(MPI) The myocardial perfusion scan is the most common nuclear medicine procedure in cardiac imaging and allows assessing the blood-flow patterns to the heart muscles. The comparison of the radiopharmaceutical distribution after stress and at rest provides information on myocardial viability and cardiac perfusion abnormalities. ECG-gated myocardial perfusion imaging allows the assessment of global and regional myocardial function such as wall motion abnormalities.
The diagnostic accuracy of myocardial perfusion scintigraphy (also abbreviated MPS) allows reliable risk stratification and guides the selection of patients for further interventions, such as revascularization. MPI also has particular advantages over alternative techniques in the management of a number of patient subgroups, including women, the elderly, and those with diabetes. The use of this type of cardiac scintigraphy is associated with greater cost effectiveness of treatment, in terms of life-years saved, particularly in these special patient groups.
Myocardial perfusion scintigrams are acquired with a gamma camera. Single photon emission computed tomography (SPECT) is preferred over planar imaging because of the three dimensional nature of the images and their superior contrast resolution.
Common MPI radiopharmaceuticals, approved by the U.S. Food and Drug Administration (FDA) include: Tl-201 and the Tc-99m-labeled radiopharmaceuticals, such as sestamibi, tetrofosmin, and teboroxime for single-photon imaging. Rb-82 is used for positron emission tomography (PET) imaging.

See also Gated Blood Pool Scintigraphy, Myocardial Late Enhancement, Cardiac MRI and Echocardiography.

(CECT) Contrast agents are used during contrast enhanced computed (or computerized) tomography examinations to highlight specific tissues and parts of the body. Bones can be clearly seen on x-ray images, the visualization of some other organs and soft tissues is more difficult. Sufficient contrast is important in perceiving a difference in the density between areas of a CT image. The identification of a disease may be challenging due to very low contrast between pathological tissues (for example tumors, metastases and abscesses), normal organ structures and surrounding tissues.
Contrast agents are used in CT angiography (CTA) to delineate vessels, in multiphasic CT studies to provide dynamic information of blood supply (e.g., liver CT) and in CECT studies of various body parts to achieve opacification of tissue of interest (e.g., kidney CT) in relation to the background tissue. Contrast enhanced multi-detector row CT (MDCT) replaces several conventional diagnostic imaging methods such as intravenous urography, cholangiography, or catheter angiography, due to advanced CT studies with fast examination times, high contrast enhancement, perfusion measurement and multiplanar reformatting capabilities.
See also Contrast Media Injector, Single-Head CT Power Injector, Multi-Head Contrast Media Injector, Syringeless CT Power Injector, CT Power Injector.

(GBPS) The gated blood pool scintigraphy is an examination to evaluate the ventricular performance. This scintigraphic blood pool imaging uses an electrocardiographic synchronizer or gating device to acquire data during repeated heart cycles at specific times in the heart cycle. Radionuclides, for example 99mTc-humanserumalbumin (HSA), are used as intravascular tracers.
GBPS allows to determinate the left ventricular function with heart minute volume, ejection fraction (EF) at rest and under exercise. Single photon emission computed tomography (SPECT) versus planar scintigraphic imaging improves cardiac evaluation due to the three dimensional nature. The GBPS method is not suitable to analyze the right ventricular function; that is best evaluated by first-pass ventriculography.
Echocardiography vs. GBPS has important disadvantages due to problems in quantitative evaluation, in patients with anatomic variations and dyskinetic left ventricles.

See also Myocardial Perfusion Imaging.

(MIP) CT Angiography images can be processed by maximum intensity projection to interactively viewing volumes of data, where the CT number of each pixel is given by the minimum CT number through the volume. The MIP connects the high intensity dots of the blood vessels in three dimensions, providing an angiogram that can be viewed from any projection. Each point in the MIP represents the highest intensity experienced in that location on any partition within the imaging volume. For complete interpretation the base slices should also be reviewed individually and with multiplanar reconstruction (MPR) software. The MIP can then be displayed in a Cine format or filmed as multiple images acquired from different projections.

A bone scan or bone scintigraphy is used to in evaluate diseases of the skeletal system. Scintigraphic whole body bone imaging is a highly sensitive method to show changes in bone metabolism. Increased metabolic activity is seen as a hot spot.
The study requires the injection of a 99mTc-labeled radiopharmaceutical (most commonly methylene diphosphonate (MDP), hydroxymethylene diphosphonate (HMDP) or hydroxyethylene diphosphonate (HDP)). The activity administered for bone scanning is around 500 MBq (300-1100 MBq, 8-30 mCi), depending on age and weight of the patient. After 2-5 hours, the emitted gamma rays are detected by gamma cameras. The produced planar images include anterior and posterior views of the skeleton.
Multiphase bone scintigraphy is used to differentiate a bone process from tissue pathology. In some cases additional SPECT imaging is helpful to better characterize the presence, location and extent of disease.