Nuclear Medicine

Myocardial perfusion imaging is a very useful test when looking for coronary artery disease. Bone scans, a number of indications there. A very common test. H. pylori breath test is a new test study that’s being used to diagnose H. pylori because as everybody realizes, that needs to be completely eradicated. Hepatobiliary imaging. There’s a new variation on this theme. It’s called cholecystokinin and we actually look at a gall bladder ejection fraction, sort of like a left ventricular ejection fraction. If the gallbladder does not contract sufficiently, that’s an indication of disease. Thyroid imaging and VQ scans will be discussed.
Myocardial perfusion imaging. The diagnosis of coronary artery disease is critical. Cardiolyte is the best agent for this. There are three different agents that we can use. What everyone thinks of when they think of myocardial perfusion imaging is thallium scans. There’s also a newer agent called Myoview and on the top, the whole category of agents, the most common of which is cardiolyte imaging. They all pretty much do the same thing. I would leave it up to your nuclear medicine physician or radiologist to decide which agent to use.

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I prefer to use cardiolyte in the diagnosis of coronary artery disease because you can get not only a left ventricular ejection fraction which can be helpful in more advanced cases, but you can also look at focal wall motion. Basically what that does is improves the specificity of the test.

So if you have a young, slightly overweight female with large breasts, we could have an attenuation artifact which could mimic an LID infarct. Of course, we don’t want to make the diagnosis of LID infarct when really it’s just an artifact from the body habitus and cardiolyte helps us differentiate between those two.
Another time that myocardial perfusion imaging can really help you out is when you have discrepancies between your stress test results and your clinical impression. Again, if you have a positive exercise treadmill study which is very common in, say, younger females where there’s a low incidence of coronary disease, that’s where you’d want to add our test and we will improve the specificity of your findings.
Vice versa, you have an older man who has the classic symptoms and he has a negative stress test. Remember stress testing has a rather low sensitivity. You might need to increase you specificity by adding myocardial perfusion imaging studies.
Often, abnormal baseline EKGs are present that make interpretation of the stress test very difficult. Examples are left ventricular hypertrophy, the changes of digitalis, left bundle branch block. Another indication would be the presurgical screening of a high risk patient. For example, somebody that has peripheral vascular disease. I imagine a lot of family practitioners are asked by the surgeons to clear somebody medically prior to an operation and this is an excellent test to use.

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