Cardiac Perfusion Exam, Rapid Heart Scanner, CT, MRI and PET imaging – Innovations in Radiology @ Beth Israel Deaconess Medical Center
Reporter: Aviva Lev-Ari, PhD, RN
UPDATED on 7/31/2018
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A discussion with Gianluca Pontone, M.D., Ph.D., FSCCT, director of cardiovascular MRI, Centro Cardiologico Manzino, Milan, Italy, at the Society of Cardiovascular Computed Tomography (SCCT) 2018 meeting. He said CT can be comparable to the gold-standards of nuclear and MRI perfusion depending on the scanner used to acquire the images.
Read the article “CT Perfusion Imaging Ready for Mainstream.”
Five New Imaging Tests Can Help Diagnose A Variety Of Illnesses Better
(credit: Beth Israel Deaconess Medical Center)
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Beth Israel Deaconess Medical Center, Imaging Tests, Scan, Sports Medicine
By Michael Lasalandra, Beth Israel Deaconess Medical Center Correspondent
The evolution of imaging technology has resulted in doctors’ being able to more quickly and accurately diagnose many potentially life-threatening disorders, including serious abdominal issues, and coronary artery disease, as well as brain tumors and other cancers, to name a few.
“Current technologic advances in CT, MRI and PET imaging reflect advancements that have evolved over the past 20 years,” said Dr. Max Rosen, Executive Vice Chairman Radiology, Beth Israel Deaconess Medical Center. “They are a leap forward towards more personalized medicine focused on an individual patient’s specific problem. The improvements are leading to more rapid and accurate diagnoses, which potentially can lead to more effective, lifesaving treatments.”
Five examples:
Breast MRI
Breast MRI
MRI (magnetic resonance imaging) machines do not expose patients to radiation. Instead, they use a magnetic field, radio frequency pulses and a computer to obtain images. While mammograms, which use x-ray technology, are the primary method for screening for breast cancer, MRI can be used to work up more subtle cases, or for breast cancers which cannot be seen on a mammogram says Dr. Rosen. Typically, breast MRI is reserved to screen women who are at high risk for developing breast cancer, to determine extent of cancer involvement in newly diagnosed patients, to problem-solve a suspicious finding on other imaging, or to aid in surgical planning.
Abdominal CT scan
Abdominal CT Scan
Also known as computed tomography, CT scans combine a series of X-rays taken from a variety of different angles to produce cross-sectional images of the bones and soft tissues inside the body. These are often used in the Emergency Room setting to rapidly and accurately diagnose abdominal pain. “CT can accurately identify the cause of the pain,” says Dr. Rosen. “Common causes would be appendicitis, diverticulitis, kidney stones or inter-abdominal bleeding.” Such scans are also extremely useful for patients who have been in traumatic accidents. Multi-row detector CT scans can rapidly image the entire chest, abdomen and pelvis in less than a minute and can identify life-threatening fractures or other complications, he notes.
Coronary CT Angiogram to evaluate heart arteries
Coronary CT Angiogram
This test is useful in identifying narrowing in the coronary arteries. “By injecting an IV contrast dye into the vein and using a fast scanner, you can get beautiful images of the coronary arteries,” says Dr. Rosen. “You can see if there is plaque and if it is causing any narrowing.” The test is used for patients who have been having chest pain or for those at high risk for coronary disease with atypical chest pain and can identify those patients who are not having a heart attack, he says. The advantage is that cardiac catheterization – where a balloon-tipped catheter is snaked through the coronary artery – may be avoided. However, if the CTA is abnormal, the catheterization may still need to be performed prior to bypass surgery or to dilate the blocked artery using a balloon catheter or metallic stent.
PET-CT scan for cancer assessment
PET-CT scan
Positron emission tomography, also called a PET scan, is a type of nuclear medicine imaging. It uses tiny amounts of radioactive material as tracers to diagnose a variety of diseases, including many types of cancer. The scan can visualize metabolic activity in an area of suspected abnormality such as a tumor. Doctors can use PET and CT data and images together for greater diagnostic accuracy than either technique offers alone. PET-CT allows them to see not only the size of the tumors, but also their biological behavior and whether or not they are responding to therapy. This hybrid technology “is the beginning of a new wave of molecular imaging where you can target a specific tumor to help characterize it as well as see if it is growing or metabolizing,” Dr. Rosen says.
fMRI (functional MRI) for evaluation and treatment planning of brain tumors
fMRI (functional MRI) for evaluation and treatment planning of brain tumors
Functional Magnetic Resonance Imaging (fMRI) is a type of specialized MRI scan. It assesses the change in blood flow related to neural activity in the brain or spinal cord. It is widely used for brain mapping due to its high accuracy and absence of radiation. fMRI is often combined with Diffusion Tensor Imaging (DTI), which measures water diffusion in the brain, for imaging brain tumors. These methods can assist in planning surgery to avoid complications that might occur with less detailed preoperative evaluation. fMRI and DTI are routinely used when the tumor location is such that there is a concern for neurological deficits occurring during surgery. This type of imaging is usually performed shortly before surgery and can be critical in decisions of whether and how to approach the tumor, Dr. Rosen says.
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
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How PET imaging works
What is the purpose of the CT scanner? The CT scanner is needed because the major disadvantage of PET imaging is that the anatomic detail seen in a PET scan is inferior to that of a conventional CT scan. This means that although PET can see the general location of an area of abnormal glucose uptake, the exact localization of the abnormality can be difficult using PET images alone.
Anatomic Information Obtained with CT Scanning
By obtaining both CT and PET images together, and fusing the images, the Nuclear Medicine physician can simultaneously see both anatomic and physiologic changes in the body that provide the most accurate information available today for the imaging diagnosis and localization of cancer.
Cardiac Perfusion Exam
Overview
An Cardiac Perfusion scan is a test that helps your doctor see if you have coronary artery disease. Coronary artery disease is a narrowing of the blood vessels that supply oxygen to the heart muscle. If the heart muscle doesn’t get enough oxygen, it can cause chest pain or angina. Because angina typically occurs during exercise, we often do this test with you walking on a treadmill.
During this test, a radioactive material is used to take pictures of the heart. The substance is injected into your blood and travels to the heart muscle through the coronary arteries. We then take pictures of your heart, which will help your doctor decide if you have coronary artery disease.
How do I prepare for this test?
Common Foods, Beverages, and Medications Containing Caffeine
Coffee:
Regular or decaffeinated, any variety
Tea
Regular or decaffeinated, any variety
Soft Drinks:
Regular or decaffeinated, any variety
Cola, Dr. Pepper, Mello Yellow, Mountain Dew, Mr. Pibb, Tab
Foods:
Cocoa, Chocolate
Over-the-Counter Medicines:
Anacin, Excedrin, NoDoz
Prescribed Medications:
Cafegot (all forms), Darvon Compound, Fiorinal, Synalog DC, Wigraine (all forms)
- Do not eat or drink anything containing caffeine for 12 hours before this test. This includes coffee, tea, colas, and chocolate. Other things containing caffeine are listed here.
- Do not smoke for two hours before this test.
- Do not eat or drink anything except water for two hours before this test.
May I take my medication?
- You may be asked to decrease or stop certain medicines for this test. Follow your doctor’s instructions regarding medication. Do not stop your medication unless your doctor tells you to. You should start all your medicines again after the test is over. Please bring a complete listing of all your medicines with you.
- If you are a diabetic and take insulin or another diabetes medication, please check with your doctor for advice regarding doses before and after this test. Please bring your insulin or oral diabetes medicine to the hospital so you can take the dose recommended by your doctor.
What should I wear?
Please wear comfortable clothes that break at the waist (a shirt or blouse) and flat walking shoes or sneakers. Sneakers are strongly recommended. Electrodes will be placed on your chest so that your heart can be monitored during exercise. Women must remove their bras for the procedure. If you wear an unusually large or small size of clothing, please bring your own T-shirt and pants. You will be working hard during this test. Comfortable clothing will make things easier for you.
What happens during this test?
- For the first part of the test, we will put an intravenous (IV) line in your arm. This will feel like a pin prick like when you have blood drawn. The radioactive material is then injected through the IV. You will not feel anything from this injection. We will wait 30-45 minutes while the radioactive material circulates in your body. Then, while you are lying down, we will take pictures of your heart with a special camera for about 30 minutes.
- For the second part of the test, you will exercise by walking on a treadmill. Your heart will be monitored with an EKG, and we will take your blood pressure many times during this part of the test. A radioactive material will be injected into the IV about 1 minute before you stop exercising. You will not feel anything when the radioactive material is injected. We will again wait a short time while the radioactive material circulates in your bloodstream.
- The third part of the test is taking more pictures. You will lie down as before and the camera will take pictures for about 30 minutes.
How long will the test take?
The test takes a total of 3-4 hours.
After The Exam
A doctor from nuclear medicine will provide the results of this test to your doctor. Your doctor will put together the results of this test and your other tests and then will explain the meaning of these results to you.
In the example images to the left, the physician will note a defect during the exercise phase of the examination which becomes improved during the resting phase.
How safe is this test?
Nuclear medicine procedures are very safe. Your body is able to eliminate the radioactive materials that are used very quickly.
The radiation dose from this test is about 13 mSv.
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Rapid Heart Scanner
Introducing… a more advanced way to view the Heart
Beth Israel Deaconess Medical Center is the first in New England to offer patients the Cardius X-ACT Rapid Cardiac Imager. This advanced nuclear imaging system scans for coronary artery disease in half the time of traditional nuclear medicine scans. It’s more comfortable, too. Instead of lying on the stomach with arms stretched above the head, the new upright design allows patients, many with difficult symptoms such as chest pain and pressure, to remain in a seated position during the test.
Cardius X-ACT Rapid Cardiac Imager
- More Comfort: scan performed in seated position with a shorter imaging time
- Higher Clarity: state-of-the-art 3D image with motion stabilizer
- Quicker Results: reports sent directly to ordering physician– same day, in most cases
- Open Design: accommodates bariatric, claustrophobic and COPD patients
What to Expect:
When the patient arrives, an intravenous (IV) line will be placed in his arm and a small amount of radioactive material will be injected. There are no effects from the injection. After waiting 30-45 min while the material circulates, images will be taken of the heart at rest. The imaging session takes about 10 minutes.
Patient will then undergo a treadmill stress test and a second injection through the IV. After waiting 30-45 minutes a second set of images will be taken to show cardiac blood flow during exercise.
By using the computer to slice and spin the high-resolution 3-D scans taken by the Cardius imager, radiologists can see any part of the heart and the blood flow surrounding it, making diagnosis better and faster than ever before. A radiologist will read the images and provide results to your doctor within 24-hours.
The exam is covered by most medical insurance.
The rapid heart scanner is located in the nuclear medicine department on the first floor of the Rabb building, main entrance, East Campus, 330 Brookline Avenue, Boston. For more information call 617-667-2071.
Other related article published in this Open Access Online Scientific Journal:
Acute Chest Pain/ER Admission: Three Emerging Alternatives to Angiography and PCI – Corus CAD, hs cTn, CCTA
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