Myocardial Imaging in the Coronary Care Unit [antikvár]

PREFACE Noninvasive visualization of myocardial infarction using radionuclides dates back over eighteen years. Edward A. Carr and William H. Beierwaltes were first to report (1962) successful external imaging of myocardial infarcts in dogs and in man using an Anger scintillation camera. They demonstrated that after intravenous administration of ^'Rb or '^'CS an infarct was visualized as a "cold spot", while ^"Hg-labeled-chlormeridin resulted in a "hot-spot" image of the infarct. Since then, there have been major developmental improvements in available radionuclides, scintillation cameras and computer processing capabilities. In particular, the development of mobile gamma cameras opened the possibility to obtain high quality images even at the bedside of critically ill patients. Since the development in 1974 of a new radiopharmaceutical, ^"'Tl and the application of "'"Tc-pyrophosphate for myocardial imaging, these imaging agents are widely used for the detection of acute myocardial infarction. However, for practical application, frequently there appears to be uncertainty or even confusion concerning the relative merits of each method. In this volume an up-to-date review of the clinical value and limitations of both imaging techniques is presented. After an introduction on technical aspects and instrumentation, successively in a back-to-back fashion the mechanisms of myocardial accumulation, the results in acute myocardial infarction, unstable angina and in patients with atypical chest pain of ^"'Tl and "'"Tc-pyrophosphate scintigraphy are discussed. It is emphasized that rather than being competitive both techniques provide different and unique information, which is not readily obtainable by more conventional approaches, either invasive or noninvasive. The purpose of this book is to place in proper perspective the practical characteristics of the two myocardial imaging methods. Provided that the choice of imaging agent, timing and technique of scintigraphy are correct, important clinical information can be derived from the images. This book is not meant to be a textbook on nuclear cardiology. Other techniques, such as myocardial perfusion imaging following exercise, assessment of cardiac performance at rest and exercise or single photon and posi-