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Table of contents
- 3rd Edition
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- Atlas of Clinical Nuclear Medicine, Third Edition - كتب Google
- A whole-body FDG PET/MR atlas for multiparametric voxel-based analysis
This foundation has been built upon and expanded to provide the ultimate guide for beginners, those in training, and experienced practitioners.
3rd Edition
Susan E. Gary J. This is one of only a few comprehensive atlases in the field of nuclear medicine, and is expected to remain a valuable reference for many years to come. It should be available in every nuclear medicine department. Each is described in accurate detail and with emphasis on pitfalls encountered and with highest quality imaging to complement them. The editors ensure that the chapters are easy to read and well referenced.
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Summary The long-awaited third edition of An Atlas of Clinical Nuclear Medicine has been revised and updated to encapsulate the developments in the field since the previous edition was published nearly two decades ago. Reviews "With its excellent quality images, this is a valuable addition to the field. This is Figure 2, showing how SPECT imaging allows the reader to distinguish between blood pool activity ventricular cavity, etc and myocardial activity and identify regional myocardial differences in radiotracer uptake.
Cardiac amyloidosis is a highly morbid and underdiagnosed infiltrative cardiomyopathy that is characterized by the deposition of amyloid fibrils misfolded protein deposits into myocardial tissue. This results in restrictive physiology and heart failure, typically with preserved ejection fraction until late in the disease course.
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Cardiac amyloidosis is further characterized by the precursor proteins that ultimately develop into amyloid fibrils. AL cardiac amyloidosis is the result of misfolded monoclonal immunoglobulin light chains, which are typically found in plasma cell dyscrasias such as multiple myeloma. ATTR amyloidosis occurs in the setting of misfolded transthyretin protein also known as prealbumin and has two forms: wild-type non-mutant or mutated transthyretin hereditary form.
Roughly 25 percent of men over the age of 80 have some degree of transthyretin myocardial deposition. However, the clinical significance of this deposition is uncertain. Heart failure symptoms typically appear once significant deposition and myocardial thickening have occurred. This diagnosis should be considered in patients with suggestive clinical clues such as orthostatic intolerance to typical heart failure therapies including beta-blockers and ACE-inhibitors, bilateral carpal tunnel syndrome, lumbar spinal stenosis, unexplained biceps tendon rupture, unexplained peripheral neuropathy, and low-voltage on electrocardiography.
Echocardiography is typically performed and typical findings include a thickened left ventricle, diastolic dysfunction, and abnormal longitudinal strain with apical sparing. These structural findings can also be seen on cardiac magnetic resonance imaging MRI , which provides additional tissue characterization. It shows elevated T1 signal, an expanded extra-cellular volume fraction, abnormal late gadolinium-enhancement and altered tissue kinetics with a classic failure to null the myocardium all suggest diffuse fibrosis.
None of these symptom complexes or suggestive findings on echocardiography and CMR definitively diagnose cardiac amyloidosis, as they lack sufficient independent sensitivity and specificity. Confirmation of cardiac amyloidosis can be obtained invasively with a cardiac biopsy or extra-cardiac biopsy renal, fat pad, etc.
Plasma cell dyscrasias associated with AL cardiac amyloidosis can be diagnosed through acquisition of serum free light chains and serum and urine immunofixation. This lab testing must be performed in any patient suspected of having cardiac amyloidosis.
Atlas of Clinical Nuclear Medicine, Third Edition - كتب Google
With the advent and optimization of nuclear scintigraphy protocols using bone-avid radiotracers, ATTR CA can now be diagnosed noninvasively without a costly tissue biopsy. This technique has moved into mainstream clinical practice. In this context, 99mTc-PYP imaging plays an important noninvasive role in the evaluation of cardiac amyloidosis, which will ultimately impact prognosis, therapy, response to therapy and genetic counseling.
The 99mTc-PYP radiotracer is readily available and prepared by commercial radiopharmacies. The imaging protocol is also relatively straightforward. Planar imaging is obtained either one or three hours post-radiotracer injection. SPECT reconstruction is necessary to confirm localization of the radiotracer in the myocardium.
A whole-body FDG PET/MR atlas for multiparametric voxel-based analysis
In some patients renal failure, etc , significant blood pool activity can be noted and imaging is repeated at a later time point to allow adequate blood pool clearance. Planar imaging serves as a useful technique to visually interpret the degree of myocardial uptake. Quantitative analysis can be performed using planar images as regions of interest ROI are drawn over the heart and compared to the contralateral chest to measure the mean and relative counts 99mTc-PYP uptake.