluation of a patient with a nonischemic cardiomyopathies
Case vignette 3: Evaluation of a patient with a nonischemic cardiomyopathies
Association of LV remodeling, mechanical dyssynchrony, and ventricular arrhythmias
Case vignette 4: Cardiac innervation imaging for risk stratification in a patient with heart failure
Case vignette 5: Cardiac innervation imaging for risk stratification in a patient with heart failure
Adrenergic imaging for arrhythmic risk assessment in other conditions
Association between myocardial scar and arrhythmic risk
Potential role for radionuclide imaging to guide arrhythmia ablation
Questions
References
22 Screening for transplant vasculopathy
Introduction
Clinical aspects of cardiac allograft vasculopathy
Pathophysiology
Definition, epidemiology, diagnosis, and prognosis
Clinical manifestations and treatment
Rationale for screening
Noninvasive imaging approaches for screening of cardiac allograft vasculopathy
Radionuclide imaging
Screening with non-nuclear imaging modalities
Patient-centered applications of radionuclide imaging and multimodality imaging in patients after heart transplantation
Case vignette 1: Evaluation of patient with suspected clinical progression of cardiac allograft vasculopathy
Case vignette 2: Incremental diagnostic and prognostic value of quantitative myocardial blood flow
Case vignette 3: Serial assessment of cardiac allograft vasculopathy with positron emission tomography
Case vignette 4: Limitations of functional versus anatomic testing
Questions
References
23 Patient with known or suspected cardiac sarcoidosis
Introduction
Prevalence and prognosis of cardiac sarcoidosis
Clinical manifestations and presentation of cardiac sarcoidosis
Diagnosis of cardiac sarcoidosis
Role of imaging in cardiac sarcoidodis
Echocardiography
Single photon emission computed tomography myocardial perfusion imaging and 67gallium
Cardiac positron emission tomography
Patient preparation for inflammation imaging with fluorodeoxyglucose positron emission tomography
Positron emission tomography imaging protocol for cardiac sarcoidosis and interpretation
Cardiac magnetic resonance imaging
Clinical indications for imaging
Patient-centered evaluation of suspected or known cardiac sarcoidosis
Case vignette 1: Patient with known pulmonary sarcoidosis and an abnormal rest electrocardiogram
Case vignette 2: Patient with remote history of pulmonary sarcoidosis and palpitations
Case vignette 3: Patient with neurosarcoidosis and an abnormal rest electrocardiogram
Case vignette 4: Patient with known cardiac sarcoidosis undergoing antiinflammatory therapy
Case vignette 5: Patient with nonischemic cardiomyopathy presenting with ventricular arrhythmia
Case vignette 6: Patient with nonischemic cardiomyopathy and ventricular tachycardia/ventricular fibrillation cardiac arrest
Emerging applications of novel radiotracers for inflammation imaging
Questions
References
24 Patients with known or suspected amyloidosis
Introduction
Epidemiology
Clinical presentation
Clinical features
Biochemical features
Electrocardiographic and imaging features
Electrocardiographic features
Echocardiographic features
Magnetic resonance imaging features
Radionuclide imaging features
Radionuclide imaging
Bone-seeking radiotracers
99mTechnetium imaging protocols
99mTc image interpretation
Heart to contralateral ratio
Sources of false-positive 99mTc scans
Sources of false-negative 99mTc scans
Myocardial neuronal imaging radiotracers
Targeted amyloid imaging radiotracers
Imaging protocols
Image interpretation
Diagnostic criteria and appropriate use of imaging
Standardized imaging protocols
Diagnostic criteria for cardiac amyloidosis
Appropriate use criteria for imaging cardiac amyloidosis
Patient-centered applications of imaging in cardiac amyloidosis
Case vignette 1: A male patient with new-onset heart failure
Case vignette 2: An elderly patient with heart failure preserved ejection fraction and severe aortic stenosis
Case vignette 3: A patient with amyloid light chain cardiac amyloidosis
Case vignette 4: Utility of single photon emission computed tomography in patients with equivocal planar 99mTechnetium-pyr ...
Case vignette 5: Amyloid transthyretin mutation with negative 99mTechnetium-pyrophosphate scan
Case vignette 6: 99mTechnetium-methylene diphosphonate negative with positive 99mTechnetium-pyrophosphate scan
Future directions
Questions
References
25 Patients undergoing cancer treatment
Introduction
Patient-centered applications of multimodality imaging in cardio-oncology
Case vignette 1: Evaluation of cardiac function
Multigated acquisition imaging
Single photon emission computed tomography
Echocardiography
Global longitudinal strain
Cardiac magnetic resonance imaging
Case vignette 2: Evaluation of epicardial coronary artery disease
Myocardial perfusion imaging
Other imaging approaches to coronary artery disease in cardio-oncology patients
Coronary computed tomography angiography
Stress echocardiography
Stress cardiac magnetic resonance imaging
Case vignette 3: Evaluation of cardiac neoplasms
Positron emission tomography/computed tomography
Cardiac magnetic resonance imaging
Case vignette 4: Assessment of ischemic heart disease in a patient with cancer
Assessment of coronary microvascular dysfunction – cardiac positron emission tomography
Atherosclerotic cardiovascular disease risk assessment: Coronary artery calcium scoring
Emerging applications of multimodality imaging in cardio-oncology
Assessment of suspected immune checkpoint inhibitor–related myocarditis
Metabolic positron emission tomography imaging
Cardiac magnetic resonance imaging
Global longitudinal strain with echocardiography
Questions
References
26 Molecular imaging of myocardial infarction and remodeling
Introduction
Molecular repair mechanisms after acute myocardial infarction: Inflammation, fibrosis, and angiogenesis
Established molecular imaging-guided concepts
Molecular reparative interventions after acute myocardial infarction
Novel molecular imaging–guided concepts
Chemokine receptors
Somatostatin receptors
Matrix metalloproteinases
Mitochondrial translocator protein
Fibroblast activation protein
Angiogenesis marker
Angiotensin-converting enzyme and angiotensin II receptor type 1 ligands
Multimodality imaging after acute myocardial infarction
Future challenges
Questions
References
27 Patient with mechanical dyssynchrony
Introduction
Pathophysiology of mechanical dyssynchrony
The importance of mechanical dyssynchrony
Imaging methods to assess mechanical dyssynchrony
Gated single photon emission computed tomography myocardial perfusion imaging
Advantages and limitations of gated single photon emission computed tomography myocardial perfusion imaging
Positron emission tomography
Equilibrium radionuclide angiography/multigated acquisition scan
Advantages and limitations of equilibrium radionuclide angiocardiography/multigated acquisition
Clinical applications
Case vignette 1: Prognosis of patient with mechanical dyssynchrony
Case vignette 2: Patient with mechanical dyssynchrony and cardiac resynchronization therapy
Case vignette 3: Diastolic dyssynchrony
Questions
References
28 Aortic stenosis and bioprosthetic valve degeneration
Introduction
Computed tomography
Positron emission tomography
18F-fluorodeoxyglucose positron emission tomography
18F-Fluoride positron emission tomography
Left ventricular remodeling and the role of positron emission tomography imaging
Image optimization and current state of the art
Applications of 18F-Fluoride positron emission tomography
Improved pathologic understanding
End point in clinical trials
Patient management
Bioprosthetic valve degeneration
Patient-centered clinical applications
Case vignette 1: A patient with moderate aortic stenosis and intense valvular 18F-Fluoride activity uptake at baseline
Case vignette 2: A patient with moderate aortic stenosis and low valve 18F-Fluoride activity at baseline
Case vignette 3: A patient with mild to moderate aortic stenosis and high valve 18F-Fluoride activity 5 years after surgic ...
Case vignette 4: A patient with mild aortic stenosis and high valve 18F-Fluoride activity 2 years after surgical bioprosth ...
Acknowledgments
Questions
References
29 Infective endocarditis
Introduction
Technical considerations
Fundamentals of 18F-FDG-PET/CT in cardiac inflammation and infection
Patient preparation
Acquisition protocols
Technical requisites
Positron emission tomography/cardiac computed tomography angiography acquisition protocol
Image reconstruction
Image interpretation
Metabolic images
Qualitative analysis
Quantitative analysis
Computed tomography and cardiac computed tomography angiography images
Overall interpretation of positron emission tomography/cardiac computed tomography angiography scans
Infection versus postoperative inflammation
Clinical applications of 18F-FDG-PET/CCTA
Case vignette 1: Prosthetic valve endocarditis
Case vignette 2: Cardiac device infection
Special groups of greater complexity
Patients with both prosthetic valves and devices
Case vignette 3: Aortic grafts
Case vignette 4: Congenital heart disease
Patients at high surgical risk
Native valve infective endocarditis
Additional benefits of whole-body positron emission tomography/computed tomography
Peripheral findings
Alternative diagnoses
Detection of unsuspected neoplastic lesions
Diagnostic challenges
Differential diagnoses
Possible false-positive findings
Possible false-negative findings
Other nuclear imaging techniques
Radiolabeled white blood cell single photon emission computed tomography/computed tomography
Role of nuclear imaging in the multimodality evaluation of infective endocarditis
The endocarditis team
Guidelines and diagnostic algorithms
Future directions
Summary
Questions
References
30 Large-vessel vasculitis
Introduction
Classification and diagnosis of large-vessel vasculitides
Large-vessel vasculitis
Variable-vessel vasculitis
Single-organ vasculitis
Vasculitis associated with systemic disease
Infectious vasculitis of the large vessels
Multimodality imaging of large-vessel vasculitides
Morphologic imaging
Ultrasound
Computed tomography angiography
High-resolution cranial magnetic resonance imaging
Magnetic resonance angiography
Molecular/metabolic imaging
Fluorodeoxyglucose positron emission tomography/computed tomography
Patient-centered clinical applications
Case vignette 1: Evaluation of patients with isolated cranial giant cell arteritis
Case vignette 2: Evaluation of patients with cranial giant cell arteritis and large-vessel variant giant cell arteritis
Case vignette 3: Evaluation of patients with isolated large-vessel variant giant cell arteritis
Case vignette 4: Unusual presentation of patients with large-vessel variant giant cell arteritis/cranial giant cell arteritis
Case vignette 5: Assessment of takayasu’s arteritis
Case vignette 6: Assessment of takayasu’s arteritis with relapse
Case vignette 7: Assessment of variable-vessel vasculitis involving the large vessels—behcet’s disease
Case vignette 8: Assessment of single-organ vasculitis involving the large vessels—clinically isolated aortitis
Case vignette 9: Assessment of vasculitis associated with systemic disease (lupus, sarcoid, IgG4, and others)
Case vignette 10: Assessment of an infectious large-vessel vasculitis
Emerging applications of large-vessel vasculitis imaging
Morphologic imaging
Novel magnetic resonance imaging, magnetic resonance angiography, and cardiac computed tomography angiography imaging tech ...
Molecular/metabolic imaging
Imaging of the macrophage activation
Imaging of the immune checkpoints
Questions
References
31 Peripheral arterial disease
Epidemiology and the natural history of peripheral arterial disease
Compartments of peripheral arterial disease: Macrovasculature, microvasculature, angiosomes, and collateral vessels
Standard noninvasive evaluation of peripheral arterial disease
Radionuclide imaging assessment of perfusion and blood flow in the lower extremities
Imaging of arteriogenesis and angiogenesis: Potential of molecular imaging
Imaging of atherosclerosis in the lower extremities
Imaging of skeletal muscle metabolism and energetics
Image-guided therapy: Delivery of cell and gene therapies, percutaneous revascularization, and theranostics
Questions
References
32 Artificial intelligence in nuclear cardiology
Introduction
Using artificial intelligence to improve image processing
Using artificial intelligence to improve image quality
Using artificial intelligence to improve the diagnosis of coronary artery disease
Using artificial intelligence to improve risk prediction
Using artificial intelligence to quantify and integrate coronary artery calcium information
Epicardial adipose tissue quantification with artificial intelligence
Development and evaluation of artificial intelligence
Explainable artificial intelligence
Clinical implementation
Questions
References
Answer key
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Index
Inside back cover