Asnc Imaging GuidelinesASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers
Section snippets
Exercise Stress Test
Exercise testing has been used for more than 60 years for diagnostic purposes in symptomatic patients [including patients with acute chest pain without ischemia by electrocardiogram (ECG) and serum markers] and for prognosis and risk stratification in patients with known coronary artery disease (CAD), such as history of myocardial infarction or documented CAD by coronary angiography or computed tomography angiography and in those with high risk for the presence of CAD, such as patients with
Pharmacologic Vasodilator Stress
There are currently three coronary vasodilator agents available: dipyridamole, adenosine, and regadenoson. Adenosine and its analog regadenoson work by producing stimulation of A2A receptors. Dipyridamole inhibits the phosphodiesterase enzymes that break down cAMP and inhibits the cellular reuptake of endogenous adenosine, thereby indirectly acting as an adenosine agonist. Methylxanthines (e.g., caffeine, theophylline, and theobromine) are competitive inhibitors of adenosine receptors that
Pharmacologic Synthetic Catecholamine Stress
There is one synthetic catecholamine stress agent available: dobutamine. This agent works by stimulating the β receptor, resulting in an increase in heart rate, BP, and myocardial contractility similar to exercise.
Obesity
The correct dose for the obese and morbidly obese patient is unclear. It is customary to use a weight-based dose of IV dipyridamole, IV adenosine, and IV dobutamine up to the weight of 250 lbs as the upper limit.
Left Bundle Branch Block, Ventricular Pacing, Ventricular Pre-excitation (WPW Syndrome)
Pharmacologic stress with coronary vasodilators (not IV dobutamine) is the preferred stress modality with above rest ECG patterns, both for safety (inability to monitor for ischemia) and diagnostic reasons (e.g., the presence of septal perfusion defects, not always related to
Radiotracers and Protocols
There are a variety of different protocols currently used for SPECT myocardial perfusion imaging. Table 5 contains information about these protocols: the radiopharmaceuticals used, their activities [millicuries, (mCi) or megabecquerels (MBq)], and their radiation effective doses. Figures 6 to 10 provide additional information regarding the timing of stress, injections, and imaging for each protocol. Gated imaging is recommended where feasible, at least during post-stress imaging.
The protocol
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An erratum to this article can be found at http://dx.doi.org/10.1007/s12350-016-0463-x.